Folia Phoniatrica et Logopaedica最新文献

Background: The quality of life (QOL) of individuals with stroke-induced aphasia is significantly impacted by the condition. Clinicians and researchers are increasingly focusing on QOL assessments for people with aphasia (PWA) to gauge the effects of aphasia and the effectiveness of interventions. While several QOL assessment tools are utilized for PWA, there is limited literature comparing and evaluating their suitability for this population. This review aimed to explore the QOL measurement tools used with PWA, their aphasia-friendly characteristics, their applicability to severe aphasia, and the technical aspects of these questionnaires.

Summary: The review process involved two stages. Initially, a search was conducted to identify the tools used for assessing the QOL of PWA in studies published between 1975 and 2022. Various databases such as Google Scholar, PubMed, Scopus, and Web of Science were searched using specific keywords related to stroke, aphasia, QOL, questionnaires, outcome measurements, tools, scales, and instruments. Subsequently, hand searching was employed to gather additional information on the identified tools, including technical properties, communication and language domains, and crucial factors for QOL assessment in PWA. Results revealed that 28 articles met the inclusion criteria, identifying 26 tools for QOL assessment in PWA, comprising 11 generic, 9 stroke-specific, and 6 aphasia-specific tools. Technical details such as research country distribution, publication years (ranging from 1972 to 2015), completion time, administration methods (self-reporting), item formats (question or statement), response types (all tools, except SIP-136, NHP, and SA-SIP30 used Likert type scale for ratings), scoring methods (sum of score or using an algorithm), translation/adaptation status (EQ-5D-3L among generic tools, SIS-16 among stroke-specific questionnaires, and SAQOL-39 among aphasia-specific instruments received the most amount of translation/adaptation), respondent characteristics (almost all the tools except aphasia-specific tests excluded people with severe aphasia), number of dimensions (ranged 1-12), item numbers [6-136], and coverage of communication/language domains (BOSS, CDP, ALA, AIQ-21 covered all language domains) were analyzed. Notably, ALA emerged as the most suitable tool for assessing QOL in PWA due to its alignment with the desired features.

Key messages: Based on the review findings, clinicians and researchers are advised to prioritize the following features when selecting a QOL questionnaire for PWA: aphasia-specific and aphasia-friendly design, comprehensive coverage of QOL dimensions, inclusion of all language domains, and provision of self-reporting opportunities for PWA across all severity levels. ALA stands out as the preferred tool for QOL assessment in PWA based on its adherence to these criteria.

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 (β = -44.2, p < 0.0001) and sentences (β = -4.04, p < 0.0001) compared to typical controls, and the AOS+PAA group showed significantly reduced number of words compared to both PPAOS patients (β = -17.0, p = 0.02) and controls (β = -61.20, p < 0.0001), as well as reduced number of sentences compared to controls (β = -4.33, p < 0.0001). 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: Visual Analysis of Swallowing Efficiency and Safety (VASES) and Dynamic Imaging Grade of Swallowing Toxicity for Flexible Endoscopic Evaluation of Swallowing (DIGEST-FEES) are two complimentary methods for assessing swallowing during FEES. Whereas VASES is intended to facilitate trial-level ratings of pharyngeal residue, penetration, and aspiration, DIGEST-FEES is intended to facilitate protocol-level impairment grades of swallowing safety and efficiency. The aim of this study was to assess the validity of using VASES to derive DIGEST-FEES impairment grades.

Methods: DIGEST-FEES grades were blindly analyzed from 50 FEES - first using the original DIGEST-FEES grading method (n = 50) and then again using a VASES-derived DIGEST-FEES grading method (n = 50). Weighted Kappa (κw) and absolute agreement (%) were used to assess the relationship between the original DIGEST-FEES grades and VASES-derived DIGEST-FEES grades. Spearman's correlations assessed the relationship between VASES-derived DIGEST-FEES grades with measures of construct validity.

Results: Substantial agreement (κw = 0.76-0.83) was observed between the original and VASES-derived grading methods, with 60-62% of all DIGEST-FEES grades matching exactly, and 92-100% of DIGEST-FEES grades within one grade of each other. Furthermore, the strength of the relationships between VASES-derived DIGEST-FEES grades and measures of construct validity (r = 0.34-0.78) were similar to the strength of the relationships between original DIGEST-FEES grades and the same measures of construct validity (r = 0.34-0.83).

Conclusion: Findings from this study demonstrate substantial agreement between original and VASES-derived DIGEST-FEES grades. Using VASES to derive DIGEST-FEES also appears to maintain the same level of construct validity established with the original DIGEST-FEES. Therefore, clinicians and researchers may consider using VASES to increase the transparency and standardization of DIGEST-FEES ratings. Future research should seek to replicate these findings and explore the simultaneous use of VASES and DIGEST-FEES in a greater sampling of raters and across other patient populations.

Introduction: Visual Analysis of Swallowing Efficiency and Safety (VASES) and Dynamic Imaging Grade of Swallowing Toxicity for Flexible Endoscopic Evaluation of Swallowing (DIGEST-FEES) are two complimentary methods for assessing swallowing during FEES. Whereas VASES is intended to facilitate trial-level ratings of pharyngeal residue, penetration, and aspiration, DIGEST-FEES is intended to facilitate protocol-level impairment grades of swallowing safety and efficiency. The aim of this study was to assess the validity of using VASES to derive DIGEST-FEES impairment grades.

Methods: DIGEST-FEES grades were blindly analyzed from 50 FEES - first using the original DIGEST-FEES gradi

Introduction: This study explores the quality of life among patients with recurrent respiratory papillomatosis (RRP) after vocal fold surgery as measured by the outcome scores of the Voice Handicap Index (VHI) and the Distress Thermometer and Problem List in Patients with Recurrent Respiratory Papillomatosis (DT&PL). Differences in quality of life were explored within the independent variables age, surgical frequency, weeks since last vocal fold operation, gender, HPV type, surgical location, vaccination with Gardasil©, and a patient's request to speak with a speech-language pathologist.

Methods: A single-center, observational cohort study was conducted using VHI and DT&PL scores and demographic and clinical data obtained from patient files. Inclusion criteria were a confirmed HPV type, age 18 years or older, the ability to fill in both questionnaires in Dutch, and having undergone at least one surgical procedure to remove laryngeal papilloma. Relationships of the independent variables with VHI and Distress Thermometer (DT) scores were explored using univariable and multivariable regressions and linear regression models.

Results: Of 271 RRP patients, 100 met the inclusion criteria and responded to requests to fill in both questionnaires with a minimum of 12 weeks after their last operation. Our study showed a statistically significant negative relationship between age and VHI scores (p = 0.02) in the univariable, and multiple linear regressions (p = 0.01), indicating that patients experienced fewer self-perceived functional voice disabilities with each increase in age. A parallel negative relationship is seen between the variables age (p = 0.03) and DT scores. Our results showed a statistically significant positive relationship between the number of vocal fold surgeries and DT scores (p = 0.03).

Conclusion: The results of this study show a significant relationship between age, surgical frequency, and quality of life in patients with RRP. Older patients have lower Voice Handicap Index (VHI) and Distress Thermometer (DT) scores, indicating fewer self-perceived voice and disease-related quality of life problems. Conversely, a rise in surgical frequency is significantly associated with higher DT scores, reflecting greater disease-related distress.

Introduction: This study proposes a revised version of the Reflux Symptom Index (R-RSI), a seventeen-item questionnaire that was revised to increase the suspicion of laryngopharyngeal reflux disease (LPRD).

Methods: Internal validation involved 213 participants, comprising 160 subjects without a previous LPRD diagnosis and 53 subjects with a self-reported previous diagnosis of LPRD with or without gastroesophageal reflux disease (GERD). Test-retest reliability and internal consistency were calculated. For the external validation, 56 patients (independent from the previous cohort) were enrolled to explore the R-RSI screening properties and determine a cutoff using 24-h MII-pH as the gold standard.

Results: R-RSI test-retest reliability was high, both for the total score (ICC: 0.970) and for each item (ranging from 0.876 to 0.980). Cronbach's alpha was 0.910, indicating excellent internal consistency of the questionnaire. Participants with a previous self-reported diagnosis scored significantly higher (mean 24.94 ± 7.4; median 26, IQR 20-29) than those without a previous diagnosis (mean 4.66 ± 5.3; median 4, IQR 1-6) (p value <0.0001). Participants with both previous LPRD and GERD diagnoses had higher scores (27.20 ± 7.8) compared to those with only LPRD (21.77 ± 5.5) (p value = 0.003). Using 24-h MII-pH diagnosis as a gold standard, the optimal R-RSI cutoff point was determined to be 18, with a sensitivity of 84.5% and a specificity of 81.8%, positive predictive value of 95%, and negative predictive value of 60%.

Conclusions: Our results suggest that the R-RSI may be useful to suspect LPRD, with or without GERD. The R-RSI is a self-administered patient-reported outcome questionnaire that demonstrates excellent reliability and high screening properties. Employing a cutoff of ≥18 in the R-RSI can assist in diagnosing and monitoring LPRD.

Introduction: The Palin Parent Rating Scale (Palin PRS) is a structured questionnaire filled out by parents of children who stutter. It is designed to assess the effects of stuttering on both the children and their parents. The goal of this study was to translate the Palin PRS into Persian and to evaluate its validity and reliability for application in preschool children who stutter.

Methods: This research was conducted from August 2021 to December 2022, involving 139 parents of children who stutter. The parents completed the Palin PRS and provided their demographic data. Descriptive statistics were used to examine the floor and ceiling effects on all subscales of the Palin PRS. The internal consistency of the scale was assessed using Cronbach's alpha method, while the intraclass correlation coefficient (ICC) was calculated to determine its test-retest reliability. An exploratory factor analysis was also performed to clarify the factor structure of the scale.

Results: The exploratory factor analysis results were highly consistent with the factor structure found in the original version. No floor or ceiling effects were observed for the factors of the Palin PRS. The three factors of the Persian version of the Palin PRS (P-Palin PRS) showed good internal consistency (Cronbach's alpha >0.8) and excellent test-retest reliability (ICC >0.9). Additionally, normative scores were derived by converting raw scores into Stanine scores.

Conclusion: The P-Palin PRS showed strong reliability, thereby establishing it as a suitable instrument for evaluating how parents perceive the effects of stuttering on their children and themselves. Further research may explore its application in diverse clinical settings and populations.

Introduction: Children with malocclusion, combined with orofacial myofunctional disorders (OMDs), show increased risk of developing orthodontic problems and needs later in life. Speech-language therapists typically provide orofacial myofunctional therapy (OMT) after referral by dentists, orthodontists or ENT specialists. Interdisciplinary treatment is often advisable to prevent relapse after orthodontic treatment. OMDs and OMT are often found to be controversial topics by dentistry professionals. This study aimed to investigate self-reported knowledge and attitudes of Flemish dentists and orthodontists towards OMDs and OMT.

Methods: A survey containing 32 items on demographics, self-reported knowledge of OMDs and OMT, attitudes towards OMDs, OMT, and its use in clinical practice, and referral behaviour was filled out by 48 general dentists (48/79, 61%) and 31 orthodontists (31/79, 39%). The impact of specialization, degree of experience and educational programme was also evaluated.

Results: Fifty-six percent of all participants (44/79) reported insufficient to non-existent knowledge of OMT. Nevertheless, the general attitude towards the use of OMT was neutral (47%, 37/79) to (very) positive (48%, 38/79). Although they found correct, evidence-based knowledge on OMDs and OMT important, the majority indicated their formal training did not provide adequate information on OMDs (52%, 41/79) and OMT (62%, 49/79). Specialization showed significant effects, as orthodontists reported themselves knowledgeable on this topic significantly more often than general dentists (p < 0.001), and generally reported a more positive stance towards OMT (p = 0.022).

Conclusion: Dentists and orthodontists indicated a general interest in the topic of OMDs and OMT, alongside an overall lack of information provided by formal education. Current findings suggest the necessity of re-evaluating current curricula on OMDs and OMT.

Introduction: The present study aimed to validate the Voice-Related Quality of Life (V-RQOL), vocal self-assessment questionnaire for Spanish.

Methods: The validation and psychometric properties were developed according to the criteria of the Scientific Advisory Committee of Medical Outcomes Trust (SAC). The Spanish translation for linguistic and cultural adaptation of the V-RQOL was used. The study involved 193 participants, including 90 vocally healthy individuals and 103 patients with voice disorders, to establish validity. To evaluate reliability, the protocol was applied to 40 participants with dysphonia, who answered it twice before the treatment. Then to determine response changes, the responses of 13 dysphonic participants to the V-RQOL for Spanish were analyzed after intervention and then compared to the initial ones. Clinicians contrasted subjects' V-RQOL results with a perceptual analysis of voice quality using the GRBAS scale. In order to determine sensitivity and specificity cut-off values, tools results were subjected to the receiver operating characteristic curve analysis. The sensitivity was obtained from the experimental group (dysphonic group) and the specificity from the control group (non-dysphonic group).

Results: This version of the V-RQOL questionnaire may be used as part of the standard assessment process of people with voice complaints and as an outcome of treatment efficacy in clinical trials.

Conclusion: A validation of the V-RQOL for Spanish in Chilean population was achieved.

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 and SVT.

Methods: Seventeen 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, 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 grade of dysphonia, roughness, breathiness, and asthenia. 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 has 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-week 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 ± 4.68 y; range, 65-82 y). The exercise consisted of 10 repetitions per set, wherein one session comprised 7 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.