Search Results (649)

Background/Objectives: Verb anomia is a common symptom of primary progressive aphasia (PPA), particularly in the logopenic variant (lvPPA). Despite the central role of verbs in sentence construction, interventions specifically targeting verb anomia remain scarce. This study examined the effects of Personalized Observation, Execution and Mental Imagery (POEM) therapy, grounded in evidence that sensorimotor systems are recruited during action verb processing and may support verb retrieval. Methods: A 74-year-old woman with lvPPA completed pre- and post-POEM assessments (linguistic, cognitive, thymic, and motor). POEM consisted of 15 telepractice sessions delivered three times weekly using a systematic procedure with three sensorimotor strategies: action observation, gesture execution, and mental imagery. Results: No significant gains were observed in verb production across naming tasks, spontaneous speech, or functional communication contexts. However, co-verbal gesture use increased in frequency and quality, particularly during the naming of untrained verbs, suggesting that the gesture execution strategy was generalized. A delayed treatment effect was also noted, raising questions regarding the optimal duration of POEM in neurodegenerative conditions. Conclusions: While no statistically significant improvements in verb production were observed, qualitative analyses revealed increased use and quality of co-verbal gestures, suggesting that POEM had a compensatory effect. Future research involving larger cohorts and longer periods could help clarify the benefits of POEM therapy. It would also be relevant to compare in-person and remote delivery formats to evaluate POEM therapy’s robustness and adaptability in different clinical contexts. To conclude, these findings remain preliminary and should be interpreted with caution, particularly given the lack of significant improvement in primary verb production outcomes. Full article

Laryngeal adductor breathing dystonia (LABD) is a rare form of focal, task-specific respiratory dystonia affecting the laryngeal muscles of unknown aetiology. Unlike classical laryngeal dystonia (spasmodic dysphonia), LABD is not primarily characterised by impaired speech, but rather by dysfunction of respiratory laryngeal control. The hallmark pathophysiological alteration consists of involuntary, action-induced adductor spasms of the laryngeal muscles during respiration, particularly during inspiration. LABD must be distinguished from inducible laryngeal obstruction (ILO), a broader, heterogeneous condition encompassing episodic, stimulus-triggered supraglottic or glottic closure, associated with asthma, reflux, or psychological triggers, that is generally not task-specific and lacks the neurological substrate characteristic of dystonia. In contrast, LABD is a persistent, effort-dependent, neurologically driven dystonia, demonstrable by paradoxical adductor spasms on fibreoptic laryngoscopy during normal inspiration and confirmed electromyographically by paradoxical thyroarytenoid muscle activation instead of the expected inspiratory relaxation. Traditional treatments, including respiratory retraining, speech therapy, biofeedback, psychotherapy, benzodiazepines, dopamine-blocking agents, and anticholinergic drugs, have proved largely ineffective. Tracheostomy may be required in cases of severe respiratory compromise. Botulinum toxin type A (BoNT/A) injections have been reported to successfully reduce inspiratory stridor in selected patients. Here, we present three cases of LABD displaying distinct phenotypes, in which typical features were associated with involvement of extra-laryngeal cranial districts, further expanding the known phenotypic spectrum of this condition. Full article

Introduction: Teprotumumab (Tepezza^®), an insulin-like growth factor-1 receptor (IGF-1R) antagonist, is the first FDA-approved targeted therapy for thyroid eye disease (TED). While effective for reducing proptosis and inflammation, increasing post-marketing evidence has linked teprotumumab to auditory adverse events. IGF-1 signaling is essential for cochlear maintenance and neuroprotection; therefore, systemic IGF-1R inhibition presents a biologically plausible mechanism for ototoxicity. Despite growing recognition of these effects, no standardized approach exists for audiologic assessment or monitoring of patients receiving teprotumumab. This review aimed to (1) summarize proposed mechanisms and the reported spectrum of teprotumumab-related auditory effects, (2) evaluate current methods used to assess and monitor these patients, and (3) identify areas of consensus and ongoing uncertainty. Methods: An updated narrative review of the literature was conducting using PubMed, CINAHL, and Google Scholar using Boolean strings targeting teprotumumab exposure and hearing-related outcomes. Studies from 2022 onward were identified using Boolean search strings targeting teprotumumab exposure and hearing-related outcomes. Peer-reviewed English language studies reporting audiometric findings were eligible for inclusion. Results: Ten studies met inclusion criteria. Reported effects most commonly included bilateral high-frequency SNHL, tinnitus, and aural fullness, typically emerging after three to six infusions. Many cases demonstrated persistent deficits despite drug discontinuation. Baseline audiometric assessment was not uniformly reported across studies, and monitoring protocols varied considerably, with inconsistent incorporation of speech testing and immittance measures. Conclusions: Teprotumumab-associated ototoxicity is increasingly recognized and potentially irreversible. Current evidence is insufficient to guide standardized monitoring. Prospective studies are urgently needed to establish evidence-based audiologic surveillance protocols. Full article

Background: Surface electromyography is emerging as a noninvasive tool to examine neurogenic dysphagia in Parkinson’s disease (PD). This pilot study evaluated the feasibility of surface electromyography (sEMG) (acceptability, resource use, and safety), and explored changes in swallowing-related sEMG parameters following rehabilitation. Methods: Ten patients with mild to moderate PD (Hoehn Yahr 1–3) underwent clinical, respiratory, and swallowing assessments, including sEMG recordings of perioral (orbicularis oris), masticatory (masseter) and cervical muscles (submental/mylohyoid and infrahyoid group). Feasibility outcomes included recruitment, protocol completion, and adverse events. Exploratory sEMG measures comprised amplitude indices (root-mean-square, RMS; peak-to-peak, P2P range; area under curve, AUC) and activation time during saliva swallowing and continuous drinking tasks. Results: Nine out of 10 participants completed the protocol, and no adverse events were reported, indicating good acceptability and safety. Exploratory pre–post analyses showed reduced sEMG amplitude during saliva swallowing of orbicularis oris [median ΔP2P Range = −0.273 (p = 0.020), median ΔAUC = −0.145 (p = 0.027); RMS (median Δ = −0.427) (p = 0.074)] and a generalized prolongation of activation time during continuous sipping across recorded muscles. Conclusions: Multichannel sEMG assessment of swallowing muscles during speech therapy is feasible and safe in patients with PD. Exploratory signal changes warrant cautious interpretation and should be validated in larger rehabilitation-oriented studies. Full article

Background/Objectives: Digital technologies are increasingly explored as complementary tools in speech and language therapy for children with neurodevelopmental disorders. However, evidence on virtual reality-based interventions for children with developmental language disorder (DLD) remains limited. This study aimed to evaluate the effects of a Virtual Reality Rehabilitation System (VRRS)-based language intervention combined with standard speech therapy in preschool children with DLD. Secondary objectives included assessing the feasibility, usability, and safety of the VRRS-integrated intervention. Methods: A randomized controlled pilot study was conducted in preschool children diagnosed with DLD. Participants were allocated to an experimental group receiving VRRS-based language intervention integrated with conventional therapy or to a control group receiving standard speech therapy alone. Both groups attended two 60 min sessions per week for six months. Clinical language outcomes were assessed at baseline (T0) and post-intervention (T1). Feasibility was evaluated through adherence and retention rates, usability through a therapist-completed questionnaire, and safety through monitoring of adverse events during sessions. Results: All participants in the experimental group completed the intervention (100% retention). No adverse events were observed. Therapists reported good usability of the VRRS system, highlighting ease of exercise customization, intuitive monitoring of progress, and good integration into routine therapy. Conclusions: VRRS-based activities integrated into conventional speech therapy appear feasible, safe, and well accepted in preschool children with DLD. Further controlled studies with larger samples are needed to confirm these findings. Trial Registration: ClinicalTrials.gov (NCT07438639). Full article

Background and Aims: Accuracy in speech perception in bilingual children is influenced by two phonological systems. This study compares phonological development in bilingual Urdu–English (UE) children with CIs with their hearing-age-matched peers with normal hearing (NH), by investigating whether bilingualism or any spectral limitations of CI impact perception of UE phonemes. Method and Procedures: Children (n = 57) aged 3; 0–6; 11 years (28 CI, 29 NH) were assessed for speech perception using a custom-designed UE Speech Perception Test (UE-SPT), in quiet and noise (+5 dB SNR). Responses were analysed using confusion matrices, across phonological parameters of place, manner, and voicing to determine error patterns. Outcomes and Results: Significant deficits in CI children were found across all features, with voicing discrimination showing the largest errors (effect sizes d > 6), exacerbated by noise, especially for Urdu aspirated stops. CIs mastered only 8.3% Urdu-aspirated consonants at 6; 11 years compared to 91.7% mastered by NH peers, indicating critical language-specific vulnerabilities. Backing and substitutions errors were particularly seen in CI’s speech, whilst manner was preserved. Conclusion and Implications: UE bilingual phonological complexity compounded by inadequate speech processing abilities in CIs challenges them, underscoring urgent need for targeted speech therapy interventions focusing voicing contrasts and aspirated consonants, as well as environmental accommodations that reduce noise interference and enhance listening through CI, to optimise educational outcomes. This research contributes vital clinical guidance for supporting bilingual children with cochlear implants, addressing both environmental, technological and linguistic challenges. Full article

Background/Objectives: Orofacial myofunctional therapy (OMT) is a system of targeted neuromuscular exercises and behavioral retraining intended to optimize tongue, lip, jaw, and airway function during rest, breathing, swallowing, and sleep. Historically associated with tongue thrust and abnormal swallowing, OMT is now applied across an expanding range of clinical contexts, including sleep-disordered breathing (SDB), tongue-tie rehabilitation, orthodontic stability, and perioperative functional recovery. As its use has broadened, persistent questions have followed: what is myofunctional therapy, where did it originate, and how did a set of oral exercises evolve into an intervention increasingly integrated with airway health, sleep medicine, and surgical care? Methods: This article presents a narrative historical review with a perspective component, synthesizing foundational literature, interdisciplinary contributions, and selected contemporary evidence to examine the evolution of OMT from ancient functional practices to modern clinical science. It is written to trace recurring clinical observations, shifts in educational frameworks, and key inflection points that shaped how OMT has been taught and applied over time. Results: OMT did not emerge from randomized controlled trials or standardized protocols. It arose from repeated clinical encounters with patients with atypical craniofacial development, relapse of structural correction, persistent mouth breathing, and/or unresolved swallowing and speech dysfunction despite technically successful treatment. These patterns suggested that anatomy alone could not account for outcome variability. Over time, clinical attention expanded beyond isolated tongue function to include breathing patterns, posture, neuromuscular tone, and airway behavior. In the past two decades, controlled trials, cohort studies, and systematic reviews have supported selected applications of OMT, particularly in SDB and adjunctive airway care, while also revealing ongoing challenges related to training variability, terminology, scope of practice, and standardization. Conclusions: OMT has historically been described as a system of targeted neuromuscular and behavioral interventions aimed at modifying orofacial rest posture and function. Over time, the field has expanded beyond localized muscle retraining toward a broader functional framework that integrates airway physiology, craniofacial growth, sleep, and interdisciplinary rehabilitation. Full article

Background: The consolidation of specialized fields in health care requires not only scientific evidence and clinical refinement, but also clearly defined scope, competencies, and language, since terminological ambiguity increases overlap and hinders communication, comparability, education, and the organization of care. In this context, Orofacial Motricity was first recognized in Brazil as a field of practice, supported by institutional milestones that have defined its scope, standardized its terminology, and updated professional competencies. Furthermore, it has been consistently adopted in Latin American and European countries (e.g., Peru, Chile, and Portugal). In English-speaking countries, professionals working with Orofacial Myofunctional Disorders (OMDs) and Orofacial Myofunctional Therapy (OMT) are often organized under the designation Orofacial Myology, within diverse institutional and educational frameworks. Methods: This manuscript was developed as a non-institutional position paper based on structured reports from international collaborators, a documentary review of institutional and regulatory sources, and an exploratory terminological survey of databases. Results: Heterogeneity was observed in the use and conceptual level of these designations across countries and institutions, with more frequent convergence at the level of clinical condition and intervention (OMDs/OMT) than at the level of field or area. Conclusion: Clarifying the distinction among field/area, clinical condition, and therapeutic intervention may reduce ambiguities and foster scientific and educational comparability in the international context. Full article

Background: Post-thyroidectomy vocal cord dysfunction (PT-VCD) is an important side effect of thyroid surgery. With the introduction of intraoperative neuromonitoring (IONM), hopes have been raised that either the rate or severity of PT-VCD could be reduced. However, data to support these concepts are scarce. To better understand the relationship between IONM outcomes and the severity of PT-VCD, a detailed time-course evaluation of recovery of PT-VCD was performed in a continuous clinical quality registry from a specialized high-volume endocrine surgery center. Methods: Data were prospectively recorded in a single-center clinical quality assurance registry (June 2015 to May 2016) and subsequently analyzed retrospectively, with a 12-month follow-up for all cases. All patients underwent vocal cord (VC) laryngoscopy (VCL) by independent ear–nose–throat (ENT) specialists before and after surgery. Cases with newly diagnosed PT-VCD were enrolled in a detailed follow-up program (recruitment from June 2015 to May 2016) that included structured telephone interviews every 4–6 weeks to assess the exact time course of PT-VCD recovery and VC status for a period of at least 12 months. Clinical data were analyzed for variables affecting the time course of recovery by univariate analysis. Results: From 6/2015 to 5/2016 there were 1097 consecutive thyroid procedures. During this period, 78 cases of PT-VCD (1591 nerves at risk (NARs); 4.9%) were entered into the detailed follow-up-program. Of these, three cases of PT-VCD persisted at 12 months (PT-VCD 0.18% NAR), with six cases lost to follow-up (maximum rate of potentially persistent PT-VCD of 0.54% NAR). In total, 15% of PT-VCD cases recovered within 4 weeks; the mean recovery time was 4.4 months, and 6 months after thyroidectomy, 18% still had impaired VCL tests. Individual cases were followed >12 months showing late full recovery of PT-VCD, thereby challenging the definition of permanent VCD. Logistic regression analysis revealed non-transitory loss of signal (ntLOS) (OR for recovery within 12 weeks: 0.39; 95%CI 0.15–0.98; p = 0.046) and more specifically, secondary ntLOS, to be a significant independent predictor of PT-VCP recovery beyond 12 weeks (OR for recovery within 12 weeks 0.303; 95%CI 0.115–0.797; p = 0.016). Conclusions: For the first time, these data provide a detailed description of the time course of PT-VCD recovery in a large cohort, along with correlations to operative data and IONM findings. Our study indicates that recovery from PT-VCD can be prolonged, and specifically, the occurrence of ntLOS—especially secondary ntLOS—during IONM was predictive of a longer recovery trajectory. This suggests that IONM may offer an additional advantage by functioning as a prognostic tool, helping to identify patients at higher risk for extended recovery periods. Such early identification could enable a more targeted approach, potentially allowing for the earlier initiation of supportive interventions, like speech therapy, in those most likely to benefit from proactive management. Full article

Context: Automatic Speech Recognition (ASR) in healthcare is undergoing a significant shift driven by the integration of Large Language Models (LLMs). While traditional ASR focused on transcription fidelity, LLM-based systems extend this capability to intelligently reason, summarize, and structure clinical data. This scoping review maps the emerging landscape of LLM-based ASR in healthcare, examining its applications, technical foundations, evaluation practices, and reported challenges. Methods: Following PRISMA-ScR guidelines, we searched different databases for peer-reviewed, open-access studies published between January 2022 and December 2025 to ensure reproducibility and accessibility. Results: Nineteen studies met the inclusion criteria from 384 screened records. Administrative documentation was the most common application (42.1%), followed by diagnosis, therapy, and doctor–patient communication. Whisper dominated ASR (52.6%), typically paired with GPT-family or LLaMA-family LLMs in frozen configurations steered through prompting. LLMs served as the primary component in 68.4% of studies. ASR evaluation within the reviewed studies predominantly relied on word error rate, while LLM evaluation remains fragmented with no standard metric. Studies reported documentation time reductions of 30–90%, though privacy reporting was inconsistent, equity concerns were rarely tested systematically, and only five studies provided replication packages. Conclusions: LLM-based ASR shows potential for reducing documentation burden and supporting clinical workflows, but gaps in evaluation standardization, equity testing, and reproducibility must be addressed before safe clinical deployment. Full article

Background/Objectives: Spectral resolution is strongly associated with speech perception for adult cochlear implant users, but the developmental trajectory of spectral resolution in childhood is more complex and far less understood. Music-based training presents a unique opportunity to address this gap, as musical stimuli feature spectral complexity and fine frequency cues which map to spectral resolution. This study explored if a 12-week music-based intervention could support better spectral resolution in children with cochlear implants. Methods: Twelve children with cochlear implants participated in this longitudinal, repeated-measures study. The music training intervention consisted of group-based in-person music therapy and a take-home music app. Participants (six boys, six girls; M age = 7.3 years) were pseudo-randomized into an immediate training group (n = 4) or delayed-start waitlisted group (n = 8). Inclusion criteria required bilateral moderate-to-profound sensorineural hearing loss, prelingual device fitting, and consistent bilateral device use. Eight children had bilateral CIs and four were bimodal listeners. Results: Spectral resolution perception was significantly enhanced after participating in the music intervention with a mean increase of 2 rpo, F(3, 10.7) = 3.859, p = 0.017. Previous engagement with music and age were not associated with spectral resolution. Conclusions: Despite the known limitations of CIs on spectral resolution, the results of this study indicate that music training can improve spectral resolution perception in children using CIs. Full article

Background: Negative public attitudes promote undesirable stereotypes and stigma in stutterers. Method: To mitigate negative attitudes, 403 respondents combined from 16 international samples filled out the Public Opinion Survey of Human Attributes–Stuttering (POSHA–S) before and after interventions to improve attitudes and were compared to 249 respondents from seven control groups. Investigators aimed (a) to replicate an extreme case of regression to the mean (i.e., “crossover” effect) reported earlier in larger combined samples in which respondents with high pre-scores ended with low post-scores, respondents with low pre-scores finished with high post-scores, and intermediate scorers were unchanged; and (b) to identify individual POSHA–S items related to overall attitude change and among the high and low scorers. Results: As in previous studies, stuttering attitudes improved in the intervention group but not in the control group. Intervention and control respondents demonstrated “crossover” but less than the earlier samples due to lower pre–post correlations. Item contributions to pre–post change and differences among the three change groups were inconsistent; however, high agreement items by respondents were less likely to vary than low agreement items. Conclusion: The “crossover” effect was replicated, and future research should explore its presence in other measures or conditions. Full article

(1) Background: Social media addiction (SMA) is conceptualized as a behavioral addiction linked to emotional dysregulation. This study investigates whether multidimensional state boredom mediates the relationship between the quest for significance and SMA, exploring the moderating role of age cohorts. (2) Methods: A cross-sectional study was conducted with 316 Spanish participants (aged 18–68) divided into Generation Z, Millennials, and Generation X. Standardized measures (BSMAS, SQS, MSBS) were analyzed using a multiple moderated mediation model (PROCESS Model 14), controlling for gender. (3) Results: Boredom dimensions correlated positively with both quest for significance and SMA. The final model explained 53.5% of SMA variance. High-arousal boredom and inattention were positively associated with SMA, while low-arousal boredom showed a negative association. Notably, the quest for significance was indirectly associated with SMA through high-arousal boredom exclusively among Generation Z, with no significant indirect effects found in older cohorts. (4) Conclusions: The findings highlight high-arousal boredom as a key link between existential motives and SMA, particularly in younger individuals. These results underscore the importance of age-specific emotional and motivational processes in designing prevention and intervention strategies for problematic social media use. Full article

Background/Objectives: Patient satisfaction and supportive care are key quality indicators in certified Head and Neck Cancer Centers (HNCC). We assessed patient-reported experiences across diagnostic staging and surgical treatment pathways, focusing on discharge management and supportive service integration. Materials and Methods: In this prospective cross-sectional study, 84 inpatients were surveyed at the time of hospital discharge after diagnostic tumor staging (n = 45) or surgical treatment (n = 39) at a German tertiary HNCC. Phase-specific standardized questionnaires with five-point Likert scales were analyzed using Pearson’s chi-square and Fisher’s exact tests. Associations of sex and treatment intensity with satisfaction and supportive care utilization were explored descriptively and in an exploratory manner. Results: Overall ratings were high across both cohorts for admission processes, inpatient organization and medical and nursing care, with no statistically significant between-group differences (p > 0.05). Information regarding diagnostic and perioperative procedures was rated very positively in both groups. Discharge-related items were generally favorable. However, patients who underwent surgery reported greater uncertainty and lower reported utilization of formal discharge management. This difference did not reach statistical significance (p = 0.0559) and should therefore be interpreted as a non-significant trend toward less positive evaluation compared with diagnostic patients. Supportive services were rated predominantly good to very good by users (>95% positive ratings). Utilization differed by treatment intensity: Speech therapy was more frequent in operative patients (p < 0.001) and social work counseling was offered and utilized more often in patients undergoing extensive surgery (p = 0.042 and p = 0.027, respectively). Overall dissatisfaction was strongly associated with perceived deficiencies in information on diagnostic procedures and tumor-related counseling (both p < 0.001), whereas waiting time for surgery was not associated with negative overall ratings. Conclusions: Patient satisfaction was consistently high across diagnostic and surgical pathways. Adequate, transparent and repeated information, particularly on diagnostics and tumor counseling, was strongly associated with higher overall satisfaction, whereas objective timing metrics were not associated with negative ratings. Discharge management may represent a sensitive transition point, particularly after extensive surgery and may therefore be a relevant target for further optimization and proactive integration of supportive care services. Sex-specific findings were limited and should be interpreted cautiously due to small subgroup sizes. Full article

Background: COVID-19 is primarily a respiratory disease, but increasing evidence suggests possible oral and maxillofacial complications. This study presents a case series of post-COVID maxillary osteonecrosis (PC-RONJ) cases from western Romania and explores the possible association between SARS-CoV-2 infection, its treatment, and this complication. Methods: We conducted a multicenter retrospective case series of two patients with recent PCR-confirmed SARS-CoV-2 infection who subsequently developed maxillary osteonecrosis (ONC) between 2021 and 2023. Clinical examination, CT imaging (including 3D reconstructions), and ENT assessment were used to assess the severity of the disease. All medical records were reviewed to identify comorbidities, details of COVID-19 treatment, and the appearance of maxillofacial symptoms. Results: Both patients had been hospitalized for severe COVID-19 and treated according to the national protocol with systemic corticosteroids, oxygen therapy, anticoagulation, and antivirals. CT scans revealed marked osteolytic destruction of the maxilla and maxillary sinus walls, with extension toward adjacent facial bones. Microbiological analysis revealed a complex polymicrobial profile, including Gram-positive and Gram-negative bacteria as well as opportunistic fungal species, consistent with a chronic biofilm-associated infectious process. Patients received surgical treatment, followed by local care and, in both cases, prosthetic rehabilitation with maxillary obturators, which improved speech, chewing, and oral function. Conclusions: This case series suggests a possible association between severe COVID-19, its treatment, and subsequent maxillary osteonecrosis in susceptible patients; however, the small number of cases precludes causal inference. To our knowledge, this is the first Romanian report describing such cases in patients without prior antiresorptive therapy. These findings highlight the need for careful use of systemic corticosteroids and vigilant post-recovery monitoring of maxillofacial complications. Further studies are required to clarify the underlying mechanisms and risk factors. Full article