Assessing and developing the written reflective practice skills of speech-language pathology students.

PURPOSE: Written reflective practice aims to support critical thinking and problem solving skills in speech-language pathology (SLP) clinical education programmes. Yet, there has been limited investigation of students' development of written reflective practice skills over time and during a real-time clinical experience. The purpose of this study was to investigate students' development of breadth and depth of written reflective practice across a six-week clinical experience. METHOD: Participants were 59 undergraduate and 14 postgraduate SLP students. Participants wrote critical reflections describing an interaction with a client/s at the conclusion of weeks two, four and six of their clinical experience. Formative feedback was provided after each submission. Breadth and depth of reflection were coded using a modification of Plack et al.'s coding schema. RESULT: There was a statistically significant association between time and likelihood of development of breadth of reflection for the elements process and content. Depth of reflection improved significantly across time. The majority of participants were classified as "reflectors" or critical reflector at the conclusion of the study. CONCLUSION: SLP students can make significant improvements in both breadth and depth of written reflective practice over a six-week period. Implications for clinical teaching are discussed.

Creaky voice or extreme vocal fry in young women.

An extreme use of a voice feature with a lowered rough sound called vocal fry or creaky voice has become increasingly recognised in American, British and New Zealand English speaking young women. It is not regarded as an involuntary voice disorder, but rather as a volitional strategy. Intermittent vocal fry is recognised as a common voice feature, particularly at the end of a sentence. It occurs at the lowest range of a speaker's F0 (pitch). We present evidence that vocal fry use is increasing in young New Zealand women. This article is to highlight the new phenomenon of extreme and sustained vocal fry as a vocal style, which is the first voice feature to have come to the attention of the general public through the news media.

Communication restriction in adults who stutter: Part III.

This is the third article in a series examining communication restriction in adults with stuttering (AWS). The aim was to explore interpersonal communication behaviour in AWS at long-term treatment follow-up, using systemic functional linguistics (SFL) as an analytical framework. The performance of 10 AWS within 10-minute conversation samples was compared across pretreatment (T1), post-treatment (T2), and 12-month follow-up (T3), in terms of language productivity and complexity, modality, and appraisal. At T1 and T3, comparisons were also made to a control group (AWNS). Post-treatment increases in (1) language complexity, (2) frequency of modal operators, and (3) expression of appraisal were maintained in the AWS group at T3. No significant differences in these areas were found between AWS and AWNS at T3. The findings suggest that intensive comprehensive stuttering treatment can affect lasting functional change in interpersonal language use for AWS.

Communication restriction in adults who stutter: Part II.

This article presents a follow-up study to Lee, van Dulm, Robb, and Ormond (2015). The aim was to explore communication restriction in adults with stuttering (AWS) using typical language measures and systemic functional linguistics (SFL) analyses. The article compared the pre- and post-treatment performance of AWS in language productivity and complexity, transitivity, modality, appraisal, and theme. Ten-minute conversational samples were obtained from 20 AWS before and after participation in intensive stuttering treatment. Transcripts were analysed for quantity and complexity of verbal output, and frequency of transitivity, modality, appraisal and theme resources. Between pre- and post-treatment, the following differences were observed: (1) a significant increase in frequency of modal operators, and trends approaching significance for (2) increased language complexity (3) increased language expressing appraisal. These changes suggest increased flexibility of language use in AWS following treatment, particularly towards interpersonal engagement. The value of SFL to this area of research is discussed.

Communication restriction in adults who stutter.

This study explored communication restriction in adults with stuttering (AWS) by means of typical language measures obtained using the Systematic Analysis of Language Transcripts - New Zealand (SALT-NZ) software, as well as systemic functional linguistics (SFL) analyses. The areas of language productivity and complexity, modality (i.e. linguistic politeness) and the language of appraisal were compared between AWS and typically fluent speakers (adults with no stuttering (AWNS)). Ten-minute conversational samples were obtained from 20 AWS and 20 age- and sex-matched AWNS. Transcripts were analysed for quantity and complexity of verbal output, and frequency of use of modality and appraisal resource subtypes. Means comparison and correlation analyses were conducted using grouped data. AWS produced less language and less complex language than AWNS, measured by SALT-NZ and SFL indices. AWS also differed from AWNS in their use of modality resources to express politeness - they produced fewer modal operators and more comment adjuncts than AWNS. A smaller proportion of their language expressed the explicit appreciation of things. The linguistic patterns identified in the conversational language of AWS suggested a reduced openness to interpersonal engagement within communication exchanges, which may restrict opportunities for and the experience of such exchanges. The value of SFL to this area of research is discussed.

The role of language familiarity in bilingual stuttering assessment.

The aim of this study was to evaluate the ability of English-speaking speech-language pathologists (SLPs) to evaluate stuttering behaviour in two Spanish-English bilingual adults who stutter (AWS1 and AWS2). The English-speaking SLPs were asked to judge the frequency, severity, type, duration, and physical concomitants of stuttering in both languages of the two AWS. The combined results from the English-speaking SLPs were then compared to the judgements of three Spanish-English bilingual SLPs. Results indicated that English-speaking SLPs (1) judged stuttering frequency to be greater in Spanish than English for AWS1, and equal in Spanish and English for AWS2, (2) were more accurate at evaluating individual moments of stuttering for the English samples compared to the Spanish samples, (3) identified fewer and less severe stuttering behaviours than the bilingual SLPs in both languages, and (4) were accurate judges of overall stuttering severity in both languages. The results correspond to past research examining the accuracy of stuttering evaluations in unfamiliar languages. Possible explanations for the findings, clinical implications, and future research directions are discussed.

Evaluating iPhone recordings for acoustic voice assessment.

AIMS: This study examined the viability of using iPhone recordings for acoustic measurements of voice quality. METHODS: Acoustic measures were compared between voice signals simultaneously recorded from 11 normal speakers (6 females and 5 males) through an iPhone (model A1303, Apple, USA) and a comparison recording system. Comparisons were also conducted between the pre- and post-operative voices recorded from 10 voice patients (4 females and 6 males) through the iPhone. Participants aged between 27 and 79 years. RESULTS: Measures from iPhone and comparison signals were found to be highly correlated. Findings of the effects of vowel type on the selected measures were consistent between the two recording systems and congruent with previous findings. Analysis of the patient data revealed that a selection of acoustic measures, such as vowel space area and voice perturbation measures, consistently demonstrated a positive change following phonosurgery. CONCLUSION: The present findings indicated that the iPhone device tested was useful for tracking voice changes for clinical management. Preliminary findings regarding factors such as gender and type of pathology suggest that intra-subject, instead of norm-referenced, comparisons of acoustic measures would be more useful in monitoring the progression of a voice disorder or tracking the treatment effect.

Extended follow-up of a randomized controlled trial of the Lidcombe Program of Early Stuttering Intervention.

BACKGROUND: In the Lidcombe Program of Early Stuttering Intervention, parents present verbal contingencies for stutter-free and stuttered speech in everyday situations. A previous randomized controlled trial of the programme with preschool-age children from 2005, conducted in two public speech clinics in New Zealand, showed that the odds of attaining clinically minimal levels of stuttering 9 months after randomization were more than seven times greater for the treatment group than for the control group. AIMS: To follow up the children in the trial to determine extended long-term outcomes of the programme. METHODS & PROCEDURES: An experienced speech-language therapist who was not involved in the original trial talked with the children on the telephone, audio recording the conversations using a telephone recording jack. Parental reports were gathered in addition to the children's speech samples in order to obtain a balance of objective data and reports from a wide range of situations. OUTCOMES & RESULTS: At the time of this follow-up, the children were aged 7-12 years, with a mean of 5 years post-randomization in the 2005 trial. Twenty of the 29 children in the treatment arm and eight of the 25 children in the control (no treatment) arm were able to be contacted. Of the children in the treatment group, one (5%) failed to complete treatment and 19 had completed treatment successfully and had zero or near-zero frequency of stuttering. Three of the children (16%) who had completed treatment successfully had relapsed after 2 or more years of speech that was below 1% syllables stuttered. Meaningful comparison with the control group was not possible because an insufficient number of control children were located and some of them received treatment after completing the trial. CONCLUSIONS & IMPLICATIONS: The majority of preschool children are able to complete the Lidcombe Program successfully and remain below 1% syllables stuttered for a number of years. However, a minority of children do relapse and will require their parents to reinstate the treatment procedures.

Voice of postradiotherapy nasopharyngeal carcinoma patients: evidence of vocal tract effect.

This study was aimed at identifying acoustic and physiological measures useful for monitoring voice changes in postnasopharyngeal patients with nonlaryngeal malignancies, and providing evidences of vocal tract effect on voice through comparisons between individuals with and without intact vocal tract. Simultaneous acoustic-electroglottographic signals recorded during phonation of vowels /i/ and /a/ sustained at habitual, high, and low pitch levels were compared among 10 postradiotherapy patients with nasopharyngeal carcinoma (NPC), 10 voice patients (VPs) with intact vocal tract, and 10 healthy individuals with normal voice (NORM). Results from a series of discriminant analyses revealed that the NPC group generally exhibited lower signal-to-noise (SNR) and open quotient (OQ) and higher Formant 1 frequency (F(1)) and speed quotient (SQ) than the NORM group. Unlike both VP and NORM groups, the NPC group failed to show a pitch effect on all voice measures, including OQ, SQ, percent jitter, percent shimmer, and SNR, suggesting an effect of radiotherapy and/or vocal tract on laryngeal behaviors. For the vowel /i/, on the other hand, only the NPC and NORM groups showed a pattern of pitch-dependent F(1) raising, a reflection of increased pharyngeal narrowing. These findings suggested that the pitch effect on laryngeal behaviors differed not only between individuals with intact vocal tract and those without but also between those with structural and dynamic changes of vocal tract.

Randomised controlled trial of the Lidcombe programme of early stuttering intervention.

OBJECTIVES: To evaluate the efficacy of the Lidcombe programme of early stuttering intervention by comparison to a control group. DESIGN: A pragmatic, open plan, parallel group, randomised controlled trial with blinded outcome assessment. SETTING: Two public speech clinics in New Zealand. PARTICIPANTS: Stuttering preschool children who presented to the speech clinics for treatment. Inclusion criteria were age 3-6 years and frequency of stuttering of at least 2% syllables stuttered. Exclusion criteria were onset of stuttering during the six months before recruitment and treatment for stuttering during the previous 12 months. 54 participants were randomised: 29 to the Lidcombe programme arm and 25 to the control arm. 12 of the participants were girls. INTERVENTION: Lidcombe programme of early stuttering intervention. MAIN OUTCOME MEASURES: Frequency of stuttering was measured as the proportion of syllables stuttered, from audiotaped recordings of participants' conversational speech outside the clinic. Parents in both arms of the trial collected speech samples in three different speaking situations before randomisation and at three, six, and nine months after randomisation. RESULTS: Analysis showed a highly significant difference (P = 0.003) at nine months after randomisation. The mean proportion of syllables stuttered at nine months after randomisation was 1.5% (SD 1.4) for the treatment arm and 3.9% (SD 3.5) for the control arm, giving an effect size of 2.3% of syllables stuttered (95% confidence interval 0.8 to 3.9). This effect size was more than double the minimum clinically worthwhile difference specified in the trial protocol. CONCLUSIONS: The results provide evidence from a randomised controlled trial to support early intervention for stuttering. The Lidcombe programme is an efficacious treatment for stuttering in children of preschool age.