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Nip ISB. Articulatory and Vocal Fold Movement Patterns During Loud Speech in Children With Cerebral Palsy. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2024; 67:477-493. [PMID: 38227476 PMCID: PMC11000802 DOI: 10.1044/2023_jslhr-23-00411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/19/2023] [Accepted: 11/25/2023] [Indexed: 01/17/2024]
Abstract
PURPOSE Speech motor control changes underlying louder speech are poorly understood in children with cerebral palsy (CP). The current study evaluates changes in the oral articulatory and laryngeal subsystems in children with CP and their typically developing (TD) peers during louder speech. METHOD Nine children with CP and nine age- and sex-matched TD peers produced sentence repetitions in two conditions: (a) with their habitual rate and loudness and (b) with louder speech. Lip and jaw movements were recorded with optical motion capture. Acoustic recordings were obtained to evaluate vocal fold articulation. RESULTS Children with CP had smaller jaw movements, larger lower lip movements, slower jaw speeds, faster lip speeds, reduced interarticulator coordination, reduced low-frequency spectral tilt, and lower cepstral peak prominences (CPP) in comparison to their TD peers. Both groups produced louder speech with larger lip and jaw movements, faster lip and jaw speeds, increased temporal coordination, reduced movement variability, reduced spectral tilt, and increased CPP. CONCLUSIONS Children with CP differ from their TD peers in the speech motor control of both the oral articulatory and laryngeal subsystems. Both groups alter oral articulatory and vocal fold movements when cued to speak loudly, which may contribute to the increased intelligibility associated with louder speech. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.24970302.
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Levy ES, Moya-Galé G. Revisiting Dysarthria Treatment Across Languages: The Hybrid Approach. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023:1-10. [PMID: 38056466 DOI: 10.1044/2023_jslhr-23-00629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
PURPOSE Ten years after Miller and Lowit's (2014) groundbreaking book providing a cross-linguistic perspective on motor speech disorders, we ask where we are regarding dysarthria treatment across languages in two specific populations: adults with Parkinson's disease (PD) and children with cerebral palsy (CP). METHOD In this commentary, we consider preliminary evidence for both language-independent and language-specific approaches to treatment and propose a hybrid approach to speech treatment across languages, centered on the individual with dysarthria who speaks any given language. CONCLUSIONS Treatment research on individuals with dysarthria secondary to PD and CP is advancing, but several areas remain to be explored. Next steps are suggested for addressing the paucity and complexity of cross-linguistic speech treatment research.
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Korkalainen J, McCabe P, Smidt A, Morgan C. The Effectiveness of Rapid Syllable Transition Treatment in Improving Communication in Children with Cerebral Palsy: A Randomized Controlled Trial. Dev Neurorehabil 2023; 26:309-319. [PMID: 37401894 DOI: 10.1080/17518423.2023.2218485] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 04/21/2023] [Accepted: 05/23/2023] [Indexed: 07/05/2023]
Abstract
Cerebral palsy (CP) is a movement disorder and majority of children with CP have communication impairments which impact participation with this population. Rapid Syllable Transition Treatment (ReST) is a motor speech intervention primarily for children with Childhood Apraxia of Speech (CAS). A recent pilot study in which ReST was trialed with children with CP showed improved speech performance. Therefore, a single blind randomized controlled trial to compare ReST to usual care with 14 children with moderate-to-severe CP and dysarthria was conducted. ReST was provided on telehealth. ANCOVA with 95% confidence intervals indicated significant group differences in favor of ReST in speech accuracy (F = 5.1, p = .001), intelligibility (F = 2.8, p = .02) and communicative participation on both the FOCUS (F = 2, p = .02) and Intelligibility in Context Scale (F = 2.4, p = .04). ReST was found to be more effective than usual care.
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Affiliation(s)
| | | | - Andy Smidt
- The University of Sydney, Camperdown, Sydney, Australia
| | - Catherine Morgan
- The University of Sydney, Cerebral Palsy Alliance Research Institute, Brain Mind Centre, Camperdown, Sydney, Australia
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Allison KM, Nip ISB, Rong P. Use of Automated Kinematic Diadochokinesis Analysis to Identify Potential Indicators of Speech Motor Involvement in Children With Cerebral Palsy. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:2835-2846. [PMID: 36126294 PMCID: PMC9911111 DOI: 10.1044/2022_ajslp-21-00241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
PURPOSE This study examined multiple variables obtained from an automated measure of lip movement during a diadochokinesis (DDK) task to identify those with potential to detect mild speech motor involvement in school-age children diagnosed with cerebral palsy (CP). METHOD Eight children with CP and high speech intelligibility and a matched group of eight children with typical development (TD) completed a DDK task while their lip and jaw movements were recorded. A custom MATLAB algorithm was used to automatically extract 23 kinematic measures of children's lip movements during production of the DDK sequences. Mann-Whitney U tests were used to compare groups on the kinematic measures, and receiver operating characteristic (ROC) analysis was used to evaluate the diagnostic accuracy of measures that significantly differed between groups. RESULTS Five of the 23 kinematic variables differed significantly between the CP and TD groups. These were two measures of overall DDK performance (i.e., duration of the DDK sequence and number of cycles) and three spatial and temporal measures of lip movement. Duration of the DDK sequence and the mean displacement of the lips across cycles had the highest diagnostic accuracy, differentiating CP and TD groups with 88% sensitivity and 88% specificity. CONCLUSIONS Automatically derived kinematic measures of DDK sequences differentiated children with CP and high intelligibility from typically developing children. Future research is needed to determine the clinical utility of these measures for detecting speech motor impairment.
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Affiliation(s)
- Kristen M. Allison
- Department of Communication Sciences and Disorders, Northeastern University, Boston, MA
| | - Ignatius S. B. Nip
- School of Speech, Language, and Hearing Sciences, San Diego State University, CA
| | - Panying Rong
- Department of Speech-Language-Hearing: Sciences & Disorders, The University of Kansas, Lawrence
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Bóna J, Váradi V. Speech tempo in Hungarian speaking children and adolescents: The effects of age and speaking tasks. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2022; 152:184. [PMID: 35931529 DOI: 10.1121/10.0012327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 06/17/2022] [Indexed: 06/15/2023]
Abstract
This paper provides new data on speech tempo in typically developing Hungarian-speaking children and adolescents obtained in three different speaking contexts and analyzed using an extended set of temporal measures. We asked whether the expected developmental trend across four age levels (6, 9, 13, and 17 years) was equally reflected in children's speech rate, articulation rate, and pausing (frequency, duration, and proportion of pauses), and how their speech tempo was modulated by the cognitive demands of different speaking tasks (spontaneous narratives, story retellings, and story generations). We found a systematic incremental increase in speech rate and articulation rate with each higher age level, but the corresponding decrease in the frequency, duration, and proportion of pauses was less systematic. Increased cognitive demands in the story generation and retelling tasks resulted in slower speech and articulation rates than in spontaneous narratives. The demands of different tasks were also reflected in a distinct pattern of pausing. Overall, the study suggests a protracted developmental time course of temporal control in narrative discourse production and underscores the importance of considering speaking contexts when comparing findings across experimental studies.
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Affiliation(s)
- Judit Bóna
- Department of Applied Linguistics and Phonetics, ELTE Eötvös Loránd University, H-1088 Budapest, Múzeum krt 4/A, Hungary
| | - Viola Váradi
- Department of Applied Linguistics and Phonetics, ELTE Eötvös Loránd University, H-1088 Budapest, Múzeum krt 4/A, Hungary
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Carl M, Levy ES, Icht M. Speech treatment for Hebrew-speaking adolescents and young adults with developmental dysarthria: A comparison of mSIT and Beatalk. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2022; 57:660-679. [PMID: 35363414 DOI: 10.1111/1460-6984.12715] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 02/16/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Individuals with developmental dysarthria typically demonstrate reduced functioning of one or more of the speech subsystems, which negatively impacts speech intelligibility and communication within social contexts. A few treatment approaches are available for improving speech production and intelligibility among individuals with developmental dysarthria. However, these approaches have only limited application and research findings among adolescents and young adults. AIMS To determine and compare the effectiveness of two treatment approaches, the modified Speech Intelligibility Treatment (mSIT) and the Beatalk technique, on speech production and intelligibility among Hebrew-speaking adolescents and young adults with developmental dysarthria. METHODS & PROCEDURES Two matched groups of adolescents and young adults with developmental dysarthria participated in the study. Each received one of the two treatments, mSIT or Beatalk, over the course of 9 weeks. Measures of speech intelligibility, articulatory accuracy, voice and vowel acoustics were assessed both pre- and post-treatment. OUTCOMES & RESULTS Both the mSIT and Beatalk groups demonstrated gains in at least some of the outcome measures. Participants in the mSIT group exhibited improvement in speech intelligibility and voice measures, while participants in the Beatalk group demonstrated increased articulatory accuracy and gains in voice measures from pre- to post-treatment. Significant increases were noted post-treatment for first formant values for select vowels. CONCLUSIONS & IMPLICATIONS Results of this preliminary study are promising for both treatment approaches. The differentiated results indicate their distinct application to speech intelligibility deficits. The current findings also hold clinical significance for treatment among adolescents and young adults with motor speech disorders and application for a language other than English. WHAT THIS PAPER ADDS What is already known on the subject Developmental dysarthria (e.g., secondary to cerebral palsy) is a motor speech disorder that negatively impacts speech intelligibility, and thus communication participation. Select treatment approaches are available with the aim of improving speech intelligibility in individuals with developmental dysarthria; however, these approaches are limited in number and have only seldomly been applied specifically to adolescents and young adults. What this paper adds to existing knowledge The current study presents preliminary data regarding two treatment approaches, the mSIT and Beatalk technique, administered to Hebrew-speaking adolescents and young adults with developmental dysarthria in a group setting. Results demonstrate the initial effectiveness of the treatment approaches, with different gains noted for each approach across speech and voice domains. What are the potential or actual clinical implications of this work? The findings add to the existing literature on potential treatment approaches aiming to improve speech production and intelligibility among individuals with developmental dysarthria. The presented approaches also show promise for group-based treatments as well as the potential for improvement among adolescents and young adults with motor speech disorders.
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Affiliation(s)
- Micalle Carl
- Department of Communication Disorders, Ariel University, Ariel, Israel
| | - Erika S Levy
- Teachers College, Columbia University, New York, NY, USA
| | - Michal Icht
- Department of Communication Disorders, Ariel University, Ariel, Israel
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Ertan E, Gürvit HI, Hanağası HH, Bilgiç B, Tunçer MA, Yılmaz C. Intensive voice treatment (the Lee Silverman Voice Treatment [LSVT ®LOUD]) for individuals with Wilson's disease and adult cerebral palsy: two case reports. LOGOP PHONIATR VOCO 2021; 47:262-270. [PMID: 34287100 DOI: 10.1080/14015439.2021.1951348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objective: In this case report, we aimed to examine the effects of an intensive voice treatment (the Lee Silverman Voice Treatment [LSVT®LOUD]) for Wilson's disease (WD), and adult cerebral palsy (CP), and dysarthria.Method: The participants received LSVT®LOUD four times a week for 4 weeks. Acoustic, perceptual (GRBAS) analyses were performed and data from the Voice Handicap Index (VHI) were obtained before and after treatment.Results: Besides the Harmonics-to Noise Ratio (HNR) value (dB) of the participant with WD, for both participants' fundamental frequencies (Hz), jitter (%), and shimmer (%) values showed significant differences (p < .05) after therapy. Both participants showed significant improvements (p < .05) in the duration (s) and the sound pressure level (dB, SPL) of sustained vowel phonation (/a/), in SPL (dB) of pitch range (high and low /a/) and reading and conversation (p < .01). There was a positive improvement in the high-frequency values (Hz) of both participants but not in the low-frequency values (Hz) in the participant with WD. Perceptual analysis with GRBAS judgements of sustained vowel (/a/) and paragraph reading of two participants also showed improvement. After therapy, perceived loudness of the participants' voice increased.Conclusions: The findings provide some preliminary observations that the individuals with WD and the adult individuals with CP can respond positively to intensive speech treatment such as LSVT®LOUD. Further studies are needed to investigate speech treatments specific to WD and adult CP.
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Affiliation(s)
- Esra Ertan
- Institut für Deutsche Sprache und Linguistik, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Hakan I Gürvit
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Haşmet H Hanağası
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Başar Bilgiç
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Müge A Tunçer
- Department of Speech and Language Therapy, Faculty of Health Science, Sıtkı Koçman University, Muğla, Turkey
| | - Cemil Yılmaz
- Department of Speech and Language Therapy, Faculty of Health Science, Anadolu University, Eskişehir, Turkey
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Moya-Galé G, Keller B, Escorial S, Levy ES. Speech Treatment Effects on Narrative Intelligibility in French-Speaking Children With Dysarthria. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:2154-2168. [PMID: 33719503 DOI: 10.1044/2020_jslhr-20-00258] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose This study examined the effects of Speech Intelligibility Treatment (SIT) on intelligibility and naturalness of narrative speech produced by francophone children with dysarthria due to cerebral palsy. Method Ten francophone children with dysarthria were randomized to one of two treatments, SIT or Hand-Arm Bimanual Intensive Therapy Including Lower Extremities, a physical therapy (PT) treatment. Both treatments were conducted in a camp setting and were comparable in dosage. The children were recorded pre- and posttreatment producing a story narrative. Intelligibility was measured by means of 60 blinded listeners' orthographic transcription accuracy (percentage of words transcribed correctly). The listeners also rated the children's naturalness on a visual analogue scale. Results A significant pre- to posttreatment increase in intelligibility was found for the SIT group, but not for the PT group, with great individual variability observed among the children. No significant changes were found for naturalness ratings or sound pressure level in the SIT group or the PT group posttreatment. Articulation rate increased in both treatment groups, although not differentially across treatments. Conclusions Findings from this first treatment study on intelligibility in francophone children with dysarthria suggest that SIT shows promise for increasing narrative intelligibility in this population. Acoustic contributors to the increased intelligibility remain to be explored further. Supplemental Material https://doi.org/10.23641/asha.14161943.
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Affiliation(s)
- Gemma Moya-Galé
- Department of Communication Sciences and Disorders, Long Island University, Brooklyn, NY
| | - Bryan Keller
- Department of Human Development, Teachers College, Columbia University, New York, NY
| | - Sergio Escorial
- Departamento de Psicobiología y Metodología en Ciencias del Comportamiento, Universidad Complutense de Madrid, Spain
| | - Erika S Levy
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
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Levy ES, Chang YM, Hwang K, McAuliffe MJ. Perceptual and Acoustic Effects of Dual-Focus Speech Treatment in Children With Dysarthria. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:2301-2316. [PMID: 33656916 DOI: 10.1044/2020_jslhr-20-00301] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose Children with dysarthria secondary to cerebral palsy may experience reduced speech intelligibility and diminished communicative participation. However, minimal research has been conducted examining the outcomes of behavioral speech treatments in this population. This study examined the effect of Speech Intelligibility Treatment (SIT), a dual-focus speech treatment targeting increased articulatory excursion and vocal intensity, on intelligibility of narrative speech, speech acoustics, and communicative participation in children with dysarthria. Method American English-speaking children with dysarthria (n = 17) received SIT in a 3-week summer camplike setting at Columbia University. SIT follows motor-learning principles to train the child-friendly, dual-focus strategy, "Speak with your big mouth and strong voice." Children produced a story narrative at baseline, immediate posttreatment (POST), and at 6-week follow-up (FUP). Outcomes were examined via blinded listener ratings of ease of understanding (n = 108 adult listeners), acoustic analyses, and questionnaires focused on communicative participation. Results SIT resulted in significant increases in ease of understanding at POST, that were maintained at FUP. There were no significant changes to vocal intensity, speech rate, or vowel spectral characteristics, with the exception of an increase in second formant difference between vowels following SIT. Significantly enhanced communicative participation was evident at POST and FUP. Considerable variability in response to SIT was observed between children. Conclusions Dual-focus treatment shows promise for improving intelligibility and communicative participation in children with dysarthria, although responses to treatment vary considerably across children. Possible mechanisms underlying the intelligibility gains, enhanced communicative participation, and variability in treatment effects are discussed.
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Affiliation(s)
- Erika S Levy
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| | - Younghwa M Chang
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| | - KyungHae Hwang
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| | - Megan J McAuliffe
- School of Psychology, Speech and Hearing and New Zealand Institute of Language, Brain and Behaviour, University of Canterbury, Christchurch, New Zealand
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McFadd ED, Hustad KC. Communication Modes and Functions in Children With Cerebral Palsy. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2020; 63:1776-1792. [PMID: 32459163 PMCID: PMC7839031 DOI: 10.1044/2020_jslhr-19-00228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 11/18/2019] [Accepted: 01/04/2020] [Indexed: 06/11/2023]
Abstract
Purpose This study seeks to determine how speech-language impairments relate to the frequency and diversity of communication modes and functions produced by children with cerebral palsy (CP) during interactions with their mothers. Method We studied 40 children with CP (M age = 62 months) comprising three groups: those who were unable to speak and had anarthria (n = 15), those with speech motor impairment and language comprehension impairment (SMI-LCI; n = 15), and those with speech motor impairment and typical language comprehension (SMI-LCT; n = 10). Mother-child play interactions were coded for child modes and functions. Generalized linear regression models were used to examine the relationship between profile group and frequencies of communication modes and functions. Results Results indicated groups SMI-LCI and SMI-LCT had significantly higher mean frequencies of vocalizations, vocalizations + gestures, comments, initiations, and requests than the group of those who were unable to speak and had anarthria. All children used vocalizations primarily, though these vocalizations were often not understood. SMI-LCI and SMI-LCT differed on two measures: frequency of gestures and frequency of initiations. The majority of children in this sample did not have access to augmentative and alternative communication devices. Conclusion Results of this study highlight the need for parent-mediated interventions for children with CP that emphasize multimodal communication tailored to impairment profiles. Supplemental Material https://doi.org/10.23641/asha.12354704.
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Affiliation(s)
- Emily D. McFadd
- Department of Communication Sciences and Disorders, University of Wisconsin–Madison
- Waisman Center, University of Wisconsin–Madison
- MIND Institute, University of California, Davis
| | - Katherine C. Hustad
- Department of Communication Sciences and Disorders, University of Wisconsin–Madison
- Waisman Center, University of Wisconsin–Madison
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Levy ES, Moya-Galé G, Chang YM, Campanelli L, MacLeod AAN, Escorial S, Maillart C. Effects of speech cues in French-speaking children with dysarthria. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2020; 55:401-416. [PMID: 32077196 DOI: 10.1111/1460-6984.12526] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 12/22/2019] [Accepted: 01/19/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Articulatory excursion and vocal intensity are reduced in many children with dysarthria due to cerebral palsy (CP), contributing to the children's intelligibility deficits and negatively affecting their social participation. However, the effects of speech-treatment strategies for improving intelligibility in this population are understudied, especially for children who speak languages other than English. In a cueing study on English-speaking children with dysarthria, acoustic variables and intelligibility improved when the children were provided with cues aimed to increase articulatory excursion and vocal intensity. While French is among the top 20 most spoken languages in the world, dysarthria and its management in French-speaking children are virtually unexplored areas of research. Information gleaned from such research is critical for providing an evidence base on which to provide treatment. AIMS To examine acoustic and perceptual changes in the speech of French-speaking children with dysarthria, who are provided with speech cues targeting greater articulatory excursion (French translation of 'speak with your big mouth') and vocal intensity (French translation of 'speak with your strong voice'). This study investigated whether, in response to the cues, the children would make acoustic changes and listeners would perceive the children's speech as more intelligible. METHODS & PROCEDURES Eleven children with dysarthria due to CP (six girls, five boys; ages 4;11-17;0 years; eight with spastic CP, three with dyskinetic CP) repeated pre-recorded speech stimuli across three speaking conditions (habitual, 'big mouth' and 'strong voice'). Stimuli were sentences and contrastive words in phrases. Acoustic analyses were conducted. A total of 66 Belgian-French listeners transcribed the children's utterances orthographically and rated their ease of understanding on a visual analogue scale at sentence and word levels. OUTCOMES & RESULTS Acoustic analyses revealed significantly longer duration in response to the big mouth cue at sentence level and in response to both the big mouth and strong voice cues at word level. Significantly higher vocal sound-pressure levels were found following both cues at sentence and word levels. Both cues elicited significantly higher first-formant vowel frequencies and listeners' greater ease-of-understanding ratings at word level. Increases in the percentage of words transcribed correctly and in sentence ease-of-understanding ratings, however, did not reach statistical significance. Considerable variability between children was observed. CONCLUSIONS & IMPLICATIONS Speech cues targeting greater articulatory excursion and vocal intensity yield significant acoustic changes in French-speaking children with dysarthria. However, the changes may only aid listeners' ease of understanding at word level. The significant findings and great inter-speaker variability are generally consistent with studies on English-speaking children with dysarthria, although changes appear more constrained in these French-speaking children. What this paper adds What is already known on the subject According to the only study comparing effects of speech-cueing strategies on English-speaking children with dysarthria, intelligibility increases when the children are provided with cues aimed to increase articulatory excursion and vocal intensity. Little is known about speech characteristics in French-speaking children with dysarthria and no published research has explored effects of cueing strategies in this population. What this paper adds to existing knowledge This paper is the first study to examine the effects of speech cues on the acoustics and intelligibility of French-speaking children with CP. It provides evidence that the children can make use of cues to modify their speech, although the changes may only aid listeners' ease of understanding at word level. What are the potential or actual clinical implications of this work? For clinicians, the findings suggest that speech cues emphasizing increasing articulatory excursion and vocal intensity show promise for improving the ease of understanding of words produced by francophone children with dysarthria, although improvements may be modest. The variability in the responses also suggests that this population may benefit from a combination of such cues to produce words that are easier to understand.
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Affiliation(s)
- Erika S Levy
- Program in Communication Sciences and Disorders, Teachers College, Columbia University, New York, NY, USA
| | - Gemma Moya-Galé
- Program in Communication Sciences and Disorders, Teachers College, Columbia University, New York, NY, USA
- Department of Communication Sciences & Disorders, Long Island University, Brooklyn, NY, USA
| | - Younghwa Michelle Chang
- Program in Communication Sciences and Disorders, Teachers College, Columbia University, New York, NY, USA
| | - Luca Campanelli
- Haskins Laboratories, New Haven, CT, USA
- The Graduate Center, CUNY, New York, NY, USA
| | - Andrea A N MacLeod
- Faculty of Rehabilitation Medicine-Communication Sciences and Disorders, University of Alberta, Edmonton, AB, Canada
| | - Sergio Escorial
- Departamento de Psicobiología y Metodología en Ciencias del Comportamiento, Universidad Complutense de Madrid, Madrid, Spain
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Braza MD, Sakash A, Natzke P, Hustad KC. Longitudinal Change in Speech Rate and Intelligibility Between 5 and 7 Years in Children With Cerebral Palsy. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2019; 28:1139-1151. [PMID: 31251882 PMCID: PMC6802916 DOI: 10.1044/2019_ajslp-18-0233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 12/28/2018] [Accepted: 02/20/2019] [Indexed: 06/09/2023]
Abstract
Purpose We examined growth between 5 and 7 years in speech intelligibility, speech rate, and intelligible words per minute (IWPM) in 3 groups of children: those who were typically developing (TD), those with cerebral palsy (CP) and clinical speech motor impairment (SMI), and those with CP and no SMI (NSMI). Method Twenty-six children with CP, 16 with SMI, and 10 with NSMI were each seen at 5, 6, and 7 years of age. A cross-sectional group of 30 age-matched TD children, 10 in each age group, were included as controls. All children produced a corpus of utterances of 2-7 words. Results All groups of children showed increases in intelligibility and IWPM between 5 and 7 years. Only children with SMI showed increases in speech rate over time. Patterns of change were similar for children in the TD and NSMI groups but different for children in the SMI group. Conclusions The window of time between 5 and 7 years is an important period of growth for the production of connected speech where nearly all children, regardless of group, made significant changes in speech intelligibility and IWPM. Interventions focusing specifically on enhancing intelligibility in this age range may help facilitate even further growth in children with SMI, who still had marked intelligibility reductions at 7 years of age.
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Affiliation(s)
- Meredith D. Braza
- Department of Communication Sciences & Disorders, University of Wisconsin–Madison
- Waisman Center, University of Wisconsin–Madison
| | | | | | - Katherine C. Hustad
- Department of Communication Sciences & Disorders, University of Wisconsin–Madison
- Waisman Center, University of Wisconsin–Madison
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Hustad KC, Sakash A, Broman AT, Rathouz PJ. Differentiating Typical From Atypical Speech Production in 5-Year-Old Children With Cerebral Palsy: A Comparative Analysis. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2019; 28:807-817. [PMID: 31306596 PMCID: PMC6802859 DOI: 10.1044/2018_ajslp-msc18-18-0108] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 08/31/2018] [Accepted: 09/19/2018] [Indexed: 05/19/2023]
Abstract
Objective Early diagnosis of speech disorders in children with cerebral palsy (CP) is of critical importance. A key problem is differentiating those with borderline or mild speech motor deficits from those who are within an age-appropriate range of variability. We sought to quantify how well functional speech measures differentiated typically developing (TD) children from children with CP. Method We studied speech production in 45 children with CP (26 with clinical speech motor impairment [SMI] and 19 with no evidence of speech motor impairment [NSMI]) and in 29 TD children of the same age. Speech elicitation tasks were used. Intelligibility, speech rate, and intelligible words per minute were examined. Results All measures differentiated between all 3 groups of children with considerable precision based on area under the receiver operating characteristic curve (AUC) data. AUC was highest for overall intelligibility, which ranged from .88 to .99. Intelligible words per minute also yielded very strong AUCs, ranging from .81 to .99. In each of the receiver operating characteristic models, discrimination between groups was highest for children with speech motor impairment versus TD children. Data indicated that 90% of TD children had overall intelligibility above 87% at 5 years of age, but that no child was 100% intelligible. Furthermore, 90% children with SMI had intelligibility below 72%. Conclusion Findings suggest that functional speech measures differentiate very clearly between children with and without CP and that even children who do not show evidence of speech motor impairment have functional differences in their speech production ability relative to TD peers.
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Affiliation(s)
- Katherine C. Hustad
- Department of Communication Sciences and Disorders, University of Wisconsin–Madison
- Waisman Center, University of Wisconsin–Madison
| | | | - Aimee Teo Broman
- Department of Biostatistics and Medical Informatics, School of Medicine and Public Health, University of Wisconsin–Madison
| | - Paul J. Rathouz
- Waisman Center, University of Wisconsin–Madison
- Department of Biostatistics and Medical Informatics, School of Medicine and Public Health, University of Wisconsin–Madison
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Hustad KC, Sakash A, Natzke PEM, Broman AT, Rathouz PJ. Longitudinal Growth in Single Word Intelligibility Among Children With Cerebral Palsy From 24 to 96 Months of Age: Predicting Later Outcomes From Early Speech Production. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2019; 62:1599-1613. [PMID: 31112444 PMCID: PMC6808366 DOI: 10.1044/2018_jslhr-s-18-0319] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 10/23/2018] [Accepted: 12/27/2018] [Indexed: 05/19/2023]
Abstract
Purpose Children with cerebral palsy (CP) are at risk for significant communication problems. Reduced speech intelligibility is common, even for those who do not have speech motor deficits. Development of intelligibility has not been comprehensively quantified in children with CP; as a result, we are currently unable to predict later speech outcomes. Such information would advance treatment decision making. We sought to examine growth in speech intelligibility among children with CP using a prospective longitudinal design, with a focus on age of crossing target intelligibility thresholds, age of greatest intelligibility growth, and how well intelligibility at 36 months predicted intelligibility at 96 months. Method Sixty-nine children with CP were followed longitudinally between 24 and 96 months of age. A total of 566 time points were examined across children ( M = 8.2 time points per child, SD = 2.6). We fitted a nonlinear random effects model for longitudinal observations and then used the fitted model trajectories to generate descriptive analyses of growth. We used results of the model to generate a set of simulations, which we analyzed to determine how well 36-month intelligibility data predicted 96-month data. Results Half of children crossed 25% and 50% intelligibility thresholds at 36 and 49 months of age, respectively. Slightly more than half of children did not reach 75% intelligibility by 96 months of age. Age of crossing 25%, 50%, and 75% intelligibility thresholds was highly negatively correlated with intelligibly at 96 months. Children had the steepest intelligibility growth at 36 months, followed by 48 and 60 months. Intelligibility at 36 months was highly predictive of intelligibility at 96 months. Conclusions The developmental window from 3 to 5 years constitutes a time of rapid growth in speech intelligibility in children with CP. Children who cross intelligibility thresholds of 25%, 50%, and 75% at earlier ages have better outcomes when they are older; early performance is highly predictive of later speech intelligibility outcomes. Children with CP as a group have delayed speech intelligibility development but are still growing through 96 months of age.
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Affiliation(s)
- Katherine C. Hustad
- Department of Communication Sciences and Disorders, University of Wisconsin–Madison
- Waisman Center, University of Wisconsin–Madison
| | | | | | - Aimee Teo Broman
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison
| | - Paul J. Rathouz
- Waisman Center, University of Wisconsin–Madison
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison
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Pennington L, Hustad KC. Construct Validity of the Viking Speech Scale. Folia Phoniatr Logop 2019; 71:228-237. [PMID: 31189170 DOI: 10.1159/000499926] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 03/21/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The Viking Speech Scale (VSS) reliably classifies the speech performance of children with cerebral palsy. This paper aims to establish the construct validity of the VSS by testing the extent to which percentage intelligibility in single word speech and connected speech predicts VSS rating. PATIENTS AND METHODS This is a secondary analysis of two sets of anonymised data collected for previous research. The full data set comprised 79 children with cerebral palsy from the US (n = 43) and the UK (n = 36): (43 boys, 36 girls); mean age 7.2 years (SD 3.3). Single word intelligibility was measured using the TOCS+ words for US children and Children's Speech Intelligibility Measure for the UK children. Connected speech intelligibility was measured from a subset of repeated sentences in TOCS+ for US children and picture description for the UK children. We used ordinal logistic regression to examine prediction of VSS rating by percentage single word and connected speech intelligibility scores in both samples. RESULTS Percentage single word intelligibility and connected speech intelligibility predicted VSS rating in univariate and multivariate regression models for both the US and UK samples. CONCLUSION Intelligibility predicts VSS for both single words and connected speech, establishing the construct validity of VSS.
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Affiliation(s)
- Lindsay Pennington
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom,
| | - Katherine C Hustad
- Department of Communication Sciences and Disorders, University of Wisconsin, Madison, Wisconsin, USA.,Waisman Center, University of Wisconsin, Madison, Wisconsin, USA
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Pennington L, Rauch R, Smith J, Brittain K. Views of children with cerebral palsy and their parents on the effectiveness and acceptability of intensive speech therapy. Disabil Rehabil 2019; 42:2935-2943. [PMID: 30925074 DOI: 10.1080/09638288.2019.1577504] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Purpose: To understand children and parents' views of the effectiveness and acceptability of intensive dysarthria therapy.Materials and Methods: Twenty-two children with cerebral palsy and dysarthria joined a pilot RCT comparing intensive therapy and usual care. Children (n = 11) allocated to dysarthria therapy comprising three 40-minute sessions per week for six weeks and their parents (n = 11) were interviewed two weeks before and six weeks after therapy. Interviews were transcribed verbatim and analysed thematically.Results: Analysis revealed five themes: Motivations, My new voice; The new me; I can do more; Success rooted in therapy design. Children had received little therapy for speech and were keen to improve intelligibility. Overall, therapy was viewed as effective. Participants described changes in children's speech production, which they associated with increased speech intelligibility. Children were described as more confident following the therapy, to have more successful conversations, with a wider range of partners in more environments, thereby increasing their social participation. The programme was viewed as acceptable, despite its intensity, due to the short term commitment and wider benefits for the child. Parents valued the organised structure and individualisation of the programme and inclusion in the therapy process.Conclusion: Families found the intervention acceptable and effective. A definitive trial of its clinical effectiveness is warranted.Implications for rehabilitationChildren with cerebral palsy who have dysarthria and their parents reported that intensive speech therapy focussing on creating a stronger voice and a steady speech rate increased the clarity of children's voice and the intelligibility of their speech.Therapy may have additional benefits for children's self-confidence and social participation.The programme of therapy comprising three sessions per week for six weeks was seen as manageable by families in view of the results achieved.
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Affiliation(s)
- Lindsay Pennington
- Institute of Health and Society, Sir James Spence Institute, Royal Victoria Infirmary, Newcastle University, Newcastle Upon Tyne, UK
| | - Rosie Rauch
- Institute of Health and Society, Sir James Spence Institute, Royal Victoria Infirmary, Newcastle University, Newcastle Upon Tyne, UK
| | - Johanna Smith
- Institute of Health and Society, Sir James Spence Institute, Royal Victoria Infirmary, Newcastle University, Newcastle Upon Tyne, UK
| | - Katie Brittain
- Department of Nursing, Midwifery & Health, Northumbria University, Newcastle Upon Tyne, UK
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Pennington L, Stamp E, Smith J, Kelly H, Parker N, Stockwell K, Aluko P, Othman M, Brittain K, Vale L. Internet delivery of intensive speech and language therapy for children with cerebral palsy: a pilot randomised controlled trial. BMJ Open 2019; 9:e024233. [PMID: 30705241 PMCID: PMC6359732 DOI: 10.1136/bmjopen-2018-024233] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 11/16/2018] [Accepted: 11/19/2018] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVES To test the feasibility of recruitment, retention, outcome measures and internet delivery of dysarthria therapy for young people with cerebral palsy in a randomised controlled trial. DESIGN Mixed methods. Single blind pilot randomised controlled trial, with control offered Skype therapy at end of study. Qualitative study of the acceptability of therapy delivery via Skype. SETTING Nine speech and language therapy departments in northern England recruited participants to the study. Skype therapy was provided in a university setting. PARTICIPANTS Twenty-two children (14 M, 8 F) with dysarthria and cerebral palsy (mean age 8.8 years (SD 3.2)) agreed to take part. Participants were randomised to dysarthria therapy via Skype (n=11) or treatment as usual (n=11). INTERVENTIONS Children received either usual speech therapy from their local therapist for 6 weeks or dysarthria therapy via Skype from a research therapist. Usual therapy sessions varied in frequency, duration and content. Skype dysarthria therapy focused on breath control and phonation to produce clear speech at a steady rate, and comprised three 40 min sessions per week for 6 weeks. PRIMARY AND SECONDARY OUTCOME MEASURES Feasibility and acceptability of the trial design, intervention and outcome measures. RESULTS Departments recruited two to three participants. All participants agreed to random allocation. None withdrew from the study. Recordings of children's speech were made at all time points and rated by listeners. Families allocated to Skype dysarthria therapy judged internet delivery of the therapy to be acceptable. All families reported that the study design was acceptable. Treatment integrity checks suggested that the phrases practised in one therapy exercise should be reduced in length. CONCLUSIONS A delayed treatment design, in which dysarthria therapy is offered at the end of the study to families allocated to treatment as usual, is acceptable. A randomised controlled trial of internet delivered dysarthria therapy is feasible.
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Affiliation(s)
- Lindsay Pennington
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Elaine Stamp
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Johanna Smith
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Helen Kelly
- Speech and Language Therapy, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Naomi Parker
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Katy Stockwell
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Patricia Aluko
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | | | - Katie Brittain
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, UK
| | - Luke Vale
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
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