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Chang YM, Jeong PY, Hwang K, Ihn BY, McAuliffe MJ, Sim H, Levy ES. Effects of Speech Cues on Acoustics and Intelligibility of Korean-Speaking Children With Cerebral Palsy. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2024; 67:2856-2871. [PMID: 38573834 DOI: 10.1044/2024_jslhr-23-00457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
PURPOSE Reduced speech intelligibility is often a hallmark of children with dysarthria secondary to cerebral palsy (CP), but effects of speech strategies for increasing intelligibility are understudied, especially in children who speak languages other than English. This study examined the effects of (the Korean translation of) two cues, "speak with your big mouth" and "speak with your strong voice," on speech acoustics and intelligibility of Korean-speaking children with CP. METHOD Fifteen Korean-speaking children with CP repeated words and sentences in habitual, big mouth, and strong voice conditions. Acoustic analyses were performed and intelligibility was assessed by means of 90 blinded listeners' ease-of-understanding (EoU) ratings and percentage of words correctly transcribed (PWC). RESULTS In response to both cues, children's vocal intensity and utterance duration increased significantly and differentially, whereas their vowel space area gains did not reach statistical significance. EoU increased significantly in the big mouth condition at word, but not sentence, level, whereas in the strong voice condition, EoU increased significantly at both levels. PWC increases were not statistically significant. Considerable variability in children's responses to cues was noted overall. CONCLUSIONS Korean-speaking children with CP modify their speech styles differentially when provided with cues aimed to increase their articulatory working space and vocal intensity. The results provide preliminary support for the use of the strong voice cue, in particular, to increase EoU. While the findings do not offer conclusive evidence of the intelligibility benefits of these cues, investigation with a larger sample size should provide further insight into optimal cueing strategies for increasing intelligibility in this population. Implications for language-specific versus language-independent treatment approaches are discussed. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.25521052.
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Affiliation(s)
| | - Pil-Yeon Jeong
- Ewha Womans University Center for Child Development and Disability, Seoul, South Korea
| | | | - Bo-Yeon Ihn
- Teachers College, Columbia University, New York, NY
| | | | | | - Erika S Levy
- Teachers College, Columbia University, New York, NY
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Morison LD, Kennis MGP, Rots D, Bouman A, Kummeling J, Palmer E, Vogel AP, Liegeois F, Brignell A, Srivastava S, Frazier Z, Milnes D, Goel H, Amor DJ, Scheffer IE, Kleefstra T, Morgan AT. Expanding the phenotype of Kleefstra syndrome: speech, language and cognition in 103 individuals. J Med Genet 2024; 61:578-585. [PMID: 38290825 PMCID: PMC11148766 DOI: 10.1136/jmg-2023-109702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 01/18/2024] [Indexed: 02/01/2024]
Abstract
OBJECTIVES Speech and language impairments are core features of the neurodevelopmental genetic condition Kleefstra syndrome. Communication has not been systematically examined to guide intervention recommendations. We define the speech, language and cognitive phenotypic spectrum in a large cohort of individuals with Kleefstra syndrome. METHOD 103 individuals with Kleefstra syndrome (40 males, median age 9.5 years, range 1-43 years) with pathogenic variants (52 9q34.3 deletions, 50 intragenic variants, 1 balanced translocation) were included. Speech, language and non-verbal communication were assessed. Cognitive, health and neurodevelopmental data were obtained. RESULTS The cognitive spectrum ranged from average intelligence (12/79, 15%) to severe intellectual disability (12/79, 15%). Language ability also ranged from average intelligence (10/90, 11%) to severe intellectual disability (53/90, 59%). Speech disorders occurred in 48/49 (98%) verbal individuals and even occurred alongside average language and cognition. Developmental regression occurred in 11/80 (14%) individuals across motor, language and psychosocial domains. Communication aids, such as sign and speech-generating devices, were crucial for 61/103 (59%) individuals including those who were minimally verbal, had a speech disorder or following regression. CONCLUSIONS The speech, language and cognitive profile of Kleefstra syndrome is broad, ranging from severe impairment to average ability. Genotype and age do not explain the phenotypic variability. Early access to communication aids may improve communication and quality of life.
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Affiliation(s)
- Lottie D Morison
- Speech and Language, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Audiology and Speech Pathology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Milou G P Kennis
- Department of Clinical Genetics, Radboudumc, Nijmegen, Netherlands
| | - Dmitrijs Rots
- Department of Clinical Genetics, Erasmus MC, Rotterdam, Netherlands
| | - Arianne Bouman
- Department of Clinical Genetics, Radboudumc, Nijmegen, Netherlands
| | - Joost Kummeling
- Department of Clinical Genetics, Radboudumc, Nijmegen, Netherlands
| | - Elizabeth Palmer
- Sydney Children's Hospital Network, Randwick, New South Wales, Australia
- Discipline of Paediatrics and Child Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Adam P Vogel
- Department of Audiology and Speech Pathology, The University of Melbourne, Melbourne, Victoria, Australia
- Redenlab, Melbourne, Victoria, Australia
| | - Frederique Liegeois
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Amanda Brignell
- Department of Paediatrics, Monash University, Clayton, Victoria, Australia
- Department of Developmental Paediatrics, Monash Children's Hospital, Clayton, Victoria, Australia
| | | | - Zoe Frazier
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Di Milnes
- Genetic Health Queensland, Herston, Queensland, Australia
| | - Himanshu Goel
- Hunter Genetics, Waratah, New South Wales, Australia
| | - David J Amor
- Speech and Language, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Ingrid E Scheffer
- Melbourne Brain Centre, Austin Health, Heidelberg, Victoria, Australia
- The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
| | - Tjitske Kleefstra
- Department of Clinical Genetics, Radboudumc, Nijmegen, Netherlands
- Department of Clinical Genetics, Erasmus MC, Rotterdam, Netherlands
| | - Angela T Morgan
- Speech and Language, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Audiology and Speech Pathology, The University of Melbourne, Melbourne, Victoria, Australia
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Hahn Arkenberg RE, Mitchell SS, Craig BΑ, Brown B, Burdo-Hartman W, Lundine JP, Goffman L, Smith A, Malandraki GA. Neuromuscular adaptations of swallowing and speech in unilateral cerebral palsy: shared and distinctive traits. J Neurophysiol 2023; 130:1375-1391. [PMID: 37877193 PMCID: PMC11068406 DOI: 10.1152/jn.00502.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 10/02/2023] [Accepted: 10/19/2023] [Indexed: 10/26/2023] Open
Abstract
Our aims were to 1) examine the neuromuscular control of swallowing and speech in children with unilateral cerebral palsy (UCP) compared with typically developing children (TDC), 2) determine shared and separate neuromuscular underpinnings of the two functions, and 3) explore the relationship between this control and behavioral outcomes in UCP. Surface electromyography (sEMG) was used to record muscle activity from the submental and superior and inferior orbicularis oris muscles during standardized swallowing and speech tasks. The variables examined were normalized mean amplitude, time to peak amplitude, and bilateral synchrony. Swallowing and speech were evaluated using standard clinical measures. Sixteen children with UCP and 16 TDC participated (7-12 yr). Children with UCP demonstrated higher normalized mean amplitude and longer time to peak amplitude across tasks than TDC (P < 0.01; and P < 0.02) and decreased bilateral synchrony than TDC for swallows (P < 0.01). Both shared and distinctive neuromuscular patterns were observed between swallowing and speech. In UCP, higher upper lip amplitude during swallows was associated with shorter normalized mealtime durations, whereas higher submental bilateral synchrony was related to longer mealtime durations. Children with UCP demonstrate neuromuscular adaptations for swallowing and speech, which should be further evaluated for potential treatment targets. Furthermore, both shared and distinctive neuromuscular underpinnings between the two functions are documented.NEW & NOTEWORTHY Systematically studying the swallowing and speech of children with UCP is new and noteworthy. We found that they demonstrate neuromuscular adaptations for swallowing and speech compared with typically developing peers. We examined swallowing and speech using carefully designed tasks, similar in motor complexity, which allowed us to directly compare patterns. We found shared and distinctive neuromuscular patterns between swallowing and speech.
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Affiliation(s)
- Rachel E Hahn Arkenberg
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, Indiana, United States
| | - Samantha S Mitchell
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, Indiana, United States
| | - Bruce Α Craig
- Department of Statistics, Purdue University, West Lafayette, Indiana, United States
| | - Barbara Brown
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, Indiana, United States
| | - Wendy Burdo-Hartman
- Nationwide Children's Hospital, Columbus, Ohio, United States
- Department of Pediatrics, College of Medicine, Ohio State University, Columbus, Ohio, United States
| | - Jennifer P Lundine
- Nationwide Children's Hospital, Columbus, Ohio, United States
- Department of Speech & Hearing Sciences, Ohio State University, Columbus, Ohio, United States
| | - Lisa Goffman
- Callier Center for Communication Disorders, School of Behavioral and Brain Sciences, University of Texas at Dallas, Dallas Texas, United States
| | - Anne Smith
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, Indiana, United States
| | - Georgia A Malandraki
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, Indiana, United States
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana, United States
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Darling-White M, Polkowitz R. Sentence Length Effects on Intelligibility in Two Groups of Older Children With Neurodevelopmental Disorders. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:2297-2310. [PMID: 37625147 PMCID: PMC10567119 DOI: 10.1044/2023_ajslp-23-00093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/16/2023] [Accepted: 06/16/2023] [Indexed: 08/27/2023]
Abstract
PURPOSE The purpose of this study was to examine the impact of sentence length on intelligibility in two groups of older children with neurodevelopmental disabilities. METHOD Nine children diagnosed with cerebral palsy (CP) and eight children diagnosed with Down syndrome (DS), between the ages of 8 and 17 years, repeated sentences varying in length from two to seven words. Three hundred forty adult listeners (20 listeners per child) provided orthographic transcriptions of children's speech, which were used to calculate intelligibility scores. RESULTS There was a significant main effect of sentence length on intelligibility for children with CP. Intelligibility significantly increased from two- and three-word sentences to four-, five-, and six-word sentences, then significantly decreased from four-, five-, and six-word sentences to seven-word sentences. There was a main effect of sentence length on intelligibility for children with DS. Intelligibility significantly increased from two-word sentences to four-, five-, and six-word sentences. CONCLUSIONS The primary findings of this study include the following: (a) Unlike in typically developing children, sentence length continues to influence intelligibility well into adolescence for children with neurodevelopmental disorders, and (b) sentence length may influence intelligibility differently in children with CP than in children with DS; however, other factors besides the type of neurodevelopmental disorder (e.g., severity of speech motor involvement and/or cognitive-linguistic impairment) could play a role in the relationship between sentence length and intelligibility and must be investigated in future studies.
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Affiliation(s)
- Meghan Darling-White
- Department of Speech, Language, and Hearing Sciences, The University of Arizona, Tucson
| | - Rachel Polkowitz
- Department of Speech, Language, and Hearing Sciences, The University of Arizona, Tucson
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Korkalainen J, McCabe P, Smidt A, Morgan C. Motor Speech Interventions for Children With Cerebral Palsy: A Systematic Review. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:110-125. [PMID: 36623233 DOI: 10.1044/2022_jslhr-22-00375] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
PURPOSE Dysarthria is common among children with cerebral palsy (CP) and results in poor speech intelligibility and subsequently low communicative participation. Neuroplasticity evidence suggests that adherence to principles of motor learning (PML) improves motor speech intervention outcomes. Motor speech interventions aim to improve speech intelligibility and ultimately facilitate participation, but the effectiveness of these interventions and their inclusion of PML are not clear. Aims are as follows: (a) evaluate the effectiveness motor speech interventions in improving speech intelligibility; (b) summarize the aims, outcome measures, and outcomes relating to the International Classification of Functioning and Disability Child and Youth; and (c) summarize the principles of motor learning used in the intervention. METHOD Eight databases were searched, complemented by a hand search. Studies of any level of evidence were included if they used a motor speech intervention and measured speech in children with CP aged 0-18 years. Studies before 2000 or not in English were excluded. The review was conducted and reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Study quality was rated using the Single Case Experimental Design Scale and Physiotherapy Evidence Database-P rating scales. The strength of evidence was evaluated with Grading of Recommendations, Assessment, Development and Evaluation. RESULTS Of 1,036 initial articles, 21 were included. Eight interventions were identified including 131 participants aged 3-18 years. All studies aimed to improve speech intelligibility or articulation and reported improvement at sound, word, or sentence level. One study reported improvements in communicative participation. The strength of evidence ranged from very low to moderate for one intervention. Adherence to PML was inconsistent. CONCLUSIONS The quality of evidence is very low to moderate. More research on motor speech interventions that adhere to PML is required. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.21817959.
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Affiliation(s)
| | - Patricia McCabe
- The University of Sydney, Camperdown, New South Wales, Australia
| | - Andy Smidt
- The University of Sydney, Camperdown, New South Wales, Australia
| | - Catherine Morgan
- Cerebral Palsy Alliance Research Institute, Brain Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
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Fiori S, Ragoni C, Podda I, Chilosi A, Amador C, Cipriani P, Guzzetta A, Sgandurra G. PROMPT to improve speech motor abilities in children with cerebral palsy: a wait-list control group trial protocol. BMC Neurol 2022; 22:246. [PMID: 35794522 PMCID: PMC9258135 DOI: 10.1186/s12883-022-02771-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 06/27/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Children with cerebral palsy (CP) often have communication impairments, including speech altered intelligibility. Multiple levels of disrupted speech have been reported in CP, which negatively impact on participation and quality of life, with increase of care needs. Augmentative Alternative Communication (AAC) is an option, with debated benefits and limitations, in particular for its functional use. This is supported by a substantial lack of defined evidences in favor of direct speech articulation intervention in CP. Motor learning-based interventions are effective in CP and are the basis of speech motor interventions such as PROMPT (Prompts for Restructuring Oral Muscular Phonetic Targets). The PROMPT speech motor treatment provides tactile-kinesthetic inputs to facilitate articulatory movements by dynamic modelling, resulting in more efficient motor patterns that can be integrated into speech and communication. In CP, exploratory evidences support the feasibility and preliminarily advantages on intelligibility of motor speech treatments, such as PROMPT, with increased speech motor control, also documented by kinematic analyses. METHODS A randomized waitlist-control trial will be conducted in children aged between 3- and 10-years having CP and dysarthria (estimated sample size = 60 children). Children will be allocated in the immediate intervention or in the waitlist control group. The intervention consists of an intensive 3 weeks period of twice-a-day administration of PROMPT. Standard care will be administered in the control (waitlist) group. After repeated baseline assessments (T0), the PROMPT treated group will undergo the experimental 3-week intervention period, with T1 assessment at the end. A further T2 assessment will be provided at medium term (3 months after the end of the intervention) for evaluating the stability of intervention. Primary and secondary speech clinical and kinematics outcome measures will be collected at T0, T1 and T2. DISCUSSION This paper describes the study protocol consisting of a RCT with two main objectives: (1) to evaluate the or short-term benefits of an intensive speech motor intervention on speech and intelligibility in children with CP and the stability of the intervention at medium term; (2) to describe the kinematic correlates of speech motor control modifications. TRIAL REGISTRATION Trial registration date 06/12/2019; ClinicalTrials.gov Identifier: NCT04189159 .
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Affiliation(s)
- S Fiori
- IRCCS Stella Maris Foundation, Pisa, Italy.
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
| | - C Ragoni
- IRCCS Stella Maris Foundation, Pisa, Italy
| | - I Podda
- Parole al Centro Studio di Logopedia, Genoa, Italy
| | - A Chilosi
- IRCCS Stella Maris Foundation, Pisa, Italy
| | - C Amador
- IRCCS Stella Maris Foundation, Pisa, Italy
| | - P Cipriani
- IRCCS Stella Maris Foundation, Pisa, Italy
| | - A Guzzetta
- IRCCS Stella Maris Foundation, Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - G Sgandurra
- IRCCS Stella Maris Foundation, Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Morison LD, Braden RO, Amor DJ, Brignell A, van Bon BWM, Morgan AT. Social motivation a relative strength in DYRK1A syndrome on a background of significant speech and language impairments. Eur J Hum Genet 2022; 30:800-811. [PMID: 35437318 PMCID: PMC9259653 DOI: 10.1038/s41431-022-01079-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/10/2022] [Accepted: 02/24/2022] [Indexed: 11/09/2022] Open
Abstract
Speech and language impairments are commonly reported in DYRK1A syndrome. Yet, speech and language abilities have not been systematically examined in a prospective cohort study. Speech, language, social behaviour, feeding, and non-verbal communication skills were assessed using standardised tools. The broader health and medical phenotype was documented using caregiver questionnaires, interviews and confirmation with medical records. 38 individuals with DYRK1A syndrome (23 male, median age 8 years 3 months, range 1 year 7 months to 25 years) were recruited. Moderate to severe intellectual disability (ID), autism spectrum disorder (ASD), vision, motor and feeding impairments were common, alongside epilepsy in a third of cases. Speech and language was disordered in all participants. Many acquired some degree of verbal communication, yet few (8/38) developed sufficient oral language skills to rely solely on verbal communication. Speech was characterised by severe apraxia and dysarthria in verbal participants, resulting in markedly poor intelligibility. Those with limited verbal language (30/38) used a combination of sign and graphic augmentative and alternative communication (AAC) systems. Language skills were low across expressive, receptive, and written domains. Most had impaired social behaviours (25/29). Restricted and repetitive interests were most impaired, whilst social motivation was a relative strength. Few individuals with DYRK1A syndrome use verbal speech as their sole means of communication, and hence, all individuals need early access to tailored, graphic AAC systems to support their communication. For those who develop verbal speech, targeted therapy for apraxia and dysarthria should be considered to improve intelligibility and, consequently, communication autonomy.
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Affiliation(s)
- Lottie D Morison
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Ruth O Braden
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - David J Amor
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
- The University of Melbourne, Melbourne, VIC, Australia
- Royal Children's Hospital, Melbourne, VIC, Australia
| | - Amanda Brignell
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Monash University, Melbourne, VIC, Australia
- Australian Catholic University, Melbourne, VIC, Australia
| | | | - Angela T Morgan
- Murdoch Children's Research Institute, Melbourne, VIC, Australia.
- The University of Melbourne, Melbourne, VIC, Australia.
- Royal Children's Hospital, Melbourne, VIC, Australia.
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Icht M. Improving speech characteristics of young adults with congenital dysarthria: An exploratory study comparing articulation training and the Beatalk method. JOURNAL OF COMMUNICATION DISORDERS 2021; 93:106147. [PMID: 34461556 DOI: 10.1016/j.jcomdis.2021.106147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 08/06/2021] [Accepted: 08/16/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION This exploratory study compared the effects of two speech therapy approaches on speech characteristics of young adults with congenital dysarthria resulting from various etiologies: a) articulation training focusing on consonant articulation exercises at various levels (isolation, syllables, and words), and b) the Beatalk method, based on human beatboxing, i.e., producing various instrumental sounds in an a-cappella musical context. Both interventions were designed to increase participants' speech intelligibility. METHODS Twelve adults with congenital dysarthria and reduced speech intelligibility participated in treatment groups for eight weeks. Six participants were assigned to the articulation training group, and six to the Beatalk group. Intelligibility of single words and continuous speech, voice measures, and oral-diadochokinesis rates were measured before and after the treatment. RESULTS The results showed that the Beatalk intervention yielded a significant overall pre- to post-treatment effect. Specifically, it resulted in gains in articulatory accuracy and intelligibility for single words. Improvements were not noted following articulation training. CONCLUSIONS The results present initial evidence of the positive effect of the Beatalk method as an intervention tool for adults with congenital dysarthria. This relatively easy-to-learn technique shows promise, as it involves intense and repetitive production of speech sounds while controlling rhythm and breathing in an enjoyable context.
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Affiliation(s)
- Michal Icht
- Department of Communication Disorders, Ariel University 40700, Israel.
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Sakash A, Mahr TJ, Natzke PEM, Hustad KC. Effects of Rate Manipulation on Intelligibility in Children With Cerebral Palsy. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:127-141. [PMID: 31869242 PMCID: PMC7231911 DOI: 10.1044/2019_ajslp-19-0047] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 06/26/2019] [Accepted: 08/22/2019] [Indexed: 05/29/2023]
Abstract
Purpose We evaluated the effects of a speech supplementation strategy to reduce rate and improve intelligibility in children with cerebral palsy. Method Twenty-five children with cerebral palsy (M age = 12.08 years) completed a structured speaking task in 2 speech conditions: habitual speech and slow speech. Fifteen children had mild intelligibility deficits; 10 had moderate-severe intelligibility deficits. In each condition, children repeated utterances of 2-7 words in length. In the habitual speech condition, children used their natural and unaltered speaking rate. In the slow speech condition, children were cued to insert pauses between words. Intelligibility ratings were obtained from orthographic transcriptions by unfamiliar adult listeners (n = 100). Speech rate, in words per minute, was measured for each utterance. Results All children, regardless of severity group, were able to reduce their rate of speech when implementing the slow speech strategy. Only children in the moderate-severe group showed an improvement in intelligibility when implementing the slow speech strategy. Although there was considerable individual variability, there was a greater improvement in intelligibility for longer utterances compared to shorter ones. Conclusion A slow speech strategy may be beneficial for children with moderate-severe intelligibility deficits who speak in longer utterances. Future studies should seek to further examine the clinical feasibility of slow speech for children with reduced intelligibility.
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Affiliation(s)
| | | | | | - Katherine C. Hustad
- Waisman Center, University of Wisconsin–Madison
- Department of Communication Sciences and Disorders, University of Wisconsin–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, 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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12
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Morgan AT, Haaften LV, van Hulst K, Edley C, Mei C, Tan TY, Amor D, Fisher SE, Koolen DA. Early speech development in Koolen de Vries syndrome limited by oral praxis and hypotonia. Eur J Hum Genet 2017; 26:75-84. [PMID: 29225339 DOI: 10.1038/s41431-017-0035-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 10/10/2017] [Accepted: 10/17/2017] [Indexed: 11/10/2022] Open
Abstract
Communication disorder is common in Koolen de Vries syndrome (KdVS), yet its specific symptomatology has not been examined, limiting prognostic counselling and application of targeted therapies. Here we examine the communication phenotype associated with KdVS. Twenty-nine participants (12 males, 4 with KANSL1 variants, 25 with 17q21.31 microdeletion), aged 1.0-27.0 years were assessed for oral-motor, speech, language, literacy, and social functioning. Early history included hypotonia and feeding difficulties. Speech and language development was delayed and atypical from onset of first words (2; 5-3; 5 years of age on average). Speech was characterised by apraxia (100%) and dysarthria (93%), with stuttering in some (17%). Speech therapy and multi-modal communication (e.g., sign-language) was critical in preschool. Receptive and expressive language abilities were typically commensurate (79%), both being severely affected relative to peers. Children were sociable with a desire to communicate, although some (36%) had pragmatic impairments in domains, where higher-level language was required. A common phenotype was identified, including an overriding 'double hit' of oral hypotonia and apraxia in infancy and preschool, associated with severely delayed speech development. Remarkably however, speech prognosis was positive; apraxia resolved, and although dysarthria persisted, children were intelligible by mid-to-late childhood. In contrast, language and literacy deficits persisted, and pragmatic deficits were apparent. Children with KdVS require early, intensive, speech motor and language therapy, with targeted literacy and social language interventions as developmentally appropriate. Greater understanding of the linguistic phenotype may help unravel the relevance of KANSL1 to child speech and language development.
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Affiliation(s)
- Angela T Morgan
- Murdoch Childrens Research Institute, Melbourne, Australia. .,Department of Speech Pathology and Audiology, University of Melbourne, Melbourne, Australia. .,Royal Children's Hospital, Melbourne, Australia.
| | - Leenke van Haaften
- Donders Centre for Neuroscience, Department of Rehabilitation, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Karen van Hulst
- Donders Centre for Neuroscience, Department of Rehabilitation, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Carol Edley
- Cook Children's Medical Centre, Fort Worth, TX, USA
| | - Cristina Mei
- Murdoch Childrens Research Institute, Melbourne, Australia
| | - Tiong Yang Tan
- Victorian Clinical Genetics Services, Murdoch Childrens Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - David Amor
- Murdoch Childrens Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Simon E Fisher
- Language and Genetics Department, Max Planck Institute for Psycholinguistics, Nijmegen, The Netherlands.,Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - David A Koolen
- Department of Human Genetics, Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
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13
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Lampe R, Blumenstein T, Turova V, Alves-Pinto A. Mobile communication jacket for people with severe speech impairment. Disabil Rehabil Assist Technol 2017; 13:280-286. [PMID: 28447491 DOI: 10.1080/17483107.2017.1319427] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Cerebral palsy is a movement disorder caused by damage to motor control areas of the developing brain during early childhood. Motor disorders can also affect the ability to produce clear speech and to communicate. The aim of this study was to develop and to test a prototype of an assistive tool with an embedded mobile communication device to support patients with severe speech impairments. METHODS A prototype was developed by equipping a cycling jacket with a display, a small keyboard, a LED and an alarm system, all controlled by a microcontroller. Functionality of the prototype was tested in six participants (aged 7-20 years) with cerebral palsy and global developmental disorder and three healthy persons. A patient questionnaire consisting of seven items was used as an evaluation tool. RESULTS A working prototype of the communication jacket was developed and tested. The questionnaire elicited positive responses from participants. Improvements to correct revealed weaknesses were proposed. Enhancements like voice output of pre-selected phrases and enlarged display were implemented. CONCLUSIONS Integration in a jacket makes the system mobile and continuously available to the user. The communication jacket may be of great benefit to patients with motor and speech impairments. Implications for Rehabilitation The communication jacket developed can be easily used by people with movement and speech impairment. All technical components are integrated in a garment and do not have to be held with the hands or transported separately. The system is adaptable to individual use. Both expected and unexpected events can be dealt with, which contributes to the quality of life and self-fulfilment.
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Affiliation(s)
- Renée Lampe
- a Research Unit of the Buhl-Strohmaier-Foundation for Paediatric Neuro-Orthopaedics and Cerebral Palsy of the Clinic for Orthopaedics and Sports Orthopaedics , Clinic 'rechts der Isar' of the Technical University of Munich , Munich , Germany.,b Markus Würth Professor Fellowship , Clinic 'rechts der Isar' of the Technical University of Munich , Munich , Germany
| | - Tobias Blumenstein
- a Research Unit of the Buhl-Strohmaier-Foundation for Paediatric Neuro-Orthopaedics and Cerebral Palsy of the Clinic for Orthopaedics and Sports Orthopaedics , Clinic 'rechts der Isar' of the Technical University of Munich , Munich , Germany
| | - Varvara Turova
- a Research Unit of the Buhl-Strohmaier-Foundation for Paediatric Neuro-Orthopaedics and Cerebral Palsy of the Clinic for Orthopaedics and Sports Orthopaedics , Clinic 'rechts der Isar' of the Technical University of Munich , Munich , Germany
| | - Ana Alves-Pinto
- a Research Unit of the Buhl-Strohmaier-Foundation for Paediatric Neuro-Orthopaedics and Cerebral Palsy of the Clinic for Orthopaedics and Sports Orthopaedics , Clinic 'rechts der Isar' of the Technical University of Munich , Munich , Germany
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14
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Turner SJ, Brown A, Arpone M, Anderson V, Morgan AT, Scheffer IE. Dysarthria and broader motor speech deficits in Dravet syndrome. Neurology 2017; 88:743-749. [PMID: 28148630 DOI: 10.1212/wnl.0000000000003635] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 11/23/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To analyze the oral motor, speech, and language phenotype in 20 children and adults with Dravet syndrome (DS) associated with mutations in SCN1A. METHODS Fifteen verbal and 5 minimally verbal DS patients with SCN1A mutations (aged 15 months-28 years) underwent a tailored assessment battery. RESULTS Speech was characterized by imprecise articulation, abnormal nasal resonance, voice, and pitch, and prosody errors. Half of verbal patients had moderate to severely impaired conversational speech intelligibility. Oral motor impairment, motor planning/programming difficulties, and poor postural control were typical. Nonverbal individuals had intentional communication. Cognitive skills varied markedly, with intellectual functioning ranging from the low average range to severe intellectual disability. Language impairment was congruent with cognition. CONCLUSIONS We describe a distinctive speech, language, and oral motor phenotype in children and adults with DS associated with mutations in SCN1A. Recognizing this phenotype will guide therapeutic intervention in patients with DS.
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Affiliation(s)
- Samantha J Turner
- From the Department of Paediatrics, The University of Melbourne (S.J.T., M.A., V.A., A.T.M., I.E.S.), and Department of Psychology (V.A.), The Royal Children's Hospital; Neuroscience of Speech Group, Clinical Sciences Theme (S.J.T., A.T.M.), Australian Centre for Child Neuropsychological Studies (A.B., M.A., V.A.), Murdoch Childrens Research Institute, Melbourne; Epilepsy Research Centre, Department of Medicine (I.E.S.), The University of Melbourne, Austin Health; and Florey Institute of Neuroscience and Mental Health (I.E.S.), Melbourne, Australia
| | - Amy Brown
- From the Department of Paediatrics, The University of Melbourne (S.J.T., M.A., V.A., A.T.M., I.E.S.), and Department of Psychology (V.A.), The Royal Children's Hospital; Neuroscience of Speech Group, Clinical Sciences Theme (S.J.T., A.T.M.), Australian Centre for Child Neuropsychological Studies (A.B., M.A., V.A.), Murdoch Childrens Research Institute, Melbourne; Epilepsy Research Centre, Department of Medicine (I.E.S.), The University of Melbourne, Austin Health; and Florey Institute of Neuroscience and Mental Health (I.E.S.), Melbourne, Australia
| | - Marta Arpone
- From the Department of Paediatrics, The University of Melbourne (S.J.T., M.A., V.A., A.T.M., I.E.S.), and Department of Psychology (V.A.), The Royal Children's Hospital; Neuroscience of Speech Group, Clinical Sciences Theme (S.J.T., A.T.M.), Australian Centre for Child Neuropsychological Studies (A.B., M.A., V.A.), Murdoch Childrens Research Institute, Melbourne; Epilepsy Research Centre, Department of Medicine (I.E.S.), The University of Melbourne, Austin Health; and Florey Institute of Neuroscience and Mental Health (I.E.S.), Melbourne, Australia
| | - Vicki Anderson
- From the Department of Paediatrics, The University of Melbourne (S.J.T., M.A., V.A., A.T.M., I.E.S.), and Department of Psychology (V.A.), The Royal Children's Hospital; Neuroscience of Speech Group, Clinical Sciences Theme (S.J.T., A.T.M.), Australian Centre for Child Neuropsychological Studies (A.B., M.A., V.A.), Murdoch Childrens Research Institute, Melbourne; Epilepsy Research Centre, Department of Medicine (I.E.S.), The University of Melbourne, Austin Health; and Florey Institute of Neuroscience and Mental Health (I.E.S.), Melbourne, Australia
| | - Angela T Morgan
- From the Department of Paediatrics, The University of Melbourne (S.J.T., M.A., V.A., A.T.M., I.E.S.), and Department of Psychology (V.A.), The Royal Children's Hospital; Neuroscience of Speech Group, Clinical Sciences Theme (S.J.T., A.T.M.), Australian Centre for Child Neuropsychological Studies (A.B., M.A., V.A.), Murdoch Childrens Research Institute, Melbourne; Epilepsy Research Centre, Department of Medicine (I.E.S.), The University of Melbourne, Austin Health; and Florey Institute of Neuroscience and Mental Health (I.E.S.), Melbourne, Australia
| | - Ingrid E Scheffer
- From the Department of Paediatrics, The University of Melbourne (S.J.T., M.A., V.A., A.T.M., I.E.S.), and Department of Psychology (V.A.), The Royal Children's Hospital; Neuroscience of Speech Group, Clinical Sciences Theme (S.J.T., A.T.M.), Australian Centre for Child Neuropsychological Studies (A.B., M.A., V.A.), Murdoch Childrens Research Institute, Melbourne; Epilepsy Research Centre, Department of Medicine (I.E.S.), The University of Melbourne, Austin Health; and Florey Institute of Neuroscience and Mental Health (I.E.S.), Melbourne, Australia.
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