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martes, 12 de mayo de 2015

Singing to speaking

Hi everybody! 
vvv
I have choosen this article because I love music, when I feel stress or need some motivation, I just listen to music to change my mood. So, when, I heard about this new therapy, I just get exited because our brain is amazing and using such a simple tools, we can help patients recover from their disabilities such as the capacity of communication. 

But, first of all, you can listen this song and have a litte bit of motivation :)

https://www.youtube.com/watch?v=nEjLFpU2pJ4 

I hope you enjoy this article.

SINGING TO SPEAKING

It's amazing to see stroke survivors who've lost the ability to speak suddenly produce accurate words when singing familiar songs. This phenomenon was first reported by Swedish physician Olaf Dalin in 1736. Dr. Dalin described a young man who had lost his ability to talk as a result of brain damage, but who surprised townsfolk by singing hymns in church.

The acquired language disorder now called “aphasia” became a subject of clinical study and a target for rehabilitation beginning in the mid-1880s. Since that time, every clinician working with aphasia has seen individuals who can produce words only when singing. Indeed, this observation prompted American neurologist Charles Mills to suggest (in 1904!) that it might help to play the piano and encourage patients with aphasia to sing well-known songs.  
There appear to be psychological benefits, but singing familiar songs alone doesn’t seem to improve the speech of people with aphasia. This is probably because words that come automatically when singing are intricately linked to the melodies and are not easily separated. 

The spoken word is a different matter. We know the brain has difficulty starting in the middle of highly memorized spoken passages (such as the “Pledge of Allegiance”). We need a “running start” to prime the pump of recall. 
Songs themselves might be used to communicate. I had a patient who struggled to tell his son he wanted to go to a Boston Red Sox game. He finally got his point across by bursting forth with “Take Me Out to the Ball Game.” Unfortunately, there aren’t appropriate songs for every communication need, so it would be better if singing could be used to unblock residual speech abilities. This was the motivation for the aphasia treatment approach known as “Melodic Intonation Therapy,” which we began to develop in 1972.

Why Does It Work For Some People?
We know that aphasia typically results from a stroke or other damage that affects the left hemisphere of the brain, where language ability usually is located. We thought it might be because a stroke increased the use of the brain’s right hemisphere, where many aspects of music and the melody of speech are located. Using this treatment, the dominance of the damaged left hemisphere language areas might diminish while the right hemisphere became more involved.

A recent study using functional magnetic resonance imaging with individuals treated with melodic intonation therapy showed that the right hemisphere does, indeed, play a role in response to this method. Preliminary results suggest that the amount of speech recovery may be associated with how much and what part of the right hemisphere is activated. This study demonstrates the flexibility of adult brains, even those with stroke-related damage.

It is encouraging to know that with special treatment we can learn to use undamaged portions of our brains to perform “new tricks” – even one as complicated as speaking.

Trial And Error
Robert Sparks, a speech-language pathologist, Martin Albert, a behavioral neurologist, and I were working on the Aphasia Unit of the Boston VA Hospital. We saw a woman whose only purposeful speech was the combination of nonsense syllables: “nee-nee-nah-nah.”

At that time, a hospital volunteer was coming to each inpatient ward with a piano on wheels and conducting sing-along sessions with the patients. One day we observed our patient sitting beside him in her wheelchair and singing many of the words of popular songs. Though we had seen this before, this new example convinced us we had to try to develop a method that capitalized on this preserved ability to produce speech when singing.

We knew that simply singing familiar songs with this woman would not do the trick. Through trial and error, we discovered that if we melodically intoned everyday phrases such as “open the window” while helping her tap out the syllables with her unaffected hand, she could produce phrases in unison with us.  Then she could intone the phrases with just a little help at the beginning. Finally, she could produce them on her own.
From this experience, we created a treatment program using melodically intoned and tapped out phrases of increasing length. Usually within a few sessions, patients’ production of nonsense syllables had disappeared and they began to communicate verbally in everyday situations. Our continued research helped identify the best candidates for this method. 

domingo, 3 de mayo de 2015

Medical Surplus


Hi future doctors!

This week I would like you to introduce you into a discussion of something realated with Medicine but is not about any subject.

Sometimes, because of we are so busy studying, with our clinical clerkship and other stuff that we are not informed about what's happening in the medical world.
As you all know, i'm in touch with this world and I want to explain you the situation that we have nowadays in Spain. I would like you to think about it and at the end I would make you some questions.


There are too many medical schools in Spain, and is still expected to open seven more, which, for the Medical Profession Forum, which brings together the most representative industry organizations (schools, deans, students ...), equivalent to an excess of graduates that the system can not absorb. The mismatch between supply of MIR (the specialized training needed to practice in Spain) and graduates every year out of medical schools is now 1,000 doctors. Meanwhile, unemployment among Doctors increases, and with it, migration for work.

"Spain is the second country of over 20 million people with more medical schools per capita, and if they open the seven that are now planned, will be the number one," said today Ricardo Rigual, president of the National Conference of Deans of Medical Schools. "In just eight years we have gone from 28 to 40 schools and 3,450 students who enter school at 7,000," he added during a press conference. Both medical colleges and students, deans, trade unions and scientific societies agree: the absolute control that has reigned in the opening of new faculties must end.

The seven new powers provided are Campus Mare Nostrum (Murcia) and Catholic University San Antonio (Alicante), both private; Concerted in Vic (Barcelona) and four public, three in Andalusia (Almería, Jaén and Huelva) and one in the Balearic Islands.
Doctors have insisted this morning emerging from 7,000 faculty Doctors, but there are only 6,000 places MIR. "Setting those two numbers is essential", said the president of the Confederación Estatal de Sindicatos Médicos (CESM), Francisco Miralles, who has pointed to another problem: the money invested in training a doctor who ends up working outside Spain . "Being a doctor costs between 200,000 and 250,000 euros, according to some calculations we did a few years ago," he explained. Moreover, Mir places offered have declined in the last two calls by 10 percent, while the number of students entering this degree it has in only 1.35 percent, according to the Forum of the medical profession.


What do you think about this measure of creating more medicine faculties in Spain? 40 faculties are few? 
What do you think about our future as a doctors, when the MIR places are reduced each year?
Is something that we could do to try to solve this? 


Have a nice weekend! :) 



Mercè
 

miércoles, 22 de abril de 2015

Margaret G. Spinelli

Dear friends,

This week, I would like to change our work method and give the responsibility of diagnosis to all you. I hope you enjoy playing doctors!

I present you Mrs. A, a 34-year-old married mother. I want you to read down her story, which was studied by Margaret G. Spinelli, and write a clinical comment.

You could name her symptoms one by one and, considering her particular context, find out a diagnosis. If you can add more information about it etiology, management or treatment don’t be shy and explain us, it will be really interesting!

I am going to analyze this case in detail in my conclusion so don’t forget to come back in four or five days to check your answers.

Good luck and have fun, doctors!


María Lamana Villegas



Mrs. A, a 34-year-old married mother who lived with her husband and their 5-year-old daughter, strangled her infant son to death 3 weeks after birth. She had a planned, healthy pregnancy with some depression at 28 weeks’ gestation. She had a normal spontaneous vaginal delivery, giving birth to a healthy boy, “B.” She began breastfeeding immediately. From postpartum days 2 through 11, her depression worsened. She was unable to sleep but could not get out of bed or attend to her hygiene. She was suspicious that her husband would harm B. On postpartum day 2, she began having obsessional, ego-dystonic images of throwing B out the window. She believed, despite the pediatrician’s reassurances, that she was harming B with her breast milk and that he was losing weight. She was unable to give him a bath, believing that he had “gas” or “something bad” inside and could not be moved.
On day 12, while alone in the car with B, she thought of killing herself and the baby, although “at the time I don’t think I had any idea why.” On day 13, she attempted suicide by overdose. She slept through the night and did not report the suicide attempt to anyone. She abruptly weaned B and then became disorganized and confused, unsure of what formula and size and types of bottles and nipples to use. She was agitated, calling friends day and night for opinions. On day 15 she attempted to smother B with a towel. “I don’t believe it was a thought,” she said. “It was ‘autopilot.’” Her husband came upstairs, and Mrs. A believes that his presence shook her out of the “state” she was in. “I did not have the compulsion to hurt him any more after that evening … I just thought something was wrong, and I wasn’t thinking straight.” Her husband knew that she was not herself, but he did not understand that she was depressed and psychotic. Mrs. A did not receive treatment for her illness.
On postpartum day 20, Mrs. A awoke at 6:30 a.m. to feed B when he cried. Her husband and daughter kissed her goodbye, and Mr. A walked their daughter to school before going to work. She soon felt as if she was “taken over.” She describes a dazed, trance-like state with confusion: “Something internal like a force … it was not a voice … but I did not have control. It was an instant. I don’t recall thinking anything … I had no feelings. It was happening but I wasn’t there.… At the time, nothing came into my head saying, ‘No, do not do this.’ … My inside was gone and it was something else.” She briefly placed a towel over B’s nose and mouth, but stopped. The “force” then became intense. She placed a washcloth in B’s mouth and then strangled him with a telephone cord. She felt she was not connected to her own hands. When B was dead, she washed him with a cloth, removed the remnants of his umbilical cord, changed his diaper, and left the room. She went into the bathroom, where she made an unsuccessful attempt to cut her wrists.
Mrs. A was charged with homicide and was incarcerated. She described her psychiatric history as “moody” with cycling states, every 3 days, of jocularity, creativity, and high energy alternating with an irritable, withdrawn mood and tearfulness. She had two previous episodes of major depression, including a postpartum depression after the birth of her daughter that was associated with ego-dystonic images of throwing her daughter against a wall or hitting her with a hammer. She denied psychotic thoughts. The depression resolved in 6 months without treatment. She was a successful “supermom” with her daughter and was an energetic worker in her job.
Mrs. A’s mother has a diagnosis of bipolar disorder, which worsened after the birth her second child. She had multiple psychiatric hospitalizations for psychotic episodes with chronic paranoia and grandiose, volatile moods.





martes, 7 de abril de 2015

PREVENTION OF COGNITIVE DECLINE

Hi everybody! 

Although it seems obvious that healthy habits prevent from several disorders, I think it is interesting to find out evidence with clinical trials. That' s why I have chosen this article. After reading it, some questions came to my mind: Why is it so hard for most people to follow healthy habits, even knowing their benefits? Should the Government fund healthy diets and gym classes instead of drugs? Could a pill substitutes the whole benefit from healthy lifestyle? 

You can give your opinion about those questions or comment anything else, it's up to you. Enjoy it ;)



Mental and physical exercises may protect against cognitive decline in the elderly 



add your  featured

The results of the first ever randomized controlled trial investigating a comprehensive program to slow cognitive decline among older people have been published in The Lancet.
older man on treadmill and doctor
The intervention included muscle and cardiovascular training, mental exercises and advice on how to manage metabolic and vascular risk factors.
Earlier today, Medical News Today reported on the results of a study published in the journal Neurologythat suggested physical activity may protect seniors from the effects of brain damage on motor function.
That study, conducted by researchers at Rush University Medical Center in Chicago, IL, found that the most active participants were unaffected by greater volumes of "white matter hyperintensities" - small areas of damage found in the brains of older people that are associated with impaired motor functioning.
In the study published in The Lancet, researchers from Sweden and Finland examined the effects on brain function of an intervention addressing assorted risk factors for age-related dementia.
These important risk factors included high body mass index (BMI) and heart health, and the intervention included healthy eating guidance, exercise, brain training and management of metabolic and vascular risk factors.
From across Finland, 1,260 participants aged between 60 and 77 were recruited for the study. Based on scores of standardized tests, all of the participants were considered to be at risk of dementia. Half were randomized into the intervention group and half formed a control group.

Intervention included regular meetings with health professionals over 2 years

Those in the intervention group participated in regular meetings over 2 years with health professionals, where participants were provided with "comprehensive advice" on maintaining a healthy diet, muscle and cardiovascular training, mental exercises and how to use blood tests and other means to manage metabolic and vascular risk factors.
At the conclusion of this 2-year study period, the researchers used the standardized Neuropsychological Test Battery to assess participants' mental function. They found that, overall, the intervention group scored an average of 25% higher on this test than the control group - a higher score corresponds to better mental functioning.
Breaking down the test's various components, the team also found that the intervention group scored 83% higher than the control group on ability to organize and regulate thought processes (executive functioning) and 150% higher on processing speed.
The participants will be followed for at least a further 7 years to establish whether the reduction in cognitive decline demonstrated by the intervention group is followed by a reduction in diagnoses of dementia and Alzheimer's disease.
"Much previous research has shown that there are links between cognitive decline in older people and factors such as diet, heart health and fitness," says lead author Prof. Miia Kivipelto, from the Karolinska Institutet in Stockholm, Sweden.
"However," Prof. Kivipelto adds, "our study is the first large randomized controlled trial to show that an intensive program aimed at addressing these risk factors might be able to prevent cognitive decline in elderly people who are at risk of dementia."
Last month, MNT looked at a study published in the journal Frontiers in Psychology that suggested meditation may reduce brain aging.
Written by 

Copyright: Medical News Today

Nisha Lal

Mental and physical exercises may protect against cognitive decline in the elderly

Cardiovascula
The results of the first ever randomized controlled trial investigating a comprehensive program to slow cognitive decline among older people have been published in The Lancet.
older man on treadmill and doctor
The intervention included muscle and cardiovascular training, mental exercises and advice on how to manage metabolic and vascular risk factors.
Earlier today, Medical News Today reported on the results of a study published in the journal Neurologythat suggested physical activity may protect seniors from the effects of brain damage on motor function.
That study, conducted by researchers at Rush University Medical Center in Chicago, IL, found that the most active participants were unaffected by greater volumes of "white matter hyperintensities" - small areas of damage found in the brains of older people that are associated with impaired motor functioning.
In the study published in The Lancet, researchers from Sweden and Finland examined the effects on brain function of an intervention addressing assorted risk factors for age-related dementia.
These important risk factors included high body mass index (BMI) and heart health, and the intervention included healthy eating guidance, exercise, brain training and management of metabolic and vascular risk factors.
From across Finland, 1,260 participants aged between 60 and 77 were recruited for the study. Based on scores of standardized tests, all of the participants were considered to be at risk of dementia. Half were randomized into the intervention group and half formed a control group.

Intervention included regular meetings with health professionals over 2 years

Those in the intervention group participated in regular meetings over 2 years with health professionals, where participants were provided with "comprehensive advice" on maintaining a healthy diet, muscle and cardiovascular training, mental exercises and how to use blood tests and other means to manage metabolic and vascular risk factors.
At the conclusion of this 2-year study period, the researchers used the standardized Neuropsychological Test Battery to assess participants' mental function. They found that, overall, the intervention group scored an average of 25% higher on this test than the control group - a higher score corresponds to better mental functioning.
Breaking down the test's various components, the team also found that the intervention group scored 83% higher than the control group on ability to organize and regulate thought processes (executive functioning) and 150% higher on processing speed.
The participants will be followed for at least a further 7 years to establish whether the reduction in cognitive decline demonstrated by the intervention group is followed by a reduction in diagnoses of dementia and Alzheimer's disease.
"Much previous research has shown that there are links between cognitive decline in older people and factors such as diet, heart health and fitness," says lead author Prof. Miia Kivipelto, from the Karolinska Institutet in Stockholm, Sweden.
"However," Prof. Kivipelto adds, "our study is the first large randomized controlled trial to show that an intensive program aimed at addressing these risk factors might be able to prevent cognitive decline in elderly people who are at risk of dementia."
Last month, MNT looked at a study published in the journal Frontiers in Psychology that suggested meditation may reduce brain aging.
Written by 

Copyright: Medical News Today
Not to be reproduced without permission