Oral Incompetence: changes in speech intelligibility following facial nerve paralysis.

BACKGROUND: Speech may be compromised following facial nerve paralysis (FNP), depending on the cause of the paralysis. This can result in lower quality of life and a reduced capacity to return to vocational roles. Despite its prevalence, it is incompletely understood and rarely described. This study prospectively evaluated the impact of FNP on speech intelligibility. METHODS: This observational study recruited patients who were diagnosed with FNP and who reported oral incompetence from the Sydney Facial Nerve Service. Their speech was analysed using patient reported outcome measures (Speech Handicap Index) and perceived intelligibility (Speech Pathologist, community member control participants, participant self-rating, and dictation software). RESULTS: Forty participants with FNP and 40 controls were recruited. Participants with FNP rated their intelligibility to be significantly worse than other raters (p <0.001). Consonant analysis demonstrated bilabial, fricatives and labiodental phonemes to be most commonly affected following FNP. CONCLUSION: Oral competence is compromised after FNP which can lead to a poorer perception of their intelligibility and reduced speech related quality of life.

Responsiveness of the EAT-10 to Clinical Change in Head and Neck Cancer Patients with Dysphagia.

Purpose: This retrospective study evaluated the external responsiveness of the Eating Assessment Tool-10 (EAT-10) to clinical changes in a single cohort (n = 105) treated with chemoradiotherapy (CRT) or radiotherapy (RT) for head-and-neck cancer.Method: Patients completed the EAT-10 four times: (I) Within two weeks of commencing (C)RT, (II) in the final week of (C)RT, (III) two weeks post-(C)RT and (IV) following discharge from speech-language pathology services. Data was compared to their oral intake status, using the Functional Oral Intake Scale (FOIS).Result: Using Cohen's d, changes in the EAT-10 and FOIS were comparable, however, a difference was observed at data-point IV. At data-points I, II and III, the EAT-10 had a strong negative correlation with the FOIS (Spearman's ρ= -0.81, -0.80 and -0.81 resp.). At data-point IV the correlation strength decreased (Spearman's ρ= -0.69). Fisher's Z transformation found no statistically significant correlation coefficient differences between data-points I, II and III. A significant difference in correlation was found between these data-points and data-point IV (p = 0.027; p = 0.039 and p = 0.022 resp.). A very high internal consistency was found (Cronbach's α > 0.95) for all data-points.Conclusion: This study's results indicate that the EAT-10 has weaknesses in the external responsiveness and has redundancy of its question items.

Efficacy of electronic portable assistive devices for people with acquired brain injury: a systematic review.

A systematic review was conducted to evaluate the efficacy of electronic portable assistive devices (EPADs) for people with acquired brain injury. A systematic database search (OVID, CINAHL) found 541 citations published between 1989 and the end of 2012. A total of 23 reports met the inclusion/exclusion criteria, namely intervention studies (group, n-of-1) testing the efficacy of EPADs as compensatory devices for cognitive impairment for people with acquired brain injury aged 16-65 years. Study quality was rated by the PEDro (Physiotherapy Evidence Database) scale, (randomised controlled trials), the Downes and Black tool (other group intervention studies), and the Single Case Experimental Design tool (single participant studies). Levels of evidence were determined using five levels of classification based on the Spinal Cord Injury Rehabilitation Evidence table. Results found no Level 1 studies (RCTs with PEDro score ≥ 6), four Level 2 studies and 10 Level 3 studies. There was insufficient evidence to recommend any practice standards, but sufficient evidence to recommend the use of electronic reminder systems in supporting the everyday functioning of people with acquired brain injury as a practice guideline. Higher quality studies are required to support a broader range of compensatory roles that EPADs have the potential to play in neurorehabilitation and the long-term support of people with acquired brain injury.