Urdu Receptive Language Scale (URLS): Modification & development of protocol for administration in Urdu.

Objective: To conduct pretesting of Urdu Receptive Language Scale (URLS) for scale modification and development of protocol for administration on children. Methods: This exploratory research was conducted from December 2021 to June 2022 in Lahore, Pakistan. Objective was achieved by pretesting in three steps including literature review, expert review and pilot testing on infants, toddlers and children aged 0-6 years utilizing purposive sampling technique. For expert review five experts' speech language pathologists with minimum five years of experience and for pilot study 48 normal developing children age range birth to six years were recruited. The analysis was done using content validity ratio, content validity index and Cronbach alpha. Protocol for administration of test items and stimulus with minimum three correct responses among four children's responses were finalized. Results: Of the 59 items, 57 with CVR = 0.99 were retained. Item number 3 (age 6-11 months) and item 5 (age 3.6-3.11 years) were eliminated as CVR was <0.99. CVI was one for retained items indicating acceptable validity. Cronbach's alpha was 0.95 indicating high level of internal consistency for the scale. Task groups of protocol of administration directions included: Selection of scale items, testing environment, seating arrangements, rapport building and involving the caregiver, handling the scale material and scoring the task responses. Conclusion: The modified 57 items has high validity and internal consistency with suitable protocol of administration. It is linguistically appropriate for the application on larger scale with children of different cultural backgrounds in Pakistan.

Treatment approaches to Motor Speech Disorders: A step towards Evidence Based Practice.

Motor Speech Disorders is an umbrella term for a set of separate dysfunctions of speech outcome associated with neurological disorders. Motor speech disorders (MSD) are classified as Speech Motor delay (SMD), Childhood dysarthria (CD), Childhood Apraxia of Speech (CAS), and Concurrent CD and CAS. The incidence and prevalence of MSD in population is uncertain. A research gap exists, making evidence-based practice questionable as regards intervention for MSD and is an area of research. Hence, current narrative review was conducted to review and highlight treatment of MSD since evidence-based treatment approach may benefit patient even years after a brain lesion. To achieve this objective literature search was conducted using search engines and data bases including google, google scholar, web of science & PubMed from 1998 to 2023 with keywords "motor speech disorder, dysarthria, apraxia, speech motor delay and combinations of these words with English language and no other limitations. Our search revealed 170 articles, news, publications of which 34 were used for review (Fig.1).

Cochlear duct length in Pakistani cochlear implant recipients gender, age and side association: A Radiological Measure.

Objectives: To analyze the gender, age and side association of cochlear duct length in Pakistani-Asian cochlear implant recipient population based on computed tomography imaging study. Methods: Current study retrospectively studied charts of cases who underwent cochlear implantation at the Department of Otolaryngology & Auditory Implant Centre, Capital Hospital Islamabad, over a period of two years from 1st May 2017 to 30th April 2019. These included 200 cases of both genders and of any age. In addition to basic demographic data, computed tomography findings of the temporal bone were utilized to measure the cochlear duct length. Data was analyzed using SPSS Version 23. Results: Study revealed a mean Cochlear duct length of 29.935±2.173mm (range: 25.12 to 37.60) with significant (p<0.001) association with gender with longer cochlear duct in males compared to females on right (30.50±2.384 vs. 29.36±1.887) and on left side (30.50±2.236 vs.29.32±1.935). However, no significant difference was noted for side with slightly longer cochlear duct on the right side compared to left (29.95±2.224 vs.29.92±2.171). Also, no significant association with age was noted with p=0.578 & p=0.824 for right and left side respectively. Conclusion: Pakistani population is characterized by a short mean CDL of 29.935±2.173 mm with significant association (p<0.001) with gender with longer cochlear duct length in males; and side with larger CDL on right side. However, no significant association with age was noted.

World Health Organization Success In Rehabilitation 2030 Including Refugees' Rehabilitation Across South Asia: A Narrative Review.

Despite acknowledging the inadequacy of rehabilitation systems to meet the ever-increasing burden of disability, the World Health Organization's Rehabilitation 2030 initiative has not highlighted nor adequately analysed the deficiencies of the rehabilitation care structures of populous countries in South Asia. The pragmatic and operational realisation of the initiative is not high in terms of visibility in developing countries with fragmented rehabilitative care structures. Hence, the current narrative review was planned to highlight the spectrum of rehabilitation healthcare in the perspective of Sustainable Development Goal-3 with reference to the most populous South Asian countries, including Pakistan. A total of 40 relevant English-language articles, publications, reports and online resources were reviewed. The narrative review is significant since it may result in mainstreaming the individuals with disabilities, improving their quality of life, enhance their productivity and lessen the burden and socio-economic costs of disability on the community. For current study, 40 relevant, English-language, articles, publications, reports and online resource were reviewed.

Vocal health of parents of children with hearing assistive devices.

Background & Objectives: VH (Vocal health) is the need of the hour. VH of parents of children with hearing assistive devices (HAD) reveals a literature gap, during the habilitation process of their children. To explore the vocal health of parents of children with hearing assistive devices. Methods: This cross-sectional study was conducted at Riphah International University from September to December 2021. Study recruited N=384 parents of Hearing Impaired children (HIC) using HAD for at least two years, of both genders and aged 2-9 years using convenience sampling. Voice-related quality of life (V-RQOL), and vocal health Index (VHI) -10 were used for data collection. Data was analyzed on SPSS Version 25. Descriptive statistics, Anova and t-test were utilized to see difference between means of groups. P<0.05 shows significant-results. Results: Parents of children using hearing assistive devices had excellent V-RQOL score in 350(91.14%) parents. There was no significant difference in V=RQOL as regards type of hearing assistive device use (p=0.102), laterality of device use (p=0.918) and degree of hearing loss (p=0.143). However, type of hearing loss revealed significant difference (p=0.021). Also VHI score revealed significantly (p=0.008) lower means in parents of children with cochlear implants. Conclusion: Current study concludes that the parents raising hearing impaired children with hearing assistive devices, possess good vocal health as determined by VHI and V-RQOL scores with only a very small number of parents reporting vocal symptoms.

Post-Stroke Swallowing And Communication Complications: Prevalence And Association With Comorbid Conditions And Risk Factors.

A cross sectional study utilising convenience sampling was conducted to determine the co-morbidities and risk factors in post stroke patients with swallowing and communication complications. The study recruited 150 diagnosed cases of stroke with no gender and age limitation from Combined Military Hospital, Fatima Memorial Hospital, and Mayo Hospital, Lahore, from January to June 2015. Glasgow coma scale, Modified Massey Bedside Swallow Screener, informal clinical assessment by SLP, and medical history sheet were employed for data collection, while the data was analysed using SPSS -23. Results revealed 103 (68.7%) patients with swallowing and 99 (66%) with communication difficulties. Swallowing issues revealed significant association with age (p=.016); history of stroke (p=.017), smoking (p=.004), alcohol intake (p=.035), diabetes mellitus (p=.003), and GCS (p=.009). Communication difficulties had significant association with hypertension (p=.029), GCS (p=.000). Hence, stroke related dysphagia is associated with diabetes mellitus; level of consciousness, previous history of stroke, smoking, alcohol abuse, and age, while communication issues are associated with hypertension and level of consciousness.

Dysphagia and obstructive sleep apnoea in post-extubated intensive care unit patients.

OBJECTIVE: To determine the relationship between dysphagia and obstructive sleep apnoea and its association with age, gender and Glasgow Coma Scale in post-extubated patients in an intensive care setting. METHODS: The correlational study was conducted from July 1 to October 31, 2021, at the intensive care unit of Evercare Hospital, Lahore, Pakistan, and comprised post-extubated patients of either ender aged 45-70 years within 72 hours following extubation and having Glasgow comma scale score 11-15. Gugging Swallowing Screen and Obstructive Sleep Apnoea questionnaires were used for data collection. Data was analysed using SPSS 25. RESULTS: Of the 29 patients with a mean age of 57.45±8.74 years, 18(62.1%) were males. There was a significant correlation between dysphagia and obstructive sleep apnoea (p=0.005). The Obstructive Sleep apnoea score had a significant negative correlation with Glasgow Coma Scale score (p=0.01), while dysphagia revealed a significant positive correlation (p<0.001) with Glasgow Coma Scale score. Age and gender had no significant association with either dysphagia or obstructive sleep apnoea (p>0.05). CONCLUSIONS: There was a significant correlation between dysphagia and obstructive sleep apnoea in post-extubated patients under intensive care. Both dysphagia and obstructive sleep apnoea had a significant correlation with Glasgow Coma Scale score.

Hearing impairment and its impact on children and parents in Pakistan.

Background: Hearing impairment and its consequences in children are often worsened by late identification in Pakistan. Deep-rooted cultural beliefs make some parents reluctant to seek clinical treatment, making adaptable solutions that traverse levels of socio-ecological model necessary. Aims: To determine the impact of hearing impairment on children's participation in social activities, and the financial burden on their parents. Methods: This cross-sectional study included 377 parents of children with hearing impairment. The sample was recruited from special education schools and hospitals in Islamabad and Lahore, Pakistan, from November 2015 to April 2016. A 15-item structured questionnaire was used for data collection. SPSS version 21 was used for statistical analysis. Results: Among children with hearing impairment, 47.5% faced moderate challenges in joining social activities, and 26.0% faced severe challenges. There was a significant positive correlation between the severity of hearing impairment, the person who suspected hearing impairment, age of detection of hearing impairment, and time of referral. Children with hearing impairment caused moderate financial strain on 39.0% of parents and mild strain on 26.8%. Conclusion: Hearing impairment can significantly impact children's participation in social activities and cause financial burdens on their parents.

Neuromuscular Training following Anterior Cruciate Ligament reconstruction - Pain, Function, Strength, Power & Quality of Life Perspective: A Randomized Control Trial.

Objectives: To determine the effectiveness of neuromuscular physical Therapy as compared to strength training following anterior cruciate ligament reconstruction in terms of pain, function, quality of life, strength and power of participants. Methods: A randomized clinical trial was conducted at Kanaan Physiotherapy & Spine Clinic, Lahore, Pakistan from July 2020 to December 2020. Seventy-six patients were selected by non-probability convenience sampling technique and randomly divided into either neuromuscular training or strength training group. Sample included 20-40 years aged adults with unilateral anterior cruciate ligament injury who had undergone surgical reconstruction of ACL two months ago using hamstring graft. Patients were assessed using the Cincinnati Knee Score for function, Numeric Pain Rating Scale (NPRS) for pain, SF-36 for quality of life, and Single Leg Hop, Triple Hop, Crossover Hop and 6-meter Hop test for power and strength. Data was analyzed using SPSS Version-21. A t-test was used to assess difference between groups. P<0.05 was considered significant. Results: Results revealed that neuromuscular training is statistically significant in reducing pain (p<0.001) and improving function (p<0.001), power & strength (p<0.001) and quality of life (p=0.001). Conclusion: Study concludes that compared to strength training, neuromuscular training was significantly more effective in reducing pain; improving function, quality of life, strength and power.

Prevalence of vocal tract discomfort in patients with voice disorders.

OBJECTIVE: To analyse the prevalence of vocal tract discomfort in patients with voice disorders. METHODS: The analytical cross-sectional study was conducted at Riphah International University, Lahore, Pakistan, from September 2020 to January 2021, and comprised voice disorder patients of either gender aged 18-65 years enrolled from Mayo Hospital, Sheikh Zayed Hospital and Jinnah Hospital, Lahore. The Vocal Tract Discomfort Scale was used for data-collection. Data was analysed using SPSS 21. RESULTS: Of the 137 patients, 68(49.6%) were males and 69(50.4%) were females. The overall mean age was 36.36±12.47 years. The most affected age group was 18-33 years 70(51.1%) while those aged 50-65 years were the least affected 28(20.4%). The most common VTD symptom was dryness with mean frequency 3.48±1.97 and mean severity 3.36±1.99, followed by irritation 2.88±2.08 and 2.88±2.12, and lump in the throat 2.42±2.27 and 2.31±2.23, respectively. CONCLUSIONS: Dryness, irritation and a lump in the throat were the most common symptoms of vocal tract discomfort.

Paediatric vocal fold nodules: management strategies to restore normal phonation-Speech-Language Pathologists perspective: A cross-sectional survey.

Vocal fold nodules are benign vocal cord lesions which develop in voice abusers, including children, though chronic cough, sinusitis, and reflux may also be the causative agents. Since low or no-evidence treatment strategies, like the boone technique, are in use in paediatrics, this study was conducted to determine the treatment strategies used by speech-language pathologists in paediatric vocal fold nodules using a cross-sectional survey at Riphah International University, Lahore, from October 2016 to May 2017. Sixty-five speech-language pathologists working with children in private clinics and multidisciplinary settings were recruited using purposive sampling. A self-structured questionnaire was used for data collection. Analysis using SPSS -18 revealed that a combination of voice therapy and vocal hygiene was the most favoured treatment used by 65 (100%) speech-language pathologists, followed by 58 (89.2%) who also favoured respiratory and relaxation exercises, and 56 (86.2%) who also included parental counselling. Hence, a combination of voice therapy and vocal hygiene is a good therapeutic technique being practiced by speech pathologists for the treatment of vocal nodules among paediatric population.

Teaching strategies for rehabilitation curriculum: Coping with the Covid-19 situation.

The novel corona virus pandemic culminated in a global emergency shutting down educational institutions with recommendations of distant learning. Developing countries like Pakistan faced challenges in terms of keeping the education stream running. The current narrative review was planned to discuss the teaching strategies adopted by various institutes for coping with the situation created by the coronavirus disease-2019. Literature search was done using search engines and databases with key words 'Academics', 'Coping strategies', 'Covid-19', 'Online learning', 'Rehabilitation curriculum' and their combinations. As a result, 37 articles were analysed for education involving conformation of curricula to social distancing protocol, and use of video-conferencing software, practical rehabilitation curriculum delivery, and evaluation methods. Developing countries, like Pakistan, should upgrade and revise their rehabilitation curriculum at theoretical and practical levels and try to convert the adversity of the pandemic into an opportunity to develop standardised e-learning programmes and compatible software.

Indiscipline in rehabilitation curriculum regulation-restricting development perspective: A narrative review.

Curriculum regulation and its oversight are indispensable and vital components of professional development. Regulatory bodies along with professional organisations have an essential role in curriculum regulation. The Pakistan Speech and Language Pathology Association, a body duly registered under the laws of Pakistan and whose governing body exclusively comprises pathologists with master's in Speech Language Pathology, has taken up the matter of standardisation and uniformity of curriculum with universities and with the Higher Education Commission. The commission regulates the undergraduate curricula, but there remains lack of uniformity in curriculum and its monitoring in Pakistan. The current narrative review was planned to highlight the indiscipline in rehabilitation curriculum development and implementation and its causes.

Novel therapeutic techniques for post stroke aphasia: A narrative review.

Aphasia, an acquired language disorder, commonly results from a stroke affecting network of cortical and subcortical structures. Aphasia lacks effective standardised treatment. Neuroimaging and behavioural research indicate that some interventions promote neuroplasticity changes in aphasia. Research has suggested that non-invasive brain stimulation may be effective, causing functional reorganisation of language areas between the two hemispheres. This reorganisation evolves from different researches exploring novel procedures, including transcranial magnetic stimulation and intracranial direct current stimulation, which may modulate cortical activity in aphasia. The current narrative review was planned to assess these techniques while examining the casual role of specific regions of brain and the understanding of the underlying mechanism for treatment effects of brain stimulation. Literature was explored on search engines and databases, like Medline, Web of Science and bibliography of published studies. The key words used for the search were 'non-invasive brain stimulation', 'post-stroke aphasia', 'transcranial magnetic stimulation' and 'transcranial direct current stimulation'. Of the 175 publications downloaded, 40(23%) full-text English publications were reviewed.

International and national perspective of disability and policy disconnect in Pakistan: A narrative review.

In the developed societies, supportive environmental, physical and social conditions enable participation of persons with disabilities in the mainstream through actions, like provision of ramps and reserved parking. In contrast, in the developing countries like Pakistan, with focus on visual disability, years lost to disabilities compromise and restrict the productive life span of the disabled. The current narrative review was planned to highlight the perspective of disability in the context of Pakistan to bring to limelight the issues requiring immediate focus of the health authorities and the government through a holistic and sustainable approach. Of the 177 publications found on literature search, 33(%) English-language, full-text studies were reviewed. To address disability issues, long-term sustainable actions, like health reforms, including ensuring availability of rehabilitation professionals in hospitals, legislative reforms to initiate relevant legislations, capacity-building of persons with disabilities, including their mainstreaming, are deemed essential.

Association of social and psychological aspects of quality of life and educational level of patients with different orofacial cleft.

OBJECTIVE: To determine the social and psychological domains of quality of life of children with orofacial clefts in the context of different types of clefts and educational levels. METHODS: The cross-sectional study was conducted at Clapp Hospital and Mayo Hospital, Lahore, Pakistan from September 1, 2020, to January 31, 2021, and comprised subjects of either gender aged 6-18 years having orofacial clefts. Data was collected using the CLEFT-Questionnaire along with a basic demographic sheet. Data was analysed using SPSS 23. RESULTS: Of the 80 subjects, 40(50%) each were males and females. The overall mean age was 12.41±3.39 years. A significant association of types of orofacial clefts with social function (p<0.05) and psychological function (p<0.05) was observed. The highest mean score of 27.89±3.41 and 26.11±1.76 was noted for unilateral left side cleft lip, and primary palate, respectively. No significant association of level of education with social function (p>0.05) and psychological function (p>0.05) was noted. CONCLUSIONS: Different types of orofacial clefts affected the psychological and social aspects of quality of life of patients differently, but the difference was not significantly correlated with the education level.

Development & Validation of Urdu Receptive Language Scale (URLS).

OBJECTIVES: To develop "Urdu Receptive Language Scale (URLS)" for Urdu speaking Pakistani children of age 0-6 years. METHODS: This exploratory study was done at mainstream schools and day care centers on children with normal language development between the ages of 0-6 years from 1st March 2016 to 31st August 2016, by using convenient sampling technique. Firstly, the items for the questionnaire were constructed from four sources: literature review, experts, parents and direct observation of 384 Children of same age. Secondly the constructed test items were sent to the field experts (SLP's) for the purpose of improvement. Thirdly, after incorporation of suggestions, the improved items were securitized by Urdu experts and finalized. In the next step, these items were tested for Relevance, Ambiguity, Clarity and Simplicity from field experts. The developed scale was then analyzed for reliability and validity by SPSS Version-18. RESULTS: Study resulted in a 59 items Urdu Receptive Language Scale with each age range having different test items distribution. The mean of the relevance, clarity, simplicity, and ambiguity of test items was 3.89. The Item content validity index value was one for each of the 59 items. The content validity index for the entire scale was also one. The Cronbach's alpha was 0.948, which indicates a high level of internal consistency. CONCLUSION: The developed 59 Item Urdu Receptive Language Scale is reliable and valid tool for language assessment of Urdu speaking Pakistani children of 0-6 years age.

A Novel Virtual Reality Training Strategy for Poststroke Patients: A Randomized Clinical Trial.

Stroke patients suffer impairments including sensory, motor, visual, and cognitive areas, as well as gait and balance manifestations making activities of daily living difficult. In such conditions, virtual reality training can be a potential rehabilitation tool in comparison to conventional physical therapy to cater to the burden of this disability; hence, this randomized clinical trial compared the effects of virtual reality training and conventional physical therapy on balance and lower extremity function in stroke patients. The sample of 68 poststroke participants from Kanaan Physical Therapy and Spine Clinic, Lahore, Pakistan, were divided into N = 34 cases each using the lottery method with one group given virtual reality training and the other received conventional physical therapy. Each group received 60 minutes intervention, 3 days per week for 6 weeks. The Berg balance scale and the Fugl-Meyer assessment-lower extremity scale were employed for data collection preintervention, immediate postintervention, and 6 weeks postintervention. The statistically significant differences between virtual reality and conventional physical therapy groups for the Berg Balance score (p < 0.001), Fugl-Meyer assessment (FMA)-lower extremity domains of FMA-motor function (p < 0.001), FMA-joint pain, and joint range (p < 0.001); however, there is no significant difference (p=0.202) for time vs. group interaction and significant (p < 0.001) for the time main effect for FMA sensation. Hence, virtual reality training is more effective to restore balance and lower extremity function compared to conventional physical therapy in stroke patients. The results of the study have significant implications for the clinicians with better case management enhancing quality of life of patients along with the dearth of local literature, thus providing base for future research from a developing country's perspective.

Aphasia-Diagnostic Challenges and Trends: Speech-Language Pathologist's Perspective.

OBJECTIVES: To explore current aphasia assessment practices and barriers among Pakistani speech language pathologists. METHODS: Descriptive study design with qualitative parameters was used. Participants were identified using purposive sampling over a period of eight months from 1st December 2018 to 31st July 2019. Sample comprised of ten speech-language pathologists with least five years' experience of working with aphasic clients from four major cities of Pakistan including Islamabad, Karachi, Lahore and Peshawar. Study included in depth interviews using a self-structured interview guide with probe questions. Data recorded was transcribed and thematic analyses were drawn manually. RESULTS: Thematic analysis revealed that most Speech language pathologists rely heavily on informal assessment techniques. With no aphasia assessment tool available in Urdu language, no consensus as to the optimal evaluation strategy or tool for aphasia assessment was noted. However, need for such tool was highlighted by all participants. Hence, non-availability of standardized and culturally appropriate assessment tool in "Urdu" language turned out to be the major barrier in adopting formal assessment for aphasic clients, while time consumed in formal testing remained second most reported issue. CONCLUSION: There is a dire need of quick aphasia assessment tool in Urdu language with established psychometric properties and culturally appropriate norms.

Complications of Cochlear Implant Surgery: A Public Implant Centre Experience.

OBJECTIVES: To determine the prevalence of complications of cochlear implant surgery in children with congenital profound sensorineural hearing loss. METHODS: This study retrospectively & consecutively reviewed charts of children who underwent cochlear implantation from July 2015 to July 2019 at Cochlear Implant Centre of Otolaryngology Department of Capital Hospital, Islamabad Pakistan. These included cases of both genders aged one to 12 years operated at least one year before the time of data collection. Basic demographic data, complications including major and minor complications and treatment received was noted and statistically analyzed using SPSS-23. Results were presented using descriptive statistics. RESULTS: Current study included a sample of N=251 having a mean age of 4.05±2.15 years including 154(61.4%) males and 97(38.6%) females revealed a prevalence of complications of 16(6.4%) with 4(1.6%) major and 12(4.8%) minor complications. Wound infection and acute otitis media with frequency of 3(1.2%) each were the commonest complications, followed by , facial nerve twitching, tinnitus and vertigo, infection and extrusion; and device failure in 2(0.8%) each. However, there was no significant association of complications with age group and gender with P=0.344 and P=0.519 respectively. CONCLUSION: Present public sector implant program is characterized with a very low prevalence of complications of 16(6.4%) with 4(1.6%) major and 12(4.8%) minor complications. Wound infection and acute otitis media were the commonest complications.