Folia Phoniatrica et Logopaedica最新文献

Introduction: This study proposes a revised version of the Reflux Symptom Index (R-RSI), a seventeen-item questionnaire that was revised to increase the suspicion of laryngopharyngeal reflux disease (LPRD).

Methods: Internal validation involved 213 participants, comprising 160 subjects without a previous LPRD diagnosis and 53 subjects with a self-reported previous diagnosis of LPRD with or without gastroesophageal reflux disease (GERD). Test-retest reliability and internal consistency were calculated. For the external validation, 56 patients (independent from the previous cohort) were enrolled to explore the R-RSI screening properties and determine a cutoff using 24-h MII-pH as the gold standard.

Results: R-RSI test-retest reliability was high, both for the total score (ICC: 0.970) and for each item (ranging from 0.876 to 0.980). Cronbach's alpha was 0.910, indicating excellent internal consistency of the questionnaire. Participants with a previous self-reported diagnosis scored significantly higher (mean 24.94 ± 7.4; median 26, IQR 20-29) than those without a previous diagnosis (mean 4.66 ± 5.3; median 4, IQR 1-6) (p value <0.0001). Participants with both previous LPRD and GERD diagnoses had higher scores (27.20 ± 7.8) compared to those with only LPRD (21.77 ± 5.5) (p value = 0.003). Using 24-h MII-pH diagnosis as a gold standard, the optimal R-RSI cutoff point was determined to be 18, with a sensitivity of 84.5% and a specificity of 81.8%, positive predictive value of 95%, and negative predictive value of 60%.

Conclusions: Our results suggest that the R-RSI may be useful to suspect LPRD, with or without GERD. The R-RSI is a self-administered patient-reported outcome questionnaire that demonstrates excellent reliability and high screening properties. Employing a cutoff of ≥18 in the R-RSI can assist in diagnosing and monitoring LPRD.

Introduction: The Palin Parent Rating Scale (Palin PRS) is a structured questionnaire filled out by parents of children who stutter. It is designed to assess the effects of stuttering on both the children and their parents. The goal of this study was to translate the Palin PRS into Persian and to evaluate its validity and reliability for application in preschool children who stutter.

Methods: This research was conducted from August 2021 to December 2022, involving 139 parents of children who stutter. The parents completed the Palin PRS and provided their demographic data. Descriptive statistics were used to examine the floor and ceiling effects on all subscales of the Palin PRS. The internal consistency of the scale was assessed using Cronbach's alpha method, while the intraclass correlation coefficient (ICC) was calculated to determine its test-retest reliability. An exploratory factor analysis was also performed to clarify the factor structure of the scale.

Results: The exploratory factor analysis results were highly consistent with the factor structure found in the original version. No floor or ceiling effects were observed for the factors of the Palin PRS. The three factors of the Persian version of the Palin PRS (P-Palin PRS) showed good internal consistency (Cronbach's alpha >0.8) and excellent test-retest reliability (ICC >0.9). Additionally, normative scores were derived by converting raw scores into Stanine scores.

Conclusion: The P-Palin PRS showed strong reliability, thereby establishing it as a suitable instrument for evaluating how parents perceive the effects of stuttering on their children and themselves. Further research may explore its application in diverse clinical settings and populations.

Introduction: Thickened liquids are frequently recommended for individuals with swallowing disorders who are at risk of aspiration. However, thickened liquids may be poorly tolerated and result in reduced fluid intake, which may impact performance in a number of areas. The purpose of this study was to examine the possible impact of a thickened liquid regimen on visuospatial skills in young healthy adults.

Methods: Twenty young adults, aged 19-26 years, were included as participants. Baseline data consisting of urine specific gravity (USG) measurements as a marker of hydration status and completion of a visuospatial task were obtained prior to initiation of the experimental protocol. Participants in the experimental group followed a thickened liquid protocol, which consisted of drinking nectar-thick liquids for 48 h. Data collection procedures were repeated.

Results: Participants in the experimental group exhibited significantly higher USG levels and required more time to complete the visuospatial task post-thickened liquids. No significant change in performance accuracy was found. Participants in the experimental group reported a decrease in fluid intake.

Conclusion: Performance accuracy on a visuospatial task was not significantly impacted by a 48-h period of thickened liquid intake, but time required to complete the task increased and was associated with mild dehydration as indicated by higher USG levels.

Introduction: Traditionally, fundamental frequency increase has been viewed as largely associated with vocal fold length as a consequence of tilting the thyroid cartilage forward and downward, a so-called thyroid tilt, caused by cricothyroid muscle contraction. Recent pilot studies in singers suggest vocal fold elongation independent from fo as related to a pedagogical parameter called "phonatory density," suggesting a further discrete mechanism of the thyroid cartilage tilt related to voice quality. This study endoscopically, EGG, acoustically, and auditory perceptually explores different vocal modes in relation to degree of phonatory density independent of changes in fo across loudness and voice quality conditions.

Methods: Case-control with 20 professional singers performing sustained-vowel samples (C4 males, B4 females) for 8 different voice quality conditions with different degrees of auditory-perceptual "density" while undergoing endoscopic examination and concurrent EGG and acoustic measurement. Endoscopic vocal tract assessments were blindly rated according to a 33-item systematic assessment tool and a forced consensus paradigm. MANOVA, Spearman's rho, and factor density were calculated at p ≤ 0.05. Auditory-perceptual assessments of 64 samples of the 8 voicing conditions were performed by 33 professional singing teachers. Fleiss' kappa and percentage agreement were used to calculate assessor accuracy and inter-rater reliability.

Results: Forward and downward thyroid tilt was related to the perceptual category of "reduced density (RD)" as the only statistically significant endoscopic assessment variable: "fuller density" conditions exhibited little to no forward visible articulation of the thyroid cartilage, whereas RD conditions exhibited visible to marked forward articulation of the thyroid cartilage across tested conditions suggesting vocal fold elongation for RD conditions while maintaining an unchanged fo with high ICC for the assessors (r = 0.70 and r = 0.94 for male/female datasets, respectively). Correlation analyses revealed negative correlations for SPL, shimmer, and CPP measures for RD conditions, while Qx did not vary with statistical significance. Panel assessors accurately assessed the 8 tested conditions with 87% accuracy and good inter-rater reliability agreement (k: 0.772, p < 0.001).

Conclusion: Phonatory density, as an auditory-perceptual denotation of vocal weight, is controlled by the degree of thyroid cartilage tilt. The study documents systematic variations in vocal fold lengths across several conditions of loudness while fo is maintained. The findings suggest a further mechanism of the thyroid cartilage related to voice quality beyond the control of fo. Further studies are needed to document pitch production mechanisms compensating for the maintenance of fo given vocal fold elongation during RD conditions.

Introduction: Flexible endoscopic evaluations of swallowing (FEES) involve the administration of a variety of foods and liquids to assess outcomes related to pharyngeal residue, penetration, and aspiration. While the type and color of thin liquids used during FEES have been found to significantly affect FEES ratings, it is unknown if similar effects are observed with pureed foods. Therefore, the aims of this study were to assess the effects of puree type (applesauce vs. pudding) and color (natural, blue, green) on ratings of pharyngeal residue, penetration, and aspiration during FEES.

Methods: Pharyngeal residue, penetration, and aspiration were assessed in 37 consecutive outpatient adults undergoing FEES. Patients were presented with two types of puree: 5 mL applesauce and 5 mL pudding. Each puree type was presented once with either blue or green food coloring added to it by a clinician. Each puree type was also presented once with no clinician-added food coloring ("natural"). The order of presentation was randomized between patients and all data were blindly analyzed by pairs of independent raters using the Visual Analysis of Swallowing Efficiency and Safety (VASES). Multilevel statistical models were used to examine the effects of puree type and color on oropharyngeal residue, hypopharyngeal residue, and Penetration-Aspiration Scale scores (PAS).

Results: Pudding trials were associated with higher oropharyngeal residue ratings compared to applesauce trials. Blue-colored applesauce was associated with higher oropharyngeal and hypopharyngeal residue ratings when compared to natural applesauce. Lastly, green-colored applesauce and green-colored pudding were both associated with higher hypopharyngeal residue ratings compared to natural applesauce and natural pudding, respectively.

Conclusion: This study identified statistically significant effects of puree type and color and ratings of pharyngeal residue ratings, but not penetration or aspiration, as seen during FEES. These data suggest that clinicians and researchers should consider standardizing the type and color of pureed food used during FEES.

Introduction: Semantic Feature Analysis (SFA) therapy is a widely used approach for single-word naming treatment in monolingual and bilingual persons with aphasia (BiPWAs). There is evidence that SFA leads to naming improvements in both treated and untreated languages of BiPWAs. However, research on the generalization effects of SFA on narrative production is scarce. This study investigated the within- and cross-language generalization effects of SFA on narrative production and its relationship to naming gains in a group of L1-Russian-L2-Hebrew chronic-stage BiPWAs.

Methods: The study included two groups of BiPWAs. In the experimental group, ten individuals received one or two blocks of SFA, while ten participants who did not receive therapy served as a control group. We compared the changes in narrative production between the experimental and control groups and examined whether the narrative changes in the experimental group were related to naming gains.

Results: The results indicated that SFA generalized to narrative production in the experimental group. Within-language generalization was observed following SFA in L1, while cross-language generalization was found following SFA in both L1 and L2.

Conclusion: Although SFA has the potential to generalize to narrative production in BiPWAs, this effect did not consistently align with the therapy gains in naming. To achieve greater within- and cross-language generalization effects, we recommend providing SFA in the L1 of BiPWAs.

Introduction: Social participation for emerging symbolic communicators on the autism spectrum is often restricted. This is due in part to the time and effort required for both children and partners to use traditional augmentative and alternative communication (AAC) technologies during fast-paced social routines. Innovations in artificial intelligence provide the potential for context-aware AAC technology that can provide just-in-time communication options based on linguistic input from partners to minimize the time and effort needed to use AAC technologies for social participation.

Methods: This preliminary study used an alternating treatment design to compare the effects of a context-aware AAC prototype with automated cloze phrase response options to traditional AAC for supporting three young children who were emerging symbolic communicators on the autism spectrum in participating within a social routine.

Results: Visual analysis and effect size estimates suggest the context-aware AAC condition resulted in increases in linguistic participation, vocal approximations, and visual attention for all three children.

Conclusion: While this study was only an initial exploration and results are preliminary, context-aware AAC technologies have the potential to enhance participation and communication outcomes for young emerging symbolic communicators on the autism spectrum and more research is needed.

Introduction: In this study, the correlations between traditional acoustic measures (TAMs) and cepstral analysis (CA) were explored in Persian.

Methods: This investigation was a cross-sectional study including 179 dysphonic (n = 141) and normophonic (n = 38) speakers. The TAMs (jitter, shimmer, and noise-to-harmonic ratio) and CA (cepstral peak prominence and cepstral peak prominence smoothed) values were obtained during vowel prolongation, reading a standard sentence, and a nonstandard running speech sample using Praat software. The difference of acoustic measures between normophonic and dysphonic speakers and intercorrelation among acoustic measures and correlation between the acoustic measures and perceived dysphonia levels were analyzed with independent t test, Mann-Whitney U test, Pearson, Spearman, and Kendall's Tau-b correlation tests using IBM SPSS Statistics.

Results: The findings showed that dysphonic speakers had higher TAM values and lower CA values than normophonic speakers (p < 0.05). In dysphonic speakers, a large correlation was discovered among all acoustic measurements (r = 0.52-0.96; p < 0.05), while in various perceived dysphonic speakers, there was a correlation of varying strength (r = 0.25-0.97; p < 0.05). Ultimately, there was a significant small-to-large correlation between the acoustic measures and perceived dysphonia levels (r = 0.34-0.58; p < 0.05).

Conclusion: This research demonstrated that Persian speakers with dysphonia experienced a rise in TAM and a corresponding reduction in CA. In the future, multi-parametric indices can be developed using both TAM and CA to include various aspects of vocal production and yield a single, comprehensive value.

Introduction: Nasalance is an acoustic representation of perceived nasality with proven clinical and research utility. Its validity is contingent on appropriate speech sample sets and distinct normative databases based on known impact factors such as language and phonetic environment, but little is known about the potential effects of lexical tone on nasalance. Its use in international cross-linguistic studies necessitates definition and added considerations of speech sampling protocol.

Methods: Part I: a methodological review was undertaken using PRISMA (2020), the Scottish Intercollegiate Guidelines Network (SIGN) Methodology Checklist for evaluating the risk of bias, and calculation of effect sizes and/or visual displays using tables showing the grouping of similar data for the synthesis of findings. Part II: a pilot study explored the effect of lexical tone on nasalance in Cantonese, a lexical tone language.

Results: Part I: a total of 17 studies met the inclusion criteria. In addressing possible confounders and minimizing the risk of bias, 13 studies were assigned an overall quality rating of acceptable (+) and the remaining 4, a high rating (++). For the 9-word string, there was a (non-clinical) difference of 3-5% between Swedish and Brazilian-Portuguese, and a moderate effect size for age (d = 0.49); for the consonant-vowel syllables set, clinical differences across languages were identified for adults and between 5 and 10% for children and adolescents. Part II: the pilot study showed a significant effect of lexical tone on nasalance, where nasalance for the high-level tone 1 was significantly higher than that for high-rising tone 2, low-rising tone 5, and low-falling tone 4.

Discussion: There is a need for further evidence from other languages, including tonal languages, to better define the evidence and speech methodology of international cross-linguistic nasalance studies.