Journal of medical speech-language pathology最新文献

Cochlear implants (CI) have demonstrated success in improving young deaf children's speech and low-level speech awareness across a range of auditory functions, but this success is highly variable, and how this success correlates to high-level language development is even more variable. Prevalence on the success rate of CI as an outcome for language development is difficult to obtain because studies vary widely in methodology and variables of interest, and because not all cochlear implant technology (which continues to evolve) is the same. Still, even if the notion of treatment failure is limited narrowly to those who gain no auditory benefit from CI in that they cannot discriminate among ambient noises, the reported treatment failure rate is high enough to call into question the current lack of consideration of alternative approaches to ensure young deaf children's language development. Recent research has highlighted the risks of delaying language input during critical periods of brain development with concomitant consequences for cognitive and social skills. As a result, we propose that before, during, and after implantation deaf children learn a sign language along with a spoken language to ensure their maximal language development and optimal long-term developmental outcomes.

Purpose: To describe the types of talking tracheostomy tubes available, present four case studies of critically ill patients who used a specialized tracheostomy tube to improve speech, discuss their advantages and disadvantages, propose patient selection criteria, and provide practical recommendations for medical care providers.

Methods: Retrospective chart review of patients who underwent tracheostomy in 2010.

Results: Of the 220 patients who received a tracheostomy in 2010, 164 (74.55%) received a percutaneous tracheostomy and 56 (25.45%) received an open tracheostomy. Among the percutaneous tracheostomy patients, speech-language pathologists were consulted on 113 patients, 74 of whom were on a ventilator. Four of these 74 patients received a talking tracheostomy tube, and all four were able to speak successfully while on the mechanical ventilator even though they were unable to tolerate cuff deflation.

Conclusions: Talking tracheostomy tubes allow patients who are unable to tolerate-cuff deflation to achieve phonation. Our experience with talking tracheostomy tubes suggests that clinicians should consider their use for patients who cannot tolerate cuff deflation.

This case describes the course of a patient who was admitted to an acute care hospital with pneumonia and odynophagia and found to have severe, idiopathic oropharyngeal dysphagia. The assessment, treatment, and outcome are reported alongside suggestions for best practice in the treatment of dysphagia in hospital settings. Timely instrumental assessment, interdisciplinary management, and post-discharge follow-up were needed to provide optimum care and to achieve a positive outcome for this patient with life-threatening dysphagia.

Background: A systematic review of the use of stroboscopy as a treatment outcome measure of vocal fold function in patients treated for laryngeal cancer is presented.

Methods: Computerized literature searches were performed. Eligible articles were admitted when stroboscopy was used to measure vocal fold function before and after treatment in patients with laryngeal cancer. Data extracted included: tumor stage and location, treatment modality, stroboscopy parameters, parameter scale, number of raters, rater reliability, methodology, and level of evidence.

Results: Of 520 articles retrieved, 11 studies met inclusion criteria. A total of twenty-four parameters were reported. Rating scales and rater reliability varied.

Discussion: Major methodological differences exist in studies using stroboscopic findings as voice outcome measures in patients' post-cancer treatment. These differences lead to equivocal findings when assessing the utility of stroboscopy as an outcome measure. Standardized, reliable scoring and reporting systems for laryngeal stroboscopic examinations are needed.

In Parkinson's Disease (PD), qualitative speech changes such as decreased variation in pitch and loudness are common, but quantitative vocal changes are not well documented. The variability of fundamental frequency (F0) in 32 individuals (23 male) with PD both ON and OFF levodopa medication was compared with 32 age-matched healthy controls (23 male). Participants read a single paragraph and estimates of fundamental frequency (F0) variability were determined for the entire reading passage as well as for the first and last sentences of the passage separately. F0 variability was significantly increased in controls relative to both PD groups and PD patients showed significantly higher F0 variability while ON medication relative to OFF. No significant effect of group was seen in the change in F0 variability from the beginning to the end of the reading passage. Female speakers were found to have higher F0 variability than males. F0 variability was both significantly reduced in PD relative to controls and significantly increased in patients with PD during use of dopaminergic medications. F0 variability changes over the course of reading a paragraph may not be indicative of PD but rather dependent on non-disease factors such as the linguistic characteristics of the text.

Purpose: The goal of this exploratory study was to investigate longitudinally the changes in facial kinematics, vowel formant frequencies, and speech intelligibility in individuals diagnosed with bulbar amyotrophic lateral sclerosis (ALS). This study was motivated by the need to understand articulatory and acoustic changes with disease progression and their subsequent effect on deterioration of speech in ALS.

Method: Lip and jaw movements and vowel acoustics were obtained for four individuals with bulbar ALS during four consecutive recording sessions with an average interval of three months between recordings. Participants read target words embedded into sentences at a comfortable speaking rate. Maximum vertical and horizontal mouth opening and maximum jaw displacements were obtained during corner vowels. First and second formant frequencies were measured for each vowel. Speech intelligibility and speaking rate score were obtained for each session as well.

Results: Transient, non-vowel-specific changes in kinematics of the jaw and lips were observed. Kinematic changes often preceded changes in vowel acoustics and speech intelligibility.

Conclusions: Nonlinear changes in speech kinematics should be considered in evaluation of the disease effects on jaw and lip musculature. Kinematic measures might be most suitable for early detection of changes associated with bulbar ALS.

Many individuals with cerebral palsy (CP) have a slower speaking rate compared with their typically developing peers. Previous studies examining age-related changes in speaking rate in typical development suggest that (1) cognitive and linguistic processing increases account for most of these changes, and (2) changes to linguistic task demands affect the articulatory strategies used to produce the target stimuli (e.g., truncating movements for tasks with fewer linguistic demands). The purpose of this study was to determine the relations between linguistic and physiologic factors in individuals with CP to better understand how the pathophysiology of CP affects speech production in these individuals. Four participants with CP and 38 age-matched peers were asked to complete a diadochokinetic (DDK) task, a vowel-consonant-vowel syllable repetition task, and a sentence repetition task. Speaking rate for the tasks and lower lip maximum movement speed, range of movement, and duration of the closing and opening gestures common to each task were measured. In general, participants with CP have reduced speaking rates compared with their typically developing peers despite increased movement speeds. In both groups, linguistic task effects were observed; higher linguistic demands resulted in slower speaking rates and higher movement speeds. Range of movement was greater for participants with CP than their typically developing peers and may have contributed to the observed decreased speaking rates in individuals with CP.

American English can be produced with two types of /s/: apical or laminal. These productions differ in that the apical gesture requires independent tongue tip elevation, and the laminal does not. Postglossectomy speakers, who have lost a unilateral portion of the tongue body along the outer edge, lose innervation to the tongue tip. We hypothesize that postglossectomy patients, even those with a preserved tongue tip, will be more likely to use laminal tongue shapes because of reduced control of the tongue tip. This study examines /s/ type, palate height, and related parameters in 24 control participants and 13 patients with lateral resections using cine-MRI and dental casts. Results of this dataset show that palate height affects choice of /s/ in control participants, but not in patients. Patients tend to use laminal /s/.

Exaggerated and redundant prosodic cue use has been noted among adults with dysarthria secondary to cerebral palsy (CP) (Patel, 2004; van Doorn & Sheard, 2001). A possible explanation may be that speakers heighten prosodic contrasts to increase intelligibility. The current work examined whether children with dysarthria due to CP also produce exaggerated prosodic contours and if so, how prosodic cue use in these speakers impacts intelligibility. Acoustic analyses were conducted on a previously collected dataset of 2-7 word utterances produced by fourteen children with CP (7 with dysarthria and 7 without) (Hustad, Gorton & Lee, 2010). The dataset also included sentence-level transcriptions obtained from five listeners per speaker. Word intelligibility scores were derived from these transcripts and used to determine whether prosodic modulation differed for words with high versus low intelligibility. Although mean fundamental frequency (F0) and intensity range were similar across groups, words produced by children with dysarthria were slower and more variable in F0 than the group without dysarthria. Moreover, intelligibility decreased when children with dysarthria increased F0 and duration beyond the range used by children without dysarthria. Thus findings suggest that interventions targeting appropriate prosody may be beneficial in improving intelligibility in children with dysarthria and CP.

Childhood apraxia of speech (CAS) is often characterized by an ability to produce phonemes in isolation, but not in more complex phonetic sequences. This has led to the hypothesis that articulator coordination is impaired in CAS, This study explored whether coordination between the lips and jaw during speech production is impaired in this group. We used two methods to investigate interarticulatory relationships. Cross-correlation analysis directly measures spatial-temporal coupling of articulator movements. The spatiotemporal index (STI; Smith, Goffman, Zelaznik, Ying, & MeGillem, 1995) measures repetition stability and has also been used as an indirect measure of interarticulatory coordination by providing an index of the coordinative consistency of the relationship between articulators within a pair (Smith & Zelaznik, 2004). Three groups of children were included: children with CAS; children with a speech sound disorder involving articulation, phonological errors, or both (the SD group); and typically developing (TD) children. A facial motion capture system was used to track upper lip, lower lip, and jaw movement during a naming task in which stimuli varied by word length. The CAS, SD, and TD children did not significantly differ in spatial-temporal coupling; however, coefficients of variation of the spatial and temporal coupling measures did differentiate the CAS and SD groups. Additionally, the CAS children were distinguished from the SD children by higher lip aperture STI values, indicating that the CAS group had more difficulty generating stable movement plans.