근긴장성 발성장애의 후두마사지 효과: 체계적 고찰 및 메타분석

김재옥,Kim, Jaeock 대한후두음성언어의학회 2021 대한후두음성언어의학회지 Vol.32 No.2

Background and Objectives This study was to investigate the voice quality and articulation effects of laryngeal massage on muscle tension dysphonia (MTD). Materials and Method A systematic review of articles published between January 2000 and December 2020 in Cochrane, PubMed, ScienceDirect, SpingerLink, ERIC, and Naver Academic was conducted. From the total of 2094 articles identified, 10 peer-reviewed articles were included in a meta-analysis. Mean effect sizes of the variables related to voice quality (jitter, shimmer, harmonic to noise ratio or noise to harmonic ratio, high-F0, low-I, cepstral peak prominence) and articulation (F1, F2, F1 slope, F2 slope) were calculated by Hedges'g. Results Meta-analysis of the selected articles showed that laryngeal massage had medium to large effects on all variables of voice quality and articulation except F0-high and F1 slope in the MTD patients. Conclusion This study provided comprehensive clinical evidence that it is highly desirable to apply laryngeal massage to MTD patients.

한국 정상 성인의 모음과 문단 산출 시 전기성문파형 측정

김재옥(Kim Jaeock) 한국음성학회 2010 말소리와 음성과학 Vol.2 No.4

This study investigated the closed quotient and other voice quality parameters using electroglottography (EGG) in sustaining the vowel /a/ and reading a sentence at the comfortable pitch and loudness in healthy Korean adults. Seventy two healthy adults (36 men, 36 women) aged 20~40 years were included in the study. The tasks were recorded and analyzed using Lx Speech Studio. In vowel sustaining task, closed quotient (Qx), fundamental frequency (Fx), sound pressure level (SPL), Jitter, and Shimmer were measured. In sentence reading task, closed quotient (DQx), fundamental frequency (DFx), and sound pressure level (DAx) were measured. The sex effects were observed on Qx, Fx, Shimmer, DQx, and DFx. Men had significantly higher Qx and DQx than women, but had significantly lower Shimmer than women. However, there was no sex effect on Jitter. The task effects on Qx and SPL as well as DQx and DAx were also assessed. Qx and SPL were significantly higher than DQx and DAx in both gender. This study showed that the closed quotients in both vowel sustaining and sentence reading tasks were significantly related to other voice quality parameters. Therefore, clinicians and researchers should describe the voice quality parameters like fundamental frequency, sound pressure level, Jitter, Shimmer, and so on when reporting closed quotients using EGG.

KayPENTAX Phonatory Aerodynamic System Model 6600을 이용한 한국 성인의 공기역학적 변수들의 정상치

김재옥(Kim, Jaeock) 한국음성학회 2014 말소리와 음성과학 Vol.6 No.1

The purpose of this study was to (1) establish a Korean adult normative database for phonatory aerodynamic measures obtained with the KayPENTAX Phonatory Aerodynamic System (PAS) Model 6600, (2) investigate the intra-subject reliability of these measures across three testing sessions, and (3) examine the effect of gender on those measures. 170 healthy normal speakers (70 men and 100 women) between the ages 18 and 49 years participated in the study. The PAS protocol of maximum phonation and voicing efficiency were conducted and 25 measures were obtained. All aerodynamic measures taken in this study demonstrated high intra-subject reliability in clinical aspect. There were no significant effect of gender in the measures related to sound pressure and subglottal pressure. However, significant differences for gender were found for phonation time, airflow rate, expiratory volume, aerodynamic power, SPL range, pitch range, mean pitch, aerodynamic resistance, and aerodynamic efficiency. Clinicians should be aware of significant gender effects in some aerodynamic parameters when interpreting the data obtained from PAS.

평가자의 청지각적 음성평가와 대상자의 주관적 음성평가 비교

김재옥(Jaeock Kim),최홍식(Hong-Shik Choi) 한국언어청각임상학회 2009 Communication Sciences and Disorders Vol.14 No.2

배경 및 목적: 음성장애를 평가할 때 객관적 평가와 청지각적 평가가 주로 사용된다. 그러나이들 뿐만 아니라 음성장애를 경험하는 대상자들의 주관적인 평가가 요구된다. 이에 본 연구에서는 청지각적 평가와 주관적 평가 간의 상관성을 파악하고자 한다. 방법: 음성장애로 진단받은 120명과 정상인 120명을 대상으로 한국어판 음성장애지수(KoreanVoice HandicapIndex: K-VHI, 이하 K-VHI)와 한국어판 음성과 관련된 삶의 질(Korean Voice-RelatedQuality of Life: K-VRQOL, 이하 K-VRQOL)을 작성하게 하였으며, 숙련된 음성언어치료사와 이비인후과 전문의가 GRBAS 척도로 평가하였다. 결과: GRBAS 척도 중 G 척도와K-VHI 및 K-VRQOL의 총점수와 세부영역별 점수 간에는 약한 상관관계를 보였으나, G 척도에 따른 음성장애 중증도가 높아질수록 K-VHI의 영역별 점수는 높았으며, K-VRQOL의 영역별 점수는 낮았다. 또한 진단별 분류에 따라 K-VHI의 신체 점수를 제외한 K-VHI의모든 영역별 점수와 K-VRQOL의 모든 영역별 점수 간에 통계적으로 유의미한 차이를 보였다. 논의 및 결론: 청지각적 평가와 주관적 평가 간에는 유의미한 상관관계가 없어 평가자가 평가한 음성장애의 정도와 대상자가 지각하고 있는 음성장애의 정도가 다름을 알 수 있었다.그러나 청지각적 평가 분류 및 진단별 분류에 따라 주관적 평가의 차이가 있었다. 이에, 음성장애를 평가할 때 대상자의 주관적 평가를 함께 포함하는 다양한 측면의 음성평가가 요구된다. Background & Objectives: Among the different types of voice evaluations, objective quantitative evaluations and clinicians’ perceptual evaluations are commonly used. However, patients’ subjective evaluations must be considered to accomplish a more accurate and total assessment of voice disorders. The purpose of this study was to examine the relationship between clinicians’ perceptual evaluations and patients’ subjective evaluations of voice disorders. Methods: We enrolled 120 people with voice disorders and 120 people without voice disorders and asked them to fill out Korean Voice Handicap Index (K-VHI) and Korean Voice Related Quality of Life (K-VRQOL) forms. The patients’ voices were perceptually evaluated by an experienced speechlanguage pathologist and an otolaryngologist using GRBAS scales. Results: There was a low degree of correlation between the G scale on the GRBAS scales and the K-VHI and K-VRQOL self-reports. However, mean scores on both total and subscales in K-VHI and K-VRQOL decreased as the severity of voice disorders on the G scale Increased. In particular, G3 differed significantly from G0, G1, and G2 in the results of both K-VHI and K-VRQOL. In addition, patients who were diagnosed differently had significantly different total and subscale scores on the K-VHI and K-VRQOL, with the exception of the physical score on the K-VHI. Discussion & Conclusion: There was no significant relationship between clinicians’ perceptual evaluations and patients’ subjective evaluations of voice disorders. The severity of voice disorders assessed by clinicians differed from the voice handicap and voice-related quality of life perceptions of patients. Therefore, there is a need to use various assessment methods when evaluating voice disorders, including patients’ subjective evaluations.

변성이전, 변성 및 변성이후 남성의 발성범위 프로파일

김재옥(Jaeock Kim),이승진(Seung Jin Lee) 한국음성학회 2021 말소리와 음성과학 Vol.13 No.4

본 연구는 변성 과정의 남성 음역대 특성을 살펴보기 위해 변성이전(21명), 변성(16명), 변성이후(20명) 단계에 있는 57명의 남성을 대상으로 활창과 축약된 발성범위 프로파일(voice range profile, VRP)을 사용하여 음역대를 비교하였다. 또한 측정방법별로 진성구와 가성구 VRP의 차이를 비교하였다. 연구 결과, 평균기본주파수(F0)는 변성이전>변성>변성이후 순이었고, 최고기본주파수(F0max), 기본주파수범위(F0range), 최대음성강도(Imax) 및 음성강도 범위(Irange)는 변성 단계에서 가장 낮았으며, 가성구가 진성구에 비해 높았다. 또한 대부분의 변수에서 활창이 축약된 VRP에 비해 높았으나 차이는 유의하지 않았다. 본 연구를 통해 변성 단계에 있는 남성은 변성기의 일시적인 후두의 해부학적 및 생리학적 변화로 인해 성대 진동이 불안정하게 됨으로써 음역대 또한 다른 연령대와 다른 양상을 보임을 알 수 있었다. 이와 더불어 활창을 이용한 VRP와 축약된 VRP 모두 검사자가 숙련된 경우에 임상에서 모두 사용하기에 적합하며, VRP 측정 시 가성구 외에도 진성구 범위까지 측정해야 한다는 사실을 확인하였다. This study compared the voice range profiles (VRPs) with glissando and simplified VRP methods with 57 men who were in premutation (8–13 years), mutation (11–16 years), and postmutation (10–24 years) stages. The difference between modal and falsetto areas measured in two VRP methods was also compared. As the results, the average fundamental frequency (F0) was in the order of premuaton>mutation>postmutation. The maximum F0 (F0max), the range of F0 (F0range), the maximum intensity (Imax), and the range of intensity (Irange) were the lowest in the mutation stage, and these variables were higher in falsetto area than in modal area in both methods. In addition, most variables of VRP in glissando were higher than in simplified VRP, but the differences were not significant. This study showed that, in men in mutation stage, due to the temporary anatomical and physiological changes of the larynx, the mechanism of the vocal folds vibration changes and VRP shows a different pattern from that of other age groups. Both the VRPs of glissando and simplifed VRP are suitable for clinical practice by experienced examiners. And it is necessary to measure not only the falsetto area but also the modal area when measuring VRP.

한국어판 음성장애지수와 음성관련 삶의 질의 타당도 및 신뢰도 연구

김재옥(Jaeock Kim),임성은(Sung-Eun Lim),박선영(Sun-Young Park),최성희(SeungHee Choi),최재남(Jae Nam Choi),최홍식(Hong-Shik Choi) 한국음성학회 2007 음성과학 Vol.14 No.3

It is important to examine patients’ subjective evaluation as well as objective measures and clinician’s rating to assess voice disorders. This study aimed to evaluate validity and reliability of Korean-version of Voice Handicap Index (KVHI) and Voice-Related Quality of Life (KVQOL) with 113 adults with voice disorders and 111 normal adults. Content validity was verified by three experienced speech-language pathologists. Concurrent validity was revealed by examining the correlation among KVHI, KVQOL, and Voice Rating Scale as well as item discrimination coefficients. Total scores of KVHI and KVQOL of adults with voice disorders were significantly different from those of normal adults. Test-retest reliability and internal consistencies were significantly high in both KVHI and KVQOL. Correlations among scores of each subscale and total score were also significantly high in each tool. The study revealed that KVHI and KVQOL are suitable tools to be used in clinics and research areas in Korea, which can subjectively evaluate the effects of voice disorders on daily life as well as on quality of life.

음도 고정 유무에 따른 공기역학, 음성효율성 및 성대접촉률 차이

김재옥(Kim, Jaeock) 한국음성학회 2013 말소리와 음성과학 Vol.5 No.1

The aerodynamic characteristics (subglottal pressure (Ps) and mean airflow rate (MFR)), fundamental frequency (Fo), intensity (I), vocal efficiency (VE), and closed quotient (CQ) were compared during a sustained vowel /o/ sound under three conditions: in a comfortable loudness and pitch level (condition 1), in a maximum loudness level with a fixed pitch (condition 2), and in a maximum loudness level without a fixed pitch (condition 3). Also, multiple regression analyses were done to measure the aerodynamic characteristics affect on the VE and the CQ in each condition. The results showed the Fo, Ps, MFR, VE, and CQ increased as I increased with and without fixed pitch. Most notably, VE in condition 3 was the highest of all the conditions, but CQ was not very high. By the results of multiple regression analysis, VE was significantly affected by I and Ps in all conditions; Fo was the other main key for affecting VE in high pitch. However, none of the aerodynamic characteristics significantly affected CQ. As I increases, Fo should be increased by increasing Ps and VE. Therefore, researchers should consider and specify an a priori to Fo, Ps, and I when measuring VE to examine the complex and delicate vocal mechanism.

Speech and Voice Range Profile in Hyper- and Hypo-functional Voice Disorders

Jaeock Kim(김재옥),Seung Jin Lee(이승진),Jae-Yol Lim(임재열),Sung-Eun Lim(임성은) 한국언어치료학회 2021 한국언어치료학회 학술발표대회 논문집 Vol.2021 No.11

언어치료를 위한 발달재활서비스 이용 현황 및 지원금의 적정성 연구: 부모를 대상으로

김재옥(Jaeock Kim),김태우(Taewoo Kim),이조영(Jo-Young Lee),정경희(Kyunghee Jung) 한국언어청각임상학회 2018 Communication Sciences and Disorders Vol.23 No.4

배경 및 목적: 발달재활서비스 지원금은 물가나 최저임금 등의 상승을 고려하지 않은 채 10여 년이 지난 현재까지 동일하게 유지되고 있어 질 높은 재활치료서비스를 제공하지 못하고 있다. 이에 본 연구는 발달재활서비스를 이용하는 아동의 부모를 대상으로 국내 발달재 활서비스 지원금에 대한 인식 및 발달재활서비스 이용 현황, 특히 언어치료서비스의 이용 현황에 대한 인식을 조사하고자 하였다. 방법: 발달재활서비스를 이용하는 아동의 부모를 대상으로 발달재활서비스 지원금 인식, 발달재활서비스 이용 현황과 언어치료 발달재활서 비스 이용 현황에 관한 24문항으로 구성된 설문지를 배부하고 성실하게 응답된 276부의 자료를 분석하였다. 결과: 발달재활서비스 현황에서 현행 발달재활서비스 지원금이 적정하지 않다고 응답한 비율이 85%였고, 31-40만 원이 가장 적정한 지원금이라고 응답한 비율이 가장 높았으며, 발달재활서비스 이용기간이 길수록 적정하다고 인식하는 발달재활서비스 지원금의 액수가 높아졌다. 아동이 현재 발달재활서비스로 제공받는 치료의 개수는 2개가 가장 많았으며, 가장 필요하고 가장 많이 이용하는 치료 유형은 언어치료였다. 발달재 활서비스를 이용한 월평균 언어치료 횟수는 4회가 가장 많았으나 적정하다고 인식하는 언어치료 횟수는 8회가 가장 많았다. 발달재활 서비스 지원금 외 추가로 부담하는 자부담금은 응답자의 약 74%가 80,000원 이상을 지불한다고 하였다. 또한 응답자의 약 94%가 아동이 성인이 된 후에도 정부로부터의 치료지원금이 필요하다고 하였다. 논의 및 결론: 장애아동의 치료지원을 위해 마련된 발달재활서비 스는 현행 제공되는 지원금이 이용 아동의 부모들이 인식하기에 충분하지 않으며 지원금의 인상이 반드시 필요하다고 보여진다. Objectives: The subsidy of developmental rehabilitation service (voucher) has gone unchanged for more than 10 years without consideration of rising prices or minimum wages, and thus they do not provide high quality rehabilitation services. The purpose of this study was to examine the awareness of the parents of disabled children using vouchers in regards to the use status and subsidy appropriateness of vouchers, in particular, vouchers for speech-language therapy (ST) services. Methods: A questionnaire consisted of 24 questions about the use status and subsidy appropriateness of vouchers and vouchers for ST was distributed to parents of disabled children who were currently using vouchers. Two hundred seventy-six questionnaires were collected and analyzed. Results: Eighty-five percent of the respondents answered that the current subsidy of voucher was not appropriate, with the most frequent response being that KRW 310,000-400,000 would be the appropriate amount. Most children were receiving two types of therapy using vouchers, and the most commonly used type of therapy was ST. The number of ST sessions per month using vouchers was 4 times, however the number of ST session believed to be necessary was 8 times. Seventy-four percent of the respondents said that they paid more than KRW 80,000 in addition to voucher. Conclusion: The developmental rehabilitation service voucher has been provided for the purpose of improving the functioning of disabled children and alleviating the burden of their family, however there is not enough voucher support to achieve t purpose, and it is necessary to increase the amount of voucher subsidy.

언어치료전공 임상교과 및 임상실습의 국내 현황 조사

김재옥(Jaeock Kim),최성희(Seong Hee Choi),김향희(HyangHee Kim),장선아(Son A Chang),김효정(Hyo Jung Kim),황보명(BoMyung Hwang),박현린(Hyun Rin Park),박희준(Hee-June Park) 한국언어청각임상학회 2018 Communication Sciences and Disorders Vol.23 No.3

배경 및 목적: 현재까지 국내 언어치료학과를 개설하고 있는 대학수는 총 50개교이고, 교육과정 프로그램은 총 87개까지 양적으로 증가하고 성장하였으나, 국내 전반에 걸친 임상교육, 훈련 및 환경에 대한 정확한 정보는 아직 제공되지 않은 실정이다. 이에, 본 연구는 전문적인 임상의 질적 기준을 마련하고자 국내 언어재활전공 프로그램을 운영하는 전문대학, 4년제 대학교 및 대학원을 대상으로 임상 교과와 임상실습 운영에 관한 현황을 파악하고자 수행되었다. 방법: 임상교과과정, 임상실습, 임상교육환경으로 설문을 구성하였으며, 국내 언어치료교육과정 프로그램 87개 중 설문에 회신한 57개(10개 전문대학, 19개 4년제 대학교, 28개 대학원) 과정들의 자료룰 분석 하였다. 결과: 비록 대부분의 프로그램들이 국가자격증을 취득하기 위한 핵심 임상 교과과정은 운영하고 있으나, 임상교과 학점, 시수, 훈련 내용과 실습 영역 및 임상환경은 다르게 나타났다. 대부분의 대학원 프로그램들은 언어치료전공자나 자격증을 보유하고 있는 학생들에게 임상수업활동이나 임상실습을 면제하였다. 또한, 대부분의 프로그램들이 가장 많이 실습하는 주된 영역은 학령전기/학령기 언어발달장애 영역이었다. 모든 실습과목 담당 교수진이나 임상감독자들은 언어치료를 전공한 교원으로 언어재활사자격증을 가진 전문가였으나, 세 개의 학제 간에 다양한 자격증 유형과 교수진의 형태를 보였다. 논의 및 결론: 언어치료학과 프로그램들 간의 일관된 질적 임상 훈련이나 교육을 보장하기 위해서는 임상교육 훈련 내용이나 임상 환경에 관한 좀 더 구체화된 최소 표준 임상규준이 마련되어야 할 것이다. 더 나아가 언어재활사의 전문성을 향상시키고 우리의 미래 의사소통장애 분야의 발전을 위해서는 다양한 임상교육과 훈련이 제공되어야 할 것이다. Objectives: The number of educational programs in speech-language pathology/therapy in Korea continues to increase, and has reached a total of 87 programs in 50 universities. However, no nationwide survey on the clinical curricula and practica of the educational programs has been carried out. Methods: A questionnaire consisting of items on clinicbased courseworks, clinical practicum, and clinical educational setting was distributed, and a total of 57 (10 community college, 19 undergraduate, 28 graduate) programs participated in the survey. Results: Although most of programs ran core clinical courses required for obtaining the national license, various credits of clinical courses, clinical hours, and practical area, and clinical environments were documented. Most graduate school programs permitted students with speech-language pathology backgrounds or speech-language pathologist (SLP) licenses to be exempt from clinical coursework and practicums. Language development in preschool or school-age children was the most predominant practice area in most of the programs. Supervision of clinical activities in all three types of educational settings was provided by licensed faculty or supervisors. Conclusion: In order to ensure the consistency of qualified clinical training or education across the speech-language pathology programs, standard clinical guidelines regarding education training contents or environment should be established. Moreover, diverse clinical education and training should be provided to enhance the SLP profession and to facilitate the development of the field of communication sciences and disorders in the upcoming years.