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Biomedical subjects

J P Dworkin

Publications and source records attributed to J P Dworkin.

At least 19 recordsLinked to original sources
PubMed1998

Laryngeal obstructing saccular cysts: a review of this disease and treatment approach emphasizing complete endoscopic carbon dioxide laser excision.

Airway-obstructing saccular cysts in adults are rare laryngeal anomalies. Treatment with tracheotomy may be needed for control of the airway, often followed by marsupialization of the cyst wall. Unfortunately, recurrence rates are high following marsupialization. We describe 2 patients with saccular cysts obstructing the airway and discuss airway management and the results following complete endoscopic carbon dioxide laser excision. Both patients had normal voice and swallowing function postoperatively and are disease free.

Adult↗
PubMed1998

Videostroboscopy of the pharyngoesophageal segment in total laryngectomees.

OBJECTIVES: The reconstructed pharyngoesophageal segment (PES) serves as the neoglottis following total laryngectomy, as it provides the source of vibration for production of tracheoesophageal puncture (TEP) voice. To date, little information exists regarding the vibratory characteristics of the PES. The purpose of this investigation was to study the anatomy and physiology of the PES using videostroboscopy. STUDY DESIGN: Prospective study investigating the anatomy and physiology of the PES in 34 laryngectomees who used TEP speech as their primary form of communication. MATERIALS AND METHODS: Videostroboscopy and voice recordings were graded by three trained, blinded judges using a seven-point scale. RESULTS: The patients demonstrated differences that allowed for separation of patients into two main groups: "poor" and "effective" TEP speakers. The voice quality differences were explained by anatomic and physiologic characteristics of the PES. Redundant, thick, and dyssynchronous PES features were observed in patients with poor TEP speech skills; the effective speakers exhibited less redundant, thinner mucosa and more synchronous vibratory patterns. Moreover, the latter subgroup consistently demonstrated a greater degree of volitional PES control and less spasmodic activity than their poorly speaking counterparts. Length of the PES opening (measured in the horizontal plane) as well as amount and consistency of secretions did not appear to influence TEP speech or voice proficiency. CONCLUSION: Videostroboscopy in laryngectomees is a noninvasive, inexpensive, easily performed procedure that may contribute valuable information regarding the anatomy and physiology of the PES, especially in patients who experience difficulties achieving satisfactory TEP voice and speech production.

Adult↗
PubMed1991

Nonsurgical treatment of drooling in a patient with closed head injury and severe dysarthria.

The purpose of this investigation was to measure the effectiveness of the antimuscarinic drug atropine sulfate in the treatment of chronic drooling in a patient with a history of severe closed head injury and resultant widespread oral neuromuscular and higher cortical disturbances. Results of the A-B-A-B-A-B withdrawal paradigm, chosen to demonstrate the functional relationship between drug therapy and the degree of drooling, revealed that administration of atropine sulfate reduced by more than 50% of baseline levels the amount of resting secretion, intraoral accumulation, and pharyngeal-laryngeal pooling of saliva, with negligible side effects. These results are discussed and compared to the alternative drug and surgical approaches to treatment that have been the primary focus of recent research on drooling.

Adult↗
PubMed1988

Apraxia of speech: the effectiveness of a treatment regimen.

This investigation describes a treatment program for an adult patient with apraxia of speech. The program was composed of a series of physiologic (nonspeech) and phonetic (articulatory) tasks that began with oroneuromotor control activities and progressed to consonant-vowel (CV) syllable, word, and sentence drills. All activities were paced by a metronome. Detailed descriptions are provided about the (a) nature of the specific treatment steps, (b) sequence of steps followed, (c) criteria used for progression within and between steps, (d) actual number of trials and time required to reach criteria for each step, and (e) steps that were especially easy or difficult to master. A multiple probe design employed to test program efficacy revealed that (a) all tasks in the treatment program were successfully acquired, (b) control of all treatment behaviors was maintained, and (c) carry-over from treated to nontreated behaviors did not occur. Results confirmed that the program positively affected the patient's performance. Suggestions are offered outlining possible modification of the treatment steps so as to yield similar results with greater clinical efficiency.

Aphasia↗
PubMed1986

Tongue strength and alternate motion rates in normal and dysarthric subjects.

Tongue strength and alternate motion rates were measured in 50 normal subjects and in 18 subjects who had different neuropathologic types of dysarthria. The dysarthric subjects did not differ significantly from one another on any of the test measures. However, as a group they differed significantly from their normal counterparts in that they demonstrated weaker tongue strength, reduced and unsustained levels of maximum tongue strength effort, and slower alternate motion rates. Clinical implications are discussed.

Adolescent↗
PubMed1985

Oral structural and neuromuscular characteristics in children with normal and disordered articulation.

The primary purpose of this study was to determine whether there were any signs of structural and/or neuromuscular aberrations in the speech mechanisms of children who were previously diagnosed as having "functional" articulation disorders. These children were compared with a group of normally articulating children. Results of in-depth oral mechanism examinations revealed no significant differences between these groups on any of the measures made. The clinical implications of such findings are discussed.

Articulation Disorders↗
PubMed1982

Glossectomy: a case report.

A 27-year-old man, a law student, underwent partial glossectomy, right hemimandibulectomy and radical neck dissection due to recurrent carcinoma of the oral cavity. These surgical procedures resulted in severe swallowing and speech difficulties for which he was treated by tube feeding and speech therapy, respectively. Emphasis in therapy was placed on compensatory articulator techniques for the improvement of speech intelligibility. Those adaptive tongue stump, labial, and palato-pharyngeal compensations which were employed are discussed. After. 9 months of speech therapy, he was judged to have achieved fair-to good speech intelligibility, and was able to continue law school. At the time of this writing, he was practicing law.

Adult↗
PubMed1980

Characteristics of frontal lispers clustered according to severity.

The purpose of this investigation was to determine the relationship among frontal lisping, protrusive lingual force, and lingual diadochokinetic rates when subjects are grouped according to severity of lisping. Results revealed that when compared to normal speaking counterparts: (1) lispers in each severity subgroup exhibited significantly weaker protrusive lingual forces and that the significance of such differences increased with the severity of lisping; and (2) all but the moderately severe lispers displayed significantly slower lingual diadochokinetic rates. These findings suggest that clustering lispers into homogeneous severity subgroups before examining the relationships between their misarticulations and the lingual factors studied may offer important information regarding the diagnosis, treatment, and prognosis of their articulatory problems.

Articulation Disorders↗
PubMed1980

Tongue strength: its relationship to tongue thrusting, open-bite, and articulatory proficiency.

Maximum protrusive tongue strength was measured for two experimental groups of 35 normal speaking children and 21 children with frontal lisping, anterior tongue thrusting during swallow, and open-bite malocclusion, and a control group of 85 children with normal speech and occlusion who did not thrust their tongues during swallow. No significant differences in tongue strength were found among these groups. The findings were interpreted to support the view that tongue strengthening exercises recommended by some authors for the correction of tongue thrusting or associated frontal lisping may be superfluous.

Adolescent↗
PubMed1980

Tongue force in normals and in dysarthric patients with amyotrophic lateral sclerosis.

Tongue force, rate of syllable repetition, and judgments of articulatory defectiveness were measures obtained on 19 dysarthric adults with amyotrophic lateral sclerosis and on 125 normal adults. Anterior and lateral tongue forces were measured by means of a pressure transducer clasped between the teeth; the tongue forces were recorded on a pen-writing ECG apparatus. Audio-recorded syllable repetitions of /p lambda/, /t lambda/, and /k lambda/ also were transcribed on ECG paper and counted. Three listeners rated articulatory precision on a 7-point scale of severity. The normal males had significantly higher tongue forces than normal females; normal subjects had significantly higher tongue forces than dysarthric patients; and anterior tongue forces were significantly greater than lateral in normal and dysarthric patients. There was a high negative correlation between tongue force and severity of articulatory defect. Syllable repetitions were significantly slower in the dysarthric patients than in the normal patients, and a high negative correlation was obtained between syllabic rate and severity of articulatory defect.

Adult↗
PubMed1980

Tongue strength Part I: Following total laryngectomy.

Surgical repositioning of the genioglossus muscle, as in total laryngectomy, may have an adverse effect on the protrusive strength of the tongue. To test this premise, anterior and lateral tongue strength measures were obtained from 10 laryngectomized and 15 normal subjects by means of a pressure transducer and recording device. The results indicated no significant difference between laryngectomized and normal subjects on tongue strength measures. Further, all laryngectomized subjects were judged to have good to excellent esophageal speech. It was concluded that laryngectomy does not adversely affect the major musculature concerned with protrusive tongue strength for proficient esophageal speakers.

Adult↗
PubMed1980

Tongue strength. Part II: in artificial alaryngeal speech.

Tongue strength does not appear to be reduced in proficient esophageal speakers. However, no data exist on tongue strength for laryngectomized subjects who have not developed esophageal speech. Anterior and lateral tongue strength measures were obtained from 13 laryngectomized subjects who used an artificial larynx and 15 normal subjects by means of a pressure transducer and recording device. The results indicated that laryngectomized subjects had significantly weaker tongues in two of three directions measured. It was concluded that laryngectomy may affect tongue strength, but that the method of alaryngeal speech utilized postoperatively influences the return to normal.

Aged↗
PubMed1980

Tongue strength measurement in patients with amyotrophic lateral sclerosis: qualitative vs quantitative procedures.

Tongue weakness and articulatory imprecision have been found to be significantly related in patients with amyotrophic lateral sclerosis (ALS). To determine the strength of the tongue musculature, qualitative measurement techniques are routinely used during the neurologic examination. Recently, a quantitative measurement procedure was described and reported to have yielded important diagnostic and therapeutic implications for patients with ALS. This paper briefly compares and contrasts the applicability of qualitative versus quantitative procedures of tongue strength measurement, as well as different approaches to articulatory remediation for these patients.

Amyotrophic Lateral Sclerosis↗
PubMed1979

Influence of lingual muscular strength on articulatory proficiency.

The purpose of this study was to examine the relationship between lingual muscular strength (LMS) and articulatory proficiency in 45 normal and 45 lisping speakers utilizing a Lingual Force Scale designed specifically for this investigation. Results revealed that lispers exhibited significantly reduced LMS as compared to their matched controls. No significant differences in LMS between males and females with lisped speech, or between normal speaking males and females were found to exist at 5 age levels. Significant positive correlations were noted between age and LMS in both groups of subjects. In light of these findings, it might be suggested that lisping should not be viewed always as a purely functional disorder of the speech musculature.

Articulation Disorders↗