Vocal Health Knowledge Status and Attitudes of Professional and Amateur Performing Artists in Greece.

OBJECTIVE: This study aimed to investigate the vocal health literacy level and attitudes of professional and amateur performing artists in Greece and identify possible gaps and limitations that should be addressed in the future. METHODS: This mixed-methods study took place in two successive stages. The first stage involved 4 focus groups with professional and amateur actors and singers. The focused discussions of this stage, which were moderated by one otolaryngologist and one speech and language therapist, provided necessary information for the design of the structured questionnaire used during the second stage of the study (online survey). The online questionnaire included questions about responders' knowledge and attitudes of vocal health. Although not compulsory, the Greek version of the Singing Voice Handicap Index (SVHI) was also part of the online survey. RESULTS: The online questionnaire was validly answered by 305 respondents during a 10-month period (May 2020 to March 2021). Considerable knowledge gaps were observed regarding anatomy, physiology, and vocal disorders management. The vast majority of participants (94.1%) had at some point experienced problems with their voice. Gastroesophageal reflux (21.6%), vocal nodules (12.5%), and vocal polyps (3.9%) were the most frequently mentioned diagnoses in our sample. A small proportion of participants (9.5%) stated that they have never visited an ENT, while 84.3% have never seen a speech and language therapist. The total scores on the SVHI in our sample were compatible to the ones in previous studies targeting healthy professional and amateur artists (range 0-116, mean 32, SD 24.7). CONCLUSIONS: This study provides insights into Greek performing artists' knowledge and attitudes regarding vocal health and may pave the way towards improving vocal health awareness among performing artists.

Precision rehabilitation for aphasia by patient age, sex, aphasia severity, and time since stroke? A prespecified, systematic review-based, individual participant data, network, subgroup meta-analysis.

BACKGROUND: Stroke rehabilitation interventions are routinely personalized to address individuals' needs, goals, and challenges based on evidence from aggregated randomized controlled trials (RCT) data and meta-syntheses. Individual participant data (IPD) meta-analyses may better inform the development of precision rehabilitation approaches, quantifying treatment responses while adjusting for confounders and reducing ecological bias. AIM: We explored associations between speech and language therapy (SLT) interventions frequency (days/week), intensity (h/week), and dosage (total SLT-hours) and language outcomes for different age, sex, aphasia severity, and chronicity subgroups by undertaking prespecified subgroup network meta-analyses of the RELEASE database. METHODS: MEDLINE, EMBASE, and trial registrations were systematically searched (inception-Sept2015) for RCTs, including ⩾ 10 IPD on stroke-related aphasia. We extracted demographic, stroke, aphasia, SLT, and risk of bias data. Overall-language ability, auditory comprehension, and functional communication outcomes were standardized. A one-stage, random effects, network meta-analysis approach filtered IPD into a single optimal model, examining SLT regimen and language recovery from baseline to first post-intervention follow-up, adjusting for covariates identified a-priori. Data were dichotomized by age (⩽/> 65 years), aphasia severity (mild-moderate/ moderate-severe based on language outcomes' median value), chronicity (⩽/> 3 months), and sex subgroups. We reported estimates of means and 95% confidence intervals. Where relative variance was high (> 50%), results were reported for completeness. RESULTS: 959 IPD (25 RCTs) were analyzed. For working-age participants, greatest language gains from baseline occurred alongside moderate to high-intensity SLT (functional communication 3-to-4 h/week; overall-language and comprehension > 9 h/week); older participants' greatest gains occurred alongside low-intensity SLT (⩽ 2 h/week) except for auditory comprehension (> 9 h/week). For both age-groups, SLT-frequency and dosage associated with best language gains were similar. Participants ⩽ 3 months post-onset demonstrated greatest overall-language gains for SLT at low intensity/moderate dosage (⩽ 2 SLT-h/week; 20-to-50 h); for those > 3 months, post-stroke greatest gains were associated with moderate-intensity/high-dosage SLT (3-4 SLT-h/week; ⩾ 50 hours). For moderate-severe participants, 4 SLT-days/week conferred the greatest language gains across outcomes, with auditory comprehension gains only observed for ⩾ 4 SLT-days/week; mild-moderate participants' greatest functional communication gains were associated with similar frequency (⩾ 4 SLT-days/week) and greatest overall-language gains with higher frequency SLT (⩾ 6 days/weekly). Males' greatest gains were associated with SLT of moderate (functional communication; 3-to-4 h/weekly) or high intensity (overall-language and auditory comprehension; (> 9 h/weekly) compared to females for whom the greatest gains were associated with lower-intensity SLT (< 2 SLT-h/weekly). Consistencies across subgroups were also evident; greatest overall-language gains were associated with 20-to-50 SLT-h in total; auditory comprehension gains were generally observed when SLT > 9 h over ⩾ 4 days/week. CONCLUSIONS: We observed a treatment response in most subgroups' overall-language, auditory comprehension, and functional communication language gains. For some, the maximum treatment response varied in association with different SLT-frequency, intensity, and dosage. Where differences were observed, working-aged, chronic, mild-moderate, and male subgroups experienced their greatest language gains alongside high-frequency/intensity SLT. In contrast, older, moderate-severely impaired, and female subgroups within 3 months of aphasia onset made their greatest gains for lower-intensity SLT. The acceptability, clinical, and cost effectiveness of precision aphasia rehabilitation approaches based on age, sex, aphasia severity, and chronicity should be evaluated in future clinical RCTs.

The Use of Standardized Intraoperative Language Tests in Awake Craniotomies: A Scoping Review.

Assessment of speech and language functions is an essential part of awake craniotomies. Although standardized and validated tests have several advantages compared to homemade (or mixed) batteries, in the literature it is unclear how such tests are used or whether they are used at all. In this study, we performed a scoping review in order to locate standardized and validated intraoperative language tests. Our inquiry included two databases (PubMED and MEDLINE), gray literature, and snowball referencing. We discovered 87 studies reporting use of mixed batteries, which consist of homemade tasks and tests borrowed from other settings. The tests we found to meet the validation and standardization criteria we set were ultimately three (n = 3) and each one has its own advantages and disadvantages. We argue that tests with high sensitivity and specificity not only can lead to better outcomes postoperatively, but they can also help us to gain a better understanding of the neuroanatomy of language.

The Greek linguistic assessment for awake brain surgery: development process and normative data.

Language mapping with direct electrical stimulation is considered the gold standard in surgical treatment of brain tumors. Assessing a variety of language functions intraoperatively can affect the extent of the tumor resection as well as the patient's postoperative quality of life. Although most tests include preoperative sessions where tasks are personalised to each patient, normative data are essential since they can ensure that the presented stimuli can be responded appropriately. In this study, we describe the development and standardisation procedures of the first linguistic test in Greek, designed specifically for brain mapping during awake craniotomies. The tasks are developed to comply with the special conditions and restrictions of language assessment inside the operating room. Each task is controlled for various psycholinguistic and lexical variables and it is associated with specific neuroanatomical areas and linguistic processes. Our population consists of 80 right-handed, healthy, Greek-speaking individuals aged 20-60 years. We found only a few main effects and interactions of demographic variables on our test scores. Most differences were found between age groups, since older participants tend to perform slightly worse than younger ones. Therefore, percentiles and cut-off scores were calculated separately for each demographic group. Regarding the clinical application of GLAABS, we describe the procedures we followed to administer it to brain tumor patients from our department and also discuss how sensitivity and specificity can affect patients' postoperative course.

Musicians' Hearing Handicap Index: A New Questionnaire to Assess the Impact of Hearing Impairment in Musicians and Other Music Professionals.

Purpose We aimed to develop and validate the Musicians' Hearing Handicap Index (MHHI), a new self-evaluation tool for quantifying occupation-related auditory difficulties in music professionals. Although pure-tone audiometry is often considered the "gold standard" and is usually employed as the main instrument for hearing assessment, it cannot fully describe the impact of hearing dysfunction. The MHHI is an attempt to complement the hearing impairment assessment toolbox and is based on a unique approach to quantify the effects of hearing-related symptoms or hearing loss on the performance of musicians and other music industry professionals. Method An initial set of 143 questionnaire items was successively refined through a series of critical appraisals, modifications, and suggestions. This yielded an intermediate questionnaire consisting of 43 items, which was administered to 204 musicians and sound engineers. After exploratory factor analysis, the final form of the MHHI questionnaire was obtained, consisting of 29 items. The questionnaire's test-retest reliability, internal consistency, discriminating power, content validity, criterion validity, and aspects of construct validity and inherent conceptual structure were assessed. Results Exploratory factor analysis revealed a combination of four common factors for the 29 validated questionnaire items. They were named "impact on social and working lives," "difficulties in performance and sound perception," "communication difficulties," and "emotional distress." The MHHI was shown to be a valid and reliable instrument to assess musicians' and sound engineers' occupational difficulties due to hearing impairment and related symptoms. Conclusion The ability of the MHHI to discriminate between groups of music professionals with different auditory symptoms or pure-tone audiometry thresholds suggests that auditory symptoms might influence a professional's performance to an extent that cannot be assessed by a pure-tone audiogram.

RELEASE: a protocol for a systematic review based, individual participant data, meta- and network meta-analysis, of complex speech-language therapy interventions for stroke-related aphasia.

Background: Speech and language therapy (SLT) benefits people with aphasia following stroke. Group level summary statistics from randomised controlled trials hinder exploration of highly complex SLT interventions and a clinically relevant heterogeneous population. Creating a database of individual participant data (IPD) for people with aphasia aims to allow exploration of individual and therapy-related predictors of recovery and prognosis. Aim: To explore the contribution that individual participant characteristics (including stroke and aphasia profiles) and SLT intervention components make to language recovery following stroke. Methods and procedures: We will identify eligible IPD datasets (including randomised controlled trials, non-randomised comparison studies, observational studies and registries) and invite their contribution to the database. Where possible, we will use meta- and network meta-analysis to explore language performance after stroke and predictors of recovery as it relates to participants who had no SLT, historical SLT or SLT in the primary research study. We will also examine the components of effective SLT interventions. Outcomes and results: Outcomes include changes in measures of functional communication, overall severity of language impairment, auditory comprehension, spoken language (including naming), reading and writing from baseline. Data captured on assessment tools will be collated and transformed to a standardised measure for each of the outcome domains. Conclusion: Our planned systematic-review-based IPD meta- and network meta-analysis is a large scale, international, multidisciplinary and methodologically complex endeavour. It will enable hypotheses to be generated and tested to optimise and inform development of interventions for people with aphasia after stroke. Systematic review registration: The protocol has been registered at the International Prospective Register of Systematic Reviews (PROSPERO; registration number: CRD42018110947).

A Systematic Review of Semantic Feature Analysis Therapy Studies for Aphasia.

Purpose: The purpose of this study was to review treatment studies of semantic feature analysis (SFA) for persons with aphasia. The review documents how SFA is used, appraises the quality of the included studies, and evaluates the efficacy of SFA. Method: The following electronic databases were systematically searched (last search February 2017): Academic Search Complete, CINAHL Plus, E-journals, Health Policy Reference Centre, MEDLINE, PsycARTICLES, PsycINFO, and SocINDEX. The quality of the included studies was rated. Clinical efficacy was determined by calculating effect sizes (Cohen's d) or percent of nonoverlapping data when d could not be calculated. Results: Twenty-one studies were reviewed reporting on 55 persons with aphasia. SFA was used in 6 different types of studies: confrontation naming of nouns, confrontation naming of verbs, connected speech/discourse, group, multilingual, and studies where SFA was compared with other approaches. The quality of included studies was high (Single Case Experimental Design Scale average [range] = 9.55 [8.0-11]). Naming of trained items improved for 45 participants (81.82%). Effect sizes indicated that there was a small treatment effect. Conclusions: SFA leads to positive outcomes despite the variability of treatment procedures, dosage, duration, and variations to the traditional SFA protocol. Further research is warranted to examine the efficacy of SFA and generalization effects in larger controlled studies.

Treatment integrity of elaborated semantic feature analysis aphasia therapy delivered in individual and group settings.

BACKGROUND & AIMS: This study ran within the framework of the Thales Aphasia Project that investigated the efficacy of elaborated semantic feature analysis (ESFA). We evaluated the treatment integrity (TI) of ESFA, i.e., the degree to which therapists implemented treatment as intended by the treatment protocol, in two different formats: individual and group therapy. METHODS & PROCEDURES: Based on the ESFA manual, observation of therapy videos and TI literature, we developed two ESFA integrity checklists, for individual and group therapy, and used them to rate 15 videos of therapy sessions, delivered by three speech-language therapists (SLTs). Thirteen people with aphasia (PwA) were involved in this study. Reliability of the checklists was checked using Kappa statistics. Each session's TI was calculated. Differences in TI scores between the two therapy approaches were calculated using independent sample t-tests. Treating SLTs' views on what facilitates TI were also explored through a survey. OUTCOMES & RESULTS: Inter- and intra-rater reliability were excellent (.75 ≤ κ ≤ 1.00) for all but one video (κ = .63). Overall, a high TI level (91.4%) was achieved. Although both approaches' TI was high, TI for individual therapy sessions was significantly higher than for group sessions (94.6% and 86.7% respectively), t(13) = 2.68, p = .019. SLTs found training, use of the treatment manual, supervision and peer support useful in implementing ESFA therapy accurately. CONCLUSIONS & IMPLICATIONS: ESFA therapy as delivered in Thales is well described and therapists can implement it as intended. The high TI scores found enhance the internal validity of the main research project and facilitate its replication. The need for more emphasis on the methodological quality of TI studies is discussed.

International patterns of the public awareness of aphasia.

BACKGROUND: It has been suggested that public awareness of aphasia is vital for extending services, research support, social inclusion and targeted raising of awareness. Earlier studies show that knowledge of aphasia varies across a range of variables, but is very low compared with other conditions. AIMS: To report a series of surveys of public awareness of aphasia from six countries, the largest study conducted this far. METHODS & PROCEDURES: Surveys were conducted in Argentina (N = 800), Canada (N = 831), Croatia (N = 400), Greece (N = 800), Norway (N = 251) and Slovenia (N = 400) using the same methodology requesting information on age, sex and occupation, asking whether respondents had heard of aphasia and where they had heard of it. Respondents were tested on their levels of knowledge of aphasia. OUTCOMES & RESULTS: Results revealed low levels of awareness of aphasia in countries surveyed with marked variability that appeared to interact with occupation, country, age and sex. We surveyed 3483 respondents (mean age = 43.16; SD = 17.68). Between 60% (Croatia) and 16% (Slovenia) said they had heard of aphasia (37.1% overall), but those with actual knowledge ranged from 13.9% (Norway) to 1.0% (Argentina). The combined mean of those with basic knowledge was 9.2%. Those who had heard of aphasia were younger; and females had higher levels of awareness. We also found associations between socio-economic status and awareness. Those working in health, social and educational spheres had the highest levels. Respondents mainly heard about aphasia through the media and work or personal contact with aphasia. CONCLUSIONS & IMPLICATIONS: Levels of awareness are low everywhere in absolute terms, and relative to the awareness of other conditions, with significant variability between countries, sex and socio-economic status. We examine how surveys can be utilized to plan ways to increase understanding and discuss the comparison of awareness of aphasia with other conditions.

Quality of life after stroke: evaluation of the Greek SAQOL-39g.

BACKGROUND/AIMS: Stroke and aphasia rehabilitation aims to improve people's quality of life. Yet, scales for measuring health-related quality of life in stroke typically exclude people with aphasia. They are also primarily available in English. An exception is the 39-item generic version of the Stroke and Aphasia Quality of Life Scale (SAQOL-39g). This scale has been tested with people with aphasia; it has been adapted for use in many countries including Greece. The aim of this study was to examine the psychometric properties of the Greek SAQOL-39g. METHODS: An interview-based psychometric study was carried out. Participants completed: receptive subtests of the Frenchay Aphasia Screening Test, the Greek SAQOL-39g, the 12-item General Health Questionnaire, the Frenchay Activities Index, the Montreal Cognitive Assessment and the Barthel Index. RESULTS: 86 people took part; 26 provided test-retest reliability data. The Greek SAQOL-39g demonstrated excellent acceptability (minimal missing data; no floor/ceiling effects), test-retest reliability [intraclass correlation coefficient = 0.96 (overall scale), 0.83-0.99 (domains)] and internal consistency [Cronbach's alpha = 0.96 (overall scale), 0.92-0.96 (domains)]. There was strong evidence for convergent [r = 0.53-0.80 (overall scale), 0.54-0.89 (domains)] and discriminant validity [r = 0.52 (overall scale), 0.04-0.48 (domains)]. CONCLUSION: The Greek SAQOL-39g is a valid and reliable scale. It is a promising measure for use in stroke and aphasia treatment prioritization, outcome measurement and service evaluation.

Differential effect of linguistic and non-linguistic pen-holding tasks on motor cortex excitability.

Writing and drawing are unique human activities. They are complex high-precision actions, which involve not only the motor system but also various cognitive systems, such as attention, short-term memory, action control, and language. In relation to motor control, the study of writing and drawing is of great interest as they provide insight in the interaction between motor control processes and the concurrent non-motor processes. Although sharing similar motor and mechanical demands, writing and drawing involve different levels of linguistic/semantic load and thus may be associated with different modulation of motor cortical excitability. Here, we have used transcranial magnetic stimulation to study separately activation of excitatory and inhibitory mechanisms of the motor cortex during performance of writing and drawing acts as well as during simple pen-squeezing task. While cortical excitatory mechanisms appeared to be saturated by the pure motor demands of the tasks, and thus not amenable to modulation by the tasks' linguistic load, variation in cortical inhibitory activity was the main vehicle for differential modulation of motor cortical excitability by linguistic demands of the tasks. The results of this study highlight the importance of cortical inhibitory mechanisms in the physiology of higher cognitive activities. They also provide further evidence that the task specific modulation of the excitability of the motor cortex goes beyond motor complexity of the task and is also dependant on associated cognitive components.

Cerebellum and reading.

BACKGROUND: Traditionally, the cerebellum has been considered to control coordinated movement. However, in recent years it has been argued that it contributes to higher cognitive functions. OBJECTIVES: This review aims to present recent evidence concerning the role of the cerebellum and discusses how it can contribute to reading. METHOD: The procedure used involves findings coming from three quite different areas, lesion, anatomic and functional imaging studies. RESULTS: These studies indicate a link between cerebellum and reading and its relationship with specific reading difficulties. CONCLUSIONS: Our review provides evidence which is in accordance with the recently established role of the cerebellum as a regulator of mental functions and supports theoretical models suggesting that cerebellar deficits might be a cause of developmental dyslexia.

Plasticity of motor cortex excitability induced by rehabilitation therapy for writing.

The mechanisms of rehabilitation-induced plasticity in the motor system after stroke are not defined. The authors studied seven patients with residual poststroke agraphia, aphasia, and right hemiparesis. After a 40-minute rehabilitation therapy that promoted use of the paretic hand for writing, the authors observed a task-specific increase in recruitment of ipsilateral corticospinal pathways. Rehabilitation aimed to increase the use of the paretic hand may induce recruitment of previously silent ipsilateral corticospinal pathways even in poorly recovered poststroke patients.