Teaching Counseling Skills in Audiology Graduate Programs: Clinical Supervisors’ Perceptions and Practices

Counseling is a critical component within audiological service delivery. Partnering with patients to support them in learning to effectively cope with their hearing challenges is a key component in achieving desired outcomes. Even though there is agreement on the foundational role counseling plays in audiology service delivery, counseling instruction varies among audiology training programs.

The purpose of this study was to investigate the perspectives and practices of supervisors in audiology graduate training programs related to mentoring students in the acquisition of counseling skills.

A cross-sectional design was used; participants completed a self-report survey.

The survey was sent to 323 clinical supervisors in AuD graduate programs in the United States.

Completed surveys were received from 205 supervisors. Responses were analyzed using descriptive statistics to identify practice trends.

Participants reported their perceptions about importance of teaching counseling skills to audiology students, their confidence in teaching skills, their self-efficacy for supporting student learning, how they provide feedback to students, and challenges they encounter. Most participants reported their program requires a counseling course (88%; n = 176). Most of the participants reported confidence in teaching counseling skills; however, fewer reported being very or extremely confident in teaching students how to talk with clients about their emotions (53%; n = 109) and explaining the rationale behind specific counseling strategies (47%; n = 97). Participants with more years of supervisory experience had statistically significantly higher self-ratings for teaching confidence and self-efficacy for supporting student learning in counseling than those with fewer years of experience.

Audiology supervisors in AuD programs believe counseling is important to teach to students; however, they report variability in use of methods for providing feedback, evaluating student performance, and in their self-efficacy for supporting student learning. Future audiologists would benefit from a more systematic approach within graduate training for teaching counseling skills.

Age-Related Changes in Speech and Voice: Spectral and Cepstral Measures

Purpose This study examined differences in selected acoustic measures of speech and voice according to age and sex and across families. Method Participants included 169 individuals, 79 men and 90 women, from 18 families, ranging in age from 17 to 87 years. Participants reported no history of articulation disorders, stroke or active neurologic disease, or severe-to-profound hearing loss. They read aloud two passages to facilitate examination of the following speech and voice acoustic parameters: fricative spectral moments (center of gravity, standard deviation, skewness, and kurtosis), the proportion of time spent speaking, mean speaking fundamental frequency, semitone standard deviation (STSD), and cepstral peak prominence smoothed. Results The results indicated a significant age effect for fricative spectral center of gravity, spectral skewness, and speaking STSD. There was a significant sex effect for spectral center of gravity, spectral kurtosis, and mean fundamental frequency. Familial relationship was significant for spectral skewness, STSD, and cepstral peak prominence smoothed. Conclusions These findings revealed that certain speech and voice features change with age and some change differently for men and women. Additionally, speakers from the same family units may demonstrate similar patterns for prosody, voicing, and articulatory behavior. The results also demonstrated normal differences in speech and voice variation across age, sex, and family unit. Understanding patterns and differences across these demographic variables in healthy speakers is important to distinguishing more confidently between normal and disordered speech and voice patterns clinically.

Voice amplification versus vocal hygiene instruction for teachers with voice disorders: a treatment outcomes study

Voice problems are common among schoolteachers. This prospective, randomized clinical trial used patient-based treatment outcomes measures combined with acoustic analysis to evaluate the effectiveness of two treatment programs. Forty-four voice-disordered teachers were randomly assigned to one of three groups: voice amplification using the ChatterVox portable amplifier (VA, n = 15), vocal hygiene (VH, n = 15), and a nontreatment control group (n = 14). Before and after a 6-week treatment phase, all teachers completed: (a) the Voice Handicap Index (VHI), an instrument designed to appraise the self-perceived psychosocial consequences of voice disorders; (b) a voice severity self-rating scale; and (c) an audiorecording for later acoustic analysis. Based on pre- and posttreatment comparisons, only the amplification group experienced significant reductions on mean VHI scores (p = .045), voice severity self-ratings (p = .012), and the acoustic measures of percent jitter (p = .031) and shimmer (p = .008). The nontreatment control group reported a significant increase in level of vocal handicap as assessed by the VHI (p = .012). Although most pre- to posttreatment changes were in the desired direction, no significant improvements were observed within the VH group on any of the dependent measures. Between-group comparisons involving the three possible pairings of the groups revealed a pattern of results to suggest that: (a) compared to the control group, both treatment groups (i.e., VA and VH) experienced significantly more improvement on specific outcomes measures and (b) there were no significant differences between the VA and VH groups to indicate superiority of one treatment over another. Results, however, from a posttreatment questionnaire regarding the perceived benefits of treatment revealed that, compared to the VH group, the VA group reported more clarity of their speaking and singing voice (p = .061), greater ease of voice production (p = .001), and greater compliance with the treatment program (p = .045). These findings clearly support the clinical utility of voice amplification as an alternative for the treatment of voice problems in teachers.

The aging voice: a review, treatment data and familial and genetic perspectives

This paper will provide a review of aspects of vocal aging within the context of general body aging and describe two data sets related to the aging voice. Data will be presented which document pre- to posttreatment improvement in select voice characteristics (sound pressure level, subglottal air pressure, thyroarytenoid laryngeal muscle activity and voice quality) following application of an intensive voice treatment program (the LSVT) to 3 individuals with aged voice. Additionally, physiological data (forced expiratory volume, visual accommodation, bone density, taste discrimination, white blood count and resting heart rate) and select perceptual (perceived age) and acoustic measures (reflecting both cycle-to-cycle and longer-term intensity and frequency stability) from 67 subjects will be reviewed from the work of Gray and colleagues to document the differential impact of the global aging process across organ systems including the aging voice.

An evaluation of the effects of two treatment approaches for teachers with voice disorders: a prospective randomized clinical trial

Teachers commonly report voice problems and often seek medical assistance for voice-related complaints. Despite the prevalence of voice disorders within this occupation, there are no studies evaluating the effectiveness of treatment programs designed to remedy the voice problems of teachers. To assess the functional effects of two voice therapy approaches, 58 voice-disordered teachers were randomly assigned to 1 of 3 groups: vocal hygiene (VH, n = 20), vocal function exercises (VFE, n = 19), and a nontreatment control group (CON, n = 19). Subjects completed the Voice Handicap Index (VHI)-an instrument designed to appraise the self-perceived psychosocial consequences of voice disorders-before and following a 6-week treatment phase. The VFE and VH subjects also completed a posttreatment questionnaire regarding the perceived benefits of treatment. Only the group who adhered to the VFE regimen reported a significant reduction in mean VHI scores (p <.0002). Furthermore, when compared to the VH group, the exercise group reported more overall voice improvement (p < .05) and greater ease (p < .02) and clarity (p < .01) in their speaking and singing voice after treatment. These findings suggest that the VFE should be considered as a useful alternative or adjunct to vocal hygiene programs in the treatment of voice problems in teachers.