PubMed Health⌕ Search

Biomedical subjects

R T Wertz

Publications and source records attributed to R T Wertz.

At least 19 recordsLinked to original sources
PubMed2001

Inter- and intrajudge reliability for videofluoroscopic swallowing evaluation measures.

Interjudge reliability for videofluoroscopic (VFS) swallowing evaluations has been investigated, and results have, for the most part, indicated that reliability is poor. While previous studies are well-designed investigations of interjudge reliability, few reports of intrajudge reliability are available for VFS measures derived from frame-by-frame analysis that clinicians typically employ. The purpose of this study was to examine the inter- and intrajudge reliability of VFS examination measures commonly used to assess swallowing functions. No training to criteria occurred. VFS examinations were conducted on 20 patients who had suffered a stroke within six weeks and had no structural abnormalities or tracheostomies. Three clinical judges served as subjects and rated the VFS examinations from videotape using frame-by-frame analysis. A clinician's repeated review of measures employed in the 20 examinations indicated high intrajudge reliability for a number of measures, suggesting that an experienced clinician may employ consistent standards for rating certain VFS measures across patients and time. These standards appear to vary among clinicians and yield unacceptable interjudge reliability. The need to train clinicians to criteria to improve interjudge reliability is discussed.

Adult↗
PubMed2000

Inter- and intrajudge reliability of a clinical examination of swallowing in adults.

This study investigates inter- and intrajudge reliability of a clinical examination of swallowing in adults. Several investigations have sought correlations between clinical indicators of dysphagia and the actual presence of dysphagia as determined by videofluoroscopy. Whereas some investigations have reported interjudge reliability for the videofluoroscopic measures employed, none have reported reliability for clinical measures. Without established reliability for rating clinical measures, conclusions drawn regarding the utility of a measure for detecting aspiration can be called into question. Results of the present study indicate that fewer than 50% of the measures clinicians typically employ are rated with sufficient inter- and intrajudge reliability. Measures of vocal quality and oral motor function were rated more reliably than were history measures or measures taken during trial swallows. There is a need to define more clearly the measures employed in clinical examinations and to be consistent in reporting reliability for clinical measures of swallowing function in future research.

Adult↗
PubMed1998

"Speech problem" subsequent to carbon monoxide exposure? I the jury.

Exposure to carbon monoxide can damage the nervous system. Sometimes that damage disrupts speech, and sometimes it does not. And, when it does, not all of what one hears may have an organic basis. Coming to grips with altered speech can alter people in different ways--consciously and unconsciously. Finding out what is real and what is not is a good reason for getting up in the morning. It's my job. I'm a speech pathologist.

Aphasia↗
PubMed1997

Promoting recovery in chronic aphasia with an interactive technology.

OBJECTIVE: To assess chronic aphasic patients' responses to resumption of therapy using an innovative, computer-based treatment system. DESIGN: Patients were assessed pretreatment and posttreatment using standardized assessment tools. Pretreatment and posttreatment performance score means were computed and compared, with statistical significance of the differences established using a one-tailed, matched t test. SETTING: The work was conducted at (1) a Veterans Affairs medical center participating in treatment research and (2) a regional aphasia center delivering therapy services for reimbursement. PATIENTS: Chronic aphasic patients (n = 23) from 6 months to more than 15 years postonset were enrolled in the study. They included a wide range of types and severities of aphasia, and all had received traditional speech-language therapy services earlier. INTERVENTIONS: All patients were treated in 1-hour clinical sessions by speech-language pathologists using the designated computer-based treatment system. All but one of the patients had access to the computer-based treatment system at home for practice between clinical therapy sessions. MAIN OUTCOME MEASURES: The outcome measures used were (1) the Porch Index of Communicative Ability (PICA), (2) the Boston Naming Test (BNT), (3) the Western Aphasia Battery (WAB), and (4) the Boston Diagnostic Aphasia Examination (BDAE). RESULTS: The majority of patients improved significantly in multiple modalities as assessed by these instruments. CONCLUSIONS: Specific measures of language function can be broadly, positively, and significantly influenced by computer-based language therapy in chronic aphasia.

Adult↗
PubMed1997

The efficacy of computer-provided reading treatment for chronic aphasic adults.

We examined the effects of computer-provided reading activities on language performance in chronic aphasic patients. Fifty-five aphasic adults were assigned randomly to one of three conditions: computer reading treatment, computer stimulation, or no treatment. Subjects in the computer groups used computer 3 hours each week for 26 weeks. Computer reading treatment software consisted of visual matching and reading comprehension tasks. Computer stimulation software consisted of nonverbal games and cognitive rehabilitation tasks. Language measures were administered to all subjects at entry and after 3 and 6 months. Significant improvement over the 26 weeks occurred on five language measures for the computer reading treatment group, on one language measure for the computer stimulation group, and on none of the language measures for the no-treatment group. The computer reading treatment group displayed significantly more improvement on the Porch Index of Communicative Ability "Overall" and "Verbal" modality percentiles and on the Western Aphasia Battery Aphasia "Quotient" and "Repetition" subtest than the other two groups. The results suggest that (a) computerized reading treatment can be administered with minimal assistance from a clinician, (b) improvement on the computerized reading treatment tasks generalized to non-computer language performance, (c) improvement resulted from the language content of the software and not stimulation provided by a computer, and (d) the computerized reading treatment we provided to chronic aphasic patients was efficacious.

Adult↗
PubMed1996

Crossed aphasia. Functional brain imaging with PET or SPECT.

OBJECTIVES: To study patients with crossed aphasia (aphasia secondary to lesions in the right hemisphere in right-handed patients) with functional brain imaging using positron emission tomography (PET) or single photon emission computed tomography (SPECT); to see whether left hemisphere structures were metabolically depressed during the acute phase and, in 1 patient, during recovery; and to review the modern literature on crossed aphasia, with special reference to left hemisphere involvement. DESIGN: Case studies of 3 patients with crossed aphasia, including language testing, computed tomographic scanning, and functional imaging with PET or SPECT. SETTING: Hospital case studies. PATIENTS: Three right-handed patients with crossed aphasia secondary to acute infarctions in the right hemisphere and left hemiparesis. METHODS: All 3 patients were studied by means of bedside language testing, computed tomographic scanning, and functional brain imaging with PET or SPECT. Patient 1 also underwent serial testing with the Boston Diagnostic Aphasia Examination and follow-up PET scanning after 2 months of recovery. OUTCOME MEASURES: Clinical examination in all 3 patients and follow-up Boston Diagnostic Aphasia Examination and PET scanning in patient 1. RESULTS: Two patients had severe global aphasia and 1 had Broca aphasia. In all cases, computed tomographic scans failed to reveal any left hemispheric lesions. Functional imaging with PET or SPECT showed extensive hypometabolism or hypoperfusion in the right hemisphere, with initial reductions in the left hemisphere as well. In patient I, a follow-up PET image showed only persistent hypometabolism in the right hemisphere. CONCLUSIONS: These findings suggest that abnormal dominance for at least some language functions in the right hemisphere underlies the syndrome of crossed aphasia. Diaschisis, or functional depression of the anatomically normal left hemisphere, was seen in all 3 patients during the acute phase, but not in patient 1 after recovery had begun.

Aged↗
PubMed1994

MRI asymmetries and language dominance.

OBJECTIVE: To examine the relationship between language dominance, as measured by Wada testing, and hemispheric asymmetries on MR brain images. BACKGROUND: A previous report that did not include verification of language dominance compared the length of the planum temporale with hemispheric asymmetries seen on CT and inferred that occipital lobe asymmetry is related to language dominance. METHODS: Language dominance was identified by the Wada test in 57 patients evaluated for surgical treatment of epilepsy. Fifty-five had an MRI scan that allowed accurate measurement. In a blinded fashion, two examiners independently measured bilateral frontal, parietal, and occipital lobe lengths on MR scan for each patient. Measurements of asymmetries were compared with language dominance established by the Wada test. RESULTS: Reliability of measurement between the examiners was 97%. Asymmetry of the occipital lobe length on MR scan 10 mm above the tentorium was the only measurement significantly related to language dominance (p < 0.01). Occipital lobe length was longer on the left in 19 (40%) and on the right in 10 (21%) patients with left dominance. The right lobe was longer in six of seven (86%) patients with bilateral dominance. One patient with right hemisphere dominance had a longer left lobe. None of the measurements significantly related to handedness. CONCLUSION: Asymmetries of occipital lobe length relate to language dominance, but such dominance cannot be reliably identified by MR in an individual patient.

Adolescent↗
PubMed1989

Computer-based visual communication in aphasia.

The authors describe their recently developed Computer-aided VIsual Communication (C-VIC) system, and report results of single-subject experimental designs probing its use with five chronic, severely impaired aphasic individuals. Studies replicate earlier results obtained with a non-computerized system, demonstrate patient competence with the computer implementation, extend the system's utility, and identify promising areas of application. Results of the single-subject experimental designs clarify patients' learning, generalization, and retention patterns, and highlight areas of performance difficulties. Future directions for the project are indicated.

Aphasia↗
PubMed1989

Processing of visual syntax in a globally aphasic patient.

A globally aphasic patient was trained on a computerized visual communication system. His ability to comprehend reversible locative prepositional phrases after training was studied and compared with the performance of Broca's aphasics on a similar task. This patient's ability to generalize symbols for actions was also investigated. The results demonstrate our patient's capacity to master a formal visual syntax in the absence of natural language and illustrate how this capacity may be used successfully in a visual communication system. A problem in generalizing symbols for actions is demonstrated, suggesting that certain heuristic and cueing capabilities in the approach may be helpful.

Aphasia↗
PubMed1989

Home treatment for aphasic patients by trained nonprofessionals.

Thirty-seven aphasic men received 8-10 hr of individual treatment each week for 12 weeks from a home therapist (wife, friend, relative) who was trained and directed by a speech pathologist. Treatment was followed by 12 weeks of no treatment. Patients were evaluated at entry and at 6, 12, 18, and 24 weeks after entry with a battery of speech and language measures. The group made substantial progress on all measures during the 12 weeks of treatment and ceased to progress when treatment was discontinued. Progress for the home treatment patients did not differ significantly from that of patients who received 12 weeks of individual treatment from speech pathologists or from that of patients for whom treatment was deferred for 12 weeks. Patient selection, training of the home therapists, and other methodological aspects are described to assist speech pathologists in making decisions about the use of trained volunteers in aphasia treatment.

Aged↗
PubMed1986

Comparison of clinic, home, and deferred language treatment for aphasia. A Veterans Administration Cooperative Study.

Aphasic patients who met stringent selection criteria were assigned randomly to three groups: clinic treatment by a speech pathologist for 12 weeks, followed by 12 weeks of no treatment; home treatment by a trained volunteer for 12 weeks, followed by 12 weeks of no treatment; or deferred treatment for 12 weeks, followed by 12 weeks of treatment by a speech pathologist. At 12 weeks after entry, language measures indicated that the clinic-treatment patients made significantly more improvement than did the deferred-treatment patients, and improvement in home-treatment patients did not differ significantly from either clinic- or deferred-treatment patients. At 24 weeks after entry, after deferred-treatment patients had received clinic treatment, there were no significant differences among the groups. These results suggest that clinic treatment for aphasia is efficacious, and delaying treatment for 12 weeks does not compromise ultimate improvement.

Aged↗
PubMed1983

Spectrographic analysis of vowel and word duration in apraxia of speech.

Most normal speakers of English reduce the duration of the stem word vowel as words increase in length. Theoretically, this durational reduction reflects low-level linguistic knowledge. We posed two questions in this study: First, do speakers with apraxia of speech progressively reduce vowel durations as words increase in length, and second, do these vowel and word durations differ significantly from normal productions? We asked 11 apraxia of speech patients and 11 normal speakers to repeat three sets of three words which progressively increased in length, and we analyzed these productions spectrographically. Our results revealed that both groups reduced vowel duration as words increased in length. Word and vowel duration for apraxia of speech patients, however, were often significantly longer than those for normal speakers. Our results suggest that vowel reduction is a robust phenomenon which resists impairment in apraxia of speech, despite often significant disturbances in motor programming.

Adult↗
PubMed1981

Veterans Administration cooperative study on aphasia: a comparison of individual and group treatment.

Five Veterans Administration Medical Centers participated in an investigation designed to compare individual with group treatment for aphasic patients who had suffered a left hemisphere cerebral vascular accident. Patients who met selection criteria were assigned randomly to either traditional, individual, stimulus-response type treatment of specific language deficits or group therapy designed to improve communication through group interaction and discussion with no direct treatment of specific language deficits. All patients received eight hours of therapy each week beginning at four weeks postonset and continuing until 48 weeks postonset or until they dropped out of the study. A battery of language measures and a clinical neurologic evaluation were administered at intake and every 11 weeks a patient was in the study. Results show both individually and group-treated patients made significant improvement in language abilities. Individual treatment resulted in significantly better overall performance on the Porch Index of Communicative Ability; however, no significant differences were observed between groups on the other language measures. If the traditional belief is correct that significant spontaneous recovery is complete by three to six months postonset, significant improvement in both groups beyond 26 weeks postonset indicates both individual and group treatment are efficacious methods for managing aphasic patients.

Adult↗