Publications by authors named "Negin Moradi"

24 Publications

  • Page 1 of 1

Comparison of Vocal Fatigue in Speech Therapists With Other Rehabilitation Therapists.

J Voice 2021 Feb 15. Epub 2021 Feb 15.

English Literature.

Introduction: Voice, as one of the most important communication tools in humans, can cause many problems in a person's daily life if it is damaged. One type of voice complaint is vocal fatigue, which is common among people who use their voices a lot. Rehabilitation therapists may be more vulnerable to a variety of vocal disorders and complaints due to extensive voice use and long-term relationships with clients. The aim of this study is to investigate and compare vocal fatigue among therapists in Ahvaz rehabilitation fields.

Method: This cross-sectional, descriptive-analytical study was performed on 100 therapists in Ahvaz rehabilitation fields. For this purpose, the Persian version of the vocal fatigue index questionnaire has been used. One Way Anova parametric tests were used to compare target variables. The relationship between vocal fatigue and work experience and working hours per day was calculated using Spearman correlation coefficient.

Results: A comparison of the scores of the vocal fatigue index in the rehabilitation therapists showed that there was a significant difference between the therapists scores in the field of speech therapy and the therapists scores in other fields (P < 0.05).

Conclusion: Due to the nature of rehabilitation fields and the use of voice during daily interactions with different clients, especially clients with special disabilities, the possibility of voice disorders and complaints in this population should be considered. Therefore, providing the necessary training for voice care and voice health of this population should be noted in order to prevent voice disorders and complaints.
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http://dx.doi.org/10.1016/j.jvoice.2020.12.036DOI Listing
February 2021

Relationship Between Work Engagement and Voice Complaints Among Elementary School Teachers.

J Voice 2020 Mar 5. Epub 2020 Mar 5.

Musculoskeletal Rehabilitation Research Center, Department of Speech Therapy, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. Electronic address:

Introduction: Engaged teachers feel rewarded at work, complete assignments in a positive manner and, often immerse themselves in their work. However, voice complaints are more common for teachers than other professionals which may negatively affect their engagement. This study aims to determine the relationship between work engagement and voice complaints for elementary school teachers.

Method: This descriptive-analytical, cross-sectional study was conducted on 300 elementary school teachers in 2018. To study voice complaints, the researchers used the self-reporting question "Have you complained about your voice during the past year or so?" Work engagement was measured by the Utrecht Work Engagement Scale (UWES). To analyze the data, descriptive and analytical statistical methods, including two-way ANOVA, were used.

Results: A total of 55.67% (n = 167) of the teachers had voice complaints, and 44.33% (n = 133) had no voice complaints. After controlling for gender, the results of the study showed that there is a statistically significant relationship between voice complaints and work engagement (P < 0.001) and its three dimensions, including: vigor (P ≤ 0.001), dedication (P ≤ 0.001), and absorption (P ≤ 0.001).

Conclusion: The results of the present study showed that teachers with voice complaints have lower work engagement than those without. Given the central importance of work engagement in organizational, social, and financial systems, undivided attention should be given to treatment of voice disorders among teachers.
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http://dx.doi.org/10.1016/j.jvoice.2019.12.001DOI Listing
March 2020

Factor Analysis of the Persian Version of the Voice Disability Coping Questionnaire.

J Voice 2020 Nov 16;34(6):965.e1-965.e11. Epub 2019 Jul 16.

Musculoskeletal Rehabilitation Research Center, Department of Speech Therapy, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. Electronic address:

Introduction: Voice disorders can affect the quality of life and coping mechanisms and also coping mechanisms can affect the way in which patients deal with their voice problems. People with voice disorders need to use coping strategies to deal with the problems caused by their voice disorder. The purpose of this study was to examine the psychometric properties and cultural adaptation of the Voice Disability Coping Questionnaire in the Iranian population.

Methods: The translation and cross-cultural adaptation procedures were performed according to the basic rules and instructions set by the International Quality of Life Assessment Project. Two hundred and forty-eight adults (218 patients with voice disorder and 30 healthy controls) were participated in the study. Face and content validity, clinical validity, and construct validity of the questionnaire were investigated by modern psychometric methods.

Results: Quantitative methods were used to measure content validity and all items were detected applicable. This means that the final version was clear and easy to answer. Clinical validity shows that the Persian version of VDCQ can distinguish between patients and healthy controls (P < 0.001). The construct validity of the VDCQ was tested in a cross-sectional study. The questionnaire was analyzed by exploratory and confirmatory factor analyses. Investigation of initial communality and after extraction of factors by Varimax rotation method showed that the share of items for all items in the questionnaire except item 12, is higher than 0.5. Therefore, item 12 should be removed from the questionnaire (Table 3). Based on the confirmatory factor analysis model, items 2 and 10, whose factor load were less than 0.4, were excluded from the questionnaire (Fig. 1). For reliability the Cronbach's alpha coefficient and ICC were obtained as 0.82 and 0.99, respectively. The results of studying the role of items in the reliability of the VDCQ showed that all items increase internal consistency.

Conclusion: Based on modern statistical analysis conducted in this study, the original 15 item questionnaire was reduced to 12 item. The 12 item questionnaire is a valid and reliable tool for quantifying coping strategies in people with voice disorder.
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http://dx.doi.org/10.1016/j.jvoice.2019.06.001DOI Listing
November 2020

The Effect of Teamwork on Children With Cleft Lip and Palate and Their Mother's Quality of Life.

Cleft Palate Craniofac J 2019 11 11;56(10):1353-1358. Epub 2019 Jun 11.

Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Objective: Maintaining and improving patients' quality of life (QOL) are regarded as the most important aims in health-care systems. These are directly associated with intervention of health-care providers across the world. The aim of the present study was to evaluate the impact of teamwork on frequency of care provided to children with cleft lip and palate and their mothers' QOL.

Methods: This analytical epidemiology study was conducted on 101 children with cleft lip and palate and their mothers who were divided into 2 groups: a multidisciplinary team and a group of individual providers. Data were collected using convenience sampling. Quality of Life Questionnaire (Short Form-36) was assessed. The statistical analysis was performed using the χ test, independent test, and Mann-Whitney test in SPSS (20).

Results: Both groups were matched. There was a significant statistical difference among the members of multidisciplinary team who received surgery, genetic counseling, and dental care ( ≤ .043) and the individual providers groups. The 2 groups did not have significant difference in receiving the hearing test, speech therapy, and dental care 12 months before the interview. There were significant differences in QOL scores between the multidisciplinary team and the group of individual providers ( = .013).

Conclusions: The services provided as a multidisciplinary team leads to a better outcome and improves the QOL of our patients and their families. It is recommended that services should be provided in the team approach for patients with cleft lip and palate.
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http://dx.doi.org/10.1177/1055665619853749DOI Listing
November 2019

Comparison of verbal fluency in monolingual and bilingual elderly in Iran.

Appl Neuropsychol Adult 2021 Jan-Feb;28(1):80-87. Epub 2019 Apr 30.

Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Verbal fluency is one of the first and most important cognitive functions that deteriorate during the aging process. Verbal fluency is defined as the skill and speed of finding words and finding semantic and phonetic connections between words. One of the most important factors in verbal fluency is bilingualism. Therefore, the current study aimed to investigate the effect of bilingualism on the verbal fluency of the elderly in Iran. A total of 12 normal elderly bilingual (Arabic-Persian) speakers and 12 normal elderly monolingual (Persian) speakers participated in this comparative-analytical study. To assess verbal fluency, two semantic and phonetic fluency tasks were used. Data were analyzed using the Wilcoxon-Mann-Whitney tests. The results obtained from the comparison of phonetic fluency and semantic fluency of native languages of the two groups showed a better performance of monolingual participants in semantic fluency and phonetic fluency tasks in Persian language compared to the Arabic bilingual elderly. No difference was observed in verbal fluency of Persian monolinguals and bilinguals. However, in bilingual elderly participants, faster retrieval was observed in Persian language than in Arabic. This can be considered in assessment and treatment measures for Arabic-Persian bilinguals.
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http://dx.doi.org/10.1080/23279095.2019.1594234DOI Listing
April 2019

The Efficacy of Phonological Processing Treatment on Stuttering Severity in Persian Pre-School Children.

Iran J Child Neurol 2019 ;13(2):89-102

Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Objectives: Correct phonological encoding is crucial to fluent speech production. Phonological working memory and phonological awareness are important phonological processes that affect phonological encoding. The purpose of this study was to investigate the effect of phonological processing on stuttering severity of Persian pre-school children.

Materials & Methods: Six children were targeted in this study in Ahvaz City, southern Iran in 2018, with Quasi-experimental design (Before and after clinical trial). These children participated in a treatment protocol, scheduled in 13-sessions. The treatment protocol of the phonological processing included nonword repetition in the phonological working memory and phonological awareness therapy. Overall, 30 nonwords were taken to examine the phonological working memory. The Persian test of language development was taken to examine phonological awareness. Stuttering severity measurements were performed with pre- and post-treatment. The severity rating was instructed to the parents based on Guitar protocol. They were asked to keep score every day until the end of the treatment sessions, and they reported the score to the therapist.

Results: The stuttering severity score in pre and post-treatment was significant (=0.027), and in the follow-up, phase was not significant (=0.236); stuttering severity was reduced in children who stutter. Moreover, the severity rating score reported by parents during treatment was significant (= 0.0001). This showed a reduction in stuttering severity.

Conclusion: The poor performance of phonological awareness and phonological working memory in phonological processing affect stuttering severity. Treatment of sub-systems of phonological processing can have an important role in reducing stuttering severity and increasing speech fluency.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6451850PMC
January 2019

Reliability, validity, and normative investigation of Persian version of a High-Level Language Test (BESS).

Appl Neuropsychol Adult 2020 Nov-Dec;27(6):540-548. Epub 2019 Apr 5.

Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Our study aimed at reliability, validity, and normative investigation of the Persian version of the High-Level Language Test (BESS). This study was conducted on 60 multiple sclerosis (MS) patients as well as 60 healthy individuals. After translating the BESS into Persian, its content validity was determined based on 10 experts working in the same field. The reliability of the test was determined using techniques such as the test-retest method, Cronbach's alpha, and clinical validity. The content validity ratio (CVR) was higher than 0.62 for every subtest, and the content validity index (CVI) was between 0.1 and 0.8 for all subtests. Cronbach's alpha coefficient was between 0.70 and 0.93, and intraclass correlation coefficient (ICC) was between 0.80 and 0.96. Clinical validity results showed a significant difference between means of patients' scores and healthy subjects scores ( ≤ 0.005). The Persian version of BESS benefits from high reliability and validity values. Speech therapists can use the test to examine high-level language disorders in MS patients.
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http://dx.doi.org/10.1080/23279095.2019.1575221DOI Listing
April 2019

The Relationship Between Vocal Fatigue Index and Voice Handicap Index in University Professors With and Without Voice Complaint.

J Voice 2020 Sep 13;34(5):809.e1-809.e5. Epub 2019 Feb 13.

Musculoskeletal Rehabilitation Research Center, Department of Speech Therapy, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. Electronic address:

Introduction: University professors, just like teachers, are considered as professional voice users, who are subject to voice disorders and complaints due to their field of work. The present study aims to investigate the relationship between vocal fatigue index and voice handicap index in university professors with and without voice complaint.

Methods: This is a cross-sectional descriptive-analytic study that was conducted on 84 university professors with an average age of 38.27 ± 9.95. University professors were divided into two groups with and without voice complaints based on the opinion of the professors about the existence or absence of voice complaint. Data obtained from this study was analyzed using SPSS 22 software at a significant level of less than 0.05.

Results: There was a significant correlation between vocal fatigue index and voice handicap index in university professors (P <0.05). In the university professors without voice complaints, only the third factor of the vocal fatigue index was not significant (P > 0.05). However, in this group, there was a significant correlation between the first and the second factor of vocal fatigue index and voice handicap index (P < 0.05).

Conclusion: The results of this study indicate the effect of vocal fatigue on the quality of life of university professors. University professors, like teachers, are exposed to voice disorders and, thus, complaints which leave impacts on their career and should be addressed as a group of professional voice users to prevent voice disorder among them.
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http://dx.doi.org/10.1016/j.jvoice.2019.01.010DOI Listing
September 2020

Use of formant centralization ratio for vowel impairment detection in normal hearing and different degrees of hearing impairment.

Logoped Phoniatr Vocol 2019 Dec 15;44(4):159-165. Epub 2019 Jan 15.

Department of Epidemiology and Biostatistics, Faculty of Health, Health promotion research center, Zahedan University of Medical Sciences , Zahedan , Iran.

Hearing-impaired (HI) speakers show changes in vowel production and formant frequencies, as well as more cases of overlapping between vowels and more restricted formant space, than hearing speakers. This study was intended to explore whether the use of different acoustic parameters (Formant Centralization Ratio (FCR), Vowel Space Area (VSA), F2i/F2u ratio (second formant of/i,u/)) was suitable or not for characterizing impairments in the articulation of vowels in the speech of HL speakers. In fact, correlated acoustic parameters are used to determine the limits of tongue movements in vowel production in different severity degrees of hearing impairment. Speech recordings of 40 speakers with HL and 40 healthy controls were acoustically analyzed. The vowels (/a/,/i/,/u/) were extracted from the word context and, then, the first and second formants were calculated. The same vowel-formant elements were used to construct the FCR, expressed as (F2u + F2a + F1i + F1u)/(F2i + F1a), the F2i/F2u ratio, and the vowel space area (VSA), expressed as ABS((F1i*(F2a-F2u)+F1a*(F2u-F2i)+F1u*(F2i-F2a))/2). The FCR differentiated HL groups from the control group and the discrimination was not gender-sensitive. All parameters were found to be strongly correlated with each other. The findings of this study showed that FCR was a more sensitive acoustic parameter than F2i/F2u ratio and VSA to distinguish speech of the HL groups from that of the normal group. Thus, FCR is considered to be applicable as an early objective measure of impaired vowel articulation in HL speakers.
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http://dx.doi.org/10.1080/14015439.2018.1545867DOI Listing
December 2019

Dysphonia Characteristics and Vowel Impairment in Relation to Neurological Status in Patients with Multiple Sclerosis.

J Voice 2020 May 19;34(3):364-370. Epub 2018 Oct 19.

Air Pollution and Respiratory Disease Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Purpose: In this study, we attempted to assess the phonation and articulation subsystem changes in patients with multiple sclerosis compared to healthy individuals using Dysphonia Severity Index and Formant Centralization Ratio with the aim of evaluating the correlation between these two indexes with neurological status.

Materials And Methods: A sample of 47 patients with multiple sclerosis and 20 healthy speakers were evaluated. Patients' disease duration and disability were monitored by a neurologist. Dysphonia Severity Index and Formant Centralization Ratio scores were computed for each individual. Acoustic analysis was performed by Praat software; the statistical analysis was run using SPSS 21. To compare multiple sclerosis patients with the control group, Mann-Whitney U test was used for non-normal data and independent-samples t test for normal data. Also a logistic regression was used to compare the data. Correlation between acoustic characteristics and neurological status was verified using Spearman correlation coefficient and linear regression was performed to evaluate the simultaneous effects of neurological data.

Results: Statistical analysis revealed that a significant difference existed between multiple sclerosis and healthy participants. Formant Centralization Ratio had a significant correlation with disease severity.

Conclusion: Multiple sclerosis patients would be differentiated from healthy individuals by their phonation and articulatory features. Scores of these two indexes can be considered as appropriate criteria for onset of the speech problems in multiple sclerosis. Also, articulation subsystem changes might be useful signs for the progression of the disease.
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http://dx.doi.org/10.1016/j.jvoice.2018.09.018DOI Listing
May 2020

Cross-Cultural Adaptation and Validation of the Vocal Fatigue Index into Persian.

J Voice 2019 Nov 30;33(6):947.e35-947.e41. Epub 2018 Aug 30.

Department of Audiology and Speech-Language Pathology, East Tennessee State University, Johnson City, Tennessee.

Introduction: The aim of the present study was the cross-cultural adaptation and validation of the Vocal Fatigue Index (VFI) in Persian.

Methods: The English version of the VFI was translated to Persian using the guidelines of International Quality of Life Assessment. Eighty participants with voice disorders and 50 healthy controls without any voice disorders completed the Persian version of the VFI. The 80 participants with voice disorders completed the VFI a second time a week from the initial completion to evaluate test-retest reliability.

Results: The VFI measure demonstrated a strong internal consistency. Cronbach alpha coefficient was 0.95 for tiredness and avoidance of voice use, 0.86 for physical discomfort and 0.83 for improvement or lack thereof of symptoms with voice rest. VFI also showed a high test-retest reliability (r = 0.75-0.89).

Conclusions: The Persian version of the VFI is considered to be a valid and reliable questionnaire for identifying individuals with probable vocal fatigue. The VFI can be utilized in clinics across Iran in the assessment and treatment of individuals with vocal fatigue.
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http://dx.doi.org/10.1016/j.jvoice.2018.07.024DOI Listing
November 2019

Diagnostic evaluation of dysphagia in multiple sclerosis patients using a Persian version of DYMUS questionnaire.

Mult Scler Relat Disord 2017 Oct 1;17:240-243. Epub 2017 Sep 1.

Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Background: Multiple sclerosis is a chronic neurological disease that may cause swallowing disorders. Dysphagia is a common problem, which patients with different levels of disability may encounter, but it is usually underestimated; therefore, effective assessments need to be performed before any serious complications. The aim of this study was to identify the frequency and characteristics of dysphagia in multiple sclerosis patients of Khuzestan MS society, using a Persian version of Dysphagia in Multiple Sclerosis (DYMUS) questionnaire.

Method: 105 consecutive MS patients (84 F and 21 M, mean age 33.8 ± 8.5 years, mean disease duration 3.5 ± 3.1 years, mean Expanded Disability Status Scale (EDSS) 1.8 ± 1.3) participated in the study and the DYMUS questionnaire was administered by a trained speech therapist.

Results: The results have shown that 55 MS patients (52.4%) had dysphagia and the dysphagia was significantly associated with the disease course of MS (p = 0.02). However, significant associations between DYMUS values and EDSS, disease duration, age, and gender were not observed. (Respectively, p = 0.4, p = 0.09, p = 0.1, p = 1.0). In the dysphagia group, based on dysphagia severity, 17.1% and 35.2% of patients had mild and alarming dysphagia, respectively. Although, the patients with alarming dysphagia had longer disease duration, higher EDSS score and more with SP, PP and PR disease course than the patients with mild dysphagia, these differences were not significant.

Conclusion: The oropharyngeal dysphagia in MS patients is very common even in early stages of the disease; therefore, it is important to assess these patients carefully and to initiate a treatment program if needed.
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http://dx.doi.org/10.1016/j.msard.2017.08.012DOI Listing
October 2017

Voice Handicap Index in Persian Speakers with Various Severities of Hearing Loss.

Folia Phoniatr Logop 2016 17;68(5):211-215. Epub 2017 Jun 17.

Department of Speech Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran.

Objectives: The purpose of this study was to assess and compare the total score and subscale scores of the Voice Handicap Index (VHI) in speakers with and without hearing loss. A further aim was to determine if a correlation exists between severities of hearing loss with total scores and VHI subscale scores.

Patients And Methods: In this cross-sectional, descriptive analytical study, 100 participants, divided in 2 groups of participants with and without hearing loss, were studied. Background information was gathered by interview, and VHI questionnaires were filled in by all participants.

Results: For all variables, including mean total score and VHI subscale scores, there was a considerable difference in speakers with and without hearing loss (p < 0.05). The correlation between severity of hearing loss with total score and VHI subscale scores was significant.

Conclusion: Speakers with hearing loss were found to have higher mean VHI scores than speakers with normal hearing. This indicates a high voice handicap related to voice in speakers with hearing loss. In addition, increased severity of hearing loss leads to more severe voice handicap. This finding emphasizes the need for a multilateral assessment and treatment of voice disorders in speakers with hearing loss.
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http://dx.doi.org/10.1159/000455230DOI Listing
June 2017

A Comparative Study of Iranian Female Primary School Teachers' Quality of Life With and Without Voice Complaints.

J Voice 2016 Nov 4;30(6):688-692. Epub 2016 Mar 4.

Islamic Azad University of Kashan, Kashan, Iran.

Objectives/hypothesis: As the largest group of professional voice users, teachers are more likely to face voice disorders because of their specific job conditions. This study aimed to compare the quality of life in female teachers with and without voice complaints.

Study Design: This is a cross-sectional descriptive-analytical study.

Methods: This was a cross-sectional study of samples of primary school female teachers with (n = 60) and without (n = 60) voice disorders. All teachers were serving in Tehran, Iran. Professional background information was obtained through interviews, and quality of life was measured using the 36-item Short Form Health Survey questionnaire. A comparison was made between the study groups to analyze the data.

Results: The mean age of teachers was 44 (standard deviation = 3.95) years. There were no significant differences between the two groups regarding their professional background. However, significant differences were observed between the two groups in all subscales of the 36-item Short Form Health Survey, including physical and social functioning, role limitations because of either physical or emotional problems, bodily pain, general health, vitality, and mental health (P < 0.05).

Conclusion: Findings of this study point to the effect of voice complaint on quality of life and showed that teachers with voice complaints suffer from poor health-related quality of life. Therefore, both voice-specific and unspecific assessment methods are required for clinical diagnostics.
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http://dx.doi.org/10.1016/j.jvoice.2015.08.019DOI Listing
November 2016

Relationship Between Voice and Motor Disabilities of Parkinson's Disease.

J Voice 2016 Nov 22;30(6):768.e17-768.e22. Epub 2015 Dec 22.

Iran University of Medical Sciences (IUMS), Tehran, Iran.

To evaluate voice of Iranian patients with Parkinson's disease (PD) and find any relationship between motor disabilities and acoustic voice parameters as speech motor components. We evaluated 27 Farsi-speaking PD patients and 21 age- and sex-matched healthy persons as control. Motor performance was assessed by the Unified Parkinson's Disease Rating Scale part III and Hoehn and Yahr rating scale in the "on" state. Acoustic voice evaluation, including fundamental frequency (f0), standard deviation of f0, minimum of f0, maximum of f0, shimmer, jitter, and harmonic to noise ratio, was done using the Praat software via /a/ prolongation. No difference was seen between the voice of the patients and the voice of the controls. f0 and its variation had a significant correlation with the duration of the disease, but did not have any relationships with the Unified Parkinson's Disease Rating Scale part III. Only limited relationship was observed between voice and motor disabilities. Tremor is an important main feature of PD that affects motor and phonation systems. Females had an older age at onset, more prolonged disease, and more severe motor disabilities (not statistically significant), but phonation disorders were more frequent in males and showed more relationship with severity of motor disabilities. Voice is affected by PD earlier than many other motor components and is more sensitive to disease progression. Tremor is the most effective part of PD that impacts voice. PD has more effect on voice of male versus female patients.
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http://dx.doi.org/10.1016/j.jvoice.2015.10.022DOI Listing
November 2016

Temporal characteristics of nasalization in Persian speaker children with and without cleft palate.

Int J Pediatr Otorhinolaryngol 2015 Apr 30;79(4):546-52. Epub 2015 Jan 30.

Faculty of Paramedical Sciences, Mashad University of Medical Science, Mashhad, Iran.

Objectives: The purpose of this study was to measure and compare temporal patterns of nasalization in Persian children with and without cleft palate in three vowel contexts.

Methods: A Sample of 14 children with repaired cleft palates with or without cleft lip with moderate to severe hyper nasality and 14 children without cleft palate was chosen as subjects. The subjects were chosen from the ages of 4 to 12 years. The nasal onset interval, nasal offset interval and total nasalization duration were obtained from acoustic waveforms and spectrograms in three vowel contexts using Praat Software. For eliminating the effect of different speed of speech in the cleft palate group and control group, the ratio of nasalization duration was calculated.

Results: Total nasalization duration are demonstrated by acoustic signals which shows the total significant different temporal patterns in children with cleft palate and without cleft palate and across the vowel contexts (P<0.000).

Conclusions: Longer nasalization durations in children with cleft palate in comparison to children without cleft palate show the delayed or deviant temporal patterns in children with cleft palate. The duration of nasalization reflecting temporal patterns of the oral-nasal acoustic impedance in children with cleft palate may have an influence on the perception of hyper nasality.
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http://dx.doi.org/10.1016/j.ijporl.2015.01.026DOI Listing
April 2015

Voice-related disability of Iranian patients with temporomandibular disorders.

J Voice 2014 Nov 28;28(6):841.e17-20. Epub 2014 Aug 28.

University of Tehran, Tehran, Iran.

Introduction: The relationship between handicaps because of voice disorders and temporomandibular disorders (TMDs) severity was examined.

Method: Fifty-two Persian women with temporomandibular disorder (TMD) were examined by two dentists in separate sessions and the assessment protocol of the Dentistry Clinic of Tehran University of Medical Sciences was filled by both dentists and finally they gave their opinion separately about the existence of TMD and categorized the severity of TMD as mild, moderate, and severe. To assess perceived disability resulting from voice disorders in TMD patients, the voice handicap index (VHI) questionnaire was used.

Results: The total score of VHI in 80.8% of patients with TMD was equal to or more than 14.5. A significant positive relationship was found between the severity of TMD and the total score of VHI (P = 0.000, r = 0.79).

Conclusions: It seems that a comprehensive voice assessment should be included in the evaluation of TMD, and considering different effects of voice disorders on patients' lives, a complete voice evaluation including voice-related disability is necessary to understand the nature of pathophysiology of TMD.
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http://dx.doi.org/10.1016/j.jvoice.2014.04.001DOI Listing
November 2014

Cross-cultural adaptation and validation of the voice-related quality of life into Persian.

J Voice 2014 Nov 5;28(6):842.e1-9. Epub 2014 Jul 5.

Department of Speech Therapy, University of Social Welfare and Rehabilitation Science, Tehran, Iran.

The purpose of this study was to adapt and determine reliability, validity, and responsiveness of voice-related quality of life (V-RQOL) for Persian. A total of 300 patients with voice disorders participated in the study. Also, 116 people without any voice disorders volunteered to participate in the study as a control group. All participants filled in the Persian version of V-RQOL. The reliability, validity, and responsiveness were studied. Results demonstrated that the discrimination coefficient is significant for all items. The V-RQOL measure showed a strong internal consistency (Cronbach alpha coefficient = 0.88-0.91) and a good test-retest reliability (r = 0.93-0.95). Pre- and post-treatment results showed a significant responsiveness (functioning, 0.000; social-emotional, 0.001; and total, 0.000). Effect size range of 1.26-1.59 and the standardized response mean range of 1.07-1.41 were obtained for V-RQOL. It seems that the Persian version of V-RQOL is valid, reliable, and responsive to change, and this questionnaire can be used for completing voice evaluation for patients with dysphonia.
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http://dx.doi.org/10.1016/j.jvoice.2014.03.013DOI Listing
November 2014

Intrarater and interrater reliability of sagittal head posture: a novel technique performed by a physiotherapist and a speech and language pathologist.

J Voice 2014 Nov 18;28(6):842.e11-6. Epub 2014 Jun 18.

Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Introduction: Different professionals such as speech and language pathologists and voice scientists are involved in the evaluation of head and neck posture. Therefore, a reliable, time-efficient, and precise method of posture assessment is essential for use in clinical and research settings. Photogrammetry is one of the most commonly used methods to assess head and neck posture. The objectives of this study were to evaluate the intrarater reliability of the method with a large sample size and the interrater reliability by two different specialists (a physiotherapist and a speech and language pathologist).

Method: A total of three hundred four subjects (144 males and 160 females) aged between 18 and 28 years participated in the study. During the test session, a photograph was taken of the left-side profile of each subject in their ordinary and comfortable position. The head posture angle of each picture was calculated by two raters. The whole procedure was repeated in a retest session, 24 hours later. A total number of eight analyses were performed for each subject. The reliability was evaluated at several stages hierarchically and after confirming the reliability in each step, the next step was investigated. Paired t tests on the differences of scores obtained at all the aforementioned stages were used to ensure the absence of any systematic bias. To assess the reliability, intraclass correlation coefficients (ICCs) and the standard error of measurements (SEMs) were calculated.

Results: There was no significant difference between the mean values of the test and the retest angles at any stage of calculating the head posture angle in both pictures by both examiners (P > 0.05). The ICC and SEM values calculated for all stages were between 0.86-0.97 and 0.52-1.53, respectively.

Conclusion: Systematic bias has not occurred at any stage. The ICC and SEM values calculated have demonstrated that there were appropriate relative and absolute reliabilities in all stages. This method is suggested to be used simply in research and clinical areas by different specialists.
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http://dx.doi.org/10.1016/j.jvoice.2014.02.014DOI Listing
November 2014

Assessment of hypernasality for children with cleft palate based on cepstrum analysis.

J Med Signals Sens 2013 Oct;3(4):209-15

Department of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran.

Hypernasality is a frequently occurring resonance disorder in children with cleft palate. In general, an operation is necessary to reduce the hypernasality and therefore an assessment of hypernasality is imperative to quantify the effect of the surgery and design the speech therapy sessions, which are crucial after surgery. In this paper, a new quantitative method is proposed to estimate hypernasality. The proposed method used the fact that an autoregressive (AR) model for vocal tract system of a patient with hypernasal speech is not accurate; because of the zeros appear in the frequency response of the vocal tract system. Therefore in our method, hypernasality was estimated by a quantity calculated from comparing the distance between the sequences of cepstrum coefficients extracted from AR model and autoregressive moving average model. K-means and Bayes theorem were utilized to classify the utterances of subjects by means of proposed index. We achieved the accuracy up to 81.12% on utterances and 97.14% on subjects. Since the proposed method needs only computer processing of speech data, compared with other clinical methods it provides a simple evaluation of hypernasality.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3967423PMC
October 2013

Long-term average spectra of adult Iranian speakers' voice.

J Voice 2014 May 13;28(3):305-10. Epub 2013 Nov 13.

Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Introduction: Long-term average spectrum (LTAS) allows quantifying the voice quality and provides an overview of the mean spectral characteristics of a voice. The aims of this study were to survey normal spectral characteristics of Persian and investigate sex-related changes in the source characteristics of dynamic speech using LTAS.

Method: Speech samples obtained from 30 male and 30 female Persian-speaking participants reading a text in habitual pitch and loudness level. At the LTAS window and using Praat software, the amplitude values were obtained at equal intervals of 160 Hz, ranging from 0 to 8 kHz.

Results: The main features of the average spectrum were as follows: peak in the region of 480 Hz with a reduction at higher frequencies, a 20 dB decline from 480 to 960 Hz, a flat region from 960 to 1920 Hz, a further decline from 1920 to 3040 Hz, and a further flat region from 3040 to 8000 Hz. In comparison to men, women revealed significant lower levels of amplitude at frequencies of 160 and 320 Hz and higher levels of amplitude at frequencies of 960, 3360, 3520, 3680, 3840, and 5920 Hz.

Conclusion: The overall shape and gender-related energy distribution pattern of the LTAS of Persian were more similar to those of English than to those of Korean. The more phonetic differences between Persian and Korean compared with Persian and English might contribute to different spectral characteristics. The present study tried to clarify the spectral characteristics of Iranian male and female voices and focused on more breathy voice quality for women than men.
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http://dx.doi.org/10.1016/j.jvoice.2013.09.002DOI Listing
May 2014

Relation between Voice Handicap Index (VHI) and disease severity in Iranian patients with Parkinson's disease.

Med J Islam Repub Iran 2012 Nov;26(4):157-63

MSc of speech and language pathology, Department of Speech Therapy, Jundishapur University of Medical Sciences, Ahvaz, Iran.

Background: One third of patients with Parkinson's disease (PD) have mentioned "dysphonia" as their most debilitating communication deficit. Patient-based measurements, such as Voice Handicap Index (VHI) add necessary supplementary information to clinical and physiological assessment. There are a few studies about relation between VHI and disease severity in PD, although none of them showed any significant correlation. The goal of this study was to find correlation between these variables in Iranian PD patients.

Method: This cross-sectional, analytical and non-interventional study was done on 23 PD patients who reported a voice disorder related to their disease. They were selected from attendants of movement disorders clinic of Hazrat Rasool Akram Hospital. The relationship between disease severity (according to Hoehn and Yahr/H&Y and Unified Parkinson's Disease Rating Scale-part3 /UPDRS-III) and VHI questionnaire (and its 3 domains) was investigated based on patients' sex, UPDRS-III score H&Y and VHI.

Results: Total VHI and its 3 domains had no relationship with disease severity (H&Y) in all patients and by sex separation. However, there was a positive correlation between VHI and disease severity (UPDRS-III) (r = 0.485). There was also a relation between physical and functional domains of VHI and UPDRS (rP=0.530, rF=0.479) while no relationship observed regarding sex differences. 9 out of 18 UPDRS-III items had strong relationship with VHI (total and 3subscales).

Conclusion: Iranian PD patients feel handicap according to voice disorder caused by PD. Patient satisfaction of voice decreases with the disease severity and progression. A larger sample size is necessary to find relationship in genders. VHI is an important issue could be offered to be used in PD beside other assessments.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3562535PMC
November 2012

Cross-cultural equivalence and evaluation of psychometric properties of voice handicap index into Persian.

J Voice 2013 Mar 29;27(2):258.e15-258.e22. Epub 2012 Dec 29.

Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Quality of life is one of the important aspects in the assessment of health and treatment data output. The purpose of this study was to adapt and determine reliability and validity of Voice Handicap Index (VHI) in Persian. The subjects were 80 patients with voice disorders and 80 volunteers without any voice disorders as a control group. All subjects filled in the Persian version of VHI. The test was repeated 2 weeks later. The reliability and validity were studied. All items had significant discrimination coefficient. The internal consistency and reliability of test and retest in VHI total score and three subtests were achieved. It seems that the Persian version of VHI is a valid and reliable questionnaire, which voice therapists may use for completing their evaluation for patients with voice disorders, and it gives more information about the nature of voice disorder to specialists.
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http://dx.doi.org/10.1016/j.jvoice.2012.09.006DOI Listing
March 2013

Cutoff point at voice handicap index used to screen voice disorders among persian speakers.

J Voice 2013 Jan 22;27(1):130.e1-130.e5. Epub 2012 Nov 22.

Department of Speech Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran.

Purpose: This study aimed to determine the cutoff point at Voice Handicap Index (VHI) as a diagnostic tool in the process of voice disorder assessment. It further surveyed a correlation between diagnosis made by speech specialist and a corresponding opinion reported by client on the existence/nonexistence of any voice disorder.

Method: A sample of 160 individuals who completed the VHI questionnaire were assigned to clinical and nonclinical groups. They were asked about the opinions of their voices on a Likert scale.

Results: A correlation was found between the specialists' diagnosis and clients' opinion on their own voices (r=0.882); however, this was reduced (r=0.717) when a mild voice disorder existed among the nonclinical group. The cutoff point, at which VHI sensitivity (for screening subjects with and without normal voices) reached its maximal value (92%) and its highest level of specificity (95%), was observed to be 14.5.

Conclusion: Occasional incompatibility between specialists' diagnoses and that of clients' opinion about existence/nonexistence of voice disorders within the individuals should be considered significant. Also, a score of 14.5 can be accepted as the cutoff point at VHI (Persian version) in the voice disorder assessment process.
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http://dx.doi.org/10.1016/j.jvoice.2012.08.007DOI Listing
January 2013