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Purpose: Non-invasive ventilation (NIV) provides respiratory support without invasive endotracheal intubation but can hinder patients' ability to communicate effectively. The current study presents preliminary results using a novel in-mask ventilator microphone to enhance talker intelligibility while receiving NIV.Method: A proof-of-concept study assessed sentence intelligibility of five healthy adult talkers using a prototype model of the microphone under continuous positive airway pressure (CPAP; 5/5 cm H2O) and bilevel positive airway pressure (BiPAP; 8/4 cm H2O) ventilator conditions. A pilot study then assessed intelligibility, subjective comprehensibility and naturalness, and patient- and conversation partner-reported communication outcomes for eight patients undergoing therapeutic NIV while being treated in an intensive care unit (ICU).Result: Intelligibility increased significantly with the microphone on in the BiPAP condition for healthy volunteers. For patients undergoing NIV in an ICU, intelligibility, comprehensibility, and patient and conversation partner ratings of conversation satisfaction significantly improved with the microphone on. Patients with lower baselines without the microphone in certain measures (intelligibility, comprehensibility) generally showed a greater microphone benefit than patients with higher baselines.Conclusion: Use of a novel microphone integrated into NIV improved intelligibility during ventilation for both healthy volunteers and patients undergoing therapeutic NIV. Additional clinical studies will define precise benefits and implications of such improved intelligibility.
RESUMEN
PURPOSE: Stimulability assessment is a common part of the voice evaluation, but little information exists about what is involved in the process, how it is measured, and how it impacts therapeutic decisions. The aim of this study was to establish the frequency, circumstances, techniques, and rationale for stimulability assessment among voice-specialized speech-language pathologists (SLPs). METHOD: An anonymized online survey was distributed to voice-specialized SLPs through email lists, online communities, and professional networks. Surveys queried clinical demographic information, respondents' definition of stimulability, importance of stimulability assessment, frequency with which stimulability assessment is performed for various patient populations, preferred facilitating techniques, importance of stimulability assessment for a variety of clinical goals, and methods of measuring voice stimulability. RESULTS: Eighty-eight responses were analyzed. All respondents perform voice stimulability assessment, with 97% considering the practice important. Stimulability assessment is completed with all voice disorders and is consistently completed with muscle tension dysphonia, phonotraumatic disorders, vocal fold mobility disorders, and presbyphonia. Ninety-one percent of the sample does not use a structured stimulability assessment protocol. All respondents felt that stimulability is, to some degree, predictive of successful voice therapy outcomes. Resonance modifications and semi-occluded vocal tract techniques were the most commonly used facilitating strategies. Respondents felt that stimulability assessment was very important for assessing patient awareness, estimating prognosis, and identifying training gestures. CONCLUSIONS: Responding voice clinicians felt that stimulability assessment is an important part of the voice evaluation. This study provides information on how stimulability assessment is being used and outlines what is needed to study its impact.