The Sheba Medical Center Protocol for Bedside Evaluation of Swallowing Disorders Among Tracheotomized Patients.

The Sheba Blue Dye Test Protocol (SBDTP) is a swallowing bedside evaluation for tracheotomized patients (TP). It is based on the Modified Evans' Blue Dye Test (MEBDT), but includes several modifications that aim to overcome previously described caveats of the traditional MEBDT. These modifications include evaluating the patient three times, with increasing quantities of bolus. The purpose of this study was to examine the rates of positive and negative results of TP undergoing the SBDTP, in comparison to the MEBDT, which, generally, consists of a single evaluation. The study included a cohort of 39 TP admitted to the Sheba general hospital with various background diseases. Findings indicated that the percentage of positive results increased significantly from the first (18%) to the last stage (46.2%) of the SBDTP. This result demonstrated the advantage of the SBDTP as a more reliable evaluation for tracing aspiration among TP, especially in cases where access to instrumental examination is limited.

Resilience in people who stutter: Association with covert and overt characteristics of stuttering.

PURPOSE: Recent literature stresses the importance of resilience, as a trait, for successful coping with life's difficulties or stressors. However, only a limited number of studies were conducted on resilience among people-who-stutter (PWS). These studies did not examine the association between resilience and the specific characteristics of stuttering. This study was, therefore, aimed to directly examine the association between resilience and measures of both the covert and overt characteristics of stuttering. METHOD: Thirty adults who stutter completed the Connor-Davidson Resilience Scale (CD-RISC) and the Overall Assessment of Speaker's Experience of Stuttering - Adults (OASES-A). In addition, stuttering severity of all participants was quantified using the Stuttering Severity Instrument-4 (SSI-4). The associations between all measures were examined statistically. RESULTS: A strong and significant association was found between the participants' scores on the CD-RISC and the OASES-A (r= -.79, p < .001). In contrast, no significant correlation was found between the participants' scores in the CD-RISC and the SSI-4 (r = .02, p > .05). Within our cohort, no significant association was observed between the participants' gender and age and their resilience levels (p > 0.05). CONCLUSION: This study demonstrates the role of resilience in shaping the individual's experience with stuttering. Results also show that the individuals' resilience levels do not necessarily predict stuttering severity per se, or its overt manifestations but can predict the individuals' subjective perception of his/her stuttering. This highlights the importance of addressing and promoting resilience among PWS in stuttering therapy.

Pilot Program Combining Acceptance and Commitment Therapy with Stuttering Modification Therapy for Adults who Stutter: A Case Report.

BACKGROUND: The impact of stuttering far exceeds its effects on speech production itself. It includes increased anxiety levels and avoidance of speech situations that may impact the general quality of life. Therefore, psychological treatment methods have been incorporated into speech therapy programs with positive results. Acceptance and commitment therapy (ACT) is a relatively recent addition to the field of stuttering. In this case report, we present a pilot program of integrating acceptance and commitment therapy (ACT) with stuttering modification therapy for adults who stutter. METHOD: Eight adults who stutter entered the approximately year-long program, which consisted of three parts: group ACT, individual/pair stuttering modification therapy, and monthly stabilization/follow-up sessions. RESULTS: Improvement was observed in group mean measures of mindfulness skills, speech-related attitudes, anxiety, daily communication, quality of life, and stuttering frequency. Improvement in quality of life was also self-described by participants throughout the program. CONCLUSIONS: Participant improvement and positive self-reports suggest a potentially promising effect of combining ACT with stuttering modification therapy. Further research is needed to evaluate treatment efficacy.

The Prevalence of Self-Reported Voice Disorders in Israel.

OBJECTIVE: Data on the prevalence of voice disorders is vital in order to describe and understand the phenomenon. The aim of this study was to estimate the prevalence of voice disorders in Israel, and perform a preliminary comparison between the two major societies in the country. METHODS: A sample of 1146 people participated in a survey on voice disorders. This sample comprised 510 Israeli Jews and 627 Israeli Arabs. Each participant completed a questionnaire concerned with voice and its disorders as well as the shortened Voice Handicap Index-10 (VHI-10). RESULTS: The overall prevalence of voice disorders within our sample was 13.90%. In addition, 30.26% of the participants reported experiencing a voice problem over the last year, while 12.81% reported seeing a physician for that reason. No significant differences were found in the prevalence of voice disorders between participants who identified themselves as either Jews or Arabs. A higher prevalence of voice disorders was found in the older age groups, and among people who reside in the southern region of the country. In contrast, no significant differences in the prevalence of reported voice disorders were found between men and women. CONCLUSION: The prevalence of reported voice disorders in Israel is comparable with previous prevalence reports from other regions and societies. Data show that despite cultural, religion, language, and other factors, the prevalence of voice disorder among Israeli Jews and Arabs is very similar.

Speech rate adjustment of adults during conversation.

PURPOSE: Speech rate convergence has been reported previously as a phenomenon in which one's speech rate is influenced by his/her partner's speech rate. This phenomenon has been demonstrated in artificial settings, and to some extent, in mother-child interactions. The purpose of this study was to explore speech rate adjustment in a quasi-natural adult-adult conversation. METHODS: An A-B-A-B paradigm was used, in which ten adults conversed on a given topic with two experimenters. Speech rates of both communication partners were measured. RESULTS: Participants significantly reduced their speech rate, in response to the experimenters' reduction in speech rate. However, the participants' reduction in speech rate was significantly smaller than the experimenters' reduction in speech rate. In addition, during the controlled slow speech rate, the participants' speech rate correlated negatively with that of the experimenters'. CONCLUSION: Results suggest that speech rate convergence is a non-linear phenomenon, and may be affected by various linguistic as well as communicational factors. From a clinical perspective, the results support the use of the modeling strategy in speech therapy, as a means to facilitate a reduction in clients' speech rate.

The experience of stuttering among Ultra-Orthodox and Secular/Traditional Jews.

PURPOSE: This groundbreaking research compares the experience of stuttering among adult male People Who Stutter (PWS) from the ultra-Orthodox (UO) Jewish community in Israel to those from Secular/Traditional (ST) backgrounds. METHODS: Participants were 32 UO and 31 ST PWS, aged 18-67 years. Self-report questionnaires utilized: Perceived Stuttering Severity (PSS); Overall Assessment of the Speaker's Experience of Stuttering (OASES-A); Students' Life Satisfaction Scale (SLSS); Situation Avoidance Behavior Checklist (SABC). Demographic, religious, and stuttering information was collected. Groups were compared on scales, and correlations between scales and the PSS. RESULTS: Subjective stuttering severity ratings were significantly higher among the UO. A significant group effect was found for the OASES-A quality of life subscale, but not other subscales. Significant positive correlations were found between: 1) PSS and OASES-A Total Impact; 2) PSS and 3 OASES subscales; and 3) PSS and SABC (indicating increased avoidance with increased stuttering severity rating). A significant negative correlation was found between the PSS and SLSS, indicating lower life satisfaction with higher rates of stuttering severity among the ST. Interestingly, when tested by group, significant correlations between the PSS and all other study measures were observed only among the ST. CONCLUSION: UO participants showed higher subjective stuttering severity ratings, yet less impact on quality of life, and no correlation between subjective stuttering and other measures of stuttering experience. These novel findings may result from the combined protective effect of religiosity and socio-cultural characteristics on UO PWS' well-being, despite heightened concern about social consequences of stuttering within UO society.

The relationship between the experience of stuttering and demographic characteristics of adults who stutter.

PURPOSE: This study aims to examine the association between adults' experience of stuttering and their age, gender and marital status, as well as to evaluate the psychometric properties of the Hebrew version of the OASES-A. METHODS: The Hebrew version of the OASES-A was administered to 91 adults-who-stutter. The validity of the translated version was evaluated using a subset of 43 participants, who also completed three additional instruments: (a) a Perceived Stuttering Severity (PSS) self-rating scale, (b) the Situation Avoidance Behavior Checklist (SABC), (c) the Students Life Satisfaction scale (SLSS). Finally, the correlations between the participants' OASES-A scores and their age, gender and marital status were calculated. RESULTS: A negative correlation was found between the participants' OASES-A impact scores and their age (p<0.01). In addition, married participants exhibited lower OASES-A impact scores compared with unmarried participants (p<0.05). On the other hand, the speakers' gender was not associated with OASES-A impact scores. RESULTS: revealed high internal consistency of the Hebrew OASES-A, and moderate to strong correlations with the additional examined instruments. Finally, results of the Hebrew version of the questionnaire were comparable with those obtained in other languages. CONCLUSION: Our results indicated that, within our cohort, age and marital status are significantly associated with the personal experience of stuttering, whereas gender is not. In addition, the Hebrew version of the OASES-A is valid and comparable with equivalent versions in other languages. This facilitates the application of the OASES-A in future clinical and research settings.

Video-assisted swallowing therapy for patients with Parkinson's disease.

BACKGROUND: Conventional swallowing therapy for patients with Parkinson's disease (PD) and swallowing difficulties has poor carryover to everyday life. Herein, we test the effectiveness of visual information while treating swallowing disturbances in patients with PD. METHODS: Forty two non-demented PD patients with swallowing disturbances were randomly divided into two groups. An experimental group received video-assisted swallowing therapy (VAST) and a control group (n = 21) was given conventional therapy. Both groups were given 6 interventional sessions by the same speech and swallowing therapist. Patients in the VAST group were exposed to video of the swallowing process in general as well as of their own, as part of all therapy sessions. Swallowing function was assessed before and post-intervention by fiberoptic endoscopic evaluation of swallowing (FEES). Quality of life, quality of care and the degree of pleasure from eating were also assessed by questioners pre and post-intervention. RESULTS: There was a significant improvement in swallowing functions following both interventions. The FEESs demonstrated a significantly greater reduction in food residues in the pharynx in the VAST group compared to the conventional treatment group. There were significant group improvement in some parameters of the quality of life, quality of care and pleasure of eating scales. CONCLUSION: In cognitively intact patients with PD with swallowing disturbances VAST was associated with improved swallowing related QOL and less food residues in the pharynx.