Psychometric Testing of the CEECCA Questionnaire to Assess Ability to Communicate among Individuals with Aphasia.

(1) Background: The CEECCA questionnaire assesses the ability to communicate among individuals with aphasia. It was designed using the NANDA-I and NOC standardised nursing languages (SNLs), reaching high content validity index and representativeness index values. The questionnaire was pilot-tested, demonstrating its feasibility for use by nurses in any healthcare setting. This study aims to identify the psychometric properties of this instrument. (2) Methods: 47 individuals with aphasia were recruited from primary and specialist care facilities. The instrument was tested for construct validity and criterion validity, reliability, internal consistency, and responsiveness. The NANDA-I and NOC SNLs and the Boston test were used for criterion validity testing. (3) Results: five language dimensions explained 78.6% of the total variance. Convergent criterion validity tests showed concordances of up to 94% (Cohen's κ: 0.9; p < 0.001) using the Boston test, concordances of up to 81% using DCs of NANDA-I diagnoses (Cohen's κ: 0.6; p < 0.001), and concordances of up to 96% (Cohen's κ: 0.9; p < 0.001) using NOC indicators. The internal consistency (Cronbach's alpha) was 0.98. Reliability tests revealed test-retest concordances of 76-100% (p < 0.001). (4) Conclusions: the CEECCA is an easy-to-use, valid, and reliable instrument to assess the ability to communicate among individuals with aphasia.

Objective Analysis Of Voice Quality In Patients With Thyroid Pathology.

OBJECTIVE: The goal of this study is to analyze the voice in patients with thyroid pathology through two objective indexes with great diagnostic accuracy. Overall vocal quality was evaluated with the Acoustic Voice Quality Index (AVQI v.03.01) and the breathy voice with the Acoustic Breathiness Index (ABI). DESIGN: Observational case-control study. SETTING: Hospital Universitario Nuestra Señora de Candelaria. PARTICIPANTS: Fifty-eight subjects, 29 controls and 29 thyroidectomy candidates. MAIN OUTCOME MEASURES: All participants with thyroid pathology completed the Spanish version of Voice Handicap Index-10. Also, patient complaints relating to possible laryngeal dysfunction were assessed through closed questions. A sustained vowel and three phonetically balanced sentences were recorded for each subject (118 samples). AVQI v.03.01 and ABI were assessed using the Praat program. Two raters perceptually evaluated each voice sample by using the Grade parameter of GRABS scale. RESULTS: Acoustic analysis shows that 55.17% of subjects present values above the pathological threshold of the AVQI, and 58.62% above that of the ABI. Results of the Student's test comparisons of the AVQI and ABI values between the control group and the thyroid group show significantly higher values of AVQI (t[56]  = -3.85, p < .001) and ABI (t[54.39]  = -4.82, p < .001) in thyroidectomy candidates. CONCLUSION: A mild decrease in vocal quality is part of the symptomatology presented by thyroidectomy candidates.

The validity of the Acoustic Breathiness Index in the evaluation of breathy voice quality: A Meta-Analysis.

BACKGROUND: The evaluation of voice quality with acoustic measurements is useful to objectify the diagnostic process. Particularly, breathiness was highly evaluated and the Acoustic Breathiness Index (ABI) might have promising features. OBJECTIVE OF REVIEW: The goal of the present meta-analysis is to quantify, from existing cross-validation studies, the evidence for the diagnostic accuracy of ABI, including its sensitivity and specificity. TYPE OF REVIEW: Meta-analysis. SEARCH STRATEGY: We searched in MEDLINE, Google Scholar and Science Citation Index, and as manual search for the term Acoustic Breathiness Index from inception to February 2020. Studies were included that used equal proportion of continuous speech and sustained vowel segments, a recording hardware with a sufficient standard for voice signal analyses, the software Praat for signal processing and the customised Praat script, and two groups of subjects (vocally healthy and voice-disordered). Furthermore, the diagnostic accuracy of ABI was measured. EVALUATION METHOD: The primary outcome variable was ABI. The score ranged from 0 to 10 with varying thresholds according to different languages to determine the absence or presence of breathiness. A meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses of diagnostic test accuracy study guidelines. Data were extracted, and the risk of bias was assessed using the QUADAS-2 tool. The pooled sensitivity and specificity of ABI were determined using a summary receiver operating characteristic (SROC) approach to calculate also a weighted threshold value of ABI with its sensitivity and specificity. RESULTS: A total of 34 unique citations were screened, and 10 full-text articles were reviewed, including six studies. In total, 3603 voice samples were considered for further analysis separating into 467 vocally healthy and 3136 voice-disordered voice samples. The pooled sensitivity was 0.84 (95% CI, 0.83-0.85), and the pooled specificity was 0.92 (95% CI, 0.89-0.94). The area under the curve of the SROC curve of this analysis showed an excellent value of 0.94. The weighted ABI threshold was determined at 3.40 (sensitivity: 0.86, 95% CI, 0.84-0.87.; specificity: 0.90, 95% CI 0.88-0.92). CONCLUSIONS: The results confirm the ABI as robust and valid objective measure for evaluating breathiness.

Análisis cepstral de la voz normal y patológica en adultos españoles. Medida de la prominencia del pico cepstral suavizado en vocales sostenidas versus habla conectada / Cepstral analysis of normal and pathological voice in Spanish adults. Smoothed cepstral peak prominence in sustained vowels versus connected speech

INTRODUCCIÓN Y OBJETIVOS: En los últimos años se ha incrementado el uso de medidas cepstrales para la evaluación acústica de la voz. Uno de los parámetros más investigados es la prominencia del pico cepstral suavizado (CPPs). Los objetivos de este trabajo son conocer la utilidad de esta medida acústica en la evaluación objetiva de las alteraciones de la voz en español y determinar qué tipo de muestra de voz (vocales sostenidas o habla conectada) es la más sensible para evaluar la severidad de la disfonía. MÉTODO: En este estudio participaron 40 sujetos, 20 normofónicos y 20 con disfonía. Se grabaron 2 muestras de voz para cada sujeto (una/a/sostenida y 4 frases fonéticamente balanceadas) y se calculó la CPPs con el programa Praat. Tres expertos valoraron perceptivamente la voz de la muestra con el parámetro grado de la escala GRABS. RESULTADOS: Se encontraron valores significativamente menores en las voces disfónicas, tanto para la/a/(t[38] = 4,85, p < 0,000) como para las frases (t[38] = 5,75, p < 0,000). En relación con el tipo de muestra de voz más indicado para evaluar la severidad de las alteraciones de la voz se encontró una fuerte correlación con la escala acústico-perceptiva de la CPPs calculada a partir del habla conectada (rs = -0,73) y moderada con la calculada a partir de la vocal sostenida (rs= -0,56). CONCLUSIÓN: Los resultados de este estudio preliminar apuntan a que la CPPs es una buena medida para detectar la disfonía y para evaluar objetivamente el grado de severidad de las alteraciones en la voz

INTRODUCTION AND OBJECTIVES: In recent years, the use of cepstral measures for acoustic evaluation of voice has increased. One of the most investigated parameters is smoothed cepstral peak prominence (CPPs). The objectives of this paper are to establish the usefulness of this acoustic measure in the objective evaluation of alterations of the voice in Spanish and to determine what type of voice sample (sustained vowels or connected speech) is the most sensitive in evaluating the severity of dysphonia. METHOD: Forty subjects participated in this study 40, 20 controls and 20 with dysphonia. Two voice samples were recorded for each subject (one sustained vowel/a/and four phonetically balanced sentences) and the CPPs was calculated using the Praat programme. Three raters perceptually evaluated the voice sample with the Grade parameter of GRABS scale. RESULTS: Significantly lower values were found in the dysphonic voices, both for/a/(t[38] = 4.85, P < .000) and for phrases (t[38] = 5,75, P < .000). In relation to the type of voice sample most suitable for evaluating the severity of voice alterations, a strong correlation was found with the acoustic-perceptual scale of CPPs calculated from connected speech (rs = -0.73) and moderate correlation with that calculated from the sustained vowel (rs = -0,56). CONCLUSION: The results of this preliminary study suggest that CPPs is a good measure to detect dysphonia and to objectively assess the severity of alterations in the voice

Validation of the Acoustic Voice Quality Index Version 03.01 and the Acoustic Breathiness Index in the Spanish language.

OBJECTIVE: The aim of this study was to validate the Acoustic Voice Quality Index 03.01 (AVQIv3) and the Acoustic Breathiness Index (ABI) in the Spanish language. METHOD: Concatenated voice samples of continuous speech (cs) and sustained vowel (sv) from 136 subjects with dysphonia and 47 vocally healthy subjects were perceptually judged for overall voice quality and breathiness severity. First, to reach a higher level of ecological validity, the proportions of cs and sv were equalized regarding the time length of 3 seconds sv part and voiced cs part, respectively. Second, concurrent validity and diagnostic accuracy were verified. RESULTS: A moderate reliability of overall voice quality and breathiness severity from 5 experts was used. It was found that 33 syllables as standardization of the cs part, which represents 3 seconds of voiced cs, allows the equalization of both speech tasks. A strong correlation was revealed between AVQIv3 and overall voice quality and ABI and perceived breathiness severity. Additionally, the best diagnostic outcome was identified at a threshold of 2.28 and 3.40 for AVQIv3 and ABI, respectively. CONCLUSIONS: The AVQIv3 and ABI showed in the Spanish language valid and robust results to quantify abnormal voice qualities regarding overall voice quality and breathiness severity.

Cepstral analysis of normal and pathological voice in Spanish adults. Smoothed cepstral peak prominence in sustained vowels versus connected speech. / Análisis cepstral de la voz normal y patológica en adultos españoles. Medida de la prominencia del pico cepstral suavizado en vocales sostenidas versus habla conectada.

INTRODUCTION AND OBJECTIVES: In recent years, the use of cepstral measures for acoustic evaluation of voice has increased. One of the most investigated parameters is smoothed cepstral peak prominence (CPPs). The objectives of this paper are to establish the usefulness of this acoustic measure in the objective evaluation of alterations of the voice in Spanish and to determine what type of voice sample (sustained vowels or connected speech) is the most sensitive in evaluating the severity of dysphonia. METHOD: Forty subjects participated in this study 40, 20 controls and 20 with dysphonia. Two voice samples were recorded for each subject (one sustained vowel/a/and four phonetically balanced sentences) and the CPPs was calculated using the Praat programme. Three raters perceptually evaluated the voice sample with the Grade parameter of GRABS scale. RESULTS: Significantly lower values were found in the dysphonic voices, both for/a/(t[38]= 4.85, P<.000) and for phrases (t[38] = 5,75, P<.000). In relation to the type of voice sample most suitable for evaluating the severity of voice alterations, a strong correlation was found with the acoustic-perceptual scale of CPPs calculated from connected speech (rs = -0.73) and moderate correlation with that calculated from the sustained vowel (rs = -0,56). CONCLUSION: The results of this preliminary study suggest that CPPs is a good measure to detect dysphonia and to objectively assess the severity of alterations in the voice.

Estudio piloto sobre los valores acústicos de las vocales en español como indicadores de la gravedad de la disartria / Pilot study of the acoustic values of the vowels in Spanish as indicators of the severity of dysarthria

Introducción. El análisis acústico es una herramienta que proporciona datos objetivos sobre las alteraciones del habla en la disartria. Objetivos. Evaluar en la disartria atáxica la relación del nivel de inteligibilidad del habla con el área del espacio vocálico (VSA), la ratio de centralización de los dos primeros formantes (FCR) y la media de las distancias primarias. Sujetos y métodos. Se utilizó una muestra de 14 hablantes de español, 10 con disartria y cuatro controles. Se analizaron los valores del primer y segundo formante en 140 vocales extraídas de 140 palabras. Para calcular el nivel de inteligibilidad participaron siete oyentes y se utilizó una tarea de identificación de estímulos verbales. Resultados. Los sujetos disártricos tienen un menor contraste entre las vocales medias y altas y entre las vocales posteriores. Se observan diferencias significativas del VSA, la FCR y la media de las distancias primarias respecto a los sujetos controles (p = 0,007, 0,005 y 0,030, respectivamente). Los análisis de regresión muestran la relación del VSA y la media de las distancias primarias con el nivel de inteligibilidad del habla (r = 0,60 y 0,74, respectivamente). Conclusiones. Los sujetos con disartria atáxica presentan un menor contraste vocálico y una centralización en la realización de las vocales. Las medidas acústicas estudiadas en este trabajo preliminar tienen una alta sensibilidad en la detección de la disartria, pero sólo el VSA y la media de las distancias primarias informan sobre la gravedad de este tipo de alteración del habla

Introduction. The acoustic analysis is a tool that provides objective data on changes of speech in dysarthria. Aim. To evaluate, in the ataxic dysarthria, the relationship between the vowel space area (VSA), the formant centralization ratio (FCR) and the mean of the primary distances with the speech intelligibility. Subjects and methods. A sample of fourteen Spanish speakers, ten with dysarthria and four controls, was used. The values of first and second formants in 140 vowels extracted of 140 words were analyzed. To calculate the level of intelligibility seven listeners were involved and a task of identification verbal stimuli was used. Results. The dysarthric subjects have less contrast between middle and high vowels and between back vowels. Significant differences in the VSA, FCR and mean of the primary distances compared to control subjects (p = 0.007, 0.005 and 0.030, respectively) are observed. Regression analysis show the relationship between VSA and the mean of primary distances with the level of speech intelligibility (r = 0.60 and 0.74, respectively). Conclusions. Ataxic dysarthria subjects have lower contrast and vowel centralization in carrying out the vowels. The acoustic measures studied in this preliminary work have a high sensitivity in the detection of dysarthria but only the VSA and the mean of primary distances provide information on the severity of this type of speech disturbance

Relación entre las pendientes del segundo formante y las alteraciones motoras del habla en la disartria / Relationship between second-formant slopes and the motor speech disorders in dysarthria

Las transiciones representan el movimiento del tracto vocal desde la configuración articulatoria de la consonante a la de la vocal. El análisis acústico de la velocidad de estas transiciones en el segundo formante es un procedimiento utilizado en la evaluación e investigación del habla disártrica, ya que aporta información sobre los movimientos de la lengua en la articulación. El objetivo de este trabajo es estudiar los valores de la velocidad de las transiciones en diptongos a través de las pendientes del segundo formante y establecer su relación con la severidad de la disartria. Participaron 12 sujetos con disartria atáxica y 10 neurológicamente sanos. Se obtuvieron las características de las transiciones del segundo formante en los diptongos de las palabras causa, piojo y tierra, y se estudió la relación de las pendientes con los valores obtenidos en la escala de inteligibilidad para alteraciones motoras del habla. Los resultados muestran pendientes significativamente menores en el grupo disártrico en las transiciones de los diptongos de las 3 palabras estudiadas. En relación a la severidad de la disartria, se encontraron correlaciones altas con la escala de inteligibilidad utilizada. El análisis acústico de la velocidad de las transiciones del segundo formante ha demostrado ser una herramienta útil en la evaluación objetiva de la disartria. Proporciona información sobre la severidad de las alteraciones motoras del habla y aporta datos objetivos sobre la progresión de la terapia logopédica (AU)

Transitions represent the vocal tract movement of the articulatory configuration from the consonant to the vowel. The acoustic analysis of the velocity of these transitions in the second-formant is a procedure used in the evaluation and investigation of dysarthric speech, as it provides information on the movements of the tongue in the joint. The aim of this work is to study the values of the speed of the transitions in diphthongs through the second-formant slopes and establish their relationship with the severity of dysarthria. Twelve subjects with ataxic dysarthria and ten neurologically healthy subjects participated. The characteristics of the second-formant transitions were obtained in the diphthongs of the words causa, piojo and tierra, and a study was made of the relationship of the slopes with the values obtained in the scale of intelligibility for speech motor disorders. The results show slopes significantly lower in the dysarthric group in the transitions of the diphthongs of the three words studied. As regards the severity of dysarthria, high correlations were found with the intelligibility scale used. Acoustic analysis of the speed of the second formant transitions has proved a useful tool in the objective assessment of dysarthria. It provides information about the severity of motor speech disorders and gives objective data on the progression of speech therapy (AU)