Below is a sampling of research currently in
progress and recent presentations. If you would
like to participate or assist with Dr. Hancock's
research please email
or call (202) 994-0975.
Take the Transgender Voice-Related Quality of Life survey
Acoustical Society of America 2011 Lay-Language Paper
Transgender Voice and Communication Treatment: A Retrospective Chart Review of 25 Cases
Demographic information and treatment outcome data (e.g., acoustic measures) were collected via chart review of 25 of the 32 cases discharged from the George Washington University Speech and Hearing Center between 2006 and 2010. Treatment goals included the following (listed in order of percentage of cases that addressed the topic): forward resonance, increased pitch, relaxation, intonation, phonotraumatic behaviors, breath control, non-verbal communication, pragmatics, and vocal hygiene. After treatment, clients had increased speaking fundamental frequency in sustained vowel, reading, and monologue tasks by 5-6 semitones, which is statistically significant. Gains in pitch correlated significantly with total number of sessions, but no other correlations were significant. Further research is warranted to determine efficacy of specific treatment protocols and potentially influential factors such as initial voice status. This research is under review for publication and will be presented at GWU’s Research Day 2012.
Effective voice and communication treatment for an adolescent MTF person
Current research to describe and evaluate effectiveness of voice and communication therapy for male-to-female transgender people is limited to adults. This paper, currently under review for publication, provides rationale, procedures, and outcomes from voice and communication therapy for a male-to-female transgender adolescent 15 years of age. Treatment addressed vocal hygiene, breath support, fundamental frequency, intonation, resonance and vocal quality, and rate. Positive psychosocial, acoustic, and perceptual outcomes confirm treatment effectiveness.
Measuring subjective perceptions of vocal femininity and gender
Vocal femininity of male-to-female (MtF) transgender clients in voice therapy is typically measured subjectively. Rating scales are commonly used but have a great deal of variability among listeners' ratings. Shrivastav et al. (2005) proposed methods of data transformation to mitigate factors contributing to poor inter-rater agreement when rating breathiness. This study applies those methods to ratings of vocal femininity and gender perceptions. Preliminary results suggest that there is no difference in the inter-rater reliability levels of listeners’ first rating of femininity and levels based on a) averaged ratings of successive stimuli presentations, b) standardized scores of ratings, or c) standardized scores of average ratings. Further data analysis is in progress.
Self- and listener-perceptions of vocal femininity are related to quality of life
The validation of appropriate subjective and objective measures for determining vocal femininity will guide the development of more effective clinical practice for transgender voice treatment. Our data support the use of acoustic and perceptual targets and the TSEQ in vocal feminization treatment. Speakers and listeners rated voices as more feminine as pitch increased and semitone range decreased. Perturbation measures (indicative of voice quality) were not correlated with femininity ratings for this sample of healthy voices. Scores on the TSEQ strongly correlated with scores from the VHI and V-QOL and self-ratings of vocal femininity and likability. Test-retest reliability for the psychosocial measures was excellent (.85-.97). Portions of this research have been presented at the Voice Symposium (Philadelphia, USA) and World Professional Association for Transgender Health Conference (Oslo, Norway).
Hancock, A.B., Krissinger, J. & Owen, K. (2011). Voice-related quality of life for transgender individuals. Journal of Voice, 25(5), 553-558.
Owen, K. & Hancock, A.B. (2011). The role of self-and-listener perceptions of femininity in voice therapy. International Journal of Transgenderism, 12(4), 1-13.
WPATH 2009: Presentation
DCSHA 2011 Presentation
Language features of American men and women in the 21st Century
Holly Wilder completed this study as her Master's thesis work (2010), a manuscript for publication is in progress. Previous research regarding differences between men and women's language is inconsistent, and the impact of language on gender perception remains unexamined. Literature is unclear on whether to incorporate language into transgender communication therapy. This study aimed to understand language differences between men and women as well as the relationship among language and perceptions of gender and femininity/masculinity. Frequency of 15 linguistic variables was counted in 40 spoken narratives about an illness and compared between genders, then 40 readers judged the gender and femininity/masculinity of the typed narratives. Languages of men and women were generally indistinguishable. Men had statistically significantly longer T-units and more T-units, dependent clauses, and personal pronouns; however reader's judgments of gender and femininity/masculinity were unrelated to the linguistic variables. Although language may not be a valuable goal in transgender therapy, further studies are needed to determine consistency and accuracy of these results.
Motor Learning for Apraxia
This study examined the effectiveness of a modified versin of the Motor Learning Guided (MLG) approach, a treatment protocol to establish functional speech that incorporates principles of motor learning: blocked and random practice schedules, delayed and summary knowledge of response (KR) feedback, and specificity of training. A 29-year-old male survivor of traumatic brain injury diagnosed with moderate-severe apraxia of speech (AOS) participated in this protocol. A time-series ABA design measured the participant's production of two sets of five target items, and his ability to maintain accurate productions several months after treatment. Improvements were seen in the participant's abilty to produce both sets of trained items, however the second set of target items were practiced with more frequency, which may have lead to a greater accuracy of production in less time compared to the first set of five target items. Application of motor learning principles through the modified MLG approach can lead to increased accuracy and automaticity of trained target items, and the ability to maintain accurate phrase production following cessation of treatment. Adherence to a frequent practice schedule and other motor learning principles is influential to success of this treatment of AOS
Friedman, I., Hancock, A., Bamdad, M., & Schulz, G. (2010). Using principles of motor learning to treat apraxia of speech after traumatic brain injury. Journal of Medical Speech-Language Pathology. 18(1), 1-12.
2008 DCSHA Winter Conference: Motor
Learning Guided Handout
Script training treatment for adults with apraxia of speech and aphasia (Youmans, Youmans, Hancock)
Script training is a functional treatment which has been successful for individuals with aphasia, but has not been applied to individuals with AOS. Principles of motor learning were incorporated into training to promote long term retention of scripts. A multiple-baseline, across behaviors design examined acquisition of client-selected scripts for three individuals with AOS and Aphasia. Errors and speaking rates were also analyzed. Random practice and delayed feedback were incorporated into training to promote motor learning. All clients successfully acquired their scripts, and probes demonstrated script retention six months following treatment. Errors generally decreased but remained variable even during maintenance and retention probes. Speakig rate increased for two clients, but also remained variable. Clients reported increased confidence, speaking ease, and speech naturalness. Although scripts did not become errorless, clients retained their scripts and reported using them frequently.
Youmans, G., Youmans, S., & Hancock, A.B. (2011). Script training treatment for adults with apraxia of speech. American Journal of Speech-Language Pathology, 20(1), 23-27.
Variables Predicting the Social Validity of Speech Treatment (Youmans, Youmans, Hancock)
Abbreviated abstract: The purposes of this investigation were to evaluate the social validity of a modified script training treatment protocol, to explore how aspects of a client’s speech correspond to varying rater judgments, and to determine which of the rater judgments were most predictive of ratings of overall quality. One-hundred-twenty-four, young, naïve listeners were asked to judge the quality of speech of an 81 year-old woman with moderate –severe apraxia of speech during utterances with varying levels of script correctness (low, medium, high), number of errors (low, high), and rate (slow, fast). Judgments were made on the understandability, ease of production, naturalness, and overall quality of speech. As script correctness increased, errors increased, and rate increased, participant ratings increased significantly. The participant ratings predicted improved perceptions of overall quality weighted highest to lowest: understandability, naturalness, and ease of production. Error types were analyzed and revealed that phrase repetitions were perceived positively and that unintelligible words and interjections were perceived negatively. Raters appeared to perceive struggle behaviors as negative, increased speech output (including repetitions and empty speech) as positive, faster speech (closer to a normal speaker’s average word per minute) preferable to slow speech, and more understandable speech and more natural speech as better quality speech. Based on these data, important goals could focus on the accuracy and fluency of script production. This research was reported at the 2010 Clinical Aphasiology Conference and is currently in review for publication.
Use of biofeedback and motor speech principles for treatment of VPI (Hancock, Sibbald)
A 15-year-old male with VeloCardioFacial Syndrome and hypernasality due to velopharyngeal incompetency is currently undergoing speech treatment guided by knowledge of consonant airflow pressure, biofeedback, and principles of motor learning. Treatment progress is tracked in average percent nasalance and perceptual ratings from naive listeners. Thus far, little carryover has been noted as the percent nasalance is fairly constant: 21% for Zoo (no nasal sounds), 44% for High Flow, and 57% for Low Flow passages. However perceptually we hear a slight decrease in nasal and effortful, strained speech. The partiicpant reports that his grandfather didn’t recognize him on the phone when he answered. We are hopeful that as this participant continues to utilize the biofeedback and practice frequently we will see his progress transfer to untrained sentences as well. Either way, careful collection and reporting of these results will be valuable information in the growing body of literature regarding hypernasal speech treatment.
Effect of voice and diction training on public speaking apprehension (Hancock, Regnell, Brundage).
Several questionnaires about speaking apprehension and confidence are administered at the beginning and end of my Voice and Diction classes. Comparisons have demonstrated significant improvement after the course. Data from a more traditional public speaking course taught by colleagues at Florida State University was also collected and preliminary analyses suggest equitable improvements in indirect (GWU) and direct (FSU) treatment approaches to apprehension of public speaking.
Editor's Award for Journal of Allied Health
Hancock, Stone, Brundage, & Zeigler (2009). Public speaking attitudes: Does curriculum make a difference? Journal of Voice, 24(3), 302-307.
2008 Voice Symposium: Presentation
Formative feedback, rubrics, and assessment of professional competency (Hancock, Brundage)
Abbreviated Abstract: In the allied health professions there are profession-specific competencies and core competencies that are desired regardless of profession. The aim of this paper is to present a system to quantify progress in professional skill areas for use in formative and summative assessment of graduate students. Our speech-language pathology department’s process of developing, testing, and implementing a Graduate Student Development Profile (GSDP) in rubric format is described as an example of how it might be done. A rubric for rating Responsibility for Learning, Critical Thinking, Cognitive Flexibility, Professionalism, and Communication, each with specific subcategories, was tediously created, developed, and implemented by faculty and clinical staff to guide the three sequential evaluations each Master’s level student receives during the five-semester SLP program. Out of a possible five levels in each subcategory, students are expected to be around level 3 after their first semester, level 4 after two semesters, and level 5 just before their last semester when they go to clinical externships. After implementation of the GDSP, we tracked one cohort’s average scores throughout the program; their overall scores and progression was congruent with our expected levels. . In addition to documenting student behaviors over time, a rubric system provides formative feedback helpful to student learning and development as a professional. Faculty and staff have found the comprehensive, transparent, and objective nature of the GDSP to be strengths. The web-based version brings convenience and efficiency to the often formidable, but fundamentally necessary, process of providing formative and summative feedback to students. This research was presented at AAUP Conference on the State of Higher Education (Washington DC, 2010).
Hancock, A.B. & Brundage, S.B. (2010). A rubric for formative assessment of students in communication science and disorders programs. Journal of Allied Health.
Assessment of Orientation to Clinical Practice: a model for program effectiveness. (Brundage, Hancock, Mahshie)
One commonly used assessment cycle involves setting goals, developing assessment strategies, implementing an assessment plan, and using the resulting data to make programmatic adjustments based on those assessment results (Suskie, 2004). The assessment cycle described here involves initial preparation of students for their clinical experience in speech-language pathology. A decision to explore revisions to clinical orientation was influenced by focus group discussions with faculty and with students after their first semester experience. Data obtained from both groups converged, indicating similar concerns that were targeted for assessment and subsequent change. The objectives for orientation sessions were used to create an assessment instrument administered to students prior to orientation (Pre) and one-week following completion of the orientation program (1-week post). Additionally, objectives related to each topic area were queried immediately following presentation of that topic area (immediate post). For each objective, students were asked to rate their knowledge, comfort, and confidence related to each of 32 objectives using a five-point, equal-appearing interval scale where “1 = not at all” and “5= to a great extent”. Twenty-nine students participated in the orientation program and assessment. Pre, immediate post, and 1-week post mean scores for self-reported measures of knowledge, comfort, and confidence were analyzed using a repeated measures ANOVA. Statistically significant results suggest that students’ perceptions of their own knowledge, confidence, and comfort increased after orientation and confidence and comfort levels were maintained 1-week after orientation and at the end of the first semester of graduate study. This research was presented at AAUP Conference on the State of Higher Education (Washington DC, 2010).
Teaching Research Methods (Ekmekci, Hancock, Swayze)
In this paper, we examine the challenge of teaching research methods in three specific settings, as encountered in a private university based in Washington, DC and discuss how we, as instructors, employ innovative approaches to deal with this challenge, whether we happen to be sitting with them in the same classroom or exchanging emails over a distance. We ground our discussion within the confines of how we teach research methods in three different settings: (1) in an on-campus clinical master’s program; (2) across multiple on-campus master’s degree programs; and (3) in a distance education master’s program. We conclude the paper with an outline of the similarities between the approaches we use and propose recommendations guided by adult learning principles. This research was presented at World Congress of Comparative Education Societies (Istanbul, Turkey, 2010) and is in review for publication:
Ekmekci, O., Hancock, A. & Swayze, S. (in review). Teaching Research Methods: Connecting with Students across Invisible Borders.