This study was developed to investigate the readiness or willingness of providers, speech language therapists (SLPs), and patients to participate in telepractice for speech-language therapy services in rural areas of Nevada. Nevada has not ranked high in healthcare for several years and was noted to have low SLP to patient ratios, especially in rural areas of Nevada. A thorough literature review identified international and national studies that have shown resistance to telepractice expressed by patients and providers, but it has also shown an increase in interest post telepractice therapy. Nevada does not have current research on readiness to participate in telepractice medical settings of rural areas of Nevada, therefore a survey was developed to ask providers and patients for their opinions about participating in telepractice. Providers were selected using an online directory search, and patient participants were chosen at the discretion of the providers. A unique survey was presented to each type of participant (provider or patient) in order to compare opinions and readiness of each participant type. Specific questions related to voice and swallowing disorders were addressed. A large sample size was not obtained, but the researcher was able to make some associations to readiness to participate in telepractice and possible factors that may or may not have affected a participant’s opinion. Age of participants, type of internet used, availability of webcam, and area of the state did not appear to have an association with the readiness to participate in telepractice. A positive response rate to engaging in telepractice of 40% was noted across patients and providers. Though the participant sample size was small, there is still some indication that telepractice could be used to address the needs of patients who need speech-language therapy services in rural areas of Nevada.

Self-determination is the ability to control one’s life and to actively participate in the decisions which affect the direction of one’s life. This ability is considered a critical life skill for individuals with developmental disabilities. The ability to make choices, plan, and self-evaluate are among the primary skills included in the development of self-determination. Currently, there is very limited emphasis on the importance of self-determination in the literature of communication disorders. This study was designed to determine if a teaching paradigm which incorporates key elements of self-determination is as or more effective and efficient in teaching syntax than a traditional, clinician-directed teaching paradigm for students with developmental disabilities. Two methods of syntax instruction were compared for 4 students with Down syndrome between the ages of 7 and 13 years using an Adapted Alternating Treatment (AAT) single subject design. In the Clinician Directed (CD) condition, the clinician selected the reinforcing activities, scheduled the order of those activities, and provided the students with feed-back on the accuracy of their productions. In the Self-Determined (SD) condition, the students chose the reinforcing activities from 4 possible choices, scheduled the order of activities, and self-evaluated the accuracy of their productions. Results of the study indicated that both the traditional clinician-directed approach (CD)and the self-determined approach (SD) were effective in teaching syntax targets with all 4 students achieving criterion at an unexpectedly rapid rate and maintaining skills regardless of the teaching condition. The CD condition was slightly more efficient than the SD condition in achieving criterion for 3 of the 4 students in the study; however, for 2 of these 3 students, there was a difference of only 1 session between the 2 conditions. In the SD condition the students were required to self-evaluate responses, a key element in the development of self-determination skills. Interestingly, students appeared to learn to self-correct errors slightly sooner in the SD than the CD condition. Further investigation is needed, but a case might be made that including elements of self-determination in syntax training could justify the slight loss of efficiency, and does so without disrupting teaching effectiveness.

ABSTRACT Autism Spectrum Disorder (ASD) is often accompanied by atypical attention to faces. Some previous studies have suggested that children with ASD demonstrate strengths when processing visual information from cartoons, whereas others have argued that photographic stimuli confer benefits. No previous studies have compared photograph and cartoon images of faces (i.e., Boardmaker [BM] images) in the context of a Social Story™ (Gray, 2010): a common intervention to support behavior and social cognition in children with ASD. In this study, we examined visual attention to static face stimuli in the context of Social Stories™. Participants were 19 typically developing (TD) children and 18 age-matched children with ASD. We addressed two questions: 1) Is there a difference between TD children and children with ASD in how they attend to cartoon and photographic stimuli in the context of a Social Story™? and 2) Do group differences in visual attention to BM and/or photographic stimuli correlate with age and indices of autism severity, executive function, intellectual functioning, and weak central coherence? With regard to question 1 and with one exception, we found no differences between groups when viewing images of faces. The exception involved our cartoon and photograph images that differed in content from the other face images in that they represented a person's full body as well as a range of objects (i.e., it was a more complex scene). For these images an interaction was observed such that the TD and ASD groups were no different in their looking patterns in the BoardMaker condition but they were different in the photograph condition. More specifically, we found that a shift toward more mouth-looking in the photograph condition among children with ASD was negatively associated with attention shifting and verbal IQ and that a shift toward more "other"-looking (i.e., looking that occurred outside the eye and mouth region of the face) was negatively associated with attention shifting, age, and central coherence. These findings suggest that children with ASD demonstrate typical visual attention patterns to both cartoon and photographic stimuli representing faces but that children with ASD employ an atypical scanning strategy when presented with photographic stimuli representing more complex social scenes. The theoretical and clinical implications of the findings are discussed.

The present study compared lateralization of cortical activation patterns in the prefrontal cortex (PFC) of adults who stutter (AWS) and typical speakers (TS) as measured with functional near infrared spectroscopy (fNIRS) in habitual and fluency-enhanced speaking conditions. Participants were AWS (n = 11) and gender- and age-matched TS (n = 11) who completed speaking tasks in three condition blocks: (1) habitual speech using no speaking strategy (2) prolonged speech after receiving short-term training in fluency-shaping strategy-use (3) syllable-timed speech after being trained to speak in rhythm with a metronome at 92 beats per minute. The three primary dependent variables were mean change in HbO (oxygenation) relative to resting baseline in the right and left PFC hemispheres and a Laterality Index (L-R)/(L+R) calculated from these values. Two primary hypotheses were tested: (1) AWS will present with greater right-hemisphere PFC oxygenation relative to TS in a habitual or everyday speaking task (2) AWS will present with reduced right-hemisphere PFC activation (leftward shift in laterality more similar to TS) during fluency-enhanced speech strategy tasks relative to a habitual speech task. Real-time stuttered speech measures using fNIRS indicated greater effortfulness of speech production in AWS when speaking fluently and disfluently as measured by greater bilateral change in PFC HbO relative to TS. AWS laterality did not differ from TS during everyday conversation and did not significantly change when using fluency-enhancing strategies, which was counter to the hypotheses. The TS group presented with significantly greater leftward PFC HbO in the metronome condition compared to AWS. Prolonged speech and metronome-timed speech seem to be associated with different activation patterns in the PFC for AWS and for TS. Results suggest an alternative explanation for compensatory activation in AWS during speech production, such that AWS present with greater overall activation in both PFC hemispheres relative to TS which results in greater right-sided laterality than TS. Future long-term studies on adults receiving prolonged speech treatment and examination of similar measures in young children who stutter may reveal more about the compensatory versus causal nature of stuttering.

As alterações comunicativas têm sido descritas em muitas pesquisas como sendo uma das primeiras preocupações dos pais de crianças do espectro do autismo, além de serem consideradas parâmetro de diagnóstico e indicações de intervenções terapêuticas. O objetivo deste estudo foi, a partir da percepção dos pais e/ou cuidadores, buscar compreender as variáveis relevantes quanto às dificuldades comunicativas percebidas por eles. Considera-se que a interpretação e a atitude dos pais frente aos comportamentos, não somente das crianças, mas também das outras pessoas, tenha influência no processo comunicativo da díade. O questionário envolve aspectos fundamentais para o relacionamento interpessoal, tanto no âmbito comunicativo quanto social. Ele é dividido em 24 questões fechadas que abrangem quatro domínios (impressão dos pais sobre si mesmos, em relação às outras pessoas, em relação a seus filhos e atitudes dos pais em relação a seus filhos) e uma questão aberta. Neste estudo o questionário foi aplicado a um grande grupo de pais e/ou cuidadores em diferentes regiões do Brasil e as variáveis sociodemográficas consideradas foram idade da criança, posição entre outros irmãos; idade e nível de escolaridade dos cuidadores. Os resultados foram estatisticamente analisados e indicaram que, de uma forma geral, os dados sociodemográficos não apresentaram relação significativa com as respostas obtidas no questionário. Em relação aos domínios, a impressão dos pais a respeito das reações das outras pessoas às manifestações de seus filhos originou a maior parte das dificuldades relatadas. Três questões específicas destacaram-se como aquelas em que houve um volume significativo de concordâncias: elas dizem respeito à dificuldade de comunicação das outras pessoas com a criança, hábitos de comunicação da díade e preocupação com o futuro e a falta de informações a respeito do tema. O tratamento dos dados possibilitou identificar as dificuldades recorrentes apontadas pelos cuidadores. Caberá ao fonoaudiólogo usar essas informações e, ao mesmo tempo, valorizar o há de individual e peculiar a cada família nos processos de orientação. / Communication disorders have been described in several studies as one of the first worries of autism spectrum children\'s parents and also as a diagnostic and therapeutic intervention parameter. The aim of this study was to, based on the perception of parents and caregivers, understand the relevant variables of the communication difficulties they undergo. It is considered that their interpretation and attitudes towards the child\'s behavior and also towards other people\'s behavior influences the communication processes. The questionnaire that was used involves fundamental aspects of the interpersonal relationship in the communicative as well as in the social domain. It has 24 multiple choice questions about four domains (parents\' impressions about themselves, about other people and about their children and parent\'s attitudes about their children) and one open question. In this study the questionnaire was applied to a great number of parents and caregivers from different regions of Brazil and the social-demographic variables considered were child\'s age and position among peers; parents\' or caregivers\' age and educational level. The results were statistically analyzed and show that generally the social demographic data are not related to the presented answers. In what refer to the domains, the parents/caregivers impressions about other people\'s reactions to their children\'s behavior produced most of the reported difficulties. Three specific questions are highlighted as the ones with the largest agreement rates: they refer to the difficulties to communicate with other people, the dyad\'s communication habits and worries about the future and lack of information about the issue. The data analysis allowed the identification of recurrent difficulties pointed out by parents/caregivers. The speech-language pathologist should use this information and, at the same time consider aspects that are individual and peculiar to each dyad during the orientation processes.

An excised animal larynx model has been used in many studies to better understand the physiological and anatomical properties of the human larynx. One difference between an ex vivo model and an in vivo model is that ion loss occurs postmortem. To compensate for this in the excised model, researchers most commonly use a preservation method that includes completely submerging the specimen in isotonic saline (0.9% Na+Cl-) and then flash freezing it in liquid nitrogen. The flash freezing method allows researchers to maintain the integrity of the structures while also being able to gather specimens as they become available. Not enough research has been done to understand the effects of a preservation method on the outcomes of the study. Additionally, no common method has been established for preservation across studies to ensure that results are not being influenced by this variable. This prospective, mixed experimental design study includes three groups, a control group and two experimental groups. The control group consisted of 10 bench-mounted porcine larynges that were soaked in isotonic saline and flash frozen with liquid nitrogen. Prior to the experiment, the frozen larynges were thawed overnight before trials. The other two groups consisted of 10 bench-mounted porcine larynges each; these larynges were soaked in either isotonic saline or Ringer’s solution, a balanced fluid used in vivo to counteract dehydration. Larynges from these two groups were kept fresh and stored in a refrigerator overnight before trials. On the day of experimentation, each larynx was mounted on a bench top setup including three micropositioners to stabilize, adduct, and elongate the vocal folds. All the larynges were connected to a pseudolung via the trachea and humidified air was passed through to the vocal folds until phonation was achieved. Phonatory trials consisted of brief phonation followed by 5-minute desiccation intervals until phonation was no longer achieved. Phonation threshold flow (PTF), defined as the flow observed at the onset of phonation, was observed during each phonation trial; and flow values were compared within and between groups. Statistically significant differences were found between the Ringer’s group and the fresh saline group as well as between the Ringer’s group and the frozen saline group, indicating that PTF is influenced by the larynx preservation method.

It is understood that children learn the use of grammatical categories in their native language, and previous models have only been partially successful in describing this acquisition. The present study uses an adaptation selection algorithm to continue the work in addressing this question. The input for the computer model is child-directed speech towards three children, ages ranging from 1;1 to 5;1 during the course of sampling. The output of the model consists of the input words labeled with a grammatical category. This output data was evaluated at regular intervals through its ability to correctly identify the grammatical categories of language of the target child. The findings suggest that the use of this type of model is effective in categorizing words into grammatical categories in both accuracy and completion.

Language samples are naturalistic sources of information that supersede many of the limitations found in standardized test administration. Although language samples have clinical utility, they are often time intensive. Despite the usefulness of language samples in evaluation and treatment, clinicians may not perform language sample analyses due to the necessary time commitment. Researchers have developed language sample analysis software that automates this process. Coding schemes such as that used by the Systematic Analysis of Language Transcripts (SALT) software were developed to provide more information regarding appropriate grammatical tag selection. The usefulness of SALT precoding in aiding automated grammatical tagging accuracy was evaluated in this study. Results indicate consistent, overall improvement over an earlier version of the software at the tag level. The software was adept at coding samples from both developmentally normal and language impaired children. No significant differences between tagging accuracy of SALT coded versus non-SALT coded samples were found. As the accuracy of automated tagging software advances, the clinical usefulness of automated grammatical analyses improves, and thus the benefits of time savings may be realized.

Subglottic stenosis (SGS) is a narrowing of the airway in the region of the cricoid cartilage below the vocal folds and above the tracheal rings. Individuals with SGS experience difficulty breathing at rest and during exertion both of which become increasingly difficult with the level of stenosis severity. Some individuals also experience negative voice changes. Individuals whose stenoses significantly impact breathing generally require medical procedures or surgery, either balloon dilation or cricotracheal resection (CTR). CTR has been shown to improve patients' ability to breathe, but it can also result in permanent vocal changes. Alternatively, balloon dilation results in similar breathing improvements but for a relatively short period of time. Many studies have been published on the effectiveness of CTR; however, only a few have examined the effects of CTR on vocal production. The purpose of this study is to quantify the acoustic and auditory-perceptual features of subglottic stenosis and examine possible acoustic and auditory-perceptual changes in voice production following a revised CTR aimed to minimize voice impact in a group of women. A retrospective chart review identified women with idiopathic SGS who received revised CTR at The University of Utah Voice Disorders Center between 2008 and 2014. Presurgical and postsurgical groups included patients with both pre and post recordings (n = 11) as well as patients with only pre (n = 6) or post (n = 9) recordings. Acoustic quantification of voice signal periodicity, as well as cepstral, spectral, and fundamental frequency (F0) analyses were performed. Auditory-perceptual ratings of overall quality and monotonicity were performed. Cross-sectional and pre-post surgery analyses were completed. Aggregate analyses revealed that both pre and posttreatment SGS patients demonstrated voice disorders in the mild to moderate severity range. Pre-post comparisons indicated no significant voice change after surgery. Mean fundamental frequency decreased from 215 Hz (SD = 40 Hz) to 201 Hz (SD = 65 Hz). Voice disorder severity based on the cepstral spectral index of dysphoniaTM for sustained vowels decreased (i.e., improved) from 41 (SD = 41) to 25 (SD = 21) points. Semitone standard deviation (2.2 semitones) was equivalent from pretreatment to posttreatment. Auditory-perceptual ratings demonstrated similar results. These preliminary results indicate that the revised CTR procedure is promising in minimizing adverse voice effects. Future research is needed to determine causative factors for pretreatment voice disorders, as well as to optimize treatments in this population.

While recorded speech audiometry materials have been developed in Spanish for adults, currently there are no speech audiometry materials available in Spanish that are suitable for a pediatric population. Thus, the purposes of this study were (a) to analyze Spanish bisyllabic words previously developed for adults to determine the words' appropriateness when testing word recognition scores in native Spanish-speaking children and (b) to compare the logistic regressions results from the Spanish adult data obtained in a previous study with the logistic regressions from Spanish pediatric data obtained in the present study. Using common-use children's dictionaries in the Spanish language, a subset of child-appropriate words was adapted from a set of materials developed for Spanish adults. A total of 129 frequently used bisyllabic words were chosen; the words were split into five lists; four lists contained 26 words and one list contained 25 words; each was digitally recorded by both male and female Spanish talkers. Twenty native Spanish-speaking children with normal hearing between the ages of four and eight years were selected to listen to words to obtain psychometric functions. Each word was presented to the listener at 5 levels of intensity from -5 to 35 dB HL in increments of 10 dB. Custom software was used to control randomization, timing, and presentation of the words. The participants were not familiarized with the words prior to testing. The words received a ranked order based on performance to create lists and half-lists that were equivalent. Logistic regression was used to calculate psychometric functions for the lists and half-lists. Subsequently, a chi-square analysis was completed. The analysis revealed no statistical differences among the lists and half-lists for either male or female talkers. The mean bisyllabic psychometric function slopes for lists and half-lists were 5.0%/dB for the male-talker words and 5.2%/dB for the female-talker words. The 50% threshold for male and female were 16.2 dB HL and 15.5 dB HL, respectively.