1.The Introduction of a Secondary Reinforcer During Therapy Based on the ABA Model for Children with Autisme
Ban Weng Lun ; Susheel Kaur Dhillon Joginder Singh ; Kartini Ahmad
Malaysian Journal of Health Sciences 2016;14(2):89-102
Applied Behavior Analysis (ABA) is a technique used to teach children with autisme a variety of skills. In ABA, children with autisme often do not receive reinforcers because they have difficulty performing their targeted behaviors, which consequently leads to challenging behaviors. Objectives of this study are to increase spontaneous request and decrease challenging behavior among children with autisme by introducing a secondary reinforcer during therapy based on ABA model. Secondary reinforcer has lower reinforcing value than the primary reinforcer. When the children tried but were unable to produce their targeted behavior, they were given the secondary reinforcer. The children were divided into two groups, five children in the intervention group and four children in the control group, and they were taught specific target requesting behavior (TRB) to request for a preferred item. Three children in the intervention group recorded an increase in spontaneous request and a reduction in challenging behaviors. Only two children from the control group recorded an increase in spontaneous request and a decrease in challenging behaviors. However, only children from the intervention group were able to maintain their performance during the generalization sessions. The results suggest that children respond differently to specific prompts and interventions. Future studies should focus on how prompts affect children’s performance and also on reinforcer selection. Bigger scale studies are still needed to further determine the effectiveness of a secondary reinforcer in assisting the learning of requesting skill and in reducing challenging behaviors among children with autisme during therapy based on ABA model.
2.Toxic Epidermal Necrolysis as the First Presentation of Systemic Lupus Erythematosus
Anisha Bhullar ; Wan Syazween Iyana Wan Ahmad Kamal ; Kartini Rahim
Malaysian Journal of Dermatology 2017;38(June):83-86
Toxic epidermal necrolysis (TEN) is a severe mucocutaneous disease characterized by extensive
epidermal detachment with drugs as the most probable cause. We describe a unique case of TEN
where systemic lupus erythematosus (SLE) was found to be the precipitating underlying disease. Our
patient was managed in ICU, however succumbed one month after her diagnosis due to overwhelming
sepsis and multiorgan failure.
3.Mimics and diagnostic pitfalls of intracranial lesions in conventional MRI: Clues on advanced MRI
Alan Basil Peter ; Norlisah Ramli ; Kartini Rahmat ; Faizatul Izza Rozalli ; Che Ahmad Mazlan
Neurology Asia 2015;20(2):161-165
Objective: To delineate and differentiate between late subacute hemorrhage and intracranial lipomas
in clinically available conventional and advanced MR sequences. Methods: Two cases of late subacute
hemorrhage and two cases of intracranial lipoma were reviewed with CT scans and 3.0T scanner MRI.
The sequences evaluated in MRI were T1-weighted (T1W) fast spin echo (FSE), T2-weighted (T2W)
FSE, gradient echo T2*-weighted (GRE T2*W) images, diffusion weighted (DWI), apparent diffusion
coefficient (ADC) and multivoxel spectroscopy. Results: Late subacute hemorrhage and intracranial
lipoma have similar imaging features on T1W, T2W FSE with blooming artefact at the margins on
GRE T2*W. However on GRE T2*W sequence, the central area of lipoma demonstrates low signal;
while hemorrhage demonstrates high signal. In DWI, late subacute hemorrhage shows hyperintensity;
while in lipoma there is loss of signal.
Conclusion: Awareness of the potential pitfalls in standard sequence are important, as these entities
appear to have similar T1W/ T2W characteristic with blooming artefact on T2*W. Knowing the
distinctive central signal intensity pattern on GRE T2W* and DWI is therefore essential to differentiate
between these lesions as there are differences to their clinical management.
Magnetic Resonance Imaging
4.The Validation Of The Malay Preschool Language Assessment Tool (Mplat): The Screening And Diagnostic Versions
Rogayah A Razak ; Amelia Inbam Neelagandan ; Norlenawati Md Yusuf ; Lim Hui Woan ; Kartini Ahmad ; Charles Madison
Malaysian Journal of Public Health Medicine 2018;18(Special Volume (1)):191-115
The paper describes the validation of the Malay Preschool Language Assessment Tool (MPLAT), a standardized normed referenced language assessment tool for Malay preschoolers within the ages of 4;0-6;11 and whose native language is Malay. The MPLAT (A Razak et al. 2010) is an assessment tool which is designed to assess the areas of receptive language, expressive language and early literacy skills. The MPLAT contains six subtests i.e. picture vocabulary, grammatical understanding, sentence repetition, referential meaning, relational meaning and early literacy skills. This paper is divided into 2 studies. Study 1 tested the psychometric properties and normative data of the diagnostic version of MPLAT on 300 participants recruited from preschools in the rural area of Gua Musang and the urban area of Kota Bahru located in the East Coast state of Kelantan. The construct validity is high with a strong correlation (r = 0.942) between test scores and age, validating the developmental nature of the test. There was also moderate to strong positive correlation between each subtest and the test total, as well as between subtests. It also has high test-retest reliability (r = 0.998 (p < 0.01) and inter-rater reliability (rho = 1.000). The second study looked at the psychometrics properties of the MPLAT short version (screening) compared to the full version diagnostic. The short version of MPLAT is about a quarter of the full (diagnostic) version. About 108 subjects in the urban area of the the Klang Valley, consisting of Kuala Lumpur and Selangor, were administered both versions of the MPLAT. The Pearson correlation revealed a strong positive correlation between the total scores and age (r = 0.718, p<.01), and strong positive correlation for the test-retest reliability (r = 0.881, n=12) for the short MPLAT version. For the full version, the Spearman correlation revealed a strong positive correlation between total scores and age (r = 0.791, p<.01) and a very strong positive Pearson correlation for test-retest reliability (r = 0.943). Cronbach's Alpha values demonstrated the internal consistency of the full version (0.972) and short version (0.929). In summary, both versions of the MPLAT were found to be valid tools to screen and diagnose language problems among Malay preschool children in Malaysia. MPLAT also has the potential to be a useful research tool to delineate language development of the preschool Malay children.
Malay Preschool Language Assessment Tool (MPLAT)
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screening tool
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diagnostic tool
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language assessment
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Malay preschool children
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test development
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test validation
5.An exploratory study on speech and hearing outcomes in children with cleft lip and palate
Hasherah Mohd Ibrahim ; Fatin Hanim Mohamed Yusoff ; Kartini Ahmad ; Sandra Van Dort
The Medical Journal of Malaysia 2015;70(6):321-325
Introduction: Little is known about the treatment outcomes
of children with cleft lip and/or palate (CLP) receiving
surgical care for primary lip and palate closure in Malaysia.
Objectives: This study examined the speech and hearing
status of Malay-speaking children with CLP residing in Kuala
Lumpur.
Methods: Parents whose children were between the age of 5
and 7 years were recruited via the Cleft Lip and Palate
Association of Malaysia (CLAPAM) registry. Parents
completed a survey and the children completed a speech
and hearing assessment at the Audiology and Speech
Sciences Clinic, Universiti Kebangsaan Malaysia.
Outcomes: Speech measures include nasality rating,
nasalance scores, articulation errors and speech
intelligibility rating, while hearing measures include hearing
thresholds and tympanometry results for each child.
Results: Out of 118 registered members who fulfilled the
inclusion criteria, 21 agreed to participate in the study. The
overall speech and hearing status of children in this sample
were poor. Only four (19%) participants had normal speech
intelligibility rating and normal hearing bilaterally. In terms
of overall cleft management, only four (19%) participants
were seen by a cleft team while seven (33%) had never had
their hearing tested prior to this study.
Conclusion: Participants in this sample had poor outcomes
in speech and hearing and received uncoordinated and
fragmented cleft care. This finding calls for further large
scale research and collaborative efforts into improving and
providing centralised, multidisciplinary care for children
born with CLP.
6.Bilateral thalamic internal medullary lamina involvement in a case of dengue encephalitis
Sherrini Bazir Ahmad ; Chin Sum Cheong ; Shen-Yang Lim ; Kartini Rahmat ; Faizatul Izza Rozalli ; Shamala Devi Sekaran ; Helmi Sulaiman, Sasheela Ponnampalavanar ; Kheng Seang Lim ; Chong Tin Tan
Neurology Asia 2016;21(4):375-379
There are 50-100 million dengue infections each year, but dengue encephalitis is relatively
uncommon. The aetiology of neuronal injury is proposed to be due to direct viral neurotropism or
host immune response-mediated inflammation causing neuronal damage. We report a case of severe
dengue encephalitis, presenting during the acute viraemic phase of the disease. This was associated
with inflammation and haemorrhage of the internal medullary lamina of both thalami which, to our
knowledge, has not yet been reported in other infections of the central nervous system.
Dengue
7.Level 4 comprehensive epilepsy program in Malaysia, a resource-limited country
Kheng-Seang LIM ; Sherrini Ahmad Bazir Ahmad ; Vairavan NARAYANAN ; Kartini RAHMAT ; Norlisah Mohd RAMLI ; Kein-Seong MUN ; Kum-Thong WONG ; Noraini ISMAIL ; Shweh-Fern LOO ; Chong-Tin TAN
Neurology Asia 2017;22(4):299-305
Background and Objective: There is a great challenge to establish a level 4 epilepsy care offeringcomplete evaluation for epilepsy surgery including invasive monitoring in a resource-limited country.This study aimed to report the setup of a level 4 comprehensive epilepsy program in Malaysia and theoutcome of epilepsy surgery over the past 4 years. Methods: This is a retrospective study analyzingcases with intractable epilepsy in a comprehensive epilepsy program in University Malaya MedicalCenter (UMMC), Kuala Lumpur, from January 2012 to August 2016. Results: A total of 92 caseshad comprehensive epilepsy evaluation from January 2012 till August 2016. The mean age was 35.57years old (range 15-59) and 54 (58.7%) were male. There were 17 cases having epilepsy surgeryafter stage-1 evaluation. Eleven cases had mesial temporal sclerosis and 81% achieved Engel classI surgical outcome. Six cases had lesionectomy and 60% had Engel class I outcome. A total of 16surgeries were performed after stage-2 evaluation, including invasive EEG monitoring in 9 cases.Among those with surgery performed more than 12 months from the time of data collection, 5/10(50%) achieved Engel I outcome, whereas 2 (20%) had worthwhile improvement (Engel class III)with 75% and 90% seizure reduction.Conclusion: Level 4 epilepsy care has an important role and is possible with joint multidisciplinaryeffort in a middle-income country like Malaysia despite resource limitation.
8.A validation study of the Bahasa Malaysia version of the National Institute of Health Stroke Scale
Najma Kori ; Wan Asyraf Wan Zaidi ; Rabani Remli ; Azman Ali Raymond ; Norlinah Mohamed Ibrahim ; Hui Jan Tan ; Syed Zulkifli Syed Zakaria ; Zhe Kang Law ; Kartini Ahmad ; Wan Nafisah Wan Yahya ; Ramesh Sahathevan
Neurology Asia 2018;23(3):225-232
Background & Objectives: The National Institute of Health Stroke Scale (NIHSS) provides a valid
and quick assessment of stroke severity in hyperacute stroke management. Stroke patients who are
eligible for reperfusion therapy require prompt assessment. There is no validated Bahasa Malaysia
(BM) version of the NIHSS that allows easier assessment by BM-speaking health professionals.
This study aimed to translate and validate a BM version of the NIHSS. Methods: The English NIHSS
was translated to BM, then back translated to ensure linguistic accuracy. We also adapted the language
assessment of the NIHSS to be more culturally appropriate. Training and certification videos were
downloaded from the NIH website and dubbed into BM. We determined intra-class correlation and
unweighted kappa as the best measure of reliability. Median scores were used in the analysis for
language items. Results: One hundred and one raters participated in the test-retest reliability study.
Agreement between the original NIHSS and our translated version of the BM-NIHSS was good (ICC
= 0.738, 95% CI: 0.611 to 0.823). Fair to moderate agreement was found on item-by-item analysis
(unweighted κ=0.20-0.50) despite high observed agreement. Fifty patients participated in the language
assessment arm. Scores were better in BM for reading, naming objects and repetition (Mdn = 100, p
< 0.001). There was no difference in the median scores for the description component.
Conclusions: The BM-NIHSS is a valid translation of the NIHSS, and may be used in clinical practice
by BM-speaking healthcare professionals.
9.Perkembangan Bahasa dan Pertuturan Kanak-Kanak Melayu Pengguna Implan Koklea di bawah Program Implan Koklea Kebangsaan, Kementerian Kesihatan Malaysia (Speech and Language Development of Malay Children with Cochlear Implants under the National Cochlear Implant Program, Ministry of Health Malaysia)
NORYANTIMARLINA ABDULLAH ; BASYARIATUL FATHI OTHMAN ; KARTINI AHMAD ; PHILIP RAJAN DEVESAHAYAM ; YAZMIN AHMAD RUSLI
Malaysian Journal of Health Sciences 2022;20(No.1):37-50
Speech and language skills are among the crucial components in determining cochlear implant habilitation outcomes.
The purpose of this study was to investigate speech and language skills of Malay cochlear implant children using a
developmental scale questionnaire and to identify the demographic factors that contribute to their performance. This
study involved 26 children recruited from the National Cochlear Implant Program under the Malaysian Ministry of
Health with chronological ages between 33 to 99 months (mean=72, SD=18.9), implant ages between 18 to 71 months
(mean=40, SD=13.5) and hearing ages between 13 to 48 months (mean=30, SD=10.5). The instrument used was The
Integrated Scale of Development-Malay version 2 (ISD-Mv2). The questionnaires were given to the parents or caregivers
followed with by a phone call interview later. Results from the study showed that only 9 subjects (35%) were able score
on the ISD-Mv2 equally or higher than their hearing age. From the six components in the ISD-Mv2, cognitive was scored
the highest with 96.79% meanwhile expressive language was the lowest with 76.21%. Pearson correlation test revealed
strong positive correlation between audition-receptive language (r=0.554, p<0.05) and cognitive–social communication/
pragmatic (r= 0.625, p<0.05). Speech and language performance of children with demographic factors did not show
significant differences. The findings suggests that majority of the Malay cochlear implant children demonstrated delayed
speech and language performance as compared to normal hearing children.