The original unedited recordings were also graded as “normal” or “abnormal” by 2 independent raters to determine the ability of an impartial observer to correctly and quickly identify singing impairment in the clinical setting. The raters were other undergraduate members of the study team without significant training in language processing, given our desire to evaluate a screen that would be useful for those of varied backgrounds (physicians, nurses, and therapists with or without additional expertise). Raters were told simply to evaluate changes in pitch matching the familiar tune of “Happy Birthday,” rather than the clarity or correctness of speech. A “normal” rating indicated the expected presence of variations in pitch, while an “abnormal” rating indicated the absence of such variation. The raters were blinded to the participant's identity or stroke location. A Cohen kappa was calculated for inter-rater reliability. When needed, disagreements over singing rating were resolved by group consensus among the 2 raters. Ties were broken by a third party with similar training.

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