SFEECU: I‘Zu “1R“!SH P :n' "(gflu‘ iti" :5? 1: an: M53 G}, SEAL “““““ Thesis fer the Sewee c: :A. A. ME CH? SAN STAT : EJH :‘ERSETY SEiZAi‘élé-E HEART ”’ ELEGER CLAYTON ‘ l§75 'gdfflflé tJ;‘!-~:~‘ AJ Lam-«u. 4‘ '0. r : 4‘ .‘J' ?;‘}'~;'. :5 t’.’:- 1;?» .. ‘fit t... . ‘ . . 5'; l A."’JO-&‘;l‘. b n. . A- - ’ . . r. _ ." O O .. ' .. ' ' '~' ' ‘ ‘1‘ ' . “'0 .._..‘...p a! u g, . ' - 4‘ ' t " ' ' Q ‘ I. M v- < ‘ v r r» \ 'H-.- '3 ”-mA—l _@~.L—- A... l , we .- IINDING IV ‘ ' am a sun:- soax mum mu. ' IIMRY IINDERS mum-n2. @Emfii) ABSTRACT ESOPHAGEAL SPEECH: RELATIONSHIP OF WORD, SENTENCE AND GLOBAL PROFICIENCY BY Suzanne Mary De Vlieger Clayton Esophageal speech is one of several techniques a laryngectomized individual has at his disposal for the purpose of regaining verbal communication. It is important that the individual make positive efforts to resume employment and social interaction. To do this, he will have to find a new means of communication. The present study investigated the relationship of word, sentence, and global proficiency ratings of 24 esophageal speakers. Thirty-three naive judges rated the speakers on all three tasks. Results indicated that the three measures of intelligibility are significantly correlated at the .01 level of confidence. The results also indi- cated that an individual's ability to do well at the sentence level has stronger bearing on whether his speech is acceptable than does his ability to do well at the single word level. ESOPHAGEAL SPEECH: RELATIONSHIP OF WORD, SENTENCE AND GLOBAL PROFICIENCY BY Suzanne Mary De Vlieger Clayton A THESIS Submitted to Michigan State University in partial fulfillment of the requirements for the degree of MASTER OF ARTS Department of Audiology and Speech Sciences I976 Copyright by SUZANNE MARY DE VLIEGER CLAYTON 1976 Accepted by the faculty of the Department of Audiology and Speech Sciences, College of Communication Arts and Sciences, Michigan State University, in partial fulfillment of the requirements for the Master of Arts degree. \.~__._.’/ Thesis Committee: ‘\: :/**'< /éi:;c¢a Director A ) I DEDICATION To Frank, my husband for his love, understanding, assistance and good humor throughout this project ii ACKNOWLEDGMENTS I would especially like to thank my committee members: Dr. Leo Deal, Dr. Linda Gillum, Dr. Daniel Martin, and Dr. Y. P. Kapur for their collective interest in this study, as well as for their individual guidance and support. I am also grateful for the cooperation of all those individuals who participated as subjects and judges. Kenneth Stonebrook, David Ruppert, and Janis Bisset were of great assistance in technical matters. Last, but not least, I would like to acknowledge the constant love and support of my parents, parents-in- law, brothers, sisters, and friends. iii TABLE OF CONTENTS Chapter I. II. III. IV. V. INTRODUCTION . . . . . . . . . Purpose of Study . . . . . . . Experimental Questions . . . . . REVIEW OF THE LITERATURE . . . . . PROCEDURES . . . . . . . . . . Subjects. . . . . Speech Samples. . . Recording Procedures. Judges . . . . . Judgment Procedures . RESULTS 0 O O O O O O O O O 0 Word Intelligibility Results . . . Sentence Intelligibility Results. . Result of Global Proficiency Ratings Correlation of Word Intelligibility Scores and Ratings of Overall Speaking Proficiency . . . . . . . Correlation of Sentence Intelligibility Scores and Ratings of Overall Speaking Proficiency . . . . . . Correlation of WOrd Intelligibility Scores and Sentence Intelligibility Scores. . . . . . . . . . CONCLUSIONS AND RECOMMENDATIONS . . . Conclusions. . . . . . . Implications for Further Research . iv H GUILD 11 11 12 13 14 14 17 17 17 18 19 20 22 24 24 26 APPENDICES APPENDIX A. MULTIPLE-CHOICE INTELLIGIBILITY TESTS . B. READING INSTRUCTIONS FOR SPEAKERS . . C. SENTENCE INTELLIGIBILITY TESTS . . . D. GLOBAL PROFICIENCY TEST. . . . . . E. WORD INTELLIGIBILITY ANSWER SHEET . . F. SENTENCE INTELLIGIBILITY ANSWER SHEET . G. GLOBAL PROFICIENCY RATING ANSWER SHEET. LIST OF REFERENCES . . . . . . . . . 29 37 38 46 47 55 63 64 Table l. 2. LIST OF TABLES Distribution of Word Intelligibility Scores Distribution of Sentence Intelligibility Scores . . . . . . . . . Distribution of Global Proficiency Scores. Subject's Mean Scores and Statistics vi 17 18 19 27 Figure l. 2. 3. LIST OF FIGURES Graph of word and paragraph scores . . Graph of sentence and paragraph scores. Graph of sentence and word scores . . vii 20 21 23 CHAPTER I INTRODUCTION Cancer of the larynx affects the lives of approxi- mately 9,000 individuals in the United States each year. One out of every eight are females. The first and most critical factor which must be considered when cancer of the larynx develops is surgery. This entails removal of the larynx and of growths on adjacent neck muscles. The trachea is then sewn to a hole in the neck in order to provide a permanent stoma for respiratory purposes. Following this operation the individual is unable to produce sound in the usual way because of the missing vocal folds. Even if a person learns to produce voice in substitute ways, there will be alterations in inflec- tion, intensity, pitch, and the emotional expressions of crying and laughing. It is easy to understand the radical effect these physiological changes cause both emotionally and socially. Therefore, the second most critical factor in regard to cancer of the larynx is speech re-education. Ideally, rehabilitation begins prior to the removal of the larynx. The prospective laryngectomized patient may meet with his surgeon, with a speech 1 pathologist, and with others who have already undergone the operation. This provides the individual with a more realistic understanding of his post-operative condition. Post-operative therapy begins as soon as possible. It is important that the individual make positive efforts to resume employment and social interaction. To do this, he will have to find a new means of communication. It is also important to family members that some form of oral communication be restored. There are several compensatory methods available for speaking, namely: a reed larynx, an electro-larynx, buccal speech, and esophageal Speech. Generally, it is agreed that esophageal speech is the preferred method, if it can be acquired. The reasoning behind this view is that the reed and electro-larynx devices fall short of esophageal speech in regard to naturalness. To acquire esophageal speech, a patient learns to bring air into his esophagus and expel the air for phona- tory purposes. This can be accomplished in one of four ways: (a) the inhalation method, (b) the injection method, (c) the plosive injection method, (d) the swallowing method. Many esophageal speakers employ a combination of air intake methods. An individual should be able to learn esophageal speech if (a) he has a strong desire to speak again; (b) he is physically strong enough in regard to his respiratory function; (G) he has not suffered extensive anatomical damage by operation or X-ray treatment, resulting in the formation of dense scar tissue. Esophageal speakers will have a frequency level one octave below the normal adult speaker. Female laryngectomized patients react with more disheartenment to this reality, admitting embarrassment at the lower pitch of esoPhageal speech. Several weeks of speech therapy are usually neces- sary to master the elements of esophageal speech. Then, several months of practical experience with this method are necessary before conversational speech proficiency is gained. The degree of speech proficiency that patients are able to attain and the factors that relate to this skill will be looked at more closely in this paper. Purpose of Study Creech (1962) evaluated two methods available for the quantification of speech intelligibility among eso- phageal Speakers. One method was a scale judgment of how intelligibly a person Speaks (overall speaking intel- ligibility). The other method was of actual Speaking efficiency whereby a count is made of the number of words understood by observers as compared to the total number of words spoken. Since the two methods proved to be Significantly correlated, Creech supported the use of these scores as meaningful and good professional measures of esophageal Speakers. Hoops and Curtis (1970) studied the intelligibility of esophageal Speakers in relation to sentence intelligi- bility scores and overall ratings of speech proficiency. The effects of speech background noise on esophageal speech production was investigated by Clarke and Hoops (1970). Martin, Hoops, and Shanks (1974) investigated the relationship between selected measures of auditory function and esophageal speech proficiency. Hoops and Noll (1971) evaluated listener sophistication in relation to esophageal Speech. Shames, Font, and Matthews (1963) analyzed 59 variables for their relation to speech pro- ficiency of the laryngectomized. The relative intelligi- bility of esophageal speech and artificial-larynx speech was studied by McCroskey and Mulligen (1971). Tikofsky (1965) compared esophageal Speaker's intelligibility and normal Speaker's intelligibility. It is the purpose of this study to investigate the relationship of word intelligibility and sentence intelligibility to global ratings of esophageal Speech proficiency. No study to date has correlated these three areas of intelligibility within the framework of a Single study. Experimental Questions Question 1: Is there a significant correlation between mean ratings of global speech proficiency and mean scores of word intelligibility, at the .01 level of con- fidence, among esophageal speakers? Question 2: IS there a significant correlation between mean ratings of global Speech proficiency and mean scores of sentence intelligibility, at the .01 level of confidence, among esophageal Speakers? Question 3: IS there a Significant correlation between mean Scores of word intelligibility and mean scores of sentence intelligibility, at the .01 level of con- fidence, among esophageal speakers? CHAPTER II REVIEW OF THE LITERATURE Hoops and Curtis' study in 1970 attempted to answer the question: Is esophageal Speech intelligibility related to listener judgments of global eS0phageal Speech proficiency? The Beranek sentence lists, which contain 20 sentences each with five key words italicized, were used by Hoops and Curtis to derive a Speech intelligi- bility score for each of their laryngectomized subjects. Listeners supplied the key words in each sentence as it was read to them. The scores obtained for the 28 subjects ranged from 21.6 to 96.0 with a mean of 75.13, indicating that Beranek's sentence lists provide a broad range of intelligibility scores. Listeners' judgments of global esophageal proficiency were obtained by having the judges rate each Speaker's reading of the first paragraph of Fairbank's "Rainbow Passage" on a 1-7 point equal- appearing interval scale. The resulting correlation between speech proficiency in sentences and global ratings of speech proficiency was .376, as correlated by a Pearson product-moment correlation procedure. Hoops and Curtis state that this correlation is signifi- cant at the .05 level of confidence; but if it is con- sidered on an absolute basis, the correlation is not high. Clark and Hoops (1970) did a similar study but incorporated Speech background noise to determine its effect on ratings of sentence intelligibility and general speech proficiency. Again, Beranek's sentence lists and Fairbank's "Rainbow Passage" were the testing materials used. The findings indicated that the judges rated the Speakers the same under the conditions of 0 dB and 40 dB sound pressure level of noise, but they gave each speaker a Significantly lower score under 75 dB SPL of noise. The Pearson r correlation coefficient for sentence intelligibility and Speech proficiency ratings was found to be r = .528, which was not Significant at the .05 level of confidence. Shames, Font, and Matthews (1963) analyzed 59 variables for their relation with each of five measures of Speech proficiency. Of interest to the present study are the ratings of sentence intelligibility and word intelligibility. Shames et a1. were comparing esophageal Speakers to those individuals using an artificial larynx. The Harvard PB word intelligibility lists (Egan, 1945) and the Harvard sentence intelligibility lists (Abrams et al., 1944) were the materials used to collect data. There were 20 word lists each containing 50 monosyllabic words. Each of the sentence lists used contained 20 sentences with five key words in each sentence. For both groups of subjects the resulting correlations among word intelligibility and sentence intelligibility ranged from .80 to .86 and were statistically Significant. Tikofsky (1965) compared the intelligibility of nine esophageal speakers and 10 normal Speakers. All subjects read three lists of words: 50 consonant- nucleus-consonant words (CNC), 60 monosyllabic cluster words, and 50 spondee words. Intelligibility was measured in terms of the number of words correctly identified by the listeners. Although there was one more Speaker in the normal group than in the esophageal group, the differences between the two groups are still great. The mean scores received by the esophageal popu- lation were 24.86 on CNC words, 32.91 on clusters, and 40.79 on spondee words; the normal Speaking population scores were 44.54 on CNC words, 54.92 on clusters, and 48.98 on Spondee words. The results also indicated that the intelligibility scores for esophageal Speakers were significantly different from each other on all measures studied. Scores for normal speakers were not Signifi- cantly different. Martin, Hoops, and Shanks (1974) did a study to determine whether the ability to understand esophageal speech is related to Success in learning esophageal speech. Twenty-one esophageal Speakers, representing various degrees of proficiency, were selected for the study. Each was asked to record a multiple choice dis- crimination test. Judges were asked to rate each Speaker on a 7-point global scale of speaking proficiency. In addition, each of the 21 esophageal Speakers listened to a normal speaker and three eSOphageal Speakers (one good, one average, and one poor) read Schultz and Schuberts' multiple-choice discrimination tests and drew a line beside each word he believed to be the stimulus word on his response form. Findings supported the original observation that the ability to understand esophageal Speech is related to success in esophageal speech learn- ing. The data also support the contention that eso- phageal Speech skills are significantly related to auditory sensitivity. Hoops and N011 (1971) studied the effects of listener sophistication on judgments of esophageal Speech. The judges were divided into two groups, one comprising 30 sophisticated listeners and one comprising 30 naive listeners. Twenty-two laryngectomized Speakers with a broad range of esophageal proficiency were recorded reading the first paragraph of the "Rainbow Passage" on color motion picture film with sound track. All judges were asked to rate speakers under three conditions: hearing each reader but not seeing him, seeing each 10 reader but not hearing him, and both hearing and seeing each speaker. Results indicated that sophisticated judges gave poorer ratings than did naive judges. The authors also concluded that judges evaluate esophageal speakers differently on the basis of seeing and hearing them than when just seeing or hearing them. McCroskey and Mulligen (1963) observed the rela- tive intelligibility of esophageal Speech and artificial- larynx Speech using three panels of listeners: (a) exper- ienced speech pathologists, (b) graduate students in Speech with some exposure to laryngectomized individuals, and (c) naive listeners. The Black (1957) multiple-choice intelligibility word lists were used as the stimulus material. Results indicated that listeners in panels one and two found esophageal Speakers to be Significantly more intelligible than speakers using artificial devices, whereas the third panel of listeners rated esophageal Speakers Slightly lower than those using an artificial larynx. McCroskey and Mulligen suggest that professional bias, in favor of esophageal speech, may have influenced the scores obtained. CHAPTER III PROCEDURES Subjects The present study utilized 24 laryngectomized Speakers, one female and 23 males. The criteria for inclusion in the study was that the individuals use esophageal Speech for daily communication and that they have adequate hearing for their age. To insure that hearing was adequate, a Beltone model 10C audiometer was used to measure each subject's hearing in the range of 500 Hz, 1000 Hz, and 2000 Hz. All subjects responded to these frequencies within normal limits for their age and sex, as determined by the National Health Survey 1935-1936 (Hearing Study Series Bulletins 1-7). It was the desire of the investigator that the 24 subjects represent a wide range of Speaking ability, from poor to superior, at the sentence level. Therefore, subjects were included who underwent surgery from four months to 18 years prior to the recording date of this study. Six individuals underwent surgery in 1975, nine had surgery between 1970-1974, six had surgery between 1965-1969, and three individuals underwent surgery 11 12 between 1958-1959. Ten subjects were enrolled in Speech therapy at the time of this study. Four individuals reported having never enrolled in speech therapy, whereas others had 15 months of speech therapy. Seven months was the average length of esophageal speech training. Speech Samples For the purpose of obtaining word intelligibility measurements, each subject was asked to read one of Black and Haagen's (1960) multiple-choice intelligibility tests, Form A, speaker lists one thru eight (see Appendix A). Each speaker list requires the subject to read three words in succession, for example: swarm, canvas, quart. Each group of words is read as a unit or phrase. Each list consists of eight groups of words. After specific instructions were given for the reading of the test (see Appendix B), each subject was given a trial reading practice on an alternate test form. This precaution assured the investigator that the subject understood the task at hand before recording was begun. It was also during the trial reading for each subject that the investigator adjusted the recording level with the VU- meter on the tape recorder to insure maximum recording level without distortion and to insure equal loudness levels. One of the eight Beranek sentence lists (1949) was read by each subject to permit assessment of sentence 13 intelligibility (see Appendix C). Each list consists of 20 sentences containing a total of 100 key words. The only instructions given each subject were to state their name and to pause for five seconds between sentences. All subjects were given sufficient time to look over the reading material and to clarify with the investigator any words which were not clear. For the judgment of overall ratings of Speech pro- ficiency, each subject read the first paragraph of Fair- bank's (1960) "Rainbow Passage" (see Appendix D). Suf- ficient time was given to each speaker to review the paragraph and ask questions. The instructions given were to state your name and to read the paragraph. Recording Procedures Recordings of each subject's production of stimu- lus materials were made in six different rooms. The Bruel and Kjaer impulse precision Sound Level Meter (type 2204) measured the sound level of each room on the "A" scale to fall between 30 dB and 40 dB. A Uher 400 Report-L tape recorder and Uher-M516 microphone with tripod stand were the recording instruments used. Subjects were recorded in a sitting position with the microphone positioned 12" from the Speaker at the level of the upper lip to mini- mize the effects of stomal blast. 14 Judges Thirty-three naive listeners enrolled in a Voice and Articulation course at Michigan State University served as judges for each of the three tasks recorded by the 24 laryngectomized subjects. Naive listeners were chosen because the investigator felt that it is the naive listener who is communicating with laryngectomized indi- viduals in their daily encounters within the community. The criteria for inclusion as a judge were two-fold: (a) the individual report having never heard esophageal Speech, (b) the individual report having normal hearing. To insure that hearing was adequate, a Beltone model 100 audiometer was used to measure each judge's hearing in the range of 500 Hz, 1000 Hz, and 2000 Hz. All judges responded to these frequencies at 20 dB or better in both ears. Judgment Procedures Three listening sessions were held in room 109 of the Audiology and Speech Clinic building at Michigan State University. This is a carpeted room with acoustical tile on each of the four walls. Using the Bruel and Kjaer impulse precision Sound Level Meter (type 2204), the measured sound level of this room was 40 dB on the "A" scale. The recordings obtained from each subject were randomized, using a table of random numbers, so that the 15 judges would hear a variety of speech proficiencies. The tapes were then spliced onto master 5" reels. Each listening group heard eight subjects read the word intelligibility lists, eight different subjects read the sentence intelligibility lists, and eight different subjects read the "Rainbow Passage." Each group of judges heard the three tasks read in the same order, and no subject was heard more than once by any judge. The tapes were played free-field, at an approximate level of 60 dB, on the Uher 4000 Report-L tape recorder. All judges' seats were situated in the listening room so that the sound level received from the loud Speaker was the same at each seat. The first task required of the judges was to listen to eight subjects read eight sets of three words each. AS the subjects read each of the three words, the judges crossed out the apprOpriate three words on their answer Sheets (see Appendix E). Each test word appeared on the response form with three foils. Eight appropriate forms were provided for each judge. Three seconds were provided between groups of words to allow sufficient time for judges to record their responses. The second task required the judges to listen to eight subjects read a list of 20 sentences. An appropriate answer sheet was provided for each group of sentences heard (see Appendix F). The judges filled in the five 16 key words missing from each sentence on his answer Sheet. They were told to write in what they thought they heard the subjects say. They were also told that their responses would be considered correct if not ortographi- cally correct but phonemically correct. The third task required the judges to listen to eight subjects read the 97 word "Rainbow Passage." They were instructed to rate each subject's overall speech proficiency on an equal appearing 5-point scale, with 1 being very poor and 5 being very good (see Appendix G). Answer sheets were provided for each judge to mark his ratings. CHAPTER IV RESULTS Word Intelligibility Results The mean word intelligibility scores for the 24 subjects ranged from 10 to 23 with the mean of the means being 16.6. The highest possible score on the word test was 24. Table 1 shows the distribution of scores among the subjects. Table 1 Distribution of Word Intelligibility Scores Scores _ Received N - 24 23 20 19 18 17 16 15 14 13 11 10 HHWNNI—‘NU‘INhH Sentence Intelligibility Results The highest possible score that could be attained on the sentence intelligibility test was 100. This would 17 18 indicate that the judges were able to identify correctly the five key words in each of the 20 sentences they heard a speaker read. The mean scores obtained for the 24 sub- jects ranged from 6 to 85, with the mean of the means being 54. Table 2 represents the distribution of Scores received. Table 2 Distribution of Sentence Intelligibility Scores Scores Received N = 24 85 81 73 71 65 62 61 60 58 55 53 47 45 44 42 37 32 29 12 6 Hrth~AAAJHAdhawrahawrahawranawrd Result of Global Proficiency Ratings Judges subjectively rated the overall speaking proficiency of the 24 subjects on a five—point equal- appearing interval scale where: 1 = very poor, 2 = poor, 19 3 = average, 4 = good, 5 = very good. Table 3 shows the distribution of these ratings among the 24 subjects. Table 3 Distribution of Global Proficiency Scores Scores Received N - 24 5 3 4 8 3 7 2 4 l 2 This table indicates that a wide range of esophageal Speech proficiencies were obtained within the population selected by the investigator. Correlation of Word Intelligibility Scores and Ratings of Over-all Speaking Proficiency A Pearson r correlation coefficient was computed to determine whether word intelligibility scores and ratings of overall Speech proficiency were Significantly correlated at the .01 level of confidence. The variables used were the means scores received by each subject on the two tests, as determined by the 33 judges. The resulting correlation was 0.623 which is significantly different from a zero order correlation at the .01 level, with N = 24. This finding indicates that there is a positive correlation between the two measures of intelli- gibility. 20 Figure 1 shows the coordinates of each subject's mean word score plotted against his rating on the overall speech proficiency task. 24 23 o 22 21 20 ' o 19 - . 18 ' " oo 17 ' . 16 ' 15 o o 14 ' 13 o ' o 12 11 ' 10 ' OI—‘NUJQU‘IO’AQCDW l 2 3 4 5 Figure 1. Graph of word and paragraph scores. Correlation of Sentence Intelligibility Scores and Ratings of Overall Speakifig Proficiency A Pearson r correlation coefficient was computed to determine whether sentence intelligibility scores and ratings of overall Speech proficiency were Significantly correlated at the .01 level of confidence. The variables used were the mean scores received by each subject on the two tests. Computation of these values yielded a 21 Pearson r correlation coefficient of 0.830 which is Sig- nificantly different from a zero order correlation at the .01 level, with N = 24. This finding indicates a high positive correlation between sentence intelligibility scores and overall ratings of speaking proficiency, Since 0.830 is significantly greater than the cut-off value of .471 that the two measures of intelligibility were com- pared against. Figure 2 shows the coordinates of each subject's mean sentence score plotted against his rating on the overall Speech proficiency task. It can be seen on this graph that only four subjects received overall Speech proficiency ratings lower than their obtained mean score on the sentence intelligibility test. 96-100 91-95 86-90 . 81-85 2 76-80 71-75 ' 66-70 , 61-65 . 56-60 . 51-55 46-50 41-45 ' 36-40 31-35 . 26-30 21-25 16-20 11-15 ' 6-10 ' 1-5 0 Q \ g C 5 \“ l 2 3 4 5 Figure 2. Graph of sentence and paragraph scores. 22 Correlation of Word Intelligibility Scores and Sentence Intelligi- bility_Scores A Pearson r correlation coefficient was computed to determine whether word intelligibility scores were significantly correlated with sentence intelligibility scores at the .01 level of confidence. The variables used were the mean scores received by each subject on the two tests, as determined by the 33 judges. The resulting correlation was 0.713 which is Significantly different from a zero order correlation at the .01 level, with N = 24. This finding indicates that there is a positive correlation between the two measures of intelligibility. Figure 3 Shows the coordinates of each subject's mean sentence score plotted against his mean word score. 23 .mmnoom ©H03 paw mosmpcwm mo ammuw .m musmflm «N mm mm Hm om ma ma 5H ma ma vH ma NH Ha OH m m h m m w m N H mIH . oalm . mHIHH omlmH mNIHN omlmm . . mmlam ovlmm . . . vaHv omlmv . mmlam . omlwm . a . mmlam mhlmm . . . mhlah . omlwh . mmlam . omlwm mmlam ooalmm CHAPTER V CONCLUSIONS AND RECOMMENDATIONS Conclusions The findings of this study indicate that: 1. There is a Significant correlation between mean ratings of global speech proficiency and mean scores of word intelligibility, at the .01 level of confidence, among esophageal speakers. 2. There is a Significant correlation between mean ratings of global speech proficiency and mean scores of sentence intelligibility, at the .01 level of confidence, among esophageal speakers. 3. There is a Significant correlation between mean scores of word intelligibility and mean scores of sentence intelligibility, at the .01 level of confidence, among esophageal speakers. 4. Esophageal Speakers who do well on single words do not necessarily receive high global proficiency ratings. 5. Esophageal speakers who do well on sentence tasks will receive high global proficiency ratings. 24 25 6. Esophageal speakers tend to receive higher scores on single word tasks than on sentence tasks. However, as word scores increased, sentence scores increased proportionately. Hoops and Curtis' (1970) study on intelligibility of the esophageal speaker indicated significantly dif- ferent results from those reported in the present study, in reference to sentence intelligibility vs. global pro- ficiency. They found a positive, but low, correlation (.376) between sentence intelligibility scores and ratings of global speech proficiency. Hoops and Curtis utilized Beranek's sentence lists for the sentence intel- ligibility task and the "Rainbow Passage" for the global proficiency task, as did the present study. The size of the experimental populations were Similar: their study used 28 esophageal speakers and the present study used 24 esophageal Speakers. Both studies varied the range of proficiencies accepted in the study. Hoops and Curtis did, however, utilize 21 speech pathologists as the judges of the sentence intelligibility test and 75 naive individuals as judges of the global proficiency test. The present study utilized only naive judges. Caution must be taken in interpreting this difference. Although this difference may have some bearing on the results obtained in the two studies, we cannot be sure that it was the sole contributing factor. 26 The investigator emphasizes the importance of training esophageal speakers to Speak in phrases and sentence structures as soon as possible and with as much proficiency as possible. It is sentence proficiency and not individual word proficiency which appears to have Significant bearing on whether or not an esophageal speaker is considered a good speaker by the naive popu- lation, and most people in the outside community fall in the category of naive listeners. It was beyond the scope of this paper to investi- gate all variables which affect esophageal speech pro- ficiency. However, it is important to keep in mind that there are many variables which do indeed affect one's ability to master esophageal Speech. Several of the variables that the investigator was able to obtain are charted in Table 4. Date of operation was the only variable among the six variables looked at which appeared to have a consistent effect on the scores received. All but one individual who received a global proficiency rating of l or 2 had undergone surgery in 1974-75. Age, sex, months of therapy, hearing, and degree of surgery were not consistently favorable or unfavorable factors for the subjects in this study. Implications for Further Research In respect to sentence intelligibility Skills and their correlation to global ratings of speech proficiency, 27 Table 4 Subject's Mean Scores and Statistics Speakers #6 #17 #13 #4 #8 #18 #15 #3 Mean Scores Words 17 18 l6 13 18 ll 18 20 Sentences 81 73 58 60 55 6 61 73 Paragraph 5 4 4 3 3 l 2 3 Variables Age 68 69 69 63 72 55 67 60 Sex m m m m m m m m Yr. of operation '70 '73 '75 '70 '65 '75 '75 '67 Mos. therapy 6 36 4 0 3 4 3 3 Hearing (dB) Avg. rght. 17 32 15 7 18 35 3 17 Avg. 1ft. 13 28 22 7 13 42 18 22 Degree of surgery T T T T T T T T Speakers #11 #7 #14 #16 #2 #21 #12 #9 Mean Scores Words 17 20 10 14 20 15 l3 l3 Sentences 44 62 32 42 81 71 12 29 Paragraph 3 4 3 2 5 4 1 2 Variables Age 68 67 70 54 75 61 75 70 Sex m m m f m m m m Yr. of operation '67 '59 '72 '75 '58 '69 '75 '74 Mos. therapy 6 6 36 4 6 0' 4 16 Hearing (dB) . Avg. rght. 38 13 10 10 23 10 23 23 Avg. 1ft. 37 15 13 l3 18 10 23 33 Degree of surgery T T T T/R T/RL T T T/L Speakers #22 #5 #23 #24 #10 #1 #19 #20 Mean Scores Words 14 18 20 15 18 l9 19 23 Sentence 45 47 65 37 65 85 53 65 Paragraph 3 4 4 2 3 5 4 4 Variables Age 55 59 56 63 44 60 53 52 Sex m m m m m m m m Yr. of operation '58 '67 '71 '68 '75 '71 '71 '73 Mos. therapy 0 2 l 0 2 15 6 3 Hearing (dB) Avg. rght. 40 12 18 25 10 10 15 20 Avg. 1ft. 40 8 20 43 10 2 10 22 Degree of surgery T T T/R T/R T T T T Key: Degree of surgery T - total laryngectomy T/R - total laryngectomy, plus right radical neck dissection T/L - total laryngectomy, plus left radical neck dissection T/RL - total laryngectomy, plus right and left radical neck dissection 28 it is important to clarify why there was a difference in the results obtained in this study vs. the study done by Hoops and Curtis (1970). Points which would be interest- ing to research are (a) experimental design (amount of time the judges were given to record what they heard, etc.), (b) the sample of esophageal speakers employed, (c) the time of year recordings were made, (d) the judges employed (naive vs. sophisticated). It is also recommended that investigation be made to determine why sentences are more difficult to master. That is, why do some individuals do well at the Single word level but not at the sentence level? What factors come into play which make sentence skill more difficult to obtain than single word skills? What factors, if any, are good prognostic signs that an individual will be able to obtain adequate skill with esophageal Speech at the sentence level? 4 L APPENDICES APPENDIX.A MULTIPLE-CHOICE INTELLIGIBILITY TESTS APPENDIX A MULTIPLE-CHOICE INTELLIGIBILITY TESTS Speaker test 1, 9, 17 READ FROM THIS CARD In reading the test, remember to pause after each group of three words. I am Speaker . I say again I am Speaker . My name is (last name and initials). Number 1: swarm canvas quart Number 2: airport bark tassel Number 3: group flicker beef Number 4: legion wonder horn Number 5: threat deer garden Number 6: curtain export final Number 7: rage city all Number 8: knuckle dress screech 29 30 Speaker Test 2, 10, 18 READ FROM THIS CARD In reading the test, remember to pause after each group of three words. I am Speaker . I saw again I am Speaker My name is (last name and initials). Number 1: skid mood twist Number 2: profane thin receive Number 3: hard fasten anger Number 4: joke shaft knitting Number 5: course balance rank Number 6: lanky horror unfold Number 7: pipe beast spray Number 8: drift concern first 31 Speaker Test 3, ll, 19 READ FROM THIS CARD In reading the test, remember to pause after each group of three words. I am Speaker . I say again I am Speaker My name is (last name and initials). Number 1: feed conclude train Number 2: Virtue hire patch Number 3: dinner envy rumor Number 4: spear goal mettle Number 5: fault birch praise Number 6: Slack kernel drab Number 7: go lady break Number 8: chain ten heart 32 Speaker Test 4, 12, 20 READ FROM THIS CARD In reading the test, remember to pause after each group of three words. I am Speaker . I say again I am Speaker . My name is (last name and initials). Number 1: pardon hall double Number 2: top cruel storage Number 3: eight dissolve needle Number 4: fable recline tolley Number 5: shade infect card Number 6: brain squad tramp Number 7: plan lift behold ZNumber 8: glory nut force Speaker Test 5, 33 13, 21 READ FROM THIS CARD In reading the test, remember to pause after each group of three words. I am Speaker . I say again I am Speaker My name is (last name and initials). Number Number Number Number Number Number Number Number crook brick Shook flame fair amble dim matching Opal trail were relief plot kind sleeping eighty world unfit swoop quit handy dot reverse budget 34 Speaker Test 6, 14, 22 READ FROM THIS CARD In reading the test, remember to pause after each group of three words. I am Speaker . I say I am Speaker . My name is (last name and initials). Number 1: term hate commit Number 2: proud waist meaning Number 3: deflect law jobber Number 4: tell invite flat Number 5: faithful suit became Number 6: rural noon save Number 7: edge binding prince Number 8: desk vote young 35 Speaker Test 7, 15, 23 READ FROM THIS CARD In reading the test, remember to pause after each group of three words. I am Speaker . I say again I am Speaker . My name is (last name and initials). Number 1: chisel bond dream Number 2: forge seal notion Number 3: verse harvest tight Number 4: guide jungle blunt Number 5: pun speed hail Number 6: eat pad depth Number 7: wife rocket keep Number 8: content fork ask 36 Speaker Test 8, 16, 24 READ FROM THIS CARD In reading the test, remember to pause after each group of three words. I am Speaker . I say again I am Speaker My name is (last name and initials). Number 1: gadget why belt Number 2: sandy power fit Number 3: attic main describe Number 4: cattle heel tare Number 5: ring option class Number 6: killer Span thimble Number 7: dozen guard chapter Number 8: wealth prevent foremost APPENDIX B READING INSTRUCTIONS FOR SPEAKERS APPENDIX B READING INSTRUCTIONS FOR SPEAKERS Instructions for Speakers This is a test of your ability to be intelligible, that is, to be heard. Your rating as a Speaker depends upon the number of times the words that you speak are recorded correctly by your listeners. It is important that you read the words exactly as they are printed on the page. As an illustration, suppose your card con- tained the following words: "I am Speaker One. I say again I am Speaker One. My name is Clayton, S.D." Number 1: mortar shut assist. Number 2: blimp injure knob. You would read as I did. You may have noticed that I read Number One: mortar shut assist, as a unit, as if the words were a sentence and made sense. They usually don't but read them as though they do. Questions? Now, read this practice test. 37 APPENDIX C SENTENCE INTELLIGIBILITY TESTS APPENDIX C SENTENCE INTELLIGIBILITY TESTS Speaker Test 1, 9, 17 READ FROM THIS CARD In reading the test, remember to pause after each sentence. I am 11. 12. l3. 14. 15. 16. 17. 18. 19. 20. . . (last name and initials). The birch canoe slid on the smooth planks. Glue the Sheet to the dark blue background. It's easy to tell the depth of a well. These days a chicken leg is a rare dish. Rice is often served in round bowls. John is just a dope of long standing. The juice of lemons makes fine punch. The chest was thrown beside the parked truck. The hogs were fed chopped corn and garbage. A cry in the night chills my marrow. Blow high or low but follow the notes. Four hours of steady work faced us. A large size in stockings is hard to sell. Many are taught to breathe through the nose. Ten days' leave is coming up. The Frenchman was shot when the sun rose. A rod is used to catch_pink salmon. He smoked a pipe until it burned his tongue. The light flashed the message to the eyes of the watcher. The source of the huge river is the clear Spring. 38 39 Speaker Test 2, 10, 18 READ FROM THIS PAGE In reading the test, remember to pause after each sentence. Iam ll. 12. 13. 14. 15. 16. 17. 18. 19. 20. . . (last name and initials). Death marks the end of our efforts. The gift of speech was denied the poor child. Never kill a snake with your bare hands. Kick the ball straight and follow throggh. Help the woman get back to her feet. Put a dot on the i and Sharpen the point. The hum of bees made Jim Sleepy. A pint of tea helps to pass the evening. Smokey fires lack flames and heat. The soft cushion broke the man's fall. While he spoke, the others took their leave. The core of the apple housed a green worm. The salt breeze came across from the sea. The girl at the booth sold fifty bonds. The purple_pupggnawed a hole in the sock. The fish twisted and turned on the bent hook. A lot of fat slows a mile racer. Press the pants and sew a button on the vest. The swan dive was far Short of perfect. James tried his best to gain ground. 40 Speaker Test 3, ll, 19 READ FROM THIS PAGE In reading the test, remember to pause after each sentence. I am 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. . . (last name and initials). For guick cleaning, buy a hemp rug. The beauty of the view stunned the young boy. Two blue herring swan in the sink. Her purse was full of useless trash. The colt reared and threw the sick rider. It snowed, rained, and hailed the same morning. An eel tastes sweet but looks awful. Read verse out loud for pleasure. Hoist the load to ygur left Shoulder. He was bribed to cause the new motor to fail. Take the winding_path to reach the lake. Red pencil the words Spelled wrong. A plump hen is well fitted for stew. The tempo was slow but picked up soon. Note closely the Size of the gas tank. Haste may cause a loss of power. The coast was guarded by field guns in the hills. Cold, damp rooms are bad for romance. A true saint is lean but quite human. Wipe the grease off your dirty face. 41 Speaker Test 4, 12, 20 READ FROM THIS PAGE In reading the test, remember to pause after each sentence. I am . . (last name and initials) 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. Mend the coat before you go out. The wrist was badly strained and hung limp. The stray cat bore_green kittens. A pest may be a man or a disease. The coy girl gave no clear response. The meal was cooked before the bell rang. What_joy there is in living. A king ruled the state in early days. The ship was torn apart on the sharp reef. Soldiers poured through the wide breach in the wall. The deep cave wound left then straight. He quoted the book by the hour. A frog grunts loudly if he wants food. Sickness kepp him home the third week. Give her the gun, he shouted then. The broad road shimmered in the hot sun. The lazy cow lay in the cool grass. Joe blew his bass horn wildly. Lift the square stone over the fence. The rope will bind the seven mice at once. 42 Speaker Test 5, 13, 21 READ FROM THIS PAGE In reading the test, remember to pause after each sentence. I am 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. . . (last name and initials). Hop over the fence and plunge in. A dead dog is no use for hunting ducks. This soup tastes like stewed buzzard. The ape grinned and gnashed his yellow teeth. The friendly gang is gone from the drug store. Mesh wire keeps chicks inside. Sue the bank under a false name. The frosty air passed through the coat. He drank a coke with rum therein. The crooked maze failed to fool the mouse. Print her name beside the plain cross. Adding fast leads to wrong sums. The show was a huge flop at the very start. The berry hung and swayed on the same stem. Sam loves his sour and grouchy wife. pg the task guickly or you fail. A saw is a tool used for making boards. She horned in pp the gossip of the girls. The plague killed thirpy_cows in a week. Weeds stop the plants from getting big. 43 Speaker Test 6, 14, 22 READ FROM THIS PAGE In reading the test, remember to pause after each sentence. Iam ll. 12. 13. 14. 15. 16. 17. 18. 19. 20. . . (last name and initials). The wagon moved on well oiled wheels. The fleas hopped on both the cat and the chair. Never buy a blind pig in a bag. March the soldiers past the next hill. A cup of sugar makes sweet fudge. Place a rosebush near the porch steps. George gave his sister a lot of coins. Both lost their lives in a raging storm. We talked of the side Show in the circus. Use a pencil to write the rough draft. He ran half way to the hardware store. Eight cops visit the new cook. A cute baby is not shy or cross. The clock struck to mark the third period. College girls are full of zip and verve. A small creek cut across the field. Boys thrive on rough games and candy. Cars and busses stalled in snow drifts. The set of china hit the floor with a crash. May is a grand season for hikes on the road. 44 Speaker Test 7, 15, 23 READ FROM THIS PAGE In reading the test, remember to pause after each sentence. I am . . (last name and initials) 1. The dune rose from the edge of the water. 2. Those words were the cue for the actor to leave. 3. Farmers hate to use a hoe or rake. 4. A yacht slid around the point into the bay. 5. The two met while playing on the sand. 6. It's foolish to make a pass at Jane. 7. The ink stain dried on the finished page. 8. Fail once on this job and be discharged. 9. Scotch can't be bought today at all. 10. The walled town was seized without a figh . 11. The lease ran out in Sixteen weeks. 12. They pulled a fast one on the deacon. 13. The lewd face stared out of the window. 14. A fine starrygnight greets the pair. 15. I am speaking dumb and vain words. 16. A tame squirrel makes a nice pe . 17. The throb of the car woke the sleeping cop. 18. George the second was then queen of the May. 19. Great men are the worst husbands. 20. The heart beat strongly and with firm strokes. 45 Speaker Test 8, 16, 24 READ FROM THIS PAGE In reading the test, remember to pause after each sentence. I am . . (last name and initials) l. The pearl was worn in a thin silver ring. 2. The fruit peel was cut in thick slices. 3. The Navy attached the big task force. 4. See the catgglaring at the scared mouse. 5. The crest of the wave was eight feet below. 6. There are more than two factors here. 7. Breed dogs until you win the prize. 8. The climb was warm and done without water. 9. Ann tore her blonde hair in anger. 10. The hat brim was wide and too droopy. 11. Girls chat and gpssip all day. 12. The lawyer tried to lose his case. 13. The lash curled around the fence post. 14. Cut the pie into large parts. 15. Put a big crawling bag in her ear. 16. The bait was snapped and the black fox captured. 17. Men strive but seldom get rich. 18. Always close the barn door tight. 19. He lay prone and hardly moved a limb. 20. Soothe the child with cocaine and cough drops. APPENDIX D GLOBAL PROFICIENCY TEST APPENDIX D GLOBAL PROFICIENCY TEST READ FROM THIS PAGE I am .. (last name and initials) (pause) When the sunlight strikes raindrops in the air, they act like a prism and form a rainbow. The rainbow is a division of white light into many beautiful colors. These take the Shape of a long round arch, with its path high above, and its two ends apparently beyond the horizon. There is, according to legend, a boiling pot of gold at one end. People look, but no one ever finds it. When a man looks for something beyond his reach, his friends say he is looking for the pot of gold at the end of the rainbow. 46 APPENDIX E WORD INTELLIGIBILITY ANSWER SHEET APPENDIX E WORD INTELLIGIBILITY ANSWER SHEET Speaker # l, 9, l7 1 form campus court warm canvas fort swarm pamphlet port storm panther quart 2 airforce spark tassel airport park tackle air corps dark cattle airborne bark pastle 3 group quicker beef troop flicker beast coupe slicker beat fruit liquor beam 4 reason wonder corn region blunder torn legion thunder horn legend sponsor born 5 stretch hear guard threat steer hearten dread near garden bread deer bargin 6 certain export file pertain extort panel person expert funnel curtain escort final 7 raid fitting owl rate pretty call range city hall rage sitting all 8 uncle dread screech buckle dress preach knuckle rest reach stucco red Street 47 Speaker # Skid skin hid hit proclaim domain cocaine profane heart barge lard hard yoke joke choke dope court cord horse course banking flanking lanky blanket pipe pike type tight thrift drip drift grip 10, 18 move mood food smooth Spin pin thin fin fasten passion fashion passing chat chap shack Shaft balance ballot gallons valid borrow horror father power beast beat meat least confirm confer conserve concern 48 swim twin swift twist repeat receive recede reprieve angle amber anger anchor heading Sitting knitting fitting drank rank ranch drag unfold untold controlled uphold dray grey Spray pray verse first burst hurt Speaker # deed weed seed feed virtual curfew virtue virgin dimmer dinner thinner tinner sphere fear spear beer fault vault dog fog black track slack flak glow go grow goat change chain stain Shame 11, 19 protrude conclude construed include hide five hire fire envy empty entry ending gull gall gold goal burst hurt first birch kernel curdle turtle hurdle late laden lazy lady pen pin tent ten train crane strain terrain pack patch catch cat rumor roamer rubber rover petal mettle meadow settle trade trace praise pray graft draft drab grab break rake great grape hard part harsh heart Speaker # stardom pardon garden autumn top hop P0P prop eight ache hate bake able stable fable table gave Shade fade shave strange bring rain brain clad clan plan plant quarry glory gory sorry 12, 20 call ball hall small tool cruel drool cool revolve involve resolve dissolve recline refine reclaim reply effect expect inspect infect wad wash squad squash lift rift drift list such touch nut butt 50 bubble stubble trouble double storage porridge Shortage story needle fetal eagle beetle folly volley polish trolley hard card cord harsh plant clamp cramp tramp behave withhold revolt behold force fourth course horse Y! Speaker # cook crook brook book brink bridge brisk brick took shook shock cook flame blame claim plane clock block plot blot eighty aching dainty baby world whirl wool would conscript conflict assist unfit 13, 21 fair bare care pair skim hymn vim dim open oboe opal oval worm work word were kind pine fine time proof hoop group swoop happy handy candy envy refer rehearse reverse revert annual ample amble apple action matching magic smashing trial file frail trail relieve receive relief release leaping sleeping creeping reaping whip quit quick twist dodge dark dot dock budget bucket bunion budge Speaker # squirm firm term turn cloud crowd proud prod neglect deflect reflect reflex held bell fell tell playful faithful fateful baseball plural neutral rural ruler egg edge hedge head desk deck death debt 14, 22 hate haste eight take waist wake wade wait lost long log law invite insight inside advice suit shoot boot fruit norm new nude noon finding binding blinding landing both boat vote quote 52 commit submit permit commence feeling meeting feeding meaning robber jobber harbor shopper blast flat flak black depend detain became retain brave stave bathe save tint print prince tense yawn jump junk young Speaker # l cheerful drizzle chisel fiddle 2 gorge forge ford board 3 bird birth first verse 4 dive Side died guide 5 pun punch pond punt 6 eat heat heap deep 7 wipe wife wide white 8 contest contend content contempt 53 15, 23 barn bond born bomb seal steel feel field harbor Harvard harvest horrid jungle tinkle Shingle single seed speed bead greed past pass path pad rocking locker rocket locket fort fore force fork ream green dream scream lotion motion ocean notion height pipe kite tight blunt blood flood stunt sail hail rail stale death debt depth deaf keep feet peep heat add have ax ask Speaker # dagger gadget jacket jagged fancy brandy sandy candy adding addict acting attic tattle tackle paddle cattle bring ring rink drink teller pillar killer color dungeon cousin dozen doesn't weld wealth whelp well 16, 24 why wine wire wise collar pilot tower power main fame fade maid field feel heel eel option auction object action band span spend bend barge dark barred guard prevent present resent revenge 54 milk built felt belt fit sit spit fifth destroyed prescribe deprive describe fair tare hair pair clash class clap clad thimble symbol temple simple capture captor chapter captain formal forebode foremost promote APPENDIX F SENTENCE INTELLIGIBILITY ANSWER SHEET APPENDIX F SENTENCE INTELLIGIBILITY ANSWER SHEET Speaker #_____ l, 9, 17 1. The on the . 2. the to the . 3. to of a . 4. These a is a . 5. is . 6. is of . 7. The of . 8. The was the 9. The were and . 10. A in the . 11. or but the 12. of us. 13. A in is to . 14. are to the 15. is . 16. The was the . 17. A is to . 18. He a it his 19. The to the of the 20. The of the is the 55 56 Speaker # 2, 10, 18 l. the of . 2. The of was the 3. a with your 4. the and 5. the to her 6. a on the_____and the 7. The of . 8. A of to the 9. and . 10. The the . 11. he , the their . 12. The_____pf the a . 13. The from the 14. The at the . 15. The a in the 16. The and on the . 17. A of . 18. the and a on the . 19. The was of 20. his to . 57 Speaker # 3, ll, 19 1. For , a . 2. The of the the . 3. in the . 4. was of 5. The and the . 6. It , , and the . 7. An but . 8. for . 9. the to - . 10. He was to the to 11. the to the 12. the . 13. A is for . 14. The was but . 15. the of the 16. a of . 17. The was by in the 18. are for 19. A is but . 20. the Ayour . 58 in the Speaker # 4, 12, 20 l. the you 2. The was and . 3. The . 4. A a or a 5. The no 6. The was the 7. in 8. A the in 9. The was on the 10. through the 11. The then . 12. the the 13. A if he . l4. him the 15. the , he 16. The in the . 17. The in the 18. his . 19. the the . 20. The will the at 59 Speaker # 5, 13, 21 l. the and . 2. A is no for 3. This 4. The and his 5. The is from the 6. 7. the a . 8. The the 9. a with . 10. The to the 11. her the 12. to . 13. The was a at the 14. The and on the 15. his and 16. the or . 17. A is a g_for 18. in the of the 19. The in a 20. the from 60 Speaker # 6, 14, 22 1. The on . 2. The on the_____and the . 3. a in a . 4. the the 5. A of . 6. a the . 7. his a of . 8. their in a 9. of the in the 10. a to the . 11. He to the . 12. the . 13. A is or 14. The to the 15. are of and 16. A the 17. on and 18. and in 19. The of the with a . 20. is a for on the 61 Speaker # 7, 15, 23 l. The the of the 2. were for the to 3. to a . or 4. A the into the 5. The on the 6. to a at 7. The on the 8. on and be 9. be at 10. The was 11. The in 12. a on the 13. The of the 14. A the 15. am and . 16. A a . 17. The of the ‘_the 18. the was of the 19. the 20. The and with 62 Speaker # 8, 16, 24 l. The was in a 2. The was in 3. The the 4. the at the 5. The of the was 6. are than 7. __you the 8. The was and 9. her in 10. The was and 11. and 12. The to 13. The the 14. the . 15. in her 16. The was and the 17. but 18. the . 19. He and 20. the with and APPENDIX G GLOBAL PROFICIENCY RATING ANSWER SHEET APPENDIX G GLOBAL PROFICIENCY RATING ANSWER SHEET Key: 1 - very poor 2 - poor 3 - average 4 - good 5 - very good Circle the rating that best represents the speaker. Speaker #____ l 2 3 4 5 Speaker #_____1 2 3 4 5 Speaker #____ l 2 3 4 5 Speaker #____ l 2 3 4 5 Speaker #_____1 2 3 4 5 Speaker #____ l 2 3 4 5 Speaker #____ l 2 3 4 5 Speaker # l 2 3 4 5 63 LIST OF REFERENCES LIST OF REFERENCES Beranek, L. Acoustic measurements. New York: John Wiley, 1949. Black, J. W. Multiple-choice intelligibility tests. Journal of Speech and Hearing Disorder, 1957, 22, 213-234. Black, J. W., & Haagen, C. H. Multiple-choice intelligi- bility tests, forms A and B. Journal of Speech and Hearing Disorder, 1968, gg, 8I-82. Clarke, W. M., & Hoops, H. R. The effect of Speech-type background noise on esophageal Speech production. Annals of Otology, Rhinology, and Laryngology, 1970, 19, 653-665. Creech, H. B. Evaluating esophageal Speech. Journal of Speech and Hearing Association, 1966, 1, 13-19. Damaste, P. H., Van Den Berg, J. W., & Moolenaar-Bijl, A. J. Why are some patients unable to learn esophageal speech? Annals of Otology, Rhinology, and Laryngology, fig, 998-1005. Diedrich, W. M. The mechanism of esophageal speech. Annals of New York Academy of Science, 1965, 155, 303-315. Fairbanks, G. Voice and articulation drillbook. Harpers, 1940. Hoops, H. R., & Noll, J. D. The effects of listener sophistication on judgments of esophageal Speech. Journal of Communication Disorder, 1971, a, 250-260. Hoops, H. R., & Curtis, J. F. Intelligibility of the esophageal Speaker. Arch. Otolaryng., 1971, 9;, 300-303. 64 65 Martin, D. E., Hoops, H. R., & Shanks, J. C. The relationship between esophageal speech pro- ficiency and selected measures of auditory function. Journal of Speech and Hearing Research, 1974, 11, 80-85. Martin, H. Esophageal speech. Annals of Otology, Rhinology, and Laryngolong 1950, 59, 687-689. McCroskey, R., & Mulligan, M. The relative intelligibility of esophageal Speech and artificial-larynx speech. Journal of Speech and Hearing Disorder, 1971, 28, 37-41. National Institutes of Health: Hearing Study Series Bulletins 1-7, The National Health Survey, 1935- 1936 preliminary reports. Washington, D.C., Public Health Service, 1938. Shames, G. H., Font, J., & Matthews, J. Factors related to speech proficiency of the laryngectomized. Journal of Speech and Hearing Disorder, 1963, 2Q, 273-284. Snidecor, J. C., & Curry, E. T. Temporal and pitch aspects of superior esophageal speech. Annals of Otology, Rhinology, and Laryngology, 1959, £8,623-635. Snidecor, J. C. Speech rehabilitation of the laryngecto- mized. Charles Thomas, 1968. Tikofsky, R. S. A comparison of the intelligibility of esophageal and normal speakers. Folia Phoniat, 1965, 11, 19-32. 7 WIN :uimrmmu‘w: 1293 03046 I “II “ u II A“: I“ HI 3