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COMMUNIKAY Vol. 5, No. 1
Facilitator Introduced at ASHA "A clinician's dream" is how Dr. Daniel R. Boone, professor emeritus, Dept. of Speech and Hearing Sciences, Univ. of Arizona, Tucson, AZ, describes the Facilitator, Model 3500, introduced by Kay at ASHA ’97. And Boone should know. A former ASHA president, this world-renowned voice pathologist and scientist has more than 30 years of clinical experience to his credit.Developed in collaboration with Dr. Boone, the Facilitator is a unique clinical device that provides five modes of auditory feedback that can be applied to a variety of communication disorders. To Boone, the beauty of the Facilitator is that each of the five modes--speech voice amplification, looping, delayed auditory feedback (DAF), masking, and metronomic pacing--have been used clinically for years, but have never been put together in one instrument. The Facilitator was designed from the outset as a clinical tool and as a portable wearable device that can enhance carryover of therapy goals. "What’s new," Boone explains, "is the combination of, and the ease of access to each of, the modalities." The first modality is the solid-state, looping auditory playback. This mode allows recording of short tokens up to six seconds in duration, followed by immediate playback that can be repeated as desired. "Prior to the Facilitator," Boone observed, "the only way for someone to hear what he just said was to use a cassette and rewind it. The problem was finding the right place to stop." "I’ve waited for 30 years to have a good loop device," he adds. "With the Facilitator, you basically have instant replay, which you can play over and over." This is critical for anyone listening to his own pattern, and trying to change that pattern in some way, such as accent reduction, dialect training, articulation therapy, and voice therapy. As for speech voice amplification, "we’ve known for years that you’ve really got to learn to listen to yourself as you speak and that listening to yourself through headphones as you speak can actually improve the way you sound." The Facilitator enables the client to hear himself very clearly. This feature is very useful for voice disorders, articulation disorders, fluency disorders, the development of the professional voice, and learning disabilities. Individuals with speech, language, and voice disorders may benefit from either enhanced or degraded auditory feedback to assist with therapy goals. The type of feedback that is most effective, however, depends on the disorder and the patient/client. "What DAF does is destroy the feedback system, unlike amplification and looping which augment feedback," explains Boone. The DAF mode in the Facilitator provides an array of delay settings from 50 to 500 msec. "We use DAF with fluency and motor speech, and some people use it with voice," notes Boone. "For magical reasons, stutterers don’t stutter under DAF, but people who don’t normally stutter will. In fact, what we generally see is that a delay of 350 msec makes the best of us dysfluent." The masking mode also degrades auditory feedback. "It wrecks it," states Boone. "You can’t hear yourself speak." Unlike the white and pink noise that were often used in masking at intensity levels harmful to normal ears, the speech range masking of the Facilitator can be used at lower amplitude levels. Boone uses masking in every voice evaluation. "I try masking," he said, "and if they sound better, then I record that good voice produced under masking as their model. It works very well." The masking mode in the Facilitator can be continuous (i.e., on all the time) or voice-activated, so it turns on only when it detects the speaker’s voice. Using an audible pacing device such as a metronome can often help to improve speech timing or rhythm problems. The Facilitator provides metronomic pacing in both an auditory and a visual display ranging from 10-150 beats per minute. "I’ve found it useful with stutterers and in fluency and motor speech disorders," said Boone. For example, with Parkinson’s disease, presenting a metronome click at the lowest level can be very effective in slowing the patient down. "The idea of getting people back to using the auditory system more in therapy is so essential," Boone theorizes, "and, suddenly, we have an avenue to do that." An extensive applications manual written by Boone is supplied with the instrument. It presents the rationale for each mode as well as case studies and detailed tips on clinical use.
Video Phonetics Program and Database The Video Phonetics Program and Database, Model 3750, is a powerful new software option for Multi-Speech. The program allows the user to display a video window in conjunction with acoustic data. The data are time-linked for synchronous real-time display or for in-depth analysis by moving a cursor along the waveform.Included with the program is a comprehensive database of video/audio of speech sounds associated with the IPA tables. The video samples in the database provide an excellent means of comparing articulatory gestures and their concomitant speech sounds. The Video Phonetics Program has all of the acoustic analysis features of Multi-Speech since it is actually loaded within Multi-Speech. When a video file is loaded, or an IPA symbol is selected from a displayed chart, a video box associated with the active window opens. The video data are loaded into the box and the waveform corresponding to the audio portion of the .avi file is displayed as a waveform in the active window. The IPA character, if available, is entered on the IPA transcription line at the start of the waveform. Video data can also be captured using generic video capture cards. The video data most suitable for capture include a close-up of lip movement, a picture of the client’s face, endoscopic images of the larynx, jaw movement, or even a speaker’s posture, depending on the articulation in question. This capability is useful in applications such as teaching acoustic phonetics, linguistics research, articulation training, and second language training.
Wolfe, Virginia, et al. "Sentence/Vowel Correlation in the Evaluation of Dysphonia." Journal of Voice, Vol. 9, No. 3, pp. 297-303, 1995. Sustained vowels are widely used in speech and voice evaluations, both for perceptual and instrumental acoustic analysis. This study compares the perceptual analysis (25 listeners) of sustained vowels versus sentence-level tokens using 20 normal subjects and 60 dysphonic patients representing common voice problems (nodules, unilateral paralysis, etc.). Two perceptual dimensions of vocal severity and pitch/quality showed fairly strong correlations (0.78 and 0.77, respectively) between the sustained vowels and the sentence tokens. However, some of the judgments differed by two scale points or more on the vocal severity rating. The authors conclude that "sustained vowels may not be an adequate clinical index to the dysphonic severity of continuous speech." They also reference other articles which point out that similar considerations should be applied to the instrumental acoustic assessment of speech/voice. ***** Leder, Steven B., et al. "Fiberoptic Endoscopic Evaluation of Dysphagia to Identify Silent Aspiration." Dysphagia, Vol. 13, No. 1, pp. 19-21, 1998.The traditional bedside dysphagia evaluation is not normally regarded as an adequate method for identifying silent aspiration. The benchmark evaluation technique for ascertaining silent aspiration has been videofluoroscopy. This study assessed the aspiration status of 400 at-risk patients using the fiberoptic endoscopic evaluation of swallowing (FEES) procedure. Of the 400 patients, 110 were identified as silent aspirators using FEES. For patients administered both the FEES and videofluoroscopic procedures, the authors reported very high agreement regarding detection of silent aspiration. They conclude that FEES is "a reliable, transportable, repeatable, and patient-friendly method of identifying silent aspiration." ***** Elias, Maria Emilia, et al. "Normal Strobovideolaryngology: Variability in Healthy Singers." Journal of Voice, Vol. 11, No. 1, pp. 104-107, 1997.Effective clinical usage of videostroboscopy involves clinical interpretation of images based on a standard set of analysis protocols. Observation of critical features such as vocal fold symmetry, amplitude, periodicity, presence or absence of adynamic segments, etc., is part of this assessment procedure. It is essential for the clinician to understand the range of normal variability in these parameters. This study investigated stroboscopic findings in a population of healthy professional singers without voice complaints. Based on the sizeable number of "abnormal" stroboscopic findings in this asymptomatic group, the authors point out the need for caution in interpreting stroboscopic findings in patients with voice complaints. ***** Vallino-Napoli, Linda D., et al. "Examination of the Standard Deviation of Mean Nasalance Scores in Subjects with Cleft Palate: Implications for Clinical Use." Cleft Palate-Craniofacial Journal, Vol. 34, No. 6, pp. 512-519, 1997. The authors investigated the standard deviation of nasalance scores in patients with normal and abnormal nasal resonance to determine its potential value in clinical use. Additionally, mean nasalance scores were examined across varying degrees of hypernasality. The major finding of the study showed that standard deviation score does not distinguish speakers "beyond a gross normal and abnormal resonance diagnostic category." An additional finding was that a "mean nasalance score in the high 20s [using the non-nasal Zoo passage] could be used to differentiate speakers with borderline velopharyngeal function from those who were non-nasal." The authors conclude that, as with previous studies, mean nasalance score is the best score to use clinically; furthermore, nasalance scores should serve as supplements to, and not substitutes for, clinical judgments.
Could you explain the videokymographic representation of the vocal folds which was shown at the ASHA convention? Kay’s Videokymography (VKG) System consists of a modified camera used in conjunction with a rigid endoscope, constant light source, monitor, and VCR. The specialized camera scans a single line at a rate of nearly 8000 lines/second. The endoscope is positioned so the single line is transverse to the vibrating segment of interest on the vocal folds (usually the middle).The VKG image is a compilation of these single lines displayed in succession. The VKG display is therefore not an actual image of the vocal folds. The key feature of this technology is that the display accurately reflects vocal fold physiology even during aperiodic phonation making it an excellent complement to stroboscopy. Video- stroboscopy provides a complete image of the vocal folds during phonation, but the technique depends on quasi-periodic phonation which some patients are unable to produce (e.g., patients with spasmodic dysphonia). Even though the VKG image is less intuitive than that obtained with stroboscopy, the technique offers a practical method for observing vocal fold dynamics regardless of phonatory behavior. (See COMMUNIKAY Vol. 4, No. 2 for more information on the videokymography system or call to obtain a flier.)
What is the function of the image compression setting on the Stroboscopy System? The Computer Integrated Stroboscopy System has the ability to digitize images which can be stored in your computer for quick subsequent recall. The images can be stored with or without compression. Compression techniques take advantage of the redundancy in an image and allow the size of the file to be reduced significantly without noticeably degrading perceived image quality. To check the compression being used on your system, click Utilities on the main menu, then Set Image Compression. The default setting is Min Compression which compresses the stored image approximately 8:1. Without compression, an image takes up about one megabyte of disk space. With Min Compression, the size is reduced to about 125 kilobytes. The software allows further image compression, but you should make sure image quality is not sacrificed before making this change.
Can the voice parameter results obtained with the Visi-Pitch II be compared to the MDVP results? Yes. The four parameters of the Voice Quality Assessment (VQA) module extracted on the Visi-Pitch II are a subset of the more than 20 voice parameters calculated by the Multi-Dimensional Voice Program (MDVP) which runs on the Computerized Speech Lab (CSL) platform. These four parameters are RAP (Relative Average Perturbation), which is a jitter parameter using a smoothing factor of three periods; Shim (shimmer), which calculates cycle-to-cycle variability in amplitude; NHR (Noise-to-Harmonic Ratio), which is a global calculation of noise present in the voice signal; and VTI (Voice Turbulence Index), which computes a ratio of spectral inharmonic high frequency energy to spectral harmonic energy over a defined frequency range. (For those interested, the operations manual contains additional information on each parameter.)
Hard disk drive capacity Do you know how much room is left on your computer’s hard disk drive? It might be a good idea to check, particularly if you purchased your system from Kay several years ago when the typical hard drives contained much smaller storage capacity than those sold today. Customers for whom this may be an issue are those with Computer Integrated Stroboscopy Systems or computers sold with the Computerized Speech Lab. For example, the strobe systems sold in 1992-93 typically contained disk drives with a few hundred megabytes whereas current systems are supplied with drives containing a gigabyte or more (i.e., four or five times the storage capacity). If you are an intensive user and store many images, or if you frequently store speech files with high sampling rates (e.g., MDVP users), a large percentage of available disk space may have already been used. To check the remaining capacity on your hard drive, exit to MS DOS and, at the C prompt, type chkdsk. A summary of your hard drive’s capacity and, more importantly, the remaining disk space will be provided. If you find that you are approaching the end of available disk space, you may want to copy old exam files to another storage medium (e.g., tape backup system), and then delete these particular files from your hard drive; this will free disk space. Alternatively, you can have an additional hard drive installed for data storage. If you elect to add a hard drive, it is advisable to consult with Kay’s technical support staff because the procedure may vary depending on your computer’s motherboard, hard drive type, and such.
Would you like us to arrange a videoconference to demonstrate any of Kay’s products? Kay has ready access to a videoconference facility that allows easy demonstration of our instrumentation. If you are interested, please contact the Kay sales department for more information.
...And let the Kay RLS Stroboscopy System take a bow. In a recent episode of NBC’s ER, which aired on Thursday, January 15th, at 10:00 p.m. EST, the Kay strobe was prominently featured in the story line. As some of you may recall, a female patient who had been in an auto accident required a fibia replacement. Following surgery, the patient went into a coma and had to be intubated. Removal of the intubation tube led to vocal cord paralysis, requiring a vocal cord thyroplasty medialization. This entire procedure was observed and monitored with the Kay strobe directly in the OR. Kay sales manager Stephen Crump as well as product specialists Mike McCarthy and Tom Duetsch served as technical consultants.
Please look for Kay products on display at the following conferences, workshops, and congresses.
Year 2000 Compliance Almost everyone is now familiar with the anticipated Year 2000 (Y2K) problem, otherwise known as the millennium bug, and dire predictions abound for the computing havoc it could wreak. With the clock ticking, most companies have begun planning, if not implementing, Year 2000 initiatives. So what about Kay Elemetrics?Kay manufactures a variety of instrumentation for the assessment and treatment of speech, voice, and swallowing disorders. These instruments are designed to work solely with IBM-compatible computers using a DOS or Windows-based operating system. Kay products are inherently Y2K-compliant. Either they do not utilize dates and are thus Y2K compliant or they use the date simply as a date stamp, which is not used for any calculations. In all cases, the computer’s internal clock and operating system (DOS or Windows) will keep the correct time past the year 2000. Kay software is able to detect these changes and use the correct date properly.For customers who require documentation of Kay’s Y2K compliance, please contact the Kay sales department.
Each year at the ASHA convention, we encourage participants to visit the Kay Elemetrics booth and to register for our free drawing. This year’s winner received her choice of a Visi-Pitch II, a Nasometer, or a Facilitator.Kay is pleased to announce that the 1997 winner is Sandra Granger from St. Peter’s Hospital in Albany, NY. Ms. Granger will receive a Visi-Pitch II.
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