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Purpose: To determine the effects of expiratory muscle strength training (EMST) frequency on maximum expiratory pressure (MEP). Method: We assigned 12 healthy participants to 2 groups of training frequency (3 days per week and 5 days per week). They completed a 4-week training program on an EMST trainer (Aspire Products, LLC). MEP was the primary outcome measure used to determine the effect of training frequency. Results: Participants who trained 3 days per week produced equivalent amounts of improvement in MEP compared with participants who trained 5 days per week. An overall improvement in MEP over the 4-week training period indicated a 33% increase when the data was collapsed across the 2 training groups. Conclusion: The effects occurring with respiratory muscle strength training in healthy young adults are likely to be different from those occurring in patient populations. Therefore, the results of the present study suggest exploring the variable of training frequency in patient populations. Such knowledge will be informative for designing clinical protocols that are effective and may result in improved treatment compliance for those suffering from expiratory muscle weakness. (Contains 2 tables and 1 figure.)

Purpose: This study investigated the concurrent biomechanical and electromyographic properties of 2 swallow-specific tasks (effortful swallow and Mendelsohn maneuver) and 1 swallow-nonspecific (expiratory muscle strength training [EMST]) swallow therapy task in order to examine the differential effects of each on hyoid motion and associated submental activation in healthy adults, with the overall goal of characterizing task-specific and overload properties of each task. Method: Twenty-five healthy male and female adults (M = 25 years of age) participated in this prospective, experimental study with 1 participant group. Each participant completed all study tasks (including normal swallow, Mendelsohn maneuver swallow, effortful swallow, and EMST task) in random order during concurrent videofluoroscopy and surface electromyography recording. Results: Results revealed significant differences in the trajectory of hyoid motion as measured by overall displacement and angle of elevation of the hyoid bone. As well, timing of hyoid movement and amplitude differences existed between tasks with regard to the activation of the submental musculature. Conclusions: Study results demonstrated differential effects of the 3 experimental tasks on the principles of task specificity and overload. These principles are important in the development of effective rehabilitative programs. Subsequent direction for future research is suggested.

Purpose: The purpose of this study was to determine strength gains following expiratory muscle strength training (EMST) and to determine detraining effects when the training stimulus is removed. Method: Thirty-two healthy participants were enrolled in an EMST program. Sixteen participants trained for 4 weeks (Group 1) and 16 participants trained for 8 weeks (Group 2). All 32 participants were detrained for 8 weeks. Maximum expiratory pressure (MEP) was used to document change in expiratory muscle strength throughout the study. Results: Group 1 had a 41% increase and Group 2 had a 51% increase in MEP following the training. Mean MEP, for both groups, was significantly greater than baseline at the end of the training period (p = 0.0001), at the 4th week of detraining (p = 0.0001), and at the 8th week of detraining (p = 0.0001). The results also indicated that there was no significant difference in mean MEP between the groups at baseline, end of training, or throughout the detraining period (p = 0.960). Discussion: The results suggest that expiratory muscle strength gains following a 4- and 8-week EMST program do not differ significantly. Additionally, detraining rates do not appear to be dependent on length of training time. (Contains 3 figures and 2 tables.)

Rating scales are commonly used to study voice quality. However, recent research has demonstrated that perceptual measures of voice quality obtained using rating scales suffer from poor interjudge agreement and reliability, especially in the midrange of the scale. These findings, along with those obtained using multidimensional scaling (MDS), have been interpreted to show that listeners perceive voice quality in an idiosyncratic manner. Based on psychometric theory, the present research explored an alternative explanation for the poor interlistener agreement observed in previous research. This approach suggests that poor agreement between listeners may result, in part, from measurement errors related to a variety of factors rather than true differences in the perception of voice quality. In this study, 10 listeners rated breathiness for 27 vowel stimuli using a 5-point rating scale. Each stimulus was presented to the listeners 10 times in random order. Interlistener agreement and reliability were calculated from these ratings. Agreement and reliability were observed to improve when multiple ratings of each stimulus from each listener were averaged and when standardized scores were used instead of absolute ratings. The probability of exact agreement was found to be approximately .9 when using averaged ratings and standardized scores. In contrast, the probability of exact agreement was only .4 when a single rating from each listener was used to measure agreement. These findings support the hypothesis that poor agreement reported in past research partly arises from errors in measurement rather than individual differences in the perception of voice quality.

Background: Current conflict exists regarding the potential beneficial effects of dopamine medications on facial expressivity in Parkinson's disease. Via digital video analysis software, we previously found reduced facial movement (entropy) and slower time to reach peak entropy in individuals with Parkinson's disease compared to controls. Objectives: We aimed to determine whether levodopa medications improved parameters of dynamic facial expressions (amplitude, speed). Methods: A total of 34 individuals with idiopathic Parkinson's disease were videotaped making voluntary facial expressions (happy, fear, anger, disgust) when "on" and "off" levodopa. Participants were 52 to 80 years old, early to mid‐stage disease, non‐demented, and included more men (65%). Expressions were digitized and analyzed using software that extracted three variables: two indices of movement change (total entropy, percent entropy change) and time to reach peak expression. Results: Indices of facial movement (total entropy, peak entropy) and timing were significantly improved when patients were "on" vs "off" medication (all F's ≥ 3.00, P < 0.05). For total movement and time to reach peak entropy, levodopa‐related improvements were emotion nonspecific. Levodopa‐related improvement for peak entropy was driven primarily by happy expressions. There was no relationship between quantitative indices and clinical measures of mood (depression, anxiety) and motor disease severity. Conclusion: The effects of levodopa on Parkinson's disease voluntary facial movement and on timing were robust and consistent with those of levodopa on other intentional movements in Parkinson's disease. This improvement possibly occurred because of levodopa enhanced activation of face representation areas in fronto‐cortical regions or because of less movement‐based suppression. [ABSTRACT FROM AUTHOR]

The role of the speech-language pathologist (SLP) has developed considerably over the last 10 years given the medical and technological advances in life-sustaining procedures. Over time, children born with congenital, surgical, or "medically fragile" conditions have become mainstreamed into regular school-based settings, thus extending the "traditional" role of the SLP and multidisciplinary team. Understanding the impact of these voice disorders on the child's educational performance has been a struggle for many clinicians because the eligibility decisions for students in school-based settings must be made within the framework of federal legislation and regulations governing the provision of services for students with disabilities. This article discusses how to identify children with voice disorders under the Individuals With Disabilities Education Act (IDEA) definition, the role of the SLP in assigning priority in various voice management scenarios, and how models of therapy can be incorporated in the school-based setting.

This article presents an overview of the normal anatomy and physiology of the pediatric larynx, followed by some examples of pediatric voice disorders that were chosen to exemplify the alterations to the laryngeal anatomy and the subsequent modifications to laryngeal function. Vocal fold nodules are primarily reviewed due to their high incidence in the pediatric population. Three other disorders, including laryngeal hyperfunction, unilateral vocal fold paralysis, and bilateral abductor vocal fold paralysis, are discussed because of their more common occurrence and the uniqueness of their etiology and intervention, particularly for the case of bilateral abductor vocal fold paralysis.

Acoustic phonatory events were identified in 14 women diagnosed with adductor spasmodic dysphonia (ADSD), a focal laryngeal dystonia that disturbs phonatory function, and compared with those of 14 age-matched women with no vocal dysfunction. Findings indicated ADSD subjects produced more aberrant acoustic events than controls during tasks of sustained vowel production and reading. (Author/DB)

The development of the speech production system was investigated among 120 children (ages 4-14 years) and 20 adults. Aerodynamic and acoustic results suggest that men and 14-year-old boys function differently than women and all other groups of children. Data generally suggest that laryngeal and respiratory behavior of children is not easily predicted from an adult model. (Author/PB)

Purpose: Outcomes from studying the coordinative relationship between respiratory and swallow subsystems are inconsistent for sequential swallows, and the lung volume at the initiation of sequential swallowing remains undefined. The first goal of this study was to quantify the lung volume at initiation of sequential swallowing ingestion cycles and to identify the respiratory pattern(s) surrounding each sequential swallow ingestion cycle. The second goal was to compare these results with existing data for single swallows. Method: Twenty healthy young adults served as participants, 9 males and 11 females, between 19 and 28 years of age (M = 22 years of age). Participants completed 2 trials each of 100 mL of water self-delivered by cup and by straw. Calibrated respiratory inductance plethysmography, surface electromyography, and a contact throat microphone were used to detect respiratory parameters, identify swallow-related muscle contraction, and identify swallowing sounds, respectively. Results: Significantly higher lung volume initiation for trials delivered by straw and more variable respiratory patterns surrounding cup and straw sequential swallowing ingestion cycles existed compared with single swallows. Conclusions: Results show that as the physiologic demands of swallowing deviate from single, small bolus swallows, the integration of the swallowing and respiratory systems change. This may reflect obligate differences in airway protection strategy and prolonged competition for respiratory resources. Key Words: deglutition, respiration, swallow-respiratory integration, ventilation, Sequential swallowing of thin liquids requires precisely coordinated movement of multiple structures, allowing for continuous bolus flow through the oral and pharyngeal cavities without airway compromise. Under healthy conditions, humans [...]

Purpose: This study examined the relationship between swallowing and lung volume initiation in healthy adults during single swallows of boluses differing in volume and consistency. Differences in lung volume according to respiratory phase surrounding the swallow were also assessed. Method: Nine men and 11 women between the ages of 19 and 28 years served as study participants. Lung volume and respiratory phase data were recorded as each participant completed 5 trials each of 10-mL and 20-ml. water boluses by cup, and thin and thick paste boluses by spoon, presented in randomized order. Results: Significant differences in lung volume at swallow initiation were found based on bolus consistency but not on bolus volume. No differences were found for lung volume initiation based on the respiratory phase surrounding the swallow or for the respiratory pattern based on bolus volume or consistency. Conclusion: Findings of this study extend the existing knowledge base regarding the interaction of the swallow and respiratory systems by identifying targeted lung volumes at swallow initiation. In addition to other swallow-related biomechanical events and respiratory phase relationships surrounding a swallow, the lung volume at swallow initiation may be an important consideration when investigating swallow physiology and physiopathy. KEY WORDS: swallowing, respiration, swallow motor control, swallow-respiratory integration, Deglutition and respiration share the upper aerodigestive tract, which necessitates the utilization of protective mechanisms to prevent airway compromise during a swallow (Miller, 1982, 1993). Thus, normal coordination between the [...]

Purpose: This study investigated the concurrent biomechanical and electromyographic properties of 2 swallow-specific tasks (effortful swallow and Mendelsohn maneuver) and 1 swallow-nonspecific (expiratory muscle strength training [EMST]) swallow therapy task [...]

Purpose: To review the principles of neural plasticity and make recommendations for research on the neural bases for rehabilitation of neurogenic speech disorders. Method: A working group in speech motor [...]

Summary: Professional voice users comprise 25% to 35% of the U.S. working population. Their voice problems may interfere with job performance and impact costs for both employers and employees. The [...]

The results of an expiratory muscle strength training (EMST) program is described in the rehabilitation of mixed dysarthria in a patient with Lance-Adams syndrome secondary to a motor vehicle accident [...]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jvoice.2005.03.006 Byline: Karen M. Wheeler (a), Savita P. Collins (a ), Christine M. Sapienza (a) Abstract: This study was designed to examine the relationship between the Voice Handicap Index (VHI) and acoustic measures of voice samples common in clinical practice. Fifty participants, 38 women and 12 men, ranging in age from 19 to 80 years, with a mean age of 49 years, served as participants. Of these 50 participants, 17 participants could be included in the acoustic analysis of voice based on measures of error calculated with the TF32 software. All participants completed the VHI and provided voice samples including three trials of the sustained vowel /A/ at a comfortable loudness level as well as a connected speech sample consisting of the Zoo Passage. Acoustic measures were made with TF32 and Cool Edit software and included fundamental frequency, jitter %, shimmer %, signal-to-noise ratio, mean root-mean-square intensity, fundamental frequency standard deviation, aphonic periods, and breath groups. Results indicate that these measures were not predictive of overall VHI score, and no cohesive or predictable pattern was identified when comparing individual measures with overall VHI or with each subscale item. Likely contributions to this lack of correlation and subsequent clinical implications are discussed, as well as the direction for further research. Author Affiliation: (a) From the Department of Communication Sciences and Disorders, College of Liberal Arts and Sciences (a ) Department of Otolaryngology, College of Medicine, University of Florida, Gainesville, Florida Article History: Accepted 8 March 2005 Article Note: (footnote) Presented at the Voice Foundation's 33rd Annual Symposium: Care of the Professional Voice, June 2-6, 2004, Philadelphia, Pennsylvania.

Purpose: The purpose of this study was to determine strength gains following expiratory muscle strength training (EMST) and to determine detraining effects when the training stimulus is removed. Method: Thirty-two healthy participants were enrolled in an EMST program. Sixteen participants trained for 4 weeks (Group 1) and 16 participants trained for 8 weeks (Group 2). All 32 participants were detrained for 8 weeks. Maximum expiratory pressure (MEP) was used to document change in expiratory muscle strength throughout the study. Results: Group 1 had a 41% increase and Group 2 had a 51% increase in MEP following the training. Mean MEP, for both groups, was significantly greater than baseline at the end of the training period (p = .0001), at the 4th week of detraining (p = .0001), and at the 8th week of detraining (p = .0001). The results also indicated that there was no significant difference in mean MEP between the groups at baseline, end of training, or throughout the detraining period (p = .960). Discussion: The results suggest that expiratory muscle strength gains following a 4- and 8-week EMST program do not differ significantly. Additionally, detraining rates do not appear to be dependent on length of training time. KEY WORDS: expiratory muscles, training, detraining, Expiratory muscle strength training (EMST) programs are known to increase the force output of the expiratory muscles (Cerny, Panzarella, & Stathopoulus, 1997; Gosselink, Kovacs, Ketelar, Carton, & Decramer, 2000; O'Kroy [...]

Rating scales are commonly used to study voice quality. However, recent research has demonstrated that perceptual measures of voice quality obtained using rating scales suffer from poor interjudge agreement and reliability, especially in the midrange of the scale. These findings, along with those obtained using multidimensional scaling (MDS), have been interpreted to show that listeners perceive voice quality in an idiosyncratic manner. Based on psychometric theory, the present research explored an alternative explanation for the poor interlistener agreement observed in previous research. This approach suggests that poor agreement between listeners may result, in part, from measurement errors related to a variety of factors rather than true differences in the perception of voice quality. In this study, 10 listeners rated breathiness for 27 vowel stimuli using a 5-point rating scale. Each stimulus was presented to the listeners 10 times in random order. Interlistener agreement and reliability were calculated from these ratings. Agreement and reliability were observed to improve when multiple ratings of each stimulus from each listener were averaged and when standardized scores were used instead of absolute ratings. The probability of exact agreement was found to be approximately .9 when using averaged ratings and standardized scores. In contrast, the probability of exact agreement was only .4 when a single rating from each listener was used to measure agreement. These findings support the hypothesis that poor agreement reported in past research partly arises from errors in measurement rather than individual differences in the perception of voice quality. KEY WORDS: voice quality, reliability, agreement, psychometric theory, perception (voice), An understanding of how listeners perceive voice quality is important for the clinical assessment and management of patients with voice disorders. Such information is also important for development in technological [...]

Summary: Adductor spasmodic dysphonia (ADSD) adversely affects a speaker's ability to effectively communicate. For many individuals suffering with ADSD, botulinum toxin (Botox) is the chosen treatment to remediate the symptoms. [...]

Summary: This longitudinal study gathered data with regard to the question: Does singing training have an effect on the speaking voice? Fourteen voice majors (12 females and two males; age [...]

Summary: Vocal training (VT) has, in part, been associated with the distinctions in the physiological, acoustic, and perceptual parameters found in singers' voices versus the voices of nonsingers. This study [...]

Summary: A single subject design was used to determine if pressure threshold training strengthens the inspiratory muscles in a subject with a limited glottal airway as well as diminish dyspnea [...]

Voice problems are a common occupational hazard of teaching school, yet few studies exist that have objectively evaluated treatment approaches aimed at rehabilitating these occupation-related voice disorders. This randomized clinical trial used patient-based treatment outcome measures to evaluate the effectiveness of three treatment programs. Sixty-four teachers with voice disorders were randomly assigned to 1 of 3 treatment groups: voice amplification using the ChatterVox portable amplifier (VA, n = 25), resonance therapy (RT; n = 19), and respiratory muscle training (RMT; n = 20). Before and after a 6-week treatment phase, all teachers completed (a) the Voice Handicap Index (VHI; B. H. Jacobson et al., 1997), an instrument designed to appraise the self-perceived psychosocial consequences of voice disorders, and (b) a voice severity self-rating scale. Both intention-to-treat and as-treated analyses revealed that only the VA and RT groups reported significant reductions in mean VHI scores and in voice severity self-ratings following treatment. Furthermore, results from a posttreatment questionnaire regarding the perceived benefits of treatment showed that compared to RT and RMT, teachers in the VA group reported significantly more overall voice improvement, greater vocal clarity, and greater ease of speaking and singing voice following treatment. These findings replicate previous results from an earlier clinical trial confirming the efficacy of VA and provide new evidence to support RT as an effective treatment alternative for voice problems in teachers. The results are discussed in the context of uneven levels of self-reported compliance and disparate dropout rates among the treatment groups. KEY WORDS: teachers, voice disorders, treatment, resonance therapy, amplification, It has been estimated that 5%-10% of the U.S. workforce would be classified as heavy occupational voice users (Titze, Lemke, & Montequin, 1997). Although this workforce includes members of the [...]

Summary: An experiment to increase expiratory muscle strength for instrumentalists, using a high-intensity, low-repetition expiratory training method, was conducted with 40 healthy high school band players. Subjects trained five days [...]

Acoustic analysis of a reading passage was used to identify the abnormal phonatory events associated with adductor spasmodic dysphonia (ADSD) pre-and postinjection of Botulinum Toxin A (Botox). Thirty-one patients (age 22 to 74 years) diagnosed with ADSD were included for study. All patients were new recipients of Botox, and the examination of their voice occurred before and after their initial injection of Botox. Acoustic events were identified from reading samples of the Rainbow Passage produced by each of the patients. These events were examined from sentences containing primarily voiced sound segments. Dependent variables included the number of phonatory breaks, frequency shifts, and aperiodic segments--all variables previously defined by the investigators. Additionally, calculated variables were made of the percentage of time these events occurred relative to the duration of the cumulative voiced segments. A sex-and age-matched control group ([+ or -] 2 years) was included for statistical comparison. Results indicated that those with ADSD produced more aberrant acoustic events than the controls. Aperiodicity was the predominant acoustic event produced during the reading, followed by frequency shifts and phonatory breaks. Within the ADSD group, the number of atypical acoustic events decreased following Botox injection. It is important that the occurrence of specific abnormal acoustic events was sufficient to differentiate the disordered speakers from the controls following as well as preceding initial Botox injection, as indicated by discriminant function analysis. This paper complements our previous work using this acoustic analysis method for defining the abnormal events present in the voice of those with ADSD and further suggests that these measures can be used in conjunction with perceptual impressions to differentiate speakers on the basis of initial severity. KEY WORDS: adductor spasmodic dysphonia, acoustic variations, connected speech, There are a number of motivations for studying the voice of those with adductor spasmodic dysphonia (ADSD), most of which concern issues of assessment and treatment. The current report is [...]

Anatomical and physiological changes of the speech production mechanism that occur with aging may result in phonatory distinctions between older and younger speakers. This investigation examined amplitude-based glottal airflow characteristics from sustained vowel production in healthy adult women. Sixty women participated in this study, 10 each in six age groups of 20-, 30-, 40-, 50-, 60-, and 70-year-olds. Measures included peak, alternating, and minimum glottal airflow. Additionally, a ratio of minimum to peak glottal airflow was calculated. Results from an analysis of variance indicated no significant group mean difference for any of the dependent measures. A greater variability in peak glottal airflow for the 70-year-old age group as compared to the 20-year-old age group was found. None of the dependent variables were significantly related to age and therefore were not good predictors of age. The results imply that laryngeal senescence in healthy women may not be significant enough to affect the magnitude of phonatory function parameters. Either the assumed anatomical changes produce less significant phonatory change in the healthy individual or the healthy individual is more capable of using strategies to counteract degenerative laryngeal changes. KEY WORDS: laryngeal, aerodynamic, women, aging

Simultaneous assessment of laryngeal and respiratory function was completed on 8 children and 10 women with bilateral vocal fold nodules and compared to that of 8 children and 10 women with normal voice production. Laryngeal function for the individuals with bilateral vocal fold nodules was characterized by significantly higher peak, alternating, and minimum glottal airflow. The presence of the high glottal airflow was accompanied by a significantly larger lung volume excursion. Both the children with nodules and those with normal voice showed laryngeal and respiratory function differences when compared to adults. All subject groups demonstrated appropriate laryngeal and respiratory function when increasing intensity from comfortable to loud speech. Simultaneous measurement of laryngeal and respiratory function using a multidimensional analysis of voice production is advocated in the evaluation of voice disorders because it can provide specific information regarding which of the subsystems of voice production are compromised. KEY WORDS: children, women, vocal nodules, simultaneous, physiological

Simultaneous procedures for making aerodynamic and kinematic observations of the laryngeal and chest wall systems were used to investigate variations in vocal intensity in normal women and men. Laryngeal results indicate that significant increases of maximum flow declination rate and laryngeal airway resistance and significant decreases in open quotient occur when higher intensity levels are produced. Respiratory results indicate that tracheal pressure, percent rib cage contribution, lung volume, and rib cage volume initiations are higher, and lung and rib cage volume excursions are larger when higher vocal intensity levels are produced. Laryngeal and respiratory function results indicate that some measures are different for women than for men. Mean data support the notion that increases in tracheal pressure are achieved by inhaling to higher lung and rib cage volumes. Individual subject data provide alternative respiratory and laryngeal patterns for changing the shape of the glottal airflow waveform.

Purpose: This article introduces a collection of consensus statements regarding the application of neuroplasticity principles to rehabilitation of dysphagia, dysarthria, apraxia, and aphasia. KEY WORDS: rehabilitation, plasticity, research, recovery ********** [...]