Multidimensional Assessment Protocol Research Articles

Comparing dysphonia severity index, objective, subjective, and perceptual analysis of voice in patients with multiple sclerosis and healthy controls

BackgroundImpairments in voice quality in Multiple Sclerosis (MS) have recently been investigated and different results were found. A voice-centered multidimensional assessment protocol with patient-reported outcome measures was conducted to evaluate all the aspects of the voice changes. ObjectivesThe study aimed to compare the objective, subjective, and perceptual measures of voice between the people with MS and the healthy control group. MethodsA total of 128 participants, including 64 people with MS age, and gender-matched healthy controls were enrolled in the study. Subjective, objective, and auditory-perceptual voice assessments of the participants were performed. The auditory-perceptual evaluation was performed with GRBAS. The Dysphonia Severity index was computed for both groups. All the participants completed the Turkish version of The Voice Handicap Index-10 (VHI-10) and the Voice-Related Quality of Life (VRQoL). ResultsAcoustic and aerodynamic parameters of voice were found significantly different for both males and females between the MS and control group. DSI was found significantly different for both males and females in the MS group compared to the control group (p<0.05). All components of the GRBAS scale were significantly higher in the MS group (p<0.001). Using a multivariate regression model, it was determined that age, gender, EDSS score, number of MS attacks, and disease duration did not affect the DSI. The overall VHI-10 score was higher in the MS group (median=1.0 range= 0–28) and lower in the control group (median=0 range= 0–4). The mean VRQoL was lower in the MS group (median=95 range= 62.5–100) than in controls (median=100 range= 85–100) (p<0.001). ConclusionOur results indicated that people with MS have significant differences in acoustic and aerodynamic parameters of voice compared to healthy individuals. A significant number of persons with MS are aware that their voice problem affects their quality of life. People with MS must be monitored for voice changes and a multidimensional voice assessment protocol should be implemented.

Prevalence and relationship between falls, frailty phenotype and physical activity in centenarians: a pilot study

The objective of this study was to associate the occurrence of falls with the frailty phenotype and physical activity (PA) in centenarians. Population-based descriptive study carried out in the state of Santa Catarina, Brazil, which included 54 centenarians (101.8 ± 2.8 years), 34 women and 20 men. To assess PA, centenarians wore a pedometer for 7 days of a typical week. The occurrence of falls was confirmed by self-report and frailty phenotype using the criteria proposed by Fried et al. (2001). All assessments were carried out following the Multidimensional Assessment Protocol for the Centennial Elderly, applied through interviews. The chi-square test with adjusted standardized residuals was used to evaluate the association between the occurrence of falls and frailty and AF, adopting a significance level of 5%. The prevalence of frailty in the sample was 53.7%. The majority of centenarians did not do PA (66.7%) and did not suffer a fall in the last 12 months (68.5%). The average number of weekly steps was higher among fallers (1,796.1 steps/week) when compared to non-fallers (797.4 min/week) (p=0.019). There was a significant association between falls and frailty (p=0.03), with fallers tending to be frail. The occurrence of falls was also associated with AF (p=0.014), with fallers tending to be physically active. Concluding that centenarians with falls in the last 12 months showed a tendency to frailty and a higher level of PA. The results demonstrate the importance of monitoring frailty in this population and of PA interventions that aim to reduce the factors causing this condition.

Pulmonary Function and Psychological Burden Three Months after COVID-19: Proposal of a Comprehensive Multidimensional Assessment Protocol.

Persisting limitations in respiratory function and gas exchange, cognitive impairment, and mental health deterioration have been observed weeks and months after acute SARS-CoV-2 (COVID-19). The present study aims at assessing the impairment at three-months in patients who successfully recovered from acute COVID-19. We collected data from May to July 2020. Patients underwent a multidimensional extensive assessment including pulmonary function test, psychological tests, thoracic echo scan, and functional exercise capacity. A total of 21 patients (M:13; Age 57.05 ± 11.02) completed the global assessment. A considerable proportion of patients showed symptoms of post-traumatic stress disorder (28.6%), moderate depressive symptoms (9.5%), and clinical insomnia (9.5%); 14.3% of patients exhibited moderate anxiety. A total of eleven patients (52.4%) showed impaired respiratory gas exchange capacity (P-DLCO, DLCO ≤ 79% pred). Compared to patients with normal gas exchange, the P-DLCO subgroup perceived a significant worsening in quality of life (QoL) after COVID-19 (p = 0.024), higher fatigue (p = 0.005), and higher impact of lung disease (p = 0.013). In P-DLCO subgroup, higher echo score was positively associated with hospitalization length of stay (p = 0.047), depressive symptoms (p = 0.042), fatigue (p = 0.035), impairment in mental health (p = 0.035), and impact of lung disease in health status (p = 0.020). Pulmonary function and echo scan lung changes were associated to worsened QoL, fatigue, and psychological distress symptoms.

Multidimensional Benefits of Improved Sanitation: Evaluating 'PEE POWER®' in Kisoro, Uganda.

With 2.3 billion people around the world lacking adequate sanitation services, attention has turned to alternative service provision models. This study suggests an approach for meeting the sanitation challenge, especially as expressed in Sustainable Development Goal 6.2, using a toilet technology system, such as Pee Power® that generates electricity using diverted urine as a fuel. A field trial was carried out in a girls’ school in Kisoro, Uganda, where the generated electricity was used to light the existing toilet block. The trial was evaluated in terms of social acceptability and user experience using a multidimensional assessment protocol. The results of our assessment show that users felt safer when visiting the toilets at night. Lights provided from the technology also helped with the perceived cleanliness of the toilets. The technology was well accepted, with 97% of the respondents saying that they liked the idea of the Pee Power® technology and 94% preferring it over other facilities on site. This shows how the technology helps meet SDG target 6.2, with its particular focus on vulnerable populations.

Multidimensional effects of voice therapy in patients affected by unilateral vocal fold paralysis due to cancer.

IntroductionPatients with unilateral vocal fold paralysis may demonstrate different degrees of voice perturbation depending on the position of the paralyzed vocal fold. Understanding the effectiveness of voice therapy in this population may be an important coefficient to define the therapeutic approach.ObjectiveTo evaluate the voice therapy effectiveness in the short, medium and long-term in patients with unilateral vocal fold paralysis and determine the risk factors for voice rehabilitation failure.MethodsProspective study with 61 patients affected by unilateral vocal fold paralysis enrolled. Each subject had voice therapy with an experienced speech pathologist twice a week. A multidimensional assessment protocol was used pre-treatment and in three different times after voice treatment initiation: short-term (1–3 months), medium-term (4–6 months) and long-term (12 months); it included videoendoscopy, maximum phonation time, GRBASI scale, acoustic voice analysis and the portuguese version of the voice handicap index.ResultsMultiple comparisons for GRBASI scale and VHI revealed statistically significant differences, except between medium and long term (p < 0.005). The data suggest that there is vocal improvement over time with stabilization results after 6 months (medium term). From the 28 patients with permanent unilateral vocal fold paralysis, 18 (69.2%) reached complete glottal closure following vocal therapy (p = 0.001). The logistic regression method indicated that the Jitter entered the final model as a risk factor for partial improvement. For every unit of increased Jitter, there was an increase of 0.1% (1.001) of the chance for partial improvement, which means an increase on no full improvement chance during rehabilitation.ConclusionVocal rehabilitation improves perceptual and acoustic voice parameters and voice handicap index, besides favor glottal closure in patients with unilateral vocal fold paralysis. The results were also permanent during the period of 1 year. The Jitter value, when elevated, is a risk factor for the voice therapy success.

Voice Improvement in Patients with Functional Dysphonia Treated with the Proprioceptive-Elastic (PROEL) Method

The objective of the study was to analyze the outcome of the proprioceptive-elastic (PROEL) voice therapy method in patients with functional dysphonia (FD). Fifty-two patients with FD were involved in the study; they were composed of three subgroups of patients with (1) FD without glottal insufficiency (n = 28), (2) FD and glottal insufficiency (n = 9), and (3) FD, glottal insufficiency, and vocal nodules (n = 15). A multidimensional assessment protocol including videolaryngostroboscopy; maximum phonation time; perceptual evaluation of dysphonia with the Grade, Instability, Roughness, Breathiness, Asthenia, and Strain (GIRBAS) scale; and 10-item version of the Voice Handicap Index was conducted before and after 15 sessions of voice therapy. All voice therapy sessions were conducted by the same speech-language pathologist. The comparison between voice assessment before and after voice therapy with the PROEL method in patients with FD, in all the three subgroups, revealed a statistically significant improvement in periodicity and the mucosal wave in the laryngostroboscopy, maximum phonation time, GIRBAS scale scores, and VHI-10. Voice of patients with FD improved after treatment with the PROEL method. Further studies are needed to analyze the efficacy of the PROEL method with randomized double-blind clinical trials using different methods for voice therapy. At present, the PROEL method represents an alternative tool for the speech pathologist to improve voice in patients with FD.

Efficacy of the Arabic Modified Fluency Shaping Program in the treatment of stuttering

Abstract The goal of fluency-shaping approaches is not to modify stuttering but rather to completely replace it with fluent speech. This is achieved by applying a range of fluency-controlling techniques, usually implemented within a slow-speech framework, which fundamentally changes the way that respiration, phonation, and articulation are coordinated for speech. The present study aimed at evaluating the efficacy of the Arabic Modified Fluency Shaping Program as a valuable treatment approach for Egyptian stutterers. The study design was a prospective longitudinal experimental controlled one. The present work was carried out on 100 stutterers of both sexes in the age range of 8–20 years. The participants were divided into two groups: the study group and the control group. A multidimensional assessment protocol was used for all participants. It included elementary diagnostic procedures (personal interview, visual perceptual assessment, and auditory perceptual assessment), clinical diagnostic aids (Stuttering Severity Instrument for Children and Adults-Arabic version, speech rate, psychometric evaluation, and assessment of feelings and attitudes using speech performance self-reported questionnaire), and additional instrumental measures (spectrographic assessment and Visi Pitch). Therapy program: Participants in the study group were trained using the Arabic Modified Fluency Shaping Program. The study group achieved better outcome with the therapeutic program regardless of the age of the patient at the time of therapy. There was marked reduction in mean total score of Stuttering Severity Instrument for Children and Adults-Arabic version in the study group and was 1.48, 1.66, and 2.12, respectively, during post-therapy, first follow-up, and second follow-up evaluations compared with 25.36 during the pretherapy evaluation. As regards spectral analysis, there were higher post-therapeutic values for voice onset time, vowel duration, syllable duration, and shorter sentence duration. As regards Visi Pitch, there were lower post-therapeutic values for percent voiced and percent pause and a higher value for the percent unvoiced, which denotes improvement. The results of speech performance self-reported questionnaire showed an increase in patient’s satisfaction with speech and trust in their abilities as a speaker; there was also a decrease in avoidance of speaking situations and speaking on the phone after therapy. The results of this study indicated the efficacy of the Arabic Modified Fluency Shaping Program in rehabilitation of stuttering. The presented program provides participants with strategies that significantly improve their speech behavior and their attitudes toward speech.

Validity of patient-reported swallowing and speech outcomes in relation to objectively measured oral function among patients treated for oral or oropharyngeal cancer.

The objective of this study was to test the construct validity of the patient-reported outcomes Swallowing Quality of Life Questionnaire (SWAL-QOL) and Speech Handicap Index (SHI) in relation to objectively measured oral function among patients treated for oral or oropharyngeal cancer. The study sample consisted of patients treated for oral or oropharyngeal cancer. Outcome measures were the SWAL-QOL and the SHI, and the Functional Rehabilitation Outcomes Grade (FROG), a test to measure oral and shoulder function. Spearman's rank correlation coefficient was used to test associations between the SHI and SWAL-QOL scales, and the FROG scales. During a study period of 3months, 38 patients (21 males, 17 females; mean age 54years) were included who visited the outpatient clinic for follow-up care 6-155months after surgical treatment (n=14) or combined surgery and radiotherapy (n=24) for oral (n=21) or oropharyngeal cancer (n=17). Most SWAL-QOL and SHI scales (except the SWAL-QOL Fatigue scale) correlated significantly with one or more FROG oral function scales. None of the SWAL-QOL and SHI scales correlated significantly with the FROG shoulder function scale. These results support the construct validity of the SWAL-QOL and SHI questionnaires for assessing speech and swallowing problems in daily life that are moderately but significantly related to oral function. A multidimensional assessment protocol is recommended for use in clinical practice and for research purposes for measuring oral function and swallowing- and speech-related problems in daily life among head and neck cancer patients.

SY31-1 * DEVELOPMENT OF STEP FOR THE ASSESSMENT AND TREATMENT OF THE INTERNET GAMING DISORDER

Internet gaming disorder (IGD) is the complicated behavioral and mental disorder. IGD is suggested as a one of the addictive disorders, also, it has unique characteristic features. Considering the public health model where agent, host and environmental factors are proposed as main determinants of addiction, the persons with IGD have the most wide age range and the internet game showed the highest accessibility. Also, based on the bio-psycho-social model of addiction, IGD relates variable spectrum of comorbid psychiatric conditions and socio-cultural context. Therefore, we developed multidimensional assessment protocol entitled K-PPC (Korean Patient Placement Criteria) for IGD and tailored individual intervention approaches entitled STEP (Stepped Tailored Empowerment Program) based on the concept proposed by the ASAM PPC (American Society of Addiction Medicine) model for the alcohol use disorders. ASAM model suggested the multidimensional matrix composed by 6 domains for the assessment of AUD. K-PPC Assessment protocol is composed by 4 domains which were internet game use behaviors, comorbid psychiatric problems, motivation, and the factors affecting recovery and relapse. STEP intervention matrix were composed by seriousness (basic and intensive) and characteristics of comorbid psychiatric problems (introversion and extroversion). The treatment program was developed based on the evidence based programs like cognitive behavioral treatment and motivational interviewing. The period of the basic and intensive intervention are 8 weeks and 16 weeks, respectively. We conducted randomized clinical trial with 80 subjects to evaluate the validity and effectiveness of the the STEP for IGD in the community setting. Regarding the validity of assessment protocol, the intensive intervention group showed more seriousness of internet game use problems compared to the basic intervention group. And, the introversion group showed more anxious and depressive psychopathologies while extroversion group showed more impulsive behavioral pattern. Regarding the efficacy of STEP, treatment outcome were better in the STEP group compared to the As Usual treatment group.

Evaluación del tratamiento logopédico en la rehabilitación de la disfonía en adultos: seguimiento de los efectos grupales y de las variaciones individuales

This study analyzed group and individual differences in the results of vocal rehabilitation in a group of dysphonic patients with different diagnoses, using a brief multidimensional assessment protocol. The voices of 21 participants with dysphonia and 21 controls were evaluated and compared in a pre- vs. post-speech therapy treatment. Voice performance was assessed before and after treatment by a set of tests that included videolaryngostroboscopy, aerodynamic tasks, and self-rating questionnaires. The speech-therapy treatment group received two sessions of speech therapy a week for 3months. Three follow-up reevaluations of group effects and individual variability were also carried out to assess the latency period after the end of treatment. MANOVA with Pillai's trace test showed a significant group effect of the vocal treatment on all of the variables assessed. A pre- vs. post- treatment T-test of individual changes was also significant in most of the dysphonic participants, despite the wide range of scores (high variance) in the different measures used after the voice therapy program. The results of both group and individual analyses support the effectiveness of vocal rehabilitation with speech therapy in at least some types of voice disorders. However, voice therapy was more effective in participants with certain characteristics and antecedents.

Suicide risk assessment in clinical practice: Pragmatic guidelines for imperfect assessments.

This practice review focuses on the challenges of conducting sensitive and accurate assessments of the relative risk for suicide attempts and completed suicides. Suicide and suicide attempts are a frequently encountered clinical crisis, and the assessment, management, and treatment of suicidal patients is one of the most stressful tasks for clinicians. An array of risk factors, warning signs, and protective factors associated with suicide risk are reviewed; however, we are not yet in possession of evidence-based diagnostic tests that can accurately predict suicide risk on an individual level without also creating an inordinate number of false-positive predictions. Given the current limitations of assessment strategies, clinicians are advised to keep in mind that patients contemplating suicide are under enormous psychological distress, requiring sensitive and thoughtful engagement during the assessment process. An overarching goal of these assessments should be conducted within the therapeutic frame, in which efforts are made to enhance the therapeutic alliance by negotiating a collaborative approach to assessing risk and understanding why thoughts of suicide are so compelling. Within this treatment heuristic, the Suicide Assessment Five-step Evaluation and Triage (SAFE-T) is recommended as a pragmatic multidimensional assessment protocol incorporating the best known risk and protective factors.

Tridimensional assessment of adductor spasmodic dysphonia pre- and post-treatment with Botulinum toxin

Spasmodic dysphonia voices form, in the same way as substitution voices, a particular category of dysphonia that seems not suited for a standardized basic multidimensional assessment protocol, like the one proposed by the European Laryngological Society. Thirty-three exhaustive analyses were performed on voices of 19 patients diagnosed with adductor spasmodic dysphonia (SD), before and after treatment with Botulinum toxin. The speech material consisted of 40 short sentences phonetically selected for constant voicing. Seven perceptual parameters (traditional and dedicated) were blindly rated by a panel of experienced clinicians. Nine acoustic measures (mainly based on voicing evidence and periodicity) were achieved by a special analysis program suited for strongly irregular signals and validated with synthesized deviant voices. Patients also filled in a VHI-questionnaire. Significant improvement is shown by all three approaches. The traditional GRB perceptual parameters appear to be adequate for these patients. Conversely, the special acoustic analysis program is successful in objectivating the improved regularity of vocal fold vibration: the basic jitter remains the most valuable parameter, when reliably quantified. The VHI is well suited for the voice-related quality of life. Nevertheless, when considering pre-therapy and post-therapy changes, the current study illustrates a complete lack of correlation between the perceptual, acoustic, and self-assessment dimensions. Assessment of SD-voices needs to be tridimensional.

Vocal Improvement After Voice Therapy in Unilateral Vocal Fold Paralysis

Unilateral vocal fold paralysis (UVFP) is associated with changes in acoustic and aerodynamic voice measurements and can have a significant impact on a patient's quality of life. Few objective data regarding the efficacy of voice therapy for UVFP exist. The aim of this study was to retrospectively analyze voice modifications in a group of patients with UVFP before and after voice therapy. Forty patients with UVFP of different etiology were included in the study. Each subject had voice therapy with an experienced speech/language pathologist twice a week; the mean number of sessions was 12.6. A multidimensional assessment protocol was used; it included videoendoscopy, the maximum phonation time (MPT), the GIRBAS scale, spectrograms and a perturbation analysis, and the Voice Handicap Index (VHI). Pre- and posttreatment data were compared by means of the Wilcoxon and Student's t tests. A complete glottal closure was seen in 8 patients before voice therapy and in 14 afterward. Mean MPT increased significantly. In the perceptual assessment, the difference was significant for five out of six parameters. A significant improvement was found on spectrographic analysis; as for perturbation analysis, the differences in jitter, shimmer, and noise-to-harmonic ratio values were significant. VHI values showed a clear and significant improvement. A significant improvement of voice quality and quality of life after voice therapy is an often reached and reasonable goal in patients with UVFP.

The INFVo perceptual rating scale for substitution voicing: development and reliability

In this paper, an experimental study of inter-judge consistency for the different dimensions of a recently proposed new scale for the rating of substitution voices is presented. The IINFVo rating scale tries to score five parameters, namely impression, intelligibility, noise, fluency and voicing. Each parameter is scored between 0 (very good substitution voicing) and 10 (very deviant substitution voicing) on a visual analogue scale. Inter-judge consistencies were measured among semi-professional as well as among professional jury members. The consistencies among semi-professionals, expressed as Pearson correlation coefficients, ranged from moderate to good (0.57-0.68), whereas those among professionals were good to excellent (0.82-0.87) and compared favourably to consistency figures published for traditional perceptual evaluation scales such as the GRBAS scale for laryngeal dysphonia. Since there is a strong correlation between the scores of impression and intelligibility, and since intelligibility is hard to score by non-native listeners, we suggest taking the mean of the two scores as the "impression" of a modified dimensional INFVo rating scale. Our experiments demonstrate that the INFVo rating scale has good potential to become a routine perceptual evaluation method in a multidimensional assessment protocol for substitution voicing.

SALIVARY CORTISOL: A PREDICTOR OF CONVICTIONS FOR DRIVING UNDER THE INFLUENCE OF ALCOHOL?

To examine the relationship between salivary cortisol and frequency of past driving under the influence of alcohol (DUI) convictions. A total of 104 males with previous DUI convictions (from one to eight) and mean age of 44.7 years were assessed on measures characterizing repeat DUI offenders, including sociodemographic information, alcohol use behaviours, biological indices of the organic consequences of chronic abuse, negative consequences of excessive drinking, past DUI conviction history, impulse control, and antisocial behaviour tendencies. Saliva samples were taken approximately every 30 min over a 6 h period during an exhaustive multidimensional assessment protocol, and were then assayed to obtain cortisol responses. Blunted cortisol response, typically observed in alcoholics and in high-risk non-alcoholics, was associated with increased number of past DUI convictions. This association was particularly pronounced in multiple DUI offenders, and was stronger than, and independent of, other measures of alcohol use severity and chronicity commonly used for DUI assessment. Cortisol response may be useful in understanding the mediators underlying repeat DUI offending and the frequent failure of intervention efforts in curbing DUI behaviour.

A comparative study between certain behavioral methods in treatment of stuttering

Stuttering is one of the controversy diseases. Thus, therapy for stuttering varies according to the therapists' belief. This study was conducted on four groups of stutterers; 30 stutterers each, with age range 15–35 years. Three groups received therapy sessions using the three different behavioral readjustment programs mainly: Coarticulation program of Stromsta, Smith Accent Method, and Van Riper's Non-Avoidance program. All patients attended individual therapy sessions, twice a week. The fourth group was a control one. All patients were assessed at the interview, after 8 weeks, and after 16 weeks.A multidimensional assessment protocol was used for assessment of all patients. It included elementary diagnostic procedures, clinical diagnostic aids, and additional instrumental diagnostic assessment.The results obtained from this study showed that there were significant improvements of the stuttering severity for most of the measurable parameters for all therapeutic groups. Although there was significant difference between all therapeutic groups and control group, there was no significant difference between the results of all therapeutic groups.

1222 How much does performance status correlate with multidimensional geriatric assessment in elderly patients with cancer (EPC)?

The present study is part of a multicentre investigation aimed at identifying an instrument of multidimensional assessment of EPC that may represent a new model of biomedical evaluation, focused not only on the neoplastic condition, but also on the associated comorbidity and disability. This instrument may be potentially useful for a more thorough treatment and follow-up of EPC. Since the performance status (PS) is widely used in medical oncology for this purpose, it is important to quantify how much the PS itself is correlated with this instrument to be implemented. Between March 1994 and February 1995, 70 consecutive EPC hospitalized at the Aviano Cancer Centre (median age:72 years, range 65–84), with haematological neoplasias and solid tumours, were enrolled into the study. They were interviewed by means of a multidimensional assessment protocol (MACE), specifically designed to collect information, among others, on socio-demographic characteristics, economic status, cognitive status (Mini Mental State—MMS—Test), Geriatric Depression Scale (GDS) and physical activity (Physical Perfonnance test—PPT; Activity of Daily Living—ADL—imd the Instrumental Activity of Daily Living—IADL—tests). The reproducibility and validity of MACE among EPC was previously tested among a sample of the present study group. The statistical correlation between PS (according to the Kamofsky scale) and MACE (MMS, PPT, GDS, ADLand IADL) was evaluated using the correlation coefficient (r). A good positive correlation emerged between PS and both IADL (r=0.55) and ADL (r=0.50), indicating that PS may identify nearly 30% of the differences among EPC measured by MACE. A lower positive correlation was found between PS and MMS (r=0.31) and PPT (r=0.29), whereas an increased PS was correlated with a lower number of depressive symptoms. In conclusion, the present results suggest that more than 70% of the variability measured by MACE could not be predicted by PS. They also highlight substantial limitations of PS alone among elderly patients, and stress the additonal need for the adoption of the multidimensional assessment approach in the oncological field.