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Purpose: Chewing problems are a major and prevalent issue in populations with neurological pathologies including cerebrovascular accident (CVA) and Parkinson’s disease (PD). We measured habitual solid chewing performance in patients with CVA or PD and compared it to that of normal older adults to identify differences in chewing ability between groups.Methods: Measures of habitual solid chewing in 32 patients with CVA, in 35 patients with PD, and in 217 normal older adults were compared. Data on the chewing duration, frequency, and rate were collected using a solid chewing task (SCT). We also analyzed the relationships between dentures, number of teeth, and SCT outcomes.Results: The chewing duration in the PD group was significantly longer than the normal group (p

Objectives: Progressive aphasia is a symptom that gradually appears and the caregivers are the ones who first notice the changes of patients’ communication abilities. Therefore, it is necessary to identify and analyze the chief complaints (CCs) reported by caregivers in order to better manage communication problems.Methods: First, communication-related CCs of 44 patients (men:women= 19:25, mean age= 70.5± 10.14) with progressive aphasia were extracted from the electronic medical records (EMRs), and thematic analysis was performed using the NVivo 1.0 program. Consequently, a 45-item interview questionnaire was developed based on the contents of the CCs. Second, a semi-structured interview using the questionnaire was conducted with 9 caregivers (men:women= 2:7, mean age= 56.5±12.82) of patients to verify the questionnaire, and additional thematic and frequency analyses of contents of the interview were performed.Results: Six main themes and 18 subthemes were extracted from the caregivers’ interview. The 6 main themes included ‘verbal expression’, ‘verbal comprehension’, ‘written expression’, ‘written comprehension’, ‘calculation’, and ‘speech’. As for the subthemes, ‘word’, ‘sentence’, ‘linguistic aspect’, ‘reading comprehension’, ‘money management’ and ‘articulation’ were the most frequently reported problems. In addition, the most severely perceived main themes of CCs were ‘verbal expression’, ‘verbal comprehension’, ‘written comprehension’ and ‘speech’.Conclusion: CCs contain crucial information regarding the current status of communication abilities of patients with progressive aphasia. The results of this study may provide information for clinicians and patients/caregivers to understand the nature of communication problems among patients and to direct future planning of the intervention program.

The objective of the present study is to evaluate swallowing-related quality of life in Chinese patients with Parkinson's disease (PD) using the validated Chinese version of the Swallowing Quality-of-Life Questionnaire (C-SWAL-QOL) and factors associated with swallowing-related quality of life, including age, disease duration, and severity of depression by 15-item Geriatric Depression Scale in Chinese version (GDS-C).C-SWAL-QOL was administered to 67 Chinese patients with PD. Upon completion of C-SWAL-QOL, they completed the 15-item GDS-C. Spearman's Rho correlation analyses were performed to examine the relationship between the 10-subscale scores of C-SWAL-QOL and (1) age, (2) disease duration, and (3) depression.Among the subscales in C-SWAL-QOL, sleep, fatigue, eating duration, and communication were the most severely affected. Significant relationships existed between composite C-SWAL-QOL score, total C-SWAL-QOL score, Dysphagia Symptom Battery (DSB) core, and depression. Significant relationships were also observed between depression and the following subscales: communication, fear, mental health, social functioning, and fatigue. Yet, no relationships existed between score of C-SWAL-QOL and age or disease duration in PD.Considering the goal of dysphagia intervention is to improve swallowing safety and efficiency and ultimately enhance patients' QOL, clinicians should consider using C-SWAL-QOL in clinical practice to measure swallowing outcomes and to better understand treatment effectiveness.Implications for rehabilitationDysphagia-related patient-reported outcome (PRO) measures such as Swallowing Quality-of-Life Questionnaire (SWAL-QOL) are the cornerstone to systematically collecting patient-centered data and monitoring rehabilitation outcomes.Based on the scores of Chinese Parkinson's disease (PD) patients in an oral feeding population indicated in the current study, treatment goal and rehabilitation plan can be set.Chinese patients with Parkinson's disease might benefit from a rehabilitation program focusing on the most severely affected subscales in C-SWAL-QOL.

배경 및 목적: 삼킴기능은 나이가 듦에 따라 변화하므로, 삼킴의 어떠한 측면에서 노인들이 어려움을 겪는지를 구체적으로 확인하는 것이 중요하다. 특히, 일부 삼킴 특색은 뇌졸중, 운동장애질환, 치매 등과 같은 노인성 질환과 연관되므로 삼킴장애의 조기 탐지가 진단및 중재에 도움이 된다. 이에, 본 연구에서는 현재 개발 중에 있는 노년층 삼킴 평가 프로토콜의...

배경 및 목적: 현재까지 삼킴 관련 삶의 질에 대한 연구가 다수 진행되었지만, 동일 질환의 환자군을 대상으로 하거나 삼킴 관련 변인의 상대적 영향력을 살펴본 연구는 드물었다. 이에 본 연구는 뇌졸중 환자군의 삼킴 관련 삶의 질에 영향을 미치는 주요 변인을 분석하여 기초자료를 마련하고자 하였다. 방법: 뇌졸중 환자 45명을 대상으로 삼킴장애지수(DHI)를...

배경 및 목적: 전체통일성 측정은 통일성의 유지 정도에 따라 각 발화에 점수를 주어 평균을 산정하는 방법, 전체통일성을 저해하는 발화를 오류로 보아 그 비율을 산정하는 방법, 담화의 전체통일성 유지 정도에 따라 전체점수를 주는 방법이 있으며, 이 중 효율적인 측정 법에 대한 결론을 도출하기 어렵다. 따라서 본 연구 목적은 세 가지 전체통일성 측정법을 여러...

BACKGROUND Tongue pressure is an effective index of swallowing function, and it decreases with aging and disease progression. Previous research has shown beneficial effects of swallowing exercises combined with myofunctional tongue-strengthening therapy on tongue function. Tongue exercises delivered through mobile health (mHealth) technologies have the potential to advance health care in the digital age to be more efficient for people with limited resources, especially older adults. OBJECTIVE The purpose of this study is to explore the immediate and long-term maintenance effects of an 8-week home-based mHealth app intervention with biweekly (ie, every 2 weeks) human mediation aimed at improving the swallowing tongue pressure in older adults. METHODS We developed an mHealth app intervention that was used for 8 weeks (3 times/day, 5 days/week, for a total of 120 sessions) by 11 community-dwelling older adults (10 women; mean age 75.7 years) who complained of swallowing difficulties. The app included a swallowing monitoring and intervention protocol with 3 therapy maneuvers: effortful prolonged swallowing, effortful pitch glide, and effortful tongue rotation. The 8-week intervention was mediated by biweekly face-to-face meetings to monitor each participant’s progress and ability to implement the training sessions according to the given protocol. Preintervention and postintervention isometric and swallowing tongue pressures were measured using the Iowa Oral Performance Instrument. We also investigated the maintenance effects of the intervention on swallowing tongue pressure at 12 weeks postintervention. RESULTS Of the 11 participants, 8 adhered to the home-based 8-week app therapy program with the optimal intervention dosage. At the main trial end point (ie, 8 weeks) of the intervention program, the participants demonstrated a significant increase in swallowing tongue pressure (median 17.5 kPa before the intervention and 26.5 kPa after the intervention; P=.046). However, long-term maintenance effects of the training program on swallowing tongue pressure at 12 weeks postintervention were not observed. CONCLUSIONS Swallowing tongue pressure is known to be closely related to dysphagia symptoms. This is the first study to demonstrate the effectiveness of the combined methods of effortful prolonged swallowing, effortful pitch glide, and effortful tongue rotation using mobile app training accompanied by biweekly human mediation in improving swallowing tongue pressure in older adults. The mHealth app is a promising platform that can be used to deliver effective and convenient therapeutic service to vulnerable older adults. To investigate the therapeutic efficacy with a larger sample size and observe the long-term effects of the intervention program, further studies are warranted. INTERNATIONAL REGISTERED REPORT RR2-10.2196/19585

BACKGROUND Swallowing difficulties (ie, dysphagia) are common among older adults, with a 13% to 54% prevalence. Adequate interventions to improve the swallowing function of older adults would reduce morbidity and enhance health-related quality of life outcomes. Mobile health (mHealth) apps may help alleviate dysphagia symptoms by providing programs that maximize the intensity and frequency of training without requiring high costs or regular clinic visits. OBJECTIVE The aim of this pilot study was to assess the usability of swallowing training apps by quantitatively and qualitatively evaluating older adults’ self-reported data, taking into consideration their educational levels and exposure to mobile technology. We conducted surveys and brief interviews while the participants used a swallowing intervention app we developed. We subsequently identified and resolved individual-specific usability issues to improve future implementation of the app protocol for older persons with swallowing difficulties. METHODS A total of 11 participants (10 women, 91%; mean age 75.7 years, SD 3.93) from two district-run senior welfare centers took part in this study. The participants were divided into a high-potential group and a low-potential group based on their total number of years of education and smart device usage. To investigate the usability of the app twice (ie, in the second week of the intervention and the postintervention stage), we used mixed methods consisting of both quantitative approaches, namely the System Usability Scale (SUS) and modified Computer Self-Efficacy Scale (mCSES) surveys, and qualitative approaches (ie, interviews). RESULTS The quantitative results of the SUS and mCSES surveys revealed that the high-potential group was more inclined to adopt and learn new technology than the low-potential group. Specifically, within the high-potential group, a Wilcoxon signed-rank test indicated that the postintervention mCSES scores (median 65.50) were significantly higher than those in the second week of intervention (median 54.00; z=–2.023, P=.04). Additionally, the usability scores in the low-potential group were within the “marginal acceptability” range even after completion of an 8-week intervention program. Qualitative analyses via semi-structured interviews yielded promising outcomes regarding app acceptability, training program utilization, emotional responses, and learning experience. CONCLUSIONS To the best of the authors’ knowledge, this usability and feasibility study is the first report of a swallowing training app designed to improve the swallowing function of older adults. Future research should consider several issues, such as user characteristics, pretraining education, and the intensity and innate characteristics of the intervention program.

Difficulties with speech and swallowing occur in patients with Parkinsonism. Lee Silverman Voice Treatment (LSVT) is proven as an effective treatment for speech and swallowing function in idiopathic Parkinson’s disease (IPD). The effect of LSVT on swallowing function in multiple system atrophy-cerebellar type (MSA-C) is unknown. We sought to determine LSVT’s effect on swallowing function in MSA-C patients compared to IPD patients. LSVT-LOUD was performed on 13 patients with Parkinsonism (6 IPD and 7 MSA-C). Maximum phonation time (MPT), voice intensity, Speech Handicap Index-15 (SHI-15), Swallowing-Quality of Life (SWAL-QOL), National Institutes of Health-swallowing safety scale (NIH-SSS), and videofluoroscopic dysphagia scale (VDS) before and after LSVT were analyzed and reevaluated three months after treatment. The IPD and MSA-C groups showed significant improvements in overall speech and swallowing measures after LSVT. In particular, pharyngeal phase score and total score of VDS improved significantly in both groups. A two-way repeated-measure ANOVA revealed a significant main effect for time in the MPT, voice intensity, NIH-SSS, pharyngeal phase score and total score of VDS, psychosocial subdomain of SHI-15, and SWAL-QOL. The MSA-C group experienced less overall improvement in swallowing function, but the two groups had an analogous pattern of improvement. In conclusion, LSVT is effective for enhancing swallowing function, particularly in the pharyngeal phase, in both IPD and MSA-C patients. This study demonstrated that LSVT elicits significant improvements in MSA-C patients. We deemed LSVT to be an effective treatment for IPD and MSA-C patients who suffer from dysphagia.

배경 및 목적: 현재까지 국내 언어치료학과를 개설하고 있는 대학수는 총 50개교이고, 교육과정 프로그램은 총 87개까지 양적으로 증가하고 성장하였으나, 국내 전반에 걸친 임상교육, 훈련 및 환경에 대한 정확한 정보는 아직 제공되지 않은 실정이다. 이에, 본 연구는 전문적인 임상의 질적 기준을 마련하고자 국내 언어재활전공 프로그램을 운영하는 전문대학, 4년제...

Background and purpose Speech-in-noise perception deficits have been demonstrated in patients with mild cognitive impairment (MCI). However, it remains unclear whether the impairment of speech perception varies between MCI subtypes. The purpose of this study was twofold: 1) to compare speech perception performance among MCI subgroups, and 2) to identify the cognitive domains specifically related to speech-in-noise perception. Methods We studied 46 patients with MCI and 39 hearing-threshold-matched cognitively normal elderly (CNE) subjects. Two different patient classifications were used: 1) patients with amnestic mild cognitive impairment (aMCI) (n=21) or nonamnestic mild cognitive impairment (naMCI) (n=25), and 2) patients with frontal-executive dysfunction (FED) (n=16) or without FED (n=30). All of the subjects underwent audiometric, neuropsychological, and speech perception assessments. Speech-in-noise perception was measured using sentence recognition tests in the presence of two types of background noise at four levels. Results First, as the level of background noise increased, the MCI with FED group scored lower than both the MCI without FED and CNE groups under both types of noise. Second, both the naMCI and aMCI groups scored lower than the CNE group, but there were no differences between the naMCI and aMCI groups in sentence recognition under any noise conditions. Third, significant correlations were found between sentence recognition and executive function scores both in the MCI groups and in the CNE group. Conclusions Our findings suggest that frontal-executive function is strongly related to speech-in-noise perception and that MCI patients with FED have greater deficits in speech-in-noise perception compared to other subgroups of MCI.

배경 및 목적: 말장애지수(Speech Handicap Index, SHI)는 말 평가에 필수적으로 실시되는 자기보고 평가로서, 구강이나 구인두암 환자의 말 기능과 심리사회적 기능을 평가하는 데 특화되어 개발된 도구이다. SHI가 말 문제를 평가하기에 적합하게 개발되었음에도 불구하고 30개라는 전체 문항 수는 시간적인 제약을 받는다. 따라서 이 연구에서는...

배경 및 목적: 대부분의 파킨슨병 환자들은 본인들의 말 문제를 스스로 인식하므로, 그로 인해 좌절감, 무능감을 느끼고 삶의 질이 저하된다. 국내외적으로 파킨슨병 환자의 일반적인 삶의 질에 관한 다양한 연구가 이루어지고 있지만 파킨슨병 환자의 말 문제에 특화된 삶의 질 연구는 그리 많지 않다. 방법: 본 연구는 파킨슨병 환자 48명을 대상으로...

BACKGROUND AND OBJECTIVES It is important to understand the frequency region of cues used, and not used, by cochlear implant (CI) recipients. Speech and environmental sound recognition by individuals with CI and normal-hearing (NH) was measured. Gradients were also computed to evaluate the pattern of change in identification performance with respect to the low-pass filtering or high-pass filtering cutoff frequencies. SUBJECTS AND METHODS Frequency-limiting effects were implemented in the acoustic waveforms by passing the signals through low-pass filters (LPFs) or high-pass filters (HPFs) with seven different cutoff frequencies. Identification of Korean vowels and consonants produced by a male and female speaker and environmental sounds was measured. Crossover frequencies were determined for each identification test, where the LPF and HPF conditions show the identical identification scores. RESULTS CI and NH subjects showed changes in identification performance in a similar manner as a function of cutoff frequency for the LPF and HPF conditions, suggesting that the degraded spectral information in the acoustic signals may similarly constraint the identification performance for both subject groups. However, CI subjects were generally less efficient than NH subjects in using the limited spectral information for speech and environmental sound identification due to the inefficient coding of acoustic cues through the CI sound processors. CONCLUSIONS This finding will provide vital information in Korean for understanding how different the frequency information is in receiving speech and environmental sounds by CI processor from normal hearing.

배경 및 목적: 본 연구는 아급성기 편측 반구 뇌졸중 환자의 삼킴 시간이 손상 위치에 따라 차이를 보이는지를 조사하고 침습 및 흡인에 영향을 준 삼킴 시간은 무엇인지를 규명하고자 하였다. 방법: 연구 대상자는 뇌자기공명영상을 통해 편측 반구 손상에 의한 뇌졸중 환자 60명이었으며, 좌반구 손상 환자 집단(27명)과 우반구 손상 환자 집단(33명)으로...

Purpose: The International Classification of Functioning, Disability, and Health can be utilized to measure individual health. Although ‘activity’ is one of the components of health, no studies have investigated the frequency of participation of the elderly in daily communication activities, such as talking, reading, and writing. We examined the daily communication behaviors of normal elderly subjects and their effects on cognitive and language test performance. Methods: Normal elderly subjects (n = 456) over 60 years old completed a questionnaire on how often they thought that they talked/read/wrote in their daily lives. Also, they were administered the Korean Mini-Mental State Examination, Controlled Oral Word Association Test, Short Form of the Korean version-the Boston Naming Test, and Sentence Comprehension Test. Results: About 50% of the participants reported that they seldom talked, read, and/or wrote daily. The more frequently that the participants reported daily talking, reading and writing, the better they performed on cognitive and/or language tests. Daily writing influenced the test results the most, which suggested that writing behavior was closely related to all four cognitive/ language tests. Conclusion: These results suggested that daily active communication behaviors play major roles in the cognitive and language abilities of the elderly.

배경 및 목적: 독립적인 생활이 여전히 가능한 치매 환자조차도 인지 기능의 저하로 인해 숫자 처리와 계산에서 어려움을 보일 수 있다. 본 연구에서는 치매 환자군이 정상군에 비해 숫자 처리와 계산 수행 시 오류율과 오류 유형에서 어떤 차이를 보이는지 살펴보았다. 방법: 알츠하이머성 치매 환자 및 일반 노인 각 16명씩을 대상으로 숫자 표기법(기수법,...

배경 및 목적: 알츠하이머성 치매(Alzheimer s Disease, AD)로 인한 한글 읽기장애가 흔히 관찰됨에도 불구하고 그에 대한 연구는 미비한 실정이다. 본 연구에서는 읽기 경로 특성과 관련하여 알츠하이머성 치매군의 단어 어휘성 및 규칙성에 따른 실독증 특성을 밝히고자 하였다. 방법: 전반적 퇴화척도 GDS 3-6에 해당하는 치매군 20명과 정상군...

배경 및 목적: 우리나라 음성 클리닉의 임상 현장에서는 환자 보고에 의한 심리측정적 평가도구가 부족하며, 활동 및 참여 측면까지 고려한 검사도구는 전무하다. 이에, 본 연구에서는 ‘음성 활동 및 참여 프로파일-한국판(K-VAPP)’의 타당성을 검증하고자 하였다. 방법: 개념적 및 언어적 등가성을 위해 권고되는 절차에 따라 ‘음성 활동 및 참여 프로파일’을...

배경 및 목적: 본 연구에서는 점진적 소자증을 나타내는 특발성 파킨슨병 환자와 정상 대조군을 대상으로 구 쓰기와 한 음절 반복 쓰기를 통하여 가로쓰기와 세로쓰기 간의 글자 크기 변화율을 비교하였다. 방법: 본 연구 대상은 H&Y 단계가 2 이상인 특발성 파킨슨병 환자 중 점진적 소자증을 나타내는 11명과 이들의 연령과 성별, 학력, 손잡이 등을...

It is increasingly agreed upon that cognitive and audiological factors are associated with self-perceived hearing handicap in old adults. This study aimed to compare self-perceived hearing handicap among mild cognitive impairment (MCI) subgroups and a cognitively normal elderly (CNE) group and determine which factors (i.e., demographic, audiometric, or neuropsychological factors) are correlated with self-perceived hearing handicap in each group. A total of 46 MCI patients and 39 hearing threshold-matched CNE subjects participated in this study, and their age ranged from 55 to 80 years. The MCI patients were reclassified into two groups: 16 with frontal-executive dysfunction (FED) and 30 without FED. All subjects underwent audiometric, neuropsychological, and self-perceived hearing handicap assessments. The Korean version of the Hearing Handicap Inventory for the Elderly (K-HHIE) was administered to obtain the hearing handicap scores for each subject. After controlling for age, years of education, and depression levels, we found no significant differences in the K-HHIE scores between the MCI and the CNE groups. However, after we classified the MCI patients into the MCI with FED and MCI without FED groups, the MCI with FED group scored significantly higher than did both the MCI without FED and the CNE groups. In addition, after controlling for depression levels, significant partial correlations of hearing handicap scores with frontal-executive function scores and speech-in-noise perception performance were found in the MCI groups. In the CNE group, the hearing handicap scores were related to peripheral hearing sensitivity and years of education. In summary, MCI patients with FED are more likely to experience everyday hearing handicap than those without FED and cognitively normal old adults. Although educational level and peripheral hearing function are related to self-perceived hearing handicap in cognitively normal old adults, speech-in-noise perception and frontal-executive function are mainly associated with hearing handicap in patients with MCI.

배경 및 목적: 말소리 지각(speech perception)은 청각적 언어 이해에 선행되는 필수적인 언어처리과정으로서, 청자의 청력뿐만 아니라 기억 등의 인지능력의 영향을 받으며, 특히 경도인지장애의 경우는 더욱 그러하다. 이에, 본 연구에서는 경도인지장애에서 소음 상황에서의 말소리 지각이 문장 내 핵심 단어의 위치에 따라 차이가 있는지 알아보았다....

OBJECTIVE AND BACKGROUND Along with auditory function, cognitive function contributes to speech perception in the presence of background noise. Older adults with cognitive impairment might, therefore, have more difficulty perceiving speech-in-noise than their peers who have normal cognitive function. We compared the effects of noise level and cognitive function on speech perception in patients with amnestic mild cognitive impairment (aMCI), cognitively normal older adults, and cognitively normal younger adults. METHODS We studied 14 patients with aMCI and 14 age-, education-, and hearing threshold-matched cognitively intact older adults as experimental groups, and 14 younger adults as a control group. We assessed speech perception with monosyllabic word and sentence recognition tests at four noise levels: quiet condition and signal-to-noise ratio +5 dB, 0 dB, and -5 dB. We also evaluated the aMCI group with a neuropsychological assessment. RESULTS Controlling for hearing thresholds, we found that the aMCI group scored significantly lower than both the older adults and the younger adults only when the noise level was high (signal-to-noise ratio -5 dB). At signal-to-noise ratio -5 dB, both older groups had significantly lower scores than the younger adults on the sentence recognition test. The aMCI group's sentence recognition performance was related to their executive function scores. CONCLUSIONS Our findings suggest that patients with aMCI have more problems communicating in noisy situations in daily life than do their cognitively healthy peers and that older listeners with more difficulties understanding speech in noise should be considered for testing of neuropsychological function as well as hearing.

The aims of the present study are two-fold: 1) to explore differences on speech perception between younger and older adults according to noise conditions; and 2) to investigate which cognitive domains are correlated with speech perception. Data were acquired from 15 younger adults and 15 older adults. Sentence recognition test was conducted in four noise conditions(i.e., in-quiet, +5 dB SNR, 0 dB SNR, -5 dB SNR). All participants completed auditory and cognitive assessment. Upon controlling for hearing thresholds, the older group revealed significantly poorer performance compared to the younger adults only under the high noise condition at -5 dB SNR. For older group, performance on Seoul Verbal Learning Test(immediate recall) was significantly correlated with speech perception performance, upon controlling for hearing thresholds. In older adults, working memory and verbal short-term memory are the best predictors of speech-in-noise perception. The current study suggests that consideration of cognitive function for older adults in speech perception assessment is necessary due to its adverse effect on speech perception under background noise.

Background Tongue pressure is an effective index of swallowing function, and it decreases with aging and disease progression. Previous research has shown beneficial effects of swallowing exercises combined with myofunctional tongue-strengthening therapy on tongue function. Tongue exercises delivered through mobile health (mHealth) technologies have the potential to advance health care in the digital age to be more efficient for people with limited resources, especially older adults. Objective The purpose of this study is to explore the immediate and long-term maintenance effects of an 8-week home-based mHealth app intervention with biweekly (ie, every 2 weeks) human mediation aimed at improving the swallowing tongue pressure in older adults. Methods We developed an mHealth app intervention that was used for 8 weeks (3 times/day, 5 days/week, for a total of 120 sessions) by 11 community-dwelling older adults (10 women; mean age 75.7 years) who complained of swallowing difficulties. The app included a swallowing monitoring and intervention protocol with 3 therapy maneuvers: effortful prolonged swallowing, effortful pitch glide, and effortful tongue rotation. The 8-week intervention was mediated by biweekly face-to-face meetings to monitor each participant’s progress and ability to implement the training sessions according to the given protocol. Preintervention and postintervention isometric and swallowing tongue pressures were measured using the Iowa Oral Performance Instrument. We also investigated the maintenance effects of the intervention on swallowing tongue pressure at 12 weeks postintervention. Results Of the 11 participants, 8 adhered to the home-based 8-week app therapy program with the optimal intervention dosage. At the main trial end point (ie, 8 weeks) of the intervention program, the participants demonstrated a significant increase in swallowing tongue pressure (median 17.5 kPa before the intervention and 26.5 kPa after the intervention; P=.046). However, long-term maintenance effects of the training program on swallowing tongue pressure at 12 weeks postintervention were not observed. Conclusions Swallowing tongue pressure is known to be closely related to dysphagia symptoms. This is the first study to demonstrate the effectiveness of the combined methods of effortful prolonged swallowing, effortful pitch glide, and effortful tongue rotation using mobile app training accompanied by biweekly human mediation in improving swallowing tongue pressure in older adults. The mHealth app is a promising platform that can be used to deliver effective and convenient therapeutic service to vulnerable older adults. To investigate the therapeutic efficacy with a larger sample size and observe the long-term effects of the intervention program, further studies are warranted. International Registered Report Identifier (IRRID) RR2-10.2196/19585

Background Swallowing difficulties (ie, dysphagia) are common among older adults, with a 13% to 54% prevalence. Adequate interventions to improve the swallowing function of older adults would reduce morbidity and enhance health-related quality of life outcomes. Mobile health (mHealth) apps may help alleviate dysphagia symptoms by providing programs that maximize the intensity and frequency of training without requiring high costs or regular clinic visits. Objective The aim of this pilot study was to assess the usability of swallowing training apps by quantitatively and qualitatively evaluating older adults’ self-reported data, taking into consideration their educational levels and exposure to mobile technology. We conducted surveys and brief interviews while the participants used a swallowing intervention app we developed. We subsequently identified and resolved individual-specific usability issues to improve future implementation of the app protocol for older persons with swallowing difficulties. Methods A total of 11 participants (10 women, 91%; mean age 75.7 years, SD 3.93) from two district-run senior welfare centers took part in this study. The participants were divided into a high-potential group and a low-potential group based on their total number of years of education and smart device usage. To investigate the usability of the app twice (ie, in the second week of the intervention and the postintervention stage), we used mixed methods consisting of both quantitative approaches, namely the System Usability Scale (SUS) and modified Computer Self-Efficacy Scale (mCSES) surveys, and qualitative approaches (ie, interviews). Results The quantitative results of the SUS and mCSES surveys revealed that the high-potential group was more inclined to adopt and learn new technology than the low-potential group. Specifically, within the high-potential group, a Wilcoxon signed-rank test indicated that the postintervention mCSES scores (median 65.50) were significantly higher than those in the second week of intervention (median 54.00; z=–2.023, P=.04). Additionally, the usability scores in the low-potential group were within the “marginal acceptability” range even after completion of an 8-week intervention program. Qualitative analyses via semi-structured interviews yielded promising outcomes regarding app acceptability, training program utilization, emotional responses, and learning experience. Conclusions To the best of the authors’ knowledge, this usability and feasibility study is the first report of a swallowing training app designed to improve the swallowing function of older adults. Future research should consider several issues, such as user characteristics, pretraining education, and the intensity and innate characteristics of the intervention program.

Summary Objectives The purpose of this study was to determine whether patients with functional voice disorders show voice activity and participation profiles different from those of the organic and neurogenic groups. Methods The Korean Version of the Voice Activity and Participation Profile (K-VAPP) was administered to 200 participants (150 patients with functional, organic, and neurogenic voice disorders, 50 for each etiological group, 50 controls without vocal complaint). The K-VAPP subscale scores of the etiological groups were compared, controlling for age, professional use of voice, and severity of voice disorder measured by overall severity of the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V). Results Results of a one-way analysis of variance indicated significant differences in the overall severity across groups (neurogenic > functional = organic > control). Among four groups, the organic group showed higher mean Z-scores of the K-VAPP than the control group, and the functional group showed higher mean Z-scores of the K-VAPP than the organic group. Compared with the neurogenic group, the functional group showed lower mean Z-scores for total score, Activity Limitation Score, SUB3, and SUB5. A comparison among three etiological groups showed that the functional group did not show higher scores than the organic group. On the contrary, the functional group showed a lower total score, Participation Restriction Score, and score for subsection 3 (effect on daily communication) than the neurogenic group. Conclusions Psychometric assessment of voice disorders using the K-VAPP could provide clinicians with baseline information that is applicable to various voice disorders. Further studies pertaining to the follow-up of voice disorders with various etiologies are needed to extend its clinical usefulness.