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No description available.

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No description available.

Although the management of Motor Neuron Disease (MND) remains devoid of a cure, persons affected by this devastating condition are nonetheless entitled to the best quality care that is available. A paucity of information exists documenting the perceptions of healthcare consumers regarding the management that is provided. In addition optimal healthcare comprises an intricate interaction of patient-centred care, patient-centred communication, and bioethical practice, and when these three dimensions are implemented according to acceptable standards, high-quality healthcare is perceived by the healthcare consumer. Given however the socio-political challenges that face healthcare systems, the management of MND needs to be considered against current trends in service delivery and the need for evidence-based medicine. An exploratory study was therefore conducted to investigate the perceptions of persons with MND and their family members regarding current medical and rehabilitative management. The sample comprised six persons with MND who presented with a communication impairment, as well as six family members. Participants’ perceptions were elicited through the use of a semi-structured interview schedule, and questions focused on healthcare professionals’ behaviours during healthcare encounters. In addition emphasis was placed on the potential of the communication impairment to influence management. A standardised dysarthria assessment was conducted to characterise the nature of the speech impairment in each person with MND. Qualitative responses obtained from the interviews were analysed in accordance with a matrix-based approach, while quantitative data from the dysarthria assessment were analysed using descriptive statistics. Despite individual variability, perceptions of both persons with MND and their family members revealed general dissatisfaction with regard to medical and rehabilitative management. The majority of persons with MND were not referred for intervention following diagnosis, and the recommended team approach for the management of MND was absent. In addition the bioethical practice of many healthcare professionals was deemed questionable, and the communication impairment was perceived to impose a significant burden on the healthcare encounter. Furthermore all participants perceived a lack of available support systems for persons with MND, and it was thus not uncommon for individuals to pursue complementary and alternative medicine. South Africa’s current healthcare climate also appeared to further limit healthcare for this clinical population. In an attempt to improve the management of MND, implications are provided in terms of health communication, intervention, bioethical practice, and support systems. A proposed new framework of ideal service delivery for healthcare consumers of MND management is also presented. Further implications are outlined with regard to the need for innovative models of service delivery in South Africa’s healthcare context, as well as the role of speech-language pathologists, other healthcare professionals, policy makers, and educators in the improvement of the medical and rehabilitative management of MND. Finally theoretical implications and implications for future research are also documented.

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The vestibular system provides us with sensory information that is essential for maintaining balance and stability. When sensory input is lost due to unilateral vestibular damage (UVD), our ability to maintain stable gaze and posture becomes compromised. Over time, vestibular function is partially restored through a process known as vestibular compensation, which is associated with the rebalancing of activity in the vestibular nuclear complex (VNC) of the brainstem. However, the physiological mechanisms associated with vestibular compensation remain elusive. We addressed several different experimental objectives pertaining to plasticity and sensory adaptation associated with vestibular compensation. First, we demonstrated that systemic manipulation of γ-amino-butyric acid type B (GABAB) receptors altered the course of vestibular behavioural recovery within the first several hours after UVD. Second, we showed that immunohistochemical labeling of the α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptor subunit GluR4 was elevated in the VNC on the intact compared to lesioned side acutely following UVD. Third, we produced preliminary data suggesting that excitatory responses to vestibular nerve stimulation may be acutely potentiated by UVD on the intact side. Finally, we established that rapid sensory adaptation may increase the dynamic ranges of vestibular neurons and perhaps improve limited vestibular reflex function in the long term. Acutely following UVD, potentiation of vestibular nerve synapses appear to be associated with an increase in GluR4 subunit expression in the contralesional VNC. Also, such potentiation could be enhanced by acute modifications in pre-synaptic GABAB receptor activation. In the long term, and independent of these plastic changes, sensory adaptation may enable the vestibular system to overcome the persistent limitations imposed by UVD.