Effect of action observation training on the oral phase of swallowing in children with cerebral palsy: a pilot randomized controlled trial.

Swallowing disorder is prevalent in children with cerebral palsy (CP), and previous studies have shown that motor-based programs benefit children with CP by facilitating motor learning. We hypothesized that action observation training (AOT) could enhance motor learning and improve the oral phase of swallowing in children. In this two-group parallel double-blind randomized controlled trial, the intervention group received AOT and sensorimotor therapy, while the control group received a sham and sensorimotor therapy. The function of the oral phase of swallowing, as the primary outcome, was measured pre-intervention, post-intervention, and at one month of follow-up. Secondary outcomes included reported symptoms of feeding problems and the impact of the child's swallowing disorder on the main caregiver, which were measured pre-intervention and post-intervention. The result of the Mann-Whitney U test showed a significant difference between the two groups in the function of the oral phase of swallowing after the intervention. Additionally, the intervention had a large effect size. However, no significant difference was found in the parent-reported scores of the feeding/swallowing impact survey and symptoms of feeding problems between the two groups. In conclusion, this pilot study provides preliminary evidence of the clinical efficacy of AOT as a safe neurorehabilitation method to improve the oral phase of swallowing in children with CP. However more studies are needed in the future.

Source Localization and Spectrum Analyzing of EEG in Stuttering State upon Dysfluent Utterances.

Purpose: The present study which addressed adults who stutter (AWS) attempted to investigate power spectral dynamics in the stuttering state by answering the questions using quantitative electroencephalography (qEEG). Method: A 64-channel electroencephalography (EEG) setup was used for data acquisition at 20 AWS. Since the speech, especially stuttering, causes significant noise in the EEG, 2 conditions of speech preparation (SP) and imagined speech (IS) were considered. EEG signals were decomposed into 6 bands. The corresponding sources were localized using the standard low-resolution electromagnetic tomography (sLORETA) tool in both fluent and dysfluent states. Results: Significant differences were noted after analyzing the time-locked EEG signals in fluent and dysfluent utterances. Consistent with previous studies, poor alpha and beta suppression in SP and IS conditions were localized in the left frontotemporal areas in a dysfluent state. This was partly true for the right frontal regions. In the theta range, disfluency was concurrence with increased activation in the left and right motor areas. Increased delta power in the left and right motor areas as well as increased beta2 power over left parietal regions was notable EEG features upon fluent speech. Conclusion: Based on the present findings and those of earlier studies, explaining the neural circuitries involved in stuttering probably requires an examination of the entire frequency spectrum involved in speech.

Translation and Psychometric Properties of the Persian Version of the Feeding/Swallowing Impact Survey in Iranian Mothers.

INTRODUCTION: Feeding is an interactive process between a child and a caregiver, and its early and chronic problems can affect the stress and quality of life of parents. Since the health and support of caregivers can affect the child's disability and performance, it is important to consider the impact of feeding and swallowing disorders on caregivers. Hence, the present study aimed to translate and investigate the validity and reliability of the Feeding/Swallowing Impact Survey (FS-IS) in Persian. METHODS: This methodological study consisted of two phases: translating the test to Persian (P-FS-IS) and evaluating psychometric properties including face and content validity (through experts' opinions and cognitive interviews), construct validity (by known-group validity and exploratory factor analysis), and reliability of the questionnaire (by internal consistency and test-retest reliability). The present study was performed on 97 Iranian mothers of children with cerebral palsy aged 2-18 years with swallowing impairments. RESULTS: Exploratory factor analysis rendered two factors with a cumulative variance of 59.71%. When evaluating known-group validity, the questionnaire scores were significantly different across the groups with different severity of the disorder (F(2, 94) = 57.1, p ≤ 0.001). P-FS-IS had a high internal consistency with Cronbach's alpha of 0.95, and there was an appropriate intra-class correlation coefficient of 0.97 for the total questionnaire. CONCLUSION: P-FS-IS has good validity and reliability and is a suitable questionnaire for assessing the impact of pediatric feeding and swallowing disorders on Persian language mothers. This scale can be used in research and clinical settings to evaluate and determine therapeutic goals.

Comparison of the Effect of Four Transcranial Direct Current Stimulation Configurations on Picture-Naming Improvement in Non-Fluent Aphasia: A Randomized Clinical Trial.

Background: Anomia is a language disorder that negatively affects communication abilities in people with aphasia (PWA). We aimed to compare the effect of transcranial direct current stimulation (tDCS) over the left and right inferior frontal gyrus (IFG) and superior temporal gyrus (STG) on the picture-naming accuracy and reaction time in PWA. Methods: A randomized, single-blind, sham-controlled crossover trial was conducted in 2021 at Mobasher Kashani Clinic, Hamadan, Iran. Sixteen patients received both five days of real-tDCS (1 mA for 20 minutes) and five days of sham-tDCS with a seven-day washout period in between. Using the Persian aphasia naming test, picture-naming accuracy and reaction time on 50 images were assessed at baseline, real-tDCS, and sham-tDCS stages. The data were analyzed using STATA software, version 11.0. P<0.05 was considered statistically significant. Results: Sixteen non-fluent PWA participated in the study. Of all patients, 64% benefited from tDCS over the STG and 18% over the IFG. The results showed that real-tDCS had a significant effect on the picture-naming accuracy (P=0.003) and the Persian-Western aphasia battery-one score (P=0.01), whereas sham-tDCS had no noticeable effects. Both the real- and sham-tDCS had no significant effect on the reaction time (P=0.28). Conclusion: Five sessions of individualized tDCS protocol (1 mA for 20 minutes) were adequate to improve picture-naming accuracy in patients with chronic aphasia.

Verbal and oral apraxia in patients with acute stroke: Frequency, relationship, and some risk factors.

Verbal and oral apraxia are two possible consequences of stroke. It seems that there are not sufficient studies regarding the frequency of these disorders. This study aimed to evaluate the frequency of Verbal and oral apraxia. In addition, the relationship between apraxia and some variables such as age, gender, and education, as well as the relationship between types of apraxia with each other, and damaged areas of the brain in apraxia of the oral system in Persian-speaking patients with stroke were studied. In this descriptive-analytical study, 42 patients participated using the convenient sampling method. Verbal and oral apraxia were assessed using the oral and verbal apraxia tasks for adults test. Data were analyzed using independent t-test, Chi-square, and Fisher's exact test. The frequency of patients with oral apraxia was 35.7%, those with verbal apraxia was 2.3%, and the combination of both verbal and oral apraxia was 4.7%. People with apraxia were significantly older than those without apraxia. There was not any significant relationship between apraxia and gender, apraxia and education, and oral apraxia with verbal apraxia (p < 0.05). The present study's findings showed the high frequency of post-stroke apraxia and the high rate of its incidence with age.

Is There Any Association Between Language Acquisition and Cognitive Development in Cochlear-Implanted Children?

OBJECTIVE: Different studies on normal children and children with a sensory or intellectual disability indicate a strong correlation between the child's vocabulary domain and his cognitive abilities. Based on this, the main focus of the present study was to investigate the cognitive performance of cochlear-implanted children after a cognition-based language intervention program. METHODS: In this experimental study, 60 cochlear-implanted children were selected and randomly allocated into case and control groups. The control group received auditory verbal therapy (AVT), while the intervention group was trained by using both AVT and a language intervention protocol that was recently developed by the authors. Finally, the participants' communication abilities were assessed through the adapted version of the language subtest of Bayley Scales of Infant and Toddler Development - Third Edition (BSID 3). Five months later, the cognitive subtest was carried out. The data gathered were then analyzed using SPSS software. RESULTS: The study was performed on 2 groups of 20- to 24-month-old cochlear implant users, and our results confirmed a high correlation between language acquisition and cognitive development (r = 0.76). In addition, the cognitive and language performance of the participants who were trained by the new and specifically designed language intervention protocol as well as AVT was significantly higher than that of the control group (P ≤ .001). CONCLUSION: The new and specifically designed language intervention protocol that was mainly established based on cognitive factors such as attention and semantic memory enhancement in cochlear-implanted children improved not only their language acquisition but also their cognitive development.

Sequential Associations Between Communication Acts of Children With and Without Autism Spectrum Disorder and Maternal Verbal Responses.

In this study, the sequential associations between child communication acts, including spontaneous communication (SC) and elicited communication (EC), and the types of verbal responses of Iranian mothers (follow-in nondirective, follow-in directive, and redirective responses) were compared between children with autism spectrum disorder (ASD) and young typically developing (TD) children. Participants were 29 children with ASD aged 3-6 years and 40 TD children aged 13-18 months, matched on expressive vocabulary. Using time-window sequential analysis, maternal verbal responses within a time interval of 3 sec following child communication were examined during 15 min of video-recorded mother-child free play interaction. Mothers in the two groups had broadly similar patterns of response to child communication acts, but some differences in responding to child EC. Across both groups, sequential associations were stronger for maternal follow-in nondirective responses to child SC than for this type of response to child EC, and were stronger for follow-in directive responses to child EC than for follow-in directive responses to child SC. Child EC and SC acts were less likely to be followed by redirective responses than other maternal responses, again across both groups. Finally, mothers of children with ASD were more likely than mothers of TD children to follow-in to child EC with both nondirective and directive responses. Our findings suggest that mothers of children with ASD synchronize their responses with their child's SC acts to the same extent as mothers of TD children, and are more synchronous in responding to their child's EC acts. LAY SUMMARY: This observational study examined how Iranian mothers verbally responded to their children's communication acts, based on whether the children's communication was spontaneous (unprompted) or elicited (prompted by the mother). Mothers of children with autism spectrum disorder or typical development responded to their children's spontaneous communication acts in similar ways, but showed some differences in responding to children's elicited communication. By prompting their children to communicate, mothers create opportunities to give additional verbal responses to their children, which may help to support children's further language development.

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.

Reliability, validity, and normative investigation of the Persian version of the Communication Attitude Test for Adults Who Stutter (BigCAT).

The purpose of this study was to establish normative and psychometric data for the Persian version of the Communication Attitude Test for Adults who Stutter (BigCAT) and to determine if there is a significant difference between the speech-associated attitude of Persian stuttering adults and their nonstuttering peers. The Persian BigCAT was administered to 90 people who stutter (PWS) and 90 people who do not stutter (PWNS). After the translation of the test and its equalization to Persian Language, content validity was determined by the opinions of experts. Then, the criterion validity with Erickson S24's test of communication attitude was determined in people who stutter. The reliability was examined using Kuder-Richardson coefficient and test-retest correlations. The results showed that the mean BigCAT score of PWS was significantly higher than that of PWNS (p < .001). The Kuder-Richardson coefficient for PWS and PWNS was high (0.88 and 0.83, respectively). The test-retest correlations as measured by Intraclass Coefficient Correlation (ICC), was also strong (0.89). The present study suggests that the Persian BigCAT is a valid instrument and can be used for the pre, peri, and post-treatment assessment of speech-related attitude of those who stutter in Iran.

Comprehension of Complex Sentences in the Persian-Speaking Patients With Aphasia.

INTRODUCTION: To study sentence comprehension in Persian-speaking Patients with Aphasia considering the factors of complexity. METHODS: In this cross-sectional study, the performance of 6 non-fluent aphasic patients were tested and their performance was compared to 15 matched control group. Comprehension of semantically reversible sentences was assessed using a binary sentence-picture matching task. The stimuli were as follows: clefts; subject clefts and object clefts, also relative clauses; subject relatives and object relatives. All of them were types of movement-derived structures and also simple declarative sentences as the control task. RESULTS: The best performance of aphasic patients were seen in the comprehension of subject clefts, although prior to this result we assumed that simple declarative sentences (in which there is no structural factor of complexity) can be understood easily. They showed the highest difficulty in the comprehension of object relatives. Furthermore, the performance of patients in the comprehension of relative clauses was significantly weaker than understanding the clefts. CONCLUSION: The outcomes of this study suggest that the sentence comprehension deficits of aphasic patients, in contrast to the specific deficit models, may not be related to linguistic disabilities. Moreover, the problems in the comprehension of non-canonical sentences may be related to failure in the allocation of attention. Finally, our results support the claims that neural characterization of the cognitive resources (e.g. working memory) is disrupted in sentence comprehension deficits.

The effectiveness of a specifically-designed language intervention protocol on the cochlear implanted children's communication development.

OBJECTIVE: Although various studies have depicted the importance of language intervention programs in facilitating language acquisition in cochlear implanted children, to this date rarely has a specific language intervention approach been recommended as better than the other and no best practice has been introduced in terms of language acquisition outcomes. Thus, the therapists remain uncertain as to which approach to follow and how to apply evidence to practice. Hence, the main goal of this study was to take a step in this regard by comparing the communication development of pediatric cochlear implant users who enrolled in two different language intervention approaches: the routine auditory-verbal approach, and the routine auditory-verbal approach plus a new intervention protocol specifically designed to enhance receptive vocabulary development in cochlear implanted children. METHOD AND MATERIALS: This prospective experimental study compared the receptive and expressive communication developmental scores of 26 cochlear implanted 20-24 months old children who received both a routine auditory-verbal intervention and a new cognitive based intervention protocol specifically designed to enhance receptive vocabulary development, with that of a group of 25 participants whose intervention program was only auditory-verbal. The children were recruited from Fars cochlear implant center situated in the city of Shiraz in Iran, and were assigned randomly to the two groups. The communication development of both groups was evaluated by the Bayley scales of Infant and Toddler Development- Third Edition, and statistical analysis was performed using the Statistical Package for Social Sciences-version 21(SPSS-21). RESULTS: The two groups were not significantly different in terms of age, sex and parents' educational level. Both the receptive and expressive communication outcomes of the children who received auditory-verbal as well as the new specifically-designed cognitive-based intervention protocol focusing on receptive vocabulary enhancement, were significantly higher than the control group (p < 0.001). CONCLUSION: The new specifically-designed cognitive-based language intervention protocol focusing on receptive vocabulary enhancement was significantly more effective in promoting and enhancing the communication development of cochlear implanted children than the routine auditory-verbal intervention.

The Development of an Interventional Package on "Receptive Vocabulary" For Cochlear Implanted Children.

OBJECTIVES: Considering the shortage of language intervention protocols which specifically concentrate on cochlear implanted children and considering the importance of timely language intervention in this group of children, the aim of the present study was to develop an interventional package on "receptive vocabulary" for cochlear implanted children. MATERIALS & METHODS: By reviewing the literature related to language acquisition theories in normal and language disordered children, as well as literature on production of intervention protocols, especially those for language impaired children, and also considering the normal process of language and speech development in normal children, the first draft of the intervention protocol was prepared. Then, the face and content validity of the intervention protocol was assessed by a Delphi team through three rounds and finally approved. RESULTS: A language intervention protocol was developed to enhance receptive vocabulary in 12-48 months-old cochlear implanted children, based on cognitive, behavioral and developmental theories. This protocol includes 5 interventional stages: 1-Drilling and Imitation; 2-Modeling; 3-Motor training; 4-Deliberate error correction; 5- Reinstatement and Generalization. Each stage consists of the description of the aims of that stage, a list of techniques, the tools required, the detailed step by step explanation of the intervention, how re-enforcement must take place, and finally the indicators of success which permit to move forward to the next stage. CONCLUSION: The interventional package produced is believed to facilitate language acquisition in cochlear implanted children, according to expert qualitative assessment and approval. Experimental research is required for verification of this assumption.

The effects of premature infant oral motor intervention (PIOMI) on oral feeding of preterm infants: A randomized clinical trial.

OBJECTIVE: Given the increase in the birth and survival rate of the premature infants, a need for supportive health care services becomes more evident. The goal of the present study was to examine the effectiveness of the Premature Infant Oral Motor Intervention (PIOMI) in the feeding progression and early intervention. This study was a double-blind randomized clinical trial. METHODS: This clinical trial included premature infants in the neonatal intensive care units (NICUs) of two hospitals in Tehran, who were randomly assigned into intervention and control group, each containing 15 infants. The PIOMI was administered to the intervention group in the course of 10 days. The infants in the control group received routine nursing services. Repeated measures ANOVA (RMA) were analyzed. The postmenstrual age and weight of the participants were examined at the time points of accomplishing one, four, and eight oral feedings a day and at the time of hospital discharge. RESULTS: The intervention group reached the first oral feeding (with a mean of 7.2 days) and eight oral feeding (with a mean of 13.47 days) earlier than the control group. The length of hospital stay in intervention group was significantly shorter (P = 0.03). RMA wasn't statistically significant between groups for weight (F: 0.76, P: 0.39, ŋ: 0.03); but within-subjects test showed that change of the weight over time and for interaction of time and group was significant (F: 74.437, P < 0.001, ŋ: 0.727). The effect size of infants' age in the measurement times was 91%. CONCLUSION: the results revealed that PIOMI is a fruitful method for premature infants. We suggest that PIOMI can be integrated in feeding rehabilitation programs of the premature infants born with gestational age of as young as 26-29 weeks, and applied at 29 weeks postmenstrual age (PMA). THE CLINICAL TRIAL REGISTRATION NUMBER: IRCT20180410039260N1.

The mediator effect of cognition on the relationship between brain lesion location and dysphagia in patients with stroke: Applying a structural equation model.

BACKGROUND: Cognitive status is important for performing the assessment and treatment of dysphagia. Nonetheless, the cognitive neuropsychological profile of patients with stroke and dysphagia is not studied as deeply enough as it should be. On the one hand, focal and non-focal brain lesions may lead to dysphagia and cognitive disorders, and on the other hand, the cognitive status possibly affects swallowing. In this study, cognition is supposed to be a mediator between brain lesion and swallowing disorder (dysphagia). The role of cognition and attention as mediators between brain lesion and dysphagia was evaluated via three causal models in which the causal mechanisms of swallowing were explained. METHODS: Eighty-eight patients with their first stroke (34 women and 54 men) in the acute phase (mean: 3.5 days after stroke; SD: 2.7) participated in this research. The data of dysphagic and non-dysphagic patients were entered into structural equation models. Two relationships were estimated: a direct relationship between brain lesion and dysphagia and an indirect association between brain lesion and dysphagia through cognition and attention. RESULTS: The goodness-of-fit indices confirmed the three models. Our first model proved a good fit [CFI = 1.00; TLI = 1.00]. The second model revealed an appropriate goodness of fit [CFI = 1.00; TLI = 1.00]. Our third model also showed a good fit [CFI = 1.00; TLI = 1.00]. CONCLUSION: It is suggested that in the assessment and treatment of dysphagia, cognition is better to be considered as a mediator along with physical aspects of dysphagia.

Comparison of Social Interaction between Cochlear-Implanted Children with Normal Intelligence Undergoing Auditory Verbal Therapy and Normal-Hearing Children: A Pilot Study.

OBJECTIVE: A cochlear implant is a device that helps hearing-impaired children by transmitting sound signals to the brain and helping them improve their speech, language, and social interaction. Although various studies have investigated the different aspects of speech perception and language acquisition in cochlear-implanted children, little is known about their social skills, particularly Persian-speaking cochlear-implanted children. Considering the growing number of cochlear implants being performed in Iran and the increasing importance of developing near-normal social skills as one of the ultimate goals of cochlear implantation, this study was performed to compare the social interaction between Iranian cochlear-implanted children who have undergone rehabilitation (auditory verbal therapy) after surgery and normal-hearing children. MATERIALS AND METHODS: This descriptive-analytical study compared the social interaction level of 30 children with normal hearing and 30 with cochlear implants who were conveniently selected. The Raven test was administered to the both groups to ensure normal intelligence quotient. The social interaction status of both groups was evaluated using the Vineland Adaptive Behavior Scale, and statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 21. RESULTS: After controlling age as a covariate variable, no significant difference was observed between the social interaction scores of both the groups (p > 0.05). In addition, social interaction had no correlation with sex in either group. CONCLUSION: Cochlear implantation followed by auditory verbal rehabilitation helps children with sensorineural hearing loss to have normal social interactions, regardless of their sex.

Effects of Age on Speech-in-Noise Identification: Subjective Ratings of Hearing Difficulties and Encoding of Fundamental Frequency in Older Adults.

BACKGROUND AND OBJECTIVES: Numerous studies have indicated deterioration of speech perception in noisy conditions among the elderly even those with normal hearing capabilities. The aim of this study was to investigate the effects of age on the speech-in-noise identification by speech-in-noise (SIN) test, subjective ratings of hearing difficulties by speech, spatial, and qualities of hearing scale (SSQ) questionnaire and encoding of fundamental frequency (F0) by Speech auditory brainstem response (ABR) in the elderly and comparing the results with young people. SUBJECTS AND METHODS: The present study was conducted on 32 elderly people aged over 60 years old (17 male and 15 female) with the mean age of 68.9 (standard deviation=6.33) possessing normal peripheral hearing and 32 young subjects (16 male and 16 female) aged 18-25 years old. RESULTS: Findings showed that the score of SIN test is lower among the elderly people as compared with young people in signal-to-noise ratios of 0 and -10 based on Iranian version of SSQ questionnaire (p<0.001). The range of F0 amplitude in the elderly people is also lower than young people (p<0.001) in Speech ABR. CONCLUSIONS: It seems that speech processing in older people is deteriorated comparing with young people regardless of their normal peripheral auditory thresholds. This decrease will result in weaker perception and improper segregation of speech from other competing sources.

Correlation of the Iranian Voice Quality of Life Profile (IVQLP) with Acoustic Measurements across Three Common Voice Disorders.

OBJECTIVES: The Iranian Voice Quality of Life Profile (IVQLP) is a recent culture-based developed tool for assessing the quality of life of dysphonic patients. The research questions addressed here are as follows: (1) Are the correlations between IVQLP scores and values of objective voice measures? (2) Do the correlations differ across the three different voice disorders? METHODS: The subjects were divided into three groups: muscle tension dysphonia (MTD) (n = 62), benign midmembranous vocal fold lesions (n = 56), and unilateral vocal fold paralysis (UVFP) (n = 32). The study sample consisted of 91 males and 59 females. The individuals had a mean age of 46.53 ± 13.84 years. All of the participants completed the IVQLP questionnaire. The PRAAT software was used to provide acoustic analyses. The correlations between fundamental frequency (F0), perturbation analyses, harmonics-to-noise ratio, and IVQLP data of the three groups of patients were measured using Pearson's correlation. RESULTS: There was a significant correlation between the total score and jitter in the MTD group. For the benign vocal fold lesion group, correlations were significant and relatively strong for numerous analyses. Again, there were numerous significant and strong correlations for the UVFP group. CONCLUSIONS: Results may indicate two interpretations. One interpretation of the results is that patients with morphological tissue changes (lesions, paralysis) appear to associate their sense of how their voice problem negatively affects their lives. A second interpretation is that there is perhaps a threshold of vocal perturbation or instability that lends itself to a patient's connection to his or her sense of how the voice affects his or her quality of life.

Correlation of Iranian Voice Quality of Life Profile (IVQLP) to VHI-30 and VRQOL: Construct Validity Evidence.

OBJECTIVES: An important domain in health-related quality of life evaluations is quality of life perceptions due to having a voice disorder. The purpose of the current study was (1) to examine the correlation of the Iranian Voice Quality of Life Profile (IVQLP) with the Voice-Related Quality of Life (VRQOL) and Voice Handicap Index-30 (VHI-30) for establishing the construct convergent validity of the IVQLP, and (2) to examine the correlation between VRQOL and VHI-30. METHODS: Study sample consisted of 150 patients, 91 male and 59 female, diagnosed with muscle tension dysphonia, benign organic disorders such as polyps and nodules, and unilateral vocal fold paralysis. In total, 150 patients aged 46.53 ± 13.84 years completed the IVQLP and Persian versions of the VHI and VRQOL. RESULTS: The results showed that Spearman rank-order correlation coefficient between the results of the VHI and IVQLP questionnaires was 0.90 (P < 0.001). The correlation coefficient between VRQOL and IVQLP was -0.88. (P < 0.001) The Spearman correlation between VHI and VRQOL was -0.94. (P < 0.001) CONCLUSIONS: The current study showed that the IVQLP has good construct validity, and it can evaluate quality of life in Iranian dysphonic patients based on their culture. Also, the VHI-30 and VRQOL correlation was very high.

Iranian Voice Quality of Life Profile (IVQLP): Factor Analysis.

OBJECTIVES: An important domain in health-related quality of life evaluations is quality of life perceptions due to having a voice disorder. The objective of this study was to examine the factor structure of the Iranian Voice Quality of Life Profile (IVQLP) based on Exploratory Factor Analysis and confirmatory factor analysis. METHODS: The study sample consisted of 280 patients (174 males and 106 females) diagnosed with MTD, benign organic disorders such as polyps and nodules, and unilateral vocal fold paralysis and cancer. To evaluate the different dimensions of the IVQLP, a principal component analysis (PCA) was conducted. Confirmatory factor analysis (CFA) was used to investigate the fitting of extracted dimensions and construct validity of the IVQLP. RESULTS: The results showed that the IVQLP has a 4-factor structure. The first factor has 17 items and refers to Emotions. The second factor has 12 items and refers to Individual/Social Relations. The third factor with 6 items refers to Occupation, and the forth with 5 items relates to Psychosomatic characteristics. CONCLUSIONS: The conclusion of this study is that the concept of quality of life in Iranian patients with voice disorders is somewhat different from that of Western patients. This difference can be seen in. the large number of items related to an Emotional factor and the identification of a Psychosomatic factor.

Development and Validation of an Iranian Voice Quality of Life Profile (IVQLP) Based on a Classic and Rasch Rating Scale Model (RSM).

OBJECTIVES: No culture based instrument exists for the people of Iran to measure outcomes of voice disorders. The objective of this study was to develop a statistically and culturally robust tool for assessing voice disorder outcomes in the Iranian population. METHODS: A 65-item assessment tool called the Iranian Voice Quality of Life Profile (IVQLP) was developed after three stages of study. IVQLP measures voice disorder outcomes in four domains: physical, emotional, functional, and cultural. The questionnaire was given to 130 individuals with various voice disorders and 30 control subjects with no vocal pathology. The data obtained were subjected to measures of reliability (internal consistency and test-retest) and validity (content, construct, and concurrent) in the classic sense, as well as examined based on Rasch rating scale model analysis. RESULTS: Results showed that IVQLP had high internal consistency (α = 0.99) and test-retest reliability (r = 0/90). IVQLP differentiated the dysphonic group from the control group. Findings using the classic models suggested adequate construct validity for 43 items of the IVQLP fit the Rasch model. The high Rasch item separation reliability, separation index, and strata statistics for 43 items indicated that IVQLP provided further evidence that the items are reliable and comprehensive representations of quality of life concepts in Iranian people with voice disorders. CONCLUSIONS: This study concludes that IVQLP is a sufficiently reliable and valid tool to measure Iranian patients' perception of their quality of life in respect to their voice problem.