Psychological Stress among Parents of Hearing Impaired versus Intellectually Disabled Pakistani Children

Background: Parents of special children face physical, psychological and social impact of their child’s disability, including hopelessness and depression. This study is important as it will help professionals plan and provide effective coping strategies so parents could have a positive perception and behavior for disabilities (like hearing impaired and intellectual disability) in their children. The objective of this study was to analyze level of psychological stress among parents of children with hearing impaired (HI) versus intellectual disability (ID) and relationship between disability and psychological stress.Material and Methods: This cross-sectional study comprised of parents (n = 200) of 100 HI and 100 ID children, of both genders, aged 1 to 16 years. These were recruited by non-probability convenience sampling after taking consent from special education centers of Punjab (Pakistan), over a period of six months from May 2017 to October 2017. After collecting demographic details, quantitative assessment of parental stress was done using Parental Stress Scale (PSS). Statistical analysis was carried out using SPSS v21.Results: The sample population (n=200) consisted of 32.5% male and 67.5% female respondents, with a mean age of 41.23 ± 6.7 years. The mean of total parental psychological stress score was 61.85 ± 17.1 with significant association between disabilities (HI and ID) and psychological stress (p<0.01). In HI group, moderate psychological stress was seen (n=53, 26.5%), while in ID group, profound level of psychological stress was noted in majority (n=70, 35%) of participants.Conclusions: Parents of both HI and ID children showed psychological stress, however, parents of ID children suffered higher level of stress

Swallowing Difficulties with Tracheostomy: A Neuro-Rehabilitation Perspective

Swallowing and breathing are complex and highly coordinated functions. These functions depend on well-coordinated work of many organs with larynx and nervous system playing a critical role. Disturbance in one of these functions negatively affects the other. Surgical airways like tracheostomies are required in a number of situations, including but not limited to major head and neck procedures, cases with decreased lung function, excessive bronchial secretions and cases requiring neuro-rehabilitation when prolonged airway is required for mechanical ventilation. Extensive neuro-rehabilitation is required since patients with surgical airway may develop swallowing difficulties including dysphagia and/or aspiration with a very high prevalence, which can pose a threat to life. This article reviews the current status of the diagnostic and therapeutic modalities for swallowing difficulties with special emphasis on current neuro-rehabilitative strategies. Electronic databases including Medline, Web-of-science, Cochrane Library, and Google scholar were used for literature search. Downloaded articles were subsequently assessed independently by two researchers to determine suitability for inclusion in the study.Key words: Neurorehabilitation, Tracheostomy, Transcranial direct current stimulation, Transcranial magnetic stimulation, swallowing difficulty &nbsp

Red Flags Associated With Knowledge Of Speech And Language Disorders Among Special Educators

Abstract Objective: To explore the knowledge about speech and language disorders among special educators of Army schools in Pakistan in association with qualification and experience. Methods: This cross-sectional descriptive study using convenience sampling was conducted at Isra Institute of Rehabilitation Sciences, Isra University from May to October 2017 and comprised of two phases. Phase 1 included the construction & pilot testing of a questionnaire utilizing a sample of N=20 educators and Phase 2 included the main study with N=100 educators of both genders from schools of Army Special Education Academy, Sir Syed School and College of Special Education and Aghosh Special Education Centre Kharian Cantonment. The sample educators included both genders, dealing with children with intellectual and hearing impairment. SPSS Version 20 was used for data analysis. Results: To assess the knowledge of the educators, a specially structured questionnaire with Cronbach’s alpha reliability coefficient of 0.79 was applied to a sample with a mean age of 32.70±6.92 years with the majority of 85(85%) being female educators. The study revealed good knowledge of educators with a total mean score of 69.70±10.61 and a significant (p=0.000) association of knowledge of educators with the highest scores for those with Masters Qualification (73.15±7.68). However, no significant association between gender (p=0.151) and work experience of educators (p=0.093) was noted, though the scores were higher for educators with 11-15 years of experience. Conclusion: The study concludes good knowledge of special educators about speech and language disorders with some red flags including the significant association of knowledge with qualification with master (special education) qualification presenting with a higher level of knowledge. However, work experience and gender did not reflect any significant association with the knowledge of educators.

Diverse trends witnessed in assessing laryngeal lesions while comparing transcutaneous laryngeal ultrasound & videolaryngoscopy

Objective: To determine the accuracy of Transcutaneous Laryngeal Ultrasound (TLUS) and Video Laryngoscopy (VL) taking Direct Laryngoscopy (DL) as Gold Standard for assessment of  laryngeal pathologies.Methodology: This Cross Sectional Comparative clinical study recruited a sample of 24 cases of either gender, requiring laryngeal examination prospectively using convenience sampling from otolaryngology outpatients of Capital Hospital, Islamabad, Pakistan over a period of six months from 1st March, 2018 to 31st August, 2018. Patients fulfilling the selection criteria were subjected to Video Laryngoscopy under local anesthesia, Transcutaneous Laryngeal Ultrasound followed by Direct Laryngoscopy under general anesthesia and findings recorded.  Data was analyzed using SPSS 23. Variables specially studied included Diagnostic values of both VDL and TLUS versus DL and presented with frequency, percentage, sensitivity, specificity, PPV and NPV and Accuracy Rate.Results: Study sample revealed 54.2% males and 45.8% females with mean age of 46.79 + 25.34 years. Hoarseness was commonest presentation (58.3%) and Laryngeal Polypi was the more frequent pathology noted (25%). VL had a sensitivity of 87.50%, specificity of 37.50%, PPV of 73.7%, NPV of 60% and Accuracy rate of 70.83%. While TLUS revealed a sensitivity of 43.80%, specificity of 70.80%, PPV of 100%, NPV of 47.15% and Accuracy rate of 62.50%.Conclusion: Video Laryngoscopy with a higher Accuracy and sensitivity compared to Transcutaneous Laryngeal Ultrasound, is more accurate examination for assessment of Laryngeal lesions

Induction of Labour by Extra-Amniotic Saline infusion in Women having Previous One Cesarean Section

Background: To determine the efficacy of labor induction by extra-amniotic saline infusion in women having previous one lower segment cesarean section. Method: All women, fulfilling inclusion criteria, were selected for study. In lithotomy position, Foley’s catheter no.16 was passed in the cervical canal extra amniotically and 30 ml sterile water was injected to inflate the balloon. Then 0.9 % normal saline at 40 ml/hour injected into the extra-amniotic space. Results: The successful cervical ripening was 74.8% (49/66). The number of women delivered vaginally within 24 hours of insertion of Foley’s catheter were 56.1% (37/66). The rate of uterine rupture was 1.5% (1/66). Thus extra-amniotic saline infusion through trans-cervical was an effective method for induction of labour in women having previous one lower segment cesarean section was 56.1% (37/66). Conclusion: Extra-amniotic saline infusion is an effective method for labor induction in women having previous one lower segment cesarean section. Keywords: Induction, labour, caesarean section, extra-amniotic saline infusion, Bishop score etc

Clavicular fractures in newborns: What happens to one of the commonly injured bones at birth?

Introduction: The clavicle is one of the most commonly injured bones during the birth process. The objective of this study was to determine the frequency and outcome of fractured clavicle amongst neonates born in a five-year period at a Secondary Hospital setting and to determine the Maternal and Neonatal Characteristics involved in such cases and compare them with a control group and determine the significance of any factors.Methods: All cases of fractured clavicle were retrospectively reviewed in a Secondary care hospital setting during a five-year period from July 2015 to June 2020. Maternal and neonatal factors were determined and then compared to a control group.Results: Out of 21,435 live births at our center during the study period, 92 infants were diagnosed to have clavicle fractures, giving an incidence of 4.29 per 1,000 live births (0.43%). 89% cases (n=82) were detected before discharge and 11 % cases (n=10) on routine follow-up visit after discharge. Physical examination identified 77% cases (n=71) whereas 23% cases (n=21) were recognized incidentally on X-ray. All babies with fracture including 3 with Erb’s palsy recovered completely without any complications. On logistic regression analysis, spontaneous vaginal delivery, prolonged second stage, vertex presentation, vitamin D deficiency in mothers, birthweight, macrosomia, all were significant risk factors.Conclusion: Neonatal clavicular fracture appears to be a transient yet unpredictable and unavoidable event with an overall good prognosis. Only the birth weight was identified as the common risk factor affecting clavicular fracture. Parental concerns and anxiety can be decreased with proper counselling and reassurance

What type of leadership is more effective for managing change during force majeure? Achieving organizational effectiveness during the pandemic

Purpose – Leaders have been facing serious challenges in managing organizations during COVID-19, which has brought the need for implementing sudden technological change across the globe. Hence, it was important to identify effective leadership styles to successfully manage the transformational process during the period. Therefore, the current study aims to explore and compare the effectiveness of transformational and ethical leadership (EL) in terms of achieving organizational goals during COVID-19 in public and private sector organizations in Pakistan. Design/methodology/approach – Comparative research was carried out to find out the effectiveness of transformational and EL during and pre-COVID-19 in public and private sector organizations using the lens of social exchange theory. Data was collected from 214 respondents representing 67.6% of public and 32.4% of private sector organizations of Pakistan at two different points in time. Detailed comparative analyses were conducted in AMOS version 24 to assess the effectiveness of leadership styles before and during COVID-19 times. Findings – On the whole, transformational leadership (TL) was found to have a greater impact on organizational effectiveness (OE) in comparison with EL in both pre-and during COVID-19 situations. Moreover, the effectiveness of TL significantly increased and the same decreased for EL during COVID-19. Additional analyses indicated that TL was effective for the private sector and EL for public sector organizations during COVID-19. Research limitations/implications – The study has not considered the mediating mechanisms of employee motivation, engagement and performance in the relationship between transformational and EL styles and OE, which can be explored in the future. Practical implications – These results have important implications for private and public sector organizations and suggest that the adoption of a TL style will generate better results in the private sector and an EL style in public sector organizations to achieve OE in uncertain situations such as COVID-19. Social implications – The study shows that leadership with more care and concern for humanity tends to perform better in terms of generating results for OE. Therefore, both transformational and EL are based on individualized consideration for employees and are effective during COVID-19 in private and public sector organizations in Pakistan. Originality/value – The study has carried out the comparative analyses in three different ways, including leadership styles (transformational and ethical), type of organization (private and public) and time frames (pre and during COVID-19), which is a true contribution of the research in the Pakistani context

Dilemma of health rights of vulnerable citizens: a narrative review

Vulnerable populations have traditionally faced non availability of health services. Enforcement of constitutional protections to vulnerable citizens is essential to secure them their health rights. Hence current narrative review in perspective of rights laws was conducted with the objective to review and highlight provisions of the constitution of different countries and World Health Organization (WHO) and the on ground situation prevailing in Pakistan. This study has immense significance, since this can invoke debate, inspire research and recognition of the enabling articles/ provisions for health care guaranteed in the Constitution. For this purpose data was searched for publications related to constitution and health of countries including Pakistan, United States, United Kingdom, China, Saudi Arabia and India using search engines, data bases and different websites.  170 reports, publications & articles were downloaded out of which 30 English, full text articles, publications and reports were utilized for the current research. Keywords: Vulnerable population

Self-reported Vocal symptoms among speech language pathologists dealing with children with hearing impairment and cerebral palsy

A cross-sectional study was conducted at the Ripah International University, Lahore, Pakistan from January to April, 2022 to evaluate and compare the Self-Reported Vocal symptoms among Speech Language Pathologists (SLP) practicing with children having Hearing Impairment (HI) and Cerebral Palsy (CP). The sample included 141 participants of both genders, aged 25 to 60 years, practicing with children with hearing impairment and cerebral palsy for at least one year. Vocal Tract Discomfort Scale (VTDS) and Voice Activity Participation Profile (VAPP) were utilised for data collection which was analysed using SPSS Ver-23. The study revealed no significant association of self-perceived vocal symptoms for SLPs catering to CP and HI children with p=0.303 and p=0.412 for VTDS and VAPP scores respectively and with higher mean scores for SLPs catering to CP children. Results revealed a total VTDS score of 40.26±13.10 with highest score for dryness, while highest VAPP mean score was noted for daily communication (53.82±23.20). Hence, there is no significant association of the speciality being catered to, while dryness is the commonest self-perceived symptom. Keywords: Cerebral Palsy, Hearing Impairment, Self-concept, Speech-Language Pathologist