ABSTRACT Background Mandarin is a tonal language in which pitch patterns at the syllable level distinguish lexical meaning. Aims This study aimed to develop and evaluate the efficacy of a pitch elevation training protocol adapted for Mandarin‐speaking transgender women. Methods and Procedures Twenty‐six Mandarin‐speaking transgender women completed ten 40‐min sessions of pitch elevation training incorporating tone‐specific pitch adjustments. Participants completed the Simplified Chinese version of the Trans Woman Voice Questionnaire (TWVQ‐SC), which included a total score, six module scores, and a 5‐point self‐rating of vocal gender. Acoustic measures were also obtained before and after training. For sustained vowels, median f o was measured; for sentence reading (SR) and spontaneous speech (SS), median f o as well as the 5th and 95th percentiles of f o were extracted. Linear mixed‐effects models examined the effects of training on f o measures, and paired t tests evaluated changes in TWVQ‐SC scores. Outcomes and Results The TWVQ‐SC total score and four of the six module scores decreased significantly, and self‐rated vocal gender shifted toward the feminine end of the scale. Median f o increased significantly across all speech tasks post‐training: 62 Hz for sustained /a/, 60 Hz for sustained /i/, 74 Hz for SR, and 72 Hz for SS. The 5th and 95th percentiles of f o also increased significantly for SR and SS. Conclusions and Implications The Mandarin‐adapted pitch elevation training protocol was associated with increases in f o and improvements in self‐reported voice outcomes in Mandarin‐speaking transgender women. Further controlled studies are warranted to examine the relative efficacy of this protocol compared with other approaches and to determine the contribution of its specific components (e.g., tone‐specific training techniques) to pitch elevation. WHAT THIS PAPER ADDS What is already known on this subject Behavioural pitch‐elevation protocols for transgender women reliably raise speaking f o and improve patient‐reported outcomes. Standard programs use hierarchical targets (e.g., humming or nasal syllables progressing to words, sentences, and conversation), often alongside resonance and intonation training. Previous research shows mean f o gains of about 25–50 Hz across speech tasks, with improvements in TWVQ scores and listener‐rated femininity, and short‐term gains maintained at 3 months. For tonal languages such as Mandarin, Tones 3 and 4 often reach the modal‐register floor and creaky voice. Whether existing protocols generalize to tonal‐language speakers or require adaptation remains underexplored. What this study adds to the existing knowledge This prospective single‐group study evaluated a Mandarin‐adapted pitch‐elevation protocol in 26 Mandarin‐speaking transgender women who completed ten 40‐min sessions over 5 weeks. The protocol incorporated tone‐specific strategies for T3/T4, a practical lower f o floor, real‐time visual pitch feedback, and on‐target humming. Median f o increased by about 62–74 Hz across sustained vowels, sentence reading, and spontaneous speech; the 5th and 95th percentiles of f o also increased in connected speech. TWVQ‐SC total scores decreased by 26.35 points, indicating improved self‐perceived voice outcomes. What are the potential or actual clinical implications of this study? Clinicians working in tonal languages can safely target higher average f o while preserving lexical tone by (1) raising entire tone contours, (2) setting a minimum f o “floor” to avoid creaky realizations, and (3) using real‐time visual feedback of pitch and “on‐target” humming to anchor pitch in connected speech. Substantial f o gains and meaningful improvements in self‐perceived vocal femininity and voice‐related quality of life can be achieved after a brief, structured training course, offering a practical framework for voice feminization in tonal‐language contexts.
ABSTRACT Purpose Speech therapists (STs) in Chinese mainland face a severe shortage of professional resources and multiple systemic challenges, including low remuneration, limited career advancement opportunities, and occupational isolation, all of which may increase their risk of burnout. Given the very small number of valid male respondents in the present survey and the female‐dominated composition of the speech therapy profession, this study focused on female speech therapists in Chinese mainland. It examined the mediating role of perceived social support in the relationship between self‐reported mindfulness and burnout, with the aim of providing empirical evidence relevant to occupational well‐being in this practitioner group. Methods A cross‐sectional design was adopted, and 391 female speech therapists were included in the final analytic sample. Participants completed the Five‐Facet Mindfulness Questionnaire (FFMQ), the Multidimensional Scale of Perceived Social Support (MSPSS), and the Maslach Burnout Inventory‐General Survey (MBI‐GS). Data were analysed using structural equation modelling (SEM), and bootstrapping was used to test the mediating effect. Results Mindfulness showed a significant negative direct path to burnout ( β = −0.152, p < 0.001) and a significant positive path to perceived social support ( β = 0.290, p < 0.001). In turn, perceived social support was significantly associated with lower burnout ( β = −0.344, p < 0.001). Bootstrapping confirmed that perceived social support significantly mediated the relationship between mindfulness and burnout ( β = −0.100, p < 0.001), accounting for 39.7% of the total effect. Further analyses of the subdimensions revealed that the mediating effects of family support, friend support, and support from significant others were all significant and comparable in magnitude. Conclusion In this cross‐sectional sample of female speech therapists in Chinese mainland, higher self‐reported mindfulness was associated with lower burnout both directly and indirectly through higher perceived social support. These findings suggest that perceived social support may be an important pathway linking self‐reported mindfulness with occupational well‐being. For this under‐resourced and emotionally demanding profession, strengthening multidimensional social support may be relevant to burnout prevention and workforce resilience. WHAT THIS PAPER ADDS What is already known on this subject Burnout is a work‐related syndrome associated with chronic occupational stress and is common in healthcare and education. Speech therapists often work with complex communication, swallowing and voice difficulties, and may face high emotional demands, limited occupational resources and professional isolation. Previous studies suggest that mindfulness and perceived social support are negatively associated with burnout, and that social support may buffer work‐related stress. However, little is known about how these factors relate to burnout among speech therapists in Chinese mainland. What this study adds to existing knowledge This cross‐sectional study of 391 female speech therapists in Chinese mainland found that higher self‐reported mindfulness and perceived social support were linked to lower burnout. Perceived social support significantly mediated the mindfulness–burnout relationship, accounting for 39.7% of the total effect. Family support, friend support and support from significant others all showed significant and comparable mediating effects. The findings suggest that burnout in this workforce should be understood in relation to both self‐reported mindfulness and multidimensional social and relational resources. What are the potential or actual clinical implications for practice? For speech therapists, approaches to burnout may need to consider both self‐reported mindfulness and the social environment around practitioners. Professional development may include self‐awareness and emotional‐regulation components, while services and professional organisations may consider strengthening peer discussion, supervision and mentoring to address professional isolation. Attention should also be given to family, friend and significant‐other support, as these sources may provide complementary emotional and practical resources. Support‐oriented strategies should be evaluated in future longitudinal and intervention studies before being treated as causal burnout‐reduction approaches.
ABSTRACT Background There is growing recognition that health research should reflect the needs and perspectives of people living with a condition and actively involve them and their families. Such involvement is particularly important in the co‐design of strategies, tools and interventions intended to support everyday functioning. Although communication difficulties are common in people with Parkinson's, relatively few studies have addressed conversational challenges, and there has been limited co‐design of communication interventions or supports with people with Parkinson's and their families reported in the literature. Aims This study aimed to identify communication supports that people with Parkinson's and their families perceive as useful for managing conversations, and to co‐design and evaluate one support method. Methods A three‐phase co‐design study was conducted. In Phase 1, three people with Parkinson's and two spouses participated in six group meetings to identify priorities for communication support. In Phase 2, two people with Parkinson's and one spouse worked collaboratively with two researchers over nine meetings to co‐design a communication‐focused website. This was one of the supports identified in Phase 1, intended to support everyday communication between people with Parkinson's and their families and to enhance communication‐related self‐efficacy. In Phase 3, a questionnaire was completed by 10 people with Parkinson's and 11 family members to evaluate the website's clarity, ease of navigation and usefulness. Results In Phase 1, co‐designers identified two preferred forms of conversational support: (i) a face‐to‐face conversation training programme for people with Parkinson's and their families and (ii) a website co‐designed by people living with Parkinson's and their families containing practical advice about communication. The website's structure, content, layout and name (‘To hear and be heard’) were co‐designed during this phase. Phase 2 focused on co‐designing and refining website content, appearance and layout, including the creation of video materials. In Phase 3, questionnaire responses indicated that the website was clear, easy to navigate, useful and appealing. In the evaluation phase participants reported that the resource would be particularly valuable for people newly diagnosed with Parkinson's and their families. Discussion This study demonstrates the value of actively involving people with Parkinson's and their families in the co‐design of communication supports. By ensuring their perspectives were central, an accessible and meaningful resource was developed to support conversations and confidence in managing communication challenges. The findings highlight the importance of including people with Parkinson's and their families in the co‐creation of communication support across the care continuum. WHAT THIS PAPER ADDS What is already known on this subject Communication difficulties, particularly those affecting everyday conversation, are common in people with Parkinson's and can have a significant impact on participation and relationships. While co‐design approaches are increasingly used in communication research, there has been very little work involving people with Parkinson's and their families in the co‐design of communication supports, with only one published study to date addressing this gap. What this paper adds to existing knowledge This study provides the first evaluation of a co‐designed, web‐based communication support developed collaboratively with people with Parkinson's and their family members. It demonstrates that people with Parkinson's and their families can meaningfully contribute to identifying priorities for conversation support and to designing an accessible resource that supports everyday communication and communication‐related self‐efficacy. What are the potential or actual clinical implications of this work? The findings highlight the importance of involving people with Parkinson's and their families in the co‐creation of communication supports that reflect real‐world needs. Clinicians may consider recommending co‐designed digital resources, such as websites, as a complement to therapy, particularly for people newly diagnosed with Parkinson's and their families.
ABSTRACT Introduction As of 2021, there were 57 million people with dementia worldwide, and there are 885,000 people with dementia in the UK. Communication difficulties occur in all forms of dementia. Increasing difficulty communicating thoughts and needs affects social interaction and personal relationships, with implications for individuals’ and their relatives’ quality of life. Speech and language therapists are trained to provide communication support to people experiencing communication difficulties. However, whether people with dementia are offered communication support from speech and language therapy services varies significantly across the UK. This study aimed to explain how speech and language therapists currently make clinical decisions about offering communication support, and to explain how further guidance such as a decision‐aid for clinicians may help people with dementia to receive more equitable care. Methods This study used realist methods to develop a programme theory relating to speech and language therapist decision‐making for dementia communication interventions, in order to inform future work to develop a decision‐aid for non‐dementia specialist speech and language therapists. Theories were produced and refined through an iterative process including literature review, stakeholder engagement and focus groups with speech and language therapists to help explain how speech and language therapists make decisions and how a decision‐aid could support this process. Data was analysed through a top‐down approach using an analytic appraisal journal, and a bottom‐up approach using deductive and inductive coding. Results Eighteen speech and language therapists participated in four focus groups. Eight theory statements were identified relating to how speech and language therapists currently make decisions about how, when and what type of communication therapy to offer people with dementia. Speech and language therapists make decisions about provision of communication therapy based on factors including staffing levels, prioritisation criteria, number of referrals received, personal beliefs, confidence, self‐perceived skills, and team culture. Eight theories relating to how a proposed decision‐aid might function were identified: provide therapy examples, peer support, service model examples, tailor for underserved groups, highlight the need for ongoing support, empower junior clinicians, and promote awareness of communication in dementia. Conclusion This study explored how and why speech and language therapists make particular decisions when working with people with dementia experiencing communication difficulties, identifying possible mechanisms through which a decision‐aid could assist this process. A decision‐aid could address barriers to decision‐making for communication support in dementia through enhancing speech and language therapists’ knowledge, skills and confidence, while promoting equitable and sustained care. WHAT THIS PAPER ADDS What is already known on this subject Progressive communication difficulties experienced as part of dementia can affect social interaction, personal relationships and quality of life of the person with dementia and their relatives. Speech and language therapists are well‐placed to provide communication support, but provision of this in dementia varies widely across the UK. It is unclear how speech and language therapists currently make decisions about offering communication support in dementia. What this study adds to the existing knowledge This study uses realist methods to better understand the current decision‐making processes of speech and language therapists relating to communication support in dementia. It uses literature review, stakeholder engagement and focus groups with clinicians to develop theories to help explain how decisions are currently made, and to propose mechanisms through which a decision‐aid may help speech and language therapists to make informed decisions. What are the clinical implications of this study? The findings suggest that speech and language therapists face significant challenges in delivering communication therapy to people with dementia due to systemic under‐resourcing, limited awareness of their role, and competing clinical priorities. The proposed decision‐aid could address some of these barriers by enhancing speech and language therapists’ knowledge, skills and confidence, while promoting equitable and sustained care. If effectively implemented, it has the potential to expand access to communication support, foster professional growth, and drive a broader recognition of communication as a vital element of dementia care.
ABSTRACT Purpose This scoping review examines lexico‐semantic and morphosyntactic skills in English‐speaking individuals with Parkinson's disease (PD) using behavioral and neuroimaging data to inform clinical assessment and intervention. Method Following PRISMA‐ScR guidelines, observational case‐control studies published between 2004 and 2024 were retrieved from PubMed, PsycINFO, Web of Science, Scopus and ERIC. Thirty‐nine studies met inclusion criteria. Methodological quality was evaluated using the Joanna Briggs Institute Checklist for Case‐Control Studies. Results Lexico‐semantic impairments in PD are characterized by deficits in semantic fluency, action‐verb retrieval, and figurative‐language processing, particularly under higher cognitive load. Individuals with PD show reduced efficiency in lexical access, difficulty shifting between semantic categories, and weaker inhibition of competing meanings. Morphosyntactic studies similarly report slower processing and lower accuracy for syntactically complex sentences. Conclusion Linguistic impairments in PD are best understood as a dynamic interaction between linguistic demands and domain‐general cognitive resources, emerging most clearly under conditions of increased cognitive load. This pattern positions language as a sensitive indicator of broader cognitive vulnerability within the communication profile of PD, with direct implications for assessment and clinical practice. WHAT THIS PAPER ADDS What is already known on the subject Language impairments are a well‐recognized non‐motor feature of PD and can significantly affect communication and quality of life. Previous studies have reported lexico‐semantic and morphosyntactic difficulties in PD, but findings are scattered across heterogeneous tasks and study designs, with no synthesis examining these domains together. What this study adds to the existing knowledge This scoping review synthesizes evidence from behavioral and neuroimaging studies and shows that language difficulties in PD are most consistently observed under conditions of increased cognitive or processing demand, particularly in high‐load contexts. Lexico‐semantic impairments emerge reliably in such high‐load contexts, while morphosyntactic difficulties appear to reflect vulnerability to processing demands rather than a generalized grammatical deficit. The review also demonstrates that methodological variability, such as cognitive screening practices, influences how language abilities are characterized across studies. What are the potential or clinical implications of this work? Language impairments affecting lexico‐semantic and morphosyntactic processing constitute a meaningful component of the communication profile in PD and should be considered alongside speech and voice symptoms in clinical assessment. Incorporating cognitive–linguistic evaluation may support a more comprehensive understanding of communication difficulties in individuals with PD.
