Search

Dysphagia patients need to carefully control their intake liquid's viscosity to reduce choking and aspiration risks. However, accurate liquid viscosity measurement requires expensive rheometers still unavailable in daily life. Though the existing approximate testing methods are low-cost, they are not convenient for everyday use as they require either tedious procedures or dedicated apparatus. This paper presents ViscoCam, the first liquid viscosity classification system for dysphagia patients or carers, which only requires a smartphone. It is easy to operate, widely deployable, and robust for daily use. ViscoCam classifies visually indistinguishable liquid of various viscosity levels by exploiting the fact that the sloshing motion of viscous liquid decays faster than thin liquid. To perform a measurement, the user shakes a cup of liquid and their smartphone to induce the liquid sloshing motion. Then, ViscoCam senses the cup's motion using the smartphone's built-in accelerometer or microphone and infers liquid viscosity from the fluid surface motion captured by flashlight camera. To combat changes in camera position, lighting conditions, and liquid sloshing motion, a 3D convolutional neural network is trained to extract reliable motion features for classification. We evaluate ViscoCam's performance in classifying three levels in the IDDSI standard, which is the most up-to-date and internationally adopted one for dysphagia patients. Results show that ViscoCam achieves an overall accuracy of 96.52% in controlled cases. It is robust to unseen liquid heights or container sizes, and >81% accuracy is maintained under extreme testing cases.

The purpose of this study was to cross-culturally adapt and validate the Hong Kong Chinese version of the Children's Voice Handicap Index-10 for Parents (CVHI-10-P(HK)), a parent-proxied quality of life (QOL) questionnaire that pairs with the Children's Voice Handicap Index-10 (CVHI-10(HK)).The English version of the (CVHI-10-P(HK)) underwent forward-backward translation and pretesting. Content validity was computed from an expert panel rating on relevance and test-retest reliability was obtained from parents and/or guardians of six dysphonic and five vocally-healthy children. Other validity and reliability measures were analyzed from CVHI-10-P(HK) completed by parents and/or guardians of 28 dysphonic and 35 vocally-healthy children who had completed CVHI-10(HK).The CVHI-10-P(HK) demonstrated excellent internal consistency (α = 0.091), excellent content validity (item- and scale-level content validity indices = 1.00), good construct validity (between group difference in total CVHI-10-P(HK) score: t(30.904) = -6.449, P0.001, Cohen's d = 1.709) and excellent test-retest reliability (r = 0.966, P0.001). Criterion validity analysis showed a moderate correlation between the total CVHI-10-P(HK) score and auditory-perceptual ratings on overall severity (r = 0.515, P0.001). Area under the curve of the receiver operating characteristic plot was found to be 0.855. The CVHI-10-P(HK) has excellent intrinsic accuracy. A cutoff of score of four may be adopted for the optimal sensitivity and specificity match. A moderate correlation was found between the total scores of CVHI-10-P(HK) and CVHI-10(HK) (r = 0.684, P0.001).The CVHI-10-P(HK) is a valid tool that measures QOL of dysphonic children from the parents' perspective. It is recommended to be used in parallel to the CVHI-10(HK) as part of a comprehensive voice assessment for children in Hong Kong.

This study aimed to investigate the application of ultrasound to the learning of swallowing maneuver. Forty non-dysphagic adults of both genders who were naive to the Mendelsohn maneuver participated in the study. They were randomly assigned to receive ultrasound or surface electromyography (sEMG) as biofeedback when acquiring the Mendelsohn maneuver. Thirty-eight subjects (n = 19) completed the Learning phase. Accuracy of executing the Mendelsohn maneuver was measured immediately (Post-training percentage accuracy) and one week post-training (Retention percentage accuracy). Whereas comparable numbers of training blocks were completed by the two groups (t(31.51) = 3.68, p = 0.330), the Ultrasound group attained significantly higher percentage accuracies than the sEMG group at both Post-training (t(28.88) = 4.04, p

Swallowing is a complex process that involves precise coordination among oral and pharyngeal structures, which is essential to smooth transition of bolus and adequate airway protection. Tongue base retraction and hyolaryngeal excursion are two significant swallowing movements, and their related events can be examined using ultrasound imaging, which is physically and radioactively non-invasive. The present study aimed to 1) establish the temporal sequences and timing of swallowing events identified using ultrasound imaging, and 2) investigate the variability of the above temporal sequences and 3) investigate the effect of bolus type on the variability of temporal sequences in non-dysphagic individuals. Forty-one non-dysphagic young adults of both genders (19 males and 22 females) participated in the study. Ultrasound images were acquired mid-saggitally at their submental region during swallowing of boluses with different volume (i.e. 5mL or 10mL) and consistencies (i.e. IDDSI Levels 0 and 4). Timing and sequence of six events 1) displacement onset (TBOn), 2) maximum displacement (TBMax) and 3) displacement offset of tongue base retraction (TBOff); and, 4) displacement onset (HBOn), 5) maximum displacement (HBMax) and 6) displacement offset of the hyoid bone excursion (HBOff) were extracted from the ultrasound images. Out of the 161 swallows, 85.7% follow a general sequence of HBOn < TBOn < HBMax < TBMax < HBOff < TBOff. Percentage adherence to six anticipated paired-event sequences was studied. Results suggested the presence of individual variability as adherence ranged from 75.8% to 98.1% in four of the anticipated sequences, leaving only two sequences (HBOn < TBMax and TBMax < HBOff) obligatory (i.e. 100% adherence). For non-obligatory sequences, it was found that bolus type may have an effect on the level of adherence. Findings of the present study lay the groundwork for future studies on swallowing using ultrasound imaging and also the clinical application of ultrasonography.

(1) Background: Ultrasound provides a radiation-free and portable method for assessing swallowing. Hyoid bone locations and displacements are often used as important indicators for the evaluation of swallowing disorders. However, this requires clinicians to spend a great deal of time reviewing the ultrasound images. (2) Methods: In this study, we applied tracking algorithms based on deep learning and correlation filters to detect hyoid locations in ultrasound videos collected during swallowing. Fifty videos were collected from 10 young, healthy subjects for training, evaluation, and testing of the trackers. (3) Results: The best performing deep learning algorithm, Fully-Convolutional Siamese Networks (SiamFC), proved to have reliable performance in getting accurate hyoid bone locations from each frame of the swallowing ultrasound videos. While having a real-time frame rate (175 fps) when running on an RTX 2060, SiamFC also achieved a precision of 98.9% at the threshold of 10 pixels (3.25 mm) and 80.5% at the threshold of 5 pixels (1.63 mm). The tracker’s root-mean-square error and average error were 3.9 pixels (1.27 mm) and 3.3 pixels (1.07 mm), respectively. (4) Conclusions: Our results pave the way for real-time automatic tracking of the hyoid bone in ultrasound videos for swallowing assessment.

This study aimed to cross-culturally adapt and validate the Hong Kong-Chinese version of the Vocal fatigue index (VFI(HK)).The original English version of the Vocal fatigue index (VFI) was translated and adapted to the VFI(HK). A total of 206 subjects (87 in the Fatigue group and 119 in the Control group) completed the VFI(HK) and validity, reliability and receiver operating characteristic (ROC) were analysed.The VFI(HK) exhibited satisfactory psychometric properties. It showed good content validity (scale-level content validity indices ≥ 0.842) and excellent internal consistency (Part 1: α = 0.945, Part 2: α = 0.914, Part 3: α = 0.951). Parts 1 and 2 of the questionnaire showed good construct validity (Part 1: t(204) = 5.743, P0.001; Part 2: t(204) = 5.049, P0.001). Test-retest reliability ranged from acceptable (Part 3: Ρ = 0.702) to good (Part 1: Ρ = 0.885, Part 2: Ρ = 0.827). ROC curves showed acceptable and close-to-acceptable intrinsic accuracies for Parts 1 (Aera under curve (AUC) = 0.712) and 2 (AUC = 0.694) respectively. Cutoff scores of 25 and 10 are suggested for Parts 1 and 2 respectively.The VFI(HK) is a valid and sensitive assessment tool. It may be adopted to identify individuals with vocal fatigue in the Hong Kong-Chinese population.

This study aimed to cross-culturally adapt and validate a Hong Kong Chinese version of the Children's Voice Handicap Index (CVHI-10(HK)) and to examine its psychometric properties as a measure of quality of life in dysphonic children.The English version of Children's Voice Handicap Index-10 was translated and adapted to Hong Kong Chinese. Content validity was obtained from ratings of an expert panel and other psychometric properties were measured from CVHI-10(HK) questionnaires completed by 63 children (Dysphonic group: n = 28, vocally-healthy Control group: n = 35) aged between eight to 14 years.CVHI-10(HK) showed good psychometric properties. Internal consistency measured with Cronbach's alpha coefficient was 0.787. It also showed excellent content validity (scale-level content validity indices ≥ 0.90) and good construct validity (between group difference in total CVHI-10(HK) score: t (33.62) = 4.393, P0.001, Cohen's d = 1.157). Analysis on criterion validity revealed a significant and moderate correlation between the total CVHI-10(HK) score and auditory-perceptual ratings on overall severity (Pearson's r = 0.505, P0.001). Receiver operating characteristic analysis showed an excellent intrinsic accuracy in discriminating the two groups of children (area under the curve = 0.808) and suggested a cutoff score of three would give the optimal sensitivity and specificity combination of the questionnaire.CVHI-10(HK) is a valid and sensitive tool that measures quality of life in dysphonic children. It is the first self-administered questionnaire that is available to the paediatric dysphonic population in Hong Kong. It may also be used as a screening tool to identify dysphonic children and those who are at risk of voice problems in the local context.

The aim of the present study was to investigate the efficacy of different straw phonation doses for vocal fatigue (VF) prevention.Thirteen males and 13 females participated in the study. Each participant received seven preventive treatments (i.e. voice rest with hydration for 15 minutes, straw phonation into air or water for one, three and five minutes) in separate visits. Phonatory threshold pressure (PTP) and self-perceived vocal fatigue (PVF) symptoms severity were adopted as the primary and secondary outcome measures, respectively. Measurements were taken before and after the preventive treatment, and after a 90-minute VF-inducing task.PTP was maintained in four of the straw phonation doses, namely; the one-minute into air, one-minute, three-minute and five-minute into water conditions; but not in the voice rest condition. Straw phonation into water of a depth of 5 cm for one minute was considered the optimal dose for VF prevention. PVF, however, was not maintained after VF-inducing task in all treatment conditions.Straw phonation into water for one minute was capable of preventing phonatory efficiency (as measured with PTP) from deteriorating. The dose identified in the present study may be adopted for future prevention studies in population that is vulnerable to VF.

This study aimed to evaluate an existing liquid-thickening guideline provided by a major manufacturer of thickener in Hong Kong and to provide directions for the implementation of the IDDSI framework. Fifteen participants who are naive to liquid thickening were required to prepare thickened liquids samples from three drink bases (i.e., Milk-tea, Chinese tea, and Herbal tea) at two target consistency levels (i.e., mildly and medium/moderately thick) based on two guidelines (i.e., the manufacturer’s guideline and an IDDSI-driven guideline). Viscosities of the samples were measured rheologically to reflect liquid consistency. The manufacturer’s guideline resulted in distinguishable viscosities at the two consistency levels (F(1, 35.464) = 113.764, p

Objectives/Hypothesis Acupuncture is a less-invasive procedure when compared with surgical treatment for benign vocal pathologies caused by vocal overuse. This study aimed to determine the wound-healing effect of acupuncture in treating phonotraumatic vocal fold lesions. Study Design Two-way, mixed-model, between- and within-subjects, prospective randomized, placebo-controlled, blinded group design. Methods Seventeen dysphonic individuals with vocal nodules were recruited from a university clinic in Hong Kong. Each participant was randomly assigned to receive one session of either genuine or sham acupuncture. The genuine acupuncture group (n = 9) received needles puncturing nine voice-related acupoints for 30 minutes, whereas the sham acupuncture group (n = 8) received blunted needles stimulating the skin surface of the nine acupoints for the same frequency and duration. Laryngeal secretions were suctioned from the surface of the vocal folds immediately before, immediately after, and 24 hours after the acupuncture. The protein concentration levels of wound-healing–related cytokines (interleukin [IL]-1β and IL-10) in these secretion samples were measured. Results Following acupuncture, a significant increase in the anti-inflammatory cytokine IL-10 was found in the genuine acupuncture group (n = 9) but not in the sham acupuncture group (n = 8). Conclusions The findings showed that acupuncture of voice-related acupoints facilitated an anti-inflammatory process in phonotraumatic vocal pathologies. This could be considered as supporting evidence to consider acupuncture as a less-invasive alternative option, when compared to surgery, for treating phonotraumatic vocal pathologies. Level of Evidence 1b Laryngoscope, 2015

BACKGROUND: Breast reconstructive surgery can improve mastectomy patients' emotional relationships and social functioning, but it may be underutilized in low-income, medically underserved women. This study assessed the impact of patient-physician communication on rates of breast reconstructive surgery in low-income breast cancer (BC) women receiving mastectomy. METHODS: A cross-sectional, California statewide survey was conducted of women with income less than 200% of the Federal Poverty Level and receiving BC treatment through the Medicaid Breast and Cervical Cancer Treatment Program. A subset of 327 women with nonmetastatic disease who underwent mastectomy was identified. Logistic regression was used for data analysis. The chief dependent variable was receipt of or planned breast reconstructive surgery by patient report at 6 months after diagnosis; chief independent variables were physician interactive information giving and patient perceived self-efficacy in interacting with physicians. RESULTS: Greater physician information giving about BC and its treatment and greater patient perceived self-efficacy positively predicted breast reconstructive surgery (OR = 1.12, P = .04; OR = 1.03, P = .01, respectively). The observed negative effects of language barriers and less acculturation among Latinas and lower education at the bivariate level were mitigated in multivariate modeling with the addition of the patient-physician communication and self-efficacy variables. CONCLUSIONS: Empowering aspects of patient-physician communication and self-efficacy may overcome the negative effects of language barriers and less acculturation for Latinas, as well as of lower education generally, on receipt of or planned breast reconstructive surgery among low-income women with BC. Intervening with these aspects of communication could result in breast reconstructive surgery rates more consistent with the general population and in improved quality of life among this disadvantaged group. Cancer 2009. © 2009 American Cancer Society.

Summary Objectives To investigate the effectiveness of acupuncture in treating phonotraumatic vocal fold lesions. Study Design/Methods A total of 123 dysphonic individuals with benign vocal pathologies were recruited. They were given either genuine acupuncture ( n = 40), sham acupuncture ( n = 44), or no treatment ( n = 39) for 6 weeks (two 30-minute sessions/wk). The genuine acupuncture group received needles puncturing nine voice-related acupoints for 30 minutes, two times a week for 6 weeks, whereas the sham acupuncture group received blunted needles stimulating the skin surface of the nine acupoints for the same frequency and duration. The no-treatment group did not receive any intervention but attended just the assessment sessions. One-hundred seventeen subjects completed the study (genuine acupuncture = 40; sham acupuncture = 43; and no treatment = 34), but only 84 of them had a complete set of vocal functions and quality of life measures (genuine acupuncture = 29; sham acupuncture = 33; and no-treatment = 22) and 42 of them with a complete set of endoscopic data (genuine acupuncture = 16; sham acupuncture = 15; and no treatment = 11). Results Significant improvement in vocal function, as indicated by the maximum fundamental frequency produced, and also perceived quality of life, were found in both the genuine and sham acupuncture groups, but not in the no-treatment group. Structural (morphological) improvements were, however, only noticed in the genuine acupuncture group, which demonstrated a significant reduction in the size of the vocal fold lesions. Conclusions The findings showed that acupuncture of voice-related acupoints could bring about improvement in vocal function and healing of vocal fold lesions.

Objectives/Hypothesis: Recent developments in voice assessment propose the use of quality of life measurements. The Voice Handicap Index (VHI) is one of the most psychometrically robust and well-studied instruments among the various instruments for measuring quality of life. Two versions of VHI (VHI-30 and VHI-10) have been shown to be valid instruments for distinguishing dysphonic from nondysphonic individuals and also for documenting treatment effect for dysphonic patients. The VHI has been used worldwide; however, the psychometric properties of the Chinese version of VHI remains untested. This study aimed to investigate such properties of the Chinese VHI-30 and VHI-10 in the Hong Kong Chinese population. Study Design: Psychometric analysis of the Chinese VHI-30 and VHI-10 in dysphonic patients and control subjects. Methods: The original VHI-30 was translated into Chinese and was completed by 131 dysphonic patients and 54 nondysphonic individuals. The dysphonic patients also self-rated their dysphonic severity. Results: Results showed high test-retest reliability and high item-total correlation for both Chinese VHI-30 and VHI-10. Both Chinese versions could be used to distinguish different dysphonic groups and between dysphonic and nondysphonic groups. Significant correlation was found between the VHI scores and the patients' self-rated dysphonic severity. Conclusion: The present study supported the original three-factorial structures of the VHI-30 and the use of the VHI for the Chinese population. It is shown that the Chinese VHI-10 is a strong representation of VHI-30 and is recommended for use in clinics because of its validity and ease of use by patients.