The Application of Clear Speech in Electrolaryngeal Speakers

Western University Scholarship@Western Electronic Thesis and Dissertation Repository 3-10-2016 12:00 AM The Application of Clear Speech in Electrolaryngeal Speakers Steven R. Cox The University of Western Ontario Supervisor Dr. Philip C. Doyle The University of Western Ontario Graduate Program in Health and Rehabilitation Sciences A thesis submitted in partial fulfillment of the equirr ements for the degree in Doctor of Philosophy © Steven R. Cox 2016 Follow this and additional works at: https://ir.lib.uwo.ca/etd Part of the Speech Pathology and Audiology Commons Recommended Citation Cox, Steven R., "The Application of Clear Speech in Electrolaryngeal Speakers" (2016). Electronic Thesis and Dissertation Repository. 3533. https://ir.lib.uwo.ca/etd/3533 This Dissertation/Thesis is brought to you for free and open access by Scholarship@Western. It has been accepted for inclusion in Electronic Thesis and Dissertation Repository by an authorized administrator of Scholarship@Western. For more information, please contact [email protected]. Abstract The present work was comprised of a series of experiments that investigated the application of clear speech (CS) in a group of electrolaryngeal (EL) speakers. Three experiments were conducted to assess the impact of CS on three important aspects of EL speech. More specifically, Experiment 1 sought to identify the impact of CS on EL speakers’ word and consonant intelligibility; Experiment 2 examined the influence of CS on the acoustic characteristics of words and vowels in EL speech; and finally, Experiment 3 sought to identify the influence of CS produced by EL speakers on auditory-perceptual ratings by naïve listeners. Results revealed that overall word and consonant intelligibility were minimally different when EL speakers used CS compared to their everyday, ‘habitual’ speech (HS) (Experiment 1). Secondly, EL speakers’ use of CS significantly increased word durations, but did not have a substantial impact on fundamental and formant frequency characteristics of vowels (Experiment 2). Finally, due to the productive changes associated with CS involving a slower rate of speech, over- articulation, and increased mouth-opening, listeners judged EL speech to be significantly less acceptable to listen to when compared to HS. However, no significant effect of speaking condition was noted on listeners’ comfort levels (Experiment 3). Overall, findings suggest that the acoustic deficits in EL speech might be too complex to derive further benefit from CS in the areas of speech intelligibility, the acoustic structure of EL speech and/or auditory-perceptual ratings of EL speakers. Clinical implications and future directions for research are discussed. Keywords electrolarynx, clear speech, intelligibility, speech acoustics, speech acceptability, listener comfort ii Co-Authorship Statement The primary author of the work contained within this thesis was Steven Randall Cox. The other author on Chapters 2, 3, and 4 was Philip C. Doyle, Ph.D., the candidate’s supervisor. iii Acknowledgements To my mentor, Dr. Philip Doyle. There are many things that I have to be grateful for during my doctoral journey. The majority of these items are the result of your consistent and tireless support, borne out of a general desire to see all of your students succeed. Thank you for your patience, motivation, and knowledge. There is no other person in this world that could have provided the level of doctoral training quite like you, especially because of the knowledge and experience that you shared during my time in your lab. This was accentuated by your unique ability to balance all of the important things in life that contribute toward improving one’s quality of life. You and Betsy also treated me like family, welcoming me into your home for wonderful celebrations to honor graduating colleagues and holiday parties filled with bountiful food and drink. Above all else, you supported me when I lost the most important person in my life. For this reason, and many more, I will always consider you more than a mentor. Thank you. To my advisory committee, Dr. Kevin Fung and Dr. J. B. Orange. Thank you for your insight and feedback as I developed my dissertation projects. It was always a pleasure to speak with both of you, whether in the Head and Neck clinic at the London Regional Cancer Program, or in the halls of Elborn College. Your support throughout my doctoral training will always be remembered and appreciated. To my thesis examination committee, Dr. J. B. Orange, Dr. Jeffrey Searl, Dr. Sandi Spaulding and Dr. Jeff Tennant. Thank you for your questions and feedback during my defense. The value and importance of the doctoral defense is something that I will cherish as I move forward in my academic career. I will continue to strengthen what I know and continue to further my knowledge in what may be currently unknown. To the ‘Labrats’, Dr. Catherine Bornbaum, Dr. Marie-Eve Caty, Mr. Eric Davis, Dr. Adam Day, Dr. Agnes Dzioba, Mrs. Melissa Nash, Ms. Grace Scott, and Ms. Lindsey Sleeth. I was blessed to have the opportunity to work alongside such an intelligent group of people (not to mention a group that understands something about work-life balance). Thank you. To the individuals who participated in the dissertation projects, the undergraduate and graduate students at Western University, and the laryngectomees. This iv work would not have been possible without any of you. I am forever thankful for your time and willingness to participate. To Mr. Sebastiano Failla and the lab volunteers. You are vital to the daily operations and pursuits of Dr. Doyle’s lab. Never forget how thankful I am to have you as part of the team. This project would not been completed without you. To the faculty and student members of the Rehabilitation Sciences Journal Club. Thank you for the opportunity to be part of such a supportive learning environment. I appreciate several invitations to share my own research, the feedback that came from these experiences, in addition to the opportunity to learn about other member’s research interests, too. To members of the Department of Otolaryngology – Head and Neck Surgery and the London Regional Cancer Program. Words cannot express how thankful I am to have worked alongside Canada’s brightest minds. Further, I am forever grateful for the invitation to numerous department gatherings and weekly grand rounds. To my colleagues in the Department of Communication and Sciences Disorders at Adelphi University, Dr. Robert Goldfarb and Dr. Lawrence Raphael, for their review and valuable feedback during the revisions of this doctoral thesis. In addition, Dr. Carolyn Springer in the Department of Psychology at Adelphi University for her assistance with the statistical analyses used in this doctoral dissertation. To my immediate and extended families, especially my brother Craig and sister Melissa. Although mom left us during my doctoral training, it was because I had both of you that I was able to carry on. Always remember that I am thankful for every text, every phone call, every visit to London, and every helping hand during a move. To my late Uncle John Pagliacci. You inspired me to begin investigating individuals’ communication and quality of life after head and neck cancer treatment. v To my wife, Dr. Katia Ciampa. I cannot thank you enough for the love and support you have provided me, especially while I was writing my dissertation. We lost a very special woman during my journey. However, it was you that helped me endure, looking toward a brighter future with fond memories. You are my destiny. Last, but not least, to my late mother, Aida Lucia (née Pilato) Macdonald. All of my life, you encouraged me to pursue my dreams. You always reminded me that anything I wanted to accomplish was possible. The completion of my doctorate is a testament to this. I move forward with the intent of making you proud as you look down from above. Grazie per “l’amor che move il sole e l‘altre stelle.”. vi Table of Contents Page Abstract ii Co-Authorship Statement iii Acknowledgements iv Table of Contents vii List of Tables xii List of Figures xiv List of Appendices xvi Chapter One 1 Introduction and Review of Literature 1 Medical Management of Laryngeal Cancer 2 Postlaryngectomy Voice and Speech 4 History of Electrolaryngeal Voice and Speech 7 Alaryngeal Speech and Voice-Related Quality of Life 11 Speech Intelligibility 13 Acoustic Properties of Electrolaryngeal Speech 18 Intensity and Signal-to-Noise Ratio 18 Frequency 20 Speaking Rate 24 Suprasegmetal Features of Electrolaryngeal Speech 26 Intonation 26 Stress 27 Rhythm 28 Juncture 29 Perceptual Features of Electrolaryngeal Speech 31 Speech Acceptability 31 Listener Comfort 33 Social Consequences of Electrolaryngeal Speech 35 Experimental Attempts to Improve Acoustic Characteristics of Electrolaryngeal Speech 37 vii Clear Speech 39 Rationale for the Present Studies 45 References 48 Chapter Two 65 The Impact of Clear Speech on Word Intelligibility of Electrolaryngeal Speakers 65 Method 70 Participant Speakers 70 Speech Stimuli 71 Acquisition of Speech Stimuli 71 Editing Speech Stimuli 72 Evaluation of Intelligibility 73 Participant Listeners 73 Listening Procedure 74 Data Analyses 76 Statistical Analyses 76 Word-Level Analyses 76 Word-Position Analyses 77 Relationships Between Speech Intelligibility Scores 77 Agreement and Reliability 77 Results 78 Word Intelligibility 78 Comparison of Word Intelligibility by Device Group 80 Relationship Between Speaking Conditions 80 Intelligibility

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