Cepstral Analysis of Voice in Patients With Temporomandibular Disorders.

OBJECTIVES: This study aimed to assess the voice quality of patients with temporomandibular disorders (TMDs) compared with healthy subjects using cepstral analysis and investigate the relationship between the TMD severity and the values of cepstral analysis. METHODS: Subjects who met the inclusion criteria completed a general health questionnaire and the Fonseca Anamnestic Index. Patients who had TMDs with FAI were subjected to an examination based on the Diagnostic Criteria for Temporomandibular Disorders. The final sample included 65 subjects, 31 TMDs patients (with a mean age ± standard deviation of 36.64 ± 13.67 years), and 34 healthy individuals in the control group (with a mean age ± standard deviation of 30.35 ± 7.78 years). Cepstral Peak Prominence (CPP) and Smoothened Cepstral Peak Prominence (CPPS) of a sustained vowel and connected speech were computed using Praat software. RESULTS: TMD patients indicated lower cepstral values and lower voice quality compared to the control group. Significant differences were found between TMD and control groups for all cepstral parameters (P < .001) and cepstral measurements showed a moderate to strong negative correlation with TMD severity (P < .001, rho = -0.57 to -0.88). CONCLUSION: The outcomes of the present study indicate that cepstral analysis can accurately distinguish the reduced voice quality of TMD patients from normal voice.

A Single-Subject Study to Consider the Premature Infant Oral Motor Intervention Combined with Kinesio-Tape in Premature Infants with Feeding Problems.

Background: The survival rate in premature infants (PIs) has increased, but many have medical and developmental complications. Difficulty with sucking, swallowing, and poor nourishment are common complications. This study aimed to investigate the effects of Kinesio-tape (KT) combined with premature infant oromotor intervention (PIOMI) on feeding efficiency (mean volume intake [%MV]), oromotor skills (Preterm Oral Feeding Readiness Assessment Scale [POFRAS]), and weight gain in PIs. Methods: In this single-subject study, 5 PIs with feeding problems were received the PIOMI-KT for 7 consecutive days. The main outcome measure was the POFRAS scale. The %MV and weight gain were the secondary outcome measures. Measurements were taken before treatment (T0), after the 4th session (T1), and after the 7th session (T3). Results: The POFRAS scores, %MV, and weight gain improved in all infants after treatment. The maximum and minimum change in level between the baseline and treatment phase was +26 and+16 for POFRAS, +54 and, +34 for %MV, +180, and +100 for weight gain. The treatment trend was upward for all infants and shown by the directions of the slopes indicated by positive values. The feeding problems were resolved in all infants after the 7th treatment session. Conclusion: The combination therapy of PIOMI-KT improved feeding function in PIs.

Voice quality in patients with temporomandibular disorders.

OBJECTIVES: This study assessed the voice quality in TMD patients compared to healthy individuals using the Dysphonia Severity Index (DSI) and evaluated the correlation between the DSI and TMD severity. METHODS: Patients who had TMD with Fonseca's anamnestic index were subjected to an examination based on the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). A sample of 35 patients with TMD and 36 healthy subjects were included in the study. RESULTS: There were significant differences in the DSI score and its components between healthy subjects and TMD patients (p < .001). A significant correlation was found between the DSI scores and TMD severity (Spearman's rho: -0.90, p < .001). CONCLUSION: Patients with TMD demonstrated lower DSI scores and lower voice quality compared to healthy subjects.

Investigation of the effectiveness of articulation therapy through tele-practice on children with cleft palate in Khuzestan Province during COVID-19 pandemic.

INTRODUCTION: A cleft palate is a common type of facial malformation. Compensatory articulation errors are one of the important causes of unclear speech in children with cleft palate. Tele-practice (TP) helps to connect therapists and clients for assessment and therapy. Our goal is to investigate the effectiveness of articulation therapy through tele-practice on cleft palate children in Khuzestan Province during the COVID-19 pandemic. MATERIALS & METHODS: Before starting the treatment, a 20-min speech sample was recorded individually from all the children. Speech intelligibility and the percentage of correct consonants were assessed for each speech sample. The control group received treatment sessions in person at the cleft palate center, and the other group received treatment via tele-practice using the ZOOM platform. Treatment sessions were provided in the form of 45-60-min group sessions, twice a week, for 5 weeks (10 sessions in total). After 10 treatment sessions, the speech sample was recorded again. The level of parental satisfaction was measured using a Likert 5-level survey. RESULTS: The mean score of intelligibility of the two groups decreased (-1.4400 and 0.7200). The two groups' mean percentage of correct consonants increased. (26.09 and 17.90). In both groups, the mean score of parents' satisfaction with the treatment was high (3.44 and 3.84). The mean of difference before and after the speech intelligibility and the percentage of correct consonants variables in both groups was statistically significant (P = 0.001 and P = 0.002, respectively). In both groups, the satisfaction variable was not associated with a statistically significant difference (P = 0.067). CONCLUSION: The effectiveness of in-person therapy over a certain period of time is higher than tele-practice. Nevertheless, the results demonstrated an increase in the intelligibility of speech and the percentage of correct consonants in both groups, thus proving the effectiveness of articulation therapy in correcting compensatory articulation errors in children with cleft palate through in-person and tele-practice.

Quality of Life in Adolescents and Young Adults with Cleft Lip and Palate with and Without Speech Therapy During COVID-19.

OBJECTIVE: Cleft-related speech concerns can affect the quality of life (QOL) in patients with cleft lip and palate (CLP). During the coronavirus disease 2019 (COVID-19), in-person speech therapy (ST) was restricted due to fear of getting infected. This study aimed to compare QOL in patients with CLP with and without ST during the pandemic. DESIGN: Cross-sectional Study. SETTING: CLP team at Tehran University of Medical Sciences (TUMS). PATIENTS/PARTICIPANTS: Thirty-six CLP subjects with a mean age of 17.33 ± 4 years participated in two groups, including with and without ST. Fifteen subjects had cleft palate only (CPO) and others had CLP. INTERVENTIONS: ST group received at least 10 ST sessions, and group without ST didn't receive ST during COVID-19. MAIN OUTCOME MEASURE(S): A virtual link of demographic and QOL adolescent cleft (QoLAdoCleft) questionnaires were sent to fill out. Results were extracted and transferred to SPSS. RESULTS: Total and subscales' scores of QoLAdoCleft were lower in ST group than without ST but differences between them weren't statistically significant (P > .05). Furthermore, according to cleft type, there weren't any statistically significant differences in total, physical, and social subscales of QoLAdoCleft (P > .05); however, psychological subscale in CLP had a higher significant score than CPO (P < .05). CONCLUSIONS: QOL was weak in all patients with CLP, and receiving/not receiving ST couldn't make noticeable differences between them. It seems; COVID-19 pandemic can have an adverse effect on these results. Also, subjects with CLP had weaker psychological than CPO due to negative psychosocial feedback related to Orofacial deformities received from society.

The effects of transcutaneous electrical nerve stimulation on muscle activity pattern in professional voice users with muscle tension dysphonia using surface electromyography data: A pilot study.

OBJECTIVES: Muscle Tension Dysphonia is a voice disorder, which results in stiffness in the laryngeal extrinsic muscles, intense collision, painful contractions, and vibrations of the vocal cords. Due to the multifactorial identity of Muscle Tension Dysphonia, its therapeutic approach must be multidisciplinary. METHODS: The participants were divided into two groups: a control group (5participants) that received Circumlaryngeal Manual Therapy (CMT) + Placebo Transcutaneous Electrical Nerve Stimulation and an experimental group (5participants) that received Transcutaneous Electrical Nerve Stimulation + CMT. Both groups received 10 sessions of treatment, twice a week, for 40 min each. Before and after treatment, participants were assessed using the Dysphonia Severity Index (DSI) and surface electromyography for their ability to sustain the vowels /e& u/and count from 20 to30. RESULT: After therapy, there were substantial improvements in the DSI (2.72 ± 0.55, P < 0.05) and muscle electrical activity in the control group. The DSI (3.66 ± 0.63, P < 0.05) and muscle electrical activity were also significantly improved in the experimental group after treatment. The findings of the between-group comparison after treatment revealed a significantly greater increase in the Dysphonia Severity Index in the experimental group compared with the control group (P = 0.037). Although there was no significant difference between the two groups in terms of muscle electrical activity, clinically significant changes were more noticeable in the experimental group when compared with the control group. CONCLUSIONS: Positive results were seen in both groups. The results demonstrate that both approaches relax vocal tract muscles. As a result, Transcutaneous Electrical Nerve Stimulation was recommended as a complementary treatment for clients with Muscle Tension Dysphonia.

Immediate Effects of Semi-occluded Vocal Tract Exercises as a Vocal Warm-Up in Singers.

OBJECTIVE: The present study aimed to investigate the Immediate Effects of Semi-occluded Vocal Tract Exercises (SOVTEs) as a vocal warm-up on the Electrical Activity of Extrinsic Laryngeal Muscles and acoustic parameters of voice in singers. STUDY DESIGN: This study used a pre-/post-interventional (quasi-experimental) design and a simple non-random sampling method. SETTING: Musculoskeletal Rehabilitation Research Center. METHOD: Surface electromyography of the suprahyoid and infrahyoid muscle areas and acoustic measurements were assessed before and immediately after performing three SOVTEs: lip-trill, humming, and straw phonation for 20 minutes as a vocal warm-up in eleven healthy male singers with an average age of 26.5 ± 4.2. RESULTS: After performing the vocal warm-up, root mean square in channels two and three (left and right infrahyoid muscle areas) in all vocal tasks, including /i/, /u/, and counting from 20 to 30 was significantly decreased (P < 0.05). The acoustic parameters, F1, and F1-F0 difference were significantly decreased (P < 0.05). CONCLUSION: The results suggest that after performing SOVTEs as a vocal warm-up, the electrical activity of the extrinsic laryngeal muscles is reduced. The acoustic analysis also demonstrated a decrease in F0, F1, and F1-F0 variables. Therefore, it seems that the results of acoustic and electromyographic assessments are in line and it is likely that SOVTEs through the vocal economy lead to a reduction in the load applied to the phonatory system.

The Relationship Between Dysphonia Severity Index and Voice-Related Quality of Life in the Elementary School Teachers with Voice Complaint.

INTRODUCTION: Teachers are one of the largest groups of professional voice users who are highly dependent on their voice in their working environment using their voice as a primary tool for their profession. Thus, they are at high risk of voice disorders. Since voice disorders are multi-causal in nature, it is necessary to evaluate them systematically and in different ways to determine the exact nature of the disorder. Therefore, in this study, the relationship between Voice-Related Quality of Life (VRQOL) and Dysphonia Severity Index (DSI) was examined from the perspective of teachers with voice complaint. METHOD: In this study, 157 primary school teachers with voice complaint (49 males and 108 females) with an average age of 38.54 ± 9.56 years were studied using DSI and VRQOL as a self-assessment. RESULTS: The mean of VRQOL was 74.379 ± 18.95 and the mean of DSI was 1.339 ± 1.62. The results of the study showed that there is a significant positive correlation between the overall scores of DSI and VRQOL scales (r = 0.545, P < 0.001). CONCLUSION: This study showed that a low dysphonia severity index, reflecting poor laryngeal function, is associated with lower voice-related quality of life. Therefore, accurate and timely assessment of the DSI in teachers can prevent the occurrence and/or progression of voice disorder and, consequently, prevent reducing the voice-related quality of life in teachers.

Comparison of Vocal Fatigue in Speech Therapists With Other Rehabilitation Therapists.

INTRODUCTION: Voice, as one of the most important communication tools in humans, can cause many problems in a person's daily life if it is damaged. One type of voice complaint is vocal fatigue, which is common among people who use their voices a lot. Rehabilitation therapists may be more vulnerable to a variety of vocal disorders and complaints due to extensive voice use and long-term relationships with clients. The aim of this study is to investigate and compare vocal fatigue among therapists in Ahvaz rehabilitation fields. METHOD: This cross-sectional, descriptive-analytical study was performed on 100 therapists in Ahvaz rehabilitation fields. For this purpose, the Persian version of the vocal fatigue index questionnaire has been used. One Way Anova parametric tests were used to compare target variables. The relationship between vocal fatigue and work experience and working hours per day was calculated using Spearman correlation coefficient. RESULTS: A comparison of the scores of the vocal fatigue index in the rehabilitation therapists showed that there was a significant difference between the therapists scores in the field of speech therapy and the therapists scores in other fields (P < 0.05). CONCLUSION: Due to the nature of rehabilitation fields and the use of voice during daily interactions with different clients, especially clients with special disabilities, the possibility of voice disorders and complaints in this population should be considered. Therefore, providing the necessary training for voice care and voice health of this population should be noted in order to prevent voice disorders and complaints.

The Dysphonia Severity Index as a Mediator for the Relationship Between the Vocal Fatigue Index and the Voice-Related Quality of Life Among Elementary Teachers with Voice Complaint.

INTRODUCTION: The multi-causal nature of voice disorders is required to be evaluated systematically and in different ways to determine the exact nature of the disorder. Given the importance of voice for teachers, the present study was designed to investigate the causal relationship between vocal fatigue index (VFI) and the voice-related quality of life (VRQOL) with the mediating role of the dysphonia severity index (DSI) among teachers with voice complaints. METHOD: This analytical and non-interventional study examined 57 male and 122 female teachers with voice complaint. The study used DSI, VRQOL and VFI. Acoustic data were extracted using Praat software, and statistical analysis was performed using SPSS. Direct and indirect path testing of the proposed research model was performed using path analysis and bootstrapping, respectively. RESULTS: Model fit indices showed that the proposed model is data fit (CFI = 0.998, GFI = 0.996, RMSEA = 0.072). Moreover, all subtests of the VFI had a significant direct relationship with VRQOL. The DSI, measured using the proposed model, does not have a significant relationship with VRQOL. Therefore, the indirect path of the present model (including tiredness of voice to VRQOL through DSI, physical discomfort to VRQOL through DSI and the improvement of symptoms with rest to VRQOL through DSI) did not show a significant relationship. CONCLUSION: The vocal fatigue directly affects VRQOL. However, it does not affect it indirectly through DSI. Therefore, it can be concluded that although DSI and VRQOL are correlated, they do not have a causal relationship and DSI, as an acoustic parameter, cannot be an appropriate mediator for the relationship between the VFI and VRQOL.

Comparison of the Outcomes of Surgical Repair of Cleft Palate Performed by Modified Von Langenbeck and Bardach (Two-Flap Palatoplasty) Methods.

Background: Cleft lip and cleft palate are one of the most common congenital craniofacial abnormalities in the skull and face. We aimed to investigate the prevalence of complications after primary cleft palate repair surgery, performed on patients referred to a children's hospital, and to use the information and results obtained from it to reduce the complications and improve the results of these surgeries. Methods: In this cross-sectional-analytical study, using a census sampling method, the medical records of 94 consecutive cleft palate patients treated in Abuzar Hospital in Ahvaz, southern Iran, in the years 2019 to 2021 were studied. The rate of postoperative complications during the first week in terms of wound opening and flap necrosis and one month later in terms of fistula formation after surgery were also extracted from the files. Results: Ninety-four patients with congenital cleft palate (57.4% male and 42.6% female) were enrolled. The gap width in all studied patients was 14 ± 5 mm. The frequency of complications of surgical wound opening, flap necrosis, oronasal fistula and hypernasality in von Langenbeck group was 9.5%, 0.15% and 28.1% respectively, and in Bardach group was 9.5 %, 15% and 33.3% respectively. Conclusion: There were no significant differences between the two surgical methods in terms of postoperative complications. Besides, what is important in choosing a surgical method is the patient's clinical condition, the surgeon's experience and skill, and his choice.

Mothers' involvement in assessing feeding skills of premature infants.

OBJECTIVE: Among the problems faced by premature infants after birth are weakness in oral-motor skills and an inability to achieve oral feeding independence. The Early Feeding Skills (EFS) Assessment is a tool for identifying infant's feeding ability level and determining the levels at which an infant requires support for safe and efficient feeding. Given the effective role of mothers and their involvement in taking care of premature infants and the importance of examining the psychometric properties of tools used for assessing infant's feeding, this study aimed at evaluating inter-rater reliability (between mother and rater) using the EFS Instrument. METHODS: This is a cross-sectional study. Participants in this study included 30 mothers with premature infants admitted to the NICU ward of Imam Khomeini Hospital in Ahvaz, Iran. To evaluate the inter-rater reliability of the "Early Feeding Skills (EFS) Assessment Instrument", feeding skills of the infants were evaluated by the mother and a rater. Statistical analysis was carried out using Intraclass Correlation Coefficients (ICC) in SPSS software (Ver. 22). RESULTS: The inter-rater reliability of the total score for each section of the EFS Instrument was good (ICC >0.75). ICC values for inter-rater agreement in assessing Oral Feeding Readiness, Ability to Maintain Engagement in Feeding, Ability to Organize Oral-Motor Functioning, Ability to Coordinate Swallowing, Ability to Maintain Physiologic Stability, and Oral Feeding Recovery were 0.87, 0.94, 0.91, 0.85, 0.95 and, 0.80, respectively. CONCLUSION: If mothers are appropriately trained on the EFS assessment, they can actively participate with the health care professionals providing care to their children. Furthermore, remote participation is possible. The findings of this study revealed significant inter-rater reliability.

Cross-Cultural Adaptation and Validation of the Speech Handicap Index into Persian.

PURPOSE: The aim of the present study was to adapt and validate the Speech Handicap Index (SHI) into the Persian language. PATIENTS AND METHODS: The original published English version of the SHI was translated into Persian using the translation protocol and guidelines of the International Quality of Life Assessment. One hundred participants with oral and oropharyngeal cancer and 40 healthy participants completed the Persian SHI. Forty participants of the patient group completed the Persian SHI a second time after a 2-weeks period to evaluate test-retest reliability. Content validity (content validity index and content validity ratio), internal consistency (Cronbach α coefficient), test-retest reliability (intraclass correlations), and construct validity (confirmatory factor analysis) were examined. Control group and patient group values were compared to determine the clinical validity. RESULTS: A significant discrimination coefficient was found across all items, and the content and clinical validity were found to be acceptable. The Persian SHI showed a high internal consistency and test-retest reliability. The construct validity was within the acceptable range. CONCLUSIONS: The P-SHI is considered to be a valid and reliable questionnaire for speech assessment in Persian-speaking patients with head and neck cancer.

Comparison of verbal fluency in monolingual and bilingual elderly in Iran.

Verbal fluency is one of the first and most important cognitive functions that deteriorate during the aging process. Verbal fluency is defined as the skill and speed of finding words and finding semantic and phonetic connections between words. One of the most important factors in verbal fluency is bilingualism. Therefore, the current study aimed to investigate the effect of bilingualism on the verbal fluency of the elderly in Iran. A total of 12 normal elderly bilingual (Arabic-Persian) speakers and 12 normal elderly monolingual (Persian) speakers participated in this comparative-analytical study. To assess verbal fluency, two semantic and phonetic fluency tasks were used. Data were analyzed using the Wilcoxon-Mann-Whitney tests. The results obtained from the comparison of phonetic fluency and semantic fluency of native languages of the two groups showed a better performance of monolingual participants in semantic fluency and phonetic fluency tasks in Persian language compared to the Arabic bilingual elderly. No difference was observed in verbal fluency of Persian monolinguals and bilinguals. However, in bilingual elderly participants, faster retrieval was observed in Persian language than in Arabic. This can be considered in assessment and treatment measures for Arabic-Persian bilinguals.

Relationship Between Work Engagement and Voice Complaints Among Elementary School Teachers.

INTRODUCTION: Engaged teachers feel rewarded at work, complete assignments in a positive manner and, often immerse themselves in their work. However, voice complaints are more common for teachers than other professionals which may negatively affect their engagement. This study aims to determine the relationship between work engagement and voice complaints for elementary school teachers. METHOD: This descriptive-analytical, cross-sectional study was conducted on 300 elementary school teachers in 2018. To study voice complaints, the researchers used the self-reporting question "Have you complained about your voice during the past year or so?" Work engagement was measured by the Utrecht Work Engagement Scale (UWES). To analyze the data, descriptive and analytical statistical methods, including two-way ANOVA, were used. RESULTS: A total of 55.67% (n = 167) of the teachers had voice complaints, and 44.33% (n = 133) had no voice complaints. After controlling for gender, the results of the study showed that there is a statistically significant relationship between voice complaints and work engagement (P < 0.001) and its three dimensions, including: vigor (P ≤ 0.001), dedication (P ≤ 0.001), and absorption (P ≤ 0.001). CONCLUSION: The results of the present study showed that teachers with voice complaints have lower work engagement than those without. Given the central importance of work engagement in organizational, social, and financial systems, undivided attention should be given to treatment of voice disorders among teachers.

Sonochemical degradation of pesticides in aqueous solution: investigation on the influence of operating parameters and degradation pathway - a systematic review.

Along with the wide production, consumption and disposal of pesticides in the world, the concerns over their human and environmental health impacts are rapidly growing. Among developing treatment technologies, sonochemistry as an emerging and promising technology for the removal of pesticides in the aqueous environment has attracted the attention of many researchers in recent years. This systematic review presents an extensive study of sonochemical degradation of different types of pesticides from aqueous solution. The influence of various parameters including reactor configurations, initial concentration of pesticide, ultrasonic frequency, intensity of irradiation, bulk solution temperature, operational pH and sonication time on the degradation efficiency has been analyzed. The mechanism of ultrasonic degradation has been discussed, and recommendations for optimum operating conditions have been reported for maximizing degradation efficiency. Additionally, the intensification of ultrasonic cavitation by combining with oxidation processes was overviewed and the main advantages and disadvantages were pointed out, in order to address future studies and promote efficient large-scale operations. As a conclusion, it appears that ultrasonic irradiation can be effectively used for intensification of the degradation of pesticides from aqueous solution.

Factor Analysis of the Persian Version of the Voice Disability Coping Questionnaire.

INTRODUCTION: Voice disorders can affect the quality of life and coping mechanisms and also coping mechanisms can affect the way in which patients deal with their voice problems. People with voice disorders need to use coping strategies to deal with the problems caused by their voice disorder. The purpose of this study was to examine the psychometric properties and cultural adaptation of the Voice Disability Coping Questionnaire in the Iranian population. METHODS: The translation and cross-cultural adaptation procedures were performed according to the basic rules and instructions set by the International Quality of Life Assessment Project. Two hundred and forty-eight adults (218 patients with voice disorder and 30 healthy controls) were participated in the study. Face and content validity, clinical validity, and construct validity of the questionnaire were investigated by modern psychometric methods. RESULTS: Quantitative methods were used to measure content validity and all items were detected applicable. This means that the final version was clear and easy to answer. Clinical validity shows that the Persian version of VDCQ can distinguish between patients and healthy controls (P < 0.001). The construct validity of the VDCQ was tested in a cross-sectional study. The questionnaire was analyzed by exploratory and confirmatory factor analyses. Investigation of initial communality and after extraction of factors by Varimax rotation method showed that the share of items for all items in the questionnaire except item 12, is higher than 0.5. Therefore, item 12 should be removed from the questionnaire (Table 3). Based on the confirmatory factor analysis model, items 2 and 10, whose factor load were less than 0.4, were excluded from the questionnaire (Fig. 1). For reliability the Cronbach's alpha coefficient and ICC were obtained as 0.82 and 0.99, respectively. The results of studying the role of items in the reliability of the VDCQ showed that all items increase internal consistency. CONCLUSION: Based on modern statistical analysis conducted in this study, the original 15 item questionnaire was reduced to 12 item. The 12 item questionnaire is a valid and reliable tool for quantifying coping strategies in people with voice disorder.

The Relationship Between Vocal Fatigue Index and Voice Handicap Index in University Professors With and Without Voice Complaint.

INTRODUCTION: University professors, just like teachers, are considered as professional voice users, who are subject to voice disorders and complaints due to their field of work. The present study aims to investigate the relationship between vocal fatigue index and voice handicap index in university professors with and without voice complaint. METHODS: This is a cross-sectional descriptive-analytic study that was conducted on 84 university professors with an average age of 38.27 ± 9.95. University professors were divided into two groups with and without voice complaints based on the opinion of the professors about the existence or absence of voice complaint. Data obtained from this study was analyzed using SPSS 22 software at a significant level of less than 0.05. RESULTS: There was a significant correlation between vocal fatigue index and voice handicap index in university professors (P <0.05). In the university professors without voice complaints, only the third factor of the vocal fatigue index was not significant (P > 0.05). However, in this group, there was a significant correlation between the first and the second factor of vocal fatigue index and voice handicap index (P < 0.05). CONCLUSION: The results of this study indicate the effect of vocal fatigue on the quality of life of university professors. University professors, like teachers, are exposed to voice disorders and, thus, complaints which leave impacts on their career and should be addressed as a group of professional voice users to prevent voice disorder among them.

Reliability, validity, and normative investigation of Persian version of a High-Level Language Test (BESS).

Our study aimed at reliability, validity, and normative investigation of the Persian version of the High-Level Language Test (BESS). This study was conducted on 60 multiple sclerosis (MS) patients as well as 60 healthy individuals. After translating the BESS into Persian, its content validity was determined based on 10 experts working in the same field. The reliability of the test was determined using techniques such as the test-retest method, Cronbach's alpha, and clinical validity. The content validity ratio (CVR) was higher than 0.62 for every subtest, and the content validity index (CVI) was between 0.1 and 0.8 for all subtests. Cronbach's alpha coefficient was between 0.70 and 0.93, and intraclass correlation coefficient (ICC) was between 0.80 and 0.96. Clinical validity results showed a significant difference between means of patients' scores and healthy subjects scores (p ≤ 0.005). The Persian version of BESS benefits from high reliability and validity values. Speech therapists can use the test to examine high-level language disorders in MS patients.

Dysphonia Characteristics and Vowel Impairment in Relation to Neurological Status in Patients with Multiple Sclerosis.

PURPOSE: In this study, we attempted to assess the phonation and articulation subsystem changes in patients with multiple sclerosis compared to healthy individuals using Dysphonia Severity Index and Formant Centralization Ratio with the aim of evaluating the correlation between these two indexes with neurological status. MATERIALS AND METHODS: A sample of 47 patients with multiple sclerosis and 20 healthy speakers were evaluated. Patients' disease duration and disability were monitored by a neurologist. Dysphonia Severity Index and Formant Centralization Ratio scores were computed for each individual. Acoustic analysis was performed by Praat software; the statistical analysis was run using SPSS 21. To compare multiple sclerosis patients with the control group, Mann-Whitney U test was used for non-normal data and independent-samples t test for normal data. Also a logistic regression was used to compare the data. Correlation between acoustic characteristics and neurological status was verified using Spearman correlation coefficient and linear regression was performed to evaluate the simultaneous effects of neurological data. RESULTS: Statistical analysis revealed that a significant difference existed between multiple sclerosis and healthy participants. Formant Centralization Ratio had a significant correlation with disease severity. CONCLUSION: Multiple sclerosis patients would be differentiated from healthy individuals by their phonation and articulatory features. Scores of these two indexes can be considered as appropriate criteria for onset of the speech problems in multiple sclerosis. Also, articulation subsystem changes might be useful signs for the progression of the disease.