Initial Theoretical Discussion of Identity as Barrier and Facilitator in Voice Habilitation and Rehabilitation.

OBJECTIVES: The purpose of this paper is to review seminal identity theories grounded in social psychology and one concept from voice science and explain how this group may point to identity factors facilitating or impeding voice habilitation and rehabilitation. METHODS: Identity theories from the social psychology literature (Dramaturgical Theory, Self-Categorization Theory, Self-Determination Theory, Identity Negotiation Theory) and vocal congruence are described. Concepts are synthesized with voice science research to explore potential identity-behavior relations at play in voice habilitation and rehabilitation. RESULTS: Applicable concepts from social psychology and voice science suggest identity-related processes by which a client may or may not develop a voice difference/disorder, seek intervention, and achieve goals in intervention. A bidirectional relationship between identity and behavior has been well-established in the social psychology literature. However, the relevance of vocal behavior has yet to be formally examined within this literature. Importantly, although connections between behavioral tendencies and voice disorders as well as the contribution of identity to gender-affirming voice treatment have been established in the voice science literature, the consideration of identity's possible role in voice habilitation and rehabilitation in cis gender individuals has thus far been scant. CONCLUSIONS: Research into identity and voice habilitation and rehabilitation may help to improve voice intervention outcomes. A possible adjunct to human studies is agent-based modeling or other computational approaches to assess the myriad factors that may be relevant within this line of inquiry.

Relative importance of speech and voice features in the classification of schizophrenia and depression.

Speech is a promising biomarker for schizophrenia spectrum disorder (SSD) and major depressive disorder (MDD). This proof of principle study investigates previously studied speech acoustics in combination with a novel application of voice pathology features as objective and reproducible classifiers for depression, schizophrenia, and healthy controls (HC). Speech and voice features for classification were calculated from recordings of picture descriptions from 240 speech samples (20 participants with SSD, 20 with MDD, and 20 HC each with 4 samples). Binary classification support vector machine (SVM) models classified the disorder groups and HC. For each feature, the permutation feature importance was calculated, and the top 25% most important features were used to compare differences between the disorder groups and HC including correlations between the important features and symptom severity scores. Multiple kernels for SVM were tested and the pairwise models with the best performing kernel (3-degree polynomial) were highly accurate for each classification: 0.947 for HC vs. SSD, 0.920 for HC vs. MDD, and 0.932 for SSD vs. MDD. The relatively most important features were measures of articulation coordination, number of pauses per minute, and speech variability. There were moderate correlations between important features and positive symptoms for SSD. The important features suggest that speech characteristics relating to psychomotor slowing, alogia, and flat affect differ between HC, SSD, and MDD.

Clinical Decision Making for Intraoperative Auditory Brainstem Response Testing in Children following Tympanostomy Tube Placement.

Intraoperative auditory brainstem response (ioABR) testing following tympanostomy tube (TT) placement may be biased due to temporary threshold shifts (TTS). The purpose of the study was to assess the evidence for TTS in children who have undergone ioABR using prolonged latencies of wave I (males > 1.95 ms, females > 1.88 ms) as a marker of a persisting air-bone gap. Eighty-three children underwent ioABR following surgical procedures at University Hospital Bonn, Germany. The primary outcome measure was the latency of wave I at 80-dB SPL. The total sample consisted of 66 males (79.5%) and 17 females (20.5%) with a mean (SD) age of 46.4 (26.6) months. Of 163 operated ears (83 children), 72 (44.2%) had no middle ear fluid, 19 (11.6%) serous fluid, and 72 (44.2%) mucoid fluid. The risk of having a prolonged latency of wave I at 80-dB SPL was OR 4.61 (95% CI 2.01-10.59; p < 0.001) in those with mucoid fluid as compared to those without mucoid fluid. Intraoperative ABR results should account for sex differences and be interpreted with caution and be verified. Ultimately, parents should be engaged in a preoperative discussion to decide if an ioABR should be postponed if mucoid fluid was found.

[Does reduction mammoplasty improve neck pain and quality of life?] / Verbessern brustverkleinernde Operationen Nackenschmerzen und die Lebensqualität?

INTRODUCTION AND OBJECTIVE: Macromastia often leads to physical complaints involving pain in the shoulder/neck area. In Germany, there are virtually no reliable data on the effects of breast reduction surgery with regard to neck and spine complaints. Therefore, the authors carried out a retrospective study to investigate the effect of breast-reducing surgery on neck pain and quality of life. METHODS: Between January 1, 2014 and December 31, 2019, 107 breast reductions were performed for macromastia. Medical records and OP reports were evaluated, and the indication for breast reduction documented. Pain was recorded preoperatively on a visual analog scale (VAS). Pretreatments and perioperative complications were also documented and evaluated. All patients were sent a questionnaire, which determined whether the objective of the operation had been achieved, how satisfied the patients were with the result of the operation, and how severe the current pain (VAS) was. The EQ-5D 3L health questionnaire was used to assess quality of life, and the Neck-Disability Index was used to assess neck complaints. Statistical analysis was carried out using the Wilcoxon test. RESULTS: After an average of 56.5 months (min: 18, max: 90), 76/107 (71%) patients could be re-examined. There were 15 complications. Pain improved from an average of 7.2 preoperatively (min: 0, max: 10) to an average of 1.6 postoperatively (min: 0, max: 4; p < 0.001). The Neck-Disability Index improved from an average of 43.8% (Min: 0, Max: 82) to an average of 10.8% (Min: 0, Max: 52) postoperatively (p < 0.001). In all, 71/76 (93%) of the examined patients were very satisfied or satisfied with the result of the operation. DISCUSSION AND CONCLUSION: With this study, the authors were able to show that there are often several reasons why breast reduction surgery is performed in patients with macromastia. A high patient satisfaction rate can be achieved and orthopedic clinical complaints associated with macromastia can be treated with a very high success rate.

Technologies During the COVID-19 Pandemic: Teleconsultation in Care Management for Patients Undergoing Liver Transplant.

BACKGROUND: The aim of this study was to identify home care management strategies for patients undergoing liver transplant, through teleconsultation, during the COVID-19 pandemic for maintenance and improvements in treatment adherence. METHODS: This was a qualitative, exploratory, and descriptive research study. Participants included patients who underwent liver transplant between 2020 and 2021. Through a semistructured script, data were analyzed according to the recommendations of content analysis and then simple statistics were applied. RESULTS: Twenty-two people participated in the study. Two analysis categories were developed, which resulted in 7 strategies and 22 care actions. The care strategy with the highest adherence involved actions related to the prevention of COVID-19. CONCLUSIONS: Teleconsultation is an excellent tool to manage and supervise post-liver transplant care of patients. Considering that teleconsultation has presented strategies and care actions, which were developed by the patients, the patients have a direct effect on treatment adherence despite pandemic impositions.

Brain death: health team's experience with parents of children and adolescents / Muerte encefálica: experiencia del equipo de salud con los padres de niños y adolescentes / Morte encefálica: vivência da equipe de saúde junto aos pais de crianças e adolescentes

ABSTRACT Objective to understand the health team's experience with parents of children and adolescents during the brain death protocol stages. Method a qualitative and exploratory research developed in two health institutions of high complexity and reference in the care of children and adolescents with polytrauma. Participants were health professionals from critical patient units. Data collection took place between October and December 2019 through semi-structured interviews. For content analysis, we used the software Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires as support. Results twenty-one professionals (physicians, nurses and nursing technicians) participated in the study. The general corpus consisted of 21 texts, separated into 123 segments, with the emergence of four classes. The study shows feelings of support and compassion at all brain death protocol stages. In the protocol opening stage, the team's emotions are focused on the actions of clarifying and revealing information in this process, in addition to pointing out the need for the team to detail the step by step of the exams to be performed. In the communication of death stage, the feeling of being, caring for and welcoming the family relates to other feelings experienced by them. Conclusion the study reveals that the health team experiences unique feelings during the brain death protocol in the reality of children and adolescents, revealing the team's concern with being with the family, paying attention and caring for the pain of loss.

RESUMEN Objetivo comprender la experiencia del equipo de salud con los padres de niños y adolescentes durante las etapas del protocolo de muerte encefálica. Método investigación con enfoque cualitativo y exploratorio desarrollada en dos instituciones de salud de alta complejidad y referencia en la atención de niños y adolescentes con politraumatismo. Los participantes fueron profesionales de la salud de unidades de pacientes críticos. La recolección de datos ocurrió entre octubre y diciembre de 2019 a través de entrevistas semiestructuradas. Para el análisis de contenido se utilizó como soporte el software Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires. Resultados participaron del estudio 21 profesionales (médicos, enfermeros y técnicos de enfermería). El corpus general estuvo compuesto por 21 textos, separados en 123 segmentos, surgiendo cuatro clases. El estudio muestra sentimientos de apoyo y compasión en todas las etapas del protocolo de muerte cerebral. En la etapa de apertura del protocolo, las emociones del equipo están enfocadas en las acciones de esclarecimiento y revelación de información en este proceso, además de señalar la necesidad de que el equipo detalle el paso a paso de los exámenes a realizar. En la etapa de comunicación de la muerte, el sentimiento de ser, cuidar y acoger a la familia se conecta con otros sentimientos vividos por ellos. Conclusión el estudio revela que el equipo de salud vive sentimientos únicos durante el protocolo de muerte encefálica en la realidad de los niños y adolescentes, revelando la preocupación del equipo por estar con la familia, prestar atención y cuidar el dolor de la pérdida.

RESUMO Objetivo: compreender a vivência da equipe de saúde junto aos pais de crianças e adolescentes durante as etapas do protocolo de morte encefálica. Método: pesquisa exploratória de abordagem qualitativa desenvolvida em duas instituições de saúde de alta complexidade e referência no atendimento a crianças e adolescentes com politrauma. Os participantes foram profissionais de saúde das unidades de pacientes críticos. A coleta de dados ocorreu entre os meses de outubro e dezembro de 2019 por meio de entrevistas semiestruturadas. Para análise de conteúdo, utilizou-se como apoio o software Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires. Resultados: participaram do estudo 21 profissionais (médicos, enfermeiros e técnicos de enfermagem). O corpus geral foi constituído por 21 textos, separados em 123 segmentos, emergindo quatro classes. O estudo mostra sentimentos de apoio e compaixão em todas as etapas do protocolo de morte encefálica. Na etapa da abertura do protocolo, as emoções da equipe estão voltadas às ações de clarificar e transparecer informações deste processo. Além de apontar a necessidade de a equipe detalhar o passo a passo dos exames a serem realizados. Na etapa da comunicação da morte, a sensação de estar, cuidar e acolher a família se conecta com outros sentimentos experimentados por eles. Conclusão: o estudo revela que a equipe de saúde vivencia sentimentos únicos durante o protocolo de morte encefálica na realidade de crianças e adolescentes. Revela também a preocupação de a equipe em estar com a família, atentar e cuidar ante a dor da perda.

Management of functional communication, swallowing, cough and related disorders: consensus recommendations for speech and language therapy.

Communication problems (eg, dysphonia, dysfluency and language and articulation disorders), swallowing disorders (dysphagia and globus), cough and upper airway symptoms, resulting from functional neurological disorder (FND), are commonly encountered by speech and language professionals. However, there are few descriptions in the literature of the most effective practical management approaches. This consensus document aims to provide recommendations for assessment and intervention that are relevant to both adults and young people. An international panel of speech and language professionals with expertise in FND were approached to take part. Participants responded individually by email to a set of key questions regarding best practice for assessment and interventions. Next, a video conference was held in which participants discussed and debated the answers to these key questions, aiming to achieve consensus on each issue. Drafts of the collated consensus recommendations were circulated until consensus was achieved. FND should be diagnosed on the basis of positive clinical features. Speech and language therapy for FND should address illness beliefs, self-directed attention and abnormal movement patterns through a process of education, symptomatic treatment and cognitive behavioural therapy within a supportive therapeutic environment. We provide specific examples of these strategies for different symptoms. Speech and language professionals have a key role in the management of people with communication and related symptoms of FND. It is intended that these expert recommendations serve as both a practical toolkit and a starting point for further research into evidence-based treatments.

An exploratory model of speech intelligibility for healthy aging based on phonatory and articulatory measures.

PURPOSE: The aims of the current study were to determine age-related changes to the phonatory and articulatory subsystems and to investigate an exploratory model of intelligibility for healthy aging based on phonatory and articulatory measures. METHOD: Fifteen healthy, older adults (55-81 years) and 15 younger adults (20-35 years) participated in instrumental assessments of the phonatory (aerodynamic, acoustic) and articulatory (kinematic) subsystems. Speech intelligibility was determined by five listeners during multi-talker babble. RESULTS: Older adults displayed shorter maximum phonation time, greater airflow during sentence reading, and lower cepstral peak prominence (CPP) and CPP SD. Additionally, older adults had slower tongue movement speed than younger adults. Speech intelligibility was also significantly reduced in the older group. A generalized estimating equations model combining phonatory and articulatory measures showed that CPP SD, low/high (L/H) spectral ratio mean and SD, Cepstral Spectral Index of Dysphonia (CSID), and maximum tongue movement speed were significant contributors to intelligibility changes in older individuals. While L/H mean and SD and CSID displayed an inverse relationship with intelligibility, CPP SD and maximum tongue speed displayed a direct relationship with intelligibility. DISCUSSION: Aging affects the phonatory and articulatory subsystems with implications for speech intelligibility. Phonatory cepstral/spectral measures (except mean CPP) were associated with speech intelligibility changes, suggesting that changes in voice quality may contribute to reduced intelligibility in older adults. Pertaining to articulation, slower tongue movement speed likely contributed to reduced intelligibility in older individuals.

Limbic and cortical control of phonation for speech in response to a public speech preparation stressor.

Knowledge on brain networks subserving vocalization in vocally healthy individuals under various task conditions is scarce but paramount to understand voice disorders. The aims of our study were to determine (1) the effect of social-evaluative stress on the central neural control of phonation underlying speech production; and (2) the neural signature, personality profile, and aerodynamic vocal function in relation to salivary cortisol responses. Thirteen vocally healthy females underwent an event-related sparse-sampling fMRI protocol consisting of voiced and whispered sentence productions with and without exposure to the social-evaluative stressor public speaking anticipation. Participants completed a personality questionnaire, rating scales of negative emotional state, and provided salivary cortisol samples. In the total sample, the task contrast of voiced productions revealed that stressor exposure resulted in a peak activation in the right caudate with concomitant deactivations in the bilateral pgACC and aMCC, and right IFG, BA 9, BA 10, insula, putamen, and thalamus. There were individual differences in stressor-induced brain activations as a function of stress reactivity with greater cortisol reactivity linked with lower laryngeal motor cortex activity and lower scores on aspects of extraversion. Our data confirm that stress alters the phonatory control for speech production through limbic-motor interactions. The findings support the Trait Theory of Voice Disorders (Roy and Bless 2000) and help provide critical insights to the study of voice disorders such as primary muscle tension dysphonia.

Biobehavioral Measures of Presbylaryngeus.

OBJECTIVE: The objective of this observational study was to assess the relationship between established aging biobehavioral measures and voice decline in normally aging adults. STUDY DESIGN: Cross-sectional study. METHODS: Participants 60-85 years of age were divided into two age and sex-matched groups, based on the presence or absence of presbylaryngeus. Both groups underwent a battery of tests measuring anthropometric variables, inflammatory markers, general health measures, and vocal function parameters. Differences from the norm were calculated for all variables. Parametric and nonparametric tests were performed to assess group differences. In addition, variable selection analysis was performed to determine variables that were most influential in predicting the occurrence of presbylaryngeus in our current sample. RESULTS: Fifty-three participants were divided into age and sex-matched groups of "presbylaryngeus" (n = 26) and "non-presbylaryngeus" (n = 27). The two groups were statistically different in select measures of inflammatory markers, general health measures, and vocal function parameters. Anthropometric measures were not statistically different. Based on variable selection, the variables most predictive of the presence of presbylaryngeus were measures of the Physical Activity Scale of the Elderly, C-reactive protein, laryngeal airway resistance, and vocal roughness. CONCLUSIONS: In addition to group differences in vocal function measures, results for the presbylaryngeus group consistently trended sub-optimally on anthropometric measures, two inflammatory markers, and general health measures. These results suggest that this sample of individuals with presbylaryngeus demonstrated greater biobehavioral deficits associated with aging as compared to age and sex-matched non-presbylaryngeus individuals.

Exploring the Neural Bases of Primary Muscle Tension Dysphonia: A Case Study Using Functional Magnetic Resonance Imaging.

Primary muscle tension dysphonia (pMTD) is a voice disorder that occurs in the absence of laryngeal pathology. Dysregulated activity of the paralaryngeal muscles is considered the proximal cause; however, the central origin of this aberrant laryngeal muscle activation is unclear. The Trait Theory (Roy and Bless, 2000a,b) proposed that specific personality traits can predispose one to laryngeal motor inhibition and pMTD, and this inhibition is mediated by a hyperactive "behavioral inhibition system (BIS)" composed of limbic system structures (and associated prefrontal connections). This case study used functional magnetic resonance imaging to detect brain activation changes associated with successful management of pMTD, thereby evaluating possible neural correlates of this poorly understood disorder. METHOD: A 61-year-old woman with moderate-to-severe pMTD underwent functional magnetic resonance imaging scans before and immediately after successful treatment using manual circumlaryngeal techniques. Experimental stimuli were blocks of repeated vowel production and overt sentence reading. RESULTS: Significantly greater activation was observed pre- versus posttreatment in all regions of interest during sentence production, that is, periaqueductal gray, amygdala, hypothalamus, anterior cingulate cortex, hippocampus, dorsolateral prefrontal cortex, Brodmann area 10, and premotor and inferior sensorimotor cortex. CONCLUSIONS: Our findings are compatible with overactivation of neural regions associated with the BIS (cingulate cortex, amygdala, hypothalamus, periaqueductal gray) and motor inhibition networks (eg, [pre-]supplementary motor area) along with the dorsolateral prefrontal cortex and medial prefrontal cortex. Heightened input from limbic regions combined with dysfunctional prefrontal regulation may interfere with laryngeal motor preparation, initiation, and execution thereby contributing to disordered voice in pMTD.

Personality, Psychological Factors, and Behavioral Tendencies in Children With Vocal Nodules: A Systematic Review.

OBJECTIVES: This systematic review examined the evidence linking vocal nodule development in children to personality traits, psychological factors, and associated behavioral tendencies. METHODS: Four electronic databases-PubMed, Scopus, ScienceDirect, EBSCO Host-as well as the reference lists from articles (including online sources) were searched. After screening for relevance, eight comparative, case-control studies were identified that met inclusion criteria. The quality of each study was evaluated by two raters using a modified, standardized checklist. RESULTS: Four studies were rated as "good quality" and four were "fair". The questionnaires used to measure personality or psychological factors varied widely among the studies, and the results linking personality dispositions (and associated behavioral inclinations) to vocal nodule development in children were mixed. CONCLUSIONS: Fair to good quality evidence exists to suggest that psychological factors or personality traits related to extraversion and impulsivity (and their related behavioral inclinations) might predispose children to vocal nodules and deserve further attention. Clinical implications, limitations of the current systematic review, and recommendations for future research are also discussed.

Classification of sEMG Signals for the Detection of Vocal Fatigue based on VFI Scores.

In this new research, we expand on our previous system for vocal fatigue detection by adding five new features in the classifier. We also perform further testing on 37 test subjects. The goals were: 1) to classify subjects performing normal versus simulated pressed vocal gestures; 2) to distinguish vocally healthy from vocally fatigued subjects as determined by VFI score on factor 1; and 3) to determine the validity of the labels vis-a-vis the choice of this same VFI-factor-1 boundary. As the results demonstrated, the choice of classifier and the new features were quite appropriate, while there is margin for better choices of the VFI-factor-1 boundary.

Size-Resolved Endotoxin and Oxidative Potential of Ambient Particles in Beijing and Zürich.

PM2.5 pollution has become a global health concern, however its size-resolved health impact remains to be poorly elucidated. Here, ambient particulate matter (PM) were collected into 13 different size ranges (10 nm to 18 µm) and the mass, metal, endotoxin distributions, and related oxidative potential were investigated in two regions (Zürich, Switzerland and Beijing, China). Results showed that the two regions had remarkably different PM distribution patterns. Swiss urban samples had a mode around 40 nm with 23.3% of total PM mass, while Chinese samples featured two modes around 0.75 and 4.23 µm with 13.8-18.6% and 13.7-20.4% of total PM mass, respectively. Two peaks for endotoxin at 40-100 nm and 1-4 µm were observed in different regions. For PM-borne metals, Chinese samples had 67.6-100% of total Cd, As, and Pb in the size range of 0.1-1 µm, and Swiss samples had similar distributions of Cd and Pb but much lower total metals than Chinese samples. The PM oxidative potential varied greatly with sizes for different regions. Accordingly, the current practice, i.e., sole use of the mass concentration, could lead to inadequate health protection for one region, but unnecessary economic costs for another without achieving significant extra health benefits.

Enhancement of aging rat laryngeal muscles with endogenous growth factor treatment.

Clinical evidence suggests that laryngeal muscle dysfunction is associated with human aging. Studies in animal models have reported morphological changes consistent with denervation in laryngeal muscles with age. Life-long laryngeal muscle activity relies on cytoskeletal integrity and nerve-muscle communication at the neuromuscular junction (NMJ). It is thought that neurotrophins enhance neuromuscular transmission by increasing neurotransmitter release. We hypothesized that treatment with neurotrophin 4 (NTF4) would modify the morphology and functional innervation of aging rat laryngeal muscles. Fifty-six Fischer 344xBrown Norway rats (6- and 30-mo age groups) were used to evaluate to determine if NTF4, given systemically (n = 32) or directly (n = 24), would improve the morphology and functional innervation of aging rat thyroarytenoid muscles. Results demonstrate the ability of rat laryngeal muscles to remodel in response to neurotrophin application. Changes were demonstrated in fiber size, glycolytic capacity, mitochondrial, tyrosine kinase receptors (Trk), NMJ content, and denervation in aging rat thyroarytenoid muscles. This study suggests that growth factors may have therapeutic potential to ameliorate aging-related laryngeal muscle dysfunction.

Detection of Simulated Vocal Dysfunctions Using Complex sEMG Patterns.

Symptoms of voice disorder may range from slight hoarseness to complete loss of voice; from modest vocal effort to uncomfortable neck pain. But even minor symptoms may still impact personal and especially professional lives. While early detection and diagnosis can ameliorate that effect, to date, we are still largely missing reliable and valid data to help us better screen for voice disorders. In our previous study, we started to address this gap in research by introducing an ambulatory voice monitoring system using surface electromyography (sEMG) and a robust algorithm (HiGUSSS) for pattern recognition of vocal gestures. Here, we expand on that work by further analyzing a larger set of simulated vocal dysfunctions. Our goal is to demonstrate that such a system has the potential to recognize and detect real vocal dysfunctions from multiple individuals with high accuracy under both intra and intersubject conditions. The proposed system relies on four sEMG channels to simultaneously process various patterns of sEMG activation in the search for maladaptive laryngeal activity that may lead to voice disorders. In the results presented here, our pattern recognition algorithm detected from two to ten different classes of sEMG patterns of muscle activation with an accuracy as high as 99%, depending on the subject and the testing conditions.

Psychobiological stress reactivity and personality in persons with high and low stressor-induced extralaryngeal reactivity.

PURPOSE: The purpose of the study was to determine whether persons who responded with high stressor-induced extralaryngeal muscle activity in a stress reactivity protocol differed from those with low muscle activity on measures of emotional and autonomic cardiovascular reactivity and personality. METHOD: Thirty-six vocally healthy women (18-35 years) were assigned to high and low extralaryngeal groups based on submental (SM) and infrahyoid (IH) surface electromyography (sEMG) recordings obtained during a stress reactivity protocol (high vs. low sEMGSM and sEMGIH, n = 18 per subgroup; Dietrich & Verdolini Abbott, 2012). Measures included assessments of basic fear and fear of public speaking, rumination, systolic blood pressure (SBP), and personality. RESULTS: The high sEMGIH group reported significantly greater basic fear across experimental phases than did the low sEMGIH group (p = .036). However, the high sEMGSM and sEMGIH versus low sEMGSM and sEMGIH groups did not differ on fear of public speaking, rumination, or SBP across phases. Both high sEMGSM and sEMGIH groups were characterized by significantly lower scores on Extraversion (p < .001). CONCLUSION: In combination with the authors' previous findings (Dietrich & Verdolini Abbott, 2012), the present findings provided robust evidence that low Extraversion was linked to stressor-induced changes in extralaryngeal functioning and that perceived fear played a contributing role.