A longitudinal study of the SF-36 version 2 in Friedreich ataxia

OBJECTIVES

The Medical Outcomes Study 36 item Short-Form Health Survey (SF-36) is one of the most commonly used patient reported outcome measure. This study aimed to examine the relationship between SF-36 version 2 (SF-36V2) summary scores and Friedreich ataxia (FRDA) clinical characteristics, and to investigate the responsiveness of the scale, in comparison with the Friedreich Ataxia Rating Scale (FARS), over 1, 2 and 3 years.

MATERIALS AND METHODS

Descriptive statistics were used to examine the characteristics of the cohort at baseline and years 1, 2 and 3. Correlations between FRDA clinical characteristics and SF-36V2 summary scores were reported. Responsiveness was measured using paired t tests.

RESULTS

We found significant correlations between the physical component summary (PCS) of the SF-36V2 and various FRDA clinical parameters but none for the mental component summary. No significant changes in the SF-36V2 were seen over 1 or 2 years; however, PCS scores at Year 3 were significantly lower than at baseline (-3.3, SD [7.6], P=.01). FARS scores were found to be significantly greater at Years 1, 2 and 3 when compared to baseline.

CONCLUSIONS

Our findings suggest that despite physical decline, individuals with FRDA have relatively stable mental well-being. This study demonstrates that the SF-36V2 is unlikely to be a useful tool for identifying clinical change in FRDA therapeutic trials.

A retrospective review of X-linked Charcot-Marie-Tooth disease in childhood

OBJECTIVE

X-linked Charcot-Marie-Tooth disease (CMTX) is infrequently diagnosed in childhood, and its clinical and neurophysiologic features are not well-described. We reviewed clinical, neurophysiologic, and pathologic findings in 17 children with CMTX.

METHODS

This was a retrospective review of children with CMTX from 2 tertiary pediatric hospitals. The diagnosis of CMTX was based on an identifiable connexin 32 mutation (CMTX1) or a consistent pedigree and neurophysiologic features in children without a connexin 32 mutation (CMTX-other).

RESULTS

Six boys and 2 girls from 8 kindreds had CMTX1, and 8 boys and 1 girl from 5 kindreds had other forms of CMTX (CMTX-other). Fifteen children, including males and carrier females, were symptomatic from infancy or early childhood (younger than 5 years). In addition to the typical Charcot-Marie-Tooth disease clinical phenotype, some patients had delayed motor development, sensorineural hearing loss, tremor, pathologic fractures, or transient CNS disturbances. Eleven children underwent nerve conduction studies. Median nerve motor nerve conduction velocities were in the intermediate to normal range (30-54 m/s) in all children older than 2 years. Axon loss, reflected by low-amplitude compound muscle action potentials, was present in all patients. A pattern of X-linked dominant inheritance, with carrier females showing an abnormal neurologic or neurophysiologic examination, correlated with the presence of a connexin 32 mutation in all but 2 pedigrees.

CONCLUSIONS

The clinical phenotype of CMTX is broader than previously reported. Onset in males and carrier females is most often in early childhood. Families with an X-linked dominant inheritance pattern are likely to have CMTX1.

Voice activity and participation profile: assessing the impact of voice disorders on daily activities

Traditional clinical voice evaluation focuses primarily on the severity of voice impairment, with little emphasis on the impact of voice disorders on the individual's quality of life. This study reports the development of a 28-item assessment tool that evaluates the perception of voice problem, activity limitation, and participation restriction using the International Classification of Impairments, Disabilities and Handicaps-2 Beta-1 concept (World Health Organization, 1997). The questionnaire was administered to 40 subjects with dysphonia and 40 control subjects with normal voices. Results showed that the dysphonic group reported significantly more severe voice problems, limitation in daily voice activities, and restricted participation in these activities than the control group. The study also showed that the perception of a voice problem by the dysphonic subjects correlated positively with the perception of limitation in voice activities and restricted participation. However, the self-perceived voice problem had little correlation with the degree of voice-quality impairment measured acoustically and perceptually by speech pathologists. The data also showed that the aggregate scores of activity limitation and participation restriction were positively correlated, and the extent of activity limitation and participation restriction was similar in all except the job area. These findings highlight the importance of identifying and quantifying the impact of dysphonia on the individual's quality of life in the clinical management of voice disorders.

Phonological disruption and subsequent self-correcting behaviour in Cantonese aphasic speakers

This study investigated the phonological disruption and subsequent self-correcting behaviour in Cantonese aphasic speakers. The self-correcting behaviour was investigated by examining the sequence of successive spontaneous attempts in producing a target sound. Five anomic, five non-fluent aphasic and five normal control subjects were assessed by using a confrontation naming task which included monosyllabic, disyllabic and trisyllabic targets. All the aphasic subjects demonstrated successive phonological self-corrections towards the target. Initial consonants were more vulnerable to phonological disruption and more resistant to self-correction than vowels, lexical tones and final consonants.

Speech intelligibility in tone language (Chinese) laryngectomy speakers

Tone language speakers use lexical tone or fundamental frequency to signal meaning. Therefore, native tone language alaryngeal speakers encountering difficulty imparting lexical tone variation would suffer loss of speech intelligibility. This study examines the intelligibility of lexical tone produced by four different alaryngeal speech methods, namely: oesophageal speech, electrolarynx, a pneumatic device and tracheo-oesophageal speech. Isolated and embedded monosyllabic Chinese words produced by 53 alaryngeal speakers were presented to three normally hearing, young adult listeners with no prior exposure to laryngectomy speech. The listeners transcribed the speech orthographically. Significant differences were found in the intelligibility level between the different speech methods. Listeners' responses were also pooled together and analysed for tone and segmental errors. Errors of tone alone were found to occur more often than segmental errors.