We conducted a two-part study that contributes to the discussion about cervical auscultation (CA) as a scientifically justifiable and medically useful tool to identify patients with a high risk of aspiration/penetration. We sought to determine (1) acoustic features that mark a deglutition act as dysphagic; (2) acoustic changes in healthy older deglutition profiles compared with those of younger adults; (3) the correctness and concordance of rater judgments based on CA; and (4) if education in CA improves individual reliability. The first part of the study focused on a comparison of the "swallow morphology" of dysphagic as opposed to healthy subjects' deglutition in terms of structure properties of the pharyngeal phase of deglutition. We obtained the following results. The duration of deglutition apnea is significantly higher in the older group than in the younger one. Comparing the younger group and the dysphagic group we found significant differences in duration of deglutition apnea, onset time, and number of gulps. Just one parameter, number of gulps, distinguishes significantly between the older and the dysphagic groups. The second part of the study aimed at evaluating the reliability of CA in detecting dysphagia measured as the concordance and the correctness of CA experts in classifying swallowing sounds. The interrater reliability coefficient AC1 resulted in a value of 0.46, which is to be interpreted as fair agreement. Furthermore, we found that comparison with radiologically defined aspiration/penetration for the group of experts (speech and language therapists) yielded 70% specificity and 94% sensitivity. We conclude that the swallowing sounds contain audible cues that should, in principle, permit reliable classification and view CA as an early warning system for identifying patients with a high risk of aspiration/penetration; however, it is not appropriate as a stand-alone tool.

Abstract

Purpose People with aphasia (PWA) use different kinds of gesture spontaneously when they communicate. Although there is evidence that the nature of the communicative task influences the linguistic performance of PWA, so far little is known about the influence of the communicative task on the production of gestures by PWA. We aimed to investigate the influence of varying communicative constraints on the production of gesture and spoken expression by PWA in comparison to persons without language impairment. Method Twenty-six PWA with varying aphasia severities and 26 control participants (CP) without language impairment participated in the study. Spoken expression and gesture production were investigated in 2 different tasks: (a) spontaneous conversation about topics of daily living and (b) a cartoon narration task, that is, retellings of short cartoon clips. The frequencies of words and gestures as well as of different gesture types produced by the participants were analyzed and tested for potential effects of group and task. Results Main results for task effects revealed that PWA and CP used more iconic gestures and pantomimes in the cartoon narration task than in spontaneous conversation. Metaphoric gestures, deictic gestures, number gestures, and emblems were more frequently used in spontaneous conversation than in cartoon narrations by both participant groups. Group effects show that, in both tasks, PWA's gesture-to-word ratios were higher than those for the CP. Furthermore, PWA produced more interactive gestures than the CP in both tasks, as well as more number gestures and pantomimes in spontaneous conversation. Conclusions The current results suggest that PWA use gestures to compensate for their verbal limitations under varying communicative constraints. The properties of the communicative task influence the use of different gesture types in people with and without aphasia. Thus, the influence of communicative constraints needs to be considered when assessing PWA's multimodal communicative abilities.

The objective of the study was to find out whether there is a connection between the perception of linguistic intonation contours and emotional intonation. Twenty-four subjects were asked to identify and discriminate emotional prosody listening to subtests 8A and 8B of the Tübinger Affect Battery as well as to 36 utterances that differed in linguistic intonation contour and were first presented normally and then low-pass-filtered. The subjects were divided into an older and a younger group in order to detect a possible age effect. The results showed that the ability to recognize and identify emotional prosody did not decline with age. These results are in contrast to the linguistic intonation contours, for which performance typically declined with age. Also, the low-pass-filtered utterances are more difficult to identify if the intonation contour is not salient, as in imperatives. Finally, the results do not show a gender difference. In sum the results indicate that emotional prosody and the reception of linguistic intonation contours seem to be processed by the same or similar brain structures.

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