Preliminary experience in transoral laryngeal surgery with a flexible robotic system for benign lesions of the vocal folds

Abstract


Purpose

This purpose of this case series is to present the first four cases utilizing micro-phonosurgical instrumentation designed specifically for use with a semi-flexible ‘robotic’ system—the Medrobotics Flex system and to evaluate the accessibility and feasibility of this platform in the context of transoral robotic surgery (TORS) for laryngeal surgery.


Methods

Four patients (3 female, 1 male; age range 49–79 years) were operated by the senior author at CHL—a tertiary hospital centre between 2016 and 2017. The ‘robot’ was deployed in all cases to assess its accessibility and ability to perform surgery in the larynx.


Results

All four patients were successfully treated using the system along with newly developed instrumentation specifically focused on phonosurgery.


Conclusion

This series has demonstrated accessibility and ability for laryngeal surgery using a novel semi-rigid operator-controlled ‘robotic’ system. We encountered no device failures and were able to perform all the selected cases uneventfully.

from ! ORL Sfakianakis via paythelady.61 on Inoreader http://ift.tt/2EaqlnK

Preliminary experience in transoral laryngeal surgery with a flexible robotic system for benign lesions of the vocal folds

Preliminary experience in transoral laryngeal surgery with a flexible robotic system for benign lesions of the vocal folds

Abstract


Purpose

This purpose of this case series is to present the first four cases utilizing micro-phonosurgical instrumentation designed specifically for use with a semi-flexible ‘robotic’ system—the Medrobotics Flex system and to evaluate the accessibility and feasibility of this platform in the context of transoral robotic surgery (TORS) for laryngeal surgery.


Methods

Four patients (3 female, 1 male; age range 49–79 years) were operated by the senior author at CHL—a tertiary hospital centre between 2016 and 2017. The ‘robot’ was deployed in all cases to assess its accessibility and ability to perform surgery in the larynx.


Results

All four patients were successfully treated using the system along with newly developed instrumentation specifically focused on phonosurgery.


Conclusion

This series has demonstrated accessibility and ability for laryngeal surgery using a novel semi-rigid operator-controlled ‘robotic’ system. We encountered no device failures and were able to perform all the selected cases uneventfully.

from ! ORL Sfakianakis via paythelady.61 on Inoreader http://ift.tt/2EaqlnK

Preliminary experience in transoral laryngeal surgery with a flexible robotic system for benign lesions of the vocal folds

Evaluation of Language Predictors of Main Concept Production in Spanish/English Bilingual Discourse Using Nicholas and Brookshire Stimuli

Purpose

A conceptual framework of bilingual aphasia assessment requires an understanding of the variables that influence discourse in bilingual speakers. This study aimed to determine predictors of main concept (MC) production, a measure of discourse completeness, as well as the effect of language dominance on MCs.

Method

The Nicholas and Brookshire (1993) picture stimuli were used to elicit English and Spanish discourse in 83 young bilinguals. Participant-reported variables (e.g., proficiency self-ratings) and measured language variables (e.g., correct information units [CIUs] in discourse) were entered into regressions to determine potential MC predictors. A repeated-measures analysis of variance evaluated MCs within and across dominance groups categorized by speaking self-ratings.

Results

Measured language variables (number of CIUs, naming accuracy) were most predictive of MCs. The participant-reported variable most associated with MC production was self-rating of speaking proficiency. Spanish- and English-dominant groups produced more MCs in their dominant language; the balanced group produced more English MCs. Between-groups differences were observed.

Conclusions

Two measures related to lexical retrieval (CIUs and naming) were most predictive of MC production across languages. Participant ratings of speaking proficiency were also highly correlated to MCs. They also accurately reflected dominance, though balanced bilinguals overestimated their Spanish abilities.

Supplemental Material

https://doi.org/10.23641/asha.5708605

from ! ORL Sfakianakis via paythelady.61 on Inoreader http://ift.tt/2BXxUka

Evaluation of Language Predictors of Main Concept Production in Spanish/English Bilingual Discourse Using Nicholas and Brookshire Stimuli

A Family-Centered Feeding Intervention to Promote Food Acceptance and Decrease Challenging Behaviors in Children With ASD: Report of Follow-Up Data on a Train-the-Trainer Model Using EAT-UP

Purpose

This research note outlines the usefulness of Easing Anxiety Together with Understanding and Perseverance (EAT-UP), a train-the-trainer, family-centered feeding intervention, for promoting food acceptance of children with autism spectrum disorder (ASD). This report is a follow-up on a pilot study (n = 4) of the EAT-UP intervention previously completed by the same authors.

Method

Participants were 3 families of children with ASD receiving services from an outpatient department of a larger rehabilitation hospital in the northeastern United States. Three professionals working with the families were also recruited and trained by the first author, a speech-language pathologist experienced with the EAT-UP method. Initial assessment was followed by a baseline period for each participant. An individual mealtime plan was drafted for each family. Data on acceptance of less preferred food and the presence of challenging mealtime behaviors were recorded using direct observation and pre-, mid-, and postintervention measures and questionnaires.

Results

All children demonstrated increased food acceptance and dietary diversity and decreased challenging behaviors. Caregivers reported decreases in the frequency of problem behaviors and in the number of problem mealtime behaviors. Measures of procedural fidelity increased from 50% to 100% for registered behavior technicians and parents over the course of the EAT-UP intervention period.

Conclusions

EAT-UP is an effective model for training professionals who work with families of children with ASD and challenging mealtime behavior. Implications for interprofessional practice and research are discussed.

from ! ORL Sfakianakis via paythelady.61 on Inoreader http://ift.tt/2Fv9EDR

A Family-Centered Feeding Intervention to Promote Food Acceptance and Decrease Challenging Behaviors in Children With ASD: Report of Follow-Up Data on a Train-the-Trainer Model Using EAT-UP

Counseling Issues: Addressing Behavioral and Emotional Considerations in the Treatment of Communication Disorders

Purpose

Counseling is an important fundamental professional activity and an established component of the speech-language pathology/audiology scope of practice as documented by the American Speech-Language-Hearing Association (2004a, 2016a). Appropriate incorporation of counseling into practice can optimize service provision, help address comorbid behavioral and emotional reactions to communication disorders, and enhance prognosis. Practitioner insecurity in incorporating counseling into practice has been documented by Phillips and Mendel (2008), as well as Atkins (2007). This tutorial seeks to present general counseling constructs and treatment applications primarily utilizing a humanistic counseling perspective.

Method

This tutorial incorporated relevant publications from communication disorders and counseling psychology literature databases over a 3-year period. The tutorial evolved through interviews with practicing speech-language pathology practitioners and educators and was undertaken to provide transparency and clarity to support the assertions and recommendations offered.

Results

This tutorial organizes and presents general counseling considerations along with specific suggestions, which can help practitioners who are seeking to expand their understanding, skill, and confidence in incorporating counseling into their practice. The tutorial identifies some of the potential and impactful comorbid emotional and behavioral responses to experiencing a communication disorder and/or to the treatment process for the communication disorder issue(s). Theoretically grounded considerations for mitigating such potentially impactful responses are offered.

Conclusion

Continued and enhanced efforts may be necessary to meet American Speech-Language-Hearing Association’s mandate for universal incorporation of empirically supported counseling approaches and in advancing universal speech-language pathology/audiology training in this area. It is hoped that this tutorial serves as an initial guide for addressing this need until universal preparation and practice is achieved.

from ! ORL Sfakianakis via paythelady.61 on Inoreader http://ift.tt/2E34Sk6

Counseling Issues: Addressing Behavioral and Emotional Considerations in the Treatment of Communication Disorders

Novel Mealtime Duration Measures: Reliability and Preliminary Associations With Clinical Feeding and Swallowing Performance in Self-Feeding Children With Cerebral Palsy

Purpose

The purpose of this study is to examine (a) the reliability of newly developed measures of mealtime duration and (b) their relationship to clinical feeding/swallowing performance in children with spastic cerebral palsy (SCP).

Method

Seventeen self-feeding children (9 boys, 8 girls) with SCP (age range = 5;1 [years;months] to 17;6, Gross Motor Function Classification System range = I–IV) were assessed during mealtimes using the Dysphagia Disorder Survey (DDS; Sheppard, Hochman, & Baer, 2014). Children were divided into 2 groups, children with primarily unilateral or bilateral brain involvement. Duration measures included mealtime duration and total sip/bite duration for each bolus type (liquid and solid).

Results

Excellent intra- and inter-rater reliability for all duration measures was observed (intraclass correlation coefficient [ICC] = 1.00 and 0.955, respectively, for mealtime duration; ICC = 1.00 and 0.963, respectively, for solid/bite duration; ICC = 1.00 and 0.957, respectively, for liquid/sip duration). Positive correlations were found between total mealtime duration and DDS Part 1, r s = .514 [.045–.797], p = .035; Part 2, r s = .528 [.064–.804], p = .029; and total scores, r s = .665 [.271–.868], p = .004, and between total solid/bite duration and DDS Part 1, r s = .579 [.137–.828], p = .015; Part 2, r s = .620 [.199–.847], p = .007; and total scores, r s = .762 [.444–.909], p < .001. Children with unilateral brain involvement exhibited significantly lower DDS total (p = .049) and Part 2 scores (p = .026), indicating better feeding/swallowing performance/skills. They also had shorter mealtime duration (p = .019) and solid/bite duration (p = .025) compared with children with bilateral involvement.

Conclusions

Our new mealtime duration measures are reliable and correlate with feeding/swallowing performance in a sample of self-feeding children with SCP. Therefore, they may be useful supplements to feeding/swallowing assessments for this population.

Supplemental Material

https://doi.org/10.23641/asha.5715076

from ! ORL Sfakianakis via paythelady.61 on Inoreader http://ift.tt/2Blf2Yx

Novel Mealtime Duration Measures: Reliability and Preliminary Associations With Clinical Feeding and Swallowing Performance in Self-Feeding Children With Cerebral Palsy

Early Development of Emotional Competence (EDEC) Assessment Tool for Children With Complex Communication Needs: Development and Evidence

Purpose

This article introduces and provides initial data supporting “The Early Development of Emotional Competence (EDEC): A tool for children with complex communication needs (CCNs).” The EDEC was developed to raise awareness about the relation of language and emotional competence and to maximize the likelihood that intervention includes language to discuss emotions in ways that are consistent with the values and goals of the family.

Method

First, the theoretical and clinical foundations of the EDEC development were discussed. Then, a description of preferred translation practices was provided, with examples of Korean and Mandarin Chinese translations. Finally, initial data from a pilot study with two sociocultural communities (i.e., 10 American and 10 Korean mothers of children developing typically) were presented to demonstrate the potential of the tool.

Results

The pilot test offered preliminary support for the sensitivity of the EDEC. The tool solicited responses reflecting cultural differences between American and Korean mothers’ perception of a child’s emotional skills and mother-child conversation about emotions as predicted based on many cross-cultural studies in emotion.

Conclusions

The information elicited from the EDEC shows promise for enabling culturally natural conversation about emotions with appropriate vocabulary and phrases in their augmentative and alternative communication systems.

Supplemental Materials

https://doi.org/10.23641/asha.5643076

from ! ORL Sfakianakis via paythelady.61 on Inoreader http://ift.tt/2AWFn2p

Early Development of Emotional Competence (EDEC) Assessment Tool for Children With Complex Communication Needs: Development and Evidence