The Vocal Score Profile in Verdi's Characters

OBJECTIVES: Selecting the appropriate repertoire for an opera singer may be crucial for both the prevention of voice disorders and the career progression. Here, we reviewed the score of 14 Verdi's operas to gain the data for the creation of the vocal score profile of each role. MATERIALS AND METHODS: Seven musicians were involved in the analysis process. Notes were counted and reported as absolute and relative frequency. Pitch measurements included pitch range, percentage of high-pitched notes, percentage of medium-pitched notes, percentage of low-pitched notes, high-pitched and low-pitched notes rate, percentage of the notes in the passaggio, identification of the prevalent octave, percentage of notes in the prevalent octave, and percentage of notes in a moderate range tessitura. The total phonation time was calculated for each character. RESULTS: A heterogeneity among pitch and duration measurement was found among roles within the same voice type, leading to highly different vocal efforts required by the performer. CONCLUSIONS: Data on 67 Verdi characters were gained, and the vocal demand of each role was discussed. Potentially, these results may support singers, singing teachers, and vocal coaches in the selection of the repertoire. The data may also assist clinicians in the conduction of counseling and during eventual voice therapy. Future studies must investigate the predictive value of the vocal score profile in appraising the risk of vocal injury

Predictors of oral feeding resumption after stroke in a rehabilitation hospital : a retrospective study

Background: Dysphagia is common after stroke, requiring exclusive enteral feeding in 20% of patients. Recovery of oral feeding is associated with increased quality of life, better functional outcomes, and decreased mortality rates. However, evidence is heterogeneous and not conclusive on which factors are predictive of oral feeding recovery for stroke patients in rehabilitation units. Aim: To investigate predictors of complete oral feeding recovery. Design: Retrospective study. Setting: Intensive inpatient rehabilitation hospital. Population: Poststroke dysphagic individuals with enteral feeding. Methods: Retrospective chart review of demographic, clinical, rehabilitation, and swallowing factors. Univariate analysis and multivariate regression analysis were used to compare variables between the oral feeding recovery group and the enteral feeding group at discharge. Results: One hundred thirty-nine patients were included in the analysis. A total of 61.9% of the sample population resumed complete oral intake at discharge. There were statistically significant differences between the 2 groups in Functional Independence Measure cognitive score, clinical swallow evaluation, and instrumental swallow evaluation at admittance, and dysphagia rehabilitation. Multiple logistic regression analysis identified the absence of aspiration signs with liquids associated with a higher probability of the resumption of complete oral feeding (odds ratio [OR] 3.57; 95% confidence interval [CI] 1.07-11.89). Age between 73 and 79 years (OR .96; 95% CI .01-.58), the presence of aspiration and/or penetration (OR .22; 95% CI .07-.72), and the presence of residue (OR .14; 95%CI .04-.43) during fiberoptic endoscopic evaluation of swallowing presented lower probability of returning to complete oral feeding. Conclusion: Several demographic and swallowing characteristics predicted oral feeding recovery. Absence of dysphagia signs documented on fiberoptic endoscopic evaluation of swallowing was the strongest predictor of complete oral feeding resumption

Relationship Between Quality of Life and Dysarthria in Patients With Multiple Sclerosis.

OBJECTIVE: To evaluate dysarthria and dysarthria-related quality of life (QOL) and analyze its relations with duration of disease, severity, and general QOL in patients with multiple sclerosis (MS). DESIGN: Cross-sectional observational study. SETTING: Rehabilitation center. PARTICIPANTS: Consecutive patients with MS (N=163) were recruited (mean age, 52\ub110.4y; mean MS duration, 19\ub110.4y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Presence of dysarthria; dysarthria characteristics; MS severity and duration; and dysarthria-related and generic QOL were evaluated by means of the therapy outcome measure scale; Robertson profile; Expanded Disability Status Scale (EDSS), years of disease; QOL of the dysarthric speaker questionnaire; and Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), respectively. RESULTS: The mean EDSS score was 6.5\ub11.3. Dysarthria affected 57 (35%) of the 163 patients. Dysarthria severity was mild in most of the 57 patients with dysarthria. Median Robertson profile scores were slightly but significantly higher in the nondysarthric group compared with the dysarthric group (P=.001). The QOL for the dysarthric speaker questionnaire was significantly more compromised in patients with dysarthria (P=.001). No difference on the SF-36 scores between patients with and without dysarthria was found, with the exception of the physical activity and physical pain subscales. The QOL for the dysarthric speaker questionnaire showed no correlation with MS duration and a weak correlation with EDSS score (r=.25). Correlations between the SF-36 and QOL for the dysarthric speaker scores were few and weak, with the exception of the role limitations because of emotions (r=-.428) and mental health subscales (r=-.383). CONCLUSIONS: Dysarthria-related QOL is compromised in patients with MS and dysarthria and might be used as a supplementary measure in clinical practice and research for patients who have MS

Validation of the Italian version of the American Speech-Language and Hearing Association—Functional Assessment of Communication Skills for adults (I-ASHA-FACS)

ackground: Impairment of communicative-linguistic and cognitive functions is common after stroke and traumatic brain injury (TBI). While assessment of language function is usually performed in clinical practice, standardised assessment of pragmatic, functional, and communicative competences is less common, even though suggested by many recent national and international guidelines. The \u201cAmerican Speech-Language and Hearing Association\u2014Functional Assessment of Communication Skills for adults\u201d (ASHA-FACS) is a measure of communication disability that investigates functional communication. It has been translated and adapted into Italian in 2001, but psychometric properties of Italian version of ASHA-FACS (I-ASHA-FACS) have not yet been investigated. Aims: To investigate psychometric properties of the I-ASHA-FACS scale and provide normative data. Methods & Procedures: Participants included 100 healthy adult persons without neurological disorders nor communicative-cognitive deficits and 80 post-acute outpatients with aphasia following stroke (n = 60) or TBI (n = 20). Mini Mental State Examination (MMSE) was used to exclude control participants with cognitive decline (MMSE > 24). I-ASHA-FACS was completed for all participants. All patients were also assessed with Functional Independent Measure (FIM) and either Aachener Aphasie Test (AAT) for persons with aphasia due to stroke or Levels of Cognitive Functions scale (LCF) for TBI persons. I-ASHA-FACS internal consistency, inter- and intra-rater reliability and construct validity were calculated; normative data were also calculated for healthy controls stratified by age and education. Cronbach\u2019s alpha was used for internal consistency analysis. Spearman\u2019s test was used to correlate I-ASHA-FACS and FIM, AAT, and LCF scores. Outcomes & Results: I-ASHA-FACS showed good internal consistency (\u3b1 > .84) and strong intra- and inter-rater reliability (r > .97 and >.89). All healthy persons showed very high level of functional communication abilities in all domains of communication independence (higher than 6, on a 7-point scale) and all qualitative dimensions scores (higher than 4, on a 5-point scale). Correlations between I-ASHA-FACS scores and FIM were strong in aphasic persons, particularly in problem solving (r > .71) and comprehension (r > .73) subscales. Correlations between I-ASHA-FACS and AAT were generally from moderate to strong (r values ranging from r = .31 to r = .81), and particularly strong in spontaneous speech subtest (r > .70). Correlations between I-ASHA-FACS and LCF did not reach statistical significance. Conclusions: I-ASHA-FACS shows good internal consistency, strong intra- and inter-rater reliability and satisfactory validity. The application of I-ASHA-FACS to the Italian population of patients with communicative deficits due to aphasia or TBI is recommended

The Falls Efficacy Scale International is a valid measure to assess the concern about falling and its changes induced by treatments

Objective To test with the Rasch analysis the psychometric properties of the Falls Efficacy Scale International, a questionnaire for measuring concern about falling. Design Longitudinal observational study, before-after rehabilitation. Setting Inpatient rehabilitation. Subjects A total of 251 neurological patients with balance impairment. Interventions Physiotherapy and occupational therapy aimed at reducing the risk of falling. Main measures Participants (median age, first-third quartile: 74.0, 65.5-80.5 years; stroke and polyneuropathy: 43% and 21% of the sample, respectively) received a balance assessment (Falls Efficacy Scale International included) pre- and post-rehabilitation. Rasch analysis was used to evaluate the Falls Efficacy Scale International. Differential item functioning, which assesses the measures' stability in different conditions (e.g. before vs. after treatment) and in different groups of individuals, was tested for several variables. Results Patients suffered a moderate balance impairment (Mini-BESTest median score; first-third quartile: 15; 11-19), mild-moderate concern about falling (Falls Efficacy Scale International: 28; 21-37) and motor disability (Functional Independence Measure, motor domain: 70.0; 57.0-76.5). Falls Efficacy Scale International items fitted the Rasch model (range of infit and outfit mean square statistics: 0.8-1.32 and 0.71-1.45, respectively) and the questionnaire's reliability was satisfactory (0.87). No differential item functioning was found for treatment, gender, age and balance impairment. Differential item functioning was found for diagnosis and disability severity, but it is shown that it is not such as to bias measures. Conclusions Falls Efficacy Scale International ordinal scores can be turned into interval measures, i.e. measures of the type of temperature. Being differential item functioning-free for treatment, these measures can be safely used to compare concern about falling before and after rehabilitation, such as when interested in assessing the rehabilitation effectiveness

Amartya K. Sen: The idea of justice. The Belknap Press of Harvard University Press, Cambridge, Massachusetts, 2009, 468 pp

Recension parue dans Social Choice and Welfare n°35 (2010)Amartya Sen's readers were expecting the second volume of a series of two devoted to rationality, freedom and justice. Surprisingly The Idea of Justice is not exactly the book announced by Sen (2002); it offers a new perspective of Sen's enterprise. Calling economic orthodoxy into question is not enough; Sen envisages calling philosophical orthodoxy into question too. This review essay will focus on four salient points of the book: the partition of the different approaches of justice in two traditions; the concept of "positional objectivity" to serve impartiality; the will to reconcile reason and sentiments; the capability approach as important but not exclusive