Speech intelligibility and perceptions of communication effectiveness by speakers with dysarthria following traumatic brain injury and their communication partners

A Comparison of Voice Amplifiers and Personal Communication Systems for Hypophonia: An Exploration of Communicative Participation

PURPOSE

The primary purpose of this study was to evaluate how individuals with hypophonia (HP; also referred to as HP participants) and their primary communication partners (PCPs; also referred to as PCP participants) rate communicative participation before and after experience with a speech amplification device. A secondary purpose was to evaluate pre- and post-device effects on self-rated communicative participation for each of the three speech amplification devices trialed outside of the laboratory.

METHOD

Seventeen individuals with HP and their PCPs participated in a crossover design study that compared three different amplification devices: a wired belt-pack amplifier, a wireless stationary amplifier, and a personal frequency modulation (FM) system. Both the individuals with HP and their PCPs self-rated communicative participation at baseline and after trialing each device following 1-week device trial periods at home. Patient-reported outcome measures included the Communicative Effectiveness Survey (CES) and the Voice Activity and Participation Profile (VAPP). Following study completion, participants indicated whether they would like to select a specific device to continue using.

RESULTS

Overall, HP participants rated communicative participation following device use higher than that in the pre-device condition, with the FM system resulting in the overall highest VAPP ratings and second highest CES ratings. Furthermore, HP and PCP participants rated these measures similarly. Finally, HP participants who selected a device to continue using self-reported lower total communicative effectiveness scores and greater voice activity limitations and participation restrictions at baseline in comparison to the nonselectors.

CONCLUSIONS

This study contributes to an increased understanding of how communicative participation is experienced within this clinical population resulting from speech amplification. It is suggested that the inclusion of participation-based outcome measurement is essential to ensure a multidimensional and comprehensive approach to device prescription for individuals with HP.

Speech error rates after a sports-related concussion

Background

Alterations in speech have long been identified as indicators of various neurologic conditions including traumatic brain injury, neurodegenerative diseases, and stroke. The extent to which speech errors occur in milder brain injuries, such as sports-related concussions, is unknown. The present study examined speech error rates in student athletes after a sports-related concussion compared to pre-injury speech performance in order to determine the presence and relevant characteristics of changes in speech production in this less easily detected neurologic condition.

Methods

A within-subjects pre/post-injury design was used. A total of 359 Division I student athletes participated in pre-season baseline speech testing. Of these, 27 athletes (18-22 years) who sustained a concussion also participated in speech testing in the days immediately following diagnosis of concussion. Picture description tasks were utilized to prompt connected speech samples. These samples were recorded and then transcribed for identification of errors and disfluencies. These were coded by two trained raters using a 6-category system that included 14 types of error metrics.

Results

Repeated measures analysis of variance was used to compare the difference in error rates at baseline and post-concussion. Results revealed significant increases in the speech error categories of pauses and time fillers (interjections/fillers). Additionally, regression analysis showed that a different pattern of errors and disfluencies occur after a sports-related concussion (primarily time fillers) compared to pre-injury (primarily pauses).

Conclusion

Results demonstrate that speech error rates increase following even mild head injuries, in particular, sports-related concussion. Furthermore, the speech error patterns driving this increase in speech errors, rate of pauses and interjections, are distinct features of this neurological injury, which is in contrast with more severe injuries that are marked by articulation errors and an overall reduction in verbal output. Future studies should consider speech as a diagnostic tool for concussion.

Communicative Participation in Dysarthria: Perspectives for Management

Communicative participation is restricted in many conditions associated with dysarthria. This position paper defines and describes the construct of communicative participation. In it, the emergence of this construct is reviewed, along with the predictors of and variables associated with communicative participation in the dysarthrias. In doing so, the features that make communicative participation unique and distinct from other measures of dysarthria are highlighted, through emphasizing how communicative participation cannot be predicted solely from other components of the World Health Organization’s International Classification of Functioning, Disability and Health (ICF), including levels of impairment or activity limitations. Next, the empirical literature related to the measurement of communicative participation and how this research relates to dysarthria management is presented. Finally, the development of robust clinical measures of communicative participation and approaches to management is described from the point of view of the clinician. We argue that communicative participation should be a primary focus of treatment planning and intervention to provide patient-centered, holistic, and value-based clinical interventions which are responsive to the needs of individuals living with dysarthria.

The impact of Lee Silverman Voice Treatment (LSVT LOUD®) on voice, communication, and participation: Findings from a prospective, longitudinal study

BACKGROUND

Lee Silverman Voice Treatment (LSVT LOUD®), an intensive 4-week program of voice therapy, is regarded as the most well-researched, efficacious treatment for hypokinetic dysarthria in individuals with Parkinson's disease (PD). Although numerous studies have published acoustic and perceptual findings, there is comparatively little information about the impact of LSVT LOUD® on functional communication outcomes.

METHODS

This prospective, longitudinal study investigated the impact of treatment on daily communication in 25 individuals with PD. Three validated communication measures (the Voice Handicap Index, the Communicative Effectiveness Scale, and the Communicative Participation Item Bank) were given before and after treatment and again 4-8 weeks and 3-6 months following treatment. Communication partners were also asked to rate communication effectiveness at all four timepoints.

RESULTS

Significant improvements were found for all three self-reported scales which remained above baseline across all post-treatment timepoints. In addition, self-reported communicative effectiveness was significantly correlated with the assessments of communication partners. Particular benefits were reported for more complex communicative activities such as asking questions, giving detailed information, communicating in noisy situations, and speaking in groups.

CONCLUSIONS

Overall, the findings suggested that LSVT LOUD® promotes an increased sense of personal control over the communication difficulties resulting from PD by decreasing voice handicap and improving communication effectiveness and communicative participation. For individuals with PD, LSVT LOUD® may reduce the risk of social isolation by improving communication and facilitating social participation.

LEARNING OUTCOMES

As a result of this activity, the participant will be able to (1) describe the impact of PD on voice and communication, (2) discuss how these characteristics may be associated with more global measures of functional communication and particularly communicative participation, (3) explain which aspects of functional communication were affected by LSVT LOUD® as assessed by study participants and their communication partners.

Psychosocial Impact of Dysarthria: The Patient-Reported Outcome as Part of the Clinical Management

BACKGROUND

Dysarthria in neurological disorders can have psychosocial consequences. The dysarthric speaker's perspective towards the disorder's psychosocial impact is essential in its global assessment and management. For such purposes, assessment tools such as the Dysarthria Impact Profile (DIP) are indispensable.

OBJECTIVE

We aimed to confirm the relevance of using the DIP to quantify the psychosocial consequences of dysarthria in neurological diseases.

METHODS

We studied 120 participants, 15 healthy controls and 105 patients with different kinds of dysarthria induced by several neurological disorders (Parkinson's disease [PD], Huntington's disease, dystonia, cerebellar ataxia, progressive supranuclear palsy [PSP], multiple system atrophy, lateral amyotrophic sclerosis). All participants underwent a cognitive evaluation and a speech intelligibility assessment and completed three self-reported questionnaires: the 36-Item Short Form Health Survey, the Voice Handicap Index (VHI), and the DIP.

RESULTS

The psychometric properties of the DIP were confirmed, including internal consistency (α = 0.93), concurrent validity (correlation with the VHI: r = -0.77), and discriminant validity (accuracy = 0.93). Psychosocial impact of dysarthria was revealed by the DIP for all patients. Intelligibility loss was found strongly correlated with the psychosocial impact of dysarthria: for a similar level of intelligibility impairment, the DIP total score was similar regardless of the pathological group. However, our findings suggest that the psychosocial impact measured by the DIP could be partially independent from the severity of dysarthria (indirectly addressed here via speech intelligibility): the DIP was able to detect patients without any intelligibility impairment, but with a psychosocial impact.

CONCLUSIONS

All patients reported a communication complaint, attested by the DIP scores, despite the fact that not all patients, notably PD, ataxic, and PSP patients, had an intelligibility deficit. The DIP should be used in clinical practice to contribute to a holistic evaluation and management of functional communication in patients with dysarthria.

Relationship between perceived social support and patient-reported communication outcomes across communication disorders: a systematic review

BACKGROUND

Beyond the severity of voice, speech and language impairments, one potential predictor of communication success across adult populations with communication disorders may be perceived social support: the expectation that others will provide support if needed. Despite the preponderance of intervention approaches that assume a positive relationship between perceived social support and patient-reported communication success, the evidence base for these relationships is limited.

AIMS

The aim of this systematic review is to explore relationships between measures of perceived social support and patient-reported communication outcomes in adult populations with communication disorders.

METHODS & PROCEDURES

The PRISMA guidelines were followed in the conduct and reporting of this review. Electronic databases including PubMed, PsychINFO and CINAHL were systematically searched up to 19 May 2017. Additional data were obtained for two studies. All the included studies were appraised using the Critical Appraisal Skills Program (CASP) tools. Given the heterogeneous nature of the studies, data synthesis was narrative for the quantitative studies. A meta-ethnographic approach was used to synthesize qualitative data.

OUTCOMES & RESULTS

Eight quantitative and four qualitative studies met eligibility criteria. All quantitative studies met eight of eight quality criteria. For the qualitative studies, one study met nine of nine quality criteria; the remaining three studies met three, seven and eight quality criteria. Of the eight included quantitative studies, six independent data sets were used. Results revealed no significant relationships between perceived social support and communication outcomes in three studies (two aphasia with one data set, one Parkinson's disease), while perceived social support was a weak, but significant predictor in two studies (one multiple sclerosis, one head and neck cancer). Three additional studies (two aphasia with one data set; one Parkinson's disease) found that relationships were initially weak, but strengthened over time to become moderate. Results from qualitative studies (one head and neck cancer, two aphasia, one multiple sclerosis) revealed that perceived social support acted as a facilitator, and absent or misguided support acted as a barrier to communication outcomes. Skilful, responsive family members were able to facilitate better quality of communicative interactions, whereas lack of social support, or negative attitudes and behaviours of other people, were barriers.

CONCLUSIONS & IMPLICATIONS

While perceived social support may affect communication outcomes in adults with communication disorders, current measures may not adequately capture these constructs. Results have implications for future research and interventions for speech and language therapists.

Separate and Combined Influence of Cognitive Impairment and Dysarthria on Functional Communication in Multiple Sclerosis

PURPOSE

Dysarthria is a consequence of multiple sclerosis (MS) that can co-occur with cognitive impairment. Clinical management thus requires understanding the separate and combined effects of dysarthria and cognitive impairment on functional communication in MS. This study compared perceptual measures of intelligibility and speech severity that capture functional communication deficits for 4 operationally defined groups with MS. The relationship between communication participation and perceptual measures was also examined.

METHOD

Forty-eight adults with MS and 12 healthy controls participated. Cognitive testing and dysarthria diagnosis determined group assignment: (a) MS with cognitive impairment (MSCI), (b) MS with a diagnosis of dysarthria and no cognitive impairment (MSDYS), (c) MS with dysarthria and cognitive impairment (MSDYS + CI), and (d) MS without dysarthria or cognitive impairment (MS). Sentence Intelligibility Test scores, scaled speech severity obtained from the "Grandfather Passage," and Communication Participation Item Bank (CPIB) scores were analyzed.

RESULTS

Sentence Intelligibility Test scores approached 100% for all groups. Speech severity was greater for the MSDYS + CI and MSDYS groups versus controls. CPIB scores were greatest for the MSDYS + CI group and were not significantly correlated with either perceptual measure.

CONCLUSIONS

The CPIB and speech severity were sensitive to aspects of communication problems for some groups with MS not reflected in a measure of sentence intelligibility. Findings suggest the importance of employing a variety of measures to capture functional communication problems experienced by persons with MS.

Consonant Acoustics in Parkinson's Disease and Multiple Sclerosis: Comparison of Clear and Loud Speaking Conditions

PURPOSE

The impact of clear speech or an increased vocal intensity on consonant spectra was investigated for speakers with mild dysarthria secondary to multiple sclerosis or Parkinson's disease and healthy controls.

METHOD

Sentences were read in habitual, clear, and loud conditions. Spectral moment coefficients were obtained for word-initial and word-medial /s/, /ʃ/, /t/, and /k/. Global production differences among conditions were confirmed with measures of vocal intensity and articulation rate.

RESULTS

Static or slice-in-time first moments (M1) for loud differed most frequently from habitual, but neither loud nor clear enhanced M1 contrast for consonant pairs. In several instances, the clear and loud conditions yielded stable or nonvarying fricative M1 time histories. Spectral contrast was reduced for word-medial versus word-initial consonant pairs.

CONCLUSION

The finding that the loud and especially clear condition yielded fairly subtle changes in consonant spectra suggests these global techniques may minimally enhance consonant segmental production or contrast in mild dysarthria. The robust effect of word position on consonant spectra indicates that this variable deserves consideration in future studies. Future research also is needed to investigate how or whether consonant production bears on the improved intelligibility previously reported for these global dysarthria treatment techniques.

Development of the Aboriginal Communication Assessment After Brain Injury (ACAABI): A screening tool for identifying acquired communication disorders in Aboriginal Australians

PURPOSE

Acquired communication disorders (ACD), following stroke and traumatic brain injury, may not be correctly identified in Aboriginal Australians due to a lack of linguistically and culturally appropriate assessment tools. Within this paper we explore key issues that were considered in the development of the Aboriginal Communication Assessment After Brain Injury (ACAABI) - a screening tool designed to assess the presence of ACD in Aboriginal populations.

METHOD

A literature review and consultation with key stakeholders were undertaken to explore directions needed to develop a new tool, based on existing tools and recommendations for future developments.

RESULT

The literature searches revealed no existing screening tool for ACD in these populations, but identified tools in the areas of cognition and social-emotional wellbeing. Articles retrieved described details of the content and style of these tools, with recommendations for the development and administration of a new tool. The findings from the interview and focus group views were consistent with the approach recommended in the literature.

CONCLUSIONS

There is a need for a screening tool for ACD to be developed but any tool must be informed by knowledge of Aboriginal language, culture and community input in order to be acceptable and valid.

Variability and Diagnostic Accuracy of Speech Intelligibility Scores in Children

PURPOSE

We examined variability of speech intelligibility scores and how well intelligibility scores predicted group membership among 5-year-old children with speech motor impairment (SMI) secondary to cerebral palsy and an age-matched group of typically developing (TD) children.

METHOD

Speech samples varying in length from 1-4 words were elicited from 24 children with cerebral palsy (mean age 60.50 months) and 20 TD children (mean age 60.33 months). Two hundred twenty adult listeners made orthographic transcriptions of speech samples (n = 5 per child).

RESULTS

Variability associated with listeners made a significant contribution to explaining the variance in intelligibility scores for TD and SMI children, but the magnitude was greater for TD children. Intelligibility scores differentiated very well between children who have SMI and TD children when intelligibility was at or below approximately 75% and above approximately 85%.

CONCLUSIONS

Intelligibility seems to be a useful clinical tool for differentiating between TD children and children with SMI at 5 years of age; however, there is considerable variability within and between listeners, highlighting the need for more than one listener per child to ensure validity of an intelligibility measure.

Examining the relationship between speech intensity and self-rated communicative effectiveness in individuals with Parkinson's disease and hypophonia

PURPOSE

To examine the relationship between speech intensity and self-ratings of communicative effectiveness in speakers with Parkinson's disease (PD) and hypophonia. An additional purpose was to evaluate if self-ratings of communicative effectiveness made by participants with PD differed from ratings made by primary communication partners.

METHODS

Thirty participants with PD and 15 healthy older adults completed the Communication Effectiveness Survey. Thirty primary communication partners rated the communicative effectiveness of his/her partner with PD. Speech intensity was calculated for participants with PD and control participants based on conversational utterances.

RESULTS

Results revealed significant differences between groups in conversational speech intensity (p=.001). Participants with PD self-rated communicative effectiveness significantly lower than control participants (p=.000). Correlational analyses revealed a small but non-significant relationship between speech intensity and communicative effectiveness for participants with PD (r=0.298, p=.110) and control participants (r=0.327, p=.234). Self-ratings of communicative effectiveness made participants with PD was not significantly different than ratings made by primary communication partners (p=.20).

CONCLUSIONS

Obtaining information on communicative effectiveness may help to broaden outcome measurement and may aid in the provision of educational strategies. Findings also suggest that communicative effectiveness may be a separate and a distinct construct that cannot necessarily be predicted from the severity of hypophonia.

Effect of the number of presentations on listener transcriptions and reliability in the assessment of speech intelligibility in children

BACKGROUND

The assessment of intelligibility is an essential part of establishing the severity of a speech disorder. The intelligibility of a speaker is affected by a number of different variables relating, inter alia, to the speech material, the listener and the listener task.

AIMS

To explore the impact of the number of presentations of the utterances on assessments of intelligibility based on orthographic transcription of spontaneous speech, specifically the impact on intelligibility scores, reliability and intra-listener variability.

METHODS & PROCEDURES

Speech from 12 children (aged 4:6-8:3 years; mean = 5:10 years) with percentage consonants correct (PCC) scores ranging from 49 to 81 was listened to by 18 students on the speech-language pathology (SLP) programme and by two recent graduates from that programme. Three conditions were examined during the transcription phase: (1) listening to each utterance once; (2) listening to each utterance a second time; and (3) listening to all utterances from a given child a third time after having heard all of its utterances twice.

OUTCOMES & RESULTS

Statistically significant differences between intelligibility scores were found across the three conditions, i.e. the intelligibility score increased with the number of presentations while inter-judge reliability was unchanged. The results differed markedly across listeners, but each individual listener's results were very consistent across conditions.

CONCLUSIONS & IMPLICATIONS

Information about the number of times an utterance is presented to the listener is important and should therefore always be included in reports of research involving intelligibility assessment. There is a need for further research and discussion on listener abilities and strategies.

Motor speech impairment, activity, and participation in children with cerebral palsy

The present study used a population-based sample of children with cerebral palsy (CP) to estimate the prevalence of motor speech impairment and its association with activity and participation. A sample of 79 Victorian children aged 4 years 11 months to 6 years 5 months was recruited through the Victorian CP Register. The presence of motor speech impairment was recorded using the Viking Speech Scale (VSS). Activity and participation outcomes included speech intelligibility (the National Technical Institute for the Deaf rating scale, NTID), the Functional Communication Classification System (FCCS) and Communication Function Classification System (CFCS). A parent completed rating scale was used to examine the association between motor speech impairment and participation. Ninety per cent (71/79) of children demonstrated a motor speech impairment. Strong associations were found between the VSS and NTID (< .001), CFCS (< .001), and FCCS levels (<.001). VSS levels III-IV were significantly associated with restrictions in home, school, and community-based participation as perceived by parents. Although some diversity in activity and participation outcomes was observed within specific VSS levels, the results of this study suggested that children with mild motor speech impairments are more likely to demonstrate superior activity and participation outcomes compared to children with moderate or severe deficits.

Patient-Reported Outcomes for Acquired Dysarthria

The purpose of this article is to review the state of the art in patient-reported outcome (PRO) development for acquired dysarthria for clinicians and researchers interested in adding the patient's perspective to the information they garner from their standard assessment repertoire. In particular, the author summarizes what PROs are available at this time for researchers and clinicians treating individuals with acquired motor speech disorders. At this time, for the motor speech population, few valid and reliable PRO measures exist, and those that do are in various stages of development. Although each PRO measures a different aspect of treatment outcome, each offers an alternative to having no input from the patient's perspective at all.

Perceived changes in communicative interaction in atypical parkinsonism

The aim of this study was to examine if atypical parkinsonism affects the communicative ability in conversational interaction. Fifteen persons close to individuals with atypical parkinsonism answered a questionnaire, “Assessment of Change in Communicative Interaction” (ACCI), estimating perceived change in interactive skills compared to before the onset of the disease. The study also examined if perceived change correlated with disease duration. The results showed that at group level, the participants experienced change in many aspects of conversational interaction, particularly regarding the affected person's speech, body communication, response latency, phrase length, word finding, and ability to make themselves understood. There was no correlation between perceived change and disease duration. In conclusion, results indicated that the communicative interaction of individuals with atypical parkinsonism is significantly affected and that information elicited from significant others can help define specific problem areas or foci of concern that need to be targeted in communicative intervention or at least considered in interaction with these persons.