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Stroboscopy Evaluation Rating Form (SERF) - Revised
Bruce J. PoburkaMinnesota State University-Mankato
Diane M. BlessUniversity of Wisconsin-Madison
Rita PatelUniversity of Kentucky
IntroductionThe Stroboscopy Evaluation Rating Form (SERF) was developed to resolve various challenges with stroboscopy rating (Poburka, 1999; Poburka & Bless, 1998). The SERF used a graphics-based approach to facilitate rating of selected parameters. The form has been revised and renamed to reflect new features.
The new form is called Voice-Vibratory Assessment with Laryngeal Imaging (VALI). It expands the use of graphics-based rating, has improved graphic elements, and includes parameters to be assessed with high speed imaging (HSI).
All revisions and additions are discussed in greater detail below.
Stroboscopy Evaluation Rating Form (SERF)
Rater: Client: Date:
LR
86420 108 6 410 2
Amplitude(Rate @ normal pitch & loudness)
24
6810
X1024
68
10
Left:____%Right:____%
Mucosal Wave(Rate @ normal pitch & loudness)
LR
86420 108 6410 2
Left:____%Right:____%
X10
01
23
45
ML:_____
A-P:_____
LR
Supraglottic Activity(Ignore voice onsets)
Fo:______ Fo:______
Bruce J. Poburka, Ph.D.
Non-vibrating Portion(shade in affected areas)
Each box = 5%
Left %
R L
Right %
Page 1
Vocal Fold Edge SmoothnessLeft FoldRight Fold
0 1 2 3 4 5smooth rough
0 1 2 3 4 5smooth rough
circle one
Vocal Fold Edge Straightness
0 1 2 3 4 5straight irregular
Left FoldRight Fold0 1 2 3 4 5
straight irregular
circle one
Summary/Additional Comments:
Vertical Level Phase Closure Phase Symmetry Regularity
Rate @normal pitch & loudness
Rate @ point of contact Rate @ point of contact
Frame count:open phase: _____Closed phase:_____
Method(s) used:stop phase _____running phase_____
open closed% of time % of time symmetrical
% of time regular
Always assymmetrical
Always symmetrical
Always irregular
Always regular
0%20%40%60%80%
100%
0%20%40%60%80%
100%
on-plane
off-plane
+90%
66%
33%
<10%
<10%
33%
66%
+90%
“Normal”
Incomplete IrregularHourglass
Glottal Closure
If closure pattern is variable, indicate the predominant closure pattern:_____________
CompletePosterior
GapAnterior
GapSpindle
Gap
VVariablepattern
Page 2
Stoboscopy Evaluation Rating Form (SERF) - 1999
Voice-Vibratory Assessment with Laryngeal Imaging (VALI) (Stroboscopy Section) - 2010
Voice-Vibratory Assessment with Laryngeal Imaging (VALI)
A-P: ___
Supraglottic ActivitySelect concentric ring; ignore voice onsets
R L
M-L: ___
432
0
5
1
Patient:______________________Examiner:____________________Date:___________
Notes:____________________________________________________________________________________________________________________________________________________________________________________
Right: ___%
Non-vibrating PortionShade in affected area
R L
Left: ___%Full box = 5%
Right: ___%
AmplitudeRate @ normal pitch & loudness
246810
R L
x10
Left: ___%
F0: ___ Hz.
2 4 6 8 10
Right: ___%
Mucosal WaveRate @ normal pitch & loudness
246810
R L
x10
Left: ___%F0: ___ Hz.
2 4 6 810
Glottal Closure - Circle Predominant Pattern
Spindle Gap Irregular Incomplete Complete Posterior Gap Anterior Gap
Voice-Vibratory Assessment with Laryngeal Imaging (VALI)
Vertical PlaneCircle one
↓
off-plane; right lower
LR
on-planeLR
off-plane; left lower
LR
Phase Symmetry - % of exam - Circle one100%-90-80-70-60-50-40-30-20-10-0%
Never symmetrical
Always symmetrical
Free Edge ContourCircle type/degree of impairment
Severe SevereR L
ModerateModerateR L
R LNormalNormal
R LR L
Smooth but
Convex
Smooth but Concave
LMildMild
R
Regularity% of exam - circle one
100% 908070605040302010
0%
! (√) Not reliable; strobe not tracking
√ Method(s): ! stop mode ! running mode ! both modes
irregular
neverregular
alwaysregular
Phase Closure - Rate @ point of VF contact
Open phase predominates
Normal
Closed phase predominates
Mark point on ↓ continuum
! Could not judge
Stroboscopy Section Revisions• Glottal Closure
• improved images of glottal closure patterns
• Amplitude
• simpler indices for rating movement; less clutter
• Mucosal Wave
• wave graphics added to avoid confusion with amplitude parameter
• Non-vibrating Portion & Supraglottic Activity
• no changes
Revisions (cont.)
• VF Edge Smoothness/Straightness
• simplified into a single parameter called “free edge contour”
• replaced numerical scale w/ images
• added concave and convex ratings
• Vertical Plane
• added image-based examples of how a plane difference may appear (lighting differences)
• added corresponding cross-sectional images
• Regularity
• anchor terms changed for clarity
• added image depicting irregularity
Revisions (cont.)
• Phase Closure
• replaced numerical scale with image-based depictions of key phase closure patterns
• Phase Symmetry
• provided images depicting asymmetry
• anchor terms changed for clarity
High Speed Imaging (HSI)• Unlike stroboscopy, high speed imaging (HSI) is not
dependent on accurate tracking of fundamental frequency (F0) for motion extraction. Furthermore, HSI has high temporal resolution and is capable of recording from the moment of voice onset. Accordingly, HSI is particularly useful in cases of moderate to severe dysphonia where pitch extraction is difficult or impossible.
• In a study comparing HSI to stroboscopy, Patel, Dailey, and Bless (2008) concluded that HSI can be viewed as augmentative to stroboscopy and may aid in clinical decision making.
• Because of its value in assessment of moderate to severe dysphonia, HSI was incorporated into the VALI form. Parameters that are most likely to be assessed with HSI are presented below.
High Speed Imaging SectionParameters (Re)assessed using High Speed Imaging (HSI)
Voice-Vibratory Assessment with Laryngeal Imaging (VALI)
Regularity/Periodicity-HSI - % of exam - Circle one
100%--90--80--70--60--50--40-30--20--10--0%Never
RegularAlways Regular
Regular/Periodic
Irregular/Aperiodic
Symmetry-HSI - % of exam - Circle one for each plane
Symmetrical
Asymmetrical (M-L & A-P)
100%--90--80--70--60--50--40-30--20--10--0%Anteroposterior (A-P)
100%--90--80--70--60--50--40-30--20--10--0%Mediolateral (M-L)
Phase Closure-HSI - Rate @ pt. of VF contact; mark continuum
Normal
Mark point on ↓ continuum
Open predom-
inates
Closed predom-
inates
Voice-Vibratory Assessment with Laryngeal Imaging (VALI)
Comments:
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Summary & Recommendations:
___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Other Voice-Vibratory Patterns - HSI - circle type & √ check frequency of occurrence
! minimally ! occasionally ! persistently
Vocal Fry
Pressed! minimally ! occasionally ! persistently
Breathy
! minimally ! occasionally ! persistently
HSI Section of VALI Form P. 1 HSI Section of VALI Form P. 2
HSI Parameters
• Regularity/Periodicity
• rater indicates percentage of exam that vibration is regular
• Phase Closure
• rater uses a continuum to indicate the type of phase closure observed
HSI Parameters (cont.)
• Phase Symmetry
• rater indicates the percentage of exam that vibration was symmetrical
• separate ratings are made for A-P and M-L planes
• Other Voice-Vibratory Patterns
• rater can check whether common voice types (e.g., fry, breathy, etc.) are observed
• rater checks frequency of occurrence
Summary & ReferencesThe SERF form has been revised and renamed the VALI. The revised form features expanded use of graphics-based rating and it can be used with both videostroboscopy and high speed imaging. With the emergence of high speed imaging, it is important to establish a conventional set of parameters for assessing laryngeal function using this technology. The VALI form provides a set of these parameters and a means of assessing them. Future research is planned to evaluate agreement & reliability using the VALI form.
References
Patel, R., Dailey, S., and Bless, D., (2008). Comparison of high speed digital imaging with stroboscopy for laryngeal imaging of glottal disorders. Annals of Otology, Rhinology, & Laryngology, 117(6): 413-424.
Poburka, Bruce J. (1999). A new stroboscopy rating form. Journal of Voice, 13 (3):403-13.
Poburka, Bruce J., Bless, DM. (1998). A multi-media, computer-based method for stroboscopy rating training. Journal of Voice,12(4), 513-26.