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Grillo EU, Corej B, Wolfberg J. Normative Values of Client-Reported Outcome Measures and Self-Ratings of Six Voice Parameters via the VoiceEvalU8 App. J Voice 2024; 38:964.e17-964.e27. [PMID: 34895987 PMCID: PMC9177899 DOI: 10.1016/j.jvoice.2021.10.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/22/2021] [Accepted: 10/25/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Ecological momentary assessments (EMA) and interventions (EMI) have the potential to assess and offer interventions repeatedly within the client's daily life through mobile app technology. Considering the development of the EMA VoiceEvalU8, the current work provided normative data by comparing traditional (i.e., paper and pencil) and electronic (i.e., VoiceEvalU8 app) administration modalities of client-reported outcome measures and client self-ratings of six voice parameters twice a day in their functional environment. METHODS In Experiment 1, 50 vocally healthy cisgender women and men completed the Voice Handicap Index (VHI)-30, VHI-10, and Vocal Fatigue Index (VFI) with paper and pencil and the VoiceEvalU8 app. The order of administration modality and perceptual scales was randomized for each participant. In Experiment 2, 104 vocally healthy cisgender women and men used the VoiceEvalU8 app across five days in the morning before talking all day and in the evening after talking all day to self-rate six voice parameters (i.e., overall quality, roughness, breathiness, strain, pitch, and loudness) on a scale from 0 - 100. Mann Whitney U tests were run for all measures. Means and standard deviations are reported for descriptive analysis and normative values. RESULTS In Experiment 1, results showed no significant differences between paper and pencil and VoiceEValU8 app administration for the VHI-30, VHI-10, and VFI for vocally healthy adults. Normative values in the current study were consistent with previous literature for the VHI-10 and VFI factor 1 and 2, but slightly higher for the VHI-30 and slightly lower for the VFI factor 3. In Experiment 2, results demonstrated significant differences for all six voice parameters between the morning and evening log sessions. Normative values demonstrated higher self-ratings in the morning as compared to the evening. CONCLUSIONS For vocally healthy adults, completing the VHI-30, VHI-10, and VFI via paper and pencil and the VoiceEvalU8 app yielded the same results. Client self-ratings of six voice parameters on a scale from 0 - 100 twice a day demonstrated that vocally healthy adults perceived voice to be worse in the morning before talking all day as compared to the evening after talking all day. The results from the current work are promising for EMA via the VoiceEvalU8 app and support the need for continued investigations with clients with voice differences, problems, and/or disorders.
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Affiliation(s)
- Elizabeth U Grillo
- Department of Communication Sciences and Disorders, West Chester University, West Chester, Pennsylvania, USA.
| | - Brigit Corej
- Department of Communication Sciences and Disorders, West Chester University, West Chester, Pennsylvania, USA
| | - Jeremy Wolfberg
- Massachusetts General Hospital Institute of Health Professions, Speech-Language Pathology Master's Program, Boston, Massachusetts, USA
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Moya-Galé G, Pagano G, Walsh SJ. Perceptual consequences of online group speech treatment for individuals with Parkinson's disease: A pilot study case series. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024:1-16. [PMID: 38692287 DOI: 10.1080/17549507.2024.2330538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
PURPOSE We examined perceptual changes in the domains of ease of understanding, naturalness, and speech severity, as well as changes in self-perceptions of voice disability, following an online group speech treatment program for people with Parkinson's disease (PD) conducted during the COVID-19 pandemic. METHOD Seven speakers with hypokinetic dysarthria associated with PD participated in a university and community-based online group speech program for 10 weeks. Speech recordings occurred remotely 1 week before and 1 week after the online program. Thirty naïve listeners rated ease of understanding, naturalness, and speech severity based on the speech recordings. Speakers' self-perceptions of voice disability were also obtained at both time points. RESULT Individual analysis of the speech data showed that for most speakers with dysarthria, ease of understanding and perceptions of severity were rated the same or better pre- to post-treatment. Naturalness, however, was only perceived to be the same or better post-treatment in three out of seven speakers. Over half of the speakers reported improvements in their self-perception of voice disability. CONCLUSION This pilot study highlighted the individual variability among speakers with dysarthria and the potential of online group speech treatment to maintain and/or improve speech function in this population.
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de Oliveira AG, Fabbron EMG. Play-Based Strategies for Speech Therapy and Vocal Health Face-to-Face and Distance Learning Actions for Children: An Integrative Literature Review. J Voice 2024; 38:538.e1-538.e10. [PMID: 34732288 DOI: 10.1016/j.jvoice.2021.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 09/08/2021] [Accepted: 09/09/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Diversifying voice therapy strategies is critical to get children and adolescents to adhere to the therapeutic process. PURPOSE To investigate the face-to-face and distance playful strategies have been used for vocal health education and voice therapy in children and adolescents. METHODS An integrative literature review was carried out based on the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA). A search for full texts was conducted on the Virtual Health Library, Scientific Electronic Library Online (SCIELO) and PuBMed databases using the following descriptors, and their corresponding Medical Subject Headings (MeSH): voice (voz); voice quality (qualidade da voz); dysphonia (disfonia); voice disorders (distúrbios da fala); voice training (treinamento da voz); telemedicine (telemedicina); therapeutics (terapêutica); health promotion (promoção da saúde); group practice (prática de grupo); recreation therapy (terapia recreacional); child (criança); preschool (pré-escolar) and adolescent (adolescente). RESULTS After full reading of the studies, 15 articles were included and categorized into the following topics: face-to-face and distance playful strategies for voice therapy in children; playful strategies with gamification for education and for voice therapy in children; and vocal health educational actions in children. CONCLUSION The study found a higher number of studies that carried out educational actions and playful strategies, while fewer studies were related to the production of materials, gamification and online services for voice therapy in children. Given the proven benefits of this strategy for children, further studies focusing on the development and application of playful strategies, such as the use of gamification, should be conducted in order to stimulate the skills and adherence of this population to therapy.
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Affiliation(s)
- Amanda Gabriela de Oliveira
- Speech Therapist, Specialist in Voice by the Federal Council of Speech Therapy (CFFa), Master of Science from the Bauru School, Dentistry/University of São Paulo (FOB/USP); Doctoral Student in Speech-Language Pathology and Audiology at the School of Philosophy and Sciences/São Paulo State University 'Júlio de Mesquita Filho' (FFC/UNESP) Marília, São Paulo, Brazil; Speech-Language Pathology and Audiology Department, Acoustic and Articulatory Analysis Laboratory (LAAc), School of Philosophy and Sciences/São Paulo State University 'Júlio de Mesquita Filho' (FFC/UNESP), Marília, São Paulo, Brazil and Member of the research group Language Studies, of the Conselho Nacional de Desenvolvimento Científico e Tecnológico (GPEL/CNPq), São Paulo, Brazil.
| | - Eliana Maria Gradim Fabbron
- Speech Therapist, Professor of the Graduated Program in Speech-Language Pathology and Audiology; Speech-Language Pathology and Audiology Department, Acoustic and Articulatory Analysis Laboratory (LAAc), School of Philosophy and Sciences/São Paulo State University 'Júlio de Mesquita Filho' (FFC/UNESP), Marília, São Paulo, Brazil
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Schneider SL, Habich L, Weston ZM, Rosen CA. Observations and Considerations for Implementing Remote Acoustic Voice Recording and Analysis in Clinical Practice. J Voice 2024; 38:69-76. [PMID: 34366193 DOI: 10.1016/j.jvoice.2021.06.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/12/2021] [Accepted: 06/15/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES/HYPOTHESIS Remote voice recording and acoustic analysis allow for comprehensive voice assessment and outcome tracking without the requirements of travel to the clinic, in-person visit, or expensive equipment. This paper delineates the process and considerations for implementing remote voice recording and acoustic analysis in a high-volume university voice clinic. STUDY DESIGN Clinical Focus. METHODS Acoustic voice recordings were attempted on 108 unique patients over a 6-month period using a remote voice recording phone application. Development of the clinical process including determining normative data in which to compare acoustic results, clinician training, and clinical application is described. The treating Speech Language Pathologists (SLPs) were surveyed 2 months after implementation to assess ease of application, identify challenges and assess implementation of potential solutions. RESULTS Of 108 unique patients, 83 patients were successful in completing the process of synchronous remote acoustic voice recording in conjunction with their SLP clinician. The process of downloading the application, setting up, and obtaining voice recordings was most commonly 10-20 minutes according to the 8 SLPs surveyed. Challenges and helpful techniques were identified. CONCLUSIONS Remote acoustic voice recordings have allowed SLPs to continue to complete a comprehensive voice evaluation in a telepractice model. Given emerging knowledge about the viability of remote voice recordings, the success in obtaining acoustic data remotely, and the accessibility of a low-cost app for SLPs makes remote voice recordings a viable option to facilitate remote clinical care and research investigation.
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Affiliation(s)
- Sarah L Schneider
- UCSF Voice and Swallowing Center, Department of Otolaryngology Head and Neck Surgery, University of California San Francisco, San Francisco, California.
| | - Laura Habich
- UCSF Voice and Swallowing Center, Department of Otolaryngology Head and Neck Surgery, University of California San Francisco, San Francisco, California
| | - Zoe M Weston
- UCSF Voice and Swallowing Center, Department of Otolaryngology Head and Neck Surgery, University of California San Francisco, San Francisco, California
| | - Clark A Rosen
- UCSF Voice and Swallowing Center, Department of Otolaryngology Head and Neck Surgery, University of California San Francisco, San Francisco, California
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Liu H, Hao G, Chen S, Ouyoung L, Liu Y, Li J, Duan H, Li Z, Liu Y, Zhong J, Liu B, Jiang J. Effectiveness and Feasibility of Telepractice on Voice Therapy for Female Teachers in Elementary Schools with Self-Reported Voice Disorders. J Voice 2024; 38:244.e1-244.e13. [PMID: 34583880 DOI: 10.1016/j.jvoice.2021.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 07/20/2021] [Accepted: 07/20/2021] [Indexed: 11/22/2022]
Abstract
PURPOSE The purpose of this study is to explore the effectiveness of telepractice in voice intervention for female teachers in elementary schools with self-reported voice disorders. METHODS Thirty-five female elementary school teachers with self-reported voice disorders volunteered to participate in the study. They were divided into a telepractice voice intervention group (experimental group N=18) and a face-to-face voice intervention group (control group N=17) based on their employment setting. The exact same treatment protocol was applied to both groups of subjects, except that the intervention group was seen through telepractice, and the control group was seen face-to-face. The treatment protocol includes vocal hygiene education and resonant voice therapy twice a week for a total of eight sessions. Auditory perceptual analysis, acoustic assessment, aerodynamic assessment and self-assessment protocol were conducted before the intervention and one week after the last intervention, and the differences before and after interventions within each group and between groups were compared. RESULTS There was no significant difference in baseline data including age, working years, and voice symptoms between the two groups. Both groups showed significant improvement (P<0.05) in all voice assessment before and after the treatment sessions, except for the Voice Handicap Index-10 (VHI-10) assessment. No statistical difference was found in other pre- and post-intervention voice assessment changes between the two study groups. The control group presented higher improvement in the total score, and the two subdomain assessments of physiology and emotion. CONCLUSIONS Telepractice voice intervention can effectively improve the voice quality of female teachers in elementary schools, and telepractice therapy can be an effective alternative to face-to-face voice intervention.
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Affiliation(s)
| | | | | | | | | | - Jinrang Li
- the Sixth Medical Center of PLA General Hospital
| | | | | | - Yang Liu
- The Sixth Medical Center of PLA General Hospital
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Weston ZM, Gochman G, Schneider SL. Predictors of Voice Therapy Attendance in an Interdisciplinary Care Model. J Voice 2023:S0892-1997(23)00375-2. [PMID: 38044170 DOI: 10.1016/j.jvoice.2023.11.015] [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: 08/30/2023] [Revised: 11/13/2023] [Accepted: 11/14/2023] [Indexed: 12/05/2023]
Abstract
OBJECTIVES/HYPOTHESIS The purpose of this study is to elucidate factors associated with voice therapy attendance within the interdisciplinary care model. STUDY DESIGN This was a retrospective review. METHODS Patients referred for voice therapy following interdisciplinary evaluation involving speech language pathology and laryngology were included. Independent variables were (1) duration between interdisciplinary voice evaluation and first voice therapy session, (2) plan of care determined at the time of evaluation, (3) mode of voice therapy delivery, and (4) stimulability for improvement during evaluation. Voice therapy attendance was measured as (1) attendance to the first voice therapy session and (2) overall voice therapy attendance. RESULTS Of 272 patients referred for voice therapy, 69.12% attended the first session, 17.28% canceled/no-showed (C/NS), and 13.6% did not schedule the first session. Of 235 patients who scheduled voice therapy, 48.94% attended all their scheduled sessions, and 51.06% C/NS at least one session. Patients with a plan of care including voice therapy + surgery were 86% less likely (risk ratio [RR] = 0.14, P = 0.0014) to C/NS any of their voice therapy sessions. In contrast, patients with plan of care including voice therapy + medication were more likely to C/NS at least one voice therapy session (RR = 1.27, P = 0.1419), although this finding was not significant. No other covariates had a significant impact on voice therapy initiation or overall attendance. CONCLUSIONS This study provides further support for the positive impact of interdisciplinary evaluation on voice therapy initiation. However, once voice therapy is initiated, overall C/NS rates are persistently high, consistent with previous investigations of voice therapy dropout. Our findings suggest that plan of care determined at the time of evaluation may have an impact on voice therapy attendance.
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Affiliation(s)
- Zoe M Weston
- UCSF Voice and Swallowing Center, Department of Otolaryngology Head and Neck Surgery, University of California San Francisco, San Francisco, California.
| | - Grant Gochman
- Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois
| | - Sarah L Schneider
- UCSF Voice and Swallowing Center, Department of Otolaryngology Head and Neck Surgery, University of California San Francisco, San Francisco, California
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Atará-Piraquive ÁP, Herrera-Guzmán CL, Hernández-Contreras JR, Rincón-Pinilla MP, Peña-Campagnoli AT, Florez-Lancheros GP, Cantor-Cutiva LC. Effect of a Workplace Vocal Health Promotion Program and Working Conditions on Voice Functioning of College Professors. J Voice 2023; 37:886-896. [PMID: 34275725 DOI: 10.1016/j.jvoice.2021.05.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 05/22/2021] [Accepted: 05/24/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine the effect of a Workplace Vocal Health Promotion Program (WVHPP) and working conditions on voice functioning of college professors. STUDY DESIGN This is a pre-post intervention study. METHODS College professors were randomly assigned in a control group or an intervention group. Participants filled out a questionnaire and recorded a voice sample at baseline and at the end of the follow-up. This program contains four sessions (2 face-to-face and 2 virtual sessions; one per week) focused on voice hygiene, vocal training, and strategies to modify teaching-learning process. RESULTS The Intervention group (n = 15) showed increased scores in V-RQOL in comparison with the control group (n = 14), but the effect was not statistically significant. After the program, shimmer decreased (P = 0.05), whereas MPT and HNR increased (P = 0.02 and 0.04 respectively) among professors in the intervention group after the implementation of the WVHPP. Concerning working conditions, number of students per class was statistically associated with SPL. MPT was statistically associated with age and good acoustics inside the classroom. CONCLUSIONS Our results indicate that implementation of a WVHPP, as well as working conditions, influence voice functioning measured by means of instrumental voice measures and voice-related quality of life. Therefore, workplace promotion programs may be good approaches to decrease the high prevalence of voice disorders among professors.
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Affiliation(s)
| | | | | | | | | | | | - Lady Catherine Cantor-Cutiva
- Department of Collective Health, Universidad Nacional de Colombia, Bogotá, Colombia; Program of Speech-Language Pathology, Universidad Manuela Beltrán, Bogotá, Colombia
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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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Gherson S, Tripp R, Goudelias D, Johnson AM. Rapid Implementation of Teletherapy for Voice Disorders: Challenges and Opportunities for Speech-Language Pathologists. J Voice 2023:S0892-1997(23)00206-0. [PMID: 37537109 DOI: 10.1016/j.jvoice.2023.06.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 06/27/2023] [Accepted: 06/28/2023] [Indexed: 08/05/2023]
Abstract
INTRODUCTION The COVID-19 pandemic necessitated a rapid restructuring of the clinical management of voice and upper airway disorders by speech-language pathologists (SLPs). As in-person therapy sessions were suspended, voice-specialized SLPs across healthcare settings shifted to online teletherapy. In this survey study, we queried voice therapists on their experiences with and opinions regarding the adoption of teletherapy into routine clinical practice. METHODS Voice-specialized SLPs were recruited nationwide to complete an online survey which included questions about the usability of software and hardware, patient management, the effectiveness of therapy, overall satisfaction, and suggestions for improvement. RESULTS 48 participants completed the survey. The majority of respondents reported frequent technical difficulties and poor access to or understanding of appropriate equipment. Overall, participants endorsed better patient access, attendance, and compliance, as well as increased scheduling flexibility. While 95% of the respondents stated they would recommend teletherapy to another SLP, only 20% supported a shift to exclusively virtual sessions. Forty percent of respondents endorsed a hybrid model consisting of initial in-person sessions followed by virtual ones. DISCUSSION Incorporating teletherapy into clinical voice practice has, for the most part, followed Carl May's normalization process theory framework, in that clinicians have invested understanding, training, time and effort, and appraisal into its implementation. However, the unusually rapid pace of change necessitated by the pandemic has presented its own set of challenges. Given the inherent conveniences of virtual therapy, the online modality is likely here to stay. It is critical that we understand the facilitators and barriers to its successful adoption.
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Affiliation(s)
- Shirley Gherson
- Department of Otolaryngology, New York University Grossman School of Medicine, New York, NY
| | - Raquel Tripp
- Department of Communicative Sciences and Disorders, New York University, New York, NY
| | - Deanna Goudelias
- Department of Communicative Sciences and Disorders, New York University, New York, NY
| | - Aaron M Johnson
- Department of Otolaryngology, New York University Grossman School of Medicine, New York, NY.
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Sresuganthi JR, Nallamuthu A, Boominathan P. Comparison of Client-Led Asynchronous and Clinician-Led Synchronous Online Methods for Evaluation of Subjective Vocal Measures in Teachers: A Feasibility Study. J Voice 2022:S0892-1997(22)00127-8. [PMID: 35641382 DOI: 10.1016/j.jvoice.2022.04.015] [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: 02/24/2022] [Revised: 04/21/2022] [Accepted: 04/21/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND COVID-19 has transformed face to face teaching in classrooms to online and hybrid modes. Increased vocal intensity/ pitch to call attention of students and transact in the online class, inappropriate posture (head, neck & upper trunk) while using the laptop and other online tools cause vocal loading leading to voice related concerns in teachers. Tele voice assessment is a feasible alternative means to seek professional help in the current situation and possibly in the future too. Client-led asynchronous and clinician-led synchronous voice recordings for clinical vocal measures among school teachers were compared in this study. METHOD Twenty-five school teachers (21 females & four males) from Chennai consented to the study. Information of voice use, its impact on the day-to-day situations, self-perception of vocal fatigue, and their recorded voice sample (phonation & speaking) were obtained online (asynchronous mode). Within a period of ten days, the clinician-led synchronous session was planned on a mutually convenient time for obtaining voice samples through zoom call. The voice samples obtained were compared for clinical measures and perceptual voice evaluation. RESULTS Participants reported of vocal symptoms and increased vocal fatigue scores. The maximum phonation time values obtained through synchronous mode were lesser when compared to asynchronous mode. Also, variability was noted in the perceptual vocal measures of voice samples obtained through synchronous mode. During synchronous voice recording & evaluation, the background noise, internet stability, audio enhancement feature, and microphone placement & quality could be monitored, and immediate feedback was provided. Additionally, the asynchronous recording can be supplemented for synchronous recording, with clear instructions & demonstration. CONCLUSION This study explored the feasibility of using synchronous and asynchronous voice recording for voice analysis in school teachers. The findings could serve as a base to understand the advantages and challenges of using client-led asynchronous and clinician-led synchronous methods for estimating vocal measures.
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Affiliation(s)
| | - Aishwarya Nallamuthu
- Department of Speech Language & Hearing Sciences, Sri Ramachandra Institute of Higher Education & Research, Chennai, Tamil Nadu, India.
| | - Prakash Boominathan
- Department of Speech Language & Hearing Sciences, Sri Ramachandra Institute of Higher Education & Research, Chennai, Tamil Nadu, India
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Rodríguez Marconi D, Morales C, Araya P, Ferrada R, Ibarra M, Catrifol MT. Uso del smartphone en telepráctica para trastornos de la voz. Una revisión desde el concepto de Mhealth. REVISTA DE INVESTIGACIÓN EN LOGOPEDIA 2022. [DOI: 10.5209/rlog.78550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
El uso de los smartphones y el concepto de mobile health (mHealth) es reciente en vocología y sus posibles beneficios en el tratamiento y entrenamiento vocal en contexto de telepráctica. Se realizó una revisión narrativa con el objetivo describir los beneficios de la mHealth a través del smartphone en el contexto de la telepráctica fonoaudiológica de los trastornos vocales. Se buscaron artículos científicos en Pubmed, ScienceDirect y Google Scholar, asociados al uso del smartphone en vocología, considerando voces humanas normales, patológicas y voces sintéticas; relacionados a la intervención, evaluación, valoración, monitoreo, prevención, intervención, supervisión, educación, consulta y entrenamiento vocal. Se revisaron 42 estudios, de los cuales fueron seleccionados 15 de acuerdo a los criterios de inclusión. Los estudios analizados se relacionan con grabación de voz para análisis acústico con smartphone, teleterapia con smartphone y dispositivos periféricos para análisis vocal y seguimiento. Se destaca el potencial de los dispositivos móviles para incrementar accecibilidad, reducir costos y favorecer el seguimiento terapéutico con medidas objetivas en diversos contextos de salud vocal.
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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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Castillo-Allendes A, Contreras-Ruston F, Cantor L, Codino J, Guzman M, Malebran C, Manzano C, Pavez A, Vaiano T, Wilder F, Behlau M. Terapia de voz en el contexto de la pandemia covid-19; recomendaciones para la práctica clínica. J Voice 2021; 35:808.e1-808.e12. [PMID: 32917457 PMCID: PMC7442931 DOI: 10.1016/j.jvoice.2020.08.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Since the beginning of the new pandemic, COVID-19 health services have had to face a new scenario. Voice therapy faces a double challenge, interventions using telepractice, and delivering rehabilitation services to a growing population of patients at risk of functional impairment related to the COVID-19 disease. Moreover, as COVID-19 is transmitted through droplets, it is critical to understand how to mitigate these risks during assessment and treatment. OBJECTIVE To promote safety, and effective clinical practice to voice assessment and rehabilitation in the pandemic COVID-19 context for speech-language pathologists. METHODS A group of 11 experts in voice and swallowing disorders from 5 different countries conducted a consensus recommendation following the American Academy of Otolaryngology-Head and Neck Surgery rules building a clinical guide for speech-language pathologists during this pandemic context. RESULTS The clinical guide provides 79 recommendations for clinicians in the management of voice disorders during the pandemic and includes advice from assessment, direct treatment, telepractice, and teamwork. The consensus was reached 95% for all topics. CONCLUSION This guideline should be taken only as recommendations; each clinician must attempt to mitigate the risk of infection and achieve the best therapeutic results taking into account the patient's particular reality.
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Affiliation(s)
- Adrián Castillo-Allendes
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing, Michigan
| | - Francisco Contreras-Ruston
- Speech-Language Pathology and Audiology Department, Universidad de Valparaíso, San Felipe, Chile,Address correspondence and reprint requests to Francisco Contreras-Ruston, CEV–Centro de Estudos da Voz, Rua Machado Bittencourt, 361, SP 04044-001, Brazil
| | - Lady Cantor
- Department of Collective Health, Universidad Nacional de Colombia, Bogotá, Colombia,Program of Speech and Language Pathology, Universidad Manuela Beltrán, Bogotá, Colombia
| | - Juliana Codino
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing, Michigan,Lakeshore Professional Voice Center, Lakeshore Ear, Nose, and Throat Center, St. Clair Shores, Michigan
| | - Marco Guzman
- Universidad de los Andes, Chile, Santiago, Chile
| | - Celina Malebran
- Escuela de Fonoaudiología, Universidad Católica Silva Henríquez, Santiago, Chile
| | - Carlos Manzano
- Hospital Médica Sur, Ciudad de México, México,Centro Médico ABC, Ciudad de México, México
| | - Axel Pavez
- Physical Medicine and Rehabilitation Service, Hospital de Urgencia Asistencia Pública. Santiago, Chile
| | - Thays Vaiano
- CEV - Centro de Estudos da Voz, São Paulo, Brazil,Speech-Language Pathology and Audiology Department, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil
| | - Fabiana Wilder
- Carrera de Fonoaudiología, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina,Servicio de Fonoudiología, Hospital de Clínicas “José de San Martin”, Buenos Aires, Argentina
| | - Mara Behlau
- CEV - Centro de Estudos da Voz, São Paulo, Brazil,Speech-Language Pathology and Audiology Department, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil
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Castillo-Allendes A, Contreras-Ruston F, Cantor L, Codino J, Guzman M, Malebran C, Manzano C, Pavez A, Vaiano T, Wilder F, Behlau M. Terapia Vocal No Contexto Da Pandemia Do Covid-19; Orientações Para A Prática Clínica. J Voice 2021; 35:808.e13-808.e24. [PMID: 32917460 PMCID: PMC7439998 DOI: 10.1016/j.jvoice.2020.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Since the beginning of the new pandemic, Corona Virus Disease 2019 (COVID-19) health services have had to face a new scenario. Voice therapy faces a double challenge, interventions using telepractice, and delivering rehabilitation services to a growing population of patients at risk of functional impairment related to the COVID-19 disease. Moreover, as COVID-19 is transmitted through droplets, it is critical to understand how to mitigate these risks during assessment and treatment. OBJECTIVE To promote safety, and effective clinical practice to voice assessment and rehabilitation in the pandemic COVID-19 context for speech-language pathologists. METHODS A group of 11 experts in voice and swallowing disorders from five different countries conducted a consensus recommendation following the American Academy of Otolaryngology-Head and Neck Surgery rules building a clinical guide for speech-language pathologists during this pandemic context. RESULT The clinical guide provides 79 recommendations for clinicians in the management of voice disorders during the pandemic and includes advice from assessment, direct treatment, telepractice, and teamwork. The consensus was reached 95% for all topics. CONCLUSION This guideline should be taken only as recommendation; each clinician must attempt to mitigate the risk of infection and achieve the best therapeutic results taking into account the patient's particular reality.
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Affiliation(s)
- Adrián Castillo-Allendes
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing, Michigan
| | - Francisco Contreras-Ruston
- Speech-Language Pathology and Audiology Department, Universidad de Valparaíso, San Felipe, Chile,Address correspondence and reprint requests to Francisco Contreras-Ruston, CEV–Centro de Estudos da Voz, Rua Machado Bittencourt, 361, SP 04044-001, Brazil
| | - Lady Cantor
- Department of Collective Health, Universidad Nacional de Colombia, Bogotá, Colombia,Program of Speech and Language Pathology, Universidad Manuela Beltrán, Bogotá, Colombia
| | - Juliana Codino
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing, Michigan,Lakeshore Professional Voice Center, Lakeshore Ear, Nose, and Throat Center, St. Clair Shores, Michigan
| | - Marco Guzman
- Universidad de los Andes, Chile, Santiago, Chile
| | - Celina Malebran
- Escuela de Fonoaudiología, Universidad Católica Silva Henríquez, Santiago, Chile
| | - Carlos Manzano
- Hospital Médica Sur, Ciudad de México, México,Centro Médico ABC, Ciudad de México, México
| | - Axel Pavez
- Physical Medicine and Rehabilitation Service, Hospital de Urgencia Asistencia Pública. Santiago, Chile
| | - Thays Vaiano
- CEV - Centro de Estudos da Voz, São Paulo, Brazil,Speech-Language Pathology and Audiology Department, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil
| | - Fabiana Wilder
- Carrera de Fonoaudiología, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina,Servicio de Fonoudiología, Hospital de Clínicas “José de San Martin,” Buenos Aires, Argentina
| | - Mara Behlau
- CEV - Centro de Estudos da Voz, São Paulo, Brazil,Speech-Language Pathology and Audiology Department, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil
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Castillo-Allendes A, Contreras-Ruston F, Cantor-Cutiva LC, Codino J, Guzman M, Malebran C, Manzano C, Pavez A, Vaiano T, Wilder F, Behlau M. Voice Therapy in the Context of the COVID-19 Pandemic: Guidelines for Clinical Practice. J Voice 2021; 35:717-727. [PMID: 32878736 PMCID: PMC7413113 DOI: 10.1016/j.jvoice.2020.08.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 07/30/2020] [Accepted: 08/03/2020] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Since the beginning of the new pandemic, COVID-19 health services have had to face a new scenario. Voice therapy faces a double challenge, interventions using telepractice, and delivering rehabilitation services to a growing population of patients at risk of functional impairment related to the COVID-19 disease. Moreover, as COVID-19 is transmitted through droplets, it is critical to understand how to mitigate these risks during assessment and treatment. OBJECTIVE To promote safety, and effective clinical practice to voice assessment and rehabilitation in the pandemic COVID-19 context for speech-language pathologists. METHODS A group of 11 experts in voice and swallowing disorders from five different countries conducted a consensus recommendation following the American Academy of Otolaryngology-Head and Neck Surgery rules building a clinical guide for speech-language pathologists during this pandemic context. RESULTS The clinical guide provides 65 recommendations for clinicians in the management of voice disorders during the pandemic and includes advice from assessment, direct treatment, telepractice, and teamwork. The consensus was reached 95% for all topics. CONCLUSION This guideline should be taken only as recommendation; each clinician must attempt to mitigate the risk of infection and achieve the best therapeutic results taking into account the patient's particular reality.
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Affiliation(s)
- Adrián Castillo-Allendes
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing, Michigan
| | | | - Lady Catherine Cantor-Cutiva
- Department of Collective Health, Universidad Nacional de Colombia, Bogotá, Colombia; Program of Speech and Language Pathology, Universidad Manuela Beltrán, Bogotá, Colombia
| | - Juliana Codino
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing, Michigan; Lakeshore Professional Voice Center, Lakeshore Ear, Nose, and Throat Center, St. Clair Shores, Michigan
| | - Marco Guzman
- Universidad de los Andes, Chile, Santiago, Chile
| | - Celina Malebran
- Escuela de Fonoaudiología, Universidad Católica Silva Henríquez, Santiago, Chile
| | - Carlos Manzano
- Hospital Médica Sur, Ciudad de México, México; Centro Médico ABC, Ciudad de México, México
| | - Axel Pavez
- Physical Medicine and Rehabilitation Service, Hospital de Urgencia Asistencia Pública. Santiago, Chile
| | - Thays Vaiano
- CEV - Centro de Estudos da Voz, São Paulo, Brazil; Speech-Language Pathology and Audiology Department, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil
| | - Fabiana Wilder
- Carrera de Fonoaudiología, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina; Servicio de Fonoudiología, Hospital de Clínicas "José de San Martin", Buenos Aires, Argentina
| | - Mara Behlau
- CEV - Centro de Estudos da Voz, São Paulo, Brazil; Speech-Language Pathology and Audiology Department, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil
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Grillo EU. A Nonrandomized Trial for Student Teachers of an In-Person and Telepractice Global Voice Prevention and Therapy Model With Estill Voice Training Assessed by the VoiceEvalU8 App. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:566-583. [PMID: 33524262 PMCID: PMC8740681 DOI: 10.1044/2020_ajslp-20-00200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 09/03/2020] [Accepted: 11/03/2020] [Indexed: 05/30/2023]
Abstract
Purpose This study investigated the effects of the in-person and telepractice Global Voice Prevention and Therapy Model (GVPTM) treatment conditions and a control condition with vocally healthy student teachers. Method In this single-blinded, nonrandomized trial, 82 participants completed all aspects of the study. Estill Voice Training was used as the stimulability component of the GVPTM to train multiple new voices meeting all the vocal needs of the student teachers. Outcomes were assessed using acoustic, perceptual, and aerodynamic measures captured by the VoiceEvalU8 app at pre and post in fall and during student teaching in spring. Results Significant improvements were achieved for several acoustic and perceptual measures in the treatment conditions, but not in the control condition. The in-person and telepractice conditions produced similar results. The all-voiced phrase and connected speech were more successful in demonstrating voice change for some of the perturbation measures as compared to sustained /a/. Conclusions The treatment conditions were successful in improving the participants' voices for fundamental frequency and some acoustic perturbation measures while maintaining the improvements during student teaching. In addition, the treatment conditions were successful in decreasing the negative impact of voice-related quality of life and vocal fatigue during student teaching. Future research should address the effectiveness of the various components of the GVPTM, the application of the GVPTM with patients with voice disorders, the relevance of defining auditory-perceptual terms by the anatomy and physiology of the voice production system (i.e., Estill Voice Training), and the continued use of the VoiceEvalU8 app for clinical voice investigations. Supplemental Material https://doi.org/10.23641/asha.13626824.
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Affiliation(s)
- Elizabeth U. Grillo
- Department of Communication Sciences and Disorders, West Chester University, PA
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17
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Pierce JL, Tanner K, Merrill RM, Shnowske L, Roy N. A Field-Based Approach to Establish Normative Acoustic Data for Healthy Female Voices. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:691-706. [PMID: 33561361 DOI: 10.1044/2020_jslhr-20-00490] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose The primary aim of this study was to obtain high-quality acoustic normative data in natural field environments for female voices. A secondary aim was to examine acoustic measurement variability in field environments. Method This study employed a within-subject repeated-measures experimental design that included 45 young female adults with normal voices. Participants were stratified by age (18-23, 24-29, and 30-35 years). After initial evaluation and instruction, participants completed voice recordings during seven consecutive days using a standard protocol, including both connected speech and sustained vowels. Thirty-two cepstral-, spectral-, and time-based acoustic measures were acquired using Praat and the Analysis of Dysphonia in Speech and Voice. Results Among the 958 total recordings, greater than 90% satisfied inclusion criteria based on protocol compliance, peak clipping, and signal-to-noise ratio. Significant differences were observed for age (p < .05). For 19 acoustic measures, values improved significantly as signal-to-noise ratio increased. Cepstral- and spectral-based measures demonstrated less measurement variability as compared with time-based measures. Conclusions With adequate training, field audio recordings represent a viable option for clinical voice management. The significant age effects observed in this study support the need for more specific criteria when collecting and applying normative data. Cepstral- and spectral-based measures demonstrated the least measurement variability. This study provides additional evidence for multiparameter acoustic voice measurement, specifically toward ecologically valid sampling in natural environments. Future studies should expand on these findings in other populations with normal and disordered voices.
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Affiliation(s)
- Jenny L Pierce
- Department of Surgery, The University of Utah, Salt Lake City
- Department of Communication Sciences & Disorders, The University of Utah, Salt Lake City
| | - Kristine Tanner
- Department of Communication Disorders, Brigham Young University, Provo, UT
| | - Ray M Merrill
- Department of Public Health, Brigham Young University, Provo, UT
| | - Lauren Shnowske
- Department of Communication Sciences & Disorders, The University of Utah, Salt Lake City
- Department of Communication Sciences and Disorders, University of Kentucky, Lexington
| | - Nelson Roy
- Department of Communication Sciences & Disorders, The University of Utah, Salt Lake City
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18
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Hseu AF, Spencer G, Woodnorth G, Kagan S, Kawai K, Nuss RC. Barriers to Voice Therapy in Dysphonic Children. J Voice 2021; 37:410-414. [PMID: 33637356 DOI: 10.1016/j.jvoice.2021.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 01/06/2021] [Accepted: 01/08/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND The most common etiologies of dysphonia in the pediatric population are vocal fold nodules and muscle tension dysphonia. Vocal therapy is the first line treatment for these disorders in children. Despite this, not all children undergo therapy. The goal of this study is to examine how factors such as patient demographics and parental perceptions differ between children that choose to undergo or not to undergo voice therapy. METHODS A retrospective review was conducted of all pediatric patients seen at a tertiary voice clinic between January 2014 and December 2017. Patients were included if diagnosed with vocal fold nodules and/or muscle tension dysphonia. Patients were divided into groups of children that received voice therapy at our institution and those that did not. Data include demographics, Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) scores and pediatric Voice Handicap Index (pVHI) scores. Distance to therapy site was approximated using patient zip codes. RESULTS Three hundred and forty-six children were included, 224 (65%) boys and 122 (35%) girls. In the 2 years following initial diagnosis, 74 (21%) children participated in voice therapy at our institution. Patients who underwent voice therapy were older than those who did not (mean age: 9.1 [SD 3.5] vs 7.6 [SD 3.8] years; P = 0.004). Patients who received voice therapy were more likely to live closer to the therapy site (mean distance: 15.5 [SD 13.0] vs 24.3 [SD 23.9] miles; P< 0.001). Likelihood of receiving voice therapy did not differ by gender or health insurance status (private vs public). Patients who underwent voice therapy had significantly greater CAPE-V Overall Severity scores than those who did not (mean score: 44.6 [SD 19.4] vs 37.4 [SD 18.0]; P = 0.003). Higher CAPE-V Strain scores were associated with increased likelihood of voice therapy. pVHI scores did not differ between the two groups. CONCLUSION Older age, shorter distance to therapy site, and increased CAPE-V Overall Severity and Strain scores were associated with higher likelihood of receiving voice therapy. Gender, insurance status, and pVHI scores did not affect likelihood of receiving voice therapy. Patients may primarily consider ease of access and necessity of treatment when considering voice therapy.
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Affiliation(s)
- Anne F Hseu
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts; Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts.
| | - Grant Spencer
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts
| | - Geralyn Woodnorth
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts
| | - Sydney Kagan
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts
| | - Kosuke Kawai
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts; Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts
| | - Roger C Nuss
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts; Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts
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Grillo EU. Functional Voice Assessment and Therapy Methods Supported by Telepractice, VoiceEvalU8, and Estill Voice Training. Semin Speech Lang 2021; 42:41-53. [PMID: 33596603 DOI: 10.1055/s-0040-1722753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Functional assessment and therapy methods are necessary for a client-centered approach that addresses the client's vocal needs across all environments. The purpose of this article is to present the approach with the intent to encourage discussion and implementation among educators, clinicians, researchers, and students. The functional approach is defined and its importance is described within the context of the World Health Organization's International Classification of Functioning, Disability, and Health with support provided by synchronous and asynchronous telepractice, the VoiceEvalU8 app, server, and web portal, and a framework that defines voice qualities (e.g., resonance, twang, loud, and others) by the anatomy and physiology of the voice production system (i.e., Estill Figures for Voice). Case scenarios are presented to highlight application of the functional voice approach.
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Affiliation(s)
- Elizabeth U Grillo
- Department of Communication Sciences and Disorders, West Chester University, West Chester, Pennsylvania
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Becker DR, Gillespie AI. In the Zoom Where It Happened: Telepractice and the Voice Clinic in 2020. Semin Speech Lang 2021; 42:64-72. [PMID: 33596605 DOI: 10.1055/s-0040-1722750] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Telemedicine-conveying medical information virtually for planning, diagnosis, or treatment-has been a part of the American medical system for over 100 years. A constantly evolving modality, telepractice was a supplemental care delivery system for most speech-language pathologists (SLPs) until March 2020 when the COVID-19 pandemic forced clinical operations to halt in-person activities and convert as much as possible to virtual platforms. The purpose of this article is to provide an overview of the need for telepractice prior to and beyond the current pandemic, the efficacy of telepractice for the voice-specialized SLP, limitations of telepractice, and best practices for providing care over telepractice with a specific focus on voice disorder diagnosis and treatment.
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Affiliation(s)
- Diana Rose Becker
- Emory Voice Center, Department of Otolaryngology, Emory Healthcare, Emory University Hospital Midtown, Atlanta, Georgia
| | - Amanda I Gillespie
- Emory Voice Center, Department of Otolaryngology, Emory Healthcare, Emory University Hospital Midtown, Atlanta, Georgia
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21
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Ditthapron A, O Agu E, C Lammert A. Privacy-Preserving Deep Speaker Separation for Smartphone-Based Passive Speech Assessment. IEEE OPEN JOURNAL OF ENGINEERING IN MEDICINE AND BIOLOGY 2021; 2:304-313. [PMID: 35402977 PMCID: PMC8940203 DOI: 10.1109/ojemb.2021.3063994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/24/2021] [Accepted: 03/01/2021] [Indexed: 12/03/2022] Open
Abstract
Goal: Smartphones can be used to passively assess and monitor patients’ speech impairments caused by ailments such as Parkinson’s disease, Traumatic Brain Injury (TBI), Post-Traumatic Stress Disorder (PTSD) and neurodegenerative diseases such as Alzheimer’s disease and dementia. However, passive audio recordings in natural settings often capture the speech of non-target speakers (cross-talk). Consequently, speaker separation, which identifies the target speakers’ speech in audio recordings with two or more speakers’ voices, is a crucial pre-processing step in such scenarios. Prior speech separation methods analyzed raw audio. However, in order to preserve speaker privacy, passively recorded smartphone audio and machine learning-based speech assessment are often performed on derived speech features such as Mel-Frequency Cepstral Coefficients (MFCCs). In this paper, we propose a novel Deep MFCC bAsed SpeaKer Separation (Deep-MASKS). Methods: Deep-MASKS uses an autoencoder to reconstruct MFCC components of an individual’s speech from an i-vector, x-vector or d-vector representation of their speech learned during the enrollment period. Deep-MASKS utilizes a Deep Neural Network (DNN) for MFCC signal reconstructions, which yields a more accurate, higher-order function compared to prior work that utilized a mask. Unlike prior work that operates on utterances, Deep-MASKS operates on continuous audio recordings. Results: Deep-MASKS outperforms baselines, reducing the Mean Squared Error (MSE) of MFCC reconstruction by up to 44% and the number of additional bits required to represent clean speech entropy by 36%.
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Affiliation(s)
- Apiwat Ditthapron
- Computer Science DepartmentWorcester Polytechnic Institute Worcester MA 01609 USA
| | - Emmanuel O Agu
- Computer Science DepartmentWorcester Polytechnic Institute Worcester MA 01609 USA
| | - Adam C Lammert
- Biomedical Engineering DepartmentWorcester Polytechnic Institute Worcester MA 01609 USA
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22
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Grillo EU, Wolfberg J. An Assessment of Different Praat Versions for Acoustic Measures Analyzed Automatically by VoiceEvalU8 and Manually by Two Raters. J Voice 2020; 37:17-25. [PMID: 33384248 PMCID: PMC8236489 DOI: 10.1016/j.jvoice.2020.12.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 12/03/2020] [Accepted: 12/04/2020] [Indexed: 01/17/2023]
Abstract
INTRODUCTION The purpose of the study was to assess acoustic measures of fundamental frequency (fo), standard deviation of fo (SD of fo), jitter%, shimmer%, noise-to-harmonic ratio (NHR), smoothed cepstral peak prominence (CPPS), and acoustic voice quality index analyzed through multiple Praat versions automatically by VoiceEvalU8 or manually by two raters. In addition, default settings to calculate CPPS in two Praat versions manually analyzed by two raters were compared to Maryn and Weenik20 procedures for CPPS automatically analyzed by VoiceEvalU8. METHODS Nineteen vocally healthy females used VoiceEvalU8 to record three 5-s sustained /a/ trials, the all voiced phrase "we were away a year ago," and a 15-s speech sample twice a day for five consecutive days. Two raters manually completed acoustic analysis using different versions of Praat and compared that analysis to measures automatically generated through a version of Praat used by VoiceEvalU8. One-way analyses of variance were run for all acoustic measures with post-hoc testing by the Bonferroni method. For acoustic measures that demonstrated significant differences, intraclass correlation coefficients were conducted. RESULTS Results showed no significant differences across automatic and manual analysis for different versions of Praat for all acoustic measures during /a/, for fo, jitter%, shimmer%, and NHR during the phrase, for jitter%, shimmer%, NHR, and CPPS during speech, and for acoustic voice quality index calculated from both sustained /a/ and the phrase. The default Praat settings for CPPS were not significantly different from the Maryn and Weenik20 procedures for sustained /a/ and speech. Significant differences were present for SD of fo and CPPS during the phrase and fo and SD of fo during speech. SD of fo and CPPS in the phrase were moderately correlated and fo and SD of fo during speech demonstrated good to excellent correlations across the different versions of Praat. CONCLUSIONS Acoustic measures analyzed through sustained /a/ and some of the acoustic measures during the phrase and speech were not different across multiple versions of Praat. Automatic analysis by VoiceEvalU8 produced similar mean values as compared to manual analysis by two raters. Even though SD of fo and CPPS in the phrase and fo and SD of fo in speech were different across the versions of Praat, the measures demonstrated moderate to excellent reliability.
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Affiliation(s)
- Elizabeth U. Grillo
- West Chester University, Department of Communication Sciences and Disorders, 201 Carter Drive, Suite 413, West Chester, PA, 19383, USA
| | - Jeremy Wolfberg
- Massachuetts General Hospital Institute of Health Professions, Speech-Language Pathology Master’s Program, Boston, MA, USA
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23
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Brockmann-Bauser M, Balandat B, Bohlender JE. Immediate Lip Trill Effects on the Standard Diagnostic Measures Voice Range Profile, Jitter, Maximum Phonation Time, and Dysphonia Severity Index. J Voice 2019; 34:874-883. [PMID: 31196690 DOI: 10.1016/j.jvoice.2019.04.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 04/18/2019] [Accepted: 04/18/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Semi-occluded vocal tract exercises are widely applied to improve vocal performance in speakers, singers, and voice patients. This study investigates immediate lip trill effects on standard voice assessment measures including voice range profiles, jitter, maximum phonation time, and Dysphonia Severity Index in vocally healthy women. STUDY DESIGN Experimental study. SETTING Otolaryngology clinic within tertiary hospital. SUBJECTS AND METHODS Twenty-five vocally healthy women between 19 and 58 years (mean 38.4) were assessed before and after 3 minutes of standardized lip trill training combined with defined voice fundamental frequency and intensity modulations. Main outcome measures were fundamental frequency (F0) during counting (F0 counting), the singing voice range profile parameters minimum, maximum and range of F0 and voice sound pressure level (voice SPL), jitter (%), maximum phonation time (MPT), and the Dysphonia Severity Index (DSI). Wilcoxon signed rank test was applied to determine significant changes after exercise. RESULTS After exercise the singing F0 and SPL range significantly increased from 549 (SD 217) to 612 (238) Hz and 45.1 (10.1) to 47.3 (9.8) dBA, resepctively (P<0.05). Maximum voice SPL significantly increased from 90.9 (10.3) to 94 (9.7) dBA (P<0.05). Mean F0 during counting showed a highly significant increase from 198 (SD 25.6) to 209 Hz (SD 25.4, P<0.01). No significant changes were found for all other parameters. CONCLUSIONS In vocally healthy women, lip trill training immediately facilitates increases in mean F0 during counting, and singing F0 and SPL range. Future studies should investigate, if changes to these parameters indicate immediate responsiveness to voice exercise also in voice patients, and if these findings transfer to long-term effects through prolonged training.
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Affiliation(s)
- M Brockmann-Bauser
- University Hospital Zürich, Department of Phoniatrics and Speech Pathology, Zurich, Switzerland; University of Zürich, Zurich, Switzerland.
| | - B Balandat
- University Hospital Zürich, Department of Phoniatrics and Speech Pathology, Zurich, Switzerland; University of Zürich, Zurich, Switzerland
| | - J E Bohlender
- University Hospital Zürich, Department of Phoniatrics and Speech Pathology, Zurich, Switzerland; University of Zürich, Zurich, Switzerland
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Grillo EU, Brosious JN. Results of a Voice-Related Survey of Physical Education Student Teachers. COMMUNICATION DISORDERS QUARTERLY 2019; 40:99-108. [PMID: 32952447 PMCID: PMC7500702 DOI: 10.1177/1525740118774207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
The current study investigated physical education (PE) student teachers' understanding of the vocal demands of their future profession, interest in participating in a voice-training program, and the current impact of the voice on quality-of-life by the Voice Handicap Index (VHI, Jacobson et al., 1997). Seventy-four PE student teachers completed a voice-related survey and the VHI. Forty-three percent of participants indicated that teaching will negatively affect the voice and 29% of participants reported that they may develop a voice problem because of teaching; however, only 17% of participants indicated that a voice training program was needed to learn healthy and effective voice use for teaching. Based on the results, participants knew that teaching may negatively impact the voice, but they were not convinced that a voice training program was necessary. In addition, the student teachers' voices were not negatively impacting quality- of-life, as determined by the VHI.
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Affiliation(s)
- Elizabeth U Grillo
- West Chester University, Department of Communication Sciences and Disorders, 201 Carter Drive, Suite 413, West Chester, PA 19383
| | - Jenna N Brosious
- West Chester University, Department of Communication Sciences and Disorders, 201 Carter Drive, Suite 413, West Chester, PA 19383
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Grillo EU. Building a Successful Voice Telepractice Program. PERSPECTIVES OF THE ASHA SPECIAL INTEREST GROUPS 2019; 4:100-110. [PMID: 31544152 PMCID: PMC6754185 DOI: 10.1044/2018_pers-sig3-2018-0014] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE Telepractice offers prevention, assessment, treatment, and consultation at a distance. This article provides an overview of telepractice with specific considerations and examples related to voice across licensure requirements, state and federal laws, reimbursement, documentation, and telepractice methods. CONCLUSION As technology continues to advance and as client demand for telepractice services increases, practitioners need to create successful telepractice programs.
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Affiliation(s)
- Elizabeth U. Grillo
- Department of Communication Sciences and Disorders, West Chester University, PA
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