Paul M. Evitts

Perceptual and acoustic evidence of speaker adaptation to a thin pseudopalate

The purpose of this study was to examine the effect of a thin pseudopalate on the speech of normal adults. It was hypothesized that speech would be initially altered, but speakers would adapt quickly to the device. Eleven speakers produced words without the pseudopalate and at six intervals with the appliance in place. Consonant acoustics were changed initially, but returned to baseline within ∼30 minutes. Perceptually, consonant identification and distortion ratings were unchanged when wearing the pseudopalate. Results suggest an initial alteration to speech detectable acoustically, but rapid adaptation, for most speakers. Investigators using thin pseudopalates must recognize that speech is altered, at least initially, and account for this in their procedures and interpretation of results.

Communication adjustment of patients with a laryngectomy in Turkey: Analysis by type of surgery and mode of speech

Previous studies have routinely shown that individuals with a laryngectomy (IWL) have a decreased quality of life (QoL). However, the questionnaires frequently used are not specifically designed for persons with laryngeal cancer and may not reflect the issues of most concern to IWL. The purpose of this study was to investigate (1) the overall communication adjustment of IWL in Turkey, (2) the differences in communication adjustment among types of surgery for the treatment of laryngeal cancer, and (3) the differences in communication adjustment among types of speech following treatment for laryngeal cancer. Fifty-two patients (50 males and two females) who underwent surgical treatment for laryngeal cancer (i.e. total, supraglottic, frontolateral, vertical, supracricoid) and were being seen for follow-up care were recruited from an ENT clinic in Bursa, Turkey. Patients were provided with a written translation of the Self-Evaluation of Communication Experiences after Laryngectomy (SECEL) which yielded information on three subscales (General, Environment, and Attitude) and a Total score. Kruskall–Wallis and Wilcoxon signed ranks nonparametric tests of significance showed that overall adjustment was within the well-adjusted range for all types of surgery and modes of speech with two exceptions: Mean scores for supracricoid laryngectomy with cricohyoidopexy (28.5) and esophageal speech (29.3) were both within the poorly adjusted range on the Environment subscale [lowest mean score = 8.7 (supraglottic)]. Total mean scores ranged from 19.8 (supraglottic) to 49.9 (esophageal speech). Mean scores of the General subscale ranged from 4.0 (electrolaryngeal speech) to 7.7 (tracheoesophageal speech). Mean scores of the Attitude subscale ranged from 6.2 (supraglottic) to 19 (electrolaryngeal). Results of the Kruskall–Wallis test also showed a significant difference between type of surgery for the Environment subscale (p = 0.003), the Attitude subscale (p = 0.039), and the Total score (p = 0.007). The results suggest that overall, IWL in Turkey are well-adjusted to their new voice. However, results also showed that certain conservation surgeries (i.e. supraglottic, frontolateral, vertical) yielded more favorable outcomes than either supracricoid laryngectomy or speech following total laryngectomy. This finding is most likely related to the amount of tissue preserved following conservation surgery, in particular the preservation of the vocal folds.

Effects of audio-visual information on the intelligibility of alaryngeal speech

BACKGROUND There is minimal research on the contribution of visual information on speech intelligibility for individuals with a laryngectomy (IWL). AIMS The purpose of this project was to determine the effects of mode of presentation (audio-only, audio-visual) on alaryngeal speech intelligibility. METHOD Twenty-three naïve listeners were randomly presented 176 phonemically balanced sentences produced by three alaryngeal (tracheoesophageal, esophageal, electrolaryngeal) and one typical, laryngeal speaker in both audio-only and audio-visual modes of presentation. RESULTS Overall, results showed a small (3%) but statistically significant higher speech intelligibility score for audio-visual stimuli compared to audio-only stimuli as well as a significant interaction effect between mode of speech and mode of presentation. Within mode of speech, electrolaryngeal speech was the only mode that benefited significantly from the inclusion of visual information (10% increase). Overall intelligibility showed similar patterns both within audio-only and audio-visual modes of presentation: typical laryngeal and tracheoesophageal speech modes were significantly more intelligible than both esophageal and electrolaryngeal. CONCLUSIONS Results suggest that listeners may benefit more from visual information from speakers with poor baseline speech intelligibility. Results also show similar intelligibility between typical, laryngeal and tracheoesophageal modes of speech. Results should be interpreted with caution, however, as only one speaker from each mode of speech was included. Further research is required to determine the nature of the increase. LEARNING OUTCOMES Readers will (1) increase their understanding of the potential impact of visual information in the perception of alaryngeal speech; (2) identify potential factors that may augment or hinder speech perception; and (3) discuss how individual modes of alaryngeal speech may be affected by audio-visual information.

Reliability and validity of the Italian self-evaluation of communication experiences after laryngeal cancer questionnaire

The Self‐Evaluation of Communication Experiences after Laryngeal Cancer (SECEL) questionnaire assesses the impact of total laryngectomy on communication‐related quality of life (QOL). This study evaluates the Italian version of the SECEL (I‐SECEL), including reliability, concurrent validity, and differences in scores between patients who undergo either total laryngectomy or partial laryngectomy.

Impairments in dichotic listening in patients presenting anterior communicating artery aneurysm.

Impaired dichotic listening has been documented in numerous etiologies, but there is limited information on patients who present with anterior communicating artery (ACoA) aneurysm. The sequelae following ACoA aneurysm is frequently associated with neurobehavioral impairments, such as confabulation, memory, and behavior, as a result of the areas of innervation (DeLuca, 1992; DeLuca & Diamond, 1995). Clinical experience, however, shows ACoA aneurysm to also be associated with impairments in dichotic listening. Participants in this study were divided into 2 groups: patients who presented with ACoA aneurysm with agematched controls, and patients who presented moderate to severe traumatic brain injury (TBI) with age-matched controls. TBI patients were included for test-validity purposes and to allow a comparison between diffuse and focal cerebral damage. Dichotic listening results revealed a similar pattern for patients with ACoA aneurysm and those with brain injury. The findings suggest that central auditory pathways are susceptible to damage following ACoA aneurysm.

Oral Feeding Outcome in Infants with a Tracheostomy

ABSTRACT Purpose: Currently, there is a lack of evidence‐based guidelines on the proper protocol for feeding infants with a tracheostomy in the neonatal intensive care unit (NICU). The purpose of this study was to provide preliminary insight into the outcomes of these infants in one mid‐Atlantic pediatric hospital. Design and Methods: Retrospective and descriptive. The study team reviewed 114 patient records, 42 of which met the inclusion criteria. Data were organized based on: 1) general demographics and history; b) feeding‐related variables at multiple points; c) speech‐related variables, including assessments and swallowing studies; d) respiratory variables at multiple points; and, e) discharge data. Other variables included birth‐related information, ventilation settings and feeding modifications. Results: Infants were placed into three groups at discharge based on feeding outcomes. Forty‐three percent were discharged on full oral feeds, 38% on combined oral and gavage, and 19% of infants were discharged on full gavage feeds. Informal analysis showed that all three categories of infants gained weight during hospitalization, different PEEP pressures and different lengths of hospitalization were observed among the groups, and infant characteristics (e.g., APGAR, gestational ages) were similar across groups. Conclusions: Overall results provide insight into factors that may be predictive of feeding status at discharge for infants with a tracheostomy in an NICU. Practical Implications: Results of this study can provide important insight into the feeding outcomes of infants in a NICU with a tracheostomy and can hopefully lead to additional research to help determine the most efficacious procedures for feeding this patient population. HIGHLIGHTSThere is a lack of evidence‐based guidelines on feeding infants with a tracheostomy in a NICU.Prolonged intubation appears to impede the development of oral feeding skills in infants with a tracheostomy.Gestational age may not play a role with feeding outcomes.Most infants were discharged on either full oral or combined oral and gavage feeds.Infants who were discharged on full gavage feeds required longer hospitalization times than the other two groups.

Meeting the Needs of Signers in the Field of Speech and Language Pathology Some Considerations for Action

Deaf individuals who use American Sign Language (ASL) are rarely the focus of professionals in speech-language pathology. Although society is widely thought of in terms of those who speak, this norm is not all-inclusive. Many signing individuals exhibit disorders in signed language and need treatment much like their speaking peers. Although there is validation of the existence of disorders in signed language, provisions for signed language therapies are rare. Spoken language bias is explored with a focus on the concerning history of therapies provided for spoken language only. This article explores attitudes regarding ASL along with how signed language reading can help identify and treat language learning disabilities among deaf children. Addressing the topic of signed language disorders aims at meeting the needs of individuals who are deaf, which could lead to professional training and treatment options in signed language pathology (e.g., aphasia, stuttering).

The Impact of Dysphonic Voices on Healthy Listeners: Listener Reaction Times, Speech Intelligibility, and Listener Comprehension

Purpose There is currently minimal information on the impact of dysphonia secondary to phonotrauma on listeners. Considering the high incidence of voice disorders with professional voice users, it is important to understand the impact of a dysphonic voice on their audiences. Methods Ninety-one healthy listeners (39 men, 52 women; mean age = 23.62 years) were presented with speech stimuli from 5 healthy speakers and 5 speakers diagnosed with dysphonia secondary to phonotrauma. Dependent variables included processing speed (reaction time [RT] ratio), speech intelligibility, and listener comprehension. Voice quality ratings were also obtained for all speakers by 3 expert listeners. Results Statistical results showed significant differences between RT ratio and number of speech intelligibility errors between healthy and dysphonic voices. There was not a significant difference in listener comprehension errors. Multiple regression analyses showed that voice quality ratings from the Consensus Assessment Perceptual Evaluation of Voice (Kempster, Gerratt, Verdolini Abbott, Barkmeier-Kraemer, & Hillman, 2009) were able to predict RT ratio and speech intelligibility but not listener comprehension. Conclusions Results of the study suggest that although listeners require more time to process and have more intelligibility errors when presented with speech stimuli from speakers with dysphonia secondary to phonotrauma, listener comprehension may not be affected.

Current knowledge and impressions of speech-language pathologists of the swallow of persons who are obese.

Abstract Purpose: The overall goal of this study was to provide insight on the topic of dysphagia in the obese population. More specifically, the purpose of this study was to obtain preliminary descriptive data on the knowledge and impressions of speech-language pathologists (SLPs) working in the field of dysphagia on the swallow of persons who are obese. Methods: One hundred seventy-seven SLPs responded to a web-based survey that was posted on two popular listserves that serve the dysphagia community. Results: Descriptive results showed that nearly all SLPs have assessed and treated patients who are obese for dysphagia, that there is little consensus as to how the obese swallow compares to the normal swallow, and that there is a consensus that dysphagia observed in the obese population is most likely related to other concomitant disorders. Conclusions: Results provide preliminary insight into the knowledge and impressions of SLPs working with dysphagia and highlight the need for future research to determine (1) if there is an increased incidence of dysphagia in the obese population, and (2) if obesity itself constitutes a risk factor for dysphagia or if any dysphagia observed in this population is related to other comorbidities. Implications for Rehabilitation Many healthcare professionals (i.e. speech-language pathologists [SLPs]) assess, diagnose and treat individuals for swallowing disorders who are obese in the absence of research or evidence-based medicine on the impact of obesity on the swallow or the impact of obesity on dysphagia rehabilitation (e.g. swallowing exercises). Results of this study suggest that: there is not a consensus among SLPs on the swallowing characteristics of persons who are obese; that persons who are obese are more at risk for swallowing disorders; and that the increased risk of dysphagia may be related to concomitant disorders and not the presence of obesity itself. Clinicians who work with dysphagia need to understand the impact of obesity on the swallow and on dysphagia rehabilitation with persons who are obese. Future research should focus on establishing estimates of swallowing function in persons who are obese. This information can provide a foundation for efficacy studies of various therapy techniques (e.g. exercises) and ultimately can assist with goal setting and intervention planning.