Assessment Sessions Research Articles

Baseline Measures of Cortical Inhibition Predict Motor Performance Changes after Exercise Interventions

<h3>Research Objectives</h3> To investigate the relationship of transcranial magnetic stimulation (TMS) measures on cortical inhibition before and after an exercise intervention in older adults. Our hypothesis is that higher levels of cortical inhibition would predict greater motor skill acquisition. We predicted that persons randomized to an aerobic spin exercise intervention would increase cortical inhibition and motor performance as compared to light strength training. <h3>Design</h3> The study design is randomized controlled trial with two groups investigating a balance and strength training intervention (both lasting 12-weeks or 36 sessions) against an Aerobic Cycling Intervention. The assessment sessions included behavioral testing, TMS taken at study baseline and after 12-weeks. <h3>Setting</h3> This project involved community dwelling older adults and was performed in a medical center. The main study sites were the Atlanta VA and Emory University. <h3>Participants</h3> We randomized 20 participants to either an exercise intervention or a balance and strength training group after obtaining informed consent. Participants were required to be over the age of 60 years and reportedly healthy at inclusion. This report is on 13 completers. <h3>Interventions</h3> Participants were randomized to either a 12-week interval aerobic spin cycling (HIIT spin) or a 12-week intervention involving light strength training both under supervised trainers thrice weekly for up to 45 minutes per session. <h3>Main Outcome Measures</h3> We acquired transcranial magnetic stimulation measures of: cortical excitability (motor threshold), Short intracortical inhibition, Long Intracortical Inhibition, Short Interhemispheric inhibition, long interhemispheric inhibition. Speed and accuracy of motor learning was the behavioral outcome. <h3>Results</h3> Baseline measures of SICI and LICI showed participants with higher levels of disinhibition showed better motor performance. We found no effect for group. Contrary to our hypothesis, individuals with greater increases in TMS inhibition showed lower motor skill performance after interventions. <h3>Conclusions</h3> We can conclude from the preliminary data that measures of cortical inhibition taken from TMS do show change associated with interventions in older adults and predict improvement in motor skill acquisition. Additional study is needed to identify the mechanisms of change in cortical inhibition. <h3>Author(s) Disclosures</h3> None.

BreakThrough Communication in a Hybrid World: Amplifying Interactive, Experiential Learning

This case study document describes the research foundation and instructional design of BreakThrough Communication, an evidence-based hybrid learning enterprise that builds organizational capacity by boosting communication skill in individuals and teams. BTC’s tiered talent development program combines asynchronous, self-paced video instruction in foundational knowledge; live virtual workshops customized to engage learners in practicing new skills on organizational challenges they face; and change-sustaining follow-through to embed new skills through assessment, video reinforcers, and real-time practice sessions. A certificate program that prepares internal trainers to assume communication coach roles completes the process. The BTC learning system is grounded in the traditional pedagogy of the communication field, aligns with adult learning theory, and reflects recent neuroscience research on how the human brain most efficiently learns. Three distinct areas of communication skill comprise the program’s subject material: inter-personal conflict; teamwork; persuasive speaking. The communication models within each area have been validated in both experimental and field studies, shown to change behavior and affect outcomes.

Plasmodium cynomolgi in humans: current knowledge and future directions of an emerging zoonotic malaria parasite.

Plasmodium cynomolgi (Pcy), a simian malaria parasite, is a recent perfect example of emerging zoonotic transfer in human. This review summarizes the current knowledge on the epidemiology of natural Pcy infections in humans, mosquitoes and monkeys, along with its biological, clinical and drug sensitivity patterns. Knowledge gaps and further studies on Pcy in humans are also discussed. This parasite currently seems to be geographically limited in South-East Asia (SEA) with a global prevalence in human ranging from 0 to 1.4%. The Pcy infections were reported in local SEA populations and European travelers, and range from asymptomatic carriage to mild/moderate attacks with no evidence of pathognomonic clinical and laboratory patterns but with Pcy strain-shaped clinical differences. Geographical distribution and competence of suitable mosquito vectors and non-primate hosts, globalization, climate change, and increased intrusion of humans into the habitat of monkeys are key determinants to emergence of Pcy parasites in humans, along with its expansion outside SEA. Sensitization/information campaigns coupled with training and assessment sessions of microscopists and clinicians on Pcy are greatly needed to improve data on the epidemiology and management of human Pcy infection. There is a need for development of sensitive and specific molecular tools for individual diagnosis and epidemiological studies. The development of safe and efficient anti-hypnozoite drugs is the main therapeutic challenge for controlling human relapsing malaria parasites. Experience gained from P. knowlesi malaria, development of integrated measures and strategies-ideally with components related to human, monkeys, mosquito vectors, and environment-could be very helpful to prevent emergence of Pcy malaria in humans through disruption of transmission chain from monkeys to humans and ultimately contain its expansion in SEA and potential outbreaks in a context of malaria elimination.

Understanding how people with Parkinson's disease turn in gait from a real-world in-home dataset

IntroductionTurning in gait digital parameters may be useful in measuring disease progression in Parkinson's disease (PD), however challenges remain over algorithm validation in real-world settings. The influence of clinician observation on turning outcomes is poorly understood. Our objective is to describe a unique in-home video dataset and explore the use of turning parameters as biomarkers in PD. Methods11 participants with PD, 11 control participants stayed in a home-like setting living freely for 5 days (with two sessions of clinical assessment), during which high-resolution video was captured. Clinicians watched the videos, identified turns and documented turning parameters. ResultsFrom 85 hours of video 3869 turns were evaluated, averaging at 22.7 turns per hour per person. 6 participants had significantly different numbers of turning steps and/or turn duration between “ON” and “OFF” medication states. Positive Spearman correlations were seen between the Movement Disorders Society-sponsored revision of the Unified Parkinson's Disease Rating Scale III score with a) number of turning steps (rho = 0.893, p < 0.001), and b) duration of turn (rho = 0.744, p = 0.009) “OFF” medications. A positive correlation was seen “ON” medications between number of turning steps and clinical rating scale score (rho = 0.618, p = 0.048). Both cohorts took more steps and shorter durations of turn during observed clinical assessments than when free-living. ConclusionThis study shows proof of concept that real-world free-living turn duration and number of turning steps recorded can distinguish between PD medication states and correlate with gold-standard clinical rating scale scores. It illustrates a methodology for ecological validation of real-world digital outcomes.

Psychometric properties of the MOBITEC-GP mobile application for real-life mobility assessment in older adults

Aim of this study was to test the reliability and validity of the life-space measures and walking speed delivered by the MOBITEC-GP app. Participants underwent several supervised walking speed assessments as well as a 1-week life-space assessment during two assessment sessions 9 days apart. Fifty-seven older adults (47.4% male, mean age= 75.3 (±5.9) years) were included in the study. The MOBITEC-GP app showed moderate to excellent test-retest reliability (ICCs between 0.584 and 0.920) and validity (ICCs between 0.468 and 0.950) of walking speed measurements of 50 meters and above and of most 1-week life-space parameters, including life-space area, time spent out-of-home, and action range. The MOBITEC-GP app for Android is a reliable and valid tool for the assessment of real-life walking speed (at distances of 50 metres and above) and life-space parameters of older adults. Future studies should look into technical issues more systematically in order to avoid invalid measurements.

Effects of a short-term in-season break on repeated-sprint ability, jump height and locomotor performance in small-sided games in female soccer players

The current study aimed to analyse the effects of an in-season break period (2-week) on specific performance in amateur young female soccer players. Twelve female soccer players completed four assessment sessions, two before (BD-d1 and BD-d2) and two after (AD-d1 and AD-d2) a 2-week in-season break detraining period (both separated by 24 h). In each session, players completed a repeated sprint ability test (repeated sprint ability = 8 sprints of 30 m with 25 s of recovery), a countermovement jump test and locomotor performance in small-sided games (small-sided games = 3 sets of 5 min in a 5 vs. 5). Players exhibited a significant decrease in mean of repeated sprint ability (mean time of 8 sprints, p = 0.000, effect size = 2.04) and countermovement jump ( p = 0.009, effect size = 1.39) performance between BD-d1 and AD-d1. The percentage of change between BD-d1 and BD-d2 from AD-d1 and AD-d2 shows significant differences ( p = 0.05, effect size = 1.12) in best of repeated sprint ability (best time of 8 sprints) but not ( p = 0.517, effect size = 0.31) in mean of repeated sprint ability. Significantly less high-intensity acceleration was performed in BD-d2 and AD-d2 from BD-d1 ( p = 0.003, effect size = 3.21 and p = 0.002, effect size = 3.25, respectively). Only a 2-week in-season break inactivity was sufficient to decrease mean of repeated sprint ability and countermovement jump performance but not the best of repeated sprint ability. Therefore, it is necessary to apply specific training strategies to prevent decreases in performance in female soccer players in specific periods of the season.

Altered stability of brain functional architecture after sleep deprivation: A resting-state functional magnetic resonance imaging study.

Background and aimsResting-state functional magnetic resonance imaging (fMRI) studies using static and dynamic functional connectivity (FC) approaches have revealed brain dysfunction resulting from sleep deprivation (SD). The effects of SD on the stability of brain functional architecture remain unclear. This study investigated the functional stability (FS) changes induced by SD and its association with neurocognitive alterations.Materials and methodsIn this study, we recruited 24 healthy women. All participants underwent two sessions of resting-state fMRI scanning and neurocognitive assessment. The assessments included the Digit Symbol Test, Digit Span Test, Trail-Making Test (TMT), and Complex Figure Test (CFT). Participants completed one session under rested wakefulness (RW) and one session after SD for 24 h. To estimate dynamic FC, we used the sliding window approach; and then, to characterize the FS of each voxel, we measured dynamic FC concordance over time. We used a paired t-test to identify differences in FS between RW and SD. To examine the relationship between these changes in FS and alterations in neurocognitive performance, we conducted Spearman’s correlation analyses.ResultsSD affected the performance of the Digit Symbol Test, Digit Span Test, and CFT. Compared with RW, subjects with SD exhibited decreased FS in the bilateral anterior and posterior cingulate gyrus and medial frontal gyrus, right superior frontal gyrus, and cerebellum posterior lobe, while they exhibited increased FS in the bilateral precentral/postcentral gyrus and supplementary motor area, right parahippocampal gyrus and fusiform gyrus, left inferior occipital gyrus, and bilateral cerebellum anterior lobe. After SD, FS changes in the right parahippocampal gyrus and fusiform gyrus were correlated with altered performance in the Digit Symbol Test and CFT.ConclusionOur findings showed that the stability of the brain’s functional architecture could be altered by SD. This stability alteration may correspond to multiple neurocognitive domain changes.

Acute and chronic cardiometabolic responses induced by resistance training with blood flow restriction in HIV patients

Resistance training with blood flow restriction (RTBFR) allows physically impaired people living with HIV (PWH) to exercise at lower intensities than traditional resistance training (TRT). But the acute and chronic cardiac and metabolic responses of PWH following an RTBFR protocol are unknown. The objective was to compare the safety of acute and chronic effects on hemodynamic and lipid profiles between TRT or RTBFR in PWH. In this randomized control trial, 14 PWH were allocated in RTBFR (GRTBFR; n = 7) or TRT (GTRT; n = 7). Both resistance training protocols had 36 sessions (12 weeks, three times per week). Protocol intensity was 30% (GRTBFR) and 80% (GTRT). Hemodynamic (heart rate, blood pressure) and lipid profile were acutely (rest and post exercise 7th, 22nd, and 35th sessions) and chronically (pre and post-program) recorded. General linear models were applied to determine group * time interaction. In the comparisons between groups, the resistance training program showed acute adaptations: hemodynamic responses were not different (p > 0.05), regardless of the assessment session; and chronicles: changes in lipidic profile favors GRTBFR, which significantly lower level of total cholesterol (p = 0.024), triglycerides (p = 0.002) and LDL (p = 0.030) compared to GTRT. RTBFR and TRT induced a similar hemodynamic adaptation in PWH, with no significant risks of increased cardiovascular stress. Additionally, RTBFR promoted better chronic adequacy of lipid profile than TRT. Therefore, RTBFR presents a safe resistance training alternative for PWH.Trial registration: ClinicalTrials.gov ID: NCT02783417; Date of registration: 26/05/2016.

Building Trust between Speech Pathologists and Interpreters in the Assessment of Aphasia

ABSTRACT Background Where a person with aphasia and the treating speech pathologist come from different linguistic backgrounds, an interpreter is often called upon to facilitate the clinical assessment. Previous research has documented the challenges that multilingual aphasia assessment can pose for both interpreter and speech pathologist. These challenges highlight the importance of interprofessional trust for an effective collaborative partnership. Aim Our aim is to understand how provider-interpreter trust – as an activity-specific practice – develops through interactions in aphasia assessment sessions. Methods & Procedures Extracts from two interpreter-mediated aphasia assessments involving speakers of two different languages (Tagalog and Greek) were selected from a larger corpus. Using interactional sociolinguistic discourse analysis, we identified particular interactional choices and patterns that contributed to the building of rapport and trust between the interpreter and speech pathologist. Outcomes Analysis revealed that participants invoked a range of interactive frames during the assessment sessions. Using the Framework of Provider-Interpreter Trust (Hsieh et al., 2010), we were able to demonstrate how socio-relationally oriented frames and clinically oriented frames can both serve the practice of trust building. Conclusions Interactional features that reflect shared goals between the interpreter and speech pathologist, as well as acknowledgement of professional boundaries, can foster trust. We argue that there is scope for trust to be further enhanced by providing space for the interpreter to offer cultural insights relevant to the speaker’s lifeworld that may be unfamiliar to the speech pathologist. We also argue that much of this work would be best achieved during dedicated pre-session briefings and post-session debriefings.

Feasibility and usefulness of a consumer-grade device for physical activity monitoring for patients with Parkinson's disease and Parkinsonism

The identification of the best measures to improve quality of life, awareness and care management for senior users with neurodegenerative diseases, and the implementation of personalized recommendations to support the user through gamification techniques and to adopt healthy habits, to maintain a good daily routine and to follow the prescribed actions by professionals for maintaining and improving their health condition, are the main contributions of PROCare4Life, an EU funded project. In fact, by proposing an integrated scalable and interactive care ecosystem, this solution can be easily adapted to the reality of several chronic diseases. The ability to passively track continuous ambulatory activity over time in a real-world scenario in patients with Parkinson’s disease (PD) has many potential uses. Wrist-worn physical activity monitors may be a valuable tool for tracking and/or increasing physical activity among patients with Parkinson. Because of differences in technology acceptance associated with age, and variable clinical conditions, feasibility and usefulness of Fitbits may vary among these subjects. The purpose of this study was to evaluate the patients’ adherence during the period of physical activity monitoring and to analyze the correlation between steps counts and clinical parameters. Patients with idiopathic PD (Parkinson’s disease) or Parkinsonism were recruited at Casa di Cura del Policlinico (Milan, Italy). Participants attended one assessment session at hospital with an expert neurologist. Age, gender, disease duration, falls history and medication intake were collected by an interview. Disease severity was measured using the Unified Parkinson’s Disease Rating Scale (UPDRS) and stage of disease rated using Hoehn and Yahr scale (H&Y). All participants signed an informed consent. All research procedures were approved by the Local Ethics Committee. Patients’ physical activity monitoring was performed by means of the wearable sensor Fitbit Versa 2 (Fitbit Inc, San Francisco, California, USA), a small wearable activity tracker that is worn like a watch with a triaxial accelerometer and that displays step count. The activity tracker was provided to patients at the time of enrollment together with the instructions for use. Patients were asked to wear it at all times for 60 days, excluding while bathing and sleeping. Step count was recorded while participants wore the smartwatch. While no specific recommendations were given on amount of physical activity and there was no daily step target, patients were invited to follow their daily routine for the period of the monitoring. Correlation between step count data from the Fitbit, demographic indicators and clinical scales were examined using Pearson’s correlation coefficient. 13 subjects were enrolled (73.23 ± 6.56 years; 8 males; 10 with diagnosis of PD; UDPRS at baseline: 67.92 ± 35.30; H&Y: 2.69 ± 0.75). Three of the 13 participants did not complete the study due to wristband’s usability problems. Among the subjects that completed the study, the number of mean daily steps during the monitoring period was 4879.76 ± 3385.69, with individual participants’ means ranging from 62.54 to 11727.86. The majority of subjects (60%) could be classified as sedentary (i.e., mean daily steps lower than 5000) [1]. Using the adherence definition of >100 steps, on average the participants wore wristband 49.80 ± 16.86 days, with an adherence of 83.00 ± 28.11% of the 60-day study period. Noteworthy, for the quasi-totality of subjects (70%) the adherence was very high (96.67 ± 5.69%), for two participants was high (68.33-75.00%) and for one participant very low (10.00%). A significant correlation between steps taken and UPDRS (R= -0.76, p=0.010) at the end of the monitoring period was found. Removing the subjects with very low adherence and the one that never reached 5000 steps per day, a high significant correlation for steps taken and H&Y scale (R = 0.71, p = 0.047) resulted. An additional high significant correlation was found between steps taken and the differences in global score of UPDRS (R = 0.75, p = 0.031) assessed at the beginning and at the end of the monitoring period. The preliminary results show that the use of a consumer-grade device in patients with neurodegenerative disease is feasible with reasonable adherence. The positive correlation between steps taken and modification in UPDRS scales means that higher steps correspond to a smaller worsening in UPDRS scale assessment. These preliminary results, if confirmed in large scale scenario, could be useful in the framework of the PROCare4Life project, in order to develop and validate an ICT-based integrated care ecosystem that will improve the quality of life of the users in their care delivery, and by improving social and medical services through automation and digitalisation.

Recent Advances of Telepractice for Autism Spectrum Disorders in Speech and Language Pathology.

Telepractice or teletherapy is defined as the means of service delivery via technology-based platforms that allow long-distance interventions across populations, age spans, and geographical locations. Specifically, telepractice capitalizes on communication technologies such as online modules, videoconferencing, and computerized software programs, in servicing populations with communication challenges. Notably, telepractice has emerged as a potentially effective, low-cost, and promising means of conducting and completing online assessment, diagnosis, and intervention sessions for individuals with autism spectrum disorders (ASD). Moreover, telepractice allows the inclusion of parents, caregivers, and educators as potential facilitators in supporting treatment delivery in populations with ASD. This thematic review article aims to highlight and acquaint practitioners and other stakeholders with relatively recent information regarding the advantages and disadvantages of the telepractice service delivery model in ASD. Furthermore, the emergence of the COVID-19 pandemic has impacted service delivery in the field of Health Sciences including speech and language pathology (SLP). Consequently, the need to avoid face-to-face therapy sessions, recommended to SLPs as to all health practitioners, resulted in the call for adaptation and adjustment of service telepractice. This paper attempts to answer this call by suggesting supplementing traditional diagnostic and therapy resources with training modules consisting of online materials and use of animated and specially designed programs in SLP intervention with individuals with ASD. Lastly, the paper includes a discussion of research findings in the field, a conclusion, and a take-home message.

ASSESSMENT OF RIGHT VENTRICULAR PULMONARY ARTERIAL (RV-PA) UNCOUPLING DURING EXERCISE IN PULMONARY ARTERIAL HYPERTENSION

ASSESSMENT OF RIGHT VENTRICULAR PULMONARY ARTERIAL (RV-PA) UNCOUPLING DURING EXERCISE IN PULMONARY ARTERIAL HYPERTENSION

PULMONARY INVOLVEMENT WITH PLEOMORPHIC ADENOMA: 30-YEAR EXPERIENCE WITH THIS RARE ENTITY AT A TERTIARY REFERRAL CENTER

PULMONARY INVOLVEMENT WITH PLEOMORPHIC ADENOMA: 30-YEAR EXPERIENCE WITH THIS RARE ENTITY AT A TERTIARY REFERRAL CENTER

Reliability of TMS measurements using conventional hand-hold method with different numbers of stimuli for tibialis anterior muscle in healthy adults.

Objective: The objective of this study was to determine the reliability of corticomotor excitability measurements using the conventional hand-hold transcranial magnetic stimulation (TMS) method for the tibialis anterior (TA) muscle in healthy adults and the number of stimuli required for reliable assessment.Methods: Forty healthy adults participated in three repeated sessions of corticomotor excitability assessment in terms of resting motor threshold (rMT), slope of recruitment curve (RC), peak motor evoked potential amplitude (pMEP), and MEP latency using conventional TMS method. The first two sessions were conducted with a rest interval of 1 h, and the last session was conducted 7–10 days afterward. With the exception of rMT, the other three outcomes measure elicited with the block of first 3–10 stimuli were analyzed respectively. The within-day (session 1 vs. 2) and between-day (session 1 vs. 3) reliability for all four outcome measures were assessed using intraclass correlation coefficient (ICC), standard error of measurement, and minimum detectable difference at 95% confidence interval.Results: Good to excellent within-day and between-day reliability was found for TMS-induced outcome measures examined using 10 stimuli (ICC ≥ 0.823), except in pMEP, which showed between-day reliability at moderate level (ICC = 0.730). The number of three stimuli was adequate to achieve minimum acceptable within-day reliability for all TMS-induced parameters and between-day reliability for MEP latency. With regard to between-day reliability of RC slope and pMEP, at least seven and nine stimuli were recommended respectively.Conclusion: Our findings indicated the high reliability of corticomotor excitability measurement by TMS with adequate number of stimuli for the TA muscle in healthy adults. This result should be interpreted with caveats for the specific methodological choices, equipment setting, and the characteristics of the sample in the current study.Clinical Trial Registration: http://www.chictr.org.cn, identifier ChiCTR2100045141.

Side-Scan Sonar Coupled with Scuba Diving Observation for Enhanced Monitoring of Benthic Artificial Reefs along the Coast of Terengganu, Peninsular Malaysia

Since the 1970s, artificial reef (AR) deployment has been one of the common approaches to augment the local production of coastal fish in Malaysia. However, there is a lack of strategy to assess and evaluate the success of pre-deployed AR. Realizing the need for an effective qualitative and quantitative monitoring and evaluation of AR, this study proposes side-scan sonar coupled with scuba diving observation for the enhanced monitoring of pre-deployed Bioceramic Korean (BK) AR along the coast of Terengganu, Peninsular Malaysia. This method employs an integrated side-scan sonar with a data acquisition system for the detection of the precise location of the BK AR which were deployed at Tukun Telaga Batin off the Terengganu coastline in 2003 by the Fisheries Development Authority of Malaysia (FDAM). Following the determination of the exact location of three BK AR areas, a scuba diving team was sent to survey the physical conditions of the AR and assess the feasibility of the AR as an artificial habitat for marine life. The scan sonar images were compared with the captured photographs and videos acquired during the scuba diving session for a comprehensive value-added assessment. The collected data from the scuba diving session were also processed to measure the fish diversity, the fish biomass, and identify the fish community surrounding the AR. Based on the results, the BK AR remained in extremely good condition, physically intact, without significant breakage or damage, and with no major subsidence into the sediment after 19 years of deployment. A total of 108 BK AR modules were detected in three large groups using the mosaicked sonar images. Following cross-examination to validate the AR measurements using the AR’s shadows on the seafloor, the height of the BK AR consistently ranged from 1.7 m to 1.8 m. In addition, 34 species of fish from 14 families and 26 genera were identified, with most species classified as reef-associated (RA) fish with a biomass value of 1173.31 ± 1136.69 kg m−3, indicating the successfulness of the BK AR as fish-aggregating devices (FADs). The growth of hard corals on top of the bioceramic plate of the AR module further supported the diversified community of marine life surrounding the BK AR. In conclusion, the side-scan sonar coupled with scuba diving observation demonstrates an effective qualitative and quantitative technique for the monitoring and evaluation of pre-deployed AR. This strategy is recommended to be utilized to determine the success of pre-deployment AR.

Validation of Pressure-Sensing Insoles in Patients with Parkinson's Disease during Overground Walking in Single and Cognitive Dual-Task Conditions.

There is a need for unobtrusive and valid tools to collect gait parameters in patients with Parkinson’s disease (PD). The novel promising tools are pressure-sensing insoles connected to a smartphone app; however, few studies investigated their measurement properties during simple or challenging conditions in PD patients. This study aimed to examine the validity and reliability of gait parameters computed by pressure-sensing insoles (FeetMe® insoles, Paris, France). Twenty-five PD patients (21 males, mean age: 69 (7) years) completed two walking assessment sessions. In each session, participants walked on an electronic pressure-sensitive walkway (GaitRite®, CIR System Inc., Franklin, NJ, USA) without other additional instructions (i.e., single-task condition) and while performing a concurrent cognitive task (i.e., dual-task condition). Spatiotemporal gait parameters were measured simultaneously using the pressure-sensing insoles and the electronic walkway. Concurrent validity was assessed by correlation coefficients and Bland–Altman methodology. Test–retest reliability was examined by intraclass correlation coefficients (ICC) and minimal detectable changes (MDC). The validity results showed moderate to excellent correlations and good agreement between the two systems. Concerning test–retest reliability, moderate-to-excellent ICC values and acceptable MDC demonstrated the repeatability of the measured gait parameters. Our findings support the use of these insoles as complementary instruments to conventional tools during single and dual-task conditions.

CC Thinker: Mobile-based Assessment to Train Creative and Critical Thinking in Students

This research aims to combine assessment of creative and critical thinking in a mobile device context, to see its effect on the creative and critical thinking of students. Design-based research as the method was used to develop the assessment as learning. It is begun with the assessment model and android application development, also experiments in the end. Three assessment sessions are participated by 46 students. The analysis using Kruskal Wallis gains the result that there are significant differences in the creative thinking (Chi-square 18.245, Asymp. Sig 0.000) and the critical thinking (Chi-square 7.620. Asymp. Sig 0.022). A significant difference in creative thinking is seen since the second session, while the difference in critical thinking needs the time up to the third session.

Wearable Neck Surface Accelerometers for Occupational Vocal Health Monitoring: Instrument and Analysis Validation Study.

BackgroundNeck surface accelerometer (NSA) wearable devices have been developed for voice and upper airway health monitoring. As opposed to acoustic sounds, NSA senses mechanical vibrations propagated from the vocal tract to neck skin, which are indicative of a person’s voice and airway conditions. NSA signals do not carry identifiable speech information and a speaker’s privacy is thus protected, which is important and necessary for continuous wearable monitoring. Our device was already tested for its durable endurance and signal processing algorithms in controlled laboratory conditions.ObjectiveThis study aims to further evaluate both instrument and analysis validity in a group of occupational vocal users, namely, voice actors, who use their voices extensively at work in an ecologically valid setting.MethodsA total of 16 professional voice actors (age range 21-50 years; 11 females and 5 males) participated in this study. All participants were mounted with an NSA on their sternal notches during the voice acting and voice assessment sessions. The voice acting session was 4-hour long, directed by a voice director in a professional sound studio. Voice assessment sessions were conducted before, during, and 48 hours after the acting session. The assessment included phonation tasks of passage reading, sustained vowels, maximum vowel phonation, and pitch glides. Clinical acoustic metrics (eg, fundamental frequency, cepstral measures) and a vocal dose measure (ie, accumulated distance dose from acting) were computed from NSA signals. A commonly used online questionnaire (Self-Administered Voice Rating questionnaire) was also implemented to track participants’ perception of vocal fatigue.ResultsThe NSA wearables stayed in place for all participants despite active body movements during the acting. The ensued body noise did not interfere with the NSA signal quality. All planned acoustic metrics were successfully derived from NSA signals and their numerical values were comparable with literature data. For a 4-hour long voice acting, the averaged distance dose was about 8354 m with no gender differences. Participants perceived vocal fatigue as early as 2 hours after the start of voice acting, with recovery 24-48 hours after the acting session. Among all acoustic metrics across phonation tasks, cepstral peak prominence and spectral tilt from the passage reading most closely mirrored trends in perceived fatigue.ConclusionsThe ecological validity of an in-house NSA wearable was vetted in a workplace setting. One key application of this wearable is to prompt occupational voice users when their vocal safety limits are reached for duly protection. Signal processing algorithms can thus be further developed for near real-time estimation of clinically relevant metrics, such as accumulated distance dose, cepstral peak prominence, and spectral tilt. This functionality will enable continuous self-awareness of vocal behavior and protection of vocal safety in occupational voice users.

Evaluating Community Pharmacist Provided Short Education Program to Improve Clinical Status of Selected Asthmatic Patients

Background: Incorrect inhaler usage is very common issue that leads to poorly managed asthma. Clinical pharmacist enhanced patient education is critical in reducing such errors. Education on inhaler technique is one area where pharmacists may significantly impact on asthma therapy and improvement in clinical features. Aim: This study aim to evaluate the efficacy of a pharmacist-delivered education program for improving patients' inhaler technique and clinical outcomes. Patients and Methods: This prospective cohort trial included 51 individuals with asthma, divided up between an intervention group of 26 participants who were subjected to pharmacist intervention as well as a control group of 25 participants. MDI and turbuhaler users were gathered to participate in the study from five community pharmacies in different areas of the Thi-Qar province (Nasirriya, Suq Al-Shoyookh, and Al Eslaah cities). Basic asthma control and spirometry parameters were evaluated using standardized questionnaire of asthma control test and spirometer respectively. Patients in intervention group were taught how to properly use their inhalers using a combination including demonstrations and re-demonstrations counselling with aid of advices leaflet. After one month for both groups, clinical outcomes (asthma control and spirometry) were reassessed and comparisons were made. Results: A total of 51 patients were involved, with 35 using a turbuhaler and 16 using an MDI. At first session of assessment for all participants, a low asthma control and low median value of FEV1/FVC ratio were recording. After intervention, the median values for asthma control test and all pulmonary parameters was increased significantly (for ACT of 18.5 to 21, p=0.000, for PEF of 2.2 to 2.8, p=0.001, for FEV1 of 1.6 to 1.9, p=0.001, for FEV1/FVC ratio of 63 to 71.5, p=0.002). Conclusion: Community pharmacist based education program applied to patients with asthma to increase awareness of patients about proper inhaler technique have positive impact in improvement of asthma control level and pulmonary functions parameters. This short education program highly applicable and should be consider as one of daily community pharmacist duties. Keywords: Community pharmacist, asthma control test, asthmatic patients, spirometer, inhaler technique, Thi-Qar.

Classifying Interpreter Behaviors During Aphasia Assessments: Survey Results and Checklist Development.

It is known that interpreter-mediated aphasia assessments may not provide the linguistic information that speech-language pathologists (SLPs) need to provide accurate diagnoses and determine treatment goals. The purpose of our study was to understand the perceptions of SLPs and interpreters who collaborate in a medical setting and to develop a checklist to categorize and quantify the errors interpreters make. Interpreter training may lead to unintentional errors that impact the information the SLP gains from the assessment session. In Phase 1 of the study, 38 hospital SLPs and 26 interpreters responded to survey questions about their experiences working with the other discipline. In Phase 2, eight Spanish-speaking interpreters and two Spanish-speaking participants with fluent aphasia took part in a standardized interpreter-mediated aphasia assessment. A bilingual SLP and a Spanish-speaking interpreter analyzed and coded the assessments for errors in the interpreters' behaviors. Results from the survey demonstrated that both SLPs and interpreters would like the interpreters to have more education regarding the diagnosis of aphasia and an understanding of the SLP's goals during an aphasia assessment. A lack of time was considered the primary hindrance to educating interpreters during an evaluation session. The checklist included interpreter behaviors that could significantly impact the SLP's ability to diagnose aphasia: omission of speech/language information, meaning errors, and cueing. Positive behaviors noted were calling attention to patient error and pointing out potential confusing items. Education for both disciplines will enhance the accuracy of interpreter-mediated aphasia assessments. A checklist tool with specific examples of errors may be useful in educating not only experienced interpreters and SLPs but also students in both disciplines.