Showing papers in "Folia Phoniatrica Et Logopaedica in 2016"

Characteristics of a Dysphonic Population Referred for Voice Assessment and/or Voice Therapy

Abstract: Objective: The aim of this study was to define patient characteristics of a dysphonic population in terms of voice disorder, gender, age, and subjective and objective vocal parameters and to explore the relevant characteristics of the most frequent groups of voice disorders. Patients and Methods: Patient records from 4,447 subjects referred for voice assessment and/or voice therapy were analyzed. Results: Significantly more cases of dysphonia were structural as compared to nonstructural. This significant difference was found in almost all age groups. Significantly more women were diagnosed with dysphonia than men. The most common symptom was light-to-moderate hoarseness. The average voice handicap index was 31 and the average dysphonia severity index was -0.6. Vocal fold nodules (VFN), functional voice disorders (FVD) and vocal fold paralysis (VFP) were the three most frequently diagnosed vocal pathologies and were analyzed in detail. Women were found to be significantly more vulnerable to FVD, VFN and cysts, whereas men were significantly more often diagnosed with carcinoma, hyperkeratosis, laryngitis, papillomatosis, presbyphonia, puberphonia and VFP. Conclusions: The results of this study allow a better estimation of the clinical needs and costs for a specific dysphonic population looking for help and highlight the gender-related risks of specific voice disorders.

Validation and Cultural Adaptation of the Arabic Version of the Eating Assessment Tool (EAT-10).

Abstract: Background and Objectives: The Eating Assessment Tool (EAT-10) is a 10-item self-administered questionnaire. It is a noninvasive tool to measure patients' perception of their swallowing problems. The purposes of the present study were to develop an Arabic version of the EAT-10 and to evaluate its validity, consistency, and reliability in the Arabic-speaking population with oropharyngeal dysphagia. Setting and Design: This was a prospective study carried out at the Communication and Swallowing Disorders Unit, King Saud University, Riyadh, Saudi Arabia. Subjects and Methods: The Arabic EAT-10 was administered to 138 patients with oropharyngeal dysphagia and 83 control subjects. Internal consistency and test-retest reliability were evaluated. Content and clinical validity were studied, and the EAT-10 results were compared across patients and control groups. Results: The Arabic EAT-10 showed excellent internal consistency (Cronbach's α = 0.92). Also, good test-retest reliability was found for the total scores of the Arabic EAT-10 (intraclass correlation = 0.73). There was a significant difference in Arabic EAT-10 scores between the oropharyngeal dysphagia group and the control group (p Conclusion: This study demonstrated that the Arabic EAT-10 is a valid tool that can be used for screening of dysphagia-related problems in an Arabic-speaking population.

Complications with Fiberoptic Endoscopic Evaluation of Swallowing in 2,820 Examinations.

Abstract: Objective: To perform a retrospective evaluation of the incidence of complications and adverse events during fiberoptic endoscopic evaluation of swallowing (FEES) in 2,820 examinations. Patients and Methods: Subjects included in- and outpatients at Pisa University Hospital referred for FEES by other physicians due to dysphagia symptoms. Neurologic diseases were the most commonly diagnosed conditions in the patients tested (48.3%). Informed consent was obtained from all subjects. Results: Our study showed minor side effects (discomfort, occasional gagging and vomiting) and a few complications [three cases of anterior epistaxis (0.1%), one case of posterior epistaxis (0.04%), three cases of vasovagal syncope (0.1%) and two cases of laryngospasm (0.07%)]. These cases of laryngospasm occurred in patients with amyotrophic lateral sclerosis (ALS) and spontaneously resolved after some difficulty. Conclusions: Our study confirms the published data regarding the safety of FEES and the incidence of complications with this procedure, but also highlights that in neurologic patients with neurodegenerative diseases such as ALS, laryngospasm is more likely to occur as a severe complication. The overall risk of FEES is minimal, but it is recommended that clinicians be well trained in recognising the signs and symptoms of adverse reactions and be ready to take appropriate action if these occur.

Speech Characteristics and Intelligibility in Adults with Mild and Moderate Intellectual Disabilities

Abstract: Purpose: Adults with intellectual disabilities (ID) often show reduced speech intelligibility, which affects their social interaction skills. This study aims to establish the main predictors of this reduced intelligibility in order to ultimately optimise management. Method: Spontaneous speech and picture naming tasks were recorded in 36 adults with mild or moderate ID. Twenty-five naive listeners rated the intelligibility of the spontaneous speech samples. Performance on the picture-naming task was analysed by means of a phonological error analysis based on expert transcriptions. Results: The transcription analyses showed that the phonemic and syllabic inventories of the speakers were complete. However, multiple errors at the phonemic and syllabic level were found. The frequencies of specific types of errors were related to intelligibility and quality ratings. Conclusions: The development of the phonemic and syllabic repertoire appears to be completed in adults with mild-to-moderate ID. The charted speech difficulties can be interpreted to indicate speech motor control and planning difficulties. These findings may aid the development of diagnostic tests and speech therapies aimed at improving speech intelligibility in this specific group.

A Participatory Design Approach to Develop a Web-Based Self-Care Program Supporting Early Rehabilitation among Patients after Total Laryngectomy

Abstract: Aim: To develop a Web-based self-care program for patients after total laryngectomy according to a participatory design approach. Methods:

Verbal Fluency Tasks: Effects of Age, Gender, and Education.

Abstract: Objectives: This study presents data for semantic fluency, phonemic fluency, action fluency, and alternate fluency. The aim is to provide normative data by age, g

The Effect of Age and Type of Noise on Speech Perception under Conditions of Changing Context and Noise Levels

Abstract: Objective: Everyday life includes fluctuating noise levels, resulting in continuously changing speech intelligibility. The study aims were: (1) to quantify the amount of decrease in age-related speech perception, as a result of increasing noise level, and (2) to test the effect of age on context usage at the word level (smaller amount of contextual cues). Patients and Methods: A total of 24 young adults (age 20-30 years) and 20 older adults (age 60-75 years) were tested. Meaningful and nonsense one-syllable consonant-vowel-consonant words were presented with the background noise types of speech noise (SpN), babble noise (BN), and white noise (WN), with a signal-to-noise ratio (SNR) of 0 and -5 dB. Results: Older adults had lower accuracy in SNR = 0, with WN being the most difficult condition for all participants. Measuring the change in speech perception when SNR decreased showed a reduction of 18.6-61.5% in intelligibility, with age effect only for BN. Both young and older adults used less phonemic context with WN, as compared to other conditions. Conclusion: Older adults are more affected by an increasing noise level of fluctuating informational noise as compared to steady-state noise. They also use less contextual cues when perceiving monosyllabic words. Further studies should take into consideration that when presenting the stimulus differently (change in noise level, less contextual cues), other perceptual and cognitive processes are involved.

Factors Involved in Vocal Fatigue: A Pilot Study

Abstract: Objective: The purpose of this retrospective study was to determine the vocal characteristics of a treatment-seeking population with the primary complaint of voca

Normative Nasalance Scores for Brazilian Portuguese Using New Speech Stimuli.

Abstract: Objective: Normative data were established for newly developed speech materials for nasalance assessment in Brazilian Portuguese. Materials and Methods: Nasalance scores of preexisting passages (oral ZOO-BR, low-pressure oral ZOO-BR2 and NASAL-BR), new nasalance passages (oral Dudu no zoologico, oral Dudu no bosque, oral-nasal O caozinho Toto and nasal O nene) and Brasilcleft articulation screening sentences were collected from 245 speakers of Brazilian Portuguese, including 121 males and 124 females, divided into 4 groups: children (5-9 years), adolescents (10-19 years), young adults (20-24 years) and adults (25-35 years). Results: Across all nasalance passages, adult females scored on average 2 percentage points higher than males. Children scored 2-4 percentage points lower than older groups for the preexisting nasalance passages ZOO-BR and ZOO-BR2. Nasalance scores for the new nasalance passages were not significantly different from the preexisting passages. Scores for high-pressure sentences did not differ significantly from the oral nasalance passage Dudu no bosque. Conclusion: The nasalance scores for the new nasalance passages were equivalent to the preexisting materials. The new shortened and simplified nasalance passages will be useful for assessing young children. Normative scores for the Brasilcleft high-pressure sentences were equivalent to the new oral passage Dudu no bosque.

The Effect of Loud Voice and Clear Speech on the Use of Vocal Fry in Women.

Abstract: Objective: This study investigated the effects of clear speech and loud voice on the use of vocal fry in women. Methods: Twe

Variability in Ultrasound Measurement of Hyoid Bone Displacement and Submental Muscle Size Using 2 Methods of Data Acquisition.

Abstract: Objective This study compares variability in measures of hyoid bone displacement and submental muscle size using 2 methods of ultrasound transducer placement: fixed and hand-held. Patients and methods Twenty-four healthy participants (11 males, 13 females) aged between 51 and 84 years were scanned using both methods. Repeated measures were collected within and across 3 sessions. Results A nonlinear mixed effects model was used to estimate the effects of the method, trial, and session. The fixed transducer produced greater within- and across-session variability on several measures compared to the hand-held method. Fixed-transducer measurements of hyoid bone displacement were 9.4% smaller compared to hand-held measurements (F[1, 24.34] = 3.58, p = 0.07). Conclusion Results suggest that using a fixed transducer does not necessarily improve measurement accuracy of swallowing outcomes in a healthy system. The wide variability in individual measures indicates that further research is required before ultrasound is used for outcome measurement in rehabilitation.

Validation of the Hebrew Version of the Eating Assessment Tool-10 (H-EAT-10).

Abstract: Background and Objectives: Dysphagia is a common disability with different etiologies. In order to measure dysphagia symptom severity and effects on quality of life, the Eating Assessment Tool (EAT-10) was developed and validated in the English language. We aimed to develop a Hebrew version of the EAT-10 and to evaluate its internal consistency, test-retest reliability, and validity in Hebrew-speaking adults with dysphagia. Subjects and Methods: The Hebrew EAT-10 (H-EAT-10) questionnaire was completed by 132 patients: 56 patients with dysphagia and 76 controls. Internal consistency analysis was calculated using Cronbach α, and test-retest reliability was calculated using intraclass correlation coefficient in order to assess clinical validity. Results: Internal consistency and test-retest reliability were found to be high in the H-EAT-10 (Cronbach α = 0.955 and intraclass correla tion = 0.98). In addition, H-EAT-10 scores in the dysphagia group were found to be significantly higher than those in the control group ( p Conclusion: This study demonstrated that H-EAT-10 is a reliable and valid tool that may be implemented for clinical practice and research on dysphagia in a Hebrew-speaking population.

Reading in Autism Spectrum Disorders: A Literature Review

Abstract: Objective: To review what the literature says about reading abilities of children on the autism spectrum (autism spectrum disorders, ASD) as well as to assess the

Familiarization Effects on Consonant Intelligibility in Dysarthric Speech.

Abstract: Background/Aims: This study investigates the effects of familiarization on naive listeners' ability to identify consonants in dysarthric speech. Methods: A total of 120 listeners (30 listeners/speaker) participated in experiments over a 6-week period. Listeners were randomly assigned to one of the three familiarization conditions: a passive condition in which listeners heard audio recordings of words, an active condition in which listeners heard audio recordings of words while viewing the written material of words, and a control condition in which listeners had no exposure to the audio signal prior to identification tasks. Results: Familiarization improved naive listeners' ability to identify consonants produced by a speaker with dysarthria. The active familiarization method exhibited an advantage over the other conditions, in terms of the magnitude and rapidness of improvement. One-month delayed test scores were higher than pre-familiarization scores, but the advantage of active familiarization was not present for all speakers. Conclusion: This study supports familiarization benefits in enhancing consonant intelligibility in dysarthria and suggests that perceptual learning mechanisms be harnessed for developing effective listener-oriented intervention techniques in the management of dysarthria. Current findings call for further research on a familiarization protocol that can subserve segmental learning with maximum efficacy.

Language Parameters of 4- to 7-Year-Old Persian-Speaking Children with Cleft Lip and Palate

Abstract: Objective: There are several risk factors including hearing difficulties, lack of language stimulation, and parents' low level of expectation leading to language

Diplophonia disturbs jitter and shimmer measurement

Abstract: Objectives: The aims of this study are to investigate the effects of diplophonia on jitter and shimmer and to identify measurement limitations with regard to material selection and clinical interpretation. Materials and Methods: Four hundred and ninety-eight audio samples of sustained phonations were analyzed. The audio samples were assessed for the grade of hoarseness and the presence of diplophonia. Jitter and shimmer were reported with regard to perceptual ratings. We investigated cycle marker positions exemplarily and qualitatively to understand their implications for perturbation measurements. Results: Medians of jitter and shimmer were higher for diplophonic voices than for nondiplophonic voices with equal grades of hoarseness. The variance of jitter for moderately dysphonic voices was larger than the variance observed in a corpus from which diplophonic samples had been discarded. The positions of cycle markers in diplophonic voices did not match the positions of the pulses, indicating that the validity of jitter and shimmer values for these voices were questionable. Conclusion: Diplophonia biases the reporting of dysphonia severity via perturbation measures, and their validity is questionable for these voices. In addition, diplophonia is an influential source of variance in jitter measurements. Thus, diplophonic fragments of voice samples should be excluded prior to perturbation analysis.

Implications of Untreated Cleft Palate in the Developing World: Adaptation of an Outcome Measure.

Abstract: Objectives: To identify the implications of living with untreated cleft palate and develop an outcome measure which reflects the broad impact of surgery but is sensitive to the physical impact, speech changes, and psychosocial implications of late intervention. Design, Participants, Setting: Focus groups and individual interviews were used to gather information on the implications of living with untreated cleft palate and the impact of subsequent surgery. Participants included 11 individuals attending a cleft department in India whose cleft had persisted into adolescence or adulthood, as well as 16 of their family members. The findings were used to assess whether the Therapy Outcome Measure (TOM) could capture the implications of untreated cleft palate and the impact of surgery beyond that of speech alone. Results: The findings indicated that the implications of living with untreated cleft palate revolved around difficulties with communication, reduced autonomy, and nasal regurgitation. These issues are encapsulated within the third and fourth domains of the TOM, but there is a need for an adapted version (TOM-clp) to use in the developing world, incorporating areas specific to cleft palate. Conclusion: The TOM has potential as a global tool for measuring the broad impact, including the psychosocial benefit, from attending to untreated cleft palate.

Factors Influencing Quality of Life Six Months after a First-Ever Ischemic Stroke: Focus on Thrombolyzed Patients.

Abstract: Objective: This prospective follow-up study aimed to identify sociodemographic and clinical factors that may affect the quality of life (QoL) of patients with acu

Protocol for the Evaluation of Speech Intelligibility in Dysarthrias: Evidence of Reliability and Validity

Abstract: Background/Aims: Studies about the reliability and validity of intelligibility measures are fundamental to direct their use and interpretation in both clinical and research settings. The present study assessed inter-rater reliability, internal consistency and criterion validity of scores for the sentence and word subtests of the Protocol for the Evaluation of Speech Intelligibility (PESI). Methods: This study included 180 adult volunteers who were divided into three groups: 30 speakers with dysarthria, 30 control speakers and 120 listeners. Intelligibility scores were calculated according to the percentage of words correctly transcribed in each subtest: words in sentences and single words. Results: The intelligibility measurements exhibited a high level of inter-rater reliability for sentences [intraclass correlation coefficient (ICC) = 0.94] and for single words (ICC = 0.96). The items from the single words subtest of the PESI revealed high internal consistency (Cronbach's alpha = 0.93). The measurement of intelligibility of sentences and single words had a high discriminatory power (0.82 and 0.95, respectively), with high sensitivity and specificity, particularly for scores in the single words subtest. Conclusion: This study provides preliminary evidence of the reliability and validity of the PESI.

Language Development of Three- to Twelve-Year-Old Twins Compared to Singletons.

Abstract: Objective: The language development of twins tends to lag behind in comparison to that of singletons. The purpose of this study was to compare expressive and receptive language skills of 3- to 12-year-old twins with singletons. Secondly, correlations between language differences between twins and singletons and age were investigated. Patients and Methods: Twenty-four twins with a mean age of 5.1 years participated in the study. The control group consisted of 24 singletons who were matched for gender and age. Language development was investigated using the Clinical Evaluation of Language Fundamentals. Results: Twins scored significantly lower for expressive and receptive language skills compared to singletons. Even when excluding preterm-born children, twins still scored significantly lower for expressive language skills. There was no correlation between age and language differences between twins and their matched singletons. Conclusion: Twins score lower for expressive and receptive language skills compared to singletons, and preterm birth cannot be regarded as the main cause for the language delay. The language delay in twins is rather mild but does not seem to decrease with increasing age.

Phonological Process Occurrence in Typically Developing Toddlers

Abstract: Background/Aims: The study examined the phonological development in Cypriot Greek (CG)-speaking, typically developing (TD) toddlers for the purpose of observing o

Voice Handicap Index in Persian Speakers with Various Severities of Hearing Loss.

Abstract: Objectives: The purpose of this study was to assess and compare the total score and subscale scores of the Voice Handicap Index (VHI) in speakers with and without hearing loss. A further aim was to determine if a correlation exists between severities of hearing loss with total scores and VHI subscale scores. Patients and Methods: In this cross-sectional, descriptive analytical study, 100 participants, divided in 2 groups of participants with and without hearing loss, were studied. Background information was gathered by interview, and VHI questionnaires were filled in by all participants. Results: For all variables, including mean total score and VHI subscale scores, there was a considerable difference in speakers with and without hearing loss (p Conclusion: Speakers with hearing loss were found to have higher mean VHI scores than speakers with normal hearing. This indicates a high voice handicap related to voice in speakers with hearing loss. In addition, increased severity of hearing loss leads to more severe voice handicap. This finding emphasizes the need for a multilateral assessment and treatment of voice disorders in speakers with hearing loss.

Measuring Stuttering in Preschool-Aged Children across Different Languages: An International Study.

Abstract: Background/Aims: Many speech-language pathologists (SLPs) are working in linguistically diverse communities and have to identify and measure stuttering in a language other than their own. The aim of the present study was to extend our understanding of how well SLPs can measure stuttering in other languages and to encourage collaboration between SLPs across cultures. Methods: Speech samples consisted of seven preschool-aged children each speaking one of the following languages: Danish, English, French, German, Greek, Italian, and Persian (Farsi). The judges were classified in seven groups of SLPs (n = 170) each speaking one of the seven languages of the children and two more English-speaking groups. Each judge rated the severity of stuttering in each child using a 10-point scale. The study was conducted over the Internet. Results: Overall, the judges' proficiency in a child's language was not systematically related to the variability and agreement of the severity ratings, accounting for maximally 4.6% of the variance. Conclusion: SLPs should not be overly concerned about the appropriateness of their severity ratings if they feel less proficient in the native language of the stuttering children. It may also be encouraging for beginning clinicians that the severity ratings were not systematically related to professional experience.

Revisiting Communicative Competence in Augmentative and Alternative Communication.

Abstract: Objective This tutorial paper is to explore the novel nature of communicative competence in augmentative and alternative communication (AAC) practice by comparing it to communicative competence in naturally verbal dyadic communication. Patients and methods This paper first reviews the four domains of communicative competence in AAC practice. Second, it examines competence in dyadic communications between naturally verbal people without disabilities, deriving new insights and using these to analyze the evolution of communicative competence in AAC practice. Results Communicative competence in AAC practice should be reconceptualized from a new perspective as dyadic, learned, co-constructed, and of relative value, ascertained through performance. Conclusion In the past decades, the study of communicative competence in AAC practice has primarily focused on individual persons who use AAC. However, the conceptualization of communicative competence should shift away from an individualized construct toward a dyadic construct. This leads to a discussion of potential implications and future research directions. This paper might offer AAC researchers and practitioners an opportunity to deepen their understanding of communicative competence and promote more positive outcomes for people who use AAC.

The Atlanta Motor Speech Disorders Corpus: Motivation, Development, and Utility

Abstract: Background/Aims: This paper describes the design and collection of a comprehensive spoken language dataset from speakers with motor speech disorders in Atlanta, G

Nonword Repetition in Spanish-Speaking Toddlers with and without Early Language Delays.

Abstract: Background/Aims: Nonword repetition (NWR) studies with English-speaking toddlers indicate favorable diagnostic accuracy for identifying early language delays and

Voice Range Profiles of Singing Students: The Effects of Training Duration and Institution.

Abstract: Objective: The aim of the study was to assess differences in voice parameters measured by the physiological voice range profile (VRP) in groups of vocally healthy subjects differentiated by the duration of vocal training and the training institution. Patients and Methods: Six basic frequency- and intensity-related VRP parameters and the frequency dip of the register transition zone were determined from VRP recordings of 162 females studying in individual singing lessons (1st-5th level) in Dutch, Belgian, English, and French public or private training facilities. Sixty-seven nonsinging female students served as controls. Results: Singing students in more advanced singing classes demonstrated a significantly greater frequency range, particularly at high frequencies, than did first-year students. Students with private training showed a significantly increased mean intensity range in comparison to those in group classes, while students with musical theater training exhibited significantly increased frequency- and intensity-related VRP parameters in comparison to the students with classical training. When compared to nonsingers, all singing student subgroups showed significant increases in all basic VRP parameters. However, the register transition parameter was not influenced by training duration or institution. Conclusion: Our study suggests that the extension of physiological vocal limits might depend on training duration and institution.

The Relationship between Socioeconomic Status and Narrative Abilities in a Group of Italian Normally Developing Children

Abstract: Objective: Only limited and conflicting information is available regarding the relationship between socioeconomic status (SES) and narrative abilities. Besides, t

Victims Seeking Help from Speech-Language Pathologists: Bullying, Preparedness, and Perceptions

Abstract: Objective: Antibullying initiatives indicate that all school-based personnel should accept responsibility for changing the school climate and eliminating bullying

Influence of Voice Focus on Oral-Nasal Balance in Speakers of Brazilian Portuguese.

Abstract: Objectives: This study investigates whether a change in speaking voice focus affects the oral-nasal balance. The investigation was undertaken with different phone