Folia Phoniatrica et Logopaedica最新文献

Introduction: This study aimed to compare attitudes toward stuttering and cluttering among speech and language therapists (SLTs) and speech and language therapy students in China and how they differ from those in other countries. It also seeks to explore factors that may influence these attitude differences.

Methods: We utilized online versions of the Public Opinion Survey of Human Attributes-Stuttering (POSHA-S) and Public Opinion Survey of Human Attributes-Cluttering (POSHA-Cl) instruments to conduct surveys of 54 SLTs and 99 SLT students at 6 Chinese universities offering speech and language therapy programs.

Results: Chinese SLTs had more positive attitudes than did SLT students. For example, rejecting learning and emotional trauma as a cause of stuttering or cluttering (a positive response) was more likely in SLTs than in SLT students. Both groups expressed more positivity about their knowledge sources than the average ratings from international samples.

Conclusion: Increased positive exposure opportunities with stuttering or cluttering will likely positively impact on attitudes toward stuttering and cluttering in China. It is crucial for speech and language professionals in China to recognize the widespread misinformation in various sources and actively combat misconceptions about stuttering and cluttering.

Introduction: The Acoustic Voice Quality Index (AVQI) and Smoothed Cepstral Peak Prominence (CPPs) have been reported to effectively support the assessment of voice quality in persons seeking voice care across many languages. This study aimed to evaluate the diagnostic accuracy of these two measures in detecting voice disorders in American English speakers, comparing their performance to machine learning (ML) models.

Methods: This retrospective study included a cohort of 187 participants: 138 patients with clinically diagnosed voice disorders and 49 vocally healthy individuals. Each participant completed two voicing tasks: sustaining [a:] vowel and producing a running speech sample, which were then concatenated. These samples were analyzed using VOXplot software for AVQI-3 (version 03.01) and CPPs. Additionally, four ML models (random forest, k-nearest neighbors, support vector machine, and decision tree) were trained for comparison. The diagnostic accuracy of the two measures and models was assessed using various evaluation metrics, including receiver operating characteristic curve and Youden Index.

Results: A cutoff score of 1.54 for the AVQI-3 (with 55% sensitivity and 80% specificity) and 14.35 dB for CPPs (with 65% sensitivity and 78% specificity) were identified for detecting voice disorders. Compared to an average ML sensitivity of 89% and specificity of 55%, CPPs offered a better balance between sensitivity and specificity, outperforming AVQI-3 and nearly matching the average ML performance.

Conclusions: ML shows great potential for supporting voice disorder diagnostics, especially as models become more generalizable and easier to interpret. However, current tools like AVQI-3 and CPPs remain more practical and accessible for clinical use in evaluating voice quality than commonly implemented models. CPPs, in particular, offers distinct advantages for identifying voice disorders, making it a recommended and feasible choice for clinics with limited resources.

Introduction: Inflammatory bowel disease (IBD) is a chronic gastrointestinal disease that is separated into two types: ulcerative colitis (UC) and Crohn's disease (CD). Although dysphagia is a well-studied and important topic in head and neck cancers and neurological disorders, research on the relationship between IBD and swallowing problems is not yet elucidated. The aim of this study was to compare swallowing function in the UC and CD using objective and patient-reported evaluation modalities.

Methods: This was a prospective cross-sectional research with 86 patients (50 UC and 36 CD) treated at the gastroenterology department. The assessment includes flexible fiberoptic endoscopic examination (FEES). The penetration-aspiration scale, the functional oral intake scale (FOIS), the functional outcome swallowing scale (FOSS), the Eating Assessment Tool-10 (EAT-10) test, the Yale Pharyngeal Residue Severity Scale for vallecula (Yale PRSS-vallecula) and pyriform sinus (Yale PRSS-PS) were all used to determine extent of dysphagia.

Results: The CD group had higher EAT-10 scores than UC group (p = 0.014). In terms of PAS scores, there was no significant difference between the two groups in all three food types (water, yogurt, and crackers) (p > 0.05). There was not a statistically significant variance between the groups in terms of vallecular residue (p > 0.05) according to the Yale PRSS-vallecula. Based on the Yale PRSS-PS, the CD group had significantly more residue than the UC group with yogurt and cracker (p = 0.014 and 0.030, respectively). FOSS and FOIS scores did not vary significantly between the two groups (p > 0.05).

Conclusion: CD impairs subjective and pharyngeal swallowing functions more than UC. It is obvious that swallowing should be assessed in patients with IBD.

Introduction: Dysphagia is a prevalent symptom of various neurological diseases and is associated with decreased quality of life. The M.D. Anderson Dysphagia Inventory (MDADI) is globally utilized tool to assess the impact of dysphagia on quality of life. However, a Turkish version of the scale is not yet available. This study aimed to translate, culturally adapt, and evaluate the validity and reliability of the Turkish version of the MDADI.

Methods: One hundred twenty-four patients who were diagnosed with definite neurological disease completed the study. The cross-cultural adaptation and translation process of the MDADI adhered to the World Health Organization's guidelines using the forward-backward translation method. The feasibility and the floor and ceiling effects were evaluated. Cronbach's alpha was used to assess internal consistency. The Bland and Altman method and interclass correlation coefficient (ICC) were used to evaluate test-retest reliability. Absolute reliability was determined using the standard error of the measurement (SEM) and minimal detectable change (MDC). Construct validity was assessed using Pearson's correlation coefficient between the MDADI and the Turkish Swallowing Quality of Life (T-SWAL-QOL) questionnaire.

Results: Our study had a feasibility rate of 100%. No floor or ceiling effects were determined for any subscale or composite scores of the T-MDADI. The T-MDADI demonstrated excellent reliability, with Cronbach's alpha coefficients ranging from 0.89 to 0.96 and ICC values from 0.81 to 0.95, confirming strong internal consistency and test-retest reliability. Measurement precision was supported by a SEM of 3.96 and an MDC of 10.97 for the composite score. In terms of validity, significant correlations were observed between T-MDADI subdomains and T-SWAL-QOL subdomains (r = 0.61-0.80 for food selection, mental health, and social functioning; r = 0.41-0.60 for eating duration and communication; p < 0.01), demonstrating good to very good convergent validity.

Conclusion: The T-MDADI demonstrates validity and reliability as a questionnaire for assessing dysphagia-related quality of life in Turkish patients with neurological diseases.

Introduction: Broca's aphasia (BA) is a language disorder that causes grammatical errors in the language production skills of patients. Contemporary studies revealed the fact that patients with BA (PBA) also have difficulty in analyzing the meaning of phrases and sentences and comprehending the real meaning of the discourse produced by the speaker. The purpose of this study was to investigate possible effect of syntactic movement by changing the word positions in the sentence with morphological markers in order to produce clauses without changing the meaning on the phrasal comprehension skills of Turkish-speaking patients with BA.

Method: A total of 300 participants were divided as study (n = 150) and control (n = 150) groups between ages of 27-89. A test that included 20 relative clauses and 9 noun clauses (in total 29 phrases) was assigned to the PBA and the control group (CG). Relative clause phrases originated from simple sentences by adding suffixes to the verb as a function of Turkish morphology. Each suffix indicated a specific noun, object, or subject, and each figure in the test was related to one of them. A researcher asked participants to match the demanded clause with the 6 possibly related pictures for relative clause and 3 for noun clauses.

Results: Findings indicated that BA patients in our study had a lack of comprehending relative clauses due to the syntactic movement of words in the object and subject positions. Compared to the responses of the CG, PBA had significantly lower scores when the object and subject positions have moved from their original positions. BA patients also obtained significantly lower scores in object type questions.

Conclusion: Our findings support the fact that comprehension processing in PBA should be investigated profoundly to be able to understand the nature of the disorder in different languages. In Turkish, syntactic movement of words to form a relative clause caused the BA patients to have significant problems to assign the semantic roles to the words in the existence of movement or change in their original positions.

Introduction: Treatment intensity for people with aphasia (PWA) is a significant factor in enhancing recovery. Personal factors such as fatigue, physical endurance, and motivation as well as clinician availability have been described as barriers to increased intensity. The use of student therapists has been shown to assist with addressing service gaps.

Methods: The aim of the study was to explore the experiences of PWA who received enhanced community-based treatment delivered by speech-language pathology (SLP) students. Enhanced community-based treatment was defined as three or more treatment sessions per week targeting communication. Semi-structured interviews were conducted with 10 PWA living in New Zealand. Interview data were analysed with reflexive thematic analysis.

Results: Two themes and six sub-themes were developed. Theme 1 related to intensity and included more treatment is better than less (sub-theme 1), there's a "right time" for more intensive treatment (sub-theme 2), the hard work is worth the effort (sub-theme 3). Theme 2 related to working with SLP students; it didn't feel like they were students (sub-theme 4), we just got on so well (sub-theme 5), and they listened to what I wanted (sub-theme 6).

Conclusions: The findings confirm that PWA value access to more intensive treatment and desire involvement in decisions about flexible treatment schedules. PWA have positive experiences when treatment is provided by SLP students. Implications for clinical practice and future research directions are discussed.

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: Training is an integral part of learning any skill. The vocal training helps singers attain proficiency as they are the most demanding vocal group of all professional voice users. Hence, it is necessary to evaluate the influence of training on the singer's voice. The current study objective was to investigate the influence of vocal training on voice measures (acoustic and aerodynamic) between male Carnatic singers with lower (6 months-5 years) and higher (6-10 years) training using novel task "mkaram" along with lyrical task.

Methods: Group 1 consisted of 30 trained male Carnatic singers with lower vocal training, and group 2, thirty trained male singers with higher training in the age of 18-45 years. The acoustic (frequency-related parameter, cepstral, spectral, perturbation, and noise) and aerodynamic measures (maximum phonation time and s/z ratio) of voice were obtained. The test-retest reliability was conducted on a sample of 10% of the population from each group, with a 2-week interval between the tests. Cross-sectional study design was applied.

Results: The statistical analysis revealed significantly decreased frequency-related parameters (semitones) such as the mean fundamental frequency, lowest fundamental frequency, highest fundamental frequency at the low register and the highest fundamental frequency at the middle register in group 2 during "mkaram" task (p ≤ 0.05). Similarly, one of the spectral-related measures 1st harmonic-2nd harmonic (dB) during lyrical task and one of the noise-related measure harmonic-to-noise ratio (dB) at the middle register during "mkaram" task showed a significant decrease in group 2 compared to group 1 (p ≤ 0.05). Test-retest reliability revealed that most of the parameters had "acceptable to excellent" internal consistency (Cronbach's α >0.7 to 1).

Conclusion: Few frequency and noise measures during "mkaram" task and a spectral measure during lyrical task showed to be sensitive in distinguishing the impact of vocal training on the voices of male Carnatic singers. The higher vocal training was found to help the singers to perform more efficiently with enhanced vocal range particularly in the low register and to some extent in the middle register. Indeed, the study highlighted the positive effects of vocal training on male Carnatic singers.

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 f_o 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 f_o 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 f_o 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 f_o is maintained. The findings suggest a further mechanism of the thyroid cartilage related to voice quality beyond the control of f_o. Further studies are needed to document pitch production mechanisms compensating for the maintenance of f_o given

Introduction: It is well established that high vowels tend to have a higher F0 than low vowels, a phenomenon known as intrinsic vowel F0 (IF0). However, the underlying cause of IF0 remains debated. Previous research suggests that IF0 is entirely of physiological origin, while other research indicates that it is acquired to enhance perceptual contrasts between vowels.

Methods: This study explored the impact of hearing loss on IF0 in six-year-old children, both with and without hearing impairment. The Belgian Dutch vowels produced by the children in both groups during a (non-)word repetition task were acoustically analysed for F0.

Results: The main result was that all children presented IF0. Although IF0 was not significantly different between children with and without hearing impairment, there was a trend towards a smaller IF0 in the hearing-impaired group.

Conclusion: In conclusion, while the results of this study support the physiological hypothesis, they also suggest a potential role for perceptual factors in shaping IF0. The results were interpreted in relation to the combined potential effects of speech organ physiology and perception on IF0.