Screening of dysphagia in geriatrics.

BACKGROUND: The oropharyngeal dysphagia is an underestimated symptom with various causes in the geriatric population. Clinical presentation is often insidious and dysphagia symptoms are seldomly mentioned by elderly patients although causing many life-threatening complications. The aim of this work was to introduce an easy applicable tool to be used by the caregivers and general practitioners for screening of dysphagia in geriatrics for early detection of at risk individuals. METHODS: A sample of 200 Egyptian Arabic-speaking elderly patients (65 years or older) not complaining of dysphagia was recruited from nursing homes in Greater Cairo Area. They or their caregivers completed the designed screening tool, including; the designed questionnaires of dysphagia manifestations and eating habits. General, oral motor and bedside evaluation were also performed. In addition to filling in the EAT10 questionnaire and FEES that was performed for only suspected cases for the purpose of validation of the screening tool. RESULTS: The dysphagia manifestations questionnaire was significantly correlated with EAT 10 with p value of 0.001. It was correlated in some of its aspects with FEES showing quite reliability with p values' range between 0.012 and 0.044. The Questionnaire of eating habits reliability of r- value of 0.568 slightly exceeding EAT10 reliability of r -value of 0.721 in the subjects under study. The cutoff point of total score of the dysphagia manifestations was > 5, with a sensitivity of 17.65% & a specificity of 94.20%. The cutoff point of total score of the bedside evaluation was ≤ 1 with a sensitivity of 66.9% & a specificity of 56.9%. CONCLUSION: the use of this easy applicable screening tool managed to suspect and later on diagnose cases with oropharyngeal dysphagia in non-complaining aging subjects.

Validation of the Egyptian Arabic Assessment of Auditory Skills development using children with Cochlear Implants.

INTRODUCTION: Audition is the gateway to spoken language, and infants' early accomplishments in acquiring the sound structure of their native language lays a critical ground work for subsequent learning. The development of pre-lingual auditory perceptual skills for cochlear implanted children is crucial for initial development of oral language. OBJECTIVE: The aims of the present study were to validate the Egyptian Arabic Assessment of Auditory Skills, and to track the development of auditory skills in Egyptian children fitted with CI during the first three years post implantation. METHODS: The study included 90 Arabic Egyptian children attending the phoniatric unit, Kasr El Aini hospital. Their chronological age ranged from 36 to 72 months. The study lasted for 18 months from July 2015 to January 2017. The children were divided into six groups according to their cochlear age i.e., amount of implant experience. An Arabic assessment chart of auditory skills was tailored that included six auditory skills' domains; detection, identification, short term auditory memory, supra-segmental discrimination, segmental discrimination and linguistic auditory processing. This chart was then used to develop an assessment tool which was then applied to all the study participants. All children had bilateral Sensorineural Hearing Loss (SNHL) since birth. None of the participants had prior Cochlear Implant (CI), but all had tried conventional hearing aids. All participants were implanted unilateral, with CI devices. All met selection criteria applied in the Egyptian national insurance committee for cochlear implantation. RESULTS: All auditory skills domains improved with cochlear age. There was significant improvement between 1-6 and 7-12 months in the scores of the Detection (DET) domain. There was significant difference between 1-6 and 7-12 months, 7-12 and 13-18 months, 19-24 and 25-30 months in the scores of the Identification (IDENT) domain. Regarding the Short Term Auditory Memory (STAM) domain scores and the Supra-segmental Discrimination (SSD) domain scores there was significant difference between all the groups. Regarding the Segmental Discrimination (SGD) domain scores, there was significant difference between group 1-6 and 7-12 months, 7-12 and 13-18 months, 19-24 and 25-30 months, 25-30 and 31-36 months. Regarding the Linguistic Auditory Processing (LAP) domain, there was significant difference between group 1-6 and 7-12 months, 7-12 and 13-18 months, 25-30 and 31-36 months. CONCLUSIONS: Children fitted with Cochlear Implants (CIs) appeared to show improvement in acquisition of auditory skills over a period of three years that followed a hierarchy of development dependent on the cochlear age.

Pragmatic difficulties in children with Specific Language Impairment.

Most of the children having Specific Language Impairment (SLI) exhibit pragmatic difficulties that are often overlooked while their communication skills are being evaluated. Identifying pragmatic needs in such children can be lengthy and indeterminate as many of such children don't quite "fit" into a definite diagnostic category. This study aimed at identifying and clarifying the nature of pragmatic difficulties in a group of children with Specific Language Impairment by comparing their pragmatic skills with those of a group of normally developing children using a simple Pragmatic Screening protocol hoping that this would aid in reaching a better understanding of the nature of pragmatic difficulties in such children. The present study examined the pragmatic profiles of 60 age and gender matched native Cairo-Egyptian Arabic speaking children (with age range 4-6 years old). The children were divided into two groups; Group A and Group B. Group A included 30 children with normal language development whereas Group B included 30 children who had been previously diagnosed as having Specific Language Impairment. For each subject, history taking followed by audiological and psychometric evaluation to rule out the existence of any hearing difficulties or mental deficiency was performed. Afterwards, each child under study was subjected to the Arabic Pragmatic Screening tool [1]. For each child, the screening was scored by three readers; average scores were obtained and statistically analyzed. All the values obtained by the control group were found to be significantly higher than those obtained by the SLI group except for some non-verbal paralinguistic skills where non-significant differences were found between the two groups. Through the ROC curve, cut off level for Total Pragmatic Score (TPS) was found to be less than or equal to 78.16, i.e. 4-6 year old children with a TPS equal to or less than 78.16 were considered to have pragmatic difficulties. Thorough screening of pragmatic skills while evaluating the communication skills of children with specific Language Impairment should be seriously considered.

Childhood apraxia of speech and multiple phonological disorders in Cairo-Egyptian Arabic speaking children: language, speech, and oro-motor differences.

Childhood apraxia of speech is a neurological childhood speech-sound disorder in which the precision and consistency of movements underlying speech are impaired in the absence of neuromuscular deficits. Children with childhood apraxia of speech and those with multiple phonological disorder share some common phonological errors that can be misleading in diagnosis. This study posed a question about a possible significant difference in language, speech and non-speech oral performances between children with childhood apraxia of speech, multiple phonological disorder and normal children that can be used for a differential diagnostic purpose. 30 pre-school children between the ages of 4 and 6 years served as participants. Each of these children represented one of 3 possible subject-groups: Group 1: multiple phonological disorder; Group 2: suspected cases of childhood apraxia of speech; Group 3: control group with no communication disorder. Assessment procedures included: parent interviews; testing of non-speech oral motor skills and testing of speech skills. Data showed that children with suspected childhood apraxia of speech showed significantly lower language score only in their expressive abilities. Non-speech tasks did not identify significant differences between childhood apraxia of speech and multiple phonological disorder groups except for those which required two sequential motor performances. In speech tasks, both consonant and vowel accuracy were significantly lower and inconsistent in childhood apraxia of speech group than in the multiple phonological disorder group. Syllable number, shape and sequence accuracy differed significantly in the childhood apraxia of speech group than the other two groups. In addition, children with childhood apraxia of speech showed greater difficulty in processing prosodic features indicating a clear need to address these variables for differential diagnosis and treatment of children with childhood apraxia of speech.