Folia Phoniatrica et Logopaedica最新文献

Introduction: The lack of a standardized evaluation method for cleft palate speech makes it difficult to exchange information at the domestic and global levels. We aimed to develop and validate a Japanese outcome tool for the perceptual assessment of speech in patients with cleft palate.

Methods: The tool we developed was based on the Cleft Audit Protocol for Speech-Augmented (CAPS-A) with modifications to some speech parameters. We developed Japanese speech samples and parameters for the Japanese Cleft Speech Outcome Tool (CAPS-A-Japan: CAPS-A-JP). This study was conducted in the Japancleft speech working group at the Japanese Cleft Palate Association. In Phase 1, we constructed and developed the speech sampling protocol. In Phase 2, After the revision of the definitions and criteria for several cleft speech characteristics and the speech sample, a total of 20 audio recordings were tested. In Phase 3, criterion validity was assessed by comparing the CAPS-A-JP resonance outcomes reported for 40 cases with the outcomes of the clinical investigations. In Phase 4, a listening experiment with six Japanese speech-language-hearing therapists was conducted twice to test the intra- and inter-rater reliabilities for 20 cases. Intra-class correlation coefficients (ICCs) were used to analyze reliability.

Results: The mean percentage agreement on criterion validity for resonance was 71% on high-pressure sentences but 54% on low-pressure sentences. The inter-rater reliability was rated moderate/good (ICC: 0.45-0.80), except for developmental immaturities/errors that were rated fair. The ICC was very low or incalculable for hyponasality and syllable error patterns because there were few cases of hyponasality and syllable errors. The intra-rater reliability was rated as good/very good. The ICC was very low or incalculable in hyponasality, nasal emission, and syllable error patterns.

Conclusions: The standardized outcome tool, CAPS-A-JP, was developed for the first time in Japan. Future research is required to optimize this tool based on the inclusion of a training protocol.

Introduction: Behavioral feeding assessment allows for identifying the nature and the cause of abnormal feeding behaviors during mealtime, making prognostic predictions, and creating effective treatment plans. This study aimed to develop and validate an Arabic questionnaire to assess abnormal feeding behaviors among Arabic-speaking children.

Methods: Mansoura Pediatric Eating Assessment Scale (MPEAS) was developed and administered to the parents of 100 Arabic-speaking children aged 1-5, including 50 typically developing children without feeding problems and 50 children with abnormal feeding behaviors. The scale includes 40 items in four subdomains (feeding skills, mealtime circumstances, child behavior, and parent behavior). Scoring was based on a 4-point Likert scale, with lower scores indicating greater impairment. Standardized procedures were used to develop and validate the MPEAS, including the items generation phase, pilot study, validation, and reliability testing.

Results: MPEAS demonstrated excellent validity (face, content, discriminant, predictive, and convergent) and reliability.

Conclusion: MPEAS is a valid, reliable, and easily applicable tool for assessing behavioral feeding problems in Arabic-speaking children. This sensitive and specific tool has the potential to significantly improve the screening and treatment of behavioral feeding problems among Arabic-speaking children, offering hope for better outcomes.

Introduction: Injection laryngoplasty (IL) in combination with short voice therapy (SVT) has been recommended in unilateral vocal fold immobility (UVFI). This pilot study investigated functional voice changes, age, and time-to-treatment effects in UVFI after transoral IL with hyaluronic acid (HA) and SVT.

Methods: 17 adults with UVFI (mean age: 61 years) were retrospectively analyzed. Outcome measures were the Voice Handicap Index 9i (VHI-9i), perceptual Grading-Roughness-Breathiness-Asthenia-Strain (GRBAS) Scale, voice range profiles (VRP) of the speaking, calling, and singing voice, maximum phonation time (MPT), jitter, and the Dysphonia Severity Index (DSI). T-tests and Wilcoxon tests evaluated treatment effects; age and time-to-treatment effects on the magnitude of change were assessed by Spearman's correlation.

Results: There were significant improvements in VHI-9i and GRBAS scale overall G, R, B, and A. Mean speaking and mean calling sound pressure level (SPL), maximum singing SPL, and mean calling fundamental frequency (f0) increased, while the DSI and jitter improved. Time-to-treatment significantly affected the magnitude of change in mean speaking and maximum singing SPL, singing SPL range, jitter, and DSI; age influenced minimum speaking f0 only.

Conclusion: Transoral IL with SVT significantly improves subjective, perceptual, and instrumental acoustic voice outcomes in UVFI. Improvement of speaking and calling VRP after IL have not been previously documented. Our findings suggest that early treatment is beneficial for mean speaking loudness, maximum singing SPL, singing SPL range, jitter, and the DSI. More research is needed to examine the influence of time-to-treatment and age, and also to what extent SVT contributes to treatment effects.

Introduction: Effortful swallowing (ES) is known to significantly increase the activity of the submental muscles, including the suprahyoid muscles, which play an important role in elevating the hyoid bone and larynx during swallowing and contributing to the opening of the upper esophageal sphincter. However, inconsistent results have been reported regarding the long-term effects of ES exercise in increasing the submental muscle activity. Therefore, this study aimed to investigate the effect of a 6-weeks systematic ES exercise program on the activation level of the submental muscle and tongue strength.

Methods: The study included 31 healthy older adults (mean age, 75.4 ± 4.68y; range, 65-82y). The exercise consisted of 10 repetitions per set, wherein one session comprised seven sets. In sets 1-3, gradual isometric tongue pressing exercises of 60%, 80%, and 100% were performed based on the maximal isometric pressure (MIP) of the posterior oral tongue; in sets 4-7, gradual swallowing exercises were performed at 60% and 80% intensities. Resistance and biofeedback were provided to the posterior oral tongue during exercise using Iowa Oral Performance Instrument (IOPI). Each session lasted 30 min, and the exercise was performed twice a week for a total of 6 weeks.The effects of exercise on submental muscle activity (measured using surface electromyography) and tongue pressure-related variables (measured using IOPI) were verified using paired t-tests at baseline and week 7.

Results: After 6 weeks of strengthening exercise, the maximal activity of the submental muscles during ES, anterior and posterior oral tongue MIP, typical swallowing and ES pressure, and posterior oral tongue endurance significantly increased compared to those at baseline (p < 0.05).

Conclusion: The ES exercise program, which was structured by systematically adopting exercise principles related to strength training, significantly improved the swallowing-related muscle strength of healthy older adults. It is suggested that this effect was caused by systematic warm-up exercises applied prior to performing strengthening exercises for swallowing-related muscles, resistance and biofeedback provision using IOPI during main exercise, and provision of sufficient rest time between sets. Further research is needed to systematically examine the effects of variables related to the composition of exercise programs.

Introduction: Anticipation is a covert aspect of stuttering that plays a crucial role in the lives of adults who stutter (AWS). It can influence anxiety levels or provide an opportunity for self-regulation. For assessing anticipation in stuttering, The Stuttering Anticipation Scale (SAS) was developed. This study aims to develop a Turkish version of the SAS (SAS-TR) and evaluate its validity and reliability.

Method: Ninety-four AWS (aged 18-40 years) participated in the study. They completed SAS-TR and demographic information form either face-to-face or online. The internal consistency, test-retest reliability, and construct validity of the SAS-TR were assessed. Exploratory factor analysis (EFA) was also conducted as part of the construct validity evaluation.

Results: The SAS-TR scale demonstrated high internal consistency (Cronbach's alpha = 0.947) and high test-retest reliability (ICC = 0.973). SAS-TR total score and its sub-dimensions showed acceptable to high positive correlations among themselves (ranging from r = 0.209 to r = 0.962). Factor loadings for the SAS-TR items ranged between 0.572 and 0.899, exceeding 0.300 and indicating suitability for EFA.

Conclusion: The SAS-TR exhibits valid and reliable properties for Turkish-speaking AWS. It is recommended for use in both research and clinical settings to enhance understanding of anticipatory behaviors in this population.

Introduction: Quality of life and functionality are relevant in an approach based on the biopsychosocial model. Therefore, the objective of this study was to assess the influence of clinical, sociodemographic, and functionality aspects on the quality of life of children and adolescents undergoing speech-language evaluation.

Methods: Cross-sectional analytical observational study conducted with 84 Brazilian children and adolescents. The Brazilian Economic Classification Criteria and the Pediatric Quality of Life Inventory 4.0™ were applied, and data were collected on sex, complaints, SPL diagnostic hypothesis, as well as on the Body Functions, Activities and Participation, and Environmental Factors components of the International Classification of Functioning, Disability and Health (ICF). Factor analysis and structural equation modeling were used for data analysis, with a 5% significance level applied to the final models.

Results: Male sex and clinical-care variables had a direct and negative influence on functionality in the first two models (p < 0.05). Activities and Participation had a positive direct effect on self-reported quality of life (p = 0.031; β = 0.282) and parent/caregiver-reported quality of life (p = 0.003; β = 0.387). Parent-reported quality of life was negatively influenced by complaints of oro-facial motricity alterations, while self-reported quality of life was positively influenced by the diagnostic hypothesis of speech disorders.

Conclusion: The results show that sex and clinical-care complaints negatively influenced functionality, while Activities and Participation positively influenced quality of life. The use of structural equation modeling proved to be an important strategy for analyzing ICF and quality of life in SLP practice.

Introduction: Broca's Aphasia (BA) is a language disorder that causes grammatical errors in the language production skills of patients. Contemporary studies revealed the fact that BA patients also have difficulty in analyzing the meaning of phrases and sentences and comprehending the real meaning of the discourse produced by the speaker. The purpose of this study is to investigate possible effect of syntactic movement by changing the word positions in the sentence with morphological markers in order to produce clauses without changing the meaning on the phrasal comprehension skills of Turkish speaking patients with BA.

Method: A total of 300 participants were divided as study (n= 150) and control (n= 150) groups between ages of 27 - 89. A test that included 20 relative clauses and 9 noun clauses (in total 29 phrases) was assigned to the BA patients and control group. Relative clause phrases originated from simple sentences by adding suffixes to the verb as a function of Turkish morphology. Each suffix indicated a specific noun, object or subject, and each figure in the test was related to one of them. A researcher asked participants to match the demanded clause with the 6 possiblly related pictures for relative clause and 3 for noun clauses.

Results: Findings indicated that BA patients in our study had a lack of comprehending relative clauses due to the syntactic movement of words in the object and subject positions. Compared to the responses of the control group, participants with BA had significantly lower scores when the object and subject positions have moved from their original positions. BA patients also obtained significantly lower scores in object type questions Conclusion: Our findings support the fact that comprehension processing in BA should be investigated profoundly to be able to understand the nature of the disorder in different languages. In Turkish, syntactic movement of words to form a relative clause caused the BA patients to have significant problems to assign the semantic roles to the words in the existance of movement or change in their original positions.

Introduction: Apraxia of speech (AOS) is a motor speech disorder characterized by sound distortions, substitutions, deletions, and additions; slow speech rate; abnormal prosody; and/or segmentation between words and syllables. AOS can result from neurodegeneration, in which case it can be accompanied by the primary agrammatic aphasia (PAA), which when presenting together are called AOS+PAA. AOS can also be the sole manifestation of neurodegeneration, termed primary progressive AOS (PPAOS). Together these form the agrammatic-apractic spectrum disorders. Recent work has shown that agrammatic-apractic spectrum patients show reduced quantity of written language production on a picture description task versus controls. However, no study to date has investigated if there are differences in quantity (amount of writing) and quality (grammaticality) in the written language production between PPAOS and AOS+PAA patients, which was the aim of this study.

Methods: Twenty-four AOS+PAA patients, 24 PPAOS patients, and 24 typical controls performed the Western Aphasia Battery (WAB) written picture description task. The total number of words and sentences, as well as the type-token frequency, mean length of utterance, proportion of nouns and function words, and overall sentence grammaticality were compared among groups.

Results: The PPAOS group showed significantly reduced number of words (ß=-44.2, p <.0001) and sentences (ß=-4.04, p<.0001) compared to typical controls, and the AOS+PAA group showed significantly reduced number of words compared to both PPAOS patients (ß=-17.0, p=.02) and controls (ß=-61.20, p<.0001), as well as reduced number of sentences compared to controls (ß=-4.33, p<.0001). AOS+PAA patients also showed grammatical deficits consistent with their concomitant aphasia diagnosis.

Conclusions: This study provides novel quantitative data showing that agrammatic-apractic spectrum disorder patients show decreased written language output on a written picture description task compared to controls, even when there is no overt evidence of aphasia (i.e., PPAOS). Furthermore, these data show that controls, PPAOS patients, and AOS+PAA patients can all be distinguished based on the quantity of information and grammatical errors in a written picture description task. Future studies will explore sources beyond language, such as motoric impairment, that may result in reduced written quantity in agrammatic-apractic spectrum disorders.

Introduction: Young children with intellectual and developmental disabilities (IDD) who have limited speech and language require access to augmentative and alternative communication (AAC) intervention, including technology and instruction. While research shows that AAC intervention can effectively support communication from children with IDD, research on its impact on school readiness skills is limited.

Methods: Two preschool aged children with IDD participated in this study. Using a single case, multiple baseline across responses design for each participant, this study evaluated the effectiveness of an AAC intervention, including a high-tech AAC with a personalized color photo visual scene display with modeling, time delay, prompting, and social praise. The targeted responses were three questions from the participants' state kindergarten readiness standards, including: "What is your first name?"; "What is your last name?"; and "How old are you?".

Results: In baseline, both participants demonstrated little success communicating answers to questions. During intervention, both participants mastered the school readiness skill of responding accurately and independently to the targeted questions.

Conclusion: The current study shows that with early access to AAC intervention, children with IDD may begin to build communication skills that align with school readiness standards, providing them increased opportunity to participate fully and meaningfully in general education curricula, upon entering kindergarten.

Introduction: Dysphagia is a prevalent symptom of various neurological diseases and is associated with decreased quality of life. The M.D. Anderson Dysphagia Inventory (MDADI) is globally utilized tool to assess the impact of dysphagia on quality of life. However, a Turkish version of the scale is not yet available. This study aimed to translate, culturally adapt, and evaluate the validity and reliability of the Turkish version of the MDADI.

Methods: One hundred twenty-four patients who were diagnosed with definite neurological disease completed the study. The cross-cultural adaptation and translation process of the MDADI adhered to the World Health Organization's guidelines using the forward-backward translation method. The feasibility and the floor and ceiling effects were evaluated. Cronbach's alpha was used to assess internal consistency. The Bland and Altman method and interclass correlation coefficient (ICC) were used to evaluate test-retest reliability. Absolute reliability was determined using the standard error of the measurement (SEM) and minimal detectable change (MDC). Construct validity was assessed using Pearson's correlation coefficient between the MDADI and the Turkish Swallowing Quality of Life (T-SWAL-QOL) questionnaire.

Results: Our study had a feasibility rate of 100%. No floor or ceiling effects were determined for any subscale or composite scores of the T-MDADI. The T-MDADI demonstrated excellent reliability, with Cronbach's alpha coefficients ranging from 0.89 to 0.96 and ICC values from 0.81 to 0.95, confirming strong internal consistency and test-retest reliability. Measurement precision was supported by a SEM of 3.96 and an MDC of 10.97 for the composite score. In terms of validity, significant correlations were observed between T-MDADI subdomains and T-SWAL-QOL subdomains (r = 0.61-0.80 for food selection, mental health, and social functioning; r = 0.41-0.60 for eating duration and communication; p < 0.01), demonstrating good to very good convergent validity.

Conclusion: The T-MDADI demonstrates validity and reliability as a questionnaire for assessing dysphagia-related quality of life in Turkish patients with neurological diseases.