Disparities in Utilization of Outpatient Telemedicine for Neurologic Care.

Background And Objectives: To characterize outpatient telemedicine utilization for neurologic conditions and identify potential disparities.

Methods: All outpatient visits conducted by neurology clinicians at an academic medical health care system for patients aged 18 years or older from January 2019 to July 2022 were included. All telemedicine visits were synchronous audio-visual.

Geographic Disparities in Access to Neurologists and Multiple Sclerosis Care in the United States.

Background And Objectives: A shortage of neurology clinicians and healthcare disparities may hinder access to neurologic care. This study examined disparities in geographic access to neurologists and subspecialty multiple sclerosis (MS) care among various demographic segments of the United States.

Methods: Neurologist practice locations from 2022 CMS Care Compare physician data and MS Center locations as defined by the Consortium of Multiple Sclerosis Centers were used to compute spatial access for all U.

Statistical practice and transparent reporting in the neurosciences: Preclinical motor behavioral experiments.

Longitudinal and behavioral preclinical animal studies generate complex data, which may not be well matched to statistical approaches common in this literature. Analyses that do not adequately account for complexity may result in overly optimistic study conclusions, with consequences for reproducibility and translational decision-making. Recent work interrogating methodological shortcomings in animal research has not yet comprehensively investigated statistical shortcomings in the analysis of complex longitudinal and behavioral data.

Selective stimulation of human intrinsic laryngeal muscles: Analysis in a mathematical three-dimensional space.

Objectives/hypothesis: Standard stimulating methods using square waves do not appropriately restore physiological control of individual intrinsic laryngeal muscles (ILMs). To further explore our earlier study of evoked orderly recruitment by quasitrapezoidal (QT) currents, we integrated the contribution of the cricothyroideus (CT) with attention to mutual activation in an additional patient, based on recent studies of appropriate responses via strict recurrent laryngeal nerve (RLN) stimulation.

Study Design: Basic science study.

Selective intraoperative stimulation of the human larynx.

Objectives/hypothesis: Laryngeal contraction normally entails activation of mutually cooperative intrinsic laryngeal muscles (ILMs). Unfortunately, standard stimulating methods do not completely mimic the normal ongoing synchrony between the muscles. We submit that this problem can be addressed by modifying the stimulating waveform.

Subcutaneous emphysema after otologic surgery: a case report.

Subcutaneous emphysema of the head and neck after otologic surgery is exceedingly rare. The mechanism relates to the intimate relationship of the temporomandibular joint to the external auditory canal. We present a rare case of subcutaneous emphysema after otologic surgery for ear disease.

Paced glottic closure for controlling aspiration pneumonia in patients with neurologic deficits of various causes.

Objectives: We undertook to determine whether paced vocal fold adduction can check aspiration in patients with various neurologic conditions.

Methods: Five patients with fluoroscopically documented aspiration and repeated pneumonias were enrolled. Two previously reported patients with hemispheric stroke were compared to 3 additional subjects with brain stem-basal ganglia and cerebellar stroke, cerebral palsy, and multiple sclerosis.

Improvement of respiratory compromise through abductor reinnervation and pacing in a patient with bilateral vocal fold impairment.

Objectives/hypothesis: To determine whether respiratory compromise from bilateral vocal fold impairment (paralysis) can be objectively alleviated by reinnervation and pacing.

Methods: A patient with paramedian vocal folds and synkinesis had a tracheotomy for stridor after bilateral laryngeal nerve injury and Miller Fisher syndrome. One posterior cricoarytenoideus (PCA) received a nerve-muscle pedicle fitted with a perineural electrode for pacemaker stimulation.

Tissue-engineered trachea for airway reconstruction.

Objectives/hypothesis: Scaffold-free cartilage has been used to engineer biocompatible and mechanically stable neotracheas in vivo. The purpose of this animal study was to determine if neotracheal constructs, implanted paratracheally, could successfully be used for segmental tracheal reconstruction.

Study Design: Animal study.

An unusual presentation of Teflon granuloma: case report and discussion.

For more than 25 years, Teflon was the most commonly used material for injection laryngoplasty. However, the incidence of Teflon granuloma and the consequent deterioration of glottic function ultimately led to the development of other injectable materials, and as a result, Teflon granulomas are no longer frequently encountered. We present a case of Teflon granuloma that was unusual in that (1) a long period of time had elapsed between the injection and the granuloma formation and (2) there was no change in the patient's glottic function.

Fabrication of a neotrachea using engineered cartilage.

Objectives: Surgical management of long-segment tracheal stenosis is an ongoing problem. Many types of tracheal prostheses have been tried but with limited success because of immune rejection, graft ischemia, or restenosis. Tissue engineered cartilage may offer a solution to this problem, although scaffolds, which are currently often used for support, can lead to biocompatibility problems.

Hyaluronan-based scaffolds to tissue-engineer cartilage implants for laryngotracheal reconstruction.

Objectives: Donor site morbidity, including pneumothorax, can be a considerable problem when harvesting cartilage grafts for laryngotracheal reconstruction (LTR). Tissue-engineered cartilage may offer a solution to this problem. This study investigated the feasibility of using Hyalograft C combined with autologous chondrocytes to tissue engineer cartilage grafts for LTR in rabbits.

Artificial voice modulation in dogs by recurrent laryngeal nerve stimulation: electrophysiological confirmation of anatomic data.

Objectives: We hypothesized that voice may be artificially manipulated to ameliorate dystonias considered to be a failure in dynamic integration between competing neuromuscular systems.

Methods: Orderly intrinsic laryngeal muscle recruitment by anodal block via the recurrent laryngeal and vagus nerves has allowed us to define specific values based on differential excitabilities, but has precluded voice fluency because of focused breaks during stimulation and the need to treat several neural conduits. Such problems may be obviated by a circuit capable of stimulating some axons while simultaneously blocking others in the recurrent laryngeal nerve, which carries innervation to all intrinsic laryngeal muscles, including the arguably intrinsic cricothyroideus.