Rater methodology for stroboscopy: a systematic review.

OBJECTIVES: Laryngeal endoscopy with stroboscopy (LES) remains the clinical gold standard for assessing vocal fold function. LES is used to evaluate the efficacy of voice treatments in research studies and clinical practice. LES as a voice treatment outcome tool is only as good as the clinician interpreting the recordings. Research using LES as a treatment outcome measure should be evaluated based on rater methodology and reliability. The purpose of this literature review was to evaluate the rater-related methodology from studies that use stroboscopic findings as voice treatment outcome measures. STUDY DESIGN: Systematic literature review. METHODS: Computerized journal databases were searched for relevant articles using terms: stroboscopy and treatment. Eligible articles were categorized and evaluated for the use of rater-related methodology, reporting of number of raters, types of raters, blinding, and rater reliability. RESULTS: Of the 738 articles reviewed, 80 articles met inclusion criteria. More than one-third of the studies included in the review did not report the number of raters who participated in the study. Eleven studies reported results of rater reliability analysis with only two studies reporting good inter- and intrarater reliability. CONCLUSION: The comparability and use of results from treatment studies that use LES are limited by a lack of rigor in rater methodology and variable, mostly poor, inter- and intrarater reliability. To improve our ability to evaluate and use the findings from voice treatment studies that use LES features as outcome measures, greater consistency of reporting rater methodology characteristics across studies and improved rater reliability is needed.

Respiratory-swallow training in patients with head and neck cancer.

OBJECTIVE: To test a novel intervention to train swallowing to occur in the midexpiratory to low expiratory phase of quiet breathing to improve swallowing safety and efficiency. DESIGN: Safety and efficacy nonrandomized controlled trial with 1-month follow-up. SETTING: Ambulatory clinics. PARTICIPANTS: Patients (N=30) with head and neck cancer (HNC) and chronic dysphagia completed the intervention. Fifteen of these patients participated in a 1-month follow-up visit. INTERVENTIONS: Training protocol based on hierarchy of motor skill acquisition to encourage autonomous and optimal respiratory-swallowing coordination. Visual feedback of respiratory phase and volume for swallowing initiation was provided by nasal airflow and rib cage/abdomen signals. MAIN OUTCOME MEASURES: Respiratory-swallow phase pattern, Modified Barium Swallow Impairment Profile (MBSImP) scores, Penetration-Aspiration Scale (PAS) scores, and MD Anderson Dysphagia Inventory scores. RESULTS: Using visual feedback, patients were trained to initiate swallows during the midexpiratory phase of quiet breathing and continue to expire after swallowing. This optimal phase patterning increased significantly after treatment (P<.0001). Changes in respiratory-swallowing coordination were associated with improvements in 3 MBSImP component scores: laryngeal vestibular closure (P=.0004), tongue base retraction (P<.0001), and pharyngeal residue (P=.01). Significant improvements were also seen in PAS scores (P<.0001). Relative to pretreatment values, patients participating in 1-month follow-up had increased optimal phase patterning (P<.0001), improved laryngeal vestibular closure (P=.01), tongue base retraction (P=.003), and pharyngeal residue (P=.006) MBSImP scores and improved PAS scores (P<.0001). CONCLUSIONS: Improvements in respiratory-swallowing coordination can be trained using a systematic protocol and respiratory phase-lung volume-related biofeedback in patients with HNC and chronic dysphagia, with favorable effects on airway protection and bolus clearance.

Gender differences in stroke recognition among stroke survivors.

BACKGROUND: Studies suggest that gender differences exist in the recognition of stroke warning signs. Poor recognition of stroke warning signs has been attributed to negative treatment-seeking behaviors, which can result in poor outcomes. OBJECTIVE: The aim of this study was to examine gender differences in the recognition of traditional early warning signs of stroke and first action to initiate treatment in a sample of stroke survivors. METHODS: We collected survey data to examine recognition of traditional stroke warning signs and appropriate first action to initiate treatment along with demographic (age, stroke age, education, usual source of care, and insurance) and clinical (health literacy and stroke knowledge) variables. RESULTS: Seventy-one stroke survivors participated in this pilot study. Women in the sample were significantly older than men at time of stroke (62 years old vs. 55 years old; p < .05). The two groups did not differ in clinical variables. Recognition of traditional individual stroke warning signs ranged from approximately 60% to 90%. There were no significant gender differences in the recognition of individual warning signs. Women were more likely to recognize all five traditional warning signs compared with men (67% vs. 42%; p = .04). Similarly, 58% of female participants recognized all five traditional stroke warning signs collectively and would call 9-1-1 as a first action compared with only 29% of men (p = .02). CONCLUSIONS: Although women recognized traditional stroke warning signs more often than men, educational programs should emphasize both traditional and nontraditional stroke warning signs among women and address these differences with their healthcare providers.

Baseline prevalence of heart diseases, hypertension, diabetes, and obesity in persons with acute traumatic spinal cord injury: potential threats in the recovery trajectory.

BACKGROUND: Chronic diseases impede the recovery trajectory of acutely injured persons with traumatic spinal cord injury (TSCI). This study compares the odds of prevalent heart disease, hypertension, diabetes mellitus, and obesity between persons with TSCI and persons with lower extremity fractures (LEF) who were discharged from acute care facilities. METHODS: 1,776 patients with acute TSCI (cases) and 1,780 randomly selected patients with LEF (controls) discharged from January 1, 1998, through December 31, 2009, from all nonfederal hospitals were identified. Data extracted from uniform billing files were compared between cases and controls in a multivariable logistic regression model controlling for sociodemographic and clinical covariables. RESULTS: Thirty percent of patients with acute TSCI had at least 1 of 4 conditions compared with 18% of patients with LEF (P < .0001). Persons with acute TSCI were 4 times more likely (odds ratio [OR], 4.05; 95% CI, 1.65-9.97) to have obesity, 2.7 times more likely to have heart disease (P < .001), 2 times more likely to have hypertension (P < .001), and 1.7 times more likely to have diabetes (P = .044) at the onset of TSCI. Disproportionately more Blacks than Whites have TSCI and chronic diseases. CONCLUSION: This study suggests that there is an increased burden of cardiovascular and cardiometabolic diseases among persons with acute TSCI compared with LEF trauma controls. Unattended comorbid conditions will affect quality of life and the recovery process. This warrants continuous monitoring and management of chronic diseases during the rehabilitation process.

Perceptions of stroke recovery: an exclusion of communication and cognition.

BACKGROUND: Perceptions of stroke recovery can differ substantially between stroke survivors and their healthcare providers. Concordance between the two is important for collaborative goal setting to facilitate optimal outcomes. OBJECTIVE: To explore stroke survivors' perceptions of their own recovery and residual impairments with specific emphasis on communication and cognition. METHODS AND PROCEDURES: A qualitative analytic approach was used in the study. Nine stroke survivors participated in a focus group discussion as part of a larger study designed to examine post-stroke outcomes. RESULTS: Early in the focus group proceedings, a discussion emphasizing how stroke survivors perceive their overall recovery emerged. Six of the nine participants (67%) perceived their overall stroke recovery to be greater than 90%, and only physical impairments were reported. Later in the course of the interview, eight of the nine participants (89%) reported either word retrieval or memory loss deficits which negatively influenced their daily functional activities. CONCLUSIONS: Stroke survivors in this sample did not include communication and cognitive deficits in their perception of their overall recovery despite later reporting these symptoms and related impairment. Failure of patients to include such persisting deficits in their reports of recovery can cause a mismatch between stroke survivor and provider goals.

Stroboscopic Parameters Reported as Voice Outcome Measures in Patients Treated for Laryngeal Cancer: A Systematic Review.

BACKGROUND: A systematic review of the use of stroboscopy as a treatment outcome measure of vocal fold function in patients treated for laryngeal cancer is presented. METHODS: Computerized literature searches were performed. Eligible articles were admitted when stroboscopy was used to measure vocal fold function before and after treatment in patients with laryngeal cancer. Data extracted included: tumor stage and location, treatment modality, stroboscopy parameters, parameter scale, number of raters, rater reliability, methodology, and level of evidence. RESULTS: Of 520 articles retrieved, 11 studies met inclusion criteria. A total of twenty-four parameters were reported. Rating scales and rater reliability varied. DISCUSSION: Major methodological differences exist in studies using stroboscopic findings as voice outcome measures in patients' post-cancer treatment. These differences lead to equivocal findings when assessing the utility of stroboscopy as an outcome measure. Standardized, reliable scoring and reporting systems for laryngeal stroboscopic examinations are needed.

Prediction of postinjury employment and percentage of time worked after spinal cord injury.

OBJECTIVE: To use a 2-part model to identify biographic, injury, educational, and vocational predictors of postinjury employment and the percentage of time employed after spinal cord injury (SCI) onset. DESIGN: Survey. SETTING: Data were collected at 3 hospitals in the Southeastern and Midwestern United States. PARTICIPANTS: Participants were adults with traumatic SCI of at least 1 year duration, all under 65 years at the time of SCI onset. A total of 1329 observations were used in the analysis. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Postinjury employment, defined by whether the individual had ever been employed after SCI and percentage of time employed after SCI onset. RESULTS: Almost 52% of participants worked at some point in time postinjury. Among those who had worked postinjury, the mean portion of time spent working was 0.56. Several factors were significantly related to postinjury employment and portion of time worked postinjury. The probability of postinjury employment increased with successively less severe injury. However, only ambulatory participants were found to have a significantly greater portion of time postinjury among those who became employed. Having obtained either a 4-year or graduate degree after injury was associated with a greater likelihood of postinjury employment. Conversely, among those who worked postinjury, having obtained those degrees prior to injury was associated with a greater portion of time employed. Being white, a man, having completed a 4-year degree or a graduate degree, and having worked in the service industry prior to SCI onset were all associated with a greater portion of time working among those who had worked. CONCLUSIONS: The factors precipitating PE are not identical to those associated with a greater portion of time employed after SCI onset.