Comparative Study of the Effect of Experience on Auditory Processing Abilities in Voice Therapists and Other Speech-Language Pathologist in Auditory Perceptual Judgment of Voice.

OBJECTIVE: This study aimed to compare the effect of experience on central auditory processing skills in voice therapists and other Speech-Language Pathologists in the auditory perceptual evaluation of voice. STUDY DESIGN: This research is a descriptive-analytical cross-sectional observational study. METHODS: Our study population includes three groups; first-year speech-language pathology students who have not undergone any training or education in the evaluation of auditory samples (group 1; n = 10), Speech-Language Pathologists who do not have any activity in the field of voice disorders (group 2; n = 10), and therapists who have at least 2 years of experience in auditory-perceptual judgment (group 3; n = 10). Initially, the participants underwent a basic audiological evaluation (Pure Tone Audiometry, Speech Recognition Threshold, Speech Discrimination Score, tympanometry, and acoustic reflex) to assess peripheral hearing. In the next step, the auditory processing skills of the participants were evaluated with the Buffalo model (staggered spondaic word (SSW) test, phonemic synthesis test (PST), speech in noise (SPN) test). In the third step, four recorded voice samples of patients with voice disorders and healthy individuals were randomly selected for auditory perceptual judgment. These samples were the same for all participants. All the voices were previously subjected to auditory perceptual analysis by two Speech-Language Pathologist who had at least 6 years of experience in the evaluation and treatment of voice disorders; the voices were played for participants to assess auditory perception using the grade, roughness, breathiness, asthenia, strain (GRBAS) scale. RESULTS: All subjects had normal hearing and auditory processing abilities but there were some differences among the groups in processing skills. A difference was found in the SSW-qualifier and SPN-R components between the three groups. The third group had significant differences with the other two groups in the evaluation of auditory perception in the components of R, B, and S (from the GRBAS scale) in voice number one, and the components of G, R, and A in voice number three. In voice number two, there was a correlation between the SSW order effect component and the G component, as well as between the PST component and the A component. In voice number three, there was a correlation between the SPN-L component and the G component, and between the SSW condition, SSW qualifier, and SSW All errors components with the S component. In voice number four, there was a correlation between the SSW-RC, SSW-LC, SSW condition, SSW competing, and SSW order effect components with the A component. Lastly, there was a correlation between the SSW order effect and SSW type A components with the R component in voice number three in group three. CONCLUSION: The results of the present study indicate that experience has an impact on auditory processing skills and the participants of the third group, who had more experience in the evaluation of voice disorders obtained better scores than the other two groups in the auditory processing skills. Additionally, the level of experience is related to the accuracy of auditory perceptual judgment of voice. The participants of the third group performed better than the other two groups, and the performance of the first and second groups was almost the same.

The Effect of Combined Intervention on Improvement of Early Lexical Development in Minimally Verbal Children with Autism Spectrum Disorder.

Background: Autism spectrum disorder (ASD) is a neurodevelopmental disorder defined by severe communication deficits and limited and repetitive behavioral tendencies. There are several treatment approaches and methods for minimally verbal children with ASD; nonetheless, there is inconclusive evidence about how early lexical development could be improved. The present study aimed to investigate the effect of combined intervention derived from the principles of different theories-including contemporary behaviorism, schemas, sociocultural, and event representation theories-to improve early lexical development in minimally verbal children with ASD. Methods: In this single-group pretest-posttest study, 10 children with ASD (mean age, 47.9 ± 8.3 months), including 7 boys and 3 girls, participated. Participants received 16 intervention sessions in 8 weeks. The combined intervention consisted of various methods derived from contemporary behaviorism, schemas, sociocultural, and event representation approaches. The MacArthur-Bates Communicative Development Inventory 1 (Infant form) assessed early lexical development before and after intervention and after a 2-month follow-up. The Friedman test was used to analyze the data, and pairwise comparisons were performed with the Will-Coxon test. Cohen's d was used to investigate the effect sizes. Results: Significant increases in expressive vocabulary (P < 0.001) and receptive language (P < 0.001) were seen after the end of the intervention and at the follow-up (P = 0.005). Large effect sizes were found for expressive vocabulary (d = 3.7) and receptive vocabulary (d = 2.17). Conclusion: This study suggests that the combination of intervention based contemporary behaviorism, schemas, sociocultural, and event representation approaches improved receptive and expressive vocabulary in minimally verbal children with ASD.

Cross-cultural Adaption, Validation and Factor Analysis of the Persian Version of the Eating Assessment Tool: EAT-10.

The eating assessment tool (EAT-10) is a self-reported questionnaire to assess the patient's perception of swallowing difficulties. The aim of this study was to cross-culturally adapt and determine validity and reliability of the Persian version of the EAT-10 (P-EAT-10) in patients with oropharyngeal dysphagia. The EAT-10 was translated into Persian language and cross-culturally adapted. One hundred patients with dysphagia (mean age ± SD = 44.44 ± 14.69 years) participated. The test-retest reliability (time interval = 7 days) was assessed in 50 patients. Intraclass correlation coefficient (ICC), standard error of measurement (SEM) and smallest detectable change (SDC) were analyzed. The Persian version of functional oral intake scale (FOIS-P) was also recorded to assess construct validity. One hundred healthy subjects completed the P-EAT-10 for clinical validity. Factor analysis was performed to determine the P-EAT-10 structure. There were no missing responses and floor or ceiling effects. Internal consistency was high (Cronbach's α 0.91). Item-total correlations exceeded acceptable standard of 0.3 for the all items (0.62-0.83). The test-retest reliability was excellent [(ICC)agreement 0.96]. The SEM and SDC were 2.61 and 7.23, respectively. Construct validity was confirmed by a significant correlation between the P-EAT-10 and FOIS-P scores (r = 0.84). Clinical validity was supported by a significant discrimination between patients and healthy subjects (t = 29.97, P < 0.001). Factor analysis indicated 2 components for the P-EAT-10. The P-EAT-10 is a valid and reliable tool and can be used in clinic and research for the assessment of oropharyngeal dysphagia in Persian-speaking patients.

The effect of breathing exercises combined with manual therapy on muscle tension dysphonia in traditional singers: a blinded randomized controlled trial.

BACKGROUND: Muscle tension dysphonia (MTD) is common in traditional singers and can lead to serious complications, but there is inconclusive evidence about how MTD should be treated in singers as professional voice users. This study was conducted to investigate the effects of breathing exercises combined with manual therapy versus breathing exercises and manual therapy on voice quality in traditional singers suffering from MTD. METHODS: In this blinded randomized clinical trial, 60 patients with MTD were randomly allocated to four groups: (1) breathing exercises, (2) manual therapy, (3) combined intervention (CI) and (4) control. Patients received treatments for 13 sessions, once per week. Treatment effects were assessed in terms of primary outcome measures: (1) breathing performance, measured by maximum phonation time (MPT) and (2) laryngeal function, measured by Stroboscopy Evaluation Rating Form (SERF). Secondary outcome measure was patient's self-perceived voice handicap, measured by Persian version of Singing Voice Handicap Index (SVHIp). All outcome variables were measured before and after treatment. The between group comparisons on MPT and SVHIp score were investigated using analysis of covariance (ANCOVA). The Kruskal-Wallis non-parametric test was used for between group comparisons of SERF items. RESULTS: Three treatment groups had improved regarding breathing performance, laryngeal function and voice handicap over the time (P < 0.01). The improvements achieved in all outcomes were significantly greater in the CI group than those of the breathing exercises, manual therapy and control groups. CONCLUSIONS: This randomized controlled trial showed that the combination of breathing exercises and manual therapy significantly improved the laryngeal function, breathing performance and voice handicap in traditional singers suffering from MTD. TRIAL REGISTRATION: IRCT2015102524686N1.

The effect of non-nutritive sucking combined with oral motor stimulation and oral support on feeding performance in premature infants: A single-blind randomized-clinical trial.

PURPOSE: Feeding problems are common in premature infants (PIs) and may lead to negative consequences such as malnutrition, dehydration, excessive weight loss, as well as developmental and psychological deficits. Moreover, they are associated with increased length of hospital stay/cost. There is not enough evidence on how feeding problems should be treated in PIs. The goal of this study was to investigate the effects of non-nutritive sucking combined with oral motor stimulation and oral support on feeding performance in PIs. METHODS: A single-blind randomized clinical trial was performed on 44 PIs with feeding problems. Patients were randomly categorized into two groups: (1) combined intervention (CI) and (2) non-nutritive sucking (NNS). The CI group received NNS, oral motor stimulation and oral support simultaneously. Infants in both groups received 14 treatment sessions for 14 consecutive days. The Preterm Oral Feeding Readiness Assessment Scale (POFRAS) was used as the primary outcome measure. Weight, volume of milk intake, time to achieve full oral feeding, and length of hospital stay were secondary outcome measures. All measures were assessed before treatment, after the 7th session, after the 14th session, and after 7 days after the end of treatment. RESULTS: Both groups improved in all outcome measures across time (P < 0.001). The improvements in the POFRAS, volume of milk intake, and time to achieve full oral feeding were significantly greater in the CI group than the NNS group (P < 0.001). The improvements attained in weight and length of hospital stay were not significantly different between the CI and NNS groups (P > 0.05). Large effect sizes were found for POFRAS score in both CI (d = 3.98) and NNS (d = 2.19) groups. CONCLUSION: The current study showed that the combined intervention including NNS, oral motor stimulation, and oral support significantly improved the feeding performance in PIs.

Dysphagia In Multiple Sclerosis Patients: Diagnostic And Evaluation Strategies.

Dysphagia after multiple sclerosis (MS) is a common disabling symptom which can lead to serious complications. Regular screening and assessment of dysphagia in patients with MS are important. Using valid and reliable instruments to measure dysphagia in MS patients is a crucial component in clinical practice and of research quality. There are various strategies to diagnose and assess the dysphagia in patients with MS. Screening strategies are for early diagnosis of the dysphagia. Clinical, non-instrumental strategies are used to verify the presence and to determine the severity and cause of dysphagia. Instrumental strategies are complementary to clinical examination to provide objective data on the various aspects of swallowing dysfunctions. This review revealed a few validated tools for dysphagia assessment in MS. The Dysphagia in Multiple Sclerosis Questionnaire (DYMUS) and the Mann Assessment of Swallowing Ability (MASA) are the only validated MS-specific dysphagia tools. Further development of valid and reliable MS-specific screening and assessment tools that can be administered rapidly and scored easily to detect dysphagia and evaluate clinical outcomes in adults with MS is imperative. Until then, validation and metric evaluation of the screening and assessment tools currently available are required.

Effects of Dysphagia Therapy on Swallowing Dysfunction after Total Thyroidectomy.

INTRODUCTION: Swallowing disorder or dysphagia is a common complication after conventional total thyroidectomy. Traditional dysphagia therapy (TDT) has long been a routine rehabilitation program for patients with dysphagia; however, there is no evidence to support the efficacy of this approach in patients with post-thyroidectomy dysphagia. Regarding this, the purpose of the current study was to explore the effectiveness of TDT in swallowing dysfunction in patients suffering from post-thyroidectomy dysphagia. MATERIALS AND METHODS: This pilot clinical trial was conducted on 21 patients with post-thyroidectomy dysphagia. The study population was randomly assigned into two groups of TDT and control. The patients in the TDT group received 18 treatment sessions for 6 weeks, 3 times a week. The Swallowing Impairment Score (SIS-6), Functional Oral Intake Scale (FOIS), and Persian Dysphagia Handicap Index (P-DHI) were the outcome measures. The outcome variables were assessed at the baseline, at the end of the treatment, and after a 6-week follow-up. The main effects of time and group and their interaction effect on SIS-6 and P-DHI scores were examined using repeated measures ANOVA. In addition, the intergroup comparison in terms of the FOIS score was analyzed using the Mann-Whitney U test. The Cohen's d effect size was also measured to ascertain the effects of the treatment. RESULTS: According to the results, the TDT group showed a significant improvement in the SIS-6, FOIS and P-DHI scores over time (P<0.001). The results also revealed that the interaction effect of time and group was significant on SIS-6 and P-DHI scores (P<0.001). In addition, effect sizes on SIS-6, FOIS, and P-DHI scores were large in the TDT group. CONCLUSION: This study suggested that TDT could improve the swallowing dysfunction in the patients suffering from post-thyroidectomy dysphagia. As the results indicated, the improvements persisted 6 weeks after the end of TDT.

The effect of traditional dysphagia therapy on the swallowing function in patients with Multiple Sclerosis: A pilot double-blinded randomized controlled trial.

BACKGROUND: Dysphagia is common following Multiple Sclerosis (MS) and is associated with significant morbidity and mortality. The current rehabilitation program to swallowing therapy is Traditional Dysphagia Therapy (TDT), but there is a dearth of evidence about its effectiveness in MS patients. OBJECTIVES: This study was aimed to determine the effects of the TDT on the swallowing function in MS patients with dysphagia. METHODS: A pilot double blind randomized clinical trial was carried out on 20 patients with MS. Patients were randomly divided into experimental group (TDT) comprising sensorimotor exercises and swallowing maneuvers, and Usual Care (UC) comprising diet prescription and postural changes. Patients in both groups received treatments for 6 weeks, 18 treatment sessions, 3 times per week, every other day. The Mann Assessment of Swallowing Ability (MASA) was the main outcome measure. The swallowing ability was assessed before treatment (T0), after the end of 9th session (T1), after the end of 18th session (T2), and after 6 weeks follow-up (T3). Penetration-Aspiration Scale (PAS) and Pharyngeal Residue Rating Scale (PRRS) as secondary outcome measures were applied at T0 and T2. RESULTS: Both groups had improved regarding MASA, PAS and PRRS scores over the time (P < 0.001). The improvements achieved in all outcomes were significantly greater in the TDT group than those of the UC group. The Main effect of the Time × Group interaction was significant for MASA score (P < 0.001). The large effect sizes were found for MASA score in both the TDT (d = 3.91) and the UC (d = 1.11) groups. CONCLUSIONS: This pilot randomized controlled trial showed that the TDT significantly improved the swallowing function of the MS patients with dysphagia.

The effect of repetitive transcranial magnetic stimulation combined with traditional dysphagia therapy on poststroke dysphagia: a pilot double-blinded randomized-controlled trial.

Dysphagia following stroke is common and can lead to severe complications such as aspiration pneumonia, but there is inconclusive evidence on how poststroke dysphagia should be treated. This study aimed to investigate the effects of repetitive transcranial magnetic stimulation (rTMS) combined with the traditional dysphagia therapy on the swallowing function in patients with poststroke dysphagia. In this pilot double-blind randomized clinical trial, 18 patients with poststroke dysphagia were allocated randomly to three groups: (i) traditional dysphagia therapy, (ii) rTMS, and (iii) combined intervention. Patients received traditional dysphagia therapy for 18 treatment sessions three times per week. The inhibitory rTMS was applied to the intact cerebral hemisphere at 1 Hz with a train of 1200 for 5 consecutive days. The patients in the combined intervention group received traditional dysphagia therapy and rTMS simultaneously. The Mann Assessment of Swallowing Ability (MASA) and Functional Oral Intake Scale were performed before treatment, after the end of the fifth session, after the end of the 10th session, after the end of the 15th session, and after the end of the 18th session. All groups had improved on MASA and Functional Oral Intake Scale scores over time (P<0.01). The improvements achieved in all outcomes were significantly greater in the combined intervention group than those of the traditional dysphagia therapy and rTMS groups. The large effect sizes were found for the MASA score in all groups: traditional dysphagia therapy group (d = 3.57), rTMS group (d = 2.67), and combined intervention group (d = 3.87). This pilot randomized-controlled trial showed that the combination of rTMS and traditional dysphagia therapy significantly improved swallowing function in patients with poststroke dysphagia.

Cross-cultural adaption and validation of the Persian version of the SWAL-QOL.

The aim of this study was to translate and cross-culturally adapt the swallowing quality-of-life questionnaire (SWAL-QOL) to Persian language and to determine validity and reliability of the Persian version of the swallow quality-of-life questionnaire (PSWAL-QOL) in the patients with oropharyngeal dysphagia.The cross-sectional survey was designed to translate and cross-culturally adapt SWAL-QOL to Persian language following steps recommended in guideline. A total of 142 patients with dysphagia (mean age = 56.7 ±â€Š12.22 years) were selected by non-probability consecutive sampling method to evaluate construct validity and internal consistency. Thirty patients with dysphagia were completed the PSWAL-QOL 2 weeks later for test-retest reliability.The PSWAL-QOL was favorably accepted with no missing items. The floor effect was ranged 0% to 21% and ceiling effect was ranged 0% to 16%. The construct validity was established via exploratory factor analysis. Internal consistency was confirmed with Cronbach α >0.7 for all scales except eating duration (α = 0.68). The test-retest reliability was excellent with intraclass correlation coefficient (ICC) ≥0.75 for all scales.The SWAL-QOL was cross-culturally adapted to Persian and demonstrated to be a valid and reliable self-report questionnaire to measure the impact of dysphagia on the quality-of-life in the Persian patients with oropharyngeal dysphagia.

Prevalence and predictors of dysphagia in Iranian patients with multiple sclerosis.

Background: Dysphagia is frequently observed in patients with multiple sclerosis (MS). Dysphagia and its complications are common causes of morbidity and mortality in final stages of MS disease. This study aimed at determining the prevalence of dysphagia in Iranian patients with MS and identifying predictors associated with dysphagia. Methods: A total of 230 MS patients were enrolled in this cross-sectional study. Dysphagia was evaluated using Mann Assessment of Swallowing Ability (MASA). Demographic characteristics (age and gender), duration of the disease, disease course, and Expanded Disability Status Scale (EDSS) were recorded for all participants. Results: In total, dysphagia was found in 85 participants (37%) with mild to severe dysphagia (mild 50.6%; moderate 29.4%; and severe 20%). The logistic regression model demonstrated that disability status in EDSS (OR= 2.1; 95% CI 0.5-1.2) and disease duration (OR= 2.3; 95% CI 0.4-1.1) predicts a high risk for dysphagia in MS patients. Conclusion: Dysphagia is prevalent in Iranian patients with MS. Disability level and disease duration are significant predictors of dysphagia after MS.