OBJECTIVE: To identify the relationship between maximum phonation time (MPT) and swallowing function, as well as the elements of swallowing, in order to provide a rationale for speech therapy in patients with Parkinsonism manifesting dysphagia. METHODS: Thirty patients with Parkinsonism who underwent speech evaluation and videofluoroscopic swallowing study (VFSS) were recruited. The MPT, the longest periods of sustained pronunciation of /aa/, was evaluated. The VFSS was evaluated using Penetration Aspiration Scale (PAS), National Institutes of Health-Swallowing Safety Scale (NIH-SSS), and Videofluoroscopic Dysphagia Scale (VDS). The relationship between dysphagia scales and MPT was analyzed using Pearson correlation. The difference in VDS variables between subgroups (Parkinson disease or Parkinsonian syndrome, independent or dependent ambulation, and normal or abnormal MPT) and the difference in MPT between subgroups based on the VDS variables were analyzed using the independent t-test. RESULTS: Bolus formation and laryngeal elevation functions were significantly higher in the normal MPT group compared with the impaired group. In the VDS variables, patients with intact bolus formation, oral transit time, pharyngeal swallow triggering, and laryngeal elevation showed significantly longer MPTs compared with the impaired groups. In addition, MPT was significantly correlated with the VDS and modestly correlated with the NIH-SSS, but not the PAS, suggesting that phonatory function is related to the oropharyngeal swallowing function, but not directly to the aspiration itself. CONCLUSION: The correlation between MPT and several swallowing-related elements was identified, indicating an interactive correlation between swallowing and phonation. This result justifies voice therapy as a treatment for dysphagia in patients with Parkinsonism.
Academies and Institutes ; Deglutition Disorders ; Deglutition* ; Dependent Ambulation ; Humans ; Parkinson Disease ; Parkinsonian Disorders* ; Phonation* ; Speech Therapy ; Voice ; Weights and Measures

Deep brain stimulation (DBS) in internal globus pallidus is considered to be a good option for controlling generalized dystonia in patients with this condition. In this relation, it is known that DBS has already been shown to have significant effects on primary dystonia, but is seen as controversial in secondary dystonia including cerebral palsy (CP). On the other hand, intrathecal baclofen (ITB) has been known to reduce spasticity and dystonia in patients who did not respond to oral medications or botulinum toxin treatment. Here, we report a patient with dystonic CP, who received the ITB pump implantation long after the DBS and who noted remarkable improvement in the 36-Item Short Form Health Survey, Dystonia Rating Scale, Modified Barthel Index, and visual analog scale scores for pain after an ITB pump implantation was used as compared with DBS. To our knowledge, the present case report is the first to demonstrate the effects of an ITB pump on reducing pain and dystonia and improving quality of life and satisfaction, compared with DBS in a patient with CP.
Baclofen ; Botulinum Toxins ; Cerebral Palsy ; Deep Brain Stimulation ; Dystonia ; Dystonic Disorders ; Globus Pallidus ; Hand ; Health Surveys ; Humans ; Muscle Spasticity ; Quality of Life ; Visual Analog Scale

The sciatic nerve can be injured through various mechanisms, including direct compression and ischemia related to traumatic events. Reports of iatrogenic sciatic nerve injury caused by misplaced intramuscular injections are rare. We present a case involving a 5-year-old patient who developed motor weakness and hypesthesia in the left lower extremity following an intramuscular injection of diclofenac into the left buttock. An electrodiagnostic study diagnosed the patient with an injury to the left sciatic nerve, primarily affecting its peroneal division. This diagnosis was later confirmed by radiologic evaluation. Following several weeks of rehabilitation, which included gait pattern correction, verbal cueing, and electrical stimulation therapy, the patient showed improvement in sensory deficits and motor impairment. The peroneal portion of the sciatic nerve is more susceptible to injury than the tibial portion due to its structural characteristics. Additionally, the sciatic nerve follows various paths as it passes the piriformis muscle. Certain drugs, such as diclofenac, exhibit greater neurotoxicity than others. When neurologic deficits are observed, an electrodiagnostic study is recommended. This helps not only in identifying the etiology and precise location of the neural insult but also in predicting the prognosis and formulating a comprehensive treatment plan.