Oral-diadochokinesis rates across languages: English and Hebrew norms

Long-Term Outcomes for Individuals With Childhood Apraxia of Speech

PURPOSE

The study's primary aims were to describe the long-term speech outcomes for adolescents and young adults with a history of childhood apraxia of speech (CAS) and to examine the association of persistent speech sound errors with measures of literacy skills, phonological processing, motor speech production, and parent report of early motor difficulty.

METHOD

Data from a large longitudinal 25-year study were used to explore outcomes for 32 individuals with a history of CAS, ages 12;6 (years;months) to 25 years (M = 17.4, SD = 4.7). Persistent and nonpersistent groups were compared on decoding, phonological processing, multisyllabic word repetition, diadochokinetic rate, and parent report of motor involvement. Parametric (Welch's t tests) and nonparametric tests (Wilcoxon and Fisher exact tests) were used to identify differences between the groups' distributions. Developmental trajectories of speech production were plotted.

RESULTS

Outcomes for individuals with CAS are highly variable, with some demonstrating speech sound errors into adolescence and young adulthood. Speech sound errors were primarily on later developing sounds. Persistence was significantly associated with early motor difficulties. Difficulties with multisyllabic words, phonological processing, and literacy were often present regardless of persistence or nonpersistence of speech errors.

CONCLUSIONS

Children with CAS are at risk for persistent speech sound errors into adulthood. For children showing limited progress with more traditional speech therapy, alternative interventions should be explored. Individuals with persistent speech sound errors are more likely to have a history of early motor deficits. Regardless of persistence, participants with CAS demonstrated ongoing weaknesses in literacy, phonological processing skills, and complex speech production tasks.

Oral-diadochokinesis between Parkinson's disease and neurotypical elderly among Malaysian-Malay speakers

BACKGROUND

Parkinson's disease (PD) has an impact on speech production, manifesting in various ways including alterations in voice quality, challenges in articulating sounds and a decrease in speech rate. Numerous investigations have been conducted to ascertain the oral-diadochokinesis (O-DDK) rate in individuals with PD. However, the existing literature lacks exploration of such O-DDK rates in Malaysia and does not provide consistent evidence regarding the advantage of real-word repetition.

AIMS

To explore the effect of gender, stimuli type and PD status and their interactions on the O-DDK rates among Malaysian-Malay speakers.

METHODS & PROCEDURES

O-DDK performance of 62 participants (29 individuals with PD and 33 healthy elderly) using a non-word ('pataka'), a Malay real-word ('patahkan') and an English real-word ('buttercake') was audio recorded. The number of syllables produced in 8 s was counted. A hierarchical linear modelling was performed to investigate the effects of stimuli type (non-word, Malay real-word, English real-word), PD status (yes, no), gender (male, female) and their interactions on the O-DDK rate. The model accounted for participants' age as well as the nesting of repeated measurements within participants, thereby providing unbiased estimates of the effects.

OUTCOMES & RESULTS

The stimuli effect was significant (p < 0.0001). Malay real-word showed the lowest O-DDK rate (5.03 ± 0.11 syllables/s), followed by English real-word (5.25 ± 0.11 syllables/s) and non-word (5.42 ± 0.11 syllables/s). Individuals with PD showed a significantly lower O-DDK rate compared to healthy elderly (4.73 ± 0.15 syllables/s vs. 5.74 ± 0.14 syllables/s, adjusted p < 0.001). A subsequent analysis indicated that the O-DDK rate declined in a quadratic pattern. However, neither gender nor age effects were observed. Additionally, no significant two-way interactions were found between stimuli type, PD status and gender (all p > 0.05). Therefore, the choice of stimuli type has no or only limited effect considering the use of O-DDK tests in clinical practice for diagnostic purposes.

CONCLUSIONS & IMPLICATIONS

The observed slowness in O-DDK among individuals with PD can be attributed to the impact of the movement disorder, specifically bradykinesia, on the physiological aspects of speech production. Speech-language pathologists can gain insights into the impact of PD on speech production and tailor appropriate intervention strategies to address the specific needs of individuals with PD according to disease stages.

WHAT THIS PAPER ADDS

What is already known on this subject The observed slowness in O-DDK rates among individuals with PD may stem from the movement disorder's effects on the physiological aspects of speech production, particularly bradykinesia. However, there is a lack of consistent evidence regarding the influence of real-word repetition and how O-DDK rates vary across different PD stages. What this study adds to existing knowledge The O-DDK rates decline in a quadratic pattern as the PD progresses. The research provides insights into the advantage of real-word repetition in assessing O-DDK rates, with Malay real-word showing the lowest O-DDK rate, followed by English real-word and non-word. What are the potential or actual clinical implications of this work? Speech-language pathologists can better understand the evolving nature of speech motor impairments as PD progresses. This insight enables them to design targeted intervention strategies that are sensitive to the specific needs and challenges associated with each PD stage. This finding can guide clinicians in selecting appropriate assessment tools for evaluating speech motor function in PD patients.

The effect of real word stimuli versus non-word stimuli on oral diadochokinetic rates across the life span: An item discrimination analysis

BACKGROUND

Diadochokinetic (DDK) rate tasks are extensively used in the evaluation of speech disorders; however, it is unclear how the different types of speech stimuli affect DDK rate performance.

AIMS

To investigate the effect of age, gender and type of stimuli (non-words versus real words) on the DDK rates in individuals across the lifespan and to provide normative data for Greek. Also to examine the discrimination ability of the speech DDK stimuli administered (non-words and real words) based on a dual DDK assessment protocol using a polytomous item response theory (IRT) model.

METHODS & PROCEDURE

The participants were 1747 monolingual Greek speakers (376 children, aged 4-17 years; and 1371 adults, aged 18-90+ years). All participants had normal hearing acuity which allowed them to understand and follow instructions. Participants with a medical condition or a language disorder which would affect DDK rate performance were excluded from the study. The time-by-count method was used, and all participants had to repeat as accurately and fast as possible: (1) four disyllabic non-words (/'gaba/, /'taka/, /'kata/, /'baga/), (2) four disyllabic real words (/'kapa/, /'tapa/, /ka'la/, /'paka/) and (3) two trisyllabic non-words (/'pataka/, /'badaga/). All responses were recorded and the speech samples that did not include at least 5 s of correct repetitions were excluded from the analysis.

OUTCOMES & RESULTS

Age affected significantly DDK rates with performance increasing gradually until approximately the age of 40 and then gradually decreasing. Gender had no effect. Overall, there was a significant advantage of disyllabic real word stimuli over disyllabic non-word stimuli and of trisyllabic non-word stimuli over disyllabic non-word stimuli on DDK rates performance. IRT analysis suggested that the data fit the polytomous model reasonably well and all DDK stimuli (real words and non-words) showed a strong relationship (loadings > 0.50) with the latent trait.

CONCLUSIONS & IMPLICATIONS

The current study complements prior research which supports that age and type of stimuli significantly affect DDK rates performance. It is the first study, that testifies to the benefit of real-word stimuli over non-word stimuli on DDK rates across the lifespan in a large representative sample. The implementation of IRT analysis provides empirical evidence about the discrimination ability of the DDK stimuli administered and confirms the reliability of this dual DDK assessment protocol. These findings are valuable for clinicians who work with motor speech disorders.

WHAT THIS PAPER ADDS

What is already known on this subject Age, type of stimuli (real words versus non-words) and language significantly affect DDK rates performance. Current research strongly suggests the administration of language-specific norms since language-dependent features seem to have a noteworthy effect on the DDK rates, but scarce evidence exists about the discriminatory ability of the DDK speech stimuli commonly administered. What this study adds to the existing knowledge Conflicting findings have been reported about the effect of different types of DDK speech stimuli (real words and non-words) but no study to date has evaluated their discriminatory abilities. The current study is the first to implement a polytomous IRT model to examine this issue. This is also the first study to attempt an investigation of the effect of types of stimuli (real words versus non-words) on a large representative sample across the lifespan (4-90+ years) and to provide normative data for Greek. What are the practical and clinical implications of this work? The present study offers concrete evidence about the advantage of real-word stimuli over non-word stimuli in Greek, as well as normative data for the Greek-speaking populations. Moreover, the IRT analysis testifies to the discriminatory ability of real-word and non-word stimuli affirming the reliability of the present dual DDK assessment protocol as a psychometrically sound measure of DDK ability. The above has significant value for clinicians who work with individuals with motor speech disorders as the protocol can help them with the diagnosis and differential diagnosis of motor speech disorders.

A case study of bilingual neurogenic stuttering: Measures of fluency, emotion, and articulation rate

INTRODUCTION

This study explores the features of bilingual neurogenic stuttering and the potential connection between emotion and articulation rate on speech disfluencies.

METHOD

The participant is  a 59-year old, Yiddish-English bilingual male with a moderate non-fluent aphasia. Thirty-two narratives (16 in each language), elicited using cue words, were analyzed for frequency of disfluency, type of disfluency (stuttering vs. non-stuttering-like), word-type (content vs. function), within-word location of disfluency, and occurrence of accessory behaviors. Additionally, the percentage and type of emotion (positive vs. negative) expressed, and articulation rate (fluent syllables spoken/duration of fluent utterances) was assessed.

RESULTS

Disfluency occurred in each language with approximately equal frequency. The most common stuttering-like disfluencies were repetitions (monosyllabic, sound, and syllable) and prolongations. The most common non-stuttering-like disfluencies were self-correction/revisions, phrase and multisyllabic word repetitions, and pauses (silent and filled). In both languages, disfluencies occurred on both content and function words, but primarily content words, and in any position of the word, although primarily initial position. No accessory behaviors were noted. There was a similar amount of emotion words used in each language although the first acquired language, L1/Yiddish, had an overall more positive tone, and his second acquired language, L2/English, had a more negative tone. Additionally, there was a negative relationship between emotion and the number of disfluencies in L1/Yiddish, and a positive relationship in L2/English. A faster articulation rate was found in his native and more proficient language, Yiddish, than English. There was a negative relationship between articulation rate and the number of disfluencies in L1/Yiddish, and a positive relationship in L2/English.

CONCLUSIONS

Cross-linguistics differences for emotion and articulation rate demonstrates that these aspects impact on fluency and contributes to the disfluencies in each language. Clinical implications of the study demonstrates the importance of assessment of bilingual (i.e., proficiency and dominance) and fluency features of each language in the diagnostic process and the significance of considering emotional processes and articulation rate as part of a comprehensive intervention plan for acquired stuttering.

Oral diadochokinetic production in children with typical speech development and speech-sound disorders

BACKGROUND

AIMS: To investigate the developmental trajectory of the rate and perceptual assessment of oral diadochokinesis (DDK) in typically developing children compared with adults. Also to examine the characteristics of DDK productions in children with speech sound disorders (SSD) and the relationship between DDK production and percentage of consonants correct (PCC).

METHODS & PROCEDURES

Participants were 316 typically developing children and 90 children with SSD from 3 to 9 years old, as well as 20 adults with normal speech. The mono-, bi- and trisyllabic nonsense strings containing Korean tense consonants and the vowel [a] were used for DDK tasks. The number of iterations per s was measured as the DDK rate for each stimulus. The perceptual assessment of DDK productions was also performed for regularity, accuracy and rate.

OUTCOMES & RESULTS

The DDK rates increased throughout childhood, but the oldest children, 9-year-olds in the current study, did not achieve adult-like rates for all mono- and trisyllabic strings. Children with SSD also did not show significant differences from typically developing children when the DDK productions were analysed using only accurate tokens. The PCC of children with SSD showed higher correlations with regularity, accuracy and rate of perceptual ratings than the timed DDK rate.

CONCLUSIONS & IMPLICATIONS

This study highlighted the fact that the comprehensive evaluation of DDK productions may provide even more useful information about children's oral motor skills.

WHAT THIS PAPER ADDS

What is already known on the subject Rates of DDK reflect the motor skills of the articulatory systems independently of phonological skills; therefore, the tasks are widely used in the diagnostic evaluations of speech disorders in both children and adult populations. However, a substantial number of studies have questioned the validity and usefulness of DDK rates for evaluating speech abilities. Also, the literature suggested that the measure of DDK rate alone does not provide a clear and useful indication of children's oral motor skills. DDK tasks should be analysed in terms of accuracy and consistency as well as rate. What this paper adds to the existing knowledge The literature reporting normative DDK performance has mainly been based on English speakers. As different consonants have different temporal characteristics, the linguistic and segmental features of DDK tasks can impact the DDK rate. This study established a norm for DDK rate for Korean-speaking children and investigated the developmental trajectory of DDK performance in typically developing children compared with adults. This study suggested that the comprehensive evaluation of DDK productions may provide even more useful information about children's oral motor skills by examining the characteristics of DDK productions in children with SSD. What are the potential or actual clinical implications of this work? This study provided normative data of young Korean-speaking children aged 3-9 years. Normative data in children under 5 years of age are valuable given that the majority of children referred for speech difficulty assessments are between 3 and 5 years of age, but only a few studies have provided the normative data in young children. This study showed that many children could not complete DDK tasks correctly and provided additional support for the notion that other aspects of DDK performance, including accuracy and regularity, may yield more useful diagnostic indications than timed DDK rates alone.

Wav2DDK: Analytical and Clinical Validation of an Automated Diadochokinetic Rate Estimation Algorithm on Remotely Collected Speech

PURPOSE

Oral diadochokinesis is a useful task in assessment of speech motor function in the context of neurological disease. Remote collection of speech tasks provides a convenient alternative to in-clinic visits, but scoring these assessments can be a laborious process for clinicians. This work describes Wav2DDK, an automated algorithm for estimating the diadochokinetic (DDK) rate on remotely collected audio from healthy participants and participants with amyotrophic lateral sclerosis (ALS).

METHOD

Wav2DDK was developed using a corpus of 970 DDK assessments from healthy and ALS speakers where ground truth DDK rates were provided manually by trained annotators. The clinical utility of the algorithm was demonstrated on a corpus of 7,919 assessments collected longitudinally from 26 healthy controls and 82 ALS speakers. Corpora were collected via the participants' own mobile device, and instructions for speech elicitation were provided via a mobile app. DDK rate was estimated by parsing the character transcript from a deep neural network transformer acoustic model trained on healthy and ALS speech.

RESULTS

Algorithm estimated DDK rates are highly accurate, achieving .98 correlation with manual annotation, and an average error of only 0.071 syllables per second. The rate exactly matched ground truth for 83% of files and was within 0.5 syllables per second for 95% of files. Estimated rates achieve a high test-retest reliability (r = .95) and show good correlation with the revised ALS functional rating scale speech subscore (r = .67).

CONCLUSION

We demonstrate a system for automated DDK estimation that increases efficiency of calculation beyond manual annotation. Thorough analytical and clinical validation demonstrates that the algorithm is not only highly accurate, but also provides a convenient, clinically relevant metric for tracking longitudinal decline in ALS, serving to promote participation and diversity of participants in clinical research.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.23787033.

The automated screening of speech motor development in children based on the sequential motion rate

BACKGROUND

Motor skills in children have traditionally been examined via challenging speech tasks such as syllable repetition, and calculating the syllabic rate using a stopwatch or by inspecting the oscillogram followed by a laborious comparison of the scores on a look-up table representing the typical performances of children of the given age and sex. As the commonly used performance tables are over-simplified to allow for manual scoring, we raise the question of whether a computational model of motor skills development could be more informative, and could allow for the automated screening of children to detect underdeveloped motor skills.

METHODS

We recruited a total of 275 children aged four to 15 years. All the participants were native Czech speakers with no history of hearing or neurological impairments. We recorded each child's performance of/pa/-/ta/-/ka/syllable repetition. Various parameters of diadochokinesis (DDK; DDK rate, DDK regularity, voice onset time [VOT] ratio, syllable, vowel and VOT duration) were investigated in the acoustic signals using supervised reference labels. Female and male participants were analyzed separately by comparing younger, middle, and older age groups of children via ANOVA. Finally, we implemented a fully automated model that estimated the developmental age of a child based on the acoustic signal, and evaluated its accuracy using Pearson's correlation coefficient and normalized root-mean-squared errors (RMSEs).

RESULTS

The DDK rate reflected the ages of the children proportionally (p < 0.001). Other DDK parameters also showed strong sensitivity to age (p < 0.001), with the exception of VOT duration, which had a smaller effect (p = 0.091). The effect of age was found to be sex specific for the syllable length (p < 0.001) and DDK rate (p = 0.003). We observed that females spoke more slowly and had a longer VOT at preschool age (p < 0.001). The DDK rate obtained via the automated algorithm was strongly correlated with the reference (p < 0.001, Pearson's correlation coefficient of 0.97), with a low normalized RMSE of 3.77%.

CONCLUSIONS

As children develop their motor skills, they are capable of shortening the vowels to increase the rate of syllabic repetitions. The nonlinear development in childhood and adolescence, with a steady state in adulthood, follows a logistic function for the DDK rate. This study demonstrates that the development of motor skills can be examined sensitively and more appropriately by a fully automated noninvasive procedure that also accounts for the dispersion of values within age brackets.

Oral Diadochokinetic Performance on Perceptual and Acoustic Measures for Typically Developing Cantonese-Speaking Preschool Children

PURPOSE

This study investigated native Cantonese-speaking preschool children's diadochokinetic performance, including rate, accuracy, and regularity. The second aim of this study was to examine whether language-specific patterns exist by comparing diadochokinetic rates with the average DKK rate for native English speakers.

METHOD

Sixty-four typically developing preschool children who were native Cantonese speakers participated. The diadochokinetic task administered to the children involved repetitions of monosyllabic, disyllabic, and trisyllabic words and nonsense words. The maximum performance of the children was compared by diadochokinetic rate (number of syllables per second), accuracy (percentage of matched production), and regularity (pairwise variability indexes, known as PVIs).

RESULTS

Monosyllabic units were produced faster, more accurately, and more regularly than multisyllabic units. Word repetition showed higher accuracy and generally lower regularity than nonsense words but similar rates. Older children were faster and more regular (higher raw PVI of initial consonants) than younger children, but younger children performed as accurately as them. When compared with data from English speakers, the diadochokinetic rates of Cantonese children were generally lower.

CONCLUSIONS

Developmental progression was evident in terms of rate and regularity. The distinctive accuracy and regularity patterns between word and nonsense word repetition suggest a clinical value for both stimulus types. Language typology plays a role in diadochokinetic rate, supporting the use of language-specific reference data in practice. The typical diadochokinetic profile obtained in this study could serve as a clinical reference for speech motor assessments.

Diadochokinetic rates in healthy young and elderly Greek-speaking adults: The effect of types of stimuli

BACKGROUND

Diadochokinetic rates tasks are frequently used for the assessment of diadochokinesia (DKK) in young and elderly adults. However, there is scarce research on healthy elderly adults over 65 years old, and little is known about the effect of different types of stimuli (non-words/real words) in this specific population. Furthermore, the current research supports significant language variations, highlighting the need for language-specific norms.

AIMS

To investigate the effect of age, gender and type of stimuli (non-words versus real words) in DDK rates in healthy elderly adults of over 65 years of age, and to provide normative data for the Greek language.

METHODS & PROCEDURES

The participants were 791 healthy monolingual Greek-speaking adults (531 adults, aged 20-39 years; 157 participants aged 65-74 years; and 103 participants aged over 75 years). All participants were monolingual speakers of Greek and had normal hearing acuity, which allowed them to understand and follow instructions. Participants with a medical condition, which would affect DDK rates' performance, were excluded from the study. The time-by-count method was used, and all participants had to repeat as accurately and fast as possible: (1) four disyllabic non-words (/'gaba/, /'taka/, /'kata/, /'baga/); (2) four disyllabic real words (/'kapa/, /'tapa/, /ka'la/, /'paka/); and (3) two trisyllabic non-words (/'pataka/, /'badaga/). All responses were recorded and the speech samples that did not include at least 5 s of correct repetitions were excluded from the analysis.

OUTCOMES & RESULTS

Age affected DDK rates significantly, with older adults achieving slower DDK rates for all speech stimuli (non-words/real words). Gender did not have an effect on the performance of DDK rates. The type of speech stimuli affected DDK rates significantly for all age groups. Analytically, trisyllabic non-word stimuli were articulated more slowly than disyllabic non-word stimuli, and real words were produced faster than non-words. A linear regression analysis revealed that only the repetition of non-words predicted 68.4% of the performance on the repetition of trisyllabic non-words.

CONCLUSIONS & IMPLICATIONS

The above results complement prior research, which supports that real word stimuli yield faster performance than non-word stimuli. Clinicians should keep in mind that age, language and type of stimuli (non-words/real words) affect significantly the performance of DDK rates, as well as the fact that different types of stimuli tap distinct underlying levels of speech. The current research highlights the need for language-specific norms for different populations.

WHAT THIS PAPER ADDS

What is already known on the subject DDK rates are significantly affected by the types of stimuli and language used. Moreover, the normal ageing process decreases performance in terms of DDK rates, but scarce evidence exists for healthy elderly adults over 65 years old. What this paper adds to existing knowledge Most studies have examined DDK rates in healthy elderly people with restricted samples and using non-word stimuli. The current study administered different types of stimuli (non-words/words) in a large sample of healthy elderly participants. This is also the first study to attempt to provide DDK normative data for this population in the Greek language. What are the potential or actual clinical implications of this work? The results of this study strongly suggest that clinicians should bear in mind the significant impact age and language have on performance in terms of DDK rates, especially when normative data are not available for a certain language or age group. Furthermore, non-word and real-word stimuli cannot be used interchangeably since they tap into distinct underlying levels of speech, thus providing clinicians with useful information about the level of breakdown and the proper treatment plan.

Processing emotional prosody in a foreign language: the case of German and Hebrew

This study investigated the universality of emotional prosody in perception of discrete emotions when semantics is not available. In two experiments the perception of emotional prosody in Hebrew and German by listeners who speak one of the languages but not the other was investigated. Having a parallel tool in both languages allowed to conduct controlled comparisons. In Experiment 1, 39 native German speakers with no knowledge of Hebrew and 80 native Israeli speakers rated Hebrew sentences spoken with four different emotional prosodies (anger, fear, happiness, sadness) or neutral. The Hebrew version of the Test for Rating of Emotions in Speech (T-RES) was used for this purpose. Ratings indicated participants’ agreement on how much the sentence conveyed each of four discrete emotions (anger, fear, happiness and sadness). In Experient 2, 30 native speakers of German, and 24 Israeli native speakers of Hebrew who had no knowledge of German rated sentences of the German version of the T-RES. Based only on the prosody, German-speaking participants were able to accurately identify the emotions in the Hebrew sentences and Hebrew-speaking participants were able to identify the emotions in the German sentences. In both experiments ratings between the groups were similar. These findings show that individuals are able to identify emotions in a foreign language even if they do not have access to semantics. This ability goes beyond identification of target emotion; similarities between languages exist even for “wrong” perception. This adds to accumulating evidence in the literature on the universality of emotional prosody.

A Cross-Linguistic Validation of the Test for Rating Emotions in Speech: Acoustic Analyses of Emotional Sentences in English, German, and Hebrew

PURPOSE

The Test for Rating Emotions in Speech (T-RES) has been developed in order to assess the processing of emotions in spoken language. In this tool, spoken sentences, which are composed of emotional content (anger, happiness, sadness, and neutral) in both semantics and prosody in different combinations, are rated by listeners. To date, English, German, and Hebrew versions have been developed, as well as online versions, iT-RES, to adapt to COVID-19 social restrictions. Since the perception of spoken emotions may be affected by linguistic (and cultural) variables, it is important to compare the acoustic characteristics of the stimuli within and between languages. The goal of the current report was to provide cross-linguistic acoustic validation of the T-RES.

METHOD

T-RES sentences in the aforementioned languages were acoustically analyzed in terms of mean F0, F0 range, and speech rate to obtain profiles of acoustic parameters for different emotions.

RESULTS

Significant within-language discriminability of prosodic emotions was found, for both mean F0 and speech rate. Similarly, these measures were associated with comparable patterns of prosodic emotions for each of the tested languages and emotional ratings.

CONCLUSIONS

The results demonstrate the lack of dependence of prosody and semantics within the T-RES stimuli. These findings illustrate the listeners' ability to clearly distinguish between the different prosodic emotions in each language, providing a cross-linguistic validation of the T-RES and iT-RES.

Oral and Laryngeal Diadochokinesis Across the Life Span: A Scoping Review of Methods, Reference Data, and Clinical Applications

PURPOSE

The aim of this study was to conduct a scoping review of research on oral and laryngeal diadochokinesis (DDK) in children and adults, either typically developing/developed or with a clinical diagnosis.

METHOD

Searches were conducted with PubMed/MEDLINE, Google Scholar, CINAHL, and legacy sources in retrieved articles. Search terms included the following: DDK, alternating motion rate, maximum repetition rate, sequential motion rate, and syllable repetition rate.

RESULTS

Three hundred sixty articles were retrieved and included in the review. Data source tables for children and adults list the number and ages of study participants, DDK task, and language(s) spoken. Cross-sectional data for typically developing children and typically developed adults are compiled for the monosyllables /pʌ/, /tʌ/, and /kʌ/; the trisyllable /pʌtʌkʌ/; and laryngeal DDK. In addition, DDK results are summarized for 26 disorders or conditions.

DISCUSSION

A growing number of multidisciplinary reports on DDK affirm its role in clinical practice and research across the world. Atypical DDK is not a well-defined singular entity but rather a label for a collection of disturbances associated with diverse etiologies, including motoric, structural, sensory, and cognitive. The clinical value of DDK can be optimized by consideration of task parameters, analysis method, and population of interest.

"Post-lockdown Depression": Adaptation Difficulties, Depressive Symptoms, and the Role of Positive Solitude When Returning to Routine After the Lifting of Nation-Wide COVID-19 Social Restrictions

OBJECTIVES

The aim of the current study was to identify difficulties in adapting to normal life once COVID-19 lockdown has been lifted. Israel was used as a case study, as COVID-19 social restrictions, including a nation-wide lockdown, were lifted almost completely by mid-April 2021, following a large-scale vaccination operation.

METHODS

A sample of 293 mid-age and older Israeli adults (M age = 61.6 ± 12.8, range 40-85 years old) reported on return-to-routine adaptation difficulties (on a novel index), depression, positive solitude, and several demographic factors.

RESULTS

Of the participants, 40.4% met the criteria of (at least) mild depressive symptoms. Higher levels of adaptation difficulties were related to higher ratios of clinical depressive symptoms. This link was moderated by positive solitude. Namely, the association between return-to-routine adaptation difficulties and depression was mainly indicated for individuals with low positive solitude.

CONCLUSIONS

The current findings are of special interest to public welfare, as adaptation difficulties were associated with higher chance for clinical depressive symptoms, while positive solitude was found to be as an efficient moderator during this period. The large proportion of depressive symptoms that persist despite lifting of social restrictions should be taken into consideration by policy makers when designing return-to-routine plans.

Maximum repetition rate in a large cross-sectional sample of typically developing Dutch-speaking children

Purpose: The current study aims to provide normative data for the maximum repetition rate (MRR) development of Dutch-speaking children based on a large cross-sectional study using a standardised protocol.Method: A group of 1014 typically developing children aged 3;0 to 6;11 years performed the MRR task of the Computer Articulation Instrument (CAI). The number of syllables per second was calculated for mono-, bi-, and trisyllabic sequences (MRR-pa, MRR-ta, MRR-ka, MRR-pata, MRR-taka, MRR-pataka). A two-way mixed ANOVA was conducted to compare the effects of age and gender on MRR scores in different MRR sequences.Result: The data analysis showed that overall MRR scores were affected by age group, gender and MRR sequence. For all MRR sequences the MRR increased significantly with age. MRR-pa was the fastest sequence, followed by respectively MRR-ta, MRR-pata, MRR-taka, MRR-ka and MRR-pataka. Overall MRR scores were higher for boys than for girls, for all MRR sequences.Conclusion: This study presents normative data of MRR of Dutch-speaking children aged 3;0 to 6;11 years. These norms might be useful in clinical practice to differentiate children with speech sound disorders from typically developing children. More research on this topic is necessary. It is also suggested to collect normative data for other individual languages, using the same protocol.

Improving speech characteristics of young adults with congenital dysarthria: An exploratory study comparing articulation training and the Beatalk method

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.

Oral diadochokinetic rates across languages: Multilingual speakers comparison

BACKGROUND

It is unclear whether oral diadochokinetic rate (oral-DDK) performance is affected by different languages within a multilingual country.

AIMS

This study investigated the effects of age, sex, and stimulus type (real word in L1, L2 vs. non-word) on oral-DDK rates among healthy Malaysian-Malay speakers in order to establish language- and age-sensitive norms. The second aim was to compared the nonword 'pataka' oral-DDK rates produced by Malaysian-Malay speakers on currently available normative data for Hebrew speakers and Malaysian-Mandarin speakers.

METHODS & PROCEDURES

Oral-DDK performance of 90 participants (aged 20-77 years) using nonword ('pataka'), Malay real word ('patahkan'), and English real word ('buttercake') was audio recorded. The number of syllables produced in 8 seconds was calculated. Mixed analysis of variance (ANOVA) was conducted to examine the effects of stimulus type (nonword, Malay, and English real word), sex (male, female), age (younger, 20-40 years; middle, 41-60 years; older, ≥61 years), and their interactions on the oral-DDK rate. Data obtained were also compared with the raw data of Malaysian-Mandarin and Hebrew speakers from the previous studies.

OUTCOMES & RESULTS

A normative oral-DDK rate has been established for healthy Malaysian-Malay speakers. The oral-DDK rate was significantly affected by stimuli (p < 0.001). Malay real word showed the slowest rate, whereas there was no significant difference between English real word and nonword. The oral-DDK rate for Malay speakers was significantly higher than Mandarin and Hebrew speakers across stimuli (all p < 0.01). Interestingly, oral-DDK rates were not affected by age group for Malay speakers.

CONCLUSIONS & IMPLICATIONS

Stimuli type and language affect the oral-DDK rate, indicating that speech-language therapists should consider using language-specific norms when assessing multilingual speakers.

WHAT THIS PAPER ADDS

What is already known on the subject Age, sex, and language are factors that need to be considered when developing oral-DDK normative protocol. It is unclear whether oral-DDK performance is affected by different languages within a multilingual country. What this paper adds to existing knowledge No ageing effect across real word versus nonword on oral-DDK performance was observed among Malaysian-Malay speakers, contrasting with current available literature that speech movements slow down as we age. Additionally, Malaysian-Malay speakers have faster oral-DDK rates than Malaysian-Mandarin and Hebrew speakers across all stimuli. What are the potential or actual clinical implications of this work? Establishing normative data of different languages will enable speech-language therapists to select the appropriate reference dataset based on the language mastery of these multilingual speakers.

Sports Related Concussion Impacts Speech Rate and Muscle Physiology

OBJECTIVE

Establish objective and subjective speech rate and muscle function differences between athletes with and without sports related concussion (SRC) histories and provide potential motor speech evaluation in SRC.

METHODS

Over 1,110 speech samples were obtained from 30, 19-22 year-old athletes who had sustained an SRC within the past 2 years and 30 pair-wise matched control athletes with no history of SRC. Speech rate was measured via average time per syllable, average unvoiced time per syllable, and expert perceptual judgment. Speech muscle function was measured via surface electromyography over the obicularis oris, masseter, and segmental triangle. Group differences were assessed using MANOVA, bootstrapping and predictive ROC analyses.

RESULTS

Athletes with SRC had slower speech rates during DDK tasks than controls as evidenced by longer average time per syllable longer average unvoiced time per syllable and expert judgment of slowed rate. Rate measures were predictive of concussion history. Further, athletes with SRC required more speech muscle activation than controls to complete DDK tasks.

CONCLUSION

Clear evidence of slowed speech and increased muscle activation during the completion of DDK tasks in athletes with SRC histories relative to controls. Future work should examine speech rate in acute concussion.

Oral-diadochokinetic rates among healthy Malaysian-Mandarin speakers: A cross linguistic comparison

PURPOSE

This study examined the effects of non-word versus real word, age, and gender on oral-DDK rates among healthy Malaysian-Mandarin speakers. Comparison between non-word of Malaysian-Mandarin and Hebrew speakers was examined.

METHOD

One-hundred and seventeen speakers (18-83 years old, 46% men) were audio-recorded while performing non-word (repetition of "pataka") and real-word oral-DDK tasks ("butter cake" and " ([p^ha4t^ha1k^han4])"). The number of syllables produced in 8 seconds was counted from the audio recording to derive the oral-DDK rates. A MANOVA was conducted to compare the rates between age groups (young = 18-40 years, n = 56; middle = 41-60 years, n = 39; older = 61-83 years, n = 22) and gender. In a second analysis, "pataka" results were compared between this study and previous findings with Hebrew speakers.

RESULT

No gender effects were found. However, rates significantly decreased with age (p < 0.001). Repetition of real words was faster than that of non-words - English words (5.55 ± 1.19 syllables/s) > non-words (5.29 ± 1.23) > Mandarin words (4.91 ± 1.13). Malaysian-Mandarin speakers performed slower than Hebrew speakers on "pataka" task.

CONCLUSION

Aging has a large impact on oromotor functions, indicating that speech-language pathologists should consider using age-adjusted norms.

Evaluating rate and accuracy of real word vs. non-word diadochokinetic productions from childhood to early adulthood in Hebrew speakers

BACKGROUND

Oral-Diadochokinesis (oral-DDK) tasks measure how quickly and accurately one can repeat a series of target sounds. Thus, they are a popular tool for evaluating oral-motor skills for individuals with various speech disorders. Typically, oral-DDK tasks involve rapid repetition of non-words. For several populations (e.g., young children, older adults), it has been suggested that repetitions of real words may be more suitable, commonly resulting in faster rates. Yet, the literature is either silent or inconsistent regarding this real-word repetition advantage for other age groups, from preschoolers to young adults. It is not clear whether performance accuracy is affected as well. Specifically, for Hebrew speakers, this data is missing.

AIMS

The goal of this study was to compare rate and accuracy for non-word and real-word repetition, in four groups of Hebrew-speaking individuals; preschoolers (5 years old), younger elementary school children (7 years old), adolescents (15 years old) and young adults (25 years old). Secondary goals were to provide a developmental pattern for oral-DDK rates for Hebrew speakers, and to compare it to the English norms.

METHODS & PROCEDURES

All participants (n=150) had typical speech and language development. They were asked to repeat "pataka" (non-word) and "bodeket" (Hebrew real word) as quickly and accurately as possible for 10 sec. Production rates (syllables per second) and accuracy (on a 5-point scale) were measured.

OUTCOMES & RESULTS

As expected, oral-DDK rates gradually increased with age, with similar rates for both real- and non-words. Accuracy scores were higher for real- than non-word repetition, across all age groups. For the group of school-age children, the Hebrew rates differed from the English ones.

CONCLUSIONS & IMPLICATIONS

A real-word repetition advantage was documented only for repetition accuracy, but not for rate. These findings can be explained as each stimulus involves different demands on an individual's neuro-motor and linguistic processing abilities. Further research using real- and non-word tasks should be conducted with clinical populations to assess whether both procedures could assist in differential diagnosis between various speech disorders. Finally, the large differences between children of different ages, as well as the apparent rate differences between Hebrew and English, highlight the need to create age- and language-sensitive norms.

Keep it simple: Identification of basic versus complex emotions in spoken language in individuals with autism spectrum disorder without intellectual disability: A meta-analysis study

Daily functioning involves identifying emotions in spoken language, a fundamental aspect of social interactions. To date, there is inconsistent evidence in the literature on whether individuals with autism spectrum disorder without intellectual disability (ASD-without-ID) experience difficulties in identification of spoken emotions. We conducted a meta-analysis (literature search following the PRISMA guidelines), with 26 data sets (taken from 23 peer-reviewed journal articles) comparing individuals with ASD-without-ID (N = 614) and typically-developed (TD) controls (N = 640), from nine countries and in seven languages (published until February 2020). In our analyses there was no sufficient evidence to suggest that individuals with HF-ASD differ from matched controls in the identification of simple prosodic emotions (e.g., sadness, happiness). However, individuals with ASD-without-ID were found to perform significantly worse than controls in identification of complex prosodic emotions (e.g., envy and boredom). The level of the semantic content of the stimuli presented (e.g., sentences vs. strings of digits) was not found to have an impact on the results. In conclusion, the difference in findings between simple and complex emotions calls for a new-look on emotion processing in ASD-without-ID. Intervention programs may rely on the intact abilities of individuals with ASD-without-ID to process simple emotions and target improved performance with complex emotions. LAY SUMMARY: Individuals with autism spectrum disorder without intellectual disability (ASD-without-ID) do not differ from matched controls in the identification of simple prosodic emotions (e.g., sadness, happiness). However, they were found to perform significantly worse than controls in the identification of complex prosodic emotions (e.g., envy, boredom). This was found in a meta-analysis of 26 data sets with 1254 participants from nine countries and in seven languages. Intervention programs may rely on the intact abilities of individuals with ASD-without-ID to process simple emotions.

Speech Biomarkers in Rapid Eye Movement Sleep Behavior Disorder and Parkinson Disease

Objective

This multilanguage study used simple speech recording and high‐end pattern analysis to provide sensitive and reliable noninvasive biomarkers of prodromal versus manifest α‐synucleinopathy in patients with idiopathic rapid eye movement sleep behavior disorder (iRBD) and early‐stage Parkinson disease (PD).

Methods

We performed a multicenter study across the Czech, English, German, French, and Italian languages at 7 centers in Europe and North America. A total of 448 participants (337 males), including 150 with iRBD (mean duration of iRBD across language groups 0.5–3.4 years), 149 with PD (mean duration of disease across language groups 1.7–2.5 years), and 149 healthy controls were recorded; 350 of the participants completed the 12‐month follow‐up. We developed a fully automated acoustic quantitative assessment approach for the 7 distinctive patterns of hypokinetic dysarthria.

Results

No differences in language that impacted clinical parkinsonian phenotypes were found. Compared with the controls, we found significant abnormalities of an overall acoustic speech severity measure via composite dysarthria index for both iRBD (p = 0.002) and PD (p < 0.001). However, only PD (p < 0.001) was perceptually distinct in a blinded subjective analysis. We found significant group differences between PD and controls for monopitch (p < 0.001), prolonged pauses (p < 0.001), and imprecise consonants (p = 0.03); only monopitch was able to differentiate iRBD patients from controls (p = 0.004). At the 12‐month follow‐up, a slight progression of overall acoustic speech impairment was noted for the iRBD (p = 0.04) and PD (p = 0.03) groups.

Interpretation

Automated speech analysis might provide a useful additional biomarker of parkinsonism for the assessment of disease progression and therapeutic interventions. ANN NEUROL 2021;90:62–75

Evaluation of oro-phonatory development and articulatory diadochokinesis in a sample of Italian children using the protocol of Robbins & Klee

PURPOSE

The Italian version (Granocchio et al., 2019) of the protocol proposed by Robbins and Klee (1987) allows the assessment of structure of the vocal tract, oromotor and oro-phonatory ability, and articulatory diadochokinesis in children. The aim of this study was to collect the first normative sample of Italian children.

METHODS

We measured the total structural score (TSS), total functional score (TFS), oral function score (OFS), phonatory function score (PFS), maximum phonation time (MPT), speed of monosyllable repetition (SMR), and speed of polysyllable repetition (SPR) in 191 typically developing Italian children aged 2.6-6.11 years.

RESULTS

Like the finding observed in the original protocol, there were no significant age-related changes in TSS, but the correlation was observed for TFS, OFS, PFS, MPT, SMR and SPR. The Inter-observer agreement was "good" or "excellent" for all scores except for SPR that was "moderate".

CONCLUSIONS

The increase in oro-motor, oro-phonatory and diadochokinetic abilities confirmed the progressive maturation of these functions with age. The protocol can therefore be considered a useful instrument to classify speech sound disorders (SSDs) by excluding alterations in anatomical structures and evaluate the motor impairment. This normative sample of Italian children allows to use these measures for diagnostic purposes in young Italian speakers.

Sequential motion rate and oral reading rate: normative data for Greek and clinical implications

INTRODUCTION

The aim of the present study was to provide normative data in Greek, regarding sequential motion rate (SMR) and oral reading rate (ORR), and to show the sensitivity of both tasks to predict Parkinson's disease (PD).

METHODS

The speech rate of sixty-five healthy control participants was recorded and analyzed using speech acoustics. The speech rate of a subsample of 20 healthy control participants was compared to the speech rate of 20 pair-matched dysarthric parkinsonian participants. All participants produced the syllables /pataka/ (SMR task) as quickly as possible and read aloud a standard Greek passage (ORR task).

RESULTS

In normative data, the mean score for the SMR variable was 4.91 syllables per second (SD = 0.73) and for the ORR variable was 4.42 syllables per second (SD = 0.87). The Mann-Whitney test showed significant differences between the two groups of participants in the SMR (U = 64.000, Z = -4.60, p < .001) and ORR (U = 77.000, Z = -4.36, p < .001). Multiple binary logistic regression analysis examined the combined effect of ORR and SMR on the occurrence of the disease. The sensitivity of both tasks to predict PD was found to be 0.88 and the specificity 0.90. The optimal screening cutoff point was found to be 4.66 syllables/second for the SMR task and 2.79 syllables/second for the ORR task.

CONCLUSIONS

This study provided Greek normative data in SMR and ORR tasks. Both tasks showed high sensitivity and specificity to predict PD in the Greek sample of participants.

Application of childhood apraxia of speech clinical markers to French-speaking children: A preliminary study

PURPOSE

Childhood apraxia of speech (CAS) is difficult to diagnose because there is little agreement on objective clinical markers. Since studies of phonological development in French-speaking children are scarce, there are even fewer recognised markers in French as compared to English. This study aims to determine if a set of operationalised, quantitative measures derived from clinical markers of CAS in English corroborate with clinical CAS diagnosis in French-speaking children. This research contributes to improving differential diagnosis of CAS and phonological disorder cross-linguistically.

METHOD

We collected data from five children diagnosed with CAS, nine children diagnosed with phonological disorder, and 75 typically-developing children aged 5.10-9.2 years old. All children were assessed on three speech production tasks: picture-naming, non-word repetition, and diadochokinesis. We extracted 20 quantitative measures corresponding to commonly accepted clinical features of CAS.

RESULT

Similar to English-speaking children, French-speaking children with CAS exhibited a high number of vowel errors, consonant and cluster errors, consonant epentheses, devoicing errors, slow diadochokinesis rate, more inconsistency and increased errors with longer words. Contrary to studies on English, these children with CAS did not produce intrusive schwas or vowels.

CONCLUSION

This multiple-case study highlights the need for cross-linguistic diagnostic criteria for CAS.

Processing of Emotions in Speech in Forensic Patients With Schizophrenia: Impairments in Identification, Selective Attention, and Integration of Speech Channels

Individuals with schizophrenia show deficits in recognition of emotions which may increase the risk of violence. This study explored how forensic patients with schizophrenia process spoken emotion by: (a) identifying emotions expressed in prosodic and semantic content separately, (b) selectively attending to one speech channel while ignoring the other, and (c) integrating the prosodic and the semantic channels, compared to non-clinical controls. Twenty-one forensic patients with schizophrenia and 21 matched controls listened to sentences conveying four emotions (anger, happiness, sadness, and neutrality) presented in semantic or prosodic channels, in different combinations. They were asked to rate how much they agreed that the sentences conveyed a predefined emotion, focusing on one channel or on the sentence as a whole. Forensic patients with schizophrenia performed with intact identification and integration of spoken emotions, but their ratings indicated reduced discrimination, larger failures of selective attention, and under-ratings of negative emotions, compared to controls. This finding doesn't support previous reports of an inclination to interpret social situations in a negative way among individuals with schizophrenia. Finally, current results may guide rehabilitation approaches matched to the pattern of auditory emotional processing presented by forensic patients with schizophrenia, improving social interactions and quality of life.

Diadochokinetic rate in Saudi and Bahraini Arabic speakers: Dialect and the influence of syllable type

Arabic is spoken by more than 420 million people worldwide and still there are a limited number of studies on dialects of the Gulf Arabic regions where most selected respondents are male speakers. This study aimed to explore and establish normative data for the Diadochokinetic Rate (DDK) for two dialects (Saudi Arabia’s Najdi and Bahrain’s Bahraini) speakers. Furthermore, it aimed to investigate whether there are differences between the two dialects and whether sex differences are evident. In addition, it investigated syllable type differences. The study used the monosyllables /ba, da, ga/ and the multisyllabic sequence /badaga/ to analyse the DDK rates. Acoustic analysis was carried out to obtain DDK rates for the syllables. A mixed model ANOVA was performed to investigate dialect and sex differences, in addition, to syllable type. The study included 40 males and 40 female speakers from each of the two dialects. Results showed that for DDK, Saudi speakers had faster DDK rates for the monosyllables /ba/, /da/, /ga/, than Bahrainis, while, no significant differences were observed for the multisyllabic sequences. However, there were no differences between male and female speakers with regard to the DDK rates. The syllable /ga/ showed the slowest DDK rate among the monosyllables while the multisyllabic sequences displayed the slowest DDK rates. In brief, normative data for DDK rates for clinic were determined for the Arabic Nadji and Bahrain’s Bahraini dialects. DDK rate was shown to be more sensitive to dialect differences for the monosyllable tasks. However, no sex differences were observed for the Arabic dialects in this study across all DDK tasks.

Development of a method for assessment of dysarthria in a foreign language: a pilot study

Purpose: It is increasingly more common for Speech and Language Pathologists in Sweden to encounter individuals with dysarthria who speak a different language. The aim of the present pilot study was to develop and test a systematic method to be used in collaboration with an interpreter, for assessment of acquired dysarthria in people speaking a language not familiar to the Speech and Language Pathologist.Methods: Seven participants, speaking standard Arabic, were assessed by a Swedish speaking Speech and Language Pathologist using this method and with help of a certified interpreter. The participants were also assessed with equivalent test items from the Swedish "Dysarthria assessment," with instructions translated to Arabic, by a Speech and Language Pathologist speaking standard Arabic and the results were compared.Results: There were no significant differences between the assessments by the Swedish speaking Speech and Language Pathologist and the Arabic speaking Speech and Language Pathologist in the domains "Respiration and phonation," "Articulation," "Listener Comprehension" and "Severity of dysarthria." There was a significant difference between assessments in the domain "Oromotor and velopharyngeal function." Intra- and inter-rater reliability was also calculated using Intraclass Correlation Coefficient and their 95% Confidence Interval. Intra-rater reliability was excellent and inter-rater reliability was very good.Conclusion: The study indicates that a Speech and Language Pathologist, with help of an interpreter, can carry out an assessment of dysarthria in a language unknown to the Speech and Language Pathologist with results comparable to results from an assessment carried out by a Speech and Language Pathologist who speaks the foreign language.

Dysphagia characteristics in Huntington's disease patients: insights from the Fiberoptic Endoscopic Evaluation of Swallowing and the Swallowing Disturbances Questionnaire

BACKGROUND

Huntington's disease (HD) is a neurodegenerative disease characterized by increasing dysphagia as the disease progresses. Specific characteristics of the HD dysphagia are not well defined.

OBJECTIVE

To characterize the swallowing disturbances of HD patients, to evaluate the feasibility of Fiberoptic Endoscopic Evaluation of Swallowing (FEES) in assessing dysphagia in HD patients, and to discern the relation between FEES findings and patients' self-report on dysphagia symptoms and swallowing related quality of life (SWAL-QOL).

METHOD

A retrospective case series in a tertiary referral center. All recruited HD patients underwent Bed Side Swallowing Evaluation (BSE), FEES, the Unified Huntington's Disease Rating Scale (UHDRS), and the Montreal Cognitive Assessment (MoCA). All completed the Swallowing Disturbances Questionnaire (SDQ) and the SWAL-QOL questionnaire.

RESULTS

Fourteen HD patients were recruited. All were able to complete the FEES study. The FEES demonstrated delayed swallowing reflex, solid food residues, and pre/post swallowing spillage in most patients (50%, 53.5%, 83.3%, and 87.5%, respectively). The mean SDQ score was 13.2. Significant correlations were found between the SWAL-QOL fear of eating score; the SDQ oral, pharyngeal, and total scores; and the FEES parameters of pureed and solid food bolus flow time. Significant correlations were also found between the total UHDRS score, the volitional cough score, and the SWAL-QOL disease burden score.

CONCLUSION

HD patients exhibit prominent unique oropharyngeal dysphagia features that may serve as a marker of disease progression. The FEES and the SDQ are valuable tools for detecting these features in HD patients with swallowing disturbance.

A Standardized Protocol for Maximum Repetition Rate Assessment in Children

BACKGROUND/AIMS

Maximum repetition rate (MRR) is often used in the assessment of speech motor performance in older children and adults. The present study aimed to evaluate a standardized protocol for MRR assessment in young children in Dutch.

METHODS

The sample included 1,524 children of 2-7 years old with no hearing difficulties and Dutch spoken in their nursery or primary school and was representative for children in the Netherlands. The MRR protocol featured mono-, tri-, and bisyllabic sequences and was computer-implemented to maximize standardization.

RESULTS

Less than 50% of the 2-year-olds could produce >1 monosyllabic sequence correctly. Children who could not correctly produce ≥2 monosyllabic sequences could not produce any of the multisyllabic sequences. The effect of instruction ("faster" and "as fast as possible") was small, and multiple attempts yielded a faster MRR in only 20% of the cases. MRRs did not show clinically relevant differences when calculated over different numbers of repeated syllables.

CONCLUSIONS

The MRR protocol is suitable for children of 3 years and older. If children cannot produce at least 2 of the monosyllabic sequences, the multisyllabic tasks should be omitted. Furthermore, all fast attempts of each sequence should be analyzed to determine the fastest MRR.

Age-Related Differences in the Perception of Emotion in Spoken Language: The Relative Roles of Prosody and Semantics

Purpose We aim to identify the possible sources for age-related differences in the perception of emotion in speech, focusing on the distinct roles of semantics (words) and prosody (tone of speech) and their interaction. Method We implement the Test for Rating of Emotions in Speech ( Ben-David, Multani, Shakuf, Rudzicz, & van Lieshout, 2016 ). Forty older and 40 younger adults were presented with spoken sentences made of different combinations of 5 emotional categories (anger, fear, happiness, sadness, and neutral) presented in the prosody and semantics. In separate tasks, listeners were asked to attend to the sentence as a whole, integrating both speech channels, or to focus on 1 channel only (prosody/semantics). Their task was to rate how much they agree the sentence is conveying a predefined emotion. Results (a) Identification of emotions: both age groups identified presented emotions. (b) Failure of selective attention: both age groups were unable to selectively attend to 1 channel when instructed, with slightly larger failures for older adults. (c) Integration of channels: younger adults showed a bias toward prosody, whereas older adults showed a slight bias toward semantics. Conclusions Three possible sources are suggested for age-related differences: (a) underestimation of the emotional content of speech, (b) slightly larger failures to selectively attend to 1 channel, and (c) different weights assigned to the 2 speech channels.

Association between echo intensity of the tongue and its thickness and function in elderly subjects

BACKGROUND

The tongue plays an important role during the oropharyngeal phase of swallowing. Each part of the tongue has a different function during swallowing. Ageing causes changes in muscle quantity and quality. Qualitative changes, such as an increase in intramuscular adipose tissue, can be determined by the echo intensity (EI) of the tongue on ultrasonography (US).

OBJECTIVE

To clarify the relationship between EI and thickness and function of the tongue.

METHODS

Ninety-four healthy elderly individuals (30 male, 64 female) aged >65 years (mean 71.10 ± 4.13 years) were enrolled. Tongue thickness (TT) and EI were determined by US. Tongue function was evaluated by measurement of tongue pressure and oral diadochokinesis (OD). Multiple regression analysis was used to identify the factor with the strongest influence on EI of the tongue.

RESULTS

The mean thickness of the middle of the tongue was 40.42 ± 4.24 mm and that of the base was 23.35 ± 3.32 mm; the respective EI values were 46.54 ± 9.33 and 49.33 ± 9.83. The average OD rates for /ta/ and /ka/ were 5.73 ± 1.09 and 5.40 ± 1.00 times/s, respectively. Multiple regression analysis for EI showed that /ta/ (β = -2.518, P = 0.042) and thickness of the middle of the tongue (β = -1.278, P < 0.001) were significant independent variables. Similarly, the EI at the base of the tongue showed that /ka/ (β = -4.038, P = 0.021) and base of TT (β = -0.913, P = 0.004) were significant independent variables.

CONCLUSION

EI may be an indicator of TT and OD in both the middle and base of the tongue. Ultrasound is beneficial for evaluating TT and function.

Reference values of maximum performance tests of speech production

PURPOSE

Maximum performance tests examine upper limits of speech motor performance, as used by speech-language pathologists in dysarthria assessment protocols. The Radboud Dysarthria Assessment includes maximum repetition rate, maximum phonation time, fundamental frequency range and maximum phonation volume to assist in detecting pathological performance. This study aims to obtain reference values for each of these tests.

METHOD

A group of 224 healthy Dutch adults aged 18-80 years performed the maximum performance tests. Age, sex, body height, smoking habit, and profession were registered. Using multivariable linear regression, a wide range of models was tested to examine the relationship between these person characteristics and speech performance. The likelihood ratio was used to test the goodness of fit to the data.

RESULT

Above 60 years of age, maximum repetition rate, fundamental frequency range and maximum phonation volume were all negatively affected by age. Below 60 years, only women showed effects of age on fundamental frequency range (increase) and maximum phonation volume (decrease). Maximum phonation time was primarily related to body height (increase).

CONCLUSION

This study presents reference values of four maximum performance tests for comparing the performance of dysarthric patients with non-pathological performance. Age was identified as most important factor influencing maximum speech performance.

The Effect of Practice and Visual Feedback on Oral-Diadochokinetic Rates for Younger and Older Adults

Assessments of oral-diadochokinetic rates are commonly performed to evaluate oral-motor skills. However, the appropriate administration protocol is not defined, and varies across therapists, clinics and laboratories. In three experiments and an auxiliary one, this study analyzes the effects of brief (motor) practice and visual feedback on the performance of 98 younger (20-40 years old) and 78 older adults (over 65) with the sequential motion rate (SMR) version. Overall rates were significantly faster for younger over older adults. Irrespective of age-group, averaged performance was significantly better on the second round, but the third round was found to be superfluous, across experiments and age-groups. Visual feedback (using a mirror) was found to be detrimental for younger adults, eliminating the advantage reaped from a practice round. For older adults, visual feedback did not alter the effect of a practice round. Sensory (visual) degradation is presented as a possible source for this age-related difference. We discuss these findings and suggest an administration protocol for younger and older adults with the SMR version, including a total of two rounds and no visual feedback.

Bedside screen for oral cavity structure, salivary flow, and vocal production over the 14days following endotracheal extubation

PURPOSE

To describe the sequelae of oral endotracheal intubation by evaluating prevalence rates of structural injury, hyposalivation, and impaired vocal production over 14days following extubation.

MATERIALS AND METHODS

Consecutive adults (≥20years, N=114) with prolonged (≥48h) endotracheal intubation were enrolled from medical intensive care units at a university hospital. Participants were assessed by trained nurses at 2, 7, and 14days after extubation, using a standardized bedside screening protocol.

RESULTS

Within 48-hour postextubation, structural injuries were common, with 51% having restricted mouth opening. Unstimulated salivary flow was reduced in 43%. For vocal production, 51% had inadequate breathing support for phonation, dysphonia was common (94% had hoarseness and 36% showed reduced efficiency of vocal fold closure), and >40% had impaired articulatory precision. By 14days postextubation, recovery was noted in most conditions, but reduced efficiency of vocal fold closure persisted. Restricted mouth opening (39%) and reduced salivary flow (34%) remained highly prevalent.

CONCLUSIONS

After extubation, restricted mouth opening, reduced salivary flow, and dysphonia were common and prolonged in recovery. Reduced efficiency of vocal cord closure persisted at 14days postextubation. The extent and duration of these sequelae remind clinicians to screen for them up to 2weeks after extubation.

Meaningful Words and Non-Words Repetitive Articulatory Rate (Oral Diadochokinesis) in Persian Speaking Children

Repetitive articulatory rate or Oral Diadochokinesis (oral-DDK) shows a guideline for appraisal and diagnosis of subjects with oral-motor disorder. Traditionally, meaningless words repetition has been utilized in this task and preschool children have challenges with them. Therefore, we aimed to determine some meaningful words in order to test oral-DDK in Persian speaking preschool children. Participants were 142 normally developing children, (age range 4-6 years), who were asked to produce /motæka, golabi/ as two meaningful Persian words and /pa-ta-ka/ as non-word in conventional oral-DDK task. We compared the time taken for 10-times fast repetitions of two meaningful Persian words and the tri-syllabic nonsense word /pa-ta-ka/. Praat software was used to calculate the average time that subjects took to produce the target items. In 4-5 year old children, [Formula: see text] of time taken for 10-times repetitions of /pa-ta-ka, motæka, golabi/ were [Formula: see text], and [Formula: see text] seconds respectively, and in 5-6 year old children were [Formula: see text], and [Formula: see text] seconds respectively. Findings showed that the main effect of type of words on oral diadochokinesis was significant ([Formula: see text]). Children repeated meaningful words /motæka, golabi/ faster than the non-word /pa-ta-ka/. Sex and age factors had no effect on time taken for repetition of oral-DDK test. It is suggested that Speech Therapists can use meaningful words to facilitate oral-DDK test for children.

Speech and nonspeech: What are we talking about?

Understanding of the behavioural, cognitive and neural underpinnings of speech production is of interest theoretically, and is important for understanding disorders of speech production and how to assess and treat such disorders in the clinic. This paper addresses two claims about the neuromotor control of speech production: (1) speech is subserved by a distinct, specialised motor control system and (2) speech is holistic and cannot be decomposed into smaller primitives. Both claims have gained traction in recent literature, and are central to a task-dependent model of speech motor control. The purpose of this paper is to stimulate thinking about speech production, its disorders and the clinical implications of these claims. The paper poses several conceptual and empirical challenges for these claims - including the critical importance of defining speech. The emerging conclusion is that a task-dependent model is called into question as its two central claims are founded on ill-defined and inconsistently applied concepts. The paper concludes with discussion of methodological and clinical implications, including the potential utility of diadochokinetic (DDK) tasks in assessment of motor speech disorders and the contraindication of nonspeech oral motor exercises to improve speech function.

Designing Serious Computer Games for People With Moderate and Advanced Dementia: Interdisciplinary Theory-Driven Pilot Study

Background

The field of serious games for people with dementia (PwD) is mostly driven by game-design principals typically applied to games created by and for younger individuals. Little has been done developing serious games to help PwD maintain cognition and to support functionality.

Objectives

We aimed to create a theory-based serious game for PwD, with input from a multi-disciplinary team familiar with aging, dementia, and gaming theory, as well as direct input from end users (the iterative process). Targeting enhanced self-efficacy in daily activities, the goal was to generate a game that is acceptable, accessible and engaging for PwD.

Methods

The theory-driven game development was based on the following learning theories: learning in context, errorless learning, building on capacities, and acknowledging biological changes—all with the aim to boost self-efficacy. The iterative participatory process was used for game screen development with input of 34 PwD and 14 healthy community dwelling older adults, aged over 65 years. Development of game screens was informed by the bio-psychological aging related disabilities (ie, motor, visual, and perception) as well as remaining neuropsychological capacities (ie, implicit memory) of PwD. At the conclusion of the iterative development process, a prototype game with 39 screens was used for a pilot study with 24 PwD and 14 healthy community dwelling older adults. The game was played twice weekly for 10 weeks.

Results

Quantitative analysis showed that the average speed of successful screen completion was significantly longer for PwD compared with healthy older adults. Both PwD and controls showed an equivalent linear increase in the speed for task completion with practice by the third session (P<.02). Most important, the rate of improved processing speed with practice was not statistically different between PwD and controls. This may imply that some form of learning occurred for PwD at a nonsignificantly different rate than for controls. Qualitative results indicate that PwD found the game engaging and fun. Healthy older adults found the game too easy. Increase in self-reported self-efficacy was documented with PwD only.

Conclusions

Our study demonstrated that PwD’s speed improved with practice at the same rate as healthy older adults. This implies that when tasks are designed to match PwD’s abilities, learning ensues. In addition, this pilot study of a serious game, designed for PwD, was accessible, acceptable, and enjoyable for end users. Games designed based on learning theories and input of end users and a multi-disciplinary team familiar with dementia and aging may have the potential of maintaining capacity and improving functionality of PwD. A larger longer study is needed to confirm our findings and evaluate the use of these games in assessing cognitive status and functionality.

Sibilant production in Hebrew-speaking adults: Apical versus laminal

The Hebrew IPA charts describe the sibilants /s, z/ as 'alveolar fricatives', where the place of articulation on the palate is the alveolar ridge. The point of constriction on the tongue is not defined - apical (tip) or laminal (blade). Usually, speech and language pathologists (SLPs) use the apical placement in Hebrew articulation therapy. Some researchers and SLPs suggested that acceptable /s, z/ could be also produced with the laminal placement (i.e. the tip of the tongue approximating the lower incisors). The present study focused at the clinical level, attempting to determine the prevalence of these alternative points of constriction on the tongue for /s/ and /z/ in three different samples of Hebrew-speaking young adults (total n = 242), with typical articulation. Around 60% of the participants reported using the laminal position, regardless of several speaker-related variables (e.g. tongue-thrust swallowing, gender). Laminal production was more common in /s/ (than /z/), coda (than onset) position of the sibilant, mono- (than di-) syllabic words, and with non-alveolar (than alveolar) adjacent consonants. Experiment 3 revealed no acoustical differences between apical and laminal productions of /s/ and of /z/. From a clinical perspective, we wish to raise the awareness of SLPs to the prevalence of the two placements when treating Hebrew speakers, noting that tongue placements were highly correlated across sibilants. Finally, we recommend adopting a client-centred practice, where tongue placement is matched to the client. We further recommend selecting targets for intervention based on our findings, and separating between different prosodic positions in treatment.

Oral-diadochokinetic rates for Hebrew-speaking healthy ageing population: non-word versus real-word repetition

BACKGROUND

Oral-diadochokinesis (oral-DDK) tasks are extensively used in the evaluation of motor speech abilities. Currently, validated normative data for older adults (aged 65 years and older) are missing in Hebrew. The effect of task stimuli (non-word versus real-word repetition) is also non-clear in the population of older adult Hebrew speakers.

AIMS

(1) To establish a norm for oral-DDK rate for older adult (aged 65 years and older) Hebrew speakers, and to investigate the possible effect of age and gender on performance rate; and (2) to examine the effects of stimuli (non-word versus real word) on oral-DDK rates.

METHODS & PROCEDURES

In experiment 1, 88 healthy older Hebrew speakers (60-95 years, 48 females and 40 males) were audio-recorded while performing an oral-DDK task (repetition of /pataka/), and repetition rates (syllables/s) were coded. In experiment 2, the effect of real-word repetition was evaluated. Sixty-eight older Hebrew speakers (aged 66-95 years, 43 females and 25 males) were asked to repeat 'pataka' (non-word) and 'bodeket' (Hebrew real word).

OUTCOMES & RESULTS

Experiment 1: Oral-DDK performance for older adult Hebrew speakers was 5.07 syllables/s (SD = 1.16 syllables/s), across age groups and gender. Comparison of this data with Hebrew norms for younger adults (and equivalent data in English) shows the following gradient of oral-DDK rates: ages 15-45 > 65-74 > 75-86 years. Gender was not a significant factor in our data. Experiment 2: Repetition of real words was faster than that of non-words, by 13.5%.

CONCLUSIONS & IMPLICATIONS

The paper provides normative values for oral-DDK rates for older Hebrew speakers. The data show the large impact of ageing on oro-motor functions. The analysis further indicates that speech and language pathologists should consider separate norms for clients of 65-74 years and those of 75-86 years. Hebrew rates were found to be different from English norms for the oldest group, shedding light on the impact of language on these norms. Finally, the data support using a dual-protocol (real- and non-word repetition) with older adults to improve differential diagnosis of normal and pathological ageing in this task.

The sense of relational entitlement among adolescents toward their parents (SREap) - Testing an adaptation of the SRE

The quality of the adolescent-parent relationship is closely related to the adolescent's sense of entitlement. Study 1 (458 central-Israel adolescents, 69% girls, ages: 11-16) developed the sense of relational entitlement among adolescents toward their parents (SREap, adapted from the original SRE on adults' romantic relationships) and provided initial validity evidence of its three-factor structure: exaggerated, restricted and assertive - replicating the SRE's factor structure. Studies 2-5 (1237 adolescents, 56% girls) examined the link between the SREap factors and relevant psychological measures. Exaggerated and restricted SREap factors were associated with attachment insecurities. Restricted and exaggerated entitlement factors were related to higher levels of emotional problems, and lower levels of: wellbeing, positive mood and life satisfaction. Conversely, assertive entitlement was related to higher life satisfaction and self-efficacy and lower levels of emotional problems. The findings also indicate that SREap is not merely a form of narcissism. The implications of SREap are discussed.

Linguistic and emotional-valence characteristics of reading passages for clinical use and research

PURPOSE

Fluency assessment in people who stutter (PWS) includes reading aloud passages. There is little information on properties of these passages that may affect reading performance: emotional valance, arousal, word familiarity and frequency and passage-readability. Our first goal was to present an extensive examination of these factors in three commonly used (“traditional”) passages. The second goal was to compare a traditional passage to a new passage, designed to minimize the impact of these properties.

METHODS

Content words were rated (129 participants) on arousal, valence and familiarity. Other linguistic features were analyzed based on available datasets. This information was used to assess traditional passages, and to construct a new well-balanced passage, made of neutral, low-arousal and highly-familiar words. Readability for all passages was tested using formula-based and CLOZE tests (31 participants). Finally, 26 PWS were evaluated on fluency comparing the commonly used “Rainbow” passage with the novel one.

RESULTS

The three traditional passages contain a share of emotionally valenced (22-34%), high arousal (15-18%), lower familiarity (6-8%) and polysyllabic (5-9%) content words. Readability was highest for the novel passage (on formula-based scales). Average disfluencies percent for the Rainbow and our novel passage were not significantly different. Yet half of the individuals in this sample showed a large difference between the two passages.

CONCLUSION

We provide detailed information on potential sources of variance using the traditional passages. Knowledge about these characteristics can inform clinical practice (and research). We suggest a combined procedure, using more than one passage to assess stuttering in individual cases.

Prosody and Semantics Are Separate but Not Separable Channels in the Perception of Emotional Speech: Test for Rating of Emotions in Speech

PURPOSE

Our aim is to explore the complex interplay of prosody (tone of speech) and semantics (verbal content) in the perception of discrete emotions in speech.

METHOD

We implement a novel tool, the Test for Rating of Emotions in Speech. Eighty native English speakers were presented with spoken sentences made of different combinations of 5 discrete emotions (anger, fear, happiness, sadness, and neutral) presented in prosody and semantics. Listeners were asked to rate the sentence as a whole, integrating both speech channels, or to focus on one channel only (prosody or semantics).

RESULTS

We observed supremacy of congruency, failure of selective attention, and prosodic dominance. Supremacy of congruency means that a sentence that presents the same emotion in both speech channels was rated highest; failure of selective attention means that listeners were unable to selectively attend to one channel when instructed; and prosodic dominance means that prosodic information plays a larger role than semantics in processing emotional speech.

CONCLUSIONS

Emotional prosody and semantics are separate but not separable channels, and it is difficult to perceive one without the influence of the other. Our findings indicate that the Test for Rating of Emotions in Speech can reveal specific aspects in the processing of emotional speech and may in the future prove useful for understanding emotion-processing deficits in individuals with pathologies.

Oral-diadochokinetic rates for Hebrew-speaking school-age children: real words vs. non-words repetition

Oral-diadochokinesis (DDK) tasks are a common tool for evaluating speech disorders. Usually, these tasks involve repetitions of non-words. It has been suggested that repeating real words can be more suitable for preschool children. But, the impact of using real words with elementary school children has not been studied yet. This study evaluated oral-DDK rates for Hebrew-speaking elementary school children using non-words and real words. The participants were 60 children, 9-11 years old, with normal speech and language development, who were asked to repeat "pataka" (non-word) and "bodeket" (Hebrew real word). Data replicate the advantage generally found for real word repetition with preschoolers. Children produced real words faster than non-words for all age groups, and repetition rates were higher for the older children. The findings suggest that adding real words to the standard oral-DDK task with elementary school children may provide a more comprehensive picture of oro-motor function.