Texture term usage and hedonic ratings in two age-diverse cohorts of Americans.

This study explores the use of food texture terms by adults in the northeastern United States. The purpose of the study was to compare the effect of food texture on food liking and texture term usage among age groups via two complementary online surveys that differed in the specific task given to participants. Survey 1 gathered common food items associated with 25 texture terms using open-ended questions from 345 participants (45% men, 55% women; age range = 20-79 years); it also collected liking scores for foods with these textures. Next, a new group of participants (n = 349, 46% men, 54% women; age range = 20-79 years) completed Survey 2, which asked them to match up to three texture terms to 32 different foods drawn from Survey 1, using a provided list of 35 texture terms. "Tough," "Chalky," and "Rubbery" had a negative impact on food liking scores while "Tender," "Juicy," and "Crispy" were associated with higher mean food liking scores. "Soft," "Crunchy," "Crispy," "Juicy," and "Greasy" were commonly used texture terms regardless of age. Within those aged 50-79 years, "Smooth," "Tender," "Crunchy," "Soft," "Moist," "Crispy," and "Creamy" were used more often while "Chalky," "Rough," "Mealy," "Foamy/Airy," "Gritty" were used less often. Our results identified commonly used texture terms and revealed differential usage in older and younger adults. These data deepen our understanding of the texture of foods in the modern food environment, highlighting how texture perception may vary with age.

A biophysiological framework exploring factors affecting speech and swallowing in clinical populations: focus on individuals with Down syndrome.

Speech and swallowing are complex sensorimotor behaviors accomplished using shared vocal tract anatomy. Efficient swallowing and accurate speech require a coordinated interplay between multiple streams of sensory feedback and skilled motor behaviors. Due to the shared anatomy, speech and swallowing are often both impacted in individuals with various neurogenic and developmental diseases, disorders, or injuries. In this review paper, we present an integrated biophysiological framework for modeling how sensory and motor changes alter functional oropharyngeal behaviors of speech and swallowing, as well as the potential downstream effects to the related areas of language and literacy. We discuss this framework with specific reference to individuals with Down syndrome (DS). Individuals with DS experience known craniofacial anomalies that impact their oropharyngeal somatosensation and skilled motor output for functional oral-pharyngeal activities such as speech and swallowing. Given the increased risk of dysphagia and "silent" aspiration in individuals with DS, it is likely somatosensory deficits are present as well. The purpose of this paper is to review the functional impact of structural and sensory alterations on skilled orofacial behaviors in DS as well as related skills in language and literacy development. We briefly discuss how the basis of this framework can be used to direct future research studies in swallowing, speech, and language and be applied to other clinical populations.

Clinically Measuring Orofacial Somatosensation in a Cohort of Healthy Aging Adults.

PURPOSE: Humans experience the world through sensations of touch, taste, smell, vision, and audition. Alterations in sensory acuity occur across the adult life span in all types of sensation. The purpose of this study was to describe possible differences in lip and tongue somatosensation (sense of pressure) for healthy older adults using clinically available measurement tools as compared with previously published data using the same protocol. METHOD: A total of 33 healthy adults (ages 60-93 years; M = 70.5 years; 19 women) completed bilateral assessment of lip and tongue pressure detection and discrimination using two-point discrimination discs and Von Frey hair monofilaments. Participants reported basic health information and completed a pure-tone hearing threshold assessment within the same session. RESULTS: Descriptive results are presented for individual data points from healthy aging adults. Group data are compared with previously published data from a cohort of healthy young participants. Although there were no statistically significant differences between the two healthy groups, variations in standard deviations in older adults were observed. CONCLUSIONS: Two-point discrimination and tactile detection and discrimination using Von Frey hair monofilaments can be used to assess labial and lingual pressure detection and discrimination in healthy aging adults. While not reaching statistical significance, on average, older adults demonstrated increased threshold estimates compared with younger adults with increases in standard deviations up to 11.5 times larger than the younger cohort. Subtle differences in somatosensation across the ages may be important for future comparisons with clinical populations across the life span. These assessment techniques can be used with an aging population to complete objective orofacial somatosensory testing.

Translation, Validity, and Reliability of the Persian Version of the Aging Voice Index.

OBJECTIVES: The Aging Voice Index (AVI) was developed to study quality of life in older adults with voice disorders. The purpose of this study was to translate the original English version of the AVI to Persian version of Aging Voice Index (P-AVI) and validate the P-AVI for the Persian-speaking older adults with voice disorders. METHODS: A cross-sectional, descriptive, and methodological study was performed to translate and validate the Persian version of the AVI. The translation was performed in accordance with recommendations from the World Health Organization. Eighty-five treatment-seeking patients with voice disorders and 20 older adults without voice complaints were recruited for this study. Psychometric properties were investigated, including: different types of validity (content validity, construct validity, and criterion-related validity), reliability (test-retest and internal consistency), and item analysis of the Persian version of AVI. The relationship between total score of P-AVI and age, sex, and voice pathology were determined using multiple linear regression. RESULTS: A panel of three speech pathologists performed the content validity of the P-AVI and reached agreement on all of the items. Construct validity was confirmed by a significant difference in the mean of total score of the P-AVI was identified between the particiapnts with voice disorders and those with no voice complaints (P < 0.001). There was high correlation between the total scores of the participants in the Persian version of the AVI and the Persian version of the voice-related quality of life (r = 0.86, P < 0.001). All reliability measures were found to be good with scores higher than 0.8. To assess the need for item reduction, a Cronbach's alpha coefficient remained constant with the elimination of each item; therefore, all no items were removed. Age and voice pathology were not predictive for the total P-AVI score, but a weak effect was identified for sex and the total score of P-AVI (F = 18.75, P < 0.001) with an R2 of 0.21. CONCLUSIONS: The Persian version of AVI is a valid and reliable questionnaire designed specifically for older adults that speech-language pathologists and otolaryngologists can use to objectively assess the impact of voice disorders in aging Persian-speaking patients.

Speech motor control and orofacial point pressure sensation in adults with ADHD.

Attention-Deficit Hyperactivity Disorder (ADHD) is a predominant neurobehavioral disorder of childhood with motor and sensory symptoms often persisting into adulthood. Motor control theories highlight the importance of the bidirectional relationship between sensation and movement for maintaining skilled behaviors like speech. The impact of ADHD on speech in adults has not been well established. The purpose of this study is to assess group differences in quantitative speech and oral somatosensory measures in adults with and without ADHD and to describe the relationship between ADHD symptomology and speech production. A total of 50 adults (18-26 years) were recruited and divided in two groups based on diagnosis: those with (n = 28) and those without (n = 22) ADHD. All participants provided a speech sample to measure articulatory accuracy and speech rate and completed quantitative point-pressure testing using tactile detection and discrimination on bilateral sites on the lower lip and lateral edge of the tongue tip. Independent t-tests corrected for multiple comparisons identified significant group differences using FDR corrected q values in speech production for correct syllables per second and overall speech rate (q<.05). Additionally, there were significant group differences (q<.05) for detection and discrimination threshold estimates at one testing location. Bivariate correlations identified a relationship between several speech measures and self-reported ADHD symptoms such that as symptom severity increased, speech accuracy for correct syllables per second decreased. Young adults with ADHD have subtle differences in speech production compared to non-ADHD control participants. Speech scientists might consider screening for ADHD when collecting normative data samples.

Assessment of Midline Lingual Point-Pressure Somatosensation Using Von Frey Hair Monofilaments.

Detection and discrimination threshold estimates for oral point pressure are assessed using Von Frey Hair monofilaments. Consistent with previously published protocols, threshold estimates are determined using a two-interval forced choice (2-IFC) paradigm with a three down/one up approach. Detection threshold estimates determine the mean force in which a participant can identify the presence of pressure. During the detection threshold procedure, the participant is instructed to choose which of two sequentially presented observation intervals contained the tactile test stimulus. If the participant performs three correct detections in a row (i.e., 3 'hits'), the researcher decreases the stimulus to the next lower target force level. With one incorrect detection (a 'miss'), the researcher increases the force delivered to the next higher level. This threshold estimation approach is known as a 3-down/1-up adaptive staircase. Reponses are recorded on a paper ballot, and a participant's estimated threshold is defined as the geometric mean of five reversals. During the discrimination threshold procedure, the participant is asked to make a choice between two serially presented stimuli as to which is the "harder" or "stronger" pressure. The same scoring of 'hits', 'misses', and stopping points are used. Detection and discrimination testing for oral point pressure at tongue midline takes approximately 20 min to complete. Using these commercially-available clinical tools, individual touch sensation profiles for the midline tongue can be achieved in a relatively time and cost effective means.

Feasibility of Automatic Speech Recognition for Providing Feedback During Tablet-Based Treatment for Apraxia of Speech Plus Aphasia.

Purpose Individuals with neurogenic speech disorders require ongoing therapeutic support to achieve functional communication goals. Alternative methods for service delivery, such as tablet-based speech therapy applications, may help bridge the gap and bring therapeutic interventions to the patient in an engaging way. The purpose of this study was to evaluate an iPad-based speech therapy app that uses automatic speech recognition (ASR) software to provide feedback on speech accuracy to determine the ASR's accuracy against human judgment and whether participants' speech improved with this ASR-based feedback. Method Five participants with apraxia of speech plus aphasia secondary to stroke completed an intensive 4-week at-home therapy program using a novel word training app with built-in ASR. Multiple baselines across participants and behaviors designs were employed, with weekly probes and follow-up at 1 month posttreatment. Four sessions a week of 100 practice trials each were prescribed, with 1 being clinician-run and the remainder done independently. Dependent variables of interest were ASR-human agreement on accuracy during practice trials and human-judged word production accuracy over time in probes. Also, user experience surveys were completed immediately posttreatment. Results ASR-human agreement on accuracy averaged ~80%, which is a common threshold applied for interrater agreement. All participants demonstrated improved word production accuracy over time with the ASR-based feedback and maintenance of gains after 1 month. All participants reported enjoying using the app with support of a speech pathologist. Conclusion For these participants with apraxia of speech plus aphasia due to stroke, satisfactory gains were made in word production accuracy with an app-based therapy program providing ASR-based feedback on accuracy. Findings support further testing of this ASR-based approach as a supplement to clinician-run sessions to assist clients with similar profiles in achieving higher amount and intensity of practice as well as empowering them to manage their own therapy program. Supplemental Material https://doi.org/10.23641/asha.8206628.

Oral somatosensatory acuity is related to particle size perception in chocolate.

Texture affects liking or rejection of many foods for clinically relevant populations and the general public. Phenotypic differences in chemosensation are well documented and influence food choices, but oral touch perception is less understood. Here, we used chocolate as a model food to explore texture perception, specifically grittiness perception. In Experiment 1, the Just Noticeable Difference (JND) for particle size in melted chocolate was ~5 µm in a particle size range commonly found in commercial chocolates; as expected, the JND increased with particle size, with a Weber Fraction of ~0.17. In Experiment 2, individual differences in touch perception were explored: detection and discrimination thresholds for oral point pressure were determined with Von Frey Hairs. Discrimination thresholds varied across individuals, allowing us to separate participants into high and low sensitivity groups. Across all participants, two solid commercial chocolates (with particle sizes of 19 and 26 µm; i.e., just above the JND) were successfully discriminated in a forced-choice task. However, this was driven entirely by individuals with better oral acuity: 17 of 20 of more acute individuals correctly identified the grittier chocolate versus 12 of 24 less acute individuals. This suggests phenotypic differences in oral somatosensation can influence texture perception of foods.

Aging Voice Index (AVI): Reliability and Validity of a Voice Quality of Life Scale for Older Adults.

Changes in voice in aging adults impact their ability to use their voice to communicate in all situations and can lead to decreased quality of life (QOL). The primary objective of this study was to determine the validity and reliability of the Aging Voice Index (AVI)-a tool specifically designed for aging adults with voice disorders. A total of 92 older adults were asked to complete the Voice-Related Quality of Life Scale (VRQOL) and the AVI as well as provide their self-perceived voice severity rating of their voice problem and demographic information. Intraclass correlation for test-retest reliability was 0.952. The AVI was highly correlated to the VRQOL (P < 0.0001). Additionally, the AVI score was found to distinguish between self-rated voice quality (P < 0.0001) and diagnostic voice categories (P < 0.0001). No significant differences were identified for sex or race. The AVI is a valid and reliable quality of life assessment for older adults with voice disorders. The AVI will capture the quality of life impact a voice disorder has on older adults. Future studies will further explore differences in clinical diagnoses and identify clinically significant changes in pre-to post-AVI scores.

Effects of ageing on orofacial fine force control and its relationship with parallel change in sensory perception.

PURPOSE: Current theoretical models suggest the importance of a bidirectional relationship between sensation and production in the vocal tract to maintain lifelong speech skills. The purpose of this study was to assess age-related changes in orofacial skilled force production and to begin defining the orofacial perception-action relationship in healthy adults. METHOD: Low-level orofacial force control measures (reaction time, rise time, peak force, mean hold force (N) and force hold SD) were collected from 60 adults (19-84 years). Non-parametric Kruskal Wallis tests were performed to identify statistical differences between force and group demographics. Non-parametric Spearman's rank correlations were completed to compare force measures against previously published sensory data from the same cohort of participants. RESULT: Significant group differences in force control were found for age, sex, speech usage and smoking status. Significant correlational relationships were identified between labial vibrotactile thresholds and several low-level force control measures collected during step and ramp-and-hold conditions. CONCLUSION: These findings demonstrate age-related alterations in orofacial force production. Furthermore, correlational analysis suggests as vibrotactile detection thresholds increase, the ability to maintain low-level force control accuracy decreases. Possible clinical applications and treatment consequences of these findings for speech disorders in the ageing population are provided.

Clinically Available Assessment Measures for Lingual and Labial Somatosensation in Healthy Adults: Normative Data and Test Reliability.

PURPOSE: High-quality orofacial somatosensory inputs are essential for achieving rapid and accurate motor outputs. Little somatosensory testing is currently being completed in clinical settings. The purpose of this study is to assess the feasibility and test-retest reliability of clinical assessment tools for orofacial somatosensory testing in healthy young adults. METHOD: A total of 45 healthy young adults (ages 20-41 years) was recruited. Participants reported basic health information, completed pure-tone hearing thresholds, and were assessed using two-point discrimination discs and Von Frey hair detection and discrimination thresholds for bilateral lip and tongue. A subsample of participants (n = 18; 40%) returned to complete reliability testing. RESULTS: Descriptive results are presented for the normative group as well as the reliability group. Difference scores between Tests 1 and 2 for each testing measure and location show high agreement. CONCLUSION: Two-point discrimination and Von Frey hair monofilament assessment for both detection- and discrimination-threshold estimates have high test-retest reliability in a healthy young population. These testing measures could be a way to easily complete objective somatosensory testing of the orofacial region in a clinical context.

The relationship between labial vibrotactile detection and pure-tone hearing thresholds in healthy, ageing adults.

PURPOSE: Orofacial anatomy is unique from other body systems in that oral musculature inserts directly into the underlying cutaneous skin, allowing for tight temporal synchronicity between somatosensory and auditory performance feedback to maintain correct orofacial behaviours across the lifespan. Unfortunately, little is currently known regarding the changes in orofacial sensory capacities associated with ageing and how these somatosensory and auditory changes may impact feedback during functional behaviours such as speech or swallowing. The purpose of this descriptive study was to begin assessing the relationship between the auditory and labial somatosensory system in healthy ageing adults. METHOD: Pure-tone hearing thresholds were determined for 500, 1000, 2000 and 4000 Hz. Using a 2-alternative forced choice paradigm, 60 adults (19-84 years) completed vibrotactile detection thresholds (VDT) at the 5 and 10 Hz test frequencies. RESULT: A significant difference for age by group was identified at the 5 Hz test frequency. Spearman Correlations identified a significant correlation between age and pure tone hearing thresholds and the 5 Hz test frequency threshold. CONCLUSION: A relationship between pure tone hearing thresholds and labial somatosensory was identified. Future studies will begin the processing of modelling the complex multivariate sensorimotor relationship in healthy individuals before moving to a disordered population.

Labial vibrotactile somatosensory perception: a pilot study in healthy aging versus young adult participants.

The purpose of this pilot study was to begin characterizing changes in labial vibrotactile somatosensation in healthy older adults as a foundational step in determining how changes in orofacial sensation can affect functional behaviors, such as speech and feeding. Labial vibrotactile perception capacity of healthy older adults (n = 15) was compared to a cohort of healthy young adults (n = 5). Vibrotactile inputs were delivered to the glabrous surface of the left lower lip at 5, 10, 50, and 150 Hz. A modified von Bekesy (staircase) method was used to identify participants' thresholds and response standard deviations for each test frequency. Consistent with findings in other body regions, a decrease in labial vibrotactile detection sensitivity was expected in healthy older adults. The threshold values for the 5 and 10 Hz test frequencies were higher in the older group and the differences in response standard deviations at these frequencies were statistically significant. This pilot study identified changes in labial perception among healthy older adults.

Defining the lived experience of older adults with voice disorders.

OBJECTIVES: The purpose of this qualitative phenomenological study was to gather rich thick descriptive data regarding the lived experiences of older adults seeking treatment for a voice disorder. DESIGN: Using qualitative methodologies, participants completed semi-structured interviews with trained investigators to detail their thoughts, beliefs, feelings, and experiences of living with a voice disorder. Using a process of horizontalization, themes were identified that described the experiences of older adults with voice disorders. SETTING: Research was conducted at four clinical voice centers in Kentucky, Wisconsin, and Ohio. Data were analyzed in the Laryngeal and Speech Dynamics Lab at the University of Kentucky. PARTICIPANTS: A total of 28 adults (aged 65-90 years) with voice disorders were recruited for this study. RESULTS AND CONCLUSIONS: Aging adults demonstrated a strong urge to communicate; however, they tended to describe their voice quality in negative terms and were emotionally impacted by these associations. They admitted to withdrawing from some activity or social event because their voice did not meet their expectations or voice needs; thought their voice quality was part of normal aging; and had resigned to accept their current voice.

Facilitating neurorehabilitation through principles of engagement.

A primary goal of neurorehabilitation is to guide recovery of functional skills after injury through evidence-based interventions that operate to manipulate the sensorimotor environment of the client. While choice of intervention is an important decision for clinicians, we contend it is only one part of producing optimal activity-dependent neuroplastic changes. A key variable in the rehabilitation equation is engagement. Applying principles of engagement may yield greater neuroplastic changes and functional outcomes for clients. We review the principles of neuroplasticity and engagement and their potential linkage through concepts of attention and motivation and strategies such as mental practice and enriched environments. Clinical applications and challenges for enhancing engagement during rehabilitation are presented. Engagement strategies, such as building trust and rapport, motivational interviewing, enhancing the client education process, and interventions that empower clients, are reviewed. Well-controlled research is needed to test our theoretical framework and suggested outcomes. Clinicians may enhance engagement by investing time and energy in the growth and development of the therapeutic relationship with clients, as this is paramount to maintaining clients' investment in continuing therapy and also may act as a driver of neuroplastic changes.