Towards an Intraoral-Based Silent Speech Restoration System for Post-laryngectomy Voice Replacement

© Springer International Publishing AG 2017, Silent Speech Interfaces (SSIs) are alternative assistive speech technologies that are capable of restoring speech communication for those individuals who have lost their voice due to laryngectomy or diseases affecting the vocal cords. However, many of these SSIs are still deemed as impractical due to a high degree of intrusiveness and discomfort, hence limiting their transition to outside of the laboratory environment. We aim to address the hardware challenges faced in developing a practical SSI for post-laryngectomy speech rehabilitation. A new Permanent Magnet Articulography (PMA) system is presented which fits within the palatal cavity of the user’s mouth, giving unobtrusive appearance and high portability. The prototype is comprised of a miniaturized circuit constructed using commercial off-the-shelf (COTS) components and is implemented in the form of a dental retainer, which is mounted under roof of the user’s mouth and firmly clasps onto the upper teeth. Preliminary evaluation via speech recognition experiments demonstrates that the intraoral prototype achieves reasonable word recognition accuracy and is comparable to the external PMA version. Moreover, the intraoral design is expected to improve on its stability and robustness, with a much improved appearance since it can be completely hidden inside the user’s mouth

Towards an intraoral-based silent speech restoration system for post-laryngectomy voice replacement

© Springer International Publishing AG 2017,Silent Speech Interfaces (SSIs) are alternative assistive speech technologies that are capable of restoring speech communication for those individuals who have lost their voice due to laryngectomy or diseases affecting the vocal cords. However, many of these SSIs are still deemed as impractical due to a high degree of intrusiveness and discomfort, hence limiting their transition to outside of the laboratory environment. We aim to address the hardware challenges faced in developing a practical SSI for post-laryngectomy speech rehabilitation. A new Permanent Magnet Articulography (PMA) system is presented which fits within the palatal cavity of the user’s mouth, giving unobtrusive appearance and high portability. The prototype is comprised of a miniaturized circuit constructed using commercial off-the-shelf (COTS) components and is implemented in the form of a dental retainer, which is mounted under roof of the user’s mouth and firmly clasps onto the upper teeth. Preliminary evaluation via speech recognition experiments demonstrates that the intraoral prototype achieves reasonable word recognition accuracy and is comparable to the external PMA version. Moreover, the intraoral design is expected to improve on its stability and robustness, with a much improved appearance since it can be completely hidden inside the user’s mouth

Silent Speech Interfaces for Speech Restoration: A Review

This work was supported in part by the Agencia Estatal de Investigacion (AEI) under Grant PID2019-108040RB-C22/AEI/10.13039/501100011033. The work of Jose A. Gonzalez-Lopez was supported in part by the Spanish Ministry of Science, Innovation and Universities under Juan de la Cierva-Incorporation Fellowship (IJCI-2017-32926).This review summarises the status of silent speech interface (SSI) research. SSIs rely on non-acoustic biosignals generated by the human body during speech production to enable communication whenever normal verbal communication is not possible or not desirable. In this review, we focus on the first case and present latest SSI research aimed at providing new alternative and augmentative communication methods for persons with severe speech disorders. SSIs can employ a variety of biosignals to enable silent communication, such as electrophysiological recordings of neural activity, electromyographic (EMG) recordings of vocal tract movements or the direct tracking of articulator movements using imaging techniques. Depending on the disorder, some sensing techniques may be better suited than others to capture speech-related information. For instance, EMG and imaging techniques are well suited for laryngectomised patients, whose vocal tract remains almost intact but are unable to speak after the removal of the vocal folds, but fail for severely paralysed individuals. From the biosignals, SSIs decode the intended message, using automatic speech recognition or speech synthesis algorithms. Despite considerable advances in recent years, most present-day SSIs have only been validated in laboratory settings for healthy users. Thus, as discussed in this paper, a number of challenges remain to be addressed in future research before SSIs can be promoted to real-world applications. If these issues can be addressed successfully, future SSIs will improve the lives of persons with severe speech impairments by restoring their communication capabilities.Agencia Estatal de Investigacion (AEI) PID2019-108040RB-C22/AEI/10.13039/501100011033Spanish Ministry of Science, Innovation and Universities under Juan de la Cierva-Incorporation Fellowship IJCI-2017-3292

The Impact of ENT Diseases in Social Life

In the past several years, the otorhinolaryngology sector has had a significantimpact on social life. About 10% of the cancers that affect the populationannually concern the head and neck, and each year the guidelines evolve andchange.Emergencies of the otolaryngology sector are among the most common, withnumerous increases in hospitalizations in the ENT department (e.g., bleeding,abscesses, and dyspnoea). Interventions in the election can significantly improvepatients' quality of life and help avoid future complications.Given the importance of the medical and surgical branch of otorhinolaryngology,we want to underline the impact in social life of this important area

Las tecnologías de asistencia para la comunicación utilizadas por los fonoaudiólogos para la intervención de personas laringectomizadas : Revisión sistemática exploratoria.

Introducción: El cáncer de laringe afecta en mayor medida a hombres que a mujeres y se debe a múltiples factores entre ellos el alto consumo de tabaco y alcohol. El tratamiento médico más usado para el cáncer es la recesión total de la laringe la cual supone un cambio radical en la calidad de vida de las personas que padecen este tipo de enfermedades en estadios avanzados y para su entorno (Iglesias, 2017), dado que las funciones de fonación, respiración y deglución se ven gravemente comprometidas, (Bittante de Oliveira, 2005). De acuerdo con lo reportado por la literatura, la rehabilitación de las personas laringectomizadas ha estado enfatizada en el aprendizaje de los métodos clásicos como la erigmofonía, la válvula traqueoesofágica y/o el uso de la laringe electrónica. En los últimos años ha habido un aumento dramático en la gama de opciones y tecnologías de comunicación que se pueden adaptar a las necesidades de las personas con trastornos de la comunicación, (Ball et al., 2016; Light & McNaughton, 2014, citados por Childes, J. M., Palmer, A. D., & Fried-Oken, M. B. 2019). El acceso y uso de la tecnología entre esta población está aumentando, y los laringectomizados, como otros grupos, están usando computadoras para una amplia variedad de propósitos, (Kagan et al., 2005; Lea et al., 2005, citados por Childes, J. M., Palmer, A. D., & Fried-Oken, M. B. 2019). También hay una alta tendencia a la utilización de dispositivos móviles y multimedia debido su uso generalizado y aceptación, (Childes, J. M., Palmer, A. D., & Fried-Oken, M. B. 2019) Objetivo: Identificar las tecnologías de asistencia para la comunicación utilizadas por los fonoaudiólogos para la intervención de personas laringectomizadas reportadas por la literatura entre el período 2010 y 2020. Metodología: El estudio se realizó a través de una búsqueda de literatura en las bases de datos Pubmed, Scopus y Ovid. Resultados: A través de este estudio de investigación se espera encontrar en la literatura nuevas técnicas de comunicación mediadas por herramientas tecnológicas para las personas laringectomizadas que se les dificulta el aprendizaje de alguno de los métodos clásicos de rehabilitación vocal. Conclusión: en el caso de las Tecnologías de asistencia para la Comunicación se pudo identificar en este estudio que las personas laringectomizadas hacen uso de dispositivos integrados como (Computadores de escritorios, computadores portátiles, teléfonos inteligentes, aplicaciones de síntesis de texto a voz, los dispositivos generadores de voz o SGD- por sus siglas en inglés, entre otros) para comunicarse con su entorno e integrarse a la sociedad.PregradoFONOAUDIOLOGO(A

A Silent-Speech Interface using Electro-Optical Stomatography

Sprachtechnologie ist eine große und wachsende Industrie, die das Leben von technologieinteressierten Nutzern auf zahlreichen Wegen bereichert. Viele potenzielle Nutzer werden jedoch ausgeschlossen: Nämlich alle Sprecher, die nur schwer oder sogar gar nicht Sprache produzieren können. Silent-Speech Interfaces bieten einen Weg, mit Maschinen durch ein bequemes sprachgesteuertes Interface zu kommunizieren ohne dafür akustische Sprache zu benötigen. Sie können außerdem prinzipiell eine Ersatzstimme stellen, indem sie die intendierten Äußerungen, die der Nutzer nur still artikuliert, künstlich synthetisieren. Diese Dissertation stellt ein neues Silent-Speech Interface vor, das auf einem neu entwickelten Messsystem namens Elektro-Optischer Stomatografie und einem neuartigen parametrischen Vokaltraktmodell basiert, das die Echtzeitsynthese von Sprache basierend auf den gemessenen Daten ermöglicht. Mit der Hardware wurden Studien zur Einzelworterkennung durchgeführt, die den Stand der Technik in der intra- und inter-individuellen Genauigkeit erreichten und übertrafen. Darüber hinaus wurde eine Studie abgeschlossen, in der die Hardware zur Steuerung des Vokaltraktmodells in einer direkten Artikulation-zu-Sprache-Synthese verwendet wurde. Während die Verständlichkeit der Synthese von Vokalen sehr hoch eingeschätzt wurde, ist die Verständlichkeit von Konsonanten und kontinuierlicher Sprache sehr schlecht. Vielversprechende Möglichkeiten zur Verbesserung des Systems werden im Ausblick diskutiert.:Statement of authorship iii Abstract v List of Figures vii List of Tables xi Acronyms xiii 1. Introduction 1 1.1. The concept of a Silent-Speech Interface . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 1.2. Structure of this work . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 2. Fundamentals of phonetics 7 2.1. Components of the human speech production system . . . . . . . . . . . . . . . . . . . 7 2.2. Vowel sounds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 2.3. Consonantal sounds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 2.4. Acoustic properties of speech sounds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 2.5. Coarticulation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 2.6. Phonotactics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 2.7. Summary and implications for the design of a Silent-Speech Interface (SSI) . . . . . . . 21 3. Articulatory data acquisition techniques in Silent-Speech Interfaces 25 3.1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 3.2. Scope of the literature review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 3.3. Video Recordings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 3.4. Ultrasonography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 3.5. Electromyography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 3.6. Permanent-Magnetic Articulography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 3.7. Electromagnetic Articulography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 3.8. Radio waves . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 3.9. Palatography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 3.10.Conclusion and Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 4. Electro-Optical Stomatography 55 4.1. Contact sensors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 4.2. Optical distance sensors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 4.3. Lip sensor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 4.4. Sensor Unit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84 4.5. Control Unit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 4.6. Software . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 5. Articulation-to-Text 99 5.1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 5.2. Command word recognition pilot study . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 5.3. Command word recognition small-scale study . . . . . . . . . . . . . . . . . . . . . . . . 102 6. Articulation-to-Speech 109 6.1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109 6.2. Articulatory synthesis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109 6.3. The six point vocal tract model . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113 6.4. Objective evaluation of the vocal tract model . . . . . . . . . . . . . . . . . . . . . . . . 116 6.5. Perceptual evaluation of the vocal tract model . . . . . . . . . . . . . . . . . . . . . . . . 120 6.6. Direct synthesis using EOS to control the vocal tract model . . . . . . . . . . . . . . . . 125 6.7. Pitch and voicing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132 7. Summary and outlook 145 7.1. Summary of the contributions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145 7.2. Outlook . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146 A. Overview of the International Phonetic Alphabet 151 B. Mathematical proofs and derivations 153 B.1. Combinatoric calculations illustrating the reduction of possible syllables using phonotactics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153 B.2. Signal Averaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155 B.3. Effect of the contact sensor area on the conductance . . . . . . . . . . . . . . . . . . . . 155 B.4. Calculation of the forward current for the OP280V diode . . . . . . . . . . . . . . . . . . 155 C. Schematics and layouts 157 C.1. Schematics of the control unit. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158 C.2. Layout of the control unit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163 C.3. Bill of materials of the control unit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164 C.4. Schematics of the sensor unit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165 C.5. Layout of the sensor unit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166 C.6. Bill of materials of the sensor unit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167 D. Sensor unit assembly 169 E. Firmware flow and data protocol 177 F. Palate file format 181 G. Supplemental material regarding the vocal tract model 183 H. Articulation-to-Speech: Optimal hyperparameters 189 Bibliography 191Speech technology is a major and growing industry that enriches the lives of technologically-minded people in a number of ways. Many potential users are, however, excluded: Namely, all speakers who cannot easily or even at all produce speech. Silent-Speech Interfaces offer a way to communicate with a machine by a convenient speech recognition interface without the need for acoustic speech. They also can potentially provide a full replacement voice by synthesizing the intended utterances that are only silently articulated by the user. To that end, the speech movements need to be captured and mapped to either text or acoustic speech. This dissertation proposes a new Silent-Speech Interface based on a newly developed measurement technology called Electro-Optical Stomatography and a novel parametric vocal tract model to facilitate real-time speech synthesis based on the measured data. The hardware was used to conduct command word recognition studies reaching state-of-the-art intra- and inter-individual performance. Furthermore, a study on using the hardware to control the vocal tract model in a direct articulation-to-speech synthesis loop was also completed. While the intelligibility of synthesized vowels was high, the intelligibility of consonants and connected speech was quite poor. Promising ways to improve the system are discussed in the outlook.:Statement of authorship iii Abstract v List of Figures vii List of Tables xi Acronyms xiii 1. Introduction 1 1.1. The concept of a Silent-Speech Interface . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 1.2. Structure of this work . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 2. Fundamentals of phonetics 7 2.1. Components of the human speech production system . . . . . . . . . . . . . . . . . . . 7 2.2. Vowel sounds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 2.3. Consonantal sounds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 2.4. Acoustic properties of speech sounds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 2.5. Coarticulation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 2.6. Phonotactics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 2.7. Summary and implications for the design of a Silent-Speech Interface (SSI) . . . . . . . 21 3. Articulatory data acquisition techniques in Silent-Speech Interfaces 25 3.1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 3.2. Scope of the literature review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 3.3. Video Recordings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 3.4. Ultrasonography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 3.5. Electromyography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 3.6. Permanent-Magnetic Articulography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 3.7. Electromagnetic Articulography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 3.8. Radio waves . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 3.9. Palatography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 3.10.Conclusion and Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 4. Electro-Optical Stomatography 55 4.1. Contact sensors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 4.2. Optical distance sensors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 4.3. Lip sensor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 4.4. Sensor Unit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84 4.5. Control Unit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 4.6. Software . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 5. Articulation-to-Text 99 5.1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 5.2. Command word recognition pilot study . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 5.3. Command word recognition small-scale study . . . . . . . . . . . . . . . . . . . . . . . . 102 6. Articulation-to-Speech 109 6.1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109 6.2. Articulatory synthesis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109 6.3. The six point vocal tract model . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113 6.4. Objective evaluation of the vocal tract model . . . . . . . . . . . . . . . . . . . . . . . . 116 6.5. Perceptual evaluation of the vocal tract model . . . . . . . . . . . . . . . . . . . . . . . . 120 6.6. Direct synthesis using EOS to control the vocal tract model . . . . . . . . . . . . . . . . 125 6.7. Pitch and voicing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132 7. Summary and outlook 145 7.1. Summary of the contributions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145 7.2. Outlook . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146 A. Overview of the International Phonetic Alphabet 151 B. Mathematical proofs and derivations 153 B.1. Combinatoric calculations illustrating the reduction of possible syllables using phonotactics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153 B.2. Signal Averaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155 B.3. Effect of the contact sensor area on the conductance . . . . . . . . . . . . . . . . . . . . 155 B.4. Calculation of the forward current for the OP280V diode . . . . . . . . . . . . . . . . . . 155 C. Schematics and layouts 157 C.1. Schematics of the control unit. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158 C.2. Layout of the control unit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163 C.3. Bill of materials of the control unit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164 C.4. Schematics of the sensor unit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165 C.5. Layout of the sensor unit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166 C.6. Bill of materials of the sensor unit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167 D. Sensor unit assembly 169 E. Firmware flow and data protocol 177 F. Palate file format 181 G. Supplemental material regarding the vocal tract model 183 H. Articulation-to-Speech: Optimal hyperparameters 189 Bibliography 19

PRELIMINARY FINDINGS OF A POTENZIATED PIEZOSURGERGICAL DEVICE AT THE RABBIT SKULL

The number of available ultrasonic osteotomes has remarkably increased. In vitro and in vivo studies have revealed differences between conventional osteotomes, such as rotating or sawing devices, and ultrasound-supported osteotomes (Piezosurgery®) regarding the micromorphology and roughness values of osteotomized bone surfaces. Objective: the present study compares the micro-morphologies and roughness values of osteotomized bone surfaces after the application of rotating and sawing devices, Piezosurgery Medical® and Piezosurgery Medical New Generation Powerful Handpiece. Methods: Fresh, standard-sized bony samples were taken from a rabbit skull using the following osteotomes: rotating and sawing devices, Piezosurgery Medical® and a Piezosurgery Medical New Generation Powerful Handpiece. The required duration of time for each osteotomy was recorded. Micromorphologies and roughness values to characterize the bone surfaces following the different osteotomy methods were described. The prepared surfaces were examined via light microscopy, environmental surface electron microscopy (ESEM), transmission electron microscopy (TEM), confocal laser scanning microscopy (CLSM) and atomic force microscopy. The selective cutting of mineralized tissues while preserving adjacent soft tissue (dura mater and nervous tissue) was studied. Bone necrosis of the osteotomy sites and the vitality of the osteocytes near the sectional plane were investigated, as well as the proportion of apoptosis or cell degeneration. Results and Conclusions: The potential positive effects on bone healing and reossification associated with different devices were evaluated and the comparative analysis among the different devices used was performed, in order to determine the best osteotomes to be employed during cranio-facial surgery

Patient involvement in multidisciplinary team decision making in head and neck cancer :an ethnographic study

PhD ThesisHead and neck cancer (HNC) confers a poor prognosis and patients face complex treatment decisions. As with every cancer in the UK, recommendations for treatment are made through a multidisciplinary team (MDT). This thesis critically analyses the working of the MDT: data are presented from an ethnographic study across three head and neck cancer treatment centres. Data collection comprised non-participant observation of 35 MDT meetings and 37 MDT clinic appointments and semi-structured interviews with 19 patients pre- and post-treatment and nine staff members of the MDT. Data generated were analysed using a Constructionist Grounded Theory approach, drawing on symbolic interactionism and dramaturgical analysis. This thesis provides an in depth account of the backstage behaviour of the MDT members. Although an assessment of which treatment is considered ‘best’ drives their discussion, there is often disagreement or uncertainty surrounding this assessment. On delivering the recommendation to the patient, this backstage work often remains hidden, contributing to problems when offering treatment choice. Even when a choice of treatment is acknowledged, the MDT faces barriers in delivering and supporting this in the MDT clinic. For the patient, the majority of the work of decision making takes place away from the MDT clinic, a process which is not always supported by the MDT The difficulties of actively involving patients in the MDT decision process have never been explored, but the complexities of offering treatment choice in the MDT need to be recognised to support patients in this setting. The guiding principles, purpose and limitations of the MDT meeting and the resultant treatment recommendation need to be iii clear. A process of collaborative MDT decision making should allow effective communication of treatment risk and uncertainty, structured elicitation of patient preferences and support for patients to make decisions in line with their preferences and values