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COMMUNIKAY Vol. 4, No. 1
Kay, Others Partner on Training At the ASHA '96 session titled Acoustic Analysis of Speech and Voice: Issues and Answers, Kay Elemetrics President John Crump and other vendors of computer-based acoustic analysis systems met to discuss current analysis tools and techniques, as well as what the future holds with regard to this technology. The resounding theme throughout this discourse was the need for training, a goal Kay has long espoused and embraced. Although previous issues of CommuniKay have chronicled a number of diverse training activities available on-site at Kay, such as the CSL and Advanced Stroboscopy Workshops, and the In-House Training and Demonstrations, this issue presents a more in-depth look at other training opportunities with which Kay is affiliated, specifically Vanderbilt Voice Center's LVES Workshop (see article below) and the Spoleto Symposium: Medicine in the Vocal Arts (see page 4). Vanderbilt Voice Offers Strobe Workshop The Vanderbilt Voice Center is a unique medical resource not only for those who use their voices professionally, but for people from all walks of life. As such, it is designed to provide the most advanced evaluation and treatment of all problems affecting the voice. The Voice Center is equally mindful of the need to provide ongoing training for laryngologists and speech pathologists. To this end, the Laryngeal Video Endostroboscopy Workshop has been offered since 1989, with such distinguished guest faculty members as: Drs. Diane Bless, Ray Colton, Doug Hicks, Rebecca Leonard, Steve McFarland, Joseph Stemple, Daniel Martin, Daniel Kelly, Tom Waterson, Mike Karnell, and Leslie Glaze. A two-day event featuring the conduct of stroboscopic examinations, LVES provides abundant opportunity for hands-on practice as well as lectures on the operation of the equipment. It identifies what an examination should cover, with patient and examiner tasks; it also covers rigid and flexible endoscopy. One unique feature is what the course director, Ed Stone, Ph.D., calls guided observation. “We direct participants’ attention to five characteristics of the stroboscopic examination, called SAPMuC, which we find useful at the Voice Center: synchrony of movement between the two vocal cords, amplitude, periodicity, mucosal wave, and glottal closure.” Says Stone, “Day 1 is guided observation followed by time in which people practice observing and recording SAPMuC.” The second day is usually dedicated to interpretation. Six to seven concurrent sessions are repeated three times throughout the day. Registrants choose which sessions they’d like to attend from among such topics as stroboscopic implications for surgical intervention, medical intervention, behavioral intervention of the speaking voice, behavioral intervention of the singing voice, and more. One well-attended session is an introduction to Kay’s Multi-Dimensional Voice Program (MDVP), presented by one of Kay’s product specialists. “This,” explains Stone, “is an excellent option for those who may not want to spend all three concurrent sessions on stroboscopy.” Another offering is one Stone has dubbed “Histology and Pathology of Vocal Cord Lesions for Dummies.” In this session, a physician presents more in-depth views of vocal nodules, polyps, and cysts than can be visualized with indirect laryngoscopy. At the close of the day, Stone explains, “we consider financial aspects of stroboscopy, including various models for setting fees and sharing of procedures that have been effective at the Voice Center in negotiating with third-party payers.” The cost of the workshop is $495, which is typical for this type of hands-on instrumentation course. Nonetheless, Stone would like to see some type of scholarship program for clinicians who do not have access to continuing education or workshop funds. “That’s something we would like to offer because we understand that there are clinicians whose institutions do not support continuing education well, or whose budgets have been cut, and yet they are charged with learning stroboscopy.” Stone is effusive in thanking Kay Elemetrics for its role in the course and for its supportive relationship. “We would not be able to do this without the support of Kay Elemetrics. Our relationship with Kay through the years has been nothing but excellent. They’re there when we need support, and bend over backwards to help us keep up and running.” In addition to Stone, the faculty for the workshop includes the following Voice Center personnel: Kim Chachere, M.S.; Tom Cleveland, Ph.D., Director of Singing Arts and Sciences; Mark Courey, M.D., Medical Director of the Voice Center; Molly Erickson, Ph.D.; Jackie Gartner, M.S.; Stephen Mitchell, M.D.; Melissa Portell, M.S.; and Cheryl Rainey, M.S. The course is held twice per year. The 1997 dates are May 2-3 and September 19-20. For further information, contact Ms. Sherri Culp by phone at (615) 322-4030. Seaver, Earl J. "Acoustic (Nasometric) Assessment of the Velopharyngeal System." ASHA Special Interest Divisions (Division 5) Vol. 6, No. 1, October 1996. In the section of this SIDs report titled "How I Do It: Experts' Opinions on Outcome Measures of Assessment of the Velopharyngeal System", a series of short articles describing various instrumental techniques used in the assessment of patients with velopharyngeal abnormalities is presented. Among these is the article by Seaver who describes the assessment and treatment roles of nasometry in a university speech clinic for patients with oral-facial clefting, motor speech disorders, hearing impairment, and velopharyngeal dysfunction of unknown etiology. Other techniques discussed in the SIDs report include aerodynamics, videoendoscopy, and multi-view videofluoroscopy. Benninger, Michael S., et al. "Vocal Fold Scarring: Current Concepts and Management." Otolaryngology-Head and Neck Surgery, Vol. 115, No. 5, pp. 474-482, November 1996. In this review article, the common causes and treatment options available to patients with vocal fold scarring are described. Scarring has been cited as the single greatest cause of dysphonia following vocal fold surgery. Within the article, the authors point out the critical role of instrumentation in both the evaluation and voice team management of patients with scarring. Videostroboscopy is cited as "virtually indispensable" to proper diagnosis; other important voice laboratory measurements discussed include acoustic and aerodynamic/phonatory analysis. Crary, Michael A. "A Direct Intervention Program for Chronic Neurogenic Dysphagia Secondary to Brainstem Stroke." Dysphagia, Vol. 10, No. 1, pp. 6-18, 1995. The article details a therapy program used to improve swallowing function in patients with chronic dysphagia secondary to brainstem stroke. Using multi-channel surface EMG for visual feedback, the specific goals of therapy were to "increase the duration and strength of the pharyngeal aspects of swallowing and to improve swallowing coordination." The efficacy of treatment and long-term functional effects of therapy on six patients are discussed with positive results. Lane, Andrew P., et al. "Acoustic Rhinometry in the Study of the Acute Nasal Allergic Response." Annals of Otology, Rhinology & Laryngology, Vol. 105 (10), pp. 811-818, October 1996. The study presents changes in nasal cavity dimensions in response to nasal allergen challenge using the technique of acoustic rhinometry in eight subjects who were pollen-sensitive. Results were compared to other parameters including rhinomano-metry. The reliability of the technique and its clinical utility as a "reproducible" and "objective" assessment method are presented by the authors. (Note: Kay now markets the ECCOVISION Acoustic Rhinometer [see CommuniKay, Vol. 3, No. 3 or contact the company for more information]). All Kay stroboscopy customers who have not yet purchased The Atlas of Dynamic Laryngeal Pathology by Dr. C. Richard Stasney, M.D., F.A.C.S., of the Texas Voice Center, Baylor College of Medicine, can still order a copy at the discounted price of $88 plus shipping and handling (publisher's price is $175). This video-text package, published by Singular Publishing Group, San Diego, California, serves as an excellent reference for otolaryngologists, speech-language pathologists, and voice scientists. For further information, please contact a Kay product specialist. What do you suggest as a computer hard drive backup strategy? First, and foremost, we suggest that you actually do it. Each computer sold by Kay (in conjunction with an instrument) contains a tape backup system installed in the computer. The backup serves the function of copying the contents of your computer's hard disk to another storage medium. If your hard drive fails, its contents can be restored. Unfortunately, all too often we observe that end-users seldom or never run a backup. We generally recommend that you back up at least weekly, or more frequently with intensive usage. If your hard drive crashes, you will only be able to restore what has been backed up. After backing up your entire hard drive once, most backup software allows you to run a selected backup (recently stored or modified data is added to the backup copy) which takes only a few minutes. The newer backup systems are fairly fast and have large capacity. Once launched, the backup can proceed unattended. In summary, put this important task on your weekly "to do" list just in case....
What do you recommend for obtaining the best spectrogram prints using the CSL? Using [Ctrl-PrtSc] within CSL, you are using a print utility which supports a resolution of approximately 200 dots an inch which is adequate for waveforms, pitch contours, etc., but may produce spectrograms which appear somewhat "grainy" (i.e., inadequate gray scale representation). For a better spectrogram print, you can save the entire screen as a TIFF (Tagged Image File Format) file. Under System on the Main Menu, click Save TIFF and give a filename, adding the .tif extension. This .tif file is placed in the \CSL50\Output directory under the filename you provided. This file can be imported into any number of programs (e.g., most Windows-based word processing programs) which support the popular .tif file format. This approach has the added advantage of allowing you to incorporate screen pictures from CSL into evaluation reports, or enter text describing data, if desired. Insert the file (usually as a picture) into the program you have access to and print. This will produce a spectrogram with resolution provided by the printer and Windows driver supplied with it. Another approach is to use an inexpensive software package such as Pizazz 5r which allows you to capture a screen from any DOS application and print it on most printers, including color printers. Screens captured using this method produce good spectrograms as well.
Does the Laryngograph (EGG) battery charge when the strobe system is turned off? The Laryngograph, which can be used in conjunction with Kay's stroboscopy system for both pitch extraction and EGG waveform overlay on the laryngeal image, contains a nickel cadmium battery. The battery charges when the strobe system cart is switched off, but only if you also turn off the Laryngograph. All other components on the stroboscopy cart can be left in the ON position when the main power switch on the cart is turned off. The exception is the Laryngograph which must be turned off separately in order for the battery to charge. Considerations for tape dubbingRhino-Laryngeal Stroboscope or Swallowing Workstation users may wish to copy tapes for presentation at conferences or for sharing data with colleagues. Both systems use S-VHS VCRs. These VCRs allow you to record in both S-VHS and VHS modes. S-VHS provides superior image resolution on playback. This rule also applies to dubbing. For best dubbing results, you should copy to another S-VHS VCR, in S-VHS mode, resulting in image quality that is only minimally degraded compared to the original. Unfortunately, at some conferences only standard VHS VCRs are available; these will not play S-VHS recorded cassettes. In these cases, when making the dub, you must switch to VHS format on the recording deck. If time permits, you may wish to dub in S-VHS mode, and then dub the same material in the VHS mode on the same tape; this would allow you to play back on either type of deck. In order to record the video and audio signals, separate cable connections for these two signals must be made between the two VCRs. The audio output connector must correspond to the audio track used on the original recording (e.g., on the strobe, Hi Fi, Ch1). Swallowing Workstation users who also wish to video record physiologic data acquired concurrently with video data on the tape dub, require a VGA-to-video converter. This recording would replicate what is observed on the screen of an exam playing back both video and physiologic data. Each year at the ASHA convention, participants are encouraged to visit the Kay Elemetrics booth and register to win our free drawing for a Nasometer or Visi-Pitch II. Kay is pleased to announce that the winner of the 1996 drawing, held in Seattle, Washington, is Cynthia Jacobsen, Ph.D., Director of Speech Pathology, Children's Mercy Hospital, Kansas City, Missouri. Dr. Jacobsen has chosen to receive the Visi-Pitch II. Congratulations, Dr. Jacobsen!
Spoleto Course Balances Work with Play If attending a videostroboscopy training workshop over Memorial Day weekend sounds too much like a busman's holiday, then you haven't attended the Spoleto Symposium. Now in its 9th year, this unique, interactive course, designed for otolaryngologists, speech path-ologists, and voice professionals, will be held from May 23-May 26, in Charleston, South Carolina. According to symposium director, Lucinda Halstead, M.D., Medical University of South Carolina, "This will be a dynamic meeting with lots of hands-on training. We provide a number of different learning opportunities, in fairly different formats, so participants are not always in a big lecture room. It's less of a general annual meeting format and more of an instructional course." Spoleto boasts a distinguished faculty, including: Peak Woo, M.D.; James Koufman, M.D.; Krzysztof Izdebski, F.K., M.A., Ph.D., C.C.C.-SLP, and Rebecca Leonard, M.D., as well as Cathryn Hufnagle, M.S., C.C.C.-SLP, the speech pathologist on Halstead's voice team, and Deanna McBroom, a performing opera singer and the vocalist on her voice team. The Spoleto course offers both basic and advanced instructional elements, allowing participants with different experience levels to hone or acquire skills. Halstead notes that Spoleto differs from symposia where people simply present their latest research. "We, too, present recent research, but always in the context of 'this is why we do things'." At Spoleto, topics stressed include: how to work with and develop a voice team, how to use a videostroboscope, and how to manage high-level vocal professionals medically and surgically. "We also talk a lot about aerodynamic measures of voice and acoustic measurement of voice," adds Halstead. "We do some neurolaryngology and some swallowing. And, we do a lot on stroboscopy, too, teaching what to look for, what's important, and presenting stroboscopy as not only a diagnostic tool, but also, as Rebecca Leonard discusses, as a therapeutic tool." Halstead acknowledges that Kay Elemetrics is "indispensable" to the symposium. "I am very, very grateful not only for their support, but also for the equipment Kay supplies. The Kay unit is what we use, and, although we provide a lot of the instruction, Kay product specialists provide very helpful guidance and instruction as well, particularly in the hands-on work." Many participants return to Spoleto each year, in part, because the program content varies somewhat from year to year. This provides opportunities to network and to obtain other hands-on training. Perhaps the most unique aspect of the symposium is the live patient demonstrations. Explains Halstead, "We bring in real patients with real problems, from Shakespearean actresses to budding singers. Not only are they interesting, but sometimes we just don't have answers ourselves. By presenting real patients, someone from the audience will often ask or suggest things that we might not have thought about." The course itself spans four days: one full day (Friday), and three half days (Saturday, Sunday, Monday), over Memorial Day weekend, chosen because it ties in with the debut of the Spoleto Festival, an international arts festival held annually in Charleston. "We timed our symposium so that people can really enjoy the great city of Charleston," said Halstead. "There are a lot of great restaurants and a lot of culture and history. And it's one of the South's oldest cities. The festival runs for 17 days, through June 8 this year, and features opera, dance, music, and art, 24 hours a day, with hundreds of events. It's a fun, fun time." For Halstead, the nicest thing about the Spoleto festival is that most of the course participants "are a tad interested in music anyway, and this gives them a chance to enjoy some really nice theater and music. In fact, the reason we do half days," Halstead explains, "is so people can go play." For more information about the Spoleto Symposium, contact Lucinda Halstead, M.D., by phone: 803-792-7162, fax: 803-792-0546, or e-mail: halstead@musc.edu.
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