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Findlen U, Richard C. Hearing and speech interactions in children with cerebral palsy, in the first 2 years : Focus on cerebral palsy. Pediatr Res 2024:10.1038/s41390-024-03403-0. [PMID: 39003333 DOI: 10.1038/s41390-024-03403-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 06/17/2024] [Accepted: 06/24/2024] [Indexed: 07/15/2024]
Abstract
Children with cerebral palsy (CP) face communication challenges stemming from neural lesions, hearing issues, and executive function impairments, which are further complicated by interactions between motor and hearing impairments. These challenges lead to limitations in daily activities and are compounded by delays in diagnosis and interventions, adversely affecting speech, language, and cognitive function. In infants with CP, impaired motor function disrupts both feedforward and feedback mechanisms crucial for speech sound production, exacerbating the overall impact on communication development. Understanding the interplay between hearing loss and speech production in children with CP, especially in the crucial early developmental stages, is essential for implementing timely interventions and guiding multidisciplinary care teams in both clinical and home settings. IMPACT QUESTIONS: Children with cerebral palsy (CP) face communication challenges due to neural, hearing, and motor issues, impacting speech and language development. Early and comprehensive testing, including auditory brainstem response, is crucial for timely diagnosis and intervention to mitigate adverse effects. The article emphasizes the need for advanced diagnostics and multidisciplinary interventions to improve communication skills and cognitive outcomes in children with CP.
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Affiliation(s)
- Ursula Findlen
- Nationwide Children's Hospital- Division of Clinical Therapies, Columbus, OH, USA
- The Ohio State Wexner Medical Center, College of Medicine, Department of Otolaryngology - Head & Neck Surgery, OSU Eye and Ear Institute, Columbus, OH, USA
| | - Celine Richard
- Department of Otolaryngology-Head & Neck Surgery, University of Tennessee Health Science Center, Memphis, TN, USA.
- Division of Otolaryngology-Head & Neck Surgery, Lebonheur Children's Hospital, Memphis, TN, USA.
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Ning LH, Hui TC. The Accompanying Effect in Responses to Auditory Perturbations: Unconscious Vocal Adjustments to Unperturbed Parameters. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2024; 67:1731-1751. [PMID: 38754028 DOI: 10.1044/2024_jslhr-23-00543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
PURPOSE The present study examined whether participants respond to unperturbed parameters while experiencing specific perturbations in auditory feedback. For instance, we aim to determine if speakers adjust voice loudness when only pitch is artificially altered in auditory feedback. This phenomenon is referred to as the "accompanying effect" in the present study. METHOD Thirty native Mandarin speakers were asked to sustain the vowel /ɛ/ for 3 s while their auditory feedback underwent single shifts in one of the three distinct ways: pitch shift (±100 cents; coded as PT), loudness shift (±6 dB; coded as LD), or first formant (F1) shift (±100 Hz; coded as FM). Participants were instructed to ignore the perturbations in their auditory feedback. Response types were categorized based on pitch, loudness, and F1 for each individual trial, such as Popp_Lopp_Fopp indicating opposing responses in all three domains. RESULTS The accompanying effect appeared 93% of the time. Bayesian Poisson regression models indicate that opposing responses in all three domains (Popp_Lopp_Fopp) were the most prevalent response type across the conditions (PT, LD, and FM). The more frequently used response types exhibited opposing responses and significantly larger response curves than the less frequently used response types. Following responses became more prevalent only when the perturbed stimuli were perceived as voices from someone else (external references), particularly in the FM condition. In terms of isotropy, loudness and F1 tended to change in the same direction rather than loudness and pitch. CONCLUSION The presence of the accompanying effect suggests that the motor systems responsible for regulating pitch, loudness, and formants are not entirely independent but rather interconnected to some degree.
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Affiliation(s)
- Li-Hsin Ning
- Department of English, National Taiwan Normal University, Taipei City
| | - Tak-Cheung Hui
- Department of Creative Arts, Hong Kong Metropolitan University, Kowloon
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Lee SH, Lee GS. Long-term Average Spectrum and Nasal Accelerometry in Sentences of Differing Nasality and Forward-Focused Vowel Productions Under Altered Auditory Feedback. J Voice 2022:S0892-1997(22)00228-4. [PMID: 36050247 DOI: 10.1016/j.jvoice.2022.07.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/27/2022] [Accepted: 07/27/2022] [Indexed: 10/14/2022]
Abstract
OBJECTIVES AND BACKGROUND To investigate whether voice focus adjustments can alter the audio-vocal feedback and consequently modulate speech/voice motor control. Speaking with a forward-focused voice was expected to enhance audio-vocal feedback and thus decrease the variability of vocal fundamental frequency (F0). MATERIALS AND METHOD Twenty-two healthy, untrained adults (10 males and 12 females) were requested to sustain vowel /a/ with their natural focus and a forward focus and to naturally read the nasal, oral, and mixed oral-nasal sentences in normal noise-masked auditory conditions. Meanwhile, a miniature accelerometer was externally attached on the noise to detect the nasal vibrations during vocalization. Audio recordings were made and analyzed using the long-term average spectrum (LTAS) and power spectral analysis of F0. RESULTS Compared with naturally-focused vowel production and oral sentences, forward-focused vowel productions and nasal sentences both showed significant increases in nasal accelerometric amplitude and the spectral power within the range of 200∼300 Hz, and significantly decreased the F0 variability below 3 Hz, which has been reported to be associated with enhanced auditory feedback in our previous research. The auditory masking not only significantly increased the low-frequency F0 variability, but also significantly decreased the ratio of the spectral power within 200∼300 Hz to the power within 300∼1000 Hz for the vowel and sentence productions. Gender differences were found in the correlations between the degree of nasal coupling and F0 stability as well as in the LTAS characteristics in response to noise. CONCLUSIONS Variations in nasal-oral acoustic coupling not only change the formant features of speech signals, but involuntarily influence the auditory feedback control of vocal fold vibrations. Speakers tend to show improved F0 stability in response to a forward-focused voice adjustment.
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Affiliation(s)
- Shao-Hsuan Lee
- Department of Audiology and Speech Language Pathology, Mackay Medical College, New Taipei City, and Department of Speech Language Pathology and Audiology, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Guo-She Lee
- School of Medicine, College of Medicine, Yangming Campus, National Yang Ming Chiao Tung University, and Department of Otorhinolaryngology, Taipei City Hospital Renai Branch, Taipei, Taiwan.
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Lee SH, Torng PC, Lee GS. Contributions of Forward-Focused Voice to Audio-Vocal Feedback Measured Using Nasal Accelerometry and Power Spectral Analysis of Vocal Fundamental Frequency. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:1751-1766. [PMID: 35353595 DOI: 10.1044/2022_jslhr-21-00443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE The spectral powers of the modulations of vocal fundamental frequency (f o) less than 3 Hz (low-frequency power, LFP) and between 3 and 8 Hz (middle-frequency power, MFP) had been established to indicate the audio-vocal feedback status and vocal efficiency of a speaker, and a resonant voice may enhance the auditory-vocal feedback. This study aims to determine whether the auditory feedback can be augmented by a forward and resonant voice and therefore contribute to the modulations of f o variability. METHOD Vocal signals and accelerometric signals of lateral nasal cartilage were obtained from 27 healthy adults who, respectively, sustained vowels /a/ and /i/ with their habitual speaking voice and with a forward-focused voice under three auditory conditions: natural hearing (N0), high-level noise exposure (N90), and low-level noise exposure (N60). Nasal skin vibrations were measured using a nasal accelerometry to reflect voice resonance status. Vocal intensity and f o variability were also analyzed to show the auditory-vocal interactions under varied conditions of auditory feedback and voice resonance. RESULTS In both N0 and N90 conditions, forward-focused voice showed a significantly lower LFP than the speakers' habitual voice. In addition, LFP of f o would significantly increase during natural voice production as the voice feedback was greatly masked by high-intensity noise; however, with a forward-focused voice, the noise-induced variation in LFP was significantly decreased. Under N90, MFP significantly decreased during forward-focused voice production compared with that measured during natural voice production. The stability of f o modulations was not adversely affected by N60. CONCLUSION The results support the idea that vocalizing with a forward-focused voice enhance the auditory feedback of the speaker's own voice and, thus, reduce the variability of f o during sustained phonation, especially when vocalizing in the high noise condition.
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Affiliation(s)
- Shao-Hsuan Lee
- Department of Speech Language Pathology and Audiology, National Taipei University of Nursing and Health Sciences, Taiwan
| | - Pao-Chuan Torng
- Department of Speech Language Pathology and Audiology, National Taipei University of Nursing and Health Sciences, Taiwan
| | - Guo-She Lee
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taiwan
- Department of Otorhinolaryngology, Taipei City Hospital, Renai Branch, Taiwan
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Lee SH, Yu JF, Fang TJ, Lee GS. Vocal fold nodules: A disorder of phonation organs or auditory feedback? Clin Otolaryngol 2019; 44:975-982. [PMID: 31436035 DOI: 10.1111/coa.13417] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 07/19/2019] [Accepted: 08/18/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Increasing evidence supports that auditory feedback of one's own voice closely relates to real-time adjustments of vocal control. Previous studies highlighted that the low-frequency modulations of below 3 Hz (LFM) embedded in vocal fundamental frequency (F0) showed a reflex-like response to altered auditory inputs. However, the auditory feedback control of different vocal disorders remains unclear. DESIGN A cross-sectional, case-controlled study. SETTING A tertiary medical centre. PARTICIPANTS Sustained vocalisations of vowel/a/ from adult healthy controls and patients with vocal fold nodules, vocal fold polyps and vocal fold cysts, respectively. The vocalisations were made at a comfortable pitch and at the intensity of 70 ~ 80 dBC under the following four auditory conditions: natural hearing, 90-dBC speech noise, 10-dBC enhanced feedback of self-produced voice and both the noise and voice feedback. MAIN OUTCOME MEASURES Power spectral analysis of F0 contour of sustained vowel. RESULTS Patients with vocal fold nodules presented with different audio-vocal feedback behaviour and audio-vocal response to speech noise from the other two vocal pathologies of vocal fold polyp and vocal fold cyst as well as the healthy controls (P < .001, one-way ANOVA). CONCLUSION The vocal fold nodules may be not only a vocal fold disease but also a disease caused by abnormal audio-vocal feedback. Moreover, the distinct audio-vocal feedback of vocal fold nodules could be revealed by power spectral analysis of vocal fundamental frequencies. Although further investigations are necessary, adjustments of audio-vocal feedback behaviour may provide a new insight and benefit to the treatment of vocal fold nodules in the future.
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Affiliation(s)
- Shao-Hsuan Lee
- Ph.D. Program in Biomedical Engineering, College of Engineering, Chang Gung University, Taoyuan City, Taiwan
| | - Jen-Fang Yu
- Institute of Medical Mechatronics, College of Engineering, Chang Gung University, Taoyuan City, Taiwan
| | - Tuan-Jen Fang
- Department of Otolaryngology Head and Neck Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan.,School of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Guo-She Lee
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Otolaryngology, Taipei City Hospital Renai Branch, Taipei, Taiwan
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Lattenkamp EZ, Vernes SC. Vocal learning: a language-relevant trait in need of a broad cross-species approach. Curr Opin Behav Sci 2018. [DOI: 10.1016/j.cobeha.2018.04.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Lee SH, Fang TJ, Yu JF, Lee GS. Responses of Middle-Frequency Modulations in Vocal Fundamental Frequency to Different Vocal Intensities and Auditory Feedback. J Voice 2017; 31:536-544. [PMID: 28268129 DOI: 10.1016/j.jvoice.2017.01.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 01/27/2017] [Accepted: 01/30/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVES AND BACKGROUND Auditory feedback can make reflexive responses on sustained vocalizations. Among them, the middle-frequency power of F0 (MFP) may provide a sensitive index to access the subtle changes in different auditory feedback conditions. MATERIALS AND METHODS Phonatory airflow temperature was obtained from 20 healthy adults at two vocal intensity ranges under four auditory feedback conditions: (1) natural auditory feedback (NO); (2) binaural speech noise masking (SN); (3) bone-conducted feedback of self-generated voice (BAF); and (4) SN and BAF simultaneously. The modulations of F0 in low-frequency (0.2 Hz-3 Hz), middle-frequency (3 Hz-8 Hz), and high-frequency (8 Hz-25 Hz) bands were acquired using power spectral analysis of F0. Acoustic and aerodynamic analyses were used to acquire vocal intensity, maximum phonation time (MPT), phonatory airflow, and MFP-based vocal efficiency (MBVE). RESULTS SN and high vocal intensity decreased MFP and raised MBVE and MPT significantly. BAF showed no effect on MFP but significantly lowered MBVE. Moreover, BAF significantly increased the perception of voice feedback and the sensation of vocal effort. CONCLUSIONS Altered auditory feedback significantly changed the middle-frequency modulations of F0. MFP and MBVE could well detect these subtle responses of audio-vocal feedback.
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Affiliation(s)
- Shao-Hsuan Lee
- Ph.D. Program in Biomedical Engineering, College of Engineering, Chang-Gung University, Taoyuan City, Taiwan
| | - Tuan-Jen Fang
- Department of Otorhinolaryngology, Chang-Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Jen-Fang Yu
- Institute of Medical Mechatronics, College of Engineering, Chang-Gung University, Taoyuan City, Taiwan
| | - Guo-She Lee
- Department of Otorhinolaryngology, Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Otolaryngology, Taipei City Hospital Renai Branch, Taipei, Taiwan.
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