Thomas Law

The Effectiveness of Group Voice Therapy: A Group Climate Perspective

OBJECTIVES/HYPOTHESISnGroup therapy has frequently been adopted as a service delivery model for providing voice therapy. However, currently no literature has focused on understanding the underlying processes that are unique to group therapy, which contribute to treatment success. This study aimed at investigating the role of group climate in voice group therapy.nnnSTUDY DESIGNnProspective case series.nnnMETHODSnTwelve teachers with hyperfunctional dysphonia attended eight sessions of group voice therapy. Treatment comprised both direct and indirect voice therapy. Therapy techniques were introduced and practiced in a large group and small group format. Outcome measures were taken using perceptual evaluation, videostroboscopy measures, voice-related quality-of-life (V-RQOL) measures, and vocal symptom scores. The Group Climate Questionnaire was used to measure the underlying process of group therapy. Treatment outcome was measured immediately posttreatment and at 6-months posttreatment.nnnRESULTSnResults indicated statistically significant improvement in the participants V-RQOL measures and the vocal symptom scores. Treatment gain was noted to sustain up to 6-months posttreatment. The Group Climate Questionnaire indicated that the treatment group is considered as engaging rather than conflicting, which is considered to be associatedxa0with positive treatment outcome.nnnCONCLUSIONnGroup therapy as a service delivery model possesses many advantages from the psychosocial, clinical, health resources allocation perspective. This study demonstrated that group climate plays a significant role in determining treatment success in group voice therapy.

Comparison of Rater's reliability on perceptual evaluation of different types of voice sample.

OBJECTIVE/HYPOTHESISnThe objective of this study was to determine whether different types of voice samples affect rater reliability and which type of sample can be rated most reliably, with particular reference to two types of connected speech-passage reading and conversational speech.nnnSTUDY DESIGNnProspective reliability study.nnnMETHODSnOne hundred fifty voice samples from 40 speakers were presented to 14 speech pathologists experienced in managing voice disorders. Each speaker contributed three types of voice samples: sustained vowels, passage reading, and conversational speech. Ratings were made on four vocal parameters--overall severity, roughness, breathiness, and strain--on a 10-point equal-appearing interval scale.nnnRESULTSnDifferences in intrarater reliability across the three types of voice samples were noted. Higher intrarater reliability was achieved with connected speech than with sustained vowel samples. Interrater reliability showed no statistically significant difference across the three types but increased with the severity of dysphonia.nnnCONCLUSIONSnThis study reveals that raters give internally more reliable ratings for connected speech samples. Results also indicate that voices with severe disorders appear to be rated more reliably.

Treatment intensity in everyday clinical management of speech sound disorders in Hong Kong

Abstract Much evidence supports the efficacy of different treatment approaches for speech sound disorders (SSD) in children. Minimal research in the field has been conducted using treatment intensity as a research variable. This study examined the current practice of speech-language pathologists (SLPs) in Hong Kong regarding the treatment intensity prescribed to children with SSD and potential factors that were associated with the intensity. Participants were 102 SLPs working in different settings in Hong Kong who completed an online questionnaire. SLPs who had a heavier caseload offered significantly less frequent and shorter treatment duration to clients with SSD. Public and private settings differed significantly in treatment duration. Treatment approaches and clinicians’ consideration about a clients conditions did not affect treatment intensity. SLPs in Hong Kong do not plan treatment duration and frequency in an evidence-based direction because of their heavy workloads and the dearth of research evidence on treatment intensity to guide their clinical practice.

Automatic speech recognition for acoustical analysis and assessment of cantonese pathological voice and speech

This paper describes the application of state-of-the-art automatic speech recognition (ASR) systems to objective assessment of voice and speech disorders. Acoustical analysis of speech has long been considered a promising approach to non-invasive and objective assessment of people. In the past the types and amount of speech materials used for acoustical assessment were very limited. With the ASR technology, we are able to perform acoustical and linguistic analyses with a large amount of natural speech from impaired speakers. The present study is focused on Cantonese, which is a major Chinese dialect. Two representative disorders of speech production are investigated: dysphonia and aphasia. ASR experiments are carried out with continuous and spontaneous speech utterances from Cantonese-speaking patients. The results confirm the feasibility and potential of using natural speech for acoustical assessment of voice and speech disorders, and reveal the challenging issues in acoustic modeling and language modeling of pathological speech.

Does Low Dose Angiotensin Converting Enzyme Inhibitor Prevent Pneumonia in Older People With Neurologic Dysphagia–A Randomized Placebo-Controlled Trial

OBJECTIVEnTo examine if angiotensin converting enzyme inhibitor reduces the risk of pneumonia in older patients on tube-feeding because of dysphagia from cerebrovascular diseases.nnnDESIGNnRandomized placebo-controlled trial.nnnSETTINGnAcute and subacute geriatrics units, speech therapists clinic, and nursing home.nnnPARTICIPANTSnOlder patients on tube-feeding for >2xa0weeks because of dysphagia secondary to cerebrovascular diseases.nnnINTERVENTIONnParticipants were randomized to lisinopril 2.5xa0mg or placebo once daily for 26xa0weeks.nnnMEASUREMENTSnParticipants were followed up at weeks 12 and 26. The primary outcome was the incidence rate of pneumonia as determined by pneumonic changes on x-ray and clinical criteria. The secondary outcomes were mortality rate and swallowing ability as defined by the Royal Brisbane Hospital Outcome Measure for Swallowing at weekxa012.nnnRESULTSnA total of 93 older patients were randomized. In interim analysis, 71 completed the trial, whereas 15 had dropped out. Among those who had completed the trial, odds ratio (OR) for death was significantly higher in the intervention group (unadjusted OR 2.94, Pxa0=xa0.030; fully adjusted OR 7.79, Pxa0=xa0.018). There was no difference in the incidence of pneumonia or fatal pneumonia in the 2 groups. The intervention group had a marginally better swallowing function at week 12 (Royal Brisbane Hospital Outcome Measure for Swallowing score: 4.2xa0±xa01.5 in intervention group, 3.5xa0±xa01.5 in placebo group, Pxa0=xa0.053). As a result of the interim finding on mortality, the trial was prematurely terminated with 7 participants still in the trial.nnnCONCLUSIONSnLow dose lisinopril given to older tube-fed patients with neurologic dysphagia resulted in increased mortality, although swallowing function showed marginal improvement. ACE inhibitors did not prevent pneumonia in older patients with neurologic dysphagia and might increase mortality.

Role of sentence-final particles and prosody in irony comprehension in Cantonese-speaking children with and without Autism Spectrum Disorders

English-speaking children with Autism Spectrum Disorders (ASD) are less capable of using prosodic cues such as intonation for irony comprehension. Prosodic cues, in particular intonation, in Cantonese are relatively restricted while sentence-final particles (SFPs) may be used for this pragmatic function. This study investigated the use of prosodic cues and SFPs in irony comprehension in Cantonese-speaking children with and without ASD. Thirteen children with ASD (8;3–12;9) were language-matched with 13 typically developing (TD) peers. By manipulating prosodic cues and SFPs, 16 stories with an ironic remark were constructed. Participants had to judge the speakers belief and intention. Both groups performed similarly well in judging the speakers belief. For the speakers intention, the TD group relied more on SFPs. The ASD group performed significantly poorer and did not rely on either cue. SFPs may play a salient role in Cantonese irony comprehension. The differences between the two groups were discussed by considering the literature on theory of mind.

Influence of additional language learning on first language learning in children with language disorders.

BACKGROUNDnMultilingualism can bring about various positive outcomes to typically developing children. Its effect on children with language difficulties is not yet clear.nnnAIMnThe aim of this study was to examine the effects of multilingual learning as a medium of instruction (MOI) on first language (L1) acquisition of children with language disorders (LD).nnnMETHODS & PROCEDURESnNineteen Cantonese-speaking students aged 5;8-6;8 who were diagnosed with LD were recruited from a school that used Putonghua (an alternative Chinese dialect) as the MOI when learning Chinese language and were compared with 18 age-and-gender-matched Cantonese-speaking students with LD from a school that used Cantonese as the MOI when learning Chinese language. All the students also learned English (L2) as a subject at school. Proficiency in Cantonese was tested at the beginning and the end of the semester in Grade One in terms of: (1) grammar, (2) expressive vocabulary, (3) auditory textual comprehension, (4) word definition and (5) narration.nnnOUTCOMES & RESULTSnMixed-model ANOVAs revealed an effect of time on language proficiency indicating positive gains in both groups. Interaction effects between time and group were not significant. There was a trend that children learning Putonghua showed slightly more improvement in auditory textual comprehension.nnnCONCLUSIONS & IMPLICATIONSnProficiency gains were similar across groups. The study found no evidence that a multilingual learning environment hinders the language proficiency in L1 in students who have LD.

Lexical tone and stuttering in Cantonese

ABSTRACT Cantonese is a tone language, in which the variation of the fundamental frequency contour of a syllable can change meaning. There are six different lexical tones in Cantonese. While research with Western languages has shown an association between stuttering and syllabic stress, nothing is known about whether stuttering in Cantonese speakers is associated with one or more of the six lexical tones. Such an association has been reported in conversational speech in Mandarin, which is also a tone language, but which varies markedly from Cantonese. Twenty-four native Cantonese-speaking adults who stutter participated in this study, ranging in age from 18–33 years. There were 18 men and 6 women. Participants read aloud 13 Cantonese syllables, each of which was produced with six contrastive lexical tones. All 78 syllables were embedded in the same carrier sentence, to reduce the influence of suprasegmental or linguistic stress, and were presented in random order. No significant differences were found for stuttering moments across the six lexical tones. It is suggested that this is because lexical tones, at least in Cantonese, do not place the task demands on the speech motor system that typify varying syllabic stress in Western languages: variations not only in fundamental frequency, but also in duration and intensity. The findings of this study suggest that treatments for adults who stutter in Western languages, such as speech restructuring, can be used with Cantonese speakers without undue attention to lexical tone.

The Topography of Stuttering in Cantonese

Objective: This is the first study to investigate the behavioral nature (topography) of stuttering in Cantonese. Cantonese, a Sino-Tibetan language, is both tonal and syllable-timed. Previous studies of stuttering topography have mainly been in Western languages, which are mainly stress-timed. Methods: Conversational speech samples were collected from 24 native Cantonese-speaking adults who stuttered. Six consecutive stuttering moments from each participant were analyzed using the Lidcombe behavioral data language (LBDL). A complexity analysis based on the LBDL was developed to indicate the proportion of multiple-behavior stuttering moments for each participant. Results: There was no significant difference in the frequency of the 7 LBDL behaviors. Almost half the stuttering moments across participants were reported as complex, containing more than 1 stuttering behavior, and stuttering complexity correlated significantly with stuttering severity. Conclusions: These preliminary findings require replication because of their important theoretical and clinical implications. Differences in topography across languages have the potential to contribute to our understanding of the nature of stuttering. Clinically, the recognition of such differences may assist practitioners in identifying stuttering, for example when screening for early stuttering. The LBDL complexity score developed in this study has the potential to be used in other languages.

Rhythmic speech and stuttering reduction in a syllable-timed language

ABSTRACT Speaking rhythmically, also known as syllable-timed speech (STS), has been known for centuries to be a fluency-inducing condition for people who stutter. Cantonese is a tonal syllable-timed language and it has been shown that, of all languages, Cantonese is the most rhythmic (Mok, 2009). However, it is not known if STS reduces stuttering in Cantonese as it does in English. This is the first study to investigate the effects of STS on stuttering in a syllable-timed language. Nineteen native Cantonese-speaking adults who stutter were engaged in conversational tasks in Cantonese under two conditions: one in their usual speaking style and one using STS. The speakers’ percentage syllables stuttered (%SS) and speech rhythmicity were rated. The rhythmicity ratings were used to estimate the extent to which speakers were using STS in the syllable-timed condition. Results revealed a statistically significant reduction in %SS in the STS condition; however, this reduction was not as large as in previous studies in other languages and the amount of stuttering reduction varied across speakers. The rhythmicity ratings showed that some speakers were perceived to be speaking more rhythmically than others and that the perceived rhythmicity correlated positively with reductions in stuttering. The findings were unexpected, as it was anticipated that speakers of a highly rhythmic language such as Cantonese would find STS easy to use and that the consequent reductions in stuttering would be great, even greater perhaps than in a stress-timed language such as English. The theoretical and clinical implications of the findings are discussed.