In the field of speech-language pathology, there is an increasing need for valid and appropriate assessment measures for Spanish-speaking students that can reliably be given by examiners with a wide range of Spanish knowledge and scoring experience. In order to determine the level of detail needed to reliably score a standardized measure of Spanish narrative ability, 15 participants, ranging in Spanish proficiency and experience levels, scored six samples of the experimental version of the Test of Narrative Language-Spanish (TNL-Spanish). Consistency and accuracy of scores were compared with Spanish proficiency levels, comfort levels, and presentation method (written transcript and audio-recorded samples). Results indicated no significant effect for any factor, indicating that examiners of varying levels of Spanish proficiency and experience level can reliably and efficiently score an assessment in Spanish when provided with clear and specific scoring procedures and information regarding the kinds of errors present in language disorders in Spanish. / text

There have been many theories about cultural differences found between groups on intelligence test scores. The main debate has been between those in favor of a genetic explanation versus those in favor of a more environmental one. When considering environmental influences, one explanation has been that there could be differential effects due to the assessor. Although there have been several studies that have considered this possibility, the results are inconclusive. The current study attempted to tease apart the assessor effects by focusing on biases in the assessor alone and by eliminating effects from the test taker. The study is an experimental design where participants were randomly assigned a WISC-III protocol of members of different ethnic groups. It was hypothesized that different groups may score these IQ tests differentially depending on the race/ethnicity of the person who was assessed. Results showed that when given identical protocols, participants scored African American protocols lower than Caucasian American protocols in both high and average IQ conditions. Clinical implications of these results are discussed.

Dissertation submitted in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic, Durban University of Technology, 2010. / The aim of this study was to determine the inter-examiner reliability of motion palpation to detect joint dysfunction in hindfoot and midfoot joints of asymptomatic feet and feet with chronic ankle instability syndrome. The rationale for this study was that motion palpation is a commonly used assessment tool that is used by the chiropractic profession to detect the need for manipulation of the spine and extremities. Also until the reliability of motion palpation is known, other studies using motion palpation as an assessment tool to detect the need for manipulation in the hindfoot and midfoot are questionable. The study was conducted at Durban University of Technology (DUT). Patients that responded to the adverts were then screened via telephonic interview. The researcher performed a case history, physical examination and a foot and ankle regional examination on each patient. Three masters chiropractic students then independently assessed both the symptomatic and asymptomatic feet of each patient and recorded their results. The data was then statistically analysed using SPSS version 15. It was found that the inter-examiner reliability of motion palpation for detecting restrictions in feet with chronic ankle instability syndrome was fair and for detecting instability, there was moderate reliability. In the asymptomatic group the examiners showed to have poor reliability in detecting restrictions and moderate reliability in detecting instability. Inter-examiner reliability was better in the symptomatic group and in this group examiners had more agreement on detecting instability as opposed to restrictions. This study has showed that inter-examiner reliability ranged from poor to moderate in the symptomatic and asymptomatic group with the reliability ranging from poor to moderate. Therefore, one can conclude that motion palpation can be used as an assessment tool to detect joint dysfunction in hindfoot and midfoot joints. However, further studies are warranted to address other subjective and objective measurements such as tenderness and range of motion together with motion palpation.

Dissertation submitted in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic, Durban University of Technology, 2011. / Background: Myofascial pain is a disorder, characterized by the presence of trigger points (MTrP). It is recognised by unique features which include a tender point in a taut band of muscle, a local twitch response (LTR), a characteristic referred pain pattern, and the reproduction of the patient’s usual pain upon examination. A debate exists as to the precise diagnostic criteria used in identifying trigger points. This has hampered the standardized assessment and treatment of Myofascial Pain Syndrome and has led to contradictory findings being reported by various authors due to the lack of a reliable diagnostic tool. Objectives: The first objective was to determine the inter-examiner reliability of palpation of MTrPs in the trapezius and gluteus medius muscles. The second objective was to determine whether training and standardization in palpation techniques would improve inter-examiner reliability of palpation of MTrPs. Methods: This study was designed as a quantitative pre and post intervention interexaminer reliability study. Three examiners (one qualified Chiropractor, one senior chiropractic intern from the CDC and the researcher) were used to examine sixty patients (thirty symptomatic and thirty asymptomatic) for MTrPs. This study was conducted in two phases. During the myofascial examination of patients examiners were required to determine whether a MTrP was present or absent, differentiate whether the MTrP was active or latent and determine the presence or absence of the five characteristics of MTrP (tender point in a taut band of muscle, a local twitch response (LTR), a pain characteristic referred pain pattern, the reproduction of the patient’s usual pain and a jump sign) however, in phase one the researchers were blinded to the characteristics being investigated. Subsequent to phase one, examiners had to attend two, one hour discussion sessions to reduce individual variation in the application of palpation techniques. Results: Inter-examiner reliability was assessed using Fleiss Kappa statistic, percentage agreement and confidence intervals. The results show that three examiners are able to attain acceptable agreement in the palpation of MTrPs, since the features (described above) were shown to improve considerably in phase two after the training session in which standardization of techniques was emphasized. Conclusion: This study provides preliminary evidence that MTrP palpation is reliable and therefore, useful diagnostic tool in the identification of MTrPs and the diagnosis of Myofascial Pain Syndrome.

The observation or measurement of eye movement can aid in the detection and localization of vestibular pathology due to the relationship between the function of the vestibular sensory receptors in the inner ear and the eye movements produced by the vestibulo-ocular reflex (VOR). The majority of bedside and laboratory tests of vestibular function involve the observation or measurement of horizontal eye movements (i.e., horizontal VOR) produced by stimuli that activate the horizontal semicircular canals (SCCs) and the superior vestibular nerve. The video head impulse test (vHIT) is a new clinical test of dynamic SCC function that uses a high-speed digital video camera embedded in light-weight goggles to record head and eye movement during passive head rotations. An important precursor to the clinical use of a new diagnostic test is the evaluation of test reproducibility. If test reproducibility is poor, then the test is unlikely to be clinically useful. Currently, there are no published data concerning both inter- and intra-examiner reliability of the vHIT. The purpose of this study was to assess the test-retest reliability of the horizontal SCC vHIT in young healthy adult participants using the Otometrics Impulse vHIT device using a prospective repeated measures design. Forty-four young adults with normal hearing, normal caloric test results, and a negative history of vestibular disorder, neurological disease, open or closed head injury, or cervical spine injury participated in the study. Each examiner underwent one hour of training on the vHIT device prior to the initiation of the study. The vHIT was administered to each participant by each of two different examiners on two different days. Inter-session interval ranged from 1 to 10 days and examiner order was randomized. Each examiner manually rotated each participant’s head in leftward and rightward directions, and VOR gain (eye velocity/head velocity) was calculated for the left and right horizontal SCCs. The effects of examiner, session, and SCC (left horizontal versus right horizontal) on the magnitude of VOR gain were assessed using repeated measures analysis of variance. The intra-class correlation (ICC) coefficient was used to assess intra- and inter-examiner reliability. Preliminary findings obtained in 30 participants indicated that the main effects of examiner, session, and SCC on VOR gain were not significant. The ICCs for both inter-examiner (.847) and intra-examiner reliability (.813 for Examiner 1 and .845 for Examiner 2) were good. Testing was well-tolerated and completed in most participants in ~5 minutes. The vHIT has some important advantages relative to more established laboratory tests of horizontal SCC function including the ability to assess the vertical SCCs, lower cost, shorter test time, greater portability, minimal space requirements, and increased patient comfort. Additional data should be obtained from older participants with normal vestibular function and from patients with vestibular disorders. Within-subject comparisons between the results of the vHIT and the traditional tests of horizontal SCC function (caloric and rotary chair tests) will be important in determining the role of the vHIT in the vestibular test battery.

The angular vestibulo-ocular reflex (VOR) ensures gaze stability during head rotations by generating eye movements that are equal and opposite to head rotation. The gain of the VOR (eye velocity/head velocity) for natural head movements, therefore, approaches unity in healthy individuals. The VOR has four main anatomic components: the semicircular canals (SCCs) and vestibular nerve in the peripheral vestibular system, the vestibular and ocular motor nuclei in the brainstem, and the extraocular muscles. The SCCs are positioned in three nearly orthogonal planes within the head thereby allowing for the detection of head rotation about any axis in space. The SCCs function as angular accelerometers in a push-pull fashion with two coplanar canals on each side of the head working together, i.e., left and right horizontal SCCs, the right anterior and left posterior SCCs or RALP, and the left anterior and right posterior SCCs or LARP. The observation or measurement of eye movement can aid in the detection and localization of vestibular pathology due to the relationship between the function of the vestibular sensory receptors in the inner ear and the eye movements produced by the VOR. The video head impulse test (vHIT) is a relatively new clinical test of dynamic SCC function that uses a high-speed digital video camera embedded in light-weight goggles to record head and eye movement during passive head rotations in the horizontal and vertical planes. An important precursor to the clinical use of a new diagnostic test is the evaluation of test reproducibility. If test reproducibility is poor, then the test is unlikely to be clinically useful. There are no published data concerning both inter- and intra-examiner reliability of the vHIT. The purpose of this study was to establish normal reference intervals and assess the test-retest reliability of the vHIT in young healthy adult participants using the Micromedical vHIT device, two examiners, and a prospective repeated measures design. Each examiner underwent five hours of training on the vHIT device prior to the initiation of the study. The vHIT was administered to each participant (n = 35) by each examiner on two different days. Inter-session interval ranged from 1 to 30 days and examiner order was alternated for successive subjects; canal-plane order was randomized. At each session, participants underwent head impulse testing in each plane resulting in the stimulation of each of the six SCCs. The dependent variable was VOR gain (eye velocity/head velocity) and the effects of examiner, session, eye, and SCC on the magnitude of VOR gain were assessed using repeated measures analysis of variance. The intra-class correlation (ICC) coefficient was used to assess intra- and inter-examiner reliability. The cut-offs (5th percentiles) for normal VOR gain were 0.76 (right and left horizontal SCCs), 0.68 (right anterior SCC), 0.70 (left anterior SCC), 0.69 (right posterior SCC), and 0.75 (left posterior SCC). There was no significant effect of examiner on VOR gain and the ICCs indicated fair-to-good inter- and intra-examiner reliability with better reliability for the horizontal SCCs than for the posterior and anterior SCCs

The measurement of eye movement can aid in the detection and localization of vestibular pathology due to the relationship between the function of the vestibular sensory receptors in the inner ear and the eye movements produced by the vestibulo-ocular reflex (VOR). The majority of tests of vestibular function involve the measurement of horizontal eye movements produced by stimuli that activates the horizontal semicirculuar canals (hSCCs). The video head impulse test (vHIT) is a new clinical test of dynamic SCC function that uses a high-speed digital video camera embedded in light-weight goggles to record head and eye movement during passive head rotations. There are no published data concerning the examiner reliability of the vHIT. A prospective repeated measures design was used to assess test-retest reliability of the hSCC vHIT in young healthy adult participants (n=44). The vHIT was administered to each participant by each of two different examiners on two different days. A repeated measures analysis of variance was used to determine the effects of examiner, session, and hSCC on the magnitude of VOR gain (eye velocity/head velocity). The intra-class correlation coeffecient and the coefficient of repeatability were used to assess intra- and inter-examiner reliability.

Thesis (MPhil)--University of Stellenbosch, 2011. / Introduction: Objective Structured Clinical Examination (OSCE) examiner training is widely employed to address some of the reliability and validity issues that accompany the use of this assessment tool. An OSCE skills course was developed and implemented at the Stellenbosch Faculty of Health Sciences and the influence thereof on participants (clinicians) was evaluated. Method: Participants attended the OSCE skills course which included theoretical sessions concerning topics such as standard-setting, examiner influence and assessment instruments, as well as two staged OSCEs, one at the beginning and the other at the end of the course. During the latter, each participant examined a student role-player performing a technical skill while being video recorded. Participants‟ behaviour and assessment results from the two OSCEs were evaluated, as well as the feedback from participants regarding the course and group interviews with student role players. Results: There was a significant improvement in inter-rater reliability as well as a slight decrease in inappropriate examiner behaviour, such as teaching and prompting during assessment of students. Furthermore, overall feedback from participants and perceptions of student role-players was positive. Discussion: In this study, examiner conduct and inter-rater reliability was positively influenced by the following interventions: examiner briefing; involvement of examiners in constructing assessment instruments as well as viewing (on DVD) and reflection, by examiners, of their assessment behaviour. Conclusion: This study proposes that the development and implementation of an OSCE skills course is a worthwhile endeavour in improving validity and reliability of the OSCE as an assessment tool.

The Medical Examiner of Virginia (ME) dataset and the Virginia Department of Forensic Science Driving Under the Influence of Drugs (DUI) datasets were used to determine whether people have the potential to develop tolerances to diphenhydramine, cocaine, oxycodone, hydrocodone, methadone, and morphine. These datasets included the years 2000-2004 and were used to compare the concentrations of these six drugs between people who died from a drug-related cause of death (of the drug of interest) and people who were pulled over for driving under the influence. Three drug pattern groups were created to divide each of the six drug-specific datasets in order to compare concentrations between individuals with the drug alone, the drug and ethanol, or a poly pharmacy of drugs (multiple drugs). An ANOVA model was used to determine if there was an interaction effect between the source dataset (ME or DUI) and the drug pattern groups. For diphenhydramine and cocaine, an interaction was statistically significant, but for the other drugs, it was not significant. The other four drug-specific datasets showed that the DUI and ME were statistically significantly different from each other, and all of those datasets except for methadone showed that there was a statistically significant difference between at least two drug pattern groups. Showing that all of these datasets showed differences between the ME and DUI datasets did not provide sufficient evidence to suggest the development of tolerances to each of the six drugs. One exception was with methadone because there were 14 individuals that had what is defined as a "clinical 'lethal' blood concentration". These individuals provide some evidence for the possibility of developing tolerances.The main outcomes of this study include suggesting changes to make to the ME datasets and the DUI datasets with regard to the way data is kept and collected. Several problems with the fields of these datasets arose before beginning the analysis and had to be corrected. Some of the changes suggested are currently being considered at the Virginia Office of the Chief Medical Examiner as they are beginning to restructure their database.

The complex challenges facing the sexual assault nurse examiners program in a midwest state are underreporting, late reporting, and poor coordination of care for pediatric victims of child maltreatment with sexual abuse. The main objective of this quality improvement project was the identification of necessary practice-related approaches to care to decrease barriers associated with reporting suspicions of abuse or neglect. An evidence-based, multidisciplinary assessment clinical toolkit that followed clinical components of trauma-sensitive, child-centered screenings triggering a coordinated response to conduct a forensic medical exam within 96 hours of the alleged incident was evaluated. During 3 rounds of surveys following the Delphi technique, 10 members of an expert panel agreed upon critical success indicators were used for the review and final decision for adoption of the toolkit. The final consensus obtained, with an intraclass correlation of 0.924 with a 95% confidence interval, supported implementation of this trauma-informed toolkit which would ensure that medical care and throughput through the system of care addressed the physical and mental needs of the patient and caregivers as well as improvement in the forensic investigative data collection. A child-centered, trauma-sensitive approach to screening and evaluation by healthcare professionals will help decrease the delay to evaluation and to curtail long-term adverse impacts on survivors. This family-based primary prevention effort is a framework for healthcare practitioners to use and includes strategies (i.e., health history, mental health evaluation, family dynamics evaluation) that are child and family centered contributing significantly to positive social change.