Publications by authors named "Carolyn Baylor"

52 Publications

Predicting Communicative Participation in Adults Across Communication Disorders.

Am J Speech Lang Pathol 2021 Mar 3:1-13. Epub 2021 Mar 3.

Department of Rehabilitation Medicine, University of Washington, Seattle.

Purpose The purpose of this study was to explore the extent to which communicative participation differs across diagnoses and if there are common predictor variables for communicative participation across diagnoses. Method Survey data on self-report variables including communicative participation were collected from 141 community-dwelling adults with communication disorders due to Parkinson's disease, cerebrovascular accident, spasmodic dysphonia, or vocal fold immobility (VFI). Analysis of covariance was used to determine communicative participation differences between diagnoses, with age, sex, and hearing status as covariates. Sequential entry linear regression was used to examine associations between communicative participation and variables representing a range of psychosocial constructs across diagnoses. Results The VFI group had the least favorable communicative participation differing significantly from Parkinson's disease and spasmodic dysphonia groups. Self-rated speech/voice severity, self-rated effort, mental health, perceived social support, and resilience contributed to variance in communicative participation when pooled across diagnoses. The relationship between communicative participation and the variables of effort and resilience differed significantly when diagnosis was considered. Conclusions The findings suggest that communicative participation restrictions may vary across some diagnoses but not others. People with VFI appear to differ from other diagnosis groups in the extent of participation restrictions. Effort and resilience may play different roles in contributing to communicative participation in different disorders, but constructs such as social support, severity, and mental health appear to have consistent relationships with communicative participation across diagnoses. The findings can help clinicians identify psychosocial factors beyond the impairment that impact clients' communication in daily situations.
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http://dx.doi.org/10.1044/2020_AJSLP-20-00100DOI Listing
March 2021

Exploring the Psychosocial Impact of Botulinum Toxin Type A Injections for Individuals With Oromandibular Dystonia: A Qualitative Study of Patients' Experiences.

Am J Speech Lang Pathol 2021 Feb 25:1-15. Epub 2021 Feb 25.

Department of Rehabilitation Medicine, University of Washington, Seattle.

Purpose The purpose of this study was to explore the psychosocial impact of botulinum toxin (BoNT) injections for oromandibular dystonia (OMD) and to gain a better understanding of how participants judge the success of this treatment. Method Eight individuals with OMD and dysarthria participated in one face-to-face, semistructured interview. Interviews were audio-recorded and transcribed verbatim. Qualitative, phenomenological methods of coding, immersion, and emergence were used in the analysis of interview data. Results Two major themes and six subthemes emerged from the analysis of interview data. The first theme, , explored the participants' perspective of receiving BoNT injections and its psychosocial impact. The second theme, , explored the psychosocial impact of BoNT on speech production and participation. Conclusions Our results suggest that BoNT has a variable impact on domains related to quality of life, satisfaction with treatment, speech production, and communicative participation. This study adds novel information related to the psychosocial consequences of BoNT treatment in the management of OMD and builds on a literature that studies the consequences and experiences of living with OMD.
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http://dx.doi.org/10.1044/2020_AJSLP-20-00124DOI Listing
February 2021

Training students from rehabilitation professions on communicating with patients with communication disorders.

PM R 2021 Feb 20. Epub 2021 Feb 20.

Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA.

Introduction: FRAME, a mnemonic referring to a program for helping healthcare providers adapt patient-provider communication when working with patients with communication disorders, improves the knowledge, confidence, and communication skills of medical students for working with this population. However, the impact of the FRAME program for preparing students from the rehabilitation disciplines to work with patients with communication disorders is unknown.

Objective: To examine the effects of the FRAME program on the knowledge, confidence, and communication skills of students in physical therapy (PT), occupational therapy (OT), and prosthetics and orthotics (P&O) in terms of how to communicate effectively with patients with communication disorders.

Design: An exploratory, quasi-experimental pretest-posttest design.

Setting: PT, OT, and P&O clinical education programs at the University of Washington's Department of Rehabilitation Medicine.

Participants: Twenty rehabilitation students (PT = 12; OT = 7; and P&O = 1) participated in the FRAME training.

Interventions: The FRAME program, delivered in a single, two-hour session teaches students communication skills to use with patients with various types of communication disorders.

Main Outcome Measures: A quiz of students' knowledge about communication disorders and a self-rating of confidence for interacting with this patient population were used. Speech-language pathology graduate clinicians rated students' use of communication strategies from each area of the FRAME training during interactions with standardized patients portraying aphasia and dysarthria. Student qualitative feedback were also collected.

Results: Students' knowledge, confidence, and use of communication strategies improved significantly following training. Greatest gains were observed in students' ability to familiarize themselves with how a patient communicates and establish a method of communication before proceeding with the interview. Qualitative feedback aligned with these findings.

Conclusions: The FRAME program increases the knowledge, confidence, and use of communication strategies in rehabilitation students in order to communicate more effectively with patients with communication disorders in their future careers. This article is protected by copyright. All rights reserved.
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http://dx.doi.org/10.1002/pmrj.12580DOI Listing
February 2021

Beyond the Patient: A Mixed-Methods Inquiry Into Family Members' Involvement in the Treatment of Parkinson's Disease to Target Third-Party Disability.

Am J Speech Lang Pathol 2021 01 29;30(1):169-185. Epub 2020 Dec 29.

Department of Rehabilitation Medicine, University of Washington, Seattle.

Purpose Family members of people with Parkinson's disease (PD) may experience third-party disability, manifesting as difficulty managing communication breakdowns and changed relationships influenced by communication disorders. This study examined family involvement in therapy to address third-party disability from the perspective of family members of people with PD and speech-language pathologists (SLPs). Method A mixed-methods design was used with two phases of data collection. In Phase 1 qualitative interviews, nine family members shared their perspectives about their involvement in therapy. In Phase 2, a survey was developed from Phase 1 data to gather data from SLPs ( = 110) on their clinical practices involving family members. Results Family members and SLPs agreed that when family were involved in therapy, it was primarily to support therapy exercises for the person with PD. Many SLPs reported providing supportive activities for family members. However, qualitative data from family members suggested that the limited involvement they had in therapy did not sufficiently meet their unique needs resulting from communication changes with the person with PD and other related challenges. Constraints influencing family member involvement included insurance billing regulations, privacy laws for patients, and family members' availability. Conclusions While some families and SLPs reported efforts to specifically include families and address their needs in therapy, these practices were inconsistent and, from families' perspectives, insufficient to meet their own needs. Future research should consider family-centered approaches that involve family members in speech-language therapy to enhance their daily lives, along with persons with PD.
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http://dx.doi.org/10.1044/2020_AJSLP-20-00168DOI Listing
January 2021

Communicative Participation and Quality of Life in Pretreatment Oral and Oropharyngeal Head and Neck Cancer.

Otolaryngol Head Neck Surg 2021 Mar 15;164(3):616-623. Epub 2020 Sep 15.

Department of Speech and Hearing Sciences, University of Washington, Seattle, Washington, USA.

Objective: To determine how communicative participation is affected in patients with oral and oropharyngeal head and neck cancers (HNCs) pretreatment and whether communication function predicts HNC-specific quality of life (QOL) before treatment, beyond known demographic, medical, psychosocial, and swallowing predictors.

Study Design: Cross-sectional study.

Setting: Tertiary care academic medical center.

Methods: Eighty-seven patients with primary oral (40.2%) or oropharyngeal (59.8%) HNC were recruited prior to treatment. T stage, tumor site, and p16 status were extracted from medical records. Demographic and patient-reported measures were obtained. Communicative participation was measured using the Communicative Participation Item Bank (CPIB) General short form. A hierarchical regression analysis included demographic, medical, psychosocial, and functional measures of swallowing and communication as predictors; the University of Washington Quality of Life (UW-QOL v4) composite score was the predicted variable.

Results: Median (SD) baseline CPIB scores were 71.0 (11.83); patients with oral cancers reported worse scores. A final sequential hierarchical regression model that included all variables explained 71% of variance in QOL scores. Tumor site, T stage, and p16 status accounted for 28% of variance ( < .001). Perceived depression predicted an additional 28% of the variance ( < .001). Swallowing and communicative participation together predicted an additional 12% of variance ( = .005). Tumor site, perceived depression, swallowing, and communication measures were unique predictors in the final model. Finally, communicative participation uniquely predicted QOL, above and beyond other predictors.

Conclusion: Pretreatment communication predicted QOL and was negatively affected in some oral and oropharyngeal patients with HNC.
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http://dx.doi.org/10.1177/0194599820950718DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7933052PMC
March 2021

Validation of the Communicative Participation Item Bank as an Outcome Measure for Spasmodic Dysphonia.

Laryngoscope 2021 04 25;131(4):859-864. Epub 2020 Jul 25.

The Center for Voice and Swallowing, Department of Otolaryngology - Head & Neck Surgery, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, New York, U.S.A.

Objectives: Current patient-reported outcome measures do not adequately capture the impact of spasmodic dysphonia (SD) on communication in daily life situations. The aim of this study was to validate the Communicative Participation Item Bank (CPIB), which specifically measures a disease's impact on daily conversational situations, as an outcome measure for SD.

Study Design: Multi-institutional prospective cohort study.

Methods: A prospective study was conducted with administration of the 46-question CPIB and the Voice Handicap Index-10 (VHI-10) to 190 participants with SD before (time 1) and 6 weeks after (time 2) botulinum toxin injection. Differential item function (DIF) analyses were performed to examine potential item bias. Paired t-tests were used to assess change in each of the CPIB and VHI-10 scores after treatment. Pearson correlations were calculated between the CPIB and VHI-10.

Results: DIF analyses revealed no clinically meaningful difference between the item parameters generated for this SD sample and the original CPIB calibration sample. There were statistically significant changes between the pre-treatment and post-treatment time points for both the CPIB and VHI-10. Correlations between the CPIB and VHI were moderate-high.

Conclusions: The CPIB item bank, General Short Form, and scoring parameters can be used with people with SD for valid and reliable measurement of the impact of communication disorders on communication in everyday life. The CPIB is sensitive to changes with intervention, proving useful for clinical and research purposes to assess the efficacy and effectiveness of interventions.

Level Of Evidence: Level 2, prospective observational research with an experimental design (ie, cohort study). Laryngoscope, 131:859-864, 2021.
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http://dx.doi.org/10.1002/lary.28897DOI Listing
April 2021

Achieving Participation-Focused Intervention Through Shared Decision Making: Proposal of an Age- and Disorder-Generic Framework.

Am J Speech Lang Pathol 2020 08 28;29(3):1335-1360. Epub 2020 May 28.

Department of Speech, Language, and Hearing Sciences, The University of Arizona, Tucson.

Introduction The World Health Organization's International Classification of Functioning, Disability and Health calls on speech-language pathologists (SLPs) to provide care that impacts all aspects of an individual's experience with a communication disorder, including their participation in valued life situations. However, SLPs often report feeling unprepared to implement and document interventions that target life participation. The purpose of this article is to propose a framework to guide participation-focused intervention practices. This age- and disorder-generic framework is designed to be applicable with clients across the variety of settings in which SLPs work. Method In this clinical focus article, we draw on past research and clinical experience to propose a restructuring of World Health Organization's International Classification of Functioning, Disability and Health components such that participation is the primary focus and outcomes indicator for intervention. In this framework, a specific communicative participation situation is identified and assessed quantitatively, and a corresponding participation-focused goal is established through shared decision making. Following that, assessments are conducted and goals are established in the areas of communication skills, physical and social environments, and personal perspectives. Results The proposed framework provides a concrete organizational structure as well as assessment, goal-writing, and intervention examples to assist SLPs in translating theoretical biopsychosocial frameworks into clinical practices. Conclusions SLPs can and do provide holistic communication services to clients to help them achieve their life participation goals. This article provides an example as to how we can document the need for, as well as the value and impact of our important work, meeting the diverse life participation needs of clients. Supplemental Material https://doi.org/10.23641/asha.12360758.
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http://dx.doi.org/10.1044/2020_AJSLP-19-00043DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7893522PMC
August 2020

Exploring Associations Between a Biological Marker of Chronic Stress and Reported Depression and Anxiety in People With Aphasia.

J Speech Lang Hear Res 2019 11 25;62(11):4119-4130. Epub 2019 Oct 25.

Department of Speech & Hearing Sciences, University of Washington, Seattle.

Purpose Living with the communication impairment of aphasia can be stressful. Chronic stress, depression, and anxiety are intimately linked, may be more pervasive in people with poststroke aphasia than the general population, and may influence cognitive function and treatment outcomes. In this project, we explored the psychological constructs of depression and anxiety and their associations with a biomarker measure of chronic stress in people with aphasia. Method Fifty-seven participants with aphasia completed measures of depression and anxiety and provided a hair sample from which to extract the stress hormone cortisol. Pearson product-moment correlational analyses were used to identify associations between depression, anxiety, and long-term level of cortisol via hair sample. Results While cortisol level was not associated with depression and anxiety across this sample of people with aphasia, a post hoc analysis showed a significant, positive correlation between a subset of participants with moderate and higher levels of depression and elevated cortisol level. Conclusions Chronic stress, depression, and anxiety have been little explored in people with aphasia to date, yet they are associated with future health consequences and impaired cognitive function, motivating further research as well as consideration of these factors in aphasia rehabilitation.
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http://dx.doi.org/10.1044/2019_JSLHR-L-19-0111DOI Listing
November 2019

Experiences of Speaking With Noninvasive Positive Pressure Ventilation: A Qualitative Investigation.

Am J Speech Lang Pathol 2019 07 15;28(2S):784-792. Epub 2019 Jul 15.

Department of Rehabilitation Medicine, University of Washington, Seattle.

Purpose The aim of this study was to describe experiences of speaking with 2 forms of noninvasive positive pressure ventilation (NPPV)-mouthpiece NPPV (M-NPPV) and nasal bilevel positive airway pressure (BPAP)-in people with neuromuscular disorders who depend on NPPV for survival. Method Twelve participants (ages 22-68 years; 10 men, 2 women) with neuromuscular disorders (9 Duchenne muscular dystrophy, 1 Becker muscular dystrophy, 1 postpolio syndrome, and 1 spinal cord injury) took part in semistructured interviews about their speech. All subjects used M-NPPV during the day, and all but 1 used BPAP at night for their ventilation needs. Interviews were audio-recorded, transcribed, and verified. A qualitative descriptive phenomenological approach was used to code and develop themes. Results Three major themes emerged from the interview data: (a) M-NPPV aids speaking (by increasing loudness, utterance duration, clarity, and speaking endurance), (b) M-NPPV interferes with the flow of speaking (due to the need to pause to take a breath, problems with mouthpiece placement, and difficulty in using speech recognition software), and (c) nasal BPAP interferes with speaking (by causing abnormal nasal resonance, muffled speech, mask discomfort, and difficulty in coordinating speaking with ventilator-delivered inspirations). Conclusion These qualitative data from chronic NPPV users suggest that both M-NPPV and nasal BPAP may interfere with speaking but that speech is usually better and speaking is usually easier with M-NPPV. These findings can be explained primarily by the nature of the 2 ventilator delivery systems and their interfaces.
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http://dx.doi.org/10.1044/2019_AJSLP-MSC18-18-0101DOI Listing
July 2019

The Consequences of Oromandibular Dystonia on Communicative Participation: A Qualitative Study of the Insider's Experiences.

Am J Speech Lang Pathol 2019 07 15;28(2S):771-783. Epub 2019 Jul 15.

Department of Rehabilitation Medicine, University of Washington, Seattle.

Purpose The purpose of this study was to obtain a self-reported account of the experience of living with oromandibular dystonia (OMD) to gain a better understanding of both the daily facilitators and barriers to communicative participation and the strategies used for adapting to life with OMD. Method Eight individuals with OMD and dysarthria participated in 1 face-to-face, semistructured interview. Interviews were audio-recorded and transcribed verbatim. Qualitative, phenomenological methods of coding, immersion, and emergence were used in the analysis of interview data. Results Three major themes and 7 subthemes emerged from the analysis of interview data. First, "speaking is different now" provided examples of how speech changes are manifested in various life situations. Second, "my roles have changed" addressed how OMD has impacted work, home, and social roles. Third, "I accept it and move on" involved finding strategies that help and adopting a different perspective. Conclusion We suggest that the management of OMD must take a more holistic approach by addressing consequences beyond the physical symptoms and be tailored to each individual based on his or her personal concerns and goals.
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http://dx.doi.org/10.1044/2018_AJSLP-MSC18-18-0092DOI Listing
July 2019

Teaching Medical Students Skills for Effective Communication With Patients Who Have Communication Disorders.

Am J Speech Lang Pathol 2019 02;28(1):155-164

Department of Rehabilitation Medicine, University of Washington, Seattle.

Purpose Patients with communication impairments including speech, language, cognition, or hearing disorders face many barriers to communication in health care settings. These patients report loss of autonomy in health care decision making, are at increased risk for medical errors, and are less satisfied with health care than patients without communication disorders. Although medical students receive training in effective patient-provider communication, most of this training assumes patients have intact communication abilities. Medical students and other health care providers are often unprepared to meet the communication needs of patients with communication disorders in health care encounters. The purpose of this study was to assess the impact of a curriculum for training medical students to communicate effectively with patients who have a range of communication disorders. Method Twenty-six 2nd-year medical students volunteered for assessments before and after a required workshop in a class. This workshop included instruction about different types of communication disorders and communication strategies, followed by practice with standardized patients portraying different communication disorders. Outcome measures included a knowledge test, ratings of self-efficacy, and evaluation of students' skills when interviewing standardized patients portraying aphasia and dysarthria. Results Medical students demonstrated significant improvements in knowledge, self-efficacy, and use of recommended communication techniques. Conclusions The curriculum appeared effective in changing medical students' knowledge and skills for working with patients with communication disorders. Equipping medical students to meet the needs of patients with communication disorders is 1 key element for improving the quality of health care for this patient population.
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http://dx.doi.org/10.1044/2018_AJSLP-18-0130DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6503863PMC
February 2019

Swallowing with Noninvasive Positive-Pressure Ventilation (NPPV) in Individuals with Muscular Dystrophy: A Qualitative Analysis.

Dysphagia 2020 02 11;35(1):32-41. Epub 2019 Mar 11.

Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA.

The purpose of the study is to describe experiences of swallowing with two forms of noninvasive positive-pressure ventilation (NPPV): mouthpiece NPPV (M-NPPV) and nasal bilevel positive airway pressure (BPAP) in people with muscular dystrophy. Ten men (ages 22-42 years; M = 29.3; SD = 7.1) with muscular dystrophy (9 with Duchenne's; 1 with Becker's) completed the Eating Assessment Tool (EAT-10; Ann Otol Rhinol Laryngol 117(12):919-924 [33]) and took part in semi-structured interviews. The interviews were audio recorded, transcribed, and verified. Phenomenological qualitative research methods were used to code (Dedoose.com) and develop themes. All participants affirmed dysphagia symptoms via responses on the EAT-10 (M = 11.3; SD = 6.38; Range = 3-22) and reported eating and drinking with M-NPPV and, to a lesser extent, nasal BPAP. Analysis of interview data revealed three primary themes: (1) M-NPPV improves the eating/drinking experience: Most indicated that using M-NPPV reduced swallowing-related dyspnea. (2) NPPV affects breathing-swallowing coordination: Participants described challenges and compensations in coordinating swallowing with ventilator-delivered inspirations, and that the time needed to chew solid foods between ventilator breaths may lead to dyspnea and fatigue. (3) M-NPPV aids cough effectiveness: Participants described improved cough strength following large M-NPPV delivered inspirations (with or without breath stacking). Although breathing-swallowing coordination is challenging with NPPV, participants reported that eating and drinking is more comfortable than when not using it. Overall, eating and drinking with NPPV delivered via a mouthpiece is preferred and is likely safer for swallowing than with nasal BPAP. M-NPPV (but not nasal BPAP) is reported to improve cough effectiveness, an important pulmonary defense in this population.
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http://dx.doi.org/10.1007/s00455-019-09997-6DOI Listing
February 2020

"I would have told you about being forgetful, but I forgot": the experience of cognitive changes and communicative participation after head and neck cancer.

Disabil Rehabil 2020 04 19;42(7):931-939. Epub 2018 Nov 19.

Department of Speech and Hearing Sciences, University of Washington, Seattle, WA, USA.

Survivors of head and neck cancer have reported difficulties with memory, attention, verbal fluency, and processing speed sometimes persisting years after treatment. Self-perceived cognitive function is an important predictor of communication outcomes in this population. This study explores the lived experience of cognitive changes in survivors of non-nasopharyngeal head and neck cancer and how these changes affect communication in their daily lives. In the phenomenological tradition, five adult survivors of non-nasopharyngeal head and neck cancer participated in individual semi-structured interviews. The interviews were audio-recorded, transcribed, coded, and summarized into themes. Two major themes emerged: (1) ; and (2) . Participants described problems with memory, focus/attention, and task initiation along with slowed processing and language difficulties. These difficulties affected communication at work, socially, and at home. Participants expressed feeling unprepared for the possibility of cognitive changes, not knowing why they were happening or what to do about them. Results of this study have implications for counseling and treatment of individuals with head and neck cancer, as well as advocating for these patients to receive appropriate information and intervention.Implications for rehabilitationSurvivors of non-nasopharyngeal head and neck cancer described experiencing problems with memory and focus/attention along with slowed processing and language difficulties.Study participants generally felt both unprepared for the cognitive changes they experienced and, in many ways, unsupported by healthcare providers and others.Rehabilitation professionals should be aware that cognitive changes following medical treatment for head and neck cancer may affect a patient's ability to learn and follow complex treatment regimens.Rehabilitation professionals can advise and advocate for these patients to receive the appropriate referrals for assessment and treatment of their cognitive symptoms.
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http://dx.doi.org/10.1080/09638288.2018.1514535DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6526090PMC
April 2020

Relationship between perceived social support and patient-reported communication outcomes across communication disorders: a systematic review.

Int J Lang Commun Disord 2018 11 24;53(6):1059-1077. Epub 2018 Jul 24.

Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA.

Background: Beyond the severity of voice, speech and language impairments, one potential predictor of communication success across adult populations with communication disorders may be perceived social support: the expectation that others will provide support if needed. Despite the preponderance of intervention approaches that assume a positive relationship between perceived social support and patient-reported communication success, the evidence base for these relationships is limited.

Aims: The aim of this systematic review is to explore relationships between measures of perceived social support and patient-reported communication outcomes in adult populations with communication disorders.

Methods & Procedures: The PRISMA guidelines were followed in the conduct and reporting of this review. Electronic databases including PubMed, PsychINFO and CINAHL were systematically searched up to 19 May 2017. Additional data were obtained for two studies. All the included studies were appraised using the Critical Appraisal Skills Program (CASP) tools. Given the heterogeneous nature of the studies, data synthesis was narrative for the quantitative studies. A meta-ethnographic approach was used to synthesize qualitative data.

Outcomes & Results: Eight quantitative and four qualitative studies met eligibility criteria. All quantitative studies met eight of eight quality criteria. For the qualitative studies, one study met nine of nine quality criteria; the remaining three studies met three, seven and eight quality criteria. Of the eight included quantitative studies, six independent data sets were used. Results revealed no significant relationships between perceived social support and communication outcomes in three studies (two aphasia with one data set, one Parkinson's disease), while perceived social support was a weak, but significant predictor in two studies (one multiple sclerosis, one head and neck cancer). Three additional studies (two aphasia with one data set; one Parkinson's disease) found that relationships were initially weak, but strengthened over time to become moderate. Results from qualitative studies (one head and neck cancer, two aphasia, one multiple sclerosis) revealed that perceived social support acted as a facilitator, and absent or misguided support acted as a barrier to communication outcomes. Skilful, responsive family members were able to facilitate better quality of communicative interactions, whereas lack of social support, or negative attitudes and behaviours of other people, were barriers.

Conclusions & Implications: While perceived social support may affect communication outcomes in adults with communication disorders, current measures may not adequately capture these constructs. Results have implications for future research and interventions for speech and language therapists.
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http://dx.doi.org/10.1111/1460-6984.12417DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7335018PMC
November 2018

"I'll Have What He's Having…" and Other Restrictions in Communicative Participation.

Authors:
Carolyn Baylor

JAMA Otolaryngol Head Neck Surg 2018 08;144(8):693-695

Department of Rehabilitation Medicine, University of Washington, Seattle.

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http://dx.doi.org/10.1001/jamaoto.2018.0677DOI Listing
August 2018

Role of Psychosocial Factors on Communicative Participation among Survivors of Head and Neck Cancer.

Otolaryngol Head Neck Surg 2018 08 20;159(2):266-273. Epub 2018 Mar 20.

2 Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA.

Objective The purpose of this study was to examine the unique contribution of psychosocial factors, including perceived social support, depression, and resilience to communicative participation, among adult survivors of head and neck cancer (HNC). Study Design Cross-sectional. Setting University-based laboratory and speech clinic. Subjects and Methods Adult survivors of HNC who were at least 2 years posttreatment for HNC completed patient-reported outcome measures, including those related to communicative participation and psychosocial function. Multiple linear regression analysis was conducted to predict communicative participation. Self-rated speech severity, cognitive function, laryngectomy status, and time since diagnosis were entered first as a block of variables (block 1), and psychosocial factors were entered second (block 2). Results Eighty-eight adults who were on average 12.2 years post-HNC diagnosis participated. The final regression model predicted 58.2% of the variance in communicative participation (full model R = 0.58, P < .001). Self-rated speech severity, cognitive function, laryngectomy status, and time since diagnosis together significantly predicted 46.1% of the variance in block 1. Perceived social support, depression, resilience, and interactions significantly and uniquely predicted 12.1% of the additional variance in block 2. Conclusion For clinicians, psychosocial factors such as perceived depression warrant consideration when counseling patients with HNC about communication outcomes and when designing future studies related to rehabilitation.
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http://dx.doi.org/10.1177/0194599818765718DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6080254PMC
August 2018

Factors Associated With Communicative Participation in Amyotrophic Lateral Sclerosis.

J Speech Lang Hear Res 2017 06;60(6S):1791-1797

University of Washington, Seattle.

Purpose: People with amyotrophic lateral sclerosis frequently experience bulbar impairment and dysarthria that may restrict their ability to take part in everyday communication situations. The aim of this study is to examine selected variables that may contribute to restrictions in communicative participation.

Method: Community-dwelling participants with amyotrophic lateral sclerosis (N = 70) who reported communication changes but continued to use natural speech completed a survey, including the Communicative Participation Item Bank, demographics (age, sex, living situation, employment status, education, and time since diagnosis), and self- reported symptom-related variables (physical activity, emotional problems, fatigue, pain, speech severity, speech usage, and cognitive and communication skills). To identify predictors of restrictions in communicative participation, these variables were entered into a backward stepwise multiple linear regression analysis.

Results: Three variables (speech severity, swallowing severity, and speech usage) were included in the final model and accounted for 55% of the variability.

Conclusions: Better speech and swallowing skills and higher speech usage are associated with better communicative participation in this sample. Thus, when making clinical decisions regarding intervention, clinicians should continue their efforts to target speech and swallow abilities, while recognizing other variables that have the potential of restricting communicative participation.
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http://dx.doi.org/10.1044/2017_JSLHR-S-16-0206DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5544405PMC
June 2017

Speech Versus Speaking: The Experiences of People With Parkinson's Disease and Implications for Intervention.

Am J Speech Lang Pathol 2017 Jun;26(2S):561-568

Portland State University, ORNorthwest Clinic for Voice and Swallowing, Oregon Health & Sciences University, Portland.

Purpose: In this project, we explore the experiences of people who report speech changes associated with Parkinson's disease as they describe taking part in everyday communication situations and report impressions related to speech treatment.

Method: Twenty-four community-dwelling adults with Parkinson's disease took part in face-to-face, semistructured interviews. Qualitative research methods were used to code and develop themes related to the interviews.

Results: Two major themes emerged. The first, called "speaking," included several subthemes: thinking about speaking, weighing value versus effort, feelings associated with speaking, the environmental context of speaking, and the impact of Parkinson's disease on speaking. The second theme involved "treatment experiences" and included subthemes: choosing not to have treatment, the clinician, drills and exercise, and suggestions for change.

Conclusions: From the perspective of participants with Parkinson's disease, speaking is an activity requiring both physical and cognitive effort that takes place in a social context. Although many report positive experiences with speech treatment, some reported dissatisfaction with speech drills and exercises and a lack of focus on the social aspects of communication. Suggestions for improvement include increased focus on the cognitive demands of speaking and on the psychosocial aspects of communication.
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http://dx.doi.org/10.1044/2017_AJSLP-16-0087DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5576965PMC
June 2017

Patient-Provider Communication Training for Dysarthria: Lessons Learned from Student Trainees.

Semin Speech Lang 2017 07 15;38(3):229-238. Epub 2017 Jun 15.

Department of Rehabilitation Medicine, University of Washington, Seattle, Washington.

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http://dx.doi.org/10.1055/s-0037-1602842DOI Listing
July 2017

Incorporating the Principles of Self-Management into Treatment of Dysarthria Associated with Parkinson's Disease.

Semin Speech Lang 2017 07 15;38(3):210-219. Epub 2017 Jun 15.

Department of Speech and Hearing Sciences, Northwest Clinic for Voice and Swallowing, Oregon Health and Sciences University, Portland State University, Portland, Oregon.

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http://dx.doi.org/10.1055/s-0037-1602840DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6583887PMC
July 2017

Assessing the Believability of Standardized Patients Trained to Portray Communication Disorders.

Am J Speech Lang Pathol 2017 Aug;26(3):791-805

Department of Rehabilitation Medicine, University of Washington, Seattle.

Purpose: The purpose of this study was to evaluate the believability of standardized patients portraying individuals with communication disorders as part of a larger study in which standardized patients help train medical and allied health students about communication disorders.

Method: Two women portrayed persons with aphasia, and 2 men depicted persons with dysarthria associated with Parkinson's disease. Two stakeholder groups rated believability. Speech-language pathologists rated believability of videos online. Persons with aphasia rated aphasia videos during in-person sessions with the researchers.

Results: Targeted believability was 80 or higher (0-100 scale; 0 = not at all believable, 100 = very believable). For speech-language pathologist raters, average ratings met the target for the portrayals of the aphasia characteristics of word-finding problems, agrammaticism, nonverbal communication, and overall portrayal but not for auditory comprehension problems. Targets for the portrayals were met for the dysarthria characteristics of reduced speech movements, reduced loudness, reduced intonation, flat affect, and overall portrayal but not for speech rate. Ratings for different standardized patients portraying the same case were not significantly different from each other on most characteristics. Ratings from persons with aphasia were highly variable.

Conclusion: Standardized patients who do not have communication disorders can portray disorder characteristics in a believable manner.
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http://dx.doi.org/10.1044/2017_AJSLP-16-0068DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5829793PMC
August 2017

Employer Reactions to Adductor Spasmodic Dysphonia: Exploring the Influence of Symptom Severity and Disclosure of Diagnosis During a Simulated Telephone Interview.

Am J Speech Lang Pathol 2017 May;26(2):469-482

Speech and Hearing Sciences, University of Washington, Seattle.

Purpose: The purpose of this study was to determine the influence of symptom severity and disclosure of adductor spasmodic dysphonia (ADSD) on the perceptions of human resource personnel members (HRPs) during a simulated phone interview.

Method: One female speaker with ADSD was recorded reading an interview script at two time points: (a) pre-BOTOX injection (severe), and (b) post-BOTOX injection (mild). Thirty-two HRPs evaluated the recording in one of the two conditions via a qualitative structured interview. HRPs gave their recommendations regarding when and how to disclose ADSD.

Results: In the mild condition, no HRP perceived that the applicant had a voice disorder. Disclosure was not recommended as often, as an impairment was not initially noticed. However, 15/16 HRPs commented on the applicant's voice in the severe condition, with most suspecting she was a smoker or had lung/throat cancer. Disclosure in the severe condition was recommended more often, as it clarified symptoms that were noted at the outset.

Conclusions: Symptom severity in ADSD influences employer perceptions during the phone interview process. Incorrect assumptions may be made about applicants with severe symptoms, and apparentness of symptoms influences whether or not disclosure is recommended. Results have implications for counseling individuals with ADSD who are navigating the job interview process.
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http://dx.doi.org/10.1044/2016_AJSLP-16-0040DOI Listing
May 2017

The Effect of Information and Severity on Perception of Speakers With Adductor Spasmodic Dysphonia.

Am J Speech Lang Pathol 2017 May;26(2):327-341

Department of Rehabilitation Medicine, University of Washington, Seattle.

Purpose: The purpose of this study was to examine the effect of severity of adductor spasmodic dysphonia (ADSD) and information about it on unfamiliar listeners' attitudes about speakers' personal characteristics, perceived vocal effort, and listener comfort on the basis of ratings of speech recordings.

Method: Fifteen women with ADSD and 5 controls provided speech samples. Forty-five unfamiliar listeners were randomized into 3 groups. Listeners in Group 1 received no information, listeners in Group 2 were told that some speakers had voice disorders or had no voice concerns, and listeners in Group 3 were provided diagnostic labels for each speaker and information about ADSD. Listeners then rated speech samples for attitudes, perceived vocal effort, and listener comfort.

Results: Speakers with ADSD were judged significantly worse than controls for attitudes related to "social desirability" and "intellect." There was no effect of severity on "personality" attributes. However, provision of a diagnostic label resulted in significantly more favorable personality ratings than when no label was provided. Perceived vocal effort and comfort became significantly more negative as ADSD severity increased. Finally, most listener ratings were unaffected by provision of additional information about ADSD.

Conclusions: Listeners' perceptions about speakers with ADSD are difficult to change. Directions for counseling and public education need future study.
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http://dx.doi.org/10.1044/2016_AJSLP-15-0191DOI Listing
May 2017

Exploring the Relevance of Items in the Communicative Participation Item Bank (CPIB) for Individuals With Hearing Loss.

Am J Audiol 2017 Mar;26(1):27-37

Department of Rehabilitation Medicine, University of Washington, Seattle.

Purpose: The Communicative Participation Item Bank (CPIB) was developed to evaluate participation restrictions in communication situations for individuals with speech and language disorders. This study evaluated the potential relevance of CPIB items for individuals with hearing loss.

Method: Cognitive interviews were conducted with 17 adults with a range of treated and untreated hearing loss, who responded to 46 items. Interviews were continued until saturation was reached and prevalent trends emerged. A focus group was also conducted with 3 experienced audiologists to seek their views on the CPIB. Analysis of data included qualitative and quantitative approaches.

Results: The majority of the items were applicable to individuals with hearing loss; however, 12 items were identified as potentially not relevant. This was largely attributed to the items' focus on speech production rather than hearing. The results from the focus group were in agreement for a majority of items.

Conclusions: The next step in validating the CPIB for individuals with hearing loss is a psychometric analysis on a large sample. Possible outcomes could be that the CPIB is considered valid in its entirety or the creation of a new questionnaire or a hearing loss-specific short form with a subset of items is necessary.
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http://dx.doi.org/10.1044/2016_AJA-16-0047DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5597082PMC
March 2017

Validating the Communicative Participation Item Bank (CPIB) for use with people with aphasia: an analysis of Differential Item Function (DIF).

Aphasiology 2017 9;31(8):861-878. Epub 2016 Sep 9.

University of Washington, Department of Rehabilitation Medicine, Box 356490, Seattle, WA 98195, 206-543-3345.

Background: The term 'communicative participation' refers to participation in the communication aspects of life roles at home, at work, and in social and leisure situations. Participation in life roles is a key element in biopsychosocial frameworks of health such as the World Health Organization's (WHO) International Classification of Functioning, Disability and Health (ICF), and the Aphasia Framework for Outcomes Measurement (AFROM). The Communicative Participation Item Bank (CPIB) was developed as a patient-reported measure of communicative participation for adults. Initial validation focused on adults with motor speech or voice disorders. No prior studies have conducted quantitative validation analyses for the CPIB for persons with aphasia (PWA).

Aims: The primary purpose of this study was to begin validation of the CPIB for PWA by conducting an analysis of differential item functioning (DIF). A DIF analysis was used to identify whether item parameters of the CPIB differed between PWA and the populations used in prior CPIB calibration. Secondary analyses evaluated the level of assistance needed by PWA to complete the CPIB, relationships between the CPIB and a gold-standard patient-reported instrument for PWA - American Speech-Language-Hearing Association Quality of Communication Life Scale (ASHA-QCL), and relationships between PWA and family proxy report on the CPIB.

Methods And Procedures: This study included 110 PWA and 90 proxy raters. PWA completed a battery of patient-reported questionnaires in one face-to-face session. Speech-language pathologists (SLPs) provided communication support. Data on aphasia severity from the Western Aphasia Battery - Revised (WAB-R) and demographic data either existed from prior research or were collected during the session. Proxy raters completed a similar battery of self-report questionnaires.

Outcomes And Results: Results of the DIF analysis suggested statistically significant DIF on two of the 46 items in the CPIB, but the DIF had essentially no impact on CPIB scores. PWA with WAB-R Aphasia Quotient scores above 80 appeared comfortable reading the CPIB items, although required occasional assistance. Most participants who were unable to complete the CPIB had WAB-R Aphasia Quotient scores lower than 50. Correlation between the CPIB and ASHA-QCL was moderate; and correlation between PWA and proxy scores was low.

Conclusions: Most PWA were able to respond to CPIB items, although most required or requested support. Although these results are preliminary due to a small sample size, the data support that the CPIB may be valid for PWA. Caution is warranted regarding proxy report because of low correlation between PWA and proxy ratings.
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http://dx.doi.org/10.1080/02687038.2016.1225274DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6433404PMC
September 2016

Variables Associated With Communicative Participation After Head and Neck Cancer.

JAMA Otolaryngol Head Neck Surg 2016 12;142(12):1145-1151

Department of Rehabilitation Medicine, University of Washington, Seattle.

Importance: For patients with head and neck cancer (HNC), communication difficulties often create substantial barriers in daily life, affecting a person's ability to return to work, establish or maintain relationships, or participate in everyday activities.

Objective: To examine variables significantly associated with communication in everyday activities, or communicative participation, in adult survivors of HNC.

Design, Setting, And Participants: In a cross-sectional study, from November 1, 2008, through March 18, 2011, participants completed questionnaires about specific experiences and symptoms associated with their health and communication. Seventeen variables were considered in association with communicative participation. Data were collected from adult survivors of HNC residing in a community. Participants completed questionnaires, in English, either online or using paper forms according to their preference. Participants were recruited through support groups, professional email lists, and professional contacts.

Main Outcomes And Measures: Communicative participation and predictor variables were measured using a variety of validated patient-report scales and demographic information. Multiple linear regression analysis was conducted with variables entered using a backward stepwise regression procedure. Variables with significant regression coefficients were retained in the model and reported as change in R2.

Results: One hundred ninety-seven adults (121 males and 76 females; mean age, 61.5 years) participated, all at least 6 months posttreatment of HNC with no additional medical conditions affecting speech. The final model contained 4 significant variables (R2 = 0.462): self-rated speech severity, cognitive function, laryngectomy status, and time since diagnosis. Better communicative participation was associated with less severe speech and cognitive problems; together, these 2 variables explained 42% of the variance in the model (self-rated speech severity, R2 = 0.227, and cognitive function, R2 = 0.193 [0.227 + 0.193 = 0.420 = 42%]). To a lesser extent, better communicative participation also was associated with not having undergone a total laryngectomy surgical procedure (R2 = 0.035) and longer time since diagnosis (R2 = 0.007); full model: R2 = 0.462, P < .001; regression coefficients [SE]: self-rated speech severity 0.551 [0.065], P < .001, R2 = 0.227; cognitive function 0.063 [0.011], P < .001, R2 = 0.193; laryngectomy status 0.285 [0.117], P = .02; and time since diagnosis 0.015 [0.006], P = .02.

Conclusions And Relevance: These results suggest that communicative participation in adults with HNC is associated with self-rated speech severity, cognitive function, whether or not a person has undergone total laryngectomy, and time since diagnosis. Clinicians can use these results to inform their practice in pretreatment counseling, patient education, and rehabilitation for survivors of HNC.
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http://dx.doi.org/10.1001/jamaoto.2016.1198DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5756625PMC
December 2016

Variables associated with communicative participation in Parkinson's disease and its relationship to measures of health-related quality-of-life.

Int J Speech Lang Pathol 2017 08 27;19(4):407-417. Epub 2016 Jun 27.

b Department of Rehabilitation Medicine , University of Washington , Seattle , WA , USA.

Purpose: Communication disorders associated with Parkinson's disease (PD) often lead to restricted participation in life roles, yet there is a limited understanding of influencing factors and few quantitative measurement tools available. This study aimed to identify variables associated with communicative participation in PD and to examine the relationship between the Communicative Participation Item Bank (CPIB) and existing health-related quality-of-life (HRQoL) measures.

Method: Self-report data from 378 participants with PD from the US and New Zealand were analysed. Data included responses to the CPIB, PD Questionnaire-8, sub-scales of the Global Health instrument from the Patient Reported Outcomes Measurement Information System (PROMIS) and additional self-report instruments.

Result: Greater perceived speech disorder, lower levels of speech usage, fatigue, cognitive and emotional problems and swallowing difficulties were associated with lower levels of communicative participation. Participants' age significantly influenced findings, interacting with country of residence, sex and speech usage. Scores on the CPIB were moderately correlated with HRQoL measures.

Conclusion: Communicative participation in PD is complex and influenced by both demographic and disease-based variables, necessitating a broader view of the communicative experiences of those with PD. Measurement of communicative participation as a separate construct to existing HRQoL measures is recommended.
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http://dx.doi.org/10.1080/17549507.2016.1193900DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6190828PMC
August 2017

Addressing Communicative Participation in Treatment Planning for Adults: A Survey of U.S. Speech-Language Pathologists.

Am J Speech Lang Pathol 2016 08;25(3):355-70

Purpose: In speech-language pathology, there is increasing attention on participation-focused interventions to optimize participation in valued life roles. The purpose of this study was to investigate how speech-language pathologists (SLPs) in the United States address life participation in therapy programs, as well as their opinions regarding barriers and facilitators to participation-focused intervention.

Method: An online questionnaire presented case scenarios for aphasia, dysarthria, and laryngectomy to 66 SLPs who have worked with adults. SLPs were asked to write goals and describe therapy activities for the scenarios. The final section of the questionnaire was an open-ended question regarding barriers and facilitators to participation-focused intervention.

Results: Many SLPs addressed participation in their rationales for therapy; 50% of goals had a participation-focused rationale. However, the goals, activities, and outcomes measures typically focused more on impairment and skill performance. Only 8% of goals specifically referenced participation. Although many SLPs stated that participation-focused intervention is important, they identified many barriers to implementation including time and productivity constraints, limits of clinical settings, and documentation challenges.

Conclusions: There is potential for gaps between SLPs' participation-focused rationale for therapy and activities or outcomes measures that often do not include participation elements. SLPs are interested in participation-focused treatment resources.
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http://dx.doi.org/10.1044/2015_AJSLP-15-0049DOI Listing
August 2016

The relationship between communicative participation and postlaryngectomy speech outcomes.

Head Neck 2016 04 29;38 Suppl 1:E1955-61. Epub 2015 Dec 29.

Health and Rehabilitation Sciences, Western University, London, Ontario, Canada.

Background: The purpose of this study was to examine relationships between communicative participation and postlaryngectomy speech outcomes, including listener-rated speech intelligibility and acceptability, and patient-rated speech acceptability and voice handicap.

Methods: Thirty-six laryngectomized individuals completed the Communicative Participation Item Bank (CPIB) short form and the Voice Handicap Index-10 (VHI-10). They provided recordings from the Sentence Intelligibility Test (SIT) and a reading passage, and rated their own speech acceptability. Forty-eight inexperienced listeners transcribed the SIT sentences to derive intelligibility scores. Eighteen additional listeners judged the speech acceptability using the rating scales.

Results: Listeners judged tracheoesophageal speakers as significantly more intelligible and acceptable than electrolaryngeal speakers (p < .05). Speech acceptability was significantly more acceptable to speakers than listeners (p < .05). Weak, nonsignificant relationships were found between communicative participation and listener-rated outcomes. Stronger, significant relationships were found between communicative participation and self-rated speech acceptability and voice handicap (p < .05).

Conclusion: Patient-reported communication outcomes are complementary to listener-rated outcomes. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1955-E1961, 2016.
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http://dx.doi.org/10.1002/hed.24353DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4844835PMC
April 2016

Describing Speech Usage in Daily Activities in Typical Adults.

J Voice 2016 Jan 11;30(1):42-52. Epub 2015 Apr 11.

Department of Rehabilitation Medicine, University of Washington, Seattle, Washington.

Objectives: "Speech usage" refers to what people want or need to do with their speech to meet communication demands in life roles. The purpose of this study was to contribute to validation of the Levels of Speech Usage scale by providing descriptive data from a sample of adults without communication disorders, comparing this scale to a published Occupational Voice Demands scale and examining predictors of speech usage levels.

Study Design: This is a survey design.

Methods: Adults aged ≥25 years without reported communication disorders were recruited nationally to complete an online questionnaire. The questionnaire included the Levels of Speech Usage scale, questions about relevant occupational and nonoccupational activities (eg, socializing, hobbies, childcare, and so forth), and demographic information. Participants were also categorized according to Koufman and Isaacson occupational voice demands scale.

Results: A total of 276 participants completed the questionnaires. People who worked for pay tended to report higher levels of speech usage than those who do not work for pay. Regression analyses showed employment to be the major contributor to speech usage; however, considerable variance left unaccounted for suggests that determinants of speech usage and the relationship between speech usage, employment, and other life activities are not yet fully defined.

Conclusions: The Levels of Speech Usage may be a viable instrument to systematically rate speech usage because it captures both occupational and nonoccupational speech demands. These data from a sample of typical adults may provide a reference to help in interpreting the impact of communication disorders on speech usage patterns.
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http://dx.doi.org/10.1016/j.jvoice.2015.02.001DOI Listing
January 2016