Problem asthma clinic: Cohort observational study of the upper airway and breathing pattern

The investigations reported in this thesis are observational studies of various aspects of the upper airway and breathing pattern in patients attending a Problem Asthma Clinic (PAC) based in a large city hospital. We hypothesised that Vocal Cord Dysfunction (VCD) would be present in a proportion of patients attending our clinic and that the Forced Oscillation Technique (FOT) would play a role in the non-invasive identification of this. In addition we explored the relationships between structural nasal, laryngeal and vocal pathology and symptoms, along with a detailed assessment of vocal morbidity by both patient reported (Voice Symptom Score - VoiSS) and Speech and Language Therapy assessment (GRBAS score) methods. We hypothesised further that a strategy of performing challenge testing with Histamine and Exercise challenge would be helpful in the diagnosis of VCD. Finally we proposed that patients felt to have dysfunctional breathing (DB) on the basis of Nijmegen scores would have different physiological measurements of breathing pattern to those not felt to have DB and that physiotherapist delivered breathing control therapy (BCT) would produce an improvement in Nijmegen scores and asthma related quality of life. (Abstract shortened by ProQuest.)

A Study of Chance-Corrected Agreement Coefficients for the Measurement of Multi-Rater Consistency

Chance corrected agreement coefficients such as the Cohen and Fleiss Kappas are commonly used for the measurement of consistency in the decisions made by clinical observers or raters. However, the way that they estimate the probability of agreement (Pe) or cost of disagreement (De) 'by chance' has been strongly questioned, and alternatives have been proposed, such as the Aickin Alpha coefficient and the Gwet AC1 and AC2 coefficients. A well known paradox illustrates deficiencies of the Kappa coefficients which may be remedied by scaling Pe or De according to the uniformity of the scoring. The AC1 and AC2 coefficients result from the application of this scaling to the Brennan-Prediger coefficient which may be considered a simplified form of Kappa. This paper examines some commonly used multi-rater agreement coefficients including AC1 and AC2. It then proposes an alternative subject-by-subject scaling approach that may be applied to weighted and unweighted multi-rater Cohen and Fleiss Kappas and also Intra-Class Correlation (ICC) coefficients

A methodology for peripheral nerve segmentation using a multiple annotators approach based on Centered Kernel Alignment

Peripheral Nerve Blocking (PNB) is a technique commonly used to perform regional anesthesia and for pain management. The success of PNB procedures depends on the accurate location of the target nerve. Recently, ultrasound imaging has been widely used to locate nerve structures to carry out PNB, due to it enables a non-invasive visualization of the target nerve and the anatomical structures around it. However, the ultrasound images are affected by several artifacts making difficult the accurate delimitation of nerves. In the literature, several approaches have been proposed to carry out automatic or semi-automatic segmentation. Nevertheless, these methods are designed assuming that the gold standard is available, and for this segmentation problem this gold standard can not be obtained considering that it corresponds to subjective interpretation. In this sense, for building those segmentation models, we do not have access to the actual label but an amount of subjective annotations provided by multiple experts. To deal with this drawback we use the concepts of a relatively new area of machine learning known as “Learning from crowds”, this area deals with supervised learning problems considering the case when the gold standard is not available. In this project, we develop a nerve segmentation system that includes: a preprocessing stage, feature extraction methodology based on adaptive methods, and a Centered Kernel Alignment (CKA) based representation to measure the annotators performance for building a classifier with multiple annotators in order to support peripheral nerve segmentation. Our approach to classification with multiple annotators based on CKA is tested on both simulated data and real data; similarly, the methodology of automatic segmentation proposed in this work was tested over ultrasound images labeled by a set of specialists who give their opinion about the location of nerve structures. According to the results, we conclude that our methodology can be used to locate nerve structures in ultrasound images even if the gold standard (the actual location of nerve structures) is not available in the training stage. Moreover, we determine that the approach proposed in this work could be implemented as a guiding tool for the anesthesiologist to carry out PNB procedures assisted by ultrasound imaging

Supporting diabetes self-management in persons with cognitive impairment after acquired brain injury

Background. Individuals with cognitive impairment arising from acquired brain injury (ABI) are often supported to engage in diabetes self-management through verbal guidance provided by carers. Guide, developed by O’Neill and Gillespie (2008), is an automated verbal prompting system which aims to replicate the verbal guidance often provided to individuals with cognitive impairment by carers. Aims. The aim of this study is to investigate whether Guide can improve the ability of individuals with cognitive impairment to self-manage their diabetes. Methods. Participants were two individuals recruited from a specialist brain injury rehabilitation unit who had a diagnosis of diabetes and ABI. The study employed an ABA design using multiple baseline across participants Single Case Experimental Design (SCED) methodology. Results. Results indicated that the use of Guide significantly reduced the level of staff prompting needed for task completion when compared to baseline for both participants. For participant 1, use of Guide reduced the number of errors made during task performance and for participant 2 it increased the proportion of the task that was sequenced correctly. Applications. It is possible that Guide could be used more widely to support individuals with cognitive impairment (e.g. dementia, learning disability) and to support other complex behavioural sequences

Puheäänen akustisten ominaisuuksien ikämuutokset terveillä suomenkielisillä aikuisilla

Tässä Pro gradu -tutkielmassa tutkittiin akustisen analyysin avulla äänen perustaajuudessa, voimakkuudessa, perustaajuuden ja amplitudin vaihtelussa sekä hälyssä ikääntymisen myötä tapahtuvia muutoksia terveillä 50-, 70- ja 80-vuotiailla naisilla ja miehillä. Aiheesta on tehty ulkomailla jo useita samankaltaisia tutkimuksia, mutta ikääntyvien ihmisten äänen muutoksia on tärkeää tutkia myös Suomessa, koska äänen akustisissa ominaisuuksissa voi olla kieli- ja kulttuurikohtaisia eroavaisuuksia. Tutkimukseen osallistui yhteensä 19 henkilöä: kuusi 50-vuotiasta, seitsemän 70-vuotiasta ja kuusi 80-vuotiasta. Tutkittavista 10 oli naisia ja 9 miehiä. Jokaiselta tutkittavalta kerättiin kaksi ääninäytettä, joista toisessa tutkittava luki tekstikatkelman ja toisessa tuotti noin viiden sekunnin ajan /ɑ/-vokaalia pidennettynä. Tekstikatkelman lukemista ja vokaalifonaatiota käytettiin, koska ne ovat useissa tutkimuksissa vakiintuneet ääninäytteiden sisällöksi. Ääninäytteet analysoitiin Praat-tietokoneohjelmalla, ja tutkituille äänen ominaisuuksille laskettiin kummallekin sukupuolelle ikäryhmäkohtaiset keskiarvot. Tilastollisilla analyyseilla vertailtiin tutkittujen äänen ominaisuuksien eroja sukupuolten välillä, sekä ikäryhmien välisiä eroja sukupuolten sisällä. Tutkimuksen päätuloksena oli, että kaikissa tutkituissa äänen ominaisuuksissa tapahtui muutoksia ikääntymisen myötä. Perustaajuus laski naisilla ikääntymisen myötä, kun taas miehillä se nousi. Äänen voimakkuus oli vanhimmilla ikäryhmillä aavistuksen suurempi nuorimpaan ikäryhmään verrattuna, mutta ero ei ollut tilastollisesti merkitsevä. Naisilla sekä perustaajuuden vaihtelu (jitter) että amplitudin vaihtelu (shimmer) lisääntyivät iän myötä. Miehillä jitterin ja shimmerin lisääntyminen iän myötä ei ollut systemaattista, sillä molempia ominaisuuksia oli eniten 70-vuotiailla. Sukupuolten väliset erot jitterissä ja shimmerissä eivät olleet tilastollisesti merkitseviä. Hälyn määrä lisääntyi siitä kertovien parametrien (NHR ja HNR) perusteella naisilla systemaattisesti iän myötä, kun taas miehillä eniten hälyä havaittiin 80-vuotiailla ja vähiten 70-vuotiailla. Ero sukupuolten välillä ei ollut merkitsevä. Suurin osa tutkimuksen tuloksista oli linjassa ulkomailla tehtyjen tutkimusten kanssa, eli suomalaisilla henkilöillä voidaan todeta tapahtuvan samankaltaisia äänen ikämuutoksia kuin ulkomaisilla henkilöillä. Muutamia eroavaisuuksia kuitenkin oli, mikä saattoi johtua tutkimusmetodologisista tekijöistä, kuten erilaisista tutkimusympäristöistä, äänityslaitteistoista ja akustiseen analyysiin käytetyistä tietokoneohjelmista. Vaikka pienen otoskoon vuoksi tutkimuksen tuloksia ei voida sellaisenaan yleistää koskemaan koko populaatiota, niitä voidaan pitää suuntaa-antavina ja hyödyntää esimerkiksi puheterapeutin kliinisessä työssä mahdollisia äänihäiriöitä arvioitaessa

Models and Analysis of Vocal Emissions for Biomedical Applications

The International Workshop on Models and Analysis of Vocal Emissions for Biomedical Applications (MAVEBA) came into being in 1999 from the particularly felt need of sharing know-how, objectives and results between areas that until then seemed quite distinct such as bioengineering, medicine and singing. MAVEBA deals with all aspects concerning the study of the human voice with applications ranging from the neonate to the adult and elderly. Over the years the initial issues have grown and spread also in other aspects of research such as occupational voice disorders, neurology, rehabilitation, image and video analysis. MAVEBA takes place every two years always in Firenze, Italy

CENTRAL NEURAL AND BEHAVIORAL CORRELATES OF VOICE SECONDARY TO INDUCED UNILATERAL VOCAL FOLD PARALYSIS

Understanding the involvement of the central nervous system (CNS) in voice production is essential to incorporating principles of neuroplasticity into therapeutic practice for voice disorders. Early steps to attaining this goal require the identification of specific neural biomarkers of the changes occurring in the CNS from a voice disorder and its subsequent treatment. In the absence of an adequate animal vocalization model, the larynx has not been acutely and reversibly perturbed to concurrently examine the effect on both peripheral and central processing of the altered input/output. Using a unique, reversible perturbation approach, it was the purpose of this study to perturb the larynx to mimic a voice disorder and study short-term neuroplastic response. Functional magnetic resonance imaging (fMRI) was the neuroimaging tool of choice for this study due to its superior spatial and temporal resolution. The voice was perturbed by anesthetizing the right recurrent laryngeal nerve, with a solution of lidocaine hydrochloride and epinephrine to induce a temporary right vocal fold paralysis. The paralysis lasted for approximately 90 minutes and had an overt presentation similar to that of a true vocal fold paralysis. Behavioral and fMRI data were obtained at three time points- baseline, during the vocal fold paralysis and one hour after recovery. Patterns of activity on fMRI during the three time points were found to be distinct on both subjective examination and statistical analysis. The regions of interest examined had distinct trends in activity as a function of the paralysis. Interestingly, males and females responded differently to the paralysis and its subsequent recovery. Strong correlation was not observed between the behavioral measures and fMRI activity reflecting a disparity between the overt presentation and recovery of vocal fold paralysis and cortical activity as seen on fMRI. The fictive paralysis model employed in this study provided a perturbation model for phonation that allowed us to examine behavioral and central neural correlates for disordered phonation in a controlled environment. Although this data is representative of acute changes from a transient paralysis, it provides an insight into the response of the cortex to sudden perturbation at the peripheral phonatory mechanism

Models and Analysis of Vocal Emissions for Biomedical Applications

The MAVEBA Workshop proceedings, held on a biannual basis, collect the scientific papers presented both as oral and poster contributions, during the conference. The main subjects are: development of theoretical and mechanical models as an aid to the study of main phonatory dysfunctions, as well as the biomedical engineering methods for the analysis of voice signals and images, as a support to clinical diagnosis and classification of vocal pathologies

Models and Analysis of Vocal Emissions for Biomedical Applications

The International Workshop on Models and Analysis of Vocal Emissions for Biomedical Applications (MAVEBA) came into being in 1999 from the particularly felt need of sharing know-how, objectives and results between areas that until then seemed quite distinct such as bioengineering, medicine and singing. MAVEBA deals with all aspects concerning the study of the human voice with applications ranging from the newborn to the adult and elderly. Over the years the initial issues have grown and spread also in other fields of research such as occupational voice disorders, neurology, rehabilitation, image and video analysis. MAVEBA takes place every two years in Firenze, Italy. This edition celebrates twenty-two years of uninterrupted and successful research in the field of voice analysis