Biomedical subjects

L O Ramig

Publications and source records attributed to L O Ramig.

27 records · Page 2Linked to original sources

PubMed1995

Intensive voice treatment in Parkinson disease: laryngostroboscopic findings.

As part of ongoing research to investigate and document the efficacy of intensive voice therapy to improve functional communication in patients with idiopathic Parkinson disease, 45 patients were enrolled in a controlled, randomized, prospective study. Pre- to posttreatment comparisons are presented here on 22 of those patients who underwent laryngeal imaging examination. Of the 22 patients, 13 patients received intensive therapy aimed at increasing vocal and respiratory effort (VR), whereas nine received intensive therapy aimed at increasing respiratory effort (R) only. All patients had a pretreatment evaluation that included two (but sometimes only one) voice recordings and an otolaryngologic examination with laryngostroboscopy. At the completion of 4 weeks of therapy (16 sessions), two voice recordings were made, and laryngostroboscopy was again performed. The pre- and posttherapy videolaryngostroboscopy tapes were then randomized and rated by four judges. Raters' findings were then compared with vocal intensity measured before and after therapy. The VR therapy group showed improvements on laryngostroboscopic variables: less glottal incompetence and no significant change in supraglottal hyperfunction after therapy. No differences were observed in the R-only group. The mean intensity increase in the VR therapy group was 12.5 dB, compared with a decrease of 1.9 dB in the R-only group. These findings suggest that in patients with Parkinson disease, intensive therapy focusing on phonatory effort improves adduction of the vocal folds as assessed by laryngostroboscopy. Differences in laryngeal function in these patients observed with fiberoptic laryngoscopy and rigid telescopic laryngoscopy are discussed.

Aged↗

PubMed1995

Comparison between clinician-assisted and fully automated procedures for obtaining a voice range profile.

A comparison was made between two methods of obtaining a voice range profile. One method was traditional, involving a clinician who gave instructions, motivated the subject to achieve the greatest intensity range, and determined when the goal was achieved. The second method was completely automated, involving the use of a videotape for instruction and a computer for elicitation and evaluation. Ten men and 10 women with normal voices participated as subjects in the study, and a counterbalanced design was used. Results indicated that there is no obvious preference for the use of either method, although considerable individual differences are noted.

Adult↗

PubMed1995

Phonatory and articulatory changes associated with increased vocal intensity in Parkinson disease: a case study.

This study examined changes in voice and speech production in a patient with Parkinson disease as he increased vocal intensity following 1 month of intensive voice treatment. Phonatory function and articulatory acoustic measures were made before and after treatment as well as 6 and 12 months later. Pre- to post-treatment increases were documented in sound pressure level in sustained phonation, syllable repetition, reading, and monologue. Consistent with mechanisms of intensity change reported in normal speakers, corresponding improvements were measured in estimated subglottal pressure, maximum flow declination rate, laryngeal airway resistance, open quotient, EGGW-25, harmonic-spectral slope, and maximum vowel duration. Measures of phonatory stability in sustained phonation and semitone standard deviation in reading and speaking showed changes accompanying increased vocal intensity. In addition, changes were measured in articulatory acoustic parameters (vowel and whole word duration, transition duration, extent and rate, and frication duration and rise time) in single-word productions. These findings indicate that this patient increased his vocal intensity using phonatory mechanisms that have been associated with the nondisordered larynx. In addition, the increased vocal intensity led to changes in articulation that were not targeted in treatment.

Articulation Disorders↗

PubMed1995

Comparison of two forms of intensive speech treatment for Parkinson disease.

This study investigated the effect of two forms of intensive speech treatment, (a) respiration (R) and (b) voice and respiration (Lee Silverman Voice Treatment [LSVT]), on the speech and voice deficits associated with idiopathic Parkinson disease. Forty-five subjects with Idiopathic Parkinson disease completed extensive pretreatment neurological, otolaryngological, neuropsychological, and speech assessments. All subjects completed 16 sessions of intensive speech treatment, 4 times a week for 1 month. Pre- and post-treatment measures included intensity and maximum duration during sustained vowel phonation. Intensity, habitual fundamental frequency, fundamental frequency variability, and utterance and pause duration were measured during reading of the "Rainbow Passage" and conversational monologue as well. Family and subject self-ratings were completed pre- and post-treatment for the perceptual variables loudness, monotonicity, hoarseness, overall intelligibility, and initiation of conversation. Significant pre- to post-treatment improvements were observed for more variables and were of greater magnitude for the subjects who received the voice and respiration treatment (LSVT). Only subjects who received the LSVT rated a significant decrease post-treatment on the impact of Parkinson disease on their communication. Correlations between descriptive prognostic variables (i.e., stage of disease, speech/voice severity rating, depression, and time since diagnosis) and magnitude of treatment-related change indicated these factors did not significantly predict treatment effectiveness. These findings suggest that intensive voice and respiration (LSVT) treatment, focusing on increased vocal fold adduction and respiration, is more effective than respiration (R) treatment alone for improving vocal intensity and decreasing the impact of Parkinson disease on communication.

Aged↗

PubMed1994

Differential phonatory characteristics of four women with amyotrophic lateral sclerosis.

Patients with specific neural subsystem involvement are often reported to present with particular perceptual characteristics of voice. This has been true for diseases such as amyotrophic lateral sclerosis (ALS), a progressive disease in which mixed neurologic signs are present. This article reports acoustic data on the phonatory performance of four women diagnosed with ALS who had initial bulbar signs and progressive phonatory deterioration. The data presented here demonstrate that the phonatory characteristics of women with ALS are not uniform, but in fact may vary greatly from patient to patient.

Amyotrophic Lateral Sclerosis↗

PubMed1992

Vocal tremor analysis with the Vocal Demodulator.

Acoustic analysis of vocal tremor has the potential to make significant quantitative and diagnostic contributions to the study of vocal disorders. This paper presents a new device for analysis of vocal tremor. The Vocal Demodulator produces amplitude- and frequency-demodulated outputs and measures the frequency and level (percent) of low-frequency tremor components in sustained phonation. A standard microphone is used to transduce the voice signal for input to the demodulator. The input fundamental frequency (F0) range is 70-1200 Hz, and frequency response of the amplitude and frequency demodulation is 2.5-25 Hz. Five parameters are displayed in real time: F0, amplitude-modulation frequency, amplitude-modulation level, frequency-modulation frequency, and frequency-modulation level. Validation, calibration, and reliability data from synthesized test signals with modulation, as well as phonation from subjects with vocal tremor, subjects producing vibrato, and subjects with normal voice are presented. Research and clinical applications of this device are suggested.

Acoustics↗

PubMed1992

Rapid voice tremor, or "flutter," in amyotrophic lateral sclerosis.

In an attempt to clarify the origin and frequency characteristics of a rapid voice tremor, or "flutter," in patients with amyotrophic lateral sclerosis (ALS), eight patients (four men and four women; ages 42 to 70 years) who had ALS and rapid voice tremor and an age- and sex-matched control group of eight subjects were asked to sustain the vowel /a/ and their voices were recorded for later analysis. Each segment of phonation was demodulated into amplitude and frequency components. From each subject's 8-second amplitude and frequency signals, a fast Fourier transform analysis was done on a 1-second segment previously identified perceptually as having the most apparent tremor or flutter. The results showed that patients with ALS had multiple combinations of levels and frequencies for amplitude and frequency modulations in comparison with control subjects, who had consistently low levels of modulations. In an attempt to quantify the tremor or flutter in ALS, amplitude and frequency modulations were not clearly or predominantly represented at one point along the spectrum. Nevertheless, these frequency and amplitude modulations are more prominent in patients with ALS than in normal subjects. The origins of these aberrant frequency and amplitude modulations in ALS patients remain obscure, although speculation is that they are of peripheral rather than central nervous system origin.

Adult↗

PubMed1990

Acoustic analysis of voice in amyotrophic lateral sclerosis: a longitudinal case study.

Acoustic measures of phonatory instability (coefficient of variation for amplitude, coefficient of variation for frequency, shimmer, jitter, and harmonics-to-noise ratio), phonatory limits (maximum fundamental frequency range and maximum duration of vowel phonation), and the nasal-oral amplitude ratio were measured five times throughout a 6-month period from the phonation of a 69-year-old male patient with amyotrophic lateral sclerosis (ALS), an age- and sex-matched control subject, and on one occasion from a 16-subject control group matched to the patient in age and sex. The patient was free of vocal symptoms at the initiation of the study. When compared to the other recording sessions, the final recording of the ALS patient was characterized by increased coefficient of variation for amplitude, increased coefficient of variation for frequency, increased shimmer, increased jitter, reduced harmonics-to-noise ratio, and reduced maximum vowel duration. These acoustic manifestations of increased phonatory instability and reduced phonatory limits over time were in contrast to the consistency observed in the phonation of the longitudinal control subject and were outside the range of plus or minus one standard deviation on most acoustic variables when compared to the control group. These findings support the potential use of acoustic analysis in reflecting progression of ALS and suggest the need for further studies to investigate the relationship between acoustic analysis of voice and manifestations of neurological disease.

Aged↗

PubMedDate not supplied

The aging voice: a review, treatment data and familial and genetic perspectives.

This paper will provide a review of aspects of vocal aging within the context of general body aging and describe two data sets related to the aging voice. Data will be presented which document pre- to posttreatment improvement in select voice characteristics (sound pressure level, subglottal air pressure, thyroarytenoid laryngeal muscle activity and voice quality) following application of an intensive voice treatment program (the LSVT) to 3 individuals with aged voice. Additionally, physiological data (forced expiratory volume, visual accommodation, bone density, taste discrimination, white blood count and resting heart rate) and select perceptual (perceived age) and acoustic measures (reflecting both cycle-to-cycle and longer-term intensity and frequency stability) from 67 subjects will be reviewed from the work of Gray and colleagues to document the differential impact of the global aging process across organ systems including the aging voice.

Adolescent↗