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PubMed2005

[Contribution of day care general anaesthesia for dental care in children and handicapped patients].

Dental surgeons, pediatrists and doctors daily note the precocity and the importance of caries in children. This evolution makes essential the general anaesthesia in paediatric dentistry among the therapeutic arsenal of pedodontists. Fortunately, with the greatest knowledge of the child physiology, the better control of the anaesthetic operative protocols, general anaesthesia is very efficient. Furthermore, the development of the day care treatment now allows the access of these treatments to an increasingly large public. For pedodontists and anaesthetist, generals anaesthesia is essentially indicated for children with many decays, presenting behaviour disorders, a physical or cerebral handicap, a turmoil engraves general state. This operating mode aims to restore: This particular aspect of the dental practice remains still too little developed and cannot answer the demands. The necessity made it a rule to set up a theoretical and practical training. This specialized dentistry waits for recognition on behalf of supervisory organisms and a similar message spread by all nursing persons.

Anesthesia, General↗
PubMed2006

Pediatric Voice Handicap Index (pVHI): a new tool for evaluating pediatric dysphonia.

PURPOSE: The Voice Handicap Index (VHI) is widely used and accepted into adult clinical practice. The present study was initiated to adapt the VHI to the pediatric population and to validate it in the form of a parental proxy. METHODS: The initial modification of the adult VHI involved changing the language of the statements to reflect a parent's responses about their child and eliminating questions that would not relate to children. It was administered in conjunction with 10 open-ended questions regarding the impact of the child's voice quality on overall communication, development, education, social and family life. The pVHI was then modified in content and language, and the final 23-item parental proxy product was used for the validation process. The modified pVHI was administered to two groups of patients following IRB approval from Cincinnati Children's Hospital Medical Center. RESULTS: Normative data was obtained from 45 parents of healthy children. The group consisted of 21 males, age ranges 3-12 years old. The mean scores of the total pVHI and its subscales are: functional (F) 1.47, physical (P) 0.20, emotional (E) 0.18 and total (T) 1.84. The test group consisted of 33 guardians of children presenting for a voice evaluation pre- or post-laryngotracheal reconstruction. This group differed greatly from the control group on each subscale and total score. The mean scores of the airway group were as follows: F 13.94, P 15.48, E 12.15 and T 41.58. Test-retest reliability of the total pVHI score was measured using Pearson's correlation coefficient. The scores were 0.95, 0.77, 0.79 and 0.82, respectively. A correlation matrix for pVHI subscore and total score showed significance, with results similar to those reported for the original adult VHI. CONCLUSIONS: The aim of the present study was to modify the VHI to serve a similar role in the evaluation of the effects of dysphonia on the pediatric population. The statistical results reveal a high correlation between the VHI and the pVHI. The pVHI provides a high internal consistency and test-retest reliability. This tool will be utilized to follow a child's development following surgical, medical and behavioral interventions.

Adolescent↗
PubMed2006

Modelling and estimation of valuations for the Dutch London Handicap Scale.

This paper presents a study to estimate a preference-based participation index from the Dutch London Handicap Scale (LHS) classification system that can be applied to past or future Dutch LHS data sets. A subset of 60 states were valued by a representative sample of 285 respondents of the Dutch general adult population. Different models were estimated for predicting health state valuations for all 46,656 states defined by the LHS. Several criteria were used for comparison of the different models and for arguing which one is the most preferred model to use. Our data showed that using the English index would give systematic errors for the Dutch population preferences.

Adult↗
PubMed2005

Voice handicap index results for older patients with adductor spasmodic dysphonia.

Adductor spasmodic dysphonia (ADSD) adversely affects a speaker's ability to effectively communicate. For many individuals suffering with ADSD, botulinum toxin (Botox) is the chosen treatment to remediate the symptoms. Although Botox's effects on symptom remediation have been examined before, patient perception of improvement post-Botox has been examined less frequently. Further, no studies have addressed the symptomatic changes in older adults that occur after Botox treatment. The Voice Handicap Index (VHI) was used as the instrument to assess older patient's (>65 years) perception of how ADSD impacts certain areas of their life pre- and post-Botox injection. The outcome of the VHI was related to a clinical judgment of voice severity. Participants also completed the Social Readjustment Rating Scale (SRRS) to examine overall stress level, and the outcome of the SRRS was correlated to postinjection VHI scores. Results indicated no significant correlation between VHI scores and voice severity or SRRS ratings. The current study suggests further study of voice outcomes with older adults with ADSD is needed.

Aged↗
PubMed2006

Validation of the voice handicap index using Rasch analysis.

BACKGROUND: The Voice Handicap Index is a tool for measuring the psychosocial consequences of voice disorders and consists of three dimensions. Previous psychometric evaluation of the VHI focused on the classic evaluation of reliability and validity, which is sample dependent. The authors used Rasch analysis to re-examine the dimensionality of the VHI and to produce item and scale statistics that are less sample dependent. In addition, they provide estimates of VHI item and person severities that are reported on the same logit unit scale, allowing a more straightforward interpretation of a VHI test score. PATIENTS: Dysphonic patients (N = 530), who were referred for phoniatric examination, filled out the VHI. RESULTS: Rasch analysis revealed two truly uni-dimensional constructs: the 20-item psychosocial scale and the 9-item physical-functional scale. Logit item severity measures ranged from -2.1 to +2.7. Person severity scores ranged from -4.4 to + 4.4 logits. The internal consistency of the reduced scales was similar to that of the original total VHI (0.95 and 0.84). The VHI consisted of two uni-dimensional constructs. Raw test scores can be transformed into logit unit severity measures, making the VHI more suitable for evaluating the effectiveness of voice-related therapy.

Adult↗
PubMed2006

The voice handicap index: correlation between subjective patient response and quantitative assessment of voice.

The aim of this prospective study is to elucidate the relationship between the Voice Handicap Index (VHI) and several voice laboratory measurements in the network of the multidimensional voice assessment. Fifty-eight patients were included. Each patient replies to the questionnaire and performs a voice assessment during the same time. The following parameters were measured: minimum frequency, maximum frequency, range, minimum intensity, subglottic pressure, mean flow, maximum phonation time, jitter, and dysphonia severity index. Regarding the relationship with the scores of the VHI, poor correlations with the minimal frequency for all the scores except the emotional one (total and subscales) and with the range for only the physical one are found. Seventeen questions correlate with the voice laboratory measurements we performed, with a decreased distribution between physical, functional, and emotional subscales. We observe that acoustic parameter is correlated with the emotional subscale, the parameters of the profile range are more often involved in the emotional subscale, as is the minimal frequency, but never with the physical subscale, and all the subscales are interesting despite the smaller number of differences with the emotional one. The VHI and the laboratory measurements give independent informations in practice.

Adolescent↗
PubMed2006

Correlation of the Voice Handicap Index (VHI) and the Voice-Related Quality of Life Measure (V-RQOL).

The purpose of this study was to investigate the correlation between the Voice Handicap Index (VHI) and the Voice-Related Quality of Life Measure (V-RQOL), and to test conversion of scores between the two instruments. Understanding the relationship between instruments will facilitate comparison of voice outcome studies using different measures. A retrospective medical chart review of 140 consecutive patients with a chief complaint related to their voice presenting for speech pathology voice evaluation following laryngology evaluation and diagnosis was adopted. Each patient who filled out the VHI and V-RQOL within a 2-week period with no intervening treatment was included in the study. Correlation analysis for total scores was performed for the patients meeting inclusion criteria (n=132). Correlations were also performed as a function of diagnosis. Calculated VHI score based on measured V-RQOL score was compared to measured VHI score. Pearson correlation between scores on the VHI and V-RQOL was -0.82. There was no significant difference between the mean measured and mean calculated VHI scores. For individual scores, however, regression analysis did reveal a significant difference between calculated and measured VHI. The VHI and V-RQOL are highly correlated; however, this study suggests that the two instruments are not interchangeable for individuals.

Disability Evaluation↗
PubMed2004

Short, self-report voice symptom scales: psychometric characteristics of the voice handicap index-10 and the vocal performance questionnaire.

OBJECTIVE: Short, self-report symptom questionnaires are useful in routine clinical situations for assessing the progress of disorders and the influence of interventions. The Voice Handicap Index-10 (VHI-10) and Vocal Performance Questionnaire (VPQ) are brief self-reported assessments of voice pathology, apparently useful in the general voice clinic population. Little is known of the structure or internal consistency of either tool, nor whether they correlate. This study carried out a substantial, systematic evaluation of their performance in the Laryngology office setting. STUDY DESIGN AND SETTING: 330 adult (222 women, 108 men) voice clinic attenders completed the VHI and the VPQ. RESULTS: The VHI-10 and VPQ each had a large, single principal component, high internal consistency, and were highly correlated (disattenuated r=0.91). CONCLUSION: The VHI-10 and the VPQ are similar, short, convenient, internally-consistent, unidimensional tools. SIGNIFICANCE: The total VHI-10 or VPQ score is a good overall indicator of the severity of voice disorders.

Adult↗
PubMed2006

Success of posterior semicircular canal occlusion and application of the dizziness handicap inventory.

OBJECTIVES: To determine the long-term efficacy and patient satisfaction of posterior semicircular canal occlusion (PSCO) as a treatment for intractable benign paroxysmal positional vertigo (BPPV). STUDY DESIGN AND SETTING: Retrospective analysis of patients with BPPV who underwent PSCO was conducted in a tertiary referral center. Demographic data, clinical records, and audiometric data were reviewed. Dix-Hallpike maneuver, dizziness handicap inventory (DHI), and a specific PSCO questionnaire (PCOQ) were used to measure outcome. RESULTS: Twenty-eight patients underwent PSCO. The mean follow-up time was 40 months. All patients had normalization of the Hallpike test. DHI scores of 20 patients were recorded. The mean preoperative score was 70 compared with postoperative mean of 13 (P < 0.001). Mild hearing loss was found in 1 patient. CONCLUSIONS AND SIGNIFICANCE: PSCO is highly successful. The DHI scores postoperatively show significant improvement. The PCOQ revealed an overall 85% patient satisfaction rate. PSCO is a safe and effective intervention for intractable BPPV with a high patient satisfaction rate. EBM RATING: C-4.

Adult↗
PubMed2006

Evaluating the validity of the Voice Handicap Index-10 (VHI-10) among Hebrew speakers.

OBJECTIVE: To evaluate the validity of a translated version of the Voice Handicap Index-10 (VHI-10). STUDY DESIGN AND SETTING: In a parallel group design, 221 patients with different laryngeal pathologies and 172 people with no laryngeal pathology completed a Hebrew version of the VHI-10. Validity and reliability were assessed as well as group differences. RESULTS: Statistical analyses demonstrated high reliability values (Cronbach's Alpha r = 0.949). Responses were not affected by age (P = 0.373) or gender (P = 0.360). The control group received significantly lower scores than all pathological groups (P < 0.05). Within the pathological groups, the "neurogenic" and "mucosa irregularity" groups were rated higher than all other pathological groups (P < 0.05). CONCLUSION: The VHI-10 questionnaire maintains its validity and reliability across translation to Hebrew. Moreover, although the VHI-10 is essentially a unidimensional tool, it provides partial information on the 3 subjective dimensions of the full VHI.

Adolescent↗
PubMed2005

Validity of the sleep subscale of the Diagnostic Assessment for the Severely Handicapped-II (DASH-II).

Currently there are no available sleep disorder measures for individuals with severe and profound intellectual disability. We, therefore, attempted to establish the external validity of the Diagnostic Assessment for the Severely Handicapped-II (DASH-II) sleep subscale by comparing daily observational sleep data with the responses of direct care staff to the sleep subscale of the DASH-II. Participants included 25 individuals with severe intellectual disability and 25 individuals with profound intellectual disability who reside in a large developmental center in central Louisiana. Four of the five items of the DASH-II were shown to have external validity. Implications of these findings for future research and practice are discussed.

Child↗
PubMed2006

Influenza vaccination in severely multiply handicapped persons/children.

BACKGROUND: Many reports about the preventative effects of inactivated influenza vaccine have been published, targeting persons with underlying medical conditions. However, the effectiveness for severely multiply handicapped persons/children (SMHPs) is not yet well established. METHODS: The study group consisted of 79 SMHPs (36 males and 43 females, aged 18-66 years), with long-term hospitalization in Niigata National Hospital. We compared serum antibody responses before and after two-doses vaccination. RESULTS: Before vaccination for the 2004-2005 season, SMHPs showed continuously high HAI titer in A/New Caledonia/20/99(H1N1)-strain from March to October in 2004. The seroprotection rates were increased after the first dose, but no remarkable change was seen after the second dose in all three strains. Subjects less than 30 years old (< or = 29 group) had a high antibody titers against all three strains compared with subjects aged >40 years old. On the other hand, in the seroconversion rates, there were no significant differences in age, gender, and severity of symptoms. CONCLUSIONS: According to our study, SMHPs are low responders except < or = 29 group and the influenza vaccine effectiveness is more affected by their age than severity of symptoms. We suggest a recommendation for influenza vaccination especially in SMHPs; inactivated influenza virus vaccine (one dose) should be performed during the previous fall. In addition, further studies are needed about chemoprophylaxis, which can prevent influenza outbreaks in SMHPs.

Adolescent↗
PubMed2004

Effect of interstitial stereotactic radiosurgery on behavior and subjective handicap of epilepsy in patients with gelastic epilepsy.

Patients with symptomatic epilepsy due to hypothalamic hamartomas often are compromised not only by pharmacoresistant epileptic seizures but also by behavioral disturbances and cognitive dysfunction. We report the effect of successful treatment with stereotactic interstitial radiosurgery by intrahypothalamic implantation of 125I seeds on behavior and subjective handicap. In all patients rendered seizure-free or suffering only from auras, improvement of behavior was reported by parents and colleagues or schoolteachers. Parents' ratings according to the Child Behavior Checklist showed improvements with respect to social problems and attention. Self-ratings of quality of life by adult patients showed improvements in activities, working situation, and self-perception. These improvements were not observed in patients in whom clinically manifest seizures and interictal EEG discharges persisted after radiosurgery.

Activities of Daily Living↗
PubMed2006

[Factors predicting Voice Handicap Index].

OBJECTIVE: To assess factors that may be predictive of patient perception of dysphonia severity, as quantified by the Voice Handicap Index (VHI) score. MATERIAL AND METHODS: A prospective study is carried out in 81 voice samples from patients diagnosed with benign vocal fold lesions. Variables assessed for predictive value to VHI score are maximum fonation time, narrow band spectrogram, jitter, shimmer, HNR, NNE, F0 and the auditory perceptual evaluation of severity of dysphonia GRABS. RESULTS: HNR, F0 and B and S parameters of GRABS were predictors of total VHI score, functional and emotional subscales. No parameter was found to predict the physical subscale. CONCLUSIONS: VHI score is correlated with the perceived breathy voice and its acoustic attributes, such as signal-to-noise ratio. In other studies, patient perception of dysphonia is independent of many factors commonly assessed during the evaluation of voice disorders. It is reasonable to assume that the severity of glottic gap caused by benign vocal folds lesions is related to a low signal-to-noise ratio and the breathy phonation as its perceptual correlate. The physical subscale appears to be an independent element in the assessment of the patient perception of dysphonia.

Adult↗
PubMed1998

Chronic pain in a community-based sample of men with spinal cord injury: prevalence, severity, and relationship with impairment, disability, handicap, and subjective well-being.

OBJECTIVE: To assess the prevalence, severity, and correlates of chronic pain in a community-based sample of men with spinal cord injury (SCI). DESIGN: Survey. SETTING: Community. PARTICIPANTS: Seventy-seven men with SCI randomly selected from a sampling frame solicited from the community. METHOD: Participants completed standardized questionnaires assessing many areas of life, were interviewed in their homes, and underwent a physical examination at a hospital. There they were interviewed by an anesthesiologist regarding chronic pain, and a nurse administered objective pain measures. RESULTS: Seventy-five percent of the men reported chronic pain. Chronic pain was associated with more depressive symptoms, more perceived stress, and poorer self-assessed health. Greater intensity of pain was related to less paralytic impairment, violent etiology, and more perceived stress. Area of the body affected by pain was related to independence and mobility. CONCLUSIONS: Because of the high prevalence of chronic pain in the population with SCI and its relation to disability, handicap, and quality of life, health care providers need to give this issue the same priority given to other SCI health issues. Analysis of individual pain components provides better information than assessing overall pain. It is futile to treat SCI pain without giving full attention to subjective factors.

Activities of Daily Living↗
PubMed1983

Surgical and prosthodontic reconstruction of the severely handicapped edentulous patient.

There is among some prosthodontists a negative attitude toward preprosthetic reconstructive surgery because of previous poor experience with reconstructive or preprosthetic surgical procedures. Such experiences may have resulted from the limitations of techniques previously used; and, therefore, the prosthodontist may resort to conventional prosthodontic techniques. There are, however, limits to what can be achieved with special impression techniques, tooth form and placement, and so forth. This article was written not only to present the rationale of current techniques but to encourage the prosthodontist to consider and present to the severely handicapped edentulous patient the choice of preprosthetic reconstructive surgery.

Alveolar Process↗
PubMed1981

Aminoaciduria in handicapped children: a study using ion-exchange chromatography as a screening test.

The aminoacid excretion levels of 59 normal and 75 physically and/or mentally handicapped children were measured with ion-exchange chromatography. A computer-assisted statistical analysis of the results from the normal population was used to calculate an approximating frequency distribution. 18 patients were found to be excreting one or more aminoacids above the normal 99.75th or 100th percentiles. They included 1 with dibasic aminoaciduria; 1 six-year-old with phenylketonuria; 1 with hyperphenylalaninuria; 5 with cystathioninuria; 2 with hyperglycinuria; 1 with hyperglycinuria and hypertaurinuria; 5 with hypertaurinuria; 1 excreting high levels of taurine, serine, tyrosine, and histidine, and 1 with asparaginuria.

Amino Acids↗
PubMed1987

Experience with hepatitis B vaccination in nurses in a hospital for the mentally handicapped.

The extent of HBV infection in the staff of a large hospital for the mentally handicapped was investigated. Nurses with direct patient contact were identified as a particular risk group and hepatitis B vaccination was offered to them. Of the 500 who received a full course of vaccination 96% had detectable antibodies 9 months after starting vaccination. High titres (over 1000 IU/l) were found in 59.4%. Females responded better than males and the response was age-dependent. In only 2 of 20 non-responders did lasting immunity develop with a fourth dose of vaccine. Antibody titre decreased rapidly in all vaccinees followed up. In vaccinees with an initial titre above 100 IU/l the decrease in titre could be reversed by a booster dose. Those with a titre below 100 IU/l had a variable response to the booster dose and lasting immunity developed in only a few. A recall system was started that predicts when a booster dose will be required to maintain a protective level of antibody. Servicing such a vaccination programme is not easy.

Adult↗