The Lidcombe Program for Early Stuttering in Non-English-Speaking Countries: A Systematic Review.

BACKGROUND: The Lidcombe Program is a stuttering treatment approach for children between the ages of 3 and 6 years. Most papers about the Lidcombe Program, however, are based on studies conducted in native English-speaking countries. The aim of this paper is to systematically review the delivery and implementation of the Lidcombe Program in non-native English-speaking countries. SUMMARY: A resource search was conducted between October and November 2019. Scopus, PubMed, ASHA, Cochrane Library, ERIC, Google Scholar, and SpeechBITE databases and reference lists of relevant papers were searched for the identification process. Joanna Briggs Institute tools were used for the appraisal of the studies. The search yielded 8 studies conducted in non-native English-speaking countries. The Lidcombe Program is efficacious in non-native English-speaking countries when delivered to both preschool and young school age children who stutter. It is reported to be delivered with minor changes and challenges. The number of weekly clinic visits and the total time needed to reach zero or near-zero stuttering levels with the Lidcombe Program can be up to 3 times greater in non-native English-speaking countries than in native English-speaking countries, mostly due to the increased time needed to introduce the parental verbal contingencies. KEY MESSAGES: Speech and language therapists practicing in non-native English-speaking countries are encouraged to use the Lidcombe Program for both preschool and young school age children who stutter, although this can take more time than that reported in native English-speaking countries. Further investigation to explore the therapy process with children and parents in non-native English-speaking countries is needed.

Acoustic and Perceptual Effects of Articulation Exercises in Transgender Women.

PURPOSE: This study measured the impact of articulation exercises using a cork and articulation exercises for lip spreading on the formant frequencies of vowels and listener perceptions of femininity in transgender women. METHODS: Thirteen transgender women were recorded before and after the cork exercise and before and after the lip spreading exercise. Speech samples included continuous speech during reading and were analyzed using Praat software. Vowel formant frequencies (F1, F2, F3, F4, F5) and vowel space were determined. A listening experiment was organized using naïve cisgender women and cisgender men rating audio samples of continuous speech. Masculinity/femininity, vocal quality and age were rated, using a visual analogue scale (VAS). RESULTS: Concerning vowel formant frequencies, F2 /a/ and F5 /u/ significantly increased after the lip spreading exercise, as well as F3 /a/, F3 /u/ and F4 /a/ after the cork exercise. The lip spreading exercise had more impact on the F2 /a/ than the cork exercise. Vowel space did not change after the exercises. The fundamental frequency (fo) increased simultaneously during both exercises. Both articulation exercises were associated with significantly increased listener perceptions of femininity of the voice. CONCLUSION: Subtle changes in formant frequencies can be observed after performing articulation exercises, but not in every formant frequency or vowel. Cisgender listeners rated the speech of the transgender women more feminine after the exercises. Further research with a more extensive therapy program and listening experiment is needed to examine these preliminary findings.

Thyroplasty Type III to Lower the Vocal Pitch in Trans Men.

About 20% of trans men do not achieve cisgender male frequencies (F0≤131 Hz) after gender-affirming hormone treatment (GAHT) with testosterone. The surgical procedure Isshiki thyroplasty type III (TPIII) is described to lower F0, but data on this technique in trans men are lacking. In this study, 8 trans men, unsatisfied with their voice after a minimum of 12 months of GAHT, underwent TPIII to lower F0 at the Department of Head and Neck Surgery at Ghent University Hospital. TPIII was performed by 1 surgeon using the same method each time. Pre- and postoperatively, an acoustic evaluation of the voice took place. The F0 dropped significantly from the preoperative mean of (154.60 ± 12.29) Hz to the postoperative mean of (105.37 ± 10.52) Hz (t = 9.821, P < .001). TPIII is an effective method for lowering the F0 in trans men who are not satisfied with their voice after long-term GAHT.

Category specific recall in acute stroke: a case with letter speech.

Category selective recall in spontaneous speech after stroke has been reported only rarely. We recently described three cases demonstrating transient number speech in the acute stage of left hemispheric stroke and hypothesized a link with multilingualism and mathematical proficiency. In this report, we describe a similar case with a transient episode of utterances of randomly selected letters. Like in the three previous cases, this episode was preceded by a brief stage of mutism and ultimately evolved to Wernicke's aphasia over a period of days. This phenomenon is reviewed with reference to linguistic models and neuroanatomic and neurophysiological correlates.

Nasality in Homosexual Men: A Comparison with Heterosexual Men and Women.

Several studies reported that pitch and articulation may vary according to a person's sexual orientation. The purpose of this study was to investigate whether homosexual males also demonstrate differences in nasal resonance compared to heterosexual males. Speech samples of 30 self-identified homosexual males, 35 heterosexual males, and 34 heterosexual females were compared both instrumentally and perceptually. Nasalance scores were calculated for the sounds /a/, /i/, /u/, and /m/ and for an oronasal, oral, and nasal text. In addition, the Nasality Severity Index was determined. Spontaneous speech samples were used for a perceptual evaluation of nasal resonance. Neither the nasalance scores nor the Nasality Severity Index were significantly different between the homosexual and heterosexual males. Heterosexual females, on the other hand, showed significantly higher nasalance values for the oronasal and oral text and a significantly lower Nasality Severity Index than both the homosexual and the heterosexual males. The perceptual judgment revealed no significant differences between the three groups. The results of this study suggest that, in contrast to pitch and articulation, nasality does not tend to vary with sexual orientation.

Measuring Articulation Rate: A Comparison of Two Methods.

PURPOSE: Mean articulatory rate (MAR) is an alternative approach to measure articulation rate and is defined as the mean of 5 rate measures in minimally 10 to maximally 20 consecutive syllables in perceptually fluent speech without pauses. This study examined the validity of this approach. METHOD: Reading and spontaneous speech samples were collected from 80 typically fluent adults ranging in age between 20 and 59 years. After orthographic transcription, all samples were subjected to an articulation rate analysis first using the prevailing "global" method, which takes into account the entire speech sample and involves manipulation of the speech sample, and then again applying the MAR method. Paired-samples t tests were conducted to compare global measurements to MAR measurements. RESULTS: For both spontaneous speech and reading, a strong correlation was found between the 2 methods. However, for both speech tasks, the paired-samples t tests revealed a significant difference with MAR values being higher than the global method values. CONCLUSIONS: The MAR method is a valid method to measure articulation rate. However, it cannot be used interchangeably with the prevailing global method. Further standardization of the MAR method is needed before general clinical use can be suggested.

Public awareness and knowledge of stuttering in Japan.

PURPOSE: To determine laypeople's knowledge and awareness of stuttering in Japan. METHODS: A total of 303 respondents, recruited by street sampling, completed a questionnaire assessing the prevalence, onset, gender distribution, occurrence in different races, cause, treatment, association with intelligence, and hereditariness of stuttering. The questionnaire used was a Japanese version of that devised by Van Borsel, Verniers, and Bouvry (1999) for use in Belgium. RESULTS: Although around half of the respondents had heard or met a stutterer, they tended to misunderstand the stuttering; e.g., respondents estimated the prevalence of stuttering as high. Knowledge also differed according to age, gender, and education level. Specifically, older individuals, females, and individuals with higher levels of education tended to have greater knowledge of stuttering. In comparing the results of the present study with similar studies conducted in Belgium, China, and Brazil, we observed several similarities and differences. DISCUSSION: Although most respondents were to some extent familiar with stuttering, their overall knowledge of the condition was limited. Certain factors could be involved in having knowledge of stuttering, such as one's life experience, cultural background, and social attitudes toward stuttering. The findings suggest the need for growing knowledge and awareness of stuttering.

The Effectiveness of Pitch-raising Surgery in Male-to-Female Transsexuals: A Systematic Review.

OBJECTIVES: This study aimed to review the evidence of the effectiveness of pitch-raising surgery performed in male-to-female transsexuals. METHODS: A search for studies was performed in PubMed, Web of Science, Science Direct, EBSCOhost, Google Scholar, and the references in retrieved manuscripts, using as keywords "transsexual" or "transgender" combined with terms related to voice surgery. We included eight studies using cricothyroid approximation, six studies using anterior glottal web formation, and six studies using other surgery types or a combination of surgical techniques, leading to 20 studies in total. RESULTS: Objectively, a substantial rise in postoperative fundamental frequency was identified. Perceptually, mainly laryngeal web formation seems risky for decreasing voice quality. The majority of patients seemed satisfied with the outcome. However, none of the studies used a control group and randomization process. Further investigation regarding long-term results is necessary. CONCLUSION: Future research needs to investigate long-term effects of pitch-raising surgery using a stronger study design.

When will a stuttering moment occur? The determining role of speech motor preparation.

The present study aimed to evaluate whether increased activity related to speech motor preparation preceding fluently produced words reflects a successful compensation strategy in stuttering. For this purpose, a contingent negative variation (CNV) was evoked during a picture naming task and measured by use of electro-encephalography. A CNV is a slow, negative event-related potential known to reflect motor preparation generated by the basal ganglia-thalamo-cortical (BGTC) - loop. In a previous analysis, the CNV of 25 adults with developmental stuttering (AWS) was significantly increased, especially over the right hemisphere, compared to the CNV of 35 fluent speakers (FS) when both groups were speaking fluently (Vanhoutte et al., (2015) doi: 10.1016/j.neuropsychologia.2015.05.013). To elucidate whether this increase is a compensation strategy enabling fluent speech in AWS, the present analysis evaluated the CNV of 7 AWS who stuttered during this picture naming task. The CNV preceding AWS stuttered words was statistically compared to the CNV preceding AWS fluent words and FS fluent words. Though no difference emerged between the CNV of the AWS stuttered words and the FS fluent words, a significant reduction was observed when comparing the CNV preceding AWS stuttered words to the CNV preceding AWS fluent words. The latter seems to confirm the compensation hypothesis: the increased CNV prior to AWS fluent words is a successful compensation strategy, especially when it occurs over the right hemisphere. The words are produced fluently because of an enlarged activity during speech motor preparation. The left CNV preceding AWS stuttered words correlated negatively with stuttering frequency and severity suggestive for a link between the left BGTC - network and the stuttering pathology. Overall, speech motor preparatory activity generated by the BGTC - loop seems to have a determining role in stuttering. An important divergence between left and right hemisphere is hypothesized.

Factors involved in the identification of stuttering severity in a foreign language.

Speech-language pathologists nowadays are more and more confronted with clients who speak a language different from their own mother tongue. The assessment of persons who speak a foreign language poses particular challenges. The present study investigated the possible role and interplay of factors involved in the identification of stuttering severity in a foreign language. Nineteen speech-language pathologists from five different countries (i.e. Iceland, Sweden, Norway, Finland, and Belgium) rated stuttering severity of speech samples featuring persons who stutter speaking Icelandic, Swedish, Norwegian, or Dutch. Additionally, they were asked to score how easy they found it to rate the samples. Accuracy of rating stuttering severity in another language appeared to be foremost determined by the client's stuttering severity, while experienced ease of rating stuttering severity was essentially related to closeness of the language of the clinician to that of the client and familiarity of the clinician with the client's language. Stuttering measurement training programmes in different languages are needed.

Increased motor preparation activity during fluent single word production in DS: A correlate for stuttering frequency and severity.

Abnormal speech motor preparation is suggested to be a neural characteristic of stuttering. One of the neurophysiological substrates of motor preparation is the contingent negative variation (CNV). The CNV is an event-related, slow negative potential that occurs between two defined stimuli. Unfortunately, CNV tasks are rarely studied in developmental stuttering (DS). Therefore, the present study aimed to evaluate motor preparation in DS by use of a CNV task. Twenty five adults who stutter (AWS) and 35 fluent speakers (FS) were included. They performed a picture naming task while an electro-encephalogram was recorded. The slope of the CNV was evaluated at frontal, central and parietal electrode sites. In addition, a correlation analysis was performed with stuttering severity and frequency measures. There was a marked increase in CNV slope in AWS as compared to FS. This increase was observed over the entire scalp with respect to stimulus onset, and only over the right hemisphere with respect to lip movement onset. Moreover, strong positive correlations were found between CNV slope and stuttering frequency and severity. As the CNV is known to reflect the activity in the basal ganglia-thalamo-cortical-network, the present findings confirm an increased activation of this loop during speech motor preparation in stuttering. The more a person stutters, the more neurons of this cortical-subcortical network seem to be activated. Because this increased CNV slope was observed during fluent single word production, it is discussed whether or not this observation refers to a successful compensation strategy.

Translation and preliminary evaluation of the Brazilian Portuguese version of the Transgender Voice Questionnaire for male-to-female transsexuals.

PURPOSE: To contribute to the development of a Brazilian Portuguese language version of the vocal self-assessment questionnaire, Transsexual Voice Questionnaire: Male-to-Female (TVQ:MtF), and to evaluate the questionnaire for use in Brazil. METHODS: The research was divided into two parts: (1) translation and adaptation of the questionnaire (TVQ:MtF) and demographic form and (2) preliminary study of the psychometric properties (internal consistency and test-retest reliability) of the adapted version of the questionnaire. For the translation and adaptation, the following steps were taken: translation, reconciliation, back-translation, harmonization, and pilot test. The TVQ:MtF questionnaire and the demographic form were applied to 13 male-to-female transsexuals, aged between 21 and 47 years. The participants agreed to answer the TVQ:MtF on two occasions (test and retest), with an optimal interval of 30 days. RESULTS: Two psychometric properties were investigated: internal consistency and test-retest reliability. High levels of internal consistency (in both test (α=0.911) and retest (α=0.952) conditions) and reliability (with an average ICC=0.957 (95%CI 0.916-0.984)), were found. CONCLUSION: The TVQ:MtF is an appropriate instrument for vocal self-assessment of male-to-female transsexual patients, which can be recommended for clinical and research goals.

Translation and preliminary evaluation of the Brazilian Portuguese version of the Transgender Voice Questionnaire for male-to-female transsexuals / Tradução e avaliação preliminar da versão em Português do Questionário de Autoavaliação Vocal para Transexuais de Homem para Mulher

PURPOSE: To contribute to the development of a Brazilian Portuguese language version of the vocal self-assessment questionnaire, Transsexual Voice Questionnaire: Male-to-Female (TVQ:MtF), and to evaluate the questionnaire for use in Brazil. METHODS: The research was divided into two parts: (1) translation and adaptation of the questionnaire (TVQ:MtF) and demographic form and (2) preliminary study of the psychometric properties (internal consistency and test-retest reliability) of the adapted version of the questionnaire. For the translation and adaptation, the following steps were taken: translation, reconciliation, back-translation, harmonization, and pilot test. The TVQ:MtF questionnaire and the demographic form were applied to 13 male-to-female transsexuals, aged between 21 and 47 years. The participants agreed to answer the TVQ:MtF on two occasions (test and retest), with an optimal interval of 30 days. RESULTS: Two psychometric properties were investigated: internal consistency and test-retest reliability. High levels of internal consistency (in both test (α=0.911) and retest (α=0.952) conditions) and reliability (with an average ICC=0.957 (95%CI 0.916-0.984)), were found. CONCLUSION: The TVQ:MtF is an appropriate instrument for vocal self-assessment of male-to-female transsexual patients, which can be recommended for clinical and research goals. .

OBJETIVO: O propósito deste estudo é desenvolver a versão em língua portuguesa do questionário de autoavaliação vocal TVQ: MtF (Transgender Voice Questionnaire for male to female Transsexuals), bem como verificar a aplicabilidade do instrumento para uso no Brasil. MÉTODOS: A pesquisa foi dividida em duas partes: (1) tradução e adaptação do questionário TVQ: MtF e da ficha demográfica; e (2) estudo preliminar das propriedades psicométricas (consistência interna e confiabilidade teste-reteste) da versão adaptada do questionário. Para a tradução e adaptação foram seguidos os seguintes estágios: tradução, conciliação, retrotradução, harmonização e teste piloto. O questionário TVQ: MtF e a ficha demográfica foram aplicados em 13 transexuais de homem para mulher, com idades entre 21 e 47 anos. As participantes concordaram em responder o TVQ: MtF em dois momentos (teste e reteste), cujo intervalo entre as aplicações idealizado foi de 30 dias. RESULTADOS: Duas propriedades psicométricas foram investigadas: consistência interna e confiabilidade teste-reteste. Foram obtidos altos níveis de consistência interna no teste (α=0,911) bem como no reteste (α=0,952), com alta confiabilidade, CCI médio=0,957(IC95% 0,916-0,984). CONCLUSÃO: O TVQ: MtF é um instrumento indicado para autoavaliação vocal de pacientes transexuais de homem para mulher, sendo recomendado para fins clínicos e de pesquisa. .

CNV amplitude as a neural correlate for stuttering frequency: A case report of acquired stuttering.

A neural hallmark of developmental stuttering is abnormal articulatory programming. One of the neurophysiological substrates of articulatory preparation is the contingent negative variation (CNV). Unfortunately, CNV tasks are rarely performed in persons who stutter and mainly focus on the effect of task variation rather than on interindividual variation in stutter related variables. However, variations in motor programming seem to be related to variation in stuttering frequency. The current study presents a case report of acquired stuttering following stroke and stroke related surgery in the left superior temporal gyrus. A speech related CNV task was administered at four points in time with differences in stuttering severity and frequency. Unexpectedly, CNV amplitudes at electrode sites approximating bilateral motor and left inferior frontal gyrus appeared to be inversely proportional to stuttering frequency. The higher the stuttering frequency, the lower the activity for articulatory preparation. Thus, the amount of disturbance in motor programming seems to determine stuttering frequency. At right frontal electrodes, a relative increase in CNV amplitude was seen at the test session with most severe stuttering. Right frontal overactivation is cautiously suggested to be a compensation strategy. In conclusion, late CNV amplitude elicited by a relatively simple speech task seems to be able to provide an objective, neural correlate of stuttering frequency. The present case report supports the hypothesis that motor preparation has an important role in stuttering.

Cross-cultural adaptation of the Western Aphasia Battery - Revised screening test to Brazilian Portuguese: a preliminary study.

PURPOSE: The purpose of this study was to translate and cross-culturally adapt the Western Aphasia Battery - Revised (WAB-R) screening test, thus contributing to future applications of the instrument with Brazilian adults. METHODS: The adaptation was based on a universalist perspective. The steps for conceptual, item, semantic and operational equivalence were strictly followed, resulting in a short version used in the pretest. The study participants were 30 individuals, between 18 to 89 years old; all were Brazilian speakers, with Portuguese as their first language. However, only 28 volunteers met the criteria for inclusion in the study. Two participants were excluded because they had low scores on the mini-mental state examination and were referred to geriatric assessment. RESULTS: The short version of the WAB-R screening test, used in the pretest, allowed us to observe the behavior and language of the individuals during interactions, to collect impressions of overall communication, and to quantify communication ability by calculating the aphasia quotient and the language quotient, according to parameters of the original instrument. CONCLUSION: When adapting an instrument, it is important to maintain its original characteristics. However, the properties of measurement may not be in accordance with the psychometric properties of Brazilian culture. Therefore, we propose further analyses of the reliability and validation of the instrument in question in Brazil, which will occur by means of measurement and functional equivalence.

Lisping and male homosexuality.

The present study examined the popular stereotype that gay men lisp by evaluating to what extent listeners associated dental or frontal articulation/lisping with gayness. Fifteen heterosexual males and 15 heterosexual females listened to 275 samples of read speech and judged the sexual orientation of the speakers. A total of 175 of the samples were of homosexual men, 74 (42.3 %) of which had been identified with lisping in a previous study; 100 were of heterosexual men, 18 (18 %) of which had been identified with lisping previously. Based on the ratings of the listeners of the present study, lisping speakers were significantly more often judged to be homosexual. This was true for the group as a whole as well as for the subgroup of homosexual and heterosexual men separately. Furthermore, there was no significant gender difference with respect to associating lisping with gayness. Male and female judges associated lisping with gayness to a similar degree. Additional analysis showed that overall 56.2 % of the time the judges were correct in their judgment of the speakers' sexual orientation. The results of this study confirmed previous preliminary findings that suggested that frontal or dental articulation/lisping is a feature that listeners associate with gayness. The reason for this association remains to be clarified.

Conversational topics in transsexual persons.

Abstract In general, speech language therapy for transsexual persons focuses on pitch and pitch variation and more recently also on resonance. Other communicative aspects are dealt with far less often, especially language. This study investigated to what extent conversational topics might need attention in therapy for transsexual persons. A total of 111 males, 116 females, 28 male-to-female and 18 female-to-male transsexuals were asked to indicate on a list with 34 topics how often they speak about each topic (never, sometimes, often) in conversations with males, with females and in a gender mixed group. Results showed that transsexual persons behave in accordance with the desired gender. However, they also tend to adopt a position depending on the gender of their conversational partner. It can be concluded that in general it is not necessary to pay attention to conversational topics in therapy for transsexual persons.

The effectiveness of facial exercises for facial rejuvenation: a systematic review.

BACKGROUND: Although aesthetic correction of facial aging had long been the exclusive domain of plastic surgeons and dermatologists, alternative nonmedical approaches to facial rejuvenation are becoming more popular, such as facial acupuncture, facial acupressure, and facial exercises. However, the effectiveness of these alternative approaches is still a topic of debate. OBJECTIVES: The authors review the evidence of the effectiveness of facial exercises for facial rejuvenation. METHODS: A literature search was performed in Medline, Web of Science, Science Direct, SciELO, and LILACS databases for the terms facial rejuvenation, facial exercises, facial massage, face building, face yoga, (oro)facial (a)esthetics, (a)esthetic logopedics, and (a)esthetic speech therapy. Nine reports were identified from the search and were subject to further assessment. RESULTS: Although positive outcomes were achieved in all 9 studies, none of the studies used a control group and randomization process. They were single case reports, small case series, or studies with a single-group pretest-posttest design. Moreover, the effectiveness assessments in most of the studies were purely subjective, carried out by the authors and/or the patients themselves, without blinding. CONCLUSIONS: The evidence to date is insufficient to determine whether facial exercises are effective for facial rejuvenation. Evidence from large randomized controlled trials will be needed before conclusions can be drawn.

Voice in female-to-male transsexual persons after long-term androgen therapy.

OBJECTIVES/HYPOTHESIS: The aim of the present study was to 1) document voice in a large sample of female-to-male transsexual persons (FMT), 2) compare their vocal characteristics with those of heterosexual biological males, and 3) determine hormonal factors with impact on their fundamental frequency. STUDY DESIGN: This was a controlled cross-sectional study. It is the largest study to date on voice and voice change in FMT, and the first to include a control group and FMT who were under long-term androgen administration. METHODS: Thirty-eight FMT, ranging in age between 22 and 54 years, and 38 controls, frequency matched by age and smoking behavior, underwent a voice assessment that comprised the determination of pitch, intonation, and perturbation parameters measured during sustained vowel production, counting, and reading. Hormonal factors explored were hematocrit, total testosterone level, luteinizing hormone level, and biallelic mean length of the cytosine-adenine-guanine (CAG) trinucleotide repeat sequence in the androgen receptor gene. RESULTS: It was found that the FMT as a group did not differ significantly from controls for any of the acoustic voice variables studied. However, in about 10% pitch lowering was not totally unproblematic. The lowest-pitched (i.e., more male) voices were observed in FMT with higher hematocrit and longer CAG repeats. CONCLUSION: After long-term androgen therapy, FMT generally demonstrate an acceptable male voice. Pitch-lowering difficulties can be expected in about 10% of cases and appear, at least in part, to be associated with diminished androgen sensitivity. LEVEL OF EVIDENCE: 3b.

Facial exercises for facial rejuvenation: a control group study.

OBJECTIVE: Facial exercises are a noninvasive alternative to medical approaches to facial rejuvenation. Logopedists could be involved in providing these exercises. Little research has been conducted, however, on the effectiveness of exercises for facial rejuvenation. This study assessed the effectiveness of 4 exercises purportedly reducing wrinkles and sagging of the facial skin. METHOD: A control group study was conducted with 18 participants, 9 of whom (the experimental group) underwent daily training for 7 weeks. Pictures taken before and after 7 weeks of 5 facial areas (forehead, nasolabial folds, area above the upper lip, jawline and area under the chin) were evaluated by a panel of laypersons. In addition, the participants of the experimental group evaluated their own pictures. Evaluation included the pairwise presentation of pictures before and after 7 weeks and scoring of the same pictures by means of visual analogue scales in a random presentation. RESULTS: Only one significant difference was found between the control and experimental group. In the experimental group, the picture after therapy of the upper lip was more frequently chosen to be the younger-looking one by the panel. CONCLUSION: It cannot be concluded that facial exercises are effective. More systematic research is needed.