Validation of the Persian version of the LittlEARS® auditory questionnaire for assessment of auditory development in children with normal hearing.

OBJECTIVES: To adapt the LittlEARS® Auditory Questionnaire into Persian and evaluate the psychometric properties of the Persian version of the questionnaire for children with normal hearing. METHODS: A "back-translation" method was used to translate and adapt the LittlEARS Auditory Questionnaire into Persian. The translated version was first evaluated by means of an expert-appraisal method. After having improved the Persian version of LittlEARs with the results obtained from that evaluation, various psychometric analyses were carried out to determine the validity and reliability. A group of 240 Persian speaking parents of children below 24 months of age with normal hearing completed the LittlEARS® Auditory Questionnaire. Various psychometric analyses (scale analysis and item analysis) were conducted. RESULTS: In the current study, the following scale and item characteristics were investigated: Corrected item-total correlations ranged from 0.14 to 0.74; Cronbach's alpha coefficient value was 0.960; the split-half reliability r was 0.734; predictive accuracy Guttman's lambda was 0.965; the correlation between the overall score and age of the children was 0.808 (p < 0.001). The regression curve, which reflects the age-dependence of auditory behavior, was produced. The regression analysis that was conducted to obtain normative data showed that 80% of the variance in the total scores could be explained by age. CONCLUSION: The data obtained from psychometric analysis support the use of the Persian version of the LittlEARS Auditory Questionnaire as a reliable and valid tool to assess the development of auditory behavior in Persian speaking children who are 24 months old or younger.

Postural Control in Deaf Children.

This cross-sectional study aimed to determine the reliability of static control evaluation with Synapsys Posturography System (SPS, Marseille, France) and to compare the static postural control of deaf children with typically developing children. This study was conducted in 2 phases on 81 children of 7 to 12 years old in Tehran schools. The first phase examined the reliability of static balance evaluation with SPS. In this phase, a total of 12 children with typical development were evaluated and then do a re-test 1 week later. In the second phase, 30 children with profound sensorineural hearing loss (SNHL) and high risk in their balance (selected from Baghcheban Schools for the Deaf) as the experimental group, and 37 children with typical development (selected randomly from 2 primary schools for girls and boys in District 12 of Tehran Department of Education) as control group were enrolled in the study. They were all placed under sensory organization test evaluation. Based on the results of intraclass correlation coefficient (ICC), the unilateral random effects model, test-retest reliability in different sensory conditions, the moderate to excellent results were obtained (ICC between 0.68 and 0.94). Also, the mean displacement of pressure center in all sensory conditions, the limits of stability (LOS) area, the overall balance scores, and scores for balance sensory ratio (except the somatosensory ratio) of children with typical development were better than the deaf peers (P˂0.05). The SPS has acceptable reliability to evaluate static posture in children between the ages of 7 and 12 years. Furthermore, deaf children as compared to children with typical development had a lower static postural control in all sensory conditions. This finding confirms the need to examine the postural control for identifying the extent of sensory deficit that has caused poor balance function, and also the need for early intervention to address the balance deficit in deaf children.

Parental training and externalizing behaviors of children with severe hearing loss.

Background: Externalizing behavior in deaf children causes many psychological problems for their parents. Aggression and rule breaking behaviors in children with severe hearing loss may cause psychological problems in parents and in managing children's behavior. Consequently, the present study aimed at investigating the effect of parental behavioral training of mothers on reducing the externalized behaviors (aggression and rule breaking behavior) of their 9- to 10- year old children with severe hearing loss. Methods: This was an experimental study with pretest, posttest, and a control group. The research population included all students with severe hearing loss and their mothers. Thus, 30 mothers whose children had the most severe hearing loss were selected as our main sample among 80 mothers who had completed the Child Behavior Checklist. Then, they were placed into the experimental (n=15) and control groups (n=15) after being matched based on age, educational level, and socioeconomic status. The research tool was Child Behavior Checklist-Persian Version. The parental behavior training was provided for the experimental group in nine 90- minute sessions. Results: The results of the present study indicated the effectiveness of experimental treatment on decreasing the aggressive behaviors of children of mothers in the experimental group compared to mothers of the control group (p=0.001). Moreover, the results revealed a decrease in rule breaking behaviors (p= 0.007) in children of mothers of the experimental group compared to mothers of the control group. Conclusion: Parents' behavioral training is important in decreasing the aggressive and offensive behaviors in children with severe hearing loss who are at risk of behavioral problems. Furthermore, some research has highlighted the necessity of such trainings for parents of these children. Thus, the present study, emphasizing the importance of childhood problems, found that mothers' behavioral training could prevent behavioral problems of school-aged children with hearing loss and reduce the recurrence of such problems.

The Effect of Vestibular Rehabilitation Therapy Program on Sensory Organization of Deaf Children With Bilateral Vestibular Dysfunction.

The purpose of this study was to determine the effect of vestibular rehabilitation therapy program on the sensory organization of deaf children with bilateral vestibular dysfunction. This cross-sectional and analytic study was conducted on 24 students between the age of 7 and 12 years (6 girls and 18 boys) with the profound sensorineural hearing loss (PTA>90 dB). They were assessed through the balance subtest in Bruininks-Oseretsky test of motor proficiency (BOTMP). For children which the total score of the balance subtest was 3 standard deviation lower than their peers with typical development, vestibular function testing was completed pre-intervention. Posturography Sensory organization testing (SOT) was completed pre- and post-intervention with SPS (Synapsys, Marseille, France). Children with bilateral vestibular impairment were randomly assigned to either the exercise or control group. Exercise intervention consisted of compensatory training, emphasizing enhancement of visual and somatosensory function, and balance training. The exercise group entered in vestibular rehabilitation therapy program for 8 weeks. The children initially participating in the control group were provided the exercise intervention following the post-test. Based on the results there was significant difference in condition 5 and 6, areas of limits of stability (LOS), vestibular ratio and global score in posturography at the end of the intervention, but there was no significant difference in the control group in posturography (P<0.05). The results indicated that testing of vestibular, and postural control function, as well as intervention for deficiencies identified, should be included in deaf children rehabilitation program.

Balance Performance of Deaf Children With and Without Cochlear Implants.

 The aim of this study was to compare the static and dynamic balance performance of deaf children with and without cochlear implants. This is a cross-sectional study of 145 school children, aged between 7 and 12 years comprising 85 children with congenital or early acquired bilateral profound sensorineural hearing loss (the hearing loss group) and 60 normal hearing aged-matched control counterparts were assessed using the balance subtest of Bruininks-Oseretsky test of Motor Proficiency (BOTMP). The hearing loss group, 50 without cochlear implants (the non-implant group) and 35 of them with unilateral cochlear implants (the implant group) were recruited from schools for the deaf and normal hearing children (the control group) randomly selected from two randomly selected elementary schools of Tehran city. The scores were analyzed using one-way ANOVA. The total score of deaf children especially the implant group were significantly lower than the control group )P<0.001). The balance performance of the control group was better than the implant group in all of the items as well as the non-implant group except the fourth tested item (walking forward on a line) (P<0.05). The balance score of the implant group was significantly lower than the non-implant group except for the third tested item (standing on the preferred leg on a balance beam with eyes closed). The findings suggested that deaf children, specifically those with cochlear implants are at risk for motor and balance deficits. Thus, vestibular and motor evaluations, as well as interventions to improve balance and motor skills, should be prioritized for this population.

Developing a bilingual "persian cued speech" website for parents and professionals of children with hearing impairment.

BACKGROUND: The use of the internet as a source of information gathering, self-help and support is becoming increasingly recognized. Parents and professionals of children with hearing impairment have been shown to seek information about different communication approaches online. Cued Speech is a very new approach to Persian speaking pupils. Our aim was to develop a useful website to give related information about Persian Cued Speech to parents and professionals of children with hearing impairment. METHODS: All Cued Speech websites from different countries that fell within the first ten pages of Google and Yahoo search-engines were assessed. Main subjects and links were studied. All related information was gathered from the websites, textbooks, articles etc. RESULTS: Using a framework that combined several criteria for health-information websites, we developed the Persian Cued Speech website for three distinct audiences (parents, professionals and children). CONCLUSION: An accurate, complete, accessible and readable resource about Persian Cued Speech for parents and professionals is available now.