Bari Hoffman Ruddy

Improved voluntary cough immediately following office-based vocal fold medialization injections.

This study examined changes in voluntary cough airflow measures immediately following in‐office injection of Radiesse in patients diagnosed with glottic insufficiency. Due to significant comorbidities, these patients were poor candidates for medialization under general anesthesia. Each patient presented with dysphonia and dysphagia and ineffective voluntary cough, resulting in a poor clearing of secretions and a presence of ingested fluids on examination.

A Model for Treating Voice Disorders in School-Age Children within a Video Gaming Environment

OBJECTIVE Clinicians use a variety of approaches to motivate children with hyperfunctional voice disorders to comply with voice therapy in a therapeutic session and improve the motivation of children to practice home-based exercises. Utilization of current entertainment technology in such approaches may improve participation and motivation in voice therapy. The purpose of this study is to test the feasibility of using an entertainment video game as a therapy device. STUDY DESIGN Prospective cohort and case-control study. METHODS Three levels of game testing were conducted to an existing entertainment video game for use as a voice therapy protocol. The game was tested by two computer programmers and five normal participants. The third level of testing was a case study with a child diagnosed with a hyperfunctional voice disorder. Modifications to the game were made after each feasibility test. RESULTS Errors with the video game performance were modified, including the addition of a time stamp directory and game controller. Resonance voice exercises were modified to accommodate the gaming environment and unique competitive situation, including speech rate, acoustic parameters, game speed, and point allocations. CONCLUSION The development of video games for voice therapeutic purposes attempt to replicate the high levels of engagement and motivation attained with entertainment video games, stimulating a more productive means of learning while doing. This case study found that a purely entertainment video game can be implemented as a voice therapeutic protocol based on information obtained from the case study.

A GPU-based framework for modeling real-time 3D lung tumor conformal dosimetry with subject-specific lung tumor motion.

In this paper, we present a graphics processing unit (GPU)-based simulation framework to calculate the delivered dose to a 3D moving lung tumor and its surrounding normal tissues, which are undergoing subject-specific lung deformations. The GPU-based simulation framework models the motion of the 3D volumetric lung tumor and its surrounding tissues, simulates the dose delivery using the dose extracted from a treatment plan using Pinnacle Treatment Planning System, Phillips, for one of the 3DCTs of the 4DCT and predicts the amount and location of radiation doses deposited inside the lung. The 4DCT lung datasets were registered with each other using a modified optical flow algorithm. The motion of the tumor and the motion of the surrounding tissues were simulated by measuring the changes in lung volume during the radiotherapy treatment using spirometry. The real-time dose delivered to the tumor for each beam is generated by summing the dose delivered to the target volume at each increase in lung volume during the beam delivery time period. The simulation results showed the real-time capability of the framework at 20 discrete tumor motion steps per breath, which is higher than the number of 4DCT steps (approximately 12) reconstructed during multiple breathing cycles.

Behavior Assessment Battery: A Pilot Study of the Affective, Behavioral, and Cognitive Correlates Surrounding Spasmodic Dysphonia

OBJECTIVE/HYPOTHESIS This study investigates if adults with adductor spasmodic dysphonia (ADSD) report to experience anxiety and voice problems in particular situations, indicate the presence of negative speech-associated attitude, and/or the use of coping behaviors, by means of the Behavior Assessment Battery (BAB) modified for voice. METHODS Thirty-two participants with ADSD and 32 adults without a voice disorder participated in this study. Each person completed four different BAB-Voice subtests. These standardized self-report tests are adaptations of the original BAB for people who stutter and explore an individuals speech-related belief, negative emotional reaction to and speech problems in particular speech situations, and the use of concomitant behaviors. RESULTS Individuals with spasmodic dysphonia (SD) scored statistically significantly higher compared to typical speakers on all BAB subtests, indicating that individuals with SD report being significantly more anxious and experiencing significantly more voice problems in particular speech circumstances. They also reported a significant amount of negative speech-associated attitude and the use of a significant number of coping behaviors. Internal reliability was good for three of the four BAB subtests. CONCLUSIONS The BAB is capable of reflecting the dimensions that surround the disorder of SD. The self-report measures have the potential to augment the observations made by the clinician and may lead to a more diverse and all-encompassing therapy for the person suffering from SD. Future research with a revised version of the BAB-Voice will continue to explore the validity, reliability, and replicability of the initial data.

Quantifying Laryngopharyngeal Reflux in Singers: Perceptual and Objective Findings

This study examines the relationship between laryngopharyngeal reflux (LPR) symptoms and oropharyngeal pH levels in singers. We hypothesized that reported symptoms would correlate with objective measures of pH levels from the oropharynx, including the number and total duration of reflux episodes. Twenty professional/semiprofessional singers completed the Reflux Symptom Index (RSI) and underwent oropharyngeal pH monitoring. Mild, moderate, or severe pH exposure was recorded during oropharyngeal pH monitoring. Correlations were performed to examine potential relationships between reflux symptoms and duration of LPR episodes. Symptom severity did not correlate with pH levels; however, we found a number of covariances of interest. Large sample sizes are necessary to determine if true correlations exist. Our results suggest that singers may exhibit enhanced sensitivity to LPR and may therefore manifest symptoms, even in response to subtle changes in pH. This study emphasizes the importance of sensitive and objective measures of reflux severity as well as consideration of the cumulative time of reflux exposure in addition to the number of reflux episodes.

Computational Modelling of Cough Function and Airway Penetrant Behavior in Patients with Disorders of Laryngeal Function

Patients with laryngeal disorders often exhibit changes to cough function contributing to aspiration episodes. Two primary cough variables (peak cough flow: PCF and compression phase duration: CPD) were examined within a biomechanical model to determine their impact on characteristics that impact airway compromise.

Mathematical modelling of tongue deformation during swallow in patients with head and neck cancer

ABSTRACT Cancer localized to the tongue is often characterized by increased stiffness in the affected region. This stiffness affects swallow in a manner that is difficult to quantify in patients. A biomechanical model was developed to simulate the spatio-temporal deformation of the tongue during the pharyngeal phase of swallow in patients with cancer of the tongue base. The model involves finite element analysis (FEA) of a three-dimensional (3D) model of the tongue reconstructed from magnetic resonance images (MRI). The tongue tissue is assumed to be hyper-elastic. In order to examine the effects of tissue change (increased stiffness) due to the presence of cancer localized to the tongue base, various sections of the 3D geometry are modified to exhibit different elastic properties. Three cases are considered, representing the normal tongue, a tongue with early-stage cancer, and tongue with late-stage cancer. Early- and late-stage cancers are differentiated by the degree of stiffness within the base of tongue tissue. Analysis of the model suggests that healthy tongue has a maximum deformation of 9.38 mm, whereas tongues having mild cancer and severe cancer have a maximum deformation of 8.65 and 6.17 mm, respectively. Biomechanical modelling is a useful tool to explain and estimate swallowing abnormalities associated with tongue cancer and post-treatment characteristics.

A Preliminary Investigation of the Affective, Behavioral and Cognitive VariablesAssociated with Spasmodic Dysphonia

Background: Spasmodic dysphonia (SD) is often assessed and treated in a rather mono-dimensional way, despite knowledge of the impact of SD on a person’s quality of life. This study investigates how adults with SD think and feel about their speech, and cope with their voice problem. Methods: Adults with SD were asked to fill out the Behavior Assessment Battery’s (BAB-Voice) self-report tests. The Speech Situation Checklist-Emotional Reaction and Speech Disruption investigate negative emotional reaction and voice problems in particular speech situations. The Behavior Checklist provides an inventory of behaviours that might be used to avoid or escape voice problems. The Communication Attitude Test for Adults assesses speechassociated attitude. Results: Adults with SD had elevated scores on all BAB tests. Their results were comparable to BAB research with people who stutter. Conclusion: The data show the BAB’s potential to assist clinicians in diagnosis and in designing a tailored multidimensional treatment plan.