title: Perceptual Detection of Subtle Dysphonic Traits in Individuals with Cervical Spinal Cord Injury Using an Audience Response Systems Approach.
abstract: OBJECTIVE
  Reduced respiratory function following lower cervical spinal cord injuries (CSCIs) may indirectly result in vocal dysfunction. Although self-reports indicate voice change and limitations following CSCI, earlier efforts using global perceptual ratings to distinguish speakers with CSCI from noninjured speakers have not been very successful. We investigate the use of an audience response system-based approach to distinguish speakers with CSCI from noninjured speakers, and explore whether specific vocal traits can be identified as characteristic for speakers with CSCI.
  
  
  METHODS
  Fourteen speech-language pathologists participated in a web-based perceptual task, where their overt reactions to vocal dysfunction were registered during the continuous playback of recordings of 36 speakers (18 with CSCI, and 18 matched controls). Dysphonic events were identified through manual perceptual analysis, to allow the exploration of connections between dysphonic events and listener reactions.
  
  
  RESULTS
  More dysphonic events, and more listener reactions, were registered for speakers with CSCI than for noninjured speakers. Strain (particularly in phrase-final position) and creak (particularly in nonphrase-final position) distinguish speakers with CSCI from noninjured speakers.
  
  
  CONCLUSIONS
  For the identification of intermittent and subtle signs of vocal dysfunction, an approach where the temporal distribution of symptoms is registered offers a viable means to distinguish speakers affected by voice dysfunction from non-affected speakers. In speakers with CSCI, clinicians should listen for presence of final strain and nonfinal creak, and pay attention to self-reported voice function and voice problems, to identify individuals in need for clinical assessment and intervention.
authors: Division of Speech and Language Pathology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet (KI), Stockholm, Sweden; Department of Speech and Language Pathology, Karolinska University Hospital, Stockholm, Sweden; Division of Clinical and Experimental Medicine (IKE), Division of Neuro and Inflammation Sciences (NIV), Linköping University, Linköping, Sweden. Electronic address: kerstin.johansson@ki.se.
authors: Kerstin
authors: K
authors: Johansson
authors: Division of Speech and Language Pathology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet (KI), Stockholm, Sweden.
authors: Sofia
authors: S
authors: Strömbergsson
authors: Division of Speech and Language Pathology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet (KI), Stockholm, Sweden; Aix Marseille Université, CNRS, LPL UMR 7309, Aix en Provence, France.
authors: Camille
authors: C
authors: Robieux
authors: Division of Speech and Language Pathology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet (KI), Stockholm, Sweden; Department of Speech and Language Pathology, Karolinska University Hospital, Stockholm, Sweden.
authors: Anita
authors: A
authors: McAllister
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D002574:Cervical Vertebrae / Q000293:injuries* / Q000503:physiopathology; D055154:Dysphonia / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D005260:Female; D006801:Humans; D007600:Judgment; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D013061:Speech Acoustics; D013067:Speech Perception; D013068:Speech Production Measurement; D013066:Speech-Language Pathology / Q000379:methods*; D013119:Spinal Cord Injuries / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D013997:Time Factors; D014833:Voice Quality; D055815:Young Adult
keywords: Voice Handicap Index (VHI); cervical spinal cord injury; dysphonia; perceptual assessment; respiration