Concurrent and Predictive Validity of the Mann Assessment of Swallowing Ability in Belgian Acute Stroke Patients Based on a 1-Year Follow-Up Study.

INTRODUCTION: The Mann Assessment of Swallowing Ability (MASA) is a standardized clinical swallowing examination, specifically developed as a diagnostic test for the presence of oropharyngeal dysphagia and aspiration in the early period after stroke onset. In the original validation study, cutoff scores of <178 and <170 points, respectively, for the identification of dysphagia and aspiration risk are reported. However, a literature search revealed that alternative cutoff scores for dysphagia and/or aspiration provide better diagnostic accuracy. The aim of this secondary data analysis study was to evaluate the concurrent and predictive validity of the MASA. METHODS: Data were derived from a Belgian cohort study of an acute stroke population (n = 151). The MASA total score (MASA-TS), which is the sum of weighted scores on the 24 items, was evaluated against the Fiberoptic Endoscopic Dysphagia Severity Scale (FEDSS) to assess concurrent validity. To assess predictive validity of the MASA-TS, pneumonia during hospitalization and over 1 year and mortality acted as a future criterion. Analyses included receiver operating characteristic curves and area under the curve (AUC). RESULTS: Diagnostic accuracy of the MASA-TS was good for dysphagia (AUC = 0.85) and for the presence of relevant aspiration risk (AUC = 0.84). Using the original cutoff scores, the MASA-TS showed perfect sensitivity (Se = 1.00) for the identification of dysphagia and aspiration but inadequate specificity (Sp) for dysphagia (Sp = 0.16) and aspiration (Sp = 0.43). After determining new MASA cutoff scores, the optimal MASA cutoff scores were ≤146 for both dysphagia and aspiration with adequate thresholds (Se = 0.71 and Sp = 0.81 for dysphagia; Se = 0.73 and Sp = 0.80 for aspiration). The MASA-TS was a significant predictor of pneumonia during hospitalization (AUC = 0.85) and 1-year follow-up (AUC = 0.86), and of mortality (AUC = 0.79). CONCLUSION: The MASA-TS showed good concurrent validity with the FEDSS. Furthermore, using new cutoff scores (≤146 for the identification of dysphagia and aspiration) lead in general to more accurate diagnostic indexes. The MASA-TS is a good predictor of aspiration pneumonia during hospitalization and 1-year follow-up and of mortality.

Assessment of radio(chemo)therapy-related dysphagia in head and neck cancer patients based on cough-related acoustic features: a prospective phase II national clinical trial (ACCOUGH-P/A trial).

BACKGROUND: Radiation-associated dysphagia is defined as impaired swallowing efficiency/safety following (chemo)radiotherapy in head and neck cancer patients. In a dysphagia framework, impaired coughing may lead to lung aspiration and fatal lung infection. Although cough efficacy is a predictor of the risk of aspiration, cough investigation is minimal in patients with radiation-associated dysphagia. Because cough is a transient signal, existing software for speech analysis are not appropriate. The goal of our project is to develop an assessment method using acoustic features related to voluntary and reflexive coughs as biomarkers of the risk of penetration/aspiration in patients with radiation-associated dysphagia. METHODS: Healthy subjects and head and neck cancer patients with and without dysphagia will produce voluntary coughs, throat clearings and reflexive coughs. Recordings will be made using an acoustic microphone and a throat microphone. The recorded signals will be manually segmented and subsequently analysed with a software under development. Automatic final segmentation enables to measure cough duration. The first method of analysis includes temporal features: the amplitude contour, the sample entropy and the kurtosis. These features report respectively the strength, the unpredictability (turbulence noise due to the air jet) and the impulsive quality (burst) of the signal. The second method of analysis consists of a spectral decomposition of the relative cough signal energy into several frequency bands (0-400 Hz, 400-800 Hz, 800-1600 Hz, 1600-3200 Hz, > 3200 Hz). The primary outcome of this exploratory research project is the identification of a set of descriptive acoustic cough features in healthy subjects as reference data (ACCOUGH). The secondary outcome of this research in head and neck cancer patients with radiation-associated dysphagia includes the identification of (1) a set of descriptive acoustic cough features as biomarkers of penetration-aspiration (ACCOUGH-P/A), (2) swallowing scores, (3) voice features and (4) aerodynamic cough features. DISCUSSION: This study is expected to develop methods of acoustic cough analysis to enhance the assessment of radiation-associated dysphagia in head and neck cancer patients following (chemo)radiation. TRIAL REGISTRATION: International Standard Randomized Controlled Trials Number (ISRCTN) registry ISRCTN16540497. Accepted on 23 June 2023.

Assessment of cough in head and neck cancer patients at risk for dysphagia-An overview.

BACKGROUND: This literature review explores the terminology, the neurophysiology, and the assessment of cough in general, in the framework of dysphagia and regarding head and neck cancer patients at risk for dysphagia. In the dysphagic population, cough is currently assessed perceptually during a clinical swallowing evaluation or aerodynamically. RECENT FINDINGS: Recent findings have shown intra and inter-rater disagreements regarding perceptual scoring of cough. Also, aerodynamic measurements are impractical in a routine bedside assessment. Coughing, however, is considered to be a clinically relevant sign of aspiration and dysphagia in head and cancer patients treated with concurrent chemoradiotherapy. CONCLUSION: This article surveys the literature regarding the established cough assessment and stresses the need to implement innovative methods for assessing cough in head and neck cancer patients treated with concurrent chemoradiotherapy at risk for dysphagia.

Patient-reported and proxy-reported outcome measures for the assessment of health-related quality of life among patients receiving enteral feeding: a systematic review protocol.

REVIEW QUESTION/OBJECTIVE: The objective is to systematically review the psychometric properties and the clinical utility of patient-reported outcome measures (PROMs) and proxy-reported outcome measures that assess health-related quality of life (HRQoL) among patients receiving enteral feeding to make recommendations for use in clinical practice and research. The purpose of this systematic review is to evaluate the psychometric properties and the clinical utility of:The research question is: What are the psychometric properties and the clinical utility of these measures? We will summarize evidence on the following properties: validity (content validity, criterion-related validity, construct validity, floor and ceiling effects), reliability (reproducibility and internal consistency) and responsiveness and clinical utility (interpretability and feasibility to complete the PROM and the proxy-reported outcome measure).

Oral health screening: feasibility and reliability of the oral health assessment tool as used by speech pathologists.

BACKGROUND: The aim of this study was to investigate the feasibility and reliability of the Oral Health Assessment Tool (OHAT) as used by speech pathologists, to become part of a comprehensive clinical swallowing examination. METHODS: A multicentre study in 132 elderly subjects was conducted by speech pathologists. The inter-rater, test-retest and intra-rater reliabilities of the OHAT were assessed in R statistics, version 3.0.1. Intraclass correlation coefficients (ICCs) were used for the total OHAT, and Kappa statistics were used for the individual categories. RESULTS: Total OHAT scores showed good inter-rater (ICC = 0.96), intra-rater (ICC ≥ 0.95) and test-retest (ICC ≥ 0.78) agreement. The inter-rater Kappa statistics were almost perfect (κ ≥ 0.83) for seven of the eight individual categories of the OHAT and perfect for 'dental pain' (κ = 1.00). The test-retest Kappa statistics indicated excellent agreement for 'natural teeth' and 'dentures' (κ ≥ 0.86). The intra-rater per cent agreement was excellent for all categories except 'gums and tissues'. CONCLUSIONS: This is the first study to examine the feasibility and reliability of the OHAT as used by speech pathologists. As the results showed both good feasibility and reliability, the OHAT has the potential to add to the clinical swallowing examination. However, future research investigating actual referral strategies and adaptation of care strategies following assessment with OHAT is needed.

Assessment of voice quality: Current state-of-the-art.

Voice quality is not clearly defined but it can be concluded that it is a multidimensional perceived construct. Therefore, there are broadly two approaches to measure voice quality: (1) subjective measurements to score a client's voice that reflects his or her judgment of the voice and (2) objective measurements by applying specific algorithm to quantify certain aspects of a correlate of vocal production. This paper proposes a collection and discusses a number of critical issues of the current state-of-the-art in voice quality assessments of auditory-perceptual judgment, objective-acoustic analysis and aerodynamic measurements in clinical practice and research that maybe helpful for clinicians and researchers.

Characteristics of a Dysphonic Population Referred for Voice Assessment and/or Voice Therapy.

OBJECTIVE: The aim of this study was to define patient characteristics of a dysphonic population in terms of voice disorder, gender, age, and subjective and objective vocal parameters and to explore the relevant characteristics of the most frequent groups of voice disorders. PATIENTS AND METHODS: Patient records from 4,447 subjects referred for voice assessment and/or voice therapy were analyzed. RESULTS: Significantly more cases of dysphonia were structural as compared to nonstructural. This significant difference was found in almost all age groups. Significantly more women were diagnosed with dysphonia than men. The most common symptom was light-to-moderate hoarseness. The average voice handicap index was 31 and the average dysphonia severity index was -0.6. Vocal fold nodules (VFN), functional voice disorders (FVD) and vocal fold paralysis (VFP) were the three most frequently diagnosed vocal pathologies and were analyzed in detail. Women were found to be significantly more vulnerable to FVD, VFN and cysts, whereas men were significantly more often diagnosed with carcinoma, hyperkeratosis, laryngitis, papillomatosis, presbyphonia, puberphonia and VFP. CONCLUSIONS: The results of this study allow a better estimation of the clinical needs and costs for a specific dysphonic population looking for help and highlight the gender-related risks of specific voice disorders.

Assessment of prosodic communicative efficiency in Parkinson's disease as judged by professional listeners.

This study examines the impact of Parkinson's disease (PD) on communicative efficiency conveyed through prosody. A new assessment method for evaluating productive prosodic skills in Dutch speaking dysarthric patients was devised and tested on 36 individuals (18 controls, 18 PD patients). Three professional listeners judged the intended meanings in four communicative functions of Dutch prosody: Boundary Marking, Focus, Sentence Typing, and Emotional Prosody. Each function was tested through reading and imitation. Interrater agreement was calculated. Results indicated that healthy speakers, compared to PD patients, performed significantly better on imitation of Boundary Marking, Focus, and Sentence Typing. PD patients with a moderate or severe dysarthria performed significantly worse on imitation of Focus than on reading of Focus. No significant differences were found for Emotional Prosody. Judges agreed well on all tasks except Emotional Prosody. Future research will focus on elaborating the assessment and on developing a therapy programme paralleling the assessment.

The Acoustic Voice Quality Index: toward improved treatment outcomes assessment in voice disorders.

UNLABELLED: Voice practitioners require an objective index of dysphonia severity as a means to reliably track treatment outcomes. To ensure ecological validity however, such a measure should survey both sustained vowels and continuous speech. In an earlier study, a multivariate acoustic model referred to as the Acoustic Voice Quality Index (AVQI), consisting of a weighted combination of 6 time-, frequency- and quefrency-domain metrics, was developed to measure dysphonia severity in both speaking tasks. In the current investigation, the generalizability and clinical utility of the AVQI are evaluated by first assessing its external cross-validity and then determining its sensitivity to change in dysphonia severity following surgical and/or behavioral voice treatment. The results, based upon a new set of normal and disordered voices compared favorably with outcomes reported earlier, indicating acceptable external validity. Furthermore, the AVQI was sensitive to treatment-related changes, validating its role as a potentially robust and objective voice treatment outcomes measure. LEARNING OUTCOMES: Readers will be able to: (1) explain methodological issues surrounding the development of voice treatment outcomes measures (such as external cross-validity and responsiveness to change), (2) appreciate the relevance of measuring dysphonia severity in both sustained vowels and connected speech, (3) describe the method of obtaining the Acoustic Voice Quality Index (AVQI), (4) appreciate differences among a variety of estimates of diagnostic accuracy, and (5) discuss the AVQI as a clinically valid treatment outcomes measure.

Speech technology-based assessment of phoneme intelligibility in dysarthria.

BACKGROUND: Currently, clinicians mainly rely on perceptual judgements to assess intelligibility of dysarthric speech. Although often highly reliable, this procedure is subjective with a lot of intrinsic variables. Therefore, certain benefits can be expected from a speech technology-based intelligibility assessment. Previous attempts to develop an automated intelligibility assessment mainly relied on automatic speech recognition (ASR) systems that were trained to recognize the speech of persons without known impairments. In this paper automatic speech alignment (ASA) systems are used instead. In addition, previous attempts only made use of phonemic features (PMF). However, since articulation is an important contributing factor to intelligibility of dysarthric speech and since phonological features (PLF) are shared by multiple phonemes, phonological features may be more appropriate to characterize and identify dysarthric phonemes. AIMS: To investigate the reliability of objective phoneme intelligibility scores obtained by three types of intelligibility models: models using only phonemic features (yielded by an automated speech aligner) (PMF models), models using only phonological features (PLF models), and models using a combination of phonemic and phonological features (PMF + PLF models). METHODS & PROCEDURES: Correlations were calculated between the objective phoneme intelligibility scores of 60 dysarthric speakers and the corresponding perceptual phoneme intelligibility scores obtained by a standardized perceptual phoneme intelligibility assessment. OUTCOMES & RESULTS: The correlations between the objective and perceptual intelligibility scores range from 0.793 for the PMF models, over 0.828 for PLF models to 0.943 for PMF + PLF models. The features selected to obtain such high correlations can be divided into six main subgroups: (1) vowel-related phonemic and phonological features, (2) lateral-related features, (3) silence-related features, (4) fricative-related features, (5) velar-related features and (6) plosive-related features. CONCLUSIONS & IMPLICATIONS: The phoneme intelligibility scores of dysarthric speakers obtained by the three investigated intelligibility model types are reliable. The highest correlation between the perceptual and objective intelligibility scores was found for models combining phonemic and phonological features. The intelligibility scoring system is now ready to be implemented in a clinical tool.

Reliability and clinical relevance of segmental analysis based on intelligibility assessment.

OBJECTIVE: In persons with a speech pathology, improved intelligibility is the fundamental goal of treatment. Identification of specific phonetic features that affect intelligibility, contributes to selecting intervention targets. The main purpose of this study was to investigate whether a segmental analysis based on a perceptual phoneme intelligibility assessment is reliable and can be used for target selection. Secondly, the hypothesis that the degree of agreement for phoneme identification may depend on the intelligibility of the speaker is addressed. PATIENTS AND METHODS: 30 patients with pathological speech (11 dysarthric, 10 hearing impaired, 9 laryngectomees) were assessed by means of a standardized phoneme intelligibility assessment. The samples were judged twice by 9 experienced listeners. The inter- and intra-rater reliability for each test item were examined. RESULTS: The inter-rater reliability per patient for phoneme identification varied between fair and almost perfect (k: 0.24-0.89). The higher the patient's intelligibility, the higher the level of agreement (p < 0.001). The intra-rater reliability for phoneme identification across all patients was good (k: 0.603-0.787). CONCLUSION: A segmental analysis based on a phoneme intelligibility assessment is only reliable and clinically relevant in patients with a slightly to moderately decreased overall intelligibility level.