Language and Neurocognitive Impairments Associated with Hypothyroidism.

INTRODUCTION: Accumulating clinical evidence has indicated that hypothyroidism was associated with neurocognitive and linguistic impairments; however, these impairments were not reported in Arabic individuals. The aims of the present study were (1) to investigate the patterns of linguistic and neurocognitive impairments associated with hypothyroidism in native speakers of Jordanian Arabic and (2) to examine the accuracy of TFT in confirming a clinical diagnosis of hypothyroidism. METHODS: A cross-sectional design with random recruitment of participants from targeted hypothyroid (HT) and euthyroid (ET) groups was conducted. Clinical evaluation of hypothyroidism was obtained via a structured questionnaire followed by TFT. Evaluation measures included digit span, confrontation naming, color naming, auditory and visual memory, and visual recognition tasks. The HT group comprised 36 participants including 8 males and 28 females with a ratio of 1:3.5. Their age ranged between 5.11 and 10.7 years (M = 7.7, SD = ±1.4). The ET group included an equal number of participants in terms of age and gender, their age ranged between 5.9 and 10.8 years (M = 7.6, SD = ±1.5). RESULTS: Results revealed significant differences between the two experimental groups in all of the linguistic and neurocognitive tasks. The HT showed 10- and 26-s delayed responses on a timed color naming and visual recognition tasks compared to the ET group, whereas the ET group showed larger scores compared to the HT on the digit span, confrontation naming, auditory memory, and visual memory tasks. Differences were 2.2, 4, 1.7, and 3 points, respectively. CONCLUSION: Hypothyroidism influences linguistic and neurocognitive functions mainly naming ability, working memory, and auditory and visual processes needed for learning. Clinicians ought to be attentive to these impacts when designing screening and therapy protocols for children with hypothyroidism. Furthermore, TSH showed higher prediction of hypothyroidism and may be used in favor of FT3 and FT4.

Nasalance Scores for Normal Speakers of American English Obtained by the Nasometer II Using the MacKay-Kummer SNAP-R Test.

OBJECTIVE: To establish nasalance score norms for adolescent and young adult native speakers of American English and also determine age-group and gender differences using the Simplified Nasometric Assessment Procedures (SNAP) Test-R and Nasometer II. DESIGN: Prospective study using a randomly selected sample of participants. SETTING: Greater Cincinnati area and Miami University of Ohio. PARTICIPANTS: Participants had a history of normal speech and language development and no history of speech therapy. Participants in the adolescent group were recruited from schools in West Clermont and Hamilton County, whereas the young adults were recruited from Miami University of Ohio. The participants of both groups were residents of Cincinnati, Ohio or Oxford, Ohio and spoke midland American English dialect. OUTCOME MEASURES: Mean nasalance scores for the SNAP Test-R. RESULTS: Normative nasalance scores were obtained for the Syllable Repetition/Prolonged Sounds, Picture-Cued, and Paragraph subtests. Results showed statistically significant nasalance score differences between adolescents and young adults in the Syllable Repetition, Picture-Cued, and Paragraph subtests, and between males and females in the Syllable Repetition and the Sound-Prolonged subtests. A significant univariate effect was found for the syllables and sentences containing nasal consonants and high vowels compared to syllables and sentences containing oral consonants and low vowels. Across all the SNAP Test-R subtests, the females' nasalance scores were higher than the males. A significant univariate effect was also found across nasal syllables, and high vowels such that the females' nasalance scores were higher than the males. Tables of normative data are provided that may be useful for clinical purposes. CONCLUSION: Norms obtained demonstrated nasalance score differences according to age and gender, particularly in the Syllable Repetition/Prolonged Sound subtest. These differences were discussed in light of potential reasons for their existence and implications for understanding velopharyngeal function. In addition, nasalance scores are affected by the vowel type and place of articulation of the consonant. These facts should be considered when nasometry is used clinically and for research purposes.

An Assessment of Patients Factors Effect on Prescriber Adherence to Ischemic Stroke Secondary Prevention Guidelines.

BACKGROUND: Stroke is the leading cause of long-term disability worldwide. Stroke recurrence is a major health problem with devastating consequences. Adherence to secondary prevention guidelines reduced stroke recurrence. Data regarding prescriptions adherence to secondary prevention guidelines in the Middle East and North Africa is lacking. OBJECTIVES: The aim of this study is to assess the degree of physician adherence to ASA guidelines and the patient specific factors that affect their prescribing patterns in a major teaching hospital in Jordan. METHODS: Ischemic stroke patients referring to King Abdullah University Hospital were approached and offered a description of the study to obtain their informed consent. After getting the informed consent, their prescription at the time of discharge was evaluated for adherence to secondary prevention guidelines and classified into adherent and non-adherent based on a composite score that included each of the guidelines which indicated therapeutic classes. Odds ratio for adherence and their 95%confidence intervals were calculated and adherence to specific therapeutics classes was evaluated. RESULTS: Two hundred and seventy-five patients were included in this evaluation. Less than 50% of the patients received guideline's adherent prescriptions. Patients with hypertension and hyperlipidemia were associated with a lower probability were prescribed a guidelines adherent regimen (OR 0.485, 0.0.225, respectively). ACEI/ARBs combination with thiazides was prescribed to about 11.52% of the patients. CONCLUSION: Adherence to stroke secondary prevention guidelines was suboptimal especially in the antihypertensive prescription component. Further assessments and evaluations are required to improve guidelines adherence.

An evaluation of the ability of thrombospondin-1 to predict stroke outcomes and mortality after ischemic stroke.

INTRODUCTION: Thrombspondin-1 (TSP-1) is a glycoprotein that has a variety of functions including suppression of angiogenesis and regulation of extracellular matrix deposition. These functions are central to the recovery process after stroke. Data regarding the association and predictive value of TSP-1 and stroke outcomes are limited. PATIENTS AND METHODS: Patients with ischemic stroke who referred to King Abdullah University Hospital were evaluated for inclusion. The level of serum TSP-1 on admission was assayed using ELISA. Data regarding comorbid diseases as well as stroke severity at baseline, functional outcome and mortality at 6 months were collected prospectively. Favorable outcome was identified as NIHSS or mRS ≤ 1. RESULTS: Ninety-six patients with an average age of 66.7 years were included. One-third of the patients (32 patients) had favorable outcome on admission. The serum TSP-1 levels in patients with favorable outcome were significantly higher (719.7 vs. 639.9; p = 0.028). Similarly, patients with favorable outcome at 6 months had higher levels of TSP-1 at baseline (714.3 vs. 614.7; p = 0.003). TSP-1 was identified as an independent predictor of favorable outcome at baseline (OR = 0.993, p = 0.038) and after 6 months (OR = 0.99, p = 0.008). CONCLUSION: TSP-1 can predict favorable outcomes with regard to the initial severity and long-term functional outcome.

Social and religious attitudes of Jordanian parents toward children born with orofacial clefts.

BACKGROUND AND GOALS: Parental attitudes towards orofacial clefts (OFC) can be influenced by culture. Interestingly, there are no studies up to date examined parental attitudes towards these congenital anomalies in Jordan. The objectives of this study were to 1) explore the social and religious attitudes of Jordanian parents toward their children born with OFCs, and 2) determine the predictors of social and religious beliefs and behaviors. METHODS AND SETTINGS: A descriptive study conducted at a tertiary care teaching hospital. Hundred and fifty-three parents participated in the study. All the participants completed the questionnaire were the biological either father or mother; (61) and (92) respectively. The patients with OFC were 95 males and 58 females ranged in age from 0.1 to 20 years (M = 8.2 years, SD = 6.4). The prevalence of OFC was characterized by 40 CL, 24 CP and 89 CLP. Patients' gender and age, residence, other family incidences, and receiving health education about the cleft were the independent variables used in the binary regression to predict the social and religious beliefs. RESULTS: The majority of the parental responses denied any social negativity in regard to the ability of their children to establish friendships, being hidden from the public, facing social difficulties. However, substantial parental concerns were found in regard to teasing and bullying (102 = 76.8%; p < 0.0001). No negative religious beliefs were observed. None of the independent variables showed significant relationships with the social beliefs except for "receiving health education about the cleft" which predicted the possibility of encountering "social difficulties" (B = 2.9; CI 3.2-100.5; p < 0.001; OR = 18.1). Regression model showed that parent with no education tended to hide the child (2.0%; St. Res = 3.4). Difficulty making friends was related to cleft lip type (Chi2 = 6.05; p < 0.05). Believing the deformity is because of an evil spirit" was related to cleft lip type (Chi2 = 6.6; p < 0.04). CONCLUSIONS: Irrespective to particular negative viewpoints observed among the parents towards OFCs, the majority of families tend to have positive social and religious beliefs. These affirmative constructs towards the cleft deformity may reflect positively on the provision of health care services. The establishment of an in depth family counseling and health education routine programs concerning the attributes of OFCs at a wider scale to maintain the integrity of parents' beliefs of the OFC deformity may be warranted.

Normal Patterns of Nasometric Values in Adult Jordanian Speakers of Arabic.

PURPOSE: The study sought to establish normative nasometric values for adult Jordanian speakers of Arabic. Gender-related differences and intraspeaker variability of nasalance scores were investigated. METHODS: A total of 113 adult speakers of Jordanian Arabic (56 men and 57 women) without speech-language and hearing impairments or craniofacial anomalies ranging in age between 18 and 55 participated in the study. Nasometer II, Model 6400 was used to obtain nasalance scores as speakers produced 3 recitations for each of the 3 standardized passages consisting of an oral passage, an oronasal passage, and nasal sentences. Descriptive statistics of nasalance scores for each passage were obtained and gender-related differences were determined by ANOVA. Standard deviation for the 3 repetitions for each passage was considered an index for intraspeaker variability. RESULTS: Average nasalance for each passage was (11.23%) for the oral passage, (25.48%) for the oronasal passage, and (51.92%) for the nasal sentence. There was no gender effect on nasalance on the oral passage, however women exhibited higher nasalance scores than men on the both oronasal passage (P = 0.002) and nasal sentences (P = 0.017). Intraspeaker variability for all speakers fell below 4.5% with repeated readings. CONCLUSION: The study provides normative nasometric data for Arabic speaking Jordanian adults to serve as references for the assessment of velopharyngeal dysfunction in craniofacial clinics. Arabic speakers demonstrated different nasalance scores than speakers of other languages. Gender differences can be attributed to variations in anatomical structure and velopharyngeal function between men and women.

Validity of test stimuli for nasalance measurement in speakers of Jordanian Arabic.

OBJECTIVE: The objective of the study was to establish the validity of passages for measuring nasalance of Jordanian speakers of Arabic. DESIGN: Two Arabic text passages were constructed; the Spring Passage is devoid of nasal consonants and the Home Passage contains both oral and nasal consonants. Nasalance was measured for participants while reciting each passage three times. Perceptual ratings of hypernasality were also obtained for each participant on each passage using a 5-point equal-appearing rating scale. PARTICIPANTS: Forty-seven children and adults ranging in age between 9 and 26 years participated in the study. Twenty-three participants had no history of communication disorders, and 24 had repaired cleft palate. RESULTS: Correlation coefficient between ratings of hypernasality and the nasalance scores was significant for the Spring Passage (r = 0.88, p > 0.001) and for the Home Passage (r = 0.78, p > .001). Using cutoff scores of 17% and 36% of nasalance for the Spring and the Home Passages, respectively, and a threshold score of 1.5 for hypernasality, sensitivity for the Spring Passage was 88% and the Home Passage was 78%. CONCLUSIONS: Results showed the validity of the Spring Passage and the Home Passage in measuring nasalance scores as proved by their high sensitivity and strong correlation with perceptual rating of hypernasality.

Prosthodontic Rehabilitation of Arabic Speaking Individuals with Velopharyngeal Incompetence: A Preliminary Study.

BACKGROUND: Hypernasality is a frequently encountered problem in the speech of individuals with velopharyngeal incompetence. The use of palatal lift appliance (PLA) is the main treatment option for correction of velopharyngeal incompetence. The literature on the outcomes of using prosthetics treatment for Arabic speaking patients is scarce. OBJECTIVE: The aim of this study was to investigate the effect of using PLA on hypernasality of Arabic speaking patients with velopharyngeal incompetence. METHODS: Six participants with age ranging from 9 to 61 years (4 males and 2 females) were recruited between October 2013 and August 2014. Written informed consents were taken from all the adult participants/the guardians of under-aged participants. All patients exhibited hypernasality with different etiologies for velopharyngeal incompetence (head injury, cerebrovascular accident, and neurological disorders). They were treated with PLAs which were constructed to elevate the dysfunctional soft palate. Nasalance scores and perceptual speech acceptability ratings were measured/evaluated in both situations; with and without appliances. Paired t-test was used to analyze the perceptual ratings and nasalance scores in order to detect any significant change in hypernasality pre and post insertion of PLA. RESULTS: There was a statistically significant decrease (p>0.05) in nasalance scores (Pa, Pi, Ma, Mi, a, i) after PLA insertion. The subtest /u/ showed insignificant change (p= 0.056). Perceptual ratings showed significant reduction in hypernasality which was consistent with nasalance measurements. CONCLUSION: PLAs can reduce hypernasality in Arabic speaking patients who suffer from velopharyngeal impairment.

Cleft Lip and Palate: Demographic Patterns and the Associated Communication Disorders.

PURPOSE: This study investigated demographical characteristics, health status, and associated communication disorders in patients with orofacial clefts (OFCs) in Northern Jordan. METHODS: A retrospective study of 226 cleft patients and their families was carried out between March 2012 and September 2016 at the Speech and Hearing Clinic and the Maxillofacial Center at King Abdullah University Hospital. Data were collected by interviewing patients and caregivers, having patients or caregiver to complete a questionnaire and reviewing the patient's medical records. The frequencies of OFC type, demographic, health status, and communication disorders variables were calculated. χ analysis was used to test for significance of associated demographic and communication disorders variables with OFC type. RESULTS: Results revealed higher percentage of males compared with female patients. The majority of OFC patients were born to families who lived in urban areas, obtained high school diploma or lower educational level, lived below poverty cutoff, and showed nonconsanguineous marriages. Most mothers took the prescribed pregnancy supplements. Only one-third of the families received health education and reported other incidences of OFCs. Twenty percent of the patients had other congenital anomalies, 80% experienced dysphagia prior to the cleft repair, dropped to 14% after the repair. Higher percentage of patients with isolated cleft palate and cleft lip and palate exhibited hearing loss, hypernasality, articulation and phonological disorders, and dysphagia compared with those with cleft lip only. None of the demographic variables was associated with OFC type. CONCLUSIONS: Data suggested that families who had children with OFCs displayed poor socioeconomic status and low educational level which may impede the delivery of health education by health practitioners. Increased risk of comorbid communication disorders and malformations in OFC patients must be emphasized and disseminated to health professionals involved in the management of patients with OFC.

Outcomes of Palatal Lift Prosthesis on Dysarthric Speech.

PURPOSE: This study was designed to investigate the effect of palatal lift prosthesis (PLP) on the speech of individuals with different types of dysarthria. PARTICIPANTS: Thirty (19 males and 11 females) native speakers of Jordanian Arabic with dysarthria participated in the study. The age of the participants ranged from 8 to 67 years with an average of 34.1 years. Traumatic brain injury was the most common etiology of dysarthria among 12 participants, stroke among 11, multiple sclerosis among 3, and pseudobulbar palsy among 2; 1 participant had Parkinson disease, and another participant had amyotrophic lateral sclerosis. METHODS: Five acoustic and aerodynamic measures were evaluated to determine the speech outcomes including nasalance scores, sequential motion rate, speech rate, vital capacity, and sound pressure level. The acoustic measures were obtained from the participants in PLP-out and PLP-in conditions. RESULTS: Results showed statistically significant decrease in the nasalance scores of the syllable repetition, vowel prolongation, and sentence repetition tasks in the PLP-in condition below the 28% cutoff score. Furthermore, results revealed statistically significant increase in sequential motion rate, speech rate, vital capacity, and sound pressure level (P = 0.000). CONCLUSION: The use of PLP is an effective treatment option of dysarthric speech. Besides nasalance scores, the sequential motion rate, speech rate, vital capacity, and sound pressure level are considered reliable speech measures that may be used to evaluate the effect of PLP on dysarthria.

The relationship of vocal tract dimensions and substitution of the palatal approximant /j/ for the alveolar trill /r/.

PURPOSE: To investigate the relationship of the vocal tract dimensions and dental arches in participants with substitution of palatal approximant /j/ for the trill variant of /r/. METHOD: Cephalograms and dental casts of 60 native speakers of Arabic were used for comparison. The experimental group included 30 participants with substitution of /j/ for the trill variant of /r/ (17 males and 13 females, age ranged between 15-20 years, M = 18.7 years, SD = 1.27). The control group included 30 normal speakers (15 males and 15 females, age ranged between 15-20 years, M = 18.3 years, SD = 1.67). Both groups had class I occlusion. RESULT: The experimental group showed significantly shorter maxillary length, p < 0.05, and narrower vocal tract dimensions compared to the control group, p < 0.05. Tongue length (TGL) and height (TGH) and soft palate length (PNSP) and thickness (MPT) were statistically significantly reduced in the experimental group compared to the control group, p < 0.05. The distance between the hyoid bone and retrognathion or C3 was significantly shorter in the experimental group compared to the control group, p < 0.05. Inter-canine widths and dental arch lengths were significantly shorter in the experimental group compared to the control group, p < 0.05. CONCLUSION: The substitution of /j/ for the trill variant of /r/ is associated with altered dimensions of the vocal tract. These alterations may explain the residual articulation disorder during the production of the trilled /r/ compared to other sound classes that respond to speech therapy. Orthodontic and Maxillo facial surgery consultation might be needed when providing therapy to individuals with this particular articulation disorder.