Temporal and Spectral Models as Correlates to Auditory-Perceptual Judgments of Overall Severity and Listener Comfort in Tracheoesophageal Voice.

INTRODUCTION: This study pursued two objectives: (1) to determine the potential association between listener (n = 51) judgments of 20 male tracheoesophageal speaker samples for two auditory-perceptual dimensions of voice, overall severity (OS) and listener comfort (LC); and (2) to assess the temporal and spectral acoustic correlates for these auditory-perceptual dimensions. METHODOLOGY: Three separate correlation analyses were performed to evaluate the association between OS and LC. First, scores of OS and LC from all listeners were pooled together, and then the correlation between OS and LC was computed. Second, scores of OS and LC were averaged over all listeners to derive a single estimate of OS and LC for each TE speaker sample; the correlation between the average OS and LC was then computed. Third, listener-to-listener variability in the association between OS and LC was evaluated by computing the correlation between OS and LC scores from each listener across all TE samples. Finally, two stepwise multiple regression models were created to relate the average LC score to spectral and temporal variation in the acoustic signal. RESULTS: While the pooled OS and LC scores had a moderate positive correlation (r = 0.66, p < 0.00001), the averaged OS and LC exhibited a near perfect positive correlation (r = 0.99, p < 0.00001). The significant differences between the pooled and averaged scores were explained by significant listener-to-listener variability in the association between OS and LC. OS and LC scores from 5 listeners had non-significant correlations, 10 had moderate correlations (r < 0.7), 35 listeners had high correlations (0.7 < r < 0.9), and 1 listener had a very high correlation (r < 0.9 < 1). Finally, the acoustic models created based on the spectral and temporal variations in the signal were able to account for 87.7% and 61.8% of variation in the average LC score. CONCLUSIONS: The strong correlations between OS and LC suggest that LC may, in fact, provide a more comprehensive auditory-perceptual surrogate for the voice quality of TE speakers. Although OS and LC are distinct conceptual dimensions, LC appears to have the advantage of assessing the social impact and potential communication disability that may exist in interactions between TE speakers and listeners.

Perceptions and practices of people with a total laryngectomy during COVID-19 pandemic: A mixed methods analysis.

PURPOSE: People with a total laryngectomy (PTL) confront safety threats related to altered airway anatomy and risk of adverse events is amplified during healthcare crises, as exemplified by COVID-19 pandemic. Understanding these challenges, how they are navigated by PTL, and what resources can be deployed to alleviate risk can improve interprofessional care by speech-language pathologists (SLPs), otolaryngologists, and other professionals. MATERIALS AND METHODS: An online survey was disseminated to PTL in the United States during the COVID-19 pandemic, querying participants about safety concerns and sources of information accessed to address care. Descriptive statistics and Chi-square were used to analyze information sources consumed by tracheoesophageal, esophageal, and electrolaryngeal speakers. Content analysis was completed to identify themes and quantify responses by subtheme. RESULTS: Among 173 respondent PTL, tracheoesophageal speakers preferentially sought otolaryngologist input, whereas esophageal and electrolaryngeal speakers more often chose SLPs (p < .01). Overall, tracheoesophageal speakers had more SLP or otolaryngologist contact. Many PTL reported stringent handwashing, neck cleaning, and hygienic risk mitigation strategies. Six themes emerged in content analysis involving risk of infection/transmission, heightened vigilance, changes to alaryngeal communication, modified tracheostoma coverage, diagnostic testing, and risk from comorbid conditions. Limited provider contact suggested pandemic barriers to healthcare access. CONCLUSIONS: PTL have a range of laryngectomy-specific needs and concerns, and type of alaryngeal communication was associated with source of information sought. Collaborations among healthcare professionals need to be optimized to improve patient navigation and overall access to specialized care.

Exploring the Feasibility of a Comprehensive Screening for Voice and Swallowing Function in Post-Extubation Patients: A Pilot Study

Objectives: This pilot study aimed to identify and test a battery of time-efficient and cost-effective voice and swallowing screening tools for post-extubated patients in Chile. Methods: A panel of four experts selected and rated voice and swallowing screening tools. Seven measures were selected: smoothed cepstral peak prominence (CPPS) and maximum phonation time (MPT) for voice assessment, Volume-Viscosity Swallow Test (V-VST) for swallowing, voluntary and reflex peak cough flow for cough assessment, Eating Assessment Tool-10 (EAT-10), and Vocal Symptom Scale (VoiSS) for patient-reported outcomes. These tools were applied to four post-extubation patients within 48-72 hours post-hospital discharge, alongside the assessment of 17 matched controls. Results: Post-extubation patients showed significantly shorter MPT, lower CPPS values, increased V-VST dysphagia signs, reduced voluntary peak cough flow, and more pronounced symptoms on both the VoiSS and EAT-10 compared to controls. Limitations: The study had a modest sample size and relied solely on clinical screening tools. Value: This pilot study suggests a feasible and cost-effective approach to voice and swallowing screening for post-extubation patients, valuable in resource-constrained settings. Conclusion: While these accessible tools are not gold-standard assessments, they offer valuable insights and can guide future research. This study underscores the potential of selected tools in facilitating early detection of voice and swallowing disorders in post-extubation patients.

Objetivos: Este estudio piloto tuvo como objetivo identificar y probar una batería de herramientas de detección de problemas de voz y deglución que fueran eficientes en cuanto a tiempo y costo para pacientes chilenos postextubados. Métodos: Un panel de cuatro expertos seleccionó y evaluó herramientas de detección de voz y deglución. Se seleccionaron siete medidas: prominencia de pico cepstral suavizado (CPPS) y tiempo máximo de fonación (TMF) para la evaluación de la voz, prueba de volumen-viscosidad (V-VST) para la deglución, flujo máximo voluntario y reflejo de la tos para evaluar la tos, Eating Assessment Tool-10 (EAT-10) y la Escala de Sintomas Vocales (ESV) para los resultados informados por los pacientes. Estas herramientas se aplicaron a cuatro pacientes postextubados (48-72 horas), junto con la evaluación de 17 controles pareados. Resultados: Los pacientes postextubados mostraron un TMF y CPPS significativamente más bajos, aumento de los indicios de disfagia en la V-VST, reducción del flujo máximo de la tos y síntomas más pronunciados tanto en la ESV como en la EAT-10 en comparación con los controles. Limitaciones: El estudio tuvo un tamaño de muestra reducida y se basó únicamente en herramientas de detección clínica. Valor: Este estudio piloto sugiere un enfoque factible y rentable para la detección de problemas de voz y deglución en pacientes postextubados, valioso en entornos con recursos limitados. Conclusión: Aunque ese abordaje no sustituye a las evaluaciones de referencia, ofrece información valiosa y puede guiar futuras investigaciones que busquen facilitar la detección temprana de los trastornos de la voz-deglución en pacientes postextubados.

Usage of Heat and Moisture Exchange Devices, Virtual Visits, Masking, and Vaccinations Among People With a Laryngectomy During COVID-19.

PURPOSE: This study described the COVID-19 risk mitigation actions of people with a total laryngectomy (TL) during the pandemic. METHOD: An online survey was completed by 215 people with a TL who lived in the United States. The survey was open from December 1, 2021, to January 15, 2022. RESULTS: There was a significant increase in frequency of heat and moisture exchange (HME) device use during the pandemic compared with pre-COVID-19. Frequency of HME use was significantly greater for those who were vaccinated and those who had at least one clinical visit with their speech-language pathologist (SLP). The use of virtual visits increased from 9% pre-COVID-19 to 37% during the pandemic. Seventy percent of respondents were "satisfied" or "very satisfied" with virtual visits and 51% judged them "as good as in-person." Eighty percent were vaccinated for COVID-19 and 75% received a booster. One third reported that they did not wear mask over the face or over the tracheostoma. Twenty percent had tested positive for COVID-19 with 70% of these people requiring hospitalization. CONCLUSIONS: HME use and virtual SLP visits increased during the pandemic and the vaccination rate was high among this group of respondents. Overall, there were still large percentages of people with a TL who were not using an HME, not vaccinated, and did not wear a mask. SLPs should consider reaching out directly to their TL caseload, particularly those not yet seen during the pandemic, to support uptake of COVID-19 mitigation activities specific to people with a TL as the pandemic persists.

Image representation of the acoustic signal: An effective tool for modeling spectral and temporal dynamics of connected speech.

Recent studies have advocated for the use of connected speech in clinical voice and speech assessment. This suggestion is based on the presence of clinically relevant information within the onset, offset, and variation in connected speech. Existing works on connected speech utilize methods originally designed for analysis of sustained vowels and, hence, cannot properly quantify the transient behavior of connected speech. This study presents a non-parametric approach to analysis based on a two-dimensional, temporal-spectral representation of speech. Variations along horizontal and vertical axes corresponding to the temporal and spectral dynamics of speech were quantified using two statistical models. The first, a spectral model, was defined as the probability of changes between the energy of two consecutive frequency sub-bands at a fixed time segment. The second, a temporal model, was defined as the probability of changes in the energy of a sub-band between consecutive time segments. As the first step of demonstrating the efficacy and utility of the proposed method, a diagnostic framework was adopted in this study. Data obtained revealed that the proposed method has (at minimum) significant discriminatory power over the existing alternative approaches.

Voice and Lifestyle Behaviors of Student Singers: Impact of History Gathering Method on Self-Reported Data.

OBJECTIVES: This study described voice use and lifestyle information about student singers with a focus on describing differences in self-reported information at study intake compared to data from 21 consecutive days of a voice Log. METHODS: Twenty-seven student singers estimated voice and lifestyle behaviors at study initiation including daily speaking time, singing/performance time, vocal warm-up, and cool-down minutes; fluid intake; perceived effort when talking, and when singing, among other items. These same parameters were tracked for 21 consecutive days in a voice log kept by the singer at home. Study intake data was compared to the median estimates from the 21-day voice log on each variable using nonparametric statistics. RESULTS: Student singers reported warming up the voice regularly at study intake (100%), but several logged ≥ 7 days out of 21 without warming up even though all days had singing minutes. Less than half reported voice cool downs at intake, and even fewer logged minutes of cool down in the daily tracking. High occupational voice demands not involving singing were reported by 37%. Large percentages of students reported frustration (63%), worry/anxiety (41%), and depression (26%) regarding their voice in the prior 2 weeks. Estimates at study intake statistically overestimated daily speaking minutes, effort during singing and number of nights eating within 2 hours of sleep compared to the 3-week log. CONCLUSION: Student singers reported several voice use and behavior items that could impact vocal health. Additionally, how the information was obtained (intake estimate vs. daily log) did alter what was reported for some parameters.

Daily Phonatory Activity of Individuals With Parkinson's Disease.

PURPOSE: This study evaluated the amount of phonatory activity of Persons with Parkinson disease (PwPD) compared to adults without Parkinson's disease measured over 3 days. The relationship between the amount of phonatory activity and Voice Handicap Index (VHI) total score was assessed as were differences in voicing activity across 3 days of data collection. METHODS: Fifteen PwPD receiving dopaminergic medication and fifteen age and sex matched adults without Parkinson's disease completed the VHI and then wore a VocaLog vocal monitor (VM) for 3 consecutive days. From the VM data, the number of 1-second windows with dB sound pressure level > 0 were summed as a measure of phonatory activity (PA) and reported relative to the time the VM was worn (%PA). RESULTS: The percentage of time the VM was worn did not differ between groups or across days. The PwPD had statistically significantly fewer minutes of PA per day than controls (F = 21.782, P < 0.001) by 54 minutes on average. The %PA also differed significantly (F = 31.825, P < 0.001) with a mean of 11.1% for PwPD and 18.6% for controls. Neither PA nor %PA differed across the 3 days of vocal monitoring. VHI total score was significantly correlated with PA (r = -0.436, P = 0.016) and %PA (r = -0.534, P = 0.002) for all participants. CONCLUSIONS: The results indicate that PwPD engaged in less verbal communication in their daily environment compared to adults without Parkinson's disease. The findings support reports in the literature indicating that PwPD often have reduced communication participation. Measures such as %PA could serve as a quantifiable metric in future studies assessing communication changes in PwPD as a function of disease progression or therapeutic interventions.

Clinical Experiences of People With a Laryngectomy During the SARS COVID-19 Pandemic.

Purpose This study described the clinical experiences of patients with a total laryngectomy (TL) during the COVID-19 pandemic and identified changes in communication, tracheostoma care, and heat-moisture exchange (HME) use that were recommended or self-implemented. Method An online survey addressing the study aims was completed by 173 people with a TL who live in the United States. The survey was open from July 5 to August 10, 2020. Results In-person clinic visits, appointment cancellations, and contact from their speech-language pathologists (SLPs) were reported by 42%, 19%, and 54% of the TL respondents, respectively. At clinic visits, 78% were required to wear a mask over their nose/mouth, and 73% were required to wear a mask over their tracheostoma. Masks, gloves, and face shields worn by the SLP at these visits were reported by 84%, 82%, and 70% of the TL patients, respectively. Alaryngeal communication changes were recommended by the SLP for 7%-18% of TL patients, depending on their method of communication, whereas 43%-45% implemented changes on their own. Changes in tracheostoma care and HME use were recommended by the SLP for 27% and 21% of the TL respondents, respectively, whereas 54% and 47% made changes on their own. Conclusions Individuals with a TL will require in-person care even during a pandemic, as reflected in this study. Many had not been contacted by their SLP or otolaryngologist about TL guidelines that were becoming available. Notably, larger percentages of TL patients reported self-initiated changes to their communication, tracheostoma care, and HME use because of the pandemic than their SLP had advised. The types of communication changes varied in part, depending on the method of alaryngeal speech a respondent used. Supplemental Material https://doi.org/10.23641/asha.16807270.

The Impact of COVID-19 on Speech-Language Pathologists Engaged in Clinical Practices With Elevated Coronavirus Transmission Risk.

Purpose This study assessed and described potential clinical practice changes secondary to COVID-19 that emerged as an early response to the pandemic for speech-language pathologists (SLPs) engaged in voice, alaryngeal, and swallowing activities that may increase the risk of virus transmission. Method SLPs from the United States and Canada (n = 665) who were engaged in clinical activities that might elevate the risk of COVID-19 exposure completed an online survey regarding their clinical practices. Topics assessed included potential clinical service modifications, COVID-19 testing and health, and potential financial impacts in the early time period of the pandemic. Results The percentage of SLPs completing the most endoscopic procedures prepandemic (≥ 10/week) was reduced from 39% of respondents to 3% due to the pandemic. Those who completed the most tracheoesophageal puncture voice prosthesis changes (≥ 5/week) reported a reduction in frequency from 24% to 6%. Twenty-five percent of SLPs reported that they were tested for COVID-19, and 6% reported a positive result. Descriptive statistics suggest that COVID-19 testing rates of SLPs, the percentage of SLPs experiencing a financial impact, and the percentage who were furloughed varied across SLP work setting. Conclusions These findings provide the first data characterizing the impact on COVID-19 on clinical practice for SLPs engaged in procedures such as endoscopy and laryngectomy care. The results indicate that, as frontline workers, SLPs were directly impacted in their practice patterns, personal health, safety, and financial security, and that these reported impacts occurred differently across SLP work settings.

Listener impressions of alaryngeal communication modalities.

Purpose: Following a total laryngectomy in which the larynx is completely removed, individuals in the USA have three primary options for alaryngeal verbal communication including tracheoesophageal speech (TES), oesophageal speech (ES) and electrolarynx (EL). Using a large sample of participants from across the USA, this study investigated listener impressions of each primary type of alaryngeal communication. As these are the individuals more likely to be participating in social interactions and in positions of hiring for employment, the general public's impressions of TES, ES and EL may be a vital consideration during the treatment process.Method: A total of 381 individuals rated eight speech samples, including samples from speakers of each alaryngeal communication modality as well samples from age and sex matched laryngeal speakers, with regards to three outcome measures: intelligence, likability and employability.Result: Listener impressions of alaryngeal speech samples were modulated by the type of communication mode. Further, the patterns of results differed by speaker sex, with ES speech rated consistently more favourable for female speakers across all outcome measures and TES rated consistently more favourable for male speakers across all outcome measures.Conclusion: An overall preference for laryngeal speech was noted, particularly with male speakers. The female ES stimuli, interestingly, was the highest rated alaryngeal communication modality. Regardless of speaker sex, all alaryngeal modes greatly affected impressions of employability relative to impressions of likeability and intelligence.

Voice and Lifestyle Behaviors of Speech-Language Pathology Students: Impact of History Gathering Method on Self-Reported Data.

OBJECTIVES: This study described voice use and lifestyle information from student speech-language pathologists (SLP) and assessed the impact of history gathering method on the acquired data. METHODS: One hundred sixty-two SLP students completed a detailed history form and estimated voice and life style parameters at study intake and subsequently tracked the same parameters daily for three consecutive weeks. Nonparametric statistical comparisons were applied to assess differences in estimates at intake versus the 3-week log. RESULTS: Voice problems diagnosed by a physician or SLP were reported by 11% of the students. A similar percentage reported frequent loud talking and heavy occupational voice demands beyond clinical training use. Furthermore, high stress was reported by 49%, frequent anxiety by 53%, and depression by 17%. Comparing data from study intake relative to the 3-week log, SLP students statistically significantly overestimated speaking time, and underestimated singing, second hand smoke exposure time, and hours of sleep. Additionally, they overestimated water intake and daily stress, and underestimated caffeine and alcohol intake, at the study onset versus the log. The experience of vocal fatigue was common within the 3-week log, but how a student identified at study intake on this parameter (experiencing it frequently or not) did not differentiate how many days of vocal fatigue were reported in 3 weeks. CONCLUSIONS: SLP students engage in some voice use and lifestyle behaviors that place them at risk for voice problems. The method of soliciting information about the voice and lifestyle of SLP students impacted the information obtained. Optimal methods of gathering accurate and reliable clinical history and voice us data are needed.

Voice and Lifestyle Behaviors of Student Actors: Impact of History Gathering Method on Self-Reported Data.

OBJECTIVES: This study described voice use and lifestyle information about student actors and assessed whether different information is reported at study intake compared to data extracted from a 3-week voice Log. METHODS: Twenty-five student actors estimated 14 voice and life style parameters at the start of the study. These included daily speaking time, performance time, vocal warm-up, and cool-down time; intake of water, caffeine, and alcohol; perceived voice effort (speaking and performance), among other items. The same parameters were tracked by the actor for 21 consecutive days. Nonparametric statistical comparisons of the estimates at intake to the median estimate from 21 days were applied. RESULTS: Student actors reported frequent yelling (48%), frustration, anxiety, and depression about their voice (52%, 48%, and 16%), issues with breath support (56%), vocal fatigue (36%), and mild-moderate effort in the speaking (24%) and performance voice (70%). Estimates at study intake statistically overestimated daily speaking, performance, and vocal warm-up time compared to the 3-week Log. Intake reporting underestimated perceived effort in the speaking voice. Intake reporting of vocal fatigue and voice quality did not closely correspond to the Log data. CONCLUSION: Student actors reported a number of voice use and lifestyle behaviors that may increase their risk for voice problems. Additionally, the method of soliciting the history altered the information reported by the students for several parameters. The findings highlight the need to develop history gathering or other methods that optimize accuracy and reliability of the information sought.

Auditory-vocal integration impairment: New challenges and opportunities for voice assessment and therapy / Alteración de la integración auditivo-vocal: nuevos retos y oportunidades para la evaluación y la terapia de la voz

This reflection paper addresses the importance of the interaction between voice perception and voice production, emphasizing the processes of auditory-vocal in-tegration that are not yet widely reported in the context of voice clinicians. Given the above, this article seeks to 1) highlight the important link between voice pro-duction and voice perception and 2) consider whether this relationship might be exploited clinically for diagnostic purposes and therapeutic benefit. Existing theories on speech production and its interaction with auditory perception provide context for discussing why the evaluation of auditory-vocal processes could help identify associ-ated origins of dysphonia and inform the clinician around appropriate management strategies. Incorporating auditory-vocal integration assessment through sensorimotor adaptation paradigm testing could prove to be an important addition to voice assess-ment protocols at the clinical level. Further, if future studies can specify the means to manipulate and enhance a person's auditory-vocal integration, the efficiency of voice therapy could be increased, leading to improved quality of life for people with voice disorders

Este artículo de reflexión aborda la importancia de la interacción entre la percepción y la producción de la voz, haciendo hincapié en los procesos de integración auditivo-vocal, los cuales aún no han sido muy divulgados en el contexto de los clínicos de voz. Dado lo anterior, este articulo busca: 1) destacar la importante relación entre la producción y la percepción de la voz y 2) considerar si esta relación pudiese explotarse clínicamente con fines diagnósticos y terapéuticos. Las teorías existentes sobre la producción de la voz y su interacción con la percepción auditiva proporcionan el contexto para discutir por qué la evaluación de los procesos auditivo-vocales podría ayudar a identificar los orígenes asociados a cierto tipo de disfonías e informar al clínico sobre las estrategias de abordaje adecuadas. La incorporación de la evaluación de la integración auditivo-vocal a través de la prueba del paradigma de adaptación sensoriomotora podría ser una importante adición a los protocolos de evaluación de la voz a nivel clínico. Además, si los estudios futuros pueden especificar los medios para manipular y mejorar la integración auditivo-vocal de una persona, la eficacia de la terapia de la voz podría aumentar, lo que llevaría a mejorar la calidad de vida de las personas con trastornos de la voz

Sense of Effort and Articulatory Contact Pressure Associated with Talking by Individuals Using Tracheoesophageal Speech.

BACKGROUND/AIMS: The aims of this study were (1) to determine locations of increased effort in the body when talking using tracheoesophageal speech (TES); (2) to compare talking effort for participants using TES and those using laryngeal speech; (3) to compare tongue-palate contact pressure during talking for TES and laryngeal speech; and (4) to assess the relationship between talking effort and articulatory contact pressure (ACP). METHODS: This cohort comparison study included 16 individuals using TES and 10 using laryngeal speech. Participants rated talking effort on a visual analog scale and then rated effort in the lungs, throat, oral cavity, brain (cognitive) and arm/shoulder. ACP for /t/, /d/, and /n/ produced in sentences was measured using a pressure sensor on the alveolar ridge. RESULTS: Factor analysis of effort ratings across body locations by participants using TES revealed two latent variables associated with non-voice production locations and voice production. Ratings of effort and ACP were statistically significantly higher in participants using TES. The correlation between overall talking effort and ACP was strong and statistically significantly. CONCLUSIONS: The effort ratings suggest adults with functional TES experience talking as more effortful than adults with a larynx. Some increased effort was focused in the voice production process, but regions outside of voicing were also implicated.

Articulation contact pressures scaled to the physiologic range of the tongue in amyotrophic lateral sclerosis: A pilot study.

OBJECTIVE: The aim of this study was to compare the percentage of the maximum isometric lingual strength range at which lingual-alveolar consonants are produced (%Pmax) by people with amyotrophic lateral sclerosis (PALS) compared to people without the disease measured at study entry, and then 3 and 6 months later. DESIGN: Prospective cohort comparison study over time. METHODS: Ten people with ALS and nine without produced the consonants /t, d, s, z, l, n/ in real words within sentences as the articulatory contact pressure (ACP) between the tongue tip and palate was sensed by a miniature transducer. Maximum isometric tongue pressing values also were obtained to allow calculation of %Pmax. Data were analyzed to compare PALS with bulbar symptoms, PALS with spinal-only symptoms, and people without ALS. RESULTS: %Pmax did not differ between any of the three participant groups at any of the three measurement times. Maximum isometric pressure did decrease significantly in both ALS groups when comparing baseline to 3- and 6-months later. Maximum pressures remained stable for the non-ALS group at the three measurement times. CONCLUSION: The results suggest that speech motor activity of the tongue in people with ALS may be scaled relative to their overall tongue strength, such that the %Pmax does not change as the tongue gets progressively weaker.

Sense of Effort and Fatigue Associated With Talking After Total Laryngectomy.

Purpose: Sense of effort and fatigue associated with talking was compared in individuals with and without a total laryngectomy. Method: An online survey of individuals using tracheoesophageal speech (TES; n = 222), electrolaryngeal speech (ELS; n = 132), esophageal speech (n = 41), and laryngeal speech (LS; n = 112) asked about 3 domains of effort when talking: frequency of occurrence, withdrawal from talking, and location in the body. Three aspects of fatigue were explored: frequency of occurrence, fatigue type, and duration of talking before fatigue. Results: Alaryngeal groups reported significantly more talking-related effort and fatigue than the LS group. Sixty-three percent of all respondents indicated that effort caused them to talk less, with no group differences on this item. Significantly more effort was localized to the lips and tongue by ELS compared with TES and LS groups. Both the ELS and TES groups had higher shoulder/arm effort when talking compared with the esophageal speech and LS groups. ELS respondents reported less fatigue than the TES group. When fatigue was present, the TES group had more physical and less mental fatigue than the ELS group. The duration of talking before experiencing fatigue was significantly shorter for the alaryngeal groups compared with the LS group. Conclusions: Effort and fatigue associated with talking are a common report for individuals using alaryngeal speech. The location of effort within the body and the type of fatigue experienced vary to some extent across alaryngeal speaking methods.

Whispering by Individuals Using Tracheoesophageal Speech.

OBJECTIVES: This study compared whispering attempts by adults using tracheoesophageal (TE) speech with those by adults with a larynx. Comparisons were based on listener judgments, visual-perceptual assessment of spectrograms, and measures of the acoustic signal. STUDY DESIGN: This was a prospective, cross-sectional study. METHODS: Seventeen TE and 10 laryngeal speakers produced sentences in a whisper and in their spoken voice. Listeners judged sentences as whispered or spoken. Judges signal-typed the spectrograms based on presence-absence of a "voicing bar." Speaking rate, articulation rate, percent pause, and dB sound pressure level were measured. RESULTS: Twenty-nine percent of TE speakers were perceived to be whispering on whisper attempts; most others were perceived to be using spoken voice while attempting to whisper. Spectrograms of TE whispering were most often categorized as "mostly voiced." Speaking and articulation rates were slower for TE speakers. There was a significantly greater reduction in speaking rate from spoken to whisper for the TE group. Percent pause did not differ significantly between groups and speaking mode. TE speakers had a significantly smaller difference in dB sound pressure level between spoken and whisper modes. CONCLUSIONS: Some individuals using TE speech can whisper based on auditory-perceptual judgment, but most were perceived to be speaking during these attempts. The fact that some TE participants could whisper indicates the behavior is possible and might be considered a therapeutic target if it is of importance to an individual. The percentage of TE speakers who can learn to whisper, and the optimal training approach, are yet to be determined.

Changes in lingual-alveolar contact pressure during speech over six months in amyotrophic lateral sclerosis.

PURPOSE: This study compared lingual-alveolar contact pressures during consonant (LACP-Sp) production between adults with and without amyotrophic lateral sclerosis (ALS) over three visits within six months and assessed the relationship between LACP-Sp and speech intelligibility. METHODS: Ten people with ALS and nine without read sentences with lingual-alveolar consonants embedded as LACP-Sp was recorded. Recordings were done at study entry, then three and six months after entry. Six of ten with ALS had bulbar symptoms detected in clinical encounter at the time of study enrollment (ALS-B); the remaining four had only spinal symptoms (ALS-S). RESULTS: Main and interaction effects varied across experimental stimuli. However, the pattern of results from the ANOVAs indicated that the ALS-B had lower LACP-Sp values than the other groups. Time main effects were present indicating a reduction in LACP-Sp. However, there were interaction effects for fricatives and/l/, with the ALS-S group demonstrating greater reduction over time than the other groups. Word intelligibility had moderate to large correlations with LACP-Sp but confidence intervals were broad and only a few were statistically significant. CONCLUSION: LACP-Sp does decrease over time in people with ALS and may reflect a general weakening of the tongue. Confirmation of these group changes will require assessment with a larger sample size.

Lingual-Alveolar Contact Pressure During Speech in Amyotrophic Lateral Sclerosis: Preliminary Findings.

Purpose: This preliminary study on lingual-alveolar contact pressures (LACP) in people with amyotrophic lateral sclerosis (ALS) had several aims: (a) to evaluate whether the protocol induced fatigue, (b) to compare LACP during speech (LACP-Sp) and during maximum isometric pressing (LACP-Max) in people with ALS (PALS) versus healthy controls, (c) to compare the percentage of LACP-Max utilized during speech (%Max) for PALS versus controls, and (d) to evaluate relationships between LACP-Sp and LACP-Max with word intelligibility. Method: Thirteen PALS and 12 healthy volunteers produced /t, d, s, z, l, n/ sounds while LACP-Sp was recorded. LACP-Max was obtained before and after the speech protocol. Word intelligibility was obtained from auditory-perceptual judgments. Results: LACP-Max values measured before and after completion of the speech protocol did not differ. LACP-Sp and LACP-Max were statistically lower in the ALS bulbar group compared with controls and PALS with only spinal symptoms. There was no statistical difference between groups for %Max. LACP-Sp and LACP-Max were correlated with word intelligibility. Conclusions: It was feasible to obtain LACP-Sp measures without inducing fatigue. Reductions in LACP-Sp and LACP-Max for bulbar speakers might reflect tongue weakness. Although confirmation of results is needed, the data indicate that individuals with high word intelligibility maintained LACP-Sp at or above 2 kPa and LACP-Max at or above 50 kPa.

Assessment of Deformational Plagiocephaly Severity and Neonatal Developmental Delay.

Deformational plagiocephaly (DP) in infants has been associated with developmental delay that can last until adolescence. Despite this association and a 5-fold increase in incidence of DP over the past 2 decades, there are currently no guidelines regarding screening for developmental delay or identification of which infants with DP are at the greatest risk of delay. A prospective, nonrandomized study was performed. Infants diagnosed with DP who had no prior intervention were eligible for enrollment. Cranial deformity was measured by cross-cranial measurements using calipers, and developmental delay was measured using the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III). Correlation between cranial deformity and developmental delay was analyzed using a linear regression. Twenty-seven infants, ages 4.0 to 11.0 months (mean = 6.61 months) diagnosed with DP were studied. Developmental delay was observed on the composite language (n = 3 of 27, 11%), and composite motor (n = 5 of 23, 22%) scales, but not the cognitive scale. Severity of cranial deformity did not correlate with scores on any Bayley-III scales (cognitive R = 0.058, P = 0.238; composite language R = 0.03, P = 0.399; composite motor R = 0.0195, P = 0.536). This study demonstrates that severity of cranial deformity cannot be used to predict presence or degree of developmental delay. Craniofacial surgeons should be aware of this risk and consider developmental screening based on clinical suspicion.