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

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.

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.

Neuromuscular adaptations of swallowing and speech in unilateral cerebral palsy: shared and distinctive traits

Our aims were to 1) examine the neuromuscular control of swallowing and speech in children with unilateral cerebral palsy (UCP) compared with typically developing children (TDC), 2) determine shared and separate neuromuscular underpinnings of the two functions, and 3) explore the relationship between this control and behavioral outcomes in UCP. Surface electromyography (sEMG) was used to record muscle activity from the submental and superior and inferior orbicularis oris muscles during standardized swallowing and speech tasks. The variables examined were normalized mean amplitude, time to peak amplitude, and bilateral synchrony. Swallowing and speech were evaluated using standard clinical measures. Sixteen children with UCP and 16 TDC participated (7-12 yr). Children with UCP demonstrated higher normalized mean amplitude and longer time to peak amplitude across tasks than TDC (P < 0.01; and P < 0.02) and decreased bilateral synchrony than TDC for swallows (P < 0.01). Both shared and distinctive neuromuscular patterns were observed between swallowing and speech. In UCP, higher upper lip amplitude during swallows was associated with shorter normalized mealtime durations, whereas higher submental bilateral synchrony was related to longer mealtime durations. Children with UCP demonstrate neuromuscular adaptations for swallowing and speech, which should be further evaluated for potential treatment targets. Furthermore, both shared and distinctive neuromuscular underpinnings between the two functions are documented.NEW & NOTEWORTHY Systematically studying the swallowing and speech of children with UCP is new and noteworthy. We found that they demonstrate neuromuscular adaptations for swallowing and speech compared with typically developing peers. We examined swallowing and speech using carefully designed tasks, similar in motor complexity, which allowed us to directly compare patterns. We found shared and distinctive neuromuscular patterns between swallowing and speech.

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.

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.

Childhood Dysarthria: Auditory-Perceptual Profiles Against the Background of Typical Speech Motor Development

PURPOSE

The purpose of this study was to describe childhood dysarthria by means of auditory-perceptual analyses covering all speech subsystems. We aimed to identify the most seriously affected auditory-perceptual dimensions in the observed dysarthria profiles and to detect specific markers of childhood dysarthria against the backdrop of typical speech development. Moreover, the relationship between the speech disorder and other relevant aspects of multiple disability was investigated.

METHOD

Thirty-one children with neurologic conditions were assessed with Bogenhausen Dysarthria Scales for Childhood Dysarthria, a German tool for the auditory-perceptual analysis of dysarthria in children. Nine relevant speech dimensions (scales, e.g., voice quality [VOQ]) and 29 individual symptoms (features, e.g., breathy) were evaluated. Moreover, we documented motor, communicative, and cognitive-linguistic measures (i.e., Gross Motor Function Classification System [GMFCS], Communication Function Classification System [CFCS], Test for Reception of Grammar [TROG-D], and memory span). Recently published data from typically developing children were used for the purpose of age normalization.

RESULTS

Dysarthria severity was moderately correlated with GMFCS and CFCS but not with TROG-D and memory span. At the group level, respiration, articulation, and prosodic modulation were most severely affected, whereas voice function was only mildly affected or even spared in the majority of children. Four features were identified as most relevant markers of childhood dysarthria: conspicuous rhythm/stress pattern, hypernasality, strained-strangled voice, and reduced articulatory precision.

CONCLUSIONS

Childhood dysarthria is part of a complex multiple disability, but speech motor skills may still dissociate from gross-motor and cognitive-linguistic functions. Auditory-perceptual analyses incorporating age norms allow for a comprehensive description and identification of childhood dysarthria.

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 Treatment Effects on Narrative Intelligibility in French-Speaking Children With Dysarthria

Purpose This study examined the effects of Speech Intelligibility Treatment (SIT) on intelligibility and naturalness of narrative speech produced by francophone children with dysarthria due to cerebral palsy. Method Ten francophone children with dysarthria were randomized to one of two treatments, SIT or Hand-Arm Bimanual Intensive Therapy Including Lower Extremities, a physical therapy (PT) treatment. Both treatments were conducted in a camp setting and were comparable in dosage. The children were recorded pre- and posttreatment producing a story narrative. Intelligibility was measured by means of 60 blinded listeners' orthographic transcription accuracy (percentage of words transcribed correctly). The listeners also rated the children's naturalness on a visual analogue scale. Results A significant pre- to posttreatment increase in intelligibility was found for the SIT group, but not for the PT group, with great individual variability observed among the children. No significant changes were found for naturalness ratings or sound pressure level in the SIT group or the PT group posttreatment. Articulation rate increased in both treatment groups, although not differentially across treatments. Conclusions Findings from this first treatment study on intelligibility in francophone children with dysarthria suggest that SIT shows promise for increasing narrative intelligibility in this population. Acoustic contributors to the increased intelligibility remain to be explored further. Supplemental Material https://doi.org/10.23641/asha.14161943.

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.

Speech-Language Profile Groups in School Aged Children with Cerebral Palsy: Nonverbal Cognition, Receptive Language, Speech Intelligibility, and Motor Function

Purpose: To explore the relationship of intelligibility, receptive language, executive functioning, and motor skills to nonverbal cognitive skills among children with cerebral palsy (CP) in different speech-language profile groups. Method: Twenty-seven children with CP aged 10-12 years old participated in the study. They completed a battery of standard clinical assessments. The relationship of various skillsets with nonverbal cognitive ability was explored using correlational procedures. Additionally, we examined pairwise differences in nonverbal cognitive skills among profile groups. Cohen's Kappa and Chi-square tests were used to study the consistency of receptive language and nonverbal cognitive performance. Results: Children who showed better nonverbal cognitive abilities demonstrated better motor, receptive language, and intelligibility skills. Nonverbal cognition was generally consistent with receptive language. Conclusion: Nonverbal cognitive impairment often co-occurs with language and speech motor impairment among children with CP. Speech-language profile groups are a useful framework for describing both communication and cognitive abilities.