Appraising the quality of randomized controlled trials: inter-rater reliability for the OTseeker evidence database

Rationale and aims 'OTseeker' is an online database of randomized controlled trials (RCTs) and systematic reviews relevant to occupational therapy. RCTs are critically appraised and rated for quality using the 'PEDro' scale. We aimed to investigate the inter-rater reliability of the PEDro scale before and after revising rating guidelines. Methods In study 1, five raters scored 100 RCTs using the original PEDro scale guidelines. In study 2, two raters scored 40 different RCTs using revised guidelines. All RCTs were randomly selected from the OTseeker database. Reliability was calculated using Kappa and intraclass correlation coefficients [ICC (model 2,1)]. Results Inter-rater reliability was 'good to excellent' in the first study (Kappas >= 0.53; ICCs >= 0.71). After revising the rating guidelines, the reliability levels were equivalent or higher to those previously obtained (Kappas >= 0.53; ICCs >= 0.89), except for the item, 'groups similar at baseline', which still had moderate reliability (Kappa = 0.53). In study 2, two PEDro scale items, which had their definitions revised, 'less than 15% dropout' and 'point measures and variability', showed higher reliability. In both studies, the PEDro items with the lowest reliability were 'groups similar at baseline' (Kappas = 0.53), 'less than 15% dropout' (Kappas

Articulatory function following traumatic brain injury in childhood: A perceptual and instrumental analysis

Primary objective: To investigate the articulatory function of a group of children with traumatic brain injury (TBI), using both perceptual and instrumental techniques. Research design: The performance of 24 children with TBI was assessed on a battery of perceptual (Frenchay Dysarthria Assessment, Assessment of Intelligibility of Dysarthric Speech and speech sample analysis) and instrumental ( lip and tongue pressure transduction systems) assessments and compared with that of 24 non-neurologically impaired children matched for age and sex. Main outcomes: Perceptual assessment identified consonant and vowel imprecision, increased length of phonemes and overall reduction in speech intelligibility, while instrumental assessment revealed significant impairment in lip and tongue function in the TBI group, with rate and pressure in repetitive lip and tongue tasks particularly impaired. Significant negative correlations were identified between the degree of deviance of perceptual articulatory features and decreased function on many non-speech measures of lip function, as well as maximum tongue pressure and fine force tongue control at 20% of maximum tongue pressure. Additionally, sub-clinical articulatory deficits were identified in the children with TBI who were non-dysarthric. Conclusion: The results of the instrumental assessment of lip and tongue function support the finding of substantial articulatory dysfunction in this group of children following TBI. Hence, remediation of articulatory function should be a therapeutic priority in these children.

The mismatch negativity (MMN) response to complex tones and spoken words in individuals with aphasia

Background: The mismatch negativity (MMN) is a fronto-centrally distributed event-related potential (ERP) that is elicited by any discriminable auditory change. It is an ideal neurophysiological tool for measuring the auditory processing skills of individuals with aphasia because it can be elicited even in the absence of attention. Previous MMN studies have shown that acoustic processing of tone or pitch deviance is relatively preserved in aphasia, whereas the basic acoustic processing of speech stimuli can be impaired (e.g., auditory discrimination). However, no MMN study has yet investigated the higher levels of auditory processing, such as language-specific phonological and/or lexical processing, in individuals with aphasia. Aims: The aim of the current study was to investigate the MMN response of normal and language-disordered subjects to tone stimuli and speech stimuli that incorporate the basic auditory processing (acoustic, acoustic-phonetic) levels of non-speech and speech sound processing, and also the language-specific phonological and lexical levels of spoken word processing. Furthermore, this study aimed to correlate the aphasic MMN data with language performance on a variety of tasks specifically targeted at the different levels of spoken word processing. Methods M Procedures: Six adults with aphasia (71.7 years +/- 3.0) and six healthy age-, gender-, and education-matched controls (72.2 years +/- 5.4) participated in the study. All subjects were right-handed and native speakers of English. Each subject was presented with complex harmonic tone stimuli, differing in pitch or duration, and consonant-vowel (CV) speech stimuli (non-word /de:/versus real world/deI/). The probability of the deviant for each tone or speech contrast was 10%. The subjects were also presented with the same stimuli in behavioural discrimination tasks, and were administered a language assessment battery to measure their auditory comprehension skills. Outcomes O Results: The aphasic subjects demonstrated attenuated MMN responses to complex tone duration deviance and to speech stimuli (words and non-words), and their responses to the frequency, duration, and real word deviant stimuli were found to strongly correlate with performance on the auditory comprehension section of the Western Aphasia Battery (WAB). Furthermore, deficits in attentional lexical decision skills demonstrated by the aphasic subjects correlated with a word-related enhancement demonstrated during the automatic MMN paradigm, providing evidence to support the word advantage effect, thought to reflect the activation of language-specific memory traces in the brain for words. Conclusions: These results indicate that the MMN may be used as a technique for investigating general and more specific auditory comprehension skills of individuals with aphasia, using speech and/or non-speech stimuli, independent of the individual's attention. The combined use of the objective MMN technique and current clinical language assessments may result in improved rehabilitative management of aphasic individuals.

Access to written information for people with aphasia

Background: Accessibility is often constructed in terms of physical accessibility. There has been little research into how the environment can accommodate the communicative limitations of people with aphasia. Communication accessibility for people with aphasia is conceptualised in this paper within the World Health Organisation's International Classification of Functioning, Disability and Health (ICF). The focus of accessibility is considered in terms of the relationship between the environment and the person with the disability. Thus: This paper synthesises the results of three Studies that examine the effectiveness of aphasia-friendly written material. Main Contribution: The first study (Rose, Worrall, & McKenna, 2003) found that aphasia-friendly formatting of written health information improves comprehension by people with aphasia, but not everyone prefers aphasia-friendly formatting. Brennan, Worrall, and McKenna (in press) found that the aphasia-friendly strategy of augmenting text with pictures, particularly ClipArt and Internet images, may be distracting rather than helpful. Finally, Egan, Worrall, and Oxenham (2004) found that the use of ail aphasia-friendly written training manual was instrumental in assisting people with aphasia to learn the Internet. Conclusion: Aphasia-friendly formatting appears to improve the accessibility of written material for people with aphasia. Caution is needed when considering the use of illustrations, particularly ClipArt and Internet images, when creating aphasia-friendly materials. A research, practice, and policy agenda for introducing aphasia-friendly formatting is proposed.

The rellationship between specific features of aphasia-friendly written material and comprehension of written material for people with aphasia: An exploratory study

Background: Written material is often inaccessible fro people with aphasia. The format of written material needs to be adapted to enable people with aphasia to read with understanding. Aims: This study aimed to further explore some issues raised in Rose, Worrall, and MacKenna (2003) concerning the effects of aphasia-friendly formats on the reading comprehension of people with aphasia. It was hypothesised that people with aphasia would comprehend significantly more paragraphs that were formatted in an aphasia-friendly manner than control paragraphs. This study also aimed to investigate if each single aspect of aphasia-friendly formatting (i.e., simplified vocabulary and syntax, large print, increased white spacem and pictures) used in isolation would result in increased comprehension compared to control paragraphs. Other aims were to compare the effect of aphasia-friendly fromatting with the effects of each single adaptation, and to investigate if the effects of aphasia-friendly formates were related to aphasia severity. Methods & Procedures: Participants with mild to moderately severe aphasia (N = 9) read a battery of 90 paragraphs and selected the best word of phrase from a choice of four to complete each paragraph. A linear mixed model (p < .05) was used to analyse the differences in reading comprehension with each paragraph fromat across three reading grade levels. Outcomes & Results: People with aphasia comprehended significantly more aphasia-friendly paragraphs than control paragraphs. They also comprehended significantly more paragraphs with each of the following single adaptations: simplified vocabulary and syntax, large ptint, and increased white spaces. Although people with aphasia tended to comprehend more paragraphs with pictures added than control paragraphs, this difference was not significant. No significant correlation between aphasia severity and the effect of aphasia-friendly formatting was found. Conclusion: This study supports the idea that aphasia-friendly formats increase the reading comprehension of people with aphasia. It suggests that adding pictures, particularly Clip Art pictures, may not significantly improve the reading the reading comprehension of people with aphasia. These findings have implications for all written communication with people with aphasia, both in the clinical setting and in the wider community. Applying these findings may enable people with aphasia to have equal access to written information and to participate in society.

A visiting occupational therapy service to indigenous children in school: Results of a pilot project

The need for additional support for Indigenous children at school is well documented. Occupational therapists are well positioned to form part of this support. However, many occupational therapists report that Indigenous families do not access their services and when they do, the occupational therapist feels uncertain about how best to meet their needs. This article documents a pilot project which delivered occupational therapy services within several schools and preschools in Brisbane which had significant numbers of Indigenous students. The project was evaluated using a qualitative methodology and included focus groups and interviews with teachers and parents. The results indicated that in general the service provided valuable support to students, teachers and parents. In particular, providing the service within the school context was seen as critical to its success. Suggestions for improvements in future support services are also provided.

Widespread sensory hypersensitivity is a feature of chronic whiplash-associated disorder but not chronic idiopathic neck pain

Objectives: To investigate sensory changes present in patients with chronic whiplash-associated disorders and chronic idiopathic neck pain using a variety of quantitative sensory tests to better understand the pain processing mechanisms underlying persistent symptoms. Methods: A case control study was used with 29 subjects with chronic whiplash-associated disorders, 20 subjects with chronic idiopathic neck pain, and 20 pain-free volunteers. Pressure pain thresholds were measured over the articular pillars of C2-C3, C5-C6, the median, radial, and ulnar nerve trunks in the arm and over a remote site, the muscle belly of tibialis anterior. Heat pain thresholds, cold pain thresholds, and von Frey hair sensibility were measured over the cervical spine, tibialis anterior, and deltoid insertion. Anxiety was measured with the Short-Form of the Spielberger State Anxiety Inventory. Results: Pressure pain thresholds were decreased over cervical spine sites in both subject groups when compared with controls (P < 0.05). In the chronic whiplash-associated disorders group, pressure pain thresholds were also decreased over the tibialis anterior, median, and radial nerve trunks (P < 0.001). Heat pain thresholds were decreased and cold pain thresholds increased at all sites (P < 0.03). No differences in heat pain thresholds or cold pain thresholds were evident in the idiopathic neck pain group at any site compared with the control group (P > 0.27). No abnormalities in von Frey hair sensibility were evident in either neck pain group (P > 0.28). Discussion: Both chronic whiplash-associated disorders and idiopathic neck pain groups were characterized by mechanical hyperalgesia over the cervical spine. Whiplash subjects showed additional widespread hypersensitivity to mechanical pressure and thermal stimuli, which was independent of state anxiety and may represent changes in central pain processing mechanisms. This may have implications for future treatment approaches.

Remembrance of things past: Amnesic syndrome with partial preservation of professional skills

J.L., then a 25-year-old physiotherapist, became densely amnesic following herpes simplex encephalitis. She displayed severe retrograde amnesia, category-specific semantic memory loss, and a profound anterograde amnesia affecting both verbal and visual memory. Her working memory systems were relatively spared as were most of her cognitive problem-solving abilities, but her social functioning was grossly impaired. She was able to demonstrate several previously learned physiotherapy skills, but was unable to modify her application of these procedures in accordance with patient response. She showed no memory of theoretical or propositional knowledge, and could neither plan treatment or reason clinically. Three years later, J.L. had profound impairment of anterograde and retrograde declarative memory, with relative sparing of working memory for problem solving and long-term memory of procedural skills. The theoretical and practical implications of her amnesic syndrome are discussed.

Ototoxicity and tolerance assessment of a TrisEDTA and polyhexamethylene biguanide ear flush formulation in dogs

Clinically healthy mixed breed dogs (n = 20) were used to determine if a Tris (tromethamine)-buffered test solution, Otinide((R)) (Trademark of Dermcare-Vet Pty-Ltd, Australia), containing disodium ethylenediamine tetraacetic acid (EDTA; 1.21 g/L) and polyhexamethylene biguanide (PHMB; 0.22 g/L) caused ototoxicity or vestibular dysfunction. The dogs were randomly assigned to either a control group (group A, n = 10) receiving saline, or a treatment group (group B, n = 10) receiving the test solution. Phase 1 of the study consisted of applying 5.0 mL of saline to both ears of the control group (group A) and 5 mL of test solution to both ears of the test group (group B), for 21 days. A bilateral myringotomy was then performed on each dog under deep sedation. Phase 2 of the study then consisted of applying 2.0 mL of the saline to both ears of the control group (group A) and 2.0 mL of the test solution to both ears of the test group (group B), for 14 days. Throughout the study, dogs were examined for clinical health, and underwent otoscopic, vestibular and auditory examinations. The auditory examinations included brainstem auditory evoked potential (BAEP) threshold and supra-threshold assessments using both click and 8 kHz tone burst stimuli. The absence of vestibular signs and effects on the BAEP attributable to the test solution suggested the test solution could be applied safely to dogs, including those with a damaged tympanic membrane.

Measuring the ability of school children with a history of otitis media to understand everyday speech

The present study compared the ability of school-aged children with and without a history of otitis media (OM) to understand everyday speech in noise using the University of Queensland Understanding of Everyday Speech Test (UQUEST). Participants were 484 children (246 boys, 238 girls) attending Grade 3 (272, mean age = 8.25 yr., SD = 0.43) and Grade 4 (212, mean age = 9.28 yr., SD = 0.41) at 19 primary schools in Brisbane metropolitan and Sunshine Coast schools. Children selected for inclusion were native speakers of English with normal hearing on the day of testing and had no reported physical or behavioral impairments. The children were divided into three groups according to the number of episodes of OM since birth. The results showed no significant differences in speech scores across the participant groups. However, a significant difference in mean speech scores was found across the grades and the noise conditions. Although children with a history of OM performed equally well at a group level when compared to the controls, they exhibited a large range of abilities in speech comprehension within the same group.