Voice Intensity Research Articles

Effects of Lee Silverman Voice Treatment (LSVT LOUD) on Swallowing in Patients with Progressive Supranuclear Palsy: A Pilot Study.

ABSTRACTObjectives:Progressive supranuclear palsy (PSP) is an uncommon progressive neurodegenerative disease with no effective cure at present. The initial symptoms resemble those of Parkinson’s disease; however, the prevalence of PSP is about one-tenth that of Parkinson’s disease. In many cases, dysphagia is severe, and the development of dysphagia is an early predictor of life expectancy. The aim of the current study was to define the effects of Lee Silverman Voice Treatment (LSVT LOUD) on swallowing and voice/speech in seven patients with PSP.Methods: Each patient underwent swallowing and voice/speech evaluations before and after 4 weeks of LSVT. Swallowing motility disorders were defined, temporal measures of swallowing were determined by videofluoroscopic evaluation, and voice measures of maximum phonation and speech intelligibility in reading and monologue were examined.Results:After LSVT, the median duration of opening of the upper esophageal sphincter (from the beginning of the posterior movement of the bolus to upper esophageal sphincter opening) on videofluoroscopy was significantly shortened from 0.42 to 0.38 s (Wilcoxon signed-rank test P=0.016). The oral transit duration was decreased in five patients, but the decrease was not significant. Voice changes after LSVT included increases in voice intensity and in sustained duration were not significant.Conclusion:In this small study, it was found that LSVT may improve swallowing functions in patients with PSP.

Speech disorders in Parkinson’s disease - characteristics, assessment and treatment

Introduction. Parkinson?s disease belongs to the group of extrapyramidal neurodegenerative diseases and occurs as a consequence of the loss of dopaminergic neurons in the substantia nigra of the mesencephalon. Persons with Parkinson?s disease may experience a wide range of motor and non-motor symptoms. Material and Methods. A literature search was conducted using electronic databases on the Internet and electronic databases of Serbian libraries. Results. Speech disorders in Parkinson?s disease are classified in the group of hypokinetic dysarthria. Empirical data show that the basic characteristics of dysarthria in people with Parkinson?s disease are changes in voice quality, difficulties in articulating consonants, abnormalities in vowel production, monotonous speech, changes in speech rate, rough and breathy voice, increased voice nasality, reduced intensity of voice, involuntary pauses during speech, and palilalia. Methods used in the assessment of speech disorders include perceptual voice analysis, such as the overall dysphonia Grade, Roughness, Breathiness, Asthenia, Strain and Consensus Auditory Perceptual Evaluation of Voice scales, acoustic voice analysis (e.g., Multi-Dimensional Voice Program), and voice quality self-assessment methods (e.g., Voice Handicap Index and the Dysarthria Impact Profile). In the treatment of dysarthria, various behavioral methods of speech therapy are used, among which the Lee Silverman method is particularly important. Conclusion. Speech disorders in Parkinson?s disease manifest as altered patterns of respiration, phonation, resonance, articulation and prosody. The best results in the treatment are achieved by combination of medical, surgical, and behavioral therapy, through the cooperation of experts of different profiles as well as with family members of the patient.

Voice Analytics of Online Influencers—Soft Selling in Branded Videos

Influencer marketing has been growing rapidly on social media, such that the influencer marketing industry is now worth $15 billion. As more consumers are eager to rely on influencers’ recommendations for shopping, the trustworthiness of influencers’ opinions becomes a key question. Specifically, consumers increasingly question the honesty of influencer opinions when influencers advertise sponsored products from brands. To help consumers make informed shopping decisions, the Federal Trade Commission (FTC)’s endorsement guidelines require influencers to disclose sponsorship. However, little is known about how influencers respond to the FTC’s endorsement guidelines. In this paper, we study how influencers change their content delivery strategies upon sponsorship and how these strategies affect consumer sentiment. Employing both the Instrumental Variable (IV), and Regression Discontinuity (RD) identification strategies, we find that influencers choose a soft selling strategy and tone down their voice loudness significantly in sponsored videos. This voice modulation strategy can help influencers win back favorable consumer sentiment. Above all, influencers who are more popular (have more view counts) are more likely to modulate their voice in their favor. We discuss implications for the four stakeholders: the FTC, brands, influencers, and consumers.

Detection of relevant changes in the speaking voice of women measured by the speaking voice profile

A healthy voice serves us as a basis for communication and an indispensable tool in a modern society with a growing number of vocal-intensive professions. There are indications that the average frequency of the speaking voice of women has decreased in recent years and is approaching that of men in the sense of sociophony. An epidemiological prospective cohort study will investigate the influences of age, personality traits and socio-demographic factors on the speaking voice of women. Within the framework of a standardized examination procedure, the speaking voice of 2478 voice-healthy female participants between 5 and 83 years of age was registered in 4 different intensity levels (softest voice, conversational voice, classroom voice and shouting voice). Subsequently, the collected values for frequency and loudness of the different intensity levels were examined for correlation with age and results from questionnaires on personality (FFFK and BFI-10), on (mental) health (Patient-Health-Questionnaire - PHQ) and on socio-economic status (SES). Significant age-related influences on the speaking voice could be demonstrated for all voice intensities. For the personality traits investigated, significant positive correlations between the volume of the calling and speaking voice and extraversion were found. For the frequency of the softest voice and speaking voice, significant correlations were found for the personality traits of extraversion and tolerance. While no significant associations were found between the voice parameters of the speaking voice and the PHQ, it was found that the SES has a significant influence on both frequency and intensity. In addition to age-related changes, relevant influences of personality traits and the SES on speaking voice parameters in women were confirmed, which should be considered in clinical care of dysphonia.

Monitorowanie wypowiedzi a realizacja intencji w procesie mówienia

Speech production is complex and high organized process. It starts with some intention, which in following steps is transformed into articulated and audible form. Sometimes speech production fails and results in a speech error (or a slip of the tongue), which changes meaning of the utterance and disturbs the process of the realization of intention. However, speech monitoring helps to detect and repair the error with respect to the original intention of the speaker. Thus the speaking appears as a way of the realization of intention and the intention plays integrational function in relation to the process of speaking. According to Frydrychowicz (1999), the process of the realization of intention can be divided into several phases, distinguished by psychophysical features of speaking. He found that voice intensity is highest when the speaker is close to fully realizing the intention. The aim of the current study is to examine this voice intensity effect in relation to speech error repairs as speaking units which re-establish the process of the realization of intention. The question is, howthese corrections of the course of speech are reflected in the voice intensity? The results obtained from errors and repairs induced in the dual task paradigm show that voice intensity rises when the speaker makes a self-repair by speaking a correct word.

Maximum vocal intensity as a primary outcome measure in unilateral vocal fold paralysis patients.

To evaluate voice intensity as the primary outcome measurement when treating unilateral vocal fold paralysis patients. This prospective observational study comprised 34 newly diagnosed unilateral vocal fold paralysis patients undergoing surgical interventions: injection laryngoplasty or medialisation thyroplasty. Voice assessments, including maximum vocal intensity and other acoustic parameters, were performed at baseline and at one and three months post-intervention. Maximum vocal intensity was also repeated within two weeks before any surgical interventions were performed. The results were compared between different time points and between the two intervention groups. Maximum vocal intensity showed high internal consistency. Statistically significant improvements were seen in maximum vocal intensity, Voice Handicap Index-10 and other acoustic analyses at one and three months post-intervention. A significant moderate negative correlation was demonstrated between maximum vocal intensity and Voice Handicap Index-10, shimmer and jitter. There were no significant differences in voice outcomes between injection laryngoplasty and medialisation thyroplasty patients at any time point. Maximum vocal intensity can be applied as a treatment outcome measure in unilateral vocal fold paralysis patients; it can demonstrate the effectiveness of treatment and moderately correlates with self-reported outcome measures.

Ayurvedic Management of Pittaja Swarabheda: A case study

Background: Voice is a means of communicating verbal messages, which serves as a powerful carrier of personality and emotional, educational, and social status. Dysphonia (impaired voice production) is a very common ailment, affecting nearly one-third of the population at some point in their life. Hoarseness of voice can be correlated to swarabheda in Ayurveda. The management provided by contemporary medicine for this condition is either conservative or surgical in nature, which is expensive. Aims and Objectives: The Aim of this study was to assess the efficacy of Ayurvedic management of pittaja swarabheda. Materials and Methods: A 43-year-old man approached to Ayurvedic hospital with complaints of burning sensation and irritation in the throat, hoarseness of voice and difficulty and pain while deglutition and talking. He was diagnosed with Pittaja swarabheda and was treated with panchakarma treatment like Baladi Ghruta Nasya and shamana Chikitsa. The treatment was continued for consecutive 1 month. Results: Hoarseness of voice was assessed after 15 days with the help of Buffalo III Voice Profile and satisfactory outcome was found especially in the quality and loudness of voice, mental strength, and confidence of patient. Conclusion: The collaborative approach of the aforementioned therapy gives symptomatic relief in Swarabheda.

The Effect of Pitch and Loudness Auditory Feedback Perturbations on Vocal Quality During Sustained Phonation

Dysphonia is a reduction in vocal quality that impacts communication and is often an early sign of a voice disorder. There is little information regarding the effects of auditory feedback control of loudness and pitch on voice quality. In this study, we used both loudness-shift and pitch-shift paradigms to study the relationship between auditory feedback control and vocal quality as measured by smoothed cepstral peak prominence (CPPS), which reflects the harmonicity of the voice signal. Experimental, mixed design. We applied 200 ms loudness-shifts (± 0, 3, or 6 dB) and pitch-shifts (± 0, 50, and 100 cents) to auditory feedback during sustained vowel production in 25 healthy adults. We then measured CPPS before and after the loudness-shift or pitch-shift to investigate the effect of changes in auditory feedback on vocal harmonicity. Results showed that, on average, CPPS significantly decreased between the first half of the measured segment and the last half of the segment in the absence of auditory feedback shifts, suggesting that voice quality may be reduced across longer vowels over time. Upward and downward shifts in loudness auditory feedback caused a relative increase in CPPS, indicating an improvement in vocal harmonicity, even in cases when vocal intensity was reduced. Pitch alterations had inconsistent and minimal effects. We propose that there may be a control mechanism for voice quality that increases harmonicity of the voice signal to improve voice audibility (ie, ability to be heard) in the presence of unpredictable variability in voice intensity.

Voice intensity changes in artificial acoustics

Voice intensity changes in artificial acoustics

Analyzing Longitudinal Data on Singing Voice Parameters of Boys and Girls Aged 8 to 12.5 and Possible Effects of a Music Pedagogical Intervention

Controlled and randomized study to analyze longitudinal voice data of boys and girls aged 8-12.5, to describe their physiological development and to evaluate the influence of a one-year music pedagogical interventional program focused on the singing voice. Singing voice profiles of 116 children (52 boys, 64 girls) aged 8-12.5 years were collected longitudinally at the beginning and the end of the third school year and the end of the fourth school year. 64 of the 116 children received a music pedagogical program during their third school year (interventional group). Maximum and minimum voice intensity, highest and lowest frequency, maximum phonation time (MPT) and Jitter were investigated. In two years' time highest frequency increased on average by 100.23 Hz from G1 up to A1 for boys and for girls. Lowest frequency decreased by 18.36Hz from Gis-1 to G-1 (boys: Gis-1-Fis-1; girls: A-1-G-1). There was no clinically relevant development of the intensity parameters for both sexes. However, after the interventional year, minimum voice intensity significantly decreased in the interventional group compared to the control group. The MPT increased by 2.41 seconds from 10.67 seconds up to 13.09 seconds in two years. Here the increase was higher for boys (+3.2 seconds) than for girls (+1.77 seconds). Jitter was found to be 0.84%-1.11%, showing no clinically relevant changes in two years. To the best of our knowledge, for the first time this study presents longitudinal data on singing voice parameters of the voice range profile of boys and girls aged 8-12.5 years. While frequency and intensity parameters develop equally for boys and girls, the MPT is found to develop more distinctly within boys. A music pedagogical intervention of a small extent has a positive effect on the ability to sing as soft as possible.

Effects of Intensive Voice Treatment (The Lee Silverman Voice Treatment [LSVT LOUD]) in Subjects With Multiple Sclerosis: A Pilot Study

The rehabilitation of voice disorders is an unmet need in multiple sclerosis (MS). The Lee Silverman Voice Treatment (LSVTLOUD) is a well-documented and effective speech treatment, developed to treat voice disorders in Parkinson Disease. The purpose of the present study was to examine the viability of applying the LSVTLOUD to individuals with MS and verify short- and long-term improvements in acoustic and perceptual voice parameters. A single subject design was performed in a consecutive sample of 8subjects with MS. The subjects' voice was recorded with PRAAT software for 5 days at baseline during the 16 treatment sessions, and at follow-up (FU)6/12months later. PRAAT provided data on sustained /a/ (SPL/a/) voice intensity and maximum phonation time (MPT/a/) of sustained /a/, and on functional sentences voice intensity. In addition, self-assessment questionnaire Voice Handicap Index, the perceptual GIRBAS scale and intensity of monologue were collected at first day of baseline, post-treatment and at FU. In the treatment phase each subject received treatment according to LSVTLOUD protocol. Visual analysis calculated for daily acoustic variables was used to determine baseline stability and analyse changes following treatment. The Wilcoxon test was used to assess statistically significant differences between baseline and post treatment. All participants completed the LSVTLOUD programme; one participant dropped out at FU. Improvements in acoustic analysis were found: SPL/a/ improved on average (± standard deviation) 11.64 ± 4.19 dB with 7 subjects showing statistically significant improvement (P < 0.05); MPT/a/ improved on average 1.2 ± 1.53seconds, while intensity of functional sentences improved on average 8.11 ± 3.46 dB with 4 and 5 subjects showed statistically significant improvement, respectively. Intensity of monologue improved 14.90 ± 3.33 dB. Acoustic values are maintained or increased at FU respect to baseline. All subjects improved perceptual ratings at Voice Handicap Index and results were maintained at FU. These changes were associated with improvements on five parameters on the GIRBAS scale at post-treatment, however no further improvement were observed at FU. Intensive LSVTLOUD treatment is a viable approach to treat hypophonia in MS. LSVTLOUD improved both quantitative-instrumental and perceptive-subjective assessments. Randomised controlled trials are needed to provide a firm support on the effectiveness of LSVTLOUD in MS.

The Relationship between Selected Demographic Factors and Speech Organ Dysfunction in Sporadic ALS Patients

Background and objectives: Speech disorders are observed in 30% of newly diagnosed sporadic amyotrophic lateral sclerosis (ALS) patients. Characterized by a dynamic course, dysfunction of articulation has not so far been well understood. The aim of this study was to analyze the influence of demographic factors (sex, age, duration of the disease) and concomitant diseases (degenerative spine disease, depression, hypertension, hypothyroidism, hyperthyroidism, and allergy) on the functioning of speech organs in ALS patients. Materials and Methods: The study group consisted of 65 patients with sporadic ALS. Patients were examined for articulatory functions by means of the Frenchay Dysarthria Assessment (FDA). Results: 68% of the study sample had spinal disorders. Logistic regression analysis showed that a decline in the functioning of lips, soft palate, length of phonation, and voice loudness was more common among men. Patients diagnosed with degenerative spine disease more often suffered from respiratory disorders, while younger patients (<60 years of age) significantly more often had the impairment of the sentence and spontaneous speech functions. Conclusions: The male gender in patients with ALS is associated with an increased risk of deterioration of the phonation length function. Patients under 60 years of age are associated with more often pronouncing sentences disorders and spontaneous speech disorders.

The Effects of Therapeutic Singing on Vocal Functions of the Elderly: A Study on Korean Elderly

This study investigated the effects of therapeutic singing as an intervention for improving the vocal functions of the elderly. Data collection for this study took place at five senior community centers in Seoul, South Korea, from August 2018 to March 2019. A total of 54 elderly with healthy voices were assigned to a therapeutic singing group, a general singing group, or a control group, using convenience sampling. The therapeutic singing intervention involved using the Alexander technique, performing oral motor and respiratory exercises, and singing participant-written songs, across 12 sessions. The general singing group sang popular and folk songs of their choice. The control group received no treatment. Using peak expiratory flow rate (PEF) and Praat analysis, the participants' vocal functions were measured before and immediately after the intervention. Vocal function was compared among the groups pre- and post-test; the therapeutic singing group showed statistically significant improvement in all vocal parameters: PEF, maximum phonation time, voice intensity (intensity), fundamental frequency (F0), jitter, shimmer, and noise-to harmonics ratio. The general singing group showed improvement only in F0, jitter, and noise-to harmonics ratio. The control group showed an overall reduction in all vocal functions, with a significant decrease in PEF and intensity, and a decrease in jitter and shimmer. Although singing is considered helpful for the voice health of the elderly, therapeutic singing, which involves posture correction and breathing exercises, is even more effective, thus proving to be a viable intervention for preventive voice care of the elderly.

A cross-language study on feedforward and feedback control of voice intensity in Chinese–English bilinguals

AbstractSpeech production requires the combined efforts of feedforward and feedback control, but it remains unclear whether the relative weighting of feedforward and feedback control is organized differently between the first language (L1) and the second language (L2). In the present study, a group of Chinese–English bilinguals named pictures in their L1 and L2, while being exposed to multitalker noise. Experiment 1 compared feedforward control between L1 and L2 speech production by examining intensity increases in response to a masking noise (90 dB SPL). Experiment 2 compared feedback control between L1 and L2 speech production by examining intensity increases in response to a weak (30 dB SPL) or strong noise (60 dB SPL). We also examined a potential relationship between L2 fluency and the relative weighting of feedforward and feedback systems. The results indicated that L2 speech production relies less on feedforward control relative to L1, exhibiting attenuated Lombard effects to the masking noise. In contrast, L2 speech production relies more on feedback control than L1, producing larger Lombard effects to the weak and strong noise. The relative weighting of feedforward and feedback control is dynamically changed as second language learning progresses.

Narrative rhythmanalysis: the art and politics of listening to women’s narratives of forced displacement

ABSTRACT In this paper I draw on my experiences of listening to migrant and refugee women’s stories of displacement and explore questions around discourses and practices of listening across borders and languages. In doing so, I particularly focus on the materiality of listening, the force of corporeal voices, the rhythms of oral narratives and their effects on understanding and making connections within the web of human relations. Following tracks and traces of a rich body of literature around sounds, voices and texts in narrative analytics and feminist theory, I have turned my attention to aurality and I have suggested narrative rhythmanalysis as a mode of understanding and as a method. What I argue is that turning our attention to listening practices as a neglected process in theoretical analysis illuminates the perspective of the storyteller, mobilizes affective forces in the milieu of relational narratives and enacts the materiality of knowledge through the intensity and uniqueness of the corporeal voice. What I finally suggest is that perhaps we should move beyond the imperatives of clarity and transparency in an attempt to be in the world with others. Here the sound of narratives could become a trope that can take us down the path of decolonizing our ways of knowing and understanding.

THE COMPREHENSION OF THE CONCEPTS OF NOISE AND SILENCE IN PRIMARY SCHOOL CHILDREN

Acoustically ergonomic classrooms prevent teachers’ voice disorders and improve comprehension of learning instructions by pupils. High activity noise in the classroom, which increases voice loudness, is one of the most common complaints by teachers. The aim of the study was to find out how primary school children comprehend the concepts of noise and silence. Two hundred eighty five children representing Grade 1 to four were included in the study. Children were asked to draw how they imagine the silence and noise. Drawings were categorised in the following groups: sources of noise and silence, effects of noise and silence, noisy and silent places. Drawings imagining school environment were analysed separately. We found that primary school pupils can identify noise sources in the classroom, at home, and in environment. They can detect the impact of noise on the psycho-emotional state of the person. Children reflected a much more extensive range of noise generating activities than activities related to silence. The silence was mostly associated with sleeping and learning while noise with positive (singing, playing) and negative (screaming, fighting) actions.Not only teachers but also pupils should know about classroom acoustic ergonomics. Teachers’ education programs should provide education in ergonomics, and teachers should forward this knowledge to children.

Effect of Tracheal Intubation Mode on Cuff Pressure During Retractor Splay and Dysphonia Recovery After Anterior Cervical Spine Surgery: A Randomized Clinical Trial.

Prospective, randomized, double-blinded trial. The aim of this study was to investigate whether the mode of tracheal intubation affects intraoperative endotracheal tube cuff pressure on retractor splay and post-anterior cervical spine surgery (ACSS) voice outcome. The combination of endotracheal tube (ETT) and cervical retractors has been implicated in recurrent laryngeal nerve compression and neuropraxia after ACSS. The asymmetric position of the oroETT within the larynx, as being fixed distally by the cuff and proximally by taping on one side of the mouth, may contribute to unilateral vocal palsy. Adult patients undergoing ACSS were randomized to receive either nasotracheal or orotracheal intubation under anesthesia. The primary endpoint was the maximal endotracheal tube cuff pressure (ETCP) when the retractors were set up. After the maximal ETCPs were recorded, then ETCPs were controlled to less than 25 mmHg. Secondary endpoints were self-assessed hoarseness, pitch, and loudness of voice on postoperative days (PODs) 1, 2, 7, and 30. We equally allocated 110 patients to nasotracheal and orotracheal intubation. The maximal ETCP during retractor splay did not differ for both the means and distributions of pressure range. After the surgery, more patients in the nasotracheal intubation group reported none or mild change of voice than did the orotracheal intubation group on PODs 1 and 2, in terms of hoarseness, pitch, and loudness (P = 0.001, 0.001, and 0.005, respectively, on POD 1; P = 0.002, 0.003, and 0.011, respectively, on POD 2). Mixed model analysis demonstrated that patients with nasotracheal intubation had significantly lower dysphonia scores after surgery (estimate treatment effect: -1.62, P < 0.0001). Statistics was adjusted to exclude interaction with ETT sizes. The tracheal intubation modes did not affect ETCP during retractor splay. However, nasotracheal intubation had a beneficial effect on dysphonia recovery after ACSS. 2.

Zarządzanie głosem w perspektywie edukacyjnej

Artykuł dotyczy umiejętności zarządzania głosem przez uczniów kończących szkołę średnią i składa się z trzech części. W pierwszej przedstawiam wyniki analiz wypowiedzi przeprowadzonych pod kątem wybranych elementów paralingwalnych mających wpływ na efektywność wypowiedzi (natężenie głosu, ton, tempo mówienia oraz pauzę i frazowanie). W drugiej części przyglądam się treściom kolejnych podstaw programowych (1999, 2002, 2009, 2017) poświęconym zagadnieniom związanych z kształceniem kodu parawerbalnego. W tej części interesuje mnie zwłaszcza przełożenie zapisów programowych na zawartość najnowszych podręczników do nauczania języka polskiego. W ostatniej części artykułu – mającej charakter podsumowania – szukam odpowiedzi na pytanie, dlaczego tak wielu uczniów nie potrafi właściwie zarządzać swoim głosem.

Speech accommodation toward older people in 7- To 12-year-old children.

From an early age, children develop stereotypes toward older adults leading to potential ageism. In young adults, ageism includes conversational changes, also known as elderspeak, characterized by louder, slower, and simplified speech. Although it has direct consequence on older adults, to date no studies have explored elderspeak in children. We invited 137 Belgian children aged 7-12 to take part in a guessing game through a dissimulated Skype session. The child had to make two female interlocutors in turn, one young (25years old) and the other old (75), guess two different words each. During the session, children remained unaware of the real purpose of the game. Prosody, verbal fluency, and semantic content of their speech were measured using the Praat and VocabProfil software. The results, analyzed using mixed-design ANOVA, showed that children spoke louder to the older interlocutor and tended to judge her less competent to guess words than the younger participant. When the older person was second in turn, children engaged in lengthier and more detailed explanations. Unexpectedly, positive views on older people correlated with higher voice intensity, suggesting that the child's differential vocal attitudes may reflect benevolent ageism. In conclusion, significant speech accommodation can be detected in 7- to 12-year-old children when they speak to an older compared with a younger interlocutor. This accommodation is characterized by louder voice and lengthier explanations.

Design and Development of Intelligent Wearable Biofeedback Fuzzy Logic-based Device for Monitoring and Treatment of Voice Loudness

Development of medical devices are expanding rapidly. This is occurring as results of development of high tech electronics, information technology and wireless communication technology. Integrating these technologies helps to provide good, less cost and more effective healthcare services. In this paper a novel intelligent medical biofeedback device is developed for accurate monitoring of the voice loudness using fuzzy logic compared with proportional control. This accurate biofeedback monitoring device then enhanced treatment of people who are unable to control excessive or low loudness due to intellectual disability or aggressive behavior causing loudness levels rejected by others. These people with this behavior may often be unaware of their problems and hence an intelligent biofeedback device is necessary to be used by the patients outside the clinic for self-controlling excessive or low loudness without the need to follow-up in speech pathology clinic for the continuous therapeutic. The use of the intelligent wearable biofeedback device proved to be an effective due to its enhanced features. The design considerations, enhanced features, simulation and evaluation of the device will be presented.