The effect of traditional dysphagia therapy on the swallowing function in patients with Multiple Sclerosis: A pilot double-blinded randomized controlled trial

Background: Dysphagia is common following Multiple Sclerosis (MS) and is associated with significant morbidity and mortality. The current rehabilitation program to swallowing therapy is Traditional Dysphagia Therapy (TDT), but there is a dearth of evidence about its effectiveness in MS patients. Objectives: This study was aimed to determine the effects of the TDT on the swallowing function in MS patients with dysphagia. Methods: A pilot double blind randomized clinical trial was carried out on 20 patients with MS. Patients were randomly divided into experimental group (TDT) comprising sensorimotor exercises and swallowing maneuvers, and Usual Care (UC) comprising diet prescription and postural changes. Patients in both groups received treatments for 6 weeks, 18 treatment sessions, 3 times per week, every other day. The Mann Assessment of Swallowing Ability (MASA) was the main outcome measure. The swallowing ability was assessed before treatment (T 0 ), after the end of 9th session (T 1 ), after the end of 18th session (T 2 ), and after 6 weeks follow-up (T 3 ). Penetration�Aspiration Scale (PAS) and Pharyngeal Residue Rating Scale (PRRS) as secondary outcome measures were applied at T 0 and T 2 . Results: Both groups had improved regarding MASA, PAS and PRRS scores over the time (P < 0.001). The improvements achieved in all outcomes were significantly greater in the TDT group than those of the UC group. The Main effect of the Time � Group interaction was significant for MASA score (P < 0.001). The large effect sizes were found for MASA score in both the TDT (d = 3.91) and the UC (d = 1.11) groups. Conclusions: This pilot randomized controlled trial showed that the TDT significantly improved the swallowing function of the MS patients with dysphagia. © 2018 Elsevier Lt

Development, cross-cultural adaptation, and psychometric characteristics of the persian progressive aphasia language scale in patients with primary progressive aphasia: A pilot study

Introduction: Primary Progressive Aphasia (PPA) is a neurological condition characterized by progressive dissolution of language capabilities. The Progressive Aphasia Language Scale (PALS) is an easy-to-apply bedside clinical scale capable of capturing and grading the key language features essential for the classification of PPA. The objective of the present study was to develop and validate the Persian version of the PALS (PALS-P) as a clinical language assessment test. Methods: In this cross-sectional study, PALS was translated and adapted into Persian according to the international guidelines. A total of 30 subjects (10 subjects with PPA and 20 control subjects without dementia) were recruited to evaluate the intra-rater reliability and discriminant validity of PALS-P. Results: The intra-rater reliability of the PALS-P within a 14-day interval was excellent for each subtest (ICC agreement range=0.81-1.0). PALS-P results were statistically significant among groups, suggesting its discriminative validity. Conclusion: This preliminary study indicates that PALS-P was successfully developed and translated. It seems to be a valid and reliable screening tool to assess language skills in Persian-speaking subjects with progressive aphasia

Development, cross-cultural adaptation, and psychometric characteristics of the persian progressive aphasia language scale in patients with primary progressive aphasia: A pilot study

Introduction: Primary Progressive Aphasia (PPA) is a neurological condition characterized by progressive dissolution of language capabilities. The Progressive Aphasia Language Scale (PALS) is an easy-to-apply bedside clinical scale capable of capturing and grading the key language features essential for the classification of PPA. The objective of the present study was to develop and validate the Persian version of the PALS (PALS-P) as a clinical language assessment test. Methods: In this cross-sectional study, PALS was translated and adapted into Persian according to the international guidelines. A total of 30 subjects (10 subjects with PPA and 20 control subjects without dementia) were recruited to evaluate the intra-rater reliability and discriminant validity of PALS-P. Results: The intra-rater reliability of the PALS-P within a 14-day interval was excellent for each subtest (ICC agreement range=0.81-1.0). PALS-P results were statistically significant among groups, suggesting its discriminative validity. Conclusion: This preliminary study indicates that PALS-P was successfully developed and translated. It seems to be a valid and reliable screening tool to assess language skills in Persian-speaking subjects with progressive aphasia

National guidelines for cognitive assessment and rehabilitation of Iranian traumatic brain injury patients

Background: Individuals with moderate to severe traumatic brain injury (TBI) often have prolonged cognitive impairments, resulting in long-term problems with their real-life activities. Given the urgent need for evidence-based recommendations for neuropsychological management of Iranian TBI patients, the current work aimed to adapt eligible international guidelines for cognitive assessment and rehabilitation of the TBI patients in Iran. Methods: The project was led by an executive committee, under the supervision of the Iranian Ministry of Health and Medical Education (MOHME). Following a systematic literature search and selection process, four guidelines were included for adaptation. Clinical recommendations of the source guidelines were tabulated as possible clinical scenarios for 90 PICO clinical questions covering all relevant phases of care. After summing up the scenarios, our initial list of recommendations was drafted according to the Iranian patients� conditions. The final decision-making, with the contribution of a national interdisciplinary panel of 37 experts from across the country, was conducted in two rounds using online and offline survey forms (Round 1), and face-to-face and telephone meetings (Round 2). Results: A total of 63 recommendations in six sections were included in the final list of recommendations, among which 24 were considered as key recommendations. In addition, some of the recommendations were identified as fundamental, meaning that proper implementation of the other recommendations is largely dependent on their implementation. Conclusion: Iranian health policy makers and rehabilitation program managers are recommended to address some fundamental issues to provide the necessary infrastructure to set up an efficient cognitive rehabilitation service system. © 2020 Academy of Medical Sciences of I.R. Iran. All rights reserved

The effect of traditional dysphagia therapy on the swallowing function in patients with Multiple Sclerosis: A pilot double-blinded randomized controlled trial

Background: Dysphagia is common following Multiple Sclerosis (MS) and is associated with significant morbidity and mortality. The current rehabilitation program to swallowing therapy is Traditional Dysphagia Therapy (TDT), but there is a dearth of evidence about its effectiveness in MS patients. Objectives: This study was aimed to determine the effects of the TDT on the swallowing function in MS patients with dysphagia. Methods: A pilot double blind randomized clinical trial was carried out on 20 patients with MS. Patients were randomly divided into experimental group (TDT) comprising sensorimotor exercises and swallowing maneuvers, and Usual Care (UC) comprising diet prescription and postural changes. Patients in both groups received treatments for 6 weeks, 18 treatment sessions, 3 times per week, every other day. The Mann Assessment of Swallowing Ability (MASA) was the main outcome measure. The swallowing ability was assessed before treatment (T0), after the end of 9th session (T1), after the end of 18th session (T2), and after 6 weeks follow-up (T3). Penetration-Aspiration Scale (PAS) and Pharyngeal Residue Rating Scale (PRRS) as secondary outcome measures were applied at T0 and T2. Results: Both groups had improved regarding MASA, PAS and PRRS scores over the time (P < 0.001). The improvements achieved in all outcomes were significantly greater in the TDT group than those of the UC group. The Main effect of the Time � Group interaction was significant for MASA score (P < 0.001). The large effect sizes were found for MASA score in both the TDT (d = 3.91) and the UC (d = 1.11) groups. Conclusions: This pilot randomized controlled trial showed that the TDT significantly improved the swallowing function of the MS patients with dysphagia. © 2018 Elsevier Ltd