• The Journal of the Korea Contents Association
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• v.19 no.4
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• pp.207-217
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• 2019

The current study aimed to examine how the caregivers and speech language pathologists (SLPs) would perceive the important communication contexts for 3~6 year-old children in the script-based intervention. Analytic Hierarchy Process analyses were conducted for the obtained survey data from SLPs and caregivers. Results showed that caregivers perceived 'educational and social life' and SLPs perceived 'family life' as the most important contexts from among three high-level contexts. Within each high-level context, 'meal time' in 'family life', 'playing with friends' in 'educational and social life', and 'playground' in 'culture and leisure life' were the most important communication contexts. Also, from among 35 global priority rank, caregivers perceived 'playing with friends' while SLPs perceived 'meal time' as the most important contexts, and 'family life' was high priority among first five ranked context both in caregivers and SLPs. In caregiver groups by children's age, 3 year- and 6 year-caregiver groups perceived 'family life' and 4 year- and 5 year-caregiver groups perceived 'educational and social life' as the most important contexts. There were also slight differences between caregiver groups by age in the rank order of communication contexts across the high level contexts. These results suggest that SLPs may need to consider not only child's age and developmental level but also caregiver's demands in selecting the appropriate communication contexts when delivering the script-based speech language intervention.

• Speech Sciences
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• v.10 no.3
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• pp.7-27
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• 2003

Esophageal Speech uses the esophageal air during phonation. Fluent esophageal speakers frequently intake air in oral communication, but unskilled esophageal speakers are difficult with swallowing lots of air. The purpose of this study was to investigate the difference of acoustic characteristics of vowel and consonants production according to the speech proficiency level in esophageal speech. 13 normal male speakers and 13 male esophageal speakers (5 unskilled esophageal speakers, 8 skilled esophageal speakers) with age ranging from 50 to 70 years old. The stimuli were sustained /a/ vowel and 36 meaningless two syllable words. Used vowel is /a/ and consonants were 18 : /k, n, t, m, p, s, c, $C^{h},\;k^{h},\;t^{h},\;p^{h}$, h, I, k', t', p', s', c'/. Fundermental frequency (Fx), Jitter, shimmer, HNR, MPT were measured with by electroglottography using Lx speech studio (Laryngograph Ltd, London, UK). 36 meaningless words produced by esophageal speakers were presented to 3 speech-language pathologists who phonetically transcribed their responses. Fx, Jitter, HNR parameters is significant different between skilled esophageal speakers and unskilled esophageal speakers (P<.05). Considering manner of articulation, ANOVA showed that differences in two esophageal speech groups on speech proficiency were significant; Glide had the highest number of confusion with the other phoneme class, affricates are the most intelligible in the unskilled esophageal speech group, whereas in the skilled esophageal speech group fricatives resulted highest number of confusions, nasals are the most intelligible. In the place of articulation, glottal /h/ is the highest confusion consonant in both groups. Bilabials are the most intelligible in the skilled esophageal speech, velars are the most intelligible in the unskilled esophageal speech. In the structure of syllable, 'CV+V' is more confusion in the skilled esophageal group, unskilled esophageal speech group has similar confusion in both structures. In unskilled esophageal speech, significantly different Fx, Jitter, HNR acoustic parameters of vowel and the highest confusions of Liquid, Nasals consonants could be attributed to unstable, improper contact of neoglottis as vibratory source and insufficiency in the phonatory air supply, and higher motoric demand of remaining articulation due to morphological characteristics of vocal tract after laryngectomy.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.22 no.2
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• pp.191-205
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• 2000

The purpose of this study was undertaken to determine the effects of orthognathic surgery on speech. The hyposis stated herein is that functional behaviors of the dentofacial complex, such as speech production, may be adversely affected by deviations of a structural nature(especially, Class III malocclusion). Twenty adults with Class III malocclusion(13 female and 7 male) were studied preoperative, immediate postoperative and either 6 or 12 months postoperative lateral cephalograms. They had mandibular prognathism and had undergone mandible setback operation. The position of tongue, soft palate(Uvula), hyoid bone, respiratory track width, and pharyngeal depth were assessed on lateral cephalograms with 23 cephalometric variables, ANOVA, Paired t-tests and Pearson's product-moment correlation coefficient tests were used to evalute the operative changes in all cephalometric parameters. A experienced speech and language pathologists performed narrow phonetic transcriptions of tape-recorded words and sentences produced by each of the ninth patients and the recording tapes were analyzed by phonetic computer program(Computerized Speech Lab(CSL) Model 4300BI(U.S.A.)) These judges also recorded their ratings of each patient's overall consonants, hypernasality, hyponasality, and articulation proficiency. The results obtained are as follows; 1. There were significant changes in distance of posterior pharyngeal wall to tongue (TI-TW2, TS-TW3) after the surgery at 6 months postoperatively(each p<0.01 p<0.05). 2. The posterior tongue point(TI, TS, PPT) moved posteriorly after surgery and remained to its changed position at 6 months postoperatively(p<0.05). The displacement of tongue was correlated with the movement of mandibular setback amount(p<0.05). The hyoid bone moved posteriorly superiorly after immediate postoperative period. There was significant changes in hyoid bone movement after immediated postoperative period(p<0.05), but returned to its original position during the follow-up period(p>0.05) 3. The soft palate was displaced posteriorly superiorly after immediated operative period and remained to its changed position at 6 months postoperatively(p<0.05). ANS-PNS-SPT angle increasing, PPU-PPPo distance narrowing was showed after surgery, and remained its appearance 6 months postoperatively(p<0.05). 4. There were significant changes in formant value and squre diagram of vowel sound after the orthognathic surgery and the follow-up period. There were significant changes in /ㅅ/sound and posterior tongue sound. 5. The posterior movement of tongue and the posteriosuperior movement of soft palate was correlated with mandibular setback amount after orthognathic surgery. On the vowel squre diagram, the author found that the place of articulation after operation moved downward, backward, upward. 6. In assessing speech abnormalities, dental occlusion should be considered as a contributing factor. The vast majority of subjects with preoperative misarticulations eliminated or reduced their errors following orthognathic surgery. There was significant difference in speech impovement between pre- and postoperation.

• Phonetics and Speech Sciences
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• v.6 no.3
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• pp.63-72
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• 2014

The current study assessed the utility of acoustic analyses the most commonly used in routine clinical voice assessment including perturbation, nonlinear dynamic analysis, and Spectral/Cepstrum analysis based on signal typing of dysphonic voices and investigated their applicability of clinical acoustic analysis methods. A total of 70 dysphonic voice samples were classified with signal typing using narrowband spectrogram. Traditional parameters of %jitter, %shimmer, and signal-to-noise ratio were calculated for the signals using TF32 and correlation dimension(D2) of nonlinear dynamic parameter and spectral/cepstral measures including mean CPP, CPP_sd, CPPf0, CPPf0_sd, L/H ratio, and L/H ratio_sd were also calculated with ADSV(Analysis of Dysphonia in Speech and VoiceTM). Auditory perceptual analysis was performed by two blinded speech-language pathologists with GRBAS. The results showed that nearly periodic Type 1 signals were all functional dysphonia and Type 4 signals were comprised of neurogenic and organic voice disorders. Only Type 1 voice signals were reliable for perturbation analysis in this study. Significant signal typing-related differences were found in all acoustic and auditory-perceptual measures. SNR, CPP, L/H ratio values for Type 4 were significantly lower than those of other voice signals and significant higher %jitter, %shimmer were observed in Type 4 voice signals(p<.001). Additionally, with increase of signal type, D2 values significantly increased and more complex and nonlinear patterns were represented. Nevertheless, voice signals with highly noise component associated with breathiness were not able to obtain D2. In particular, CPP, was highly sensitive with voice quality 'G', 'R', 'B' than any other acoustic measures. Thus, Spectral and cepstral analyses may be applied for more severe dysphonic voices such as Type 4 signals and CPP can be more accurate and predictive acoustic marker in measuring voice quality and severity in dysphonia.

• Phonetics and Speech Sciences
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• v.2 no.3
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• pp.157-164
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• 2010

This study investigated the characteristics of two aerodynamic indices, PTP (Phonation threshold pressure) and PTF (Phonation threshold flow) in patients with ADSD (adductor spasmodic dysphonia) and to see if two new aerodynamic indices can differentiate between normal and ADSD group. Additionally, PTP and PTF values were compared in terms of overall severity of ADSD in the patient group. The severity of ADSD was rated on a 7-point rating scale by two experienced speech language pathologists. The Kay Elemetrics Phonatory Aerodynamic System (PAS) (Kay Elemetrics Corp., Lincoln Park, NJ) was used to collect PTP and PTF measurements from 16 female normal subjects, 31 female patients with ADSD. Significantly lower PTF values (P< 0.05) were observed in ADSD when compared to those of normal control. Also, significantly lower PTF values in severe ADSD patients (P<.001). However, PTP could not distinguish patients with ADSD from control groups (P=0.119) and among the ADSD groups according to the severity (P=0.177). Consequently, PTF was more sensitive than PTP which might differentiate between normal speakers and ADSD and among different levels of severity within ADSD, suggesting that PTF could be a useful diagnostic parameter to measure the aerodynamic function of ADSD and provide the neurolaryngeal dysfunction in patients with ADSD.

• Phonetics and Speech Sciences
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• v.15 no.4
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• pp.81-90
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• 2023

Auditory perceptual assessment and acoustic analysis are commonly used in clinical practice for voice evaluation. This study aims to explore the effects of speech task context on auditory perceptual assessment and acoustic measures in patients with voice disorders. Sustained vowel phonations (/a/, /e/, /i/, /o/, /u/, /ɯ/, /ʌ/) and connected speech (a standardized paragraph 'kaeul' and nine sub-sentences) were obtained from a total of 22 patients with voice disorders. GRBAS ('G', 'R', 'B', 'A', 'S') and CAPE-V ('OS', 'R', 'B', 'S', 'P', 'L') auditory-perceptual assessment were evaluated by two certified speech language pathologists specializing in voice disorders using blind and random voice samples. Additionally, spectral and cepstral measures were analyzed using the analysis of dysphonia in speech and voice model (ADSV).When assessing voice quality with the GRBAS scale, it was not significantly affected by the vowel type except for 'B', while the 'OS', 'R' and 'B' in CAPE-V were affected by the vowel type (p<.05). In addition, measurements of CPP and L/H ratio were influenced by vowel types and sentence positions. CPP values in the standard paragraph showed significant negative correlations with all vowels, with the highest correlation observed for /e/ vowel (r=-.739). The CPP of the second sentence had the strongest correlation with all vowels. Depending on the speech stimulus, CAPE-V may have a greater impact on auditory-perceptual assessment than GRBAS, vowel types and sentence position with consonants influenced the 'B' scale, CPP, and L/H ratio. When using vowels in the voice assessment of patients with voice disorders, it would be beneficial to use not only /a/, but also the vowel /i/, which is acoustically highly correlated with 'breathy'. In addition, the /e/ vowel was highly correlated acoustically with the standardized passage and sub-sentences. Furthermore, given that most dysphonic signals are aperiodic, 2nd sentence of the 'kaeul' passage, which is the most acoustically correlated with all vowels, can be used with CPP. These results provide clinical evidence of the impact of speech tasks on auditory perceptual and acoustic measures, which may help to provide guidelines for voice evaluation in patients with voice disorders.

• Journal of mucopolysaccharidosis and rare diseases
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• v.5 no.1
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• pp.29-33
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• 2021

Prader-Willi Syndrome (PWS) is a neurodevelopmental genomic imprinting disorder involving a lack of gene expression from the paternal chromosome 15q11-q13 region. This is typically due to paternal 15q11-q13 deletions (in approximately 60% of cases), maternal uniparental disomy 15, or when both 15s are from the mother (about 35% of cases). An imprinting center controls the expression of imprinted genes in the chromosome 15q11-q13 region. PWS is a neurodevelopmental disorder characterized by mental retardation and distinct physical, behavioral, and psychiatric features. Characteristic behavioral disturbances in PWS include excessive interest in food, skin picking, difficulty with a change in routine, temper tantrums, obsessive and compulsive behaviors, and mood fluctuations. Individuals with PWS typically have intellectual disabilities (borderline to mild/moderate mental retardation) and exhibit a higher overall level of behavior disturbances compared to individuals with similar intellectual disabilities. This condition severely limits social adaptations and quality of life. Different factors have been linked to the intensity and form of these behavioral disturbances, but there is no consensus regarding the cause. Consequently, there is still controversy surrounding management strategies and there is a need for new data. PWS is a multisystem disorder. Family members, caregivers, physicians, dieticians, and speech-language pathologists all play an important role in the management and treatment of symptoms in an individual with PWS. Here we analyze behavioral problems in children and adults with PWS by age and review appropriate management and treatment strategies for these symptoms.

• Phonetics and Speech Sciences
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• v.12 no.1
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• pp.65-74
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• 2020

This study aims to compare the acoustic characteristics of vowel phonation in children with spastic and dyskinetic cerebral palsy (CP). Thirty-four children aged 4-12 years with CP participated in the study (spastic 26, dyskinetic 8). Voice samples for the acoustic analysis were extracted from a sustained vowel /a/. All acoustic measures were made using Praat. Group differences were compared by an independent t-test or Welch-Aspin test, if the equivalence assumption was not met. The results of this study are as follow. First, maximum phonation time(MPT) was significantly shorter for the dyskinetic CP than for the spastic CP. Second, shimmer percent was significantly increased in the dyskinetic CP than in the spastic CP. Lastly, there were no significant group differences in both the first formant and the second formant. These findings indicate that the dyskinetic CP has a poorer respiratory capacity and poorer laryngeal function than the spastic CP. On the other hand, both groups have a comparable ability to articulate the vowel /a/. The results of the present study help speech language pathologists identify the speech motor control ability of children with two types of CP (spastic and dyskinetic) and help to make an intervention plan associated with a specific type of CP.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.16 no.2
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• pp.129-134
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• 2005

Background and Objectives : Artecoll(R) is an injectable soft tissue filler, which is a suspension of polymethylmethacrylate microspheres in $3.5\%$ bovine collagen solution. The authors aimed to determine the clinical of Artecoll of Artecoll(R) as an injection material into the vocal fold to correct the glottal insufficiency caused by unilateral vocal cord paralysis. Materials and Methods : Forty-one consecutive patients with unilateral vocal cord paralysis received percutaneous Artecoll injections under local anesthesia. Acoustic, aerodynamic and stroboscopic analyses were prospectively provided before, 1 week and 3 months after injection. Perceptual GRBAS grading by speech language pathologists and subjective ratings of the hoarseness and aspiration by the patients were also obtained. Results : Aerodynamic parameter(maximal phonation time) were significantly improved after the injection (p<0.05). Acoustic parameters (jitter and shimmer) were improved at the 3rd month follow-up. GRBAS uading and patients own subjective scaling of hoarseness and aspiration also showed significant improvement (p<0.05). Early or delayed significant side effects were not observed. Conclusion : Vocal fold injection with Artecoll is a convenient, safe and useful method of temporarily correcting the glottal insufficiency. Further long-term follow-up studies will answer the usefulness and safety of the Artecoll injection laryngoplasty.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.14 no.2
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• pp.117-122
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• 2003

Background and Objectives : $VoCoM^{\circledR}$ is a commercialized set composed of prefabricated hydroxylapatite implants and shims of various sizes which are specially designed for the type I thyroplasty. Even though a previously published preliminary report showed that $VoCoM^{\circledR}$ is a convenient and safe product for the type I thyroplasty, further investigations or experiences are yet to be reported. Authors aimed to evaluate the efficacy of $VoCoM^{\circledR}$type I thyroplasty, and its advantage and/or disadvantage. Materials and Method : Twenty three consecutive patients with unilateral vocal cord palsy enrolled for the study, who received type I thyroplasty with $VoCoM^{\circledR}$ between July 2001 and June 2003. Acoustic, aerodynamic and stoboscopic analyses were performed prior to surgery and 1 to 3 months after surgery. Speech language pathologists evaluated their voice quality by GRBAS scale, and patients themselves reported subjective changes of their voice by visual analog scale. Results : The average time for the operation was 80 min, which is about 30 min less than other methods. Preoperative jitter was 3.25$\pm$1.65% and improved to 1.94$\pm$1.79% postoperatively (p<0.05). Preoperative shimmer was 9.72$\pm$6.56% and improved to 5.61 $\pm$3.76% (p<0.05), Maximal phonation time increased from 4.41$\pm$2.99 to 7.98$\pm$4.35 sec (p<0.05) The postoperative stroboscopy revealed an effective medialization in 91.3% of the patients. The subjective phonetic improvements were reported in 21 out of 23 patients. GRBAS scale improved from 2.71$\pm$0.46 to 1.47$\pm$1.12(p<0.05). Additional medialization with $Gore-Tex^{\circledR}$ was easily performed in two revision cases. Previously inserted $VoCoM^{\circledR}$ implant was hard to remove because of the tight integration of soft tissues around the implant. Side effects such as extrusion or foreign body reaction are not observed. $VoCoM^{\circledR}$ was relatively expensive and costed more than 10 times of $Gore-Tex^{\circledR}$. Conclusion : Prefabricated hydroxylapatitie implant($VoCoM^{\circledR}$) provides a convenient, safe and efficient way of vocal fold medialization. However it is relatively expensive and hard to remove.