Inventory of current EU paediatric vision and hearing screening programmes

Background: We examined the diversity in paediatric vision and hearing screening programmes in Europe. Methods: Themes relevant for comparison of screening programmes were derived from literature and used to compile three questionnaires on vision, hearing and public-health screening. Tests used, professions involved, age and frequency of testing seem to influence sensitivity, specificity and costs most. Questionnaires were sent to ophthalmologists, orthoptists, otolaryngologists and audiologists involved in paediatric screening in all EU fullmember, candidate and associate states. Answers were cross-checked. Results: Thirty-nine countries participated; 35 have a vision screening programme, 33 a nation-wide neonatal hearing screening programme. Visual acuity (VA) is measured in 35 countries, in 71% more than once. First measurement of VA varies from three to seven years of age, but is usually before the age of five. At age three and four picture charts, including Lea Hyvarinen are used most, in children over four Tumbling-E and Snellen. As first hearing screening test otoacoustic emission (OAE) is used most in healthy neonates, and auditory brainstem response (ABR) in premature newborns. The majority of hearing testing programmes are staged; children are referred after one to four abnormal tests. Vision screening is performed mostly by paediatricians, ophthalmologists or nurses. Funding is mostly by health insurance or state. Coverage was reported as >95% in half of countries, but reporting was often not first-hand. Conclusion: Largest differences were found in VA charts used (12), professions involved in vision screening (10), number of hearing screening tests before referral (1-4) and funding sources (8)

Bedeutung von Hörqualität für die kommunikative Partizipation im Unterricht und den Schulerfolg bei hörgeschädigten Grundschülern an allgemeinen Schulen

Good listening is a key qualification for academic success at school and essential for classroom participation. Instruments available to date do not allow to assess sufficiently the self-evaluation of deaf and hard of hearing (DHH) students with regard to the ability to hear and understand in real-life situations at school. In the study presented here the questionnaire E-HAK (students’ evaluation of listening experiences in everyday life) was adapted from the English “LIFE-Inventories for Education” and 30 DHH third- and fourth-graders from general education classes in public schools were tested with this new instrument. Using the E-HAK, the students have to evaluate their listening comprehension in 12 different situations which are important for successful learning in the classroom. The data from this pilot study reveal that the E-HAK proves to be an appropriate and reliable tool to obtain information which has practical relevance assessing subjective listening comprehension. Amongst others, there are better results in listening comprehension when using assistive wireless technology, and there are also significant correlations between the degree of subjective listening quality assessed by the E-HAK, communicative participation at school and academic success. For further studies, the E-HAK should be tested on larger and more representative samples. Likewise, also hearing students should be involved regarding the assessment of listening quality in the classroom.Gutes Hören ist eine Schlüsselqualifikation für schulischen Erfolg und wesentlich für das Partizipationserleben im Unterricht. Wie hörgeschädigte Schüler Hören und Verstehen in realen Situationen im Alltag Schule erleben, wird mit den bisher zur Verfügung stehenden Untersuchungsinstrumenten nur unzureichend erfasst. Im Rahmen der vorliegenden Studie wurde der Fragebogen E-HAK (Einschätzung der Hörsituation im Alltag von Kindern) aus den englischsprachigen „LIFE-Inventories for Education“ weiterentwickelt und bei 30 einzelinklusiv beschulten hörgeschädigten Dritt- bzw. Viertklässlern an allgemeinen Schulen erprobt. Im E-HAK sollen die Schüler ihr Hörverstehen in 12 verschiedenen unterrichtsrelevanten Situationen subjektiv einschätzen. Die Daten der vorliegenden Pilotstudie zeigen, dass sich der E-HAK als probates und zuverlässiges Instrument erweist, um praxisrelevante Informationen zum subjektiven Hörverstehen zu erhalten. So werden bessere Ergebnisse im Hörverstehen bei der Nutzung einer Übertragungsanlage erzielt und es zeigen sich signifikante Zusammenhänge zwischen subjektiv beurteilter Hörqualität, kommunikativer Partizipation im Unterricht und schulischen Leistungen. Für weiterführende Studien sollte der E-HAK an größeren und repräsentativeren Stichproben überprüft werden. Ebenso sollten hörende Mitschüler in die Beurteilung der Hörqualität im Unterricht eingebunden werden

Intelligenz : ein relevantes differenzialdiagnostisches Merkmal bei Sprachentwicklungstörungen?

Die Spezifische Sprachentwicklungsstörung (SSES) ist als erwartungswidrige Minderleistung der Sprachentwicklung im Vergleich zur kognitiven Entwicklung definiert. Untersucht wird, (1) ob sich für SSES-Kinder im Vergleich zu unterdurchschnittlich intelligenten sprachentwicklungsgestörten Kindern (SES-Lb) ein typisches Muster von sprachlichen Leistungen sowie von Teilleistungsstörungen nachweisen lässt, das für eine Differenzialdiagnostik und damit für eine Untergruppenbildung sprachentwicklungsgestörter Kinder nutzbringend eingesetzt werden kann, (2) ob und in welcher Weise eine solche Differenzierung Konsequenzen für die Diagnostik und nachfolgend für eine Therapie zeitigt und (3) ob es Defizite in umschriebenen Leistungsbereichen gibt, die als Bedingungsfaktoren für eine Sprachentwicklungsstörung gelten, sich aber als unabhängig von der Intelligenz erweisen. Eine Gruppe von 138 fünf- und sechsjährigen Kindern mit einer schweren Sprachentwicklungsstörung, von denen 108 eine normale nonverbale Intelligenz aufwiesen, wurde anhand von IDIS (Inventar diagnostischer Informationen bei Sprachentwicklungsauffälligkeiten) untersucht. Erfasst wurden neben den sprachlichen Fähigkeiten auf der phonetisch-phonologischen, der semantisch-lexikalischen, der morphologisch-syntaktischen und der pragmatischen Ebene auch die Intelligenz, die auditive und visuelle Wahrnehmung, die auditive und visuelle Merkfähigkeit, sowie die Fein- und Grobmotorik. In den meisten geprüften Bereichen zeigt sich ein deutlicher Effekt der Intelligenz auf die Leistungen, der nicht nur auf Unterschiede in der Profilhöhe, sondern auch im Profilverlauf, also auf strukturelle Leistungsdifferenzen, hinweist. Als ein von der Intelligenz unabhängiger Bedingungsfaktor für eine Sprachentwicklungsstörung gilt eine gestörte phonologische Schleife, das auditive Subsystem des Arbeitsgedächtnisses. Für die Beibehaltung der Differenzierung der Sprachentwicklungsstörungen nach der kognitiven Leistungsfähigkeit wird nicht nur aufgrund der unterschiedlichen Leistungsstrukturen plädiert, sondern auch, weil die therapeutischen Möglichkeiten in Abhängigkeit von der Intelligenz als verschiedenartig eingeschätzt werden.Specific language impairment (SLI) is defined as an developmental disorder in which language comprehension and the child’s ability to use expressive spoken language is markedly below the appropriate level for his or her mental age (cf. ICD-10, F80.2). Intelligence of SLI children is in normal range while their language abilities are impaired. „Normal intelligence“ as a defining feature of SLI is questioned in this study. Which differences exist between SLI children and those children (LI) which have impaired language abilities and intelligence below normal range? Do the profiles in various domains only differ quantitatively, or do qualitative differences exist which point to structural differences between SLI and LI children, too? Is intelligence a useful feature to classify into SLI und LI children? Such a classification must have consequences for assessment and therapy. Using IDIS (an inventory of diagnostic information in language impairment) 138 children aged 5 and 6 years with severe language impairment, 108 SLI and 30 LI children were examined. Various indicators of speech and language such as articulation, the ability to discriminate sounds, lexicon, grammar and pragmatic abilities but also auditory and visual perception, auditory and visual memory, fine and gross motor function were assessed. The performance of the SLI children was significantly higher in most of the tests compared to LI children. Factor analysis showed that the two groups differ both in level of performance and in structure of performance. In most children auditory short term memory was reduced irrespective of intelligence. It is proposed to retain the differentiation of subgroups of developmental speech and language disorders depending on the level of intelligence

How does biographic-narrative intervention influence identity negotiation and quality of life in aphasia? - The participants' perspective

Problem Many persons with aphasia experience a loss of Quality of Life (QoL). Although life story work supports processes of sense-making and by this QoL improvement, only a few studies made use of the “talk-based” approach in aphasic patients because of the language deficit (e.g. Shadden, 2005). We developed an adapted interdisciplinary biographic-narrative intervention, which was already shown to be effective in terms of gains in quantitative measures of QoL (Corsten, Konradi, Schimpf, Hardering, & Keilmann, 2013). For a deeper understanding we will now analyze the participants’ perspective obtained in interviews. Procedure and Analysis Five face-to-face in-depth interviews and seven group sessions were conducted over ten weeks in a mixed-method-design with pre- and post-tests and a follow-up assessment three months after the intervention. The multidimensional construct of QoL was measured with a battery of instruments: – the pictorial version of the Aachen Life Quality Inventory (ALQI, Engell, Hütter, Willmes, & Huber, 2003) – the Satisfaction with Life Scale (SWLS, Diener, Emmons, Larsen, & Griffin, 1985) – a German version of the Visual Analogue Mood Scales (VAMS, Stern, 1997) Semi-structured interviews, conducted post-treatment, included questions concerning the participants‘ experiences with the intervention, identity change and future perspectives e.g. Analysis was based on interpretative principles from grounded theory (Corbin & Strauss, 2008). Results For our entire sample of 27 participants with chronic but different types of aphasia we found a significant and stable growth in health-related QoL (ALQI, Wilcoxon signed-ranks test, two-tailed, p < .05). Self-reported states of mood also improved significantly (VAMS, t-test, two-tailed, p < .05). As expected, overall life satisfaction (SWLS) did not change. The interviews revealed three main themes “effectiveness of the intervention”, “QoL” and “self-concept”. The following associations with improvements in QoL were identified: enhanced coping regarding chronic illness, improved self-efficacy and control, and a more differentiated picture of self. The impacts of the different kinds of intervention are discussed. Discussion The quantitative and the qualitative results were complementary in demonstrating the effectiveness of the biographic-narrative intervention. As predicted, there was a specific treatment effect with a significant and stable improvement in QoL. Analysis of the semi-structured interviews indicated that through the approach the participants’ sense of self changed. The findings provide foundations for future work into intervention

Effects of a conservative in-patient voice treatment on the voice-related self-concept

Purpose!#!Observational study to determine if the voice-related self-concept as measured via the Fragebogen zur Erfassung des Stimmlichen Selbstkonzepts FESS (questionnaire for the assessment of the voice self-concept) can be improved through in-patient voice therapy.!##!Methods!#!234 female and 80 male patients that underwent an intensive 3- to 4-week in-patient voice treatment due to varying types of dysphonia. After imputation of missing items but not missing questionnaires, 255 patients were eligible for FESS evaluation, 313 for VHI-12 evaluation. The German questionnaire for the assessment of the voice self-concept (FESS) and the German 12-item short-form of the Voice Handicap Index (VHI-12) were administered at the beginning and at the end of the hospital stay. Before-after comparisons are made visually and via t test.!##!Results!#!The Voice Handicap was significantly reduced, demonstrating the effectiveness of the administered therapy. Of the three scales of the FESS, the relationship with one's own voice and the awareness of the use of one's own voice was increased and thus improved. The connection between voice and emotional changes decreased significantly but only slightly.!##!Conclusion!#!Conservative voice rehabilitation can not only reduce the voice handicap, but also improve the voice self-concept and the results can be measured

Real-World Verbal Communication Performance of Children Provided With Cochlear Implants or Hearing Aids

Objective To compare the real-world verbal communication performance of children provided with cochlear implants (CIs) with their peers with hearing aids (HAs). Study Design Cross-sectional study in university tertiary referral centers and at hearing aid dispensers. Methods Verbal communication performance was assessed by the Functioning after Pediatric Cochlear Implantation (FAPCI) instrument. The FAPCI was administered to 38 parents of children using CIs and 62 parents of children with HAs. According to the WHO classification, children with HAs were categorized into three groups (mild-moderate-severe hearing loss). Analysis of variance (ANOVA) was performed on the FAPCI scores, with study group, hearing age (i.e., device experience), and age at hearing intervention as sources of variation. Results ANOVA showed that hearing age and study group significantly contribute to the FAPCI outcome. In all study groups except the children with mild hearing loss, FAPCI scores increased alongside growing experience with the devices. Children with mild hearing loss using HAs showed higher scores than those with severe hearing loss or implanted children. There were no significant differences between the children with CIs and the children with moderate or severe hearing loss using HAs. Conclusion Real-world verbal communication abilities of children with CIs are similar to those of children with moderate-to-severe hearing loss using amplification. Because hearing age significantly influences performance, children with moderate-to-severe hearing loss using HAs and implanted children catch up with children with mild hearing loss at a hearing age of approximately 3 years

Cross-Validation and Normative Values for the German Vocal Tract Discomfort Scale

Purpose The Vocal Tract Discomfort Scale (VTD Scale) is a self-rating questionnaire investigating physical symptoms in the larynx associated with vocal pathology. The aim of this work was to investigate the reliability, validity, sensitivity, and specificity of the first German version and to provide normative data with thresholds for pathology and a scaling scheme. Study Design A retrospective multicenter study was performed. Method A total of 571 participants (409 female and 162 male), with a mean age of 47.2 years, were recruited at three German centers; of these, there were 447 participants with voice disorder and 124 vocally healthy participants. The clinical examination consisted of patient history, visual laryngeal examination, acoustic and aerodynamic assessment, perceptual analysis by the Grading-Roughness-Breathiness-Asthenia-Strain Scale, and subjective evaluation using the VTD Scale and the Voice Handicap Index (VHI). Statistics included group comparisons (t test and analysis of variance), Pearson correlation coefficient (between VTD Scale and VHI), and Cronbach's alpha to assess validity and reliability. Analysis of receiver operating characteristics was performed to examine VTD Scale's discriminatory ability and provide a cutoff score. Additionally, percentiles were applied to provide VTD Scale ranges. Results There were highly significant differences between healthy participants and participants with voice disorder regarding the total score and both subscales of the VTD Scale. Internal consistency was excellent (α = .928). We found moderate, positive correlation between the VTD Scale and VHI (ρ = .596, p < .001). Receiver operating characteristics analysis showed an area under the curve of 0.876 (p < .001, 95% confidence interval [0.846, 0.906]). VTD Scale ranges were no (score: 0–13), mild (score: 14–26), moderate (score: 27–40), and severe (score: 41–96) disorder. Conclusions Results confirm an excellent reliability and validity of the German VTD Scale. It provides additional and independent diagnostic information and is a useful instrument to complement voice assessment. The scaling into four severity subgroups allows the tool to be used for screening patients and considers a transferral to a voice specialist