Rehabilitation for patients recovering from surgical removal of the larynx should include vocational considerations with accompanying economic modifications. The literature pertaining to rehabilitative management of laryngectomees revealed numerous investigations concerned with physical restoration, remedial speech training and psycho-social adjustment, while few studies have been conducted concentrating upon vocational consequences of a laryngectomy. The primary purpose of this investigation was to examine the pre- and post-operative vocational status of laryngectomized patients residing in the Northwestern section of the United States.

Our purpose was to explore developmental changes in the organization and access to the mental lexicon between the ages of three-, five-, and seven years. Six-hundred and seventy three Mandarin-speaking participants listed all exemplars of animals and foods that came to mind within two one-minute intervals. Compared to younger participants, the older children demonstrated more correct responses and fewer errors, suggesting that they have greater knowledge of category-relevant vocabulary. They produced more subcategories, many of which involved embedding and overlapping, which suggests they have more sophisticated lexical-semantic organization. Also, they produced fewer and less closely spaced repetitions, suggesting they could more effectively monitor retrieval responses. We conclude that between the ages of three to seven, children expand and refine the organization of their mental lexicons. Improved monitoring may reflect growth in executive functioning.

Alteration in the tension or stiffness of the vocal folds, mediated by the cricothyroid (CT) muscle activation, is one of the laryngeal strategies attributed to devoicing during speech production. While some studies have reported a consistent increase in CT activity associated with voiceless sounds in comparison to their voiced cognates during speech (Kagaya & Hirose, 1975; Dixit & MacNeilage,1981; Lofqvist, McGarr & Honda, 1984; Löfqvist et al., 1989; Hoole et al., 2004), other studies have suggested that closer relation of CT activity to supra-segmental characteristics of the utterance rather than voicing contrasts (Hirose & Gay, 1972; Hirose and Ushijima,1978; Collier, Lisker, Hirose & Ushijima, 1979). The purpose of this study was to test the hypothesis that during intervocalic syllable production, CT muscle activity was consistently higher for voiceless sounds than their voiced cognates, to assist in vowel devoicing, when pitch, intensity, stress and aspiration were kept controlled. Simultaneous recordings of thyroarytenoid and cricothyroid muscle activity, video-nasendoscopy, and audio signals were obtained from eight, gender-matched adult speakers during intervocalic (VCV) syllable production. The speech sounds represented contrasts in manner of production including, plosives, affricates and fricatives with their voiced-voiceless and aspirated-unaspirated cognates Two voicing transition events were identified and marked on the EMG signals: Vowel-Consonant Transition (VC) and Consonant-Vowel Transition (CV).The mean amplitude of CT muscle activity during voicing transitions (VC, CV) was calculated over a 60 ms time window preceding the acoustic event. CT muscle activity was normalized to a percent of mean maximum activity and compared between voiced/voiceless and aspirated/unaspirated cognates across different categories of speech sounds, subjects and, VC and CV transitions. During the VC transition of intervocalic syllable production of voiceless and voiced speech sounds, a consistent increase in CT muscle activation was not observed across all subjects suggesting that CT activity is not essential for devoicing. Four of the eight subjects (M1, M4, F2, F3) showed consistently higher CT activity for voiceless than voiced sounds while, four of the eight subjects (M2, M3, F1, F4) either did not show any increase in CT muscle activity or showed an inconsistent pattern of increase. The magnitude of difference in CT activity between voiceless and voiced sounds ranged from 3-24% with the highest difference for voiceless fricatives, followed by voiceless aspirated stop plosives and voiceless affricates, and with least difference for unaspirated stop plosives. During consonant vowel (CV) transition of intervocalic syllable production seven of the eight subjects showed lower or comparable levels of CT EMG activity for voiceless speech sounds in comparison to their voiced cognates. Results of one-tailed unpaired t-test revealed that four of the eight participants, M1 [t (60.69) = 10.17, p < .001], M4 [t (8.88) = 57.03, p < .001], F2 [t (5.88) = 35.20, p < .001] and F3 [t (8.91) = 51.00, p < .001], showed significantly higher CT activity for the voiceless than voiced sounds during the VC transition of intervocalic syllable production but the results were not significant for subjects M2, M3, F1 and F4. No statistically significant difference was found between aspirated and unaspirated cognates for all the eight subjects on a two-tailed, unpaired t-test. No gender differences were observed in the findings.

The vocal demands placed on actors are higher than those of the typical speaker. Actors' livelihood is predicated on their ability to consistently perform at peak levels, many times in conditions that are not optimal for vocal efficiency (e.g. theaters with poor acoustics). Further, many actors perform after spending the day at a second job to ensure they have a sufficient income to support themselves. Despite challenges, the hallmark of the strong actor is to strive for peak performance. To do so, many actors implement some form of theatre voice training. One popular method is Fitzmaurice Voicework®. Fitzmaurice Voicework® is comprised of two phases: Destructuring and Restructuring. Destructuring is based in decreasing tension through relaxation and tremoring. Restructuring focuses on maximizing voice function with the least amount of effort needed. This study specifically looked at the effect of Fitzmaurice Voicework® training on the voice, as it has little more than anecdotal evidence to support its effect. Six graduate student actors enrolled in a theatre voice course based on Fitzmaurice Voicework® completed pre and post training measures examining the changes in maximum phonation time, average loudness and loudness range, fundamental frequency and frequency range, jitter, shimmer, and noise to harmonic ratio, and perceptual measures of vocal quality (e.g. strain, breathiness, and roughness) on the CAPE-V. Despite no statistically significant findings due to the small sample size and noted variability between individual subjects, trends of more efficient performance post training were present for individuals without a history of voice problems.

Children with high-functioning autism, children with specific language impairment, children with autism and language impairment, and controls produced sentences after a prompt to form a sentence using a specific word. The sentences were analyzed for syntactic complexity. Children with language impairment, regardless of autism diagnosis, made less complex sentences than their age peers. However, children with autism and language impairment exhibited a broader range of ability than children with language impairment alone. Children with high-functioning autism without concomitant structural language impairment created sentences of similar complexity to age peers. Word variables also influenced sentence complexity, with word meaning (abstract vs. concrete) having the most robust effect and word frequency having a negligible effect. Implications for this study in relation to double-deficit and syntactic bootstrapping models are discussed.

Frequency-lowering signal processing in hearing aids has re-emerged as an option to improve audibility of the high frequencies by expanding the input bandwidth. However, few studies have investigated the usefulness of the scheme as a bimodal option for cochlear implant users. In this study, that question was posed. It was hypothesized that, following fitting and a period of adjustment to a frequency-compression hearing aid, sound localization and speech perception would be improved compared to conventional amplification. More specifically, more high-frequency cues would be perceived in the hearing aid ear using frequency compression, thereby providing better sensitivity to interaural level differences when a cochlear implant is used contralaterally. There were two experiments in this study. In the first experiment, the goal was to determine if frequency compression was a better bimodal option than conventional amplification. Performance was assessed on tests of sound localization, speech perception in a background of noise, and using questionnaires. Ten subjects with a cochlear implant plus hearing aid participated in experiment one. In the second experiment, the goal was to determine the impact of frequency compression on speech perception in quiet. Consonant and vowel perception in quiet was assessed using the frequency-compression and conventional hearing aid. Seventeen adult subjects participated in the second experiment. In both experiments, subjects alternated daily between a frequency-compression and conventional hearing aid for two months. The parameters of frequency compression were set individually for each subject and audibility was measured for the frequency compression and conventional hearing aid programs by comparing estimations of the Speech Intelligibility Index (SII) using a modified algorithm (Bentler, R., Cole, B., Wu, Y-H. (2011, March). Deriving an audibility index for frequency-lowered hearing aids. Poster session presented at the meeting of the American Auditory Society, Scottsdale, AZ). In both experiments, the outcome measures were administered following the hearing aid fitting to establish baseline performance and after two months of use. Results revealed no significant difference between the frequency-compression and conventional hearing aid on tests of localization and consonant recognition. Spondee-in-noise and vowel perception scores were significantly higher with the conventional hearing aid compared to the frequency-compression hearing aid after two months of use. These results suggest that, for the subjects in this study, frequency compression is not a better bimodal option than conventional amplification. In addition, speech perception may be negatively influenced by frequency compression because formant frequencies are too severely compressed and can no longer be distinguished.

The use of neuromuscular electrical stimulation (NMES) for the treatment of swallowing disorders has become increasingly popular, yet little is known about its long-term effects on muscle physiology. This study indirectly assessed suprahyoid muscle physiology using electromyography (EMG) during a jaw-opening task that was completed before training, immediately after training, and two-weeks after training. Comparisons were made in muscle performance between control participants who engaged in effortful swallowing training and participants who received conjunctive NMES during effortful swallow training. All participants completed four weeks of swallowing exercises conducted five days a week (20 sessions) and consisting of 120 swallows each session. Results revealed that participants collectively improved their peak force production following training, but peak force and EMG median frequency did not vary as a function of training method. The observed high variability in median frequency between trials in addition to the documented improvement in function without a measured change in physiology suggests the need to consider alternate electrode placements during EMG or other tools of assessment. These findings suggests that both effortful swallow training and long-term conjunctive NMES with effortful swallowing improves jaw-opening strength of healthy adults, though adding NMES to the treatment was no more effective than training without it. Further research is necessary to determine the effects of long-term NMES training on swallowing physiology in vivo using other indirect measurements, or direct measurements such as muscle biopsy if possible.

Previous research into the communication of people with amnesia found that they, and their familiar communication partners, used verbal play less frequently than pairs without amnesia (Duff et al., 2009). This study attempts to analyze an additional dimension of playful language use: partner response to verbal play. A rubric was developed to rate verbal play response on a 0-5 scale. The rubric was used to rate partner response in four communication pairs containing one partner with amnesia and one familiar communication partner; and four healthy pairs for comparison. The responses of the experimenter participating in the conversations were also rated. While the study found no differences between the two groups in terms of the familiar communication partners or the experimenter, the participants with amnesia received significantly lower overall scores than participants without amnesia. The participants with amnesia also produced a significantly lower proportion of responses with multiple turns than did healthy participants. This result adds to the body of evidence that memory disorders can affect social interaction. The rubric developed for this study suggests a possible direction for including partner response in analyses of conversational discourse.

Background & Purpose Approximately 50β of children born with cleft lip and/or palate (CL/P) will need speech and language intervention (Lockhart, 2003). Speech difficulties are related to poorer academic performance, higher risk of retention in younger grades, and greater risk of being bullied or having a low self-esteem (Byrd, 1994; Lockhart, 2003). Since parents are the primary decision makers when it comes to treatment for their child, how closely do parents' perceptions of speech, appearance, and emotional consequences match the perception of their child? This study assessed differences in perceptions between parents and children with CL/P regarding speech, the emotional impact of having a cleft, and quality of life. Methods & Description Twenty parent-child dyads were recruited at a University based cleft palate clinic. The children were between 7 and 17 years of age, with a diagnosis of cleft palate, cleft lip and alveolus, submucous cleft only, or cleft lip and palate. During a routine clinic appointment, the child and a parent/legal guardian completed the VPI Effects of Life Outcome (VELO) Survey. Parents and children completed the VELO Survey separately to facilitate open, unbiased responses, especially regarding sensitive issues such as facial appearance and emotional health. Results Overall, parents and their affected children did not view the child's speech significantly differently. A Wilcoxon signed rank test found that the differences between parent and child responses were not significant (p=0.3979). Gender, age, and cleft type were not found to have statistically significant impact on differences between parent and child scores. The VELO Survey is divided into five main sections. This study identified the subsection relating to speaking in various situations as having a significantly greater parental concern when compared across all VELO subsections. After applying a Bonferroni multiple comparison adjustment to control the type error rate at 0.05 for all five subsections, a statistically significant relationship was found indicating higher parent ratings than their child in this subsection (p=0. 0.0184). Speech-language pathologist ratings showed a statistically significant linear relationship with the child total VELO scores (p=0.0116), and with parent total VELO scores (p=0.0009). This means that a higher score on the VELO by the parent or the child, and a lower SLP rating, both indicate lower severity of impact of the cleft disorder on the child's life. Conclusion While parents, children, and the speech-language pathologist often agreed with each other in their rating how having a cleft affected the child's life, significant differences did exist between some parent-child dyads. These differences have important clinical implications, primarily the importance of including both parents and children in discussions of the impact of the cleft condition and treatment options.

The purpose of this dissertation was to understand perceived hearing loss and hearing health care use among older adults from Hispanic/Latino backgrounds using the Andersen model of health care utilization as a framework. A cross sectional analysis of audiometric and survey data from the Hispanic Community Health Study/Study of Latinos was used to estimate factors that characterize perceived hearing handicap and hearing aid use, and to determine hearing aid use rates in a large group of older Hispanic/Latino adults. Data came from 6970 adults aged 45 to 76. Results revealed that self-perceived hearing handicap is significantly correlated to measured hearing levels, and is characterized by health insurance status, age, sex, pure tone average, and language acculturation. Reported hearing aid use was characterized by poorer measured pure tone average of the better ear, higher Hearing Handicap Inventory – Screening scores, and current health insurance. Overall hearing aid uptake rate among included individuals was 3.7%. Hearing aid uptake rates among included individuals were low compared to rates of clinically significant hearing loss. The primary variable associated with underutilization of hearing aid uptake for those who could pose to benefit was a lack of health insurance.