A Comparison of the Dysphonia Severity Index and Singing Voice Handicap Index Between Trained and Untrained Male Iranian Traditional Singers

OBJECTIVES

This study aimed to compare trained and untrained Iranian traditional singers on the Dysphonia Severity Index (DSI) and the Singing Voice Handicap Index. The second objective was to examine the relationship between the DSI and Persian version of the Singing Voice Handicap Index (P-SVHI) scores in each group of trained and untrained Iranian traditional singers.

STUDY DESIGN

This study is a comparative cross-sectional study.

METHODS

This study included 17 trained male Iranian traditional singers who were compared with 17 untrained ones who were matched in terms of age. The P-SVHI was completed by trained and untrained Iranian traditional singers. Measures of jitter, lowest intensity, highest phonational frequency, and maximum phonation time (MPT) were obtained from each participant. The DSI scores were calculated using these values.

RESULTS

Trained male traditional singers had an average age of 33.76 ± 7.45 years, 3.24 ± 1.85 hours of daily practice, 5.24 ± 3.78 years of training, 3.06 ± 2.65 no. of professional performances, and untrained singers had an average age of 32.76 ± 12.92 years, 1.53 ± 1.17 hours of daily practice, and 0.88 ± 1.65 no. of professional performances. Trained singers had lower P-SVHI scores and sub-scores, longer MPT, higher F0 high, lower jitter, and lower I low, resulting in higher DSI values (P < 0.05). There was no significant correlation between P-SVHI scores and DSI values in each group of trained and untrained Iranian traditional singers (P > 0.05).

CONCLUSIONS

The results of this study show that the vocal abilities of professional vocalists are enhanced through voice training (higher DSI scores in trained singers vs untrained ones). Voice training can also help to lessen the perception of a handicap related to the singing voice. Hence, it may be necessary to consider alternative norms for the DSI and P-SVHI when administering them to patients who have undergone guided vocal training, such as voice/singing lessons. The current research indicates that the perception of singing voice handicap and DSI values are two distinct characteristics that do not have a significant correlation.

Relationship Between Postural Asymmetry, Balance, and Pain in Children With Spastic Cerebral Palsy

BACKGROUND

Primary symptoms of cerebral palsy (CP), such as spasm and weakness, can lead to secondary musculoskeletal problems. Exploring the interplay and impact of secondary symptoms is essential in CP management.

METHODS

A total of 56 children (32 males and 24 females) aged eight to 12 years in level I to III of Gross Motor Function Classification System (GMFCS) completed The Pediatric Balance Scale and Wong-Baker Faces Scale and the Posture and Postural Ability Scale. Relationships between the three groups were examined using the Kruskal-Wallis test, Tukey test, gamma coefficient, De Somers D, phi coefficient, Cramér V, and one-way analysis of variance.

RESULTS

There was a significant correlation between balance and postural asymmetry (P < 0.001), and no significant difference in balance was there between the severe and moderate asymmetry groups (P = 0.759) and between the mild asymmetry and no asymmetry groups (P = 0.374). Furthermore, there was a significant relationship between postural asymmetry and each of the variables of pain (P < 0.001) and gross motor function (P = 0.002). Although a meaningful correlation was identified between balance and gross motor function (P < 0.001), the relationship between postural asymmetry and balance in GMFCS levels was not found (P = 0.052, P = 0.052, P = 0.233). Conversely, no significant relationship was detected between pain and gross motor function (P = 0.072).

SIGNIFICANCE

Postural asymmetry negatively impacts balance and correlates with pain intensity. Addressing postural problems can contribute to pain management and improved balance.

Prevalence of depression, stress and suicide tendency among individuals with long COVID and determinants: a protocol of a systematic review and meta-analysis

BACKGROUND

It is well known that the COVID-19 pandemic has had a devastating impact on mental health, especially among individuals with long COVID. This systematic review and meta-analysis aims to investigate the prevalence of depression, stress and suicide tendencies among individuals with long COVID, as well as to explore the factors that contribute to these conditions.

METHODS AND ANALYSIS

A comprehensive review of literature will be conducted in various databases of including PubMed, including Medline, Embase, PsycINFO, CINAHL and Cochrane Library. The studies to be included in this review will be published in the English language, and the time frame of included studies will be from the date of inception of COVID-19 until 30 December 2023. Two independent reviewers will identify studies for inclusion based on a screening questionnaire, and the JBI standardised critical appraisal checklist for studies reporting prevalence data will be used to assess the methodological quality. The strength of the body of evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. To analyse the data, a robust Bayesian approach will be applied using the STATA software package (V.14; STATA) and JASP software. The findings of this systematic review and meta-analysis will provide valuable insights into the prevalence of depression, stress and suicide tendencies among individuals with long COVID, as well as the factors that contribute to these conditions.

ETHICS AND DISSEMINATION

There is no research ethics board approval required. The dissemination plan is to publish results in a peer-reviewed academic journal.

PROSPERO REGISTRATION NUMBER

CRD42022346858.

Factors associated with smoking intensity among adult smokers: findings from the longitudinal cohort of the Tehran lipid and glucose study

BACKGROUND

Smoking is a significant public health problem, and there is a scarcity of documents regarding its severity, particularly in developing countries. This study aimed to determine factors related to the number of cigarettes consumed daily by adult smokers in Tehran.

METHODS

This study was conducted within the framework of the longitudinal study of Tehran Lipid and Glucose Study (TLGS). The study included 786 adult smokers living during four consecutive follow-ups from 2005 to 2016. The intensity of smoking was measured by the number of cigarettes consumed daily by adult smokers. Data analysis was done longitudinally and based on the mixed effects zero-inflated discrete Weibull (ZIDW) regression model.

RESULTS

The mean age of the individuals was 40.35 ± 12.68 years, and 643 (81.8%) of them were men. Also, 52.7% of individuals were daily smokers, 15.6% were occasional smokers, and 31.7% were non-smokers who became smokers during the study. Variables of age 1.005 (95%CI: 1.001-1.008), gender of male 1.196 (95%CI: 1.051-1.39), and marital status (divorced/widowed vs. single) 1.168 (95%CI: 1.015-1.39) were positively associated with smoking intensity. Education level (master and higher vs. illiterate) 0.675 (95%CI: 0.492-0.926)), employment status (student vs. unemployed) 0.683 (95%CI: 0.522-0.917), (housewife vs. unemployed) 0.742 (95%CI: 0.606-0.895), (Unemployed with income vs. unemployed) 0.804 (95%CI: 0.697, 0.923), implementation of smoking prohibition regulations (yes vs. no) 0.88 (95%CI: 0.843-0.932), and history of cardiovascular disease in male relatives (yes vs. no) 0.85 (95%CI: 0.771-0.951) were associated with lower smoking intensity.

CONCLUSION

We showed that demographic factors are associated with the intensity of smoking among adults and should be considered in policymakers' intervention programs to reduce smoking and quit smoking.

Modification of cortical electrical activity in stroke survivors with abnormal subjective visual vertical: An eLORETA study

Objectives

Balance impairment is among the main complications of stroke. The gravity-based subjective vertical (SV) is considered an important reference for upright posture and navigation affected by stroke. The correlation between injury location and pathological perception of verticality remains controversial. This study aimed to evaluate the cortico-cortical network of vertical perception among patients with the right hemisphere stroke and abnormal visual-vertical perception compared with healthy individuals.

Materials and methods

This observational cross-sectional study included 40 patients with the right hemisphere stroke and 35 healthy participants. All patients had abnormal visual-vertical perception. The EEG connectivity analysis was conducted through the exact low-resolution brain electromagnetic tomography analysis (eLORETA).

Results

Stroke survivors manifested a power spectral density that reduced within the beta-2 frequency band in the left hemisphere and increased within the beta-3 frequency band in the right hemisphere compared with controls (p < 0.01). The lagged-phase synchronization was increased within alpha-1, beta-2, and beta-3 bands and decreased in stroke survivors compared with controls in the vestibular network involved in visual-vertical perception (p < 0.01).

Conclusion

The results of this study demonstrated variations in the function and functional connectivity of cortical areas involved in the visual-vertical perception that are mainly located in the vestibular cortex.

Point-of-care salivary oxidative and renal functional markers to assess kidney function in reperfusion-induced acute kidney injury in male rats

OBJECTIVES

Saliva is one of the most promising body fluids in the research of new biomarker for various diseases diagnosis. However, serial sampling in this condition is very dangerous and pose iatrogenic anemia with blood loss. This study was done to evaluate the cost-effectiveness of point-of-care salivary tests and identify the validity of salivary markers.

METHODS

Rats were randomly assigned to four experimental groups: (1) control (2) IR-3 h (3) IR-6 h (4) IR-24 h. Both renal pedicles were occluded for 55 min and then were declamped to allow reperfusion for 3, 6 and 24 h in IR groups. After reperfusion, all rats received pilocarpine 1 mg/kg to collect saliva. Plasma samples were also collected. Renal parameters including Cr, uric acid, and urea, malondialdehyde (MDA) levels, Bax/Bcl2 ratio, nitrite/nitrate ratio, corticosterone levels and oxidant/antioxidant ratio were measured in both plasma and salivary samples.

RESULTS

There were significant increased level of renal function parameters, MDA levels, Bax/Bcl2 ratio, nitrite/nitrate ratio and corticosterone in both saliva and plasma. The comparison of above parameters in both saliva and plasma showed significant correlation.

CONCLUSIONS

This study demonstrated that concentrations of indices specifically renal functional parameters increase in saliva in the IR-induced kidney injury in male rats and result indicate the potential of saliva as a tool to monitoring AKI. Measurement of salivary parameters may can become reliable diagnostic tests for patients with AKI.

Development and validation of the Autism Communicative Skills Questionnaire (ACSQ): An autism screening measure in Farsi

There has been a steady increase in the number of children diagnosed with autism spectrum disorder (ASD) worldwide. However, screening tools that focus primarily on communicative development that are culturally sensitive and linguistically appropriate are needed, particularly in languages, such as Farsi, which is spoken in countries that may benefit from additional resources. Therefore, the purpose of this study was to develop and validate a screening tool, written in Farsi by Iranians, that focuses on communication and factors affecting the development of communication for children with autism. A variety of statistical analyses were conducted and implemented to assess the relevance of various questions related to communication, along with other behaviors that interfere with the development of communication, that may distinguish between children with and without ASD. Exploratory factor analysis was performed to examine the underlying structure of the Autism Communicative Skills Questionnaire (ACSQ). This study represents the first stage in the development of a comprehensive questionnaire to assist with the screening of areas that impact the development of social communication and are unique to ASD.

Investigating the Effect of Leap Motion on Upper Extremity Rehabilitation in Children with Cerebral Palsy: A Randomized Controlled Trial

In this randomized clinical trial, we look for the following questions' answer: How does the integration of LMC affect (1) upper extremity (UE) function, (2) grip strength, and (3) lateral and palmar pinch strength in children with cerebral palsy (CP), in comparison with conventional rehabilitation methods? Twenty patients were randomly assigned to LMC (case) or conventional (control) groups. The grip, lateral and palmar pinch forces increased in case group patients more than control group both at the end of intervention (P < .001 for all three), and at 20 weeks' follow-up (P values 0.035, 0.002, and 0.002). The Quality of Upper Extremity Skills Test (QUEST) score changes were similar between two groups, except for grasp score at the end of step 2 and 3 (P = .04 and 0.01, respectively). The addition of LMC to the rehabilitation program of patients with CP may improve the UE motor function outcomes.

Cross-cultural Adaptation and Psychometric Evaluation of the Persian Version of the Satisfaction and Recovery Index (SRI): Structural Validity, Construct Validity, Internal Consistency, and Test-retest Reliability

Background

The Satisfaction and Recovery Index (SRI) is a generic importance-weighted health satisfaction tool to measure the process and state of recovery following musculoskeletal injuries. The objectives of this study are (1) to translate and cross-culturally adapt the SRI to Persian and (2) evaluate its psychometric properties.

Methods

The forward-backward translation technique was used for translation, and two rounds of cognitive interviews were conducted to assess cultural appropriateness. Participants (n=100, mean age=32.5, 82%male) had acute (i.e., <30 days) musculoskeletal injuries of any etiology. Structural validity, construct validity, internal consistency, and test-retest reliability were evaluated.

Results

Participants identified issues in 3/6 areas of a coding system during the cognitive interviews: comprehension/clarity, relevance, and inadequate response definition. These issues informed subsequent changes to arrive at the final version of the SRI-P. The SRI-P had adequate construct validity (P<0.001), the confirmatory factor analysis demonstrated a two-factor structure, the internal consistency was acceptable (Cronbach's α=0.83), and it was deemed reliable (ICC_{2, 1}=0.72).

Conclusion

The psychometric evaluation revealed that the SRI-P has adequate construct validity, internal consistency, and test-retest reliability. Unlike the original English version, the SRI-P has a two-factor structure, which appears to be related to cultural differences in interpreting some of the items. The clinical importance of this study is that the SRI (which captures the state of recovery and how important the various items of the tool are to each patient and how satisfied they are with their recovery) can now be available to surgeons and therapists in the orthopedic and rehabilitation realms in Persian populations.

Assessing related factors to fasting blood sugar and glycosylated hemoglobin in patients with type 2 diabetes simultaneously by a multivariate longitudinal marginal model

The multivariate marginal model can be used to simultaneously examine the factors affecting both FBS and HbA1c using longitudinal data. The model fitted to multivariate longitudinal data should prevent redundant parameter estimation in order to have greater efficiency. In this study, a multivariate marginal model is used to simultaneously investigate the factors affecting both FBS and HbA1c with longitudinal data for patients with type 2 diabetes in Northern Iran. The present research is a retrospective cohort study. Overall, 500 medical records with complete information were reviewed. The multivariate marginal model is used to determine the factors associated with FBS and HbA1c using longitudinal data. Data have been analyzed in R-3.4.0 using ‘mmm2’ package. Given that the coefficients for the interactions of rtype with the intercept, time, family history of diabetes, history of hypertension, history of smoking, insulin therapy, systolic/diastolic blood pressure and duration of disease at first visit are significantly different from zero (P < 0.05), the effect of the independent variables on the two response variables is different and different coefficients should be used for each. Therefore, the interactions of these variables with rtype are kept in the final model. The coefficients for the interactions of rtype with sex, age at first visit, history of high cholesterol, and weight are not significantly different from zero (P > 0.05), indicating that their effect on the two response variables is similar and only one coefficient should be used for each. We examined the similarity of coefficients when fitting the longitudinal multivariate model for the relationship between FBS/HbA1c and sex, age, history of high blood cholesterol, and body weight. If an independent variable has similar effects on both responses, only one coefficient should be estimated, which will increase the efficiency of the model and the reliability of the results.

Neural Correlates of Enhancing Question Asking and Initiations in Children with Autism Spectrum Disorders: A Randomized Clinical Trial

Children diagnosed with autism spectrum disorder (ASD) demonstrate challenges in various areas of social communication. The aim of this study was to examine the effect of Pivotal Response Treatment (PRT) targeting question-asking on brain activity in twenty 6-12-year-old autistic boys, using a Randomized Clinical Trial (RCT) design. Verbal children, diagnosed with autism, who lacked question asking in their communication were matched based on age and mean length utterance (MLU) and were randomly placed in either PRT intervention or treatment as usual (TAU) groups. Sessions were individually administered, lasting for 60 minutes three days a week for a two-month period. All children were tested before and after intervention to assess behavioral areas (questions, general communicative skills, and MLU) and both groups underwent electroencephalography for 10 minutes in open and closed eye resting-state conditions to assess neural correlates. Data were analyzed using covariance analysis and post-hoc using Mann-Whitney and Wilcoxon methods. Significant behavioral improvements in the PRT group were observed after intervention that correlated with changes in Electroencephalography (EEG) oscillations at several brain regions compared to the TAU group. The results of this study support other studies suggesting collateral neural changes following the PRT.

The Effectiveness of Group Therapy based on Acceptance and Commitment on Self-Esteem of Female Students With Visual Impairment

Objective: Students with visual impairments have built negative attitudes towards their abilities due to difficulties in achieving social skills, orientation, and independent mobility. Their negative attitude towards blindness puts them at high-risk developing loneliness, social isolation, depression, anxiety, decreased life expentancy, no participation in group activities, and low levels of social support. Lack or no social skill reduces social acceptance and real feeling about themselves, which in turn reduces self-esteem in students with visual impaiments. Using appropriate therapeutic intervention with the aim of ensuring mental health as well as promoting self-esteem can prevent many psychological problems in these people. The acceptance and commitment therapy (ACT) is one of the third wave approaches to behavioral therapy that aims to control effectively the pain, suffering and stress that a person faces in the life. The acceptance and commitment therapy helps the person increases her psychological relations with herself and her feelings, trying to adapt to the environment and community instead of changing her cognition. The present study aimed to determine the effectiveness of the acceptance and commitment group therapy on self-esteem of students with visual impairment in Tehran City. Materials & Methods: The present study was a quasi-experimental study in which a pre-test and post-test design with a control group used along with a two-month follow-up. The sample was consisted of twenty-eight 14-20 year old female students who was selected from the population of students with visual impairment studying in the schooling year of 2019-2020 in Narjes day-and-night school for the blind individuals. In Tehran, there is only one school for female blind students and the sample purposefully selected according to the probability of sample’s dropout. At first, 50 students completed the Cooper Smith Self-Esteem Questionnaire (CSSEQ) and after scoring the CSSEQ, twenty-eigth students selected according to receiving a score of 23 or lower in the CSSEQ. All subjects matched based on their age and grade, then randomly assigned to the experimental and the control group. The experimental group (two subgroups consisted of seven people in each) participated in eight therapeutic sessions (twice a week and 75 minutes for per session) and received the acceptance and commitment group therapy while the control group participated only in the mainstream programs at the school. At the end of the therapeutic sessions all subjects completed the CSSEQ again and the experimental group completed CSSEQ after two months follow-up.The multiple analysis of covariance (MANCOVA) used for analyzing the obtained data. Furthermore, for comparing the posttest and follow-up situations in the experimental group the related t-test used. Results: The results of multiple analysis of covariance for the data obtained from the self-esteem questionnaire showed that the participation of female students with visual impairment in the acceptance and commitment group therapy sessions led to significant increase (P<0.001) in self-esteem (general, family, social, and educational) of them. In fact, according to Eta quotient, 71%, 78%, 78%, and 72% of variation in self-esteem (general, family, social, and educational respectively) of the experimental group can be explained by participating in the acceptance and commitment group therapy sessions. The results of the related t-test for comparing the self-esteem of the experimental group in post test and follow-up situations showed that the effectiveness of group therapy based on acceptance and commitment has been lasted on the self-esteem (general, family, social, and educational) of the experimental group after two months follow-up later (P>0.05). Conclusion: we conclude according to the findings of the present study that the acceptance and commitment group therapy can use for planning and policy making instructional courses suitable for students with visual impairments. Furthermore, the specialists who are working with these children can use the ACT as a practical technique for improving self-esteem and the adaptation in many areas such as family, social and educational areas in students with visual impaiments. Additionally, the ACT recommend improving self-esteem and positive performance of students with visual impairment in social, educational and family areas along side the routin instructional couses. However, the acceptance and commitment group therapy helps the students with visual impairment know how to control their thoughts and feelings in order to prevent problems from getting worse. This therapeutic method helpls them to accept their behavioral changes through accepting the unpleasant thoughts and feelings.

Long Latency Auditory Evoked Potentials and Object-Related Negativity Based on Harmonicity in Hearing-Impaired Children

Hearing-impaired children (HIC) have difficulty understanding speech in noise, which may be due to difficulty parsing concurrent sound object based on harmonicity cues. Using long latency auditory evoked potentials (LLAEPs) and object-related negativity (ORN), a neural metric of concurrent sound segregation, this study investigated the sensitivity of HIC in processing harmonic relation. The participants were 14 normal-hearing children (NHC) with an average age of 7.82 ± 1.31 years and 17 HIC with an average age of 7.98 ± 1.25 years. They were presented with a sequence of 200 Hz harmonic complex tones that had either all harmonic in tune or the third harmonic mistuned by 2%, 4%, 8%, and 16% of its original value while neuroelectric brain activity was recorded. The analysis of scalp-recorded LLAEPs revealed lower N2 amplitudes elicited by the tuned stimuli in HIC than control. The ORN, isolated in difference wave between LLAEP elicited by tuned and mistuned stimuli, was delayed and smaller in HIC than NHC. This study showed that deficits in processing harmonic relation in HIC, which may contribute to their difficulty in understanding speech in noise. As a result, top-down and bottom-up rehabilitations aiming to improve processing of basic acoustic characteristics, including harmonics are recommended for children with hearing loss.

Different Effects of Aerobic Exercise and Diaphragmatic Breathing on Lower Esophageal Sphincter Pressure and Quality of Life in Patients with Reflux: A Comparative Study

BACKGROUND Gastroesophageal reflux disease (GERD) is a worldwide disorder with an increasing prevalence. The quality of life (QOL) of the patients may be influenced by reflux disease. Diaphragmatic breathing (DB), as well as aerobic exercise (AE), may improve the symptoms of reflux disease, although it remains a controversial issue. The aim of this study was to compare the effects of AE and DB on QOL and lower esophageal sphincter (LES) pressure of patients with moderate to severe reflux. METHODS This was a case-control study that was conducted for 8 weeks among patients with moderate to severe GERD. The block randomization method was designed to randomize patients into three groups (AE, DB, and control) to achieve equal sample sizes. The control group received omeprazole 20 mg once daily. The other groups, in addition to omeprazole, received AE and DB. QOL and LES pressure were measured before and after the study by Questionary and Manometry method, respectively. RESULTS 75 patients were enrolled in this study. Positive effects of DB on LES pressure was approved (p = 0.001). DB had significantly more effects on QOL than aerobic exercise (p = 0.003). AE can significantly improve QOL in patients (p = 0.02) but no significant change in LES pressure (p = 0.38). There was no change in the control group for both variables. CONCLUSION AE had no effects on LES pressure but can improve QOL of the patients. DB had more effects on QOL than AE, so injured or disable patients with reflux who cannot do AE, can benefit from DB to improve their reflux symptoms.

New Biomarkers Based on Smoking-Related Phenotypes for Smoking Cessation Outcomes of Nicotine Replacement Therapy: A Prospective Study

Introduction:

Identifying a potent biomarker for smoking cessation can play a key role in predicting prognosis and improving treatment outcomes. This study aimed to evaluate the contribution of new biomarkers based on the levels of Cotinine (Cot) and carbon monoxide (CO) to the short- and long-term quit rates of nicotine replacement therapies (Nicotine Patch [NP] and Nicotine Lozenge [NL]).

Methods:

In this prospective interventional study, 124 smokers under treatment with the 5A’s method were selected from an outpatient smoking cessation center in district 18 of Tehran City, Iran. The study was conducted from April 2016 to December 2018. They were divided into NP (n=56) and NL (n=61) intervention groups. The levels of Cot and CO were measured using ELISA and breath analysis at the beginning of the study. Three markers were calculated: Cot/CO, Cot to cigarette per day ratio (Cot/CPD), and CO/CPD. Binary logistic regression models and generalized estimating equations models were analyzed by SPSS software, version 21 to determine the chances of quitting smoking.

Results:

Of the NP participants, 30.4% and 19.6% were abstinent after 2 and 6 months, respectively, while NL was found less effective with 19.7% for 2-month follow-up and 13.1% for 6-month follow-up. The 6-month success of quitting attempts was significantly different for the NP participants at the second half of Cot/CO (P=0.029). Of the NL participants, CO/CPD would be a superior predictor for smoking cessation success (P>0.05).

Conclusion:

The findings of this study suggested two markers of Cot/CO and CO/CPD in this order for the optimum treatment outcomes of NP and NL.

The Effect of Teaching Initiations on the Communication of Children with Autism Spectrum Disorder: A Randomized Clinical Trial

This study examined the effect of Pivotal response treatment (PRT) to improve verbal initiations in children with Autism Spectrum Disorder, age 6-12 years old, using a Randomized Clinical Trial design. Intervention was conducted three times a week for 2 months, for a total of 24 one-hour sessions. The PRT intervention taught a variety of questions and attention/assistance-seeking initiations. The treatment as usual (TAU) group received standard language intervention. Results showed that the PRT group made significant improvements in their number of verbal initiations as well as collateral gains in general communicative skills and mean length of utterance (MLU) compared to the TAU group. Theoretical implications of including motivational approaches to develop social initiations are reviewed.

Overload of anxiety on postural control impairments in chronic stroke survivors: The role of external focus and cognitive task on the automaticity of postural control

Background

Despite the high prevalence of anxiety among chronic stroke survivors and evidence of its negative effects on postural control in healthy subjects, it is unclear whether anxiety also affects postural control in these patients. Recent evidence of improved postural control of healthy subjects by distracting the attention using an external focus (EF) or cognitive task, raises the question of whether similar benefits would be observed in stroke survivors. Thus, the current study aimed to investigate the effects of anxiety and distracting the attention on postural control of chronic stroke survivors in terms of both postural sway measures and neuromuscular regulation.

Methods

Postural sway measures and ankle muscle activity of chronic stroke survivors with the high and low level of anxiety (HA-stroke (n = 17), and LA-stroke (n = 17), respectively) and age-, sex-, height-, and weight-matched healthy subjects (n = 17) were assessed while standing on rigid and foam surfaces under following conditions: baseline, internal focus (IF), EF, simple and hard cognitive tasks (SC and HC, respectively).

Results

Stroke survivors, particularly HA-stroke participants, showed greater postural sway measures (i.e. postural instability) and enhanced co-contraction of ankle muscles (i.e. stiffening of the neuromuscular system) compared with healthy subjects. As opposed to baseline and IF conditions, postural instability and neuromuscular stiffening significantly reduced in EF condition and decreased more in cognitive task conditions, particularly HC condition.

Conclusions

The results suggest that anxiety enhances stroke-induced postural instability promoting improper neuromuscular control of posture with stiffening strategy, which can be alleviated by EF and cognitive tasks.

Comparison of efficacy of vestibular rehabilitation and noisy galvanic vestibular stimulation to improve dizziness and balance in patients with multiple sclerosis

BACKGROUND

Dizziness and imbalance are common symptoms in patients with multiple sclerosis (PwMS), and rehabilitation interventions varying greatly in effectiveness.

OBJECTIVE

To compare the effectiveness of vestibular rehabilitation therapy (VRT) and noisy galvanic vestibular stimulation (nGVS) on dizziness and balance in PwMS.

METHODS

This was a single-blind, randomized controlled trial. Twenty-four PwMS were randomly divided into groups of VRT, nGVS, and Control. The VRT and the nGVS groups underwent the intervention program. The patients were assessed with the composite score in anteroposterior and lateral directions (CS AP and LAT) obtained by sensory organization test (SOT), Dizziness Handicap Inventory (DHI), and Activities-Specific Balance Confidence Scale (ABC).

RESULTS

The VRT group showed greater improvements in CS AP and LAT, DHI total score, and ABC total score compared with the nGVS group and the control group. No significant difference was found between the nGVS group and the control group. These results were approximately stable at the 4-week follow-up.

CONCLUSIONS

These findings provided evidence for effectiveness of the VRT in improvement of dizziness and balance in PwMS. These improvements were not associated with the nGVS. Further studies are needed to assess the effectiveness of the nGVS on dizziness and balance in PwMS.

Assessing the Validity and Reliability of the Persian Version of the Interpersonal Problem Solving Skills Assessment Tool in Schizophrenia

Objective: This study aimed to translate the Assessment of Interpersonal Problem-Solving Skills (AIPSS) into Persian and to evaluate the validity and reliability of the Persian version of AIPSS to use for adults with schizophrenia. Materials & Methods: In this methodological study, the translation process was performed according to the International Quality of Life Assessment (IQOLA) protocol. The face validity of the translated AIPSS was determined based on the opinions of experts and The Content Validity Index (CVI) and Content Validity Ratio (CVR) were also calculated for each item. The Persian version of the test was performed on 52 patients with schizophrenia disorders at Tehran’s Razi Mental Hospital; they were selected using a convenience sampling method. Cronbach’s alpha coefficient was used to evaluate internal consistency. Inter-rater reliability was determined by the Intraclass Correlation Coefficient (ICC). A retest was complete on 15 patients with 2 weeks interval and ICC was used to determine the test-retest reliability. Results: Face validity was confirmed by the experts’ opinions. The Content Validity Ratio (CVR) and the Content Validity Index (CVI) were equal to one for all scenes. Cronbach's alpha coefficient for all scales was ranged between 0.511 and 0.821. The ICC in all scales were more than 0.98 for inter-rater reliability. In calculating test-retest reliability, the ICC for all scales ranged 0.733-0.893. Conclusion: Results show that the Persian version of AIPSS has acceptable face validity, content validity, internal consistency, inter-rater reliability test-retest reliability. Therefore, this instrument can be used in clinical fields and research studies to assess the social skills of Iranian patients with schizophrenia.

A comparison of the performance of Persian speaking children who do and do not stutter on three nonwords repetition tasks

PURPOSE

The purpose of the study was to examine the performance of Persian speaking children who stutter (CWS) and children who do not stutter (CWNS) on three nonword repetition tasks, while also focusing on which task and scoring method best differentiates the two groups of children.

METHOD

Thirty CWS and 30 CWNS between the ages of 5;0 to 6;6 completed three nonword repetition tasks that varied in complexity. Each task was scored using two methods: nonwords correct and phonemes correct. Between-group differences in performance on each task were examined, along with disfluencies for CWS and the task and scoring method that best differentiated the CWS and CWNS.

RESULTS

The findings revealed that, across all three nonword repetition tasks, the CWS consistently produced fewer nonwords correct and phonemes correct than the CWNS group at virtually all syllable lengths. The CWS produced more disfluencies on longer nonwords than shorter nonwords in all three nonword repetition tasks. The nonword repetition task with lower wordlikeness and more phonologically complex items best differentiated the two groups of children. Findings further revealed that discriminative accuracy was highest for scoring based on the number of phonemes produced correctly.

CONCLUSION

Findings provide further evidence to suggest that CWS may have difficulty with phonological working memory and/or phonological processing.

Comparison of Definitional skills in school-age children with cochlear implants and normal hearing peers

Objective

The auditory experience is important because makes a major contribution to the development of speech, language, cognitive, and social skills. Knowledge of the lexicon has been increased throughout life. Input factors and linguistic and metalinguistic knowledge are effective factors in the acquisition of definitional skills. This study was done to investigate definitional skills in cochlear-implanted (CI) children and their typically developing (TD) peers.

Materials & methods

A total of 46 third-grade primary school children (16 with cochlear implants and 30 their TD peers) were recruited. The verbal definitional task included 14 common high-frequency nouns and 11 common high-frequency verbs. All definitions were scored for both content (semantic) and grammatical forms. Statistical analysis was conducted to compare the definitional skills between the two groups.

Results

There were significant differences between CI children and their TD peers for word definition skills in both categories of content and form (p<0.001). The results showed the mean scores of content and

form aspects of word definition in the TD group were approximately twice higher than the CI ones (M±SD=133±28 and M±SD= 78±23, respectively).

Conclusion

Children with CI may have trouble with definitional skills. It seems that the lower scores of CI children in definitional skills were due to a lack of auditory experience. Considering interventions on definitional skills in CI children is suggested.

Longitudinal Trend of Fasting Blood Glucose and Related Factors in Patients with Type 2 Diabetes

Background

Control of diabetes plays an important role in improving complications and disabilities and quality of life. This study aimed to evaluate the 3-year changes in fasting blood glucose (FBG) values and its related factors in patients with type 2 diabetes.

Methods

In this retrospective cohort study, 500 patients with type 2 diabetes covered by the National Diabetic Prevention and Care Plan during 2013-2016 were selected based on random cluster systematic sampling. A linear mixed model was used to study changes in FBG levels and their related factors. The data were analyzed using the R3.2.0 software.

Results

The patients' mean age was 47.7 years. Among these patients, 58.6% were female, 19.8% had a history of smoking. High FBG was associated with high disease duration, high body mass index (BMI), low age, normal BMI at baseline, insulin therapy, smoking, and family history of diabetes. Trend of FBG in follow-up was decreasing.

Conclusions

Given that patients who received insulin therapy had higher mean FBG, it is recommended to examine their insulin dose and modifications should be made in terms of the patients' needs during their continuous follow-up. Weight loss during follow-up and cessation of smoking indicate a favorable prognosis of disease. More attention should be paid to younger patients in care. Patients are encouraged to start treatment and care at the same time diagnose.

Development and Validation of an Educational Booklet to Improve Occupational Performance of the Primary Caregivers of Individuals With Multiple Sclerosis

Objective: Caring for individuals with multiple sclerosis (MS) can affect their caregivers’ occupational performance in various areas such as work, rest/sleep, and social participation. Part of the rehabilitation process is educating caregivers. Primary caregivers need knowledge and information to deliver their caring role. Although face-to-face learning is useful, it can have some limitations. For example, a caregiver should refer to a specific center to receive information and interventions, which is often time-consuming and may trouble them to perform other roles, including their occupational roles. Written health education is used for complementing or strengthening verbal education and maximizing its effectiveness. These materials play an essential role in increasing knowledge, self-management, and commitment to treatment. When health professionals and health services are not available to caregivers, written health education materials can partially answer their questions and needs. It can also help reduce the costs of health care for caregivers. The present study aims to develop and validate the appearance and content of an educational booklet to improve the occupational performance of primary caregivers of individuals with MS (PCIMS). Materials & Methods: This is a methodological study conducted. 1. preparing the content based on grounded theory study of PCIMS and their challenges, and then preparing an initial draft, 2. examining the face validity and content validity of the initial draft according to the opinions of 22 experts in MS, and 3. examining the face validity and content validity of the initial draft according to views of 22 PCIMS. An item-level content validity index (I-CVI) value of ≥0.78 and a scale-level content validity index/average (S-CVI/Ave) value of ≥0.9 were considered as the criteria for having acceptable validity in the second and third phases. The binomial test was also used to test the statistical reliability of the I-CVIs at a significance level of 0.05 and the expected proportion of agreement (test proportion) of 0.8. Results: The minimum I-CVI and S-CVI/Ave values for the items of a scale designed to assess the face validity and content validity of the booklet were respectively reported 0.9 and 0.97, according to the panel of experts. Also, the minimum observed proportion of agreement for items under the binomial test was obtained 0.9, which was higher than the expected proportion of agreement (0.8). I-CVIs values, S-CVI/Ave value and the observed proportion of agreement between PCIMS were equal to 1. For participating experts and PCIMS, the booklet had appropriate validity, and their comments on the appearance and content of the booklet were applied to the final version of the booklet. Conclusion: The developed educational booklet has acceptable face validity and content validity, and specialists can use it for the rehabilitation intervention of PCIMS. Further studies are recommended to investigate the effectiveness of this booklet on improving the quality of life of PCIMS.

Effect of Vowel Auditory Training on the Speech-In-Noise Perception among Older Adults with Normal Hearing

Introduction:

Aging reduces the ability to understand speech in noise. Hearing rehabilitation is one of the ways to help older people communicate effectively. This study aimed to investigate the effect of vowel auditory training on the improvement of speech-in-noise (SIN) perception among elderly listeners.

Materials and Methods:

This study was conducted on 36 elderly listeners (17 males and 15 females) with the mean±SD of 67.6±6.33. They had the normal peripheral auditory ability but had difficulties in SIN perception. The samples were randomly divided into two groups of intervention and control. The intervention group underwent vowel auditory training; however, the control group received no training.

Results:

After vowel auditory training, the intervention group showed significant changes in the results of the SIN test at two signal-to-noise ratios of 0 and -10 and the Iranian version of the Speech, Spatial, and Qualities of Hearing Scale, compared to the control group (P<0.001). Regarding the Speech Auditory Brainstem Response test, the F₀ magnitude was higher in the intervention group (8.42±2.26), compared to the control group (6.68±1.87) (P<0.011).

Conclusion:

This study investigated the effect of vowel auditory training on the improvement of SIN perception which could be probably due to better F₀ encoding and receiving. This ability enhancement resulted in the easier perception of speech and its more proper separation from background noise which in turn enhanced the ability of the old people to follow the speech of a specific person and track the discussion.

Time-Varying Covariates and Risk Factors for Graft Loss in Kidney Transplantation

OBJECTIVES

The present study was designed to evaluate the factors involved in long-term graft survival in recipients of kidney transplantation.

MATERIALS AND METHODS

We reviewed 755 Iranian adult recipients who underwent kidney transplantation at Shahid Labbafinejad Medical Center in Tehran, Iran. Patients were followed for 5 years after transplantation. The primary outcome was the time between transplantation and graft loss. Using Cox regression, we studied the effect of time-independent variables (recipients' age and sex, donors' age, and type of donor), time-dependent covariates (body mass index [BMI], systolic blood pressure, diastolic blood pressure, high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol levels, proteinuria and serum creatinine level), and immunosuppressive drugs on graft loss 60 months after transplantation. The results are presented as the hazard ratio (HR) with 95% confidence intervals.

RESULTS

Result from Cox proportional hazards model showed that the HR of graft loss was 1.62 (95% CI: 1.03-2.54) in cadaveric donor compared with living donor kidney recipients. The HR of graft loss for recipient age was 1.02 (95% CI: 1.002-1.030). Moreover, according to obtained results, the risk of losing functional transplant increased for each mg/dL rise in serum creatinine at least 9% and at most 40%. Our results also showed that 1 unit increase of BMI has at least a 2% and at most a 15% decremented effect on the hazard ratio of graft loss.

CONCLUSIONS

Having lower levels of creatinine and receiving a kidney from a younger living donor were associated with a decreased risk of graft loss. Graft loss is more likely to occur in patients with lower BMI.

How primary caregivers of individuals with multiple sclerosis cope with social isolation: a grounded theory study in an Iranian context

Background/aims

Multiple sclerosis is a progressive neurological disease that can significantly impact the psychosocial aspects of primary caregivers of individuals with multiple sclerosis. This study explored the process of social isolation among primary caregivers of individuals with multiple sclerosis in Kerman, Iran.

Methods

A grounded theory approach was employed to explore the various aspects of social isolation. Data were collected through unstructured and semi-structured interviews with 15 primary caregivers of individuals with multiple sclerosis, 13 individuals with multiple sclerosis and five health care providers who were selected based on purposeful and theoretical sampling. The data were analysed via constant comparative analysis.

Results

The core variable identified from the interviews was social isolation. Other concepts that were connected with this were: insufficient knowledge and awareness, escaping stigma, occupational difficulties, marital challenges and management of restrictions.

Conclusions

Social isolation can affect the wellbeing of primary caregivers of individuals with multiple sclerosis. Recognition and awareness of the process of social isolation and factors influencing it can be beneficial in designing theory-driven evaluation and intervention methods. It is recommended that rehabilitation specialists pay close attention to the common needs and interests of both individuals with multiple sclerosis and their primary caregivers.

Auditory temporal processing assessment in children with developmental stuttering

OBJECTIVE

Stuttering is a developmental disorder of speech production with a dynamic and multifactorial nature. Scientific theories mentioned the role of auditory processing disorder in stuttering. Investigating the auditory processing in stuttering would provide insights into the mechanisms of stuttering. The details of basic auditory processing in children with stuttering (CWS) continue to remain uncertain. This study aimed to investigate the auditory temporal processing (ATP) in CWS and also its relationship with the stuttering severity.

METHODS

The participants of this comparative cross-sectional study were 54 CWS and 63 children without stuttering (CWOS). All children were between 7 and 12 years old. ATP ability of the participants was measured using the Backward Masking (BM), Duration Pattern (DP), and Gap in Noise (GIN) tests. Then, the groups were compared in terms of ATP results. The correlation between the scores of these tests and stuttering severity was assessed.

RESULTS

According to the results, CWS showed poorer performance on DP, BM and GIN tests when compared with CWOS. Moreover, the stuttering severity had a significant negative correlation with the DP scores and percentage of correct identification scores in GIN; whereas it had a significant positive correlation with the BM thresholds.

CONCLUSIONS

The results showed that some CWS have ATP disorder, which could exacerbate their stuttering. These findings highlighted the role of ATP disorder in stuttering.

The effects of consecutive sessions of anodal transcranial direct current stimulation over the primary motor cortex on hand function in healthy older adults

BACKGROUND

With advancing age, changes in the central nervous system may lead to motor functional deficits. Non-invasive brain stimulation techniques are suggested to help modifying brain function.

OBJECTIVES

The aim of the current study was to investigate the effect of using multi session anodal transcranial Direct Current Stimulation (a-tDCS) over the primary motor cortex (M1) on the hand function in healthy older adults.

METHOD

In this randomized, double-blinded, sham-controlled study 32 participants received active or sham a-tDCS (1 mA, 20 min, for five consecutive days) and performed the Purdue Pegboard Test (PPT) on the first day before tDCS application, immediately (T1), 30 min (T2), and one week after the last session (5th day) (T3) of the stimulation.

RESULTS

There was a significant improvement for PPT (p < 0.05) in a-tDCS group at all post-test values except for PPT for left hand (PPTL) at T1. Compared to the sham group, the results indicated significant improvement in all PPT subtests (P < 0.05), except for PPTL at T1, PPT for both hands at T2 and PPT assembly at T3 in a-tDCS group.

CONCLUSION

The current findings suggest a-tDCS can be considered as a promising stand-alone technique in the intervention of the age-related decline of manual dexterity for improving hand function.

Spectro-temporal modulation detection and its relation to speech perception in children with auditory processing disorder

OBJECTIVES

Poor speech perception in noise is one of the most common complaints reported for children with auditory processing disorder (APD). APD is defined as a deficit in perceptual processing of acoustic information in the auditory system in which decreased spectro-temporal resolution may also contribute. Since the recognition of spoken message in the context of other sounds, is based on the processing of auditory spectro-temporal modulations, the assessment of spectro-temporal modulations sensitivity can evaluate the listener's ability to retrieve and integrate speech segments covered by noise. Therefore, the purpose of this study was to examine spectro-temporal modulation (STM) detection and its relation to speech perception in children with APD and to compare the results with aged-matched normally developed children.

METHODS

35 children with APD and 32 normal hearing children (8-12 years old) were enrolled. In order to examine STM detection performance, six different STM stimulus conditions were employed using three different temporal modulation rates (4, 12 and 32 Hz) and two different spectral modulation densities (0.5 and 2.0 cycles/octave). Initially, the STM detection thresholds at these six STM stimulus conditions were measured in both groups and the results were compared. Thereafter, the relation between STM detection thresholds and speech perception tests, including consonant-vowel in noise and word in noise tests were assessed.

RESULTS

The STM sensitivity was poorer than normal for APD children at all STM stimulus conditions. Children with APD displayed significantly poorer STM detection thresholds than those of normally developed children (p < 0.05). Significant correlations were found between STM detection thresholds and speech perception in noise in both groups (p < 0.05).

CONCLUSION

The results suggest that the altered encoding of spectro-temporal acoustic cues in the auditory nervous system may be one of the underlying factors of reduced STM detection performance in children with APD. The present study may suggest that poor ability to extract STM cues in children with APD, can be an underlying factor for their listening problems in noise and poor speech perception in challenging situations.

The comparison of acromiohumeral distance and scapular dyskinesis prevalence in females with and without rounded shoulder posture

Background: Altered scapular kinematics in individuals with rounded shoulder posture (RSP) may affect acromiohumeral distance (AHD). The purpose of this study was to compare AHD and scapular dyskinesis prevalence in individuals with and without RSP. Methods: A total of 44 women (RSP, n=21; control, n=23) participated in the study. RSP was assessed by measuring acromion to table distance (ATD) in supine position and forward shoulder angle (FSA) using a camera and the AutoCAD software from the lateral side. According to these measurements, ATD more than 2.6 cm and FSA equal or more than 52° were considered as RSP. AHD was measured via ultrasonography with the arm at rest and 90 º of active elevation in scapular plane (scaption). Also, scapular dyskinesis was assessed by Uhl yes/no rating system. Independent and paired t tests were used to compare AHD between and within groups' comparisons, respectively. Chi-square test was used to compare the scapular dyskinesis prevalence in individuals with or without RSP. The data were analyzed using the SPSS statistical software version 17. Significance level was set at 0.05 Results: There were no statistically significant differences in participants' AHD in rest position (dominant side, p=0.187, nondominant side, p=0.144) and 90° scaption (dominant side, p=0.144, nondominant side, p=0.182) in each side between the 2 groups. Also, the results of chi-square test showed that there were not any significant differences in the prevalence of scapular dyskinesis during shoulder flexion (dominant side, p=0.653, nondominant side, p=0.541) and shoulder abduction (dominant side, p=0.141, nondominant side, p=0.277) in individuals with and without rounded shoulder postures. Conclusion: According to our results, RSD cannot lead to reduced AHD and higher prevalence of scapular dyskinesis.

Caregiving burden in family caregivers of patients with schizophrenia: A qualitative study

INTRODUCTION:

After the psychiatric revolution and implementation of deinstitutionalization policies, caring for people with a mental health condition shifted from psychiatric hospitals to their families. In this way, family caregivers were forced to take full responsibility for taking care of the patients that lead to the occurrence of challenges for them. Only a few studies have investigated the caregiving challenges of family caregivers in patients with schizophrenia.

AIM:

This study aimed to gain a better understanding of caregiving burden in family caregivers of patients with schizophrenia and its related factors.

MATERIALS AND METHODS:

This qualitative study was performed based on 12 family caregivers of schizophrenia patients visiting a psychiatric hospital in Tehran in 2018. Sampling was carried out based on the purposive sampling method and was continued until data saturation. All interviews were recorded, transcript, and imported into the MAXQDA software. Then, qualitative content analysis was conducted based on Graneheim and Lundman's five-step method.

RESULTS:

One theme, two main categories, and five subcategories were identified from the continuous analysis and data comparison. The “Perceived objective burden” as theme included two main categories: “Heavy involvement of caregivers” and “Challenges of the healthcare system”.

CONCLUSION:

The results of this study indicate that the family caregivers of the patients with schizophrenia encounter many problems related to multiple responsibilities in the caring process and challenges in the provision of mental health-care services. This finding could improve psychiatric and mental health nurses’ knowledge and awareness about caregiving challenges in family caregiver of patients with schizophrenia and related factors.

The Relationship between Spiritual Intelligence and Resiliency of Rehabilitation Staff

This research aims to determine the relationship between spiritual intelligence and resiliency of rehabilitation staff. The reliable and validated spiritual intelligence and CD-RISC resiliency and demographic scales were used to collect data. There is a significant relationship between spiritual intelligence and the resiliency of rehabilitation staff (r = 0.38). Results showed that by increasing spiritual intelligence, resilience could increase.

Defining the concept of family caregiver burden in patients with schizophrenia: a systematic review protocol

BACKGROUND

Since the deinstitutionalization policy, in psychiatric hospitals, the care of patients with schizophrenia was left to their families which has been imposing a heavy burden on them. Family caregiver burden could have consequences for caregivers, patients, and the society. There is very little consensus on the definition and dimensions of the caregiver burden, which leads to a lack of consistency in the results of research. Thus, the present study was aimed to redefine the family caregiver burden of patients with schizophrenia.

METHODS

The databases PubMed, Scopus, Web of Science, MEDLINE (Via Ovid), ProQuest, SCI, Magiran, SID, and IranDoc will be searched from 1940 to 2018 using subject headings and appropriate terms in both Farsi and English languages. Also, gray literature and the reference list of included articles will be used to offer an appropriate definition of the family caregiver burden in patients with schizophrenia. Two independent reviewers will participate in study selection, data collection, and quality assessment steps. The result will be presented in tabular form, and meta-synthesis will be performed.

DISCUSSION

The result of this systematic review will help present the comprehensive definition of the family caregiver burden in patients with schizophrenia according to its evolutionary trend.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42018099372.

Correlation between Auditory Spectral Resolution and Speech Perception in Children with Cochlear Implants

Background:

Variability in speech performance is a major concern for children with cochlear implants (CIs). Spectral resolution is an important acoustic component in speech perception. Considerable variability and limitations of spectral resolution in children with CIs may lead to individual differences in speech performance. The aim of this study was to assess the correlation between auditory spectral resolution and speech perception in pediatric CI users.

Methods:

This cross-sectional study was conducted in Shiraz, Iran, in 2017. The frequency discrimination threshold (FDT) and the spectral-temporal modulated ripple discrimination threshold (SMRT) were measured for 75 pre-lingual hearing-impaired children with CIs (age=8-12 y). Word recognition and sentence perception tests were completed to assess speech perception. The Pearson correlation analysis and multiple linear regression analysis were used to determine the correlation between the variables and to determine the predictive variables of speech perception, respectively.

Results:

There was a significant correlation between the SMRT and word recognition (r=0.573 and P<0.001). The FDT was significantly correlated with word recognition (r=0.487 and P<0.001). Sentence perception had a significant correlation with the SMRT and the FDT. There was a significant correlation between chronological age and age at implantation with SMRT but not the FDT.

Conclusion:

Auditory spectral resolution correlated well with speech perception among our children with CIs. Spectral resolution ability accounted for approximately 40% of the variance in speech perception among the children with CIs.

Effect of wireless remote microphone application on speech discrimination in noise in children with cochlear implants

OBJECTIVES

Although cochlear implantation has significantly contributed to the speech perception of cochlear implant (CI) users, these individuals still have significant difficulty in understanding speech, especially in noisy environments and keeping track of the target speaker in the presence of speech sounds of others. This study was aimed to evaluate the effect of wireless Remote Microphones (RM) on speech discrimination scores in noise in child CI users.

MATERIALS AND METHODS

Twenty children with unilateral cochlear implantation were enrolled in this study with mean ± SD age of 5.8 ± 0.83 years who have undergone CI for at least one year. Speech discrimination scores in noise were assessed using the Words-in-Noise (WIN) test at a constant signal-to-noise ratio (SNR) of 0 dB, in the presence and absence of a wireless RM. Three loudspeakers were placed at a distance of 1 m in front of the child to present the speech and babble noise. The wireless microphone was placed on a base with a height equivalent to the height of the middle speech loudspeaker at a distance of 30 cm from it.

FINDINGS

The mean speech discrimination score in noise in the absence of wireless RM in all children was obtained 34% (6.8 words out of 20 words), with minimum and maximum of 15% and 50% words. Findings revealed the mean speech discrimination score in noise in the presence of wireless RMs is equivalent to 65% (13 words out of 20 words), with the minimum and maximum scores of 35% and 95%, respectively. The result showed that speech discrimination scores in noise improved in the presence of wireless RM.

CONCLUSION

The significant improvement was observed in speech discrimination in noise in all cochlear implanted children when the wireless RM was used, as compared to the absence of a wireless RM, which suggests the usefulness of this hearing aid accessory in CI users.

Comparing mastoid and posterior cervical muscles vibration effects on eye movement in normal subjects

Background and Aim: Vibration is a method for stimulating the vestibular system. This met­hod can unmask asymmetry between two vesti­bular systems (such as unilateral peripheral ves­tibular disorders). The occurrence of vibration-induced nystagmus (VIN) in healthy subjects can affect the diagnosis of patients with uni­lateral peripheral vestibular disorders. Thus, the evaluation of VIN in healthy subjects is critical to help the diagnosis of unilateral peripheral vestibular disorders. Methods: This study was carried out on 72 hea­lthy subjects (mean ± SD age: 27.12 ± 4.97 years) in the Auditory and Balance Clinic of Rofeideh Rehabilitation Hospital. Vibration sti­mulation with a frequency of 30 and 100 Hz was used on mastoid and posterior cervical mus­cles (PCMs) and simultaneously eye movements were recorded and analyzed using videonystag­mography. Results: The mastoid vibration with a frequ­ency of 30 and 100 Hz, respectively produced VIN in 16.67% and 27.78% of subjects and VIN observed in PCMs vibration with a frequency of 30 and 100 Hz in 4.17% and 9.72% of the subjects. Conclusion: The occurrence of VIN in healthy subjects was more probable with mastoid vib­ration in 100 Hz. In this study, VIN was pre­dominantly horizontal, its direction was toward the stimulated side, and its slow phase velocity was lower than 5 deg/s. These criteria could be used for differentiation between normal and abnormal subjects.

The Persian version of infant-toddler meaningful auditory integration scale

Background and Aim: The current study aim­ed to investigate the validity and reliability of the Persian version of the Infant-Toddler Mean­ingful Auditory Integration Scale (IT-MAIS) questionnaire. Because cochlear implantation is done today at younger ages, the use of a suitable questionnaire is necessary to evaluate auditory skills and follow up the rehabilitation progress. Methods: IT-MAIS was translated according to the International Quality of Life Assessment (IQOLA) translation protocol. The content vali­dity was performed using Lawshe method with the participation of 10 expert professionals. The questionnaire was completed for 34 parents of cochlear-implanted children before initial prog­ramming of the device, two weeks after the reh­abilitation program, and finally three months later. The intraclass correlation coefficient was calculated for test-retest reliability for each IT-MAIS subscale. The internal consistency reli­ability was analyzed using the Cronbach α coe­fficient. Results: The content validity ratio for all items was above 0.79, and the content validity index Background and Aim: The current study aim­ed to investigate the validity and reliability of the Persian version of the Infant-Toddler Mean­ingful Auditory Integration Scale (IT-MAIS) questionnaire. Because cochlear implantation is done today at younger ages, the use of a suitable questionnaire is necessary to evaluate auditory skills and follow up the rehabilitation progress. Methods: IT-MAIS was translated according to the International Quality of Life Assessment (IQOLA) translation protocol. The content vali­dity was performed using Lawshe method with the participation of 10 expert professionals. The questionnaire was completed for 34 parents of cochlear-implanted children before initial prog­ramming of the device, two weeks after the reh­abilitation program, and finally three months later. The intraclass correlation coefficient was calculated for test-retest reliability for each IT-MAIS subscale. The internal consistency reli­ability was analyzed using the Cronbach α coe­fficient. Results: The content validity ratio for all items was above 0.79, and the content validity index was obtained to be higher than 0.96. The Cronbach α for the entire questionnaire was 0.74, and for different sections of it was obtai­ned as 0.63‒0.67. A significant difference was observed between the total score of the ques­tionnaire before and after the rehabilitation pro­gram and its sub-items (p < 0.001). Conclusion: The Persian version of the ques­tionnaire of IT-MAIS is a valid instrument in terms of translation quality as well as reliability and validity for assessing cochlear implant user children who are younger than three years.

Binaural Interaction Component of Middle Latency Response in Children Suspected to Central Auditory Processing Disorder

Binaural processing disorder is an important deficit in children with (C)APD so binaural processing evaluations are crucial. There are subjective and objective tests for assessing binaural processing. Subjective tests require patient attention and active so objective evaluation of binaural processing is important. The aim of present study was investigating binaural interaction component (BIC) of middle latency response (MLR) in children suspected to (C)APD. Sixty 8-12 year-old children suspected to (C)APD and sixty normal children were selected based on inclusion criteria. Both groups were matched in terms of sex (40 boys and 20 girls) and age (9.05 ± 1.25 years old). MLR test (monaural right ear, monaural left ear and binaural) was performed in all the cases and BIC was calculated by subtracting binaural response from summed monaural responses. Independent t test showed that latency of Pa and Na (ms), Pa-Na amplitude (µv), BIC latency (ms) and amplitude (µv) were significantly different from normal subjects (p value ≤0.001). Present study showed that MLR and BIC of MLR are clinically available and objective tests that can be used to determining children suspected to (C)APD. These tests might have the potential to separating normal children from children with (C)APD objectively.

Binaural hearing advantages for children with bimodal fitting

OBJECTIVES

Bimodal fitting (BF) allows children with cochlear implant to benefit from binaural hearing advantages. Three major binaural hearing advantages, which enhance hearing function of people with normal hearing, are head shadow effect (HSE), binaural squelch effect (BSQ) and binaural summation effect (BSU). This study in pediatric patients attempting to measure the auditory benefits of bimodal stimulation in children with long-standing use of a cochlear implant (CI), and residual hearing on the contralateral side.

METHODS

This cross-sectional study investigated binaural advantages in 24 children of 8-12 years who had undergone cochlear implantation in a cochlear implant center in Tehran and continuously used BF. Improved score of speech perception in noise (SPiN) under BF condition, as compared to the application of cochlear implant alone, was a binaural advantage found in this study. Each binaural advantage was measured by obtaining the SPiN score under different listening and noise conditions, using relevant formulas. The measured value of each advantage reflects the improved score of SPiN, caused by that certain advantage.

RESULTS

In this study, improved mean SPiN score caused by the HSE, BSQ and BSU was, respectively, 3.13, 1.42 and 2.04 dB, indicating greater binaural advantages and hence improved SPiN, under BF condition in comparison with cochlear implant alone.

CONCLUSION

Children with unilateral cochlear implant and measurable residual hearing in non-implanted ear can benefit from binaural advantages and better SPiN when hearing aid is used in the unaided ear.

Overall Effects of Risk Factors Associated with Dental Caries Indices Using the Marginalized Zero-Inflated Negative Binomial Model

The purpose of this paper is to identify risk factors for decayed, missing, and filled permanent teeth (DMFT) in a population of 12-15-year-old schoolchildren and to apply the marginalized zero-inflated negative binomial (MZINB) model for determination and estimation of the overall effects of the risk factors. A cross-sectional survey comprising 764 students aged between 12 and 15 years was used to analyze the association between caries in children and some background characteristics in children and their parents. Information on the samples' social, behavioral, and demographic status was obtained through a series of closed questions. The incidence rate ratios (IRR) were used to associate some risk factors with caries. In the entire sample, the frequency of zero was 194 (25.4%). The result of the shared-parameter marginalized zero-inflated negative binomial (SP-MZINB) model showed that being a girl (IRR = 1.18; p value = 0.021), higher dental visits frequency (IRR = 1.20; p value <0.001), lower tooth brushing frequency (IRR = 0.91; p value = 0.019), higher flossing frequency (IRR = 1.11; p value = 0.001), and lower mothers' education (IRR = 0.89; p value = 0.042) are associated with DMFT. Our results may provide better insights of the factors associated with DMFT, and health programs should focus their efforts on healthcare services, for both preventive and curative purposes. This regression model provides an appropriate fit and meaningful interpretation to handling zero-inflated count outcomes. Also, it provides direct estimates of the effects of risk factors on the overall mean that does not require postmodeling computations.

The relationship between working memory capacity and temporal and dichotic auditory processing in teachers

Background and Aim: Because speech percep­tion is disturbed in people who are exposed to noise, this study aimed to investigate the effect of work environment noise on working memory capacity, temporal, and dichotic auditory proce­ssing and relationship between them in elemen­tary school teachers. Methods: Fifty-six female aged 30−50 years were enrolled in our study case and control groups. A total of 28 teachers with normal hearing and poor speech perception in noise were in the case group, and 28 women were controls with normal hearing and good scores in speech perception in noise who did not work in a noisy environment. Working memory tests, dichotic digit test (DDT) and gap-detection test (GDT) were performed for both groups. The mean score of each test was obtained from the two groups and the results were analyzed. Results: Comparison of means between the two groups in DDT, GDT, and working memory capacity test showed that the scores of the case group were significantly lower than those in the control group (p < 0.05). There was no correla­tion between working memory capacity test, DDT, and GDT scores. (p > 0.05, r < 0.1). Conclusion: Noise exposure in the work envi­ronment causes weakness in temporal and dich­otic auditory processing, and working memory capacity. But there was no correlation between working memory capacity and auditory proce­ssing. The findings of this study show the eff­ects of noise exposure on speech perception and the need to protect hearing from noise.

The effect of vestibular rehabilitation on dizziness and headache in patients with vestibular migraine

Background and Aim: Vestibular rehabilita­tion is suggested as one of the effective treat­ments for vestibular-originated dizziness and vertigo. As there is a proven biologic link bet­ween vestibular symptoms and headache, head­ache improvement with vestibular improvement after vestibular rehabilitation is expected. The aim of the present study was examining vesti­bular rehabilitation effects on dizziness and hea­dache in 9−15 year old subjects with a vestibu­lar migraine. Methods: Eight subjects with vestibular migra­ine were referred to Rofeideh Rehabilitation Hospital after diagnosis by a pediatric neurolo­gist. They were evaluated via dizziness handi­cap inventory (DHI), headache impact test-6 (HIT-6) and dizziness and headache frequency. Then they received a home-based vestibular reh­abilitation and after one month they were ree­valuated. Results: After vestibular rehabilitation for one month, changes in the DHI and HIT-6 score were statistically significant (p < 0.01). In addition, reduction in the dizziness and hea­dache frequency in a month was statistically significant. Conclusion: As vestibular rehabilitation has noticeable effects on dizziness and headache, this treatment is introduced as an effective and non-invasive treatment in children and adoles-cents with a vestibular migraine.  

Auditory Lateralization Training Effects on Binaural Interaction Component of Middle Latency Response in Children Suspected to Central Auditory Processing Disorder

Many children with central auditory processing disorder (C)APD suffer from spatial processing disorder and benefit from binaural processing training including auditory lateralization training. There are subjective tests for evaluating auditory training effects in children with (C)APD but they rely on patient's attention and cooperation so there is a need for appropriate objective tests. The aim of present study was investigating effects of auditory lateralization training on binaural interaction component (BIC) of middle latency response (MLR). This study was an analytical interventional study. Sixty children suspected to (C)APD (40 boys and 20 girls) were selected based on inclusion criteria and were divided into two groups: control and training group. Auditory lateralization training included 12 formal sessions under headphone by using interaural time difference and performed as a game. MLR (monaural right ear, monaural left ear and binaural) and monaural selective auditory attention test (mSAAT) tests were performed in all the cases. BIC was calculated by subtracting binaural response from summed monaural responses. Covariance test showed that BIC latency decreased and BIC amplitude increased significantly and mSAAT score increased significantly in training group after auditory lateralization training (p value ≤ 0.001). In present study BIC of MLR had potential to show underlying neurophysiologic changes after auditory lateralization training in children suspected to (C)APD objectively. It is in agreement with behavioral improvements after training (mSAAT improvements).

Evaluation of speech perception in noise in Kurd-Persian bilinguals

Background and Aim: In most everyday sett­ings, speech is heard in the presence of com­peting sounds and speech perception in noise is affected by various factors, including cognitive factors. In this regard, bilingualism is a pheno­menon that changes cognitive and behavioral processes as well as the nervous system. This study aimed to evaluate speech perception in noise and compare differences in Kurd-Persian bilinguals versus Persian monolinguals. Methods: This descriptive-analytic study was performed on 92 students with normal hearing, 46 of whom were bilingual Kurd-Persian with a mean (SD) age of 22.73 (1.92) years, and 46 other Persian monolinguals with a mean (SD) age of 22.71 (2.28) years. They were examined by consonant-vowel in noise (CV in noise) test and quick speech in noise (Q-SIN) test. The obtained data were analyzed by SPSS 21. Results: The comparison of the results showed differences in both tests between bilingual and monolingual subjects. In both groups, the reduc­tion of signal-to-noise ratio led to lower scores, but decrease in CV in noise test in bilinguals was less than monolinguals (p < 0.001) and in the Q-SIN test, the drop in bilinguals’ score was  more than monolinguals (p = 0.002). Conclusion: Kurd-Persian bilinguals had a bet­ter performance in CV in noise test but had a worse performance in Q-SIN test than Persian monolinguals.