Effectiveness of a Verbal Expressive Skills Management Program for Pakistani Patients with Broca Aphasia: A Randomized Clinical Trial.

Background: It is estimated that 25% of the patients in Pakistan experience stroke resulting in problems with language. Among many of the conditions, problem with verbal expressive production (Broca's Aphasia) is one of the main problem faced by people having stoke. Many traditional therapies are incorporated to treat symptoms of Aphasia including fluent and non- fluent Aphasia. Objectives: The primary objective of the current study was to determine the effectiveness of Verbal Expressive Skill Management Program in Urdu (VESMP-U) with convention speech therapy, Melodic Intonation therapy (MIT) in enhancing the verbal expressive skills in patients with severe Broca's Aphasia. Another objective of this study was to compare the efficacy of Verbal Expressive Skill Management Program in Urdu (VESMP-U) with traditional therapy, as well as the quality of life of patients with severe Broca's Aphasia. Methods: A randomized control trial (NCT03699605, clinicaltrials.gov) was conducted from November 2018 - June 2019 in Pakistan railway Hospital (PRH). Patients having a three-month history of severe Broca's Aphasia, aged between 40-60 years, bilingual (Urdu and English language) and having the ability to use a smart phone were included in the study. Patients with cognitive impairments were excluded. Total of 77 patients were evaluated for eligibility criteria according to the G Power software for sample size. Out of 77, 54 individuals fulfilled the inclusion criteria. The participants were divided into 2 groups (27 each) through sealed envelope method. Patients of both groups were assessed pre and post intervention using the Boston Diagnostic Aphasia Examination (BADE) battery (Primary outcome measure). Experimental group n = 25 received VESMP-U therapy and control group n = 25 (2 drop out in each group) received MIT for 16 weeks i.e. 4 days per week having 64 sessions altogether. Each intervention session lasted up to 30-45 minutes for both groups. Results: Within and between group analysis after intervention showed that the VESMP-U group had significantly improved BDAE scores (P = .001; 95% CI) than the MIT group for all variables (articulatory intelligibility, phrase length, grammatical form, prosody/intonation, spontaneous speech, word finding, repetition, and auditory comprehension). The BDAE scores of participants in experimental group having VESMP-U therapy pre- and post-intervention were statistically significant (P = .001; 95% CI), which indicates that participant's communication skills were enhanced by use of VESMP-U. Conclusion: Android based application VESMP-U has been found to be effective in improving expression and quality of life of patients with severe Broca's aphasia.

Effects of Kinesio Taping Compared with Manipulation Therapy on Drooling and Speech Intelligibility in Children with Oral Dysphagia: A Pilot Study.

OBJECTIVE: To determine the effectiveness of Kinesio Taping (KT) and Manipulation Therapy (MT) on drooling and speech intelligibility in children with oral dysphagia. METHODS: A randomized clinical trial was conducted at Helping Hand Institute of Rehabilitation Sciences in Mansehra, Pakistan. A total of 20 patients were recruited via the random sampling technique and later assigned to one of two groups: KT (n = 10) or MT (n = 10). Every patient in both groups received their intervention 5 days a week for 1 month (20 sessions total), and each session lasted 45 minutes. Data was collected and analyzed at baseline and 1 month. Drooling was assessed via the Modified Teachers' Drooling Scale and speech intelligibility determined via the 7-Point Intelligibility Rating Scale. Mann Whitney U-test was used for between-group comparisons and for within-group comparisons the Wilcoxon signed-rank test and their effect size was used. RESULTS: The mean age of study patients was 5.4 years. Of the 20 patients, 14 were male and 6 were female. Within-group comparisons showed significant improvement in both drooling and speech intelligibility (P < .05), while between-group comparisons showed no significant difference (P ≥ .05) in either the KT or MT group regarding drooling severity and speech intelligibility. CONCLUSION: KT and MT significantly improved drooling and speech intelligibility.

Dark Tetrad Personality during COVID-19: An Overview of Psycho-somatic Therapies for Managing Mental Health Response.

The recent empirical data represented the unprecedented opportunity to understand how threatful situations affect people adaptive and mal-adaptive behaviour and diverse ways to cope with the situation. In particular, the people with existing mental health issues such as dark tetrad personality found to be higher in forming an unhealthy relationship on cyber as well as real life during COVID-19. The current paper provides an interesting but alarming picture of how people with dark tetrad personality trait formed relationships with others during COVID-19. Also, the current paper highlights the significance of psycho-somatic therapies in managing their mental health response during COVID-19.

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.