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Levy ES, Moya-Galé G. Revisiting Dysarthria Treatment Across Languages: The Hybrid Approach. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023:1-10. [PMID: 38056466 DOI: 10.1044/2023_jslhr-23-00629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
PURPOSE Ten years after Miller and Lowit's (2014) groundbreaking book providing a cross-linguistic perspective on motor speech disorders, we ask where we are regarding dysarthria treatment across languages in two specific populations: adults with Parkinson's disease (PD) and children with cerebral palsy (CP). METHOD In this commentary, we consider preliminary evidence for both language-independent and language-specific approaches to treatment and propose a hybrid approach to speech treatment across languages, centered on the individual with dysarthria who speaks any given language. CONCLUSIONS Treatment research on individuals with dysarthria secondary to PD and CP is advancing, but several areas remain to be explored. Next steps are suggested for addressing the paucity and complexity of cross-linguistic speech treatment research.
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Bouvier L, Green JR, Tapia CB, Tilton-Bolowsky V, Maffei MF, Fless Z, Seaver K, Huynh A, Gutz SE, Martino R, Abrahao A, Berry J, Zinman L, Yunusova Y. Amyotrophic Lateral Sclerosis-Bulbar Dysfunction Index-Remote: Test-Retest and Interrater Reliability of Candidate Items. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:1884-1900. [PMID: 37494887 PMCID: PMC10561957 DOI: 10.1044/2023_ajslp-22-00177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 10/27/2022] [Accepted: 06/05/2023] [Indexed: 07/28/2023]
Abstract
PURPOSE The primary aim of this study was to establish the reliability of candidate items as a step in the development of the Amyotrophic Lateral Sclerosis-Bulbar Dysfunction Index-Remote (ALS-BDI-Remote), a novel tool being developed for the detection and monitoring of bulbar signs and symptoms in remote settings. METHOD The set of candidate items included 40 items covering three domains: cranial nerve examination, auditory-perceptual evaluation, and functional assessment. Forty-eight participants diagnosed with ALS and exhibiting a range of bulbar disease severity were included. Data collection for each participant took place on Zoom over three sessions. During Session 1, the participants were instructed to adjust their Zoom settings and to optimize their recording environment (e.g., lighting, background noise). Their cognition and eating were screened to determine their ability to follow instructions and their eligibility to perform the swallowing and chewing tasks. During Session 2, two speech-language pathologists (SLPs) administered the tool consecutively to determine the items' interrater reliability. During Session 3, one of the SLPs readministered the tool within 2 weeks of Session 1 to assess test-retest reliability. The reliability of each item was estimated using weighted kappa and the percentage of agreement. To be considered reliable, the items had to reach a threshold of 0.5 weighted kappa or 80% percentage agreement (if skewed distribution of the scores) for both interrater and test-retest reliability. RESULTS In total, 33 of the 40 candidate items reached the reliability cutoff for both reliability analyses. All assessment domains included reliable items. Items requiring very good visualization of structures or movements were generally less reliable. CONCLUSIONS This study resulted in the selection of reliable items to be included in the next version of the ALS-BDI-Remote, which will undergo psychometric evaluation (reliability, validity, and responsiveness analyses). Additionally, the results contributed to our understanding of the remote administration of SLP assessments for telehealth applications.
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Affiliation(s)
- Liziane Bouvier
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Department of Speech-Language Pathology, Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
- KITE—University Health Network, Toronto, Ontario, Canada
| | - Jordan R. Green
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
- Speech and Hearing Biosciences and Technology, Harvard University, Boston, MA
| | - Carolina Barnett Tapia
- Division of Neurology, Department of Medicine, University of Toronto and University Health Network, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Victoria Tilton-Bolowsky
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
| | - Marc F. Maffei
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
| | - Zuzana Fless
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Katie Seaver
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
| | - Anna Huynh
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Department of Speech-Language Pathology, Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
- KITE—University Health Network, Toronto, Ontario, Canada
| | - Sarah E. Gutz
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
- Speech and Hearing Biosciences and Technology, Harvard University, Boston, MA
| | - Rosemary Martino
- Department of Speech-Language Pathology, Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
- Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Ontario, Canada
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Agessandro Abrahao
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - James Berry
- Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston
| | - Lorne Zinman
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Yana Yunusova
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Department of Speech-Language Pathology, Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
- KITE—University Health Network, Toronto, Ontario, Canada
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Liu B, Hao G, Cui Y, Fang J, Ji M, Wu J, Jiang J, Shao J, Liu H. Introduction of Voice Type Component (VTC) as an Effective Acoustic Voice Analysis Method in Tele-evaluation. J Voice 2023:S0892-1997(23)00215-1. [PMID: 37544815 DOI: 10.1016/j.jvoice.2023.07.005] [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: 05/11/2023] [Revised: 07/06/2023] [Accepted: 07/06/2023] [Indexed: 08/08/2023]
Abstract
OBJECTIVE Telepractice in voice health care and evaluation services has attracted much attention in recent years. Multiple studies have proven the effectiveness of voice therapy with telepractice. However, voice evaluations are still mostly conducted in person due to the lack of sensitive acoustic analysis methods. METHODS This study examined various acoustic analysis methods for voice evaluation in telepractice. Eighteen female elementary school teachers with self-reported voice disorders volunteered to participate in the study. Speech samples were collected before and after the interventions using two voice sampling methods concurrently. One set of data was collected using the traditional voice sample collection method by the therapist in person. The second set of data was collected on the same speech samples using the clients' own smartphones, and the collected voice samples were later sent to the researcher for further acoustic analysis. The voice type component (VTC) measurement represented the proportion of different VTCs in a voice by measuring the chaos and intrinsic dimension. RESULTS Voice analyses were conducted on both sets of data, and the correlation between the two sampling procedures was analyzed. It appears that the VTC could be a more reliable method for producing acoustic analysis results with voice samples collected from smartphones compared to other objective voice assessment procedures. This reliability has been demonstrated via statistical analysis, including correlation coefficient, pairwise t test, d-prime, and area under the curve. The results of this study highlighted the VTC as an effective and accurate acoustic analysis method in tele-evaluation. CONCLUSIONS This feasible voice sampling method, which utilizes participants' own smartphones, will reduce barriers to accessing limited voice specialists due to distance and will decrease the cost of care by minimizing expenses associated with travel and additional equipment for voice sampling. Ultimately, this approach will enhance the effectiveness of voice care delivered through telepractice to patients in remote and underserved areas.
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Affiliation(s)
- Boquan Liu
- School of Humanities, Shanghai Jiao Tong University, Shanghai, China
| | - Grace Hao
- Department of Communication Sciences and Disorders, North Carolina Central University, North Carolina, USA
| | - Ying Cui
- School of Journalism and Communication, Shanghai University of Sport, Shanghai, China
| | - Jin Fang
- School of Humanities, Shanghai Jiao Tong University, Shanghai, China
| | - Mingjun Ji
- School of Humanities, Shanghai Jiao Tong University, Shanghai, China
| | - Jianfeng Wu
- International Cultural Exchange School, Fudan University, Shanghai, China
| | - Jack Jiang
- Department of Surgery-Division of Otolaryngology, University of Wisconsin School of Medicine and Public Health, Wisconsin, USA
| | - Jing Shao
- Department of English Language and Literature, Hong Kong Baptist University, Hong Kong, China
| | - Hengxin Liu
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital Affiliated to Capital Medical University, National Center for Children's Health, Beijing, China; Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery, Beijing, China
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Saccente-Kennedy B, Szczepanska A, Harrison J, Archer J, Watson NA, Orton CM, Costello D, Calder JD, Shah PL, Reid JP, Bzdek BR, Epstein R. Mitigation of Respirable Aerosol Particles from Speech and Language Therapy Exercises. J Voice 2023:S0892-1997(23)00124-8. [PMID: 37248120 DOI: 10.1016/j.jvoice.2023.04.001] [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: 03/16/2023] [Accepted: 04/05/2023] [Indexed: 05/31/2023]
Abstract
INTRODUCTION Phonation and speech are known sources of respirable aerosol in humans. Voice assessment and treatment manipulate all the subsystems of voice production, and previous work (Saccente-Kennedy et al., 2022) has demonstrated such activities can generate >10 times more aerosol than conversational speech and 30 times more aerosol than breathing. Aspects of voice therapy may therefore be considered aerosol generating procedures and pose a greater risk of potential airborne pathogen (eg, SARS-CoV-2) transmission than typical speech. Effective mitigation measures may be required to ensure safe service delivery for therapist and patient. OBJECTIVE To assess the effectiveness of mitigation measures in reducing detectable respirable aerosol produced by voice assessment/therapy. METHODS We recruited 15 healthy participants (8 cis-males, 7 cis-females), 9 of whom were voice-specialist speech-language pathologists. Optical Particle Sizers (OPS) (Model 3330, TSI) were used to measure the number concentration of respirable aerosol particles (0.3 µm-10 µm) generated during a selection of voice assessment/therapy tasks, both with and without mitigation measures in place. Measurements were performed in a laminar flow operating theatre, with near-zero background aerosol concentration, allowing us to quantify the number concentration of respiratory aerosol particles produced. Mitigation measures included the wearing of Type IIR fluid resistant surgical masks, wrapping the same masks around the end of straws, and the use of heat and moisture exchange microbiological filters (HMEFs) for a water resistance therapy (WRT) task. RESULTS All unmitigated therapy tasks produced more aerosol than unmasked breathing or speaking. Mitigation strategies reduced detectable aerosol from all tasks to a level significantly below, or no different to, that of unmasked breathing. Pooled filtration efficiencies determined that Type IIR surgical masks reduced detectable aerosol by 90%. Surgical masks wrapped around straws reduced detectable aerosol by 96%. HMEF filters were 100% effective in mitigating the aerosol from WRT, the exercise that generated more aerosol than any other task in the unmitigated condition. CONCLUSIONS Voice therapy and assessment causes the release of significant quantities of respirable aerosol. However, simple mitigation strategies can reduce emitted aerosol concentrations to levels comparable to unmasked breathing.
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Affiliation(s)
- Brian Saccente-Kennedy
- Department of Speech and Language Therapy (ENT), Royal National Ear, Nose and Throat and Eastman Dental Hospitals, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Alicja Szczepanska
- School of Chemistry, University of Bristol, Cantock's Close, Bristol, United Kingdom
| | - Joshua Harrison
- School of Chemistry, University of Bristol, Cantock's Close, Bristol, United Kingdom
| | - Justice Archer
- School of Chemistry, University of Bristol, Cantock's Close, Bristol, United Kingdom
| | - Natalie A Watson
- Department of Ear, Nose and Throat Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Christopher M Orton
- Department of Respiratory Medicine, Royal Brompton Hospital, London, United Kingdom; Department of Respiratory Medicine, Chelsea and Westminster Hospital, London, United Kingdom; National Heart and Lung Institute, Guy Scadding Building, Imperial College London, London, United Kingdom
| | - Declan Costello
- Ear, Nose and Throat Department, Wexham Park Hospital, United Kingdom
| | - James D Calder
- Department of Bioengineering, Imperial College London, United Kingdom; Fortius Clinic, Fitzhardinge St, London, United Kingdom
| | - Pallav L Shah
- Department of Respiratory Medicine, Royal Brompton Hospital, London, United Kingdom; Department of Respiratory Medicine, Chelsea and Westminster Hospital, London, United Kingdom; National Heart and Lung Institute, Guy Scadding Building, Imperial College London, London, United Kingdom
| | - Jonathan P Reid
- School of Chemistry, University of Bristol, Cantock's Close, Bristol, United Kingdom
| | - Bryan R Bzdek
- School of Chemistry, University of Bristol, Cantock's Close, Bristol, United Kingdom
| | - Ruth Epstein
- Department of Speech and Language Therapy (ENT), Royal National Ear, Nose and Throat and Eastman Dental Hospitals, University College London Hospitals NHS Foundation Trust, London, United Kingdom.
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McKenna VS, Gustin RL, Hobek AL, Howell RJ, Dickinson TE, Shanley SN, Patel TH. Factors Related to Treatment Attendance for Patients Seeking Gender-Affirming Voice Therapy. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:216-233. [PMID: 36584326 DOI: 10.1044/2022_ajslp-22-00004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
OBJECTIVE The purpose of this study was to investigate factors related to treatment attendance for patients seeking gender-affirming voice therapy (GAVT). METHOD We completed retrospective chart reviews of 50 patients (43 transgender women, three transgender men, four nonbinary patients; aged 18-67 years, M = 34.92 years, SD = 12.32 years) referred for GAVT at a Midwest outpatient center from 2016 to 2021. Data extraction included patient demographics, therapy visit specifics (e.g., number of sessions attended, treatment completion status, and in-person vs. virtual visits) and treatment timing (in relation to the onset of the COVID-19 pandemic), and psychosocial and socioeconomic information. RESULTS There was no impact of treatment-timing relative to the onset of the pandemic on any attendance measure; however, patients were 1.9 times more likely to complete therapy with each virtual telehealth session attended. Individual factors of outside social support and hormone replacement therapy were positively related to the number of therapy sessions attended, whereas insurance provider and employment status were related to therapy completion. CONCLUSIONS Telehealth attendance during the COVID-19 pandemic was positively associated with GAVT completion. Future research should investigate psychosocial and socioeconomic factors to understand how to identify patients at risk for poor treatment adherence and facilitate access to clinical care.
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Affiliation(s)
- Victoria S McKenna
- Department of Communication Sciences and Disorders, University of Cincinnati, OH
- Department of Biomedical Engineering, University of Cincinnati, OH
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, OH
| | - Renee L Gustin
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, OH
| | - Amy L Hobek
- Department of Communication Sciences and Disorders, University of Cincinnati, OH
| | - Rebecca J Howell
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, OH
| | - Tara E Dickinson
- Department of Communication Sciences and Disorders, University of Cincinnati, OH
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, OH
| | - Savannah N Shanley
- Department of Communication Sciences and Disorders, University of Cincinnati, OH
| | - Tulsi H Patel
- Department of Communication Sciences and Disorders, University of Cincinnati, OH
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Guarin DL, Taati B, Abrahao A, Zinman L, Yunusova Y. Video-Based Facial Movement Analysis in the Assessment of Bulbar Amyotrophic Lateral Sclerosis: Clinical Validation. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:4667-4678. [PMID: 36367528 PMCID: PMC9940890 DOI: 10.1044/2022_jslhr-22-00072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 05/31/2022] [Accepted: 08/12/2022] [Indexed: 06/03/2023]
Abstract
PURPOSE Facial movement analysis during facial gestures and speech provides clinically useful information for assessing bulbar amyotrophic lateral sclerosis (ALS). However, current kinematic methods have limited clinical application due to the equipment costs. Recent advancements in consumer-grade hardware and machine/deep learning made it possible to estimate facial movements from videos. This study aimed to establish the clinical validity of a video-based facial analysis for disease staging classification and estimation of clinical scores. METHOD Fifteen individuals with ALS and 11 controls participated in this study. Participants with ALS were stratified into early and late bulbar ALS groups based on their speaking rate. Participants were recorded with a three-dimensional (3D) camera (color + depth) while repeating a simple sentence 10 times. The lips and jaw movements were estimated, and features related to sentence duration and facial movements were used to train a machine learning model for multiclass classification and to predict the Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised (ALSFRS-R) bulbar subscore and speaking rate. RESULTS The classification model successfully separated healthy controls, the early ALS group, and the late ALS group with an overall accuracy of 96.1%. Video-based features demonstrated a high ability to estimate the speaking rate (adjusted R 2 = .82) and a moderate ability to predict the ALSFRS-R bulbar subscore (adjusted R 2 = .55). CONCLUSIONS The proposed approach based on a 3D camera and machine learning algorithms represents an easy-to-use and inexpensive system that can be included as part of a clinical assessment of bulbar ALS to integrate facial movement analysis with other clinical data seamlessly.
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Affiliation(s)
- Diego L. Guarin
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville
| | - Babak Taati
- KITE–Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
- Department of Computer Science, University of Toronto, Ontario, Canada
- Institute of Biomedical Engineering, University of Toronto, Ontario, Canada
| | - Agessandro Abrahao
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Division of Neurology, Department of Medicine, University of Toronto, Ontario, Canada
| | - Lorne Zinman
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Division of Neurology, Department of Medicine, University of Toronto, Ontario, Canada
- L.C. Campbell Cognitive Neurology Research Unit, Cognitive Neurology, Sunnybrook Research Institute, University of Toronto, Ontario, Canada
| | - Yana Yunusova
- KITE–Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Department of Speech-Language Pathology and Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
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Venkatraman Y, Mahalingam S, Boominathan P. Development and Validation of Sentences in Tamil for Psychoacoustic Evaluation of Voice Using the Consensus Auditory-Perceptual Evaluation of Voice. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:4539-4556. [PMID: 36368051 DOI: 10.1044/2022_jslhr-22-00169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
PURPOSE The Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) is a standardized instrument used in voice assessment to assess voice quality. It has been translated and culturally adapted in several languages. This study aimed at developing and validating a Tamil version of CAPE-V through auditory perceptual evaluation of remotely recorded voice samples. METHOD The Tamil version was adapted with permission from the American Speech-Language-Hearing Association to match the rationale in English CAPE-V. The sentences were constructed by the first author and validated for content by two panels of experts. Forty-five participants (15 cases and 30 controls) were included in the study. Data recording was conducted online (Zoom Video Communications, Inc., app) for all samples. Three raters participated in the auditory evaluation and scored all samples using Grade, Roughness, Breathiness, Asthenia, and Strain (GRBAS) scale followed by CAPE-V with a week gap in between. Twenty percent of samples were repeated to assess intrarater reliability. The intrarater and interrater reliability measures for Tamil CAPE-V were established using intraclass coefficients (ICCs). To ensure construct validity, group differences were determined between the cases and controls. The concurrent validity was established by correlating Tamil CAPE-V with the GRBAS scale. RESULTS The intrarater reliability for Tamil CAPE-V ranged from moderate to excellent (ICC: .610-.998). The Tamil CAPE-V obtained moderate to good interrater reliability for all parameters (ICC: .525-.790) except pitch (ICC: .405). The differences between the cases and controls were statistically significant (p < .01). The correlation between CAPE-V and GRBAS was strong for overall severity, breathiness, and strain (r s = .725-.861) and moderate for roughness (r s = .678). CONCLUSION The Tamil CAPE-V is a reliable and valid tool for auditory perceptual evaluation in Tamil-speaking populations. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.21513885.
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Affiliation(s)
- Yamini Venkatraman
- Department of Speech, Language and Hearing Sciences, Sri Ramachandra Faculty of Audiology & Speech Language Pathology, Sri Ramachandra Institute of Higher Education and Research (Deemed to be University), Chennai, India
| | - Shenbagavalli Mahalingam
- Department of Speech, Language and Hearing Sciences, Sri Ramachandra Faculty of Audiology & Speech Language Pathology, Sri Ramachandra Institute of Higher Education and Research (Deemed to be University), Chennai, India
| | - Prakash Boominathan
- Department of Speech, Language and Hearing Sciences, Sri Ramachandra Faculty of Audiology & Speech Language Pathology, Sri Ramachandra Institute of Higher Education and Research (Deemed to be University), Chennai, India
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Requena-Komuro MC, Jiang J, Dobson L, Benhamou E, Russell L, Bond RL, Brotherhood EV, Greaves C, Barker S, Rohrer JD, Crutch SJ, Warren JD, Hardy CJ. Remote versus face-to-face neuropsychological testing for dementia research: a comparative study in people with Alzheimer's disease, frontotemporal dementia and healthy older individuals. BMJ Open 2022; 12:e064576. [PMID: 36428012 PMCID: PMC9702828 DOI: 10.1136/bmjopen-2022-064576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 10/20/2022] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES We explored whether adapting neuropsychological tests for online administration during the COVID-19 pandemic was feasible for dementia research. DESIGN We used a longitudinal design for healthy controls, who completed face-to-face assessments 3-4 years before remote assessments. For patients, we used a cross-sectional design, contrasting a prospective remote cohort with a retrospective face-to-face cohort matched for age/education/severity. SETTING Remote assessments were conducted using video-conferencing/online testing platforms, with participants using a personal computer/tablet at home. Face-to-face assessments were conducted in testing rooms at our research centre. PARTICIPANTS The remote cohort comprised 25 patients (n=8 Alzheimer's disease (AD); n=3 behavioural variant frontotemporal dementia (bvFTD); n=4 semantic dementia (SD); n=5 progressive non-fluent aphasia (PNFA); n=5 logopenic aphasia (LPA)). The face-to-face patient cohort comprised 64 patients (n=25 AD; n=12 bvFTD; n=9 SD; n=12 PNFA; n=6 LPA). Ten controls who previously participated in face-to-face research also took part remotely. OUTCOME MEASURES The outcome measures comprised the strength of evidence under a Bayesian framework for differences in performances between testing environments on general neuropsychological and neurolinguistic measures. RESULTS There was substantial evidence suggesting no difference across environments in both the healthy control and combined patient cohorts (including measures of working memory, single-word comprehension, arithmetic and naming; Bayes Factors (BF)01 >3), in the healthy control group alone (including measures of letter/category fluency, semantic knowledge and bisyllabic word repetition; all BF01 >3), and in the combined patient cohort alone (including measures of working memory, episodic memory, short-term verbal memory, visual perception, non-word reading, sentence comprehension and bisyllabic/trisyllabic word repetition; all BF01 >3). In the control cohort alone, there was substantial evidence in support of a difference across environments for tests of visual perception (BF01=0.0404) and monosyllabic word repetition (BF01=0.0487). CONCLUSIONS Our findings suggest that remote delivery of neuropsychological tests for dementia research is feasible.
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Affiliation(s)
- Maï-Carmen Requena-Komuro
- Dementia Research Centre, University College London, London, UK
- Kidney Cancer Program, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Jessica Jiang
- Dementia Research Centre, University College London, London, UK
| | - Lucianne Dobson
- Dementia Research Centre, University College London, London, UK
| | - Elia Benhamou
- Dementia Research Centre, University College London, London, UK
- Cognition and Brain Sciences Unit, Cambridge University, Cambridge, UK
| | - Lucy Russell
- Dementia Research Centre, University College London, London, UK
| | - Rebecca L Bond
- Dementia Research Centre, University College London, London, UK
| | | | | | - Suzie Barker
- Dementia Research Centre, University College London, London, UK
| | | | | | - Jason D Warren
- Dementia Research Centre, University College London, London, UK
| | - Chris Jd Hardy
- Dementia Research Centre, University College London, London, UK
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Virtual vs in-person otolaryngology evaluation: The patient perspective. Am J Otolaryngol 2022; 43:103546. [DOI: 10.1016/j.amjoto.2022.103546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 07/24/2022] [Indexed: 11/20/2022]
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10
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Myers B, Hary E, Ellerston J, Barkmeier-Kraemer JM. Telepractice Considerations for Evaluation and Treatment of Voice Disorders: Tailoring to Specific Populations. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:678-688. [PMID: 35077650 DOI: 10.1044/2021_ajslp-21-00206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE The aim of this clinical focus article is to provide recommendations for implementation of telepractice services for the evaluation and treatment of voice disorders and to use case examples to highlight the advantages of this modality of service delivery. METHOD In this clinical focus article, key factors for successful telepractice evaluation and treatment of voice and related disorders are discussed relative to clinical outcome measures. Case examples of telepractice voice therapy are described for a pediatric, transgender, and chronic cough client including associated acoustic, auditory-perceptual, and quality-of-life treatment outcomes. RESULTS Acoustic, perceptual, and quality-of-life outcome measures demonstrated functional voice improvements after treatment using the telepractice modality. The pediatric client showed decreased perceptual voice strain and increased speech intelligibility. The transgender client showed increased habitual speaking fundamental frequency (pitch) and quality of life. The chronic cough client showed improved vocal hygiene and reduced cough severity. CONCLUSIONS A review of the literature shows comparable outcomes for in-person and telepractice voice therapy, but special considerations must be made to ensure therapeutic success. We present three representative types of voice cases that illustrate implementation of voice evaluation and treatment using the telepractice modality. In all three cases, the clients' personal therapeutic goals were achieved without needing to travel to the clinic. Furthermore, asynchronous practice opportunities were found to be positive byproducts of using the telepractice modality.
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Affiliation(s)
- Brett Myers
- Department of Communication Sciences and Disorders, The University of Utah, Salt Lake City
- Voice Disorders Center, University of Utah Health, Salt Lake City
| | - Elizabeth Hary
- Voice Disorders Center, University of Utah Health, Salt Lake City
| | - Julia Ellerston
- Voice Disorders Center, University of Utah Health, Salt Lake City
| | - Julie M Barkmeier-Kraemer
- Department of Communication Sciences and Disorders, The University of Utah, Salt Lake City
- Voice Disorders Center, University of Utah Health, Salt Lake City
- Division of Otolaryngology-Head and Neck Surgery, The University of Utah, Salt Lake City
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Awan SN, Shaikh MA, Desjardins M, Feinstein H, Abbott KV. The Effect of Microphone Frequency Response on Spectral and Cepstral Measures of Voice: An Examination of Low-Cost Electret Headset Microphones. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:959-973. [PMID: 35050724 PMCID: PMC9150670 DOI: 10.1044/2021_ajslp-21-00156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 08/12/2021] [Accepted: 10/11/2021] [Indexed: 06/14/2023]
Abstract
PURPOSE The purpose of this study was to establish the frequency response of a selection of low-cost headset microphones that could be given to subjects for remote voice recordings and to examine the effect of microphone type and frequency response on key acoustic measures related to voice quality obtained from speech and vowel samples. METHOD The frequency responses of three low-cost headset microphones were evaluated using pink noise generated via a head-and-torso model. Each of the headset microphones was then used to record a series of speech and vowel samples prerecorded from 24 speakers who represented a diversity of sex, age, fundamental frequency (F o), and voice quality types. Recordings were later analyzed for the following measures: smoothed cepstral peak prominence (CPP; dB), low versus high spectral ratio (L/H ratio; dB), CPP F o (Hz), and cepstral spectral index of dysphonia (CSID). RESULTS The frequency response of the microphones under test was observed to have nonsignificant effects on measures of the CPP and CPP F o, significant effects on the CSID in speech contexts, and strong and significant effects on the measure of spectral tilt (L/H ratio). However, the correlations between the various headset microphones and a reference precision microphone were excellent (rs > .90). CONCLUSIONS The headset microphones under test all showed the capability to track a wide range of diversity in the voice signal. Though the use of higher quality microphones that have demonstrated specifications is recommended for typical research and clinical purposes, low-cost electret microphones may be used to provide valid measures of voice, specifically when the same microphone and signal chain is used for the evaluation of pre- versus posttreatment change or intergroup comparisons.
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Affiliation(s)
- Shaheen N. Awan
- Department of Communication Sciences and Disorders, University of South Florida, Tampa
| | - Mohsin A. Shaikh
- Department of Communication Sciences and Disorders, Bloomsburg University of Pennsylvania
| | - Maude Desjardins
- Department of Communication Sciences & Disorders, University of Delaware, Newark
| | - Hagar Feinstein
- Department of Communication Sciences & Disorders, University of Delaware, Newark
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Dahl KL, Weerathunge HR, Buckley DP, Dolling AS, Díaz-Cádiz M, Tracy LF, Stepp CE. Reliability and Accuracy of Expert Auditory-Perceptual Evaluation of Voice via Telepractice Platforms. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:2446-2455. [PMID: 34473568 PMCID: PMC9132030 DOI: 10.1044/2021_ajslp-21-00091] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/23/2021] [Accepted: 05/24/2021] [Indexed: 05/24/2023]
Abstract
Purpose This study assessed the reliability and accuracy of auditory-perceptual voice evaluations by experienced clinicians via telepractice platforms. Method Voice samples from 20 individuals were recorded after transmission via telepractice platforms. Twenty experienced clinicians (10 speech-language pathologists, 10 laryngologists) evaluated the samples for dysphonia percepts (overall severity, roughness, breathiness, and strain) using a modified Consensus Auditory-Perceptual Evaluation of Voice. Reliability was calculated as the mean of squared differences between repeated ratings (intrarater agreement), and between individual and group mean ratings (interrater agreement). Repeated measures analyses of variance were constructed to measure effects of transmission condition (e.g., original recording, WebEx, Zoom), dysphonia percept, and their interaction on intrarater agreement, interrater agreement, and average ratings. Significant effects were evaluated with post hoc Tukey's tests. Results There were significant effects of transmission condition, percept, and their interaction on average ratings, and a significant effect of percept on interrater agreement. Post hoc testing revealed statistically, but not clinically, significant differences in average roughness ratings across transmission conditions, and significant differences in interrater agreement for several percepts. Overall severity had the highest agreement and strain had the lowest. Conclusion Telepractice transmission does not substantially reduce reliability or accuracy of auditory-perceptual voice evaluations by experienced clinicians.
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Affiliation(s)
- Kimberly L. Dahl
- Department of Speech, Language and Hearing Sciences, Boston University, MA
| | - Hasini R. Weerathunge
- Department of Speech, Language and Hearing Sciences, Boston University, MA
- Department of Biomedical Engineering, Boston, University, MA
| | - Daniel P. Buckley
- Department of Speech, Language and Hearing Sciences, Boston University, MA
- Department of Otolaryngology—Head & Neck Surgery, Boston, University School of Medicine, MA
| | - Anton S. Dolling
- Department of Speech, Language and Hearing Sciences, Boston University, MA
| | - Manuel Díaz-Cádiz
- Department of Speech, Language and Hearing Sciences, Boston University, MA
| | - Lauren F. Tracy
- Department of Otolaryngology—Head & Neck Surgery, Boston, University School of Medicine, MA
| | - Cara E. Stepp
- Department of Speech, Language and Hearing Sciences, Boston University, MA
- Department of Otolaryngology—Head & Neck Surgery, Boston, University School of Medicine, MA
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