Sociodemographic Characteristics of People in Leadership Positions of Graduate Programs in Communication Sciences and Disorders.

OBJECTIVES: Knowledge associated with the construct of leadership and the sociodemographic profiles of those in leadership positions within academic communication sciences and disorders (COSD) programs in the United States is limited. The purpose of this study was to investigate the sociodemographic profiles of people holding department chair and/or program director positions in accredited graduate speech-language pathology (SLP) and audiology (AUD) programs. METHODS: A cross-sectional observational investigation using public information was conducted to profile individuals in leadership positions of academic programs. Tabulated data included program variables (SLP, AUD, or SLP+AUD), degree offered, program level, and national ranking, in addition to sociodemographic variables of the individuals holding a leadership position. A multidimensional statistical analysis was employed to address three research questions examining: (a) the sociodemographic characteristics of people in COSD leadership positions, (b) gender distribution within leadership positions, and (c) national ranking of institutions from which leaders obtained their terminal degree. RESULTS: Data were acquired from 502 people holding a department chair or program director positions at 305 universities, representing 98% of all accredited graduate programs. Over 80% of leaders held a research doctorate (PhD) in COSD, and a large majority of all leadership positions were in standalone academic departments. A greater proportion of males held leadership positions when compared to the distribution of male members of the American Speech-Language-Hearing Association (ASHA), but the proportion of male academic leaders was equivalent to their representation among all male COSD faculty (20%). A larger proportion of academic COSD leaders tended to have earned their terminal degree from a highly ranked academic program. CONCLUSIONS: This study illuminates the current profiles of those in leadership positions of academic graduate programs in COSD. Given the critical shortage of qualified faculty to staff accredited COSD programs, findings from this study may inform potential solutions to the problem of faculty sufficiency to assume leadership roles.

Laryngeal symptoms related to motor phenotypes in Parkinson's disease: A systematic review.

Objective: This study aimed to systematically review the associations between motor clinical phenotypes in Parkinson's disease (PD) and laryngeal disease symptoms. Laryngeal dysfunctions such as dysphonia and dysphagia are ubiquitous in people with Parkinson's disease (PwPD). Similar to other disease symptoms, they manifest variably across PwPD. Some of the variability within PD has been explained by clinical phenotypes. However, it is unclear how laryngeal symptoms of PD express themselves across these phenotypes. Methods: Five databases were searched (MEDLINE, CINAHL, Web of Science, Embase, Scopus) in May 2022. After the removal of duplicates, all retrieved records were screened. Cohort, case-control, and cross-sectional studies in English discussing laryngeal symptoms and clinical PD phenotypes were included. Data were extracted, tabulated, and assessed using Moola et al.'s (2021) appraisal tool for systematic reviews of risk and etiology. Results: The search retrieved 2370 records, representing 540 PwPD. After the removal of duplicates and screening, eight articles were included for review. The most common phenotype categories were tremor-dominant and postural-instability gait disordered (PIGD). Five studies addressed vocal characteristics, while four considered swallowing. Differences and lack of rigor in methodology across studies complicated conclusions, but a tendency for tremor-dominant phenotypes to present with less severe laryngeal symptoms was found. Conclusion: Some minor differences in laryngeal function were found between tremor-dominant and PIGD phenotypes in PD. However, there is a need for more standardized and high-quality studies when comparing motor phenotypes for laryngeal function.

A Pilot Study of the Effect of a Non-Contact Boxing Exercise Intervention on Respiratory Pressure and Phonation Aerodynamics in People with Parkinson's Disease.

This study investigated the effects of a non-contact boxing exercise program on maximum expiratory pressure and aerodynamic voice measurements. METHODS: Eight adult males diagnosed with Parkinson's disease participated in the study. Individuals participated in twice-weekly exercise classes lasting one hour across 12-months. Dependent variables were measured on three baseline days and then at six additional time points. A pressure meter acquired maximum expiratory pressure, and a pneumotachograph system acquired transglottal airflow and subglottal air pressure. RESULTS: Measures of average maximum expiratory pressure significantly increased after 9- and 12- months of exercise when compared to baseline. There was an increasing trend for these measures in all participants, with a corresponding large effect size. Measures of transglottal airflow and subglottal pressure did not change over the course of 9- or 12-months, although their stability may indicate that the exercise program influenced maintenance of respiratory-phonatory coordination during voicing. CONCLUSIONS: A non-contact boxing exercise program had a significant effect on maximum expiratory pressure in people with Parkinson's disease. The aerobic nature of the program and challenges to the respiratory muscles potentially explain the "ingredient" causing this effect. The small sample size of this pilot study necessitates future research incorporating larger and more diverse participants.

Clinical practice patterns of speech-language pathologists for screening and identifying dysphagia.

PURPOSE: To identify how speech-language pathologists (SLPs) in the United States are screening for and identifying dysphagia. To do this, we examined the approaches most often used to screen for dysphagia and the influence of contextual factors such as setting, continuing education and means of staying up to date with the most current literature on screening approaches. METHOD: A web-based survey composed of 32 questions was developed and field tested for content, relevance and workflow. The survey was distributed online, via social media, online SLP forums and through the American Speech-Language-Hearing Association's Special Interest Group 13 (swallowing disorders). One hundred and thirty-seven clinicians from the United States completed the survey and were included for analysis using descriptive statistics and linear regression modelling to assess associations of continuing education and years practicing with screening protocols and consumption of evidence. RESULTS: Respondents worked in a variety of settings, including acute care, skilled nursing facilities, and inpatient rehabilitation. Most respondents worked with adult populations (88%). The most common screening protocols reported were a volume-dependent water swallow test (74%), subjective patient report (66%), and trials of solids/liquids (49%). Twenty-four percent (24%) reported using a questionnaire, the Eating Assessment Tool (80%) being most common. How clinicians consume their evidence was significantly associated with the types of screening approaches used. Continuing education hours were significantly associated with dysphagia screening protocol choice (p < 0.001) and how clinicians stayed up to date with evidence (p < 0.001). CONCLUSIONS: Results from this study provide an in-depth look at the choices clinicians are making in the field regarding how to effectively screen patients for the presence of dysphagia. Contextual factors such as evidence base consumption patterns should serve researchers to continue seeking alternative ways to share evidence with clinicians, accessibly. Associations between continuing education and protocol choice show the need for continued evidence-based and high-quality continuing education opportunities. WHAT THIS PAPER ADDS: This study provides an in-depth look at the choices clinicians are making in the field regarding effective dysphagia screening practices. Clinician screening choices are examined with contextual factors such as evidence base consumption patterns and continuing education. This paper increases knowledge of the most used dysphagia screening practices and context for clinicians and researchers to improve use, evidence and dissemination of best practices.

Self-perceived affective, behavioral, and cognitive reactions associated with voice use in people with Parkinson's disease: a pilot study.

PURPOSE: This study aimed to compare the affective, behavioral, and cognitive reactions related to vocal function in people with Parkinson's disease (PWPD) and healthy controls using the Behavior Assessment Battery - Voice (BAB-Voice). The test's internal consistency was also described. METHODS: 31 PWPD and 19 healthy controls were recruited from September 2020 to March 2021. Participants completed four BAB-Voice subtests: Speech Situation Checklist - Emotional Reaction (SSC-ER), the Speech Situation Checklist - Speech Disruption (SSC-SD), Behavior Checklist (BCL), and Communication Attitude Test for Adults (BigCAT), describing the experienced negative emotional reaction, voice disruptions, coping behaviors, and negative attitude regarding communication respectively. Subtest scores were calculated and analyzed. RESULTS: The scores of the PWPD were significantly different from those of the controls (Pillai's Trace = 0.344, F[4] = 5.508, p = .001, ηp2 = .344): PWPD showed more negative emotions and voice problems, more coping behaviors, and more negative speech-related attitude compared to healthy controls. All subtests showed excellent internal consistency. CONCLUSIONS: The BAB-Voice proved a tool with a good internal consistency that measured different psychosocial reactions in PWPD versus controls. PWPD exhibited significantly more negative emotions and voice problems in specific speech situations, more coping behaviors, and a more negative speech-related attitude. The specificity of information obtained from the BAB-Voice may aid in improving the treatment planning of voice disorders in PWPD.

Partner perception of affective, behavioral, and cognitive reactions to voice use in people with Parkinson's disease.

Introduction: People with Parkinson's disease (PWPD) experience negative feelings, thoughts, and coping behaviors due to the experienced communication challenges. This study aimed to compare the perceptions of PWPD with those of proxies for the affective, behavioral, and cognitive reactions specific to voice production during communicative interactions. Methods: The Behavior Assessment Battery - Voice (BAB-Voice) was administered to 31 PWPD and their close communication partner/proxy. The BAB-Voice contained four subtests: Speech Situation Checklist - Emotional Reaction (SSC-ER), Speech Situation Checklist - Speech Disruption (SSC-SD), Behavior Checklist (BCL), and Communication Attitude Test for Adults (BigCAT). The scores for each of these subtests were calculated and statistically analyzed. Results: A repeated measures MANOVA did not find statistically significant differences between the subscores of PWPD and proxies (Pillai's trace = 0.25, F[4] = 2.22, p =.094, ηp 2  = 0.25). Fair to excellent agreement between the PWPD and proxies was found. The highest agreement was found on the BigCAT (ICC = 0.80). The SSC-SD (ICC = 0.77) and SSC-ER (ICC = 0.71) still showed excellent agreement, while only fair agreement was found for the BCL (ICC = 0.57). Conclusion: Proxies were able to identify the affective, behavioral, and cognitive reactions to voice use in PWPD. Communication partners close to the PWPD could, therefore, provide valuable information regarding the assessment and treatment of hypophonia in PD.

The Degree of Change and Relationship in Self-perceived Handicap and Acoustic Voice Quality Associated With Voice Therapy.

INTRODUCTION: Outcome measures describing acoustic voice quality and self-perceived vocal handicap are commonly used in clinical voice practice. Previous reports of the relationship between acoustic and self-perceived measures have found only limited associations, but it is unclear if acoustic measures associated with voice quality and self-perceived voice handicap change in a similar manner over the course of voice treatment. The current study, therefore, considered the relationship between the degree of change in Acoustic Voice Quality Index (AVQI) and Voice Handicap Index (VHI-30 and VHI-10) in dysphonic patients receiving treatment in a private practice voice clinic. METHODS: Data were collected retrospectively from patient records of a private practice voice clinic over 80 consecutive months. For each patient, their voice disorder diagnosis, age, and biological sex were collected as well as pre-and post-treatment measures of the AVQI and VHI-30 or VHI-10 depending on which version was used. Correlations were calculated between the AVQI and VHI-30 and the AVQI and VHI-10 before and after treatment as well as for the percentage change of AVQI and VHI-30/VHI-10. Friedman and Kruskal-Wallis tests were used to determine the pre-and post-treatment effect and group differences respectively. RESULTS: Seventy-eight patients were included in the analyses. The scores of the AVQI (χ²[1] = 24.01, P < 0.001), VHI-30 (χ²[1] = 18.00, P < 0.001), and VHI-10 (χ²[1] = 38.35, P < 0.001) all improved significantly after treatment. However, correlations between the AVQI and VHI-30, and the AVQI and VHI-10 were all non-significant, except for a moderate correlation between the AVQI and VHI-10 before treatment (r[43] = 0.31, P = 0.04). The percentage change of the AVQI and the VHI-30/VHI-10 did not correlate significantly. CONCLUSIONS: Voice therapy significantly improved acoustic and self-perceived vocal outcome measures. However, there was no significant relationship between these measures before or after treatment, nor was there a relationship in their degree of change. Results support the notion that VHI and AVQI measure unique constructs and that voice therapy can have a positive impact on both.

Perceptual Characterization of Voice Quality in Nonadvanced Stages of Parkinson's Disease.

INTRODUCTION: Parkinson's disease (PD) is a neurodegenerative disorder that impacts motor and nonmotor systems, and consequently influences voice. In later stages of the disease, people with PD develop salient hypokinetic dysarthria. However, it is unclear how extensive the voice impairment is in the nonadvanced stages of PD. Therefore, the aim of the current research was to investigate the auditory-perceptual characteristics of voice in people with Parkinson's disease (PWPD) in nonadvanced stages. METHODS: 29 PWPD and 32 healthy older controls were recruited. For each participant, a recording of the sentence "We were away a year ago" was acquired. These recordings were evaluated by 2 licensed and experienced speech-language pathologists, who provided perceptual ratings of overall dysphonia severity, breathiness, roughness, and perceived age. RESULTS: MANCOVA analysis showed that, when controlling for age and intensity, there was a significant effect of group (P = 0.001) on perceptual voice quality. PWPD were perceived to be significantly older, more breathy and more severely dysphonic than the older healthy controls. No differences were found for the perceived roughness. CONCLUSIONS: The results suggest that perceptual features of hypokinetic dysarthria in voice, specifically breathiness, are present in nonadvanced stages of PWPD and may contribute to listener perceptions of speaker age. Moreover, the perceptual voice profiles in PWPD showed great variability, possibly reflecting the heterogeneity of disease impact on individuals. The results of this study may inform how research targets rehabilitation and maintenance of voice and laryngeal function in PWPD at nonadvanced stages.

Epidemiological Patterns and Treatment Outcomes in a Private Practice Community Voice Clinic.

OBJECTIVES: Voice therapy is administered by speech-language pathologists in multiple practice settings, including private practice community voice clinics. However, the evidence for diagnosis patterns and voice treatment outcomes in community voice clinics is very limited. The purpose of this study was to extend knowledge from a previous investigation by assessing the epidemiological patterns of patient referrals to a private practice community voice clinic across a 4-year period (50 months) and to measure the effectiveness of treatment outcomes for patients who were followed up with voice therapy in the same setting. STUDY DESIGN: Retrospective case series. METHODS: Consecutive patient records from November 2014 through January 2019 were reviewed. Patients were grouped into seven categories of distinctive diagnoses. Descriptive data for each group were extracted to determine epidemiological patterns of disorder diagnosis, voice handicap, voice quality severity, age, and gender. For patients who completed at least three treatment sessions, pre- and posttreatment measurements of two assessments, the Voice Handicap Index (VHI) and the Acoustic Voice Quality Index (AVQI), were extracted and compared using a multivariate analysis of variance. RESULTS: Records from 454 consecutive patient referrals over a 50-month time period were reviewed. The most frequent diagnoses were multifactorial etiologies or those with only a few cases, categorized collectively as an "other" diagnosis category. Diagnoses of nonspecific dysphonia and mid-membranous lesions were also common. Consensus Auditory Perceptual Evaluation of Voice-scale scores were not different among disorders; however, group differences were found for VHI and AVQI. Treatment data were available for 292 patients, with 47 of those patients completing at least three treatment sessions and with data for pre- and posttreatment VHI and AVQI. A mixed multivariate analysis of variance showed a significant effect of treatment (Wilks' Lambda = 0.42, F[2] = 27.58, P < 0.001, ƞp² = 0.58), where both AVQI and VHI improved significantly across the pre- to posttreatment measurements. CONCLUSIONS: Patient characteristics and diagnosis patterns across a 50-month period were similar when compared to a previous study that investigated epidemiological patterns in this clinic across 28 months. Voice therapy administered in this community voice clinic to patients with varied diagnoses was found to be effective based on changes in VHI and AVQI measurements.

Oral Myofunctional and Articulation Disorders in Children with Malocclusions: A Systematic Review.

BACKGROUND: Relationships between malocclusion and orofacial myofunctional disorders (OMD), as well as malocclusions and articulation disorders (AD) have been described, though the exact relationships remain unclear. Given the high prevalence of these disorders in children, more clarity is needed. SUMMARY: The purpose of this study was to determine the association between OMD (specifically, bruxism, deviate swallowing, caudal resting tongue posture, and biting habits), AD, and malocclusions in children and adolescents aged between 3 and 18 years. To conduct a systematic review, 4 databases were searched (MEDLINE, Embase, Web of Science, and Scopus). The identified articles were screened for the eligibility criteria. Data were extracted from the selected articles and quality assessment was performed using the tool of Munn et al. [Int J Health Policy Manag. 2014;3:123-81] in consensus. Using the search strategy, the authors identified 2,652 articles after the removal of duplicates. After reviewing the eligibility criteria, 17 articles were included in this study. One of the included articles was deemed to have an unclear risk of bias, whereas all other articles were considered to have a low risk of bias. The articles showed a relationship between anterior open bite and apico-alveolar articulatory distortions, as well as between anterior open bite and deviate swallowing. For the biting habits, bruxism, and low tongue position no clear conclusions could be drawn. Key Messages: The current review suggests a link between specific types of malocclusion and OMD and AD. However, more high-quality evidence (level 1 and level 2, Oxford Levels of Evidence) is needed to clarify the cooccurrence of other OMD, AD, and malocclusions.

Stages in the Development and Validation of a Belgian Dutch Outcome Tool for the Perceptual Evaluation of Speech in Patients With Cleft Palate.

OBJECTIVE: To develop and validate a Belgian Dutch outcome tool for the perceptual evaluation of speech in patients with cleft palate. SETTING: Cleft palate team in a tertiary university hospital. METHODS: The tool was based on the Cleft Audit Protocol for Speech-Augmented (John et al., 2006; Sell et al., 2009), with adaptations to some of the speech variables and the structured listening protocol. Following a preliminary listening experiment in phase 1, the tool was optimized. In the second phase, a listening experiment with 4 experienced listeners was set up to assess face validity, inter- and intrarater reliability and criterion validity. RESULTS: Results of phase 1 indicated good to very good inter- and intrarater reliability for the majority of the speech variables, good discriminant validity, and varying sensitivity and specificity based on a comparison with nasalance values and the Nasality Severity Index 2.0 (criterion validity). Results of phase 2 showed good to very good interrater reliability for 5 of the 14 variables and good intrarater reliability in 3 of the 4 experienced listeners. Sensitivity and specificity were sufficient, except the specificity of the hypernasality judgments in comparison with the nasalance values of the oral text. Overall, listeners positively judged the face validity of the tool. CONCLUSION: The 2-phase evaluation indicated varying validity and reliability results. Future studies will aim to optimize validity and reliability of the developed tool based on adaptations to the listening protocol, the addition of speech variables, and the inclusion of a more elaborate training.

Brain activity during phonation in healthy female singers with supraglottic compression: an fMRI pilot study.

This pilot study evaluated the usability of functional magnetic resonance imaging (fMRI) to detect brain activation during phonation in healthy female singers with supraglottic compression. Four healthy female classical singers (mean age: 26 years) participated in the study. All subjects had normal vocal folds and vocal characteristics and showed supraglottic compression. The fMRI experiment was carried out using a block design paradigm. Brain activation during phonation and exhalation was analyzed using Brain Voyager software (Brain Innovation B.V., Maastricht, The Netherlands). An fMRI data analysis showed a significant effect of phonation control in the bilateral pre/postcentral gyrus, and in the frontal, cingulate, superior and middle temporal gyrus, as well as in the parietal lobe, insula, lingual gyrus, cerebellum, thalamus and brainstem. These activation areas are consistent with previous reports using other fMRI protocols. In addition, a significant effect of phonation compared to exhalation control was found in the bilateral superior temporal gyrus, and the pre/postcentral gyrus. This fMRI pilot study allowed to detect a normal pattern of brain activity during phonation in healthy female singers with supraglottic compression using the proposed protocol. However, the pilot study detected problems with the experimental material/procedures that would necessitate refining the fMRI protocol. The phonation tasks were not capable to show brain activation difference between high-pitched and comfortable phonation. Further fMRI studies manipulating vocal parameters during phonation of the vowels /a/ and /i/ may elicit more distinctive hemodynamic response (HDR) activity patterns relative to voice modulation.

The Impact of a Teaching or Singing Career on the Female Vocal Quality at the Mean Age of 67 Years: A Pilot Study.

OBJECTIVES: The purpose of this study was to measure the objective and subjective vocal quality in women aged between 60 and 75 years. Secondly, the impact of a teaching or singing career on the vocal quality was investigated by comparing the vocal quality of retired women with different careers. STUDY DESIGN: This is a case-control study. METHODS: Seventy-three retired women between 60 and 75 years (mean age: 67 years, standard deviation: 4.49) participated in the study and were divided into three groups: women with a teaching career (n = 21), choir singers with a singing career (n = 12), and women with a non-vocal career (n = 40). All subjects underwent the same assessment protocol consisting of objective (aerodynamic, maximum performance, vocal range, acoustic measurements, and the Dysphonia Severity Index) and subjective (the Voice Handicap Index, auditory-perceptual evaluations by three listeners) voice measurements. RESULTS: In all three groups, objective and perceptual voice analysis showed a mild dysphonia. No differences in the Dysphonia Severity Index were found between the three groups. The voices of choir singers with a singing career were perceived significantly less rough than voices of the women with a non-vocal career. Additionally, the lowest frequency of the frequency range was significantly lower in the retired teachers and choir singers than in the controls. CONCLUSION: The results of this study prudently suggest that a singing or a teaching career compared with a non-vocal career has a positive impact on the vocal frequency range, and that singing has a positive impact on the perceptual vocal quality of the older female voice.