| This series of original experiments focused on multiple issues related to voice and speech rehabilitation in individuals who were diagnosed with and surgically treated for laryngeal malignancy. These experiments focused on two lines of inquiry. First, psychophysical phenomena associated with postlaryngectomy voice rehabilitation were investigated. Specifically, Experiments 1 and 2 evaluated overall speech severity, naturalness, acceptability, and pleasantness in speakers who used one particular method of alaryngeal communication-tracheoesophageal (TE) speech. Equal-appearing interval (EAI) and direct magnitude estimation (DME) scales were assessed for their construct validity in measuring four auditory-perceptual dimensions, as proposed by Stevens (1975). Results revealed that overall speech severity and pleasantness in TE speech were consistent with prothetic continua, indicating that DME scales were more appropriate for listeners' evaluations of these dimensions in TE speakers. In contrast, speech naturalness and acceptability were found to be consistent with metathetic continua, indicating that either EAI or DME scales were appropriate for listener evaluation of these dimensions of TE speech. The second line of inquiry related to both auditory-perceptual evaluation of TE speech through listener judgments, in addition to exploring self-perceptions of a group of TE speakers. In Experiment 3, TE speakers' self-evaluations of quality of life were measured using a head and neck cancer specific quality of life tool, the University of Michigan Head and Neck Quality of Life (HNQOL) instrument. Results demonstrated the utility of listeners' ratings for differentiating speech function, as well as the differential penalty that listeners assigned for female TE speakers. Findings also indicated relatively good QOL outcomes for the present group of TE speakers. A minimal relationship between listeners' ratings of speech and QOL, as defined by the TE speakers, indicated that auditory-perceptual tools and QOL tools are complementary. Both clinical instruments endorse the use of a comprehensive approach for evaluating health, functioning, and disablement, and have a direct influence on improving rehabilitation efforts with those who undergo laryngectomy. This approach is consistent with the underlying conceptual model of functioning, disability and health promoted by the World Health Organization (WHO) in the International Classification of Functioning, Disability, and Health (ICF) (WHO, 2001). |
