Τρίτη, 7 Μαΐου 2019

Voice

Evaluation of Voice Quality in Patients With Vocal Fold Polyps: The Size of a Polyp Matters or Does it?

Journal of Voice

Publication stage: In Press Corrected Proof

Abstract

Objective

This study aimed to investigate the correlation between morphological features of vocal fold polyps (VFPs) and subjective/objective voice parameters.

Methods

Perceptual evaluations, aerodynamic and acoustic tests were performed on 47 patients with VFPs. Still images were captured from video and the morphological features associated with the size of VFP were quantified. To reveal the correlation between size-related morphological features (length of polyp base, the ratio of polyp base to vocal fold length, glottal gap area) and objective/subjective parameters of voice, Pearson's and Spearman's tests were carried out.

Results

This cohort was composed of 30 (63.8 %) male and 17 (36.2%) female patients with the mean age of 45.2 years and 41.3 years, respectively. No correlation was found between the morphological features of VFPs and any of perceptual, aerodynamic and acoustic voice parameters.

Conclusions

Our findings indicated that controversies still exist regarding the role of vocal fold polyp morphology in clinical decision making.

Article in Press
Classifying and Identifying Motor Learning Behaviors in Voice-Therapy Clinician-Client Interactions: A Proposed Motor Learning Classification Framework

Journal of Voice

Publication stage: In Press Corrected Proof

Summary

Purpose

We studied whether concepts in motor skill learning could be operationalized to identify clinical interactions and behaviors in a voice therapy setting. Our aim was to test the feasibility of measuring these behaviors in the prepractice phase so that we could eventually evaluate and apply principles of motor learning and skill acquisition to Speech-Language Pathology. Four general categories of behaviors that have been identified in the client-clinician prepractice phase were identified: motivation, modeling, verbal information, and feedback. All variables were extracted from a proposed Motor Learning Classification Framework.

Method

Nine participants categorized clinician behaviors in three voice therapy training videos into specific, described, prepractice variables.

Results

Good intrarater reliability was shown across viewings. Inter-rater reliability was high for modeling and verbal information, but raters were not consistent when identifying behaviors classified as motivation and feedback. Raters responded positively to the classification exercise and the categories encompassed nearly all noted behaviors.

Conclusion

Behaviors described within the motor learning literature can be identified in the initial stages of voice therapy, providing evidence that motor learning concepts can be used to identify interactions and behaviors in clinical settings. Disagreement in classification among raters was influenced by differences in implicit and explicit interpretations of verbal information. This suggests that greater clarity in specific concepts is needed to support teaching of motor learning principles and implementation of these principles in clinical practice for the treatment of speech-language pathology.

Article in Press
Vocal Health Education in Undergraduate Performing Arts Training Programs

Journal of Voice

Publication stage: In Press Corrected Proof

SUMMARY

Purpose

Vocal health is taught in multiple formats and to varying degrees across undergraduate training programs. The aim of the study is to identify what methods of instruction lead to a better self-perception of vocal health in order to more adequately prepare graduates for the extreme demands of the performing arts industry.

Method

A survey investigating how vocal health and vocal injury are being taught was administered to students within 5 years of graduation. This study looked at what type of information is taught, when information is presented, how prepared students feel they are to handle their health and injuries upon graduation, the prevalence of injuries while in school and during the first 5 years of postgraduation, and students' suggestions to improve their overall vocal health education. The survey compares vocal health education between the various disciplines of classical voice, musical theatre, and acting.

Results

Students learn more about general vocal hygiene than voice disorders in their undergraduate programs. Classical voice and musical theatre majors learn more about vocal health than acting majors, yet acting majors report a higher incidence of vocal injury within the first 5 years of graduation. Students also retain more vocal health knowledge when presented with information multiple times in their education.

Conclusions

Creating a more specific, consistent vocal health curriculum for all voice-related performing arts programs will improve self-efficacy regarding vocal health upon graduation.

Article in Press
The Influence of Linguistic Demand on Symptom Expression in Adductor Spasmodic Dysphonia
Department of Communication Sciences and Disorders, Elmhurst College, Elmhurst, Illinois

Journal of Voice

Publication stage: In Press Corrected Proof

Summary

Introduction

Adductor Spasmodic Dysphonia (ADSD), a form of focal dystonia, has been defined as a neurogenic, task-specific disorder characterized by abrupt spasms of intrinsic laryngeal muscles that result in phonatory breaks. Voice breaks are typically isolated to propositional speech, and reported to increase in severity as speaking demand or complexity increases. Research to date has focused on variations in phonologic contexts and their influence on voice breaks. The influences of variables at lexical and syntactic levels of analysis have been less well-researched and yet may provide insight into observed variability of symptom manifestation in this rare voice disorder.

Objectives

This study investigated frequency of voice breaks over 20 standard sentences in 38 individuals with ADSD according to linguistic complexity measures including lexical density and a four-level lexical frequency and type paradigm. Two research questions about linguistic influences and ADSD symptom manifestation were posed: (1) does the frequency of voice breaks vary according to the lexical density of a string? and (2) does the frequency of voice breaks vary according to a measure of lexical frequency/type?

Results

Results revealed a nonsignificant relationship between string length and voice break frequency, whereas a significant relationship was found between lexical density and voice break frequency (P = 0.029, r = 0.488). Lexical analysis results revealed a significant relationship between lexical frequency and voice breaks, with words within technical/academic classes relating to the highest rates of voice break across 38 subjects with ADSD.

Conclusions

Results from this secondary analysis provide support for the hypothesis that variation in linguistic demand may modulate symptom expression in SD. Specifically, lexical density and lexical frequency modulated the frequency of symptom expression in classic forms of SD in this purposive sample.

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