Clark (2016)

 

 CRITIQUE OF UNSUPPORTED PROCEDURAL DESCRIPTIONS

KEY

C =  clinician

FtM =  Female to Male

MtF =  Male to Female

NA = not applicable

P =  patient or participant

pmh =  Patricia Hargrove, blog developer

SLP = speech-language pathologist

TG =  transgender

Source: Clark, C. J. (2016.) Voice and communication therapy for the transgender or transsexual client: Service delivery and treatment options. Graduate Independent Studies- Communication Sciences and Disorders.  Paper 2.  h8p://ir.library.illinoisstate.edu/giscsd/2

Reviewer(s):  pmh

 

Date:  January 25, 2019

 

Overall Assigned Grade:__not graded due to lack of supportingdata

 

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/interpretations. [

 

Take Away:  [This graduate paper contains 2 pamphlets:  one for transgender  (TG) consumers who are seeking speech/voice therapy and one for speech-language pathologists (SLPs) wishing to work with TG individuals. Both pamphlets provide background information and definitions of important terms. For the TG consumer, the author also highlights issues such as finding an SLP, what expect when visiting the SLP, common assessment and treatment practices, as well as common concerns. While the SLP pamphlet also contains information about assessment and treatment it is geared to the professional. The SLP pamphlet also alterts SLPs to social-cultural issues to help clinicians work more efficiently and sensitively with their clients. The pamphlets were concerned with several aspects of communication. This review only focuses on outcomes related to prosody.

 

  1. Was there a review of the literature supporting components of the intervention?Yes

 

  • Thetype of review was Narrative Review which is traditional review of the literature in which an author surveys a topic but does not provide evidence of a priori criteria for literature selection and analysis.

 

 

  1. Were the specific procedures/components of the intervention tied to the reviewed literature? Yes, for a good part of the intervention.
  2. 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 implied?  Yes

 

–  The following prosodic outcomes were derived from the pamphlets as examples of suitable prosodic outcomes for Female to Male (FtM ) Clients:

 

PITCH OUTCOMES

  • Outcome #1: Improve overall vocal health such as reducing vocal tension to minimize damage from previous “self therapy”

 

  • Outcome #2: Lower speaking fundamental frequency (i.e., pitch) safely to the typical male range 100-150 Hz. (This may even be needed after hormone therapy.)

 

  • Outcome #3: To facilitate lower pitch, increase the use of abdominal/diaphragmatic breathing

 

  • Outcome #4: Increase speaking rate

 

  • Outcome #5: Increase vocal intensity/loudness

 

  • Outcome #6: Decrease the duration of select sounds

 

–  The following prosodic outcomes were derived from the pamphlets as examples of suitable prosodic outcomes for Male to Female (MtF) Clients:

 

  • Outcome #7: Increase speaking fundamental frequency (i.e., pitch.)

 

  • Outcome #8: To facilitate increasing pitch, decrease muscle tension

 

  • Outcome #9: Decrease vocal intensity/loudness

 

  • Outcome #10: Decrease speaking rate

 

  • Outcome #11: Increase the duration of vowels.

 

  • Outcome #12: Increase articulatory precision/overarticulation (concordance)

 

 

  1. Was generalization addressed? Yes.  The author suggested that several of the outcomes be observed in conversational speech.

 

 

  1. Was maintenance addressed? No

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To present pamphlets for potential transgender clients and clinicians working with transgender clients describing concerns, assessment, and treatment of  speech/communication skills.

 

POPULATION: Transgender adults

 

MODALITY TARGETED:  Production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  pitch, loudness, rate, pause, duration, concordance

 

DOSAGE: Not provided

 

ADMINISTRATOR:  SLP

 

 

MAJOR COMPONENTS:

 

  • The author described strategies for treating several of the outcome. The recommendations are listed with the targeted outcome.

 

∞ For FtM Clients:

 

  • Outcome #1: Improve overall vocal health such as reducing vocal tension to minimize damage from previous “self therapy”

 

  • Outcome #2: Lower speaking fundamental frequency (i.e., pitch) safely to the typical male range 100-150 Hz. (This may even be needed after hormone therapy.)

– Use vocal exercises to lower pitch

 

  • Outcome #3: To facilitate lower pitch, increase the use of abdominal/diaphragmatic breathing

– The author warned that overuse of easy onsets may increase the perception of feminine speech patterns.

 

  • Outcome #4: Increase speaking rate

– Target oral reading

– Decrease pausing during conversation

 

  • Outcome #5: Increase vocal intensity/loudness

– Target oral reading

 

  • Outcome #6: Decrease the duration of select sounds

     –  No specific recommendations provided.

 

∞  For MtF Clients:

 

  • Outcome #7: Increase speaking fundamental frequency (i.e., pitch.)

– The clinician should identify a safe speaking fundamental frequency that does not tax the client’s physiology

 

  • Outcome #8: To facilitate increasing pitch, decrease muscle tension

– Use tactile and visual cues, relaxation exercises, yawn-sigh techniques,

– Encourage softer, breather phonation

–  Move from isolated sounds, to sentences, to conversation

 

  • Outcome #9: Decrease vocal intensity/loudness

– Clinician explains the difference between the client’s current level and the targeted level.

– Target self-awareness

 

  • Outcome #10: Decrease speaking rate

– Clinician explains the difference between the client’s current level and the targeted level.

– Target self-awareness

 

  • Outcome #11: Increase the duration of vowels.

     –  No specific recommendations provided.

 

  • Outcome #12: Increase articulatory precision/overarticulation (concordance)

–  Replace hard glottal attacks with easy onsets

–  Increase articulatory precision using light contacts and delicate contacts wit articulatory.

–  Move from isolated sounds, to words, to phrases, to sentences, to conversation.

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