Search

This study explored the demonstration of culturally responsive service provision when planning intervention by speech-language pathologists (SLPs). A fifteen-item survey revealed (a) SLPs consider culture when choosing therapeutic materials, and (b) family structure was the cultural factor selected by the most SLPs, followed closely by race and/or ethnicity. Religion was the least commonly selected cultural factor. Knowledge of multiple factors of culture should be considered to provide culturally competent intervention.

Purpose: The purpose of this meta-analysis was to assess the frequency of sex, race, and ethnicity reporting and proportional representation in funded, noncancerous voice clinical trials to determine the state of compliance with National Institutes of Health (NIH) guidelines for inclusivity in clinical research. Method: Clinical trials registered with the NIH/U.S. National Library of Medicine between January 1988 and September 2021 were analyzed. Primary reports of the trials were obtained from clinicaltrials.gov and PubMed. Outcomes included the proportion of trials reporting sex, race, and ethnicity and the proportion of participants by sex, race, and ethnicity in the trials. Descriptive statistics and chi-square tests were used to analyze the data with 95% confidence intervals (CIs) reported. Results: The search yielded 46 research studies. After inclusion and exclusion criteria were applied and attempts to locate studies were conducted, 11 total articles were ultimately evaluated. Descriptively, there were more female subjects, yet overall, no significant difference in sex distribution (X[superscript 2] = 0.07, p = 0.75, 95% CI [-0.25, -0.19]). Race and ethnicity were only reported in two clinical trials. Black participants were underrepresented in one clinical trial (X[superscript 2] = 4.93, p = 0.02, 95% CI [-0.11, -0.02]), whereas Hispanic participants were underrepresented in a second trial (X[superscript 2] = 11.27, p < 0.00, 95% CI [-0.20, -0.13]). Conclusions: This preliminary analysis highlights the disparities in race and ethnicity recruitment and reporting in noncancerous voice clinical trials. There is a need for strategic recruitment strategies and improved reporting practices to adhere to the NIH inclusivity directives.

The purpose of this study was to assess the competence of speech-language pathologists (SLPs) in serving bilingual or English-language learning children. Specifically, are SLPs able to identify acceptable English productions of a native Spanish speaker when described and/or given in context? Data were collected through an anonymous 28-question, web-based survey designed for practicing SLPs who worked with children. A total of 99 completed responses were received. The majority of SLPs demonstrated a basic understanding of aspects of Spanish-Influenced English (SIE) and dialectal features associated with native speakers of Spanish; however, SLPs were better able to identify errors in context than features of SIE. To ensure best practice in service provision for children who are English-language learners, SLPs need an understanding of the features of SIE and other English variants. Training programs should therefore provide education on the specific contrasts between languages/dialects while encouraging critical thinking and self-study.

Purpose: The purpose of this meta-analysis was to assess the frequency of sex, race, and ethnicity reporting and proportional representation in funded, noncancerous voice clinical trials to determine the state of compliance with National Institutes of Health (NIH) guidelines for inclusivity in clinical research. Method: Clinical trials registered with the NIH/U.S. National Library of Medicine between January 1988 and September 2021 were analyzed. Primary reports of the trials were obtained from clinicaltrials.gov and PubMed. Outcomes included the proportion of trials reporting sex, race, and ethnicity and the proportion of participants by sex, race, and ethnicity in the trials. Descriptive statistics and chi-square tests were used to analyze the data with 95% confidence intervals (CIs) reported. Results: The search yielded 46 research studies. After inclusion and exclusion criteria were applied and attempts to locate studies were conducted, 11 total articles were ultimately evaluated. Descriptively, there were more female subjects, yet overall, no significant difference in sex distribution ([chi square] = 0.07, p = .75, 95% CI [-0.25, -0.19]). Race and ethnicity were only reported in two clinical trials. Black participants were underrepresented in one clinical trial ([chi square] = 4.93, p = .02, 95% CI [-0.11, -0.02]), whereas Hispanic participants were underrepresented in a second trial ([chi square] = 11.27, p < .00, 95% CI [-0.20, - 0.13]). Conclusions: This preliminary analysis highlights the disparities in race and ethnicity recruitment and reporting in noncancerous voice clinical trials. There is a need for strategic recruitment strategies and improved reporting practices to adhere to the NIH inclusivity directives., The National Institutes of Health (NIH) Revitalization Act of 1993 established guidelines for the NIH to prioritize the inclusion of women and people from minority backgrounds in federally funded research, [...]

Purpose: The primary aim of this study was to investigate the extent to which individuals with facial and/or speech differences secondary to a craniofacial anomaly experienced bullying through social media platforms during late school age and adolescence. Method: Using an online survey platform, a questionnaire was distributed via several public and private social media groups designated for individuals with craniofacial anomaly and their caregivers. Results: The majority of participants (n = 38; 88.4%) indicated they had been bullied during late school-age and adolescence and that they believed this was due to their facial difference and/or speech disorder (n = 27; 71.1%). Almost one third indicated they had been victims of cyberbullying during this time (n = 12; 31.6%) with the most common venues being texting and Facebook. Despite the large percentage of participants who reported being bullied through social media, half (n = 6) indicated they did not often report these instances of cyberbullying. Conclusions: As social media use continues to increase, it appears inevitable that cyberbullying will occur. Particularly vulnerable to both traditional and cyberbullying are individuals with craniofacial anomalies. Because of the specialized training of speech-language pathologists, school-based speech-language pathologists are in a unique position to play a key role in school-wide antibullying efforts and to educate school personnel on ways in which to support the needs of children with craniofacial anomalies both inside and outside of the classroom.

Purpose: The aim of this study was to examine the influence of menstrual cycle phases (follicular, ovulatory, luteal, and ischemic) and hormone levels (estradiol, testosterone, progesterone, and neuropeptide Y) on vocal fold vibrations in reproductive and postmenopausal women. Method: Glottal area waveforms were extracted from high-speed videoendoscopy during sustained phonation, inhalation phonation, and voice onset/offset in the reproductive (n = 15) and postmenopausal (n = 13) groups. Linear mixed-model analysis was conducted to evaluate hormone levels and high-speed videoendoscopy outcome variables between the reproductive and postmenopausal groups. In the reproductive group, simple linear regression and multiple regression were conducted to determine the effects of hormones on the dependent variables. Results: Group differences between reproductive and postmenopausal women were identified for stiffness index, oscillatory onset time, and oscillatory offset time. Neuropeptide Y hormone in the ischemic phase significantly predicted changes in the reproductive group for some dependent variables; however, the relationship varied for sustained phonation and inhalation phonation. Conclusion: These findings provide preliminary evidence that vocal fold vibrations in the reproductive group are different predominantly in the ischemic phase due to neuropeptide Y changes.

The article focuses on whether it's advisable for singers to perform while ill. Topics include the impact of fever and infection on singing, the effects of nasal congestion, laryngitis, and pulmonary conditions on vocal performance, and the importance of consulting with medical professionals to avoid long-term vocal issues.

The aim of this article is to examine speech-language pathologists' (SLPs) knowledge and competence using Percentage of Consonants Correct (PCC). Participants were recruited through posts on social media and message boards for the American Speech-Language-Hearing Association (ASHA) Special Interest Groups. In addition, surveys were emailed via the ASHA membership directory to SLPs in selected states who reported working in settings with a primarily pediatric population. The majority of SLPs reported a lack of academic and clinical training in the area of PCC. Participants demonstrated limited knowledge of the rules for calculating PCC in addition to decreased calculation ability and confidence. Because PCC is well-validated, SLPs would benefit from increased clinical and academic exposure to the measure; however, as many report that they do not use PCC, this calls into question its clinical practicality. The question remains if there is a need for a more expedient process by which to objectively quantify severity, such as use of an automated metric.

Purpose: This preliminary study examined the influence of menstrual cycle phase and hormone levels on acoustic measurements of vocal function in reproductive and postmenopausal females. Mean fundamental frequency (f0), speaking fundamental frequency (Sf0), and cepstral peak prominence (CPP) were evaluated. It was hypothesized that Sf0 and CPP would be lower during the luteal and ischemic phases of the menstrual cycle. Group differences with lower values in postmenopausal females and greater variability in the reproductive females were also hypothesized. Method: A mixed factorial analysis of variance was used to examine differences between reproductive and postmenopausal females and the four phases of the menstrual cycle. Separate analyses of variances were implemented for each of the dependent measures. Twenty-eight female participants (15 reproductive cycling, 13 postmenopausal) completed the study. Participants were recorded reading the Rainbow Passage and sustaining the vowel /a/. Mean vocal f0, Sf0, and CPP were determined from the acoustic samples. Blood assays were used to determine estrogen, progesterone, testosterone, and neuropeptide Y levels at four data collection time points. Results: Group differences in hormone levels and Sf0 values were established with the postmenopausal group having significantly lower hormone levels and significantly lower Sf0 than the reproductive cycling group across the phases. Analysis of the reproductive group by hormone levels and cycle phase revealed no significant differences for CPP or Sf0 across phases. Higher estrogen was identified in the ovulation phase, and higher progesterone was identified in the luteal phase. Conclusions: Significant differences in hormone levels and Sf0 were identified between groups. Within the reproductive cycling group, the lack of significant difference in acoustic measures relative to hormone levels indicated that the measures taken may not have been sensitive enough to identify hormonally mediated vocal function changes. The participant selection may have biased the findings in that health conditions and medications that are known to influence voice function were used as exclusion criteria.

Purpose: The aim of this study was to examine the influence of menstrual cycle phases (follicular, ovulatory, luteal, and ischemic) and hormone levels (estradiol, testosterone, progesterone, and neuropeptide Y) on vocal fold vibrations in reproductive and postmenopausal women. Method: Glottal area waveforms were extracted from high-speed videoendoscopy during sustained phonation, inhalation phonation, and voice onset/offset in the reproductive (n = 15) and postmenopausal (n = 13) groups. Linear mixed-model analysis was conducted to evaluate hormone levels and high-speed videoendoscopy outcome variables between the reproductive and postmenopausal groups. In the reproductive group, simple linear regression and multiple regression were conducted to determine the effects of hormones on the dependent variables. Results: Group differences between reproductive and postmenopausal women were identified for stiffness index, oscillatory onset time, and oscillatory offset time. Neuropeptide Y hormone in the ischemic phase significantly predicted changes in the reproductive group for some dependent variables; however, the relationship varied for sustained phonation and inhalation phonation. Conclusion: These findings provide preliminary evidence that vocal fold vibrations in the reproductive group are different predominantly in the ischemic phase due to neuropeptide Y changes., To date, investigations addressing hormonal influences on voice function have primarily focused on evidence related to acoustic and perceptual measures. Studies of laryngeal imaging differences relative to blood plasma levels [...]

Purpose: The aim of the current study was to review neuromuscular development, summarize the current body of evidence describing the use of neuromuscular electrical stimulation (NMES) therapy in infants, and identify possible contraindications for the use of NMES in the neonate and young infant. Method: After a review of the literature describing neuromuscular development, we created a timeline of the developmental processes. Key milestones were determined, and a literature search was conducted to identify potential effects of electrical stimulation on this process. Results: Current evidence supporting the use of NMES in the pediatric population is limited and of poor quality. Contraindications of the use of NMES in the neonate and young infant were identified, including (a) inhibited expression of the neural cell adhesion molecule that is vital for neuromuscular development, (b) alteration of muscle fiber type metabolic profile away from intended muscle fiber type morphology, and (c) interruption of postsynaptic acetylcholine receptor synthesis during neuromuscular junction development. Conclusion: The use of NMES for the treatment of dysphagia in the neonate and young infant may influence early neuromuscular development in a manner that is not currently well understood. Future research is needed to further understand the effects of NMES on the developing neuromuscular system.

Purpose: The purpose of this tutorial is to summarize how sex hormones affect both laryngeal senescence and neuromuscular response to exercise, highlighting the importance of considering sex differences in developing treatment for the senescent voice. Conclusion: Men and women's voices are sexually dimorphic throughout the life span, including during the laryngeal adaptations observed during senescence. Therefore, presbyphonia (age-related dysphonia) likely clinically manifests differently for men and women due to differences in how the male and the female larynx change in response to aging. Because sexual dimorphism is evident in both laryngeal aging and response to exercise, voice therapy programs aimed at treating the typical and disordered aged voice should consider sex differences in their design.

Purpose: The purpose of this preliminary study was to identify a vocal task that could be used as a clinical indicator of the vocal aptitude or vocal fitness required for vocally demanding occupations in a manner similar to that of the anaerobic power tests commonly used in exercise science. Performance outcomes for vocal tasks that require rapid acceleration and high force production may be useful as an indirect indicator of muscle fiber complement and bioenergetic fitness of the larynx, an organ that is difficult to study directly. Method: Sixteen women (age range: 19-24 years, Mage = 22 years) were consented for participation and completed the following performance measures: forced vital capacity, three adapted vocal function tasks, and the horizontal sprint test. Results: Using a within-participant correlational analyses, results indicated a positive relationship between the rate of the last second of a laryngeal diadochokinesis task that was produced at a high fundamental frequency/high sound level and anaerobic power. Forced vital capacity was not correlated with any of the vocal function tasks. Conclusions: These preliminary results indicate that aspects of the laryngeal diadochokinesis task produced at a high fundamental frequency and high sound level may be useful as an ecologically valid measure of vocal power ability. Quantification of vocal power ability may be useful as a vocal fitness assessment or as an outcome measure for voice rehabilitation and habilitation for patients with vocally demanding jobs., Ecologically valid methods to assess vocal fitness or aptitude for extensive voice work that is required for occupations such as teaching or fitness instruction have not been developed to date. [...]

Purpose: This preliminary study examined the influence of menstrual cycle phase and hormone levels on acoustic measurements of vocal function in reproductive and postmenopausal females. Mean fundamental frequency (f0), speaking fundamental frequency (Sf0), and cepstral peak prominence (CPP) were evaluated. It was hypothesized that Sf0 and CPP would be lower during the luteal and ischemic phases of the menstrual cycle. Group differences with lower values in postmenopausal females and greater variability in the reproductive females were also hypothesized. Method: A mixed factorial analysis of variance was used to examine differences between reproductive and postmenopausal females and the four phases of the menstrual cycle. Separate analyses of variances were implemented for each of the dependent measures. Twenty-eight female participants (15 reproductive cycling, 13 postmenopausal) completed the study. Participants were recorded reading the Rainbow Passage and sustaining the vowel /a/. Mean vocal f0, Sf0, and CPP were determined from the acoustic samples. Blood assays were used to determine estrogen, progesterone, testosterone, and neuropeptide Y levels at four data collection time points. Results: Group differences in hormone levels and Sf0 values were established with the postmenopausal group having significantly lower hormone levels and significantly lower Sf0 than the reproductive cycling group across the phases. Analysis of the reproductive group by hormone levels and cycle phase revealed no significant differences for CPP or Sf0 across phases. Higher estrogen was identified in the ovulation phase, and higher progesterone was identified in the luteal phase. Conclusions: Significant differences in hormone levels and Sf0 were identified between groups. Within the reproductive cycling group, the lack of significant difference in acoustic measures relative to hormone levels indicated that the measures taken may not have been sensitive enough to identify hormonally mediated vocal function changes. The participant selection may have biased the findings in that health conditions and medications that are known to influence voice function were used as exclusion criteria., The National Institute on Deafness and Other Communication Disorders estimates that 7.5 million individuals experience difficulty with their voice. Women have a significantly higher prevalence of voice disorders than men, [...]

Purpose: The purpose of this document is threefold: (a) review the uses of the terms 'vocal fatigue,' 'vocal effort,' 'vocal load,' and 'vocal loading' (as found in the literature) in order to track the occurrence and the related evolution of research; (b) present a 'linguistically modeled' definition of the same from the review of literature on the terms; and (c) propose conceptualized definitions of the concepts. Method: A comprehensive literature search was conducted using PubMed/MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Scientific Electronic Library Online. Four terms ('vocal fatigue,' 'vocal effort,' 'vocal load,' and 'vocal loading'), as well as possible variants, were included in the search, and their usages were compiled into conceptual definitions. Finally, a focus group of eight experts in the field (current authors) worked together to make conceptual connections and proposed consensus definitions. Results: The occurrence and frequency of 'vocal load,' 'vocal loading,' 'vocal effort,' and 'vocal fatigue' in the literature are presented, and summary definitions are developed. The results indicate that these terms appear to be often interchanged with blurred distinctions. Therefore, the focus group proposes the use of two new terms, 'vocal demand' and 'vocal demand response,' in place of the terms 'vocal load' and 'vocal loading.' We also propose standardized definitions for all four concepts. Conclusion: Through a comprehensive literature search, the terms 'vocal fatigue,' 'vocal effort,' 'vocal load,' and 'vocal loading' were explored, new terms were proposed, and standardized definitions were presented. Future work should refine these proposed definitions as research continues to address vocal health concerns., In the current examination of healthy and unhealthy phonation, the relationship between 'vocal load,' 'vocal loading,' 'vocal effort,' and 'vocal fatigue' has been frequently explored. For example, patients with voice [...]

The primary aim of this investigation was to evaluate listener auditory-perceptual assessment of employability for individuals with hypernasal speech. Using an online survey platform, listeners with managerial experience evaluated speech samples from individuals with varying hypernasal resonance disorder severity to determine auditory-perceptual judgements regarding intelligence and employability. Speech samples of individuals with hypernasal speech were rated lower on scales of intelligence and employability, and more likely to be selected for jobs with infrequent rates of communication and lower levels of responsibility. Additionally, males with hypernasal speech were perceived as less intelligent, less employable, and more likely to be selected for a job with infrequent communication in comparison to females with hypernasal speech. Results of this preliminary investigation suggest that individuals with hypernasal speech may face employment barriers. The conclusions collected from this initial investigation open the doors for further research addressing linguistic considerations and aspects of employability. This is an important consideration for individuals with either acquired or congenitally related hypernasal resonance disorder. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this tutorial is threefold: (a) present relevant exercise science literature on skeletal muscle metabolism and synthesize the limited available research on metabolism of the adult human speech musculature in an effort to elucidate the role of metabolism in speech production; (b) introduce a well-studied metabolic serum biomarker in exercise science, lactate, and the potential usefulness of investigating this metabolite, through a well-established exercise science methodology, to better understand metabolism of the musculature involved in voice production; and (c) discuss exercise physiology considerations for future voice science research that seeks to investigate blood lactate and metabolism in voice physiology in an ecologically valid manner. Method: This tutorial begins with relevant exercise science literature on the basic cellular processes of muscle contraction that require energy and the metabolic mechanisms that regenerate the energy required for task execution. The tutorial next synthesizes the available research investigating metabolism of the adult human speech musculature. This is followed by the authors proposing a hypothesis of speech metabolism based on the voice science literature and the application of well-studied exercise science principles of muscle physiology. The tutorial concludes with a discussion and the potential usefulness of lactate in investigations to better understand the metabolism of the musculature involved in vocal demand tasks. Conclusion: The role of metabolism during speech (respiratory, laryngeal, and articulatory) is an understudied yet critical aspect of speech physiology that warrants further study to better understand the metabolic systems that are used to meet vocal demands. [ABSTRACT FROM AUTHOR]

Purpose: Translating exercise-science methodology for determination of muscle bioenergetics, we hypothesized that the temporal voice-use patterns for classroom and music teachers would indicate a reliance on the immediate energy system for laryngeal skeletal-muscle metabolism. It was hypothesized that the music-teacher group would produce longer voiced segments than the classroom teachers. Method: Using a between- and within-group multivariate analysis-of-variance design (5 classroom teachers; 7 music teachers), we analyzed fundamental-frequency data--collected via an ambulatory phonation monitor--for length (seconds) of voiced and nonvoiced intervals. Data were collected for 7.5 hr during the workday, over the course of several workdays for each teacher. Results: Descriptive analyses of voiced and nonvoiced intervals indicated that over 99% of voiced segments for both groups were no longer than 3.15 s, supporting the hypothesis of reliance on the immediate energy system for muscle bioenergetics. Significant differences were identified between and within the classroom- and music-teacher groups, with the music-teacher group producing longer voiced segments overall. Conclusions: Knowledge of probable intrinsic laryngeal skeletal-muscle bioenergetics requirements could inform new interdisciplinary considerations for voice habilitation and rehabilitation.

Purpose: Intrinsic laryngeal skeletal muscle bioenergetics, the means by which muscles produce fuel for muscle metabolism, is an understudied aspect of laryngeal physiology with direct implications for voice habilitation and rehabilitation. The purpose of this review is to describe bioenergetic pathways identified in limb skeletal muscle and introduce bioenergetic physiology as a necessary parameter for theoretical models of laryngeal skeletal muscle function. Method: A comprehensive review of the human intrinsic laryngeal skeletal muscle physiology literature was conducted. Findings regarding intrinsic laryngeal muscle fiber complement and muscle metabolism in human models are summarized and exercise physiology methodology is applied to identify probable bioenergetic pathways used for voice function. Results: Intrinsic laryngeal skeletal muscle fibers described in human models support the fast, high-intensity physiological requirements of these muscles for biological functions of airway protection. Inclusion of muscle bioenergetic constructs in theoretical modeling of voice training, detraining, fatigue, and voice loading have been limited. Conclusions: Muscle bioenergetics, a key component for muscle training, detraining, and fatigue models in exercise science, is a little-considered aspect of intrinsic laryngeal skeletal muscle physiology. Partnered with knowledge of occupation-specific voice requirements, application of bioenergetics may inform novel considerations for voice habilitation and rehabilitation.

Purpose: The purpose of this study was to examine the influence of the heating, ventilation, and air-conditioning method on voice function following a voicing task using ecologically valid offices, one with radiant HVAC and one with forced air. Method: A total of 12 consented participants (6 women, 6 men) narrated a video in each of 4 environmental conditions in a within-between repeated-measures design. Acoustic data were collected with an ambulatory phonation monitor and perceived phonatory effort was determined following the voicing task. Data were analyzed using a within-between repeated-measures analysis of variance with significance set at a < 0.05. Results: Perceived phonatory effort did not differ between environments; however, a significant difference in vocal amplitude between 2 trials was identified for the male participants and physiologically significant differences in vocal amplitude were identified for male and female participants. Conclusions: The findings suggest that perceived phonatory effort may not be a sensitive measure of vocal function differences following a voicing task in ecologically valid office spaces despite significant acoustic findings. Future research should address longer exposure to environmental differences combined with a longer voicing task within ecologically valid work spaces as well as the recruitment of participants who have particular vulnerability to environmental perturbations.

Purpose: The aim of the current study was to review neuromuscular development, summarize the current body of evidence describing the use of neuromuscular electrical stimulation (NMES) therapy in infants, and identify possible contraindications for the use of NMES in the neonate and young infant. Method: After a review of the literature describing neuromuscular development, we created a timeline of the developmental processes. Key milestones were determined, and a literature search was conducted to identify potential effects of electrical stimulation on this process. Results: Current evidence supporting the use of NMES in the pediatric population is limited and of poor quality. Contraindications of the use of NMES in the neonate and young infant were identified, including (a) inhibited expression of the neural cell adhesion molecule that is vital for neuromuscular development, (b) alteration of muscle fiber type metabolic profile away from intended muscle fiber type morphology, and (c) interruption of postsynaptic acetylcholine receptor synthesis during neuromuscular junction development. Conclusion: The use of NMES for the treatment of dysphagia in the neonate and young infant may influence early neuromuscular development in a manner that is not currently well understood. Future research is needed to further understand the effects of NMES on the developing neuromuscular system., Neuromuscular electrical stimulation (NMES) therapy is used by some speech-language pathologists as a supplemental tool to traditional dysphagia interventions in adult and pediatric populations. Current literature on the use of [...]

Purpose: The purpose of this tutorial is to summarize how sex hormones affect both laryngeal senescence and neuromuscular response to exercise, highlighting the importance of considering sex differences in developing treatment for the senescent voice. Conclusion: Men and women's voices are sexually dimorphic throughout the life span, including during the laryngeal adaptations observed during senescence. Therefore, presbyphonia (age-related dysphonia) likely clinically manifests differently for men and women due to differences in how the male and the female larynx change in response to aging. Because sexual dimorphism is evident in both laryngeal aging and response to exercise, voice therapy programs aimed at treating the typical and disordered aged voice should consider sex differences in their design., It is well established that age differentially impacts the voices of men and women (W. S. Brown, Morris, Hollien, & Howell, 1991; Goy, Fernandes, PichoraFuller, & van Lieshout, 2013; Linville, [...]

This study explored the demonstration of culturally responsive service provision when planning intervention by speech-language pathologists (SLPs). A fifteen-item survey revealed (a) SLPs consider culture when choosing therapeutic materials, and (b) family structure was the cultural factor selected by the most SLPs, followed closely by race and/or ethnicity. Religion was the least commonly selected cultural factor. Knowledge of multiple factors of culture should be considered to provide culturally competent intervention. [ABSTRACT FROM AUTHOR]

Purpose: Translating exercise-science methodology for determination of muscle bioenergetics, we hypothesized that the temporal voice-use patterns for classroom and music teachers would indicate a reliance on the immediate energy system for laryngeal skeletal-muscle metabolism. It was hypothesized that the music-teacher group would produce longer voiced segments than the classroom teachers. Method: Using a between- and within-group multivariate analysis-of-variance design (5 classroom teachers; 7 music teachers), we analyzed fundamental-frequency data--collected via an ambulatory phonation monitor--for length (seconds) of voiced and nonvoiced intervals. Data were collected for 7.5 hr during the workday, over the course of several workdays for each teacher. Results: Descriptive analyses of voiced and nonvoiced intervals indicated that over 99% of voiced segments for both groups were no longer than 3.15 s, supporting the hypothesis of reliance on the immediate energy system for muscle bioenergetics. Significant differences were identified between and within the classroom- and music-teacher groups, with the music-teacher group producing longer voiced segments overall. Conclusions: Knowledge of probable intrinsic laryngeal skeletal-muscle bioenergetics requirements could inform new interdisciplinary considerations for voice habilitation and rehabilitation., Teachers worldwide have a higher prevalence of voice-use problems than nonteachers and are believed to be at a higher risk for the development of voice disorders (Morrow & Connor, 2011; [...]

Purpose: Intrinsic laryngeal skeletal muscle bioenergetics, the means by which muscles produce fuel for muscle metabolism, is an understudied aspect of laryngeal physiology with direct implications for voice habilitation and rehabilitation. The purpose of this review is to describe bioenergetic pathways identified in limb skeletal muscle and introduce bioenergetic physiology as a necessary parameter for theoretical models of laryngeal skeletal muscle function. Method: A comprehensive review of the human intrinsic laryngeal skeletal muscle physiology literature was conducted. Findings regarding intrinsic laryngeal muscle fiber complement and muscle metabolism in human models are summarized and exercise physiology methodology is applied to identify probable bioenergetic pathways used for voice function. Results: Intrinsic laryngeal skeletal muscle fibers described in human models support the fast, high-intensity physiological requirements of these muscles for biological functions of airway protection. Inclusion of muscle bioenergetic constructs in theoretical modeling of voice training, detraining, fatigue, and voice loading have been limited. Conclusions: Muscle bioenergetics, a key component for muscle training, detraining, and fatigue models in exercise science, is a little-considered aspect of intrinsic laryngeal skeletal muscle physiology. Partnered with knowledge of occupation-specific voice requirements, application of bioenergetics may inform novel considerations for voice habilitation and rehabilitation., There is a growing interest in the development and application of targeted muscle training programs for voice and other disorders of respiration and swallowing for habilitative and rehabilitative means (Burkhead, [...]

Purpose: The purpose of this study was to examine the influence of the heating, ventilation, and air-conditioning method on voice function following a voicing task using ecologically valid offices, one with radiant HVAC and one with forced air. Method: A total of 12 consented participants (6 women, 6 men) narrated a video in each of 4 environmental conditions in a within-between repeated-measures design. Acoustic data were collected with an ambulatory phonation monitor and perceived phonatory effort was determined following the voicing task. Data were analyzed using a within-between repeated-measures analysis of variance with significance set at a < .05. Results: Perceived phonatory effort did not differ between environments; however, a significant difference in vocal amplitude between 2 trials was identified for the male participants and physiologically significant differences in vocal amplitude were identified for male and female participants. Conclusions: The findings suggest that perceived phonatory effort may not be a sensitive measure of vocal function differences following a voicing task in ecologically valid office spaces despite significant acoustic findings. Future research should address longer exposure to environmental differences combined with a longer voicing task within ecologically valid work spaces as well as the recruitment of participants who have particular vulnerability to environmental perturbations., Individuals with voice impairment who rely on their voice for work often attribute environmental factors to a perceived decline in voice quality and an increase in perceived phonatory effort (PPE). [...]

Purpose: Phonation threshold pressure and perceived phonatory effort were hypothesized to increase and upper airway temperature to decrease following exposure to cold and/or dry air. Greater changes were expected with mouth versus nose breathing. Method: In a within-participant repeated measures design, 15 consented participants (7 men, 8 women) completed 20-min duration trials to allow for adequate thermal equilibration for both nose and mouth breathing in 5 different environments: 3 temperatures (°C) matched for relative humidity (% RH), cold (15 °C, 40% RH), thermally neutral (25 °C, 40% RH), and hot (35 °C, 40% RH); and 2 temperatures with variable relative humidity to match vapor pressure for the neutral environment (25 °C, 40% RH), cold (15 °C, 74% RH) and hot (35 °C, 23% RH). Following each equilibration trial, measures were taken in this order: upper airway temperature (transnasal thermistor probe), phonation threshold pressure, and perceived phonatory effort. Results: Data were analyzed using repeated measures analysis of variance, and no significant differences were established. Conclusions: The study hypotheses were not supported. Findings suggest that the upper airway is tightly regulated for temperature when challenged by a realistic range of temperature and relative humidity environments. This is the first study of its kind to include measurement of upper airway temperature in conjunction with measures of vocal function.

Paradoxical vocal fold motion (PVFM) is a complex adductory disorder of the vocal folds that frequently is mistaken for asthma. PVFM typically requires behavioral intervention by a trained speech-language pathologist for complete resolution of the symptoms. Once thought to be limited to adults, PVFM has been increasingly documented and successfully treated in the child and adolescent population. Understanding PVFM requires thorough knowledge of the differential diagnoses, the clinical features of PVFM, the differentiation of PVFM from asthma, the medical professionals involved in the diagnosis and treatment, and the behavioral interventions that are commonly prescribed. Teachers, school nurses, and coaches may be the first professionals to see the symptoms in children and assume that they have asthma. Successful referral, diagnosis, and behavioral treatment requires a team of individuals in the child's community, including the school speech-language pathologist, who can work together to ensure identification and resolution of the symptoms. This article discusses etiologies, differential diagnosis, referral, medical management, evaluation, and behavioral treatment of the child or adolescent with PVFM.