Healthcare Students' Perceptions and Attitudes Towards Peers with Autism Spectrum Disorders.

PURPOSE: The present study investigates healthcare students' affective, behavioral, and cognitive attitudes toward hypothetical peers with autism spectrum disorder (ASD) and the effect of the ASD label on their attitudes. METHODS: The MAS scale for ASD persons in the postsecondary education (Matthews et al., 2015) was translated and adapted in Greek according to the guidelines of World Health Organization (2016). Participants (n = 444) were randomly divided into three equal groups and completed their demographic information. Each participant read the three vignettes of the Greek-adapted MAS scale describing a communicative interaction with one hypothetical fellow student with autistic characteristics in three different social situations but in each group, the vignette's character was labeled differently (High-functioning, typical college student, and no-label). RESULTS: Students in the High-functioning group demonstrated more positive affective, behavioral, and cognitive attitudes toward the vignette characters than students in the no-label condition. Furthermore, students in the typical student group reported more rejective behaviors toward the vignette characters than students in the high-functioning group, implying that atypical behavior evokes rejection and stigmatization, while the label did not. Male students presented more positive cognitive attitudes across study groups in comparison to female students, while previous contact with individuals with ASD did not seem to impact significantly attitudes. CONCLUSION: The findings of the study indicate that knowledge of an ASD diagnosis leads to greater acceptance and have important implications for future research, disability policy makers, and university support services.

Validation and cultural adaptation of a Greek Version of Pediatric Eating Assessment Tool 10 (PEDI - EAT - 10) in Greek-Cypriot Parents.

PURPOSE: The Pediatric Eating Assessment Tool (PEDI-EAT-10) is a parents/caregivers screening tool that assesses pediatric patients at risk of penetration and/or aspiration symptoms. The aim of this study was the validation of PEDI-EAT-10 in the Greek language. MATERIALS AND METHODS: This cross-sectional study included 222 parents/caregivers of children with (n = 122) and without (n = 100) feeding and/or swallowing disorders, with age range 3 - 12 years. The children were selected from Cypriot schools and health settings. All parents filled out the PEDI-EAΤ-10 questionnaire and after its initial completion, it was re-administered after 2 weeks. RESULTS: A statistically significant difference was observed in the PEDI-EAT-10 total mean scores between the study's two groups [t (220) = 9.886, p < 0.001]. Internal consistency was high (Cronbach's alpha= 0.801) with very good split-half reliability equal to 0.789. A significant and strong test-retest reliability was computed (r = 0.998, p < 0.001). The PEDI-EAT-10 cutoff point was 11.00 (AUC: 0.869, p < 0.001) for children with feeding and/or swallowing disorders in accordance with the PAS scale. CONCLUSIONS: In conclusion, the Greek version of PEDI-EAT-10 is shown to be a valid and reliable screening tool for the assessment of the pediatric population with a risk of dysphagia.

The Pediatric Eating Assessment Tool (PEDI - EAT - 10) is a clinical screening tool to assess pediatric patients at risk of penetration and/or aspiration reported by parents or caregivers.This study is a cross cultural translation of PEDI - EAT - 10 in Greek language and it is proven to have excellent internal consistency, reliability, and validity.The use of PEDI ­ EAT ­ 10 will be a very useful utility for health professionals in rehabilitation settings.

Cross-Cultural Adaptation and Validation of the Greek Cypriot Montreal Children's Hospital Feeding Scale.

INTRODUCTION: Assessing pediatric feeding difficulties (PFD) is essential for a child's development to prevent severe consequences. The assessment procedures for PFD may include parents' questionnaires such as the Montreal Children's Hospital Feeding Scale (MCH-FS). The aim of this study was the cross-cultural adaptation of the MCH-FS to the Greek language. METHODS: 100 parents of Greek Cypriot children with PFD (clinical group) and 100 parents of healthy Greek Cypriot children (control group) aged six months to 16 years old participated in the study and completed the MCH-FS. World Health Organization (WHO) guidelines were implemented for translation and cultural adaptation. RESULTS: The internal consistency was excellent α= 0.85 (ICC: 0.817-0.891). Content validity was significant (S-CVI=1) with an agreement equal to 14. A strong and significant correlation of MCH-FS was computed according to Principal Component Αnalysis (PCA) [14 items ranging between -0.6 and 0.7]. The Kaiser-Meyer-Olkin (KMO) Factor analysis was equal to 0.91 with substantial correlations (Bartlett's test= 0.001654804). The MCH-FS cut-off point between the two groups was 38.00 [AUC 0.901, (95% CI: 0.859-0.942), p<0.001; sensitivity= 0.800 and 1-specificity= 0.630]. A statistically significant difference between the two groups was observed for the MCH-FS total score, with the clinical group scoring higher [U= 992.00, p< 0.001]. Likewise, the same differences were observed among children with different PFD, H (3) = 96.715, p< 0.001. CONCLUSION: The MCH-FS had good psychometric properties in its current form in Greek. It is suggested that the MCH-FS can be used as a valid tool for children with PFD in the Greek Cypriot population.

Exploring the diagnostic accuracy and applicability of the Gugging Swallowing Screen in children with feeding and/or swallowing disorders.

BACKGROUND: The Gugging Swallowing Screen (GUSS) is a bedside dysphagia screening tool that has been designed to determine the risk of aspiration in acute stroke patients. There is no evidence in the literature for the GUSS for the pediatric population. The present study aimed to determine the diagnostic accuracy of GUSS as a screening tool in the Greek language for children with dysphagia. METHODS: Eighty-Greek-Cypriot children aged 3-12 years who had dysphagia participated in this retrospective study. The translated into Greek GUSS was administered twice (pre- and post-therapy) to each patient throughout 24 sessions of dysphagia therapy. KEY RESULTS: The GUSS showed a high internal consistency (Cronbach's α = 0.826), good test-retest reliability (rs = 0.767), convergent validity compared to the Greek Pediatric Eating Assessment tool-10 (PEDI-EAT-10) total score (rs = -0.365), and inter-rater reliability (κ = 0.863). A total cutoff points equal to 13.00 was also calculated. Aspiration was identified by the GUSS with low sensitivity and high specificity (PPV 100%, NPV 57%, LR+ NA, LR- 0.79); dysphagia/penetration was identified with high sensitivity and low specificity (PPV 33%, NPV 100%, LR+ 0.102, LR- NA). CONCLUSIONS & INFERENCES: The pediatric version of GUSS has been found to be a valuable tool in identifying the risk of aspiration as that of adults. It proved to be used as a good screening guide for selecting and confirming the existence of dysphagia from instrumental assessments. This is the first study of the pediatric version of GUSS, and future studies on this topic are needed.

Societal Attitudes Towards Autism (SATA): Validation of the Greek Version in the General Population.

This study examined the validity of the Greek version of the Societal Attitudes Towards Autism (SATA) scale in a Greek community sample (n = 633) and explored how the demographic variables of the sample modulate knowledge and attitudes regarding people with Autism Spectrum Disorder (ASD). The principal component analysis confirmed the three-dimension model and explained 40.5% of the variance. All Cronbach's alpha values obtained were over 0.70. SATA's subscales were significantly and positively correlated, indicating good internal reliability. Participants presented moderate knowledge about ASD and mediocre positive attitudes towards people with ASD. Gender, age, and educational level significantly affected SATA total scores. Overall, this Greek version of SATA showed acceptable psychometric properties, indicating that can be a reliable scale for use.

The effect of real word stimuli versus non-word stimuli on oral diadochokinetic rates across the life span: An item discrimination analysis.

BACKGROUND: Diadochokinetic (DDK) rate tasks are extensively used in the evaluation of speech disorders; however, it is unclear how the different types of speech stimuli affect DDK rate performance. AIMS: To investigate the effect of age, gender and type of stimuli (non-words versus real words) on the DDK rates in individuals across the lifespan and to provide normative data for Greek. Also to examine the discrimination ability of the speech DDK stimuli administered (non-words and real words) based on a dual DDK assessment protocol using a polytomous item response theory (IRT) model. METHODS & PROCEDURE: The participants were 1747 monolingual Greek speakers (376 children, aged 4-17 years; and 1371 adults, aged 18-90+ years). All participants had normal hearing acuity which allowed them to understand and follow instructions. Participants with a medical condition or a language disorder which would affect DDK rate performance were excluded from the study. The time-by-count method was used, and all participants had to repeat as accurately and fast as possible: (1) four disyllabic non-words (/'gaba/, /'taka/, /'kata/, /'baga/), (2) four disyllabic real words (/'kapa/, /'tapa/, /ka'la/, /'paka/) and (3) two trisyllabic non-words (/'pataka/, /'badaga/). All responses were recorded and the speech samples that did not include at least 5 s of correct repetitions were excluded from the analysis. OUTCOMES & RESULTS: Age affected significantly DDK rates with performance increasing gradually until approximately the age of 40 and then gradually decreasing. Gender had no effect. Overall, there was a significant advantage of disyllabic real word stimuli over disyllabic non-word stimuli and of trisyllabic non-word stimuli over disyllabic non-word stimuli on DDK rates performance. IRT analysis suggested that the data fit the polytomous model reasonably well and all DDK stimuli (real words and non-words) showed a strong relationship (loadings > 0.50) with the latent trait. CONCLUSIONS & IMPLICATIONS: The current study complements prior research which supports that age and type of stimuli significantly affect DDK rates performance. It is the first study, that testifies to the benefit of real-word stimuli over non-word stimuli on DDK rates across the lifespan in a large representative sample. The implementation of IRT analysis provides empirical evidence about the discrimination ability of the DDK stimuli administered and confirms the reliability of this dual DDK assessment protocol. These findings are valuable for clinicians who work with motor speech disorders. WHAT THIS PAPER ADDS: What is already known on this subject Age, type of stimuli (real words versus non-words) and language significantly affect DDK rates performance. Current research strongly suggests the administration of language-specific norms since language-dependent features seem to have a noteworthy effect on the DDK rates, but scarce evidence exists about the discriminatory ability of the DDK speech stimuli commonly administered. What this study adds to the existing knowledge Conflicting findings have been reported about the effect of different types of DDK speech stimuli (real words and non-words) but no study to date has evaluated their discriminatory abilities. The current study is the first to implement a polytomous IRT model to examine this issue. This is also the first study to attempt an investigation of the effect of types of stimuli (real words versus non-words) on a large representative sample across the lifespan (4-90+ years) and to provide normative data for Greek. What are the practical and clinical implications of this work? The present study offers concrete evidence about the advantage of real-word stimuli over non-word stimuli in Greek, as well as normative data for the Greek-speaking populations. Moreover, the IRT analysis testifies to the discriminatory ability of real-word and non-word stimuli affirming the reliability of the present dual DDK assessment protocol as a psychometrically sound measure of DDK ability. The above has significant value for clinicians who work with individuals with motor speech disorders as the protocol can help them with the diagnosis and differential diagnosis of motor speech disorders.

The Utility of Stroboscopy in Evaluating Patients with Benign Vocal Fold Lesions.

Purpose: The present study aims to provide a comprehensive analysis of the use of stroboscopy as an assessment tool for patients with benign lesions of the vocal folds. Methods: The current study was based on an extensive review of the international bibliography regarding the evaluation of voice in patients with benign lesions of the vocal cords using videostroboscopy. Results: Stroboscopy is a convenient technique used by otolaryngologists that has been established as a valuable diagnostic tool for assessing patients with dysphonia and benign vocal cords lesions. Conclusions: Stroboscopy is recommended in the literature as the preferred method for assessing vocal cord vibratory function. The future poses challenges in standardizing guidelines and quantifying measurements of stroboscopic findings.

Psychometric Properties of the Greek Version of the Autism Parenting Stress Index (APSI) among Parents of Children with Autism Spectrum Disorder.

(1) Background: This study aimed to validate the Greek version of the Autism Parenting Stress Index (APSI) among parents of children with ASD. (2) Methods: The translated version was administered to 113 parents (Male: 12, Female: 101, 39.24 years old, SD 6.70, age range, 25-58) of children diagnosed with ASD and 127 parents (Male: 24, Female: 103, 41.08 years old, SD 6.22, age range: 27-56) of typically developing children. (3) Results: Significant differences between the APSI total scores and three domains between groups were observed. Although the initial factor structure could not be replicated, the APSI's internal consistency was excellent (a = 0.914), with a high positive item-total correlation (0.900-0.917). The APSI's test-retest reliability was excellent, showing an ICC equal to 0.922 [95%, CI: 0.900-0.940]. The APSI's total score cut-off point was equal to 12.00 (AUC 0.845, p < 0.001) with a sensitivity of 0.839 and 1-specificity of 0.220. A principal component analysis of the 13 items, using varimax rotations, identified three factors, which explained approximately 45.8% of the overall variance. (4) Conclusions: The Greek version of the APSI exhibited discriminant validity for measuring parents of children with ASD. Greek health professionals can use it to assess the stress experienced by parents of children with ASD.

Lawton's Instrumental Activities of Daily Living for Greek-Speaking Adults with Cognitive Impairment: A Psychometric Evaluation Study with Additional Receiver Operating Characteristic Curve Analysis.

One of the components of a dementia diagnosis is the assessment of functional abilities. These abilities are measured via screeners, such as the Instrumental Activities of Daily Living (IADL) scale. The IADL scale is a valid tool that has been adapted in many languages. This study aimed to provide a cut-off point and validate the Greek version of the IADL scale in populations with cognitive impairment. IADL data were collected from 132 individuals: 24 PD patients, 24 Parkinson's disease dementia (PDD) patients, and 24 AD patients. The remaining 60 participants were cognitive healthy adults (CHAs). The CHA group and the PD group served as the cognitively unimpaired group (CUG), while the PDD and AD groups served as the cognitively impaired group (CIG). Additionally, the MMSE, the AMTS, the Clock Drawing Test CDT, the Arizona Battery for Communication Disorders of Dementia (ABCD), the NPI, and the GDS-15 were administered to the participants. Statistically significant differences in the IADL scores were exhibited between all subgroups. The IADL scale showed high internal consistency (Cronbach's alpha = 0.890). A threshold equal to 6.00 (AUC = 0.888, p < 0.001) was estimated between the CUG and the CIG. Significant positive correlations were observed between IADL and MMSE (r = 0.764, p < 0.001), IADL and AMTS (r = 0.724, p < 0.001), IADL and ABCD (r = 0.702, p < 0.001), and IADL and CDT (r = 0.627, p < 0.001) results. Given the obtained results, the IADL scale is a valid tool for clinical use with high reliability and sensitivity. Also, the IADL scale is a valuable instrument for screening functional abilities associated with cognitive impairment.

Measuring parental stress, illness perceptions, coping and quality of life in families of children newly diagnosed with autism spectrum disorder.

BACKGROUND: A variety of psychosocial factors have been shown to affect the quality of life of families (FQoL). AIM: This study aimed to assess the impact of mother's demographic characteristics, parental stress, illness perceptions about autism spectrum disorder (ASD), coping strategies, ASD severity and time since diagnosis on FQoL during the initial period following diagnosis (≤6 months). METHOD: Fifty-three mothers of children newly diagnosed with ASD completed the Beach Center Family Quality of Life Scale, the Autism Parenting Stress Index, the Brief Illness Perception Questionnaire and the Brief Coping Orientation to Problems Experienced Inventory. A descriptive analysis was conducted on the demographic characteristics of the family. Eta coefficients and Pearson's analysis were used to determine the associations between the variables and the FQoL dimensions. Hierarchical regression was used to determine whether variables explained a statistically significant family quality of life variance. RESULTS: Pearson's analysis and eta coefficients indicated several correlations. Hierarchical regression analysis showed that higher parental stress related to core autism symptoms was associated with poorer FQoL (95% CI -0.08 to -0.02, P = 0.001), and higher perceived treatment control was associated with better FQoL (95% CI 0.04-0.16, P = 0.001). In addition, stronger perceived personal control was associated with higher physical/material well-being (95% CI 0.01-0.16, P = 0.022) and higher disability-related support (95% CI 0.30-0.61, P = 0.001). Higher family monthly income was associated with better FQoL (95% CI 0.08-0.027, P = 0.000), whereas marital status (divorced mother) was correlated with poorer FQoL (95% CI -0.68 to -0.16, P = 0.002). CONCLUSIONS: Interventions should emphasise managing the disorder's characteristics and implementing psychoeducational and supportive programmes for parents, immediately after the diagnosis, to enhance FQoL.

Specificity of phonological representations in school-age high-functioning ASD children.

PURPOSE: Well-specified phonological representations are important for the development of spoken and written language. This study investigates the types of speech errors and the quality of phonological representations in Greek-speaking school-age children with high-functioning autism spectrum disorder (HF-ASD), as well as the relationship between stored phonological representations and speech output in this sample, according to Stackhouse and Wells' (1997) model. METHOD: All participants completed a phonological and a naming test, and a non-word repetition task. A receptive phonological task was administered to a subgroup of HF-ASD and typically developing (TD) participants. According to performance in the phonological test, the HF-ASD children were categorised as ASD with Speech Sound Disorder (SSD) or ASD without SSD. RESULT: The HF-ASD children made significantly more speech errors and showed significant difficulties in the repetition of non-words and the stored phonological representations compared to the TD group but had the same naming abilities with their TD peers. The ASD children with SSD and without SSD performed alike in the receptive task, indicating that both groups had unspecified phonological representations. CONCLUSION: These results support the hypothesis of distinct phonological representations for speech input and output and highlight the need of using receptive tasks to evaluate underlying phonological knowledge, a process which could allow clinicians to identify the level of speech breakdown.

Diadochokinetic rates in healthy young and elderly Greek-speaking adults: The effect of types of stimuli.

BACKGROUND: Diadochokinetic rates tasks are frequently used for the assessment of diadochokinesia (DKK) in young and elderly adults. However, there is scarce research on healthy elderly adults over 65 years old, and little is known about the effect of different types of stimuli (non-words/real words) in this specific population. Furthermore, the current research supports significant language variations, highlighting the need for language-specific norms. AIMS: To investigate the effect of age, gender and type of stimuli (non-words versus real words) in DDK rates in healthy elderly adults of over 65 years of age, and to provide normative data for the Greek language. METHODS & PROCEDURES: The participants were 791 healthy monolingual Greek-speaking adults (531 adults, aged 20-39 years; 157 participants aged 65-74 years; and 103 participants aged over 75 years). All participants were monolingual speakers of Greek and had normal hearing acuity, which allowed them to understand and follow instructions. Participants with a medical condition, which would affect DDK rates' performance, were excluded from the study. The time-by-count method was used, and all participants had to repeat as accurately and fast as possible: (1) four disyllabic non-words (/'gaba/, /'taka/, /'kata/, /'baga/); (2) four disyllabic real words (/'kapa/, /'tapa/, /ka'la/, /'paka/); and (3) two trisyllabic non-words (/'pataka/, /'badaga/). All responses were recorded and the speech samples that did not include at least 5 s of correct repetitions were excluded from the analysis. OUTCOMES & RESULTS: Age affected DDK rates significantly, with older adults achieving slower DDK rates for all speech stimuli (non-words/real words). Gender did not have an effect on the performance of DDK rates. The type of speech stimuli affected DDK rates significantly for all age groups. Analytically, trisyllabic non-word stimuli were articulated more slowly than disyllabic non-word stimuli, and real words were produced faster than non-words. A linear regression analysis revealed that only the repetition of non-words predicted 68.4% of the performance on the repetition of trisyllabic non-words. CONCLUSIONS & IMPLICATIONS: The above results complement prior research, which supports that real word stimuli yield faster performance than non-word stimuli. Clinicians should keep in mind that age, language and type of stimuli (non-words/real words) affect significantly the performance of DDK rates, as well as the fact that different types of stimuli tap distinct underlying levels of speech. The current research highlights the need for language-specific norms for different populations. WHAT THIS PAPER ADDS: What is already known on the subject DDK rates are significantly affected by the types of stimuli and language used. Moreover, the normal ageing process decreases performance in terms of DDK rates, but scarce evidence exists for healthy elderly adults over 65 years old. What this paper adds to existing knowledge Most studies have examined DDK rates in healthy elderly people with restricted samples and using non-word stimuli. The current study administered different types of stimuli (non-words/words) in a large sample of healthy elderly participants. This is also the first study to attempt to provide DDK normative data for this population in the Greek language. What are the potential or actual clinical implications of this work? The results of this study strongly suggest that clinicians should bear in mind the significant impact age and language have on performance in terms of DDK rates, especially when normative data are not available for a certain language or age group. Furthermore, non-word and real-word stimuli cannot be used interchangeably since they tap into distinct underlying levels of speech, thus providing clinicians with useful information about the level of breakdown and the proper treatment plan.

Validation of a Greek Sentence Repetition Task with Typically Developing Monolingual and Bilingual Children.

This study provides a preliminary validation of a Greek Sentence Repetition Task (SRT) with a sample of 110 monolingual and bilingual typically developing (TLD) children and examines the test's ability to distinguish between Greek monolingual children and age-matched Albanian-Greek bilinguals using a Receiver Operating Characteristics (ROC) analysis. This is the first study to report on the psychometric evaluation of a Greek SRT and its discriminatory ability with typical populations. Since most language assessments are standardized with monolinguals and bilingual children tend to underperform on these compared to monolinguals, it is essential to establish the level of bilingual TLD children's ability on the same tests before moving on to diagnose language impairment in bilinguals. Results showed that the Greek SRT had very high validity and reliability scores, with Accuracy measures being more reliable than Grammaticality measures. The school-age monolingual and bilingual TLD children reached different cut-off scores on this task.

Validation of the Greek version of the Affiliate Stigma Scale among mothers of children with autism spectrum disorder.

BACKGROUND: Caregivers of children with autism spectrum disorder (ASD) are sensitive to the internalisation of the stigma, known as affiliate stigma, resulting in reduced self-esteem, isolation and poor psychological well-being. AIMS: This study aims to validate the Greek version of the Affiliate Stigma Scale (ASS) among mothers of children with ASD. METHOD: The translated version of ASS in Greek was administered to 53 mothers of children newly diagnosed with ASD in two time periods: 1-6 months from diagnosis (time point 1) and 12 months from the initial assessment (time point 2). The control group consisted of 62 mothers of typically developing children. RESULTS: The ASS total mean score revealed a moderate level of stigma to the ASD group in both assessments. The reliability measures by item showed a satisfactory composite reliability (affective 0.828, cognitive 0.833, behaviour 0.857). Cronbach's alpha revealed that the estimated internal consistency was excellent (α = 0.888), and it found a high positive item-total correlation. Receiver operating characteristic analysis results indicated a statistically significant positive discrimination (area under the curve 0.849, P = 0.000) between the groups. The cut-off point was 31.00, with a sensitivity of 0.849 and a 1 - sensitivity of 0.258. CONCLUSIONS: The proposed version of the ASS has good psychometric properties and is valid and reliable for measuring affiliate stigma among caregivers of children with ASD in Greece. Health professionals can use it to assess and understand the stigma experienced by caregivers of children with ASD, and design appropriate interventions to reduce their affiliate stigma.

Validation of the Greek version of the Abbreviated Mental Test Score: Preliminary findings for cognitively impaired patients of different etiology.

BACKGROUND: Screening people's cognitive skills have been proven essential for reference to full assessment. These methods include short scales, such as the Abbreviated Mental Test Score (AMTS). The AMTS is a valid 10-item questionnaire that has been translated into many languages, but not in Greek yet. The aim of this study is the validation of the Greek version of the AMTS with an additional estimation of its cutoff scores. METHODS: About 132 individuals [60 controls and 72 patients (24 with Parkinson's disease (PD), 24 with Parkinson's disease dementia (PDD), and 24 with Alzheimer's disease (AD)] participated in this study. All participants besides the AMTS completed the Mini Mental State Examination (MMSE), the Tuokko's Clock Drawing Test (CDT), the Instrumental Activities of Daily Living (IADL), the Arizona Battery for Communication Disorders of Dementia (ABCD), the Hellenic versions of the Neuropsychiatric Inventory (NPI), and the Geriatric Depression Scale (GDS-15). RESULTS: Statistically significant differences were found between all subgroups for the AMTS. The AMTS showed high internal consistency (Cronbach alpha = 0.819 and coefficient omega ω = 0.814). A threshold equal to 6.50 (AUC: 0.908, p = 0.000) between groups with and without cognitive impairment was calculated. The AMTS was significantly correlated with the CDT, IADL, and MMSE. CONCLUSION: The proposed version of the AMTS can distinguish between groups with and without cognitive impairment. Additionally, the AMTS is found to be clinically valid having high reliability and classification accuracy. Conclusively, it is a valuable instrument for screening different types of cognitively impaired patients.

ROC Analysis Cut-off Points of Hellenic Voice Handicap Index for Neurogenic Voice Disorders Patients: an Exploratory Study.

OBJECTIVE: The inclusion of subjective methods for evaluating Voice Disorders is proven an essential factor for diagnosis as these methods include self-reported questionnaires (eg, Voice Handicap Index-VHI) for everyday clinical practice. In turn, by obtaining cut-off scores of self-perceived questionnaires intended for assessment procedures of different voice disorders (eg, patients with neurological problems), the clinicians might be helped toward finding their patients' needs leading to better monitoring, and treatment suggestions. Consequently, the purpose of this study was to estimate the cut-off scores for the Greek VHI relevant to patients with neurogenic voice disorders. METHODS: Ninety subjects participated in this research. Sixty-six of them served as the control group while the remaining 24 patients exhibited Neurogenic Voice Disorders (eg, spasmodic dysphonia or vocal fold paralysis). They filled in the VHI and the Voice Evaluation Template. All participants were examined with the use of video laryngeal endoscopy and stroboscopy. RESULTS: The analysis revealed higher medians in all domains (of the VHI) for the patients compared to the control group. The cut-off points were estimated at the values of 24.50 (Total Score-AUC 0.932, P = 0.000), 9.00 (Functional Domain-AUC 0.917, P = 0.000), 10.00 (Physical Domain-AUC 0.948, P = 0.000), and 9.00 (Emotional Domain-AUC 0.830, P = 0.000). CONCLUSION: The estimated cut-off scores are in agreement with previous studies. These scores could probably used to enhance therapeutic monitoring of patients who suffer from neurogenic voice disorders. This study underlines the importance of considering different cutoff points for individuals with voice disorders due to diverse neurogenic etiologies.

Lexical Diversity in Cypriot-Greek-Speaking Toddlers: A Preliminary Longitudinal Study.

BACKGROUND/AIMS: The number of different words (NDW), an essential measure of lexical diversity, is extremely valuable towards providing data regarding children's language development. However, in Cyprus, practitioners are deprived of the opportunity to utilize NDW, as no normative data exist for toddlers who speak Cypriot Greek (CYG). METHODS: The language samples of 36 monolingual CYG-speaking toddlers (aged 36, 40, 44, and 48 months) with a typical course of language development were collected and quantitatively analyzed. Based on the language sample analysis, we ascertained typical NDW values at the aforementioned ages and tested through a linear mixed-effects model whether gender and age affected NDW. RESULTS: The results showed that age significantly predicted NDW increase; gender did not emerge as a significant predictor of NDW, but this may be due to the small statistical power. CONCLUSION: This study intends to provide the first step towards longitudinal investigation of the level of NDW for CYG-speaking children with a typical course of language development. The provided data, which could serve as preliminary norms, may be used - under some restrictions for the time being - during language assessment. Moreover, these acquired data could contribute to the development of an NDW database for diverse CYG-speaking populations of different age ranges in the future.

The Tuokko version of the Clock Drawing Test: A validation study in the Greek population.

INTRODUCTION: The present study aims to be the first to validate the Tuokko version of the Clock Drawing Test (CDT) and estimate its cutoff score after its translation into the Greek language and administration in the Greek population. METHODS: One hundred and thirty-two individuals participated in this study [60 with Good Cognitive Health (GCH), 24 with Parkinson's Disease (PD), 24 with Parkinson's Disease Dementia (PDD) and 24 with Alzheimer's Disease (AD)]. The CDT was administered to all participants. Additionally, the cognitive and mental status of the sample were estimated through the use of the Mini Mental State Examination (MMSE), Abbreviated Mental Test Score (AMTS), Arizona Battery for Communication Disorders of Dementia (ABCD), Instrumental Activities of Daily Living (IADL), the Neuropsychiatric Inventory (H-NPI) and the Geriatric Depression Scale -15 (GDS-15). RESULTS: Statistically significant differences were found between all groups on the CDT, with AD patients having lower scores than all subgroups in the study. The CDT showed a high internal consistency (Cronbach's alpha = 0.832). The ROC analysis provided a cutoff point equal to 4.00 (AUC: 0.821, p < 0.001) between the Cognitively Unimpaired Group (CUG: GCH and PD group) and the Cognitively Impaired Group (CIG: PPD and AD patients), 5.00 (AUC: 0.845, p < 0.001) between the GCH group and the PDD group, and 4.00 (AUC: 0.780, p < 0.001) between the GCH group and the AD group. Finally, the cutoff point between the PD group and the PDD group was 4.00 (AUC: 0.896, p < 0.005), and 3.00 (AUC: 0.899, p < 0.001) between the PD group and the AD group. Significant positive Pearson's correlations were observed between CDT and MMSE (r = 0.808, p < 0.001), CDT and AMTS (r = 0.688, p < 0.001), CDT and ABCD (r = 0.770, p < 0.001), CDT and the ABCD Visuospatial Construction subdomain (r = 0.880, p < 0.001); while a negative correlation was found between CDT and IADL (r = -0.627, p < 0.001) between the CUG and the CIG groups. CONCLUSION: Given the results obtained, the CDT appears to be a clinically valid screening instrument for the assessment of visuospatial abilities, with high reliability in Greek populations with cognitive impairment.

The Hellenic Voice Handicap Index of Different Laryngeal Mass Lesions: A Receiver-Operating Characteristic Analysis.

BACKGROUND: Voice disorders influence the quality of people's life. When the type of disorder is determined then the clinicians are capable of finding their patients' needs and address their complaints concerning their vocal problems. One of the most used tools, for assessing the patients' quality of life (in accordance with their vocal status), is the Voice Handicap Index. In this study, we determined the cut-off scores of Voice Handicap Index for population with laryngeal mass lesions such as vocal polyps and nodules. The calculated cut-off points further guide clinicians toward applying a needed interventional method/therapy even in the cases where the condition of a person could not be easily estimated. METHODS: The study involved 130 participants (aged 19-74). Specifically, 90 nondysphonic people served as the control group, while 40 participants had already been diagnosed with voice disorders due to laryngeal mass lesions. Participants who were diagnosed with a laryngeal inflammation or had undergone a surgery were excluded from the study. The cut-off scores were determined through a receiver-operating characteristic (ROC) analysis. RESULTS: The calculated cut-off points were 19.50 for the total score of VHI, 7.50 for the functional domain, and 8.50 for the physical and the emotional domain. CONCLUSIONS: The aforementioned cut-off points could be used in empowering the everyday clinical practice. Moreover, their knowledge could help the construction of an individualized therapy plan, as well as monitoring-biofeedback tool for the populations with vocal fold lesions.

Cross-cultural Adaptation and Validation of the Greek Voice Handicap Index-10 (GVHI-10) With Additional Receiver Operating Characteristic Analysis.

OBJECTIVE(S): The use of subjective evaluation tools are proven useful and of high clinical value in the case of voice disordered population. For that type of evaluation, self-assessment questionnaires about the severity of the voice like Voice Handicap Index-30 (VHI-30) have been developed. The VHI-30 is the most studied tool which includes psychometrically robustness while guiding physician's therapeutic decision making. Additionally, a valid abbreviated version of VHI-30 was developed for the first time in the Greek Language which is named as Greek Voice Handicap Index-10 (GVHI-10). Consequently, the aim of our study was to validate the proposed version of the VHI-10. METHODS: Ninety nondysphonic individuals and 90 dysphonic patients were classified by Otolaryngologists and Speech Language Pathologists. The study's subjects were evaluated with endoscopy and stroboscopy. Also, they were administrated the GVHI-30 and the translated version of the Voice Evaluation Template (VEF). The GVHI-10 was extracted by the Greek version of VHI-30. RESULTS: The group with voice disorders exhibited higher statistical significance in all GVHI-10 scores compared to those of the control group. The GVHI-10 showed a high internal consistency (Cronbach's a = 0.915 and split-half reliability coefficient equal to 0.86), good sensitivity compared to Greek VHI-30 (r = 0.764, P = 0.000) and intraclass correlation. A total cut-off point equal to 6.50 (AUC: 0.964; P < 0.001) was also calculated. CONCLUSIONS: The proposed version of GVHI-10 distinguished the perceived levels of voice between dysphonic and nondysphonic groups and between different voice disordered populations. The GVHI-10 is shown to be clinically valid and sensitive exhibiting high reliability.