Drug-induced stuttering: A case study.

The Effect of Rural Guidance Plan on the Subjective Quality of Life among Rural Communities (Case Study: Fariman County)

Background: Autism Spectrum Disorder (ASD or autism) is characterized by difficulties in social communication and interaction, which negatively impact on individuals and their families' quality of life. Currently no pharmacological interventions have been shown to be effective for improving social communication in autism. Previous trials have indicated the potential of arbaclofen for improving social function among autistic children and adolescents with fluent speech. The AIMS2TRIALS-Clinical Trial 1 (AIMS-CT1) will examine whether arbaclofen is superior to placebo in improving social function and other secondary outcomes over 16 weeks, along with safety and tolerability profiles.Methods: AIMS-CT1 is an international, multi-site, double-blind, parallel group Phase II randomized clinical trial. It will include 130 males and females aged 5:0–17:11 years, with a diagnosis of ASD and fluent speech. Eligible participants will be randomized on a ratio of 1:1 for a 16-week treatment period. Medication will be titrated over 5 weeks. The primary outcome is the effect on social function from weeks 0 to 16 measured on the Socialization domain of the Vineland Adaptive Behavior Scales, 3rd editionTM. Secondary outcome measures include the CGI–S (Clinical Global Impression–Severity), CGI–I (Clinical Global Impression–Improvement), other areas of adaptive function, social communication and other autism symptoms, co-occurring behavior problems and health-related quality of life. Genetic and electrophysiological markers will be examined as potential stratifiers for treatment response. Exploratory novel digital technologies will also be used to measure change, examining simultaneously the validity of digital biomarkers in natural environments. The safety and tolerability of the drug will also be examined. Our protocol is very closely aligned with a parallel Canadian trial of 90 participants (ARBA Study, US NCT number: NCT03887676) to allow for secondary combined analyses. Outcomes will be compared using both an Intent-to-reat and Per Protocol approach.Discussion: The outcomes of this trial, combined with the parallel Canadian trial, will contribute to the evidence base for medications used to help social difficulties among young autistic individuals; demonstrate the capabilities of the AIMS-2-TRIALS network of academic centers to deliver clinical trials; and support future drug development.Clinical Trial Registration: EudraCT number: 2018-000942-21 and ClinicalTrials.gov registry number: NCT03682978. Currently under protocol v.7.2, dated 20.11.2020.

BACKGROUNDStroke is one of the leading causes of death and disability worldwide. In patients suffering from strokes and other acute brain injuries, the prevalence of pituitary dysfunction is high, and growth hormone deficiency is commonly found. Previous studies have demonstrated that administration of recombinant human growth hormone provides adult growth hormone deficiency (AGHD) patients with beneficial effects such as improving body compositions and quality of life. Nevertheless, other physiological benefits of growth hormone substitution are still controversial and inconclusive.CASE SUMMARYA female with a history of hypertension suffered intracranial hemorrhage, intraventricular hemorrhage, and hydrocephalus at 56 years of age. Her mobility, fluency of speech, and mentality were impaired ever since the event occurred. After five years, the 61-year-old patient was further diagnosed with AGHD and received six-month growth hormone replacement therapy (GHRT). After six months of GHRT, the patient’s body composition was improved. A substantial improvement in Mini-Mental State Examination score was also observed, accompanying with ameliorations in mobility, fluency of speech, and mentality.CONCLUSIONIn addition to improvements in body composition, GHRT for AGHD may provide further beneficial effects in patients with cognitive or motor impairments due to intracerebral hemorrhage.

Based on the theory of psycho-genetics that shows the existence of a parallel between affective and cognitive aspects of behavior, the objective of this research is to verify the relationship between these aspects in children with and without learning disabilities. Twelve boys and girls with ages ranging from 9 years and 1 month to 10 years and 10 months were chosen to be observed. The children were attending 3 rd grade in a public primary school in a suburban town in the state of Sao Paulo, Brazil. Based on the assessment by their teacher, half of the children showed gaps in learning and the other half had no learning disabilities. The test group was observed with other students in a classroom environment, performing teacher directed learning activities and playing activities such as rule games. In order to get further information about the children's behavior in school and in their family environment, both the teacher and family members were interviewed. Classical operational Piaget tests and the game Find the Animal were applied individually to all twelve participants engaged in the research. By analyzing the data obtained from observation and interviews some affective and cognitive categories were set. The affective aspects of the behavior were compared between the two groups and then were related to operational index, performance in school content and cognitive performance in the game. Comparing the affective aspects occurring in school work and in playful activities, it was shown that there were some differences between the groups. Children with no learning disabilities displayed more positive affective aspects concerning school work whereas the children with learning disabilities showed a lack of positive affection. It was clear that in both groups the positive affect was predominant in regard to playful activities. Regarding the relationship between analyzed affective and cognitive aspects the results showed that there was correlation between the aspects observed in the school work of both groups. However, with the group that exhibits learning disabilities, the relationship did not exist with the playful activities because these kinds of activities seem to require positive affective behavior, which guarantees interest without modifying cognitive aspects. Because this was an empirical study it contributes to a better understanding of the relationship between affection and cognition in children with and without learning disabilities as well as an understanding that affective and cognitive aspects are complementary, inseparable and irreducible.

The aim of the present work is to analyze the interrelationship of cognition and emotion in the creative process of Carl Gustav Jung during the years 1906–1916, the period in which he sketched the basic ideas of his theory of the collective unconscious. The framework of this work is that of Howard Gruber, especially developed for carrying out psychological studies on scientific creativity, and designed for studying both the affective and cognitive aspects of the creative person, in order to recover the individual behind a work through the analysis of the three spheres in which she/he moves: private (personal documents, diaries), semi-private (discussions with close friends, face-to-face or by letter), and public (teachers, colleagues, etc.). Gruber attributes equal importance to all three; nevertheless, in this research the emphasis is placed on the semi-private sphere, as the connecting thread of the creative process, in that it is the most appropriate analytical space in which the cognitive and affective aspects are manifested in Jung. Therefore, its functioning is studied during the creative process, mentioning first its importance as the core of analysis in case studies, and moving on to analyze how it is projected toward the public sphere and toward the private sphere by means of inter-sphere connections.

Cerebral palsy (CP) is a group of neurological disorders that affect movement, muscle tone, and motor skills. Here, we present a case of an 11-year-old female patient who presented with tightness in both lower limbs, since birth, and delayed walking, accompanied by difficulty walking due to spasticity. She was diagnosed with spastic diplegic cerebral palsy. This case highlights the combined use of palliative and rehabilitative care. Developmental milestones were delayed, and she was diagnosed with CP at an early age. A comprehensive treatment plan was implemented, including physical therapy, speech therapy, and pharmacological treatment with baclofen to reduce spasticity. Non-pharmacological treatments such as neurodevelopmental therapy, biofeedback, and orthotic support were also employed. The child's rehabilitation progress included improved mobility, speech fluency, and reduced spasticity, with notable benefits in gait. Palliative care played a critical role in addressing the emotional, psychological, and social aspects of the child's condition and providing the family support, counseling, and guidance on managing the care burden. This integrated approach emphasizes the importance of early palliative care alongside rehabilitation to optimize a child's quality of life. This case highlights how a multidisciplinary approach addressing both physical and emotional needs can lead to better overall outcomes for children with cerebral palsy, improving not just mobility but also their well-being and family support system.

We assessed health-related quality of life (QoL) of patients with progressive supranuclear palsy (PSP), identified the most important QoL issues in patients with this disorder, and assessed the usefulness of existing QoL measures in patients with PSP. Twenty-seven patients in all stages of PSP and their carers underwent a semistructured in-depth interview on the impact of PSP and a neurological examination. They were also asked to complete existing measures of QoL and depression. An item-pool of issues relevant to QoL of patients with PSP was created from the patient and carer interviews. Carers and patients largely agreed on issues relevant for patients' QoL but more carers than patients considered symptoms of frontal lobe dysfunction as problematic for the patients. There was no association of QoL with age and gender, as assessed in interviews and on two QoL instruments. QoL deteriorated with increasing disease duration and severity and greater cognitive impairment and was associated with worse depression scores. While the generic SF-36 was not found to be useful to assess QoL in PSP, feasibility and validity for the PDQ-39 and the EQ-5D were acceptable in this study. However, additional issues relevant to patients with PSP that were not addressed in these instruments included visual disturbances, dysarthria, dysphagia, muddled thinking, confusion, and apathy. The generic EQ-5D and the Parkinson's disease-specific PDQ-39 are useful instruments to assess QoL in patients with PSP. However, they lack questions on important aspects of QoL in PSP that were reported by patients and carers in semistructured interviews. The item pool created in these interviews provides the basis for the development of disease-specific QoL instruments for patients with PSP.

The aim of this paper is to analyze the effects of intensive speech therapy intervention in a case of progressive non-fluent aphasia (PNFA). This is a dementia syndrome characterized by a progressive deficit in expressive language fluency and syntactic analysis, and by agrammatism and phonemic paraphasias. Although in the early stages there are no alterations in memory, comprehension, or visual processing, personality changes can slightly occur. To analyze the effects of speech therapy in this syndrome, a single case design with pre- and post-test was used. The participant was a male patient of 84 years with PNFA, who for twelve months received weekly speech therapy to stimulate the phonological, lexical and syntactic processing. He underwent neuropsychological assessment in three stages: six months before the onset of therapy, six months after therapy started and after completing 12 months of intervention. Assessment involved linguistic processing, general cognition, neuropsychiatric symptoms, quality of life (QOL) and activities of daily living (ADL). As a result of therapy, the patient showed a slight improvement in language prosody, fluency, and content of spontaneous speech, and a significant improvement in repetition, reading aloud, and oral-phonatory praxis. Other aspects of cognitive functioning (orientation, verbal naming, praxis, and memory) remained stable; ADLs and QoL improved. It is concluded that prolonged speech therapy can improve language processing and have a positive impact on other cognitive and socio-emotional processes in PNFA. This 12-month therapeutic stimulation not only slowed cognitive decline, but allowed to see maintenance of achievements and improvement of symptoms, which can be regarded as a success in PNFA treatment, considering the rapid progression of the disease.

Understanding and investigating the quality of life of people with communication disabilities is particularly challenging, as few people beyond the person, his/her family, and the speech pathologist identify and experience the power that communication contributes to life quality. Communication is implicated in relationships, personal development, identity, and social interactions, and has been perceived by clients and clinicians as having a primary role in life. Society has overlooked the importance of communication because of a focus on body, health and functioning. Three factors have deterred inquiry into quality of life investigation with people with communication disabilities: the lack of a sound theoretical and socially valid definition of quality of life, as it relates to communication and disability; the lack of appropriate assessment tools; and the perceived barrier of communication disability to the evaluation process. It is precisely the relationship between communication and quality of life, and the suitability of using significant others as proxy respondents for obtaining quality of life information, which are the foci of the research described in this thesis. Two population groups were chosen to investigate the relationship of communication to quality of life: older people with aphasia (pathological communication change) and healthy older people (normal communication change). Communication in aphasia and healthy ageing was conceptualised as impairment, activity and participation, in accordance with the disability framework of the World Health Organisation, the International Classification of Impairment, Activity and Participation Revised. Quality of life was evaluated by personal descriptions and global rating, as well as using standard assessments of health-related quality of life and psychological well-being. In order to examine the relationship between communication and quality of life, 30 older participants with predominantly mild to moderate aphasia and 75 healthy older people were interviewed and assessed. For both groups, participants' communication was associated with their social health and psychological well-being, however age, emotional health and physiological and functional health exhibited powerful influences over the relationships. In aphasic participants, functional communication ability and language functioning to a lesser degree, were implicated in their quality of life, while social participation and communicative activities were more important to healthy older people. Naming, vision and hearing functioning were also associated with healthy participants' health-related quality of life, suggesting that health remains a primary concern in an ageing population. The research provided substantial evidence that older people's communication relates to being actively involved in conversation, reading and writing; that family and friends are essential in communicative and socially active lives; and that leisure activities are important social components in ageing. Contrasted with healthy older people, aphasic participants had restricted and unsatisfying communicative and social lives, with fewer social contacts. Overall, the results of interviews suggested that communication in life is interpreted as activities and social participation, that communication is more important in the aphasic than healthy population, and that communication is valued more by people who experience aphasia, and naming and hearing impairments. Collectively, family members and friends were poor judges of older people's quality of life, having only fair to moderate agreement with participant responses. Proxy respondents were better at estimating objective quality of life domains, such as physical health, than subjective domains such as pain, vitality and emotional health. Living with participants, providing emotional support, and knowing the participant for a length of time generally increased proxy reliability for some subjective life quality domains. Proxy respondents for aphasic people were considerably worse than their counterparts with up to 38% less agreement than proxies for healthy people. Proxy respondent depressive symptoms, communication barriers, different perceptions of functioning, and altered life priorities were proposed as reasons for this further discrepancy in ratings in aphasia. The implication of this research from a clinical perspective is that aphasia rehabilitation needs a multidisciplinary approach, including speech pathologists, counsellors, social workers and physiotherapists in assessment and intervention, and needs to concentrate on people's activities and reduce disability as a means of improving their quality of life. The findings indicate that quality of life is influenced by people's emotional and physical health as much as it is determined by their communication. From a theoretical perspective, communication was associated with social participation and psychological well-being, and physical functioning was relevant for people with concomitant physical disability. Conversely, healthy older people's quality of life constituted both health and well-being. The relationship between communication and quality of life is stronger for people with aphasia, suggesting that communication becomes important when loss is experienced. From a socio-political perspective, the results imply that communication is a devalued determinant of social participation and quality of life, and calls for attitudinal changes at a community level. Society's focus on the primacy of health restricts quality of life to a solely health-related concept. Communication is thus excluded and its importance is not recognised. This view needs to be altered so that speech pathologists can demonstrate how communication rehabilitation for clients relates to achieving and maintaining a satisfying quality of life.

Introduction Sarcomas of bone and soft tissue are rare neoplasms with diverse histology and biologic behavior. Approximately 6,600 new cases of soft-tissue sarcoma and 2,500 new cases of bone sarcoma present each year.1 Most of these tumors develop in the extremities. An increased understanding of sarcoma biology, advances in diagnostic imaging modalities, the development of effective adjuvant therapy regimens, and the application of new technologies and techniques for surgical resection and reconstruction have changed the nature and scope of treatment for these tumors. These advances have helped shape current surgical strategies and have prompted an increase in technically demanding limb-sparing surgical procedures. Successful limb conservation preserves, repairs, or reconstructs critical structures necessary for limb function without compromising the oncologic objective of complete tumor extirpation. Because of several factors, the number of patients who are candidates for limb conservation is increasing without a significant increase in the risk of local tumor recurrence or an adverse effect on overall patient survival.2-4 The factors causing this result include refinements in diagnostic and extirpative approaches, improvements in bone and joint reconstruction, and better techniques for coverage of soft-tissue defects. These developments have prompted a critical evaluation of the variables affecting limb preservation, functional outcome, and quality of life for the sarcoma survivor. This report discusses the strategies used at The University of Texas M.D. Anderson Cancer Center to improve the quality of life for patients diagnosed with these complex extremity tumors. Four case examples illustrate the range of clinical challenges confronting the sarcoma oncology team as members try to attain a better patient outcome using multimodality therapy and limb-sparing surgery.

Background: A growing consensus among speech-language pathologists that treatment goals should be significant to the consumer and society has spurred clinicians to address stroke survivors' quality of life (QOL) as a possible target for remediation. Use of formal measures to detect decreased QOL presumes that test performance of aphasic patients is different from that of non-brain-injured (NBI) adults. Treatment directed towards decreased QOL presupposes that its symptoms are attributable to a diagnosis of aphasia. Differential performance for chronically aphasic and NBI adults on two QOL measures has been established. However, relationships between residual language and/or communication deficits and QOL have not been confirmed. Aims: We examined relationships between residual language and/or communication deficits and QOL to determine whether, within NBI adult and chronically aphasic adult groups, there are significant relationships between language impairment and QOL measures; whether there are significant relationships between communication activity limitation and QOL measures; and, whether the strengths of these relationships differ between groups. Methods & Procedures: A total of 18 NBI controls and 18 adults with chronic aphasia were administered two language impairment tests (WAB, PICA), two communication activity limitation assessments (CADL-2, ASHA FACS), and two QOL measures (WHOQOLBREF, PWI). Correlation analyses were used to examine relationships between residual language and/or communication deficits and QOL. Outcome & Results: Although chronically aphasic adults scored significantly lower on all measures than did NBI adults, language-based disability generally was not significantly related with QOL in either group. Within the NBI group, only one language impairment and one QOL measure were significantly related. Within the chronically aphasic group, there were no significant relationships between language impairment and QOL measures, and there were no significant between-groups differences in the strengths of these relationships. Within either group, there were no significant relationships between communication activity limitation and QOL measures. Furthermore, there were no significant between-groups differences in the strengths of these relationships. Conclusions: The results of this investigation may be interpreted to suggest that decreased QOL in chronically aphasic adults is not closely related with language-based disablement. Thus, speech therapy that directly targets QOL in aphasic patients may not be justified. However, the use of correlational analysis limits the ability to rule out viable, alternative hypotheses or to account for misinterpretation due to measurement error. To examine relationships between language-based disablement, other undetermined factors, and QOL, further study, using larger sample sizes and causal modelling techniques, is recommended.

This study examines the effect of decision makers’ cognitive and affective aspects in decision making, especially when a firm implementing Balanced Scorecard (BSC). Cognitive aspect deals with decision makers’ cognitive capabilities and characteristics in utilizing all kinds of BSC measures, including common and unique measures. Affective aspect deals with negative emotions that often present in interpersonal relationships. There were three hypotheses being tested in a laboratory experiment using 2x2x2x2 mixed-subjects design. One hundred and sixty eight Accountancy and Management graduate students from Gadjah Mada University were randomly assigned in one of eight treatment cells. The results show that common and unique measures do have statistically significant effects on performance evaluation judgment and bonus allocation, and decision makers place greater emphasis on common than unique measures. These findings consistent with prior research that suggest sample with BSC knowledge will be able to utilizing both kinds of BSC measures. Although there were no statistically significant support for affect effect, this study provide important evidences for the BSC adopters to consider the makers’ cognitive (and affective) aspects if they want to pursue effective Balanced Scorecard.

The aim of research was to study cognitive impairment (CI) in patients on hemodialysis (HD): 63 people (25 men and 38 women) aged 38 to 72 years (mean age 54. 2±11. 1 years). The main group consisted of 43 people on HD. The control group consisted of 20 relatively healthy individuals without kidney disease. A clinical neurological examination, MoCA and Mini-Cog tests were conducted. It was found that CI are much more common in patients on HD (according to MoCA, 81. 4%; Mini-Cog, 34. 9%). The inverse dependence of the cognitive status on the duration of dialysis patients was demonstrated (r=-0. 27, p≤0. 05). A weak correlation between MoCA test and the adequacy of the dialysis dose (kt/V index) was detected. The structure of CI in HD patients was dominated by memory impairment, visual-constructive disorders, changes in the executive skills and fluency of speech.

The article analyzes the physical and psychological components of the quality of life (QOL) in patients with diabetic polyneuropathy (DP) on the background of type I and II diabetes mellitus (DM) with comorbidity. Has been demonstrated the prevalence of more frequent multimorbidity in this nosology and its effect on patients’ QOL. QOL is recognized as an integral part of a comprehensive analysis of new methods of diagnosis, treatment, prevention, quality of treatment and medical assistance [2]. With the highest frequency in DM detect sensory or sensorimotor forms of distal symmetrical DP. However, there are motor symptoms in DM, including cranial neuropathy and Bruns-Garland syndrome (diabetic amyotrophy) [3], which interfere with the satisfactory functioning of patients. The purpose of our work was to assess the extent of physical and mental functioning of people with DP on the background of multimorbidity. Materials and methods. We examined 92 patients with DP on the background of type I and II DM, aged from 19 to 69 years, which were divided into 2 groups: from DP on the background of type 1 DM (group I) and type II (group II). We distinguished such subgroups: DP on the background of type I DM and concomitant cardiovascular pathology (CVP) (group A), DP on the background of type II DM and concomitant CVP (group B), DP on the background of type I DM and gastroenterological pathology (GEP) (group C), DP on the background of type II DM and GEP (group D), DP on the background of type I DM and pathology of the thyroid gland (thyroid) (group E), DP on the background of type II DM and thyroid pathology (group F). Patients underwent clinical and neurological examination, laboratory tests and ultrasound examination of the abdominal cavity and thyroid gland, electromyography (EMG). Static calculation was done in MS Excel 2003. Results and discussion. In groups A and B with the highest frequency among CVP was arterial hypertension - 91% vs 97% and coronary heart disease - 27% vs 41%. In group C - chronic hepatitis (40%), chronic cholecystitis (40%), chronic pancreatitis (40%), chronic gastroduodenitis (40%). In people of group D, gallstone disease was diagnosed more often than in other pathologies (43%). The leading place in group E was occupied by autoimmune thyroiditis (29%), idiopathic hypothyroidism (29%), thyrotoxicosis (29%), in group F - nodular goiter (57%). The longest duration of DM was observed in group A - 24.54 ± 2.46 years, the smallest in group D - 7.14 ± 1.01 years. Diabetic foot syndrome was diagnosed in patients of groups A and B in 14%, group C - in 2%. In patients of group I, the indicators of QOL were higher than in group II. The highest indicators were of groups I and II in the domains social (SF) and physical functioning (PF) - 66.75 ± 2.41; 65.5 ± 3.23 and 63.39 ± 3.54; 61.42 ± 3.88. In group A, the level of QOL was slightly higher than in group B, in particular in the domains of mental health (MH) - 53.09 ± 3.12, bodily pain (BP) - 50.90 ± 4.05. In addition, the manifestations of DP in such group of individuals (group A) were manifested by the absence or mild pain, which causes in people of this group higher rate of QOL. QOL in patients of group C was higher than in group D, in particular, the indicators of physical functioning (PF) - 68.75 ± 5.88, social functioning (SF) - 65.62 ± 5.35, role emotional (RE) - 58.33 ± 18.75, mental health (MH) - 54 ± 5.36. In group D, the data were high in the domains of social functioning (SF) 60.71 ± 16.0 and physical functioning (PF) 57.14 ± 8.37. In the examined patients of group F the level of QOL was higher than in group E, it was, in the domains of physical functioning (PF) - 76.42 ± 7.99, bodily pain (BP) - 61.28 ± 11.18, general health (GH) - 60.85 ± 7.33. Physical health (PH) was low in all groups, but slightly higher in group F (47.90 ± 3.45). The mental health (MH) was low in all groups of patients, slightly higher in group C (47.89 ± 3.59). Conclusions. The level of QOL in persons with DP on the background of type I and II DM with multimorbidity was generally not high. Patients in group D showed the lowest levels of QOL, they also had a level of glycated hemoglobin much higher than in other groups. In group F, the data of QOL were higher, because people with DP on the background of type I DM (group E) had a higher frequency of concomitant thyroid damage, the manifestations of which significantly complicate the course of the underlying disease and reduce levels of functioning. Often manifestations of diabetic foot occur in the onset of DP, when the fibers responsible for sensitivity were damaged, which causes the appearance of the neuropathic component of pain, so in persons of group B the lowest among all groups was the level of QOL in the domain of pain intensity. In addition, it was convenient to monitor the results of treatment by conducting a QOL survey several times a year. Careful analysis of QOL in all areas of functioning in patients with DP allowed detecting early mental disorders and timely start treatment, including psychotherapy sessions. Keywords: quality of life, diabetic polyneuropathy, comorbidity, diabetic foot.

Quality of life: public planning and private living