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Rowe HP, Gochyyev P, Lammert AC, Lowit A, Spencer KA, Dickerson BC, Berry JD, Green JR. The efficacy of acoustic-based articulatory phenotyping for characterizing and classifying four divergent neurodegenerative diseases using sequential motion rates. J Neural Transm (Vienna) 2022; 129:1487-1511. [PMID: 36305960 PMCID: PMC9859630 DOI: 10.1007/s00702-022-02550-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 10/13/2022] [Indexed: 01/25/2023]
Abstract
Despite the impacts of neurodegeneration on speech function, little is known about how to comprehensively characterize the resulting speech abnormalities using a set of objective measures. Quantitative phenotyping of speech motor impairments may have important implications for identifying clinical syndromes and their underlying etiologies, monitoring disease progression over time, and improving treatment efficacy. The goal of this research was to investigate the validity and classification accuracy of comprehensive acoustic-based articulatory phenotypes in speakers with distinct neurodegenerative diseases. Articulatory phenotypes were characterized based on acoustic features that were selected to represent five components of motor performance: Coordination, Consistency, Speed, Precision, and Rate. The phenotypes were first used to characterize the articulatory abnormalities across four progressive neurologic diseases known to have divergent speech motor deficits: amyotrophic lateral sclerosis (ALS), progressive ataxia (PA), Parkinson's disease (PD), and the nonfluent variant of primary progressive aphasia and progressive apraxia of speech (nfPPA + PAOS). We then examined the efficacy of articulatory phenotyping for disease classification. Acoustic analyses were conducted on audio recordings of 217 participants (i.e., 46 ALS, 52 PA, 60 PD, 20 nfPPA + PAOS, and 39 controls) during a sequential speech task. Results revealed evidence of distinct articulatory phenotypes for the four clinical groups and that the phenotypes demonstrated strong classification accuracy for all groups except ALS. Our results highlight the phenotypic variability present across neurodegenerative diseases, which, in turn, may inform (1) the differential diagnosis of neurological diseases and (2) the development of sensitive outcome measures for monitoring disease progression or assessing treatment efficacy.
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Affiliation(s)
- Hannah P Rowe
- Department of Rehabilitation Sciences, MGH Institute of Health Professions, Charlestown, Boston, MA, USA
| | - Perman Gochyyev
- School of Healthcare Leadership, MGH Institute of Health Professions, Boston, MA, USA
- Berkeley Evaluation and Assessment Research Center, University of California at Berkeley, Berkeley, CA, USA
| | - Adam C Lammert
- Department of Biomedical Engineering, Worchester Polytechnic Institute, Worcester, MA, USA
| | - Anja Lowit
- Department of Speech and Language Therapy, University of Strathclyde, Glasgow, Scotland, UK
| | - Kristie A Spencer
- Department of Speech and Hearing Sciences, University of Washington, Seattle, WA, USA
| | - Bradford C Dickerson
- Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - James D Berry
- Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Jordan R Green
- Department of Rehabilitation Sciences, MGH Institute of Health Professions, Charlestown, Boston, MA, USA.
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Nault DR, Mitsuya T, Purcell DW, Munhall KG. Perturbing the consistency of auditory feedback in speech. Front Hum Neurosci 2022; 16:905365. [PMID: 36092651 PMCID: PMC9453207 DOI: 10.3389/fnhum.2022.905365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 08/04/2022] [Indexed: 11/13/2022] Open
Abstract
Sensory information, including auditory feedback, is used by talkers to maintain fluent speech articulation. Current models of speech motor control posit that speakers continually adjust their motor commands based on discrepancies between the sensory predictions made by a forward model and the sensory consequences of their speech movements. Here, in two within-subject design experiments, we used a real-time formant manipulation system to explore how reliant speech articulation is on the accuracy or predictability of auditory feedback information. This involved introducing random formant perturbations during vowel production that varied systematically in their spatial location in formant space (Experiment 1) and temporal consistency (Experiment 2). Our results indicate that, on average, speakers’ responses to auditory feedback manipulations varied based on the relevance and degree of the error that was introduced in the various feedback conditions. In Experiment 1, speakers’ average production was not reliably influenced by random perturbations that were introduced every utterance to the first (F1) and second (F2) formants in various locations of formant space that had an overall average of 0 Hz. However, when perturbations were applied that had a mean of +100 Hz in F1 and −125 Hz in F2, speakers demonstrated reliable compensatory responses that reflected the average magnitude of the applied perturbations. In Experiment 2, speakers did not significantly compensate for perturbations of varying magnitudes that were held constant for one and three trials at a time. Speakers’ average productions did, however, significantly deviate from a control condition when perturbations were held constant for six trials. Within the context of these conditions, our findings provide evidence that the control of speech movements is, at least in part, dependent upon the reliability and stability of the sensory information that it receives over time.
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Affiliation(s)
- Daniel R. Nault
- Department of Psychology, Queen’s University, Kingston, ON, Canada
- *Correspondence: Daniel R. Nault,
| | - Takashi Mitsuya
- School of Communication Sciences and Disorders, Western University, London, ON, Canada
- National Centre for Audiology, Western University, London, ON, Canada
| | - David W. Purcell
- School of Communication Sciences and Disorders, Western University, London, ON, Canada
- National Centre for Audiology, Western University, London, ON, Canada
| | - Kevin G. Munhall
- Department of Psychology, Queen’s University, Kingston, ON, Canada
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Lenoci G, Celata C, Ricci I, Chilosi A, Barone V. Vowel variability and contrast in Childhood Apraxia of Speech: acoustics and articulation. CLINICAL LINGUISTICS & PHONETICS 2021; 35:1011-1035. [PMID: 33322970 DOI: 10.1080/02699206.2020.1853811] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 11/14/2020] [Accepted: 11/17/2020] [Indexed: 05/21/2023]
Abstract
Phoneme production may be affected by limited speech motor control in Childhood Apraxia of Speech (CAS), with a general instability of acoustic targets across multiple repetitions of speech stimuli. This acoustic and Ultrasound Tongue Imaging (UTI) study shows that increased variability and reduction of contrast in vowel production is found in native Italian speakers with CAS, particularly as far as the height dimension is concerned. The data suggest that vowel production should play a major role in CAS diagnosis and treatment. Moreover, this study shows that a combined acoustic and articulatory approach allows direct observation of lingual dynamics together with an estimation of changes in the acoustic dimension. The two dimensions are shown not to correspond in a straightforward way in the speech of children with CAS, and encourage consideration of articulatory compensation strategies aimed at saving the acoustic identity of vowels.
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Affiliation(s)
| | - Chiara Celata
- Dipartimento di Studi Umanistici (DISTUM), Università Degli Studi Di Urbino 'Carlo Bo', Urbino, Italy
| | - Irene Ricci
- SMART Lab, Scuola Normale Superiore, Pisa, Italy
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Haley KL, Cunningham KT, Jacks A, Richardson JD, Harmon T, Turkeltaub PE. Repeated word production is inconsistent in both aphasia and apraxia of speech. APHASIOLOGY 2019; 35:518-538. [PMID: 34924672 PMCID: PMC8681875 DOI: 10.1080/02687038.2020.1727837] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 02/03/2020] [Indexed: 05/26/2023]
Abstract
PURPOSE There is persistent uncertainty about whether sound error consistency is a valid criterion for differentiating between apraxia of speech (AOS) and aphasia with phonemic paraphasia. The purpose of this study was to determine whether speakers with a profile of aphasia and AOS differ in error consistency from speakers with aphasia who do not have AOS. By accounting for differences in overall severity and using a sample size well over three times that of the largest study on the topic to date, our ambition was to resolve the existing controversy. METHOD We analyzed speech samples from 171 speakers with aphasia and completed error consistency analysis for 137 of them. The experimental task was to repeat four multisyllabic words five times successively. Phonetic transcriptions were coded for four consistency indices (two at the sound-level and two at the word-level). We then used quantitative metrics to assign participants to four diagnostic groups (one aphasia plus AOS group, one aphasia only group, and two groups with intermediate speech profiles). Potential consistency differences were examined with ANCOVA, with error frequency as a continuous covariate. RESULTS Error frequency was a strong predictor for three of the four consistency metrics. The magnitude of consistency for participants with AOS was either similar or lower compared to that of participants with aphasia only. Despite excellent transcription reliability and moderate to excellent coding reliability, three of the four consistency indices showed limited measurement reliability. DISCUSSION People with AOS and people with aphasia often produce inconsistent variants of errors when they are asked to repeat challenging words several times sequentially. The finding that error consistency is similar or lower in aphasia with AOS than in aphasia without AOS is incompatible with recommendations that high error consistency be used as a diagnostic criterion for AOS. At the same time, group differences in the opposite direction are not sufficiently systematic to warrant use for differential diagnosis between aphasia with AOS and aphasia with phonemic paraphasia. Greater attention should be given to error propagation when estimating reliability of derived measurements.
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Affiliation(s)
- Katarina L. Haley
- Division of Speech and Hearing Sciences, Department of Allied Health Sciences, University of North Carolina, Chapel Hill, NC, USA
| | - Kevin T. Cunningham
- Division of Speech and Hearing Sciences, Department of Allied Health Sciences, University of North Carolina, Chapel Hill, NC, USA
| | - Adam Jacks
- Division of Speech and Hearing Sciences, Department of Allied Health Sciences, University of North Carolina, Chapel Hill, NC, USA
| | - Jessica D. Richardson
- Department of Speech and Hearing Sciences, University of New Mexico, Albuquerque, NM, USA
| | - Tyson Harmon
- Department of Communication Disorders, Brigham Young University, Provo, UT, USA
| | - Peter E. Turkeltaub
- Department of Neurology, Georgetown University Medical Center, and MedStar National Rehabilitation Hospital, Washington, DC, USA
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Lenoci G, Ricci I. An ultrasound investigation of the speech motor skills of stuttering Italian children. CLINICAL LINGUISTICS & PHONETICS 2018; 32:1126-1144. [PMID: 30136905 DOI: 10.1080/02699206.2018.1510983] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This study aims at evaluating speech motor skills in the fluent speech of a cohort of stuttering Italian children. Stuttering is a neurodevelopmental disorder that may arise from an innate limitation of the speech motor control system, which fails to prepare and organize the movements required for fluent speech (Van Lieshout, Hulstijn, & Peters, 2004). Anticipatory coarticulation in CV sequences and stability of speech movements have been used as measures of the maturity of articulatory processes for fluent speech production. This study aims to assess if direct measures of speech dynamics can identify impaired mechanisms in stuttering speech during a phrase-repetition task. The Ultrasound Tongue Imaging data of eight school-aged children, half of whom stutter while the other half don't, show different articulatory patterns between the two groups, for both motor aspects under investigation. Articulatory data show that the stuttering group presents a higher degree of intra-syllabic coarticulation compared to the control group and decreased stability (i.e. more variability) through multiple repetitions of the same alveolar and velar item. Outcomes of this study suggest that the speech motor control system of children who stutter is less mature in preparing and executing the speech gestures required for fluent speech. This study contributes to shedding light on the impaired articulatory patterns involved in stuttering speech and to identifying the diagnostic markers of the disorder by evaluating the speech of children close to the onset of stuttering.
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Affiliation(s)
| | - Irene Ricci
- a SMART lab , Scuola Normale Superiore , Pisa , Italy
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Haley KL, Cunningham KT, Eaton CT, Jacks A. Error Consistency in Acquired Apraxia of Speech With Aphasia: Effects of the Analysis Unit. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2018; 61:210-226. [PMID: 29392281 DOI: 10.1044/2017_jslhr-s-16-0381] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 10/15/2017] [Indexed: 06/07/2023]
Abstract
PURPOSE Diagnostic recommendations for acquired apraxia of speech (AOS) have been contradictory concerning whether speech sound errors are consistent or variable. Studies have reported divergent findings that, on face value, could argue either for or against error consistency as a diagnostic criterion. The purpose of this study was to explain discrepancies in error consistency results based on the unit of analysis (segment, syllable, or word) to help determine which diagnostic recommendation is most appropriate. METHOD We analyzed speech samples from 14 left-hemisphere stroke survivors with clinical diagnoses of AOS and aphasia. Each participant produced 3 multisyllabic words 5 times in succession. Broad phonetic transcriptions of these productions were coded for consistency of error location and type using the word and its constituent syllables and sound segments as units of analysis. RESULTS Consistency of error type varied systematically with the unit of analysis, showing progressively greater consistency as the analysis unit changed from the word to the syllable and then to the sound segment. Consistency of error location varied considerably across participants and correlated positively with error frequency. CONCLUSIONS Low to moderate consistency of error type at the word level confirms original diagnostic accounts of speech output and sound errors in AOS as variable in form. Moderate to high error type consistency at the syllable and sound levels indicate that phonetic error patterns are present. The results are complementary and logically compatible with each other and with the literature.
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Affiliation(s)
- Katarina L Haley
- Division of Speech and Hearing Sciences, Department of Allied Health Sciences, University of North Carolina, Chapel Hill
| | - Kevin T Cunningham
- Division of Speech and Hearing Sciences, Department of Allied Health Sciences, University of North Carolina, Chapel Hill
| | | | - Adam Jacks
- Division of Speech and Hearing Sciences, Department of Allied Health Sciences, University of North Carolina, Chapel Hill
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Basilakos A. Contemporary Approaches to the Management of Post-stroke Apraxia of Speech. Semin Speech Lang 2018; 39:25-36. [PMID: 29359303 DOI: 10.1055/s-0037-1608853] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Apraxia of speech (AOS) is a motor speech disorder that disrupts the planning and programming of speech motor movements. In the acute stage of stroke recovery, AOS following unilateral (typically) left hemisphere stroke can occur alongside dysarthria, an impairment in speech execution and control, and/or aphasia, a higher-level impairment in language function. At this time, perceptual evaluation (the systematic, although subjective, description of speech and voice characteristics) is perhaps the only "gold standard" for differential diagnosis when it comes to motor speech disorders. This poses a challenge for speech-language pathologists charged with the evaluation of poststroke communication abilities, as distinguishing production impairments associated with AOS from those that can occur in aphasia and/or dysarthria can be difficult, especially when more than one deficit is present. Given the need for more objective, reliable methods to identify and diagnose AOS, several studies have turned to acoustic evaluation and neuroimaging to supplement clinical assessment. This article focuses on these recent advances. Studies investigating acoustic evaluation of AOS will be reviewed, as well as those that have considered the extent that neuroimaging can guide clinical decision making. Developments in the treatment of AOS will also be discussed. Although more research is needed regarding the use of these methods in everyday clinical practice, the studies reviewed here show promise as emerging tools for the management of AOS.
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Affiliation(s)
- Alexandra Basilakos
- Arnold School of Public Health, Department of Communication Sciences and Disorders, University of South Carolina, Columbia, South Carolina
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Haley KL, Jacks A, Cunningham KT. Error variability and the differentiation between apraxia of speech and aphasia with phonemic paraphasia. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2013; 56:891-905. [PMID: 23275417 DOI: 10.1044/1092-4388(2012/12-0161)] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
PURPOSE This study was conducted to evaluate the clinical utility of error variability for differentiating between apraxia of speech (AOS) and aphasia with phonemic paraphasia. METHOD Participants were 32 individuals with aphasia after left cerebral injury. Diagnostic groups were formed on the basis of operationalized measures of recognized articulatory and prosodic characteristics of AOS and phonemic paraphasia. Sequential repetitions of multisyllabic words were elicited as part of a motor speech evaluation and transcribed phonetically. Four metrics of variability at the syllable and word levels were derived from these transcripts. RESULTS The measures yielded different magnitudes of variability. There were no group differences between participants who displayed speech profiles consistent with AOS and participants who displayed speech profiles indicative of aphasia with phonemic paraphasia. Rather, correlation coefficients and analyses of covariance showed that the variability metrics were significantly mediated by overall error rate. Additionally, variability scores for individuals with salient diagnoses of AOS and conduction aphasia were inconsistent with current diagnostic guidelines. CONCLUSIONS The results do not support diagnostic validity of error variability for differentiating between AOS and aphasia with phonemic paraphasia. Future research using error variability metrics should account for overall error rate in the analysis and matching of participant groups.
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Staiger A, Finger-Berg W, Aichert I, Ziegler W. Error variability in apraxia of speech: a matter of controversy. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2012; 55:S1544-S1561. [PMID: 23033448 DOI: 10.1044/1092-4388(2012/11-0319)] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
PURPOSE Error variability has traditionally been considered a hallmark of apraxia of speech (AOS). However, in some of the current AOS literature, relatively invariable error patterns are claimed as a mandatory criterion for a diagnosis of AOS. This paradigm shift has far-reaching consequences for our understanding of the disorder and for its (differential) diagnosis. Against the background of this controversy, the present article aims to further examine error variability in AOS. METHOD Four patients with relatively pure, mild-to-moderate AOS participated in the study. They repeated 8 target words in 2 different phrase contexts, 10 times each. Error analyses were based on phonetic transcription. Error variability was determined using several measures of (a) consistency of error occurrence and (b) consistency of error type. RESULTS All patients produced highly inconsistent reactions across multiple trials in some of the target words. However, other words were more consistently accurate or inaccurate. Several factors influencing error variability were identified. CONCLUSIONS Because this study has disclosed clear indications of variable behavior in AOS, diagnostic guidelines claiming error consistency as a mandatory criterion cannot be maintained. Because error variability is difficult to operationalize, we recommend to no longer use (in)consistency as a strict diagnostic marker of AOS.
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Affiliation(s)
- Anja Staiger
- Clinical Neuropsychology Research Group (EKN), Clinic forNeuropsychology, City Hospital München, Germany.
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Jacks A, Mathes KA, Marquardt TP. Vowel acoustics in adults with apraxia of speech. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2010; 53:61-74. [PMID: 20008683 DOI: 10.1044/1092-4388(2009/08-0017)] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
PURPOSE To investigate the hypothesis that vowel production is more variable in adults with acquired apraxia of speech (AOS) relative to healthy individuals with unimpaired speech. Vowel formant frequency measures were selected as the specific target of focus. METHOD Seven adults with AOS and aphasia produced 15 repetitions of 6 American English vowels in /hVC/ context (hid, head, hat, hot, hub, hoot). Vowel formant frequency measures (F1, F2) were Bark transformed and compared with data from archival sources. RESULTS Measures of vowel acoustics in speakers with AOS did not differ from those of unimpaired speakers, including absolute Bark formant values, vowel space area, intervowel distance, and individual trial-to-trial formant variability. CONCLUSION Comparison with normative acoustic measures suggested that vowel production at the word level is unimpaired in the current speakers with AOS, supporting previous studies that have shown vowel production is relatively intact in AOS.
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Thoonen G, Maassen B, Gabreëls F, Schreuder R. Feature analysis of singleton consonant errors in developmental verbal dyspraxia (DVD). JOURNAL OF SPEECH AND HEARING RESEARCH 1994; 37:1424-1440. [PMID: 7533219 DOI: 10.1044/jshr.3706.1424] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
The aim of this study is to quantify diagnostic characteristics related to consonant production of developmental verbal dyspraxia (DVD). For this, a paradigmatic and syntagmatic feature-value analysis of the consonant substitution and omission errors in DVD speech was conducted. Following a three-step procedure, eleven clear cases were selected from a group of 24 children with DVD. The consonants produced in a word and nonsense-word imitation task were phonetically transcribed and transferred to confusion matrices, which allows for a feature and feature-value analysis. The analysis revealed that children with DVD (a) show low percentages of retention for place and manner of articulation and voicing, due to high substitution and omission rates; (b) show a particularly low percentage of retention of place of articulation in words, which, together with error rate, is strongly related to severity of involvement; (c) are inconsistent in their feature realization and feature preference; and (d) show a high syntagmatic error rate. These results form a quantification of diagnostic characteristics. Unexpectedly, however, very few qualitative differences in error pattern were found between children with DVD and a group of 11 age-matched children with normal speech. Thus, although the children with DVD produced higher substitution and omission rates than children with normal speech, the speech profiles of both subject groups are similar. This result stresses the importance of interpreting profiles, not isolated symptoms. The hypothesis to consider DVD as a deficit in the phonological encoding process is discussed.
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Affiliation(s)
- G Thoonen
- Child Neurology Center/Institute Medical Psychology, University Hospital Nijmegen, The Netherlands
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