فهرست مطالب seyyedeh maryam khoddami

One of the most voice-related complaints in teachers is vocal tract discomfort (VTD) which can increase the voice handicap index (VHI) to different degrees. In teachers Muscle Tension Dysphonia (MTD), increases voice complaints and decreases the voice-related quality of life. The aims of this study were to evaluate and compare the frequency and severity subscales of the VTD score and total score of VHI and determine the relation between them in primary school teachers with and without MTD.

This study was cross-sectional and was performed on 80 primary female teachers with and without MTD. The participants in both groups were randomly selected after checking the inclusion criteria. Voice history, auditory-perceptual assessment of voice, palpation, and laryngeal video-stroboscopy were assessed on the teachers in two groups. Then, asked the participants to complete the Persian versions of the VTD and VHI scales. After determining the normal distribution of the data using the Kolmogorov-Smirnov test, the results of VTD, VHI, and their subscales were compared between two groups with an independent t-test. Also, the relationship between them was assessed with the Pearson correlation coefficient analysis.

The mean score of the frequency subscale of VTD in teachers with MTD was more than in teachers without MTD (30.17±5.11, 8.22±2.26), respectively. The score of severity subscales of VTD in teachers with MTD was 39.12±4.94 and in teachers without MTD was 7.89±2.13. Also, the total score of the VHI questionnaire in teachers with MTD was significantly higher than teachers without MTD (P<0.05). Moreover, there was a significant positive correlation between the frequency and severity subscales of VTD and the total score of VHI in the two groups (P<0.05).

This study showed the frequency and severity scores of the VTD and the degree of VHI experienced by MTD are remarkably higher than teachers without MTD. The authors emphasize on the use of VTD and VHI scales in screening teachers who are at risk of voice problems, and the researchers pointed out the importance of paying attention to the reduction of discomfort feelings in the vocal tract and voice handicap in the voice therapy sessions of teachers with MTD.

This study aimed to investigate the effect of Mathieson laryngeal manual therapy (MLMT) following a therapeutic course in patients with primary muscle tension dysphonia (MTD).

Twelve patients with primary MTD participated in this study. At first, videostroboscopy and perceptual voice assessment was performed, and the Persian version of vocal tract discomfort (VTDp) scale was completed. After two and a half weeks that patients received no treatment, the assessments were repeated to evaluate the effect of spontaneous recovery. For studying the effect of MLMT, it was presented in five sessions. Then, all assessments were repeated. The frequency of supraglottic activity was elicited. For the perceptual evaluation and VTDp, the Wilcoxon nonparametric test was used to study and compare the effect of spontaneous recovery and MLMT.

After spontaneous recovery, a significant difference was observed only in strain (P<0.05). After MLMT, the frequency of supraglottic activity decreased, and perceptual voice parameters significantly changed (P<0.05), but the VTDp showed no significant difference (P>0.05). There was no significant difference between spontanous recovery and MLMT based on the paerceptual voice evaluation and VTDp scale (p>0.05).

The MLMT can remarkably improve the supraglottic activity and perceptual characteristics of voice in primary MTD after a therapeutic course. Further studies are recommended to confirm the effectiveness of MLMT on decreasing VTD sensations.

Speech prosody is one of the important communication components that describes the paraliguistic features of speech. The tests are suitable tools for quantifying speech and language skills, and of necessary needs for evaluation, screening, describing, diagnosis, and treatment of various aspects. The purpose of present study was to review existing tests in speech prosody recognition, as well as their subtests, implementation and scorings, and ultimately their application in clinical and research fields of children and adults.

 An electronic search for reviewing common speech prosody tests was performed in Web of Science, PubMed, Scopus, Medline, Scientific Information Database (SID), Google Scholar, Ovid, and Magiran databases to obtain relevant articles published from 1981 to 2019. The keywords used included “Prosody”, “Assessment”, “Test”, “Tool”, “Evaluation”, “Diagnosis”, “Instrument”, and “Measurement”. The articles obtained using the inclusion criteria were studied following as access to the full text of the article and the English or Persian language. From 15 articles found, 8 tests that were adhered to the inclusion criteria were selected for consideration.Results</strong>: 8 speech prosody tests were evaluated which included 5 perceptual tests, 2 expressive tests, and 1 perceptual expressive test. The oldest test was made in 1981, and the latest in 2012.

 The literature review shows that some tests have been used more often in recent years due to the specialized expertise of the subtests. A review of speech tests suggests that the Profiling Elements of Prosody in Speech-Communication (PEPS-C) test is more prestigious due to the assessment of perceptual and expression areas, standardization for normal and disabled children, translation into several languages, and high psychometric properties.

Speech prosody is one of the important communication components that describes the paraliguistic features of speech. The tests are suitable tools for quantifying speech and language skills, and of necessary needs for evaluation, screening, describing, diagnosis, and treatment of various aspects. The purpose of present study was to review existing tests in speech prosody recognition, as well as their subtests, implementation and scorings, and ultimately their application in clinical and research fields of children and adults. An electronic search for reviewing common speech prosody tests was performed in Web of Science, PubMed, Scopus, Medline, Scientific Information Database (SID), Google Scholar, Ovid, and Magiran databases to obtain relevant articles published from 1981 to 2019. The keywords used included “Prosody”, “Assessment”, “Test”, “Tool”, “Evaluation”, “Diagnosis”, “Instrument”, and “Measurement”. The articles obtained using the inclusion criteria were studied following as access to the full text of the article and the English or Persian language. From 15 articles found, 8 tests that were adhered to the inclusion criteria were selected for consideration. 8 speech prosody tests were evaluated which included 5 perceptual tests, 2 expressive tests, and 1 perceptual expressive test. The oldest test was made in 1981, and the latest in 2012. The literature review shows that some tests have been used more often in recent years due to the specialized expertise of the subtests. A review of speech tests suggests that the Profiling Elements of Prosody in Speech-Communication (PEPS-C) test is more prestigious due to the assessment of perceptual and expression areas, standardization for normal and disabled children, translation into several languages, and high psychometric properties.

This study aimed to investigate construct convergent validity of the Persian version of consensus auditory perceptual evaluation of voice (called ATSHA), using the acoustic measurements. Moreover, the effect of voice tasks on the perceptual ratings was studied. The study data were gathered from a total of 40 dysphonic patients (Mean±SD age=36.79±8.26 years). Perceptual voice evaluation was performed using the ATSHA during sustained vowels and sentence reading tasks. The acoustic features including fundamental frequency (F0), intensity, jitter, shimmer, and Harmonics-to-Noise Ratio (HNR) were extracted using Praat application. To assess construct validity of ATSHA, correlation between perceptual and acoustic measures were studied. The effect of tasks was investigated by mean comparison and Pearson correlation. The results demonstrate that ATSHA has significant correlation with all acoustic measures except the frequency (r=-0.08-0.35; P≥0.05). There was no significant correlation between pitch and the acoustic measures of intensity and jitter (r=-0.31; P=0.05 and r=0.24; P=0.14, respectively). The highest correlation observed between the overall severity and the HNR (r=-0.85; P<0.001). The correlation between the perceptual scores in both tasks was high (r=0.82-0.99, P<0.05). The ATSHA is a valid scale for perceptual judgment on intensity, jitter, shimmer, and HNR. However, this scale could not estimate the frequency of voice in dysphonia. The current study demonstrate that vowel prolongation and sentence reading has no noticeable effect on the perceptual ratings in dysphonia.

Use of patient-based voice assessment scales is an appropriate method that is frequently used to demonstrate effectiveness of voice therapy. This study was aimed at determining the effectiveness ofvoice therapy among patients with secondary muscle tension dysphonia (MTD) and vocal mass lesions.
The study design was prospective, with within-participant repeated measures. Thirty-three patients with secondary MTD and vocal mass lesions participated in the study, selected on the basis of voice history, laryngeal palpation, and videostroboscopy examination. An experienced otolaryngologist and one experienced speech language pathologist undertook the diagnostic process. Voice therapy included both direct and indirect techniques and lasted approximately 2 months for all included patients. The voice handicap index (VHI) was used to evaluate the effectiveness ofvoice therapy among included patients. Paired t-test, size of the standardized effect (ESI),and mean standardized response (ESII) were used to analyze effectiveness of the target voice therapy.
The findings of this study indicate astatistically significant improvement after the voice therapy protocol (P1.96). Results of ESI and ESII demonstrate that the VHI scale is sufficiently responsive to detect voice therapy change (ES>0.8).
This study recommends a combination of direct and indirect voice therapy in the vocal rehabilitation of patients with secondary MTD and vocal mass lesions. Furthormore, we recommend use of the VHI scale to show voice therapy changes for both clinical and research purposes.

Naming disorder has largely been noted in Learning Disabilities (LD) by researchers. One of the aspects of naming which has been less considered in LD is verbal fluency. The current study aimed to explore verbal fluency among children with LD, to compare it with a control group, and to investigate the effect of demographic characteristics on it.
A cross-sectional study was conducted in which 30 children with LD (15 male and 15 female, aged: 8.90±1.20) diagnosed by psychiatrists and 30 age-, gender-, and grade-matched controls (15 male and 15 female, aged: 8.71±1.39). Each participant was individually asked to complete a verbal fluency task comprising of semantic and phonemic fluency.
The results revealed that the mean scores of semantic and phonemic fluency were significantly lower in the experimental group as compared to those of the control group (p0.05).
Thecurrent study demonstrated a general weakness of children with learning disability in verbal fluency. Improvement of verbal fluency with development in both groups can highlight the increasing role of reading experiments on the naming skill although gender did not show to have any effect. Considering the importance of naming and lexical skills in literacy, the present study showed the necessity for further and detailed study of verbal fluency in children with learning disabilities.

The effect of subthalamic nucleus deep brain stimulation (STN-DBS) on the voice features in Parkinson’s disease (PD) is controversial. No study has evaluated the voice features of PD underwent STN-DBS by the acoustic, perceptual, and patient-based assessments comprehensively. Furthermore, there is no study to investigate prosodic features before and after DBS in PD. The current study aimed to assess the efficacy of STN-DBS on the voice and prosodic features by acoustic, perceptual and self-reported evaluations in PD.

Methods and Analysis: An experimental prospective cohort pretest-posttest group has been designed to survey patients with PD candidates for STN-DBS surgery. All participants will be evaluated by a speech and language pathologist before and after surgery in four different conditions as follow: pre-surgery: Medication On/ Medication Off; post-surgery: Stimulation On/ Stimulation Off. To compare pre-surgery and post-surgery conditions paired- samples T Test or Wilcoxon signed-rank test will be used. A 95% confidence interval (p value of

Background and Lipoid Proteinosis (LP) is a rare hereditary progressive disorder caused by a disorder of collagen metabolism. In LP, hyaline deposits in mucous membrane of true vocal folds causes hoarseness. The studies on the laryngeal and voice features of patients with LP are rare. To the best of our knowledge, this is the first research to study acoustic and perceptual voice features in two Iranian children with LP.
Two children (siblings) were assessed. The main voice complaint was hoarseness. Voice samples were recorded and acoustically analyzed by Praat. Furthermore, perceptual voice assessment was performed according to the GRBAS scale.
Acoustic measurement represented increase in f0, jitter, and shimmer in both children. Furthermore, mean scores of the GRBAS for all voice parameters were more than 60.
Current study is the first research that describes the voice features of Persian subjects with LP. Comprehensive understanding of the etiology in voice problems helps speech and language pathologists to provide appropriate clinical services considering the nature of pathological condition to clients.

Recently, the psycholinguistic approach has been used to understand reception and expression of prosodic skills in several languages. To our knowledge, this is the first study to investigate the receptive and expressive functions of prosody based on the psycholinguistic approach in 5-10 year-old typically-developing children in a Farsi-speaking population.
This cross-sectional study recruited 60 typically-developing children (30 males and 30 females) in three age-groups of 5-6, 7-8 and 9-10 years old. At first, the Turn-end, Affect, Chunking and Focus tasks (both receptive and expressive) were designed by researchers with regard to the prosodic functions in Farsi based on the psycholinguistic approach. The tasks were then completed by all enrolled subjects.
The 5-6 and 7-8 year-old groups scored above 12 (chance level) in all receptive and expressive tasks except for the expressive focus, while the 9-10 year-old subjects scored near the ceiling scores in all tasks. In Turn-end and Focus, receptive and expressive mean scores were significantly different across age groups (p≤0.05). The analysis showed a significant correlation between the receptive and expressive performance in Turn-end and Focus (p≤0.05)
The receptive and expressive prosodic functions seem to develop by age in typically-developing Farsi-speaking children. The performance of Farsi-speaking children in reception and expression tasks of prosodic functions in 5-6 year-old kids appears to be above chance. Meanwhile, the acquisition of the Focus output skill seems to delay until the age of 10.

In voice therapy, cognitive cueing approach elicits intended vocal behaviors by stimulating mental patterns and semantic imagery that is included in the tasks. In the current study, cognitive cues were used in order to change acoustic parameters of speech prosody in normal children. This clinical control trial study was done over 120 normal children (60 male, 60 female) ranging from 8 to 12 years old. The children read 6 sentences twice with keywords including respectively “aloud”; “slowly”; “push”; “up”; “happy”, and “sad” before and after cognitive cueing. Acoustic parameters of speech prosody including fundamental frequency, intensity, duration and their changes were analyzed by Praat software throughout reading tasks. Results showed that fundamental frequency mean in all keywords and sentences (except for the sentence included “push” keyword) have been significantly increased in all age and gender groups (p˂0.05). Also intensity mean increased significantly in the sentences included “aloud”; “push”; “up”, and “happy” keywords but decreased in the sentences included “slowly”, and “sad” keywords. The duration parameter changed significantly in all keywords and sentences (p˂0.05). Cognitive cues may be able to modify various aspects of speech prosody without imposing any external model in normal Persian children. Future studies can investigate the effect of cognitive cueing approach to improve speech prosody problems of children in Persian.

Auditory-perceptual assessment of voice a main approach in the diagnosis and therapy improvement of voice disorders. Despite, there are few Iranian studies about auditory-perceptual assessment of voice. The aim of present study was development and determination of validity and rater reliability of Persian version of the Consensus Auditory Perceptual Evaluation of Voice (CAPE -V). The qualitative content validity was detected by collecting 10 questionnaires from 9 experienced speech and language pathologists and a linguist. For reliability purposes, the voice samples of 40 dysphonic (neurogenic, functional with and without laryngeal lesions) adults (20-45 years of age) and 10 normal healthy speakers were recorded. The samples included sustain of vowels and reading the 6 sentences of Persian version of the consensus auditory perceptual evaluation of voice called the ATSHA. The qualitative content validity was proved for developed Persian version of the consensus auditory perceptual evaluation of voice. Cronbach’s alpha was high (0.95). Intra-rater reliability coefficients ranged from 0.86 for overall severity to 0.42 for pitch; inter-rater reliability ranged from 0.85 for overall severity to 0.32 for pitch (p<0.05). The ATSHA can be used as a valid and reliable Persian scale for auditory perceptual assessment of voice in adults.

Teachers are a large group of professional voice users that several risk factors and voice demands causes various voice complaints among them. As the voice is multidimensional، the aim of this study was acoustic and perceptual measurement of teachers’ voice and comparing the findings between two groups with many and few voice complaints. Sixty female teachers of high school in Sari، north of Iran، were chosen by available sampling to participate in this cross-sectional study. According to a voice complaints questionnaire، 21 subjects located in few voice complaints and 31 in many voice complaints group. After a working day، subjects completed a voice self-assessment questionnaire. Also، teachers’voice were recorded during three tasks including sustained vowels /a/ and /i/، text reading and conversational speech. Acoustic parameters were analyzed by Praat software and 2 speech-language pathalogists performed auditory-perceptual assessment by GRBAS (Grade، Roughness، Breathiness، Asthenia، Strain) scale. Comparing of the voice self-assessment between the two groups demonstrated statistically significant difference (p<0. 05); however results of the acoustic and auditory-perceptual measurement did not show significant diffrence. Despite prevalent voice problems in teachers، there are various conditions in terms of complaints and assessments methods. In this study، only a remarkable deviation documented in the client-based assessments in many voice compliants group in comparison with few voice compliants، which would be probably related to different individual’s perception of voice problem between two groups. These results support paying attention to self-assessments in clinical process of voice problems.

With regard to the multidimensional concept of the voice, different assessments are needed to diagnose and treat voice disorders. Additionally, it is important to know how various aspects of voice are compared and related to each other.

The purpose of this study was to examine the correlation between the Voice Handicap Index (VHI) score and the acoustic measures in different types of Muscle Tension Dysphonia (MTD).Patients and

Eighteen females including 12 with primary MTD (group 1) and 6 with secondary MTD (group 2) participated in this cross-sectional study. All subjects completed VHI and were provided with voice samples including three trials of the sustained vowel /a/ at a comfortable loudness level as well as a connected speech sample. Acoustic measures were performed with Praat software and included fundamental frequency, jitter %, shimmer % and intensity.

Certain correlations were found between fundamental frequency in vowel and total VHI, physical, functional and emotional domains of VHI in group 1 (r = 0.636, 0.649, 0.613 and 0.592 respectively). There was good correlation between speaking fundamental frequency and total VHI and its subscales - except the physical subscale - were also correlated. In group 2, the correlations between jitter and total VHI as well as the emotional domain of VHI was very good (r = 0.829, and 0.812 respectively). Furthermore, we found very good correlation between the intensity of speech and functional domain (r = 0.812).

VHI and acoustic parameters likely measure different aspects of voice and thus are not interchangeable. However, the correlation between VHI and some laboratory measurements increases in dysphonia of the same nature, origin and same sexuality.

One of the common problems in many types of aphasia syndromes is word retrieval and/or production difficulty. So, designing a valid test that can examine this problem based on related processes and influencing factors is important. Picture confrontation naming is a typical method for assessing and treatment of word retrieval impairments. The aim of this study was determining the validity and reliability of oral picture-naming test in assessing word retrieval ability of aphasic adults. Content and face validity of the test, that contains the line drawings of 115 Persian nouns, were assessed by speech therapists, graphists and painters. Then, the test was administered on 10 aphasics and 30 age-, gender- and education-matched normal subjects in two steps. Construct validity and internal consistency of test were investigated. External consistency was analyzed by test-retest method. The content and face validity of all items were more than 90 and 85 percents, respectively. There was a statistically significant difference between the mean scores of patients and normal subjects (p<0.001). The internal consistency of 0.98 was determined for the test. The intra-class correlation coefficient of this test was 0.98. The oral picture-naming test had good content, face and construct validity. Also, internal and external consistencies were high. So, this test is a valid instrument for assessing naming ability of aphasic patients by a variety and big set of picture.

Internal evaluation is an important part of organization monitoring. One of the Ministry of Health''s policies is to encourage educational departments to conduct internal evaluations. The aim of internal evaluation of department of speech therapy was appraising its education، research and treatment qualities and determining its strengths، weaknesses، opportunities and threats (SWOTs) to identify the ways of overcoming weakness and threats. This descriptive cross-sectional study was conducted in 10 phases to evaluate 10 factors. Participants were undergraduate، graduate، and postgraduate students، academic staff، director of the department along with the patients. The internal evaluation software for educational and research centers released by Center of Medical Education Studies and Development was modified and utilized. Data was analyzed by calculating mean of means. Mean of means from highest to lowest scores were respectively as follows: the quality of diagnosis، treatment and dealing with patients 4. 15 out of 5; as well as the quality of academic staff 3. 5 were in the range of desirable category; qualities of management and organizational structure 3. 34، graduate students 3. 21، teaching and learning processes 3. 1، missions and goals 3. 09، instructional methods and curriculum models 2. 99، educational and research equipments 2. 9، students 2. 76 and research 2. 67 were within the range of rather desirable category. Total score was 3. 17 (63. 4%) which was within the range of rather desirable category. The department of speech therapy was in rather desirable state before merger. That result was appropriate according to the department''s conditions and supplies.

Glottic closure pattern is one of the most important stroboscopic signs in judging the normality of laryngeal function. According to the recent researches, complete glottic closure is not the only pattern in normal phonation. The aim of this study was to investigate the glottic closure pattern in normal subjects and to understand the role of sex in having different glottic closure patterns. In a cross-sectional study, 80 subjects (58 females and 22 males; mean age of 21.19 years) were randomly selected from a population of 218 students. After taking a full medical history and performing perceptual and voice self assessment, subjects without any vocal disorders were recruited. Videolaryngoscopic assessment was performed during producing the vowel sound /i/ in habitual, high, low, loud and soft levels of phonation. Glottic closure patterns were analyzed in different phonation and also were compared between males and females. Although complete closure was the most frequent pattern, Y posterior chink was the second pattern in males (20.2%) and females (39.4%) in all phonation. The results revealed significant difference between males and females in glottic closure pattern (p=0.001). Moreover, significant differences were observed in habitual (p=0.004), high (p=0.006) and soft (p=0.02) phonations between males and females; however, the differences in low (p=0.7) and loud (p=0.19) phonations between males and females were not significant. Y posterior chink, as well as complete closure, are likely to be normal findings in people with normal voice. Besides, gender has a significant influence on glottic closure pattern.

Laryngeal muscles contribute in sound production play a key role in specific language. Needle electromyography is the specific complementary method for muscle activity evaluation which is awfully painful and needs serenity of patient. The purpose of this study was to use Surface electromyography as a probable new approach for evaluation of laryngeal muscles activity.

34 healthy women and 34 healthy men aged 20-30 years old were enrolled in this study. Each individual was seated in an armchair. Recording electrodes were placed bilaterally (right and left) in the low anterior neck at approximately one centimeter from midline on thyroarytenoid and cricothyroid muscles. Silent activity and fricative voice (/z/, /ž/) and voiceless (/s/, /š/) activities were recorded for ten seconds followed by 10 seconds of rest, for 5 repetition. All data were processed and frequency and non linear measurements were assessed. And were compared in time and frequency domain.

Muscle activity in fricative voice in both groups was greater than rest condition (p<0.05). Moreover, muscle activity median frequency was significantly more in men than women (p<0.001).

Activity evaluation of thyroarytenoid and cricothyroid muscles using surface electromyography is difficult in women. That may be due to anatomical features such as length and width of neck in women.

Vocal abuse and misuse are the most frequent causes of voice disorders. Consequently some therapy is needed to stop or modify such behaviors. This research was performed to study the effectiveness of vocal hygiene program on perceptual signs of voice in people with dysphonia.

A Vocal hygiene program was performed to 8 adults with dysphonia for 6 weeks. At first, Consensus Auditory- Perceptual Evaluation of Voice was used to assess perceptual signs. Then the program was delivered, Individuals were followed in second and forth weeks visits. In the last session, perceptual assessment was performed and individuals’ opinions were collected. Perceptual findings were compared before and after the therapy.

After the program, mean score of perceptual assessment decreased. Mean score of every perceptual sign revealed significant difference before and after the therapy (p≤0. 0001). «Loudness» had maximum score and coordination between speech and respiration indicated minimum score. All participants confirmed efficiency of the therapy.

The vocal hygiene program improves all perceptual signs of voice although not equally. This deduction is confirmed by both clinician-based and patient-based assessments. As a result, vocal hygiene program is necessary for a comprehensive voice therapy but is not solely effective to resolve all voice problems.

Objective measurement is general and acoustic measurements in particular have become a substantial aspect of stuttering assessment during the last few decades. Measurements do not replace the perceptual judgment, but they allow a more precise diagnosis, provide more evidence for therapeutic interventions, and are useful as feedback for patients in therapy. The purpose of this investigation was to compare some adult male stutterer's and nonstutterer's acoustic features. Adult male stutterers and nonstutterers participated this case-control study. Their fluent reading of 20 sentences in Farsi, prolongation of vowels /a/ and /i/, and rhythmic counting from 1 to 20 were analyed with Dr. Speech software. There were no significant differences between two groups in fundamental frequency (f0) and standard deviation of f0 in three speech samples (vowels /a/ and /i/, reading 20 sentences, and rhythmic counting from 1 to 20). No significant difference were between two groups for jitter and shimmer. Non significant differences between two groups are somewhat due to investigation of this parameters in fluent speech of stutterers and nonstutterers.