French-Language Adaptation of the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V).

OBJECTIVES: This study aimed to adapt the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) protocol for perceptual voice assessment to the French language. The primary objective was to achieve consensus among an international panel of voice experts on the content of the adapted protocol. METHODS: To ensure the relevance and robustness of the French CAPE-V protocol, this study employed a systematic Delphi method and involved an international panel primarily comprising speech therapists and lecturers from France and Belgium. The multi-stage process included an initial panel size of 15 experts. Three rounds of online questionnaires, integrating both quantitative and qualitative data collection, were conducted. Participants provided feedback and ratings on various protocol elements until a consensus was reached. Adaptations targeted the choice of task stimuli (sustained vowel, sentence reading, semi-spontaneous speech), of the rating scales, and vocal quality terminology. RESULTS: The Delphi process achieved consensus on all elements of the adapted CAPE-V protocol. Notably, the sustained vowel task saw consensus in favor of the vowel /a/. Sentence adaptations achieved substantial agreement, with the final set unanimously approved. The simple Visual Analog Scale emerged as the preferred rating scale. Agreement on terms for describing vocal qualities marked a crucial step in establishing a shared vocabulary among French-speaking voice experts. CONCLUSIONS: The study successfully adapted the CAPE-V protocol for perceptual voice assessment to the French language through a systematic Delphi process. The final protocol closely resembles the original English version, maintaining its structure and core objectives. Consensus on sustained vowel tasks, sentence adaptations, rating scales, and vocal quality terminology indicates the relevance and robustness of the adapted protocol. Ongoing validation studies in France demonstrate the potential clinical utility of the adapted CAPE-V in French-speaking contexts, representing a significant step toward standardized and validated voice assessment tools for clinicians and researchers globally.

Validation of automated pipeline for the assessment of a motor speech disorder in amyotrophic lateral sclerosis (ALS).

Background and objective: Amyotrophic lateral sclerosis (ALS) frequently causes speech impairments, which can be valuable early indicators of decline. Automated acoustic assessment of speech in ALS is attractive, and there is a pressing need to validate such tools in line with best practices, including analytical and clinical validation. We hypothesized that data analysis using a novel speech assessment pipeline would correspond strongly to analyses performed using lab-standard practices and that acoustic features from the novel pipeline would correspond to clinical outcomes of interest in ALS. Methods: We analyzed data from three standard speech assessment tasks (i.e., vowel phonation, passage reading, and diadochokinesis) in 122 ALS patients. Data were analyzed automatically using a pipeline developed by Winterlight Labs, which yielded 53 acoustic features. First, for analytical validation, data were analyzed using a lab-standard analysis pipeline for comparison. This was followed by univariate analysis (Spearman correlations between individual features in Winterlight and in-lab datasets) and multivariate analysis (sparse canonical correlation analysis (SCCA)). Subsequently, clinical validation was performed. This included univariate analysis (Spearman correlation between automated acoustic features and clinical measures) and multivariate analysis (interpretable autoencoder-based dimensionality reduction). Results: Analytical validity was demonstrated by substantial univariate correlations (Spearman's ρ > 0.70) between corresponding pairs of features from automated and lab-based datasets, as well as interpretable SCCA feature groups. Clinical validity was supported by strong univariate correlations between automated features and clinical measures (Spearman's ρ > 0.70), as well as associations between multivariate outputs and clinical measures. Conclusion: This novel, automated speech assessment feature set demonstrates substantial promise as a valid tool for analyzing impaired speech in ALS patients and for the further development of these technologies.

Criteria for creating new standard reading passages for the assessment of speech and voice: A Delphi consensus study.

Standard reading passages allow for the study of the integrated functions of speech and voice components in contextual, running speech, with target stimuli in a controlled environment. In both clinical practice and research, these texts provide rapid insight into the characteristics of the patient's speech, with fewer hesitations than in conversational speech and better predictability by the evaluator. Although a plethora of texts exist in different languages, they present various limitations. A specifically created standardised text in each language allowing for an ecological assessment of speech and voice functions, meeting most required criteria for standard speech and voice assessment and adapted to the target language's cultural and linguistic specificities, would therefore be an interesting option. However, no guidelines exist for the creation of such a reading passage. This article describes the international Delphi consensus study carried out to identify a minimal set of criteria to take into account when creating standard reading passages for an overall speech and voice assessment in adolescents and adults. This survey was conducted in three consecutive rounds; forty experts participated in the first round, with a total dropout of 17% from round 1 to round 3. It results in a minimal set of ten criteria which were selected by a majority of the experts and were rated as most important. This set contains five phoneme-level, two word-level, two sentence-level criteria and one global-level criterion. It can be used as a general guideline for the creation of standard reading passages in Indo-European Romance and Germanic languages such as English, French and German. The construction of a new reading passage in French following this guideline is briefly described.

Development and Preliminary Validation of the Questionnaire "Evaluation of the Constitution of Social Circles" in Patients Treated for Cancer of the Upper Aerodigestive Tract.

PURPOSE: The constitution of social circles around patients treated for cancer of the upper aerodigestive tract (UADT) has a major influence on factors that affect quality of life (QOL) but is poorly assessed, mainly due to a lack of tools. The objective of this study is to develop a questionnaire that assesses the constitution of social circles in a population treated for UADT cancer and to analyze the construct (structural and clinical validity) and criterion validity. METHODS: The Evaluation of the Constitution of Social Circles (ECSC) questionnaire was developed in French by a committee of experts. Structural validity was analyzed using inter-item correlations. The scores of a group of patients treated for UADT cancer were compared with those of a group of healthy subjects (clinical validity). For criterion validity, the ECSC scores were compared to those from various questionnaires that assess social functioning (QFS), psychological status (HAD), perceived speech impairment (PHI), and QOL (EORTC QLQ-H&N35) in patients. RESULTS: Structural validity shows low to moderate inter-item correlations which is consistent with the construction of the questionnaire not assessing underlying concepts. Clinical validity was satisfactory regarding the frequency of contact (p = 0.01), satisfaction with the frequency of contact in the private circle (p = 0.03), and the size of the social circles of family and friends (p ≤ 0.01). Criterion validity was adequate with moderate correlations between the ECSC scores and the QFS sub-scores of interest (rs > 0.56, p < 0.05). Anxiety (HAD) had a low correlation (|rs| = 0.46, p < 0.05) with satisfaction with exchanges and the frequency of contact with family. Satisfaction with exchanges with the private circle was moderately correlated with the EORTC QLQ-H&N35 score (rs = 0.56, p = 0.01) and showed a negative trend on the PHI (rs < -0.39, p ≥ 0.05). CONCLUSION: While the test-retest reliability is yet to be evaluated and the sample size should be increased, this preliminary study shows that the ECSC is a valid tool for assessing the constitution of social circles in patients treated for UADT cancer. It highlights the links between social circles and their functional impact on communication and QOL.

Voice Quality in Telephone Interviews: A preliminary Acoustic Investigation.

OBJECTIVES: To investigate the impact of standardized mobile phone recordings passed through a telecom channel on acoustic markers of voice quality and on its perception by voice experts in normophonic speakers. METHODS: Continuous speech and a sustained vowel were recorded for fourteen female and ten male normophonic speakers. The recordings were done simultaneously with a head-mounted high-quality microphone and through the telephone network on a receiving smartphone. Twenty-two acoustic voice quality, breathiness and pitch-related measures were extracted from the recordings. Nine vocologists perceptually rated the G, R and B parameters of the GRBAS scale on each voice sample. The reproducibility, the recording type, the stimulus type and the gender effects, as well as the correlation between acoustic and perceptual measures were investigated. RESULTS: The sustained vowel samples are damped after one second. Only the frequencies between 100 and 3700Hz are passed through the telecom channel and the frequency response is characterized by peaks and troughs. The acoustic measures show a good reproducibility over the three repetitions. All measures significantly differ between the recording types, except for the local jitter, the harmonics-to-noise ratio by Dejonckere and Lebacq, the period standard deviation and all six pitch measures. The AVQI score is higher in telephone recordings, while the ABI score is lower. Significant differences between genders are also found for most of the measures; while the AVQI is similar in men and women, the ABI is higher in women in both recording types. For the perceptual assessment, the interrater agreement is rather low, while the reproducibility over the three repetitions is good. Few significant differences between recording types are observed, except for lower breathiness ratings on telephone recordings. G ratings are significantly more severe on the sustained vowel on both recording types, R ratings only on telephone recordings. While roughness is rated higher in men on telephone recordings by most experts, no gender effect is observed for breathiness on either recording types. Finally, neither the AVQI nor the ABI yield strong correlations with any of the perceptual parameters. CONCLUSIONS: Our results show that passing a voice signal through a telecom channel induces filter and noise effects that limit the use of common acoustic voice quality measures and indexes. The AVQI and ABI are both significantly impacted by the recording type. The most reliable acoustic measures seem to be pitch perturbation (local jitter and period standard deviation) as well as the harmonics-to-noise ratio from Dejonckere and Lebacq. Our results also underline that raters are not equally sensitive to the various factors, including the recording type, the stimulus type and the gender effects. Neither of the three perceptual parameters G, R and B seem to be reliably measurable on telephone recordings using the two investigated acoustic indexes. Future studies investigating the impact of voice quality in telephone conversations should thus focus on acoustic measures on continuous speech samples that are limited to the frequency response of the telecom channel and that are not too sensitive to environmental and additive noise.

Neurostimulation in People with Oropharyngeal Dysphagia: A Systematic Review and Meta-Analysis of Randomised Controlled Trials-Part II: Brain Neurostimulation.

Objective. To assess the effects of brain neurostimulation (i.e., repetitive transcranial magnetic stimulation [rTMS] and transcranial direct current stimulation [tDCS]) in people with oropharyngeal dysphagia (OD). Methods. Systematic literature searches were conducted in four electronic databases (CINAHL, Embase, PsycINFO, and PubMed) to retrieve randomised controlled trials (RCTs) only. Using the Revised Cochrane risk-of-bias tool for randomised trials (RoB 2), the methodological quality of included studies was evaluated, after which meta-analysis was conducted using a random-effects model. Results. In total, 24 studies reporting on brain neurostimulation were included: 11 studies on rTMS, 9 studies on tDCS, and 4 studies on combined neurostimulation interventions. Overall, within-group meta-analysis and between-group analysis for rTMS identified significant large and small effects in favour of stimulation, respectively. For tDCS, overall within-group analysis and between-group analysis identified significant large and moderate effects in favour of stimulation, respectively. Conclusion. Both rTMS and tDCS show promising effects in people with oropharyngeal dysphagia. However, comparisons between studies were challenging due to high heterogeneity in stimulation protocols and experimental parameters, potential moderators, and inconsistent methodological reporting. Generalisations of meta-analyses need to be interpreted with care. Future research should include large RCTs using standard protocols and reporting guidelines as achieved by international consensus.

Behavioural Interventions in People with Oropharyngeal Dysphagia: A Systematic Review and Meta-Analysis of Randomised Clinical Trials.

OBJECTIVE: To determine the effects of behavioural interventions in people with oropharyngeal dysphagia. METHODS: Systematic literature searches were conducted to retrieve randomized controlled trials in four different databases (CINAHL, Embase, PsycINFO, and PubMed). The methodological quality of eligible articles was assessed using the Revised Cochrane risk-of-bias tool for randomised trials (RoB 2), after which meta-analyses were performed using a random-effects model. RESULTS: A total of 37 studies were included. Overall, a significant, large pre-post interventions effect size was found. To compare different types of interventions, all behavioural interventions and conventional dysphagia treatment comparison groups were categorised into compensatory, rehabilitative, and combined compensatory and rehabilitative interventions. Overall, significant treatment effects were identified favouring behavioural interventions. In particular, large effect sizes were found when comparing rehabilitative interventions with no dysphagia treatment, and combined interventions with compensatory conventional dysphagia treatment. When comparing selected interventions versus conventional dysphagia treatment, significant, large effect sizes were found in favour of Shaker exercise, chin tuck against resistance exercise, and expiratory muscle strength training. CONCLUSIONS: Behavioural interventions show promising effects in people with oropharyngeal dysphagia. However, due to high heterogeneity between studies, generalisations of meta-analyses need to be interpreted with care.

Assessment of adult speech disorders: current situation and needs in French-speaking clinical practice.

INTRODUCTION: Speech assessment methods used in clinical practice are varied and mainly perceptual and motor. Reliable assessment of speech disorders is essential for the tailoring of the patient's treatment plan. OBJECTIVE: To describe current clinical practices and identify the shortcomings and needs reported by French-speaking clinicians regarding the assessment of speech disorders in adult patients. METHODS: Data were collected using an online questionnaire for French-speaking speech and language pathologists (SLPs) in Belgium, France, Switzerland, Luxembourg, and Maghreb. Forty-nine questions were grouped into six domains: participant data, educational and occupational background, experience with speech disorders, patient population, tools and tasks for speech assessment, and possible lacks regarding the current assessment of speech disorders. RESULTS: Responses from 119 clinicians were included in the analyses. SLPs generally use "à la carte" assessment with a large variety of tasks and speech samples. About one quarter of them do not use existing assessment batteries. Those who do mostly use them partially. Pseudo-words are rarely used and are absent from standardized batteries, in contrast to the major use of words and sentences. Perceptual evaluation largely prevails (mainly overall ratings of speech "intelligibility", "severity," and "comprehensibility" and percent-correct phonemes), whereas the recording equipment for acoustic measures is not standardized and only scarcely described by the SLPs. The most commonly used questionnaire to assess the functional impact of the speech disorder is the Voice Handicap Index; one quarter of the SLPs does not use any questionnaire. Overall, the available tools are considered only moderately satisfactory. The main reported shortcomings are a lack of objectivity and reproducibility of speech measures; exhaustiveness and consideration of specific speech parameters (prosody, speech rate, and nasality); practicality of the assessment tools. CONCLUSION: This study highlights a lack of standardization of the speech assessment in French-speaking adults and the need to offer new reliable tools for an optimized, accurate speech assessment. The automation of these tools would allow for rapid, reproducible, and accurate measures.

Intelligibility and comprehensibility: A Delphi consensus study.

BACKGROUND: Intelligibility and comprehensibility in speech disorders can be assessed both perceptually and instrumentally, but a lack of consensus exists regarding the terminology and related speech measures in both the clinical and scientific fields. AIMS: To draw up a more consensual definition of intelligibility and comprehensibility and to define which assessment methods relate to both concepts, as part of their definition. METHODS & PROCEDURES: A three-round modified Delphi consensus study was carried out among clinicians, researchers and lecturers engaged in activities in speech disorders. OUTCOMES & RESULTS: Forty international experts from different fields (mainly clinicians, linguists and computer scientists) participated in the elaboration of a comprehensive definition of intelligibility and comprehensibility and their assessment. While both concepts are linked and contribute to functional human communication, they relate to two different reconstruction levels of the transmitted speech material. Intelligibility refers to the acoustic-phonetic decoding of the utterance, while comprehensibility relates to the reconstruction of the meaning of the message. Consequently, the perceptual assessment of intelligibility requires the use of unpredictable speech material (pseudo-words, minimal word pairs, unpredictable sentences), whereas comprehensibility assessment is meaning and context related and entails more functional speech stimuli and tasks. CONCLUSION & IMPLICATIONS: This consensus study provides the scientific and clinical communities with a better understanding of intelligibility and comprehensibility. A comprehensive definition was drafted, including specifications regarding the tasks that best fit their assessment. The outcome has implications for both clinical practice and scientific research, as the disambiguation improves communication between professionals and thereby increases the efficiency of patient assessment and care and benefits the progress of research as well as research translation. WHAT THIS PAPER ADDS: What is already known on the subject Intelligibility and comprehensibility in speech disorders can be assessed both perceptually and instrumentally, but a lack of consensus exists regarding the terminology and related speech measures in both the clinical and scientific fields. What this paper adds to existing knowledge This consensus study allowed for a more consensual and comprehensive definition of intelligibility and comprehensibility and their assessment, for clinicians and researchers. The terminological disambiguation helps to improve communication between experts in the field of speech disorders and thereby benefits the progress of research as well as research translation. What are the potential or actual clinical implications of this work? Unambiguous communication between professionals, for example, in a multidisciplinary team, allows for the improvement in the efficiency of patient care. Furthermore, this study allowed the assessment tasks that best fit the definition of both intelligibility and comprehensibility to be specified, thereby providing valuable information to improve speech disorder assessment and its standardization.

The Acoustic Voice Quality Index, Version 03.01, in French and the Voice Handicap Index.

OBJECTIVES: The Acoustic Voice Quality Index (AVQI), version 03.01, is a tool for quantitative assessment of the overall severity of dysphonia. Its computation includes six acoustic parameters, which are all analyzed with Praat freeware. It is based on recordings of a sustained vowel and part of a text read aloud. The psychometric qualities of this tool in various languages, including French, have been confirmed by numerous publications. However, studies investigating the correlation between tools for objective vocal assessment and voice-related quality of life show inconsistent results. Hence, the aim of this study was to contribute to the debate on measuring the correlations between the AVQI 03.01 score computed on French samples and the Voice Handicap Index (VHI). METHODS: Data from 78 patients were used; they were collected during initial vocal assessment and stored in the ear, nose, and throat caseload database of the University Hospital of Liège. The Spearman rank-order correlations (rs) between the VHI total score and subscores and the AVQI 03.01 scores for French samples were measured. The correlation between the diagnostic decisions ("normophonia" versus "dysphonia") of both tools was assessed using Cramer's phi. RESULTS: The Spearman correlation between AVQI 03.01 score and total VHI score, controlling for age, was moderate (rs = 0.62, P < 0.0001). The correlations between the AVQI 03.01 score and the functional, emotional, and physical subscores of the VHI were also moderate (rs = 0.643, 0.543, and 0.514, respectively, P < 0.0001). The correlation between the two instruments' diagnostic decisions ("normophonia" versus "dysphonia") was also moderate (φ = 0.52, P = 0.000). CONCLUSIONS: Although AVQI 03.01 scores were moderately correlated with the VHI total score and subscores, they measure two different things. The AVQI 03.01 assesses overall voice quality in terms of acoustic parameters, whereas the VHI assesses the multidetermined impact on the patient's everyday life. Both results should thus be taken into account, as part of a comprehensive vocal assessment.

Validation of the Acoustic Voice Quality Index, Version 03.01, in French.

OBJECTIVES: The Acoustic Voice Quality Index (AVQI), version 03.01, is a tool for quantitative assessment of the overall severity of dysphonia. It is based on the recordings of a sustained vowel and part of a text read aloud. For the Dutch sample, 34 syllables must be read aloud to balance the duration of the two tasks. The first part of this study thus aimed to determine how many syllables of a commonly used text in the French-speaking part of Belgium should be used to achieve the same balance. The psychometric qualities of the AVQI have been confirmed by numerous publications in various languages. However, its validation in French relies on a small cohort of patients, who were not native French speakers. Furthermore, version 03.01 of the AVQI has not yet been validated at all on French samples. Hence, the main aim of this study was to assess the criterion-related concurrent validity and diagnostic accuracy of the AVQI 03.01 applied to a sample of native French speakers. METHODS: For the first part of this study, the optimal part of the text to be used for the AVQI was identified, taking into account both its phonemic contents and its time balance with the sustained vowel. For the validation study, 90 recordings from the University Hospital of Liège's ENT caseload database were used, as well as 30 new recordings of normophonic individuals, composing a control group. Four judges assessed the recordings using the G parameter of the GRBAS scale. Once the intra- and inter-rater reliability of the perceptual ratings was confirmed, the AVQI 03.01's criterion validity was assessed on the French sample. The diagnostic accuracy of the AVQI 03.01 in French was measured, and the cut-off score allowing for the greatest diagnostic precision determined. RESULTS: The most appropriate syllable number of the text to be read aloud was found to be 27, in order to balance the time analyzed for both the sustained vowel and the continuous speech. Regarding the validation study, intra-rater reliability was substantial for each of the four vocologists (κmean = .778, P < 0.0001), and inter-rater reliability was high (W = .895, P < 0.0001). The Spearman correlation between the perceptual judgments and the AVQI 03.01 score was strong (rs = .84, P < 0.0001). The receiver operating characteristic-curve parameters indicated that the ideal cut-off score allowing for the highest diagnostic accuracy of the AVQI, version 03.01, applied to a French sample is 2.33, with a sensitivity of 59.8%, a specificity of 100%, an infinite positive likelihood ratio (LR+) and a negative likelihood ratio (LR-) of 0.4. CONCLUSIONS: This study confirms the external validity of the AVQI 03.01 when applied on a French 27-syllable sample. The AVQI 03.01 is a robust, ecologically valid objective measure of overall voice quality. The cut-off score to be used is 2.33. However, clinicians should be cautious when the AVQI score is lower than 2.33. The AVQI 03.01 does not yield a sufficiently low negative likelihood ratio to be sure that this score indeed indicates normophonia. Also, taking into account the limitations regarding the perceptual judgements used in this study, a replication study should be carried out in order to confirm the cut-off score.

Effects of oral and oropharyngeal cancer on speech intelligibility using acoustic analysis: Systematic review.

BACKGROUND: The development of automatic tools based on acoustic analysis allows to overcome the limitations of perceptual assessment for patients with head and neck cancer. The aim of this study is to provide a systematic review of literature describing the effects of oral and oropharyngeal cancer on speech intelligibility using acoustic analysis. METHODS: Two databases (PubMed and Embase) were surveyed. The selection process, according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement, led to a final set of 22 articles. RESULTS: Nasalance is studied mainly in oropharyngeal patients. The vowels are mostly studied using formant analysis and vowel space area, the consonants by means of spectral moments with specific parameters according to their phonetic characteristic. Machine learning methods allow classifying "intelligible" or "unintelligible" speech for T3 or T4 tumors. CONCLUSIONS: The development of comprehensive models combining different acoustic measures would allow a better consideration of the functional impact of the speech disorder.