The interplay between articulation and prosody in children with impaired speech: Observations from electropalatographic and perceptual analysis

Speech and Music Therapy in the Treatment of Childhood Apraxia of Speech: An Introduction and a Case Study

PURPOSE

Speech-Music Therapy for Aphasia (SMTA), a method that combines speech therapy and music therapy, is introduced as a treatment method for childhood apraxia of speech (CAS). SMTA will be evaluated in a proof-of-principle study. The first case study is presented herein.

METHOD

SMTA was evaluated in a study with a single-subject experimental design comparing 10 weeks of treatment with 2 months of no treatment. The research protocol included a pretest, baseline phase, treatment phase, posttest, no-treatment phase, and follow-up test. The participant was a boy with CAS aged 5;8 (years;months). Outcome measures were selected to reflect both intelligibility in daily communication as well as features of CAS and speech motor planning and programming.

RESULTS

Results on the Intelligibility in Context Scale-Dutch (ICS-Dutch) and in the analysis of a spontaneous speech sample suggest generalization of treatment effects. Improvements were found in measures that reflect complex speech motor skills, that is, the production of consonant clusters and consistency.

CONCLUSIONS

This case study showed that speech production of the participant improved after treatment with SMTA. Although intelligibility as measured with the ICS-Dutch improved over the study period, objectifying changes at the level of intelligibility in daily communication proved to be difficult. Additional measures may be necessary to gain more insight into treatment effects at this level. Overall, the results of this first case study provide sufficient support and important leads for further evaluation of SMTA in the treatment of CAS in a proof-of-principle study.

Protocol for the Connected Speech Transcription of Children with Speech Disorders: An Example from Childhood Apraxia of Speech

OBJECTIVE

While it is known that connected speech has different features to single-word speech, there are currently few recommendations regarding connected speech transcription. This research therefore aimed to develop a clinically feasible protocol for connected speech transcription. The protocol was then used to assist with description of the connected speech of children with childhood apraxia of speech (CAS), as little is known about their connected speech characteristics.

PARTICIPANTS AND METHODS

Following a literature review, the Connected Speech Transcription Protocol (CoST-P) was iteratively developed and trialled. The CoST-P was then used to transcribe 50 connected utterances produced by 12 children (aged 6-13 years) with CAS. The characteristics of participants' connected speech were analysed to capture independent and relational analyses.

RESULTS

The CoST-P was developed, trialled, and determined to have adequate reliability and fidelity. The frequency of inter-word segregation (mean = 29) was higher than intra-word segregation (mean = 4). Juncture accuracy was correlated with intelligibility metrics such as percentage of consonants correct.

CONCLUSION

Connected speech transcription is challenging. The CoST-P may be a useful resource for speech-language pathologists and clinical researchers. Use of the CoST-P assisted in displaying CAS speech characteristics unique to connected speech (e.g., inter-word segregation and juncture).

Prevalence and Predictors of Persistent Speech Sound Disorder at Eight Years Old: Findings From a Population Cohort Study

PURPOSE

The purpose of this study was to determine prevalence and predictors of persistent speech sound disorder (SSD) in children aged 8 years after disregarding children presenting solely with common clinical distortions (i.e., residual errors).

METHOD

Data from the Avon Longitudinal Study of Parents and Children (Boyd et al., 2012) were used. Children were classified as having persistent SSD on the basis of percentage of consonants correct measures from connected speech samples. Multivariable logistic regression analyses were performed to identify predictors.

RESULTS

The estimated prevalence of persistent SSD was 3.6%. Children with persistent SSD were more likely to be boys and from families who were not homeowners. Early childhood predictors identified as important were weak sucking at 4 weeks, not often combining words at 24 months, limited use of word morphology at 38 months, and being unintelligible to strangers at age 38 months. School-age predictors identified as important were maternal report of difficulty pronouncing certain sounds and hearing impairment at age 7 years, tympanostomy tube insertion at any age up to 8 years, and a history of suspected coordination problems. The contribution of these findings to our understanding of risk factors for persistent SSD and the nature of the condition is considered.

CONCLUSION

Variables identified as predictive of persistent SSD suggest that factors across motor, cognitive, and linguistic processes may place a child at risk.

Orthographically sensitive treatment for dysprosody in children with childhood apraxia of speech using ReST intervention

OBJECTIVE

Impaired prosody is a core diagnostic feature of Childhood Apraxia of Speech (CAS) but there is limited evidence of effective prosodic intervention. This study reports the efficacy of the ReST intervention used in conjunction with bisyllabic pseudo word stimuli containing orthographic cues that are strongly associated with either strong-weak or weak-strong patterns of lexical stress.

METHODS

Using a single case AB design with one follow-up and replication, four children with CAS received treatment of four one-hour sessions per week for three weeks. Sessions contained 100 randomized trials of pseudo word treatment stimuli. Baseline measures were taken of treated and untreated behaviors; retention was measured at one day and four weeks post-treatment.

RESULTS

Children's production of lexical stress improved from pre to post-treatment. Treatment effects and maintenance varied among participants.

CONCLUSIONS

This study provides support for the treatment of prosodic deficits in CAS.

A Phonetic Investigation of Single Word versus Connected Speech Production in Children with Persisting Speech Difficulties Relating to Cleft Palate

Objective

To investigate the phonetic and phonological parameters of speech production associated with cleft palate in single words and in sentence repetition in order to explore the impact of connected speech processes, prosody, and word juncture on word production across contexts.

Participants

Two boys (aged 9 years 5 months and 11 years 0 months) with persisting speech impairments related to a history of unilateral cleft lip and palate formed the main focus of the study; three typical adult male speakers provided control data.

Method

Audio, video, and electropalatographic recordings were made of the participants producing single words and repeating two sets of sentences. The data were transcribed and the electropalatographic recordings were analyzed to explore lingual-palatal contact patterns across the different speech conditions. Acoustic analysis was used to further inform the perceptual analysis and to make specific durational measurements.

Results

The two boys’ speech production differed across the speech conditions. Both boys showed typical and atypical phonetic features in their connected speech production. One boy, although often unintelligible, resembled the adult speakers more closely prosodically and in his specific connected speech behaviors at word boundaries. The second boy produced developmentally atypical phonetic adjustments at word boundaries that appeared to promote intelligibility at the expense of naturalness.

Conclusion

For older children with persisting speech impairments, it is particularly important to examine specific features of connected speech production, including word juncture and prosody. Sentence repetition data provide useful information to this end, but further investigations encompassing detailed perceptual and instrumental analysis of real conversational data are warranted.

Idiosyncratic gesture use in atypical language development, and its interaction with speech rhythm, word juncture, syntax, pragmatics and discourse: a case study

Very little is known about the use of gesture by children with developmental language disorders (DLDs). This case study of 'Lucy', a child aged 4;10 with a DLD, expands on what is known and in particular focuses on a type of idiosyncratic "rhythmic gesture" (RG) not previously reported. A fine-grained qualitative analysis was carried out of video recordings of Lucy in conversation with the first author. This revealed that Lucy's RG was closely integrated in complex ways with her use of other gesture types, speech rhythm, word juncture, syntax, pragmatics, discourse, visual processing and processing demands generally. Indeed, the only satisfactory way to explain it was as a partial byproduct of such interactions. These findings support the theoretical accounts of gesture which see it as just one component of a multimodal, integrated signalling system (e.g. Goldin-Meadow, S. (2000). Beyond words: The importance of gesture to researchers and learners. Child Development, 71(1), 231-239), and emergentist accounts of communication impairment which regard compensatory adaptation as integral (e.g. Perkins, M. R. (2007). Pragmatic Impairment. Cambridge: Cambridge University Press.).

Between-word processes in children with speech difficulties: insights from a usage-based approach to phonology

There are some children with speech and/or language difficulties who are significantly more difficult to understand in connected speech than in single words. The study reported here explores the between-word behaviours of three such children, aged 11;8, 12;2 and 12;10. It focuses on whether these patterns could be accounted for by lenition, as suggested by a usage-based approach to phonology. The children carried out a repetition task, with sentences containing environments that can trigger assimilation and elision. Speech elicited was examined using a combination of perceptual and electropalatographic (EPG) analysis. All of the children produced instances of word boundary behaviours reported in adult speech, as well as some which are considered to be atypical. It is argued that all of these phenomena can be viewed as lenition, and that a usage-based approach to phonology has potential for providing a valuable framework for the description of between-word processes in disordered speech.

Instrumental and perceptual phonetic analyses: the case for two-tier transcriptions

In this article, we discuss the relationship between instrumental and perceptual phonetic analyses. Using data drawn from typical and atypical speech production, we argue that the use of two-tier transcriptions, which can compare and contrast perceptual and instrumental information, is valuable both for our general understanding of the mechanisms of speech production and perception and also for assessment and intervention for individuals with atypical speech production. The central tenet of our case is that instrumental and perceptual analyses are not in competition to give a single 'correct' account of speech data. They take instead perspectives on complementary phonetic domains, which interlock in the speech chain to encompass production, transmission and perception.

Physiological investigation of dysarthria: recent advances

Recent years have seen the development and introduction of a range of new physiological instruments for investigating various aspects of articulatory function in persons with dysarthria. Included among these techniques are electromagnetic articulography (EMA), electropalatography (EPG), and pressure-sensing EPG. The aim of this paper is to describe and evaluate these techniques, highlighting their relative advantages, disadvantages, and specific applications in assessing articulation in speakers with dysarthria associated with a variety of neurological disorders. Emphasis will be given to those instruments that enable researchers and clinicians to examine articulatory functions in 3-dimensions, such as 3D-EMA (AG500) and 3D-EPG. In addition the application of pressure-sensing EPG and ultrasonography will be outlined. Each of these physiological techniques will be fully described in terms of their component hardware and underlying principles of operation. The use of each technique in the assessment of dysarthria will be illustrated wherever possible by reference to specific case examples, and especially cases drawn from various neuropathological groups. Research findings reported to date based on each of the above physiological instruments will be reviewed and the research summarized.

Between-Word Simplification Patterns in the Continuous Speech of Children With Speech Sound Disorders

Purpose

This study was designed to identify and describe between-word simplification patterns in the continuous speech of children with speech sound disorders. It was hypothesized that word combinations would reveal phonological changes that were unobserved with single words, possibly accounting for discrepancies between the intelligibility of single-word samples and that of continuous speech.

Method

Four boys with developmental speech sound disorders provided samples of single words and continuous speech. Substitutions and deletions with single words formed the basis for determining 2 categories of between-word segment mismatches: observed and novel . Mismatches were attributed to one of 4 types of between-word simplifications reported for typical phonological development: between-word consonant deletion, between-word cluster reduction, between-word consonant sequence reduction, and between-word assimilation.

Results

Continuous speech revealed observed and novel patterns. Segment mismatches occurred differentially among potential between-word simplification environments. The most frequently occurring novel pattern involved the deletion of a coda consonant within a between-word consonant sequence.

Conclusions

Children with speech sound disorders demonstrated substitutions and deletions between words in continuous speech that may not be predicted on the basis of single-word productions. The identification of potential contexts for such mismatches may serve as a framework for the assessment of continuous speech samples of children with speech sound disorders in health care and school settings.

Word juncture behaviours in young children's spontaneous speech production

The present study explores word boundary behaviours in the spontaneous speech of a group of 6 preschool children. Speech collected in play settings is examined for the presence of normal and atypical connected speech behaviours, and to identify specific instances of open and close word juncture behaviours. The findings suggest that developmental and adult-like features co-exist in the speech of typically-developing children and that developmental changes occur in connected speech behaviours between the ages of 2-3 years. In particular, a shift from equal numbers of close and open junctures, to a preference for close junctures is noted. Individual differences are also apparent between speakers, and these are discussed.