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Wang EW, Grigos MI. Naive Listener Ratings of Speech Intelligibility Over the Course of Motor-Based Intervention in Children With Childhood Apraxia of Speech. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2024; 67:3377-3391. [PMID: 37486797 DOI: 10.1044/2023_jslhr-22-00656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
PURPOSE The aim of this study was to describe changes in speech intelligibility and interrater and intrarater reliability of naive listeners' ratings of words produced by young children diagnosed with childhood apraxia of speech (CAS) over a period of motor-based intervention (dynamic temporal and tactile cueing [DTTC]). METHOD A total of 120 naive listeners (i.e., listeners without experience listening to children with speech and/or language impairments; age range: 18-45 years) orthographically transcribed single-word productions by five children (age range: 2;6-3;11 [years;months]) across three time points over an intervention period (baseline, post-treatment, maintenance). Changes in intelligibility and interrater and intrarater reliability were examined within and across time points. RESULTS Speech intelligibility significantly increased in children with CAS over the course of treatment, and these gains were also maintained at 6 weeks posttreatment. There was poor-to-fair consistency between listeners (interrater reliability) and excellent consistency within listeners (intrarater reliability) in ratings of speech intelligibility within and across time points. CONCLUSIONS Motor-based intervention increases speech intelligibility following a period of DTTC treatment. Variability among naive listeners of speech intelligibility was also present, with intrarater reliability (within listeners) yielding greater consistency than interrater reliability (between listeners). The implications for including naive listeners as raters of speech intelligibility for research and clinical purposes are discussed.
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Affiliation(s)
- Emily W Wang
- Department of Communicative Sciences and Disorders, New York University, New York
| | - Maria I Grigos
- Department of Communicative Sciences and Disorders, New York University, New York
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Nip ISB. Articulatory and Vocal Fold Movement Patterns During Loud Speech in Children With Cerebral Palsy. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2024; 67:477-493. [PMID: 38227476 PMCID: PMC11000802 DOI: 10.1044/2023_jslhr-23-00411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/19/2023] [Accepted: 11/25/2023] [Indexed: 01/17/2024]
Abstract
PURPOSE Speech motor control changes underlying louder speech are poorly understood in children with cerebral palsy (CP). The current study evaluates changes in the oral articulatory and laryngeal subsystems in children with CP and their typically developing (TD) peers during louder speech. METHOD Nine children with CP and nine age- and sex-matched TD peers produced sentence repetitions in two conditions: (a) with their habitual rate and loudness and (b) with louder speech. Lip and jaw movements were recorded with optical motion capture. Acoustic recordings were obtained to evaluate vocal fold articulation. RESULTS Children with CP had smaller jaw movements, larger lower lip movements, slower jaw speeds, faster lip speeds, reduced interarticulator coordination, reduced low-frequency spectral tilt, and lower cepstral peak prominences (CPP) in comparison to their TD peers. Both groups produced louder speech with larger lip and jaw movements, faster lip and jaw speeds, increased temporal coordination, reduced movement variability, reduced spectral tilt, and increased CPP. CONCLUSIONS Children with CP differ from their TD peers in the speech motor control of both the oral articulatory and laryngeal subsystems. Both groups alter oral articulatory and vocal fold movements when cued to speak loudly, which may contribute to the increased intelligibility associated with louder speech. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.24970302.
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Korkalainen MJ, McCabe P, Smidt A, Morgan C. Outcomes of a novel single case study incorporating Rapid Syllable Transition treatment, AAC and blended intervention in children with cerebral palsy: a pilot study. Disabil Rehabil Assist Technol 2024; 19:167-176. [PMID: 35576498 DOI: 10.1080/17483107.2022.2071488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 04/21/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Motor speech and augmentative and alternative communication (AAC) interventions are commonly used with children with cerebral palsy (CP) but there is limited literature comparing the effectiveness of these interventions. The purpose of this study was to investigate the effectiveness of intensive AAC, Rapid Syllable Transition Treatment (ReST), and blended intervention, a combination of motor-speech and AAC, on speech accuracy and sentence length and complexity. METHODS A single case experimental design across participants with repeated measurements across phases (ABACADA design) was used. Four participants aged 8-14 years with CP who used a speech-generating device (SGD) received three 6-week intervention blocks that included ReST, AAC, and blended intervention. Measures were taken during intervention and baseline phases and at maintenance two and four weeks after the last intervention phase. Participants were randomized to starting with either ReST or AAC with the blended intervention delivered last. RESULTS All participants improved their speech accuracy and sentence length and complexity in speech and with their SGD in all three interventions. The data demonstrated overall immediacy of the effect with all interventions and retention of gains across the whole sequence of phases. The order of AAC or ReST interventions or the severity of CP did not impact the intervention gains. CONCLUSION This study suggests that intensive AAC, a multi-modal approach, and ReST improve speech accuracy and sentence length and complexity in children with moderate CP, but all require further investigation.Implications for rehabilitationIn this paper intensive AAC intervention with a speech generating device (SGD), ReST treatment and multimodal blended intervention were effective in improving speech accuracy and sentence length and complexity in both verbal speech and on communication with the SGD.ReST treatment has not been used with children with CP before. This study established a proof of concept for its effectiveness in children with CP. Further research is warranted.
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Affiliation(s)
- Marjut Johanna Korkalainen
- Discipline of Speech Pathology, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Patricia McCabe
- Discipline of Speech Pathology, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Andy Smidt
- Discipline of Speech Pathology, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Catherine Morgan
- Cerebral Palsy Alliance Research Institute, Child and Adolescent Health, The University of Sydney, Sydney, Australia
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Korkalainen J, McCabe P, Smidt A, Morgan C. The Effectiveness of Rapid Syllable Transition Treatment in Improving Communication in Children with Cerebral Palsy: A Randomized Controlled Trial. Dev Neurorehabil 2023; 26:309-319. [PMID: 37401894 DOI: 10.1080/17518423.2023.2218485] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 04/21/2023] [Accepted: 05/23/2023] [Indexed: 07/05/2023]
Abstract
Cerebral palsy (CP) is a movement disorder and majority of children with CP have communication impairments which impact participation with this population. Rapid Syllable Transition Treatment (ReST) is a motor speech intervention primarily for children with Childhood Apraxia of Speech (CAS). A recent pilot study in which ReST was trialed with children with CP showed improved speech performance. Therefore, a single blind randomized controlled trial to compare ReST to usual care with 14 children with moderate-to-severe CP and dysarthria was conducted. ReST was provided on telehealth. ANCOVA with 95% confidence intervals indicated significant group differences in favor of ReST in speech accuracy (F = 5.1, p = .001), intelligibility (F = 2.8, p = .02) and communicative participation on both the FOCUS (F = 2, p = .02) and Intelligibility in Context Scale (F = 2.4, p = .04). ReST was found to be more effective than usual care.
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Affiliation(s)
| | | | - Andy Smidt
- The University of Sydney, Camperdown, Sydney, Australia
| | - Catherine Morgan
- The University of Sydney, Cerebral Palsy Alliance Research Institute, Brain Mind Centre, Camperdown, Sydney, Australia
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Korkalainen J, McCabe P, Smidt A, Morgan C. Motor Speech Interventions for Children With Cerebral Palsy: A Systematic Review. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:110-125. [PMID: 36623233 DOI: 10.1044/2022_jslhr-22-00375] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
PURPOSE Dysarthria is common among children with cerebral palsy (CP) and results in poor speech intelligibility and subsequently low communicative participation. Neuroplasticity evidence suggests that adherence to principles of motor learning (PML) improves motor speech intervention outcomes. Motor speech interventions aim to improve speech intelligibility and ultimately facilitate participation, but the effectiveness of these interventions and their inclusion of PML are not clear. Aims are as follows: (a) evaluate the effectiveness motor speech interventions in improving speech intelligibility; (b) summarize the aims, outcome measures, and outcomes relating to the International Classification of Functioning and Disability Child and Youth; and (c) summarize the principles of motor learning used in the intervention. METHOD Eight databases were searched, complemented by a hand search. Studies of any level of evidence were included if they used a motor speech intervention and measured speech in children with CP aged 0-18 years. Studies before 2000 or not in English were excluded. The review was conducted and reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Study quality was rated using the Single Case Experimental Design Scale and Physiotherapy Evidence Database-P rating scales. The strength of evidence was evaluated with Grading of Recommendations, Assessment, Development and Evaluation. RESULTS Of 1,036 initial articles, 21 were included. Eight interventions were identified including 131 participants aged 3-18 years. All studies aimed to improve speech intelligibility or articulation and reported improvement at sound, word, or sentence level. One study reported improvements in communicative participation. The strength of evidence ranged from very low to moderate for one intervention. Adherence to PML was inconsistent. CONCLUSIONS The quality of evidence is very low to moderate. More research on motor speech interventions that adhere to PML is required. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.21817959.
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Affiliation(s)
| | - Patricia McCabe
- The University of Sydney, Camperdown, New South Wales, Australia
| | - Andy Smidt
- The University of Sydney, Camperdown, New South Wales, Australia
| | - Catherine Morgan
- Cerebral Palsy Alliance Research Institute, Brain Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
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Implementation of an Early Communication Intervention for Young Children with Cerebral Palsy Using Single-Subject Research Design. J Clin Med 2022; 12:jcm12010232. [PMID: 36615031 PMCID: PMC9821676 DOI: 10.3390/jcm12010232] [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: 11/18/2022] [Revised: 12/22/2022] [Accepted: 12/23/2022] [Indexed: 12/31/2022] Open
Abstract
The implementation of an intervention protocol aimed at increasing vocal complexity in three pre-linguistic children with cerebral palsy (two males, starting age 15 months, and one female, starting age 16 months) was evaluated utilising a repeated ABA case series design. The study progressed until the children were 36 months of age. Weekly probes with trained and untrained items were administered across each of three intervention blocks. Successive blocks targeted more advanced protophone production and speech movement patterns, individualised for each participant. Positive treatment effects were seen for all participants in terms of a greater rate of achievement of target protophone categories and speech movement patterns. Tau coefficients for trained items demonstrated overall moderate to large AB phase contrast effect sizes, with limited evidence of generalisation to untrained items. Control items featuring protophones and speech movements not targeted for intervention showed no change across phases for any participant. Our data suggest that emerging speech-production skills in prelinguistic infants with CP can be positively influenced through a multimodal intervention focused on capitalising on early periods of plasticity when language learning is most sensitive.
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Martínez-Silva B, Diéguez-Pérez M. Review on Mandibular Muscle Kinematics. SENSORS 2022; 22:s22155769. [PMID: 35957324 PMCID: PMC9371193 DOI: 10.3390/s22155769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 07/26/2022] [Accepted: 07/27/2022] [Indexed: 12/02/2022]
Abstract
The complexity of mandibular dynamics encourages constant research as a vehicle to improve oral health. The gold standard motion capture system might help us to understand its functioning and its relation to body position, aiming to perform an exhaustive bibliographic review in the Dentistry field. Six different electronic databases were used (Dentistry & Oral Sciences Source, Scopus, Web of Science, PubMed, CINAHL and SPORTDiscus) in April 2022. The selection criteria includes a biography, critical analysis, and the full text from 1984 to April 2022, based on the odontological gold standard, whether or not in combination with additional devices. Clinical cases, bibliographic reviews or meta-analysis and grey literature were excluded. The checklist of the critical assessment methodology by Joanna Brigs was used (JBI). After choosing scientific articles published in peer-reviewed journals, 23 out of 186 investigations were classified as eligible with a total of 384 participants. The issue being addressed is related to the speech properties, posture and body movement in relation to dento-oro-facial muscle and facial analysis, mandibular kinematics and mandibular dynamics during the mastication process. The markers arrangement depends on the dynamic to be analysed. From a physiologic and pathologic perspective, the applications of the optic system are relevant in Dentistry. The scarcity of literature obtained implies the need for future research.
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Affiliation(s)
- Beatriz Martínez-Silva
- Faculty of Biomedicine and Health Sciences, European University of Madrid, 28670 Villaviciosa de Odón, Spain;
| | - Montserrat Diéguez-Pérez
- Preclinical Dentistry Department, Faculty of Biomedicine and Health Sciences, European University of Madrid, C. Tajo s/n, 28670 Villaviciosa de Odón, Spain
- Correspondence:
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Fiori S, Ragoni C, Podda I, Chilosi A, Amador C, Cipriani P, Guzzetta A, Sgandurra G. PROMPT to improve speech motor abilities in children with cerebral palsy: a wait-list control group trial protocol. BMC Neurol 2022; 22:246. [PMID: 35794522 PMCID: PMC9258135 DOI: 10.1186/s12883-022-02771-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 06/27/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Children with cerebral palsy (CP) often have communication impairments, including speech altered intelligibility. Multiple levels of disrupted speech have been reported in CP, which negatively impact on participation and quality of life, with increase of care needs. Augmentative Alternative Communication (AAC) is an option, with debated benefits and limitations, in particular for its functional use. This is supported by a substantial lack of defined evidences in favor of direct speech articulation intervention in CP. Motor learning-based interventions are effective in CP and are the basis of speech motor interventions such as PROMPT (Prompts for Restructuring Oral Muscular Phonetic Targets). The PROMPT speech motor treatment provides tactile-kinesthetic inputs to facilitate articulatory movements by dynamic modelling, resulting in more efficient motor patterns that can be integrated into speech and communication. In CP, exploratory evidences support the feasibility and preliminarily advantages on intelligibility of motor speech treatments, such as PROMPT, with increased speech motor control, also documented by kinematic analyses. METHODS A randomized waitlist-control trial will be conducted in children aged between 3- and 10-years having CP and dysarthria (estimated sample size = 60 children). Children will be allocated in the immediate intervention or in the waitlist control group. The intervention consists of an intensive 3 weeks period of twice-a-day administration of PROMPT. Standard care will be administered in the control (waitlist) group. After repeated baseline assessments (T0), the PROMPT treated group will undergo the experimental 3-week intervention period, with T1 assessment at the end. A further T2 assessment will be provided at medium term (3 months after the end of the intervention) for evaluating the stability of intervention. Primary and secondary speech clinical and kinematics outcome measures will be collected at T0, T1 and T2. DISCUSSION This paper describes the study protocol consisting of a RCT with two main objectives: (1) to evaluate the or short-term benefits of an intensive speech motor intervention on speech and intelligibility in children with CP and the stability of the intervention at medium term; (2) to describe the kinematic correlates of speech motor control modifications. TRIAL REGISTRATION Trial registration date 06/12/2019; ClinicalTrials.gov Identifier: NCT04189159 .
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Affiliation(s)
- S Fiori
- IRCCS Stella Maris Foundation, Pisa, Italy.
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
| | - C Ragoni
- IRCCS Stella Maris Foundation, Pisa, Italy
| | - I Podda
- Parole al Centro Studio di Logopedia, Genoa, Italy
| | - A Chilosi
- IRCCS Stella Maris Foundation, Pisa, Italy
| | - C Amador
- IRCCS Stella Maris Foundation, Pisa, Italy
| | - P Cipriani
- IRCCS Stella Maris Foundation, Pisa, Italy
| | - A Guzzetta
- IRCCS Stella Maris Foundation, Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - G Sgandurra
- IRCCS Stella Maris Foundation, Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Malocclusion in children with speech sound disorders and motor speech involvement: a cross-sectional clinical study in Swedish children. Eur Arch Paediatr Dent 2022; 23:619-628. [PMID: 35776286 PMCID: PMC9338153 DOI: 10.1007/s40368-022-00728-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 06/10/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The objectives of this study were to investigate the occurrence, types and severity of malocclusions in children with speech sound disorder (SSD) persisting after 6 years of age, and to compare these findings to a control group of children with typical speech development (TSD). METHODS In total, 105 children were included: 61 with SSD and motor speech involvement (mean age 8:5 ± 2:8 years; range 6:0-16:7 years, 14 girls and 47 boys) and 44 children with TSD (mean age 8:8 ± 1:6; range 6:0-12:2 years, 19 girls and 25 boys). Extra-oral and intra-oral examinations were performed by an orthodontist. The severity of malocclusion was scored using the IOTN-DHC Index. RESULTS There were differences between the SSD and TSD groups with regard to the prevalence, type, and severity of malocclusions; 61% of the children in the SSD group had a malocclusion, as compared to 29% in the TSD group. In addition, the malocclusions in the SSD group were rated as more severe. Functional posterior crossbite and habitual lateral and/or anterior shift appeared more frequently in the SSD group. Class III malocclusion, anterior open bite and scissors bite were found only in the SSD group. CONCLUSION Children with SSD and motor speech involvement are more likely to have a higher prevalence of and more severe malocclusions than children with TSD.
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Fiori S, Pannek K, Podda I, Cipriani P, Lorenzoni V, Franchi B, Pasquariello R, Guzzetta A, Cioni G, Chilosi A. Neural Changes Induced by a Speech Motor Treatment in Childhood Apraxia of Speech: A Case Series. J Child Neurol 2021; 36:958-967. [PMID: 34315296 PMCID: PMC8461047 DOI: 10.1177/08830738211015800] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We report a case series of children with childhood apraxia of speech, by describing behavioral and white matter microstructural changes following 2 different treatment approaches.Five children with childhood apraxia of speech were assigned to a motor speech treatment (PROMPT) and 5 to a language, nonspeech oral motor treatment. Speech assessment and brain MRI were performed pre- and post-treatment. The ventral (tongue/larynx) and dorsal (lips) corticobulbar tracts were reconstructed in each subject. Mean fractional anisotropy and mean diffusivity were extracted. The hand corticospinal tract was assessed as a control pathway. In both groups speech improvements paralleled changes in the left ventral corticobulbar tract fractional anisotropy. The PROMPT treated group also showed fractional anisotropy increase and mean diffusivity decrease in the left dorsal corticobulbar tract. No changes were detected in the hand tract. Our results may provide preliminary support to the possible neurobiologic effect of a multimodal speech motor treatment in childhood apraxia of speech.
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Affiliation(s)
- Simona Fiori
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Pisa, Italy,Simona Fiori, MD, PhD, Department of Developmental Neuroscience, Stella Maris Foundation, Viale del Tirreno 331, 56128, Pisa, Italy.
| | - Kerstin Pannek
- CSIRO, Health and Biosecurity, Australian E-Health Research Centre, Brisbane, Australia
| | - Irina Podda
- Parole al Centro, Studio di Logopedia e Neuropsicomotricità, Genova, Italy
| | - Paola Cipriani
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Pisa, Italy
| | - V. Lorenzoni
- Institute of Management, Scuola Superiore Sant’Anna, Pisa, Italy
| | - Beatrice Franchi
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Pisa, Italy
| | - Rosa Pasquariello
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Pisa, Italy
| | - Andrea Guzzetta
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Pisa, Italy,Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Giovanni Cioni
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Pisa, Italy,Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Anna Chilosi
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Pisa, Italy
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Icht M. Improving speech characteristics of young adults with congenital dysarthria: An exploratory study comparing articulation training and the Beatalk method. JOURNAL OF COMMUNICATION DISORDERS 2021; 93:106147. [PMID: 34461556 DOI: 10.1016/j.jcomdis.2021.106147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 08/06/2021] [Accepted: 08/16/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION This exploratory study compared the effects of two speech therapy approaches on speech characteristics of young adults with congenital dysarthria resulting from various etiologies: a) articulation training focusing on consonant articulation exercises at various levels (isolation, syllables, and words), and b) the Beatalk method, based on human beatboxing, i.e., producing various instrumental sounds in an a-cappella musical context. Both interventions were designed to increase participants' speech intelligibility. METHODS Twelve adults with congenital dysarthria and reduced speech intelligibility participated in treatment groups for eight weeks. Six participants were assigned to the articulation training group, and six to the Beatalk group. Intelligibility of single words and continuous speech, voice measures, and oral-diadochokinesis rates were measured before and after the treatment. RESULTS The results showed that the Beatalk intervention yielded a significant overall pre- to post-treatment effect. Specifically, it resulted in gains in articulatory accuracy and intelligibility for single words. Improvements were not noted following articulation training. CONCLUSIONS The results present initial evidence of the positive effect of the Beatalk method as an intervention tool for adults with congenital dysarthria. This relatively easy-to-learn technique shows promise, as it involves intense and repetitive production of speech sounds while controlling rhythm and breathing in an enjoyable context.
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Affiliation(s)
- Michal Icht
- Department of Communication Disorders, Ariel University 40700, Israel.
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Case J, Grigos MI. The Effect of Practice on Variability in Childhood Apraxia of Speech: A Multidimensional Analysis. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:1477-1495. [PMID: 33826355 DOI: 10.1044/2021_ajslp-20-00167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose Variability has been interpreted in differing ways according to context (e.g., development, speech impairment, and learning). A challenge arises when interpreting variability in the context of learning for children with speech impairment characterized by high movement variability, as in childhood apraxia of speech (CAS). The objective of this study is to investigate changes in variability in CAS with practice in comparison to patterns seen in children with non-CAS speech sound disorders (SSD) and typical development. Method Speech production variability was examined in 24 children (5-6 years of age) with CAS, non-CAS SSD, and typical development in production of nonwords of varied motoric complexity. Multidimensional analyses were performed using measures of token-to-token speech consistency (percent word consistency), acoustic variability (acoustic spatiotemporal index), and movement variability (lip aperture spatiotemporal index). Changes in variability were examined in each group of children by comparing the first half to the last half of nonword tokens in the same data collection session. The impact of token complexity on practice effects was also explored across groups of children. Results All children displayed increased speech consistency within this practice period (p = .01). Only children with CAS displayed increased movement variability following practice (p = .01). Differences in acoustic and kinematic variability were observed across complexity levels in all groups, though these did not interact with practice effects. Discussion These findings suggest that increased movement variability in children with CAS might be facilitating perceptual consistency. It is believed that this finding reflects an inefficient strategy adapted by children with CAS in the absence of motor-based cueing and feedback to guide speech performance with practice.
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Affiliation(s)
- Julie Case
- Department of Speech-Language-Hearing Sciences, Hofstra University, Hempstead, NY
| | - Maria I Grigos
- Department of Communicative Sciences and Disorders, New York University, New York City
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Mogren Å, McAllister A, Sjögreen L. Range of motion (ROM) in the lips and jaw during vowels assessed with 3D motion analysis in Swedish children with typical speech development and children with speech sound disorders. LOGOP PHONIATR VOCO 2021; 47:219-229. [PMID: 33660562 DOI: 10.1080/14015439.2021.1890207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE The aim was to compare movement patterns of lips and jaw in lateral, vertical and anteroposterior directions during vowel production in children with typical speech development (TSD) and in children with speech sound disorders (SSD) persisting after the age of six. METHODS A total of 93 children were included, 42 children with TSD (6:0-12:2 years, mean age 8:9 ± 1:5, 19 girls and 23 boys) and 51 children with SSD (6:0-16:7 years, mean age 8:5 ± 3:0, 14 girls and 37 boys). Range of motion (ROM) in lips and jaw in the vowels [a, ʊ, ɪ] produced in a syllable repetition task and median values in resting position were measured with a system for 3D motion analysis. The analysis was based on the coordinates for the mouth corners and the chin centre. RESULTS There were significant differences between the groups on movements in lateral direction in both lips and jaw. Children with TSD had generally smaller and more, symmetrical movements in the lips and jaw, in all three dimensions compared to children with SSD. There were no significant differences between the groups in resting position. CONCLUSION Children with SSD persisting after the age of six years show more asymmetrical and more variable movement patterns in lips and jaw during vowel production compared with children with TSD in a simple syllable repetition task. Differences were more pronounced in lateral direction in both lips and jaw.
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Affiliation(s)
- Åsa Mogren
- Division of Speech and Language Pathology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.,Mun-H-Center, Orofacial Resource Centre for Rare Diseases, Public Dental Service, Gothenburg, Sweden
| | - Anita McAllister
- Division of Speech and Language Pathology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.,Functional Area Speech and Language Pathology, Karolinska University Hospital, Stockholm, Sweden
| | - Lotta Sjögreen
- Mun-H-Center, Orofacial Resource Centre for Rare Diseases, Public Dental Service, Gothenburg, Sweden.,Department of Health and Rehabilitation, Sahlgrenska Academy, Institute of Neuroscience and Physiology, Gothenburg, Sweden
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Beckers LWME, Stal RA, Smeets RJEM, Onghena P, Bastiaenen CHG. Single-case Design Studies in Children with Cerebral Palsy: A Scoping Review. Dev Neurorehabil 2020; 23:73-105. [PMID: 31411523 DOI: 10.1080/17518423.2019.1645226] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Aim: To critically evaluate single-case design (SCD) studies performed within the population of children/adolescents with cerebral palsy (CP).Methods: A scoping review of SCD studies of children/adolescents with CP. Demographic, methodological, and statistical data were extracted. Articles were evaluated using the Risk of Bias in N-of-1 Trials (RoBiNT) Scale and the Consolidated Standards of Reporting Trials (CONSORT) extension for N-of-1 trials (CENT 2015). Comments regarding strengths and limitations were analyzed.Results: Studies investigated the effects of a wide range of interventions on various outcomes. Most SCD types were adopted in multiple studies. All studies used visual inspection rather than visual analysis, often complemented with basic statistical descriptives. Risk of bias was high, particularly concerning internal validity. Many CENT items were insufficiently reported. Several benefits and limitations of SCD were identified.Conclusions: The quality of evidence from results of SCD studies needs to be increased through risk of bias reduction.
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Affiliation(s)
- Laura W M E Beckers
- Department of Rehabilitation Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands.,Centre of Expertise in Rehabilitation and Audiology, Adelante, Hoensbroek, Netherlands
| | - Rosalinde A Stal
- Department of Epidemiology, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
| | - Rob J E M Smeets
- Department of Rehabilitation Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands.,CIR Revalidatie, Location Eindhoven, Eindhoven, Netherlands
| | - Patrick Onghena
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Caroline H G Bastiaenen
- Department of Epidemiology, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
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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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Herreras Mercado R, Simpson K, Bellom-Rohrbacher KH. Effect of Prompts for Restructuring Oral Muscular Phonetic Targets (PROMPT) on Compensatory Articulation in Children With Cleft Palate/Lip. Glob Pediatr Health 2019; 6:2333794X19851417. [PMID: 31223632 PMCID: PMC6566466 DOI: 10.1177/2333794x19851417] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 04/16/2019] [Accepted: 04/16/2019] [Indexed: 11/16/2022] Open
Abstract
Objective. This investigation researched the effectiveness of the PROMPT (Prompts for Restructuring Oral Muscular Phonetic Targets) method to address compensatory articulation errors in children with cleft palate. Design. Single-subject AB multiple baselines across participants and behaviors. Setting. Pediatric outpatient rehabilitation department in a local hospital in a metropolitan city. Participants. The investigation consisted of 3 participants (ages = 4:4 to 12:8) born with bilateral complete cleft lip and palate. All participants underwent several reconstructive surgeries to repair their lips and palates. Interventions. The PROMPT treatment was provided for 45 minutes 3 times a week for 4 weeks (3 weeks for Participant 2). Main Outcome Measure. Therapy sessions addressed anterior lingual speech motor phonemes across 3 tiers (syllables, words, and phrases). Results. Direct visual observation of data obtained throughout this investigation indicate potential positive effects and significant correlation between improvements in sound production at 3 tiers and the implementation of the PROMPT technique. Speech intelligibility was judged by 3 blinded listeners who were unfamiliar with children with speech disorders or with cleft palate speech. All listeners identified and judged improvement in overall speech intelligibility over the course of this investigation. Listeners examined speech samples selected from sessions 3, 6, 9, and 12. Conclusion. The findings in this investigation provide a potential relationship on the effectiveness of the PROMPT method and attainment of accurate speech productions in children with cleft palate producing compensatory articulation errors, resulting in improvement in overall speech intelligibility.
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Affiliation(s)
| | - Kenneth Simpson
- Rocky Mountain University of Health Professions, Provo, UT, USA
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Schölderle T, Staiger A, Schumacher B, Ziegler W. The Impact of Dysarthria on Laypersons' Attitudes towards Adults with Cerebral Palsy. Folia Phoniatr Logop 2019; 71:309-320. [PMID: 31117109 DOI: 10.1159/000493916] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 09/19/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE This study investigated laypersons' attitudes towards adults with dysarthria due to cerebral palsy (CP). We aimed to explore the impact of the overall severity and of specific symptoms of dysarthria on laypersons' evaluations. PATIENTS AND METHODS Eighteen adults with dysarthria due to CP and 6 nondysarthric controls participated as speakers. The individuals with CP underwent dysarthria assessment based on a standardized tool. The results were compared to those of a listening experiment with 20 laypersons. A text passage spoken by all speakers was presented to the listeners, who provided their evaluations using rating scales specifically developed for this study. The tool addressed 3 dimensions of attitudes: (1) estimation of a speaker's cognitive-linguistic abilities; (2) attribution of personality and social characteristics, and (3) listeners' emotions and behavioral tendencies towards the speaker. RESULTS Severity of dysarthria was strongly correlated with the overall attitudes. Regression analyses identified different symptoms as predictors of the listeners' judgements. CONCLUSION Severity of dysarthria seems to have a major impact on laypersons' attitudes. Results suggest that speech symptoms may have a very specific influence on laypersons' evaluations. This may be important for clinical care, since symptoms with the most negative impact should be focused on in treatment.
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Affiliation(s)
- Theresa Schölderle
- Clinical Neuropsychology Research Group, Institute for Phonetics and Speech Processing, Ludwig-Maximilians-University, Munich, Germany,
| | - Anja Staiger
- Clinical Neuropsychology Research Group, Institute for Phonetics and Speech Processing, Ludwig-Maximilians-University, Munich, Germany
| | - Barbara Schumacher
- Clinical Neuropsychology Research Group, Institute for Phonetics and Speech Processing, Ludwig-Maximilians-University, Munich, Germany
| | - Wolfram Ziegler
- Clinical Neuropsychology Research Group, Institute for Phonetics and Speech Processing, Ludwig-Maximilians-University, Munich, Germany
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Nip ISB, Arias CR, Morita K, Richardson H. Initial Observations of Lingual Movement Characteristics of Children With Cerebral Palsy. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2017; 60:1780-1790. [PMID: 28655047 PMCID: PMC5544404 DOI: 10.1044/2017_jslhr-s-16-0239] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 10/24/2016] [Accepted: 11/29/2016] [Indexed: 05/19/2023]
Abstract
PURPOSE This preliminary study compared the speech motor control of the tongue and jaw between children with cerebral palsy (CP) and their typically developing (TD) peers. METHOD Tongue tip and jaw movements of 4 boys with spastic CP and 4 age- and sex-matched TD peers were recorded using an electromagnetic articulograph during 10 repetitions of "Dad told stories today." The duration, path distance, average speed, and speech movement stability of the movements were calculated for each repetition. RESULTS The children with CP had longer durations than their TD peers. Children with CP had longer path distances and faster average speed as compared with their TD peers for both articulators. The TD group but not the CP group had longer path distances and faster average speeds for the tongue than the jaw. The CP group had reduced speech movement stability for the tongue as compared with their TD peers, but both groups had similar speech movement stability for the jaw. CONCLUSIONS Children with CP had impaired speech motor control of the tongue and jaw as compared with their TD peers, and these speech motor control deficits were more pronounced in the tongue tip than the jaw.
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Affiliation(s)
- Ignatius S B Nip
- School of Speech, Language, & Hearing Sciences, San Diego State University, CA
| | - Carlos R Arias
- School of Speech, Language, & Hearing Sciences, San Diego State University, CA
| | - Kristen Morita
- School of Speech, Language, & Hearing Sciences, San Diego State University, CA
| | - Hannah Richardson
- School of Speech, Language, & Hearing Sciences, San Diego State University, CA
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Abstract
The current study investigates how interarticulator coordination changes across speaking tasks varying in articulatory and linguistic demands for children with CP and their typically-developing peers. Articulatory movements from 12 children with spastic CP (7M, 5F, 4-15 years of age) and 12 typically-developing age- and sex-matched peers were cross-correlated to determine the degree of spatial and temporal coupling between the upper lip and jaw, lower lip and jaw, and upper and lower lips. Spatial and temporal coupling were also correlated with intelligibility. Results indicated that children with CP have reduced spatial coupling between the upper and lower lips and reduced temporal coupling between all articulators as compared to their typically-developing peers. For all participants, sentences were produced with the greatest degree of interarticulator coordination when compared to the diadochokinetic and syllable repetition tasks. Measures of interarticulator coordination were correlated with intelligibility for the speakers with CP.
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Affiliation(s)
- Ignatius S B Nip
- a School of Speech, Language, and Hearing Sciences, San Diego State University , San Diego , CA , USA
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Pennington L, Parker NK, Kelly H, Miller N. Speech therapy for children with dysarthria acquired before three years of age. Cochrane Database Syst Rev 2016; 7:CD006937. [PMID: 27428115 PMCID: PMC6457859 DOI: 10.1002/14651858.cd006937.pub3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Children with motor impairments often have the motor speech disorder dysarthria, a condition which effects the tone, strength and co-ordination of any or all of the muscles used for speech. Resulting speech difficulties can range from mild, with slightly slurred articulation and breathy voice, to profound, with an inability to produce any recognisable words. Children with dysarthria are often prescribed communication aids to supplement their natural forms of communication. However, there is variation in practice regarding the provision of therapy focusing on voice and speech production. Descriptive studies have suggested that therapy may improve speech, but its effectiveness has not been evaluated. OBJECTIVES To assess whether any speech and language therapy intervention aimed at improving the speech of children with dysarthria is more effective in increasing children's speech intelligibility or communicative participation than no intervention at all , and to compare the efficacy of individual types of speech language therapy in improving the speech intelligibility or communicative participation of children with dysarthria. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2015 , Issue 7 ), MEDLINE, EMBASE, CINAHL , LLBA, ERIC, PsychInfo, Web of Science, Scopus, UK National Research Register and Dissertation Abstracts up to July 2015, handsearched relevant journals published between 1980 and July 2015, and searched proceedings of relevant conferences between 1996 to 2015. We placed no restrictions on the language or setting of the studies. A previous version of this review considered studies published up to April 2009. In this update we searched for studies published from April 2009 to July 2015. SELECTION CRITERIA We considered randomised controlled trials and studies using quasi-experimental designs in which children were allocated to groups using non-random methods. DATA COLLECTION AND ANALYSIS One author (LP) conducted searches of all databases, journals and conference reports. All searches included a reliability check in which a second review author independently checked a random sample comprising 15% of all identified reports. We planned that two review authors would independently assess the quality and extract data from eligible studies. MAIN RESULTS No randomised controlled trials or group studies were identified. AUTHORS' CONCLUSIONS This review found no evidence from randomised trials of the effectiveness of speech and language therapy interventions to improve the speech of children with early acquired dysarthria. Rigorous, fully powered randomised controlled trials are needed to investigate if the positive changes in children's speech observed in phase I and phase II studies are generalisable to the population of children with early acquired dysarthria served by speech and language therapy services. Research should examine change in children's speech production and intelligibility. It must also investigate children's participation in social and educational activities, and their quality of life, as well as the cost and acceptability of interventions.
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Affiliation(s)
- Lindsay Pennington
- Newcastle UniversityInstitute of Health and SocietySir James Spence Institute ‐ Royal Victoria InfirmaryQueen Victoria RoadNewcastle upon TyneUKNE1 4LP
| | - Naomi K Parker
- Newcastle UniversityInstitute of Health and SocietySir James Spence Institute ‐ Royal Victoria InfirmaryQueen Victoria RoadNewcastle upon TyneUKNE1 4LP
| | - Helen Kelly
- Newcastle UniversityInstitute of Health and SocietySir James Spence Institute ‐ Royal Victoria InfirmaryQueen Victoria RoadNewcastle upon TyneUKNE1 4LP
| | - Nick Miller
- Newcastle UniversityInstitute of Health and SocietySir James Spence Institute ‐ Royal Victoria InfirmaryQueen Victoria RoadNewcastle upon TyneUKNE1 4LP
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Sjögreen L, Eklund K, Nilsson A, Persson C. Speech production, intelligibility and oromotor function in seven individuals with Möbius sequence. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2015; 17:537-544. [PMID: 25833072 DOI: 10.3109/17549507.2015.1016108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE Möbius sequence is a rare disease characterized by congenital facial and abducent nerve palsy. Other cranial nerves may be affected. Cleft palate, intellectual disability and neuropsychiatric disorders are associated with the diagnosis. The aim was to explore speech production, intelligibility and oromotor function in a group of individuals with Möbius sequence. METHOD Three children (5-11 years) and four adults (26-54 years) were recruited to the study via the Swedish Möbius syndrome association. In addition to cranial nerve dysfunction, two had a hearing impairment, one Asperger syndrome and one a cleft palate. Perceptual assessments included an evaluation of intelligibility in single words and spontaneous speech, the percentage of phonemes correct (PPC) and screening of orofacial functions (NOT-S). Objective measurements were used for the evaluation of nasality, lip force and tongue force. RESULT Three individuals had severely impaired intelligibility, two slightly impaired and two had fully intelligible speech. The PPC varied between 59.3-100%. Five individuals had bilateral facial palsy, two unilateral facial palsy and six tongue impairment. One had a slightly increased nasalance score. Compensatory strategies were being effectively used. CONCLUSION This case series contributes more in-depth knowledge of speech production, intelligibility and oromotor function in this rare condition.
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Affiliation(s)
- Lotta Sjögreen
- a Mun-H-Center Orofacial Resource Centre for Rare Diseases, Public Dental Service , Västra Götaland Region, Gothenburg , Sweden
| | - Kajsa Eklund
- b Division of Speech and Language Pathology, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg , Sweden
| | - Anna Nilsson
- b Division of Speech and Language Pathology, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg , Sweden
| | - Christina Persson
- b Division of Speech and Language Pathology, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg , Sweden
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Kearney E, Granata F, Yunusova Y, van Lieshout P, Hayden D, Namasivayam A. Outcome Measures in Developmental Speech Sound Disorders with a Motor Basis. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2015. [DOI: 10.1007/s40474-015-0058-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Mary Watson R, Pennington L. Assessment and management of the communication difficulties of children with cerebral palsy: a UK survey of SLT practice. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2015; 50:241-59. [PMID: 25652139 PMCID: PMC4371637 DOI: 10.1111/1460-6984.12138] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 09/01/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND Communication difficulties are common in cerebral palsy (CP) and are frequently associated with motor, intellectual and sensory impairments. Speech and language therapy research comprises single-case experimental design and small group studies, limiting evidence-based intervention and possibly exacerbating variation in practice. AIMS To describe the assessment and intervention practices of speech-language therapist (SLTs) in the UK in their management of communication difficulties associated with CP in childhood. METHODS & PROCEDURES An online survey of the assessments and interventions employed by UK SLTs working with children and young people with CP was conducted. The survey was publicized via NHS trusts, the Royal College of Speech and Language Therapists (RCSLT) and private practice associations using a variety of social media. The survey was open from 5 December 2011 to 30 January 2012. OUTCOMES & RESULTS Two hundred and sixty-five UK SLTs who worked with children and young people with CP in England (n = 199), Wales (n = 13), Scotland (n = 36) and Northern Ireland (n = 17) completed the survey. SLTs reported using a wide variety of published, standardized tests, but most commonly reported assessing oromotor function, speech, receptive and expressive language, and communication skills by observation or using assessment schedules they had developed themselves. The most highly prioritized areas for intervention were: dysphagia, alternative and augmentative (AAC)/interaction and receptive language. SLTs reported using a wide variety of techniques to address difficulties in speech, language and communication. Some interventions used have no supporting evidence. Many SLTs felt unable to estimate the hours of therapy per year children and young people with CP and communication disorders received from their service. CONCLUSIONS & IMPLICATIONS The assessment and management of communication difficulties associated with CP in childhood varies widely in the UK. Lack of standard assessment practices prevents comparisons across time or services. The adoption of a standard set of agreed clinical measures would enable benchmarking of service provision, permit the development of large-scale research studies using routine clinical data and facilitate the identification of potential participants for research studies in the UK. Some interventions provided lack evidence. Recent systematic reviews could guide intervention, but robust evidence is needed in most areas addressed in clinical practice.
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Affiliation(s)
- Rose Mary Watson
- Institute of Health and Society, Newcastle UniversityNewcastle upon Tyne, UK
| | - Lindsay Pennington
- Institute of Health and Society, Newcastle UniversityNewcastle upon Tyne, UK
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Square PA, Namasivayam AK, Bose A, Goshulak D, Hayden D. Multi-sensory treatment for children with developmental motor speech disorders. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2014; 49:527-542. [PMID: 24617702 DOI: 10.1111/1460-6984.12083] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 12/13/2013] [Indexed: 06/03/2023]
Affiliation(s)
- Paula A Square
- Department of Speech-Language Pathology, University of Toronto, Toronto, ON, Canada
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Hayden D, Namasivayam AK, Ward R. The assessment of fidelity in a motor speech-treatment approach. SPEECH LANGUAGE AND HEARING 2014. [PMID: 26213623 PMCID: PMC4500455 DOI: 10.1179/2050572814y.0000000046] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective To demonstrate the application of the constructs of treatment fidelity for research and clinical practice for motor speech disorders, using the Prompts for Restructuring Oral Muscular Phonetic Targets (PROMPT) Fidelity Measure (PFM). Treatment fidelity refers to a set of procedures used to monitor and improve the validity and reliability of behavioral intervention. While the concept of treatment fidelity has been emphasized in medical and allied health sciences, documentation of procedures for the systematic evaluation of treatment fidelity in Speech-Language Pathology is sparse. Methods The development and iterative process to improve the PFM, is discussed. Further, the PFM is evaluated against recommended measurement strategies documented in the literature. This includes evaluating the appropriateness of goals and objectives; and the training of speech–language pathologists, using direct and indirect procedures. Three expert raters scored the PFM to examine inter-rater reliability. Results Three raters, blinded to each other's scores, completed fidelity ratings on three separate occasions. Inter-rater reliability, using Krippendorff's Alpha, was >80% for the PFM on the final scoring occasion. This indicates strong inter-rater reliability. Conclusion The development of fidelity measures for the training of service providers and treatment delivery is important in specialized treatment approaches where certain ‘active ingredients’ (e.g. specific treatment targets and therapeutic techniques) must be present in order for treatment to be effective. The PFM reflects evidence-based practice by integrating treatment delivery and clinical skill as a single quantifiable metric. PFM enables researchers and clinicians to objectively measure treatment outcomes within the PROMPT approach.
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Landa S, Pennington L, Miller N, Robson S, Thompson V, Steen N. Association between objective measurement of the speech intelligibility of young people with dysarthria and listener ratings of ease of understanding. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2014; 16:408-416. [PMID: 25011400 DOI: 10.3109/17549507.2014.927922] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE This study aimed to investigate the association between listeners' ratings of how much effort it took to understand the speech of young people with cerebral palsy and the percentage of words listeners actually understood. METHOD Thirty-one young people with dysarthria and cerebral palsy (16 males, 15 females; mean age = 11 years, SD = 3) were audio recorded repeating single words and producing speech. Objective measures of intelligibility were calculated for multiple familiar and unfamiliar listeners using a forced choice paradigm for single words and verbatim orthographic transcriptions for connected speech. Listeners rated how much effort it took to understand speech in each condition using a 5-point ordinal ease of listening (EOL) scale. RESULTS Agreement on EOL within rater groups was high (ICC > 0.71). An effect of listener was observed for familiar listeners, but not for unfamiliar listeners. EOL agreement between familiar and unfamiliar listeners was weak-moderate (ICC = 0.46). EOL predicted the percentage of speech actually understood by familiar and unfamiliar listeners (r > 0.56, p < 0.001 for all predictions). Strongest associations between EOL and intelligibility were observed for speakers with mild and profound impairments. CONCLUSIONS The findings of this study demonstrate that listeners can judge how well they have understood dysarthric speech. EOL is associated with listener familiarity, speech task and speech impairment severity. EOL is appropriate for use in clinical practice as a measure of communication activity.
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Ward R, Leitão S, Strauss G. An evaluation of the effectiveness of PROMPT therapy in improving speech production accuracy in six children with cerebral palsy. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2014; 16:355-371. [PMID: 24521506 DOI: 10.3109/17549507.2013.876662] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
This study evaluates perceptual changes in speech production accuracy in six children (3-11 years) with moderate-to-severe speech impairment associated with cerebral palsy before, during, and after participation in a motor-speech intervention program (Prompts for Restructuring Oral Muscular Phonetic Targets). An A1BCA2 single subject research design was implemented. Subsequent to the baseline phase (phase A1), phase B targeted each participant's first intervention priority on the PROMPT motor-speech hierarchy. Phase C then targeted one level higher. Weekly speech probes were administered, containing trained and untrained words at the two levels of intervention, plus an additional level that served as a control goal. The speech probes were analysed for motor-speech-movement-parameters and perceptual accuracy. Analysis of the speech probe data showed all participants recorded a statistically significant change. Between phases A1-B and B-C 6/6 and 4/6 participants, respectively, recorded a statistically significant increase in performance level on the motor speech movement patterns targeted during the training of that intervention. The preliminary data presented in this study make a contribution to providing evidence that supports the use of a treatment approach aligned with dynamic systems theory to improve the motor-speech movement patterns and speech production accuracy in children with cerebral palsy.
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Yu VY, Kadis DS, Oh A, Goshulak D, Namasivayam A, Pukonen M, Kroll R, De Nil LF, Pang EW. Changes in voice onset time and motor speech skills in children following motor speech therapy: Evidence from /pa/ productions. CLINICAL LINGUISTICS & PHONETICS 2014; 28:396-412. [PMID: 24446799 PMCID: PMC4885741 DOI: 10.3109/02699206.2013.874040] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
This study evaluated changes in motor speech control and inter-gestural coordination for children with speech sound disorders (SSD) subsequent to Prompts for Restructuring Oral and Muscular Phonetic Targets (PROMPT) intervention. We measured the distribution patterns of voice onset time (VOT) for a voiceless stop (/p/) to examine the changes in inter-gestural coordination. Two standardized tests were used (Verbal Motor Production Assessment for Children (VMPAC), GFTA-2) to assess the changes in motor speech skills and articulation. Data showed positive changes in patterns of VOT with a lower pattern of variability. All children showed significantly higher scores for VMPAC, but only some children showed higher scores for GFTA-2. Results suggest that the proprioceptive feedback provided through PROMPT had a positive influence on speech motor control and inter-gestural coordination in voicing behavior. This set of VOT data for children with SSD adds to our understanding of the speech characteristics underlying speech motor control. Directions for future studies are discussed.
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Affiliation(s)
- Vickie Y. Yu
- Neurosciences and Mental Health, Sick Kids Research Institute, 555 University Avenue, Toronto, Ontario, M5G 1X8
- Division of Neurology, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8
| | - Darren S. Kadis
- Division of Neurology and Pediatric Neuroimaging Research Consortium, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH
| | - Anna Oh
- Neurosciences and Mental Health, Sick Kids Research Institute, 555 University Avenue, Toronto, Ontario, M5G 1X8
| | - Debra Goshulak
- The Speech & Stuttering Institute, 2-150 Duncan Mill Road, Toronto, Ontario M3B 3M4
| | - Aravind Namasivayam
- The Speech & Stuttering Institute, 2-150 Duncan Mill Road, Toronto, Ontario M3B 3M4
| | - Margit Pukonen
- The Speech & Stuttering Institute, 2-150 Duncan Mill Road, Toronto, Ontario M3B 3M4
| | - Robert Kroll
- The Speech & Stuttering Institute, 2-150 Duncan Mill Road, Toronto, Ontario M3B 3M4
| | - Luc F. De Nil
- Department of Speech-Language Pathology, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7
| | - Elizabeth W. Pang
- Neurosciences and Mental Health, Sick Kids Research Institute, 555 University Avenue, Toronto, Ontario, M5G 1X8
- Division of Neurology, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8
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