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Preston JL, Caballero NF, Leece MC, Wang D, Herbst BM, Benway NR. A Randomized Controlled Trial of Treatment Distribution and Biofeedback Effects on Speech Production in School-Age Children With Apraxia of Speech. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2024; 67:3414-3436. [PMID: 37611182 DOI: 10.1044/2023_jslhr-22-00622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
PURPOSE This study examines how ultrasound biofeedback and intensive treatment distribution affect speech sound generalization during an evidence-based treatment, Speech Motor Chaining, for children with persisting speech errors associated with childhood apraxia of speech (CAS). METHOD In a 2 × 2 factorial randomized controlled trial, children ages 9-17 years meeting CAS criteria were randomized to receive (a) a distributed treatment (20 sessions twice weekly over 10 weeks) or intensive treatment (20 hr in 5 weeks, with 10 hr in Week 1) and (b) treatment with or without biofeedback. Due to the COVID pandemic, some participants were randomized to distributed/intensive telepractice treatment only. The primary outcome was percent target sounds correct on untreated phrases (i.e., generalization) at the 10-week time point. More than 50,000 narrow phonetic transcriptions were analyzed. RESULTS Forty-eight participants completed treatment. Intensive treatment significantly increased generalization at all time points. The effect of biofeedback was significant at 5 weeks from the start of treatment but not significant at the primary 10-week time point. However, when comparing each group immediately after their 20 hr of treatment finished, generalization was significantly greater in intensive over distributed treatment and greater in ultrasound over no-ultrasound treatment (with a significant interaction favoring intensive treatment with ultrasound). Only the advantage of intensive treatment remained significant 5 weeks after groups finished treatment. There was no significant difference between face-to-face and telepractice modalities. CONCLUSIONS When the number of treatment hours is fixed, an intensive schedule of Speech Motor Chaining facilitated greater improvement than a distributed schedule. Ultrasound biofeedback initially accelerated learning, but the benefits may dissipate as treatment continues or after it ends.
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Lewis BA, Miller GJ, Iyengar SK, Stein C, Benchek P. Long-Term Outcomes for Individuals With Childhood Apraxia of Speech. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2024; 67:3463-3479. [PMID: 37734154 DOI: 10.1044/2023_jslhr-22-00647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
PURPOSE The study's primary aims were to describe the long-term speech outcomes for adolescents and young adults with a history of childhood apraxia of speech (CAS) and to examine the association of persistent speech sound errors with measures of literacy skills, phonological processing, motor speech production, and parent report of early motor difficulty. METHOD Data from a large longitudinal 25-year study were used to explore outcomes for 32 individuals with a history of CAS, ages 12;6 (years;months) to 25 years (M = 17.4, SD = 4.7). Persistent and nonpersistent groups were compared on decoding, phonological processing, multisyllabic word repetition, diadochokinetic rate, and parent report of motor involvement. Parametric (Welch's t tests) and nonparametric tests (Wilcoxon and Fisher exact tests) were used to identify differences between the groups' distributions. Developmental trajectories of speech production were plotted. RESULTS Outcomes for individuals with CAS are highly variable, with some demonstrating speech sound errors into adolescence and young adulthood. Speech sound errors were primarily on later developing sounds. Persistence was significantly associated with early motor difficulties. Difficulties with multisyllabic words, phonological processing, and literacy were often present regardless of persistence or nonpersistence of speech errors. CONCLUSIONS Children with CAS are at risk for persistent speech sound errors into adulthood. For children showing limited progress with more traditional speech therapy, alternative interventions should be explored. Individuals with persistent speech sound errors are more likely to have a history of early motor deficits. Regardless of persistence, participants with CAS demonstrated ongoing weaknesses in literacy, phonological processing skills, and complex speech production tasks.
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Affiliation(s)
- Barbara A Lewis
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, OH
| | - Gabrielle J Miller
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, OH
| | - Sudha K Iyengar
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH
| | - Catherine Stein
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH
| | - Penelope Benchek
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH
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Benway NR, Preston JL. Artificial Intelligence-Assisted Speech Therapy for /ɹ/: A Single-Case Experimental Study. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 33:2461-2486. [PMID: 39173110 DOI: 10.1044/2024_ajslp-23-00448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/24/2024]
Abstract
PURPOSE This feasibility trial describes changes in rhotic production in residual speech sound disorder following ten 40-min sessions including artificial intelligence (AI)-assisted motor-based intervention with ChainingAI, a version of Speech Motor Chaining that predicts clinician perceptual judgment using the PERCEPT-R Classifier (Perceptual Error Rating for the Clinical Evaluation of Phonetic Targets). The primary purpose is to evaluate /ɹ/ productions directly after practice with ChainingAI versus directly before ChainingAI and to evaluate how the overall AI-assisted treatment package may lead to perceptual improvement in /ɹ/ productions compared to a no-treatment baseline phase. METHOD Five participants ages 10;7-19;3 (years;months) who were stimulable for /ɹ/ participated in a multiple (no-treatment)-baseline ABA single-case experiment. Prepractice activities were led by a human clinician, and drill-based motor learning practice was automated by ChainingAI. Study outcomes were derived from masked expert listener perceptual ratings of /ɹ/ from treated and untreated utterances recorded during baseline, treatment, and posttreatment sessions. RESULTS Listeners perceived significantly more rhoticity in practiced utterances after 30 min of ChainingAI, without a clinician, than directly before ChainingAI. Three of five participants showed significant generalization of /ɹ/ to untreated words during the treatment phase compared to the no-treatment baseline. All five participants demonstrated statistically significant generalization of /ɹ/ to untreated words from pretreatment to posttreatment. PERCEPT-clinician rater agreement (i.e., F1 score) was largely within the range of human-human agreement for four of five participants. Survey data indicated that parents and participants felt hybrid computerized-clinician service delivery could facilitate at-home practice. CONCLUSIONS This study provides evidence of participant improvement for /ɹ/ in untreated words in response to an AI-assisted treatment package. The continued development of AI-assisted treatments may someday mitigate barriers precluding access to sufficiently intense speech therapy for individuals with speech sound disorders. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.26662807.
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Affiliation(s)
- Nina R Benway
- Department of Electrical and Computer Engineering, University of Maryland, College Park, MD
| | - Jonathan L Preston
- Department of Communication Sciences and Disorders, Syracuse University, NY
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Carl M, Rudyk E, Shapira Y, Rusiewicz HL, Icht M. Accuracy of Speech Sound Analysis: Comparison of an Automatic Artificial Intelligence Algorithm With Clinician Assessment. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2024; 67:3004-3021. [PMID: 39173066 DOI: 10.1044/2024_jslhr-24-00009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/24/2024]
Abstract
PURPOSE Automatic speech analysis (ASA) and automatic speech recognition systems are increasingly being used in the treatment of speech sound disorders (SSDs). When utilized as a home practice tool or in the absence of the clinician, the ASA system has the potential to facilitate treatment gains. However, the feedback accuracy of such systems varies, a factor that may impact these gains. The current research analyzes the feedback accuracy of a novel ASA algorithm (Amplio Learning Technologies), in comparison to clinician judgments. METHOD A total of 3,584 consonant stimuli, produced by 395 American English-speaking children and adolescents with SSDs (age range: 4-18 years), were analyzed with respect to automatic classification of the ASA algorithm, clinician-ASA agreement, and interclinician agreement. Further analysis of results as related to phoneme acquisition categories (early-, middle-, and late-acquired phonemes) was conducted. RESULTS Agreement between clinicians and ASA classification for sounds produced accurately was above 80% for all phonemes, with some variation based on phoneme acquisition category (early, middle, late). This variation was also noted for ASA classification into "acceptable," "unacceptable," and "unknown" (which means no determination of phoneme accuracy) categories, as well as interclinician agreement. Clinician-ASA agreement was reduced for misarticulated sounds. CONCLUSIONS The initial findings of Amplio's novel algorithm are promising for its potential use within the context of home practice, as it demonstrates high feedback accuracy for correctly produced sounds. Furthermore, complexity of sound influences consistency of perception, both by clinicians and by automated platforms, indicating variable performance of the ASA algorithm across phonemes. Taken together, the ASA algorithm may be effective in facilitating speech sound practice for children with SSDs, even in the absence of the clinician.
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Affiliation(s)
- Micalle Carl
- Department of Communication Disorders, Ariel University, Israel
| | | | | | | | - Michal Icht
- Department of Communication Disorders, Ariel University, Israel
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Turner Swartz M, Hitchcock ER, Leece MC, Herbst BM, Preston JL. Caregiver and child perspectives of wellbeing in school-age children with childhood apraxia of speech. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024:1-14. [PMID: 39148437 DOI: 10.1080/17549507.2024.2364808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
PURPOSE Childhood apraxia of speech (CAS) is a communication deficit that impacts a child's overall quality of life, including their academic and social interactions, yet few studies have investigated the impact from the child's perspective. Using The World Health Organization's International Classification of Functioning, Disability, and Health (ICF) framework, we examined the children's and caregivers' perspectives on the impact of CAS on their overall wellbeing. METHOD Survey data were collected from 32 child-caregiver dyads for children ages 9-17 years with CAS. Items elicited responses along a 5-point scale to examine the perceived impact of children's speech impairments using the framework, including impact on communication, interpersonal interactions/relationships, and major life events. RESULT Results from non-parametric statistical analyses revealed: (a) caregivers reported a significantly greater impact than children across individual ICF domains; (b) child responses were not significantly correlated with their caregiver's responses or with the child's age, gender, or severity indicators; and (c) both caregivers and children indicated the domain of communication was impacted more than other domains. CONCLUSION Results suggest a potential disconnect in the perceived impact of CAS between the caregiver and child. Recommendations include facilitating a dialogue between the child-caregiver dyad and considering treatment goals that address wellbeing.
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Affiliation(s)
- Michelle Turner Swartz
- Department of Speech-Language Pathology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Elaine R Hitchcock
- Department of Communication Sciences and Disorders, Montclair State University, Montclair, NJ, USA
| | - Megan C Leece
- Department of Communication Sciences and Disorders, Syracuse University, Syracuse, NY, USA
| | - Benedette M Herbst
- Department of Communication Sciences and Disorders, Syracuse University, Syracuse, NY, USA
| | - Jonathan L Preston
- Department of Communication Sciences and Disorders, Syracuse University, Syracuse, NY, USA
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Abdulkader DM, Washington KN, Kokotek LE, Al-Tuwairqi A, Al-Tamimi A. Intelligibility in Context Scale: Psychometric evidence and implications for Saudi Arabic-English-speaking preschoolers. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 26:544-555. [PMID: 37682054 DOI: 10.1080/17549507.2023.2240040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
Purpose: To evaluate the reliability, validity, and diagnostic accuracy (sensitivity, specificity) of the Intelligibility in Context Scale in Saudi Arabic (ICS-SA) and English (ICS-E) as potential measures of functional speech intelligibility in bilingual preschool-aged Saudi Arabian children.Method: The study included 36 parent-child (aged 3;0 to 6;5 years; months) dyads who were bilingual speakers of Saudi Arabic and English, which included two groups-typically developing (TD, n = 29) and suspected speech sound disordered (sSSD, n = 7). The children's intelligibility was evaluated in both languages using the ICS-SA and ICS-E. Children's single-word productions were collected in both languages and calculated for percentage of consonants, vowels, and phonemes correct (i.e. PCC/PVC/PPC) to establish their speech-sound competence.Result: The mean scores for the entire sample (n = 36) were 4.43 (SD = 0.79) for the ICS-SA and 4.48 (SD = 0.79) for the ICS-E, showing that parents rated their children's intelligibility in both languages similarly. Both the ICS-SA and ICS-E demonstrated excellent internal consistency (α = 0.96 and α = 0.95, respectively). There was high inter-rater and test-retest reliability for the ICS-SA, while there was fair to high inter-rater and test-retest reliability in ICS-E. Significant correlations were found for the ICS-SA, but weak correlations were noted for the ICS-E, which indicated fair to moderate evidence of criterion validity. Construct validity efforts indicated a weak correlation with age on both the ICS-SA and ICS-E. The findings also indicated high discriminant accuracy for both the ICS-SA (0.86, 0.86) and ICS-E (0.71, 0.69).Conclusion: This study provides initial validation and reliability evidence for using the ICS-SA and ICS-E with Saudi Arabic- and English-speaking preschoolers, however, ICS-E scores suggest further testing is warranted. By extension, these findings expand the bilingual knowledge base and offer new tools for identifying children in Saudi Arabia who may be at risk for having a speech sound disorder.
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Affiliation(s)
- Dalia M Abdulkader
- Department of Communication Sciences and Disorders, University of Cincinnati, Cincinnati, OH, USA
- Department Health Rehabilitation Sciences-Speech and Hearing, King Saud University, Riyadh, Saudi Arabia
| | - Karla N Washington
- Department of Communication Sciences and Disorders, University of Cincinnati, Cincinnati, OH, USA
- Department of Communicative Sciences and Disorders, New York University, New York, NY, USA
- Department of Speech-Language Pathology, University of Toronto, Toronto, Ontario, Canada
| | - Leslie E Kokotek
- Department of Communication Sciences and Disorders, University of Cincinnati, Cincinnati, OH, USA
| | - Asrar Al-Tuwairqi
- Department Health Rehabilitation Sciences-Speech and Hearing, King Saud University, Riyadh, Saudi Arabia
| | - Anfal Al-Tamimi
- Department Health Rehabilitation Sciences-Speech and Hearing, King Saud University, Riyadh, Saudi Arabia
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Shields R, Hopf SC. Intervention for residual speech errors in adolescents and adults: A systematised review. CLINICAL LINGUISTICS & PHONETICS 2024; 38:203-226. [PMID: 36946222 DOI: 10.1080/02699206.2023.2186765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 02/23/2023] [Accepted: 02/23/2023] [Indexed: 06/18/2023]
Abstract
When speech sound errors persist beyond childhood they are classified as residual speech errors (RSE) and may have detrimental impacts on an individual's social, educational and employment participation. Despite this, individuals who present with RSE are usually not prioritised on large caseloads. The aim of this literature review was to examine what intervention approaches are available in remediating RSE, and how effective are they for adolescents and adults? A systematised review was undertaken. Comprehensive and systematic searching included search of terms across seven databases, forward and reverse citation searching, and key author contact. Thirty articles underwent critical appraisal before data extraction. Inductive thematic analysis was done before completion of a narrative review. Twenty-three (76.6%) of the articles were from the US and most studies involved intervention for 'r' (90%). Intervention approaches for RSE involved traditional articulation therapy, auditory perceptual training, instrumental approaches, and approaches based on principles of motor learning. Twenty-one studies (70%) investigated the use of more than one intervention approach. Measures of intervention efficacy varied between studies; however, any intervention approach tended to be more successful if delivered in a more intensive schedule. A variety of approaches can be used for RSE, but a combination of high intensity, traditional therapy with adjunctive instrumental biofeedback may be most effective, especially with highly motivated individuals. Unfortunately, this usually requires costly equipment and training to implement. More information about the best dosage and intensity intervention for RSE, evaluated for a larger number of phonemes across other languages and dialects is required.
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Affiliation(s)
- Rebecca Shields
- Speech Pathology Department, School of Allied Health, Exercise and Sport Sciences, Charles Sturt University, Albury, Australia
| | - Suzanne C Hopf
- Speech Pathology Department, School of Allied Health, Exercise and Sport Sciences, Charles Sturt University, Albury, Australia
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Ochs LC, Leece MC, Preston JL, McAllister T, Hitchcock ER. Traditional and Visual-Acoustic Biofeedback Treatment via Telepractice for Residual Speech Sound Disorders Affecting /ɹ/: Pilot study. PERSPECTIVES OF THE ASHA SPECIAL INTEREST GROUPS 2023; 8:1533-1553. [PMID: 38764857 PMCID: PMC11101137 DOI: 10.1044/2023_persp-23-00120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2024]
Abstract
Purpose This study aimed to examine the feasibility of telepractice delivery of a treatment package including visual-acoustic biofeedback and motor-based treatment for residual speech sound disorder affecting /ɹ/ in school-age children. The overall study used a single-case randomization design; however, this preliminary report will simply quantify changes in accuracy before and after completion of the treatment package. The present analysis did not differentiate between the relative contributions of biofeedback and motor-based treatments. Method Seven children aged 9-14 received speech therapy for /ɹ/ distortions via telepractice. The study design consisted of three phases: baseline (four sessions), treatment (20 sessions), and post-treatment (three sessions). Treatment included two sessions weekly for a duration of 10 weeks. The participants received one motor-based/non-biofeedback session and one visual-acoustic biofeedback session per week. The order of treatment within each week was randomly determined prior to the start of therapy. Overall progress was assessed using untrained listeners' ratings of word probes administered in the baseline and posttreatment phases. Results Findings revealed that six of the seven participants showed a clinically significant response to the overall treatment package, although the magnitude of individual responses varied across speech contexts (consonantal and vocalic) and participants. Conclusion The present results suggest that a treatment combining visual-acoustic biofeedback and motor-based treatment for residual /ɹ/ errors treatment can be effectively delivered via telepractice. Considerations for technology setup and treatment protocols are provided.
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Farquharson K, Cabbage KL, Reed AC, Moody MA. Subtract Before You Add: Toward the Development of a De-Implementation Approach in School-Based Speech Sound Therapy. Lang Speech Hear Serv Sch 2023; 54:1052-1065. [PMID: 37668554 DOI: 10.1044/2023_lshss-22-00176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2023] Open
Abstract
PURPOSE It is often difficult for school-based speech-language pathologists (SLPs) to prioritize implementing new practices for children with speech sound disorders (SSDs), given burgeoning caseloads and the myriad of other workload tasks. We propose that de-implementation science is equally as important as implementation science. De-implementation science is the recognition and identification of areas that are of "low-value and wasteful." Critically, the idea of de-implementation suggests that we first remove something from a clinician's workload before requesting that they learn and implement something new. METHOD Situated within the Sustainability in Healthcare by Allocating Resources Effectively (SHARE) framework, we review de-implementation science and current speech sound therapy literature to understand the mechanisms behind continuous use of practices that are no longer supported by science or legislation. We use vignettes to highlight real-life examples that clinicians may be facing in school-based settings and to provide hypothetical solutions, resources, and/or next steps to these common challenges. RESULTS By focusing on Phase 1 of the SHARE framework, we identified four primary practices that can be de-implemented to make space for new evidence-based techniques and approaches. These four practices were determined based on an in-depth review of SLP-based survey research: (a) overreliance on speech sound norms for eligibility determinations, (b) the omission of phonological processing skills within evaluations, (c) homogeneity of service delivery factors, and (d) the use of only one treatment approach for all children with SSDs. CONCLUSIONS De-implementation will take work and may lead to some difficult discussions. Implementing a framework, such as SHARE, can guide SLPs toward a reduction in workloads and improved outcomes for children with SSDs.
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Affiliation(s)
- Kelly Farquharson
- School of Communication Science and Disorders, Florida State University, Tallahassee
- Florida Center for Reading Research, Tallahassee
| | - Kathryn L Cabbage
- Department of Communication Disorders, Brigham Young University, Provo, UT
| | - Anne C Reed
- School of Communication Science and Disorders, Florida State University, Tallahassee
- Florida Center for Reading Research, Tallahassee
| | - Mary Allison Moody
- School of Communication Science and Disorders, Florida State University, Tallahassee
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Ancel EE, Smith ML, Rao VNV, Munson B. Relating Acoustic Measures to Listener Ratings of Children's Productions of Word-Initial /ɹ/ and /w/. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:3413-3427. [PMID: 37591234 PMCID: PMC10558147 DOI: 10.1044/2023_jslhr-22-00713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 04/06/2023] [Accepted: 05/17/2023] [Indexed: 08/19/2023]
Abstract
PURPOSE The /ɹ/ productions of young children acquiring American English are highly variable and often inaccurate, with [w] as the most common substitution error. One acoustic indicator of the goodness of children's /ɹ/ productions is the difference between the frequency of the second formant (F2) and the third formant (F3), with a smaller F3-F2 difference being associated with a perceptually more adultlike /ɹ/. This study analyzed the effectiveness of automatically extracted F3-F2 differences in characterizing young children's productions of /ɹ/-/w/ in comparison with manually coded measurements. METHOD Automated F3-F2 differences were extracted from productions of a variety of different /ɹ/- and /w/-initial words spoken by 3- to 4-year-old monolingual preschoolers (N = 117; 2,278 tokens in total). These automated measures were compared to ratings of the phoneme goodness of children's productions as rated by untrained adult listeners (n = 132) on a visual analog scale, as well as to narrow transcriptions of the production into four categories: [ɹ], [w], and two intermediate categories. RESULTS Data visualizations show a weak relationship between automated F3-F2 differences with listener ratings and narrow transcriptions. Mixed-effects models suggest the automated F3-F2 difference only modestly predicts listener ratings (R 2 = .37) and narrow transcriptions (R 2 = .32). CONCLUSION The weak relationship between automated F3-F2 difference and both listener ratings and narrow transcriptions suggests that these automated acoustic measures are of questionable reliability and utility in assessing preschool children's mastery of the /ɹ/-/w/ contrast.
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Affiliation(s)
- Elizabeth E. Ancel
- Department of Speech-Language-Hearing Sciences, University of Minnesota, Twin Cities, Minneapolis
| | - Michael L. Smith
- Department of Speech-Language-Hearing Sciences, University of Minnesota, Twin Cities, Minneapolis
| | - V. N. Vimal Rao
- Department of Educational Psychology, University of Minnesota, Twin Cities, Minneapolis
| | - Benjamin Munson
- Department of Speech-Language-Hearing Sciences, University of Minnesota, Twin Cities, Minneapolis
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Dokovova M, Sugden E, Cartney G, Schaeffler S, Cleland J. Tongue Shape Complexity in Children With and Without Speech Sound Disorders. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:2164-2183. [PMID: 37267440 DOI: 10.1044/2023_jslhr-22-00472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE This study investigates the hypothesis that younger speakers and speakers with more severe speech sound disorders are more likely to use simpler (undifferentiated) tongue gestures due to difficulties with, or immaturity of, lingual motor control. METHOD The hypothesis is tested using cross-sectional secondary data analysis of synchronous audio and high-speed ultrasound recordings from children with idiopathic speech sound disorders (n = 30, aged 5;0-12;11 [years;months]) and typically developing children (n = 29, aged 5;8-12;10), producing /a/, /t/, /ɹ/, /l/, /s/, and /ʃ/ in an intervocalic /aCa/ environment. Tongue shape complexity is measured using NINFL (Number of INFLections) and modified curvature index (MCI) from splines fitted to ultrasound images at the point of maximal lingual gesture. Age, perceived accuracy, and consonant are used as predictors. RESULTS The results suggest that as age increases, children with speech sound disorders have lower MCI compared to typically developing children. Increase in age also led to decrease of MCI for the typically developing group. In the group of children with speech sound disorders, perceptually incorrect /ɹ/ productions have lower MCI than correct productions, relative to /a/. CONCLUSIONS There is some evidence of systematic tongue shape complexity differences between typically developing children and children with speech sound disorders when accounting for increase in age. Among children with speech sound disorders, increase in age and perceptually incorrect consonant realizations are associated with decreasing tongue shape complexity.
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Affiliation(s)
- Marie Dokovova
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, United Kingdom
| | - Ellie Sugden
- School of Health Sciences, Western Sydney University, Richmond, New South Wales, Australia
| | - Gemma Cartney
- School of Health Sciences, Queen Margaret University, Edinburgh, United Kingdom
| | - Sonja Schaeffler
- School of Health Sciences, Queen Margaret University, Edinburgh, United Kingdom
| | - Joanne Cleland
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, United Kingdom
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Aakko I, Kauramäki J, Cleland J, Lee A, Vainio M, Saalasti S. Auditory-perceptual evaluation with visual analogue scale: feasibility and preliminary evidence of ultrasound visual feedback treatment of Finnish [r]. CLINICAL LINGUISTICS & PHONETICS 2023; 37:345-362. [PMID: 36106455 DOI: 10.1080/02699206.2022.2118079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 04/30/2022] [Accepted: 06/02/2022] [Indexed: 05/20/2023]
Abstract
Accumulating evidence suggests that ultrasound visual feedback increases the treatment efficacy for persistent speech sound errors. However, the available evidence is mostly from English. This is a feasibility study of ultrasound visual feedback for treating distortion of Finnish [r]. We developed a web-based application for auditory-perceptual judgement. We investigated the impact of listener's experience on perceptual judgement and the intra-rater reliability of listeners. Four boys (10-11 years) with distortion of [r], otherwise typical development, partook in eight ultrasound treatment sessions. In total, 117 [r] samples collected at pre- and post-intervention were judged with visual analogue scale (VAS) by two listener groups: five speech and language therapists (SLTs) and six SLT students. We constructed a linear mixed-effects model with fixed effects for time and listener group and several random effects. Our findings indicate that measurement time had a significant main effect on judgement results, χ2 = 78.82, p < 0.001. Effect of listener group was non-significant, but a significant main effect of interaction of group × time, χ2 = 6.33, p < 0.012 was observed. We further explored the effect of group with nested models, and results revealed a non-significant effect of group. The average intra-rater correlation of the 11 listeners was 0.83 for the pre-intervention samples and 0.92 for post-intervention showing a good or excellent degree of agreement. Finnish [r] sound can be evaluated with VAS and ultrasound visual feedback is a feasible and promising method in treatment for distortion of [r], and its efficacy should be further assessed.
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Affiliation(s)
- Iida Aakko
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Jaakko Kauramäki
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Joanne Cleland
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, Scotland
| | - Alice Lee
- Department of Speech and Hearing Sciences, University College Cork, Cork, Ireland
| | - Martti Vainio
- Department of Digital Humanities, University of Helsinki, Helsinki, Finland
| | - Satu Saalasti
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
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Ayala SA, Eads A, Kabakoff H, Swartz MT, Shiller DM, Hill J, Hitchcock ER, Preston JL, McAllister T. Auditory and Somatosensory Development for Speech in Later Childhood. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:1252-1273. [PMID: 36930986 PMCID: PMC10187971 DOI: 10.1044/2022_jslhr-22-00496] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 11/29/2022] [Accepted: 12/30/2022] [Indexed: 05/18/2023]
Abstract
PURPOSE This study collected measures of auditory-perceptual and oral somatosensory acuity in typically developing children and adolescents aged 9-15 years. We aimed to establish reference data that can be used as a point of comparison for individuals with residual speech sound disorder (RSSD), especially for RSSD affecting American English rhotics. We examined concurrent validity between tasks and hypothesized that performance on at least some tasks would show a significant association with age, reflecting ongoing refinement of sensory function in later childhood. We also tested for an inverse relationship between performance on auditory and somatosensory tasks, which would support the hypothesis of a trade-off between sensory domains. METHOD Ninety-eight children completed three auditory-perceptual tasks (identification and discrimination of stimuli from a "rake"-"wake" continuum and category goodness judgment for naturally produced words containing rhotics) and three oral somatosensory tasks (bite block with auditory masking, oral stereognosis, and articulatory awareness, which involved explicit judgments of relative tongue position for different speech sounds). Pairwise associations were examined between tasks within each domain and between task performance and age. Composite measures of auditory-perceptual and somatosensory functions were used to investigate the possibility of a sensory trade-off. RESULTS Statistically significant associations were observed between the identification and discrimination tasks and the bite block and articulatory awareness tasks. In addition, significant associations with age were found for the category goodness and bite block tasks. There was no statistically significant evidence of a trade-off between auditory-perceptual and somatosensory domains. CONCLUSIONS This study provided a multidimensional characterization of speech-related sensory function in older children/adolescents. Complete materials to administer all experimental tasks have been shared, along with measures of central tendency and dispersion for scores in two subgroups of age. Ultimately, we hope to apply this information to make customized treatment recommendations for children with RSSD based on sensory profiles.
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Affiliation(s)
- Samantha A. Ayala
- Department of Communicative Sciences and Disorders, New York University, NY
| | - Amanda Eads
- Department of Communicative Sciences and Disorders, New York University, NY
| | - Heather Kabakoff
- Department of Neurology, New York University Grossman School of Medicine, NY
| | - Michelle T. Swartz
- Department of Speech-Language Pathology, Thomas Jefferson University, Philadelphia, PA
| | - Douglas M. Shiller
- École d'orthophonie et d'audiologie, Faculté de medicine, Université de Montréal, Québec, Canada
| | - Jennifer Hill
- Center for Practice and Research at the Intersection of Information, Society, and Methodology, New York University, NY
| | - Elaine R. Hitchcock
- Department of Communication Sciences and Disorders, Montclair State University, NJ
| | | | - Tara McAllister
- Department of Communicative Sciences and Disorders, New York University, NY
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Li SR, Dugan S, Masterson J, Hudepohl H, Annand C, Spencer C, Seward R, Riley MA, Boyce S, Mast TD. Classification of accurate and misarticulated / ɑr/ for ultrasound biofeedback using tongue part displacement trajectories. CLINICAL LINGUISTICS & PHONETICS 2023; 37:196-222. [PMID: 35254181 PMCID: PMC9448831 DOI: 10.1080/02699206.2022.2039777] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 02/02/2022] [Accepted: 02/03/2022] [Indexed: 06/14/2023]
Abstract
Ultrasound biofeedback therapy (UBT), which incorporates real-time imaging of tongue articulation, has demonstrated generally positive speech remediation outcomes for individuals with residual speech sound disorder (RSSD). However, UBT requires high attentional demands and may therefore benefit from a simplified display of articulation targets that are easily interpretable and can be compared to real-time articulation. Identifying such targets requires automatic quantification and analysis of movement features relevant to accurate speech production. Our image-analysis program TonguePART automatically quantifies tongue movement as tongue part displacement trajectories from midsagittal ultrasound videos of the tongue, with real-time capability. The present study uses such displacement trajectories to compare accurate and misarticulated American-English rhotic /ɑr/ productions from 40 children, with degree of accuracy determined by auditory perceptual ratings. To identify relevant features of accurate articulation, support vector machine (SVM) classifiers were trained and evaluated on several candidate data representations. Classification accuracy was up to 85%, indicating that quantification of tongue part displacement trajectories captured tongue articulation characteristics that distinguish accurate from misarticulated production of /ɑr/. Regression models for perceptual ratings were also compared. The simplest data representation that retained high predictive ability, demonstrated by high classification accuracy and strong correlation between observed and predicted ratings, was displacements at the midpoint of /r/ relative to /ɑ/ for the tongue dorsum and blade. This indicates that movements of the dorsum and blade are especially relevant to accurate production of /r/, suggesting that a predictive parameter and biofeedback target based on this data representation may be usable for simplified UBT.
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Affiliation(s)
- Sarah R. Li
- Biomedical Engineering, University of Cincinnati, Cincinnati, United States
| | - Sarah Dugan
- Rehabilitation, Exercise, and Nutrition Sciences, University of Cincinnati, Cincinnati, United States
- Communication Sciences and Disorders, University of Cincinnati, Cincinnati, United States
| | - Jack Masterson
- Biomedical Engineering, University of Cincinnati, Cincinnati, United States
| | - Hannah Hudepohl
- Biomedical Engineering, University of Cincinnati, Cincinnati, United States
| | - Colin Annand
- The Complexity Group, Department of Psychology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Caroline Spencer
- Communication Sciences and Disorders, University of Cincinnati, Cincinnati, United States
| | - Renee Seward
- Design, University of Cincinnati, Cincinnati, Ohio
| | - Michael A. Riley
- Rehabilitation, Exercise, and Nutrition Sciences, University of Cincinnati, Cincinnati, United States
| | - Suzanne Boyce
- Communication Sciences and Disorders, University of Cincinnati, Cincinnati, United States
| | - T. Douglas Mast
- Biomedical Engineering, University of Cincinnati, Cincinnati, United States
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15
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McAllister T, Eads A, Kabakoff H, Scott M, Boyce S, Whalen DH, Preston JL. Baseline Stimulability Predicts Patterns of Response to Traditional and Ultrasound Biofeedback Treatment for Residual Speech Sound Disorder. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:2860-2880. [PMID: 35944047 PMCID: PMC9911120 DOI: 10.1044/2022_jslhr-22-00161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 05/10/2022] [Accepted: 05/10/2022] [Indexed: 05/26/2023]
Abstract
PURPOSE This study aimed to identify predictors of response to treatment for residual speech sound disorder (RSSD) affecting English rhotics. Progress was tracked during an initial phase of traditional motor-based treatment and a longer phase of treatment incorporating ultrasound biofeedback. Based on previous literature, we focused on baseline stimulability and sensory acuity as predictors of interest. METHOD Thirty-three individuals aged 9-15 years with residual distortions of /ɹ/ received a course of individual intervention comprising 1 week of intensive traditional treatment and 9 weeks of ultrasound biofeedback treatment. Stimulability for /ɹ/ was probed prior to treatment, after the traditional treatment phase, and after the end of all treatment. Accuracy of /ɹ/ production in each probe was assessed with an acoustic measure: normalized third formant (F3)-second formant (F2) distance. Model-based clustering analysis was applied to these acoustic measures to identify different average trajectories of progress over the course of treatment. The resulting clusters were compared with respect to acuity in auditory and somatosensory domains. RESULTS All but four individuals were judged to exhibit a clinically significant response to the combined course of treatment. Two major clusters were identified. The "low stimulability" cluster was characterized by very low accuracy at baseline, minimal response to traditional treatment, and strong response to ultrasound biofeedback. The "high stimulability" group was more accurate at baseline and made significant gains in both traditional and ultrasound biofeedback phases of treatment. The clusters did not differ with respect to sensory acuity. CONCLUSIONS This research accords with clinical intuition in finding that individuals who are more stimulable at baseline are more likely to respond to traditional intervention, whereas less stimulable individuals may derive greater relative benefit from biofeedback. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.20422236.
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Affiliation(s)
- Tara McAllister
- Department of Communicative Sciences and Disorders, New York University, NY
| | - Amanda Eads
- Department of Communicative Sciences and Disorders, New York University, NY
| | - Heather Kabakoff
- Department of Neurology, Grossman School of Medicine, New York University, NY
| | - Marc Scott
- Department of Applied Statistics, Social Science, and Humanities, New York University, NY
| | - Suzanne Boyce
- Haskins Laboratories, New Haven, CT
- Department of Communication Sciences and Disorders, University of Cincinnati, OH
| | - D. H. Whalen
- Haskins Laboratories, New Haven, CT
- Program in Speech-Language-Hearing Sciences, Graduate School and University Center, City University of New York, NY
| | - Jonathan L. Preston
- Haskins Laboratories, New Haven, CT
- Department of Communication Sciences and Disorders, Syracuse University, NY
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Defabianis P, Cogo C, Massa S, Romano F. Oral-Health-Related Quality of Life among Non-Syndromic School-Age Children with Orofacial Clefts: Results from a Cross-Sectional Study in Northern Italy. CHILDREN 2022; 9:children9071098. [PMID: 35884082 PMCID: PMC9321112 DOI: 10.3390/children9071098] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/15/2022] [Accepted: 07/20/2022] [Indexed: 11/16/2022]
Abstract
The aim of this cross-sectional study was to determine the influence of orofacial clefts on the oral-health-related quality of life (OHRQoL) in a group of Italian children and adolescents and to examine whether gender, age, cleft type, and surgical protocol were associated with patients’ OHRQoL. A total of 71 patients with cleft lip and/or cleft palate (CLP) and 71 age- and gender-matched controls (aged 8 to 18 years) were asked to complete the Child Oral Health Impact Profile (COHIP), a validated and reliable questionnaire to assess self-reported OHRQoL in children and teenagers. Children with orofacial clefts showed statistically significant lower quality of life scores than controls for total OHRQoL and for each of the subscales. Gender, the type of cleft, and the type of surgical protocol had no significant influence on OHRQoL. The negative impact of CLP on the area of self-image was greater in 12–18-year-olds, indicating a higher need for psychosocial counselling. These findings suggest that Italian CLP children and adolescents experience a poorer OHRQoL in comparison to their non-cleft peers.
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Peter B, Davis J, Finestack L, Stoel-Gammon C, VanDam M, Bruce L, Kim Y, Eng L, Cotter S, Landis E, Beames S, Scherer N, Knerr I, Williams D, Schrock C, Potter N. Translating principles of precision medicine into speech-language pathology: Clinical trial of a proactive speech and language intervention for infants with classic galactosemia. HGG ADVANCES 2022; 3:100119. [PMID: 35677809 PMCID: PMC9168611 DOI: 10.1016/j.xhgg.2022.100119] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 05/16/2022] [Indexed: 11/18/2022] Open
Abstract
Precision medicine is an emerging approach to managing disease by taking into consideration an individual's genetic and environmental profile toward two avenues to improved outcomes: prevention and personalized treatments. This framework is largely geared to conditions conventionally falling into the field of medical genetics. Here, we show that the same avenues to improving outcomes can be applied to conditions in the field of behavior genomics, specifically disorders of spoken language. Babble Boot Camp (BBC) is the first comprehensive and personalized program designed to proactively mitigate speech and language disorders in infants at predictable risk by fostering precursor and early communication skills via parent training. The intervention begins at child age 2 to 5 months and ends at age 24 months, with follow-up testing at 30, 42, and 54 months. To date, 44 children with a newborn diagnosis of classic galactosemia (CG) have participated in the clinical trial of BBC. CG is an inborn error of metabolism of genetic etiology that predisposes up to 85% of children to severe speech and language disorders. Of 13 children with CG who completed the intervention and all or part of the follow-up testing, only one had disordered speech and none had disordered language skills. For the treated children who completed more than one assessment, typical speech and language skills were maintained over time. This shows that knowledge of genetic risk at birth can be leveraged toward proactive and personalized management of a disorder that manifests behaviorally.
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Affiliation(s)
- Beate Peter
- College of Health Solutions, Arizona State University, Tempe, AZ, USA
| | - Jennifer Davis
- College of Health Solutions, Arizona State University, Tempe, AZ, USA
| | - Lizbeth Finestack
- Speech-Language-Hearing Sciences, University of Minnesota, Minneapolis, MN, USA
| | | | - Mark VanDam
- Speech and Hearing Sciences, Washington State University, Spokane, WA, USA
| | - Laurel Bruce
- College of Health Solutions, Arizona State University, Tempe, AZ, USA
| | - Yookyung Kim
- College of Health Solutions, Arizona State University, Tempe, AZ, USA
| | - Linda Eng
- College of Health Solutions, Arizona State University, Tempe, AZ, USA
| | - Sarah Cotter
- College of Health Solutions, Arizona State University, Tempe, AZ, USA
| | - Emily Landis
- College of Health Solutions, Arizona State University, Tempe, AZ, USA
| | - Sam Beames
- College of Health Solutions, Arizona State University, Tempe, AZ, USA
| | - Nancy Scherer
- College of Health Solutions, Arizona State University, Tempe, AZ, USA
| | - Ina Knerr
- National Centre for Inherited Metabolic Disorders, Children’s Health Ireland at Temple Street, Dublin, Ireland
| | - Delaney Williams
- Speech and Hearing Sciences, Washington State University, Spokane, WA, USA
| | - Claire Schrock
- Speech and Hearing Sciences, Washington State University, Spokane, WA, USA
| | - Nancy Potter
- Speech and Hearing Sciences, Washington State University, Spokane, WA, USA
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Overby MS, Mazeika S, DiFazio M, Ioli J, Birch K, Devorace L. Clinicians' Perspectives of Treatment for Lateralization Errors: A Quantitative and Qualitative Study. Lang Speech Hear Serv Sch 2022; 53:749-767. [PMID: 35679621 DOI: 10.1044/2022_lshss-21-00109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE This mixed-methods study aimed to obtain information regarding speech-language pathologists' (SLPs) perspectives about treatment of lateralization errors (LEs), challenges to implementing evidence-based LE treatment practice, and the sources SLPs' use to find evidence to treat LEs. This information can assist our understanding of ways to facilitate the uptake of evidence-based practice into the everyday treatment of clients with this disorder. METHOD A convergent parallel mixed-methods design was used to collect data from SLPs (N = 214) using 24 questions from an online survey distributed through electronic mailing lists and Speech and Hearing State Associations. Quantitative data were analyzed using frequencies and averages; themes and subthemes of qualitative data were analyzed using a content analysis approach with no a priori codes. Quantitative and qualitative results were compared and integrated. RESULTS Participants believed that LEs required individualized treatment before the age of 5 years, were largely caused by structural and neuromuscular factors, and required an understanding of orofacial and dental structure and function. Challenges to implementing LE treatment included a lack of skills and knowledge specific to LEs, competing demands on clinicians' time and resources, and a research-practice gap. Sources of evidence frequently used to obtain information about LE treatment were colleagues, trainings, workshops, and American Speech-Language-Hearing Association journals. CONCLUSIONS Clinicians believe that LE treatment is challenging and requires skill training. Future research in LEs will need to consider the real-world decisions clinicians must make when treating this disorder as well as clinicians' everyday constraints and challenges.
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Affiliation(s)
- Megan S Overby
- Department of Speech-Language Pathology, Duquesne University, Pittsburgh, PA
| | - Sarah Mazeika
- Department of Speech-Language Pathology, Duquesne University, Pittsburgh, PA
| | - Magdalena DiFazio
- Department of Speech-Language Pathology, Duquesne University, Pittsburgh, PA
| | - Julianna Ioli
- Department of Speech-Language Pathology, Duquesne University, Pittsburgh, PA
| | - Katherine Birch
- Department of Speech-Language Pathology, Duquesne University, Pittsburgh, PA
| | - Lauren Devorace
- Department of Speech-Language Pathology, Duquesne University, Pittsburgh, PA
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Farquharson K, Tambyraja S. Introduction: Innovations in Treatment for Children With Speech Sound Disorders. Lang Speech Hear Serv Sch 2022; 53:627-631. [PMID: 35763415 DOI: 10.1044/2022_lshss-22-00065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE There is a clear need for effective and efficient interventions for children with speech sound disorder (SSD) that can be implemented in both clinical and school-based settings. METHOD This forum was created for any clinician who treats SSDs. We asked the invited authors to include immediately actionable information, such as therapy activities, tips for goal writing or progress monitoring, assessment processes, and frameworks for conversations with parents. RESULTS We have curated nine scientifically based articles that highlight the heterogeneity of SSDs and how various subpopulations require uniquely tailored interventions. Some children with SSDs require treatment approaches that are more heavily embedded in phonological theories (e.g., maximal or multiple oppositions) or that extend beyond speech production and include speech perception and phonological awareness skills. Clinicians also need to be mindful of not only which sounds are affected, but which kinds of errors a child is making. For instance, lateral lisps and residual speech sound errors should be evaluated and treated differently from other kinds of speech sound errors. There are certainly subpopulations of children with SSDs for whom there is extremely limited data upon which speech-language pathologists can base clinical decisions, such as children under the age of 3 years or children who are multilingual. Finally, there is a crucial need to better understand the social-emotional impacts of SSDs. Tools to aid in including social-emotional data within assessment and intervention outcomes are also included in this forum. CONCLUSION The traditional articulation approach is the most commonly used approach in school-based settings; however, there are many children for whom this approach is not appropriate. We hope to provide a robust resource for busy school-based speech-language pathologists who treat children with SSD-specifically, we hope clinicians embrace the opportunity to "think outside the box" of traditional articulation therapy.
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Affiliation(s)
- Kelly Farquharson
- Florida State University, School of Communication Science and Disorders, Tallahassee, FL
| | - Sherine Tambyraja
- The Ohio State University, Crane Center for Early Childhood Research and Policy, Columbus, OH
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20
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Sayyahi F, Boulenger V. A temporal-based therapy for children with inconsistent phonological disorder: A case-series. CLINICAL LINGUISTICS & PHONETICS 2022:1-27. [PMID: 35694910 DOI: 10.1080/02699206.2022.2075792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 05/04/2022] [Accepted: 05/04/2022] [Indexed: 06/15/2023]
Abstract
Deficits in temporal auditory processing, and in particular higher gap detection thresholds have been reported in children with inconsistent phonological disorder (IPD). Here we hypothesized that providing these children with extra time for phoneme identification may in turn enhance their phonological planning abilities for production, and accordingly improve not only consistency but also accuracy of their speech. We designed and tested a new temporal-based therapy, inspired by Core Vocabulary Therapy and called it T-CVT, where we digitally lengthened formant transitions between phonemes of words used for therapy. This allowed to target both temporal auditory processing and word phonological planning. Four preschool Persian native children with IPD received T-CVT for eight weeks. We measured changes in speech consistency (% inconsistency) and accuracy (percentage of consonants correct PCC) to assess the effects of the intervention. Therapy significantly improved both consistency and accuracy of word production in the four children: % inconsistency decreased from 59% on average before therapy to 2% post-T-CVT, and PCC increased from 61% to 92% on average. Consistency and accuracy were furthermore maintained or even still improved at three-month follow-up (2% inconsistency and 99% PCC). Results in a nonword repetition task showed the generalization of these effects to non-treated material: % inconsistency for nonwords decreased from 67% to 10% post-therapy, and PCC increased from 63% to 90%. These preliminary findings support the efficacy of the T-CVT intervention for children with IPD who show temporal auditory processing deficits as reflected by higher gap detection thresholds.
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Affiliation(s)
- Fateme Sayyahi
- School of Rehabilitation, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Véronique Boulenger
- Laboratoire Dynamique du Langage, UMR5596 CNRS/Université Lyon 2, Lyon, France
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21
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Cabbage K, Farquharson K, DeVeney S. Speech Sound Disorder Treatment Approaches Used by School-Based Clinicians: An Application of the Experience Sampling Method. Lang Speech Hear Serv Sch 2022; 53:860-873. [PMID: 35640104 DOI: 10.1044/2022_lshss-21-00167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Children with speech sound disorders (SSDs) comprise a large portion of caseloads for school-based speech-language pathologists (SLPs). Despite the existence of several evidence-based SSD intervention approaches, the translation from research to practice is often limited by ecological validity because of various factors unique to school settings (e.g., scheduling constraints, caseload size, child availability). The purpose of this study was to use the experience sampling method (ESM) to examine the current practices of school-based SLPs when treating children with SSDs on their caseloads. METHOD SLPs (N = 106) from 42 different states working full-time in school-based K-12 settings participated in this study. At the beginning of the study, each SLP completed a one-time demographic survey about treatment practices for children with SSDs. The SLPs then participated in a series of brief surveys every day for one workweek using a specialized ESM phone application that randomly alerted participants to report on their treatment practices for children with SSDs. RESULTS Findings revealed that although most SLPs reported using a variety of SSD intervention approaches in a one-time survey, the majority of SLPs reported using one of three approaches in situ: the traditional articulation therapy approach, cycles, and minimal pairs. We also report a significant negative relationship between the years of experience of an SLP and the number of different approaches used. CONCLUSIONS This study is the first to use the ESM to determine which approaches school-based SLPs use to treat children with SSDs. Findings demonstrate that SLPs have knowledge of many different SSD approaches but tend to utilize only a few in school-based settings.
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Lathrop-Marshall H, Keyser MMB, Jhingree S, Giduz N, Bocklage C, Couldwell S, Edwards H, Glesener T, Moss K, Frazier-Bowers S, Phillips C, Turvey T, Blakey G, White R, Mielke J, Zajac D, Jacox LA. Orthognathic speech pathology: impacts of Class III malocclusion on speech. Eur J Orthod 2022; 44:340-351. [PMID: 34562076 PMCID: PMC9127721 DOI: 10.1093/ejo/cjab067] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Patients with dentofacial disharmonies (DFDs) seek orthodontic care and orthognathic surgery to address issues with mastication, esthetics, and speech. Speech distortions are seen 18 times more frequently in Class III DFD patients than the general population, with unclear causality. We hypothesize there are significant differences in spectral properties of stop (/t/ or /k/), fricative (/s/ or /ʃ/), and affricate (/tʃ/) consonants and that severity of Class III disharmony correlates with the degree of speech abnormality. METHODS To understand how jaw disharmonies influence speech, orthodontic records and audio recordings were collected from Class III surgical candidates and reference subjects (n = 102 Class III, 62 controls). A speech pathologist evaluated subjects and recordings were quantitatively analysed by Spectral Moment Analysis for frequency distortions. RESULTS A majority of Class III subjects exhibit speech distortions. A significant increase in the centroid frequency (M1) and spectral spread (M2) was seen in several consonants of Class III subjects compared to controls. Using regression analysis, correlations between Class III skeletal severity (assessed by cephalometric measures) and spectral distortion were found for /t/ and /k/ phones. CONCLUSIONS Class III DFD patients have a higher prevalence of articulation errors and significant spectral distortions in consonants relative to controls. This is the first demonstration that severity of malocclusion is quantitatively correlated with the degree of speech distortion for consonants, suggesting causation. These findings offer insight into the complex relationship between craniofacial structures and speech distortions.
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Affiliation(s)
- Hillary Lathrop-Marshall
- Division of Craniofacial and Surgical Care, Orthodontics, Adams School of Dentistry, University of North Carolina, Chapel Hill, USA
| | - Mary Morgan B Keyser
- Division of Craniofacial and Surgical Care, Orthodontics, Adams School of Dentistry, University of North Carolina, Chapel Hill, USA
| | - Samantha Jhingree
- Division of Craniofacial and Surgical Care, Orthodontics, Adams School of Dentistry, University of North Carolina, Chapel Hill, USA
| | - Natalie Giduz
- Division of Craniofacial and Surgical Care, Orthodontics, Adams School of Dentistry, University of North Carolina, Chapel Hill, USA
| | - Clare Bocklage
- Division of Craniofacial and Surgical Care, Orthodontics, Adams School of Dentistry, University of North Carolina, Chapel Hill, USA
| | - Sandrine Couldwell
- Division of Craniofacial and Surgical Care, Oral Surgery, Adams School of Dentistry, University of North Carolina, Chapel Hill, USA
| | - Haley Edwards
- Division of Craniofacial and Surgical Care, Orthodontics, Adams School of Dentistry, University of North Carolina, Chapel Hill, USA
| | - Tim Glesener
- Division of Craniofacial and Surgical Care, Orthodontics, Adams School of Dentistry, University of North Carolina, Chapel Hill, USA
| | - Kevin Moss
- Division of Oral and Craniofacial Health Sciences, Adams School of Dentistry, University of North Carolina, Chapel Hill, USA
| | - Sylvia Frazier-Bowers
- Division of Craniofacial and Surgical Care, Orthodontics, Adams School of Dentistry, University of North Carolina, Chapel Hill, USA
| | - Ceib Phillips
- Division of Oral and Craniofacial Health Sciences, Adams School of Dentistry, University of North Carolina, Chapel Hill, USA
| | - Timothy Turvey
- Division of Craniofacial and Surgical Care, Oral Surgery, Adams School of Dentistry, University of North Carolina, Chapel Hill, USA
| | - George Blakey
- Division of Craniofacial and Surgical Care, Oral Surgery, Adams School of Dentistry, University of North Carolina, Chapel Hill, USA
| | - Ray White
- Division of Craniofacial and Surgical Care, Oral Surgery, Adams School of Dentistry, University of North Carolina, Chapel Hill, USA
| | - Jeff Mielke
- Department of English, North Carolina State University, Raleigh, USA
| | - David Zajac
- Division of Craniofacial and Surgical Care, Craniofacial Center, Adams School of Dentistry, University of North Carolina, Chapel Hill, USA
| | - Laura A Jacox
- Division of Craniofacial and Surgical Care, Orthodontics, Adams School of Dentistry, University of North Carolina, Chapel Hill, USA
- Division of Oral and Craniofacial Health Sciences, Adams School of Dentistry, University of North Carolina, Chapel Hill, USA
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23
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Peterson L, Savarese C, Campbell T, Ma Z, Simpson KO, McAllister T. Telepractice Treatment of Residual Rhotic Errors Using App-Based Biofeedback: A Pilot Study. Lang Speech Hear Serv Sch 2022; 53:256-274. [PMID: 35050705 DOI: 10.1044/2021_lshss-21-00084] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Although mobile apps are used extensively by speech-language pathologists, evidence for app-based treatments remains limited in quantity and quality. This study investigated the efficacy of app-based visual-acoustic biofeedback relative to nonbiofeedback treatment using a single-case randomization design. Because of COVID-19, all intervention was delivered via telepractice. METHOD Participants were four children aged 9-10 years with residual errors affecting American English /ɹ/. Using a randomization design, individual sessions were randomly assigned to feature practice with or without biofeedback, all delivered using the speech app Speech Therapist's App for /r/ Treatment. Progress was assessed using blinded listener ratings of word probes administered at baseline, posttreatment, and immediately before and after each treatment session. RESULTS All participants showed a clinically significant response to the overall treatment package, with effect sizes ranging from moderate to very large. One participant showed a significant advantage for biofeedback over nonbiofeedback treatment, although the order of treatment delivery poses a potential confound for interpretation in this case. CONCLUSIONS While larger scale studies are needed, these results suggest that app-based treatment for residual errors can be effective when delivered via telepractice. These results are compatible with previous findings in the motor learning literature regarding the importance of treatment dose and the timing of feedback conditions. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.18461576.
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Affiliation(s)
- Laura Peterson
- Department of Speech-Language Pathology, Rocky Mountain University of Health Professions, Provo, UT
| | | | - Twylah Campbell
- Department of Communicative Sciences and Disorders, New York University, NY
| | - Zhigong Ma
- Department of Communicative Sciences and Disorders, New York University, NY
| | - Kenneth O Simpson
- Department of Speech-Language Pathology, Rocky Mountain University of Health Professions, Provo, UT
| | - Tara McAllister
- Department of Communicative Sciences and Disorders, New York University, NY
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Peter B, Davis J, Cotter S, Belter A, Williams E, Stumpf M, Bruce L, Eng L, Kim Y, Finestack L, Stoel-Gammon C, Williams D, Scherer N, VanDam M, Potter N. Toward Preventing Speech and Language Disorders of Known Genetic Origin: First Post-Intervention Results of Babble Boot Camp in Children With Classic Galactosemia. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:2616-2634. [PMID: 34665663 PMCID: PMC9135004 DOI: 10.1044/2021_ajslp-21-00098] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/13/2021] [Accepted: 07/08/2021] [Indexed: 05/19/2023]
Abstract
Purpose Babble Boot Camp (BBC) is a package of proactive activities and routines designed to prevent speech and language disorders in infants at predictable risk. It is implemented via parent training and currently undergoing clinical trial in children with a newborn diagnosis of classic galactosemia (CG), a metabolic disease with high risk of speech and language disorders. The purpose of this study is to provide updates to a previous pilot study and to present the first set of post-intervention results. Method The intervention and data collection occurred during child ages < 6-24 months, with follow-up assessments of speech and language at ages 2.5 and 3.5 years. Treatment targets included earliest vocalization rates, babble complexity, speech production accuracy, and vocabulary and syntactic growth. The oldest 15 children with CG (including three untreated controls) completed the first set of follow-up assessments. Aggregate data up to 10 months were available for 17 treated children with CG, six untreated children with CG, and six typical controls. Results At ages 7-9 months, babbling complexity, as measured with mean babbling level, was higher in the treated children with CG than in the untreated children with CG and the typical controls. Prior to 24 months of age, the treated children with CG had greater expressive but not receptive vocabulary sizes than an untreated control. Follow-up testing showed typical language scores for all 12 treated children with CG and typical articulation scores for 11 of these, whereas one of three untreated children with CG had low articulation and expressive language scores. Conclusions The BBC appears to be a viable intervention to support the speech and expressive language development of children with GC. Future studies will evaluate the relative contributions of the earliest and later BBC components to outcomes.
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Affiliation(s)
- Beate Peter
- Speech and Hearing Science, College of Health Solutions, Arizona State University, Tempe
- Department of Communication Sciences and Disorders, Saint Louis University, MO
| | - Jennifer Davis
- Speech and Hearing Science, College of Health Solutions, Arizona State University, Tempe
| | - Sarah Cotter
- Speech and Hearing Science, College of Health Solutions, Arizona State University, Tempe
| | - Alicia Belter
- Speech and Hearing Science, College of Health Solutions, Arizona State University, Tempe
| | - Emma Williams
- Speech and Hearing Science, College of Health Solutions, Arizona State University, Tempe
| | - Melissa Stumpf
- Speech and Hearing Science, College of Health Solutions, Arizona State University, Tempe
| | - Laurel Bruce
- Speech and Hearing Science, College of Health Solutions, Arizona State University, Tempe
| | - Linda Eng
- Speech and Hearing Science, College of Health Solutions, Arizona State University, Tempe
| | - Yookyung Kim
- Speech and Hearing Science, College of Health Solutions, Arizona State University, Tempe
| | - Lizbeth Finestack
- Department of Speech-Language-Hearing Sciences, University of Minnesota Twin Cities, Minneapolis
| | - Carol Stoel-Gammon
- Department of Speech and Hearing Sciences, University of Washington, Seattle
| | - Delaney Williams
- Department of Speech and Hearing Sciences, Elson S. Floyd College of Medicine, Washington State University, Spokane
| | - Nancy Scherer
- Speech and Hearing Science, College of Health Solutions, Arizona State University, Tempe
| | - Mark VanDam
- Department of Speech and Hearing Sciences, Elson S. Floyd College of Medicine, Washington State University, Spokane
| | - Nancy Potter
- Department of Speech and Hearing Sciences, Elson S. Floyd College of Medicine, Washington State University, Spokane
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Lewis BA, Benchek P, Tag J, Miller G, Freebairn L, Taylor HG, Iyengar SK, Stein CM. Psychosocial Comorbidities in Adolescents With Histories of Childhood Apraxia of Speech. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:2572-2588. [PMID: 34609155 PMCID: PMC9132062 DOI: 10.1044/2021_ajslp-21-00035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 04/18/2021] [Accepted: 06/29/2021] [Indexed: 06/13/2023]
Abstract
Purpose Adolescent psychosocial outcomes of individuals with histories of childhood apraxia of speech (CAS) were compared to outcomes of individuals with histories of speech sound disorders (SSD) only and SSD with language impairment (LI). It was hypothesized that individuals with more severe and persistent disorders such as CAS would report poorer psychosocial outcomes. Method Groups were compared using analyses of variance on a psychosocial assessment battery that included measures of hyperactivity and inattention, anxiety, depression, internalizing and externalizing behaviors, thought problems, and social outcomes. Results Results revealed significant group differences on self-report of social problems and parent report of hyperactivity, thought problems, and social problems at adolescence. Compared to the SSD-only group, the CAS group had significantly higher parental ratings of hyperactivity and social problems in adolescence. The CAS and SSD + LI groups did not differ on psychosocial measures, possibly due to the high rate of comorbid LI in the CAS group. The CAS group also had more individuals who scored in the borderline/clinical range on self-report of social problems than the SSD-only group. The CAS group did not differ from the SSD + LI group in the number of participants scoring in the borderline/clinical range on measures. Conclusions Individuals with histories of CAS demonstrate increased rates of social problems and hyperactivity based on parent ratings compared to adolescents with histories of SSD only; however, most do not score within the clinical range. The persistence of speech sound errors combined with self-reported and parent-reported social difficulties suggests that speech-language pathologists should be sensitive to the social and emotional impact of CAS and make appropriate referrals to mental health professionals when warranted.
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Affiliation(s)
- Barbara A. Lewis
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, OH
| | - Penelope Benchek
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH
| | - Jessica Tag
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, OH
| | - Gabrielle Miller
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, OH
| | - Lisa Freebairn
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, OH
| | - H. Gerry Taylor
- Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH
- Department of Pediatrics, The Ohio State University, Columbus
| | - Sudha K. Iyengar
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH
| | - Catherine M. Stein
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH
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Schwab SM, Dugan S, Riley MA. Reciprocal Influence of Mobility and Speech-Language: Advancing Physical Therapy and Speech Therapy Cotreatment and Collaboration for Adults With Neurological Conditions. Phys Ther 2021; 101:pzab196. [PMID: 34403483 PMCID: PMC8801003 DOI: 10.1093/ptj/pzab196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 05/28/2021] [Indexed: 11/13/2022]
Abstract
Mobility and speech-language impairments and limitations in adults with neurological conditions manifest not in isolated anatomical components but instead in the individual-environment system and are task-dependent. Optimization of function thus requires interprofessional care to promote participation in meaningful life areas within appropriate task and environmental contexts. Cotreatment guidelines (ie, the concurrent intervention of disciplines) were established by the physical therapy, occupational therapy, and speech-language and hearing professional organizations nearly 2 decades ago to facilitate seamless interprofessional care. Despite this, cotreatment between physical therapy and speech therapy remains limited. The purpose of this Perspective article is to encourage physical therapists and speech-language pathologists to increase interprofessional collaboration through cotreatment in the management of adults with neurological conditions. Evidence from pediatrics and basic motor control literature points toward reciprocal interactions between speech-language and mobility. We provide recommendations for clinical practice with an emphasis on the gains each discipline can provide the other. This Perspective is rooted in the International Classification of Functioning, Disability and Health model and ecological theory. IMPACT The goals of speech therapy and physical therapy are complementary and mutually supportive. Enhanced cotreatment, and collaboration more generally, between physical therapists and speech-language pathologists in the management of adults with neurological conditions can augment task-relevant conditions to improve function.
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Affiliation(s)
- Sarah M Schwab
- Center for Cognition, Action, and Perception, Department of Psychology, Edwards Center 1, University of Cincinnati, Cincinnati, Ohio, USA
| | - Sarah Dugan
- Center for Cognition, Action, and Perception, Department of Psychology, Edwards Center 1, University of Cincinnati, Cincinnati, Ohio, USA
- Department of Rehabilitation, Exercise, & Nutrition Sciences, Health Sciences Building, University of Cincinnati, Cincinnati, Ohio, USA
| | - Michael A Riley
- Center for Cognition, Action, and Perception, Department of Psychology, Edwards Center 1, University of Cincinnati, Cincinnati, Ohio, USA
- Department of Rehabilitation, Exercise, & Nutrition Sciences, Health Sciences Building, University of Cincinnati, Cincinnati, Ohio, USA
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Spencer C, Vannest J, Maas E, Preston JL, Redle E, Maloney T, Boyce S. Neuroimaging of the Syllable Repetition Task in Children With Residual Speech Sound Disorder. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:2223-2233. [PMID: 33705667 PMCID: PMC8740709 DOI: 10.1044/2020_jslhr-20-00269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Purpose This study investigated phonological and speech motor neural networks in children with residual speech sound disorder (RSSD) during an overt Syllable Repetition Task (SRT). Method Sixteen children with RSSD with /ɹ/ errors (6F [female]; ages 8;0-12;6 [years;months]) and 16 children with typically developing speech (TD; 8F; ages 8;5-13;7) completed a functional magnetic resonance imaging experiment. Children performed the SRT ("SRT-Early Sounds") with the phonemes /b, d, m, n, ɑ/ and an adapted version ("SRT-Late Sounds") with the phonemes /ɹ, s, l, tʃ, ɑ/. We compared the functional activation and transcribed production accuracy of the RSSD and TD groups during both conditions. Expected errors were not scored as inaccurate. Results No between-group or within-group differences in repetition accuracy were found on the SRT-Early Sounds or SRT-Late Sounds tasks at any syllable sequence length. On a first-level analysis of the tasks, the TD group showed expected patterns of activation for both the SRT-Early Sounds and SRT-Late Sounds, including activation in the left primary motor cortex, left premotor cortex, bilateral anterior cingulate, bilateral primary auditory cortex, bilateral superior temporal gyrus, and bilateral insula. The RSSD group showed similar activation when correcting for multiple comparisons. In further exploratory analyses, we observed the following subthreshold patterns: (a) On the SRT-Early Sounds, greater activation was found in the left premotor cortex for the RSSD group, while greater activation was found in the left cerebellum for the TD group; (b) on the SRT-Late Sounds, a small area of greater activation was found in the right cerebellum for the RSSD group. No within-group functional differences were observed (SRT-Early Sounds vs. SRT-Late Sounds) for either group. Conclusions Performance was similar between groups, and likewise, we found that functional activation did not differ. Observed functional differences in previous studies may reflect differences in task performance, rather than fundamental differences in neural mechanisms for syllable repetition.
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Affiliation(s)
- Caroline Spencer
- Department of Communication Sciences and Disorders, University of Cincinnati, OH
| | - Jennifer Vannest
- Department of Communication Sciences and Disorders, University of Cincinnati, OH
| | - Edwin Maas
- Department of Communication Sciences and Disorders, Temple University, Philadelphia, PA
| | - Jonathan L Preston
- Department of Communication Sciences and Disorders, Syracuse University, NY
| | - Erin Redle
- Department of Communication Sciences and Disorders, University of Cincinnati, OH
| | | | - Suzanne Boyce
- Department of Communication Sciences and Disorders, University of Cincinnati, OH
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McAllister T, Hitchcock ER, Ortiz JA. Computer-assisted challenge point intervention for residual speech errors. PERSPECTIVES OF THE ASHA SPECIAL INTEREST GROUPS 2021; 6:214-229. [PMID: 35493921 PMCID: PMC9053469 DOI: 10.1044/2020_persp-20-00191] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Purpose This preliminary case series investigated the effects of biofeedback intervention for residual rhotic errors delivered within a modified challenge point framework. In the challenge point framework, practice difficulty is adaptively adjusted with the goal of enhancing generalization learning. This study more specifically evaluated the feasibility of a computer-mediated implementation of challenge point treatment for rhotic errors using a custom open-source software, the Challenge Point Program (CPP). Method Participants were five native English speakers, ages 7;3-15;5, who had established but not generalized correct rhotic production in previous treatment; overall treatment duration was flexible. Treatment incorporated either electropalatographic or visual-acoustic biofeedback and was structured by challenge point principles implemented using the CPP software. Results Participants were highly variable in the magnitude of generalization gains attained. However, the median overall effect size was 4.24, suggesting that participants' response in treatment tended to exceed the minimum value considered clinically significant. Conclusions These findings provide preliminary evidence that computer-mediated implementation of the challenge point framework can be effective in producing generalization in some participants.
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Affiliation(s)
- Tara McAllister
- Department of Communicative Sciences and Disorders, New York University, New York, NY
| | - Elaine R. Hitchcock
- Department of Communication Sciences and Disorders, Montclair State University, Montclair, NJ
| | - Jose A. Ortiz
- Department of Hearing and Speech Sciences, University of Maryland, MD
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Cialdella L, Kabakoff H, Preston J, Dugan S, Spencer C, Boyce S, Tiede M, Whalen D, McAllister T. Auditory-perceptual acuity in rhotic misarticulation: baseline characteristics and treatment response. CLINICAL LINGUISTICS & PHONETICS 2021; 35:19-42. [PMID: 32242467 PMCID: PMC7541403 DOI: 10.1080/02699206.2020.1739749] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 02/28/2020] [Accepted: 03/04/2020] [Indexed: 05/27/2023]
Abstract
The rhotic sound /r/ is one of the latest-emerging sounds in English, and many children receive treatment for residual errors affecting /r/ that persist past the age of 9. Auditory-perceptual abilities of children with residual speech errors are thought to be different from their typically developing peers. This study examined auditory-perceptual acuity in children with residual speech errors affecting /r/ and the relation of these skills to production accuracy, both before and after a period of treatment incorporating visual biofeedback. Identification of items along an /r/-/w/ continuum was assessed prior to treatment. Production accuracy for /r/ was acoustically measured from standard/r/stimulability probes elicited before and after treatment. Fifty-nine children aged 9-15 with residual speech errors (RSE) affecting /r/ completed treatment, and forty-eight age-matched controls who completed the same auditory-perceptual task served as a comparison group. It was hypothesized that children with RSE would show lower auditory-perceptual acuity than typically developing speakers and that higher auditory-perceptual acuity would be associated with more accurate production before treatment. It was also hypothesized that auditory-perceptual acuity would serve as a mediator of treatment response. Results indicated that typically developing children have more acute perception of the /r/-/w/ contrast than children with RSE. Contrary to hypothesis, baseline auditory-perceptual acuity for /r/ did not predict baseline production severity. For baseline auditory-perceptual acuity in relation to biofeedback efficacy, there was an interaction between auditory-perceptual acuity and gender, such that higher auditory-perceptual acuity was associated with greater treatment response in female, but not male, participants.
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Affiliation(s)
- Laine Cialdella
- Department of Communicative Sciences & Disorders, New York University , New York, NY, USA
| | - Heather Kabakoff
- Department of Communicative Sciences & Disorders, New York University , New York, NY, USA
| | - Jonathan Preston
- Department of Communication Sciences and Disorders, Syracuse University , Syracuse, NY, USA
- Haskins Laboratories , New Haven, CT, USA
| | - Sarah Dugan
- Department of Communication Sciences and Disorders, University of Cincinnati , Cincinnati, OH, USA
| | - Caroline Spencer
- Department of Communication Sciences and Disorders, University of Cincinnati , Cincinnati, OH, USA
| | - Suzanne Boyce
- Haskins Laboratories , New Haven, CT, USA
- Department of Communication Sciences and Disorders, University of Cincinnati , Cincinnati, OH, USA
| | - Mark Tiede
- Haskins Laboratories , New Haven, CT, USA
| | - D Whalen
- Program in Speech-Language-Hearing Sciences, City University of New York Graduate Center , New York, NY, USA
- Department of Linguistics, Yale University , New Haven, CT, USA
| | - Tara McAllister
- Department of Communicative Sciences & Disorders, New York University , New York, NY, USA
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Farquharson K, Therrien M, Barton-Hulsey A, Brandt AF. How to Recruit, Support, and Retain Speech-Language Pathologists in Public Schools. ACTA ACUST UNITED AC 2020. [DOI: 10.1177/1052684620966062] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Over the past two decades, there has been a persistent shortage of qualified speech-language pathologists (SLPs) across the United States. This shortage is predicted to continue, as data reported by the American Speech Language Hearing Association (ASHA) from the US Bureau of Labor Statistics indicates that there will be a 27% increase in job openings through the year 2028. In some states, the shortage has led to service provision from individuals without a background in speech-language pathology and/or without speech-language pathology certification and licensure. Speech and language services that are delivered by unqualified personnel may lead to inadequate time devoted to therapy—either too much, or too little—which is ultimately unethical, illegal, and expensive. However, there is a real issue at hand for school leadership—and that is: How to recruit, support, and retain highly qualified SLPs? In the current tutorial, we will provide evidence-based action steps for how and why to recruit, support, and retain certified and licensed SLPs. Specifically, we discuss the qualifications of the SLP, roles and responsibilities of school-based SLPs, caseload versus workload considerations, various service delivery models, and a review of SLP job satisfaction research. Throughout the tutorial, we will provide concrete and evidence-based ideas for school leadership to consider when recruiting, supporting, and retaining SLPs.
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Preston JL, Benway NR, Leece MC, Hitchcock ER, McAllister T. Tutorial: Motor-Based Treatment Strategies for /r/ Distortions. Lang Speech Hear Serv Sch 2020; 51:966-980. [PMID: 32783706 PMCID: PMC7842851 DOI: 10.1044/2020_lshss-20-00012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 06/16/2020] [Accepted: 06/16/2020] [Indexed: 11/09/2022] Open
Abstract
Purpose This tutorial summarizes current best practices in treating American English /r/ distortions in children with residual speech errors. Method To enhance the effectiveness of clinicians' cueing and feedback, the phonetics of /r/ production is reviewed. Principles of acquisition, which can inform how to practice /r/ in the early stages of therapy, are explained. Elements of therapy that lack scientific support are also mentioned. Results Although there is significant variability in /r/ production, the common articulatory requirements include an oral constriction, a pharyngeal constriction, tongue body lowering, lateral bracing, and slight lip rounding. Examples of phonetic cues and shaping strategies are provided to help clinicians elicit these movements to evoke correct /r/ productions. Principles of acquisition (e.g., blocked practice, frequent knowledge of performance feedback) are reviewed to help clinicians structure the earliest stages of treatment to establish /r/. Examples of approaches that currently lack scientific support include nonspeech oral motor exercises, tactile cues along the mylohyoid muscle, and heterogeneous groupings in group therapy. Conclusion Treatment strategies informed by phonetic science and motor learning theory can be implemented by all clinicians to enhance acquisition of /r/ for children with residual errors. Supplemental Material https://doi.org/10.23641/asha.12771329.
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Affiliation(s)
| | - Nina R. Benway
- Department of Communication Sciences & Disorders, Syracuse University, NY
| | - Megan C. Leece
- Department of Communication Sciences & Disorders, Syracuse University, NY
| | - Elaine R. Hitchcock
- Department of Communication Sciences and Disorders, Montclair State University, NJ
| | - Tara McAllister
- Department of Communicative Sciences and Disorders, New York University, NY
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Cronin A, McLeod S, Verdon S. Holistic Communication Assessment for Young Children With Cleft Palate Using the International Classification of Functioning, Disability and Health:Children and Youth. Lang Speech Hear Serv Sch 2020; 51:914-938. [PMID: 32697920 DOI: 10.1044/2020_lshss-19-00122] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Purpose Children with a cleft palate (± cleft lip; CP±L) can have difficulties communicating and participating in daily life, yet speech-language pathologists typically focus on speech production during routine assessments. The International Classification of Functioning, Disability and Health: Children and Youth Version (ICF-CY; World Health Organization, 2007) provides a framework for holistic assessment. This tutorial describes holistic assessment of children with CP±L illustrated by data collected from a nonclinical sample of seven 2- to 3-year-old children, 13 parents, and 12 significant others (e.g., educators and grandparents). Method Data were collected during visits to participants' homes and early childhood education and care centers. Assessment tools applicable to domains of the ICF-CY were used to collect and analyze data. Child participants' Body Functions including speech, language, and cognitive development were assessed using screening and standardized assessments. Participants' Body Structures were assessed via oral motor examination, case history questionnaires, and observation. Participants' Activities and Participation as well as Environmental and Personal Factors were examined through case history questionnaires, interviews with significant others, parent report measures, and observations. Results Valuable insights can be gained from undertaking holistic speech-language pathology assessments with children with CP±L. Using multiple tools allowed for triangulation of data and privileging different viewpoints, to better understand the children and their contexts. Several children demonstrated speech error patterns outside of what are considered cleft speech characteristics, which underscores the importance of a broader assessment. Conclusion Speech-language pathologists can consider incorporating evaluation of all components and contextual factors of the ICF-CY when assessing and working with young children with CP±L to inform intervention and management practices.
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Affiliation(s)
- Anna Cronin
- School of Teacher Education, Charles Sturt University, Bathurst, New South Wales, Australia
| | - Sharynne McLeod
- School of Teacher Education, Charles Sturt University, Bathurst, New South Wales, Australia
| | - Sarah Verdon
- School of Community Health, Charles Sturt University, Albury, New South Wales, Australia
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Kain A, Roten A, Gale R. DIACRITIC-LEVEL PRONUNCIATION ANALYSIS USING PHONOLOGICAL FEATURES. PROCEEDINGS OF THE ... IEEE INTERNATIONAL CONFERENCE ON ACOUSTICS, SPEECH, AND SIGNAL PROCESSING. ICASSP (CONFERENCE) 2020; 2020:8084-8088. [PMID: 33613125 PMCID: PMC7888379 DOI: 10.1109/icassp40776.2020.9053836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Speech sound disorders affect 10% of preschool and school-age children, adversely affecting their communication, academic performance, and interaction level. Effective pronunciation training requires prolonged supervised practice and interaction. Unfortunately, many children have limited or no access to a speech-language pathologist. Computer-assisted pronunciation training has the potential for being a highly effective teaching aid; however, to-date such systems remain incapable of identifying pronunciation errors with sufficient accuracy. We propose a system that combines a multi-target architecture with weighted finite-state transducers to first segment and then analyze an utterance in terms of its phonological features. We analyze a corpus of 90 children aged 4-7 and find differences between the typically developing and the speech disordered groups.
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Affiliation(s)
| | - Amie Roten
- Oregon Health & Science University, Portland, OR, USA
| | - Robert Gale
- Oregon Health & Science University, Portland, OR, USA
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34
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Overby MS, Moorer LL, Belardi K, Schreiber J. Retrospective video analysis of the early speech sound development of infants and toddlers later diagnosed with lateralisation errors. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 22:196-205. [PMID: 31382784 DOI: 10.1080/17549507.2019.1645884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Purpose: Although lateralisation errors (LEs) are a common speech sound disorder, no studies have examined their early development. The purpose of this exploratory small-scale investigation was to compare the early (birth-24 months) speech sound development between children later diagnosed with LEs and typically developing children.Method: This was a between-group case-controlled design with six monolingual English-speaking participants. Participants were White, non-Hispanic girls with at least one college-educated parent. As children, three had been diagnosed with lateralisation speech sound errors and three demonstrated typical speech sound development. Participants' parents provided home video-recordings of the participants as infants/toddlers between birth and age 2. These videos were then analysed for the amount, type and diversity of sounds, and canonical babbling onset.Result: There was no statistically significant between-group difference in the volubility (i.e. combined frequency of non-resonant and resonant utterances) or in the age at which [s] or [z] emerged. However, infants/toddlers who were later diagnosed with LEs showed reduced frequency/minute in production of resonant utterances and consonants (including [s, z]), used fewer different consonants/minute, and used fewer syllable shapes/minute compared to typically developing infants/toddlers. At 7-12 months, none of the infants/toddlers later diagnosed with LEs, but all participants in the comparison group had reached the canonical babbling stage.Conclusion: Children who have LEs may have had a less robust speech sound system as infants/toddlers than their typically developing peers. However, these findings must be considered with caution due to the significant limitations of this investigation.
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Affiliation(s)
- Megan S Overby
- Department of Speech-Language Pathology, Duquesne University, Pittsburgh, PA, USA
| | - Laura L Moorer
- Department of Communication Sciences and Disorders, Texas Woman's University, Denton, TX, USA
| | - Katie Belardi
- Department of Communication Science and Disorders, University of Pittsburgh, Pittsburgh, PA, USA
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35
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Farquharson K, Tambyraja SR, Justice LM. Contributions to Gain in Speech Sound Production Accuracy for Children With Speech Sound Disorders: Exploring Child and Therapy Factors. Lang Speech Hear Serv Sch 2020; 51:457-468. [PMID: 32160111 DOI: 10.1044/2019_lshss-19-00079] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Purpose The purpose of this study was to explore the extent to which child- and therapy-level factors contribute to gains in speech sound production accuracy for children with speech sound disorders in receipt of school-based services. Method Data were obtained from 126 kindergarten and first- and second-grade children currently in receipt of speech therapy services in their public school setting. Pretest and posttest measures of spontaneous speech production and language ability were collected at the beginning and end of one academic year. Using a spontaneous speech sample, percentage of consonants correct (PCC) was calculated for each child; a gain score was computed by subtracting the pretest PCC score from the posttest PCC score. The children's speech-language pathologist completed weekly therapy logs during business-as-usual therapy, indicating the frequency, duration, and group composition of services throughout the school year. Results Results supported that gain in PCC from pretest to posttest was predicted by several child- and therapy-level variables. Children's initial speech sound severity was negatively related to gains in PCC. Our results also supported that the total number of therapy sessions received in a year was positively predictive of PCC gain. Interestingly, the number of individual therapy sessions was negatively associated with PCC gain. Conclusion Several malleable therapy factors contribute to gains in speech sound accuracy for children with speech sound disorders. Speech-language pathologists should consider how these factors may be manipulated to best tailor treatment to the individual needs of the children on their caseloads.
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Affiliation(s)
- Kelly Farquharson
- School of Communication Sciences and Disorders, Florida State University, Tallahassee
| | - Sherine R Tambyraja
- Crane Center for Early Childhood Research and Policy, The Ohio State University, Columbus
| | - Laura M Justice
- Crane Center for Early Childhood Research and Policy, The Ohio State University, Columbus
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McAllister T, Preston JL, Hitchcock ER, Hill J. Protocol for Correcting Residual Errors with Spectral, ULtrasound, Traditional Speech therapy Randomized Controlled Trial (C-RESULTS RCT). BMC Pediatr 2020; 20:66. [PMID: 32046671 PMCID: PMC7014674 DOI: 10.1186/s12887-020-1941-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 01/22/2020] [Indexed: 11/17/2022] Open
Abstract
Background Speech sound disorder in childhood poses a barrier to academic and social participation, with potentially lifelong consequences for educational and occupational outcomes. While most speech errors resolve by the late school-age years, between 2 and 5% of speakers exhibit residual speech errors (RSE) that persist through adolescence or even adulthood. Previous findings from small-scale studies suggest that interventions incorporating visual biofeedback can outperform traditional motor-based treatment approaches for children with RSE, but this question has not been investigated in a well-powered randomized controlled trial. Methods/design This project, Correcting Residual Errors with Spectral, ULtrasound, Traditional Speech therapy Randomized Controlled Trial (C-RESULTS RCT), aims to treat 110 children in a parallel randomized controlled clinical trial comparing biofeedback and non-biofeedback interventions for RSE affecting the North American English rhotic sound /ɹ/. Eligible children will be American English speakers, aged 9–15 years, who exhibit RSE affecting /ɹ/ but otherwise show typical cognitive-linguistic and hearing abilities. Participants will be randomized, with stratification by site (Syracuse University or Montclair State University) and pre-treatment speech production ability, to receive either a motor-based treatment consistent with current best practices in speech therapy (40% of participants) or treatment incorporating visual biofeedback (60% of participants). Within the biofeedback condition, participants will be assigned in equal numbers to receive biofeedback in the form of a real-time visual display of the acoustic signal of speech or ultrasound imaging of the tongue during speech. The primary outcome measure will assess changes in the acoustics of children’s production of /ɹ/ during treatment, while a secondary outcome measure will use blinded listeners to evaluate changes in the perceived accuracy of /ɹ/ production after the completion of all treatment. These measures will allow the treatment conditions to be compared with respect to both efficacy and efficiency. Discussion By conducting the first well-powered randomized controlled trial comparing treatment with and without biofeedback, this study aims to provide high-quality evidence to guide treatment decisions for children with RSE. Trial registration ClinicalTrials.gov identifier NCT03737318, November 9, 2018.
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Affiliation(s)
- Tara McAllister
- Department of Communicative Sciences and Disorders, New York University, New York, NY, USA
| | - Jonathan L Preston
- Department of Communication Sciences and Disorders, Syracuse University, 621 Skytop Rd, Suite 1200, Syracuse, NY, 13244, USA.
| | - Elaine R Hitchcock
- Department of Communication Sciences & Disorders, Montclair State University, Bloomfield, NJ, USA
| | - Jennifer Hill
- Department of Applied Statistics, Social Science, and the Humanities, New York University, New York, NY, USA
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Peer Victimization and Communication Skills in Adolescents with Down Syndrome: Preliminary Findings. J Autism Dev Disord 2019; 50:349-355. [DOI: 10.1007/s10803-019-04238-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Sugden E, Lloyd S, Lam J, Cleland J. Systematic review of ultrasound visual biofeedback in intervention for speech sound disorders. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2019; 54:705-728. [PMID: 31179581 DOI: 10.1111/1460-6984.12478] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 04/17/2019] [Accepted: 05/12/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND As cost and access barriers to ultrasound technology have decreased, interest in using ultrasound visual biofeedback (U-VBF) as a tool for remediating speech sound disorders (SSD) has increased. A growing body of research has investigated U-VBF in intervention for developmental SSD; however, diversity in study design, participant characteristics, clinical methods and outcomes complicate the interpretation of this literature. Thus, there is a need for a synthesis and review of the evidence base for using U-VBF in intervention for SSD. AIMS To synthesise and evaluate the research evidence for U-VBF in intervention for developmental SSD. METHODS A systematic review was conducted. Eight electronic databases were searched for peer-reviewed articles published before 2018. Details about study design, participants, intervention procedures, service delivery, intervention intensity and outcomes were extracted from each study that met the inclusion criteria. The included studies were rated using both a critical appraisal tool and for their reporting of intervention detail. MAIN CONTRIBUTIONS Twenty-eight papers, comprising 29 studies, met the inclusion criteria. The most common research design was single-case experimental design (44.8% of studies). The studies included between one and 13 participants (mean = 4.1) who had a mean age of approximately 11 years (range = 4;0-27 years). Within the research evidence, U-VBF intervention was typically provided as part of, or as an adjunct to, other articulatory-based therapy approaches. A range of lingual sounds were targeted in intervention, with 80.6% of participants across all reviewed studies receiving intervention targeting rhotics. Outcomes following therapy were generally positive with the majority of studies reporting that U-VBF facilitated acquisition of targets, with effect sizes ranging from no effect to a large effect. Difficulties with generalisation were observed for some participants. Most studies (79.3%) were categorised as efficacy rather than effectiveness studies and represented lower levels of evidence. Overall, the reviewed studies scored more highly on measures of external validity than internal validity. CONCLUSIONS The evidence base for U-VBF is developing; however, most studies used small sample sizes and lower strength designs. Current evidence indicates that U-VBF may be an effective adjunct to intervention for some individuals whose speech errors persist despite previous intervention. The results of this systematic review underscore the need for more high-quality and large-scale research exploring the use of this intervention in both controlled and community contexts.
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Affiliation(s)
- Eleanor Sugden
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - Susan Lloyd
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
- Clinical Audiology, Speech & Language Research Centre, Queen Margaret University, Musselburgh, UK
| | - Jenny Lam
- Paediatric Speech and Language Therapy, NHS Lothian, Edinburgh, UK
| | - Joanne Cleland
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
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Cabbage KL, Farquharson K, Iuzzini-Seigel J, Zuk J, Hogan TP. Exploring the Overlap Between Dyslexia and Speech Sound Production Deficits. Lang Speech Hear Serv Sch 2019; 49:774-786. [PMID: 30458539 DOI: 10.1044/2018_lshss-dyslc-18-0008] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 07/13/2018] [Indexed: 01/04/2023] Open
Abstract
Purpose Children with dyslexia have speech production deficits in a variety of spoken language contexts. In this article, we discuss the nature of speech production errors in children with dyslexia, including those who have a history of speech sound disorder and those who do not, to familiarize speech-language pathologists with speech production-specific risk factors that may help predict or identify dyslexia in young children. Method In this tutorial, we discuss the role of a phonological deficit in children with dyslexia and how this may manifest as speech production errors, sometimes in conjunction with a speech sound disorder but sometimes not. We also briefly review other factors outside the realm of phonology that may alert the speech-language pathologist to possible dyslexia. Results Speech-language pathologists possess unique knowledge that directly contributes to the identification and remediation of children with dyslexia. We present several clinical recommendations related to speech production deficits in children with dyslexia. We also review what is known about how and when children with speech sound disorder are most at risk for dyslexia. Conclusion Speech-language pathologists have a unique opportunity to assist in the identification of young children who are at risk for dyslexia.
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Affiliation(s)
- Kathryn L Cabbage
- Department of Communication Disorders, Brigham Young University, Provo, UT
| | - Kelly Farquharson
- Department of Communication Sciences and Disorders, Emerson College, Boston, MA
| | - Jenya Iuzzini-Seigel
- Department of Speech Pathology and Audiology, Marquette University, Milwaukee, WI
| | - Jennifer Zuk
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA.,Program in Speech and Hearing Bioscience and Technology, Division of Medical Sciences, Harvard University, Boston, MA
| | - Tiffany P Hogan
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
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Wood SE, Timmins C, Wishart J, Hardcastle WJ, Cleland J. Use of electropalatography in the treatment of speech disorders in children with Down syndrome: a randomized controlled trial. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2019; 54:234-248. [PMID: 30039902 DOI: 10.1111/1460-6984.12407] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 06/08/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Electropalatography (EPG) records details of the location and timing of tongue contacts with the hard palate during speech. It has been effective in treating articulation disorders that have failed to respond to conventional therapy approaches but, until now, its use with children and adolescents with intellectual/learning disabilities and speech disorders has been limited. AIMS To evaluate the usefulness of EPG in the treatment of speech production difficulties in children and adolescents with Down syndrome (DS) aged 8-18 years. METHODS & PROCEDURES A total of 27 children with DS were assessed on a range of cognitive and speech and language measures and underwent additional EPG assessment. Participants were randomly allocated to one of three age-matched groups receiving either EPG therapy, EPG-informed conventional therapy or 'treatment as usual' over a 12-week period. The speech of all children was assessed before therapy using the Diagnostic Evaluation of Articulation and Phonology (DEAP) and reassessed immediately post- and 3 and 6 months post-intervention to measure percentage consonants correct (PCC). EPG recordings were made of the DEAP assessment items at all time points. Per cent intelligibility was also calculated using the Children's Speech Intelligibility Measure (CSIM). OUTCOMES & RESULTS Gains in accuracy of production immediately post-therapy, as measured by PCC, were seen for all groups. Reassessment at 3 and 6 months post-therapy revealed that those who had received therapy based directly on EPG visual feedback were more likely to maintain and improve on these gains compared with the other groups. Statistical testing showed significant differences between groups in DEAP scores across time points, although the majority did not survive post-hoc evaluation. Intelligibility across time points, as measured by CSIM, was also highly variable within and between the three groups, but despite significant correlations between DEAP and CSIM at all time points, no statistically significant group differences emerged. CONCLUSIONS & IMPLICATIONS EPG was an effective intervention tool for improving speech production in many participants. This may be because it capitalizes on the relative strength of visual over auditory processing in this client group. The findings would seem to warrant an increased focus on addressing speech production difficulties in current therapy.
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Affiliation(s)
- Sara E Wood
- Clinical Audiology, Speech and Language Research Centre, Queen Margaret University, Edinburgh, UK
| | - Claire Timmins
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - Jennifer Wishart
- Moray House School of Education, University of Edinburgh, Edinburgh, UK
| | - William J Hardcastle
- Clinical Audiology, Speech and Language Research Centre, Queen Margaret University, Edinburgh, UK
| | - Joanne Cleland
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
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Abstract
Purpose
The purpose of this article is to explore the ways in which children with mild speech sound disorders (SSDs)—that is, single sound errors—may be at risk for difficulties with phonological awareness, decoding, spelling, and social–emotional well-being.
Conclusions
SSDs comprise a group of children who have difficulty in consistently and correctly producing 1 or more phonemes in their ambient language. Presently, there is a concerning trend with respect to service provision for children who have only a few—or only 1—sounds in error. That is, these children may not receive services at all. This practice is problematic, because it assumes that children with a single sound in error are not at risk for or experiencing any related educational difficulties. However, research supports connections between SSDs, including single sound errors, and decoding, spelling, and social–emotional deficits. This article aims to make the case for the single sound error—sometimes it is not “just artic.” Clinical recommendations for assessment, treatment, and advocacy are included.
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Affiliation(s)
- Kelly Farquharson
- School of Communication Science and Disorders, Florida State University, Tallahassee
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Cleland J, Scobbie JM, Roxburgh Z, Heyde C, Wrench A. Enabling New Articulatory Gestures in Children With Persistent Speech Sound Disorders Using Ultrasound Visual Biofeedback. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2019; 62:229-246. [PMID: 30950695 DOI: 10.1044/2018_jslhr-s-17-0360] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Purpose This study evaluated ultrasound visual biofeedback treatment for teaching new articulations to children with a wide variety of speech sound disorders. It was hypothesized that motor-based intervention incorporating ultrasound would lead to rapid acquisition of a range of target lingual gestures with generalization to untreated words. Method Twenty children aged 6-15 years with a range of mild to severe speech disorders affecting a variety of lingual targets enrolled in a case series with replication. Of these, 15 children completed the intervention. All of the children presented with a variety of errors. We therefore employed a target selection strategy to treat the most frequent lingual error. These individual speech targets were treated using ultrasound visual biofeedback as part of ten to twelve 1-hr intervention sessions. The primary outcome measure was percentage of target segments correct in untreated wordlists. Results Six children were treated for velar fronting; 3 children, for postalveolar fronting; 2 children, for backing alveolars to pharyngeal or glottal place; 1 child, for debuccalization (production of all onsets as [h]); 1 child, for vowel merger; and 2 children, for lateralized sibilants. Ten achieved the new articulation in the 1st or 2nd session of intervention, despite no children being readily stimulable for their target articulation before intervention. In terms of generalization, effect sizes for percentage of target segments correct ranged from no effect (5 children), small effect (1 child), medium effect (4 children), and large effect (5 children). Conclusions Ultrasound visual biofeedback can be used to treat a wide range of lingual errors in children with various speech sound disorders, from mild to severe. Visual feedback may be useful for establishing new articulations; however, generalization is more variable.
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Affiliation(s)
- Joanne Cleland
- Psychological Sciences and Health, University of Strathclyde, Glasgow, United Kingdom
| | - James M Scobbie
- Clinical Audiology, Speech and Language Research Centre, Queen Margaret University, Edinburgh, United Kingdom
| | - Zoe Roxburgh
- Clinical Audiology, Speech and Language Research Centre, Queen Margaret University, Edinburgh, United Kingdom
| | - Cornelia Heyde
- Clinical Audiology, Speech and Language Research Centre, Queen Margaret University, Edinburgh, United Kingdom
| | - Alan Wrench
- Psychological Sciences and Health, University of Strathclyde, Glasgow, United Kingdom
- Articulate Instruments Ltd., Edinburgh, United Kingdom
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Fernández D, Harel D, Ipeirotis P, McAllister T. Statistical considerations for crowdsourced perceptual ratings of human speech productions. J Appl Stat 2018; 46:1364-1384. [PMID: 31527990 PMCID: PMC6746425 DOI: 10.1080/02664763.2018.1547692] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 11/03/2018] [Indexed: 10/27/2022]
Abstract
Crowdsourcing has become a major tool for scholarly research since its introduction to the academic sphere in 2008. However, unlike in traditional laboratory settings, it is nearly impossible to control the conditions under which workers on crowdsourcing platforms complete tasks. In the study of communication disorders, crowdsourcing has provided a novel solution to the collection of perceptual ratings of human speech production. Such ratings allow researchers to gauge whether a treatment yields meaningful change in how human listeners' perceive disordered speech. This paper will explore some statistical considerations of crowdsourced data with specific focus on collecting perceptual ratings of human speech productions. Random effects models are applied to crowdsourced perceptual ratings collected in both a continuous and binary fashion. A simulation study is conducted to test the reliability of the proposed models under differing numbers of workers and tasks. Finally, this methodology is applied to a data set from the study of communication disorders.
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Affiliation(s)
- Daniel Fernández
- Institut de Recerca Sant Joan de Déu, Parc Sanitari Sant Joan de Deu, CIBERSAM, Spain
- School of Mathematics and Statistics, Victoria University of Wellington, New Zealand
| | - Daphna Harel
- Department of Applied Statistics, Social Science, and Humanities, Steinhardt School of Culture, Education, and Human Develoment, New York University, New York, USA
- PRIISM Applied Statistics Center New York University, New York, USA
| | - Panos Ipeirotis
- Leonard N. Stern School of Business, New York University, New York, USA
| | - Tara McAllister
- Department of Communicative Sciences and Disorders, Steinhardt School of Culture, Education, and Human Development, New York University, New York, USA
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Campbell H, Harel D, Hitchcock E, McAllister Byun T. Selecting an acoustic correlate for automated measurement of American English rhotic production in children. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2018; 20:635-643. [PMID: 28795872 PMCID: PMC6050150 DOI: 10.1080/17549507.2017.1359334] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Purpose: A current need in the field of speech-language pathology is the development of reliable and efficient techniques to evaluate accuracy of speech targets over the course of treatment. As acoustic measurement techniques improve, it should become possible to use automated scoring in lieu of ratings from a trained clinician in some contexts. This study asks which acoustic measures correspond most closely with expert ratings of children's productions of American English /ɹ/ in an effort to develop an automated scoring algorithm for use in treatment targeting rhotics. Method: A series of ordinal mixed-effects regression models were fit over a large sample of children's productions of words containing /ɹ/ that had previously been rated by three trained clinicians. Akaike/Bayesian Information Criteria were used to select the best-fitting model. Result: Controlling for age, sex, and allophonic contextual differences, the measure that accounted for the most variance in speech rating was F3-F2 distance normalised relative to a sample of age- and sex-matched speakers. Conclusion: We recommend this acoustic measure for use in future automated scoring of children's production of American English rhotics. We also suggest that computer-based treatment with automated scoring should facilitate increases in treatment dosage by improving options for home practice.
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Affiliation(s)
- Heather Campbell
- Department of Communicative Sciences and Disorders, NYU Steinhardt School of Culture, Education, & Human Development, New York, NY, USA
| | - Daphna Harel
- Center for the Promotion of Research Involving Innovative Statistical Methodology, New York, NY, USA
| | - Elaine Hitchcock
- Department of Communication Sciences and Disorders, Montclair State University, Montclair, NJ, USA
| | - Tara McAllister Byun
- Department of Communicative Sciences and Disorders, NYU Steinhardt School of Culture, Education, & Human Development, New York, NY, USA
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Farquharson K, Boldini L. Variability in Interpreting “Educational Performance” for Children With Speech Sound Disorders. Lang Speech Hear Serv Sch 2018; 49:938-949. [DOI: 10.1044/2018_lshss-17-0159] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 05/08/2018] [Indexed: 11/09/2022] Open
Abstract
Purpose
Speech sound disorders (SSDs) can have a negative impact on literacy development, social–emotional well-being, and participation across the life span. Despite this, many public schools do not provide appropriate or timely services to this population of children. In large part, this is a result of variation in how state and local agencies interpret “educational performance” as outlined within the Individuals With Disabilities Education Act. The purpose of this study was to explore which educational performance factors speech-language pathologists (SLPs) consider when determining eligibility for children with SSDs.
Method
This study surveyed public school SLPs to investigate how educational performance is interpreted for children with SSDs. Data from 575 SLPs across the United States are included.
Results
Results supported variability in interpretation of educational performance within a nationwide sample of SLPs. Specifically, SLPs appear to consider educational performance as multidimensional. We also found within-state and between-states variability, indicating ambiguity in interpreting federal mandates. Finally, caseload size and number of years of experience were significantly related to which educational performance factors SLPs chose.
Conclusion
There is significant variability across the United States with respect to factors considered part of educational performance for children with SSD. This variability reflects the general quality and specificity of guidelines and/or special education code published by individual states. Clinical and legislative recommendations are included.
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Rusiewicz HL, Maize K, Ptakowski T. Parental experiences and perceptions related to childhood apraxia of speech: Focus on functional implications. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2018; 20:569-580. [PMID: 28786692 DOI: 10.1080/17549507.2017.1359333] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 06/14/2017] [Accepted: 07/11/2017] [Indexed: 06/07/2023]
Abstract
PURPOSE The purpose of this study was to examine the functional implications of childhood apraxia of speech (CAS) as experienced by children and their parents. METHOD Using a mixed qualitative/quantitative design, 40 parents responded to two Likert-scale questionnaires and four phenomenological questions about their personal experiences and their perceptions of their children's (ages 3-16 years) experiences of living with CAS. RESULT Quantitative data indicated that although parents reported concern about their children's speech production as expected, they also expressed that CAS affected their children's every day activities and social interactions. Four key themes emerged from the parents' qualitative responses (1) concerns about their children's intelligibility, (2) challenges with peer relationships, (3) reliance on parent to be the child's "voice" and (4) emotional responses such as frustration. CONCLUSION Parents' perceptions of the functional implications of CAS focussed on their children's peer interactions, their own need to be the voice for their children, and the broader functional impact of CAS on their children in daily activities. These functional implications of CAS may play a role in supporting the clinical management of those with CAS by implementing peer-related activities, functional social situations and parent education/support during intervention.
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Affiliation(s)
| | | | - Theresa Ptakowski
- c Raleigh Court Health and Rehabilitation Center , Roanoke , VA , USA
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47
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Preston JL, McAllister T, Phillips E, Boyce S, Tiede M, Kim JS, Whalen DH. Treatment for Residual Rhotic Errors With High- and Low-Frequency Ultrasound Visual Feedback: A Single-Case Experimental Design. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2018; 61:1875-1892. [PMID: 30073249 PMCID: PMC6198924 DOI: 10.1044/2018_jslhr-s-17-0441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 04/03/2018] [Indexed: 05/04/2023]
Abstract
PURPOSE The aim of this study was to explore how the frequency with which ultrasound visual feedback (UVF) is provided during speech therapy affects speech sound learning. METHOD Twelve children with residual speech errors affecting /ɹ/ participated in a multiple-baseline across-subjects design with 2 treatment conditions. One condition featured 8 hr of high-frequency UVF (HF; feedback on 89% of trials), whereas the other included 8 hr of lower-frequency UVF (LF; 44% of trials). The order of treatment conditions was counterbalanced across participants. All participants were treated on vocalic /ɹ/. Progress was tracked by measuring generalization on /ɹ/ in untreated words. RESULTS After the 1st treatment phase, participants who received the HF condition outperformed those who received LF. At the end of the 2-phase treatment, within-participant comparisons showed variability across individual outcomes in both HF and LF conditions. However, a group level analysis of this small sample suggested that participants whose treatment order was HF-LF made larger gains than those whose treatment order was LF-HF. CONCLUSIONS The order HF-LF may represent a preferred order for UVF in speech therapy. This is consistent with empirical work and theoretical arguments suggesting that visual feedback may be particularly beneficial in the early stages of acquiring new speech targets.
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Affiliation(s)
- Jonathan L. Preston
- Department of Communication Sciences and Disorders, Syracuse University, NY
- Haskins Laboratories, New Haven, CT
| | - Tara McAllister
- Department of Communicative Sciences & Disorders, New York University, New York
| | | | - Suzanne Boyce
- Haskins Laboratories, New Haven, CT
- Department of Communication Sciences and Disorders, University of Cincinnati, OH
| | | | - Jackie S. Kim
- Department of Communication Sciences and Disorders, Columbia University, New York, NY
| | - Douglas H. Whalen
- Program in Speech-Language-Hearing Sciences, City University of New York Graduate Center, New York
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48
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Swaminathan D, Farquharson K. Using Response to Intervention for Speech Sound Disorders: Exploring Practice Characteristics and Geographical Differences. ACTA ACUST UNITED AC 2018. [DOI: 10.1044/persp3.sig16.53] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Divya Swaminathan
- Department of Communication Sciences & Disorders, Emerson College
Boston, MA
| | - Kelly Farquharson
- Department of Communication Sciences & Disorders, Emerson College
Boston, MA
- Dr. Farquharson is now in the School of Communication Science and Disorders at Florida State University, Tallahassee, FL
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49
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Preston JL, Leece MC. Intensive Treatment for Persisting Rhotic Distortions: A Case Series. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2017; 26:1066-1079. [PMID: 29114774 PMCID: PMC5945059 DOI: 10.1044/2017_ajslp-16-0232] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 04/25/2017] [Accepted: 06/13/2017] [Indexed: 05/21/2023]
Abstract
PURPOSE The study explored changes in accuracy of American English rhotics as a result of an intensive 1-week therapy program for adolescents and young adults with residual speech sound errors that had not resolved with previous therapy. METHOD Four case reports are presented of individuals aged 13, 17, 21, and 22 years with residual /ɹ/ distortions. Each participant attended a 1-week intensive program consisting of pretreatment assessments, 14 hr of therapy, and posttreatment assessment. Treatment sessions included structured motor-based practice, ultrasound visual feedback of the tongue, and auditory speech perception training. To assess generalization, untreated words and sentences with rhotics were recorded before and after therapy; these were rated by listeners who were blind to when the recordings were taken. RESULTS All participants showed measurable and statistically significant improvement in speech sound accuracy. Averaged across the 4 participants, rhotic accuracy at the word level improved from 35% to 83%. At the sentence level, rhotic accuracy increased from 11% pretreatment to 66% posttreatment in 1 week. CONCLUSION The promise of an intensive treatment program that includes motor-based practice, biofeedback, and auditory perception training is illustrated by the case presentations in which substantial improvements in speech sound accuracy were observed. SUPPLEMENTAL MATERIALS https://doi.org/10.23641/asha.5561254.
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Affiliation(s)
- Jonathan L. Preston
- Department of Communication Sciences and Disorders, Syracuse University, NY
- Haskins Laboratories, New Haven, CT
| | - Megan C. Leece
- Department of Communication Sciences and Disorders, Syracuse University, NY
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50
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Hitchcock ER, Byun TM, Swartz M, Lazarus R. Efficacy of Electropalatography for Treating Misarticulation of /r/. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2017; 26:1141-1158. [PMID: 28834534 DOI: 10.1044/2017_ajslp-16-0122] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 05/10/2017] [Indexed: 06/07/2023]
Abstract
PURPOSE The purpose of the present study was to document the efficacy of electropalatography (EPG) for the treatment of rhotic errors in school-age children. Despite a growing body of literature using EPG for the treatment of speech sound errors, there is little systematic evidence about the relative efficacy of EPG for rhotic errors. METHOD Participants were 5 English-speaking children aged 6;10 to 9;10, who produced /r/ at the word level with < 30% accuracy but otherwise showed typical speech, language, and hearing abilities. Therapy was delivered in twice-weekly 30-min sessions for 8 weeks. RESULTS Four out of 5 participants were successful in achieving perceptually and acoustically accurate /r/ productions during within-treatment trials. Two participants demonstrated generalization of /r/ productions to nontreated targets, per blinded listener ratings. CONCLUSIONS The present findings support the hypothesis that EPG can improve production accuracy in some children with rhotic errors. However, the utility of EPG is likely to remain variable across individuals. For rhotics, EPG training emphasizes one possible tongue configuration consistent with accurate rhotic production (lateral tongue contact). Although some speakers respond well to this cue, the narrow focus may limit lingual exploration of other acceptable tongue shapes known to facilitate rhotic productions.
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