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Ashraf A, Mumtaz N, Saqulain G. Treatment approaches to Motor Speech Disorders: A step towards Evidence Based Practice. Pak J Med Sci 2024; 40:544-548. [PMID: 38356848 PMCID: PMC10862440 DOI: 10.12669/pjms.40.3.8096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 06/03/2023] [Accepted: 11/08/2023] [Indexed: 02/16/2024] Open
Abstract
Motor Speech Disorders is an umbrella term for a set of separate dysfunctions of speech outcome associated with neurological disorders. Motor speech disorders (MSD) are classified as Speech Motor delay (SMD), Childhood dysarthria (CD), Childhood Apraxia of Speech (CAS), and Concurrent CD and CAS. The incidence and prevalence of MSD in population is uncertain. A research gap exists, making evidence-based practice questionable as regards intervention for MSD and is an area of research. Hence, current narrative review was conducted to review and highlight treatment of MSD since evidence-based treatment approach may benefit patient even years after a brain lesion. To achieve this objective literature search was conducted using search engines and data bases including google, google scholar, web of science & PubMed from 1998 to 2023 with keywords "motor speech disorder, dysarthria, apraxia, speech motor delay and combinations of these words with English language and no other limitations. Our search revealed 170 articles, news, publications of which 34 were used for review (Fig.1).
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Affiliation(s)
- Anum Ashraf
- Anum Ashraf, Senior Lecturer, Faculty of Rehab & Allied Health Sciences, Riphah International University
| | - Nazia Mumtaz
- Nazia Mumtaz, PhD Head of Department of Speech Language Pathology, Faculty of Rehab & Allied Health Sciences, Riphah International University
| | - Ghulam Saqulain
- Dr. Ghulam Saqulain, FCPS (Otorhinolaryngology) HOD & Professor of Otolaryngology, Deputy Dean, Capital Hospital PGMI, Islamabad - Pakistan
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Allison K, Stoeckel R, Olsen E, Tallman S, Iuzzini-Seigel J. Motor Speech Phenotypes in Children With Epilepsy: Preliminary Findings. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:1912-1922. [PMID: 36827527 DOI: 10.1044/2022_ajslp-22-00176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
PURPOSE This exploratory study aimed to characterize motor speech impairments in a small sample of children with epilepsy, both with and without a known seizure etiology. A secondary aim was to evaluate the validity of the Profile for Childhood Apraxia of speech and Dysarthria (ProCAD), a newly developed tool for differential diagnosis of childhood apraxia of speech and dysarthria. METHOD Thirteen children with seizure disorders completed a comprehensive speech and language assessment. Three expert speech-language pathologists rated the presence of auditory-perceptual features of motor speech impairment using the ProCAD. Motor speech features, diagnoses, and standardized test scores were compared between children with a known seizure etiology and children with idiopathic epilepsy. RESULTS Nine of the 13 children exhibited motor speech impairment; dysarthria was the most common diagnosis. Most children (11/13) exhibited language impairment. Group comparisons showed that children with a known seizure etiology had more atypical motor speech features and lower language scores than children with idiopathic seizures. CONCLUSION These preliminary findings suggest a high rate of motor speech impairment among children with epilepsy.
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Affiliation(s)
| | - Ruth Stoeckel
- Division of Neurology, Department of Speech Pathology, Mayo Clinic (retired), Rochester, MN
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Namasivayam AK, Huynh A, Bali R, Granata F, Law V, Rampersaud D, Hard J, Ward R, Helms-Park R, van Lieshout P, Hayden D. Development and Validation of a Probe Word List to Assess Speech Motor Skills in Children. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:622-648. [PMID: 33705676 DOI: 10.1044/2020_ajslp-20-00139] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose The aim of the study was to develop and validate a probe word list and scoring system to assess speech motor skills in preschool and school-age children with motor speech disorders. Method This article describes the development of a probe word list and scoring system using a modified word complexity measure and principles based on the hierarchical development of speech motor control known as the Motor Speech Hierarchy (MSH). The probe word list development accounted for factors related to word (i.e., motoric) complexity, linguistic variables, and content familiarity. The probe word list and scoring system was administered to 48 preschool and school-age children with moderate-to-severe speech motor delay at clinical centers in Ontario, Canada, and then evaluated for reliability and validity. Results One-way analyses of variance revealed that the motor complexity of the probe words increased significantly for each MSH stage, while no significant differences in the linguistic complexity were found for neighborhood density, mean biphone frequency, or log word frequency. The probe word list and scoring system yielded high reliability on measures of internal consistency and intrarater reliability. Interrater reliability indicated moderate agreement across the MSH stages, with the exception of MSH Stage V, which yielded substantial agreement. The probe word list and scoring system demonstrated high content, construct (unidimensionality, convergent validity, and discriminant validity), and criterion-related (concurrent and predictive) validity. Conclusions The probe word list and scoring system described in the current study provide a standardized method that speech-language pathologists can use in the assessment of speech motor control. It can support clinicians in identifying speech motor difficulties in preschool and school-age children, set appropriate goals, and potentially measure changes in these goals across time and/or after intervention.
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Affiliation(s)
- Aravind Kumar Namasivayam
- Oral Dynamics Lab, Department of Speech-Language Pathology, University of Toronto, Ontario, Canada
- Toronto Rehabilitation Institute, Ontario, Canada
| | - Anna Huynh
- Oral Dynamics Lab, Department of Speech-Language Pathology, University of Toronto, Ontario, Canada
| | - Rohan Bali
- Oral Dynamics Lab, Department of Speech-Language Pathology, University of Toronto, Ontario, Canada
| | - Francesca Granata
- Oral Dynamics Lab, Department of Speech-Language Pathology, University of Toronto, Ontario, Canada
| | - Vina Law
- Oral Dynamics Lab, Department of Speech-Language Pathology, University of Toronto, Ontario, Canada
| | - Darshani Rampersaud
- Oral Dynamics Lab, Department of Speech-Language Pathology, University of Toronto, Ontario, Canada
| | - Jennifer Hard
- Oral Dynamics Lab, Department of Speech-Language Pathology, University of Toronto, Ontario, Canada
| | - Roslyn Ward
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia
- School of Allied Health, Curtin University, Bentley, Western Australia, Australia
| | - Rena Helms-Park
- Linguistics, Department of Language Studies, University of Toronto Scarborough, Ontario, Canada
| | - Pascal van Lieshout
- Oral Dynamics Lab, Department of Speech-Language Pathology, University of Toronto, Ontario, Canada
- Toronto Rehabilitation Institute, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
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Namasivayam AK, Coleman D, O’Dwyer A, van Lieshout P. Speech Sound Disorders in Children: An Articulatory Phonology Perspective. Front Psychol 2020; 10:2998. [PMID: 32047453 PMCID: PMC6997346 DOI: 10.3389/fpsyg.2019.02998] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 12/18/2019] [Indexed: 01/20/2023] Open
Abstract
Speech Sound Disorders (SSDs) is a generic term used to describe a range of difficulties producing speech sounds in children (McLeod and Baker, 2017). The foundations of clinical assessment, classification and intervention for children with SSD have been heavily influenced by psycholinguistic theory and procedures, which largely posit a firm boundary between phonological processes and phonetics/articulation (Shriberg, 2010). Thus, in many current SSD classification systems the complex relationships between the etiology (distal), processing deficits (proximal) and the behavioral levels (speech symptoms) is under-specified (Terband et al., 2019a). It is critical to understand the complex interactions between these levels as they have implications for differential diagnosis and treatment planning (Terband et al., 2019a). There have been some theoretical attempts made towards understanding these interactions (e.g., McAllister Byun and Tessier, 2016) and characterizing speech patterns in children either solely as the product of speech motor performance limitations or purely as a consequence of phonological/grammatical competence has been challenged (Inkelas and Rose, 2007; McAllister Byun, 2012). In the present paper, we intend to reconcile the phonetic-phonology dichotomy and discuss the interconnectedness between these levels and the nature of SSDs using an alternative perspective based on the notion of an articulatory "gesture" within the broader concepts of the Articulatory Phonology model (AP; Browman and Goldstein, 1992). The articulatory "gesture" serves as a unit of phonological contrast and characterization of the resulting articulatory movements (Browman and Goldstein, 1992; van Lieshout and Goldstein, 2008). We present evidence supporting the notion of articulatory gestures at the level of speech production and as reflected in control processes in the brain and discuss how an articulatory "gesture"-based approach can account for articulatory behaviors in typical and disordered speech production (van Lieshout, 2004; Pouplier and van Lieshout, 2016). Specifically, we discuss how the AP model can provide an explanatory framework for understanding SSDs in children. Although other theories may be able to provide alternate explanations for some of the issues we will discuss, the AP framework in our view generates a unique scope that covers linguistic (phonology) and motor processes in a unified manner.
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Affiliation(s)
- Aravind Kumar Namasivayam
- Oral Dynamics Laboratory, Department of Speech-Language Pathology, University of Toronto, Toronto, ON, Canada
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Deirdre Coleman
- Oral Dynamics Laboratory, Department of Speech-Language Pathology, University of Toronto, Toronto, ON, Canada
- Independent Researcher, Surrey, BC, Canada
| | - Aisling O’Dwyer
- Oral Dynamics Laboratory, Department of Speech-Language Pathology, University of Toronto, Toronto, ON, Canada
- St. James’s Hospital, Dublin, Ireland
| | - Pascal van Lieshout
- Oral Dynamics Laboratory, Department of Speech-Language Pathology, University of Toronto, Toronto, ON, Canada
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
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Shriberg LD, Wren YE. A frequent acoustic sign of speech motor delay (SMD). CLINICAL LINGUISTICS & PHONETICS 2019; 33:757-771. [PMID: 30945568 PMCID: PMC6594422 DOI: 10.1080/02699206.2019.1595734] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 03/12/2019] [Accepted: 03/12/2019] [Indexed: 05/05/2023]
Abstract
Recent studies report prevalence, phenotype, and persistence findings for a paediatric motor speech disorder in addition to childhood dysarthria and childhood apraxia of speech termed Speech Motor Delay (SMD). The aim of the present study was to determine if there is a frequent acoustic sign of SMD, with implications for theory, assessment, and treatment. We examined the frequency of 19 acoustic signs of SMD in audio recordings of continuous speech and word-imitation tasks in three groups of speakers with SMD: 50 children (mean age 5.1 years) with idiopathic Speech Delay (SD) from 6 USA cities; 87 children, adolescents, and adults with eight types of complex neurodevelopmental disorders; and 9 children (mean age 8.8 years) with persistent idiopathic SD from a population-based study of children in the South West of England. The 19 acoustic signs of imprecise or unstable speech, prosody, and voice were standardized on typical speakers of the appropriate dialect. The criterion for a frequent acoustic sign was that it occurred in at least 50% of participants with SMD in each of the three groups. Findings indicated that lengthened mid-vowels and diphthongs was the one sign that met criteria, occurring in 64.4% of the 146 participants with SMD, including 71% of the 87 participants with complex neurodevelopmental disorders. Findings are interpreted to support the potential of this acoustic sign, and possibly several others associated with temporal dimensions of speech sound development, to inform explication of the neuromotor substrates of SMD.
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Affiliation(s)
- Lawrence D. Shriberg
- Intellectual & Developmental Disabilities Research Center, Waisman Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Yvonne E. Wren
- Bristol Speech and Language Therapy Research Unit, North Bristol NHS Trust; and University of Bristol, Bristol, UK
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Shriberg LD, Strand EA, Jakielski KJ, Mabie HL. Estimates of the prevalence of speech and motor speech disorders in persons with complex neurodevelopmental disorders. CLINICAL LINGUISTICS & PHONETICS 2019; 33:707-736. [PMID: 31221012 PMCID: PMC6633911 DOI: 10.1080/02699206.2019.1595732] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Estimates of the prevalence of speech and motor speech disorders in persons with complex neurodevelopmental disorders (CND) can inform research in the biobehavioural origins and treatment of CND. The goal of this research was to use measures and analytics in a diagnostic classification system to estimate the prevalence of speech and motor speech disorders in convenience samples of speakers with one of eight types of CND. Audio-recorded conversational speech samples from 346 participants with one of eight types of CND were obtained from a database of participants recruited for genetic and behavioural studies of speech sound disorders (i.e., excluding dysfluency) during the past three decades. Data reduction methods for the speech samples included narrow phonetic transcription, prosody-voice coding, and acoustic analyses. Standardized measures were used to cross-classify participants' speech and motor speech status. Compared to the 17.8% prevalence of four types of motor speech disorders reported in a study of 415 participants with idiopathic Speech Delay (SD), 47.7% of the present participants with CND met criteria for one of four motor speech disorders, including Speech Motor Delay (25.1%), Childhood Dysarthria (13.3%), Childhood Apraxia of Speech (4.3%), and concurrent Childhood Dysarthria and Childhood Apraxia of Speech (4.9%). Findings are interpreted to indicate a substantial prevalence of speech disorders, and notably, a substantial prevalence of motor speech disorders in persons with some types of CND. We suggest that diagnostic classification information from standardized motor speech assessment protocols can contribute to research in the pathobiologies of CND. Abbreviations: 16p: 16p11.2 deletion and duplication syndrome; 22q: 22q11.2 deletion syndrome; ASD: Autism Spectrum Disorder; CAS: Childhood Apraxia of Speech; CD: Childhood Dysarthria; CND: Complex Neurodevelopmental Disorder; DS: Down syndrome; FXS: Fragile X syndrome; GAL: Galactosemia; IID: Idiopathic Intellectual Disability; MSD: Motor Speech Disorder; No MSD: No Motor Speech Disorder; NSA: Normal(ized) Speech Acquisition; PEPPER: Programs to Examine Phonetic and Phonologic Evaluation Records; PSD: Persistent Speech Delay; PSE: Persistent Speech Errors; SD: Speech Delay; SDCS: Speech Disorders Classification System; SDCSS: Speech Disorders Classification System Summary; SE: Speech Errors; SMD: Speech Motor Delay; SSD: Speech Sound Disorders; TBI: Traumatic Brain Injury.
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Affiliation(s)
- Lawrence D. Shriberg
- Intellectual and Developmental Disabilities Research
Center, Waisman Center, University of Wisconsin-Madison, Madison, WI, USA
| | | | - Kathy J. Jakielski
- Department of Communication Sciences and Disorders,
Augustana College, Rock Island, IL, USA
| | - Heather L. Mabie
- Intellectual and Developmental Disabilities Research
Center, Waisman Center, University of Wisconsin-Madison, Madison, WI, USA
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Shriberg LD, Kwiatkowski J, Mabie HL. Estimates of the prevalence of motor speech disorders in children with idiopathic speech delay. CLINICAL LINGUISTICS & PHONETICS 2019; 33:679-706. [PMID: 30987467 PMCID: PMC6633906 DOI: 10.1080/02699206.2019.1595731] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 03/12/2019] [Accepted: 03/12/2019] [Indexed: 05/22/2023]
Abstract
The goal of this research was to obtain initial estimates of the prevalence of each of four types of motor speech disorders in children with idiopathic Speech Delay (SD) and to use findings to estimate the population-based prevalence of each disorder. Analyses were completed on audio-recorded conversational speech samples from 415 children recruited for research in idiopathic SD in six USA cities during the past three decades. The speech and motor speech status of each participant was cross-classified using standardized measures in the finalized version of the Speech Disorders Classification System described in the Supplement. Population-based prevalence estimates for the four motor speech disorders were calculated from epidemiological studies of SD conducted in Australia, England, and the USA. A total of 82.2% of the 415 participants with SD met criteria for No Motor Speech Disorder at assessment, 12% met criteria for Speech Motor Delay, 3.4% met criteria for Childhood Dysarthria, 2.4% met criteria for Childhood Apraxia of Speech, and 0% met criteria for concurrent Childhood Dysarthria and Childhood Apraxia of Speech. The estimated population-based prevalence of each of the first three motor speech disorders at 4 to 8 years of age were Speech Motor Delay: 4 children per 1,000; Childhood Dysarthria: 1 child per 1,000; and Childhood Apraxia of Speech: 1 child per 1,000. The latter finding cross-validates a prior prevalence estimate for Childhood Apraxia of Speech of 1-2 children per 1,000. Findings are interpreted to indicate a substantial prevalence of motor speech disorders in children with idiopathic SD. Abbreviations: CAS, childhood apraxia of speech; CD, childhood dysarthria; CND, complex neurodevelopmental disorders; DI, dysarthria index; DSI, dysarthria subtype indices; MSD, motor speech disorder; No MSD, no motor speech disorder; NSA, normal(ized) speech acquisition; PEPPER, programs to examine phonetic and phonologic evaluation records; PM, pause marker; PMI, pause marker index; PSD, persistent speech delay; PSE, persistent speech errors; SD, speech delay; SDCS, speech disorders classification system; SDCSS, speech disorders classification system summary; SE, speech errors; SMD, speech motor delay.
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Affiliation(s)
- Lawrence D Shriberg
- a Intellectual and Developmental Disabilities Research Center, Waisman Center , University of Wisconsin-Madison , Madison , WI . USA
| | - Joan Kwiatkowski
- a Intellectual and Developmental Disabilities Research Center, Waisman Center , University of Wisconsin-Madison , Madison , WI . USA
| | - Heather L Mabie
- a Intellectual and Developmental Disabilities Research Center, Waisman Center , University of Wisconsin-Madison , Madison , WI . USA
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Wilson EM, Abbeduto L, Camarata SM, Shriberg LD. Speech and motor speech disorders and intelligibility in adolescents with Down syndrome. CLINICAL LINGUISTICS & PHONETICS 2019; 33:790-814. [PMID: 31221010 PMCID: PMC6604063 DOI: 10.1080/02699206.2019.1595736] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
The goal of this research was to assess the support for motor speech disorders as explanatory constructs to guide research and treatment of reduced intelligibility in persons with Down syndrome (DS). Participants were the 45 adolescents with DS in the prior paper who were classified into five mutually-exclusive motor speech classifications using the Speech Disorders Classification System. An ordinal index classified participants' percentage of intelligible words in conversation as High (≥ 85%), Moderate (80% - 84.9%), or Low (< 80%). Statistical analyses tested for significant differences in intelligibility status associated with demographic, intelligence, and language variables, and intelligibility status associated with motor speech classifications and speech, prosody, and voice variables. For the 10 participants who met criteria for concurrent Childhood Dysarthria and Childhood Apraxia of Speech at assessment, 80% had reduced (Moderate or Low) intelligibility and 20% had High intelligibility (significant effect size: 0.644). Proportionally more of the 32 participants who met criteria for either dysarthria or apraxia had reduced intelligibility (significant effect size: 0.318). Low intelligibility was significantly associated with across-the-board reductions in phonemic and phonetic accuracy and with inappropriate prosody and voice. Findings are interpreted as support for motor speech disorders in adolescents with DS as explanatory constructs for their reduced intelligibility. Pending cross-validation of findings in diverse samples of persons with DS, studies are needed to assess the efficacy of motor speech classification status to guide selection of treatment methods and intelligibility targets. Abbreviations: CAS: Childhood Apraxia of Speech; CD: Childhood Dysarthria; DS: Down syndrome; II: Intelligibility Index; No MSD: No Motor Speech Disorder; OII: Ordinal Intelligibility Index; PSD: Persistent Speech Delay; SDCS: Speech Disorders Classification System; SMD: Speech Motor Delay.
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Affiliation(s)
- Erin M. Wilson
- Speech and Feeding Disorders Laboratory, MGH Institute of Health Professions, Boston, MA, USA
| | - Leonard Abbeduto
- MIND Institute and Department of Psychiatry and Behavioral Sciences, School of Medicine, University of California, Davis, CA, USA
| | - Stephen M. Camarata
- Department of Hearing and Speech Sciences, Vanderbilt University, Nashville, TN, USA
| | - Lawrence D. Shriberg
- Intellectual and Developmental Disabilities Research Center, Waisman Center, University of Wisconsin-Madison, Madison, WI, USA
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