Showing papers in "Folia Phoniatrica Et Logopaedica in 2010"

Effect of rate control on speech production and intelligibility in dysarthria.

Abstract: The reported study investigated the effect of 7 rate control methods (RCM) on running speech intelligibility, speaking rate (SR), articulation rate (AR) and pause characteristics in 27 individuals with dysarthria. The data reveal that with the exception of slower on demand, each RCM resulted in lower mean SRs and ARs (p < 0.05). Clinically significant improvements in intelligibility were found in half of the participants with different types of dysarthria. The majority of them had normal or decreased ARs and SRs. The most effective methods were: alphabet board, hand tapping and pacing board. For the majority of speakers, the maximal decrease in speech rate was not associated with the maximal increase in intelligibility.

Dysarthria in Friedreich’s Ataxia: A Perceptual Analysis

Abstract: The aims of this study were to: (1) evaluate the perceptual speech dimensions, speech intelligibility and dysarthria severity of a group of individuals diagnosed with Friedreich's ataxia (FRDA); (2) determine the presence of subgroups within FRDA dysarthria; (3) investigate the relationship between the speech outcome and the clinical factors of disease progression. The study included 38 individuals (21 female, 17 male) with a confirmed diagnosis of FRDA. A group of 20 non-neurologically impaired individuals served as controls. Perceptual analysis, investigating 30 different dimensions of speech, was conducted on a speech sample obtained from each participant. In addition, the Assessment of Intelligibility of Dysarthria Speech was administered. All FRDA participants presented with dysarthria with severities ranging from mild to moderate. Cluster analysis revealed 3 subgroups, the first presenting with mild dysarthric symptoms, the second with increased velopharyngeal involvement and the third characterized by increased laryngeal dysfunction. Dysarthria severity showed a significant correlation to disease duration but to no other clinical measure. The findings support the notion of subgroups in FRDA dysarthria, representing distinct impairments of the speech mechanism and perhaps reflective of differing evolutions beyond the cerebellum.

Breath group analysis for reading and spontaneous speech in healthy adults.

Abstract: Aims: The breath group can serve as a functional unit to define temporal and fundamental frequency (f 0 ) features in continuous speech. These features of the breath group are determined by the physiologic, linguistic, and cognitive demands of communication. Reading and spontaneous speech are two speaking tasks that vary in these demands and are commonly used to evaluate speech performance for research and clinical applications. The purpose of this study is to examine differences between reading and spontaneous speech in the temporal and f 0 aspects of their breath groups. Methods: Sixteen participants read two passages and answered six questions while wearing a circumferentially vented mask connected to a pneumotach. The aerodynamic signal was used to identify inspiratory locations. The audio signal was used to analyze task differences in breath group structure, including temporal and f 0 components. Results: The main findings were that spontaneous speech task exhibited significantly more grammatically inappropriate breath group locations and longer breath group duration than did the passage reading task. Conclusion: The task dif

Speech Motor Development in Childhood Apraxia of Speech: Generating Testable Hypotheses by Neurocomputational Modeling

Abstract: Childhood apraxia of speech (CAS) is a highly controversial clinical entity, with respect to both clinical signs and underlying neuromotor deficit. In the current paper, we advocate a modeling approach in which a computational neural model of speech acquisition and production is utilized in order to find the neuromotor deficits that underlie the diversity of phonological and speech-motor symptoms of CAS. Based on existing approaches and behavioral data, we first generated specific hypotheses about the underlying deficits. These hypotheses were then tested in a series of computer simulations, and the resulting speech patterns were compared to the available behavioral data. Finally, the model was used to derive further predictions that can be tested empirically in behavioral experiments and possible new angles for clinical intervention.

An interdisciplinary approach to teachers' voice disorders and psychosocial working conditions.

Abstract: Objectives: The goals of this epidemiological paper are focused on studying teachers’ vocal complaints, their voice pattern, and the impact of voice disorders on psychosocial working conditions. Patients: A representative stratified random sample of 282 teachers from kindergartens and elementary schools was studied. Two types of self-report questionnaires were applied: an inquiry about teachers’ occupational voice profile, and the adapted Spanish version of the Copenhagen Psychosocial Questionnaire (ISTAS-21). Pearson’s χ2 test was performed to search for statistical associations. Results: 62.7% of subjects were experiencing occupational voice disorders; these teachers showed significantly worse psychosocial conditions than their healthy voice colleagues. Conclusions: Occupational voice disorders affect more than 60% of teachers and have an impact on their psychosocial working conditions. Interdisciplinary work is essential to shed light on these multifactor mechanisms and effects.

Functional histology of the macula flava in the human vocal fold--Part 2: Its role in the growth and development of the vocal fold.

Abstract: Objective: This study aims to clarify the role of the maculae flavae (MFe) during growth and development of the human vocal fold mucosa (VFM) Methods: Our current results concerning the MFe in the human newborn, infant, and child VFM are summarized Results: Newborns already had immature MFe at the same sites as adults They were composed of dense masses of vocal fold stellate cells (VFSCs), whereas extracellular matrix components were sparse VFSCs in the newborn MFe had already started synthesizing extracellular matrices (EM) During infancy, the EM synthesized in the MFe appeared in the VFM to initiate the formation of the three-dimensional extracellular matrix structure of the human VFM During childhood, MFe including VFSCs continued to synthesize EM such as collagenous, reticular, and elastic fibers, and hyaluronic acid (glycosaminoglycan), which are essential for the human VFM as a vibrating tissue The MFe in newborns, infants and children were related to the growth and development of the human VFM Conclusion: Human MFe including VFSCs were inferred to be involved in the metabolism of EM, essential for the viscoelasticity of the human VFM, and are considered to be an important structure in the growth and development of the human VFM

Correlation between Acoustic Parameters and Voice Handicap Index in Dysphonic Teachers

Abstract: Objective: The aim of this study was to investigate the relationship between acoustic analysis and biopsychosocial implications of voice problems, evaluated by the Voice Handicap In

Behavioral Treatment of Voice Disorders in Teachers

Abstract: Introduction: The purpose of this paper is to review the literature on the behavioral treatment of voice disorders in teachers. The focus is on phonogenic disorders, that is voice disorders thought to be caused by voice use. Methods: Review of the literature and commentary. Results: The review exposes distinct holes in the literature on the treatment of voice problems in teachers. However, emerging trends in treatment are noted. For example, most studies identified for review implemented a multiple-therapy approach in a group setting, in contrast to only a few studies that assessed a single-therapy approach with individual patients. Although the review reveals that the evidence around behavioral treatment of voice disorders in teachers is mixed, a growing body of data provides some indicators on how effectively rehabilitation of teachers with phonogenic voice problems might be approached. Specifically, voice amplification demonstrates promise as a beneficial type of indirect therapy and vocal function exercises as well as resonant voice therapy show possible benefits as direct therapies. Finally, only a few studies identified even remotely begin to meet guidelines of the Consolidated Standards of Reporting

Professional opera tenors' vocal tract configurations in registers.

Abstract: Objective: Tenor singers may reach their top pitch range either by shifting from modal to falsetto register or by using their so-called ‘voix mixte’. Material and Methods: In this study, dynamic real-time MRI of 8 frames per second was used to analyze the vocal tract profile in 10 professional opera tenors, who sang an ascending scale from C4 (262 Hz) to A4 (440 Hz) on the vowel /a/. The scale included their register transition and the singers applied both register techniques in different takes. Results: Modal to falsetto register changes were associated with only minor vocal tract modifications, including elevation and tilting of the larynx and a lifted tongue dorsum. Transitions to voix mixte, by contrast, were associated with major vocal tract modifications. Under these conditions, the subjects widened their pharynges, their lip and jaw openings, and increased their jaw protrusion. These modifications were stronger in more ‘heavy’ tenors than in more ‘light’ tenors. The acoustic consequences of these articulatory changes are discussed.

Coordination between posture and phonation in vocal effort behavior.

Abstract: Background: Postural correlates of vocal effort are rarely described in the literature, while they are extensively dealt with in speech therapy. Objectives: This study aims at determining whether body movement is a side effect of vocal effort or an integral part of communication effort behavior. The answer to this question is mainly based on correlations between posture and phonation. Method: Twenty healthy subjects participated in this study. They had to communicate with a listener under 3 conditions requiring different levels of vocal effort. Results: The vocal parameters increased and confirmed that the subjects had made a vocal effort. The kinematic parameters (amplitude and duration of body movement) increased with vocal effort. Lastly, vocal and kinematic characteristics were significantly correlated. Conclusion: The close correlation of posture with vocal production shows that movement is not a mere consequence of vocal effort. Posture and voice are coordinated in communication behavior, and each body segment plays its specific role in the vocal effort behavior.

Functional Histology of the Macula Flava in the Human Vocal Fold – Part 1: Its Role in the Adult Vocal Fold

Abstract: Objective: This study aims to clarify the role of the maculae flavae (MFe) in the human adult vocal fold mucosa (VFM). Methods: Our current results concerning MFe in the human adult VFM are summarized. Results: MFe were found to be composed of dense masses of vocal fold stellate cells (VFSCs) and extracellular matrices (EM), such as fibrous proteins and glycosaminoglycans, which are essential for the EM in the human VFM. VFSCs in the MFe demonstrated marked morphologic differences from conventional fibroblasts. They were irregular and stellate in shape and possessed slender cytoplasmic processes. They had well-developed intracellular organelles. A number of vesicles were present at the periphery of the cytoplasm. They constantly synthesized EM. The VFSCs possessed lipid droplets and stored vitamin A. VFSCs formed an independent cell category of cells in the human VFM. The VFSCs in aged adult MFe decreased their activity, and had abnormal metabolism. Conclusion: Human MFe including VFSCs seem to be involved in the metabolism of EM which are essential for the viscoelasticity of the lamina propria of the VFM, and to be responsible for maintaining the characteristic layered structure of the human VFM. Age-related changes in VFSCs were found to influence the metabolism of EM in the VFM.

Plasticity in the Human Motor System

Abstract: It is well recognized that the number and effectiveness of synapses in the adult brain change in response to learning and that similar processes contribute to the restoration of function after central nervous system damage. It is possible to use non-invasive methods of brain stimulation in humans (transcranial magnetic stimulation or transcranial direct current stimulation) to study and even manipulate these processes. Initial studies are now underway to test whether modification of synaptic plasticity by neurostimulation can improve the recovery of motor function in patients after stroke.

Effects of online augmented kinematic and perceptual feedback on treatment of speech movements in apraxia of speech.

Abstract: Apraxia of speech (AOS) is a motor speech disorder characterized by disturbed spatial and temporal parameters of movement. Research on motor learning suggests that augmented feedback may provide a beneficial effect for training movement. This study examined the effects of the presence and frequency of online augmented visual kinematic feedback (AVKF) and clinician-provided perceptual feedback on speech accuracy in 2 adults with acquired AOS. Within a single-subject multiple-baseline design, AVKF was provided using electromagnetic midsagittal articulography (EMA) in 2 feedback conditions (50 or 100%). Articulator placement was specified for speech motor targets (SMTs). Treated and baselined SMTs were in the initial or final position of single-syllable words, in varying consonant-vowel or vowel-consonant contexts. SMTs were selected based on each participant's pre-assessed erred productions. Productions were digitally recorded and online perceptual judgments of accuracy (including segment and intersegment distortions) were made. Inter- and intra-judge reliability for perceptual accuracy was high. Results measured by visual inspection and effect size revealed positive acquisition and generalization effects for both participants. Generalization occurred across vowel contexts and to untreated probes. Results of the frequency manipulation were confounded by presentation order. Maintenance of learned and generalized effects were demonstrated for 1 participant. These data provide support for the role of augmented feedback in treating speech movements that result in perceptually accurate speech production. Future investigations will explore the independent contributions of each feedback type (i.e. kinematic and perceptual) in producing efficient and effective training of SMTs in persons with AOS.

The impact of the reactivity to stress in teachers with voice problems.

Abstract: Aims: One of the objectives of our study on voice and vocal health was to find out whether there is a relation between the reactivity to stress and voice problems in teachers

Re-thinking diagnostic classification of the dysarthrias: a developmental perspective

Abstract: Acquired childhood dysarthria (ACD) receives little attention in the research literature in contrast with the adult correlate of the disorder. Speech language pathologists working in this field find diagnosis and management challenging, arguably because there is no child-based dysarthria diagnostic classification. Clinicians are either dependent upon developmental speech models that are not specific to dysarthria and that ignore the neural basis of the disorder, or on adult-based neurobehavioural classification systems. Here we consider the necessary elements for developing a clinically useful and empirically driven diagnostic classification system for ACD. The paper is divided into 2 parts. First, we question whether an adult diagnostic model can be validly applied to children. Second, we propose a methodological approach to develop a classification system for ACD. Specifically, we propose that advancing knowledge in neurobehavioural correlations of ACD is contingent upon large-scale studies, likely requiring international collaboration, which pool brain and speech outcome data. Ideally, researchers across centres would apply standard protocols to: (1) characterize speech behaviour, and (2) brain structure, function and connectivity. When enough data is available to achieve statistical power, analysis could determine subgroups of dysarthria defined by speech behaviour. The commonalities of neural profiles of subgroups could then be examined to create an empirically driven theory of brain-behaviour relationships in ACD to underpin the classification system. Clinical diagnosis for children with ACD will remain limited until such data become available.

Communication in the Migrant Community in Malta

Abstract: Aims: The study aimed to obtain information about communication in the migrant community in Malta. The objectives were to identify the communication skills of the migrants in terms

Short-term effects of repetitive transcranial magnetic stimulation on speech and voice in individuals with Parkinson's disease.

Abstract: The main characteristics of dysarthria in Parkinson's disease (PD) are monotony of pitch and loudness, reduced stress, variable speech rate, imprecise consonants, and breathy and harsh voice. Earlier treatment studies have shown that dysarthria is less responsive to both pharmacological and surgical treatments than other gross motor symptoms. Recent findings have suggested that repetitive transcranial magnetic stimulation (rTMS) may have a beneficial effect on vocal function in PD. In the present study, 10 individuals with mild PD and no or minimal dysarthria were treated with rTMS as well as placebo stimulation in a blinded experiment. Stimulation was delivered using a frequency of 10 Hz and a stimulation intensity of 90% of the motor threshold. The site of stimulation was the cortical area corresponding to the hand, on the hemisphere contralateral to the patient's most affected side. The participants were audio-recorded before and after both rTMS and sham stimulation. Acoustic analysis was performed on 3 sustained /a:/ for each of the 4 conditions, and analyzed both for the whole group as well as for men and women separately. Results showed that there were no significant differences between any of the conditions regarding duration of sustained fricative or sustained vowel phonation, diadochokinetic rates or intelligibility. Above all, the results of acoustic analyses showed an effect of placebo; there was a significant reduction in fundamental frequency (F(0)) variation, pitch period perturbation, amplitude period perturbation, noise-to-harmonics ratio and coefficient of variation in F(0) between the recordings performed before compared to after sham stimulation.

Developmental approaches to understanding and treating autism.

Abstract: Over the past decade our understanding of early social communication development in young children with autism has undergone a remarkable change. We now know something about how young children with autism process the social world in a very different way from typical children. This has led to truly developmental models of autism. In turn, these have had profound impacts on research and practice. Several screening instruments to prospectively identify autism have been developed. In some cases autism can be diagnosed in children as young as 2 years of age. The study of 'high-risk' siblings has allowed prospective study of infants from as young as 6 months of age. There is increasing evidence that intervention approaches that focus on social and communication development can ameliorate symptoms and change the developmental course of the disorder. This article will highlight some of the key theoretical and clinical lessons learned from this decade of research.

Objective Voice Parameters and Self-Perceived Handicap in Dysphonia

Abstract: Objective: This study focuses on the relation between objective voice quality and the self-perception of a voice handicap. Patients and Methods: The study group consisted of 86 German-speaking patients (51 women, 35 men) suffering from benign dysphonia. The test persons completed the German version of the Voice-Related Quality of Life (V-RQOL) Questionnaire without prior information about their diagnosis and underwent voice analysis with the Dysphonia Severity Index (DSI) being the parameter of this study. Results: No correlation between V-RQOL and DSI could be found (p 1 0.05). On the V-RQOL, women scored worse than men, but not at a significant level. Patients with dysphonia of organic origin scored significantly worse than patients with functional dysphonia (p = 0.026). On the DSI, men’s values were significantly lower than women’s (p = 0.001). Organic dysphonia caused significantly lower DSI values than functional dysphonia (p = 0.011). Conclusion: Objective voice quality and the individual perception of voice quality by the patient are independent parameters. Both need to be assessed in clinical practice. Copyright © 2010 S. Karger AG, Basel

Mobility of Students, Academic and Administrative Staff: A Basis for Establishing a European Higher Education Area (Berlin Communiqué 2003)

Abstract: This article aims to highlight the possibilities of the Intensive Programme (IP), one of the items of the Lifelong Learning Programme of the European Commission The benefits of organizing an IP in a specific discipline-related area is illustrated by a case study of the speech-language therapy IP, which has been coordinated for 16 years by the Department of Speech-Language Therapy of the Lessius Hogeschool Antwerp, Belgium

Emerging issues in health and education in Asia-Pacific: a focus on speech-language pathology.

Abstract: The purpose of this paper is to present some emerging issues in health and education in the Asia-Pacific region. Special attention will be given to the education of speech-language pathologists (SLP) and to service provision for the people with communicative disorders whenever possible. Information on the education of SLP in Asia-Pacific is not easy to gather because of the geographical distances between areas, language differences in the data compiled and the lack of consistent collaboration and information exchanges. In this article, a case study from Singapore is also presented. Implications for clinical services and education are discussed at the end of this paper.

Studies of Chinese speakers with dysarthria: informing theoretical models.

Abstract: Most theoretical models of dysarthria have been developed based on research using individuals speaking English or other Indo-European languages. Studies of individuals with dysarthria speaking other languages can allow investigation into the universality of such models, and the interplay between language-specific and language-universal aspects of dysarthria. In this article, studies of Cantonese- and Mandarin-Chinese speakers with dysarthria are reviewed. The studies focused on 2 groups of speakers: those with cerebral palsy and those with Parkinson's disease. Key findings are compared with similar studies of English speakers. Since Chinese is tonal in nature, the impact of dysarthria on lexical tone has received considerable attention in the literature. The relationship between tone [which involves fundamental frequency (F(0)) control at the syllable level] and intonation (involving F(0) control at the sentential level) has received more recent attention. Many findings for Chinese speakers with dysarthria support earlier findings for English speakers, thus affirming the language-universal aspect of dysarthria. However, certain differences, which can be attributed to the distinct phonologies of Cantonese and Mandarin, highlight the language-specific aspects of the condition.

An introduction to the teacher's voice in a biopsychosocial perspective.

Abstract: metric – the ruler of health and disability. The WHO continues: ICF takes into account the social aspects of disability and does not see disability only as a ‘medical’ or ‘biological’ dysfunction. By including contextual factors, in which environmental factors are listed, ICF allows to record the impact of the environment on the person’s functioning. In this light, health can be considered as a condition of total physical, mental and social well-being and not only the absence of disease. Health implies function, that can be considered in three domains: impairment, disability and handicap. Impairment means restriction of function (lesion, physiological disorder). Impairment may result in restriction of activity, called disability. Disability may lead to a handicap by restriction of participation in the social context. This indicates that vocal health should be taken as a specific multifactorial issue.

Biopsychosocial impact of voicing and general coping style in teachers

Abstract: Objective: The aim of the study was to explore the general coping style of female teachers with a relatively low voice handicap compared with teachers with a relatively high voice h

Prospective evaluation of the outcome of velopharyngeal insufficiency therapy after simultaneous double z-plasty and sphincter pharyngoplasty.

Abstract: Objective: One of the main goals in the management of cleft palate is to achieve a good quality of speech. The aim of the prospective study was to evaluate the effectiveness of ther

The complexity of social/cultural dimension in communication disorders.

Abstract: There has been growing recognition in the field of communication disorders concerning the importance of multicultural and diversity issues This discussion needs to move beyond the theoretical and descriptive stage to the clinical use of this knowledge to improve the communicative functioning of diverse populations This paper argues that the tenets of evidence-based practice and the International Classification of Functioning, Disability and Health (ICF) by the World Health Organization can be used to advance the scholarship and service concerning diversity issues Both evidence-based practice and the ICF are client-based approaches that can facilitate the achievement of culturally relevant rehabilitation outcomes This article discusses the use of evidence-based practice and the ICF for providing assessment and intervention that address the social and cultural complexities of the persons we serve In addition, the author states that work on diversity issues can also be used to discover crucial underlying knowledge regarding communication and communication disorders

Trainee experience in relation to voice handicap, general coping and psychosomatic well-being in female student teachers: a descriptive study.

Abstract: Objective: The aim of this study was to investigate the relation between trainee experience and voice handicap, general coping and psychosomatic well-being in student teachers. <

Different lip asymmetry in adults who stutter: electromyographic evidence during speech and non-speech.

Abstract: The present study examined whether abnormal cerebral control was evident in the lip movements of adult stutterers (AS) compared to non-stutterers (ANS), as demonstrated during speech and non-speech tasks. Electromyographic (EMG) activity during production of words with initial /f/ and /p/ phonemes, single-sentence production and lip pursing were measured. Differences between AS and ANS were evident in all tasks. For AS, the highest EMG amplitude was in the region of the left lower lip, which is indicative of greater right hemisphere participation. However, in ANS the right lower lip displayed the highest EMG amplitude, suggesting greater left hemisphere participation. Further, AS showed greater asynchronous lip activity than ANS for all tasks. These results support the hypotheses of reversed lateralization for speech and non-speech processing and reduced coordination of speech musculature in AS.

A systematic, holistic and integrative process of self-control for voicing with optimal coping effects in teachers. 2. A process of change--an expert's opinion.

Abstract: A learning strategy is presented for eustress-euvoicing, which prevails over distress-disvoicing. It is based on the understanding of the mechanisms of stress-voicing, conceived as a dynamic circular