Longitudinal Growth in Single Word Intelligibility Among Children With Cerebral Palsy From 24 to 96 Months of Age: Predicting Later Outcomes From Early Speech Production

Efficacy and influencing factors of cervical perivascular sympathectomy in children with cerebral palsy

BACKGROUND

There is a lack of research to determine the efficacy of cervical perivascular sympathectomy (CPVS) in children with cerebral palsy (CP).

OBJECTIVE

This study aimed to evaluate the efficacy of CPVS in children with CP and analyze the associated influential factors.

METHODS

Using the method of retrospective cohort studies, children who underwent CPVS were included in the CPVS group, whereas those who underwent selective posterior rhizotomy (SPR) were included in the SPR group. The Communication Function Classification System (CFCS) and Teacher Drooling Scale (TDS) were used to evaluate the communication function and salivation in the two groups before and 12 months after surgery and compare the surgical efficiency between the two groups, and the factors affecting the efficacy were screened by binary logistic regression.

RESULTS

The study included 406 patients, 202 in the CPVS group and 204 in the SPR group. No significant differences were observed in the baseline characteristics (p > 0.05). The surgical efficacy of the CPVS group (47.01%) was significantly higher than that in the SPR group (9.81%) (χ2 = 71.08, p < 0.001). Binary logic regression analysis showed that preterm birth and Gross Motor Function Classification System (GMFCS) grade were influencing factors of surgical efficacy. Eighteen patients developed postoperative complications.

CONCLUSION

CPVS is a safe and effective surgery for cerebral palsy. Preterm birth and GMFCS grade are independent factors affecting the efficacy of surgery.

Perceptual measurement of articulatory goodness in young children: Relationships with age, speech sound acquisition, and intelligibility

Speech language pathologists regularly use perceptual methods in clinical practice to assess children's speech. In this study, we examined relationships between measures of speech intelligibility, clinical articulation test results, age, and perceptual ratings of articulatory goodness for children. We also examined the extent to which established measures of intelligibility and clinical articulation test results predicted articulatory goodness ratings, and whether goodness ratings were influenced by intelligibility. A sample of 164 (30-47 months) typically developing children provided speech samples and completed a standardised articulation test. Single word intelligibility scores and ratings of articulatory goodness were gathered from 328 naïve listeners; scores on a standardised articulation test were obtained from each child. Bivariate Pearson correlation, linear regression, and linear mixed effects modelling were used for analysis. Results showed that articulatory goodness ratings had the highest correlation with intelligibility, followed by age, followed by articulation score. Age and clinical articulation scores were both significant predictors of goodness ratings, but articulation scores made only a small contribution to prediction. Articulatory goodness ratings were substantially lower for unintelligible words compared to intelligible words, but articulatory goodness scores increased with age at the same rate for unintelligible and intelligible words. Perceptual ratings of articulatory goodness are sensitive to developmental changes in speech production (regardless of intelligibility) and yield a different kind of information than clinical articulation scores from standardised measures.

Vocal Characteristics of Infants at Risk for Speech Motor Involvement: A Scoping Review

PURPOSE

The purpose of this scoping review was to (a) summarize methodological characteristics of studies examining vocal characteristics of infants at high risk for neurological speech motor involvement and (b) report the state of the high-quality evidence on vocal characteristic trends of infants diagnosed or at high risk for cerebral palsy (CP).

METHOD

The PRISMA (Preferred Reporting Items of Systematic Reviews and Meta-Analyses) extension for scoping reviews was followed for reporting our review. Studies measured prelinguistic vocal characteristics of infants under 24 months with birth risk or genetic conditions known to commonly present with speech motor involvement. Fifty-five studies met criteria for Part 1. Eleven studies met criteria for synthesis in Part 2.

RESULTS

A smaller percentage of studies examined infants with or at risk for CP compared to studies examining genetic conditions such as Down syndrome. The median year of publication was 1999, with a median sample size of nine participants. Most studies were conducted in laboratory settings and used human coding of vocalizations produced during caregiver-child interactions. Substantial methodological differences were noted across all studies. A small number of high-quality studies of infants with or at risk for CP revealed high rates of marginal babbling, low rates of canonical babbling, and limited consonant diversity under 24 months. Mixed findings were noted across studies of general birth risk factors.

CONCLUSIONS

There is limited evidence available to support the early detection of speech motor involvement. Large methodological differences currently impact the ability to synthesize findings across studies. There is a critical need to conduct longitudinal research with larger sample sizes and advanced, modern technologies to detect vocal precursors of speech impairment to support the accurate diagnosis and prognosis of speech development in infants with CP and other clinical populations.

Clinical Practice in Childhood Dysarthria: An Online Survey of German-Speaking Speech-Language Pathologists

PURPOSE

This survey study aimed to establish current clinical practices of German-speaking speech-language pathologists (SLPs) regarding their assessment and treatment of communication disorders in children with neurological conditions, with a particular focus on the management of childhood dysarthria.

METHOD

A 23-question cross-sectional online survey was disseminated to practicing SLPs in Germany, Austria, and Switzerland via relevant professional bodies. SLPs were invited to provide information on their current assessment and treatment practices. Demographic data including case load and clinical settings were also gathered to contextualize practices.

RESULTS

One hundred two SLPs responded to the survey, of which 68 valid responses were analyzed. German-speaking SLPs comprehensively assess and treat various aspects of overall communication, language, and swallowing functions in children with neurological conditions. Speech motor aspects did not represent a main intervention focus. In cases where the dysarthric component was targeted, specific approaches for childhood dysarthria were rarely used. Instead, SLPs reported using approaches developed for speech disorders other than dysarthria.

CONCLUSIONS

German-speaking SLPs working with children with neurological conditions use various assessment and treatment methods to support children's communication. However, dysarthria-specific approaches were not an established part of clinical practice. Results of the survey highlight the need for access to relevant developments in German and for evaluation of current curricula for speech-language pathology students and continuing education opportunities for practicing clinicians.

Sentence Length Effects on Intelligibility in Two Groups of Older Children With Neurodevelopmental Disorders

PURPOSE

The purpose of this study was to examine the impact of sentence length on intelligibility in two groups of older children with neurodevelopmental disabilities.

METHOD

Nine children diagnosed with cerebral palsy (CP) and eight children diagnosed with Down syndrome (DS), between the ages of 8 and 17 years, repeated sentences varying in length from two to seven words. Three hundred forty adult listeners (20 listeners per child) provided orthographic transcriptions of children's speech, which were used to calculate intelligibility scores.

RESULTS

There was a significant main effect of sentence length on intelligibility for children with CP. Intelligibility significantly increased from two- and three-word sentences to four-, five-, and six-word sentences, then significantly decreased from four-, five-, and six-word sentences to seven-word sentences. There was a main effect of sentence length on intelligibility for children with DS. Intelligibility significantly increased from two-word sentences to four-, five-, and six-word sentences.

CONCLUSIONS

The primary findings of this study include the following: (a) Unlike in typically developing children, sentence length continues to influence intelligibility well into adolescence for children with neurodevelopmental disorders, and (b) sentence length may influence intelligibility differently in children with CP than in children with DS; however, other factors besides the type of neurodevelopmental disorder (e.g., severity of speech motor involvement and/or cognitive-linguistic impairment) could play a role in the relationship between sentence length and intelligibility and must be investigated in future studies.

Developmental Cut-Points for Atypical Speech Intelligibility in Children With Cerebral Palsy

PURPOSE

Early identification of speech motor involvement (SMI) in children with cerebral palsy (CP) is difficult because of overlapping features with many aspects of typical speech development. Quantitative measures of speech intelligibility have the potential to differentiate between children with SMI and those with no SMI (NSMI). We examined thresholds for speech intelligibility development in children with CP relative to the low end of age-specific typical developmental expectations. We sought to determine whether there were intelligibility differences between children with CP and NSMI versus typically developing (TD) age-mates across the range of development and whether there were differences between children with CP who have NSMI and those with CP who have SMI across the range of development based on speech intelligibility.

METHOD

We used two large existing data sets that included speech samples from children between the ages of 2.5 and 8 years. One data set included 511 longitudinal speech samples from children with CP; the other included 505 cross-sectional speech samples from TD children. We examined receiver operating characteristic curves and sensitivity/specificity results by age for differentiating among groups of children.

RESULTS

TD children versus those with CP and NSMI showed differentiation in their speech intelligibility across all ages, but the strength of differentiation was only marginally above chance. Children with CP and NSMI showed clear differentiation in their speech intelligibility from those with CP and SMI beginning at the earliest age point. Children with CP who have intelligibility below 40% at the age of 3 years have a very high probability of having SMI.

CONCLUSIONS

Early intelligibility screening should be performed in children diagnosed with CP. Those with intelligibility below 40% at 3 years of age should be referred immediately for speech assessment and treatment.

Naive Listener Ratings of Speech Intelligibility Over the Course of Motor-Based Intervention in Children With Childhood Apraxia of Speech

PURPOSE

The aim of this study was to describe changes in speech intelligibility and interrater and intrarater reliability of naive listeners' ratings of words produced by young children diagnosed with childhood apraxia of speech (CAS) over a period of motor-based intervention (dynamic temporal and tactile cueing [DTTC]).

METHOD

A total of 120 naive listeners (i.e., listeners without experience listening to children with speech and/or language impairments; age range: 18-45 years) orthographically transcribed single-word productions by five children (age range: 2;6-3;11 [years;months]) across three time points over an intervention period (baseline, post-treatment, maintenance). Changes in intelligibility and interrater and intrarater reliability were examined within and across time points.

RESULTS

Speech intelligibility significantly increased in children with CAS over the course of treatment, and these gains were also maintained at 6 weeks posttreatment. There was poor-to-fair consistency between listeners (interrater reliability) and excellent consistency within listeners (intrarater reliability) in ratings of speech intelligibility within and across time points.

CONCLUSIONS

Motor-based intervention increases speech intelligibility following a period of DTTC treatment. Variability among naive listeners of speech intelligibility was also present, with intrarater reliability (within listeners) yielding greater consistency than interrater reliability (between listeners). The implications for including naive listeners as raters of speech intelligibility for research and clinical purposes are discussed.

Singing and Speaking Ability in Parkinson's Disease and Spinocerebellar Ataxia

PURPOSE

This study examined spontaneous, spoken-to-a-model, and two sung modes in speakers with Parkinson's disease (PD), speakers with cerebellar disease (CD), and healthy controls. Vocal performance was measured by intelligibility scores and listeners' perceptual ratings.

METHOD

Participants included speakers with hypokinetic dysarthria secondary to PD, those with ataxic dysarthria secondary to CD, and healthy speakers. Participants produced utterances in four vocal modes: spontaneous speech, spoken-to-a-model, sung-to-a-model, and spontaneous singing. For spoken-to-a-model and sung-to-a-model modes, written material was provided the model. For spontaneous singing, participants sang songs that they endorsed as familiar.

DEPENDENT VARIABLES

In Experiment I, listeners orthographically transcribed the audio samples of the first three vocal modes. In Experiment IIa, raters evaluated the accuracy of the pitch and rhythm of the spontaneous singing of familiar songs. Finally, familiar songs and sung-to-a-model utterances were rated on a competency scale by a second group of raters (Experiment IIb).

RESULTS

Results showed increases in intelligibility during the spoken-to-a-model mode compared with the spontaneous mode in both PD and CD groups. Singing enhanced the vocal output of speakers with PD more than in speakers with CD, as measured by percent intelligibility. PD participants' pitch and rhythm accuracy and competency in singing familiar songs was rated more favorably than those produced by CD participants.

CONCLUSIONS

The findings reveal a vocal task effect for spoken utterances in both groups. Sung exemplars, more impaired in CD, suggest a significant involvement of the cerebellum in singing.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.21809544.

Implementation of an Early Communication Intervention for Young Children with Cerebral Palsy Using Single-Subject Research Design

The implementation of an intervention protocol aimed at increasing vocal complexity in three pre-linguistic children with cerebral palsy (two males, starting age 15 months, and one female, starting age 16 months) was evaluated utilising a repeated ABA case series design. The study progressed until the children were 36 months of age. Weekly probes with trained and untrained items were administered across each of three intervention blocks. Successive blocks targeted more advanced protophone production and speech movement patterns, individualised for each participant. Positive treatment effects were seen for all participants in terms of a greater rate of achievement of target protophone categories and speech movement patterns. Tau coefficients for trained items demonstrated overall moderate to large AB phase contrast effect sizes, with limited evidence of generalisation to untrained items. Control items featuring protophones and speech movements not targeted for intervention showed no change across phases for any participant. Our data suggest that emerging speech-production skills in prelinguistic infants with CP can be positively influenced through a multimodal intervention focused on capitalising on early periods of plasticity when language learning is most sensitive.

Speech intelligibility of children with an auditory brainstem implant: a triple-case study

Auditory brainstem implantation (ABI) is a relative recent development in paediatric hearing restoration. Consequently, young-implanted children's productive language has not received much attention. This study investigated speech intelligibility of children with ABI (N = 3) in comparison to children with cochlear implants (CI) and children with typical hearing (TH). Spontaneous speech samples were recorded from children representing the three groups matched on cumulative vocabulary level. Untrained listeners (N = 101) rated the intelligibility of one-word utterances on a continuous scale and transcribed each utterance. The rating task yielded a numerical score between 0 and 100, and similarities and differences between the listeners' transcriptions were captured by a relative entropy score. The speech intelligibility of children with CI and children with TH was similar. Speech intelligibility of children with ABI was well below that of the children with CI and TH. But whereas one child with ABI's intelligibility approached that of the control groups with increasing lexicon size, the intelligibility of the two other children with ABI did not develop in a similar direction. Overall, speech intelligibility was only moderate in the three groups of children, with quite low ratings and considerable differences in the listeners' transcriptions, resulting in high relative entropy scores.

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.

Swallowing and Motor Speech Skills in Unilateral Cerebral Palsy: Novel Findings From a Preliminary Cross-Sectional Study

PURPOSE

Our purpose was to start examining clinical swallowing and motor speech skills of school-age children with unilateral cerebral palsy (UCP) compared to typically developing children (TDC), how these skills relate to each other, and whether they are predicted by clinical/demographic data (age, birth history, lesion type, etc.).

METHOD

Seventeen children with UCP and 17 TDC (7-12 years old) participated in this cross-sectional study. Feeding/swallowing skills were evaluated using the Dysphagia Disorder Survey (DDS) and a normalized measure of mealtime efficiency (normalized mealtime duration, i.e., nMD). Motor speech was assessed via speech intelligibility and speech rate measures using the Test of Children's Speech Plus. Analyses included nonparametric bootstrapping, correlation analysis, and multiple regression.

RESULTS

Children with UCP exhibited more severe (higher) DDS scores (p = .0096, Part 1; p = .0132, Part 2) and reduced speech rate than TDC (p = .0120). Furthermore, in children with UCP, total DDS scores were moderately negatively correlated with speech intelligibility (words: r = -.6162, p = .0086; sentences: r = -.60792, p = .0096). Expressive language scores were the only significant predictor of feeding and swallowing performance, and receptive language scores were the only significant predictor of motor speech skills.

CONCLUSIONS

Swallowing and motor speech skills can be affected in school-age children with UCP, with wide variability of performance also noted. Preliminary cross-system interactions between swallowing, speech, and language are observed and might support the complex relationships between these domains. Further understanding these relationships in this population could have prognostic and/or therapeutic value and warrants further study.

Longitudinal change in speech classification between 4 and 10 years in children with cerebral palsy

AIM

To examine speech impairment severity classification over time in a longitudinal cohort of children with cerebral palsy (CP).

METHOD

A total of 101 children (58 males, 43 females) between the ages of 4 and 10 years with CP participated in this longitudinal study. Speech severity was rated using the Viking Speech Scale (VSS), a four-level classification rating scale, at 4, 6, 8, and 10 years (age 4 years: mean = 52 months [3 SD]; age 6 years: mean = 75 months [2 SD]; age 8 years: mean = 100 months [4 SD]; age 10 years: mean = 125 months [5 SD]). We used Bayesian mixed-effects ordinal logistic regression to model (1) the extent to which speech severity changed over time and (2) patterns of change across age groups and classification rating group levels.

RESULTS

VSS ratings decreased (speech severity became less severe) between 4 and 10 years of age. Children who were first classified in VSS levels I, II, or III at age 4 years had a high probability of staying at, or improving to, VSS level I by 10 years. Children who were first classified in VSS level IV at 4 years had a high probability of remaining in VSS level IV at 10 years.

INTERPRETATION

Early speech performance is highly predictive of later childhood speech abilities. Children with any level of speech impairment at age 4 years should be receiving speech therapy. Those with more severe speech impairments should be introduced to augmentative and alternative communication as soon as possible.

WHAT THIS PAPER ADDS

Children with early Viking Speech Scale (VSS) ratings below level IV have a good prognosis for speech improvement. Children with early VSS level IV ratings are likely to remain at VSS level IV over time. Children did not show worsening of VSS level between the ages of 4 and 10 years.

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.

Utility of the Intelligibility in Context Scale for Predicting Speech Intelligibility of Children with Cerebral Palsy

The Intelligibility in Context Scale (ICS) is a widely used, efficient tool for describing a child's speech intelligibility. Few studies have explored the relationship between ICS scores and transcription intelligibility scores, which are the gold standard for clinical measurement. This study examined how well ICS composite scores predicted transcription intelligibility scores among children with cerebral palsy (CP), how well individual questions from the ICS differentially predicted transcription intelligibility scores, and how well the ICS composite scores differentiated between children with and without speech motor impairment. Parents of 48 children with CP, who were approximately 13 years of age, completed the ICS. Ninety-six adult naïve listeners provided orthographic transcriptions of children's speech. Transcription intelligibility scores were regressed on ICS composite scores and individual item scores. Dysarthria status was regressed on ICS composite scores. Results indicated that ICS composite scores were moderately strong predictors of transcription intelligibility scores. One individual ICS item differentially predicted transcription intelligibility scores, and dysarthria severity influenced how well ICS composite scores differentiated between children with and without speech motor impairment. Findings suggest that the ICS has potential clinical utility for children with CP, especially when used with other objective measures of speech intelligibility.

Speech Development Between 30 and 119 Months in Typical Children I: Intelligibility Growth Curves for Single-Word and Multiword Productions

Purpose We extended our earlier study on normative growth curves for intelligibility development in typical children from 30 to 119 months of age. We also determined quantile-specific age of steepest growth and growth rates. A key goal was to establish age-specific benchmarks for single-word and multiword intelligibility. Method This cross-sectional study involved collection of in-person speech samples from 538 typically developing children (282 girls and 256 boys) who passed speech, language, and hearing screening measures. One thousand seventy-six normal-hearing naïve adult listeners (280 men and 796 women) orthographically transcribed children's speech. Speech intelligibility was measured as the percentage of words transcribed correctly by naive adults, with single-word and multiword intelligibility outcomes modeled separately. Results The age range for 50% single-word intelligibility was 31-47 months (50th-5th percentiles), the age range for 75% single-word intelligibility was 49-87 months, and the age range for 90% intelligibility for single words was 83-120+ months. The same milestones were attained for multiword intelligibility at 34-46, 46-61, and 62-87 months, respectively. The age of steepest growth for the 50th percentile was 30-31 months for both single-word and multiword intelligibility and was later for children in lower percentiles. The maximum growth rate was 1.7 intelligibility percentage points per month for single words and 2.5 intelligibility percentage points per month for multiword intelligibility. Conclusions There was considerable variability in intelligibility development among typical children. For children in median and lower percentiles, intelligibility growth continues through 9 years. Children should be at least 50% intelligible by 48 months. Supplemental Material https://doi.org/10.23641/asha.16583426.

Reproducibility and validity of the Functional Communication Classification System for young children with cerebral palsy

AIM

To examine interrater agreement and validity of the Functional Communication Classification System (FCCS) for young children with cerebral palsy (CP) aged 2 or 3 years.

METHOD

Speech-language pathologist (SLP) and parent FCCS ratings for 31 children with CP (aged 2y, n=16; aged 3y, n=15; 18 males, 13 females) were examined for interrater agreement using a weighted Cohen's kappa statistic. Relationships between FCCS (SLP) ratings and: (1) concurrent validity with the Language Use Inventory, a standardized pragmatic assessment for children aged 18 to 47 months, (2) gross motor and fine motor function, (3) associated impairments (visual and intellectual), and (4) primary expressive communication mode were examined using Spearman's correlation coefficients.

RESULTS

Almost perfect interrater agreement between SLP and parent FCCS ratings were found (k_w =0.94). Correlations with FCCS (SLP) were excellent for pragmatic function (r_s =-0.83, p<0.001), intellectual function (r_s =0.89, p<0.001), and primary expressive communication mode (r_s =0.92, p<0.001). Correlations were good for gross motor function (r_s =0.72, p<0.001) and visual impairment (r_s =0.70, p<0.001) and fair for fine motor function (r_s =0.53, p<0.002). Analysis was unwarranted for epilepsy (n=1 out of 31) and hearing-associated impairments (n=0 out of 31).

INTERPRETATION

The FCCS has excellent interrater agreement and validity for communication classification of children with CP aged 2 or 3 years and is highly suitable for surveillance and research purposes. What this paper adds The Functional Communication Classification System (FCCS) is a valid instrument for children with cerebral palsy (CP) aged 2 or 3 years. Excellent agreement exists between speech-language pathologist and parent FCCS ratings. The FCCS has excellent correlation with intelligence, pragmatic function, and primary expressive mode. Stronger correlations with the Gross Motor Function Classification System and vision exist for children aged 2 or 3 years. Weaker correlations with manual ability exist when compared to older children with CP.

Reliability of Perceptual Judgments of Phonetic Accuracy and Hypernasality Among Speech-Language Pathologists for Children With Dysarthria

Purpose The objectives of this study were to: (a) compare interrater reliability of practicing speech-language pathologists' (SLPs) perceptual judgments of phonetic accuracy and hypernasality between children with dysarthria and those with typical development, and (b) to identify speech factors that influence reliability of these perceptual judgments for children with dysarthria. Method Ten SLPs provided ratings of speech samples from twenty 5-year-old children with dysarthria and twenty 5-year-old children with typical development on two tasks via a web-based platform: a hypernasality judgment task and a phonetic accuracy judgment task. Interrater reliability of SLPs' ratings on both tasks was compared between children with dysarthria and children with typical development. For children with dysarthria, four acoustic speech measures, intelligibility, and a measure of phonetic accuracy (percent stops correct) were examined as predictors of reliability of SLPs' perceptual judgments. Results Reliability of SLPs' phonetic accuracy judgments and hypernasality ratings was significantly lower for children with dysarthria than for children with typical development. Among children with dysarthria, interrater reliability of perceptual judgments ranged from strong to weak. Percent stops correct was the strongest predictor of interrater reliability for both phonetic accuracy judgments and hypernasality ratings. Conclusions Reliability of perceptual phonetic accuracy judgments and hypernasality ratings among practicing SLPs for children with dysarthria is reduced compared to ratings for children with typical development. Findings underscore the need for more reliable methods to assess phonetic accuracy and hypernasality for children with dysarthria.

Developmental Courses in Childhood Dysarthria: Longitudinal Analyses of Auditory-Perceptual Parameters

Purpose The aim of this longitudinal study was to describe developmental courses of childhood dysarthria against the background of typical speech motor development by collecting auditory-perceptual data. Method Fourteen children (four girls, 10 boys; 5;1-8;4 [years;months] at Time 1) with neurological conditions (CNC) and 14 typically developing children (CTD) matched for age and gender were assessed at three points in time over an 18-month period. Speech samples were collected using the Bogenhausener Dysarthrie Skalen-Kindliche Dysarthrien (BoDyS-KiD; in English: Bogenhausen Dysarthria Scales-Childhood Dysarthria), a German tool for the assessment of childhood dysarthria, and analyzed by means of nine perceptual scales covering all clinically relevant speech components. Age normalization was performed according to a method published recently. Data from the matched controls were used to estimate whether the gradients of the CNC group's developmental trajectories exceeded those of typical development. Results The children with neurological conditions presented heterogeneous speech profiles with a wide range of severity. At the group level, relatively stable trajectories of the age-normalized dysarthria total score were found over the observation period. The nine perceptual scales showed more or less parallel developments. All patients except two followed the growth curve describing the developmental course of the typically developing children. Conclusions Most children took advantage of the developmental dynamics as they developed parallel to the age norm. With its comprehensive description of the developmental courses of 14 children with neurological conditions, this study may contribute to a more valid, statistically verified clinical assessment of the course of childhood dysarthria.

Validity of Parent Ratings of Speech Intelligibility for Children with Cerebral Palsy

Aim: To examine the relationship between subjective parent ratings of intelligibility and objectively measured intelligibility scores for children with cerebral palsy (CP) with differing levels of speech severity. Method: Fifty children (84-96 months) with CP were classified into groups based on intelligibility scores during a speech elicitation task - high intelligibility (90% or higher), mild-moderate intelligibility reduction (61-89%), and severe intelligibility reduction (60% or lower). Parent ratings of understandability (on a 7-point scale) were compared to intelligibility scores gathered from 100 naïve listeners. Results: For children with mild-moderate and severe intelligibility reduction, there was a large range of variability in parent ratings. For children with high intelligibility, ratings were consistent with intelligibility scores. There was a range of intelligibility scores within each rating, especially in the middle of the scale. Conclusions: For children with mild-moderate intelligibility deficits, parent ratings may best be used in conjunction with objective measurement of intelligibility.

Longitudinal Growth in Intelligibility of Connected Speech From 2 to 8 Years in Children With Cerebral Palsy: A Novel Bayesian Approach

Aim The aim of the study was to examine longitudinal growth in intelligibility in connected speech from 2 to 8 years of age in children with cerebral palsy. Method Sixty-five children with cerebral palsy participated in the longitudinal study. Children were classified into speech-language profile groups using age-4 data: no speech motor impairment (SMI), SMI with typical language comprehension, and SMI with impaired language comprehension. We fit a Bayesian nonlinear mixed-effects model of intelligibility growth at the child and group levels. We compared groups by age of steepest growth, maximum growth rate, and predicted intelligibility at 8 years of age. Results The no SMI group showed earlier and steeper intelligibility growth and higher average outcomes compared to the SMI groups. The SMI groups had more variable growth trajectories, but the SMI with typical language comprehension group had higher age-8 outcomes and steeper rates of maximum growth than the SMI with impaired language comprehension group. Language comprehension impairment at age of 4 years predicted lower intelligibility outcomes at age of 8 years, compared to typical language at age of 4 years. Interpretation Children with SMI at age of 4 years show highly variable intelligibility growth trajectories, and comorbid language comprehension impairment predicts lower intelligibility outcomes. Supplemental Material https://doi.org/10.23641/asha.12777659.

Measuring Speech Production Development in Children With Cerebral Palsy Between 6 and 8 Years of Age: Relationships Among Measures

Purpose Accurate measurement of speech intelligibility is essential for children with speech production deficits, but wide variability exists in the measures and protocols used. The current study sought to examine relationships among measures of speech intelligibility and the capacity of different measures to capture change over time. Method Forty-five children with cerebral palsy (CP) with and without speech motor impairment were observed at ages 6, 7, and 8 years. The speech performance of each child was rated using four measures at each time point: standardized articulation test scores, multiword intelligibility scores obtained from naïve listeners, parent ratings of intelligibility, and percent intelligible utterances obtained from language transcripts. We analyzed the correlations of measures within each age and within three different severity groups, and we analyzed how these measures changed year over year in each severity group. Results For children with CP who have mild and moderate speech deficits, different measures of speech production were weakly associated, and for children with CP with severe speech impairment, these measures showed stronger associations. The four measures also differed in their ability to capture change over time. Finally, results from standardized assessments of articulation were not found to inform overall speech intelligibility for children with mild and moderate speech deficits. Conclusions Results suggest that speech production is not fully described by any single clinical measure. In order to adequately describe functional speaking abilities and to capture change over time, multiple levels of measurement are required.

Development of Speech Intelligibility Between 30 and 47 Months in Typically Developing Children: A Cross-Sectional Study of Growth

Purpose We sought to establish normative growth curves for intelligibility development for the speech of typically developing children as revealed by objectively based orthographic transcription of elicited single-word and multiword utterances by naïve listeners. We also examined sex differences, and we compared differences between single-word and multiword intelligibility growth. Method One hundred sixty-four typically developing children (92 girls, 72 boys) contributed speech samples for this study. Children were between the ages of 30 and 47 months, and analyses examined 1-month age increments between these ages. Two different naïve listeners heard each child and made orthographic transcriptions of child-produced words and sentences (n = 328 listeners). Average intelligibility scores for single-word productions and multiword productions were modeled using linear regression, which estimated normal-model quantile age trajectories for single- and multiword utterances. Results We present growth curves showing steady linear change over time in 1-month increments from 30 to 47 months for 5th, 10th, 25th, 50th, 75th, 90th, and 95th percentiles. Results showed that boys did not differ from girls and that, prior to 35 months of age, single words were more intelligible than multiword productions. Starting at 41 months of age, the reverse was true. Multiword intelligibility grew at a faster rate than single-word intelligibility. Conclusions Children make steady progress in intelligibility development through 47 months, and only a small number of children approach 100% intelligibility by this age. Intelligibility continues to develop past the fourth year of life. There is considerable variability among children with regard to intelligibility development. Supplemental Material https://doi.org/10.23641/asha.12330956.

Longitudinal Growth in Single-Word Intelligibility Among Children With Cerebral Palsy From 24 to 96 Months of Age: Effects of Speech-Language Profile Group Membership on Outcomes

Purpose We examined whether there were differences among speech-language profile groups of children with cerebral palsy (CP) in age of crossing 25%, 50%, and 75% intelligibility thresholds; age of greatest intelligibility growth; rate of intelligibility growth; maximum attained intelligibility at 8 years; and how well intelligibility at 36 months predicts intelligibility at 96 months when group membership is accounted for. Profile groups were children with no speech motor impairment (NSMI), those with speech motor impairment and language comprehension that is typically developing (SMI-LCT), and those with speech motor impairment and language comprehension impairment (SMI-LCI). Method Sixty-eight children with CP were followed longitudinally between 24 and 96 months of age. A total of 564 time points were examined across children (M = 8.3 time points per child, SD = 2.6). We fitted a nonlinear random effects model for longitudinal observations, allowing for differences between profile groups. We used the fitted model trajectories to generate descriptive analyses of intelligibility growth by group and to generate simulations to analyze how well 36-month intelligibility data predicted 96-month data accounting for profile groups. Results Children with CP who have NSMI have different growth and better intelligibility outcomes than those with speech motor impairment. Children with SMI-LCT tend to have better outcomes but similar intelligibility growth as children with SMI-LCI. There may be a subset of children that cut across SMI-LCI and SMI-LCT groups who have severe speech motor involvement and show limited growth in intelligibility. Conclusions Intelligibility outcomes for children with CP are affected by profile group membership. Intelligibility growth tends to be delayed in children with speech motor impairment. Intelligibility at 3 years is highly predictive of later outcomes regardless of profile group. Intervention decision making should include consideration of early intelligibility, and treatment directions should include consideration of augmentative and alternative communication.

Longitudinal Change in Speech Rate and Intelligibility Between 5 and 7 Years in Children With Cerebral Palsy

Purpose We examined growth between 5 and 7 years in speech intelligibility, speech rate, and intelligible words per minute (IWPM) in 3 groups of children: those who were typically developing (TD), those with cerebral palsy (CP) and clinical speech motor impairment (SMI), and those with CP and no SMI (NSMI). Method Twenty-six children with CP, 16 with SMI, and 10 with NSMI were each seen at 5, 6, and 7 years of age. A cross-sectional group of 30 age-matched TD children, 10 in each age group, were included as controls. All children produced a corpus of utterances of 2-7 words. Results All groups of children showed increases in intelligibility and IWPM between 5 and 7 years. Only children with SMI showed increases in speech rate over time. Patterns of change were similar for children in the TD and NSMI groups but different for children in the SMI group. Conclusions The window of time between 5 and 7 years is an important period of growth for the production of connected speech where nearly all children, regardless of group, made significant changes in speech intelligibility and IWPM. Interventions focusing specifically on enhancing intelligibility in this age range may help facilitate even further growth in children with SMI, who still had marked intelligibility reductions at 7 years of age.