Initial Observations of Lingual Movement Characteristics of Children With Cerebral Palsy

The Effectiveness of Lee Silverman Voice Treatment (LSVT LOUD) on Children's Speech and Voice: A Scoping Review

BACKGROUND

This scoping review had as a primary goal a review of the literature and the an analysis of the possible effectiveness of the LSVT LOUD approach in children with voice and speech deficits.

METHODS

A search was conducted in the Scopus and PubMed databases in May of 2024. Eleven articles were obtained from the search. The standards of PRISMA recommendations were used for scoping reviews and the PCC framework was used for the eligibility criteria. Furthermore, the study used the instructions in the Cochrane Handbook for a quality assessment. The Mendeley Reference Manager software collected the studies and removed duplicates.

RESULTS

The reviewed studies employed formal and informal measures to assess voice and speech abilities in the children. Regarding the sample's characteristics, the studies mostly included children with Cerebral Palsy (CP) and also those with Down Syndrome (DS). All the studies reported that children with CP and DS undertook a total dose of the LSVT LOUD treatment. Significant post-treatment findings indicated increased speech function and sound pressure level, regarding the auditory-perceptual ratings of voice and speech improvement. In many studies, parents' and expert listeners' ratings of voice, perception of vocal loudness, speech, and communication indicated improvement.

CONCLUSIONS

The majority of the included studies provide positive evidence for the LSVT as an approach. However, the small sample size that featured in the studies, as well as their limitations, made these conclusions uncertain. Moreover, the study's findings provided recommendations that speech language therapists and other clinicians need to follow when setting a treatment plan with children with CP and DS.

Articulatory and Vocal Fold Movement Patterns During Loud Speech in Children With Cerebral Palsy

PURPOSE

Speech motor control changes underlying louder speech are poorly understood in children with cerebral palsy (CP). The current study evaluates changes in the oral articulatory and laryngeal subsystems in children with CP and their typically developing (TD) peers during louder speech.

METHOD

Nine children with CP and nine age- and sex-matched TD peers produced sentence repetitions in two conditions: (a) with their habitual rate and loudness and (b) with louder speech. Lip and jaw movements were recorded with optical motion capture. Acoustic recordings were obtained to evaluate vocal fold articulation.

RESULTS

Children with CP had smaller jaw movements, larger lower lip movements, slower jaw speeds, faster lip speeds, reduced interarticulator coordination, reduced low-frequency spectral tilt, and lower cepstral peak prominences (CPP) in comparison to their TD peers. Both groups produced louder speech with larger lip and jaw movements, faster lip and jaw speeds, increased temporal coordination, reduced movement variability, reduced spectral tilt, and increased CPP.

CONCLUSIONS

Children with CP differ from their TD peers in the speech motor control of both the oral articulatory and laryngeal subsystems. Both groups alter oral articulatory and vocal fold movements when cued to speak loudly, which may contribute to the increased intelligibility associated with louder speech.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.24970302.

Use of Automated Kinematic Diadochokinesis Analysis to Identify Potential Indicators of Speech Motor Involvement in Children With Cerebral Palsy

PURPOSE

This study examined multiple variables obtained from an automated measure of lip movement during a diadochokinesis (DDK) task to identify those with potential to detect mild speech motor involvement in school-age children diagnosed with cerebral palsy (CP).

METHOD

Eight children with CP and high speech intelligibility and a matched group of eight children with typical development (TD) completed a DDK task while their lip and jaw movements were recorded. A custom MATLAB algorithm was used to automatically extract 23 kinematic measures of children's lip movements during production of the DDK sequences. Mann-Whitney U tests were used to compare groups on the kinematic measures, and receiver operating characteristic (ROC) analysis was used to evaluate the diagnostic accuracy of measures that significantly differed between groups.

RESULTS

Five of the 23 kinematic variables differed significantly between the CP and TD groups. These were two measures of overall DDK performance (i.e., duration of the DDK sequence and number of cycles) and three spatial and temporal measures of lip movement. Duration of the DDK sequence and the mean displacement of the lips across cycles had the highest diagnostic accuracy, differentiating CP and TD groups with 88% sensitivity and 88% specificity.

CONCLUSIONS

Automatically derived kinematic measures of DDK sequences differentiated children with CP and high intelligibility from typically developing children. Future research is needed to determine the clinical utility of these measures for detecting speech motor impairment.

Intelligibility, Speech Rate, and Communication Efficiency in Children With Neurological Conditions: A Longitudinal Study of Childhood Dysarthria

PURPOSE

This study aimed to describe communication-related parameters (i.e., intelligibility, speech rate, and communication efficiency) and their developmental courses in children with neurological conditions against the background of typical development. In addition, interrelations between the developmental courses of communication-related parameters and auditory-perceptual ratings related to speech subsystems were investigated.

METHOD

Fourteen children with neurological conditions (CNC) and 14 typically developing children (CTD), matched for age and gender (four girls; 5;1-8;4 [years;months] at first examination), were assessed at three points in time over an 18-month period. Speech samples were collected using the Bogenhausener Dysarthrie Skalen-Kindliche Dysarthrien (English: Bogenhausen Dysarthria Scales-Childhood Dysarthria), a German tool for the assessment of childhood dysarthria. To assess intelligibility, naïve listeners transcribed audio samples of sentence repetitions of the children. Speech rate was measured by acoustic analyses, and communication efficiency was determined by multiplying the proportion of correctly transcribed syllables with speech rate. Age normalization was performed following a recently published approach.

RESULTS

On the group level, CNC had conspicuous raw and normalized scores for the three communication-related parameters and were more variable than the CTD group regarding their developmental courses. These differences were more pronounced for intelligibility than for speech rate. A strong relationship between communication-related and speech subsystems-related auditory-perceptual characteristics was apparent only between intelligibility and articulation/resonance.

CONCLUSIONS

For the first time, age-normalized scores for communication-related parameters were reported in children with neurological disorders and put into a developmental context within the framework of a longitudinal study. Age-normalized intelligibility was more vulnerable to large developmental changes than speech rate and was best predicted by changes in articulation and resonance. Overall, this study may contribute to a more comprehensive and valid clinical assessment of childhood dysarthria and to a better understanding of its developmental dynamics.

Speech treatment for Hebrew-speaking adolescents and young adults with developmental dysarthria: A comparison of mSIT and Beatalk

BACKGROUND

Individuals with developmental dysarthria typically demonstrate reduced functioning of one or more of the speech subsystems, which negatively impacts speech intelligibility and communication within social contexts. A few treatment approaches are available for improving speech production and intelligibility among individuals with developmental dysarthria. However, these approaches have only limited application and research findings among adolescents and young adults.

AIMS

To determine and compare the effectiveness of two treatment approaches, the modified Speech Intelligibility Treatment (mSIT) and the Beatalk technique, on speech production and intelligibility among Hebrew-speaking adolescents and young adults with developmental dysarthria.

METHODS & PROCEDURES

Two matched groups of adolescents and young adults with developmental dysarthria participated in the study. Each received one of the two treatments, mSIT or Beatalk, over the course of 9 weeks. Measures of speech intelligibility, articulatory accuracy, voice and vowel acoustics were assessed both pre- and post-treatment.

OUTCOMES & RESULTS

Both the mSIT and Beatalk groups demonstrated gains in at least some of the outcome measures. Participants in the mSIT group exhibited improvement in speech intelligibility and voice measures, while participants in the Beatalk group demonstrated increased articulatory accuracy and gains in voice measures from pre- to post-treatment. Significant increases were noted post-treatment for first formant values for select vowels.

CONCLUSIONS & IMPLICATIONS

Results of this preliminary study are promising for both treatment approaches. The differentiated results indicate their distinct application to speech intelligibility deficits. The current findings also hold clinical significance for treatment among adolescents and young adults with motor speech disorders and application for a language other than English.

WHAT THIS PAPER ADDS

What is already known on the subject Developmental dysarthria (e.g., secondary to cerebral palsy) is a motor speech disorder that negatively impacts speech intelligibility, and thus communication participation. Select treatment approaches are available with the aim of improving speech intelligibility in individuals with developmental dysarthria; however, these approaches are limited in number and have only seldomly been applied specifically to adolescents and young adults. What this paper adds to existing knowledge The current study presents preliminary data regarding two treatment approaches, the mSIT and Beatalk technique, administered to Hebrew-speaking adolescents and young adults with developmental dysarthria in a group setting. Results demonstrate the initial effectiveness of the treatment approaches, with different gains noted for each approach across speech and voice domains. What are the potential or actual clinical implications of this work? The findings add to the existing literature on potential treatment approaches aiming to improve speech production and intelligibility among individuals with developmental dysarthria. The presented approaches also show promise for group-based treatments as well as the potential for improvement among adolescents and young adults with motor speech disorders.

Native Language and Second Language Convergence and Second Language Instruction Shape Speech-Language Performance in Adult Learners

PURPOSE

We examined native language (L1) and second language (L2) convergence of underlying skills in adult L2 learners as well as the contribution of instructional L2 level on L2 attainment across speech motor, lexical, and narrative levels.

METHOD

Thirty-four adult Spanish L2 learners who had completed at least 1 year of college Spanish participated in this preliminary study. Learners were tested at the speech motor, lexical, and narrative levels in their L1 (English) and L2 (Spanish). L1-L2 convergence was indexed by associative links between corresponding L1 and L2 skills. In regression analyses, the level of Spanish instruction at the time of the study was also considered as a predictor of L2 attainment across speech motor, lexical, and narrative levels.

RESULTS

L1-L2 convergence was identified for some speech motor skills (distance, maximum speed) and for lexical skills but was limited for other speech motor skills (duration, spatiotemporal index) and for narrative measures. Furthermore, lexical and narrative measures, but not speech motor measures, showed improvements with Spanish (L2) instruction.

CONCLUSIONS

L1-L2 convergence and instructional level are predictors of L2 performance in adult language learners. These factors play somewhat different roles across speech motor, lexical, and narrative levels, warranting further "all-system" research across processing and proficiency levels.

Voice Quality of Children With Cerebral Palsy

Purpose Many children with cerebral palsy (CP) are described as having altered vocal quality. The current study utilizes psychoacoustic measures, namely, low-amplitude (H1*-H2*) and high-amplitude (H1*-A2*) spectral tilt and cepstral peak prominence (CPP), to identify the vocal fold articulation characteristics in this population. Method Eight children with CP and eight typically developing (TD) peers produced vowel singletons [i, ɑ, u] and a story retell task with the same vowels in the words "beets, Bobby, boots." H1*-H2*, H1*-A2*, and CPP were extracted from each vowel. Results were analyzed with mixed linear models to identify the effect of Group (CP, TD), Task (vowel singleton, story retell), and Vowel [i, ɑ, u] on the dependent variables. Results Children with CP have lower spectral tilt values (H1*-H2* and H1*-A2*) and lower CPP values than their TD peers. For both groups, vowel singletons were associated with lower CPP values as compared to story retell. Finally, the vowel [ɑ] was associated with higher spectral tilt and higher CPP values as compared to [i, u]. Conclusions Children with CP have more constricted and creaky vocal quality due to lower spectral tilt and greater noise. Unlike adults, children demonstrate poorer vocal fold articulation when producing vowel singletons as compared to story retell. Finally, low vowels like [ɑ] seem to be produced with less constriction and noise as compared to high vowels.

The Effect of Practice on Variability in Childhood Apraxia of Speech: A Multidimensional Analysis

Purpose Variability has been interpreted in differing ways according to context (e.g., development, speech impairment, and learning). A challenge arises when interpreting variability in the context of learning for children with speech impairment characterized by high movement variability, as in childhood apraxia of speech (CAS). The objective of this study is to investigate changes in variability in CAS with practice in comparison to patterns seen in children with non-CAS speech sound disorders (SSD) and typical development. Method Speech production variability was examined in 24 children (5-6 years of age) with CAS, non-CAS SSD, and typical development in production of nonwords of varied motoric complexity. Multidimensional analyses were performed using measures of token-to-token speech consistency (percent word consistency), acoustic variability (acoustic spatiotemporal index), and movement variability (lip aperture spatiotemporal index). Changes in variability were examined in each group of children by comparing the first half to the last half of nonword tokens in the same data collection session. The impact of token complexity on practice effects was also explored across groups of children. Results All children displayed increased speech consistency within this practice period (p = .01). Only children with CAS displayed increased movement variability following practice (p = .01). Differences in acoustic and kinematic variability were observed across complexity levels in all groups, though these did not interact with practice effects. Discussion These findings suggest that increased movement variability in children with CAS might be facilitating perceptual consistency. It is believed that this finding reflects an inefficient strategy adapted by children with CAS in the absence of motor-based cueing and feedback to guide speech performance with practice.

Perceptual and Acoustic Effects of Dual-Focus Speech Treatment in Children With Dysarthria

Purpose Children with dysarthria secondary to cerebral palsy may experience reduced speech intelligibility and diminished communicative participation. However, minimal research has been conducted examining the outcomes of behavioral speech treatments in this population. This study examined the effect of Speech Intelligibility Treatment (SIT), a dual-focus speech treatment targeting increased articulatory excursion and vocal intensity, on intelligibility of narrative speech, speech acoustics, and communicative participation in children with dysarthria. Method American English-speaking children with dysarthria (n = 17) received SIT in a 3-week summer camplike setting at Columbia University. SIT follows motor-learning principles to train the child-friendly, dual-focus strategy, "Speak with your big mouth and strong voice." Children produced a story narrative at baseline, immediate posttreatment (POST), and at 6-week follow-up (FUP). Outcomes were examined via blinded listener ratings of ease of understanding (n = 108 adult listeners), acoustic analyses, and questionnaires focused on communicative participation. Results SIT resulted in significant increases in ease of understanding at POST, that were maintained at FUP. There were no significant changes to vocal intensity, speech rate, or vowel spectral characteristics, with the exception of an increase in second formant difference between vowels following SIT. Significantly enhanced communicative participation was evident at POST and FUP. Considerable variability in response to SIT was observed between children. Conclusions Dual-focus treatment shows promise for improving intelligibility and communicative participation in children with dysarthria, although responses to treatment vary considerably across children. Possible mechanisms underlying the intelligibility gains, enhanced communicative participation, and variability in treatment effects are discussed.

Acoustic vowel analysis and speech intelligibility in young adult Hebrew speakers: Developmental dysarthria versus typical development

BACKGROUND

Developmental dysarthria is a motor speech impairment commonly characterized by varying levels of reduced speech intelligibility. The relationship between intelligibility deficits and acoustic vowel space among these individuals has long been noted in the literature, with evidence of vowel centralization (e.g., in English and Mandarin). However, the degree to which this centralization occurs and the intelligibility-acoustic relationship is maintained in different vowel systems has yet to be studied thoroughly. In comparison with American English, the Hebrew vowel system is significantly smaller, with a potentially smaller vowel space area, a factor that may impact upon the comparisons of the acoustic vowel space and its correlation with speech intelligibility. Data on vowel space and speech intelligibility are particularly limited for Hebrew speakers with motor speech disorders.

AIMS

To determine the nature and degree of vowel space centralization in Hebrew-speaking adolescents and young adults with dysarthria, in comparison with typically developing (TD) peers, and to correlate these findings with speech intelligibility scores.

METHODS & PROCEDURES

Adolescents and young adults with developmental dysarthria (secondary to cerebral palsy (CP) and other motor deficits, n = 17) and their TD peers (n = 17) were recorded producing Hebrew corner vowels within single words. For intelligibility assessments, naïve listeners transcribed those words produced by speakers with CP, and intelligibility scores were calculated.

OUTCOMES & RESULTS

Acoustic analysis of vowel formants (F1, F2) revealed a centralization of vowel space among speakers with CP for all acoustic metrics of vowel formants, and mainly for the formant centralization ratio (FCR), in comparison with TD peers. Intelligibility scores were correlated strongly with the FCR metric for speakers with CP.

CONCLUSIONS & IMPLICATIONS

The main results, vowel space centralization for speakers with CP in comparison with TD peers, echo previous cross-linguistic results. The correlation of acoustic results with speech intelligibility carries clinical implications. Taken together, the results contribute to better characterization of the speech production deficit in Hebrew speakers with motor speech disorders. Furthermore, they may guide clinical decision-making and intervention planning to improve speech intelligibility. What this paper adds What is already known on the subject Speech production and intelligibility deficits among individuals with developmental dysarthria (e.g., secondary to CP) are well documented. These deficits have also been correlated with centralization of the acoustic vowel space, although primarily in English speakers. Little is known about the acoustic characteristics of vowels in Hebrew speakers with motor speech disorders, and whether correlations with speech intelligibility are maintained. What this paper adds to existing knowledge This study is the first to describe the acoustic characteristics of vowel space in Hebrew-speaking adolescents and young adults with developmental dysarthria. The results demonstrate a centralization of the acoustic vowel space in comparison with TD peers for all measures, as found in other languages. Correlation between acoustic measures and speech intelligibility scores were also documented. We discuss these results within the context of cross-linguistic comparisons. What are the potential or actual clinical implications of this work? The results confirm the use of objective acoustic measures in the assessment of individuals with motor speech disorders, providing such data for Hebrew-speaking adolescents and young adults. These measures can be used to determine the nature and severity of the speech deficit across languages, may guide intervention planning, as well as measure the effectiveness of intelligibility-based treatment programmes.

Neuromuscular and biomechanical adjustments of the speech mechanism during modulation of vocal loudness in children with cerebral palsy and dysarthria

ABSTRACChildren with cerebral palsy (CP) are characterized as difficult to understand because of poor articulation and breathy voice quality. This case series describes the subsystems of the speech mechanism (i.e., respiratory, laryngeal, oroarticulatory) in four children with CP and four matched typically developing children (TDC) during the modulation of vocal loudness. TDC used biomechanically efficient strategies among speech subsystems to increase vocal loudness. Children with CP made fewer breathing adjustments but recruited greater chest wall muscle activity and neuromuscular drive for louder productions. These results inform future clinical research and identify speech treatment targets for children with motor speech disorders.

Effects of speech cues in French-speaking children with dysarthria

BACKGROUND

Articulatory excursion and vocal intensity are reduced in many children with dysarthria due to cerebral palsy (CP), contributing to the children's intelligibility deficits and negatively affecting their social participation. However, the effects of speech-treatment strategies for improving intelligibility in this population are understudied, especially for children who speak languages other than English. In a cueing study on English-speaking children with dysarthria, acoustic variables and intelligibility improved when the children were provided with cues aimed to increase articulatory excursion and vocal intensity. While French is among the top 20 most spoken languages in the world, dysarthria and its management in French-speaking children are virtually unexplored areas of research. Information gleaned from such research is critical for providing an evidence base on which to provide treatment.

AIMS

To examine acoustic and perceptual changes in the speech of French-speaking children with dysarthria, who are provided with speech cues targeting greater articulatory excursion (French translation of 'speak with your big mouth') and vocal intensity (French translation of 'speak with your strong voice'). This study investigated whether, in response to the cues, the children would make acoustic changes and listeners would perceive the children's speech as more intelligible.

METHODS & PROCEDURES

Eleven children with dysarthria due to CP (six girls, five boys; ages 4;11-17;0 years; eight with spastic CP, three with dyskinetic CP) repeated pre-recorded speech stimuli across three speaking conditions (habitual, 'big mouth' and 'strong voice'). Stimuli were sentences and contrastive words in phrases. Acoustic analyses were conducted. A total of 66 Belgian-French listeners transcribed the children's utterances orthographically and rated their ease of understanding on a visual analogue scale at sentence and word levels.

OUTCOMES & RESULTS

Acoustic analyses revealed significantly longer duration in response to the big mouth cue at sentence level and in response to both the big mouth and strong voice cues at word level. Significantly higher vocal sound-pressure levels were found following both cues at sentence and word levels. Both cues elicited significantly higher first-formant vowel frequencies and listeners' greater ease-of-understanding ratings at word level. Increases in the percentage of words transcribed correctly and in sentence ease-of-understanding ratings, however, did not reach statistical significance. Considerable variability between children was observed.

CONCLUSIONS & IMPLICATIONS

Speech cues targeting greater articulatory excursion and vocal intensity yield significant acoustic changes in French-speaking children with dysarthria. However, the changes may only aid listeners' ease of understanding at word level. The significant findings and great inter-speaker variability are generally consistent with studies on English-speaking children with dysarthria, although changes appear more constrained in these French-speaking children. What this paper adds What is already known on the subject According to the only study comparing effects of speech-cueing strategies on English-speaking children with dysarthria, intelligibility increases when the children are provided with cues aimed to increase articulatory excursion and vocal intensity. Little is known about speech characteristics in French-speaking children with dysarthria and no published research has explored effects of cueing strategies in this population. What this paper adds to existing knowledge This paper is the first study to examine the effects of speech cues on the acoustics and intelligibility of French-speaking children with CP. It provides evidence that the children can make use of cues to modify their speech, although the changes may only aid listeners' ease of understanding at word level. What are the potential or actual clinical implications of this work? For clinicians, the findings suggest that speech cues emphasizing increasing articulatory excursion and vocal intensity show promise for improving the ease of understanding of words produced by francophone children with dysarthria, although improvements may be modest. The variability in the responses also suggests that this population may benefit from a combination of such cues to produce words that are easier to understand.

Effect of prosodic manipulation on articulatory kinematics and second formant trajectories in children

This study investigated effects of rate reduction and emphatic stress cues on second formant (F2) trajectories and articulatory movements during diphthong production in 11 typically developing school-aged children. F2 extent increased in slow and emphatic stress conditions, and tongue and jaw displacement increased in the emphatic stress condition compared to habitual speech. Tongue displacement significantly predicted F2 extent across speaking conditions. Results suggest that slow rate and emphatic stress cues induce articulatory and acoustic changes in children that may enhance clarity of the acoustic signal. Potential clinical implications for improving speech in children with dysarthria are discussed.

Speech Sound Disorders in Children: An Articulatory Phonology Perspective

Speech Sound Disorders (SSDs) is a generic term used to describe a range of difficulties producing speech sounds in children (McLeod and Baker, 2017). The foundations of clinical assessment, classification and intervention for children with SSD have been heavily influenced by psycholinguistic theory and procedures, which largely posit a firm boundary between phonological processes and phonetics/articulation (Shriberg, 2010). Thus, in many current SSD classification systems the complex relationships between the etiology (distal), processing deficits (proximal) and the behavioral levels (speech symptoms) is under-specified (Terband et al., 2019a). It is critical to understand the complex interactions between these levels as they have implications for differential diagnosis and treatment planning (Terband et al., 2019a). There have been some theoretical attempts made towards understanding these interactions (e.g., McAllister Byun and Tessier, 2016) and characterizing speech patterns in children either solely as the product of speech motor performance limitations or purely as a consequence of phonological/grammatical competence has been challenged (Inkelas and Rose, 2007; McAllister Byun, 2012). In the present paper, we intend to reconcile the phonetic-phonology dichotomy and discuss the interconnectedness between these levels and the nature of SSDs using an alternative perspective based on the notion of an articulatory "gesture" within the broader concepts of the Articulatory Phonology model (AP; Browman and Goldstein, 1992). The articulatory "gesture" serves as a unit of phonological contrast and characterization of the resulting articulatory movements (Browman and Goldstein, 1992; van Lieshout and Goldstein, 2008). We present evidence supporting the notion of articulatory gestures at the level of speech production and as reflected in control processes in the brain and discuss how an articulatory "gesture"-based approach can account for articulatory behaviors in typical and disordered speech production (van Lieshout, 2004; Pouplier and van Lieshout, 2016). Specifically, we discuss how the AP model can provide an explanatory framework for understanding SSDs in children. Although other theories may be able to provide alternate explanations for some of the issues we will discuss, the AP framework in our view generates a unique scope that covers linguistic (phonology) and motor processes in a unified manner.

Characteristics of Speech Rate in Children With Cerebral Palsy: A Longitudinal Study

PURPOSE

The purpose of this longitudinal study was to examine the effect of time and sentence length on speech rate and its characteristics, articulation rate and pauses, within 2 groups of children with cerebral palsy (CP).

METHOD

Thirty-four children with CP, 18 with no speech motor involvement and 16 with speech motor involvement, produced sentences of varying lengths at 3 time points that were 1 year apart (mean age = 56 months at first time point). Dependent measures included speech rate, articulation rate, proportion of time spent pausing, and average number and duration of pauses.

RESULTS

There were no significant effects of time. For children with no speech motor involvement, speech rate increased with longer sentences due to increased articulation rate. For children with speech motor involvement, speech rate did not change with sentence length due to significant increases in the proportion of time spent pausing and average number of pauses in longer sentences.

CONCLUSIONS

There were no significant age-related differences in speech rate in children with CP regardless of group membership. Sentence length differentially impacted speech rate and its characteristics in both groups of children with CP. This may be due to cognitive-linguistic and/or speech motor control factors.