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Morales A, Yuz JI, Cortés JP, Fontanet JG, Zañartu M. Glottal Airflow Estimation using Neck Surface Acceleration and Low-Order Kalman Smoothing. IEEE/ACM TRANSACTIONS ON AUDIO, SPEECH, AND LANGUAGE PROCESSING 2023; 31:2055-2066. [PMID: 38130818 PMCID: PMC10732542 DOI: 10.1109/taslp.2023.3277269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
The use of non-invasive skin accelerometers placed over the extrathoracic trachea has been proposed in the literature for measuring vocal function. Glottal airflow is estimated using inverse filtering or Bayesian techniques based on a subglottal impedance-based model when utilizing these sensors. However, deviations in glottal airflow estimates can arise due to sensor positioning and model mismatch, and addressing them requires a significant computational load. In this paper, we utilize system identification techniques to obtain a low order state-space representation of the subglottal impedance-based model. We then employ the resulting low order model in a Kalman smoother to estimate the glottal airflow. Our proposed approach reduces the model order by 94% and requires only 1.5% of the computing time compared to previous Bayesian methods in the literature, while achieving slightly better accuracy when correcting for glottal airflow deviations. Additionally, our Kalman smoother approach provides a measure of uncertainty in the airflow estimate, which is valuable when measurements are taken under different conditions. With its comparable accuracy in signal estimation and reduced computational load, the proposed approach has the potential for real-time estimation of glottal airflow and its associated uncertainty in wearable voice ambulatory monitors using neck-surface acceleration.
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Affiliation(s)
- Arturo Morales
- Department of Electronic Engineering, Universidad Técnica Federico Santa María, Valparaíso 2390123, Chile
| | - Juan I Yuz
- Department of Electronic Engineering, Universidad Técnica Federico Santa María, Valparaíso 2390123, Chile
| | - Juan Pablo Cortés
- Department of Electronic Engineering, Universidad Técnica Federico Santa María, Valparaíso 2390123, Chile
| | - Javier G Fontanet
- Department of Electronic Engineering, Universidad Técnica Federico Santa María, Valparaíso 2390123, Chile
| | - Matías Zañartu
- Department of Electronic Engineering, Universidad Técnica Federico Santa María, Valparaíso 2390123, Chile
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Bullock L, Toles LE, Hillman RE, Mehta DD. Acoustic-Aerodynamic Voice Outcome Ratios Identify Changes in Vocal Function Following Vocal Fold Medialization for Unilateral Vocal Fold Paralysis. J Voice 2023:S0892-1997(23)00104-2. [PMID: 37068982 PMCID: PMC10576834 DOI: 10.1016/j.jvoice.2023.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/09/2023] [Accepted: 03/10/2023] [Indexed: 04/19/2023]
Abstract
PURPOSE This study aimed to determine whether ratio-based measures that combine acoustic (output) and aerodynamic (input) parameters detect postoperative change in vocal function following vocal fold medialization for unilateral vocal fold paralysis. METHOD Pre- and postoperative acoustic and aerodynamic measures were analyzed retrospectively from 149 patients who underwent vocal fold medialization for unilateral vocal fold paralysis. A 2 × 2 repeated-measures analysis of variance was conducted for each of four acoustic-aerodynamic ratios-traditional vocal efficiency (VE), sound pressure level to aerodynamic power (SPL/AP), SPL to average airflow (SPL/AFLOW), and SPL to subglottal pressure (SPL/Ps)-to investigate the main effects and interaction of treatment stage and loudness level (comfortable and loud). RESULTS The patient group showed significant postoperative improvements in self reports of vocal function (voice-related quality of life) and clinical auditory-perceptual judgments of dysphonia (consensus auditory-perceptual evaluation of voice). Main effects for both treatment stage and loudness level were statistically significant for all measures except SPL/Ps. There were interaction effects for VE and SPL/AP, suggesting that magnitude of the treatment effect differs based on loudness. SPL/AFLOW had medium-to-large effect sizes in both loudness conditions. There were postoperative changes in SPL/Ps that were dependent on the magnitude of the reduction in AFLOW; as expected, SPL/Ps increased postoperatively in a subgroup that had large postoperative reductions in AFLOW at the comfortable loudness level. CONCLUSIONS Acoustic-aerodynamic ratios can aid in tracking changes in vocal function following vocal fold medialization. SPL/AFLOW exhibited the largest effect size, which is expected since a reduction in abnormally high AFLOW typically accompanies the increased modulation of glottal air flow associated with successful vocal fold medialization. Future study is needed to model physiological changes in acoustic-aerodynamic voice outcome ratios across different types of voice disorders.
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Affiliation(s)
- Latané Bullock
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts; Division of Medical Sciences, Speech and Hearing Bioscience and Technology, Harvard Medical School, Boston, Massachusetts
| | - Laura E Toles
- Department of Otolaryngology-Head and Neck Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Robert E Hillman
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts; Division of Medical Sciences, Speech and Hearing Bioscience and Technology, Harvard Medical School, Boston, Massachusetts; Department of Surgery, Harvard Medical School, Boston, Massachusetts; School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Boston, Massachusetts
| | - Daryush D Mehta
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts; Division of Medical Sciences, Speech and Hearing Bioscience and Technology, Harvard Medical School, Boston, Massachusetts; Department of Surgery, Harvard Medical School, Boston, Massachusetts; School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Boston, Massachusetts.
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Nudelman CJ, Codino J, Fry AC, Bottalico P, Rubin AD. Voice Biofeedback via Bone Conduction Headphones: Effects on Acoustic Voice Parameters and Self-Reported Vocal Effort in Individuals With Voice Disorders. J Voice 2022:S0892-1997(22)00320-4. [PMID: 36372674 DOI: 10.1016/j.jvoice.2022.10.014] [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: 08/23/2022] [Revised: 10/17/2022] [Accepted: 10/18/2022] [Indexed: 11/13/2022]
Abstract
PURPOSE This study explores sidetone amplification (amplified playback of one's own voice) provided via bone conduction in participants with voice disorders. The effects of bone conduction feedback on acoustic voice parameters and vocal effort ratings are examined. METHODS Speech samples of 47 participants with voice disorders were recorded in three auditory feedback conditions: two with sidetone amplification delivered via bone conduction and one condition with no alteration of the feedback. After each task, the participants rated their vocal effort on a visual analog scale. The voice recordings were evaluated by a speech-language pathologist through the GRBAS scale and processed to calculate the within-participant centered sound pressure level (SPL) values, the mean pitch strength (PS), the time dose (Dt%), and cepstral peak prominence smoothed (CPPS). The effects of the feedback conditions on these acoustic parameters and vocal effort ratings were analyzed. RESULTS The high sidetone amplification condition resulted in a statistically significant decrease in the within-participant centered SPL values and mean pitch strength across all participants. The feedback conditions had no statistically significant effects on the vocal effort ratings, time dose (Dt%), or CPPS. CONCLUSIONS This study provides an evidence that bone conduction sidetone amplification contributes to a consistent adaptation in the within-participant centered SPL values (ΔSPL) in patients with vocal hyperfunction, glottal insufficiency, and organic/neurological laryngeal pathologies compared to conditions with no feedback.
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Affiliation(s)
- Charles J Nudelman
- Department of Speech and Hearing Science, University of Illinois Urbana-Champaign, Champaign, Illinois.
| | - Juliana Codino
- Lakeshore Professional Voice Center, Lakeshore Ear, Nose, and Throat Center, St. Clair Shores, Michigan
| | - Adam C Fry
- Lakeshore Professional Voice Center, Lakeshore Ear, Nose, and Throat Center, St. Clair Shores, Michigan
| | - Pasquale Bottalico
- Department of Speech and Hearing Science, University of Illinois Urbana-Champaign, Champaign, Illinois
| | - Adam D Rubin
- Lakeshore Professional Voice Center, Lakeshore Ear, Nose, and Throat Center, St. Clair Shores, Michigan
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Richardson K, Huber JE, Kiefer B, Kane C, Snyder S. Respiratory Responses to Two Voice Interventions for Parkinson's Disease. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:3730-3748. [PMID: 36167066 PMCID: PMC9937051 DOI: 10.1044/2022_jslhr-22-00262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/22/2022] [Accepted: 06/24/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE The purpose of this study was to examine the respiratory strategies used by persons with Parkinson's disease (PD) to support louder speech in response to two voice interventions. Contrasting interventions were selected to investigate the role of internal and external cue strategies on treatment outcomes. LSVT LOUD, which uses an internal cueing framework, and the SpeechVive prosthesis, which employs an external noise cue to elicit louder speech, were studied. METHOD Thirty-four persons with hypophonia secondary to idiopathic PD were assigned to one of three groups: LSVT LOUD (n = 12), SpeechVive (n = 12), or a nontreatment clinical control (n = 10). The LSVT LOUD and SpeechVive participants received 8 weeks of voice intervention. Acoustic and respiratory kinematic data were simultaneously collected at pre-, mid- and posttreatment during a monologue speech sample. Intervention outcomes included sound pressure level (SPL), utterance length, lung volume initiation, lung volume termination, and lung volume excursion. RESULTS As compared to controls, the LSVT LOUD and SpeechVive participants significantly increased SPL at mid- and posttreatment, thus confirming a positive intervention effect. Treatment-related changes in speech breathing were further identified, including significantly longer utterance lengths (syllables per breath group) at mid- and posttreatment, as compared to pretreatment. The respiratory strategies used to support louder speech varied by group. The LSVT LOUD participants terminated lung volume at significantly lower levels at mid- and posttreatment, as compared to pretreatment. This finding suggests the use of greater expiratory muscle effort by the LSVT LOUD participants to support louder speech. Participants in the SpeechVive group did not significantly alter their respiratory strategies across the intervention period. Single-subject effect sizes highlight the variability in respiratory strategies used across speakers to support louder speech. CONCLUSIONS This study provides emerging evidence to suggest that the LSVT LOUD and SpeechVive therapies elicit different respiratory adjustments in persons with PD. The study highlights the need to consider respiratory function when addressing voice targets in persons with PD.
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Affiliation(s)
- Kelly Richardson
- Department of Communication Disorders, University of Massachusetts Amherst
| | - Jessica E. Huber
- Department of Communication Disorders, University of Massachusetts Amherst
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, IN
| | - Brianna Kiefer
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, IN
| | - Caitlin Kane
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, IN
| | - Sandy Snyder
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, IN
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Toles LE, Seidman AY, Hillman RE, Mehta DD. Clinical Utility of the Ratio of Sound Pressure Level to Subglottal Pressure in Patients Surgically Treated for Phonotraumatic Vocal Fold Lesions. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:2778-2788. [PMID: 35914023 PMCID: PMC9911101 DOI: 10.1044/2022_jslhr-21-00658] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 04/07/2022] [Accepted: 05/02/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE This study aimed to determine whether a simplified, and potentially more stable, acoustic-aerodynamic voice outcome ratio (ratio of sound pressure level [SPL] to subglottal pressure) is comparable to a traditional vocal efficiency measure (ratio of acoustic power to the product of average subglottal pressure and average phonatory airflow) in terms of the ability to detect change in vocal function following surgical removal of bilateral phonotraumatic lesions. METHOD Pre- and postoperative acoustic and aerodynamic measures were analyzed retrospectively from 75 female patients who underwent surgical removal of bilateral phonotraumatic lesions. A 2 × 2 repeated-measures analysis of variance was conducted for each of three acoustic-aerodynamic voice outcome ratios-traditional vocal efficiency, an SPL-based ratio with both airflow and subglottal pressure, and a simplified SPL-based ratio with subglottal pressure only-to investigate the main effects of treatment stage (pre- and postsurgery), loudness condition (comfortable and loud), and their interaction. Post hoc paired samples t tests were conducted for statistically significant interactions. The within-subject variability of the measures was assessed using the coefficient of variation. RESULTS Although exhibiting an expected main effect of loudness (higher values in the loud condition), the traditional vocal efficiency ratio did not exhibit a main effect of treatment. For both SPL-based ratios, there were significant main effects of treatment stage (higher values postoperatively) and loudness condition (lower values in the loud condition). Within-subject, postoperative changes in the two SPL-based ratios moderately correlated with one another. The simplified ratio of SPL to subglottal pressure (without airflow) exhibited the least within-subject variability relative to the other two acoustic-aerodynamic ratios. CONCLUSIONS These findings indicate that SPL-based acoustic-aerodynamic voice outcome ratios increase significantly following the surgical removal of phonotraumatic vocal fold lesions. The simplified ratio of SPL to subglottal pressure exhibits the least variability and can be easily obtained without requiring the measurement of airflow.
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Affiliation(s)
- Laura E. Toles
- Massachusetts General Hospital, Boston
- MGH Institute of Health Professions, Boston, MA
- The University of Texas Southwestern Medical Center, Dallas
| | | | - Robert E. Hillman
- Massachusetts General Hospital, Boston
- MGH Institute of Health Professions, Boston, MA
- Harvard Medical School, Boston, MA
| | - Daryush D. Mehta
- Massachusetts General Hospital, Boston
- MGH Institute of Health Professions, Boston, MA
- Harvard Medical School, Boston, MA
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Castro C, Prado P, Espinoza VM, Testart A, Marfull D, Manriquez R, Stepp CE, Mehta DD, Hillman RE, Zañartu M. Lombard Effect in Individuals With Nonphonotraumatic Vocal Hyperfunction: Impact on Acoustic, Aerodynamic, and Vocal Fold Vibratory Parameters. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:2881-2895. [PMID: 35930680 PMCID: PMC9913286 DOI: 10.1044/2022_jslhr-21-00508] [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: 09/22/2021] [Revised: 03/17/2022] [Accepted: 05/11/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE This exploratory study aims to investigate variations in voice production in the presence of background noise (Lombard effect) in individuals with nonphonotraumatic vocal hyperfunction (NPVH) and individuals with typical voices using acoustic, aerodynamic, and vocal fold vibratory measures of phonatory function. METHOD Nineteen participants with NPVH and 19 participants with typical voices produced simple vocal tasks in three sequential background conditions: baseline (in quiet), Lombard (in noise), and recovery (5 min after removing the noise). The Lombard condition consisted of speech-shaped noise at 80 dB SPL through audiometric headphones. Acoustic measures from a microphone, glottal aerodynamic parameters estimated from the oral airflow measured with a circumferentially vented pneumotachograph mask, and vocal fold vibratory parameters from high-speed videoendoscopy were analyzed. RESULTS During the Lombard condition, both groups exhibited a decrease in open quotient and increases in sound pressure level, peak-to-peak glottal airflow, maximum flow declination rate, and subglottal pressure. During the recovery condition, the acoustic and aerodynamic measures of individuals with typical voices returned to those of the baseline condition; however, recovery measures for individuals with NPVH did not return to baseline values. CONCLUSIONS As expected, individuals with NPVH and participants with typical voices exhibited a Lombard effect in the presence of elevated background noise levels. During the recovery condition, individuals with NPVH did not return to their baseline state, pointing to a persistence of the Lombard effect after noise removal. This behavior could be related to disruptions in laryngeal motor control and may play a role in the etiology of NPVH. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.20415600.
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Affiliation(s)
- Christian Castro
- Department of Electronic Engineering, Universidad Técnica Federico Santa María, Valparaíso, Chile
- Department of Speech and Language Pathology, Universidad de Valparaíso, Chile
- Department of Speech and Language Pathology, Universidad de Chile, Santiago
| | - Pavel Prado
- Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibáñez, Santiago, Chile
| | | | - Alba Testart
- Department of Speech and Language Pathology, Universidad de Playa Ancha, Valparaíso, Chile
| | - Daphne Marfull
- Department of Speech and Language Pathology, Universidad de Valparaíso, Chile
| | - Rodrigo Manriquez
- Department of Electronic Engineering, Universidad Técnica Federico Santa María, Valparaíso, Chile
| | - Cara E. Stepp
- Department of Speech, Language, and Hearing Sciences, Boston University, MA
- Department of Biomedical Engineering, Boston University, MA
- Department of Otolaryngology-Head and Neck Surgery, Boston University, MA
| | - Daryush D. Mehta
- Center for Laryngeal Surgery & Voice Rehabilitation, Massachusetts General Hospital, Boston
- Department of Surgery, Harvard Medical School, Boston, MA
- MGH Institute of Health Professions, Boston, MA
| | - Robert E. Hillman
- Center for Laryngeal Surgery & Voice Rehabilitation, Massachusetts General Hospital, Boston
- Department of Surgery, Harvard Medical School, Boston, MA
- MGH Institute of Health Professions, Boston, MA
| | - Matías Zañartu
- Department of Electronic Engineering, Universidad Técnica Federico Santa María, Valparaíso, Chile
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Nusseck M, Immerz A, Richter B, Traser L. Vocal Behavior of Teachers Reading with Raised Voice in a Noisy Environment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19158929. [PMID: 35897294 PMCID: PMC9331438 DOI: 10.3390/ijerph19158929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 07/20/2022] [Accepted: 07/21/2022] [Indexed: 01/27/2023]
Abstract
(1) Objective: Teaching is a particularly voice-demanding occupation. Voice training provided during teachers’ education is often insufficient and thus teachers are at risk of developing voice disorders. Vocal demands during teaching are not only characterized by speaking for long durations but also by speaking in noisy environments. This provokes the so-called Lombard effect, which intuitively leads to an increase in voice intensity, pitch and phonation time in laboratory studies. However, this effect has not been thoroughly investigated in realistic teaching scenarios. (2) Methods: This study thus examined how 13 experienced, but vocally untrained, teachers behaved when reading in a noisy compared to quiet background environment. The quiet and noisy conditions were provided by a live audience either listening quietly or making noise by talking to each other. By using a portable voice accumulator, the fundamental frequency, sound pressure level of the voice and the noise as well as the phonation time were recorded in both conditions. (3) Results: The results showed that the teachers mainly responded according to the Lombard effect. In addition, analysis of phonation time revealed that they failed to increase inhalation time and appeared to lose articulation through the shortening of voiceless consonants in the noisy condition. (4) Conclusions: The teachers demonstrated vocally demanding behavior when speaking in the noisy condition, which can lead to vocal fatigue and cause dysphonia. The findings underline the necessity for specific voice training in teachers’ education, and the content of such training is discussed in light of the results.
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Nudelman CJ, Ortiz AJ, Fox AB, Mehta DD, Hillman RE, Van Stan JH. Daily Phonotrauma Index: An Objective Indicator of Large Differences in Self-Reported Vocal Status in the Daily Life of Females With Phonotraumatic Vocal Hyperfunction. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:1412-1423. [PMID: 35394805 PMCID: PMC9567307 DOI: 10.1044/2022_ajslp-21-00285] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 12/08/2021] [Accepted: 02/03/2022] [Indexed: 06/03/2023]
Abstract
PURPOSE The purpose of this study is to evaluate if the Daily Phonotrauma Index (DPI) can quantitatively discriminate large differences in overall vocal status in the daily life of patients with phonotraumatic vocal hyperfunction (PVH). METHOD For 1-4 weeks, 23 females with PVH wore an ambulatory voice monitor and answered three vocal status questions (i.e., difficulty producing soft, high-pitched phonation; discomfort; and fatigue) at the beginning, at 5-hr intervals, and the end of each day. DPI values were obtained for each patient's time periods of worst and best self-rated vocal status, and data for the group were analyzed for significant changes using a linear mixed-effects regression model. RESULTS The DPI was significantly lower during periods self-rated as "best vocal status" compared to during periods self-rated as "worst vocal status" (mean difference in DPI = 0.53) with a medium-to-large effect size (Cohen's d = -0.68). CONCLUSIONS In a group of patients with phonotraumatic lesions, the DPI indicated lower potential for phonotrauma during time periods of better vocal status compared to time periods of worse vocal status. Assuming that a large portion of variance in vocal status for patients with PVH is associated with the extent to which voicing is phonotraumatic, these results support the validity of obtaining estimates of DPI for much shorter time periods (i.e., an estimate every 2 min of voicing) than previous studies (i.e., a single estimate for the entire day or week). Future work can investigate the DPI's use for in-clinic assessment/treatment and ambulatory biofeedback and can gain further insights into phonatory mechanisms that underlie DPI via comparisons with other physiologically relevant measures and computational vocal fold modeling.
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Affiliation(s)
| | | | | | - Daryush D. Mehta
- MGH Institute of Health Professions, Boston, MA
- Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, MA
| | - Robert E. Hillman
- MGH Institute of Health Professions, Boston, MA
- Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, MA
| | - Jarrad H. Van Stan
- MGH Institute of Health Professions, Boston, MA
- Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, MA
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Peng ZE, Waz S, Buss E, Shen Y, Richards V, Bharadwaj H, Stecker GC, Beim JA, Bosen AK, Braza MD, Diedesch AC, Dorey CM, Dykstra AR, Gallun FJ, Goldsworthy RL, Gray L, Hoover EC, Ihlefeld A, Koelewijn T, Kopun JG, Mesik J, Shub DE, Venezia JH. FORUM: Remote testing for psychological and physiological acoustics. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2022; 151:3116. [PMID: 35649891 PMCID: PMC9305596 DOI: 10.1121/10.0010422] [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: 11/04/2021] [Revised: 03/22/2022] [Accepted: 04/22/2022] [Indexed: 05/30/2023]
Abstract
Acoustics research involving human participants typically takes place in specialized laboratory settings. Listening studies, for example, may present controlled sounds using calibrated transducers in sound-attenuating or anechoic chambers. In contrast, remote testing takes place outside of the laboratory in everyday settings (e.g., participants' homes). Remote testing could provide greater access to participants, larger sample sizes, and opportunities to characterize performance in typical listening environments at the cost of reduced control of environmental conditions, less precise calibration, and inconsistency in attentional state and/or response behaviors from relatively smaller sample sizes and unintuitive experimental tasks. The Acoustical Society of America Technical Committee on Psychological and Physiological Acoustics launched the Task Force on Remote Testing (https://tcppasa.org/remotetesting/) in May 2020 with goals of surveying approaches and platforms available to support remote testing and identifying challenges and considerations for prospective investigators. The results of this task force survey were made available online in the form of a set of Wiki pages and summarized in this report. This report outlines the state-of-the-art of remote testing in auditory-related research as of August 2021, which is based on the Wiki and a literature search of papers published in this area since 2020, and provides three case studies to demonstrate feasibility during practice.
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Affiliation(s)
- Z Ellen Peng
- Boys Town National Research Hospital, Omaha, Nebraska 68131, USA
| | - Sebastian Waz
- University of California, Irvine, Irvine, California 92697, USA
| | - Emily Buss
- The University of North Carolina, Chapel Hill, North Carolina, 27599, USA
| | - Yi Shen
- University of Washington, Seattle, Washington 98195, USA
| | | | | | | | - Jordan A Beim
- University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - Adam K Bosen
- Boys Town National Research Hospital, Omaha, Nebraska 68131, USA
| | - Meredith D Braza
- The University of North Carolina, Chapel Hill, North Carolina, 27599, USA
| | - Anna C Diedesch
- Western Washington University, Bellingham, Washington 98225, USA
| | | | | | | | | | - Lincoln Gray
- James Madison University, Harrisburg, Virginia 22807, USA
| | - Eric C Hoover
- University of Maryland, College Park, Maryland 20742, USA
| | - Antje Ihlefeld
- Carnegie Mellon University, Pittsburgh, Pennsylvania 15213, USA
| | | | - Judy G Kopun
- Boys Town National Research Hospital, Omaha, Nebraska 68131, USA
| | - Juraj Mesik
- University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - Daniel E Shub
- Walter Reed National Military Medical Center, Bethesda, Maryland 20814, USA
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Šimek M, Rusz J. Validation of cepstral peak prominence in assessing early voice changes of Parkinson's disease: Effect of speaking task and ambient noise. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2021; 150:4522. [PMID: 34972306 DOI: 10.1121/10.0009063] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 12/03/2021] [Indexed: 06/14/2023]
Abstract
Although the cepstral peak prominence (CPP) and its variant, the cepstral peak prominence smooth (CPPS), are considered to be robust acoustic measures for the evaluation of dysphonia, whether they are sensitive to capture early voice changes in Parkinson's disease (PD) has not yet been explored. This study aimed to investigate the voice changes via the CPP measures in the idiopathic rapid eye movement sleep behavior disorder (iRBD), a special case of prodromal neurodegeneration, and recently diagnosed and advanced-stage Parkinson's disease (AS-PD) patients using different speaking tasks across noise-free and noisy environments. The sustained vowel phonation, reading of passages, and monologues of 60 early stage untreated PD, 30 advanced-stage Parkinson's disease, 60 iRBD, and 60 healthy control (HC) participants were evaluated. Significant differences were found between the PD groups and controls in sustained phonation via the CPP (p < 0.05) and CPPS (p < 0.01) and the monologue via the CPP (p < 0.01), although neither the CPP nor CPPS measures were sufficiently sensitive to capture the possible prodromal dysphonia in the iRBD. The quality of the CPP and CPPS measures was influenced substantially by the addition of ambient noise. It was anticipated that the CPP measures might serve as a promising digital biomarker in assessing the dysphonia from the early stages of PD.
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Affiliation(s)
- Michal Šimek
- Department of Circuit Theory, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic
| | - Jan Rusz
- Department of Circuit Theory, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic
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11
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Marks KL, Verdi A, Toles LE, Stipancic KL, Ortiz AJ, Hillman RE, Mehta DD. Psychometric Analysis of an Ecological Vocal Effort Scale in Individuals With and Without Vocal Hyperfunction During Activities of Daily Living. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:2589-2604. [PMID: 34665647 PMCID: PMC9132024 DOI: 10.1044/2021_ajslp-21-00111] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/11/2021] [Accepted: 07/07/2021] [Indexed: 05/29/2023]
Abstract
Objective The purpose of this study was to examine the psychometric properties of an ecological vocal effort scale linked to a voicing task. Method Thirty-eight patients with nodules, 18 patients with muscle tension dysphonia, and 45 vocally healthy control individuals participated in a week of ambulatory voice monitoring. A global vocal status question was asked hourly throughout the day. Participants produced a vowel-consonant-vowel syllable string and rated the vocal effort needed to produce the task on a visual analog scale. Test-retest reliability was calculated for a subset using the intraclass correlation coefficient, ICC(A, 1). Construct validity was assessed by (a) comparing the weeklong vocal effort ratings between the patient and control groups and (b) comparing weeklong vocal effort ratings before and after voice rehabilitation in a subset of 25 patients. Cohen's d, the standard error of measurement (SEM), and the minimal detectable change (MDC) assessed sensitivity. The minimal clinically important difference (MCID) assessed responsiveness. Results Test-retest reliability was excellent, ICC(A, 1) = .96. Weeklong mean effort was statistically higher in the patients than in controls (d = 1.62) and lower after voice rehabilitation (d = 1.75), supporting construct validity and sensitivity. SEM was 4.14, MDC was 11.47, and MCID was 9.74. Since the MCID was within the error of the measure, we must rely upon the MDC to detect real changes in ecological vocal effort. Conclusion The ecological vocal effort scale offers a reliable, valid, and sensitive method of monitoring vocal effort changes during the daily life of individuals with and without vocal hyperfunction.
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Affiliation(s)
- Katherine L. Marks
- MGH Institute of Health Professions, Boston, MA
- Massachusetts General Hospital, Boston
| | - Alessandra Verdi
- MGH Institute of Health Professions, Boston, MA
- Massachusetts General Hospital, Boston
| | - Laura E. Toles
- MGH Institute of Health Professions, Boston, MA
- Massachusetts General Hospital, Boston
| | - Kaila L. Stipancic
- MGH Institute of Health Professions, Boston, MA
- University at Buffalo, NY
| | - Andrew J. Ortiz
- Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, MA
| | - Robert E. Hillman
- MGH Institute of Health Professions, Boston, MA
- Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, MA
| | - Daryush D. Mehta
- MGH Institute of Health Professions, Boston, MA
- Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, MA
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12
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Van Stan JH, Ortiz AJ, Cortes JP, Marks KL, Toles LE, Mehta DD, Burns JA, Hron T, Stadelman-Cohen T, Krusemark C, Muise J, Fox-Galalis AB, Nudelman C, Zeitels S, Hillman RE. Differences in Daily Voice Use Measures Between Female Patients With Nonphonotraumatic Vocal Hyperfunction and Matched Controls. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:1457-1470. [PMID: 33900807 PMCID: PMC8608188 DOI: 10.1044/2021_jslhr-20-00538] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Purpose The purpose of this study was to obtain a more comprehensive understanding of the pathophysiology and impact on daily voice use of nonphonotraumatic vocal hyperfunction (NPVH). Method An ambulatory voice monitor collected 1 week of data from 36 patients with NPVH and 36 vocally healthy matched controls. A subset of 11 patients with NPVH were monitored after voice therapy. Daily voice use measures included neck-skin acceleration magnitude, fundamental frequency (f o), cepstral peak prominence (CPP), and the difference between the first and second harmonic magnitudes (H1-H2). Additional comparisons included 118 patients with phonotraumatic vocal hyperfunction (PVH) and 89 additional vocally healthy controls. Results The NPVH group, compared to the matched control group, exhibited increased f o (Cohen's d = 0.6), reduced CPP (d = -0.9), and less positive H1-H2 skewness (d = -1.1). Classifiers used CPP mean and H1-H2 mode to maximally differentiate the NPVH and matched control groups (area under the receiver operating characteristic curve of 0.78). Classifiers performed well on unseen data: the logit decreased in patients with NPVH after therapy; ≥ 85% of the control and PVH groups were identified as "normal" or "not NPVH," respectively. Conclusions The NPVH group's daily voice use is less periodic (CPP), is higher pitched (f o), and has less abrupt vocal fold closure (H1-H2 skew) compared to the matched control group. The combination of CPP mean and H1-H2 mode appears to reflect a pathophysiological continuum in NPVH patients of inefficient phonation with minimal potential for phonotrauma. Further validation of the classification model is needed to better understand potential clinical uses. Supplemental Material https://doi.org/10.23641/asha.14390771.
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Affiliation(s)
- Jarrad H. Van Stan
- Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, MA
- MGH Institute of Health Professions, Boston, MA
| | | | - Juan P. Cortes
- Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, MA
| | - Katherine L. Marks
- Massachusetts General Hospital, Boston
- MGH Institute of Health Professions, Boston, MA
| | - Laura E. Toles
- Massachusetts General Hospital, Boston
- MGH Institute of Health Professions, Boston, MA
| | - Daryush D. Mehta
- Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, MA
- MGH Institute of Health Professions, Boston, MA
| | - James A. Burns
- Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, MA
| | - Tiffiny Hron
- Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, MA
| | - Tara Stadelman-Cohen
- Massachusetts General Hospital, Boston
- MGH Institute of Health Professions, Boston, MA
| | - Carol Krusemark
- Massachusetts General Hospital, Boston
- MGH Institute of Health Professions, Boston, MA
| | - Jason Muise
- Massachusetts General Hospital, Boston
- MGH Institute of Health Professions, Boston, MA
| | | | - Charles Nudelman
- Massachusetts General Hospital, Boston
- MGH Institute of Health Professions, Boston, MA
| | - Steven Zeitels
- Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, MA
| | - Robert E. Hillman
- Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, MA
- MGH Institute of Health Professions, Boston, MA
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13
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Toles LE, Ortiz AJ, Marks KL, Burns JA, Hron T, Van Stan JH, Mehta DD, Hillman RE. Differences Between Female Singers With Phonotrauma and Vocally Healthy Matched Controls in Singing and Speaking Voice Use During 1 Week of Ambulatory Monitoring. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:199-209. [PMID: 33472007 PMCID: PMC8740583 DOI: 10.1044/2020_ajslp-20-00227] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Purpose Previous ambulatory voice monitoring studies have included many singers and have combined speech and singing in the analyses. This study applied a singing classifier to the ambulatory recordings of singers with phonotrauma and healthy controls to determine if analyzing speech and singing separately would reveal voice use differences that could provide new insights into the etiology and pathophysiology of phonotrauma in this at-risk population. Method Forty-two female singers with phonotrauma (vocal fold nodules or polyps) and 42 healthy matched controls were monitored using an ambulatory voice monitor. Weeklong statistics (average, standard deviation, skewness, kurtosis) for sound pressure level (SPL), fundamental frequency, cepstral peak prominence, the magnitude ratio of the first two harmonics (H1-H2 ), and three vocal dose measures were computed from the neck surface acceleration signal and separated into singing and speech using a singing classifier. Results Mixed analysis of variance models found expected differences between singing and speech in each voice parameter, except SPL kurtosis. SPL skewness, SPL kurtosis, and all H1-H2 distributional parameters differentiated patients and controls when singing and speech were combined. Interaction effects were found in H1-H2 kurtosis and all vocal dose measures. Patients had significantly higher vocal doses in speech compared to controls. Conclusions Consistent with prior work, the pathophysiology of phonotrauma in singers is characterized by more abrupt/complete glottal closure (decreased mean and variation for H1-H2 ) and increased laryngeal forces (negatively skewed SPL distribution) during phonation. Application of a singing classifier to weeklong data revealed that singers with phonotrauma spent more time speaking on a weekly basis, but not more time singing, compared to controls. Results are used as a basis for hypothesizing about the role of speaking voice in the etiology of phonotraumatic vocal hyperfunction in singers.
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Affiliation(s)
- Laura E. Toles
- Massachusetts General Hospital, Boston
- MGH Institute of Health Professions, Boston, MA
| | | | - Katherine L. Marks
- Massachusetts General Hospital, Boston
- MGH Institute of Health Professions, Boston, MA
| | - James A. Burns
- Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, MA
| | - Tiffiny Hron
- Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, MA
| | - Jarrad H. Van Stan
- Massachusetts General Hospital, Boston
- MGH Institute of Health Professions, Boston, MA
- Harvard Medical School, Boston, MA
| | - Daryush D. Mehta
- Massachusetts General Hospital, Boston
- MGH Institute of Health Professions, Boston, MA
- Harvard Medical School, Boston, MA
| | - Robert E. Hillman
- Massachusetts General Hospital, Boston
- MGH Institute of Health Professions, Boston, MA
- Harvard Medical School, Boston, MA
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