The Unmet Needs of Caregiving Skills, Support, Emotions, and Finances of Stroke Caregivers: A Multicenter Study.

​​​​​​Background Informal stroke caregivers in Malaysia play an important role in supporting stroke survivors following acute care. Nevertheless, there is a lack of available data to inform the sufficiency of help and resources available to address the needs of local stroke caregivers. This study aimed to determine the unmet needs in caregiving skills, support, emotions, and finances as well as the associated factors of stroke caregivers in Malaysia. Methodology This multicenter, cross-sectional study used a self-administered survey developed and validated for the Malaysian population. It was prepared in paper-based and web-based formats, and it was distributed via direct contact with the respondents, post, and email. Respondents were recruited from different sites in Malaysia. In this study, unmet needs were defined as "help that was needed more or was not provided to assist caregivers and address their specific needs." This article only presents the quantitative data of this study. Data were analyzed using descriptive analysis and logistic regression to determine factors associated with unmet needs. Results Almost all study respondents (91%) reported having unmet needs. Unmet needs ranged from 1 to 10, while the mean unmet needs was 5. The highest unmet need was related to financial support (72.5%), followed by support from professionals to address their own needs (59.2%), skills to care for stroke survivors, i.e., skills in caring for stroke survivors with their daily activities (57.9%), and skills in supporting stroke survivors to perform rehabilitation at home (53.1%). The lowest unmet need was related to support in transporting stroke survivors from place to place (45.3%). Additionally, this study did not identify an association between the reported unmet needs and gender, age, ethnicity, duration of caregiving, and site of participation. Conclusions This study reported a range of unmet needs perceived by stroke caregivers in Malaysia. Further research is warranted to understand the gaps in supporting local stroke caregivers to inform future post-stroke support and services in the country.

Arabic phoneme-grapheme correspondence by non-native, deaf children with cochlear implants and normal hearing children.

OBJECTIVE: This study aimed to compare the error patterns of Arabic phoneme-grapheme correspondence by a group of Malay children with cochlear implants (CIs) and normal hearing (NH) and the effects of the visual graphical features of Arabic graphemes (no-dot, single-dot, and multiple-dots) on the phoneme-grapheme correspondence. METHODS: Participants were matched for hearing age (Mean, M = 7 ± 1.03 years) and duration of exposure to Arabic sounds (M = 2.7 ± 1.2 years). All 28 Arabic phonemes were presented through a loudspeaker and participants pointed to the graphemes associated with the presented phonemes. RESULTS: A total of 336 and 616 tokens were collected for six children with CI and 11 NH children for each task, i.e., phonemes repetition and phoneme-grapheme correspondence. Both groups found it easier to repeat phonemes than the phoneme-grapheme correspondence. The children with CIs showed more confusion ([ظ, ز, Ø°, ض, Ø®, ب, ه, س, ع, & Ø«] >10% correct scores) in phoneme-grapheme correspondence than the NH children ([ظ:14%] and [Ø«: 27%]). There was a significant interaction (p = 0.001) among the three visual graphical features and hearing status (CI and NH). CONCLUSION: Our results infer that non-native Malay children with CIs and NH use different strategies to process the Arabic graphemes' visual features for phoneme-grapheme correspondence.

Description of the Features and Vibratory Behaviors of the Nyquist Plot Analyzed From Laryngeal High-Speed Videoendoscopy Images.

Facilitative playback-based subjective measures offer a more reliable evaluation of the vocal fold vibration than those derived from direct inspection of video playback. One of the measures is a Nyquist plot, which presents the analyzed cycle-to-cycle vibratory information in a graphical form. While the potential is evident, the information of the features of the Nyquist plot, which the evaluation is based on, is still incomplete. The current identified features and their vibratory behaviors may be inadequate to guarantee accurate interpretation of the findings. The present study aims to address this issue by examining the features of the Nyquist plot and their vibratory behaviors. A total of 56 young normophonic speakers, that is, 20 males and 36 females were recruited as the participants. Each of them underwent laryngeal high-speed videoendoscopy to record the images of the vocal fold vibration, which were then analyzed to generate the Nyquist plots. The features were identified by inspecting the properties of the plot points forming the Nyquist plots. For each identified feature, its vibratory behaviors were examined. The results revealed four features: rim contour depicting the longitudinal phase difference; left edge shape signifying the glottal configuration, phase closure, and closed phase duration; rim width and rim pattern visualizing the regularity of glottal areas and the regularity of the intracycle variations, respectively. The findings present a more complete reference of the features and their vibratory behaviors that is pertinent for the Nyquist plot interpretation.

Level of Awareness, Knowledge, and Involvement of Malaysian Medical and Dental Practitioners in Dysphagia Management of Head and Neck Cancer Patients.

Head and neck cancer patients are at high risk of developing dysphagia from undergoing cancer treatment. It is essential for medical and dental practitioners to recognize speech-language pathologists' role and dysphagia symptoms to provide a timely referral to speech-language pathologists. This study aims to determine the level of awareness, knowledge, and involvement of medical and dental practitioners in dysphagia management. A total of 391 medical and dental practitioners from 22 government hospitals across Malaysia participated in this cross-sectional study. Participants completed the questionnaire specifically on the level of involvement, knowledge, awareness regarding the role of SLP and dysphagia symptoms. The results revealed a statistically significant relationship between the level of awareness of the role of SLP, χ2 (4, 391) = 9.87, p = 0.043 and the level of involvement of medical and dental practitioners, χ2 (8, 391) = 27.68, p = 0.001 and percentage of referring head and neck cancer patients. The odds of referring head and neck cancer patients for pre-treatment assessment increased three times for each one unit of the participation of medical and dental practitioners [OR] 3.65 (1.56, 8.51) p = 0.003 among those who are already highly involved in dysphagia management. These findings compel healthcare practitioners in head and neck cancer to revisit their collaborative practices. Head and neck cancer patients should receive swallowing management from speech-language pathologists to improve their swallowing function and avoid further complications such as dehydration, malnutrition, and death.

Effects of Using Laryngeal High-Speed Videoendoscopy Images Visualizing Partial Views of The Glottis on Measurement Outcomes.

Ideally, an analysis method for laryngeal high-speed videoendoscopy (LHSV) based on the glottal area waveforms (GAW) requires images of a complete view of the glottis to ensure findings that are representatives of the vibratory behaviors of the whole vocal folds. However, in practice, the preferred images may not be obtained at all times. Often, the only available images that a clinician has to work with consist of a partial view of the glottis. This study aims to examine the effects of using images of a partial view of the glottis (ie, posterior-middle, anterior-middle, or middle) on the LHSV-based measures (ie, fundamental frequency (F0GAW), frequency perturbation (jitterGAW), amplitude perturbation (shimmerGAW), open quotient (OQGAW), and Nyquist plot). The participants consisted of 9 young normophonic females. The procedures involved LHSV recording of the vibration of the vocal folds. The images of the complete view of the glottis were analyzed to obtain the LHSV-based measures. The same images were used to simulate the images of partial views of the glottis by changing the outline of the region of interest to include only either the posterior-middle, anterior-middle, or middle parts of the glottis. The LHSV-based measures from the images of the partial views were then compared to those with the complete view . The results showed that all LHSV-based measures from the images of the posterior-middle view were similar to those of the complete view. However, only the F0GAW, jitterGAW, and shimmerGAW from the images of the anterior-middle and middle views were similar to those of the complete view. Lower OQGAW and different Nyquist plots than those of the complete view were generated by the images of the anterior-middle and middle views. In conclusion, all LHSV-based measures from the images of the posterior-middle view of the glottis, and only the F0GAW, jitterGAW, and shimmerGAW from the images of the anterior-middle and middle views of the glottis reflect the vibratory behaviors of the whole vocal folds. The same conclusion could not be applied to the OQGAW and Nyquist plots of the images of the anterior-middle and middle views of the glottis. A possible effect of the presence or absence of a posterior glottal gap on the findings warrants further confirmation.

Analysis Method for Laryngeal High-Speed Videoendoscopy: Development of the Criteria for the Measurement Input.

Despite its clear advantages, laryngeal high-speed videoendoscopy (LHSV) has not yet been accepted as a routine imaging tool for the evaluation of vocal fold vibration due to the unavailability of methods to effectively analyze the huge number of images from the LHSV recording. Recently, a promising LHSV-based analysis method has been introduced. The ability of this analysis method in studying the vocal fold vibratory behaviors had been substantially demonstrated. However, some practical aspects of its clinical applications still require further attention. Most fundamental is that the criteria for the measurement input ie, a segment of interest (SOI), which has not been fully defined. Particularly, the length of the SOI and the location along the sample, where it needs to be selected require further confirmation. Meanwhile, the analysis using any options of a well-delineated glottal area demands verification. Without clear criteria for the SOI, it is difficult to demonstrate the relevance of this analysis method in clinical voice assessment. Therefore, the aim of the present study is to establish the criteria for the SOI, which involved the investigations on the length of the SOI and the location along the sample, where it needs to be selected, as well as the use of any options of a well-delineated glottal area for analysis. The participants in the present study consisted of 36 young normophonic females. The methods involved LHSV recording of the images of the vibrating vocal folds. The captured images were then analyzed using the method. The LHSV-based measures from the analyses were compared according to the specified procedures of each investigation. Results indicated that 2000 frames should be used as the SOI length. The SOI could be selected at any location along the sample as long as well-delineated glottal areas were observed. With the current findings, a more conclusive measurement protocol is available to ensure reliable LHSV-based measures. The findings further support this analysis method for clinical application, which in turn promote LHSV as a reliable laryngeal imaging tool in clinical setting.

Voice therapy for Parkinson's disease via smartphone videoconference in Malaysia: A preliminary study.

INTRODUCTION: Intensive voice therapy is one of the best evidence-based treatments to improve speech and voice difficulties to individuals with Parkinson's disease (PD). However, accessibility to intensive voice therapy is highly challenging in Malaysia due to the lack of voice specialised speech-language therapists. This study examined the feasibility of using smartphone videoconference to deliver intensive voice therapy to individuals with PD in Malaysia. METHODS: Intensive voice therapy was delivered to 11 adults with PD using a smartphone videoconference method via WhatsApp Messenger freeware. The therapy consisted of 12 sessions over four weeks and focused on increasing vocal loudness. Outcomes were assessed using objective, perceptual and quality-of-life measures pre and post treatment. Participant satisfaction with the telerehabilitation method was obtained via the Smartphone-Based Therapy Satisfaction Questionnaire. RESULTS: Significant gains were reported for sound pressure level in sustained vowels and monologue. Perceptual ratings showed significant improvements in overall mean severity and loudness after treatment. Mean scores of speech intelligibility and Voice Handicap Index-10 were significantly better post treatment. Overall, participants were highly satisfied with the smartphone videoconference method. DISCUSSION: Present results suggest that the smartphone videoconference method is feasible to deliver intensive voice therapy to individuals with PD to gain better speech and voice functions. Future studies need to address the standardisation of the system protocol to optimise this novel service delivery method in Malaysia.

Efficacy of a newly developed auditory-cognitive training system on speech recognition, central auditory processing and cognitive ability among older adults with normal cognition and with neurocognitive impairment.

AIM: To evaluate the efficacy of a newly developed auditory-cognitive training system on speech recognition, central auditory processing and cognition among older adults with normal cognition (NC) and with neurocognitive impairment (NCI). METHODS: A double-blind quasi-experiment was carried out on NC (n = 43) and NCI (n = 33) groups. Participants in each group were randomly assigned into treatment and control programs groups. The treatment group underwent auditory-cognitive training, whereas the control group was assigned to watch documentary videos, three times per week, for 8 consecutive weeks. Study outcomes that included Montreal Cognitive Assessment, Malay Hearing in Noise Test, Dichotic Digit Test, Gaps in Noise Test and Pitch Pattern Sequence Test were measured at 4-week intervals at baseline, and weeks 4, 8 and 12. RESULTS: Mixed design anova showed significant training effects in total Montreal Cognitive Assessment and Dichotic Digit Test in both groups, NC (P < 0.001) and NCI (P < 0.01). The NC group also showed significant training effects in the Malay Hearing in Noise Test (quiet) (P < 0.01), Gaps in Noise Test (P < 0.001) and Pitch Pattern Sequence Test (humming) (P < 0.05). All training effects were sustained up to 4 weeks after the training ended. CONCLUSIONS: The present study suggests that the newly developed auditory-cognitive training system has the potential to improve general cognition and some of the auditory processing abilities in both the NC and NCI groups. Because of the short test-retest intervals used in the present study, it is possible that the training effects were influenced by learning effect and, therefore, should be considered cautiously. Geriatr Gerontol Int 2019; 19: 768-773.

Patterns of recognition of Arabic consonants by non-native children with cochlear implants and normal hearing.

OBJECTIVE: This study examined the patterns of recognition of Arabic consonants, via information transmission analysis for phonological features, in a group of Malay children with normal hearing (NH) and cochlear implants (CI). METHOD: A total of 336 and 616 acoustic tokens were collected from six CI and 11 NH Malay children, respectively. The groups were matched for hearing age and duration of exposure to Arabic sounds. All the 28 Arabic consonants in the form of consonant-vowel /a/ were presented randomly twice via a loudspeaker at approximately 65 dB SPL. The participants were asked to repeat verbally the stimulus heard in each presentation. RESULTS: Within the native Malay perceptual space, the two groups responded differently to the Arabic consonants. The dispersed uncategorized assimilation in the CI group was distinct in the confusion matrix (CM), as compared to the NH children. Consonants /h/, /tˁ/, /sˁ/ and /ʁ/ were difficult for the CI children, while the most accurate item was /k/ (84%). The CI group transmitted significantly reduced information, especially for place feature transmission, then the NH group (p < 0.001). Significant interactions between place-hearing status and manner-hearing status were also obtained, suggesting there were information transmission differences in the pattern of consonants recognition between the study groups. CONCLUSION: CI and NH Malay children may be using different acoustic cues to recognize Arabic sounds, which contribute to the different assimilation categories' patterns within the Malay perceptual space.

Design, synthesis and cytotoxic evaluation of o-carboxamido stilbene analogues.

Resveratrol, a natural stilbene found in grapes and wines exhibits a wide range of pharmacological properties. Resveratrol is also known as a good chemopreventive agent for inhibiting carcinogenesis processes that target kinases, cyclooxygenases, ribonucleotide reductase and DNA polymerases. A total of 19 analogues with an amide moiety were synthesized and the cytotoxic effects of the analogues on a series of human cancer cell lines are reported. Three compounds 6d, 6i and 6n showed potent cytotoxicity against prostate cancer DU-145 (IC50=16.68 µM), colon cancer HT-29 (IC50=7.51 µM) and breast cancer MCF-7 (IC50=21.24 µM), respectively, which are comparable with vinblastine. The resveratrol analogues were synthesized using the Heck method.

Addressing education of speech-language pathologists in the World Report on Disability: development of a speech-language pathology program in Malaysia.

The current paper is a response to the Wiley, McAllister, Davidson, and Marshall lead article regarding the application of the World Report on Disability (WRD) to people with communication disorders. The current paper directly addresses recommendation 5 (improvement of human resource capacity) and indirectly addresses recommendations 7, 8, and 9 (related to improving local knowledge and data on communicative disabilities) indirectly. The paper describes Malaysia's initiatives in the early 1990s, in developing its local professional capacity to provide services for people with communication disorders (PWCD). It charts the history of development of a local undergraduate entry-level degree program for speech-language pathology (SLP) from the point of conceptualization to full execution. The article provides glimpses to the processes and challenges faced by Universiti Kebangsaan Malaysia as the pioneer university in the South East Asia region to undertake the training and education of the SLP profession and highlights relevant issues faced by newly introduced professions in a country where resources and practice traditions were previously unavailable. It underscores the important role played by government institutions and an international professional network in driving forward-looking policies to implement and sustain the program.

Vocal fold vibratory characteristics of healthy geriatric females--analysis of high-speed digital images.

OBJECTIVES/HYPOTHESIS: A high proportion of the geriatric population suffers from presbylaryngis and presbyphonia; however, our knowledge of vibratory patterns in this population is almost nonexistent. In this study, we investigate the vocal fold vibratory patterns of healthy elderly females to determine which features or combination of them could best describe the geriatric voices. STUDY DESIGN: Cross-sectional study with 20 elderly healthy females with no history of voice problems. METHODS: Hilbert transformed glottal area waveforms (GAWs) from serial high-speed digital imaging of sustained phonation are used to provide quantitative measures of glottal vibratory characteristics and perturbations; open quotient, jitter, and shimmer. Nyquist plots provide interpretable patterns to portray the vibratory characteristics as clear, pressed, breathy, and atypical patterns. RESULTS: The GAW from most elderly speakers (50%) showed vibratory characteristics associated with a more pressed voice and higher glottal perturbation values: their Nyquist plot patterns show wide scatterings around the rim of the plot reflecting a much-reduced ability in sustaining vibratory oscillation; these were distinct differences from previously reported data on younger speakers. Qualitative examination revealed more anteriorly placed glottal gaps in the geriatric females. CONCLUSION: These findings have important implications in understanding voice production in the geriatric population and in helping to establish normal perturbation references among female speakers across age.

Anti-tumour promoting activity and antioxidant properties of girinimbine isolated from the stem bark of Murraya koenigii S.

Girinimbine, a carbazole alkaloid isolated from the stem bark of Murraya koenigii was tested for the in vitro anti-tumour promoting and antioxidant activities. Anti-tumour promoting activity was determined by assaying the capability of this compound to inhibit the expression of early antigen of Epstein-Barr virus (EA-EBV) in Raji cells that was induced by the tumour promoter, phorbol 12-myristate 13-acetate. The concentration of this compound that gave an inhibition rate at fifty percent was 6.0 µg/mL and was not cytotoxic to the cells. Immunoblotting analysis of the expression of EA-EBV showed that girinimbine was able to suppress restricted early antigen (EA-R). However, diffused early antigen (EA-D) was partially suppressed when used at 32.0 µg/mL. Girinimbine exhibited a very strong antioxidant activity as compared to a-tocopherol and was able to inhibit superoxide generation in the 12-O-tetradecanoylphorbol-13-acetate (TPA)-induced differentiated premyelocytic HL-60 cells more than 95%, when treated with the compound at 5.3 and 26.3 µg/mL, respectively. However girinimbine failed to scavenge the stable diphenyl picryl hydrazyl (DPPH)-free radical.

Vocal fold vibratory characteristics in normal female speakers from high-speed digital imaging.

The purpose of the study was to investigate relationships between vocal fold vibrations and voice quality. Laryngeal images obtained from high-speed digital imaging (HSDI) were examined for their open-closed timing characteristics and perturbation values. A customized software delineated the glottal edges and used the Hilbert transform-based method of analysis to provide objective quantification of glottal perturbation. Overlay tracings of the transformed glottal cycles provided visual patterns on the overall vibratory dynamics. In this paper, we described the use of this method in looking at vibratory characteristics of a group of young female speakers (N=23). We found that, females with no voice complaints and who had been perceived to have normal voices were not a homogeneous group in terms of their glottal vibratory patterns during phonation. Their vibratory patterns showed characteristics similar to exemplar voices targeted to be clear (50%), pressed (27%), breathy (15%), or a mixed quality (8%). Perturbation range in terms of cycle-to-cycle frequency and amplitude was small and did not discriminate patterns. All these patterns yielded perceptually normal voices suggesting that in normal young speakers, the level of perturbation may be more important to the judgment than the actual pattern of closure.

N-cyanomethylnorboldine: a new aporphine isolated from Alseodaphne perakensis (Lauraceae).

A phytochemical study of the bark of Alseodaphne perakensis has yielded three aporphine alkaloids: the new compound N-cyanomethylnorboldine (1), and the two known alkaloids N-methyllaurotetanine (2) and norboldine (3). The isolation was achieved by chromatographic techniques and the structural elucidation was performed via spectral methods, notably 1D- and 2D-NMR, UV, IR, and HRFABMS. The vasorelaxation activity of compound 1 has been studied.

Oppositinines A and B: new vasorelaxant beta-carboline alkaloids from Neisosperma oppositifolia.

A phytochemical study on the bark of Neisosperma oppositifolia (Apocynaceae) yielded two new beta-carboline indole alkaloids, oppositinines A (1) and B (2), together with five known alkaloids, isoreserpiline, isocarapanaubine, vobasine, 10-methoxydihydrocorynantheol-N-oxide, and ochropposinine oxindole. Structural elucidation of 1 and 2 was performed using 2D NMR methods. Oppositinines A (1) and B (2) showed potent vasorelaxant effects on the rat aorta.

Discharging patients: A perspective from speech-language pathologists working in public hospitals in Malaysia.

Speech-language pathologists (SLPs) practising in Malaysia face similar dilemmas as their counterparts in more developed countries when it comes to deciding on discharge/termination of services for their patients. Furthermore, discharge dilemmas appear to be a frequent and inevitable part of their everyday practice. In an interview conducted for the purpose of this paper, it was clear that many SLPs found it difficult to articulate or justify the process they took to reach a decision on whether or not to terminate their services or discharge their patients. Much of the difficulty is anchored on the need to be realistic and function within the confines of limited resources. Malaysian SLPs were aware of the ideals that had to be abandoned along the way but had not allowed guilt to dissuade or discourage them from providing what they perceived as the next best available service. The not-so ideal decisions made by these SLPs may be frowned upon by international standards but must be examined within the local historical perspective of the development of the SLP profession in Malaysia. The dilemma will continue until the country produces SLPs in sufficient numbers but the profession is reminded that less-than-ideal practices may perpetuate over time into unhealthy traditions that will require major efforts to be undone.

N-{2-[2-(2,6-Dichloro-3,5-dimethoxy-phen-yl)ethen-yl]phen-yl}acetamide.

The C=C double bond in the title substituted stilbene, C(18)H(17)Cl(2)NO(3), has a trans arrangement of the aryl substit-uents. The aromatic ring of the 2-acetyl-amino-phenyl substit-uent is twisted by 39.9 (3)° with respect to the central C-C=C-C unit and that of the 2,6-dichloro-3,5-dimethoxy-phenyl substitutent is twisted by 42.7 (3)°.

N'-{2-[2-(4-Methoxyphenyl)ethenyl]phenyl}acetamide.

In the title compound, C(17)H(17)NO(2), the phenyl-ene rings are nearly coplanar [dihedral angle 7.3 (1)°]. The acetamido group is twisted out of the plane of the aromatic ring in order to form an N-H⋯O hydrogen bond to the acetamido group of an adjacent mol-ecule, generating a helical chain running along the b axis.

N'-{2-[2-(3-Methoxyphenyl)ethenyl]phenyl}acetamide.

In the title compound, C(17)H(17)NO(2), the phenyl-ene rings are bent with respect to the carbon-carbon double bond [dihedral angle between rings = 39.6 (1)°]. The acetamido group is twisted out of the plane of the aromatic ring [dihedral angle = 44.2 (1)°] in order to form an N-H⋯O hydrogen bond to the acetamido group of an adjacent mol-ecule, generating a zigzag chain running along the c axis.