Respiratory activity during speech

The aim of this project was to examine the extent of variability of speech breathing patterns in two groups of healthy subjects using non-invasive respiratory measurement (respiratory inductance plethysmography and linearised magnetometers). In the first two studies (Chapters 3 and 4), lung volume measurement of 6 young women was combined with observation of the temporal and linguistic aspects of speech breathing, as well as speech intensity measurement, as the subjects returned for up to 10 repeat sessions in 3 weeks. During oral reading, lung volumes during speech were found to be significantly variable over time, both between and within individuals, whereas the location of inspirations was relatively invariant: most pauses for breath occurred exclusively at grammatically appropriate places in the texts. Some of the intrasubject lung volume variation was associated with changes in speaking intensity, and significant associations were found between anticipatory lung volumes and the length of the upcoming breath group, suggesting that subjects scan ahead during reading and breathe accordingly. During spontaneous speech too, linguistic factors were important influences in the lung volume variation, with the volume of air inspired linked to the length of the following utterance. Further, the majority of breaths were taken at structural (clause) boundaries. In contrast to the findings during reading, speaking intensity, however, was not strongly associated with lung volume variation in spontaneous speech. Results of a self-reported mood state questionnaire (The Profile of Mood States) suggested that some of the subjects' lung volume variation was associated with day to day changes in mood, and the possibility of variation due to hormonal factors was also suggested, with data collected on the subjects' menstrual cycles indicating an association. The Lombard effect, that of increased speech intensity in background noise, was used in Study 3 (Chapter 5) to achieve louder speech in a group of 5 healthy young women, while simultaneous respiratory and speech measurements were made. Despite the wide range of speech intensity encompassed, lung volume responses were not predictable, and there were discrepancies between reading‘ and spontaneous speech. It is clear that increased lung volumes are not always the preferred mechanism for achieving the higher subglottic pressures required for louder speech. The previously reported association between inspired lung volume and the length of the upcoming utterance again held true for this study, suggesting that linguistic factors are stronger in influencing lung volume variation than speaking intensity

A descriptive case report of telesupervision and online case-based learning for speech and language therapy students in Vietnam during the COVID-19 pandemic

Background: Vietnam’s first speech and language therapy (SLT) degrees commenced in 2019 utilising international educators. Continuity of the degrees was impacted by travel restrictions during the coronavirus disease 2019 (COVID-19) pandemic. Objectives: This article presents a descriptive case report exploring the viability of online learning to continue clinical education (CE) of SLT students in Vietnam during the pandemic. Method: Students were scheduled for face to face placements throughout 2021. International SLT educators were to travel to Vietnam and work with interpreters and locally trained certificate level therapists to provide placement supervision. When travel became impossible, tele-supervision by international therapists working remotely and in partnership with local therapists and interpreters was arranged. The second wave of Covid-19 excluded students from healthcare settings early in their placements. To conclude these placements, tele-supervisors led online case-based discussions with students. For subsequent placements, Vietnamese and international therapists facilitated two to three weeks of online case-based group discussions for students, using cases with videos or avatars. Results: Learning outcomes for students, as evidenced in written and oral assessments demonstrated attainment of many of the learning objectives of the placements. Satisfaction for all participants (students, tele-supervisors, online group facilitators) was high. Students will undertake face to face placements in the future; however they will commence these placements with heightened clinical reasoning and planning skills. Conclusion: Online CE is possible in LMIC and, as part of a program which includes face to face placements, can support essential CE outcomes and enhance preparation for subsequent direct experiences with patients

Voice Disorders in Children

Most children's vocal problems are due to the use of an inappropriate vocal technique. Once congenital or acquired laryngeal pathology has been excluded, management depends upon specialist assessment and treatment by a multidisciplinary team. The principal treatment modality is speech therapy to improve behaviours and vocal technique

Voice disorders in adults: What is wrong with my voice, doctor?

A voice problem may be taken less seriously than other reasons to visit the doctor, despite the potential for health and occupational concerns. Sorting through the compounding diagnostic issues and early management are the keys to restoring vocal health

A comparison of two approaches to the treatment of chronic cough: Perceptual, acoustic, and electroglottographic outcomes

Voice problems have been reported to occur in association with chronic cough (CC) and can interfere with quality of life. Voice symptoms can improve following behavioral intervention for CC that persists despite medical management; however, formal measures of voice changes have not been reported. The aim of this study was to measure the changes in perceptual, acoustic, and electroglottographic voice characteristics after a SPEech Pathology Intervention Program for CHronic Cough (SPEICH-C) compared to a Healthy Lifestyle Education intervention program (HLE control). Eighty-two participants with CC that was refractory to medical management were randomly allocated to receive either the SPEICH-C or an HLE control. Participants in the SPEICH-C group demonstrated a significant reduction in perceptual ratings of breathy, rough, strain, and glottal fry qualities (

Acoustic and electroglottographic voice characteristics in chronic cough and paradoxical vocal fold movement

Objective: Chronic cough (CC) and paradoxical vocal fold movement (PVFM) may be associated with voice problems. Objective acoustic and electroglottographic (EGG) measures have the capacity to delineate these vocal characteristics. This study investigated acoustic and EGG voice features of CC and PVFM. Patients and Methods: Acoustic and EGG findings were compared among 5 groups of participants. The first 3 groups, CC (n = 56), PVFM (n = 8) and combined CC-PVFM (n = 55), included individuals with cough and respiratory symptoms that persisted despite medical treatment. Groups 4 and 5 included individuals with muscle tension dysphonia (n = 25) and healthy controls (n = 27). Results: Participants with CC/PVFM recorded reduced phonation times (p<0.001), greater jitter (p<0.001), reduced harmonic to noise ratio (p = 0.001), reduced phonation range (p = 0.007) and shorter closed phase of vocal fold vibration (p = 0.006) in comparison to healthy controls. Females with CC had reduced fundamental frequency in connected speech (p = 0.009). There was consistent overlap between the participants with CC and those with PVFM. Duration of closed phase and fundamental frequency were lower in the participants with CC and PVFM than in those with muscle tension dysphonia. Conclusion: These results confirm abnormalities in acoustic and EGG voice features in CC and PVFM

Voice and upper airway symptoms in people with chronic cough and paradoxical vocal fold movement

Chronic cough (CC) and paradoxical vocal fold movement (PVFM) share several common features; however, there has been no systematic comparison of these two conditions. The aims of this study were to contrast and compare the symptom profiles of CC and PVFM, to clarify the relationship between the two conditions, and to explore how symptom characteristics could be used to design an individualized treatment program. Participants included 55 people with a combination of PVFM and CC that was refractory to medical treatment, 8 people with PVFM alone, 56 people with CC alone, 25 people with voice disorders, and 27 normal controls. Symptoms and descriptive features of CC, PVFM, and voice disorders were assessed via structured case history interview, symptom frequency, and severity ratings, ratings of activity limitation, and anxiety/depression ratings. Results indicated consistent overlap in the symptom profile between people with CC and those presenting with a combination of CC and PVFM. Participants with PVFM without cough and those with voice disorders overlapped with the participants with CC on some dimensions; however, there were still some significant differences between them. These data suggest that CC and PVFM are related and manifestations of a common underlying condition but that voice disorders are a discrete entity. Most participants had normal ratings on screening for anxiety and depression. Results indicated that there were no consistent psychiatric symptoms in any of the groups studied, and they do not support the label of psychogenic cough for CC that is refractory to medical treatment. Characteristics of CC such as nature and timing of the cough provide important information for developing behavioral treatment programs for individual patients who have exhausted medical options. A template has been provided that is a practical method of designing an integrated behavioral treatment program based on those individual patient characteristics

Perceptual voice characteristics in chronic cough and paradoxical vocal fold movement

Voice problems have been reported in chronic cough ( CC) and paradoxical vocal fold movement (PVFM), however, there is a lack of a systematic description of voice characteristics in these conditions. This study examined the perceptual voice characteristics of 56 individuals with CC, 8 with PVFM and 55 with both CC and PVFM, compared to 25 people with muscle tension dysphonia (MTD) and 27 healthy controls. There was a high prevalence of abnormal voice quality in the CC and PVFM groups compared with healthy controls. More than one third of participants with CC and PVFM demonstrated strained, rough and/or breathy voices to a moderate or severe degree. The perceptual features in CC and PVFM were similar to those in MTD with greater severity evident in MTD. Possible mechanisms for abnormalities in voice quality include the presence of muscle tension and the frequency of coughing. These results have implications for the identification and management of voice disorders in CC and PVFM and suggest that clinicians should be alert to the incidence of voice abnormalities in these populations. Copyright (c) 2007 S. Karger AG, Basel