Associations Between Voice and Gestural Characteristics of Transgender Women and Self-Rated Femininity, Satisfaction, and Quality of Life

Purpose Client-based subjective ratings of treatment and outcomes are becoming increasingly important as speech-language pathologists embrace client-centered care practices. Of particular interest is the value in understanding how these ratings are related to aspects of gender-affirming voice and communication training programs for transgender and gender-diverse individuals. The purpose of this observational study was to explore relationships between acoustic and gestural communication variables and communicator-rated subjective measures of femininity, communication satisfaction, and quality of life (QoL) among transfeminine communicators. Method Twelve acoustic and gestural variables were measured from high-fidelity audio and motion capture recordings of transgender women (n = 20) retelling the story of a short cartoon. The participants also completed a set of subjective ratings using a series of Likert-type rating scales, a generic QoL questionnaire, and a population-specific voice-related QoL questionnaire. Correlational analyses were used to identify relationships between the communication measures and subjective ratings. Results A significant negative relationship was identified between the use of palm-up hand gestures and self-rated satisfaction with overall communication. The acoustic variable of average semitone range was positively correlated with overall QoL. No acoustic measures were significantly correlated with voice-related QoL, and unlike previous studies, speaking fundamental frequency was not associated with any of the subjective ratings. Conclusions The results from this study suggest that voice characteristics may have limited association with communicator-rated subjective measures of communication satisfaction or QoL for this population. Results also provide preliminary evidence for the importance of nonverbal communication targets in gender-affirming voice and communication training programs.

Subjective Self-Rated Speech Intelligibility and Quality of Life in Patients with Parkinson’s Disease in a Malaysian Sample

Objectives:

This study compared the Quality of Life (QOL) of individuals with Parkinson’s disease (PD) with a healthy control from a sample in Malaysia. The relationship between the QOL, age, gender, duration of disease, self-rated speech scale, and life satisfaction level was examined.

Methods:

Fifty-four individuals with PD and 55 non-PD control adults completed the Parkinson’s Disease Questionnaire-39 (PDQ-39) and rated their speech intelligibility [Self-Rated Speech Scale (SRSS)] and life satisfaction level [Life Satisfaction Scale (LSS)] on a 10-point scale.

Results:

PD participants reported significantly lower QOL scores than the control group (Mann-Whitney U). Although there was no significant relationship between the QOL, age, gender, and duration of disease for PD participants, moderately significant correlations were observed between QOL, LSS and SRSS ratings (Spearman correlation). Individuals with PD showed lower QOL and higher concern in their communication than the control group.

Conclusion:

Identifying patients’ perception of their speech performance could help clinicians to better understand patients’ needs when delivering speech therapy services.

A systematic review of rehabilitation interventions to prevent and treat depression in post-stroke aphasia

PURPOSE

Stepped psychological care is the delivery of routine assessment and interventions for psychological problems, including depression. The aim of this systematic review was to analyze and synthesize the evidence of rehabilitation interventions to prevent and treat depression in post-stroke aphasia and adapt the best evidence within a stepped psychological care framework.

METHOD

Four databases were systematically searched up to March 2017: Medline, CINAHL, PsycINFO and The Cochrane Library.

RESULTS

Forty-five studies met inclusion and exclusion criteria. Level of evidence, methodological quality and results were assessed. People with aphasia with mild depression may benefit from psychosocial-type treatments (based on 3 level ii studies with small to medium effect sizes). For those without depression, mood may be enhanced through participation in a range of interventions (based on 4 level ii studies; 1 level iii-3 study and 6 level iv studies). It is not clear which interventions may prevent depression in post-stroke aphasia. No evidence was found for the treatment of moderate to severe depression in post-stroke aphasia.

CONCLUSIONS

This study found some interventions that may improve depression outcomes for those with mild depression or without depression in post-stroke aphasia. Future research is needed to address methodological limitations and evaluate and support the translation of stepped psychological care across the continuum. Implications for Rehabilitation Stepped psychological care after stroke is a framework with levels 1 to 4 which can be used to prevent and treat depression for people with aphasia. A range of rehabilitation interventions may be beneficial to mood at level 1 for people without clinically significant depression (e.g., goal setting and achievement, psychosocial support, communication partner training and narrative therapy). People with mild symptoms of depression may benefit from interventions at level 2 (e.g., behavioral therapy, psychosocial support and problem solving). People with moderate to severe symptoms of depression require specialist mental health/behavioral services in collaboration with stroke care at levels 3 and 4 of stepped psychological care.

Exploratory investigation of communication management in residential-aged care: a comparison of staff knowledge, documentation and observed resident-staff communication

BACKGROUND

There is a high prevalence of communication difficulty among older people living in residential-aged care. Such functional deficits can have a negative impact on resident quality of life, staff workplace satisfaction and the provision of quality care. Systematic research investigating the nature of communication management in residential-aged care and factors impacting optimal communication management is lacking.

AIMS

To use data triangulation across multiple sources to describe resident-staff communication and communication management in residential-aged care.

METHODS & PROCEDURES

Participants included a sample of 14 residents and 29 staff directly involved in communication interactions with residents. Data were obtained from: (1) resident file review (n = 14), (2) observation of resident-staff communication (n = 14), (3) resident surveys (n = 14) and (4) staff surveys (n = 29). Data from each source were examined separately then triangulated.

OUTCOMES & RESULTS

All residents had limited opportunity for meaningful communication with staff. Documentation of residents' communication needs and strategies to facilitate resident-staff communication was insufficient to provide individualized recommendations. Although staff were observed to use various strategies to facilitate communication with residents, staff agreement about the applicability of these strategies to individual residents was inconsistent. Differences in resident-staff communication for residents who experience nil/mild versus moderate/severe communication difficulty were also found.

CONCLUSIONS & IMPLICATIONS

Resident-staff communication and communication management in residential-aged care is limited in scope and challenged in meeting residents' individual communication needs. Improvements in both documentation and staff knowledge of residents' communication needs are necessary. Strategies to facilitate communication with individual residents must be tailored, evidence based, documented in care plans and delivered to staff through ongoing education. Increased involvement of specialist providers such as speech pathologists to support better communication management in residential-aged care may provide one way of facilitating such change.

Practitioners' Perspectives on Quality of Life in Aphasia Rehabilitation in Denmark

OBJECTIVE

This study reports on Danish speech and language therapists' knowledge and understanding of quality of life (QoL) in aphasia, including therapists' views on education and training in relation to preparedness for working on QoL, use of measures, and barriers to applying QoL in practice.

METHODS

Fourteen Danish clinicians completed a 48-item online questionnaire regarding their views, perspectives and practices that included multiple-choice questions, rating scales, and boxes permitting free text responses. Descriptive statistics were used to characterize the numerical data, and content analysis was applied to text responses.

RESULTS

The clinicians interpreted QoL as subjective well-being and participation and explored it with most clients and relatives using informal methods, primarily conversation, for the purposes of identifying relevant goals to direct treatment. Clinicians perceived a need for greater theoretical, practical, and experiential knowledge regarding QoL. They also identified a need for translated QoL instruments and training in these measures in practice.

CONCLUSION

Despite a reported lack of knowledge about and tools for measuring QoL, Danish clinicians are applying QoL issues in their practice and perceive these issues as valuable and important in assessment and therapy. The findings have clear implications for tool development and workforce education.

Quality of life improves with return of voice in tracheostomy patients in intensive care: An observational study

PURPOSE

To measure patient-reported change of mood, communication-related quality of life, and general health status with return of voice among mechanically ventilated tracheostomy patients admitted to the intensive care unit (ICU).

MATERIALS AND METHODS

A prospective observational study in a tertiary ICU was conducted. Communication-related quality of life was measured daily using the Visual Analogue Self-Esteem Scale. General health status was measured weekly using the EuroQol-5D.

RESULTS

Aspects of communication self-esteem that significantly improved with the return of voice were ability to be understood by others (P = .006) and cheerfulness (P = .04), both with a median difference from before to after return of voice of 1 on the 5-point scale. Return of voice was not associated with a significant improvement in confidence, sense of outgoingness, anger, sense of being trapped, optimism, or frustration. Reported general health status did not significantly improve.

CONCLUSIONS

Return of voice was associated with significant improvement in patient reported self-esteem, particularly in being understood by others and in cheerfulness. Improved self-esteem may also improve quality of life; however, further research is needed to confirm this relationship. Early restoration of voice should be investigated as a way to improve the experience of ICU for tracheostomy patients.

‘Factors contributing to upper limb recovery after stroke: A survey of stroke survivors in Queensland Australia’

PURPOSE

To identify factors which contribute to upper limb recovery, from the perspective of stroke survivors.

METHOD

A retrospective cross-sectional survey was administered by post to 220 stroke survivors with upper limb impairment who were more than 3 months post-stroke. The content and language for the questionnaire were drawn from a series of focus groups and in-depth interviews with stroke survivors (n = 29). Where possible items or composite scales were replicated or adapted from existing surveys.

RESULTS

Many factors regarding the stroke survivors' commitment to recovery, the type and amount of exercise undertaken and their knowledge of how to progress were associated with self-reported upper limb recovery. The single most important factor was 'use of the arm in everyday tasks', which was independently responsible for more than 12% of the variance in recovery. 'Not enough movement to work with' was the second most important factor, representing the greatest barrier to recovery.

CONCLUSIONS

The findings of this survey highlight many practical day to day factors that may contribute to a stroke survivor's ability to advance the recovery of their upper limb. Stroke recovery services can use this information to tailor their services to ensure these practical concerns are addressed.

Outcomes of hearing aid fitting for older people with hearing impairment and their significant others

As hearing impairment affects communication, it seems intuitive that both the person with hearing impairment and the significant other (SO) will experience effects as a result of the impairment and subsequent rehabilitation. The present study examined the effect that hearing impairment and aural rehabilitation has on the person with hearing impairment and the SO's quality of life (QOL). Ninety-three people with hearing impairment completed a measure of hearing-specific QOL (Hearing Handicap Inventory for the Elderly) and health-related QOL (Short Form-36), while 78 SOs completed a modified version of the Quantified Denver Scale and the Short Form-36, prior to and 3 months following hearing aid fitting. The results emphasize the significant impact of hearing impairment on both the person with hearing impairment and the SO. The results also demonstrate the effective role that hearing aids play in reducing such negative effects for both parties.

The consequences of spasmodic dysphonia on communication-related quality of life: a qualitative study of the insider's experiences

The purpose of this study was to explore the biopsychosocial consequences of spasmodic dysphonia (SD) as experienced by people with SD. Qualitative research methods were used to investigate the insider's perspective of living with SD. Six adults with SD participated in face-to-face phenomenological interviews. The results are summarized in a model of personal experiences of SD which shows that communication-related quality of life (QOL) is shaped by experiences with multiple physiologic (voice quality, effort, voice dependability); personal (affective responses, changes in self-view, coping strategies) and social (physical environment, other people, participation in social roles) factors. Communication-related QOL is a complex and individualized construct with multidimensional contributors. This study suggests that understanding the nature of communication-related QOL for each individual requires exploration of each component of the model, exploration of the unique relationships among components for each person, and recognition of the multidimensional factors that shape the experience of SD.

LEARNING OUTCOMES

As a result of this activity the reader will be able to (1) identify general features of the phenomenological research method; (2) identify the three general categories of psychosocial consequences of SD; (3) identify those psychosocial consequences of SD that are under-represented in the literature; and (4) identify key conclusions of the communication-related quality of life model.