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Objectives: The purpose was to determine the changes in intelligibility and articulation after partial glossectomy in a child with Beckwith-Wiedemann syndrome. Methods: For the assessment of articulation, a speech sample was gathered by means of a picture naming test. The analyses included a description of the child’s sound production regardless of their relation to the adult target, as well as analyses comparing the patient’s pronunciations with the adult form. For the assessment of intelligibility the sample was independently rated by 2 experienced speech pathologists using a nominal scale with four categories. Results and Conclusions: Partial glossectomy resulted in a dramatic improvement of speech. Before surgery the speech was definitely not age-appropriate. The child was capable of producing only 23% of the Dutch consonants. This is far less than expected at that age. After surgery, consonant inventory was almost complete and as such was even more than age-appropriate. The partial glossectomy had obviously a positive impact on both place of articulation and manner of articulation. The analyses revealed a tendency towards vowel speech before surgery along with glottal realizations. After surgery the vowel speech and the compensatory articulation patterns had disappeared. Several factors that contributed to the improvement are discussed.Copyright © 2005 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Purpose: This study measured the impact of articulation exercises using a cork and articulation exercises for lip spreading on the formant frequencies of vowels and listener perceptions of femininity in transgender women., Methods: Thirteen transgender women were recorded before and after the cork exercise and before and after the lip spreading exercise. Speech samples included continuous speech during reading and were analyzed using Praat software. Vowel formant frequencies (F1, F2, F3, F4, F5) and vowel space were determined. A listening experiment was organized using naïve cisgender women and cisgender men rating audio samples of continuous speech. Masculinity/femininity, vocal quality and age were rated, using a visual analogue scale (VAS)., Results: Concerning vowel formant frequencies, F2 /a/ and F5 /u/ significantly increased after the lip spreading exercise, as well as F3 /a/, F3 /u/ and F4 /a/ after the cork exercise. The lip spreading exercise had more impact on the F2 /a/ than the cork exercise. Vowel space did not change after the exercises. The fundamental frequency (f o ) increased simultaneously during both exercises. Both articulation exercises were associated with significantly increased listener perceptions of femininity of the voice., Conclusion: Subtle changes in formant frequencies can be observed after performing articulation exercises, but not in every formant frequency or vowel. Cisgender listeners rated the speech of the transgender women more feminine after the exercises. Further research with a more extensive therapy program and listening experiment is needed to examine these preliminary findings., (Copyright © 2021 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Background: The Lidcombe Program is a stuttering treatment approach for children between the ages of 3 and 6 years. Most papers about the Lidcombe Program, however, are based on studies conducted in native English-speaking countries. The aim of this paper is to systematically review the delivery and implementation of the Lidcombe Program in non-native English-speaking countries., Summary: A resource search was conducted between October and November 2019. Scopus, PubMed, ASHA, Cochrane Library, ERIC, Google Scholar, and SpeechBITE databases and reference lists of relevant papers were searched for the identification process. Joanna Briggs Institute tools were used for the appraisal of the studies. The search yielded 8 studies conducted in non-native English-speaking countries. The Lidcombe Program is efficacious in non-native English-speaking countries when delivered to both preschool and young school age children who stutter. It is reported to be delivered with minor changes and challenges. The number of weekly clinic visits and the total time needed to reach zero or near-zero stuttering levels with the Lidcombe Program can be up to 3 times greater in non-native English-speaking countries than in native English-speaking countries, mostly due to the increased time needed to introduce the parental verbal contingencies., Key Messages: Speech and language therapists practicing in non-native English-speaking countries are encouraged to use the Lidcombe Program for both preschool and young school age children who stutter, although this can take more time than that reported in native English-speaking countries. Further investigation to explore the therapy process with children and parents in non-native English-speaking countries is needed., (© 2021 S. Karger AG, Basel.)

About 20% of trans men do not achieve cisgender male frequencies (F 0 ≤131 Hz) after gender-affirming hormone treatment (GAHT) with testosterone. The surgical procedure Isshiki thyroplasty type III (TPIII) is described to lower F 0 , but data on this technique in trans men are lacking. In this study, 8 trans men, unsatisfied with their voice after a minimum of 12 months of GAHT, underwent TPIII to lower F 0 at the Department of Head and Neck Surgery at Ghent University Hospital. TPIII was performed by 1 surgeon using the same method each time. Pre- and postoperatively, an acoustic evaluation of the voice took place. The F 0 dropped significantly from the preoperative mean of (154.60 ± 12.29) Hz to the postoperative mean of (105.37 ± 10.52) Hz ( t = 9.821, P < .001). TPIII is an effective method for lowering the F 0 in trans men who are not satisfied with their voice after long-term GAHT.

Category selective recall in spontaneous speech after stroke has been reported only rarely. We recently described three cases demonstrating transient number speech in the acute stage of left hemispheric stroke and hypothesized a link with multilingualism and mathematical proficiency. In this report, we describe a similar case with a transient episode of utterances of randomly selected letters. Like in the three previous cases, this episode was preceded by a brief stage of mutism and ultimately evolved to Wernicke's aphasia over a period of days. This phenomenon is reviewed with reference to linguistic models and neuroanatomic and neurophysiological correlates.

Several studies reported that pitch and articulation may vary according to a person's sexual orientation. The purpose of this study was to investigate whether homosexual males also demonstrate differences in nasal resonance compared to heterosexual males. Speech samples of 30 self-identified homosexual males, 35 heterosexual males, and 34 heterosexual females were compared both instrumentally and perceptually. Nasalance scores were calculated for the sounds /a/, /i/, /u/, and /m/ and for an oronasal, oral, and nasal text. In addition, the Nasality Severity Index was determined. Spontaneous speech samples were used for a perceptual evaluation of nasal resonance. Neither the nasalance scores nor the Nasality Severity Index were significantly different between the homosexual and heterosexual males. Heterosexual females, on the other hand, showed significantly higher nasalance values for the oronasal and oral text and a significantly lower Nasality Severity Index than both the homosexual and the heterosexual males. The perceptual judgment revealed no significant differences between the three groups. The results of this study suggest that, in contrast to pitch and articulation, nasality does not tend to vary with sexual orientation.

Purpose: Mean articulatory rate (MAR) is an alternative approach to measure articulation rate and is defined as the mean of 5 rate measures in minimally 10 to maximally 20 consecutive syllables in perceptually fluent speech without pauses. This study examined the validity of this approach., Method: Reading and spontaneous speech samples were collected from 80 typically fluent adults ranging in age between 20 and 59 years. After orthographic transcription, all samples were subjected to an articulation rate analysis first using the prevailing "global" method, which takes into account the entire speech sample and involves manipulation of the speech sample, and then again applying the MAR method. Paired-samples t tests were conducted to compare global measurements to MAR measurements., Results: For both spontaneous speech and reading, a strong correlation was found between the 2 methods. However, for both speech tasks, the paired-samples t tests revealed a significant difference with MAR values being higher than the global method values., Conclusions: The MAR method is a valid method to measure articulation rate. However, it cannot be used interchangeably with the prevailing global method. Further standardization of the MAR method is needed before general clinical use can be suggested.

Purpose: To determine laypeople's knowledge and awareness of stuttering in Japan., Methods: A total of 303 respondents, recruited by street sampling, completed a questionnaire assessing the prevalence, onset, gender distribution, occurrence in different races, cause, treatment, association with intelligence, and hereditariness of stuttering. The questionnaire used was a Japanese version of that devised by Van Borsel, Verniers, and Bouvry (1999) for use in Belgium., Results: Although around half of the respondents had heard or met a stutterer, they tended to misunderstand the stuttering; e.g., respondents estimated the prevalence of stuttering as high. Knowledge also differed according to age, gender, and education level. Specifically, older individuals, females, and individuals with higher levels of education tended to have greater knowledge of stuttering. In comparing the results of the present study with similar studies conducted in Belgium, China, and Brazil, we observed several similarities and differences., Discussion: Although most respondents were to some extent familiar with stuttering, their overall knowledge of the condition was limited. Certain factors could be involved in having knowledge of stuttering, such as one's life experience, cultural background, and social attitudes toward stuttering. The findings suggest the need for growing knowledge and awareness of stuttering., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objectives: This study aimed to review the evidence of the effectiveness of pitch-raising surgery performed in male-to-female transsexuals., Methods: A search for studies was performed in PubMed, Web of Science, Science Direct, EBSCOhost, Google Scholar, and the references in retrieved manuscripts, using as keywords "transsexual" or "transgender" combined with terms related to voice surgery. We included eight studies using cricothyroid approximation, six studies using anterior glottal web formation, and six studies using other surgery types or a combination of surgical techniques, leading to 20 studies in total., Results: Objectively, a substantial rise in postoperative fundamental frequency was identified. Perceptually, mainly laryngeal web formation seems risky for decreasing voice quality. The majority of patients seemed satisfied with the outcome. However, none of the studies used a control group and randomization process. Further investigation regarding long-term results is necessary., Conclusion: Future research needs to investigate long-term effects of pitch-raising surgery using a stronger study design., (Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

The present study aimed to evaluate whether increased activity related to speech motor preparation preceding fluently produced words reflects a successful compensation strategy in stuttering. For this purpose, a contingent negative variation (CNV) was evoked during a picture naming task and measured by use of electro-encephalography. A CNV is a slow, negative event-related potential known to reflect motor preparation generated by the basal ganglia-thalamo-cortical (BGTC) - loop. In a previous analysis, the CNV of 25 adults with developmental stuttering (AWS) was significantly increased, especially over the right hemisphere, compared to the CNV of 35 fluent speakers (FS) when both groups were speaking fluently (Vanhoutte et al., (2015) doi: 10.1016/j.neuropsychologia.2015.05.013). To elucidate whether this increase is a compensation strategy enabling fluent speech in AWS, the present analysis evaluated the CNV of 7 AWS who stuttered during this picture naming task. The CNV preceding AWS stuttered words was statistically compared to the CNV preceding AWS fluent words and FS fluent words. Though no difference emerged between the CNV of the AWS stuttered words and the FS fluent words, a significant reduction was observed when comparing the CNV preceding AWS stuttered words to the CNV preceding AWS fluent words. The latter seems to confirm the compensation hypothesis: the increased CNV prior to AWS fluent words is a successful compensation strategy, especially when it occurs over the right hemisphere. The words are produced fluently because of an enlarged activity during speech motor preparation. The left CNV preceding AWS stuttered words correlated negatively with stuttering frequency and severity suggestive for a link between the left BGTC - network and the stuttering pathology. Overall, speech motor preparatory activity generated by the BGTC - loop seems to have a determining role in stuttering. An important divergence between left and right hemisphere is hypothesized., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Abnormal speech motor preparation is suggested to be a neural characteristic of stuttering. One of the neurophysiological substrates of motor preparation is the contingent negative variation (CNV). The CNV is an event-related, slow negative potential that occurs between two defined stimuli. Unfortunately, CNV tasks are rarely studied in developmental stuttering (DS). Therefore, the present study aimed to evaluate motor preparation in DS by use of a CNV task. Twenty five adults who stutter (AWS) and 35 fluent speakers (FS) were included. They performed a picture naming task while an electro-encephalogram was recorded. The slope of the CNV was evaluated at frontal, central and parietal electrode sites. In addition, a correlation analysis was performed with stuttering severity and frequency measures. There was a marked increase in CNV slope in AWS as compared to FS. This increase was observed over the entire scalp with respect to stimulus onset, and only over the right hemisphere with respect to lip movement onset. Moreover, strong positive correlations were found between CNV slope and stuttering frequency and severity. As the CNV is known to reflect the activity in the basal ganglia-thalamo-cortical-network, the present findings confirm an increased activation of this loop during speech motor preparation in stuttering. The more a person stutters, the more neurons of this cortical-subcortical network seem to be activated. Because this increased CNV slope was observed during fluent single word production, it is discussed whether or not this observation refers to a successful compensation strategy., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Speech-language pathologists nowadays are more and more confronted with clients who speak a language different from their own mother tongue. The assessment of persons who speak a foreign language poses particular challenges. The present study investigated the possible role and interplay of factors involved in the identification of stuttering severity in a foreign language. Nineteen speech-language pathologists from five different countries (i.e. Iceland, Sweden, Norway, Finland, and Belgium) rated stuttering severity of speech samples featuring persons who stutter speaking Icelandic, Swedish, Norwegian, or Dutch. Additionally, they were asked to score how easy they found it to rate the samples. Accuracy of rating stuttering severity in another language appeared to be foremost determined by the client's stuttering severity, while experienced ease of rating stuttering severity was essentially related to closeness of the language of the clinician to that of the client and familiarity of the clinician with the client's language. Stuttering measurement training programmes in different languages are needed.

Purpose: To contribute to the development of a Brazilian Portuguese language version of the vocal self-assessment questionnaire, Transsexual Voice Questionnaire: Male-to-Female (TVQ:MtF), and to evaluate the questionnaire for use in Brazil., Methods: The research was divided into two parts: (1) translation and adaptation of the questionnaire (TVQ:MtF) and demographic form and (2) preliminary study of the psychometric properties (internal consistency and test-retest reliability) of the adapted version of the questionnaire. For the translation and adaptation, the following steps were taken: translation, reconciliation, back-translation, harmonization, and pilot test. The TVQ:MtF questionnaire and the demographic form were applied to 13 male-to-female transsexuals, aged between 21 and 47 years. The participants agreed to answer the TVQ:MtF on two occasions (test and retest), with an optimal interval of 30 days., Results: Two psychometric properties were investigated: internal consistency and test-retest reliability. High levels of internal consistency (in both test (α=0.911) and retest (α=0.952) conditions) and reliability (with an average ICC=0.957 (95%CI 0.916-0.984)), were found., Conclusion: The TVQ:MtF is an appropriate instrument for vocal self-assessment of male-to-female transsexual patients, which can be recommended for clinical and research goals.

A neural hallmark of developmental stuttering is abnormal articulatory programming. One of the neurophysiological substrates of articulatory preparation is the contingent negative variation (CNV). Unfortunately, CNV tasks are rarely performed in persons who stutter and mainly focus on the effect of task variation rather than on interindividual variation in stutter related variables. However, variations in motor programming seem to be related to variation in stuttering frequency. The current study presents a case report of acquired stuttering following stroke and stroke related surgery in the left superior temporal gyrus. A speech related CNV task was administered at four points in time with differences in stuttering severity and frequency. Unexpectedly, CNV amplitudes at electrode sites approximating bilateral motor and left inferior frontal gyrus appeared to be inversely proportional to stuttering frequency. The higher the stuttering frequency, the lower the activity for articulatory preparation. Thus, the amount of disturbance in motor programming seems to determine stuttering frequency. At right frontal electrodes, a relative increase in CNV amplitude was seen at the test session with most severe stuttering. Right frontal overactivation is cautiously suggested to be a compensation strategy. In conclusion, late CNV amplitude elicited by a relatively simple speech task seems to be able to provide an objective, neural correlate of stuttering frequency. The present case report supports the hypothesis that motor preparation has an important role in stuttering., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Phonological processing is usually associated with the activation of cortical areas, especially in the left cerebral hemisphere. This study examined if phonologically elicited evoked potentials can be recorded directly from the subthalamic nucleus in patients with Parkinson's Disease (PD). Seven PD patients who had undergone implantation of deep brain electrodes for the stimulation of the subthalamic nucleus were included. Local field potentials were recorded in a pre-attentive auditory phonological task, an attentive auditory phonological discrimination task, and a word recognition task. Auditory evoked potentials related to phonological, but not lexical processing, could be demonstrated in the subthalamic nucleus for all three tasks. Only minor changes were found after levodopa administration. This study demonstrates that the subthalamic nucleus is involved in early phonological perception, which puts the subthalamic nucleus in a position to modify phonological perception in a larger cortico-subcortical network., (Copyright © 2014 Elsevier Inc. All rights reserved.)

The present study examined the popular stereotype that gay men lisp by evaluating to what extent listeners associated dental or frontal articulation/lisping with gayness. Fifteen heterosexual males and 15 heterosexual females listened to 275 samples of read speech and judged the sexual orientation of the speakers. A total of 175 of the samples were of homosexual men, 74 (42.3 %) of which had been identified with lisping in a previous study; 100 were of heterosexual men, 18 (18 %) of which had been identified with lisping previously. Based on the ratings of the listeners of the present study, lisping speakers were significantly more often judged to be homosexual. This was true for the group as a whole as well as for the subgroup of homosexual and heterosexual men separately. Furthermore, there was no significant gender difference with respect to associating lisping with gayness. Male and female judges associated lisping with gayness to a similar degree. Additional analysis showed that overall 56.2 % of the time the judges were correct in their judgment of the speakers' sexual orientation. The results of this study confirmed previous preliminary findings that suggested that frontal or dental articulation/lisping is a feature that listeners associate with gayness. The reason for this association remains to be clarified.

Abstract In general, speech language therapy for transsexual persons focuses on pitch and pitch variation and more recently also on resonance. Other communicative aspects are dealt with far less often, especially language. This study investigated to what extent conversational topics might need attention in therapy for transsexual persons. A total of 111 males, 116 females, 28 male-to-female and 18 female-to-male transsexuals were asked to indicate on a list with 34 topics how often they speak about each topic (never, sometimes, often) in conversations with males, with females and in a gender mixed group. Results showed that transsexual persons behave in accordance with the desired gender. However, they also tend to adopt a position depending on the gender of their conversational partner. It can be concluded that in general it is not necessary to pay attention to conversational topics in therapy for transsexual persons.

Objectives/hypothesis: The aim of the present study was to 1) document voice in a large sample of female-to-male transsexual persons (FMT), 2) compare their vocal characteristics with those of heterosexual biological males, and 3) determine hormonal factors with impact on their fundamental frequency., Study Design: This was a controlled cross-sectional study. It is the largest study to date on voice and voice change in FMT, and the first to include a control group and FMT who were under long-term androgen administration., Methods: Thirty-eight FMT, ranging in age between 22 and 54 years, and 38 controls, frequency matched by age and smoking behavior, underwent a voice assessment that comprised the determination of pitch, intonation, and perturbation parameters measured during sustained vowel production, counting, and reading. Hormonal factors explored were hematocrit, total testosterone level, luteinizing hormone level, and biallelic mean length of the cytosine-adenine-guanine (CAG) trinucleotide repeat sequence in the androgen receptor gene., Results: It was found that the FMT as a group did not differ significantly from controls for any of the acoustic voice variables studied. However, in about 10% pitch lowering was not totally unproblematic. The lowest-pitched (i.e., more male) voices were observed in FMT with higher hematocrit and longer CAG repeats., Conclusion: After long-term androgen therapy, FMT generally demonstrate an acceptable male voice. Pitch-lowering difficulties can be expected in about 10% of cases and appear, at least in part, to be associated with diminished androgen sensitivity., Level of Evidence: 3b., (© 2013 The American Laryngological, Rhinological and Otological Society, Inc.)

Purpose: The purpose of this study was to translate and cross-culturally adapt the Western Aphasia Battery - Revised (WAB-R) screening test, thus contributing to future applications of the instrument with Brazilian adults., Methods: The adaptation was based on a universalist perspective. The steps for conceptual, item, semantic and operational equivalence were strictly followed, resulting in a short version used in the pretest. The study participants were 30 individuals, between 18 to 89 years old; all were Brazilian speakers, with Portuguese as their first language. However, only 28 volunteers met the criteria for inclusion in the study. Two participants were excluded because they had low scores on the mini-mental state examination and were referred to geriatric assessment., Results: The short version of the WAB-R screening test, used in the pretest, allowed us to observe the behavior and language of the individuals during interactions, to collect impressions of overall communication, and to quantify communication ability by calculating the aphasia quotient and the language quotient, according to parameters of the original instrument., Conclusion: When adapting an instrument, it is important to maintain its original characteristics. However, the properties of measurement may not be in accordance with the psychometric properties of Brazilian culture. Therefore, we propose further analyses of the reliability and validation of the instrument in question in Brazil, which will occur by means of measurement and functional equivalence.

Background: Although aesthetic correction of facial aging had long been the exclusive domain of plastic surgeons and dermatologists, alternative nonmedical approaches to facial rejuvenation are becoming more popular, such as facial acupuncture, facial acupressure, and facial exercises. However, the effectiveness of these alternative approaches is still a topic of debate., Objectives: The authors review the evidence of the effectiveness of facial exercises for facial rejuvenation., Methods: A literature search was performed in Medline, Web of Science, Science Direct, SciELO, and LILACS databases for the terms facial rejuvenation, facial exercises, facial massage, face building, face yoga, (oro)facial (a)esthetics, (a)esthetic logopedics, and (a)esthetic speech therapy. Nine reports were identified from the search and were subject to further assessment., Results: Although positive outcomes were achieved in all 9 studies, none of the studies used a control group and randomization process. They were single case reports, small case series, or studies with a single-group pretest-posttest design. Moreover, the effectiveness assessments in most of the studies were purely subjective, carried out by the authors and/or the patients themselves, without blinding., Conclusions: The evidence to date is insufficient to determine whether facial exercises are effective for facial rejuvenation. Evidence from large randomized controlled trials will be needed before conclusions can be drawn.

Objectives: The purpose of this study was to investigate to what extent lesbian women demonstrate pitch and pitch variation that is different from that of heterosexual women., Study Design: Static group comparison., Methods: The average pitch and pitch variation of a group of 34 self-identified lesbian women and an age-matched group of 68 heterosexual women were compared. The speech sample consisted of read speech. Acoustic analysis was performed by means of PRAAT., Results: Mean fundamental frequency in the group of lesbian women was significantly lower than that of the group of heterosexual women. The lesbian woman also showed significantly less pitch variation., Conclusions: Lesbian women tend to demonstrate a lower average pitch and less pitch variation than heterosexual women, but this does not mean a confirmation of the popular stereotype that lesbian women are masculine women. In their assessment of clients with voice disorders, clinicians should reckon with the sociophonetic variation that is associated with sexual orientation., (Copyright © 2013 The Voice Foundation. Published by Mosby, Inc. All rights reserved.)

Purpose: The main aim of this experiment was to investigate the perception of Foreign Accent Syndrome in comparison to speakers with an authentic foreign accent., Method: Three groups of listeners attributed accents to conversational speech samples of 5 FAS speakers which were embedded amongst those of 5 speakers with a real foreign accent and 5 native speaker controls. The listening panels differed in their familiarity with foreign accented speech and speech pathology., Results: The findings indicate that listeners' perceptual responses to the three groups of speakers were essentially different at all levels of analysis. The native speaker controls were unequivocally recognized as native speakers of Dutch while the speakers with a real foreign accent were very reliably assessed as non-native speakers. The speakers with Foreign Accent Syndrome, however, were in some sense perceived as foreign and in some sense as native by listeners, but not as foreign as speakers with a real foreign accent nor as native as real native speakers. These results are accounted for in terms of a misinterpretation of markers of speech pathology as markers regional affiliation., Conclusions: The findings of the experiment are consistent with the idea that the very nature of the foreign accent is different in both groups of speakers, although it cannot be fully excluded that the foreign impression in the two groups is one of degree., Learning Outcomes: Readers are able to: (1) define Foreign Accent Syndrome as a motor speech disorder and identify the different subtypes of FAS, (2) describe the most important differences in listeners' perceptual reactions to FAS and real foreign accents, and (3) discuss the findings of the present study in relation to other studies investigating accent attribution in FAS., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Objective: Facial exercises are a noninvasive alternative to medical approaches to facial rejuvenation. Logopedists could be involved in providing these exercises. Little research has been conducted, however, on the effectiveness of exercises for facial rejuvenation. This study assessed the effectiveness of 4 exercises purportedly reducing wrinkles and sagging of the facial skin., Method: A control group study was conducted with 18 participants, 9 of whom (the experimental group) underwent daily training for 7 weeks. Pictures taken before and after 7 weeks of 5 facial areas (forehead, nasolabial folds, area above the upper lip, jawline and area under the chin) were evaluated by a panel of laypersons. In addition, the participants of the experimental group evaluated their own pictures. Evaluation included the pairwise presentation of pictures before and after 7 weeks and scoring of the same pictures by means of visual analogue scales in a random presentation., Results: Only one significant difference was found between the control and experimental group. In the experimental group, the picture after therapy of the upper lip was more frequently chosen to be the younger-looking one by the panel., Conclusion: It cannot be concluded that facial exercises are effective. More systematic research is needed., (© 2013 S. Karger AG, Basel.)

The present study examined language production skills in Parkinson's disease (PD) patients. A unique cued sentence generation task was created in order to reduce demands on memory and attention. Differences in sentence production abilities according to disease severity and cognitive impairments were assessed. Language samples were obtained from 20 PD patients and 20 healthy control participants matched for age, sex and educational level. In addition, a cognitive test for verbal memory and resistance to cognitive interference was administered. Statistical comparisons revealed significant language changes in an advanced stage of the disease. Advanced PD patients showed a reduction in lexical diversity in notional verbs, which was absent in nouns. Cognitive dysfunctions such as impaired verbal memory are suggested to contribute to the typical noun/verb dissociation in PD patients. In addition, advanced PD patients produced more semantic perseverations, which may be related to set-switching problems. In conclusion, whether language disturbances in PD are the result of non-linguistic cognitive dysfunctions or reflect pure language deficits exacerbated by cognitive impairments, remains a matter of debate. However, the negative impact of cognitive dysfunctions may be important.

The purpose of this study was to investigate the impact of residual distortions from the perspective of the speaker. Eighty adult speakers of Brazilian Portuguese with a distortion of the alveolar fricative /s/, the alveolar tap /[symbol: see text]/, or both, completed a questionnaire that documented their therapy history, awareness of the speech distortion, and perceived impact of the disorder. Only a small number of the participants reported that they received negative reactions to their speech and only a minority were of the opinion that their speech interfered with work or social life. Yet a considerable number were of the opinion that their speech was different from that of other people and felt insecure in speech situations. The results suggest that there is a high tolerance toward minor speech errors in present day society that may be related to the fact that such disorders are not at all rare.

Objective: Neurofibromatosis type 1 (NF1) is an autosomal dominant neurocutaneous disorder, which occurs in about one in 3000-4000 people. Its hallmark features include multiple café-au-lait spots and neurofibromas. Voice characteristics of NF1 patients have been documented using both subjective and objective evaluations. However, the relative impact of these voice characteristics on daily activities has, as far as we know, not been examined yet., Methods: Thirty adults with NF1 were asked to complete the Flemish Dutch version of the Voice Handicap Index (VHI). Additionally, the level of severity of NF1 was rated and Dysphonia Severity Indices (DSIs) were collected. The results of the patient group were compared with those of a healthy control group frequency matched for age, gender, smoking behavior, and vocal usage., Results: NF1 patients obtained significantly higher VHI scores compared with healthy controls. Differences between the patient and control group were especially marked for daily functioning and affective responses. Men and women with NF1 had similar VHI scores, but total VHI score did increase with age. An apparent association between VHI, DSI, and severity of NF1 could not be demonstrated., Conclusion: It is likely that the elevated VHI scores observed in the patient group were not merely caused by the voice characteristics associated with NF1. A flow over from other psychophysical issues relating to the disease might have played a role., (Copyright © 2012 The Voice Foundation. Published by Mosby, Inc. All rights reserved.)

Unlabelled: Several authors mentioned the occurrence of articulation problems in the neurofibromatosis type 1 (NF1) population. However, few studies have undertaken a detailed analysis of the articulation skills of NF1 patients, especially in schoolchildren and adults. Therefore, the aim of the present study was to examine in depth the articulation skills of NF1 schoolchildren and adults, both phonetically and phonologically. Speech samples were collected from 43 Flemish NF1 patients (14 children and 29 adults), ranging in age between 7 and 53 years, using a standardized speech test in which all Flemish single speech sounds and most clusters occur in all their permissible syllable positions. Analyses concentrated on consonants only and included a phonetic inventory, a phonetic, and a phonological analysis. It was shown that phonetic inventories were incomplete in 16.28% (7/43) of participants, in which totally correct realizations of the sibilants /ʃ/ and/or /ʒ/ were missing. Phonetic analysis revealed that distortions were the predominant phonetic error type. Sigmatismus stridens, multiple ad- or interdentality, and, in children, rhotacismus non vibrans were frequently observed. From a phonological perspective, the most common error types were substitution and syllable structure errors. Particularly, devoicing, cluster simplification, and, in children, deletion of the final consonant of words were perceived. Further, it was demonstrated that significantly more men than women presented with an incomplete phonetic inventory, and that girls tended to display more articulation errors than boys. Additionally, children exhibited significantly more articulation errors than adults, suggesting that although the articulation skills of NF1 patients evolve positively with age, articulation problems do not resolve completely from childhood to adulthood. As such, the articulation errors made by NF1 adults may be regarded as residual articulation disorders. It can be concluded that the speech of NF1 patients is characterized by mild articulation disorders at an age where this is no longer expected., Learning Outcomes: Readers will be able to describe neurofibromatosis type 1 (NF1) and explain the articulation errors displayed by schoolchildren and adults with this genetic syndrome., (© 2011 Elsevier Inc. All rights reserved.)

Purpose: To describe the typical course of phonological acquisition in Brazilian Portuguese, in view of clinical usage., Methods: A picture naming test was used to collect speech samples from 480 children (240 female and 240 male) enrolled in public and private schools in the city of Rio de Janeiro, who were divided into five age groups between 3 and 8 years. Three types of analyses were conducted, and results were compared for age, gender, and socio-economic level: (1) phonological inventory analysis looking at how many and which consonants were acquired, (2) assessment of the percentage of consonants correct, and (3) phonological processes analysis., Results: Results clearly indicate a faster acquisition in children of higher socio-economic level than in children of lower socio-economic level. Data also indicated that age is the most important factor in phonological acquisition. The completeness of the consonant inventory, the percentage of consonants correct, and the use of phonological processes improved with increasing age, and variability among children decreased. Gender differences, however, were not observed., Conclusion: The information collected may ultimately help speech-language pathologists in the assessment and treatment of children with speech sound disorders.

When characterizing the speech of a patient with neurofibromatosis type 1 (NF1), hypernasality is often mentioned. As few studies applied technically assisted evaluations of nasality in NF1 patients, the aim of the present study was to document the nasal resonance of adults with NF1 using nasometry. The nasometric data obtained from the NF1 patients were compared with the nasalance scores of a healthy control group and with normative data. The final study group consisted of 24 adult NF1 patients and 16 controls, all living in the East Flemish part of Belgium. Nasalance scores were obtained while the participants sustained three vowels (/a:/, /i./, and /u./) and one consonant (/m/) and read three standard nasalance passages. Despite the inter- and intra-subject variability, we observed that NF1 patients as a group exhibited higher mean nasalance scores than controls. This finding was especially clear in males. Potential genotype-phenotype correlations between NF1 mutation type and hypernasality were examined but could not be demonstrated. Conversely, comparison of the nasometric data obtained from the NF1 patients with magnetic resonance imaging findings showed some degree of interesting correlation. We conclude that, notwithstanding the small sample size for some analyses, nasality is an area of interest in the NF1 population. As altered nasality influences speech intelligibility, nasality requires attention during follow-up visits, particularly when it concerns a male NF1 patient., (Copyright © 2011 Wiley Periodicals, Inc.)

Neurofibromatosis type 1 (NF1) is an autosomal dominant neurocutaneous disorder caused by mutations in the NF1 gene, which is located at the long arm of chromosome 17. Major characteristics include multiple café-au-lait spots and neurofibromas. Voice abnormalities have been reported to occur in this patient group. However, most studies relied on subjective measurements only. The present study reports the results of an objective voice assessment based on a multiparameter approach in 22 adults with NF1. Aerodynamic measurements, voice range profiles, acoustic voice quality and intonation measurements, and dysphonia severity indices were obtained and compared with data from a control group, consisting of 22 healthy adults. It was found that NF1 patients show a poorer overall voice quality compared with controls. Particularly, a reduction of vital capacity and limitations in laryngeal possibilities with respect to frequency and intensity were observed in the NF1 group., (Copyright © 2011 The Voice Foundation. Published by Mosby, Inc. All rights reserved.)

Objective: To investigate the common stereotype that homosexual males show pitch patterns that mirror those of heterosexual females., Study Design: Static group comparison., Method: Comparison of speaking fundamental frequency and pitch variation of 30 homosexual males, 56 heterosexual age-matched males, and 54 age-matched heterosexual females as demonstrated in a sample of read speech., Results: In the homosexual males, average fundamental frequency and pitch variation were significantly higher than in the heterosexual males but also significantly lower than in the heterosexual females., Conclusions: Results do not confirm the stereotype that gay male speech mirrors the patterns of women's speech with respect to pitch characteristics. It would seem that the pitch patterns of gay male speakers constitute an example of sociophonetic variation., (Copyright © 2011 The Voice Foundation. Published by Mosby, Inc. All rights reserved.)

Women and girls with complete androgen insensitivity syndrome (CAIS) invariably have a female typical core gender identity. In this case report, we describe the first case of male gender identity in a CAIS individual raised female leading to complete sex reassignment involving both androgen treatment and phalloplasty. CAIS was diagnosed at age 17, based on an unambiguously female phenotype, a 46,XY karyotype, and a 2660delT androgen receptor (AR) gene mutation, leading to a premature stop in codon 807. Bilateral gonadectomy was performed but a short period of estrogen treatment induced a negative emotional reaction and treatment was stopped. Since the age of 3, childhood-onset cross gender behavior had been noticed. After a period of psychotherapy, persisting male gender identity was confirmed. There was no psychiatric co-morbidity and there was an excellent real life experience. Testosterone substitution was started, however without inducing any of the desired secondary male characteristics. A subcutaneous mastectomy was performed and the patient received phalloplasty by left forearm free flap and scrotoplasty. Testosterone treatment was continued, without inducing virilization, and bone density remained normal. The patient qualifies as female-to-male transsexual and was treated according to the Standards of Care by the World Professional Association for Transgender Health with good outcome. However, we do not believe that female sex of rearing as a standard procedure should be questioned in CAIS. Our case challenges the role of a functional AR pathway in the development of male gender identity.

Unlabelled: The purpose of this study was to investigate the possible negative impact of stuttering on romantic opportunities for adolescents and young adults who stutter. The first part of the study investigated if being a person who stutters affects the attractiveness of adolescents and young adults to their peers. To this end, 343 males and 393 females were shown age-matched pictures with an accompanying verbal description of a person opposite his or her own sex which they scored for attractiveness. In half of the participants the verbal description mentioned that the individual depicted was as person who stutters, in the other participants no such reference was included. In a second part, 354 adolescents and young adults completed a questionnaire investigating their attitude towards engaging in a romantic relationship with a peer who stutters. In particular it was asked if stuttering would hold them from (a) starting a conversation, (b) having a date or (c) possibly "going steady" with a person. Results showed that to some extent adolescents and young adults consider peers who stutter less attractive than non-stuttering peers and that they are less likely to engage in a romantic relationship with them. Clinicians need to be aware of the obstacles that adolescent and young adult clients may have to face in their social development., Educational Objectives: The reader of this article will be able to (a) discuss the extent to which stuttering in adolescents and young adults affects attractiveness for peers and (b) discuss the extent to which stuttering in adolescents and young adults holds peers back from engaging in a romantic relationship., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Objective: The purpose of this study was to examine the impact of pitch and intensity modulation on nasalance scores., Methods: A single-group pretest-posttest design was used in which subjects produced reading passages at different pitch and intensity levels. The Nasometer was used for the registration of nasalance scores in subjects with and without cleft palate., Results: An increase in intensity in the non-cleft group resulted in a small but significant decrease in nasalance. Lowering the pitch level resulted in a small but significant decrease in nasalance scores for both the non-cleft and cleft palate subjects., Conclusions: The nasalance changes after vocal modulations during connected speech are reliable and not biased but the impact of these vocal changes on speech intelligibility and daily communication and the usefulness of these vocal modulations as part of a behavioral management program is not yet proven., (Copyright © 2010 S. Karger AG, Basel.)

Previous research has indicated that in Parkinson's disease (PD) some motor speech characteristics are changed by levodopa administration, while others are not. In advanced PD, the time course of these changes and the correlations with motor performance have not been sufficiently investigated. The purpose was to investigate the sequential changes of respiratory, articulatory, and phonatory speech characteristics across a levodopa drug cycle, using spirometry, acoustic, and motor speech analysis. Seven patients with advanced PD were included. All patients were evaluated sequentually at 15 minute intervals before and following levodopa intake. Data were analysed using repeated measures ANOVA and non-parametric analysis. Significant changes were found in motor function, vital capacity, and standard deviation of the diadochokinetic period. A trend was present for shimmer and frequency of the first formant. Significant inter-individual differences in the sequential changes were demonstrated for nearly all evaluated parameters. The conclusion is that, in advanced PD, the evaluation of speech characteristics at one moment after levodopa administration is not representative of an entire drug cycle and that an individualized evaluation of an entire drug cycle is warranted before initiation of a speech-language pathology program.

Unlabelled: A case of word-final prolongations occurring in an adult male with neurofibromatosis type 1 is reported. Speech samples were collected in five different speech modalities (i.e. spontaneous speech, monologue, repetition, automatic series and reading) and subsequently analyzed in a semi-automatic manner using Praat software. Results on the frequency, nature and distribution of the word-final prolongations are presented. The possible pathogenesis of these word-final disfluencies and their relation to stuttering is discussed., Educational Objectives: The reader will be able to: (1) describe the characteristics of word-final prolongations as displayed by an adult male with neurofibromatosis type 1 and (2) discuss the possible pathogenesis of these word-final prolongations and their relation to stuttering.

Background: Neurofibromatosis type 1 (NF1) is an autosomal-dominant neurocutaneous disorder with an estimated prevalence of two to three cases per 10,000 population. While the physical characteristics have been well documented, speech disorders have not been fully characterized in NF1 patients., Aims: This study serves as a pilot to identify key issues in the speech of NF1 patients. In particular, the aim is to explore further the occurrence and nature of problems associated with speech as perceived by the patients themselves., Methods & Procedures: A questionnaire was sent to 149 patients with NF1 registered at the Department of Genetics, Ghent University Hospital. The questionnaire inquired about articulation, hearing, breathing, voice, resonance and fluency. Sixty individuals ranging in age from 4.5 to 61.3 years returned completed questionnaires and these served as the database for the study. The results of this sample survey were compared with data of the normal population., Outcomes & Results: About two-thirds of participants experienced at least one speech or speech-related problem of any type. Compared with the normal population, the NF1 group indicated more articulation difficulties, hearing impairment, abnormalities in loudness, and stuttering., Conclusion: The results indicate that speech difficulties are an area of interest in the NF1 population. Further research to elucidate these findings is needed.

This study determined the intelligibility (words, sentences and story telling) of 43 children (mean age 4.9 years) with unilateral cleft lip and palate who received a Wardill-Kilner palatoplasty, as judged by their parents and determined the influence of age and gender. A comparison with normative data for intelligibility of 163 Dutch speaking children was made. Each child and the parents completed The Dutch intelligibility test. Measures reported include group mean intelligibility percentages for words, sentences and story telling for children aged 2.5-5.0 and 5.0-7.6 years. A significant correlation between age of the children and intelligibility was measured. No significant gender-related differences were found. An interesting finding is the absence of significant difference in intelligibility percentage between the children with cleft palate and the normative data for story telling. The reported intelligibility percentages provide important prognostic reference information for surgeons who perform palatoplasty and speech pathologists who assess the speech production of children with cleft palate., (Copyright 2010 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Neurofibromatosis type 1 (NF1) is an autosomal dominant neurocutaneous disorder with an estimated prevalence of about 1/3000. Several authors mention the occurrence of various types of speech abnormalities associated with NF1. The present study investigated speech fluency in 21 Dutch speaking adults with NF1. Speech samples were collected in five different speaking modalities (spontaneous speech, monologue, repetition, automatic series and reading) and subsequently analysed for type, number and distribution of dysfluencies. It was found that dysfluencies are a common feature of the speech of individuals with NF1. Although stuttering appears to occur in some NF1 patients, as a group, they display a dysfluency pattern that is not identical to stuttering. Educationalobjectives: The reader will be able to (1) summarize the clinical characteristics, prevalence and genetics of neurofibromatosis type 1 (NF1) and (2) describe the dysfluent behaviour displayed by individuals with NF1 regarding frequency, type and distribution of the dysfluencies.

The purpose of this communication is to report on the occurrence of stutter-like behaviour in Flemish Sign Language users. A questionnaire was sent to 38 Flemish Sign Language interpreters and 28 employees of special needs schools adapted to deaf and partially deaf pupils inquiring whether they had ever observed dysfluencies in the manual communication of the deaf and partially deaf. Of the 13 individuals who responded, nine indicated to have perceived such behaviour. The characteristics of the observed dysfluencies are summarized and implications are discussed.

During lifetime the female larynx is very sensitive to sex hormone fluctuations. The menopause forms a critical event in a women's life and also affects the laryngeal tissues. The present report gives an overview of the recent literature about the impact of the menopause on the female larynx and vocal quality. The article discusses the symptoms, aetiology and different treatment options for laryngeal changes during the menopause. The literature pertaining to the impact of the menopause on the voice and the larynx was reviewed to provide a critical summary about the menopausal voice, aetiology and therapeutic options. In postmenopausal women laryngeal changes like oedema and muscular and mucosal dystrophy and atrophy were found. For the voice, the most important acoustic changes in postmenopausal women are a decreased vocal frequency range, decreased fundamental frequency and a higher frequency perturbation. Potential direct and indirect causes for these changes are discussed. Hormone replacement therapy is prescribed in some women for the treatment of menopausal complaints. The first reports in the literature point out a tendency towards a positive, organ-conserving effect of hormone treatment on the larynx and probably the voice. The type and the form of application of hormone therapy seem to be important in the outcome of the studies.

The study aims to investigate if a similar interaction between physical appearance and voice could be found in female-to-male transsexuals as had been observed in male-to-female transsexuals. A panel of judges rated "maleness" of seven female-to-male transsexuals from video-recorded speech samples using three modes of presentation: auditory-only presentation, visual-only presentation, and audiovisual presentation. For the group of transsexuals as a whole, no significant differences were found between scores given in the auditory-only mode or the visual-only mode and those given in the audiovisual mode. Analysis of individual results, however, yielded significant differences in some individuals and there was some relation with hormone treatment. There was no significant correlation between the ratings of "maleness" in the auditory-only mode and fundamental frequency. Physical appearance in female-to-male transsexuals appears not to be a strong influencing factor in general, but may interact with gender recognition based on the voice in some individuals. The absence of a correlation between fundamental frequency and rating of maleness could mean that in female-to-male transsexuals, fundamental frequency is a relatively less important factor for gender expression or perhaps also that a higher voice in males is more accepted than a lower voice in females.

The present study tested suggestions in the literature that vocal breathiness may influence the perception of femininity of the speaker. Two listener experiments were conducted using normal and breathy voice productions by normal females. Panels of students rated femininity of samples from seven biological female speakers, each producing a normal /a/ and a breathy /a/ at similar pitch and intensity. Two listening experiments were enacted. In experiment 1, the 14 samples were presented at random to the judges as if they were from different speakers. Judges rated feminity on a five-point rating scale with 1 (little feminine) and 5 (very feminine) as left and right extremes, respectively. In experiment 2, the normal and breathy samples of each of the seven speakers were presented pair wise and judges were required to indicate which of the two in their opinion sounded most feminine. In all seven participants, the breathy voice samples were judged to be more feminine than the natural voice samples. This was the case when the breathy and natural samples were presented randomly in experiment 1 and when the samples of each speaker were presented pair wise in experiment 2. Results demonstrate that breathiness indeed may contribute to the perception of femininity but replication in a study involving biological males and transgender clients is indicated. It is unclear which degree of breathiness is required or is the most suitable for facilitating the perception of femininity.

Unlabelled: This study evaluated the stereotype that gay men lisp. Two clinicians who were unaware of the specific purpose of the study and the populations involved judged randomized audio-recordings of 175 gay males, 100 heterosexual males and 100 heterosexual females for the presence of lisping during reading of a standardized text. In the gay males a significantly higher prevalence of lisping was found than in the heterosexual males and females. Breakdown of the results of the gay participants in two different age groups showed a higher prevalence of lisping in the younger age group than in the older age group. No relation was found between lisping and age of coming-out or lisping and the probability of being gay as assessed by a questionnaire about sexual orientation. The origin of the high prevalence of lisping in gay men needs further investigation., Learning Outcomes: The readers of this article will able (1) to discuss articulatory behaviour as a possible marker that may distinguish gay from heterosexual men (2) to discuss the prevalence of lisping in gay men.