Block (2017)

May 21, 2018

 CRITIQUE OF UNSUPPORTED PROCEDURAL DESCRIPTIONS

(also known as Expert Opinion)

NOTE:  A brief summary of recommended interventions recommended by the author can be found by scrolling about ½  of the way down this page.

KEY
C =  clinician

fo=  fundamental frequency

NA = not applicable

P =  patient or participant

pmh =  Patricia Hargrove, blog developer

SLP = speech-language pathologist

Source:  Block, C. (2017.)   Making a case for transmasculine voice and communication training. Perspectives of the ASHA Special Interest Groups: Sig 3 (Part 1), 33-41.

Reviewer(s):  pmh

Date:  May 16, 201

Overall Assigned Grade: because there are no supporting data, the highest grade will be F.  This grade reflects the level of data provided in this article. It does not reflect a judgment on the value of the recommendations provided by the author.

Level of Evidence:  F = Expert Opinion, no supporting evidence for the effectiveness of the intervention although the author may provide secondary evidence supporting components of the intervention.

Take Away:  This article provides recommendations for treating voice and communication problems associated with transmasculine voices. The author highlights aspects of communication that may be a challenge to speakers and provides recommendations for treatment. In addition, the author a clear rationale for speech-language pathologists (SLPs) to provide services to speakers with transmasculine voices.

 

  1. Was there a review of the literature supporting components of the intervention?No, for many of the recommendation some existing references were briefly summarized but not critiqued.

  

  1. Were the specific procedures/components of the intervention tied to the reviewed literature? Yes

  

  1. Was the intervention based on clinically sound clinical procedures? Yes

 

  1. Did the author provide a rationale for components of the intervention? Yes

 

  1. Description of outcome measures: 

–  Are outcome measures suggested? No, but they can be derived from the article.

–  Potential outcome measures,

  • Outcome #1: Lower average fundamental frequency (fo) of speech
  • Outcome #2: Gender appropriate intonation range
  • Outcome #3: Appropriate loudness level
  • Outcome #4: Gender appropriate resonance
  • Outcome #5: Reduction in hyperfunctional vocal patterns
  • Outcome #6: Remediate problems following phonosurgery
  • Outcome #7: Language that contains more masculine gender markers

 

  1. Was generalization addressed? No

  

  1. Was maintenance addressed? No

  

SUMMARY OF INTERVENTION

PURPOSE:  The author recommended that the role of the speech-language pathologist (SLP) should be to translate research about gender and communication to an individualized treatment plan appropriate to the specific client. The focus was on the transmasculine voice

POPULATION:  Transmasculine speakers; Adults

MODALITY TARGETED:Production

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: pitch, intonation, loudness, singing

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED:resonance, language, nonverbal communication (body language)

ADMINISTRATOR:  SLP

MAJOR COMPONENTS

  • Prior to working on transmasculine related targets, the SLP should insure that the client is free from dysphonia or that issues related to dysphonia have been addressed adequately. Irrespective of the cause of the dysphonia, the SLP should employ appropriate rehabilitative techniques.

 

  • The author provided recommendations for treating selected aspects of communication. For each aspect of communication that the author addressed, the information is summarized by listing

–  the aspect of communication,

–  anticipated problems, and

–  recommendation(s) for treatment.

 

ASPECT OF COMMUNICATION:  Pitch—lower frequencies

ANTICIPATED PROBLEMS:  Some individuals do not achieve targeted lower pitch levels following testosterone therapy. This may be due to limited success with the hormone, failure to use the new pitch range that is available to the speaker, or electing not to receive testosterone treatment.

RECOMMENDATIONS FOR TREATMENT:  Behavioral pitch training including

–  a guide when to intervene

–  useful techniques such as a chant-to-speak exercise and audio and visual feedback

 

ASPECT OF COMMUNICATION:  Intonation—limited range

ANTICIPATED PROBLEMS: Speakers may compensate for the tendency to use higher pitches when speaking “expressively” (p. 34) by limiting intonation range. This can result in sounding unfriendly.

RECOMMENDATIONS FOR TREATMENT:  Behavioral intonation training including

–  limiting the use of higher pitches

–  increased use of falling intonation contours

–  modifying the production of stress using

  • producing longer vowels
  • producing louder vowels
  • increasing the slope of falling intonation patterns
  • reducing blending between words (i.e., more staccato)

 

 

ASPECT OF COMMUNICATION: Loudness

ANTICIPATED PROBLEMS: It can be difficult to modulate loudness separately from pitch particularly because if the speaker elects to receive testosterone treatment as it usually increases vocal fold mass.

RECOMMENDATIONS FOR TREATMENT: Behavioral loudness and breath control training including focusing on diaphragmatic breathing

 

 

ASPECT OF COMMUNICATION:  Resonance

ANTICIPATED PROBLEMS: Some speakers sound younger or more feminine than desired despite a fothat is within normal limits for a male. It is suggested that this is due to a small upper airway.

RECOMMENDATION(S) FOR TREATMENT:  Recommendations included focusing on

–  lowering the jaw

–  lowering the base of the tongue

 

 

ASPECT OF COMMUNICATION:  Dysphonia

ANTICIPATED PROBLEMS: If the speaker attempts to change his voice without SLP guidance, he is at risk for adapting hyperfunctional vocal patterns.

RECOMMENDATIONS FOR TREATMENT:  Vocal rehabilitation training

 

ASPECT OF COMMUNICATION:  Maladaptive response to phonosurgery

ANTICIPATED PROBLEMS: Speakers may experience problems following phonsurgery

RECOMMENDATIONS FOR TREATMENT: Vocal rehabilitation training

 

 

ASPECT OF COMMUNICATION:  Language production

ANTICIPATED PROBLEMS: Speakers may maintain their use of feminine language patterns

RECOMMENDATIONS FOR TREATMENT:  The SLP may target language behaviors such as

–  vocabulary selection

–  using fewer words to convey a meaning

 

 

ASPECT OF COMMUNICATION:  Nonverbal communication

ANTICIPATED PROBLEMS: Speakers may maintain their use of feminine body language  patterns

RECOMMENDATION(S) FOR TREATMENT:  The SLP may target nonverbal communication behaviors such as

–  taking up more space

–  increasing the rigidity of hand and body movement

 

 

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Adler (2015)

May 8, 2018

                                                                                                            

CRITIQUE OF UNSUPPORTED PROCEDURAL DESCRIPTIONS

(also known as Expert Opinion)

 

KEY

C =  clinician

NA = not applicable

P =  patient or participant

pmh =  Patricia Hargrove, blog developer

SLP = speech-language pathologist

WPATH =  World Professional Association for Transgender Health

 

SOURCE:  Adler, R. (2015.)  Voice and communication for the transgender/transsexual client: Presenting the WPATH Standing Committee on Voice and Communication.  Perspectives on Voice and Voice Disorders, 25. 32-36.

 

REVIEWER(S): pmh

 

DATE:  May 8, 2018

 

 

Overall Assigned Grade (because there are no supporting data, the highest grade will be F):  F  This grade should be interpreted as a evaluation of the Level of Evidence provided in the paper and not as a judgment about the quality of the paper or the information contained in the paper.

 

Level of Evidence:  F = Expert Opinion, no supporting evidence for the effectiveness of the recommendations although the author may provide secondary evidence supporting the interventions.

 

Take Away:  This introduction to the World Professional Association for Transgender Health (WPATH)  provides a brief rationale and history of WPATH as well as an explanation of how and why voice and communication issues were included in WPATH guidelines. In addition, the author provides a brief tutorial regarding transgender/transsexual terminology and professional resources. By accessing the WPATH webpage (referenced by the author), one can review the current “Standards of Care for the Health of Transgender, Transsexual, and Gender Nonconforming People” which includes recommendations for Speech-Language Pathologists (SLPs). This is good starting point for planning to initiate practice including people who are transgender/transsexual.

 

 

 

  1. Was there a review of the literature supporting components of the intervention?No

 

 

  1. Were the specific procedures/components of the intervention tied to the reviewed literature? Not Applicable (NA)

 

 

  1. Were the recommendations based on clinically sound clinical procedures? NA

 

 

  1. Did the author provide a rationale for the recommendations? Yes

 

 

  1. Description of recommendations:

 

  • Speech-language pathologists (SLPs) working with transgender/transsexual clients should educate themselves regarding the needs of this population. A starting point can be the information in this article and the most current “Standards of Care for the Health of Transgender, Transsexual, and Gender Nonconforming People” on the WPATH website.

 

  • SLPs’ role should include communication skills such as articulation, language, prosody as well a voice.

 

  • SLPs should remember that evidence-based practice involves

– research evidence,

– clinician’s expertise, and

– client’s needs.

 

  1. Are outcome measures suggested? NA

 

 

  1. Was generalization addressed? NA

 

 

  1. Was maintenance addressed? NA