A Comparison of the Dysphonia Severity Index and Singing Voice Handicap Index Between Trained and Untrained Male Iranian Traditional Singers.

OBJECTIVES: This study aimed to compare trained and untrained Iranian traditional singers on the Dysphonia Severity Index (DSI) and the Singing Voice Handicap Index. The second objective was to examine the relationship between the DSI and Persian version of the Singing Voice Handicap Index (P-SVHI) scores in each group of trained and untrained Iranian traditional singers. STUDY DESIGN: This study is a comparative cross-sectional study. METHODS: This study included 17 trained male Iranian traditional singers who were compared with 17 untrained ones who were matched in terms of age. The P-SVHI was completed by trained and untrained Iranian traditional singers. Measures of jitter, lowest intensity, highest phonational frequency, and maximum phonation time (MPT) were obtained from each participant. The DSI scores were calculated using these values. RESULTS: Trained male traditional singers had an average age of 33.76 ± 7.45 years, 3.24 ± 1.85 hours of daily practice, 5.24 ± 3.78 years of training, 3.06 ± 2.65 no. of professional performances, and untrained singers had an average age of 32.76 ± 12.92 years, 1.53 ± 1.17 hours of daily practice, and 0.88 ± 1.65 no. of professional performances. Trained singers had lower P-SVHI scores and sub-scores, longer MPT, higher F0 high, lower jitter, and lower I low, resulting in higher DSI values (P < 0.05). There was no significant correlation between P-SVHI scores and DSI values in each group of trained and untrained Iranian traditional singers (P > 0.05). CONCLUSIONS: The results of this study show that the vocal abilities of professional vocalists are enhanced through voice training (higher DSI scores in trained singers vs untrained ones). Voice training can also help to lessen the perception of a handicap related to the singing voice. Hence, it may be necessary to consider alternative norms for the DSI and P-SVHI when administering them to patients who have undergone guided vocal training, such as voice/singing lessons. The current research indicates that the perception of singing voice handicap and DSI values are two distinct characteristics that do not have a significant correlation.

Relationship Between Postural Asymmetry, Balance, and Pain in Children With Spastic Cerebral Palsy.

BACKGROUND: Primary symptoms of cerebral palsy (CP), such as spasm and weakness, can lead to secondary musculoskeletal problems. Exploring the interplay and impact of secondary symptoms is essential in CP management. METHODS: A total of 56 children (32 males and 24 females) aged eight to 12 years in level I to III of Gross Motor Function Classification System (GMFCS) completed The Pediatric Balance Scale and Wong-Baker Faces Scale and the Posture and Postural Ability Scale. Relationships between the three groups were examined using the Kruskal-Wallis test, Tukey test, gamma coefficient, De Somers D, phi coefficient, Cramér V, and one-way analysis of variance. RESULTS: There was a significant correlation between balance and postural asymmetry (P < 0.001), and no significant difference in balance was there between the severe and moderate asymmetry groups (P = 0.759) and between the mild asymmetry and no asymmetry groups (P = 0.374). Furthermore, there was a significant relationship between postural asymmetry and each of the variables of pain (P < 0.001) and gross motor function (P = 0.002). Although a meaningful correlation was identified between balance and gross motor function (P < 0.001), the relationship between postural asymmetry and balance in GMFCS levels was not found (P = 0.052, P = 0.052, P = 0.233). Conversely, no significant relationship was detected between pain and gross motor function (P = 0.072). SIGNIFICANCE: Postural asymmetry negatively impacts balance and correlates with pain intensity. Addressing postural problems can contribute to pain management and improved balance.

Prevalence of depression, stress and suicide tendency among individuals with long COVID and determinants: a protocol of a systematic review and meta-analysis.

BACKGROUND: It is well known that the COVID-19 pandemic has had a devastating impact on mental health, especially among individuals with long COVID. This systematic review and meta-analysis aims to investigate the prevalence of depression, stress and suicide tendencies among individuals with long COVID, as well as to explore the factors that contribute to these conditions. METHODS AND ANALYSIS: A comprehensive review of literature will be conducted in various databases of including PubMed, including Medline, Embase, PsycINFO, CINAHL and Cochrane Library. The studies to be included in this review will be published in the English language, and the time frame of included studies will be from the date of inception of COVID-19 until 30 December 2023. Two independent reviewers will identify studies for inclusion based on a screening questionnaire, and the JBI standardised critical appraisal checklist for studies reporting prevalence data will be used to assess the methodological quality. The strength of the body of evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. To analyse the data, a robust Bayesian approach will be applied using the STATA software package (V.14; STATA) and JASP software. The findings of this systematic review and meta-analysis will provide valuable insights into the prevalence of depression, stress and suicide tendencies among individuals with long COVID, as well as the factors that contribute to these conditions. ETHICS AND DISSEMINATION: There is no research ethics board approval required. The dissemination plan is to publish results in a peer-reviewed academic journal. PROSPERO REGISTRATION NUMBER: CRD42022346858.

Factors associated with smoking intensity among adult smokers: findings from the longitudinal cohort of the Tehran lipid and glucose study.

BACKGROUND: Smoking is a significant public health problem, and there is a scarcity of documents regarding its severity, particularly in developing countries. This study aimed to determine factors related to the number of cigarettes consumed daily by adult smokers in Tehran. METHODS: This study was conducted within the framework of the longitudinal study of Tehran Lipid and Glucose Study (TLGS). The study included 786 adult smokers living during four consecutive follow-ups from 2005 to 2016. The intensity of smoking was measured by the number of cigarettes consumed daily by adult smokers. Data analysis was done longitudinally and based on the mixed effects zero-inflated discrete Weibull (ZIDW) regression model. RESULTS: The mean age of the individuals was 40.35 ± 12.68 years, and 643 (81.8%) of them were men. Also, 52.7% of individuals were daily smokers, 15.6% were occasional smokers, and 31.7% were non-smokers who became smokers during the study. Variables of age 1.005 (95%CI: 1.001-1.008), gender of male 1.196 (95%CI: 1.051-1.39), and marital status (divorced/widowed vs. single) 1.168 (95%CI: 1.015-1.39) were positively associated with smoking intensity. Education level (master and higher vs. illiterate) 0.675 (95%CI: 0.492-0.926)), employment status (student vs. unemployed) 0.683 (95%CI: 0.522-0.917), (housewife vs. unemployed) 0.742 (95%CI: 0.606-0.895), (Unemployed with income vs. unemployed) 0.804 (95%CI: 0.697, 0.923), implementation of smoking prohibition regulations (yes vs. no) 0.88 (95%CI: 0.843-0.932), and history of cardiovascular disease in male relatives (yes vs. no) 0.85 (95%CI: 0.771-0.951) were associated with lower smoking intensity. CONCLUSION: We showed that demographic factors are associated with the intensity of smoking among adults and should be considered in policymakers' intervention programs to reduce smoking and quit smoking.

Modification of cortical electrical activity in stroke survivors with abnormal subjective visual vertical: An eLORETA study.

Objectives: Balance impairment is among the main complications of stroke. The gravity-based subjective vertical (SV) is considered an important reference for upright posture and navigation affected by stroke. The correlation between injury location and pathological perception of verticality remains controversial. This study aimed to evaluate the cortico-cortical network of vertical perception among patients with the right hemisphere stroke and abnormal visual-vertical perception compared with healthy individuals. Materials and methods: This observational cross-sectional study included 40 patients with the right hemisphere stroke and 35 healthy participants. All patients had abnormal visual-vertical perception. The EEG connectivity analysis was conducted through the exact low-resolution brain electromagnetic tomography analysis (eLORETA). Results: Stroke survivors manifested a power spectral density that reduced within the beta-2 frequency band in the left hemisphere and increased within the beta-3 frequency band in the right hemisphere compared with controls (p < 0.01). The lagged-phase synchronization was increased within alpha-1, beta-2, and beta-3 bands and decreased in stroke survivors compared with controls in the vestibular network involved in visual-vertical perception (p < 0.01). Conclusion: The results of this study demonstrated variations in the function and functional connectivity of cortical areas involved in the visual-vertical perception that are mainly located in the vestibular cortex.

Investigating the Effect of Leap Motion on Upper Extremity Rehabilitation in Children with Cerebral Palsy: A Randomized Controlled Trial.

In this randomized clinical trial, we look for the following questions' answer: How does the integration of LMC affect (1) upper extremity (UE) function, (2) grip strength, and (3) lateral and palmar pinch strength in children with cerebral palsy (CP), in comparison with conventional rehabilitation methods? Twenty patients were randomly assigned to LMC (case) or conventional (control) groups. The grip, lateral and palmar pinch forces increased in case group patients more than control group both at the end of intervention (P < .001 for all three), and at 20 weeks' follow-up (P values 0.035, 0.002, and 0.002). The Quality of Upper Extremity Skills Test (QUEST) score changes were similar between two groups, except for grasp score at the end of step 2 and 3 (P = .04 and 0.01, respectively). The addition of LMC to the rehabilitation program of patients with CP may improve the UE motor function outcomes.

Point-of-care salivary oxidative and renal functional markers to assess kidney function in reperfusion-induced acute kidney injury in male rats.

OBJECTIVES: Saliva is one of the most promising body fluids in the research of new biomarker for various diseases diagnosis. However, serial sampling in this condition is very dangerous and pose iatrogenic anemia with blood loss. This study was done to evaluate the cost-effectiveness of point-of-care salivary tests and identify the validity of salivary markers. METHODS: Rats were randomly assigned to four experimental groups: (1) control (2) IR-3 h (3) IR-6 h (4) IR-24 h. Both renal pedicles were occluded for 55 min and then were declamped to allow reperfusion for 3, 6 and 24 h in IR groups. After reperfusion, all rats received pilocarpine 1 mg/kg to collect saliva. Plasma samples were also collected. Renal parameters including Cr, uric acid, and urea, malondialdehyde (MDA) levels, Bax/Bcl2 ratio, nitrite/nitrate ratio, corticosterone levels and oxidant/antioxidant ratio were measured in both plasma and salivary samples. RESULTS: There were significant increased level of renal function parameters, MDA levels, Bax/Bcl2 ratio, nitrite/nitrate ratio and corticosterone in both saliva and plasma. The comparison of above parameters in both saliva and plasma showed significant correlation. CONCLUSIONS: This study demonstrated that concentrations of indices specifically renal functional parameters increase in saliva in the IR-induced kidney injury in male rats and result indicate the potential of saliva as a tool to monitoring AKI. Measurement of salivary parameters may can become reliable diagnostic tests for patients with AKI.

Cross-cultural Adaptation and Psychometric Evaluation of the Persian Version of the Satisfaction and Recovery Index (SRI): Structural Validity, Construct Validity, Internal Consistency, and Test-retest Reliability.

Background: The Satisfaction and Recovery Index (SRI) is a generic importance-weighted health satisfaction tool to measure the process and state of recovery following musculoskeletal injuries. The objectives of this study are (1) to translate and cross-culturally adapt the SRI to Persian and (2) evaluate its psychometric properties. Methods: The forward-backward translation technique was used for translation, and two rounds of cognitive interviews were conducted to assess cultural appropriateness. Participants (n=100, mean age=32.5, 82%male) had acute (i.e., <30 days) musculoskeletal injuries of any etiology. Structural validity, construct validity, internal consistency, and test-retest reliability were evaluated. Results: Participants identified issues in 3/6 areas of a coding system during the cognitive interviews: comprehension/clarity, relevance, and inadequate response definition. These issues informed subsequent changes to arrive at the final version of the SRI-P. The SRI-P had adequate construct validity (P<0.001), the confirmatory factor analysis demonstrated a two-factor structure, the internal consistency was acceptable (Cronbach's α=0.83), and it was deemed reliable (ICC2, 1=0.72). Conclusion: The psychometric evaluation revealed that the SRI-P has adequate construct validity, internal consistency, and test-retest reliability. Unlike the original English version, the SRI-P has a two-factor structure, which appears to be related to cultural differences in interpreting some of the items. The clinical importance of this study is that the SRI (which captures the state of recovery and how important the various items of the tool are to each patient and how satisfied they are with their recovery) can now be available to surgeons and therapists in the orthopedic and rehabilitation realms in Persian populations.

Effect of an Auditory Temporal Training Program on Speech Fluency of Children with Developmental Stuttering.

Objectives: The present study aims to investigate the effect of a temporal processing-based auditory training program on alleviating stuttering severity in children diagnosed with auditory temporal processing disorders. Materials & Methods: Thirty-one children with stuttering diagnosed with auditory temporal processing disorders participated in this study (intervention group: 17 participants between seven to 12 years old; control group: 14 participants between eight to 12 years old). The auditory temporal processing test and Stuttering Severity Instrument-3 (SSI-3) were examined before/after 12 sessions (nearly 540 minutes) of training and three months following the conclusion of the intervention. Results: According to the results, auditory temporal processing improved significantly in the intervention group after temporal processing-based auditory training. Besides, the differences between the intervention and control groups were significant (P<0.05). The improvement of auditory temporal processing skills remained stable in the post-training evaluation after three months (P>0.05). Although the SSI-3 score was somewhat improved in the intervention group, no significant difference was found between the two groups (P=0.984). Conclusion: The findings revealed that auditory temporal processing training acted as a complementary therapy alleviating the stuttering severity of children who stutter with auditory temporal processing disorders to some extent.

Multidimensional Voice Assessment After Management of Early Laryngeal Cancer: A Comparative Study.

Laryngeal Squamous Cell Carcinoma is one of the most common head and neck cancers, and patients experience dysphonia after treatment with transoral laser microsurgery (TLM) or radiotherapy (RT). This study aimed to investigate the multidimensional assessment of voice, based on objective and subjective evaluation. In this cross-sectional study, a group of 120 patients (mean = 57.59 years, SD = 4.87), including men (n = 116) and women (n = 4) with early laryngeal carcinoma, were divided into two groups; Patients who had undergone TLM (n = 60) or RT (n = 60). The multidimensional assessment of voice was conducted using the acoustic analysis, the dysphonia severity index (DSI), the Persian versions of Consensus Auditory Perceptual Evaluation of Voice, and the voice handicap index (VHI). Results revealed that objective voice assessment only shows differences (P < 0.001) in the DSI between TLM and RT groups, despite there being no significant differences (P = 0.196) in overall severity of voice disorder in comparison between them. Also, there is a significant difference (P < 0.05) based on the Emotional subscale of VHI, between irradiated and TLM-treated patients. This finding showed that TLM-treated patients with early laryngeal carcinoma had severe voice disorder compared to irradiated patients. In addition, radiotherapy has a greater impact on the emotions of patients with early glottic cancer.

Development and validation of the Autism Communicative Skills Questionnaire (ACSQ): An autism screening measure in Farsi.

There has been a steady increase in the number of children diagnosed with autism spectrum disorder (ASD) worldwide. However, screening tools that focus primarily on communicative development that are culturally sensitive and linguistically appropriate are needed, particularly in languages, such as Farsi, which is spoken in countries that may benefit from additional resources. Therefore, the purpose of this study was to develop and validate a screening tool, written in Farsi by Iranians, that focuses on communication and factors affecting the development of communication for children with autism. A variety of statistical analyses were conducted and implemented to assess the relevance of various questions related to communication, along with other behaviors that interfere with the development of communication, that may distinguish between children with and without ASD. Exploratory factor analysis was performed to examine the underlying structure of the Autism Communicative Skills Questionnaire (ACSQ). This study represents the first stage in the development of a comprehensive questionnaire to assist with the screening of areas that impact the development of social communication and are unique to ASD.

Therapeutic effects of CORM3 and NaHS in chronic kidney disease induced cognitive impairment via the interaction between carbon monoxide and hydrogen sulfide on Nrf2/HO-1 signaling pathway in rats.

Cognitive impairment is one of the major complications of chronic kidney disease (CKD). The present study aims to evaluate the protective effects of carbon monoxide (CO) and hydrogen sulfide (H2S) and their interactions on CKD-induced cognitive deficits by considering the Nrf2/HO-1 signaling pathway. Sixty rats were divided into six experimental groups: sham, five-sixth (5/6) nephrectomy (CKD), CKD + H2S donor (NaHS), CKD + CO-releasing molecule (CORM3), CKD + NaHS and zinc protoporphyrin IX (Znpp), CKD + CORM3 and amino-oxy acetic acid (AOAA). Eleven weeks after 5/6Nx, behavioral tests (Novel object recognition test, Passive avoidance test and Barnes maze test) were performed to evaluate the cognitive level. At the end of the twelfth week, blood urea nitrogen (BUN) and serum creatinine (sCr) levels, as well as the expression levels of nuclear factor-erythroid factor 2-related factor 2 (Nrf2) and heme oxygenase-1 (HO-1), and neuronal loss in the hippocampus and prefrontal cortex were evaluated. CKD caused enhancement of BUN and sCr, reduction of Nrf2 and HO-1 proteins and enhancement of neuronal loss in the hippocampus and prefrontal cortex. In addition, CKD led to cognitive disturbances and memory impairment. CORM3 and NaHS returned all above indices to the levels measured in the control group. However, improving effects of CORM3 on cognitive impairment and Nrf2/HO-1 signaling pathway were prevented by AOAA and decreased H2S level as well as reciprocally improving effects of NaHS on cognitive disturbances and Nrf2/HO-1 signaling pathway were prevented by Znpp and decreased CO level. In conclusion, this study demonstrated that formation of CO and H2S were interdependently improved CKD-induced cognitive dysfunctions, through interaction with Nrf2/HO-1 signaling pathway.

Assessing related factors to fasting blood sugar and glycosylated hemoglobin in patients with type 2 diabetes simultaneously by a multivariate longitudinal marginal model.

The multivariate marginal model can be used to simultaneously examine the factors affecting both FBS and HbA1c using longitudinal data. The model fitted to multivariate longitudinal data should prevent redundant parameter estimation in order to have greater efficiency. In this study, a multivariate marginal model is used to simultaneously investigate the factors affecting both FBS and HbA1c with longitudinal data for patients with type 2 diabetes in Northern Iran. The present research is a retrospective cohort study. Overall, 500 medical records with complete information were reviewed. The multivariate marginal model is used to determine the factors associated with FBS and HbA1c using longitudinal data. Data have been analyzed in R-3.4.0 using 'mmm2' package. Given that the coefficients for the interactions of rtype with the intercept, time, family history of diabetes, history of hypertension, history of smoking, insulin therapy, systolic/diastolic blood pressure and duration of disease at first visit are significantly different from zero (P < 0.05), the effect of the independent variables on the two response variables is different and different coefficients should be used for each. Therefore, the interactions of these variables with rtype are kept in the final model. The coefficients for the interactions of rtype with sex, age at first visit, history of high cholesterol, and weight are not significantly different from zero (P > 0.05), indicating that their effect on the two response variables is similar and only one coefficient should be used for each. We examined the similarity of coefficients when fitting the longitudinal multivariate model for the relationship between FBS/HbA1c and sex, age, history of high blood cholesterol, and body weight. If an independent variable has similar effects on both responses, only one coefficient should be estimated, which will increase the efficiency of the model and the reliability of the results.

Neural correlates of enhancing question asking and initiations in children with autism spectrum disorders: A Randomized Clinical Trial.

Children diagnosed with autism spectrum disorder (ASD) demonstrate challenges in various areas of social communication. The aim of this study was to examine the effect of Pivotal Response Treatment (PRT) targeting question-asking on brain activity in twenty 6-12-year-old autistic boys, using a Randomized Clinical Trial (RCT) design. Verbal children, diagnosed with autism, who lacked question asking in their communication were matched based on age and mean length utterance (MLU) and were randomly placed in either PRT intervention or treatment as usual (TAU) groups. Sessions were individually administered, lasting for 60 minutes 3 days a week for a two-month period. All children were tested before and after intervention to assess behavioral areas (questions, general communicative skills, and MLU) and both groups underwent electroencephalography for 10 minutes in open and closed eye resting-state conditions to assess neural correlates. Data were analyzed using covariance analysis and post-hoc using Mann-Whitney and Wilcoxon methods. Significant behavioral improvements in the PRT group were observed after intervention that correlated with changes in electroencephalography (EEG) oscillations at several brain regions compared to the TAU group. The results of this study support other studies suggesting collateral neural changes following the PRT.

Long latency auditory evoked potentials and object-related negativity based on harmonicity in hearing-impaired children.

Hearing-impaired children (HIC) have difficulty understanding speech in noise, which may be due to difficulty parsing concurrent sound object based on harmonicity cues. Using long latency auditory evoked potentials (LLAEPs) and object-related negativity (ORN), a neural metric of concurrent sound segregation, this study investigated the sensitivity of HIC in processing harmonic relation. The participants were 14 normal-hearing children (NHC) with an average age of 7.82 ± 1.31 years and 17 HIC with an average age of 7.98 ± 1.25 years. They were presented with a sequence of 200 Hz harmonic complex tones that had either all harmonic in tune or the third harmonic mistuned by 2%, 4%, 8%, and 16% of its original value while neuroelectric brain activity was recorded. The analysis of scalp-recorded LLAEPs revealed lower N2 amplitudes elicited by the tuned stimuli in HIC than control. The ORN, isolated in difference wave between LLAEP elicited by tuned and mistuned stimuli, was delayed and smaller in HIC than NHC. This study showed that deficits in processing harmonic relation in HIC, which may contribute to their difficulty in understanding speech in noise. As a result, top-down and bottom-up rehabilitations aiming to improve processing of basic acoustic characteristics, including harmonics are recommended for children with hearing loss.

The effectiveness of the combined transcranial direct current stimulation (tDCS) and tailor-made notched music training (TMNMT) on psychoacoustic, psychometric, and cognitive indices of tinnitus patients.

PURPOSE: Tinnitus network(s) consists of pathways in the auditory cortex, frontal cortex, and the limbic system. The cortical hyperactivity caused by tinnitus may be suppressed by neuromodulation techniques. Due to the lack of definitive treatment for tinnitus and limited usefulness of the individual methods, in this study, a combination of transcranial direct current stimulation (tDCS) over the dorsolateral prefrontal cortex (DLPFC) and tailor-made notched music training (TMNMT) was used. MATERIAL AND METHODS: In this descriptive-analytic study, 26 patients with chronic unilateral tinnitus of the right ear were randomly divided into the clinical trial group (CTG) and the control group (CG). In both groups, six sessions of tDCS with 2 mA intensity for 20 min, with anode on F4 and cathode on F3, were conducted. Simultaneous with tDCS sessions, and based on TMNMT, the participant was asked to listen passively for 120 min/day, to a CD containing her/his favorite music with a proper notch applied in its spectrum according to the individual's tinnitus The treatment outcome was measured by, psychoacoustic (loudness-matching), psychometric (awareness, loudness and annoyance Visual Analogue Scale (VAS) scores, and Tinnitus Handicap Inventory (THI)) scores, and cognitive assessments (randomized dichotic digits test (RDDT) and dichotic auditory-verbal memory test (DAVMT)). Repeated measurement test was used for statistical analyses. RESULTS: In the CTG, the tinnitus loudness and annoyance VAS scores, and THI were reduced significantly (p = 0.001). In addition, the DAVMT and RDDT scores were enhanced (p = 0.001). Such changes were not observed in the CG (p > 0.05). CONCLUSION: The combination of tDCS and TMNMT led to a reduction in the loudness, awareness, annoyance, and also disability induced by tinnitus in CTG. Furthermore, this method showed an improvement of cognitive functions (auditory divided attention, selective attention and working memory) in the CTG.

The Effect of Teaching Initiations on the Communication of Children with Autism Spectrum Disorder: A Randomized Clinical Trial.

This study examined the effect of Pivotal response treatment (PRT) to improve verbal initiations in children with Autism Spectrum Disorder, age 6-12 years old, using a Randomized Clinical Trial design. Intervention was conducted three times a week for 2 months, for a total of 24 one-hour sessions. The PRT intervention taught a variety of questions and attention/assistance-seeking initiations. The treatment as usual (TAU) group received standard language intervention. Results showed that the PRT group made significant improvements in their number of verbal initiations as well as collateral gains in general communicative skills and mean length of utterance (MLU) compared to the TAU group. Theoretical implications of including motivational approaches to develop social initiations are reviewed.

Different Effects of Aerobic Exercise and Diaphragmatic Breathing on Lower Esophageal Sphincter Pressure and Quality of Life in Patients with Reflux: A Comparative Study.

BACKGROUND Gastroesophageal reflux disease (GERD) is a worldwide disorder with an increasing prevalence. The quality of life (QOL) of the patients may be influenced by reflux disease. Diaphragmatic breathing (DB), as well as aerobic exercise (AE), may improve the symptoms of reflux disease, although it remains a controversial issue. The aim of this study was to compare the effects of AE and DB on QOL and lower esophageal sphincter (LES) pressure of patients with moderate to severe reflux. METHODS This was a case-control study that was conducted for 8 weeks among patients with moderate to severe GERD. The block randomization method was designed to randomize patients into three groups (AE, DB, and control) to achieve equal sample sizes. The control group received omeprazole 20 mg once daily. The other groups, in addition to omeprazole, received AE and DB. QOL and LES pressure were measured before and after the study by Questionary and Manometry method, respectively. RESULTS 75 patients were enrolled in this study. Positive effects of DB on LES pressure was approved (p = 0.001). DB had significantly more effects on QOL than aerobic exercise (p = 0.003). AE can significantly improve QOL in patients (p = 0.02) but no significant change in LES pressure (p = 0.38). There was no change in the control group for both variables. CONCLUSION AE had no effects on LES pressure but can improve QOL of the patients. DB had more effects on QOL than AE, so injured or disable patients with reflux who cannot do AE, can benefit from DB to improve their reflux symptoms.

Overload of anxiety on postural control impairments in chronic stroke survivors: The role of external focus and cognitive task on the automaticity of postural control.

BACKGROUND: Despite the high prevalence of anxiety among chronic stroke survivors and evidence of its negative effects on postural control in healthy subjects, it is unclear whether anxiety also affects postural control in these patients. Recent evidence of improved postural control of healthy subjects by distracting the attention using an external focus (EF) or cognitive task, raises the question of whether similar benefits would be observed in stroke survivors. Thus, the current study aimed to investigate the effects of anxiety and distracting the attention on postural control of chronic stroke survivors in terms of both postural sway measures and neuromuscular regulation. METHODS: Postural sway measures and ankle muscle activity of chronic stroke survivors with the high and low level of anxiety (HA-stroke (n = 17), and LA-stroke (n = 17), respectively) and age-, sex-, height-, and weight-matched healthy subjects (n = 17) were assessed while standing on rigid and foam surfaces under following conditions: baseline, internal focus (IF), EF, simple and hard cognitive tasks (SC and HC, respectively). RESULTS: Stroke survivors, particularly HA-stroke participants, showed greater postural sway measures (i.e. postural instability) and enhanced co-contraction of ankle muscles (i.e. stiffening of the neuromuscular system) compared with healthy subjects. As opposed to baseline and IF conditions, postural instability and neuromuscular stiffening significantly reduced in EF condition and decreased more in cognitive task conditions, particularly HC condition. CONCLUSIONS: The results suggest that anxiety enhances stroke-induced postural instability promoting improper neuromuscular control of posture with stiffening strategy, which can be alleviated by EF and cognitive tasks.

The effect of harmonic training on speech perception in noise in hearing-impaired children.

OBJECTIVE: Speech perception in noise is a highly challenging situation experienced by hearing-impaired children (HIC). Despite advances in hearing aid technologies, speech perception in noise still poses challenges. Pitch-based training improves pitch discrimination and speech perception and may facilitate concurrent sound segregation. Considering the role of harmonics in the analysis of concurrent sounds, we performed a harmonic assessment, examined the role of harmonic training in the rehabilitation of moderate-to-severe HIC, and investigated its effect on their speech perception in noise. METHODS: The participants were 57 normally hearing children (NHC) with a mean age of 7.73 ± 1.57 years and 18 HIC with a mean age of 7.94 ± 1.47 years. The two groups were compared in terms of harmonic assessment, the Pitch Pattern Sequence Test (PPST), the Consonant-Vowel in Noise (CV in noise) test, and the Bamford-Kowal Bench (BKB) test. Subsequently, the HIC underwent harmonic training, and the results of the pre- and post-harmonic training assessments were compared. RESULTS: HIC displayed poorer harmonic discrimination than NHC at all harmonics (P < 0.05). They also showed lower scores in PPST, CV in noise, and BKB tests compared to NHC (P < 0.05). Harmonic training led to HIC's better performance in harmonic assessment, PPST, and CV in noise test (P < 0.05). However, the BKB test results pre- and post-training did not significantly differ (P > 0.05). CONCLUSION: Harmonic training plays a significant role in improving the HIC's temporal processing of the PPST and CV in noise test; therefore, it can serve as a rehabilitation method to enhance temporal processing and auditory scene analysis.