Kartini Ahmad

Vocal fold vibratory characteristics of healthy geriatric females - Analysis of high-speed digital images

OBJECTIVES/HYPOTHESIS A high proportion of the geriatric population suffers from presbylaryngis and presbyphonia; however, our knowledge of vibratory patterns in this population is almost nonexistent. In this study, we investigate the vocal fold vibratory patterns of healthy elderly females to determine which features or combination of them could best describe the geriatric voices. STUDY DESIGN Cross-sectional study with 20 elderly healthy females with no history of voice problems. METHODS Hilbert transformed glottal area waveforms (GAWs) from serial high-speed digital imaging of sustained phonation are used to provide quantitative measures of glottal vibratory characteristics and perturbations; open quotient, jitter, and shimmer. Nyquist plots provide interpretable patterns to portray the vibratory characteristics as clear, pressed, breathy, and atypical patterns. RESULTS The GAW from most elderly speakers (50%) showed vibratory characteristics associated with a more pressed voice and higher glottal perturbation values: their Nyquist plot patterns show wide scatterings around the rim of the plot reflecting a much-reduced ability in sustaining vibratory oscillation; these were distinct differences from previously reported data on younger speakers. Qualitative examination revealed more anteriorly placed glottal gaps in the geriatric females. CONCLUSION These findings have important implications in understanding voice production in the geriatric population and in helping to establish normal perturbation references among female speakers across age.

Vocal Fold Vibratory Characteristics in Normal Female Speakers From High-Speed Digital Imaging

The purpose of the study was to investigate relationships between vocal fold vibrations and voice quality. Laryngeal images obtained from high-speed digital imaging (HSDI) were examined for their open-closed timing characteristics and perturbation values. A customized software delineated the glottal edges and used the Hilbert transform-based method of analysis to provide objective quantification of glottal perturbation. Overlay tracings of the transformed glottal cycles provided visual patterns on the overall vibratory dynamics. In this paper, we described the use of this method in looking at vibratory characteristics of a group of young female speakers (N=23). We found that, females with no voice complaints and who had been perceived to have normal voices were not a homogeneous group in terms of their glottal vibratory patterns during phonation. Their vibratory patterns showed characteristics similar to exemplar voices targeted to be clear (50%), pressed (27%), breathy (15%), or a mixed quality (8%). Perturbation range in terms of cycle-to-cycle frequency and amplitude was small and did not discriminate patterns. All these patterns yielded perceptually normal voices suggesting that in normal young speakers, the level of perturbation may be more important to the judgment than the actual pattern of closure.

Addressing education of speech-language pathologists in the World Report on Disability: Development of a speech-language pathology program in Malaysia

Abstract The current paper is a response to the Wiley, McAllister, Davidson, and Marshall lead article regarding the application of the World Report on Disability (WRD) to people with communication disorders. The current paper directly addresses recommendation 5 (improvement of human resource capacity) and indirectly addresses recommendations 7, 8, and 9 (related to improving local knowledge and data on communicative disabilities) indirectly. The paper describes Malaysias initiatives in the early 1990s, in developing its local professional capacity to provide services for people with communication disorders (PWCD). It charts the history of development of a local undergraduate entry-level degree program for speech-language pathology (SLP) from the point of conceptualization to full execution. The article provides glimpses to the processes and challenges faced by Universiti Kebangsaan Malaysia as the pioneer university in the South East Asia region to undertake the training and education of the SLP profession and highlights relevant issues faced by newly introduced professions in a country where resources and practice traditions were previously unavailable. It underscores the important role played by government institutions and an international professional network in driving forward-looking policies to implement and sustain the program.

Discharging patients: A perspective from speech-language pathologists working in public hospitals in Malaysia

Speech-language pathologists (SLPs) practising in Malaysia face similar dilemmas as their counterparts in more developed countries when it comes to deciding on discharge/termination of services for their patients. Furthermore, discharge dilemmas appear to be a frequent and inevitable part of their everyday practice. In an interview conducted for the purpose of this paper, it was clear that many SLPs found it difficult to articulate or justify the process they took to reach a decision on whether or not to terminate their services or discharge their patients. Much of the difficulty is anchored on the need to be realistic and function within the confines of limited resources. Malaysian SLPs were aware of the ideals that had to be abandoned along the way but had not allowed guilt to dissuade or discourage them from providing what they perceived as the next best available service. The not-so ideal decisions made by these SLPs may be frowned upon by international standards but must be examined within the local historical perspective of the development of the SLP profession in Malaysia. The dilemma will continue until the country produces SLPs in sufficient numbers but the profession is reminded that less-than-ideal practices may perpetuate over time into unhealthy traditions that will require major efforts to be undone.

Towards Developing a Therapeutic Serious Game Design Model for Stimulating Cognitive Abilities: A Case for Children with Speech and Language Delay

Recently, serious games aimed at cognitive therapy have been gaining increasing importance in general health applications, creating new possibilities for various groups, including children, to access new forms of treatment. However, to develop therapeutic serious games that stimulate the cognitive abilities of children with speech and language delay (CSLD), the needs of this group and a few other issues must be considered. Therefore, this paper aims to identify the problems affecting the cognitive functions of CSLD as well as their needs, to assist in the development of a serious game for CSLD. We conducted a preliminary study through a semi-structured interview with experts in the area of therapy. Our results indicate that CSLD indeed have major difficulties that affect the development of their cognitive abilities such as memory, attention, perception, problem solving, decision making, language, learning, and reasoning. In addition, CSLD also lack preverbal and motor skills. These findings reinforce the need to propose a model for therapeutic serious game design that stimulates the cognitive abilities of CSLD.

Patterns of recognition of Arabic consonants by non-native children with cochlear implants and normal hearing

Objective: This study examined the patterns of recognition of Arabic consonants, via information transmission analysis for phonological features, in a group of Malay children with normal hearing (NH) and cochlear implants (CI). Method: A total of 336 and 616 acoustic tokens were collected from six CI and 11 NH Malay children, respectively. The groups were matched for hearing age and duration of exposure to Arabic sounds. All the 28 Arabic consonants in the form of consonant–vowel /a/ were presented randomly twice via a loudspeaker at approximately 65 dB SPL. The participants were asked to repeat verbally the stimulus heard in each presentation. Results: Within the native Malay perceptual space, the two groups responded differently to the Arabic consonants. The dispersed uncategorized assimilation in the CI group was distinct in the confusion matrix (CM), as compared to the NH children. Consonants /ħ/, /tˁ/, /sˁ/ and /ʁ/ were difficult for the CI children, while the most accurate item was /k/ (84%). The CI group transmitted significantly reduced information, especially for place feature transmission, then the NH group (p < 0.001). Significant interactions between place-hearing status and manner-hearing status were also obtained, suggesting there were information transmission differences in the pattern of consonants recognition between the study groups. Conclusion: CI and NH Malay children may be using different acoustic cues to recognize Arabic sounds, which contribute to the different assimilation categories’ patterns within the Malay perceptual space.

Quantitative measurements of forward head posture in a clinical settings: a technical feasibility study

Abstract Introduction: Current clinical practice lacks a user-friendly quantitative method of measuring head posture in individuals with neck-related musculoskeletal disorders. Literature reveals that photogrammetry is a valid and reliable method to evaluate forward head posture (FHP) based on the angles and distance measured on a digital image. However, the adoption of the photogrammetry-based FHP assessment is not common clinical practice. This may be due to technical difficulties, high cost, and complexity of posture assessment software. Advancements in and access to information technology have allowed wide numbers of open resource software applications to be available for measurement of FHP in patients with neck pain in the clinical setting. Aim: To determine the technical feasibility of quantitative forward head posture assessment in clinical settings. Methods: A total of 15 subjects without history of neck pain and 16 subjects with neck pain were recruited for the study. Sagittal head tilt angle (SHA), craniocervical angle (CCA), and shoulder angle (SA) were measured using photogrammetry method. Angles on digital images taken were then analysed using a multi-professional open resource, the Web Plot Digitizer (WPD). Results: The CCA and SA were lower (CCA = 43.54°, SA = 49.39°) in subjects with neck pain than normal subjects (CCA = 47.43°, SA = 52.28°) indicating FHP and protracted shoulder. Subjects with neck pain demonstrated high sagittal head tilt angle (SHA = 19.89°) indicating greater upper cervical extension. Conclusion: Quantitative FHP assessment in the clinical setup using photogrammetry is technically feasible with a basic computer setup and WPD to measure the angles on a digital image.