Journal of medical speech-language pathology最新文献

Purpose: We investigated the contribution of vowel space, articulation rate, maximum utterance length, and language skills to intelligibility in 30-36 month old children with CP. We also examined differences among variables for 3 subgroups of children with CP and a small group of typically developing (TD) children.

Method: Nineteen children with CP and 5 TD children provided speech samples, and 120 listeners transcribed the speech samples. Acoustic analysis of temporal and vowel spectral measures was completed on single-word productions.

Results: Vowel space was the only variable that made a significant and independent contribution to intelligibility, though all variables collectively accounted for 74% of the variance in intelligibility scores. TD children tended to have larger vowel spaces, than children with CP, even among children with CP who had intelligibility scores within the range of TD children.

Conclusions: Of children with CP who were able to talk at 30-36 months of age, 60% had clinical speech or language deficits. Production of vowels appears to make an important contribution to intelligibility; and for many children with CP, considerable deficits in intelligibility may be evident by the age of 3. Early interventions targeting both speech and language may improve intelligibility and functional communication skills.

Background: Initial shortening of stem vowels in three-word derivational paradigms (e.g., zip, zipper, zippering) was studied in persons with Parkinson's disease (PWPD) with and without deep brain stimulation (DBS), and in normal speakers.

Method: Seven PWPD without DBS, 7 PWPD with DBS ON (DBSN) or OFF (DBSF), and 6 healthy control (CON) persons were studied. Stimuli were 7 three-word paradigms consisting of a stem word and two derived longer forms created by adding the suffixes er (+1), and er+ing (+2).

Results: Vowel durations decreased across word forms of increasing length (initial shortening) for DBSF, DBSN, PWPD, and CON. Vowel shortening did not interact with group. For each word form, CON vowel duration was shorter than those for PWPD, DBSN and DBSF but word duration did not differ between groups. DBS did not have a significant effect on either vowel or word duration.

Conclusion: These results agree with previous findings for a PWPD with accelerated speech and faster rates of speech in DBS-ON. Observations that vowel duration patterns are maintained in subcortical and cerebellar but not left hemisphere damage suggest that cortical control factors play a primary role in relational timing.

Benefits to speech intelligibility can be achieved by enhancing a listener's ability to decipher it. However, much remains to be learned about the variables that influence the effectiveness of various listener-based manipulations. This study examined the benefit of providing listeners with the topic of some phases produced by speakers with either hypokinetic or ataxic dysarthria. Total and topic word accuracy, topic-related substitutions, and lexical boundary errors were calculated from the listener transcripts. Data were compared with those who underwent a familiarization process (reported by Liss, Spitzer, Caviness, & Adler, 2002) and with those inexperienced with disordered speech (reported by Liss Spitzer, Caviness, & Adler, 2000). Results revealed that listeners of ataxic speech provided with topic knowledge obtained higher intelligibility scores than naïve listeners. The magnitude of benefit was similar to the familiarization condition. However, topic word and word substitution analyses revealed different underlying perceptual mechanisms responsible for the observed benefit. No differences attributable to listening condition were discovered in lexical segmentation patterns. Overall, the results support the need for further study of listener-based manipulations to elucidate the mechanisms responsible for the observed perceptual benefits for each dysarthria type.

Management of patients with aph asia often focuses on training nonverbal augmentative communication strategies; however, these strategies frequently do not generalize to natural situations. The limited success may be because training waS not sufficient to produce an integrated multimodal semantic representation. The purpose of this study was to examine whether simultaneous training of stimuli in both verbal and nonverbal modalities would solidify the links within the semantic network and improve switching among modalities as needed in conversation. Two individuals with severe aphasia participated in 6 to 8 hours of Multi moda I Communication Training (MeT), during which they conveyed a concept by verbalizing, gesturing, writing, and drawing. After practice with all modalities for a single concept, a new concept was introduced. Results showed that one participant increased conveyance of concepts on the functional communication task using a variety of modalities. Although some improvement was seen with the second participant, his overall performance remained poor, likely because of a greater impairment in semantic knowledge. After a brief period of semantic training, the second participant demonstrated additional gains. Thus, MeT may serve to increase switching among verbal and nonverbal modalities in individuals with intact semantic representations, thereby increasing the likelihood that individuals will use an alternative method to communicate.

This study investigated the relationship between measures of Long-Term Average Spectrum (LTAS) for speakers with Parkinson's disease (PD) and Multiple Sclerosis (MS) and scaled estimates of perceived speech severity. Perceived severity was operationally defined as listeners' overall impression of voice, resonance, articulatory precision, and prosody without regard to intelligibility. Healthy control talkers were also studied. Speakers were audio recorded while reading Harvard Sentences and the Grandfather Passage. Using TF32 (Milenkovic, 2005), the LTAS was computed for sentences. Coefficients of the first four moments were used to characterize energy across the speech spectrum. Supplemental acoustic measures of articulatory rate, vocal intensity, and fundamental frequency also were obtained. Three speech-language pathologists scaled speech severity for the reading passages. Results indicated no group differences in acoustic measures. The absolute magnitude of correlations between LTAS moment coefficients and perceptual estimates of scaled severity within and across speaker groups ranged from .16 to .53, with the strongest correlations for the PD group. These results suggest that the LTAS may prove useful in conjunction with perceptual judgments to document speech spectral changes related to treatment or disease progression. Findings further suggest that different acoustic models of severity are likely needed for dysarthria secondary to PD and dysarthria secondary to MS.

PROMPT (Prompts for Restructuring Oral Muscular Phonetic Targets) is a treatment approach that is widely used to improve sound production in children with speech impairments. This approach uses tactile cues to support and shape movements of the oral articulators in order to improve the production of individual sounds, syllables, words, and eventually connected speech. The underlying assumption is that tactile cuing will facilitate changes in articulator movements. This investigation examined articulator movement as well as the accuracy of speech production, before, during, and after a period of PROMPT treatment in a child with severe articulation impairment. A typically developing child was followed longitudinally as a control. The following research questions were addressed: (1) Does speech sound accuracy improve over an eight-week course of PROMPT treatment? (2) Does articulator movement (duration, displacement, velocity) change over an eight-week course of PROMPT treatment? The results revealed increased articulation accuracy and decreased movement duration, displacement, and velocity over the course of PROMPT treatment in the child with the articulation impairment. By the last treatment session, kinematic findings were most similar to those seen in the control. These results suggest that PROMPT facilitated changes in articulatory control in a single participant.

Kinematic analysis, also commonly referred to as biomechanical analysis, of the swallow is used to measure movement of oropharyngeal structures over time. Two laboratory directors who have used kinematic analysis in their research collaborated to determine the feasibility of establishing agreement between two separate laboratories on measures of structural movements of the swallow. This report describes the process that was followed toward the goal of establishing measurement agreement. Under the direction of the laboratory directors, one research technician from each laboratory participated in a process that included initial meetings, training sessions, and pre- and post-training evaluation of reproducibility.Because agreement on initial measures of structural movement demonstrated weak correlation on some measures, the research technicians trained together for approximately 6 hours. After training, statistical analyses indicated that (a) most Pearson correlations for measures of structural movements were greater than 0.80 and were highly statistically significant; (b) most percentages of absolute deviation were under 25%; and (c) most concordance coefficients were above .70. These statistics indicate that the two laboratories were able to increase their level of agreement in measuring selected structural movements of the swallow after a brief amount of training.Factors affecting measurement agreement include image quality, establishment of rules for measuring, and the opportunity for regular discussions among research assistants and investigators from both laboratories.

PURPOSE: The goals of this study were to 1) describe the feeding skills of young children with cerebral palsy (CP); and 2) elucidate the type and severity of feeding problems for children with and without oral-motor involvement. METHOD: Parents of 37 children (16 females, 21 males) with CP, who ranged in age from 11-58 months (mean age = 41 months), completed questionnaires regarding their child's past and current feeding abilities. Children were also clinically evaluated to determine whether each had evidence of oral-motor involvement. RESULTS: Children with CP and oral-motor involvement had significantly more difficulty with self-feeding, increased frequency of coughing and choking, increased prevalence of swallowing evaluation and feeding therapy, and were introduced to solid food at a later age relative to children with CP who did not have oral-motor involvement. Both groups of children were similar in their history of tube feeding, bottle feeding, difficulty with solid foods, use of adaptive equipment, duration of mealtimes, and presence of choking, coughing, and gagging. CONCLUSIONS: Children with and without oral-motor involvement initially presented with similar feeding difficulties. However, feeding problems appeared to resolve to a greater extent in children without oral-motor involvement. The difficulties identified early in life, for children with oral-motor involvement, appeared to persist with development.

Assessment of orofacial weakness is common during the evaluation of patients with suspected dysarthria. This study addressed the validity of clinical assessments of orofacial weakness by comparing clinical (subjective) ratings to instrumental (objective) measures. Forty-four adults referred to a speech pathology clinic for dysarthria evaluation were tested for strength of the tongue during elevation, lateralization, and protrusion, and for the strength of the muscles of the lower face during buccodental and interlabial compression. Subjective assessment of weakness involved rating maximum resistance against a firmly held tongue depressor, using a 5-point scale. Objective assessment involved the Iowa Oral Performance Instrument (IOPI), measured as the maximal pressure generated against an air-filled bulb. A recent adaptation to the IOPI permitted testing of tongue and cheek strength using tasks that are comparable to the subjective tasks. Moderate correlations were found between the objective and subjective evaluations, with the strongest correlations for tongue lateralization. Lower pressure values were associated with higher subjective ratings of weakness for each task, although there was substantial overlap in the data. These results, combined with the notion that examiner bias is inherent to clinical assessment, support the use of instrumentation to improve objectivity and precision of measurement in the clinic.

Speech variability in groups of speakers with Parkinson's disease (PD) and with Friedreich's ataxia was compared with healthy controls. Speakers repeated the same phrase 20 times at one of two rates (fast or habitual). A non-linear analysis of variability was performed which used some of the principles behind the spatio-temporal index (STI). The STI usually employs variation in lip displacement over repetitions of the same utterance and a linear analysis of such signals is conducted to represent the combined variation in spatial and temporal control. When working with patients, audio measures (here we used speech energy) are preferred over kinematics ones as they are minimally disruptive to speech. Non-linear methods allow spatial variability to be estimated separately from temporal variability. The results are tentatively interpreted as showing that PD speakers were distinguished from healthy control speakers in spatial variability and ataxic speakers were distinguished from controls in temporal variability. These findings are consistent with the speech symptoms reported for these disorders. We conclude that the non-linear analysis using the speech energy measure is worth investigating further as it is potentially revealing of the differences underlying these two pathologies.