Supporting Students with TBI: A Clinically Focused Tutorial for Speech-Language Pathologists.

Attention to pediatric traumatic brain injury (TBI) has grown in recent years, likely due to the increased awareness of mild TBI (mTBI) in contact sports. With this increased attention, along with an increased diagnosis of injury, more students with TBI need services, especially as they return to the classroom environment and progress through school. Support of students with TBI of all severities requires an interdisciplinary team with the school-based speech-language pathologist playing a critical role.

Referral Patterns as a Contextual Variable in Pediatric Brain Injury: A Retrospective Analysis.

Purpose: Access to speech-language pathology (SLP) services is a critical variable in the rehabilitation of pediatric brain injury. In this study, we examined patterns of SLP referral and factors affecting referral during the acute period following brain injury in 2 large pediatric specialty hospitals.

Method: In a retrospective, cohort chart review study, data collection focused on referrals made during the acute period using International Classification of Diseases, Ninth Revision, Clinical Modification codes for primary diagnoses of brain injury between 2007 and 2014 (Centers for Disease Control and Prevention [CDC], 2014).

Impact of obesity on the severity and therapeutic responsiveness of acute episodes of asthma.

Background: It has been suggested that obesity adversely influences both the severity and the therapeutic responsiveness of chronic asthma. However, it is unclear if it also impacts acute situations.

Methods: To determine whether adiposity worsens the clinical and physiological manifestations of acute asthma and limits therapeutic effectiveness of standard treatment, we contrasted signs, symptoms, medication use, arterial oxygen saturation, peak expiratory flow rate, and the bronchodilator response to standard doses of albuterol in 90 non-obese and 90 obese asthmatics as they presented for urgent care.

Critical comparisons of the clinical performance of oxygen-conserving devices.

Rationale: Clinical testing of oxygen-conserving devices is not mandated before marketing. Consequently, little is known about individual or comparative therapeutic effectiveness.

Objectives: To relate oxygen delivery from prototypical instruments to physiological performance.

Observations on the physiological interactions between obesity and asthma.

To explore whether asthma and obesity share overlapping pathogenic features, we examined the impact of each alone, and in combination, on multiple aspects of lung function. We reasoned that if they influenced the lungs through similar mechanisms, the individual physiological manifestations in the comorbid state should interact in a complex fashion. If not, then the abnormalities should simply add.

Impact of race on the severity of acute episodes of asthma and adrenergic responsiveness.

Rationale: African Americans acutely ill with asthma come to emergency departments more frequently and are admitted to hospital more often than whites but the reasons are unclear.

Objectives: To determine whether such phenomena represent racial differences in attack severity or limited effectiveness of beta(2)-agonist therapy.

Methods And Main Results: We contrasted clinical features, airflow limitation, and albuterol responsiveness in adults acutely ill with asthma, 155 of whom where African American and 140 white, as they presented to eight emergency departments.

Bronchoprotective effects of single doses of salmeterol combined with montelukast in thermally induced bronchospasm.

Study Objectives: Salmeterol (S) and montelukast (M) individually inhibit the obstructive consequences of thermal stimuli such as exercise and hyperventilation (HV), but there is no information on whether these drugs can interact positively.

Design: Randomized trial.

Setting: University teaching hospital.

Morphometric changes after thermal and methacholine bronchoprovocations.

To determine whether there are distinctions in the location and pattern of response between different bronchoprovocations, we performed high-resolution computer-assisted tomography in 10 asthmatic subjects before and after isocapnic hyperventilation of frigid air (HV) and methacholine (Meth). The luminal areas of the trachea, main stem, lobar, and segmental bronchi were computed before and after each provocation and blindly compared. Both stimuli reduced the 1-s forced expiratory volume similarly (percent change in 1-s forced expiratory volume HV = 28.

Desiccation and hypertonicity of the airway surface fluid and thermally induced asthma.

To determine whether drying and hypertonicity of the airway surface fluid (ASF) are involved in thermally induced asthma, nine subjects performed isocapnic hyperventilation (HV) (minute ventilation 62.2 +/- 8.3 l/min) of frigid air (-8.

Influence of hyperpnea on airway surface fluid volume and osmolarity in normal humans.

To determine the effect of hyperpnea on the characteristics of periciliary liquid, we collected airway surface fluid (ASF) and measured its osmolarity in 11 normal people while they breathed dry, frigid air (-17 +/- 1.2 degrees C) at minute ventilations (VE) of 10, 40, and 80 l/min through a heat exchanger. The ASF was collected at the fifth tracheal ring by absorption onto filter paper pledgets inserted via fiber-optic bronchoscopy.

Inhibition of nitric oxide synthesis attenuates thermally induced asthma.

To determine whether the inhibition of nitric oxide (NO) synthesis attenuates thermally induced obstruction, we had 10 asthmatic volunteers perform isocapnic hyperventilation with frigid air after inhaling 1 mg of N(G)-monomethyl-L-arginine (L-NMMA) or isotonic saline in a blinded fashion. The challenges were identical in all respects, and there were no differences in baseline lung function [1-s forced expiratory volume (FEV(1)); saline 2.8 +/- 0.

Exhaled nitric oxide and thermally induced asthma.

The purpose of the present study was to determine if nitric oxide (NO) is involved in the pathogenesis of thermally induced asthma. To provide data on this issue, 10 normal and 13 asthmatic subjects performed isocapnic hyperventilation with frigid air while the fractional concentration of NO in the expirate air (FENO) was serially monitored with a chemiluminescence analyzer. FEV1 was measured before and after hyperpnea.

Comparative effects of long-acting beta2-agonists, leukotriene receptor antagonists, and a 5-lipoxygenase inhibitor on exercise-induced asthma.

Background: Exercise-induced asthma (EIA) is a common problem that can be controlled with long-acting beta-agonists and leukotriene-modifying compounds. There is, however, limited information on the comparative effectiveness of the two classes of drugs, as well as the relative potencies of the antileukotriene agents.

Objective: The purpose of the present study was to provide data on the above issues.

Uncontrolled oxygen administration and respiratory failure in acute asthma.

Study Objectives: To determine if 100% oxygen administration adversely influences gas exchange in acutely ill asthmatic subjects.

Design: Prospective preinterventional and postinterventional comparison.

Setting: University hospital emergency department.

Integrated response of the upper and lower respiratory tract of asthmatic subjects to frigid air.

To evaluate the influence of cold air hyperpnea on integrated upper and lower airway behavior, 22 asthmatic volunteers hyperventilated through their mouths (OHV) and noses (NHV) while pulmonary and nasal function were determined individually and in combination. In the isolated studies, OHV at a minute ventilation of 65 +/- 3 l/min lowered the 1-s forced expiratory volume (FEV(1)) 24 +/- 2% (P < 0. 001) and NHV (40 l/min) induced a 31 +/- 9% (P < 0.

Inhaled albuterol powder for pulmonary function testing.

To assess the role of albuterol powder in testing for reversibility of airflow obstruction during routine pulmonary function testing, spirometric data from subjects with baseline FEV1/FVC less than 70 percent and FEV1 less than 80 percent predicted who received inhaled albuterol powder (n = 42) were compared with those who received isoetharine aerosol via metered dose inhaler (n = 49). Prebronchodilator lung function was comparable for the albuterol and isoetharine groups. With albuterol powder, 14 (33 percent) of 42 subjects showed reversibility of airflow obstruction (defined as a 15 percent or greater improvement in either FEV1 or FVC) as compared with 30 (61 percent) of 49 subjects with isoetharine aerosol.