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Item Development and feasibility of a Swallowing intervention Package (SiP) for patients receiving radiotherapy treatment for head and neck cancer—the SiP study protocol(BMC, 2016-08-04) Wells, Mary; King, Emma; Toft, Kate; MacAulay, Fiona; Patterson, Joanne; Dougall, Nadine; Hulbert-Williams, Nick; Boa, Sally; Slaven, Eleanor; Cowie, Julie; McGarva, John; Niblock, Patricia Gail; Philp, Julie; Roe, JustinBackground: Head and neck cancer (HNC) is the sixth most common cancer worldwide, and the functional, psychological and social consequences of HNC cancer and its treatment can be severe and chronic. Dysphagia (swallowing problems) affects up to two thirds of patients undergoing combined chemoradiotherapy. Recent reviews suggest that prophylactic swallowing exercises may improve a range of short- and long-term outcomes; however, the importance of psychological and behavioural factors on adherence to swallowing exercises has not been adequately studied. This study aims to develop and test the feasibility of a Swallowing intervention Package (SiP) designed in partnership with patients, speech and language therapists (SLTs) and other members of the head and neck multi-disciplinary team (MDT), for patients undergoing chemoradiotherapy (CRT) or radiotherapy (RT) for head and neck cancer. Methods/design: This feasibility study uses quantitative and qualitative research methods, within a quasi-experimental design, to assess whether patients will tolerate and adhere to the SiP intervention, which aspects of the intervention can be implemented and which cannot, whether treatment fidelity can be achieved across different contexts, whether study processes and outcome measures will be feasible and acceptable and to what extent the intervention is likely to have an impact on swallowing dysfunction and quality of life. Patients are being recruited from five sites in Scotland and England (three interventions and two usual care). The SLT based in the relevant intervention centre teaches the exercise programme and provides supporting materials. A combination of patient-reported outcome measures (PROMs), adherence measures and clinical swallowing assessments are used prior to intervention (baseline), at the end of treatment, 3 and 6 months post-treatment. Discussion: This collaborative study has taken a unique approach to the development of a patient-centred and evidence-based swallowing intervention. The introduction of an e-SiP app provides an exploration of the use of technology in delivering this intervention. The study provides an opportunity to examine the feasibility of delivering and participating in a supported swallowing intervention across several different NHS sites and will provide the evidence needed to refine intervention and study processes for a future trial. Trial registration: NCRI portfolio, 18192 & 20259Item Behaviour change technique taxonomy: A method of describing head and neck cancer dysphagia intervention delivery(Wolters Kluwer, 2017) Toft, Kate; Stringer, HelenPurpose of review The purpose of the review is to examine the current state of the art of dysphagia intervention delivery description and to propose use of a new tool to facilitate this: the behaviour change technique taxonomy version 1 (BCTTv1). Recent findings Describing intervention delivery is difficult, and published research in the field of speech and language therapy (SLT) does not include detail on this key aspect of research protocols. Interventions themselves are often poorly delineated, and a way is needed of classifying how these interventions are delivered in practice. Summary Use of the BCTTv1 would facilitate clarity and transparency in intervention delivery description and have positive implications for research, clinical practice and undergraduate teaching if employed by the SLT profession.Item Feasibility and outcomes of fibreoptic endoscopic evaluation of swallowing following prophylactic swallowing rehabilitation in head and neck cancer(Wiley, 2019-03-20) Patterson, Joanne; Toft, Kate; McAuley, Fiona; King, Emma; McLachlan, Kirsty; Roe, Justin W. G.; Wells, MaryObjectives: Investigate the feasibility and outcomes of fibreoptic endoscopic evalua‐tion of swallowing (FEES) following a programme of prophylactic swallowing exer‐cises in head and neck cancer (HNC) patients treated with radiotherapy.Design: Prospective, single cohort, feasibility study.Setting: Three head and neck cancer centres in Scotland.Participants: Pre‐radiotherapy HNC patients who consented to participate in a pro‐phylactic swallowing intervention.Outcome measures: Fibreoptic endoscopic evaluation of swallowing recruitment and retention rates, assessment acceptability and compliance, qualitative process evaluation.Results: Higher rates of recruitment and retention were achieved in centres where FEES equipment was available on‐site. Travel and anticipated discomfort were barri‐ers to recruitment. Data completion was high for all rating scales, with good reliabil‐ity. Following radiotherapy, swallowing safety significantly deteriorated for liquid boluses (P = 0.005‐0.03); pharyngeal residue increased for liquid and semi‐solid bo‐luses. Pharyngo‐laryngeal oedema was present pre‐treatment and significantly in‐creased post‐radiotherapy (P = 0.001). Patients generally reported positive experience of FEES for their own learning and establishing a baseline.Conclusions: Fibreoptic endoscopic evaluation of swallowing is an acceptable method of assessing patients for a prophylactic swallowing intervention and offers some ad‐ditional information missing from VF. Barriers have been identified and should be taken into account in order to maximise recruitment for future trials.Item Im/politeness and interpreting(Routledge, 2019-05-22) Mapson, Rachel; Tipton, Rebecca; Desilla, LouisaIn this chapter on the interpretation of politeness and impoliteness (im/politeness), im/politeness is considered as a discursive concept that exists in the way language is perceived and evaluated. This facet of pragmatics is therefore integral to the building and maintenance of interpersonal relationships but can present a significant challenge for interpreters because evaluations of im/politeness vary between different languages and cultures. Key perspectives and common themes within translation and interpreting studies literature are explored, including the affordance of familiarity with clients and context on the way im/politeness is interpreted. One theme relates to the degree of directness or indirectness involved, which may result in interpreters employing a variety of strategies, including hedges, prosody, toning down face threatening acts (FTAs) and use of third person. The influence of interpreters’ personal identity is another theme, which in some situations may manifest through use of particular terms of address. The chapter highlights the need for a greater focus on im/politeness and rapport management within interpreter training and continuous professional development (CPD), and the value of more explicit connections between translation and interpreting studies and the theoretical foundations within cross-cultural and intercultural im/politeness research.Item Towards ordinal classification of voice quality features with acoustic parameters(ESSV, 2019-03-09) Schaeffler, Felix; Eichner, Matthias; Beck, Janet M.The human voice is capable of fine-grained variation that results in listener attributions of various psychological, social and biological factors. The complexity of this process is reflected in the number and richness of terms that are used to describe human voices. In this paper we argue that any application that attempts a mapping of the acoustic voice signal onto voice descriptor labels would benefit from an intermediate auditory-phonetic level. As a point of departure we explore the relationships between acoustic parameters and some specific perceptual features derived from Vocal Profile Analysis (VPA), a phonetically motivated voice quality analysis scheme. Perceptual analysis of voice samples from 133 speakers was carried out using VPA for three key phonation features (creakiness, whisperiness, harshness). We extracted eleven acoustic parameters from the samples and used stepwise linear regression to identify acoustic parameters with predictive value. Samples from female speakers were used to derive regression equations which were then used to predict VPA ratings of male voices. Results show significant predictors for all three phonation features and indicate that predictions for the three phonation types rely mainly on different parameters. If a tolerance of ± 1 scalar degree for the perceptual analysis is accepted, then classification accuracy lies at or above 90% for all three phonation features.Item A comparison of acoustic and articulatory parameters for the GOOSE vowel across British Isles Englishes(Acoustical Society of America, 2019-12-19) Lawson, Eleanor; Stuart-Smith, Jane; Rodger, LydiaThis study quantifies vocalic variation that cannot be measured from the acoustic signal alone and develops methods of standardisation and measurement of articulatory parameters for vowels. Articulatory-acoustic variation in the GOOSE vowel was measured across three regional accents of the British Isles, using a total of eighteen speakers from the Republic of Ireland, Scotland and England, recorded with synchronous ultrasound tongue imaging, lip camera and audio. Single co-temporal measures were taken of tongue-body height and backness, lip protrusion, F1 and F2. After normalisation, mixed-effects modelling identified statistically-significant variation for region; tongue-body position was significantly higher and fronter for Irish and English speakers. Region was also significant for lip-protrusion measures, with Scottish speakers showing significantly smaller degrees of protrusion than English speakers. However, Region was only significant for acoustic height and not for frontness.Correlational analyses of all measures showed: a significant positive correlation between tongue-body height and acoustic height; a negative correlation between lip-protrusion and acoustic frontness; but no correlation between tongue-body frontness and acoustic frontness. Effectively, two distinct regional production strategies were found to result in similar normalised acoustic frontness measures for GOOSE: Scottish tongue-body positions were backer and lips less protruded, while English and Irish speakers had fronter tongue-body positions, but more protruded lips.Item What should we call children with unexplained language difficulties? A practical perspective(Wiley, 2014-08-20) Clark, Ann; Carter, GlennThis commentary reflects on Bishop's discussion of possible diagnostic terms for children with unexplained language problems. We discuss each of her four proposed terms in turn, commenting on their potential use in clinical and educational contexts by speech and language therapists and other professionals.Item Syntax(J & R Press, 2014-08-31) Bates, S.; Clark, Ann; Whitworth, Nicole; Knight, Rachael-AnneItem Prosodic development in atypical populations(John Benjamins Publishing Company, 2018-05-24) Peppé, Sue J. E.; Prieto, Pilar; Esteve-Gibert, NúriaThis chapter concerns various atypical conditions in children and how the development of prosody may be affected in them. Methods for evaluating prosodic ability are considered, taking into account receptive and expressive ability. Brief summaries of research into several conditions in which prosodic development is affected are given, including hearing impairment, language disorder, Down syndrome, childhood onset fluency disorder, Williams syndrome and a more detailed treatment of autism spectrum disorder. The chapter concludes with a brief summary of current strategies for rehabilitation.Item Reliability of clinical voice parameters captured with smartphones – measurements of added noise and spectral tilt(ISCA, 2019-09-20) Schaeffler, Felix; Jannetts, Stephen; Beck, Janet M.Smartphones have become powerful tools for data capture due to their computational power, internet connectivity, high quality sensors and user-friendly interfaces. This also makes them attractive for the recording of voice data that can be analysed for clinical or other voice health purposes. This however requires detailed assessment of the reliability of voice parameters extracted from smartphone recordings. In a previous study we analysed reliability of measures of periodicity and periodicity deviation, with very mixed results across parameters. In the present study we extended this analysis to measures of added noise and spectral tilt. We analysed systematic and random error for six frequently used acoustic parameters in clinical acoustic voice quality analysis. 22 speakers recorded sustained [a] and a short passage with a studio microphone and four popular smartphones simultaneously. Acoustic parameters were extracted with Praat and smartphone recordings were compared to the studio microphone. Results indicate a small systematic error for almost all parameters and smartphones. Random errors differed substantially between parameters. Our results suggest that extraction of acoustic voice parameters with mobile phones is not without problems and different parameters show substantial differences in reliability. Careful individual assessment of parameters is therefore recommended before use in practice.