Objectives: Multiple System Atrophy (MSA) is atypical parkinsonian syndrome (APS) affecting respiration, phonation, resonance, and articulation, which is characterized by a mixed type of dysarthria involving hypokinetic, ataxic and spastic. However, there are still very limited speech interventions for MSA, and these demonstrate contrasting effects. The purpose of this study was to investigate the efficacy of water resistance therapy (WRT) of dysarthria in patients with multiple system atrophy. Methods: A total of 9 patients with MSA-C (cerebellar type) (5 males and 4 females) underwent WRT once per week for 6 weeks. Aerodynamic, acoustic, and auditory-perceptual evaluation were performed before and after voice therapy to determine the efficacy of WRT. In addition, outcomes were compared based on disease duration (less than 4 years and more than 4 years), before and after therapy. Results: Significant improvement in aerodynamic, acoustic, and auditory-perceptual evaluation was found following WRT. After therapy, in aerodynamic analysis, increased VC, MPT and reduced Psub were observed. Significant improvements were also observed for CPP, L/H ratio and reduced Jitt, PPQ, sPPQ, vF0, Shim, APQ, sAPQ, vAm, STD, NHR, σCPP, and σL/H ratio. In addition, in auditory-perceptual analysis, harsh voice, strained-strangled voice, pitch fluctuations, vocal tremor, prolonged phonemes, and speech intelligibility were improved. Moreover, significantly reduced sAPQ, vAm & σCPP were seen in the less than 4-year group, while significant improvement in APQ was observed in the more than 4-year group. Conclusion: Accordingly, significantly positive effects were found in respiration, phonation, and articulation changes following WRT for patients with MSA. WRT may be useful speech therapy for improving dysarthria in patients with MSA.

Background and Objectives：Functional aphonia is characterized by incomplete closure of the vocal folds. Semi-occluded vocal tract exercise (SOVTE) allows smoothly vocal folds collision without damage to the vocal folds tissues to produce normal vocal intensity. The purpose of this study is to report the effect of SOVTE in patients with functional aphonia. Materials and Method：Seven patients diagnosed with functional aphonia were treated with 1-3 voice therapy sessions using voiced lip-trill, humming, Lax Vox in SOVTE. To assess the effectiveness of semi-occluded vocal tract exercise, cepstral analysis and auditory perceptual assessment were performed before and after voice therapy. Results：F0 (fundamental frequency), CPP (cepstral peak prominence) and L/H ratio (low/high spectral ratio) were significantly increased, while CPP Standard deviation, L/H ratio Standard deviation were decreased. In addition, 'Grade', 'Breathiness' and 'Asthenia' were significantly decreased in the GRBAS scale after SOVTE (p＜0.05). Conclusion：In our study, SOVTE seemed to be effective to elicit voice quickly and promote vocal folds vibration without muscular effort in patients with functional aphonia.

Objectives:Phonation onset provides an important clinical cue in diagnosing pathologic voice conditions. The aim of this current study was to explore the vocal fold kinematics during three different types (breathy, normal, hard glottal attack) of voice onset with videokymography and high-speed digital imaging. In addition, to elucidate how phonation onset affects vocal fold vibration in stable sections, quantitative parameters were measured in stable vocal fold vibrations. Methods: High speed digital imaging (HSDI) was obtained from 35 normal young adults with different phonatory onset types (normal, breathy, hard glottal attack). Pre and phonatory onset data were investigated qualitatively with digital kymography (DKG); MinArea, MaxArea, MinOpen, MaxOpen, and speed quotient (SQ), were quantitatively measured by glottal area waveform analysis using Kay's Image Processing Software; and closed quotient (CQ) and open quotient (OQ) were obtained by 2D DKG using multifunctional examination system. Results: Significantly higher MinArea were revealed in breathy phonation (p < .001) with no gender effect. With respect to MaxArea, both gender and phonation type effect was observed (p < .001). Significantly larger Max-Area was found in a breathy phonation and the male group. Similar to MinArea, breathy phonation was significantly widest in MinOpen than other phonation types (p < .001). While there were no significant differences in MaxOpen based on phonation types, the MaxOpen of males was significantly wider than that of females (p < .001). SQ was also significantly higher in breathy phonation than normal and hard phonation. On the other hand, OQ and CQ showed significant effect on phonatory type without gender effect. Conclusion: The onset of vocalization was easily observed through HSDI and DKG, and there were notable differences in pre-phonatory and vibratory onset according to phonatory onset type. In addition, voice onset gesture also affected vocal fold vibration in the steadystate portion.

Background and ObjectivesVocal fold leukoplakia is characterized as white plaque on the epithelium of the vocal folds and can be treated by angiolytic laser stripping surgery. However, postoperative changes in the vibratory patterns of vocal folds have not been investigated quantitatively. The purpose of this study was to investigate the changes in vocal fold vibration after angiolytic laser surgery in patients with unilateral vocal fold leukoplakia using the twodimensional scanning digital kymography (2D DKG). Subjects and Method Medical records of seven males (age=62.14±12.40 yrs) with unilateral vocal fold leukoplakia who underwent angiolytic laser stripping were reviewed. Before and after the surgery (post-operative day=82.57±28.55 days), a multi-dimensional voice assessment was performed along with a 2D DKG study. For 2D DKG images, the amplitude symmetry index (ASI), phase symmetry index (PSI), and open quotient (OQ) were calculated using the ImageJ program. In addition, pre-versus postoperative data were compared, and the correlation between the changes in 2D DKG parameters and voice outcomes was explored. Results Results indicated that the absolute ASI (p=0.028) and OQ (p=0.028) of the 2D DKG study, grade (p=0.038) and breathy (p=0.034) of the GRBAS scale, σPitch measured by the electroglottography (p=0.043), the physical score of the VHI (p=0.042), and the total score (p=0.043) and the tiredness score (p=0.043) of the VFI decreased after surgery. Decrease in the absolute ASI was correlated with changes in the grade (rho=0.850) and breathy (rho=0.777) scale measures, while decreased OQ were correlated with the changes in the physical score of the VHI (rho=0.901) and tiredness score of the VFI (rho=0.847).