Rearranging Voice Disorders: Refining the New Two-Dimensional Continuous Model.

BACKGROUND: Voice and laryngeal pathologies are traditionally arranged in categories. A recent study has suggested an alternative approach, using two continuous scales, Organicity and Tonicity, which form a two-dimensional plane on which all pathologies/conditions can be arranged. OBJECTIVES: This study was designed to examine the validity and reliability of the new continuous 2D model and to learn how it is affected by experts' background characteristics. METHODS: Ninety-three international experts from 16 countries participated in the study and rated a comprehensive list of 35 laryngeal and voice pathologies/conditions on two continuous scales. On the Organicity scale, 0 represented "nonorganic," and 10 defined "organic." Similarly, on the Tonicity scale, 0 described "hypotonic" and 10 represented "hypertonic." RESULTS: Cronbach's alphas were high for Organicity and Tonicity (0.99), with varied interexpert agreement scores. Pathologies/conditions populated all four quadrants of the constructed two-dimensional plane, with a majority of 21 of the 35 located in the first quadrant (high-Tonicity, high-Organicity). Results showed strong replicability when compared to the preliminary study. In addition, ratings on the two scales were found consistent and statistically unaffected by the experts' background characteristics. CONCLUSIONS: The new two-dimensional model is valid and reliable, and it provides a simple yet comprehensive approach for arranging voice disorders using a continuous perspective rather than a categorical one. Furthermore, the new model offers a framework that facilitates examination of the differences in how professional experts view different laryngeal pathologies and conditions.

Voice Disorders and Personality: New Steps on an Old Path.

OBJECTIVES: This study examined the association between voice disorders and personality by comparing a heterogenic group of dysphonic patients to non-dysphonic speakers using the NEO-FFI big-five personality inventory. METHODS: A group of 100 dysphonic patients diagnosed with 24 different pathologies was compared to 149 non-dysphonic speakers. Inter-group differences on the five NEO-FFI scales were evaluated using three analysis approaches, a general comparison between the dysphonic and non-dysphonic groups and arranging pathologies using a categorical and a continuous approach. RESULTS: Of the five NEO-FFI scales, Openness emerged as the single personality trait that yielded a statistically significant difference between the dysphonic group and the non-dysphonic group (P < 0.001). Moreover, when the 24 pathologies were arranged categorically, people with structural pathologies were lower on the Openness scale than non-dysphonic speakers (P < 0.001). Similarly, when pathologies were arranged continuously, people with pathologies characterized by high organicity were low on the Openness scale compared to the non-dysphonic group (P < 0.001). CONCLUSIONS: This study represents a new approach to examining the association between voice disorders and personality. Openness emerged as the single personality trait that repeatedly and consistently differentiated between dysphonic and non-dysphonic people and among specific pathologies, using all analysis approaches. Our findings suggest that examining a spectrum of pathologies, rather than focusing on a particular pathology, provides a new perspective and sheds light on the complex association between voice disorders and personality.

Development and Validation of the Children's Voice Questionnaire (CVQ).

OBJECTIVES: This study developed and validated the children's voice questionnaire (CVQ), a new self-administered instrument for children, and evaluated its internal consistency and reliability. STUDY DESIGN: Observational, prospective, cross-sectional study. METHODS: The initial preparation of the CVQ was conducted in four steps. First, individual interviews were conducted with dysphonic and non-dysphonic children and their parents, teachers, and speech pathologists. Second, the responses collected from the interviews were arranged into a comprehensive list of 175 items. Third, this list was reduced to a preliminary 21-item version of the questionnaire, which was tested as a pilot with 254 children. Fourth, a further reduction to 18 items was performed to construct the final version of the CVQ. The questionnaire was then administered to 342 children (73 dysphonic, 269 non-dysphonic) aged 6-18. Simultaneously, the parents of these children completed the pediatric voice handicap index (pVHI). Finally, after 2 weeks, 30 randomly selected children (nine dysphonic, 21 non-dysphonic) completed the CVQ again to evaluate test-retest reliability. RESULTS: High reliability was found for the CVQ (Cronbach's α = 0.94). Test-retest revealed strong and statistically significant reliability (r = 0.79, P < 0.001). A highly significant group difference was found between the CVQ scores obtained for the dysphonic and non-dysphonic groups (t[78.25] = 6.22, P < 0.001). In addition, significant medium-to-strong positive correlations were found between the children's evaluations using the CVQ and their parents' evaluations using the pVHI (0.59 < r < 0.66, P < 0.01). CONCLUSIONS: The newly developed CVQ is a valid and reliable instrument. Findings reveal general agreement between children and their parents, but also show that children's perspective on their dysphonia is not equivalent to the parent's perspective. This demonstrates that combining both perspectives provides a more holistic and complete overview of dysphonic children's voice-related quality of life. The self-administered CVQ reliably differentiates dysphonic from non-dysphonic children and may serve as a valuable tool for the initial or ongoing evaluation of children with voice disorders in clinical and research settings.

Hyposalivation Affecting Womens' Voice.

OBJECTIVES: Balanced hydration is crucial for optimal physiological function, whereas hypohydration may cause adverse effects. Like many other organs, the larynx is negatively affected by hypohydration, potentially affecting voice production. Therefore, the purpose of this study was to examine voice properties in women diagnosed with dry-mouth. METHODS: Twenty-four women diagnosed with hyposalivation and 24 age-matched controls were recruited. All participants underwent three sialometry tests for quantifying oral-dryness. These tests were conducted in three conditions: after 2-hour fasting, after gustatory salivary stimulation and after drinking water. After each sialometry, participants were recorded while producing the vowels /a/ and /i/, and during a standardized reading task. A basic set of acoustic measures was extracted from these recordings. Self-evaluation of voice was performed using the VHI-10 questionnaire; and listeners' perception of the voice was performed by five professional judges who rated the recordings perceptually, using the GRBAS scale. RESULTS: Significant group differences were found in fundamental frequency and jitter, but not in shimmer and noise-to-harmonic ratio (corrected P < 0.05). The participants in the hyposalivation group exhibited higher scores on the VHI-10 questionnaire compared to the control group (P = 0.002), and the judges perceptually rated their voices higher on the Grade and Roughness scales (0.03 ≤ P ≤ 0.04). In contrast with the significant group differences, no significant differences were found between the three study conditions. CONCLUSIONS: Women suffering from oral-dryness were shown to exhibit degradation in voice quality, evident in both acoustic, perceptual and self-evaluation measures. However, in this paradigm, short-term superficial hydration was not shown to elicit a significant improvement in voice properties. These findings highlight the importance of consistent oral-hydration for voice, especially among people suffering from hyposalivation.

Songbirds Must Sing: How Artistic Voice Users Perceive Their Voice in Times of COVID-19.

OBJECTIVE: The COVID-19 pandemic has led to a critical disruption in the music and performing arts industry, and affected singers and other artists. This study was designed to examine the effect of this unique time on artistic voice users, the way they perceive their voice and their voice-related behaviors. METHODS: A total of 110 participants volunteered for the study: 57 professional artistic voice users (34 singers and 19 actors) and a control group of 53 nonprofessional voice users. All participants completed three questionnaires related to their self-assessment of their voice, their voice difficulties, vocal training, and current stress in the time of the COVID-19 pandemic. RESULTS: Compared to the controls, artistic voice users were more concerned about their voice (P < 0.001), practiced their voice more often (P < 0.001), and experienced more anxiety and stress (P < 0.05). In addition, within the professional group, singers reported practicing their voice in the time of the COVID-19 significantly more than actors (P < 0.01). CONCLUSIONS: Professional artistic voice users experience the COVID-19 pandemic as a stressful time, with negative effects on their well-being and specifically on their voice. This should be considered in the treatment and maintenance of their voice and professional career at current and future stressful times.

Two-dimensional Scheme for Arranging Voice Disorders.

Importance: Prevalent schemes that have been used for arranging voice pathologies have shaped theoretical and clinical views and the conceptualization of the pathologies and of the field as a whole. However, these available schemes contain inconsistencies and categorical overlaps. Objective: To develop and evaluate a new approach for arranging voice pathologies, using 2 continuous scales, organicity and tonicity, which were used to construct a 2-dimensional plane. Design, Setting, and Participants: This survey study was conducted among experts in the fields of laryngology and/or voice disorders from 10 countries. The survey was conducted using an online platform from March to May 2021. The data were analyzed in June 2021. Of the 45 experts who were initially approached, 39 (86.7%) completed the survey. Main Outcomes and Measures: The primary outcome measures were group ratings on 2 rating scales: organicity and tonicity. On the organicity scale, 0 represented nonorganic and 10 organic. On the tonicity scale, 0 represented hypotonic and 10 hypertonic. Results: Participants included 16 laryngologists and 23 speech-language pathologists, of whom 27 (69.2%) were women and 12 (30.8%) men with a mean age of 55 years. The Cronbach α was high for organicity and tonicity (0.98 and 0.97, respectively). Interrater agreement (rwg) was moderate to very strong (rwg≥0.50) for most pathologies. The correlation between the 2 scales was moderate and negative (r = -0.38; P = .03). The pathologies were scattered across the full range of both scales and the 4 quadrants of the 2-dimensional plane, suggesting the continuity and bidimensionality of the new arrangement scheme. In addition, a latent profile analysis suggested that the 4-cluster solution is valid and roughly corresponded to the 4 quadrants of the constructed plane. Conclusions and Relevance: The findings of this survey study suggest the potential use of a 2-dimensional plane that was based on 2 continuous scales as a new arrangement scheme for voice disorders. The results suggest that this approach provides a valid representation of the field based on 2 basic measures beyond the specific etiology of each laryngeal pathology or condition. This simple and comprehensive organization scheme has the potential to facilitate new insights on the nature of voice pathologies, considering the interpathology similarities and differences.

Examining the voice of Israeli transgender women: Acoustic measures, voice femininity and voice-related quality-of-life.

BACKGROUND: Transgender women may experience gender-dysphoria associated with their voice and the way it is perceived. Previous studies have shown that specific acoustic measures are associated with the perception of voice-femininity and with voice-related quality-of-life, yet results are inconsistent. AIMS: This study aimed to examine the associations between specific voice measures of transgender women, voice-related quality-of-life, and the perception of voice-femininity by listeners and by the speakers themselves. METHODS: Thirty Hebrew speaking transgender women were recorded. They had also rated their voice-femininity and completed the Hebrew version of the TVQMtF questionnaire. Recordings were analyzed to extract mean fundamental frequency (F0), formant frequencies (F1, F2, F3), and vocal-range (calculated in Hz. and in semitones). Recordings were also rated on a voice-gender 7-point scale, by 20 naïve cisgender listeners. RESULTS: Significant correlations were found between both F0 and F1 and listeners' as well as speakers' evaluation of voice-femininity. TVQMtF scores were significantly correlated with F0 and with the lower and upper boundaries of the vocal-range. Voice-femininity ratings were strongly correlated with vocal-range, when calculated in Hz, but not when defined in semitones. Listeners' evaluation and speakers' self-evaluation of voice-femininity were significantly correlated. However, TVQMtF scores were significantly correlated only with the speakers' voice-femininity ratings, but not with those of the listeners. CONCLUSION: Higher F0 and F1, which are perceived as more feminine, jointly improved speakers' satisfaction with their voice. Speakers' self-evaluation of voice-femininity does not mirror listeners' judgment, as it is affected by additional factors, related to self-satisfaction and personal experience. Combining listeners' and speakers' voice evaluation with acoustic analysis is valuable by providing a more holistic view on how transgender women feel about their voice and how it is perceived by listeners.

How face masks influence the sinonasal quality of life during the COVID-19 pandemic.

PURPOSE: To study different mask types' impact on a sinonasal quality of life. METHODS: For this observational cross-sectional study, a web-based survey was distributed via social media forums. We used the validated Hebrew version of the Sinonasal Outcome Test-22 followed by a questionnaire developed specifically for the present study, focusing on the time of the COVID-19 pandemic (Mask Sinonasal Outcome Test), and questions regarding general health issues. The participants' mask-wearing routine was also studied. RESULTS: Seventy percent of 351 participants had experienced a change in their breathing during the time of the pandemic. The median total Sinonasal Outcome Test-22 score was 13, and 10% of the participants reported a significantly impaired quality of life. According to multivariate analyses, the only subject-related variables significantly associated with the reduced sinonasal quality of life were female gender, younger age, a background of chronic rhinitis and sinusitis, and the mask-wearing average daily duration. The mask sinonasal outcome test convergent validity was confirmed. CONCLUSION: The majority of our survey's responders, predominantly female and younger participants, reported reduced sinonasal quality of life in the COVID-19 pandemic period. It can be attributed to mask-wearing, especially for a prolonged time, irrespective of the existing mask type. These findings should encourage medical companies to produce more "airway-minded" personal protection equipment.

Speech rate association with cerebellar white-matter diffusivity in adults with persistent developmental stuttering.

Speech rate is a basic characteristic of language production, which affects the speaker's intelligibility and communication efficiency. Various speech disorders, including persistent developmental stuttering, present altered speech rate. Specifically, adults who stutter (AWS) typically exhibit a slower speech rate compared to fluent speakers. Evidence from imaging studies suggests that the cerebellum contributes to the paced production of speech. People who stutter show structural and functional abnormalities in the cerebellum. However, the involvement of the cerebellar pathways in controlling speech rate remains unexplored. Here, we assess the association of the cerebellar peduncles with speech rate in AWS and control speakers. Diffusion MRI and speech-rate data were collected in 42 participants (23 AWS, 19 controls). We used deterministic tractography with Automatic Fiber segmentation and Quantification (AFQ) to identify the superior, middle, and inferior cerebellar peduncles (SCP, MCP, ICP) bilaterally, and quantified fractional anisotropy (FA) and mean diffusivity (MD) along each tract. No significant differences were observed between AWS and controls in the diffusivity values of the cerebellar peduncles. However, AWS demonstrated a significant negative association between speech rate and FA within the left ICP, a major cerebellar pathway that transmits sensory feedback signals from the olivary nucleus into the cerebellum. The involvement of the ICP in controlling speech production in AWS is compatible with the view that stuttering stems from hyperactive speech monitoring, where even minor deviations from the speech plan are considered as errors. In conclusion, our findings suggest a plausible neural mechanism for speech rate reduction observed in AWS.

Stuttering and Incident Type 2 Diabetes: A Population-Based Study of 2.2 Million Adolescents.

PURPOSE: To investigate the association between stuttering in adolescence and incident type 2 diabetes in young adulthood. METHODS: This nationwide population-based study included 2 193 855 adolescents of age 16 to 20 years who were assessed for military service between 1980 and 2013. Diagnoses of stuttering in adolescence were confirmed by a speech-language pathologist. Diabetes status for each individual as of December 31, 2016, was determined by linkage to the Israeli National Diabetes Registry. Relationships were analyzed using regression models adjusted for socioeconomic variables, cognitive performance, coexisting morbidities, and adolescent body mass index. RESULTS: Analysis was stratified by sex (Pinteraction = 0.035). Of the 4443 (0.4%) adolescent men with stuttering, 162 (3.7%) developed type 2 diabetes, compared with 25 678 (2.1%) men without stuttering (adjusted odds ratio [OR] 1.3; 95% CI, 1.1-1.6). This relationship persisted when unaffected brothers of men with stuttering were used as the reference group (adjusted OR = 1.5; 95% CI, 1.01-2.2), or when the analysis included only adolescents with unimpaired health at baseline (adjusted OR = 1.4; 95% CI, 1.1-1.7). The association was stronger in later birth cohorts, with an adjusted OR of 2.4 (1.4-4.1) for cases of type 2 diabetes before age 40. Of the 503 (0.1%) adolescent women with stuttering 7 (1.4%) developed type 2 diabetes, compared with 10 139 (1.1%) women without stuttering (OR = 2.03; 95% CI, 0.48-2.20). CONCLUSIONS: Adolescent stuttering is associated with an increased risk for early-onset type 2 diabetes among men.

What do these sounds tell us about the therapeutic alliance: Acoustic markers as predictors of alliance.

Predicting the trajectories of alliance formation that the patient is likely to establish with the therapist during treatment, even before their first meeting, can help prevent the potentially harmful consequences of deterioration in alliance, such as poor outcome and premature dropout. The present study aimed to examine the ability of four pretreatment acoustic markers to predict the alliance that is likely to be formed in the course of treatment: F0 span, speech rate, pause proportion and jitter. Data from 560 observations of 38 patients were collected as part of an ongoing randomized clinical trial of short-term psychotherapy for major depressive disorder. The acoustic markers were measured using high-quality recordings at baseline, before the patient and therapist ever met or had any type of communication. A multilevel model was used to examine the ability of the four acoustic markers to predict the slopes of alliance formation in the course of treatment, all markers being introduced in the same model. The clinical utility of the acoustic markers was explored in two case studies. The model explained 22% of the variance in alliance formation. Higher levels of both jitter and pause proportion at baseline predicted less strengthening of the alliance in the course of treatment. The findings, which should be replicated in larger samples, suggest that much of the therapeutic alliance can be predicted based on the acoustic characteristics of the patient's voice in the first 3 min of their intake, before they even meet their therapist.

Resilience in people who stutter: Association with covert and overt characteristics of stuttering.

PURPOSE: Recent literature stresses the importance of resilience, as a trait, for successful coping with life's difficulties or stressors. However, only a limited number of studies were conducted on resilience among people-who-stutter (PWS). These studies did not examine the association between resilience and the specific characteristics of stuttering. This study was, therefore, aimed to directly examine the association between resilience and measures of both the covert and overt characteristics of stuttering. METHOD: Thirty adults who stutter completed the Connor-Davidson Resilience Scale (CD-RISC) and the Overall Assessment of Speaker's Experience of Stuttering - Adults (OASES-A). In addition, stuttering severity of all participants was quantified using the Stuttering Severity Instrument-4 (SSI-4). The associations between all measures were examined statistically. RESULTS: A strong and significant association was found between the participants' scores on the CD-RISC and the OASES-A (r= -.79, p < .001). In contrast, no significant correlation was found between the participants' scores in the CD-RISC and the SSI-4 (r = .02, p > .05). Within our cohort, no significant association was observed between the participants' gender and age and their resilience levels (p > 0.05). CONCLUSION: This study demonstrates the role of resilience in shaping the individual's experience with stuttering. Results also show that the individuals' resilience levels do not necessarily predict stuttering severity per se, or its overt manifestations but can predict the individuals' subjective perception of his/her stuttering. This highlights the importance of addressing and promoting resilience among PWS in stuttering therapy.

The Prevalence of Self-Reported Voice Disorders in Israel.

OBJECTIVE: Data on the prevalence of voice disorders is vital in order to describe and understand the phenomenon. The aim of this study was to estimate the prevalence of voice disorders in Israel, and perform a preliminary comparison between the two major societies in the country. METHODS: A sample of 1146 people participated in a survey on voice disorders. This sample comprised 510 Israeli Jews and 627 Israeli Arabs. Each participant completed a questionnaire concerned with voice and its disorders as well as the shortened Voice Handicap Index-10 (VHI-10). RESULTS: The overall prevalence of voice disorders within our sample was 13.90%. In addition, 30.26% of the participants reported experiencing a voice problem over the last year, while 12.81% reported seeing a physician for that reason. No significant differences were found in the prevalence of voice disorders between participants who identified themselves as either Jews or Arabs. A higher prevalence of voice disorders was found in the older age groups, and among people who reside in the southern region of the country. In contrast, no significant differences in the prevalence of reported voice disorders were found between men and women. CONCLUSION: The prevalence of reported voice disorders in Israel is comparable with previous prevalence reports from other regions and societies. Data show that despite cultural, religion, language, and other factors, the prevalence of voice disorder among Israeli Jews and Arabs is very similar.

"Spontaneous" late recovery from stuttering: Dimensions of reported techniques and causal attributions.

PURPOSE: (1) To survey the employed techniques and the reasons/occasions which adults who had recovered from stuttering after age 11 without previous treatment reported as causal to overcome stuttering, (2) to investigate whether the techniques and causal attributions can be reduced to coherent (inherently consistent) dimensions, and (3) whether these dimensions reflect common therapy components. METHODS: 124 recovered persons from 8 countries responded by SurveyMonkey or paper-and-pencil to rating scale questions about 49 possible techniques and 15 causal attributions. RESULTS: A Principal Component Analysis of 110 questionnaires identified 6 components (dimensions) for self-assisted techniques (Speech Restructuring; Relaxed/Monitored Speech; Elocution; Stage Performance; Sought Speech Demands; Reassurance; 63.7% variance explained), and 3 components of perceived causal attributions of recovery (Life Change, Attitude Change, Social Support; 58.0% variance explained). DISCUSSION: Two components for self-assisted techniques (Speech Restructuring; Elocution) reflect treatment methods. Another component (Relaxed/Monitored Speech) consists mainly of items that reflect a common, non-professional understanding of effective management of stuttering. The components of the various perceived reasons for recovery reflect differing implicit theories of causes for recovery from stuttering. These theories are considered susceptible to various biases. This identification of components of reported techniques and of causal attributions is novel compared to previous studies who just list techniques and attributions. CONCLUSION: The identified dimensions of self-assisted techniques and causal attributions to reduce stuttering as extracted from self-reports of a large, international sample of recovered formerly stuttering adults may guide the application of behavioral stuttering therapies.

Physical and Visual Characteristics of the Neck Predicting Gender Perception.

The association between neck characteristics (physical and visual) and the perception of gender is unclear. This association is critical, especially when the perception of the speakers' gender is of interest, such as in transgender patients. This study was the first to provide basic empirical data on this association among cisgender men and women. METHODS: The necks of 30 adult men and women were measured physically and then photographed and evaluated visually by a group of 10 judges. These judges also evaluated voice recordings of the same speakers. Another group of 124 judges rated the visual and auditory masculinity/femininity of the necks and the voices. RESULTS: While most physical measures of the neck were larger for men, neck-length did not significantly differ between genders. A stepwise multiple regression model revealed that the single physical measure that consistently differed between genders was neck-girth (P < 0.0001). The single visual-appearance measure that consistently differed between genders was thyroid-protrusion (P = 0.0003). Neck-girth was the only physical characteristic that significantly correlated with gender differences in voice. Furthermore, the size of the thyroid prominence (ie, Adam's apple) was not associated with gender differences in voice. CONCLUSIONS: Neck characteristics (both physical and visual) are significantly associated with the perception of gender. While larger necks are typically perceived as masculine, neck-length is neither associated with gender nor with the speaker's voice characteristics. These findings highlight the importance of examining various physical and visual characteristics of the neck, when considering a feminization confirmation procedure for transgender patients.

The Speech Efficiency Score (SES): A time-domain measure of speech fluency.

PURPOSE: This study is a preliminary attempt to evaluate a new speech fluency measure, the Speech Efficiency Score (SES), in comparison with subjective stuttering severity rating scales and stuttered syllable counts (%SS). METHODS: 277 listeners (92 naïve, 39 speech-language pathology (SLP) students, 124 practicing SLPs, and 22 SLPs who specialize in stuttering) evaluated short recordings of speech on an 11-point scale. Recordings were obtained from 56 adults, of whom 20 were people who stutter, 16 were people who stutter who were using fluency-shaping techniques, and 20 were speakers who do not stutter. In addition, %SS and the SES measure were obtained for each recording. RESULTS: The four listener groups rated stuttering severity similarly, with no statistically significant between-group differences. Listeners' responses on the stuttering severity rating scales and the SES yielded significant differences between all three speaker groups. The %SS measure yielded a significant difference only between the stuttering group and the other two groups but not between the fluency-shaping and the control groups. A very strong positive correlation was found between the SES and the subjective stuttering-severity rating scales (r = 0.92). The correlation between %SS and the perceptual evaluation, as well as the correlation between %SS and the SES, were lower, though they still reached significance. CONCLUSIONS: Results suggest that speech efficiency scores, which are based on a time-domain analysis, closely match subjective stuttering severity ratings and could ultimately provide a more objective way to measure speech fluency.

Speech rate adjustment of adults during conversation.

PURPOSE: Speech rate convergence has been reported previously as a phenomenon in which one's speech rate is influenced by his/her partner's speech rate. This phenomenon has been demonstrated in artificial settings, and to some extent, in mother-child interactions. The purpose of this study was to explore speech rate adjustment in a quasi-natural adult-adult conversation. METHODS: An A-B-A-B paradigm was used, in which ten adults conversed on a given topic with two experimenters. Speech rates of both communication partners were measured. RESULTS: Participants significantly reduced their speech rate, in response to the experimenters' reduction in speech rate. However, the participants' reduction in speech rate was significantly smaller than the experimenters' reduction in speech rate. In addition, during the controlled slow speech rate, the participants' speech rate correlated negatively with that of the experimenters'. CONCLUSION: Results suggest that speech rate convergence is a non-linear phenomenon, and may be affected by various linguistic as well as communicational factors. From a clinical perspective, the results support the use of the modeling strategy in speech therapy, as a means to facilitate a reduction in clients' speech rate.

[ENDOTHELIAL DYSFUNCTION: A POSITION PAPER OF THE ISRAEL HEART SOCIETY].

INTRODUCTION: Prediction of cardiovascular adverse events is challenging. It became apparent that traditional coronary artery disease (CAD) risk factors are the cornerstones of the European 10-year CAD risk SCRORE and the Framingham score. However, despite their importance, the prediction value of general assessment tools such as the SCORE and Framingham options in an individual subject is limited, especially in young adults and women. The trend toward personalized medicine and individualized risk assessment during recent years is growing strong and various functional and imaging screening tests, including endothelial function studies, have been suggested to improve accuracy and provide the functional implications of these risk factors. Endothelial dysfunction is an early stage of atherosclerosis and has been associated with adverse cardiovascular outcome events, including myocardial infarction, stroke and death. The purpose of this position paper is to review the scientific background, methods available for assessment of endothelial function and the interpretation of test results. The current manuscript also suggest some meaningful clinical guidelines on potential integration of these tests into our practice.

White matter pathways in persistent developmental stuttering: Lessons from tractography.

PURPOSE: Fluent speech production relies on the coordinated processing of multiple brain regions. This highlights the role of neural pathways that connect distinct brain regions in producing fluent speech. Here, we aim to investigate the role of the white matter pathways in persistent developmental stuttering (PDS), where speech fluency is disrupted. METHODS: We use diffusion weighted imaging and tractography to compare the white matter properties between adults who do and do not stutter. We compare the diffusion properties along 18 major cerebral white matter pathways. We complement the analysis with an overview of the methodology and a roadmap of the pathways implicated in PDS according to the existing literature. RESULTS: We report differences in the microstructural properties of the anterior callosum, the right inferior longitudinal fasciculus and the right cingulum in people who stutter compared with fluent controls. CONCLUSIONS: Persistent developmental stuttering is consistently associated with differences in bilateral distributed networks. We review evidence showing that PDS involves differences in bilateral dorsal fronto-temporal and fronto-parietal pathways, in callosal pathways, in several motor pathways and in basal ganglia connections. This entails an important role for long range white matter pathways in this disorder. Using a wide-lens analysis, we demonstrate differences in additional, right hemispheric pathways, which go beyond the replicable findings in the literature. This suggests that the affected circuits may extend beyond the known language and motor pathways.

The relationship between the experience of stuttering and demographic characteristics of adults who stutter.

PURPOSE: This study aims to examine the association between adults' experience of stuttering and their age, gender and marital status, as well as to evaluate the psychometric properties of the Hebrew version of the OASES-A. METHODS: The Hebrew version of the OASES-A was administered to 91 adults-who-stutter. The validity of the translated version was evaluated using a subset of 43 participants, who also completed three additional instruments: (a) a Perceived Stuttering Severity (PSS) self-rating scale, (b) the Situation Avoidance Behavior Checklist (SABC), (c) the Students Life Satisfaction scale (SLSS). Finally, the correlations between the participants' OASES-A scores and their age, gender and marital status were calculated. RESULTS: A negative correlation was found between the participants' OASES-A impact scores and their age (p<0.01). In addition, married participants exhibited lower OASES-A impact scores compared with unmarried participants (p<0.05). On the other hand, the speakers' gender was not associated with OASES-A impact scores. RESULTS: revealed high internal consistency of the Hebrew OASES-A, and moderate to strong correlations with the additional examined instruments. Finally, results of the Hebrew version of the questionnaire were comparable with those obtained in other languages. CONCLUSION: Our results indicated that, within our cohort, age and marital status are significantly associated with the personal experience of stuttering, whereas gender is not. In addition, the Hebrew version of the OASES-A is valid and comparable with equivalent versions in other languages. This facilitates the application of the OASES-A in future clinical and research settings.