Evaluation of Breast Skin/Nipple-Areolar Complex Sensation and Quality of Life after Nipple-Sparing Mastectomy Followed by Reconstruction.

Background and Objectives: Sensation of the breast skin and nipple-areolar complex (NAC) is commonly assumed to be diminished or completely absent following nipple-sparing mastectomy (NSM) with implant- or expander-based reconstruction. The purpose of this cohort study was to evaluate breast skin and NAC long-term touch pressure sensibility, from 1 month to 1 year, after NSM followed by reconstruction with an implant or expander, and patient quality of life (QoL), hypothesizing that sensibility may diminish with a small progressive return throughout the postoperative period. Materials and Methods: This was achieved by performing sensation tests using Semmes-Weinstein monofilaments (SWM) in nine predefined points of the breast and NAC, a two-point discrimination test (TPD) in the four quadrants of the breast, and QoL assessment using the BREAST-Q. We evaluated 42 patients in Pauls Stradins Clinical University Hospital, with a total of 66 breasts, who underwent NSM between 2021 and 2023, performing the breast sensation tests before surgery and postoperatively at 1/3/6 months and 1 year. The BREAST-Q was administered to assess patient satisfaction and well-being. Results: Our results reflect a decline in breast skin and NAC sensation in the 1-month evaluation after NSM (mean: 4.67) when compared to the assessment before surgery (mean: 2.57), with a small progressive return reflected in the 3 months (mean: 3.79), 6 months (mean: 3.68), and 1-year evaluations (mean: 3.14). The following were the mean scores obtained from the BREAST-Q: Psychosocial Well-being (mean: 66), Sexual Well-being (mean: 50), Satisfaction with Breasts Pre-OP (mean: 58), satisfaction with breast reconstruction (mean: 52), Satisfaction with Implants, Satisfaction with nipple reconstruction, Physical Well-being Chest, Adverse effects of radiation, and Satisfaction with Information. Conclusions: This study confirms that sensibility diminishes after this procedure, as observed when comparing the sensation evaluation results before the operation with the 1-month evaluation, reflecting a small progressive return in the following months.

Psychiatry and sensation: the epigenetic links.

A complex interaction among sensory, social and epigenetic determinants in psychiatric conditions was described across all age strata. The high prevalence of mental disorders in individuals with sensory deficits might be attributed to the interaction among social isolation, cognitive functioning and sensory processing. The epigenetic implications of such interactions were examined: environmental and social factors can affect gene expression and impact the pathogenesis of psychiatric disorders also through sensory processing. This article discussed the role of social determinants, in other words, social isolation, loneliness and chronic stress, in promoting psychiatric disorders and, in a vicious circle, sensory deficits (vision, hearing, olfaction and somatosensation). We emphasized the importance of integrating social, sensory and epigenetic factors to target different treatments for psychiatric conditions.

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First-person thought is associated with body awareness in daily life.

Sensations from the body are thought to play a critical role in many aspects of conscious experience, including first-person thought. In the present set of studies, we examined within-person relationships between in-the-moment subjective awareness of sensations from the body and self-reported first-person thought in real-world settings using ecological momentary assessment (EMA) protocols. In Study 1, participants reported experiencing greater first-person thoughts in moments when they also reported heightened awareness of sensations from their body, and this relationship was stable over a 4-week period even with mean-level changes in body awareness and first-person thought. In Study 2, we replicated this association in a 1-week EMA protocol using both self-report measures and measures derived from participants' open-ended descriptions of their ongoing thoughts using a natural language processing approach. Taken together, findings shed light on the role of subjective body awareness in other facets of conscious experience.

Simultaneous modulation of pulse charge and burst period elicits two differentiable referred sensations.

Objective.To investigate the feasibility of delivering multidimensional feedback using a single channel of peripheral nerve stimulation by complementing intensity percepts with flutter frequency percepts controlled by burst period modulation.Approach.Two dimensions of a distally referred sensation were provided simultaneously: intensity was conveyed by the modulation of the pulse charge rate inside short discrete periods of stimulation referred to as bursts and frequency was conveyed by the modulation of the period between bursts. For this approach to be feasible, intensity percepts must be perceived independently of frequency percepts. Two experiments investigated these interactions. A series of two alternative forced choice tasks (2AFC) were used to investigate burst period modulation's role in intensity discernibility. Magnitude estimation tasks were used to determine any interactions in the gradation between the frequency and intensity percepts.Main results.The 2AFC revealed that burst periods can be individually differentiated as a gradable frequency percept in peripheral nerve stimulation. Participants could correctly rate a perceptual scale of intensity and frequency regardless of the value of the second, but the dependence of frequency differentiability on charge rate indicates that frequency was harder to detect with weaker intensity percepts. The same was not observed in intensity differentiability as the length of burst periods did not significantly alter intensity differentiation. These results suggest multidimensional encoding is a promising approach for increasing information throughput in sensory feedback systems if intensity ranges are selected properly.Significance.This study offers valuable insights into haptic feedback through the peripheral nervous system and demonstrates an encoding approach for neural stimulation that may offer enhanced information transfer in virtual reality applications and sensory-enabled prosthetic systems. This multidimensional encoding strategy for sensory feedback may open new avenues for enriched control capabilities.

Early Penile and Donor Site Sensory Outcomes After Innervated Radial Forearm Free Flap Phalloplasty: A Pilot Prospective Study.

BACKGROUND: Radial forearm free flap phalloplasty (RFFF) is a set of complex reconstructive procedures aimed at creating an aesthetic and functional penis in transgender patients. Sensory recovery in the neophallus and donor site is crucial for optimizing outcomes, but the few prior studies that exist assess neophallus sensation at limited locations and time points. The purpose of this study was to prospectively quantify sensory outcomes in the neophallus and donor site following RFFF phalloplasty. METHODS: Sensation testing occurred prospectively over February 2019-January 2021 on Stage 1 RFFF phalloplasty patients using the Pressure Specified Sensory Device (PSSD). On the neophallus, one-point discrimination (1PS) pressure threshold and lengthwise sensory recovery were measured at six circumferential locations proximally to distally. On the donor site, 1PS was measured at three locations on the donor hand. RESULTS: Nineteen patients were included (average age 34.0 years old, range 18-53 years). Among patients that received neophallus testing (n = 13), eight had at least two follow-up appointments. Six of these patients had sensation as of their most recent measurement (75.0%), with an average of 73 days to regain sensation. There was a significantly greater proportion of patients with sensation at the right ventral (80.0% after 3 months vs. 11.1%-60.0% before 3 months, p = 0.024) and right lateral (100.0% after 3 months vs. 11.1%-60.0% before 3 months, p = 0.004) aspects of the neophallus over time. Pressure required to elicit sensation decreased by 18.0% from 1 week-1 month postoperatively to 3-7.7 months postoperatively in the right ventral neophallus (96.2 g/mm2 ± 11.3 g/mm2 to 56.6 ± 39.9 g/mm2, p = 0.037). Among patients that received donor site testing (n = 11), mixed effects regression analysis with random intercepts demonstrated significant changes in the thumb (3.4 g/mm2 ± 1.4 g/mm2, p < 0.05) and webspace (13.5 g/mm2 ± 4.9 g/mm2, p < 0.01) that returned to baseline at 3 months postoperatively (1.7 g/mm2 ± 1.0 g/mm2, p > 0.05, and 2.3 g/mm2 ± 4.0 g/mm2, p > 0.05, respectively). CONCLUSION: This pilot study demonstrates that quantitative sensory testing can be used to monitor post-phalloplasty sensory changes. Recovery was significantly associated with contralateral (i.e, right side in a left forearm RFF) aspects of the neophallus, suggesting a possible pattern of circumferential sensory innervation via RFFF sensory nerves. Future studies with a larger sample size and longer follow-ups are necessary to fully characterize sensory recovery in phalloplasty patients.

Sensory adaptation in the barrel cortex during active sensation in the behaving mouse.

Sensory Adaptation (SA) is a prominent aspect of how neurons respond to sensory signals, ubiquitous across species and modalities. However, SA depends on the activation state of the brain and the extent to which SA is expressed in awake, behaving animals during active sensation remains unclear. Here, we addressed this question by training head-fixed mice to detect an object using their whiskers and recording neuronal activity from barrel cortex whilst simultaneously imaging the whiskers in 3D. We found that neuronal responses decreased during the course of whisker-object touch sequences and that this was due to two factors. First, a motor effect, whereby, during a sequence of touches, later touches were mechanically weaker than early ones. Second, a sensory encoding effect, whereby neuronal tuning to touch became progressively less sensitive during the course of a touch sequence. The sensory encoding effect was whisker-specific. These results show that SA does occur during active whisker sensing and suggest that SA is fundamental to sensation during natural behaviour.

Brain-wide dynamics linking sensation to action during decision-making.

Perceptual decisions rely on learned associations between sensory evidence and appropriate actions, involving the filtering and integration of relevant inputs to prepare and execute timely responses1,2. Despite the distributed nature of task-relevant representations3-10, it remains unclear how transformations between sensory input, evidence integration, motor planning and execution are orchestrated across brain areas and dimensions of neural activity. Here we addressed this question by recording brain-wide neural activity in mice learning to report changes in ambiguous visual input. After learning, evidence integration emerged across most brain areas in sparse neural populations that drive movement-preparatory activity. Visual responses evolved from transient activations in sensory areas to sustained representations in frontal-motor cortex, thalamus, basal ganglia, midbrain and cerebellum, enabling parallel evidence accumulation. In areas that accumulate evidence, shared population activity patterns encode visual evidence and movement preparation, distinct from movement-execution dynamics. Activity in movement-preparatory subspace is driven by neurons integrating evidence, which collapses at movement onset, allowing the integration process to reset. Across premotor regions, evidence-integration timescales were independent of intrinsic regional dynamics, and thus depended on task experience. In summary, learning aligns evidence accumulation to action preparation in activity dynamics across dozens of brain regions. This leads to highly distributed and parallelized sensorimotor transformations during decision-making. Our work unifies concepts from decision-making and motor control fields into a brain-wide framework for understanding how sensory evidence controls actions.

From synapse to sensation: the role of circTulp4.

Recent work by Giusti and colleagues showed that circTulp4 modulates excitatory synaptic strength. Knocking down circTulp4 disrupts the excitation-inhibition (E/I) balance in mice and leads to hypersensitivity toward aversive stimuli. These observations update our appreciation of the functions of circular (circ)RNA in the nervous system and their potential implication in neurodevelopmental and neuropsychiatric disorders.

Stimuli-evoked NOergic molecules and neuropeptides at acupuncture points and the gracile nucleus contribute to signal transduction of propagated sensation along the meridian through the dorsal medulla-thalamic pathways.

Numerous studies from different international groups have demonstrated that sensations can be propagated along acupuncture channel pathways. The propagated sensation along the channel pathway (PSCP) can be elicited by electroacupuncture (EA), transcutaneous electrical nerve stimulation (TENS), manual acupuncture (MA), and heat applied to distal acupuncture points (acupoints). Nitric oxide (NO) levels were reported to be elevated in the gracile nucleus and skin regions near to the EA sites, with higher levels at acupoints associated with an enhanced expression of NO synthase and transient receptor potential vanilloid type 1. The stimuli, EA, MA, TENS, and heat, have been used to elicit axonal reflexes, which increase local release of NO and neuropeptides such as calcitonin gene related peptide. Furthermore, the sensation of PSCP along the body surface occurs only ipsilaterally to the stimulated acupoints in various human studies, which does not support the involvement of the spinal-thalamic pathway, which would involve cross over transmission of the signals. The gracile nucleus receives ascending input from the sciatic nerve and responds to somatosensory stimulation mainly on the ipsilateral side via the dorsal column pathway. EA at Zusanli (ST36) increases NO release and expression of NO synthase mainly in the ipsilateral side of the gracile nucleus, while the cardiovascular effects and analgesic responses to EA at ST36 are changed by influences of l-arginine-derived NO synthesis in the ipsilateral gracile nucleus in rats. The stimuli-induced release of NOergic molecules and neuropeptides exist high levels in the acupoints, which contain rich neuronal components and blood vessels. Enhanced NOergic molecules at acupoints cause axon reflexes during the stimuli, which elevate cutaneous blood flow. Elevated NOergic molecules and local blood flow may spread over acupoints one after another along the meridian lines differing from nerve pathways following the stimuli to induce PSCP. The same types of stimulation also elicit NO release in the gracile nucleus, which contributes to the somatosensory signal transduction of PSCP through the dorsal medulla-thalamic pathways. Other substances such as serotonin and catecholamines are proposed to mediate responses and certain effects of acupuncture-like stimulation but their mechanisms are poorly-understood. In this review we summarize the current understanding of the neurobiological processes of PSCP research with an emphasis on recent developments of NO mediating stimulation-evoked axon reflexes and somatosensory signal transduction for PSCP perceptions through the dorsal medulla-thalamic pathways. Please cite this article as: Ma SX. Stimuli-evoked NOergic molecules and neuropeptides at acupuncture points and gracile nucleus contribute to signal transduction of propagated sensation along the meridian through the dorsal medulla-thalamic pathways. J Integr Med. 2024; 22(5): 515-522.

Sensory processing in typically developing toddlers with and without sleep problems.

This study investigates the sensory processing of typically developing toddlers with and without sleep problems. The research group consisted of typically developing toddlers with sleep problems (n = 110, mean age=18.35 ± 3.4 months), while the control group included typically developing toddlers without sleep problems (n = 110, mean age=18.67 ± 3.5 months) and their mothers. Toddlers were assigned to the research and control groups based on their sleep problems, as determined by the Brief Infant Sleep Questionnaire. The sensory processing of the toddlers was evaluated using the Infant/Toddler Sensory Profile 2. Sensory patterns and sensory processing sub-parameters of the research and control groups were compared. The sensory processing of the research group showed atypical behavioral responses in low registration (low awareness or indifferent attitude to sensory stimuli), sensory sensitivity (distracted or irritable attitude, intensely stimulated by sensory stimuli), and sensory avoiding (intentional avoidance of sensory stimuli or attitudes that produce out-of-norm responses) patterns compared to the control group (p < 0.05). Behavioral responses were similar in the sensory seeking (disturbing or dangerous attitude to the environment in search of sensory stimuli) pattern (p > 0.309). Statistically significant differences were observed in all sub-parameters of sensory processing compared to the control group. Our findings indicate that toddlers with sleep problems are at risk for sensory processing issues. Toddlers with sleep problems exhibit atypical sensory responses related to sensory sensitivity, low registration, and sensory avoiding. It should be considered that toddlers with sleep problems may show sensitivity to different sensory stimuli, avoidance or may not be able to recognize sensory stimuli. These findings suggest that the inclusion of sensory profile assessments in interdisciplinary care for toddlers with sleep problems may contribute to parent-infant well-being.

Dairy versus non-dairy cheese texture: Sensory and instrumental contrasts.

With growing consumer demand for plant-based products that mimic the eating experience of animal-based products, there is a need for improvement in instrumental measurements of sensory texture. This study aimed to characterize textural differences between dairy and non-dairy cheeses, and to investigate whether Large Amplitude Oscillatory Shear (LAOS) rheometry could discriminate sensory texture better than Texture profile analysis. Commercial dairy and non-dairy cheddar, mozzarella, and cream cheese were selected to provide a wide range of textures. Sensory evaluation used the check-all-that-apply methodology with 73 consumers. Texture profile analysis force-distance data were analyzed empirically, and also converted to stress and strain (see https://shiny.csiro.au/texture_dash). The major textural differences between dairy and non-dairy cheddar were related to structural cohesion, according to both instrumental measures (dairy cheddar had 1.5-fold higher failure stress and 2.2-fold higher failure strain) and sensory measurements (dairy cheddar was more chewy and less crumbly). In contrast, cream cheeses showed similar textural properties using sensory testing but significant instrumental differences (non-dairy cream cheese had 5.7-fold higher modulus of deformability, 4.7-fold higher failure stress). For mozzarella, there were large differences in both sensory attributes (chewy, crumbly, jelly-like, stretchy) and instrumental parameters (13.6-fold difference in modulus, 2.7-fold difference in failure stress). LAOS rheometry gave insights into the mechanisms by which samples absorbed or dissipated mechanical energy at nonlinear strains. The LAOS parameter G 3 ' / G 1 ' $$ {G}_3^{\prime }/{G}_1^{\prime } $$ correlated well with sensory attributes creamy, fatty/oily, and moist, indicating the potential of this technique to measure structural phenomena linked to sensory attributes that resonate with consumers.

Development and validation of a novel questionnaire to describe and assess sensations and triggers associated with refractory and unexplained chronic cough.

INTRODUCTION: Refractory or unexplained chronic cough (RUCC) is a common clinical problem with no effective diagnostic tools. The Sensations and Triggers Provoking Cough questionnaire (TOPIC) was developed to characterise cough in RUCC versus cough in other conditions. METHODS: Content analysis of participant interviews discussing the sensations and triggers of chronic cough informed TOPIC development. Participants with chronic cough completed the draft-TOPIC (a subset repeating 5-7 days later), St George's Respiratory Questionnaire (SGRQ), Cough Severity Diary (CSD) and Global Rating of Change Scale. The draft-TOPIC item list was reduced in hierarchical and Rasch analysis to refine the questionnaire to the TOPIC. RESULTS: 49 items describing the triggers and sensations of cough were generated from participant interviews (RUCC n=14, chronic obstructive pulmonary disease (COPD) n=11, interstitial lung disease (ILD) n=10, asthma n=11, bronchiectasis n=3, cystic fibrosis n=7). 140 participants (median age 60.0 (19.0-88.0), female 56.4%; RUCC n=39, ILD n=38, asthma n=45, COPD n=6, bronchiectasis n=12) completed draft-TOPIC, where items with poor 'fit' for RUCC were removed to create TOPIC (8 trigger items, 7 sensation items). Median TOPIC score was significantly higher in RUCC (37.0) vs ILD (24.5, p=0.009) and asthma (7.0, p<0.001), but not bronchiectasis (20.0, p=0.318) or COPD (18.5, p=0.238), likely due to small sample sizes. The Rasch model demonstrated excellent fit in RUCC (χ2=22.04, p=0.85; PSI=0.88); as expected. When all participant groups were included, fit was no longer demonstrated (χ2=66.43, p=0.0001, PSI=0.89) due to the increased heterogeneity (CI=0.077). TOPIC correlated positively with SGRQ (r=0.47, p<0.001) and CSD (r=0.63, p<0.001). The test-retest reliability of TOPIC (intraclass correlation coefficient) was excellent (r=0.90, p<0.001). CONCLUSIONS: High TOPIC scores in the RUCC patients suggest their cough is characterised by specific sensations and triggers. Validation of TOPIC in cough clinics may demonstrate value as an aid to identify features of RUCC versus cough in other conditions.

Predicting tingling sensations induced by autonomous sensory meridian response (ASMR) videos based on sound texture statistics: a comparison to pleasant feelings.

Sound serves as a potent medium for emotional well-being, with phenomena like the autonomous sensory meridian response (ASMR) showing a unique capacity for inducing relaxation and alleviating stress. This study aimed to understand how tingling sensations (and, for comparison, pleasant feelings) that such videos induce relate to acoustic features, using a broader range of ASMR videos as stimuli. The sound texture statistics and their timing predictive of tingling and pleasantness were identified through L1-regularized linear regression. Tingling was well-predicted (r = 0.52), predominantly by the envelope of frequencies near 5 kHz in the 1500 to 750 ms period before the response: stronger tingling was associated with a lower amplitude around the 5 kHz frequency range. This finding was further validated using an independent set of ASMR sounds. The prediction of pleasantness was more challenging (r = 0.26), requiring a longer effective time window, threefold that for tingling. These results enhance our understanding of how specific acoustic elements can induce tingling sensations, and how these elements differ from those that induce pleasant feelings. Our findings have potential applications in optimizing ASMR stimuli to improve quality of life and alleviate stress and anxiety, thus expanding the scope of ASMR stimulus production beyond traditional methods. This article is part of the theme issue 'Sensing and feeling: an integrative approach to sensory processing and emotional experience'.

Sensing, feeling and consciousness.

Living organisms achieve homeostasis by using distinct mechanisms tailored to their physiological complexity. Unicellular organisms as well as plants, which are devoid of nervous systems, rely on covert sensing/detecting and equally covert responding mechanisms. Organisms with nervous systems rely on overt consciousness which is based on homeostatic feelings and the experiences and consequent subjectivity they generate. This article is part of the theme issue 'Sensing and feeling: an integrative approach to sensory processing and emotional experience'.

Sensing and feeling: an overview.

Emotional experiences are driven, in part, by the way we process and integrate information from different sensory modalities. Understanding how perceptual and emotional systems interact to give rise to subjective feelings is an important, complex and challenging issue, requiring new approaches and integrative thinking that fuses the fundamentals of low-level sensory perception with higher-level cognitive and affective processes. The Theme Issue 'Sensing and feeling: an integrative approach to sensory processing and emotional experience' showcases fifteen theoretical, empirical, and review articles from experts working at the intersection of perception and emotion, encompassing multiple sensory systems (visual, auditory, tactile and interoceptive), clinical and non-clinical perspectives (e.g. affective disorders and hearing loss), contextual and social perspectives, and complex emotional experiences in special populations. Articles in Part 1 emphasize recent advances across fields in sensory and emotion science and give insights into future directions. Each article in Part 2 provides more detailed and specific methodological approaches or theoretical models, and focuses on basic mechanisms linking sensation to emotional experience. This article is part of the theme issue 'Sensing and feeling: an integrative approach to sensory processing and emotional experience'.

Brain circuits in autonomous sensory meridian response and related phenomena.

Autonomous sensory meridian response (ASMR) is characterized by a tingling sensation with a feeling of relaxation and a state of flow. We explore the neural underpinnings and comorbidities of ASMR and related phenomena with altered sensory processing. These phenomena include sensory processing sensitivity (SPS), synaesthesia, Alice in Wonderland syndrome and misophonia. The objective of this article is to uncover the shared neural substrates and distinctive features of ASMR and its counterparts. ASMR, SPS and misophonia exhibit common activations in the brain regions associated with social cognition, emotion regulation and empathy. Nevertheless, ASMR responders display reduced connectivity in the salience network (SN), while individuals with SPS exhibit increased connectivity in the SN. Furthermore, ASMR induces relaxation and temporarily reduces symptoms of depression, in contrast to SPS and misophonia, which are linked to depression. These observations lead us to propose that ASMR is a distinct phenomenon owing to its attention dispatch mechanism and its connection with emotion regulation. We suggest that increased activations in the insula, along with reduction in connectivity within the salience and default mode networks in ASMR responders, may account for their experiences of relaxation and flow states. This article is part of the theme issue 'Sensing and feeling: an integrative approach to sensory processing and emotional experience'.

Through an animal's eye: the implications of diverse sensory systems in scientific experimentation.

'Accounting for the sensory abilities of animals is critical in experimental design.' No researcher would disagree with this statement, yet it is often the case that we inadvertently fall for anthropocentric biases and use ourselves as the reference point. This paper discusses the risks of adopting an anthropocentric view when working with non-human animals, and the unintended consequences this has on our experimental designs and results. To this aim, we provide general examples of anthropocentric bias from different fields of animal research, with a particular focus on animal cognition and behaviour, and lay out the potential consequences of adopting a human-based perspective. Knowledge of the sensory abilities, both in terms of similarities to humans and peculiarities of the investigated species, is crucial to ensure solid conclusions. A more careful consideration of the diverse sensory systems of animals would improve many scientific fields and enhance animal welfare in the laboratory.

Influence of Sensory Monitoring on Speech Breathing Planning Processes: An Exploratory Study in Aging Speakers Reporting Dyspnea.

PURPOSE: Previous studies have suggested that inspirations during speech pauses are influenced by the length of adjacent utterances, owing to respiratory motor planning and physiological recovery processes. The goal of this study was to examine how attention to respiratory sensations may influence these processes in aging speakers with dyspnea, by measuring the effect of sensory monitoring on the relationship between utterance length and the occurrence of inspirations, as well as on functional voice and respiratory measures. METHOD: Seventeen adults aged 50 years and older with complaints of voicing-related dyspnea completed a repeated-measures protocol consisting of a 2-week baseline phase and a 4-week sensory monitoring phase. Audiovisual recordings of semistructured speech and self-report questionnaires were collected at study onset, after the baseline phase, and after the sensory monitoring phase. Repeated-measures logistic regressions were conducted to examine changes in the relationship between utterance length and the occurrence of inspirations in adjacent pauses, and repeated-measures analyses of variance were used to investigate any changes in functional voice and respiratory measures. RESULTS: Planning and recovery processes appeared to remain constant across the baseline phase. From postbaseline to postsensory monitoring timepoints, a strengthening of the relationship between the presence of an inspiration during a speech pause and the length of the subsequent-but not preceding-utterance was noted. Significant improvements were noted in voice-related handicap from study onset to postsensory monitoring, but no changes were reported in respiratory comfort during speech. CONCLUSIONS: Results suggest that respiratory planning processes, that is, the ability to plan breath intakes based on the length of upcoming utterances, may be modifiable behaviorally through targeted sensory monitoring. Further studies are warranted to validate the proposed role of respiratory sensation awareness in achieving skilled temporal coordination between voicing and breathing.