Evaluating Parents' Concerns, Needs, and Levels of Satisfaction with the Services Provided for ASD Children in Saudi Arabia.

Background: Supporting children with autism spectrum disorder (ASD) and their parents is vital in improving their children's abilities and their parents' ability to care for them. Thus, parents' perceptions of and levels of satisfaction with the services provided for their children must be assessed. Aim: This study aimed to understand parents' perceptions of and satisfaction with the speech-language services (SLS) provided for ASD children in different health facilities in Saudi Arabia. Methods: This cross-sectional study included 109 parents of ASD children. The survey included five sections dealing with (1) general information about the child; (2) assessment of the child's ASD characteristics (including their age when diagnosed, when they first noticed symptoms, and their speech, language, and communication abilities); (3) the reasons for enrollment in SLS sessions; (4) questions about SLS; and (5) parents' perceptions of SLS, satisfaction with the service, descriptions of their children's progress, and the respect and support they received. Results: Parents' satisfaction levels were significantly higher when they had easy access to SLS, sufficient information and support, proper training in applying therapy exercises at home, and perceived respect and support from speech and language pathologists (SLPs). The reasons for discontinuing SLS included high session costs, the need for initial behavioral sessions, the lack of qualified SLPs, the end of the sessions, the lack of improvement, the nonavailability of specialized centers, and parents' dependence on home training only. They also sought opportunities for work and education, continuous and intensive SLS sessions, reduced costs, centers for adults with ASD, and accessible schools. Parents' main concerns were their children's poor speech and language skills, independence, and social acceptance. Conclusion and Implications: The study highlighted the importance of understanding parents' experiences with SLS, identifying the factors that enhance SLS use by ASD children, and improving parents' satisfaction with such services.

Predictors of public attitudes in Saudi Arabia toward people who stutter.

PURPOSE: The Public Opinion Survey of Human Attributes-Stuttering (POSHA-S) was used to measure the attitudes of the general population in Saudi Arabia toward people who stutter (PWS) and to identify the predictors of the overall stuttering score (OSS). METHOD: A total of 404 adults from Saudi Arabia (16.8% male and 83.2% female) completed an online POSHA-S questionnaire. RESULTS: The attitudes of adults in Saudi Arabia were similar to those of other samples worldwide. Working status, income, and multilingualism were substantial predictors of the OSS. CONCLUSION: Saudi adults have positive impressions, beliefs, and self-reactions to PWS. However, their knowledge of stuttering tends to be limited. Therefore, campaigns conducted to raise awareness of stuttering should adopt the most widely used sources of knowledge in the Saudi Arabian community (i.e., the Internet and social media). Sociodemographic variables predictive of positive versus negative OSS include working status and multilingualism. Unpredictive variables, that do not predict positive versus negative OSS, include age, gender, education, parental status, health, abilities, and income.

Measuring Perceived Voice Disorders and Quality of Life among Female University Teaching Faculty.

BACKGROUND: Occupations that require heavy vocal use can place the person at risk of voice disorders (VDs). Heavy demands on the voice, especially for a long time or with loud back-ground noise, can lead to vocal abuse or misuse. The study aimed to measure the prevalence of perceived voice disorders among the teaching faculty at a female university, identify the risk fac-tors that affect their voice, and determine the effect of perceived voice disorders on their quality of life (QoL). METHODS: The study sample consisted of female teaching faculty (N = 401). The ques-tionnaire included general sociodemographic data, general voice data, the vocal tract discomfort (VTD) scale, and the World Health Organization Quality of Life assessment (WHOQOL)-BREF. RESULTS: The results demonstrated that 44.1% of the participants had perceived voice disorders, and stress, reflux, and asthma had a significant relationship with self-perceived voice disorders. Furthermore, the data showed that self-perceived voice disorders negatively impacted the overall QoL of teaching faculty. CONCLUSIONS: Perceived voice disorders are affected by various factors, including health conditions, medications, and lifestyle choices. Although teaching characteristics and demo-graphic factors are believed to be the cause, in this study they did not significantly contribute to perceived voice disorders. Faculty members with perceived voice disorders have a poorer quality of life, highlighting the need for education on preventative vocal measures and awareness of voice care.

Could Plummer-Vinson Syndrome Be Associated with Celiac Disease?

A 16-year-old female presented to our hospital clinic with a main complaint of difficulty swallowing. She reported mild dizziness and frequent fatigue and denied weight loss, fever, joint pain, or a history of diarrhea. Lab and physical results showed low weight; low hemoglobin, ferritin, and vitamin D levels; and a low red blood cell count. Swallowing assessment showed esophageal webs and swallowing difficulty, especially in the pharyngeal stage, and aspiration. It was initially suspected that clinical manifestations, including esophageal webs, iron deficiency anemia (IDA), and swallowing difficulty, were related to Plummer-Vinson syndrome (PVS). However, further investigations and pathological findings revealed several gastrointestinal manifestations consistent with celiac disease (CD). Based on this finding, the patient began a gluten-free diet for the management of CD. Afterward, she began to gain weight, followed by a resolution of swallowing difficulty. Therefore, clinicians should be familiar with the symptoms of CD when conducting a thorough clinical examination and maintain a high level of suspicion to rule out other causes and reach an accurate diagnosis. It is also recommended to screen all patients presenting with IDA, esophageal web, and dysphagia for CD even in the absence of diarrhea.

Exploring the Influence of the Coronavirus Disease 2019 Pandemic on the Accessibility of Rehabilitation Services Provided to Children with Disabilities: A Cross-Sectional Study.

Background and Objectives: Children with disabilities (such as cerebral palsy, autistic spectrum disorder, and Down syndrome) are the most vulnerable and marginalized subset of the population, representing 2.7% of the total population of Saudi Arabia. The COVID-19 outbreak might have disproportionately affected children with disabilities, augmented their isolation, and induced severe disruptions to the services on which these children rely. Limited research has been conducted in Saudi Arabia to understand the impact of the COVID-19 pandemic on the rehabilitation services provided to children with disabilities and barriers. This study aimed to investigate the effect of the lockdown implemented as a result of the coronavirus disease-2019 (COVID-19) pandemic on the accessibility of rehabilitation services, including communication, occupational therapy, and physical therapy, in Riyadh, Kingdom of Saudi Arabia. Materials and Methods: In this cross-sectional study, a survey was conducted between June and September 2020 during the lockdown in Saudi Arabia. A total of 316 caregivers of children with disabilities from Riyadh participated in the study. The accessibility of rehabilitation services provided to children with disabilities was assessed by designing a valid questionnaire. Results: A total of 280 children with disabilities received rehabilitation services before the COVID-19 pandemic and showed improvement following therapeutic sessions. However, during the pandemic, most children stopped receiving therapeutic sessions because of lockdown, which deteriorated their condition. This shows a significant reduction in the accessibility of the rehabilitation services provided during the pandemic. Conclusions: The findings of this study revealed a drastic decline in services provided to children with disabilities. This caused a notable deterioration in the abilities of these children.

Swallowing Apraxia Post Ischemic Stroke.

A 55-year-old male patient with a known medical history of diabetes mellitus type 2 and treated lymphoma was first admitted with a sudden left-sided facial asymmetry and mouth deviation to the left side with no other neurological symptoms. A Computerized Tomography (CT) scan of the brain showed acute infarct and small left basal ganglia old lacunar infarction. He was discharged on a dual antiplatelet. One week later, the patient's condition had worsened and, therefore, was admitted with an impression of ischemic stroke. A bedside swallowing assessment, VFSS, and FEES study were conducted to diagnose this case. The bedside assessment did not reveal any sensory or motor deficits in his oral cavity and the FEES examination was also unable to rule out pharyngeal dysphagia. However, a videofluoroscopic swallowing study (VFSS) revealed a significant dysfunction of oral preparation and oral phases and presented difficulty initiating the pharyngeal phase. Given these features, we believe that this swallowing difficulty is caused by swallowing apraxia. This case provides additional information and understanding on management from the swallowing side.

Moderating Effects of Self-Esteem on the Relationship between Communication Anxiety and Academic Performance among Female Health College Students during the COVID-19 Pandemic.

Unprecedented quarantine due to COVID-19 exposes individuals to withdraw from face-to-face interactions, which may influence communication and self-esteem (SE). Therefore, the overarching aims of this study are to examine the communication apprehension levels among female college students, and thus to investigate the moderating role of self-esteem on the relationship between communication apprehension and academic achievement. In this cross-sectional study, 287 female college students completed the survey, which was circulated through email. The survey included the following questionnaires: General Health Characteristics, Rosenberg Self-esteem Scale, and Personal Report of Communication Apprehension Scale. The results showed that 28.2% of participants were categorized as having a high level of communication apprehension, and only 9.8% had a low level of communication apprehension. The SE reported an overall score of 24.3 ± 2.14, indicating a high self-esteem level among students. The students' grade point average (GPA) was positively correlated with SE. However, self-esteem as a moderator variable had no significant effect on the relationships between all predictors and GPA. The finding of the study highlights the need to implement different strategies to enhance students' group discussions, meetings, and interpersonal communication to ensure the best learning outcomes. Future studies are required to investigate gender-based disparities in the relationship between communication apprehension and SE.

Effect of compressive therapy on sensorimotor function of the more affected upper extremity in chronic stroke patients: A randomized clinical trial.

BACKGROUND: Common upper extremity (UE) physical impairments after stroke include paresis, abnormal muscle tone, and somatosensory affection. This study evaluated the effect of passive somatosensory stimulation using compressive therapy on sensorimotor function of the more affected UE in chronic stroke patients. METHODS: Forty chronic stroke patients were enrolled in this study. They were randomized into 2 groups: Gr1 and Gr2. Three patients dropped out leaving us with a total of 37 patients completing the study. Gr1 received UE motor program for the more affected UE along with sham electrical stimulation while Gr2 had the same UE motor program along with passive somatosensory stimulation. The session duration in both groups was 85 min. Gr1 and Gr2 received a total of 36 sessions for 6 successive weeks. UE function in Gr1 and Gr2 was examined, before and after treatment using Box and Block test (BBT) and Perdue Pegboard test (PPBT) as measures of motor of both the more affected and less affected UE while the Nottingham sensory assessment (NSA) scale was used as a measure of sensory function of the more affected UE. RESULTS: There were significant improvements in motor and sensory function of the more affected UE compared to the less affected UE in both groups, measured by the BBT, PPBT, and NSA scales post-treatment (P < .05). However, the comparison between both groups regarding improvement revealed no significant change (P > .05). CONCLUSION: Upper extremity motor and passive somatosensory stimulation techniques are effective in improving sensorimotor function of the more affected UE, but none of them had the advantage over the other, in terms of improving motor and sensory function in chronic stroke patients.

Changes in speech, language and swallowing services during the Covid-19 pandemic: The perspective of speech-language pathologists in Saudi Arabia.

PURPOSE: The study aimed to investigate changes in the role of speech-language pathologists (SLPs) during the COVID-19 pandemic in Saudi Arabia. It also assessed the SLPs' perceptions of delivering services using telehealth as a part of their everyday clinical practice before and during the COVID-19 pandemic. METHOD: SLPs in Saudi Arabia were invited to complete a web-based survey covering questions related to changes to the role of SLPs during the COVID-19 pandemic, changes in the ways speech services are delivered; and the benefits and barriers of using telehealth in clinical practice as identified by SLPs. RESULTS: Ninety-one SLPs completed the survey. About 94% of the respondents experienced changes in their role as a response to the COVID-19 pandemic. The nature of changes they had experienced including decreased work time, providing support and counseling to patients or caregivers using the telephone, providing assessment and therapy using telehealth, and working with a limited number of cases. Ninety-three percent of the respondents who have used telehealth started to use it only during the pandemic. Mostly seen caseloads were pediatric speech and language disorders. Further, 96% of respondents used telehealth for counseling, 69% for rehabilitation or treatment, 63% for screening, 56% for evaluation or assessment, 48% for a referral to other professional services, and 46% for differential diagnosis. About 70% of the SLPs showed interest to continue using telehealth in the future. Several benefits were identified to using telehealth, including accessibility, cost efficiency, and the ability to engage patients with their families in therapy sessions. On the other hand, barriers to using telehealth included internet and technical issues, lack of direct communication, and difficulty controlling the therapy setting. CONCLUSIONS: The study has shown that SLPs in Saudi Arabia have experienced changes during the COVID-19 outbreak. The survey responses also indicate that the SLPs are adopting telehealth applications at an accelerated pace as a result of the pandemic.

Effect of Resilience on Health-Related Quality of Life during the COVID-19 Pandemic: A Cross-Sectional Study.

The unprecedented outbreak of coronavirus disease 2019 (COVID-19) has caused a huge global health and economic crisis. The aim of the study was to examine the extent to which the resilience of a person is associated with the quality of life (QoL) of adults amongst Saudi Arabia. A cross-sectional study was conducted among a sample of adults in Saudi Arabia. A total of 385 adults voluntarily participated in and completed the survey. The quality of life was measured using the "World Health Organization QoL". The "Connor-Davidson Resilience Scale" instrument was also used to assess resilience during the COVID-19 pandemic. Amongst the 385 participants, 179 (46%) showed a good QoL, and 205 (54%) reported a relatively poor QoL. The resilience was found to be significantly associated with QoL. The study further revealed that gender-based differences were dominant in the QoL; the men respondents reported a significantly higher QoL in all the domains in comparison to the women respondents. The gender, income, and psychological health and interaction effect of resilience and age explained 40% of the variance in the total score of QoL. In reference to the predictors of the physical health domain of QoL, resilience, gender, and psychological health were significantly associated with the physical health domain of the QoL (R2 = 0.26, p = 0.001). It was also noted that gender was not associated with the social relationships and environmental domains of QoL (p > 0.05). Findings showed a statistically significant association between the score of QoL and resilience, age, gender, income, and psychological health. These findings highlight the significant contribution of gender-based differences, psychological health, and resilience on the domains of QoL.

Quality of Life, Needs and Fears of Mothers of Children with Disabilities in Saudi Arabia during the COVID-19 Lockdown.

Substantial changes in life dynamics resulting from the outbreak of the coronavirus disease 2019 (COVID-19) could have an impact on the quality of life (QoL) of mothers of children with and without disabilities. This study compared the quality of life (QoL) of mothers of children with disabilities (MCD) to the QoL of mothers of children without disabilities (CON) in Saudi Arabia during COVID-19 lockdown. It explored mothers' concerns and the type of support they need during the quarantine. A comparative cross-sectional study was conducted during the lockdown. An online questionnaire was distributed to mothers raising children with and without disabilities in Saudi Arabia. A total of 340 mothers participated in the study by completing the survey: 93 MCD and 247 CON. The QoL of MCD and CON was assessed using the WHOQOL-BREF questionnaire. Furthermore, detailed information was provided by the mothers regarding their needs and concerns during the lockdown. The results of the study revealed that the overall QoL was significantly higher in the CON group, compared to the MCD group, during the COVID-19 lockdown. The social well-being and environmental well-being reported by MCD were significantly lower on the total scale of the WHOQOL-BREF than those reported by the CON group. The comparison between the two groups revealed significant differences in the support required by mothers during the COVID-19 pandemic: a higher percentage of MCD needed emotional and psychological support, especially from family members. The major concerns reported by MCD were the deterioration of their children's medical conditions and the lack of medical supplies during the lockdown.

Assessment of caregivers' perspectives regarding speech-language services in Saudi Arabia during COVID-19.

BACKGROUND: As a consequence of stay-at-home and other lockdown measures, such as social distancing, all health care service provisions during the COVID-19 pandemic have been affected, including the provision of speech therapy. Telehealth services can play a major role in maintaining access to health care, help speech and language pathologists (SLPs) overcome physical barriers by providing patients and caregivers with access to health care, and limit the discontinuity of patient care. To have a better understanding of the changes that have occurred in these services during COVID-19, this research was conducted to explore the nature and current situation of speech-language services in Saudi Arabia based on caregivers' perspectives. It also investigated whether changes have occurred in these services during the COVID-19 lockdown. The study also determined the perception of caregivers in delivering SLS sessions remotely. METHOD: A cross-sectional study was conducted with 385 caregivers in Saudi Arabia. An online survey asked whether children were experiencing any SLS problems and if they had received any intervention. The survey also assessed the perception of changes in service during the COVID-19 lockdown and the perceptions, acceptance, and willingness of the caregivers to deliver telehealth speech services in Saudi Arabia. RESULTS: About 50% of the respondents had or were suspected to have a child with SLS problems, and just over half of them had accessed SLS services. Most of the respondents reported suspension of therapy sessions as a response to the COVID-19 pandemic. While the respondents had little experience using telehealth prior to the pandemic, they generally showed a willingness to use telehealth in therapy sessions, expressing a preference for video calls over other options. CONCLUSION: The study revealed that SLS services in Saudi Arabia are limited and that accessing these services is challenging. Alternative service delivery using remote services could help caregivers overcome such challenges. When telehealth was introduced as an option for service delivery, the caregivers showed welcoming responses, particularly with video calls.

Therapeutic Efficacy of Transcutaneous Electrical Nerve Stimulation Acupoints on Motor and Neural Recovery of the Affected Upper Extremity in Chronic Stroke: A Sham-Controlled Randomized Clinical Trial.

Inability to use the affected upper extremity (UE) in daily activities is a common complaint in stroke patients. The somatosensory system (central and peripheral) is essential for brain reorganization and plasticity. Neuromuscular electrical stimulation is considered an effective modality for improving UE function in stroke patients. The aim of the current study was to determine the therapeutic effects of transcutaneous electrical nerve stimulation (TENS) acupoints on cortical activity and the motor function of the affected UE in chronic stroke patients. Forty male and female patients diagnosed with stroke agreed to join the study. They were randomly assigned to group 1 (G1) and group 2 (G2). G1 received task-specific training (TST) and sham electrical stimulation while G2 received TST in addition to TENS acupoints. Session duration was 80 min. Both groups received 18 sessions for 6 successive weeks, 3 sessions per week. Evaluation was carried out before and after completion of the treatment program. Outcome measures used were the Fugl-Meyer Assessment of the upper extremity (FMA-UE) and the box and block test (BBT) as measures of the motor function of the affected UE. Brain activity of the motor area (C3) in the ipsilesional hemisphere was measured using a quantitative electroencephalogram (QEEG). The measured parameter was peak frequency. It was noted that the motor function of the affected UE improved significantly post-treatment in both groups, while no significant change was reported in the FMA-UE and BBT scores post-treatment in either G1 or G2. On the other hand, the activity of the motor area C3 improved significantly in G2 only, post-treatment, while G1 showed no significant improvement. There was also significant improvement in the activity of the motor area (C3) in G2 compared to G1 post-treatment. The results of the current study indicate that TST only or combined with TENS acupoints can be considered an effective method for improving motor function of the affected UE in chronic stroke patients, both being equally effective. However, TST combined with TENS acupoints proved better in improving brain plasticity in chronic stroke patients.

Validation and performance comparison of two SARS-CoV-2 IgG/IgM rapid tests.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes a disease called COVID-19. COVID-19 is primarily diagnosed using molecular techniques mainly real-time reverse transcriptase PCR. Reliable and accurate serologic assays for COVID-19, are an important tool for surveillance and epidemiologic studies. In this study, the IgG/IgM Rapid Test Cassette and the Prima COVID-19 IgG/IgM Rapid Test for the detection of SARS-CoV-2 antibodies in blood, serum and plasma samples collected from patients up to 48 days after symptom onset in Saudi Arabia were validated. Overall, both tests showed poor performance and cannot be utilised for COVID-19 diagnosis as a point of care test or to determine seroprevalence.

Impact of Somatosensory Training on Neural and Functional Recovery of Lower Extremity in Patients with Chronic Stroke: A Single Blind Controlled Randomized Trial.

Recovery of lower extremity (LE) function in chronic stroke patients is considered a barrier to community reintegration. An adequate training program is required to improve neural and functional performance of the affected LE in chronic stroke patients. The current study aimed to evaluate the effect of somatosensory rehabilitation on neural and functional recovery of LE in stroke patients. Thirty male and female patients were recruited and randomized to equal groups: control group (GI) and intervention group (GII). All patients were matched for age, duration of stroke, and degree of motor impairment of the affected LE. Both groups received standard program of physical therapy in addition to somatosensory rehabilitation for GII. The duration of treatment for both groups was eight consecutive weeks. Outcome measures used were Functional Independent Measure (FIM) and Quantitative Electroencephalography (QEEG), obtained pre- and post-treatment. A significant improvement was found in the FIM scores of the intervention group (GII), as compared to the control group (GI) (p < 0.001). Additionally, QEEG scores improved within the intervention group post-treatment. QEEG scores did not improve within the control group post-treatment, except for "Cz-AR", compared to pretreatment, with no significant difference between groups. Adding somatosensory training to standard physical therapy program results in better improvement of neuromuscular control of LE function in chronic stroke patients.

A Comparative Study on the Effect of Task Specific Training on Right Versus Left Chronic Stroke Patients.

Functional impairment of the upper limb (UL) after stroke is a great problem. Finding methods that can improve UL function after stroke is a major concern to all medical service providers. This study was intended to compare the effect of upper limb task specific training (TST) on brain excitability of the affected hemisphere and motor function improvements in patients with left and right stroke. Forty male patients with mild impairment of UL functions were divided into two equal groups; G1 consisted of patients with left hemisphere affection (right side stroke) while G2 consisted of patients with right hemisphere affection (left side stroke). All patients received TST for the affected UL for one hour, three sessions per week for six consecutive weeks. Evaluation was performed twice, pre-, and post-treatment. Outcome measures used were Wolf Motor Function Test (WMFT) and Box and Block Test (BBT) as measures of UL motor function and Quantitative Electroencephalogram (QEEG) of motor and sensory areas of the affected hemisphere as a measure of brain reorganization post-stroke. Both groups showed improvement in motor function of the affected UL measured by WMFT and BBT with reported significant difference between them. G1 showed greater improvement in motor function of the affected UL post-treatment compared to G2. Additionally, there was a significant increase in peak frequency of motor and sensory areas with higher and significant excitability in G1 only. These findings imply that brain reorganization in the left hemisphere responded more to TST compared to the right hemisphere. Based on findings of the current study, we can recommend adding TST to the physical therapy program in stroke patients with left hemisphere lesions.

Retrograde fiberoptic endoscopy evaluation for patients with laryngeal edema.

BACKGROUND: Airway and swallowing evaluation is a crucial step before weaning the patient from a tracheostomy tube. Different evaluation procedures can be used successfully in many patients, but sometimes, this can be difficult or impossible for patients who have laryngeal edema as the existence of edema tends to block the view of true vocal folds. Thus, a new approach using retrograde fiberoptic endoscopy evaluation of swallowing (FEES) has been suggested to help visualize the vocal folds clearly. This study was performed to evaluate the impact of such a modification to the standard FEES. METHODOLOGY: Thirty-six patients were referred for swallowing and airway evaluation. They were examined via nasopharyngolaryngobronchoscopy and FEES; nine of them had laryngeal edema and fit the inclusion criteria. RESULTS: Four out of the nine patients who had laryngeal edema could immediately swallow after evaluation with retrograde FEES. CONCLUSIONS: Retrograde FEES is suggested to be an effective way to evaluate swallowing and is a valuable tool for research in this area. LEVEL OF EVIDENCE: Level 4 (case series).