Field validation of an app based developmental and speech language screening (SRESHT screener) conducted by grass root workers.

This study validated an app-based developmental and speech language screening (SRESHT screener) conducted by Grass Roots Workers (GRWs) among children below six years of age in a rural community in the state of Tamil Nadu (the field). Method: The study was carried out in two phases, first the training of GRWs and then the validation of the screening conducted by them using the app. For the training, suitable materials were developed, and the GRW's knowledge and skills were evaluated pre- and post-training. Two closed-ended questionnaires were used to evaluate the GRWs' knowledge about the screening tools. The Observed Structured Practical Examination (OSPE) method was used to evaluate their skill. All the participants were selected by convenience sampling and were screened independently by both a Speech Language Pathologist (SLP) and a GRW using the application. Cohen's kappa and percent agreement were used to determine agreement in screening results between the SLP and GRWs. Results: All the GRWs scored at least 75 % and above in both the knowledge and skill assessments conducted post-training. "Substantial agreement" on kappa-based extent of agreement and "almost perfect" agreement on percent agreement were obtained between GRWs and SLP for the app-based screening. Conclusion: The findings of this study imply that the app-based developmental and speech language screening performed in the community by GRWs is valid.

Development and Evaluation of the Psychometric Properties of the Tamil Version of Eating Assessment Tool - 10 (EAT-10): Preliminary Findings from Persons with Head and Neck Cancer.

Aims: This study aimed to develop and evaluate the psychometric properties of the Tamil version of the Eating Assessment Tool (EAT-10). Setting & Study Design: Prospective cross-sectional study on persons with Head and Neck Cancer (HNC) during their follow-up for oncological and swallowing consultation at a tertiary care hospital and healthy individuals recruited from the community. Methods: The study was conducted in two phases: (1) translation and development of the Tamil version of EAT-10 and (2) administration of Tamil EAT-10 to assess internal consistency reliability, test-retest reliability and known-group validity. 92 participants with HNC in the clinical group and 149 healthy adults in the control group completed the Tamil EAT-10. In addition, a subgroup of 20 participants with HNC repeated the questionnaire within a week to assess test-retest reliability. Results: The Cronbach alpha for the 10 items was 0.96 indicating high internal consistency reliability. The test-retest reliability of the individual items and the total scores (r = 0.98) of the Tamil version of EAT-10 were high. The total EAT-10 scores for the HNC group (14.4 ± 11.5) were significantly higher (p < 0.001) than the scores for healthy adults (0.72 ± 2.0). Conclusion: The Tamil version of the EAT-10 developed in this study is a reliable and valid self-administered tool for identifying concerns related to swallowing among persons treated for HNC and healthy adults. This tool can be implemented for clinical practice and research in dysphagia among a Tamil-speaking population. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-022-03376-8.

An eclectic Voice Therapy Program for the Treatment of Hyperfunctional Voice Disorders (HFVD).

PURPOSE: An eclectic voice therapy program includes sequenced and structured set of exercises combining direct and indirect intervention methods. Tailor-made exercise prescription with specific cultural adaptations are needed to provide a holistic change to voice quality.1 This study detailed the construction of an exercise prescription for participants with hyperfunctional voice disorder [HFVD] in the Indian context. METHOD: The exercise program was developed based on literature related to vocal therapy approaches and delivery methods. Adaptations were introduced to a selected set of exercises. Five voice experts verified the exercises and their prescription for content and feasibility of use in the Indian context. Modification suggested by the experts were included for framing the final version of the exercise program. This structured therapy program was planned for 6 weeks (30 minutes duration/session offered individually twice per week, with a gap of two days between sessions in a week) with the goals to improve voice quality, flexibility, and endurance while speaking. Five participants with HFVD partook in the study for pilot testing. Stroboscopy, perceptual voice analysis, Dysphonia Severity Index (DSI) and Vocal Fatigue Index in Tamil (VFI-T) were used to report the therapy outcomes. Participants' report on the learning process and generalization of the program were documented. Wilcoxon-signed rank test was used to test the pre-post outcome measures. RESULTS: An eclectic voice therapy program, i.e., Comprehensive Voice Habilitation Program [CVHP] was constructed and it included vocal hygiene instructions, warm-up & cool-down, easy onset, resonant voice, and carry over exercises. Participants completed the program in 14-18 sessions (over 7 to 9 weeks of therapy). All participants showed significant changes in vocal fold movement patterns, reduction in ventricular hyperadduction, overall grade of voice quality, DSI and VFI-T. Participants reported that pictorial illustrations, feedback, and monitoring sheets were useful in learning the exercises. CONCLUSION: CVHP showed significant change in the voice-related outcome measures and was a viable program for treating HFVD.

Cross-Cultural Adaptation and Psychometric Evaluation of the Neonatal Eating Assessment Tool-Breastfeeding Into Tamil.

OBJECTIVE: To adapt the Neonatal Eating Assessment Tool-Breastfeeding (NeoEAT-Breastfeeding) into Tamil, a language spoken in several South Asian countries, to identify the tool's factor structure, and to assess its psychometric properties. DESIGN: Cross-sectional. SETTING: Tertiary care hospital in South India. PARTICIPANTS: A cohort of 323 mothers of infants ages 1 week to 7 months, including infants with and without feeding difficulties. METHOD: To adapt the English tool to Tamil, we followed standard procedures specified by the tool developers and international guidelines for tool translation and adaptation, including pilot testing and personal interviews with participants who had infants younger than 7 months. Participants completed the NeoEAT-Breastfeeding (Tamil) after assessment of breastfeeding by professionals. The 62-item tool involves rating each item on a 6-point scale, and higher scores indicate increased feeding difficulties. RESULTS: After exploratory factor analysis, we divided the tool into five subscales in the Tamil version compared to the seven subscales in the original English version. The Tamil version demonstrated high internal consistency reliability (Cronbach's α = 0.97) and test-retest reliability (intraclass correlation = 0.99) for the total scores. Infants with feeding concerns demonstrated significantly higher total and subscale scores on the NeoEAT-Breastfeeding (Tamil) than infants without feeding concerns (p = .000; construct validity). CONCLUSION: The NeoEAT-Breastfeeding (Tamil) holds promise as a culturally appropriate, clinically useful parent-report tool with evidence for initial reliability and validity for identifying feeding-related concerns among infants younger than 7 months in the Tamil-speaking population.

Visual-perceptual function of children using the developmental test of visual perception-3.

Clinical relevance: The development of region-specific norms for the Developmental Test of Visual Perception, third edition (DTVP-3), from a group of children from South India will contribute to the assessment of visual-perceptual skills in children.Background: Visual-perceptual skills are crucial for children to understand their environment, perform activities of daily living, and cope with their learning environment. These perceptual skills also influence children's behavioural characteristics. Well-constructed, norm-referenced standardised tools are vital for assessing visual-perceptual skills. Since ethnicity and cultural background may influence the performance of perceptual tasks, the proposed norms for any assessment tool need to be validated for specific populations. Hence, the current study aimed to develop norms in the Indian context for the Developmental Test of Visual Perception, third edition (DTVP-3), and compare the obtained norms with the norms established in the United States of America.Methods: One hundred and thirty-seven healthy children (mean age: 9.5 ± 1.7 years, range: 7-12 years, 67 females) participated in the study. Visual-perceptual functions including eye-hand coordination, copying, figure-ground, visual closure, and form constancy, were assessed and compared with age-matched norms provided in the test manual. Internal consistency of DTVP-3 was evaluated using Cronbach's Alpha correlation coefficients.Results: Significant differences were observed between the study groups and the given norms for assessment of the abilities of eye-hand coordination, copying skills and visual figure-ground (p < 0.05). No significant difference was found for visual closure and form constancy subtests. Cronbach's alpha coefficients for the five subtests ranged from 0.70 to 0.91 while the composite indexes had coefficients from 0.90 to 0.93.Conclusion: The DTVP-3 showed acceptable limits of internal consistency when tested in a group of children from South India. Region-specific norms need to be used for each of the subtests.

Relationship between parental report of language skills and children's performance among 3-year-olds: Implications for screening language among preschoolers.

AIM: The study compared parental ratings of children's language abilities at 3-years of age with observations of children's language performance by Speech Language Pathologists (SLPs). METHOD: Children (n=85) around 3-years of age were recruited from a child development clinic. Detailed speech and language assessments were completed during a one-hour semi-structured clinician-child interactive session. Language assessment was carried out using a criterion-referenced checklist and the language sections of the Bayley Scale for Infant Development- 3rd Edition (BSID-III). All parents rated their children's language skills using seven statements related to reception and expression domains of language on a 7-point rating scale. The language status of the child (typical language vs delay) determined by the parental report was matched with the language status as per the child's performance during the SLP assessment. RESULTS AND DISCUSSION: Mean parental ratings of children assessed as having language delay by an SLP were significantly lower than children with typical language. Total parental rating score correlated highly with overall language scores on BSID-III; the highest correlation was observed for ratings of statements related to expressive language skills focusing on formation of sentences. Parental report of below normal performance on any one of the seven statements demonstrated acceptable sensitivity (0.95) and a high negative predictive value (0.98) with the child's performance as the gold standard. CONCLUSION: Parental ratings of language skills correlated with child's performance at 3-years of age with a higher agreement for identifying children with delays. Parental reports can be useful to red-flag children for further assessment and continued monitoring of language development in busy developmental clinics and preschools, especially in the context of low-resource settings.

Cepstral Measures to Analyze Vocal Fatigue in Individuals With Hyperfunctional Voice Disorder.

OBJECTIVE: Cepstral measures are sensitive to slightest deviance in voice quality. Vocal fatigue is an initial symptom of a voice disorder. This study aimed (1) to assess the correlation of vocal fatigue and cepstral measures and (2) to identify a measure for analyzing voice change due to vocal fatigue in individuals with hyperfunctional voice disorders. STUDY DESIGN: Cross-sectional. METHODS: A total of 100 subjects participated in the study, that is Group I (50 cases) and Group II (50 controls). Vocal Fatigue Index (VFI-T) in Tamil was administered to identify the presence of fatigue. Voice samples (sustained vowel and conversational speech) were recorded using the Computerized Speech Lab (Model 4150). Mic to mouth distance was maintained at 10 cm. Extraction of cepstral peak prominence (CPP) and smoothened cepstral peak prominence (CPPS) for a vowel (v) and connected speech (cs) was done using Praat software (version 6.0.39, Boersma & Weenink, 2018). RESULTS: Independent t test was used to compare the cepstral measures between cases and controls. Individuals with vocal fatigue (cases) showed significantly lower cepstral values and higher VFI scores compared to the controls. Spearman's rho revealed moderate to strong negative correlation between factors of VFI and cepstral measures. On stepwise multiple linear regression, CPPcs was retained as a sensitive measure to analyze vocal fatigue in individuals with hyperfunctional voice disorder. CONCLUSION: Cepstral measures can be applied to analyze vocal fatigue.

Preliminary evaluation of a low-intensity parent training program on speech-language stimulation for children with language delay.

AIM: The study assessed the outcome of a low-intensity parent training program for improving parent's language input to children with language delay. METHOD: Nine parents and their children aged between 12 months to 24 months, exhibiting delay in language development, participated in a brief training program over three sessions. Training comprised of inputs on speech-language development, play development and speech-language stimulation strategies, supported by a manual. Effect of the training program on parent's language behaviour was evaluated through observations of parent-child interaction recorded before training and six-weeks and 10-weeks post training. Measures including, different functions served by verbalizations of parents and their nonverbal affective behaviours, were analysed. RESULTS AND DISCUSSION: Parents' verbalizations increased significantly from baseline to the two follow-up sessions. Proportion of comments, suggestions and reflections on the child's productions increased with a concurrent decrease in the use of direct commands and questions, from baseline to post training at 10-weeks. Parents reported regular use of the manual during and after the training sessions. Post training, they identified play-based activities and provided opportunities for interactions in daily routines. Changes in the child's communication skills were also reported. CONCLUSION: A low-intensity training program for parents, supported by a manual focusing on developmentally appropriate play and speech-language stimulation, resulted in increased verbal interaction and changes in language input to children.

School-based language screening among primary school children using telepractice: A feasibility study from India.

Purpose: This study explored the feasibility of conducting school-based language screening using telepractice to expand its scope for providing speech-language pathology services in India. Method: Thirty-two primary school children underwent language screenings through in-person and telemethods. Screening through telemethod was conducted by a Speech-Language Pathologist (SLP) using digitised picture stimuli presented through videoconferencing and remote computing with assistance of a facilitator at school site. Technology and child-related factors influencing screening were documented using an inventory. Result: Language outcomes through in-person and telemethods revealed no significant differences in both receptive and expressive domains, suggesting absence of bias due to testing method used. Use of multiple internet options at both sites helped overcome technical challenges related to connectivity during screening through telemethod. The trained facilitator played a crucial role in overcoming child related factors such as poor speech intelligibility, poor audibility of voice, motivation, interaction with SLP and need for frequent breaks. Conclusion: Feasibility of conducting school-based language screening using multiple internet options and help of a facilitator at school demonstrates promise for delivery of services by SLP in resource constrained contexts such as India.

School entry level tele-hearing screening in a town in South India - Lessons learnt.

INTRODUCTION: School screening is warranted in developing countries that do not have newborn hearing screening as schools provide access to a large number of young children between 3 and 5 years of age. Due to scarcity of technical manpower and equipment, hearing screening programs are not often conducted in developing countries. In these circumstances, telehealth services appear to be a reasonable solution. Consequently, the purpose of this study was to assess the feasibility of school hearing screening using telehealth technology operated by a practitioner located 400 kms away at a distant hospital. METHOD: Thirty one children received hearing screening procedures in their school. Each child was screened for both in-person and telehealth conditions to assess screening results. Remote computing software was employed for the telehealth condition in order for the practitioner to remotely operate an audiometer, DPOAE system and a video otoscope interfaced to a personal computer at the school site.Teamviewer version 10 was used to provide encrypted videoconferencing and synchronous hearing screening services between the hospital and school sites. All screening was conducted using a mobile phone hotspot or dongle device based internet connection to insure reliable connectivity. RESULTS: The outcome revealed no significant difference between PTA and DPOAE performed in-person and tele-hearing screening methods. Concurrence of greater than 87% was achieved between in-person and tele-video-otoscopy. Strengths and challenges were documented for tele-hearing screening in three different dimensions: technical issues, child related and school related. Understanding these challenges may provide more effective tele-audiology services. DISCUSSION: The results of the study indicate synchronous hearing screening services can be provided in a school setting using mobile hotspot or dongle connectivity in locations where Internet bandwidth is otherwise restricted.

Distinct developmental profiles in typical speech acquisition.

Three- to five-year-old children produce speech that is characterized by a high level of variability within and across individuals. This variability, which is manifest in speech movements, acoustics, and overt behaviors, can be input to subgroup discovery methods to identify cohesive subgroups of speakers or to reveal distinct developmental pathways or profiles. This investigation characterized three distinct groups of typically developing children and provided normative benchmarks for speech development. These speech development profiles, identified among 63 typically developing preschool-aged speakers (ages 36-59 mo), were derived from the children's performance on multiple measures. These profiles were obtained by submitting to a k-means cluster analysis of 72 measures that composed three levels of speech analysis: behavioral (e.g., task accuracy, percentage of consonants correct), acoustic (e.g., syllable duration, syllable stress), and kinematic (e.g., variability of movements of the upper lip, lower lip, and jaw). Two of the discovered group profiles were distinguished by measures of variability but not by phonemic accuracy; the third group of children was characterized by their relatively low phonemic accuracy but not by an increase in measures of variability. Analyses revealed that of the original 72 measures, 8 key measures were sufficient to best distinguish the 3 profile groups.