Comfortable Speech Research Articles

SS 25268:2023, an acoustic standard for listeners and speakers

The sound environment in many classrooms is not good, and we know that poor room acoustics impedes learning and has a negative effect on teachers' voice health. Sound reflections in the room have a great impact on both speech intelligibility and speech comfort. SS 25268 is a Swedish sound standard for, among others, school buildings. The standard uses reverberation time, RT, to put requirement on room acoustics. There is a connection between the amount of sound absorption in the room and RT according to Sabine formula. The problem is that Sabine formula requires a diffuse sound field witch very seldom occurs in classrooms with acoustic ceilings. Another problem is when RT is evaluated with T20, the early reflections are not included, and early reflections have a great impact on speech intelligibility. The standard have been updated to a new version, SS 25268:2023. In this standard there is an opportunity for landlords to put other requirements then RT to evaluate the room acoustics. The standard have an appendix to help landlords, principals and teachers to better understand how to put the right acoustic requirements on their school buildings to create both good speech intelligibility and speech comfort.

Lip hyper-articulation in loud voice: Effect on resonance-harmonic proximity

Men and women speakers were recorded while producing sustained vowels at comfortable and loud levels. Following comfortable speech, loud levels were produced in three different conditions: first without specific instruction (UL); then maintaining the same pitch as the comfortable level (PL); and finally, keeping both pitch and lip articulation constant (PAL). The sound pressure level, the fundamental frequency ( fo), the first two vocal tract resonances (R1 and R2), the lip geometry, and the larynx height were measured. For women, a closer proximity of R1 to its nearest harmonic, nfo, was observed in UL. However, no such increased proximity was found in PL, when speakers could, and did, hyper-articulate. Also, no increased proximity was observed in PAL, when lip articulation was constrained. No significant increase in R1: nfo proximity was observed in men in any of the three loud conditions. Finally, R2 was not observed significantly closer to a voice harmonic in loud speech, for neither men nor women.

Application and Measurement Properties of the Talk Test in Cardiopulmonary Patients: A Systematic Review.

The talk test (TT) evaluates the exercise intensity by measuring speech comfort level during aerobic exercise. There are several application protocols available to assess individuals with cardiopulmonary diseases. However, the measurement properties of the TT were not systematically reviewed yet. A systematic review was developed, registered (CRD420181068930), and reported according to PRISMA Statement. Randomized clinical trials, cross-sectional studies, or series cases were identified through multiple databases and were selected if they presented concomitant speech provocation and an exercise test. Included studies were evaluated based on methodological quality (adapted New Castle-Ottawa Scale), descriptive quality (STROBE Statement), and risk of bias (COSMIN bias risk scale). Ten studies were included. Seven studies presented moderate to high quality and the majority presented good scores according to the STROBE statement. Four hundred and fourteen subjects performed the TT, the majority being patients with coronary artery disease. The test validity was supported by the included studies. Talk Test reliability was considered satisfactory, although only one study presented an adequate reliability analysis. The studies found a correlation between the last positive stage of the TT with the first ventilatory threshold. Workload, oxygen uptake, and heart rate in the last positive stage of the TT were not different from the same parameters related to the first ventilatory threshold. The evidence indicates that the TT is suitable as an alternative tool for the assessment and prescription of exercise in individuals with cardiovascular diseases. The stage when the individual is still able to speak comfortably is suggested as the intensity for aerobic exercise prescription. As there is still no well-defined and fully explored TT protocol, caution is required when interpreting the TT results.

FEATURES OF STUDENTS' SPEECH (BASED ON THE MATERIALS OF A SPEECH SELF-PORTRAIT)

The issue of developing soft skills (in particular, communication skills) among students of higher education institutions is currently relevant. The article considers features of oral and written speech of students as speech personalities; the correlation of the concepts “Speech portrait” and “Speech self-portrait” is presented; the connection between the concepts of “Communication skills” and “Speech self-portrait” is presented. The purpose of the article is to describe the typical features of speech of students of information technology, identified by the students themselves (norm and deviations). Speech self-portraits of students were used as the research material. The results obtained allow us to identify blocks of speech features that students focus on: speech comfort; the opposition of a typo (misprint)/spelling error; lexical features of speech. Completing this task also allows students to develop the skills of observing their speech and analyzing their speech behavior.

Muscle oxygenation assessment during talk test to determine the anaerobic threshold in individuals with cardiovascular disease

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil (CAPES) - Finance Code 001. Background Cardiopulmonary exercise test (CPET) is the reference method for assessing gas exchange threshold (GET), a surrogate of the anaerobic threshold (AnT). However, muscle oxygenation has been shown as an additional tool for AnT determination, using the lower limb threshold (LLT). Besides, Talk Test (TT), a tool used to assess, prescribe, and monitor exercise intensity through speech comfort level, has shown a correlation with GET as well. Purpose To identify the AnT obtained from the traditional method from CPET (GET) and the LLT; to compare heart rate (HR) and tissue saturation index (TSI) data at AnT (GET and LLT); to compare the parameters of LLT on CPET and TT, and to correlate LLT and TT stages in cardiovascular disease (CVD) patients. Methods CVD patients underwent CPET and TT, both on a treadmill, in two distinctive days. During those tests, peripheral muscle oxygenation was assessed by the near-infrared spectroscopy method. GET (CPET) was determined by the V-slope method; LLT (CPET and TT) was determined by the visual inspection of oxyhemoglobin and deoxyhemoglobin curves. A TT protocol based on the prediction equation for the covered distance of the six-minute walk test (6MWD) was applied. TT protocol was incremental, with two-minutes stages starting at 70% of the average velocity predicted and 2% of inclination, increasing velocity in 10 percentage points (p.p.) at each stage, until the fifth stage, at which the inclination was increased in 2 p.p. until test completion. At the end of each stage, patients read a standardized paragraph and were asked about speech comfort. Shapiro-Wilk test was performed to assess data distribution. Wilcoxon test was applied to compare physiological variables (HR and TSI) at GET and LLT. Repeated measures analysis of variance (ANOVA), followed by Bonferroni post-hoc test was assessed to compare the variables at LLT and TT stages (last TT+ and first TT±). Spearman correlation coefficient was used to assess the relationship between variables. Statistical significance was set at 5%. Results 24 cardiovascular patients were included. Similar values of HR (GET vs. LLT: 102 ± 15 bpm vs. 99 ± 14 bpm, p = 0,08), and TSI (GET vs. LLT: 64,6 ± 8,2% vs. 66,4 ± 7,8%, p = 0,09) were observed during CPET. Regarding LLT at CPET and TT, there was no difference between HR (CPET vs. TT: 99 ± 14 bpm vs. 100 ± 12 bpm, p = 1,00) and TSI (CPET vs. TT: 66,4 ± 7,8% vs. 65,3 ± 4,9%, p = 1,00). Furthermore, good relationship between HR in LLT and TT stages (LLT vs. TT+: r = 0,79; LLT vs. TT±: r = 0,76; p < 0,05 for both) was found. Conclusions Our results showed similarity between LLT and GET. Besides, TT showed a similar response of muscle oxygenation and heart rate comparing to CPET, with a good correlation between LLT and TT stages. These results endorse the validity of TT as an auxiliary and low-cost tool to identify the AnT.

Can the talk test be used to predict training induced changes in ventilatory threshold?

This study was designed to assess the ability of the Talk Test (TT) to track training-related changes in ventilatory threshold (VT). Thirteen recreational athletes (20.5±1.91 years, males=7) completed two incremental exercise tests (one with respiratory gas exchange and one with the TT) before and after six weeks of self-directed increases in training load. The TT was used to predict VT by assessing the ability to speak comfortably after three-minute exercise stages, based on speech comfort while reciting a 100-word passage. Training load was documented from exercise logs based on session rating of perceived exertion (sRPE) and training duration. Repeated measures ANOVA, with the Tukey’s post-hoc analysis, was used to detect differences between the changes in power output (PO) at the equivocal stage of the Talk Test (EQ) and VT measured by gas exchange (p<.05). Significant mean differences were found between pre- vs. post-training PO and measured VT (116+32.4 vs. 134+32.4 Watts) (p<.05) but not at the EQ stage of the TT (125+40.8 vs. 135+29.8 Watts). The increase in PO at VT (+15.5%) was significantly underestimated by the change in PO at the EQ stage of the TT (+8.0%). The correlation between changes in PO at VT and PO at the EQ stage of the TT was r=0.66, p<.01. However, about 50% of participants did not change their PO at the EQ stage of the TT, so the individual correspondence between TT and measured VT was only moderately strong.

METHODS OF FACTORIAL CODING OF SPEECH SIGNALS

Context. The paper outlines the methods of factorial coding of speech signals using a factorial code to provide integrated information security and to maintain a receiver and transmitter clock phase. By integrated information security, for the methods proposed in this article, we mean data protection from effects of noise in communication channel and attempts of data unauthorized access in open multiple access telecommunication networks. Objective. The goal of the research is to provide integrated protection of real-time speech signals based on factorial coding. For this, the methods for factorial coding of speech signals and building speech codecs have been developed. These methods are based on the properties of factorial codes to keep synchronism with the working signal, to detect a significant part of errors caused by the action of noise, natural or created intentionally, to provide the ability to correct all detected errors with a finite accuracy, as well as to provide cryptographic protection against voice message unauthorized listening by hiding the law of converting speech signal samples into a permutation. Method. The main idea of the proposed methods is to choose permutations for information transferring with a specific set of properties and features that provide the ability to correct errors detected by code and to recover speech signal samples with a finite degree of accuracy (with a nonzero aperture). Results. The procedures for information coding/decoding have been determined. The results of the experimental evaluation of the model of such systems when working on a communication channel with both independent and multiple bit errors are presented. The magnitude of decoding noise due to the finite accuracy of speech signal samples recovery is determined as a function of bit error probability in a communication channel. Conclusions. The proposed methods of factorial coding of a speech signal provide integrated information security and recovery with finite accuracy of speech signal samples deformed by noise in communication channel. The requirements to the quality of communication channel (to the value of bit error probability) for comfortable speech perception are determined.

Speech evaluation during maxillary mini-dental implant overdenture treatment: A prospective study.

Large proportions of patients are edentulous and wear removable dentures leading to reduced functional comfort and less oral health‐related quality of life. Satisfaction with the oral situation after implantation depends on the outcome in eating comfort, speech comfort and aesthetics. Modification in form and location of the teeth may affect speech. The aim of this study is to determine speech, oromyofunctional behaviour, satisfaction with the treatment and the impact on quality of life of the horse‐shoe overdenture retained by mini‐dental implants (MDIs) in the maxilla. This prospective multicentre cohort study included 32 patients for treatment. 5 to 6 implants were placed, traumatically piercing the mucosa. Patients were evaluated three times during treatment (pre‐operatively with conventional prosthesis including full palatal coverage (CD), post‐operatively with provisionally relined CD and with horse‐shoe overdenture on MDI). The assessment included a phonetic evaluation, examination of oromyofunctional behaviour, evaluation of the impact on quality of life (OHIP‐14) and a rating of satisfaction with the treatment and speech on a visual analogue scale. Several speech sounds are found to be disturbed before treatment. In the next two stages of the treatment, the number of speech issues decreases. In the final stage, ten people show minor speech problems, especially with the /s/ sound. In this stage, seven people still present with oromyofunctional problems, especially whistling problems. In this last stage, people are very satisfied with the treatment (83%) and with speech (84%). The impact on quality of life is low (8.23/56).

Cepstral and Perceptual Investigations in Female Teachers With Functionally Healthy Voice

PurposeThe present study aimed at measuring the smoothed and non-smoothed cepstral peak prominence (CPPS and CPP) in teachers who considered themselves to have normal voice but some of them had laryngeal pathology. The changes of CPP, CPPS, sound pressure level (SPL) and perceptual ratings with different voice tasks were investigated and the influence of vocal pathology on these measures was studied. MethodEighty-four Finnish female primary school teachers volunteered as participants. Laryngoscopically, 52.4% of these had laryngeal changes (39.3% mild, 13.1% disordered). Sound recordings were made for phonations of comfortable sustained vowel, comfortable speech, and speech produced at increased loudness level as used during teaching. CPP, CPPS and SPL values were extracted using Praat software for all three voice samples. Sound samples were also perceptually evaluated by five voice experts for overall voice quality (10 point scale from poor to excellent) and vocal firmness (10 point scale from breathy to pressed, with normal in the middle). ResultsThe CPP, CPPS and SPL values were significantly higher for vowels than for comfortable speech and for loud speech compared to comfortable speech (P < 0.001). Significant correlations were found between SPL and cepstral measures. The loud speech was perceived to be firmer and have a better voice quality than comfortable speech. No significant relationships of the laryngeal pathology status with cepstral values, perceptual ratings, or voice SPLs were found (P > 0.05). ConclusionNeither the acoustic measures (CPP, CPPS, and SPL) nor the perceptual evaluations could clearly distinguish teachers with laryngeal changes from laryngeally healthy teachers. Considering no vocal complaints of the subjects, the data could be considered representative of teachers with functionally healthy voice.

Using the Talk Test to Prescribe and Guide Exercise Intensity: Speaking Your Way to Improved Fitness

Introduction: The Talk Test (TT) is a non-invasive, subjective method of prescribing exercise intensity. The TT involves three stages. When exercisers can speak comfortably, can speak but not comfortably, or cannot speak comfortably, they are in the positive (POS), equivocal (EQ), and negative (NEG) TT stages, respectively. The NEG stage correlates with important physiological markers such as ventilatory threshold and lactate threshold. Given the evidence demonstrating large increases peak oxygen consumption (VO2peak) when training at intensities above these markers, the purpose of the study was to test the hypothesis that the TT is efficacious for improving VO2peak at both the group and individual level in young, healthy males.&#x0D; Methods: 11 healthy males completed a maximal fitness test before and after 4 weeks of training 4 times per week for 30 minutes in the NEG stage. The TT was performed every 2.5 to 5 minutes to ensure that the resistance would be enough to elicit a NEG response. Changes in VO2peak below 2 times a previously established typical error were classified as non-response.&#x0D; Results: Four weeks of training at NEG induced a significant increase (11.5%) in VO2peak (PRE: 45.80 mL/Kg/min ± 4.92; POST 51.07 mL/Kg/min ± 5.45, p &lt; 0.001). Furthermore, only one participant (9.09%) was classified as a non-responder in VO2peak following training.&#x0D; Conclusion: These results suggest that the TT can efficaciously prescribe and guide exercise intensity in young, healthy males, and that training at an intensity that prevents comfortable speech leads to a small incidence of non-response

Comparison of the talk test and percent heart rate reserve for exercise prescription

Exercise intensity is traditionally prescribed using %HRmax, %HRR, %VO2max, or %VO2R. Recently, the Talk Test (TT) has been proposed as an alternative method to guide exercise intensity. However, it is unknown if prescribing exercise intensity solely using the TT can provoke training responses that are comparable to traditional guidelines. This study compared the responses to training using either the TT or %HRR. Forty-four subjects (17 males and 27 females: age=20.4±3.02 years; body height=170.5±9.79 cm; body weight=71.9±13.63 kg) completed an incremental maximal cycle ergometer test, were stratified by VO2max and gender, and randomly assigned to training groups guided by either %HRR (n=20) or the TT (n=24). Both groups completed 40-minute training sessions three days per week for 10 weeks. In the HRR group, exercise intensity was targeted (per ACSM guidelines) at 40-59% HRR for weeks 1-4, 50-59% HRR for weeks 5-8, and 60-79% HRR for weeks 9-10. In the TT group, exercise intensity was targeted at the highest power output (PO) that still allowed for comfortable speech. Changes in VO2max, peak power output (PPO), VO2 at ventilatory threshold (VT), and PO at VT were compared between the groups using two-way ANOVA with repeated measures. There were significant (p&amp;lt;.05) pre vs. post increases in VO2max (TT=10.6%; HRR=11.5%), PPO (TT=19%; HR=14%), VO2 at VT (T=32.7%; HRR=56.9%), and PO at VT (TT=43.1%; HRR=38.6%) in both groups, with no significant (p&amp;gt;0.05) interaction effect. Guiding exercise prescription using the TT is a simple and effective method for prescribing exercise intensity and elicits improvements in exercise performance that are comparable to the traditional %HRR guidelines.

Comparison of the Talk Test and Percent Heart Rate Reserve for Exercise Prescription

Exercise intensity is traditionally prescribed using %HRmax, %HRR, %VO2max or %VO2R. Recently, the Talk Test (TT) has been proposed as an alternative method to guide exercise intensity. However, it is unknown if prescribing exercise intensity solely using the TT can provoke training responses that are comparable to traditional guidelines. PURPOSE: To compare the training responses consequent to training using either the TT or %HRR. METHODS: Forty-four subjects (17 males and 27 females: age=20.4+3.02 yrs; ht=170.5+9.79 cm; wt=71.9+13.63 kg) completed an incremental maximal cycle ergometer test, were stratified by VO2max and gender, and randomly assigned to training groups guided by either %HRR (n=20) or the TT (n=24). Both groups completed 40-minute training sessions 3 days per week for 10 weeks. In the HRR group, exercise intensity was targeted at 40-59 %HRR for weeks 1-4, 50-59 %HRR for weeks 5-8, and 60-79 %HRR for weeks 9-10. In the TT group, exercise intensity was targeted at the highest power output that still allowed for comfortable speech. Changes in VO2max, peak power output (PPO – watts and watts/kg), ventilatory threshold (VT); and PO at VT, were compared between groups using two-way ANOVA with repeated measures. RESULTS: There were significant (p<.05) pre vs. post increases in VO2max (TT=+10.6%; HRR=+11.5%), PPO - watts (TT=+18.5%; HRR=+14.1%), PPO - watts/kg (TT=+19%; HRR=+14%), VT (TT=+56.9%; HRR=+32.7%), and PO at VT (TT=+39%; HRR=+43%) in both groups as a result of training, with no significant differences (p>.05) in the magnitude of improvement between groups. CONCLUSION: Guiding exercise prescription using the TT is a simple and effective method for prescribing exercise intensity and elicits improvements in exercise performance that are comparable to traditional %HRR guidelines.

ПО ТУ СТОРОНУ ПРОЦЕССА ПРЕПОДАВАНИЯ: К ПОСТАНОВКЕ ПРОБЛЕМЫ

Studying a foreign language still remains a challenge for many adults in the Russian Federation due to a number of psychological problems: the lack of self confidence, negative past experience etc. However, if the process of study is organized properly, these challenges could be overcome. The process of teaching a foreign language has much in common with psychoanalytical therapy. During foreign language classes, new and often more comfortable speech and activity patterns are formed due to the shift of the focus of attention from content to form, and that gives more freedom to express thoughts and feelings than by means of the native language. The use of language games combined with teacher’s empathy, amiability, tolerance can produce a consistent therapeutic effect.

Effects of speech passage length on accuracy of predicting metabolic thresholds using the talk test

The Talk Test (TT) is a simple technique for prescribing exercise training intensity, based on the ability to ‘speak comfortably’ after reciting a standard speech provoking stimulus. This study compares the length of the speech provoking stimulus on power output (PO) at standard TT speech comfort markers: last positive (LP), equivocal (EQ), negative (NEG), in relation to objective markers of exercise intensity, the ventilatory (VT) and respiratory compensation (RCT) thresholds. Eighteen healthy subjects performed incremental (25W/2 min) exercise with concomitant gas exchange to measure VT and RCT. They also performed (random order) incremental exercise without gas exchange while repeating standard speech provoking stimuli of 31, 62 and 93 words to allow identification of the LP, EQ and NEG stages of the TT. The mean (±SD) PO at LP (139±38, 117±39 and 103±38 W), EQ (164±38, 142±38 and 128±33 W) and NEG (196±42, 189±43, and 174±39 W) stages of the TT were analyzed for 31, 62 and 93 word passages, in relation to the PO at VT (128±43 W) and RCT (175±39W). PO at EQ and PO at NEG stages of the TT with the 93 word speech provoking stimulus were not significantly different than the PO at VT and PO at RCT, respectively. The mean error for predicting PO at VT approximated zero with the longer (93 word) speech passage duration for EQ (0.1±37 W) and for predicting the PO at RCT for NEG (0.1±29 W). The results suggest that a longer duration speech provoking passage optimizes accuracy of the TT estimation of VT and RCT

Effect of Speech Passage Duration on Talk Test Response

The Talk Test (TT) is a simple technique for prescribing exercise training intensity, based on the ability to ‘speak comfortably’ after reciting a standard speech provoking stimulus. PURPOSE: This study compares the duration of the speech provoking stimulus on the PO at standard TT speech comfort markers (Last Positive (LP), Equivocal (EQ), Negative (NEG). METHODS: Healthy subjects performed incremental (25W/2 min) exercise with gas exchange to measure ventilatory (VT) and respiratory compensation (RCT) thresholds. They also performed incremental exercise (random order) while repeating a standard speech provoking stimulus (31 words) 1x, 2x or 3x to allow identification of LP, EQ & NEG points in the TT. The PO at LP, EQ & NEG, in relation to the PO at VT & RCT were compared. RESULTS: The relationship between [email protected] vs LP1,2,3 (r=0.73, 0.65, 0.56) and EQ1,2,3 (r=0.74, 0.65, 0.56) and RCT vs NEG1,2,3 (r=0.78, 0.80.0.71) were reasonably strong. The mean error for predicting [email protected] was smaller with longer speech passage durations for LP1,2,3 (+11±29.6, -11.±34.2, -25+34.7 W), for EQ1,2,3 (+36±29.7, +14.±34.2, +0.1±36.65 W), and for NEG1,2,3 vs RCT (+18±24.8, +11±23.2, −0.11±28.9 W). CONCLUSION: The results suggest that longer speech duration passages (10 vs 20 vs 29s) give more a more accurate prediction of VT/RCT based on TT EQ and NEG responses.

The talk test: a useful tool for prescribing and monitoring exercise intensity.

This review focuses on recent literature examining the validity and reliability of the talk test for prescribing and monitoring exercise intensity. The utility of the talk test for high-intensity interval training and recently proposed exercise training guidelines for patients with atrial fibrillation is also examined. In healthy adults and patients with cardiovascular disease, comfortable speech is likely possible (equivocal or last positive talk test stage) when exercise intensity is below the ventilatory or lactate threshold, and not likely possible (negative talk test stage) when exercise intensity exceeds the ventilatory or lactate threshold. The talk test can be used to produce exercise intensities (moderate-to-vigorous intensity, 40-80% (Equation is included in full-text article.)) within accepted Canadian Association of Cardiovascular Prevention and Rehabilitation and American College of Sports Medicine guidelines for exercise training, to monitor exercise training for patients with atrial fibrillation, and help avoid exertional ischemia. The talk test has been shown to be consistent across various modes of exercise (i.e., walking, jogging, cycling, elliptical trainer and stair stepper). It may not be practical for high-intensity interval training. The talk test is a valid, reliable, practical and inexpensive tool for prescribing and monitoring exercise intensity in competitive athletes, healthy active adults and patients with cardiovascular disease. Healthcare professionals should feel comfortable in advocating its use in a variety of clinical and health-promotion settings.

Translation of incremental talk test responses to steady-state exercise training intensity.

The Talk Test (TT) is a submaximal, incremental exercise test that has been shown to be useful in prescribing exercise training intensity. It is based on a subject's ability to speak comfortably during exercise. This study defined the amount of reduction in absolute workload intensity from an incremental exercise test using the TT to give appropriate absolute training intensity for cardiac rehabilitation patients. Patients in an outpatient rehabilitation program (N = 30) performed an incremental exercise test with the TT given every 2-minute stage. Patients rated their speech comfort after reciting a standardized paragraph. Anything other than a "yes" response was considered the "equivocal" stage, while all preceding stages were "positive" stages. The last stage with the unequivocally positive ability to speak was the Last Positive (LP), and the preceding stages were (LP-1 and LP-2). Subsequently, three 20-minute steady-state training bouts were performed in random order at the absolute workload at the LP, LP-1, and LP-2 stages of the incremental test. Speech comfort, heart rate (HR), and rating of perceived exertion (RPE) were recorded every 5 minutes. The 20-minute exercise training bout was completed fully by LP (n = 19), LP-1 (n = 28), and LP-2 (n = 30). Heart rate, RPE, and speech comfort were similar through the LP-1 and LP-2 tests, but the LP stage was markedly more difficult. Steady-state exercise training intensity was easily and appropriately prescribed at intensity associated with the LP-1 and LP-2 stages of the TT. The LP stage may be too difficult for patients in a cardiac rehabilitation program.

Aerodynamic Analysis Comparison of Speech Breathing at Two Vocal Loudness and Life Breathing in Normal Elderly Female: Comfortable and Louder Speech

Aerodynamic Analysis Comparison of Speech Breathing at Two Vocal Loudness and Life Breathing in Normal Elderly Female: Comfortable and Louder Speech

The integration process of immigrants: limits and new contributions for a more comprehensive study

The integration process of immigrants is a complex issue of conceptualization and extensive discussion both in the field of public policy and from the academia. The alleged European consensus about integration has only been in the comfortable speech of bidirectionality and the study of the integration process in host societies has been raised ever from quantifier and objectivist parameters that are not able to grasp the diversity of thereof. Furthermore, the study of integration has overlooked the importance of the society of origin and the link that immigrants remain with them, focusing only on the host society as a place of integration. In this paper I propose the extension of the look on the integration by incorporating the perspective of origin and the subjectivity of the immigrants as an actor with the capacity to question, decide and change the patterns and contexts in which integration occurs.

Patient-Controlled Positive End-Expiratory Pressure With Neuromuscular Disease: Effect on Speech in Patients With Tracheostomy and Mechanical Ventilation Support

Communication is a major issue for patients with tracheostomy who are supported by mechanical ventilation. The use of positive end-expiratory pressure (PEEP) may restore speech during expiration; however, the optimal PEEP level for speech may vary individually. We aimed to improve speech quality with an individually adjusted PEEP level delivered under the patient's control to ensure optimal respiratory comfort. Optimal PEEP level (PEEPeff), defined as the PEEP level that allows complete expiration through the upper airways, was determined for 12 patients with neuromuscular disease who are supported by mechanical ventilation. Speech and respiratory parameters were studied without PEEP, with PEEPeff, and for an intermediate PEEP level. Flow and airway pressure were measured. Microphone speech recordings were subjected to both quantitative and qualitative assessments of speech, including an intelligibility score, a perceptual score, and an evaluation of prosody determined by two speech therapists blinded to PEEP condition. Text reading time, phonation flow, use of the respiratory cycle for phonation, and speech comfort significantly improved with increasing PEEP, whereas qualitative parameters remained unchanged. This resulted mostly from the increase of the expiratory volume through the upper airways available for speech for all patients combined, with a rise in respiratory rate for nine patients. Respiratory comfort remained stable despite high levels of PEEPeff (median, 10.0 cm H2O; interquartile range, 9.5-12.0 cm H₂O). Patient-controlled PEEP allowed for the use of high levels of PEEP with good respiratory tolerance and significant improvement in speech (enabling phonation during the entire respiratory cycle in most patients). The device studied could be implemented in home ventilators to improve speech and, therefore, autonomy of patients with tracheostomy. ClinicalTrials.gov; No.: NCT01479959; URL: clinicaltrials.gov.