مجله پژوهش در علوم توانبخشی
سال هشتم شماره 7 (1391)

Stuttering is a disruption in the fluency of speech that affects various aspects of human communication. Unhelpful thoughts and beliefs about stuttering are linked to the cognitive aspect of anxiety. Such beliefs can cause or exacerbate social anxiety in people who stutter. Early detection and treatment of such thoughts and beliefs may reduce the severity of social anxiety. The purpose of this study was to investigate the frequency of unhelpful thoughts and beliefs about stuttering and their correlation with anxiety and depression.

52 adults who stuttered were asked to complete the Unhelpful Thoughts and Beliefs about Stuttering (UTBAS), Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI-II) questionnaires and the results were analyzed using descriptive statistics and Spearman correlation test.

Unhelpful thoughts and beliefs (such as feeling an inner compulsion to control stuttering, fearing that stuttering may occur at any moment and assuming that the others will attend to stuttering) was found with varying degrees in all people who stutter. These thought correlated positively and significantly with anxiety (r = 0.55, P < 0.01) and depression (r = 0.46, P < 0.01).

There is a relationship between unhelpful thoughts and beliefs and the signs of anxiety and depression. Also the positive correlations between these behaviors indicate the importance of the attention to early signs of these thoughts and early treatment of mental health disorders in people who stutter.

Reaching ultimate therapeutic goals in rehabilitation discipline (especially, in speech therapy) requires a long-term process. Having through knowledge about the level of clients’ satisfaction may, thus, be important in achieving and maintaining treatment goals. The aim of this investigation was to evaluate and compare clients’ satisfaction with governmental and private speech therapy clinics offering speech therapy services in Ahvaz, Iran. In this cross-sectional comparative study, 425 subjects were randomly selected from all the clients who had attended at least 5 seasons at either governmental or private speech therapy clinics of Ahvaz city. The data was collected through face-to-face or by phone interviews and the level of participants’ satisfaction was calculated based on a 0-to-100 point scale. Statistical analysis was conducted using SPSS software (version 15). The mean score of clients satisfaction with private clinics (71.4 ± 0.91) was higher than those with governmental clinics (69.6 ± 5.16) and this difference was significant (P = 0.038). The satisfaction levels of private clinics’ clients with the quality of physical situation of the clinic (P = 0.001), therapeutic services (P = 0.018), and staffs’ communication style (P = 0.008) was higher than the clients of governmental clinics. In contrast, the satisfaction level of governmental clinics’ clients with time-location accessibility (P = 0.010) and financial issues (P = 0.015) was higher than the clients of private clinics. Clients’ total satisfaction of private speech therapy clinics was significantly higher than that of governmental clinics of Ahvaz city. Thus, for quantitative and qualitative improvement of governmental clinics, supervisory staff should pay attention to quality of therapeutic services, staffs’ communication style and physical environment of clinics.

Teachers comprise the largest group of professional voice users. It seems that they are more susceptibleto voice disorders than other groups of users. The purpose of this study was to determine and comparethe maximum phonation times (MPTs) offemale elementary-school teachers with and without voice complaint. It was also aimed at determining the effect of age and teaching experience on the MPT in this population. Eighty female teachers, who participated in this cross-sectional descriptive- analytical study, were divided into two group’s ofsubjects with and without voice complaints. After takingeach subject’s historythrough interviewing, allparticipants were asked to take a deep breath and sustainthe vowel /a/ for as long aspossible. Theywere requested to repeatthis task three times with 1-minute restintervals between the trials.Thelongest durationwas considered as the maximum phonation time. Themean of MPT in group with voice complaints (88.2 ± 88.12) was significantly differentfrom that of subjects without any voice complaints (17.3 ± 97.15) (P > 0.05). Moreover, age and teaching experience hada significant negative correlation with MPT in both groups. The results of this study indicated that as the age and teaching experience increased, the mean of MPT reduced in all subjects regardless of having any voice complaint or not. Also, the mean of MPT was significantly lower in the group with a voice complaint than in the group without it.

Voice disorders, in general,have various psychological, physiological, anatomical andfunctional causes and may result inthe disruption ofdifferent aspects of the affected individual’s daily life. Considering the fact that people’s personality, occupation and perception ofa disorder can affect the quality of their lives;the aim of this study was to investigate the effect ofvoice disorders’ symptoms on patients’ life quality. The participants in this study were 40 patients suffering from variousvoice disorders, who were referred to the speech therapy clinics.After obtaining voice samples through asking the subjects to sustain the vowel /a/ for ten seconds; theVHI test was completed by them. The voice sampleswere analyzedvia the inbuilt Dr.Speech’ssoftware, Voice Analyst.The calculated mean values of acoustic parameters were then statically compared with the VHI test scoresvia Pearson’s correlation coefficient using SPSS software. There was a significant relationship between both signal-to-noise ratio and harmony-to-noise ratio acoustic parameters and all obtained the scores of VHI test. Also, the standard deviation of the fundamental frequency and the scale’stotal score, the physical and functional subscales scores, andthe total as well as the physical subscale scoresand the acoustic parameter of shimmer was significantly correlated. In this study, there was either no significant or, at best, a week correlation between VHI scores and measured acoustic values. This is probably due to those factors affecting patient’s attitude toward disability including his/her personality, pervious experience regarding voice functions, occupational and social status, and disorder’s course of progress.

Children with cleft palate have limited consonant inventories with compensatory articulation (CA) errors that are considered as the primary concern for this group of children because these errors can affect early language development. Early intervention (EI) is needed to increase normal speech production and to minimize the development of CAs. As there is no study on the effectiveness of EI for children with cleft palate in Iran, this study aimed at examining the impact of an early intervention, which involved focused stimulation method, on the speech of this group of children. This clinical trial study with single subject design targeted four children with cleft palate. Their language samples were collected before and after intervention and each time, were transcribed by two independent transcribers to obtain three speech measures, namely, percent consonant correct (PCC), percent of compensatory errors and consonant inventory. All children had compensatory errors in their speech. The intervention method was “focused stimulation” which was taught to the mothers. The mothers practiced this method with their children at home. The second set of language sampling was conducted two months after the first assessment. The inter-rater reliability showed a high correlation between two independent transcriptions in most measures. As results indicated, the percent of correct consonant did not change by the intervention. No significant differences regarding the percent of compensatory errors were found in children before the initiation and after the termination of intervention in spite of some increases. Increase in consonant inventory was approximately significant. Although the changes were not significant after the intervention, children increase their consonant inventory and reduce their compensatory errors following the intervention. The findings of this study indicate that if this study replicated with a larger sample and/or with a longer period of intervention, it might lead to more significant changes. The results indicate that early intervention program in children with cleft palate may lead to improvement of speech and can prevent the establishment of compensatory errors.

Speech production involves planning, programming and implementation phases for which several specific regions of cerebrum are responsible. Deficits in these steps can be manifested in disorders of speech production and Diadochokinesis. Diadochokinetic tasks are used in assessment and management of speech disorders such as dysarthria and cerebella impairments. The aim of this research was to assess and determine Diadochokinetic performances of 7 to 9-year-old students studying at primary schools of Kermanshah, Iran.

In this cross-sectional descriptive and analytic study, 210 students (105 females, 105 males) were randomly recruited from the elementary schools of Kermanshah province and then were equally divided into three age groups (7, 8 and 9-year olds). Students had to repeat one syllable consisting of a consonant and a vowel twenty times to determine their production rate.

The result showed that the average times of repeating one syllable for 7, 8 and 9-year old children were 5.05, 4.68 and 4.47 seconds respectively.

This study showed that age and the type of vowel used in the assessment can affect Diadochokinetic skills and that the results of such assessments should be incorporated in diagnosis and treatment of articulation disorders.

Unlike the afferent system, there is a paucity of data regarding the role of efferent hearing system in different aspects of language processing such as phonological processing. The purpose of this study was to evaluate the efferent hearing system in children with phonological disorders. In this study, 20 children with normal hearing, of both genders, who aged between 5 and 8 years were divided in to two groups of children without phonological disorders (n = 11, comprising the control group) and those with phonological disorders (n = 9, serving as the study group). The study included only those children whose hearing thresholds were below or equal to 15 dB, had a type tympanometry and their acoustic reflexes were present. TEOAE and TEOAE suppression were carried out to evaluate the function of the medial olivocochlear system in both groups. There was no significant difference in the analyzed frequencies when the control and study groups were compared according to the mean effects of suppressive TEOAE. Children with phonological disorders do not show any alterations in the medial olivocochlear system.

Formant frequencies change as a function of articulatory movements and also of changes in the configuration of the vocal tract. Hearing-impaired people produce vowels with the limited vertical range and reduced arc of tongue which can lead to vowel formant centralization. The current study aimed at comparing formant frequencies of the vowels /a/, /i/and /u/ in children with varying degrees of hearing loss and their normal counterparts. The participants of this descriptive-analytic study were 80 normal and Hearing-impaired students (with moderate, moderate-to-severe, severe and profound degrees of hearing loss). The examinees were asked to produce the vowels /a/, /i/, /u/ for three times. The audio files were transferred to Praat software (version 13.3.5) for recording formants frequencies. One-way ANOVA followed by the post hoc test, Dunnett’s t, was applied for comparing the controls and subjects with hearing loss and the post hoc test, Duncan, was used for comparing the subgroups of hearing-impaired subjects. Comparing the control and hearing-impaired groups, the F2 of vowels /a/ and /i/ had significant difference while the F1 of these vowels did not show any difference (considering F2a, the p values were as follows: control group- moderate group: P = 0.031, control group- moderate to severe group: P = 0.015, control group- severe group: P = 0.023, control group- profound group: P < 0.001 and considering F2i: control group- moderate group: P = 0.005, control group- moderate-to-severe group: P < 0.001, control group- severe group: P < 0.001, control group- profound group: P < 0.001). Among the subgroups of subjects with hearing loss, however, the F1u showed the largest differences. It was revealed that F2of vowels /a/, /i/ had greater ability for distinguishing abnormal from normal speech than the F2u and F1of /a/, /i/, /u/. It seems that the measuring F2of the vowels /a/ and /i/ can offer a new approach for faster and more accurate diagnosis and assessment of vowel impairments in hearing- impaired children.

Teachers comprise the largest group of professional voice users whose specific occupational circumstances makethem more susceptible to voice disorders than other professional groups. The purpose of this study was to determine and compare the acoustic characteristics of female elementary-school teachers with and without voice complaint. In this cross-sectional descriptive- analytical study, eighty female teachers working at primary schools of Tehran, Iranwere divided into two groups of subjects with and without voice complaints. After collecting case history data through interviewing, each subject underwent acoustic assessment during which they were requested to prolong the vowel /a/ for three times. Mean fundamental frequency, jitter, harmony to noise ratio, and shimmer were calculated via Praat software (version 5.3.13), and the two groups were statistically compared. There was no significant difference between teachers who had and had not voice complaintsregarding all above- mentioned variables (P > 0.05). The results of this study indicated that there was no necessarysignificant difference between acoustic measurementsof subjects who had any voice complaint and those who had not. In other words, acoustic characteristics cannot differentiate between these two groups implying a need for studying other acoustic assessment approaches and indices such as DSI.

Stuttering is a communication disorder which includes primary and secondary behaviors. For the assessment, diagnosis and appropriate treatment of stuttering, these two kinds of behaviors should be given sufficient attention. A potential problem in generalizing and maintaining the treatment goals in people who stutter is inappropriate attitudes that may have been prevailed over them through the long periods of experiencing stuttering. For this reason, identifying these attitudes and trying to change them has a major role in the treatment of stuttering. The purpose of this study was to introduce tests to assess the attitude of people with stuttering.

For a complete and comprehensive access to the attitude assessment instruments in people with stuttering, searching was performed in different databases, books and thesis that were in accordance with the objects of this study. In the next stage, after reviewing the tests, those features that were necessary for the introduction of each test to readers were determined.

After reviewing the results, 22 tests were found in the field of assessing attitudes in people with stuttering. Ten tests were related to assessing the attitudes of children, and remaining was related to assessing adults in this regard. These tests are listed in separated tables for more convenient comparisons. Some tests had significant characteristics that will be described.

According to the results of the present paper, it can be stated that attitude assessment is an important step in the treatment process of stuttering. This issue needs to be more attended to by speech and language pathologists.