Elina Isotalo

Voice Activity and Participation Profile in Assessing the Effects of Voice Disorders on Quality of Life: Estimation of the Validity, Reliability and Responsiveness of the Finnish Version

Aim: The purpose of this study was to evaluate the validity, reliability and responsiveness of the Finnish version of the Voice Activity and Participation Profile (VAPP), a self-assessment questionnaire to measure psychosocial limitations caused by voice disorders. Methods: The study was conducted in Tampere University Hospital in 2004 and 2005. Voice patients (n = 142) with diverse chronic voice pathologies received 3–5 sessions of voice therapy. Controls were known individuals with healthy voices (n = 127). The VAPP form was completed before attending hospital, at the first visit to hospital and before and after voice therapy. Results: When comparing patients with healthy controls significant differences were found in score means. After brief voice therapy, the VAPP values improved moderately as 60% of patients had effect size of 0.27 or over. Physicians’ advice did not improve VAPP scores. The VAPP question profile was regarded as consistent. Cronbach’s alpha for the question profile was 0.958 and for the subsections 0.865. Conclusions: VAPP appeared to be valid and responsive to the intervention. In test-retest reliability, although intraclass correlation was high (0.905), there was a trend for the second answers to be better than the first. Some proposals are given to improve the practicality of the VAPP form.

Association between school performance, breast milk intake and fatty acid profile of serum lipids in ten-year-old cleft children.

The fatty acid profiles of serum lipids were examined in 53 ten-year-old cleft children. The children presented with different cleft types (cleft lip, cleft lip and palate, isolated cleft palate and submucuous cleft palate) and were recruited from the Finnish Cleft Center. We also studied associations between serum lipid fatty acids and early breast milk intake, cognitive development in terms of preschool language learning and school achievement. The fatty acid profiles of serum lipids did not differ between boys and girls. The proportion of myristic acid in serum cholesteryl esters (CE) was higher and proportion of nervonic acid in phospholipids (PL) lower in children with isolated palatal clefts than in those with submucuous clefts. Out of the present children, 30% and 60% received breast milk less than 1 or 3 months, respectively. The proportions of docosahexaenoic acid in CE and in PL were significantly higher in the children whose breast milk intake was longer than 3 months. The number of children requiring special education was higher among those who received breast milk less than 1 month than among those with longer breast milk intake. In conclusion, the fatty acid profiles of serum lipids seem to be comparable among children with different cleft types. Short breast milk intake was associated with poorer school performance.

Speech in 6-year-old children with submucous cleft palate.

Speech in 83 children (in total) with sub-mucous cleft palate was evaluated at the age of 6 years. Velopharyngeal insufficiency was graded on the basis of perceptual assessment, taking into account the co-existence of various velopharyngeal insufficiency characteristics in speech. Out of 56 patients operated with a velopharyngeal flap to eliminate velo-pharyngeal insufficiency, 42 of them (75%) achieved normal velopharyngeal function in speech. Dento-alveolar misarticulations were found in 35% of the children. Misar-ticulations occurred independently of velopharyngeal insufficiency.

Speech aerodynamics and nasalance in oral cancer patients treated with microvascular transfers.

The purpose of the current study was to assess speech aerodynamics and nasal acoustic energy during a follow-up period of 12 months in patients having undergone microvascular free flap reconstruction after tumor ablation from the oral cavity or oropharynx, usually followed by radiotherapy. Velopharyngeal function was assessed in terms of velopharyngeal orifice size by a pressure-flow measurement technique as well as by determining the instrumental correlate of perceived nasality (i.e., nasalance) during speech production. Velopharyngeal closure and nasalance were estimated to be adequate before operation both in oral cavity and oropharyngeal cancer patients. After the operation, at the group level, the oral cavity patients showed adequate velopharyngeal closure and nasalance. In contrast, the postoperative velopharynx orifice size was significantly bigger in the oropharyngeal cancer patients as compared with the oral cavity patients 6 months after operation. However, based on average aerodynamic as well as the nasalance data, the impairment of velopharyngeal function was not regarded clinically significant at the group level in either group of patients. The present treatment protocol served to maintain the prerequisites for normal or close to normal speech physiology.

Oculomotor findings mimicking a cerebellar disorder and postural control in severe Meniere's disease.

OBJECTIVE We explored whether vestibular derangement in patients with severe Menieres disease is related to gaze and fixation difficulties and could explain complains of visual blurring and visual neglect. METHODS Twenty-six patients with severe Menieres disease treated with intratympanically applied gentamicin of the affected ear were examined. Saccades (with pseudo-random timing, size and side of the step) and pursuit eye movements (PEMs; pseudo-random target trajectory made of a combination of two sinusoidal waves of different frequencies) and posturography were tested in patients. For normative data of voluntary eye movements, 45 control subjects were tested, and for posturography 29 control subjects. Severity of symptoms in Meniere patients was assessed according to the total handicap score of AAO-HNSF (1985). RESULTS Saccadic eye movements and postural stability were severely deteriorated in Meniere patients, and these disturbances correlated significantly with each other. Most of PEM parameters were significantly worse in Meniere patients than in control subjects. Prolongation of saccadic latency and reduced gains due to saccadization in PEMs were characteristic features for Menieres patients. Severity of symptoms in Meniere patients correlated with prolongation of latency in saccades and with poorer gains in PEMs. Postural instability measured with posturography correlated with saccadic latency and PEMs. CONCLUSION In severe Menieres disease, programming of oculomotor and postural responses show the same pattern of disturbance, an increased delay of processing and inaccuracy in the motor output. A fluctuant vestibular lesion with advanced severity can cause disorders of voluntary eye movements that are reflected with clinical complaints of difficulties in reading and visual scanning of surrounding.

SPEEDY babies: A putative new behavioral syndrome of unbalanced motor-speech development

Even though difficulties in motor development in children with speech and language disorders are widely known, hardly any attention is paid to the association between atypically rapidly occurring unassisted walking and delayed speech development. The four children described here presented with a developmental behavioral triad: 1) atypically speedy motor development, 2) impaired expressive speech, and 3) tongue carriage dysfunction resulting in related misarticulations. Those characteristics might be phenotypically or genetically clustered. These children didn’t have impaired cognition, neurological or mental disease, defective sense organs, craniofacial dysmorphology or susceptibility to upper respiratory infections, particularly recurrent otitis media. Attention should be paid on discordant and unbalanced achievement of developmental milestones. Present children are termed SPEEDY babies, where SPEEDY refers to rapid independent walking, SPEE and DY to dyspractic or dysfunctional speech development and lingual dysfunction resulting in linguoalveolar misarticulations. SPEEDY babies require health care that recognizes and respects their motor skills and supports their needs for motor activities and on the other hand include treatment for impaired speech. The parents may need advice and support with these children.

Hemangioblastoma and Oculomotor Pathology

We examined voluntary eye movements of 20 ophtalmologically screened patients (mean age of 51 years) with operated hemangioblastoma (HAB) in the cerebellum. Constant and pseudo-random saccades and pseudo-random smooth pursuit eye movement (PRPEM) test (with 4 frequency combinations) were evaluated. As controls 38 healthy subjects were examined. In the logistic regression analysis latency and accuracy of constant saccades were the best predictors for operated HAB with correct overall classification rate of 79.3%. Accuracy was worse and latency longer in operated HAB group than in control group. In pseudo-random saccades correct classification between the groups was achieved in 82.8% of all cases with latency and accuracy as predictors. In PRPEM test the best frequency combinations in differentiating operated HAB patients from controls were 0.25 and 0.425 Hz for gain, and 0.3 and 0.7 Hz for phase and gain, the correct overall classification rate being 73.3% in both cases. The characteristic changes in voluntary eye movements after removal of cerebellar hemangioblastoma seem to be insufficient timing of initiating the eye movement.

Somatosensory-evoked magnetic fields in examining lip area in speech-disordered children.

Magnetoencephalography (MEG) is a modern neurophysiological method to study brain activation after sensory stimulation. We aimed at determining the feasibility of MEG and somatosensory-evoked magnetic fields (SEFs) in assessing the lip area in speech-disordered children undergoing oral plate therapy (OPTH) to improve their articulation. Seven subjects (age range, 6-11 years) participated in the study. The speech was perceptually assessed, and the SEFs to tactile stimulation of the lip area were recorded before and after OPTH. Two patients did not attend the posttreatment MEG recording. Clinical perceptual analysis showed remarkable improvement of speech of the studied children after OPTH. Somatosensory-evoked magnetic fields were successfully recorded in 4 of these children, but no constant changes in the responses were found after the therapy. With this small number of patients, the possible modifications in the functioning of the cortical somatosensory area of the lip after OPTH remained undetected. The present method is, however, technically applicable in studying cortical responses to lip stimulation in speech-disordered children. Further studies using stimulation inside the mouth may provide more insight to the cortical effects of OPTH.