RESUMEN
PURPOSE: Childhood apraxia of speech (CAS) is a multivariate motor speech disorder that requires a motor-based intervention approach. There is limited treatment research on young children with CAS, reflecting a critical gap in the literature given that features of CAS are often in full expression early in development. Dynamic Temporal and Tactile Cueing (DTTC) is a treatment approach designed for children with severe CAS, yet the use of DTTC with children younger than 3 years of age has not been examined. METHOD: A multiple single-case design was employed to examine the use of DTTC in seven children with CAS (aged 2.5-5 years) over the course of 6 weeks of intervention. Changes in word accuracy were measured in treated words from baseline to posttreatment and from baseline to maintenance (6 weeks posttreatment). Generalization of word accuracy changes to matched untreated words was also examined. A linear mixed-effects model was used to estimate the change in word accuracy for treated and untreated words across all children from baseline to posttreatment and to maintenance. A quasi-Poisson regression model was used to estimate mean change and calculate effect sizes for treated and untreated words. RESULTS: Group-level analyses revealed significant changes in word accuracy for treated and untreated words at posttreatment and maintenance. At the child level, six of seven children displayed medium-to-large effect sizes where word accuracy increased in an average of 3.4/5 words across all children. Each child displayed some degree of generalization to untreated targets, specifically for words with the same syllable shape as the treated words. CONCLUSIONS: These results demonstrate that DTTC can yield positive change in some young children with CAS. Key differences in each child's performance are highlighted.
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Apraxias , Habla , Niño , Humanos , Preescolar , Logopedia/métodos , Apraxias/terapia , Trastornos del Habla/terapia , Señales (Psicología)RESUMEN
This study aimed to explore the effects of an integrated phonological awareness intervention on phonological errors and phonemic awareness among young school-age children. Three children with at least one phonological error pattern and below-average phonological awareness skills participated in a non-concurrent multiple baseline single-subject design across participants' investigation. The integrated phonological awareness intervention consisted of completing blending and segmenting activities using 20 trained words, with a dose of 70 to 100 productions of the targeted phonological error pattern for 10, 30-minute sessions. All participants showed improvement in the primary dependent variable of percent consonants correct for their targeted error pattern for trained words. Results for percent phonemes correct showed gains for both blending and segmenting for all participants. All the participants transferred targeted skills to untrained words with their error pattern and generalized blending and segmenting to consonant-vowel-consonant words that did not contain their target error pattern in a pretest/posttest. Integrated phonological awareness intervention was an effective method of simultaneously improving speech production and phonemic awareness skills for young school-age children across 5 hours of treatment. The intervention was designed to be replicable by school-based speech-language pathologists seeking to efficiently support students with phonological errors and phonological awareness deficits.
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Trastornos del Habla , Habla , Niño , Humanos , Trastornos del Habla/terapia , Logopedia/métodos , Terapia del Lenguaje/métodos , Fonética , ConcienciaciónRESUMEN
BACKGROUND: Maintenance of speech outcomes following speech-language therapy (SLT) in Parkinson's disease (PD) is an unmet expectation of people with PD (PWPD) and poorly defined in SLT practice. PD Check-In, a model for supported self-managed maintenance of speech following Lee Silverman Voice Treatment (LSVT) LOUD was investigated. AIMS: To investigate the impact of the semi-structured component of PD Check-In on the adoption of self-management concepts and behaviours and the identification of facilitators, barriers and strategies for speech maintenance by PWPD over 24 months post-treatment. METHODS AND PROCEDURE: Following LSVT LOUD, 16 PWPD participated in individual PD Check-In semi-structured discussions with a SLT at 6 and 12 weeks, and 6, 12 and 24 months post treatment. A two-stage qualitative content analysis was applied: directed content analysis using categories from the theoretical framework of PD Check-In followed by inductive content analysis to identify subcategories. OUTCOMES AND RESULTS: Statements from PWPD indicated adoption of seven concepts of self-management across participants and across time. Six concepts from the theoretical framework of PD Check-In (partnerships, self-reflection, maintenance barriers and facilitators, revision of LSVT LOUD skill, goal setting and maintenance strategies), and one new category, participation, emerged from the analysis. Self-reflection, maintenance facilitators and barriers and participation were most prevalent in discussions. PWPD identified facilitators, barriers and strategies for maintenance across time points. CONCLUSIONS AND IMPLICATIONS: Statements from PWPD indicated a positive impact of SLT-supported self-management of speech using self-tailored strategies for sustainable maintenance according to their individual circumstances and needs. WHAT THIS PAPER ADDS: What is already known on this subject People with Parkinson's disease (PWPD) have expressed their need for speech-language therapy (SLT) services that are accessible for the duration of the condition and responsive to their expectation of maintaining speech following treatment. Outcomes for maintenance of the treatment effect following Lee Silverman Voice Treatment (LSVT) LOUD are variable. What this paper adds to existing knowledge This study presents the outcomes of five PD Check-In interventions delivered in semi-structured discussions between PWPD and a SLT over 24 months following LSVT LOUD for the development of self-management skills and behaviours. PWPD adopted self-management positively using self-tailored strategies for sustainable maintenance according to their individual circumstances and needs. What are the potential or actual clinical implications of this work? PWPD responded positively to the individual development of self-management skills and behaviours over time. Individuality and flexible responsivity are features of PD Check-In which resonate with PWPD and speak to SLT supported self-managed maintenance of speech as a long-term model for PD.
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Enfermedad de Parkinson , Automanejo , Logopedia , Humanos , Masculino , Femenino , Anciano , Enfermedad de Parkinson/terapia , Enfermedad de Parkinson/rehabilitación , Persona de Mediana Edad , Automanejo/métodos , Logopedia/métodos , Entrenamiento de la Voz , Anciano de 80 o más Años , Terapia del Lenguaje/métodos , Trastornos del Habla/terapia , Trastornos del Habla/rehabilitación , Investigación CualitativaRESUMEN
Importance: Children with speech and language difficulties are at risk for learning and behavioral problems. Objective: To review the evidence on screening for speech and language delay or disorders in children 5 years or younger to inform the US Preventive Services Task Force. Data Sources: PubMed/MEDLINE, Cochrane Library, PsycInfo, ERIC, Linguistic and Language Behavior Abstracts (ProQuest), and trial registries through January 17, 2023; surveillance through November 24, 2023. Study Selection: English-language studies of screening test accuracy, trials or cohort studies comparing screening vs no screening; randomized clinical trials (RCTs) of interventions. Data Extraction and Synthesis: Dual review of abstracts, full-text articles, study quality, and data extraction; results were narratively summarized. Main Outcomes and Measures: Screening test accuracy, speech and language outcomes, school performance, function, quality of life, and harms. Results: Thirty-eight studies in 41 articles were included (N = 9006). No study evaluated the direct benefits of screening vs no screening. Twenty-one studies (n = 7489) assessed the accuracy of 23 different screening tools that varied with regard to whether they were designed to be completed by parents vs trained examiners, and to screen for global (any) language problems vs specific skills (eg, expressive language). Three studies assessing parent-reported tools for expressive language skills found consistently high sensitivity (range, 88%-93%) and specificity (range, 88%-85%). The accuracy of other screening tools varied widely. Seventeen RCTs (n = 1517) evaluated interventions for speech and language delay or disorders, although none enrolled children identified by routine screening in primary care. Two RCTs evaluating relatively intensive parental group training interventions (11 sessions) found benefit for different measures of expressive language skills, and 1 evaluating a less intensive intervention (6 sessions) found no difference between groups for any outcome. Two RCTs (n = 76) evaluating the Lidcombe Program of Early Stuttering Intervention delivered by speech-language pathologists featuring parent training found a 2.3% to 3.0% lower proportion of syllables stuttered at 9 months compared with the control group when delivered in clinic and via telehealth, respectively. Evidence on other interventions was limited. No RCTs reported on the harms of interventions. Conclusions and Relevance: No studies directly assessed the benefits and harms of screening. Some parent-reported screening tools for expressive language skills had reasonable accuracy for detecting expressive language delay. Group parent training programs for speech delay that provided at least 11 parental training sessions improved expressive language skills, and a stuttering intervention delivered by speech-language pathologists reduced stuttering frequency.
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Trastornos del Desarrollo del Lenguaje , Tamizaje Masivo , Servicios Preventivos de Salud , Niño , Humanos , Trastornos del Desarrollo del Lenguaje/diagnóstico , Habla , Trastornos del Habla/diagnóstico , Trastornos del Habla/terapia , Tartamudeo/etiología , Guías de Práctica Clínica como Asunto , Lactante , PreescolarRESUMEN
DATA SOURCES: Electronic search was conducted up to September 2021 in three electronic databases including Scopus, Web of Science, and EMBASE. Only studies in English language were selected. STUDY SELECTION: Prospective and retrospective studies including cohort, cross-sectional, randomized control trials, and qualitative studies were included. Both the inclusion and exclusion criteria were reported. The search in the databases and the selection of the studies were performed independently by two reviewers. The included studies assessed the effects of clear aligner therapy on the speech difficulty. DATA EXTRACTION AND SYNTHESIS: Data extraction was performed independently by two reviewers. The data from the relevant studies were extracted into a customized Template. The systematic review was carried out and reported based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines. Details regarding the authors, year of publication, sample size, included participants, age, groups, outcome assessment, results, and inferences were extracted from the selected studies. The quality of the selected studies was assessed based on the relevant guidelines from Cochrane Handbook for Systematic Reviews. The criteria examined sequence generation, allocation concealment, blinding, outcome data, selective reporting, and other sources of bias. Non-randomized studies were assessed using the ROBINS-I tool (Risk of Bias in Non-randomized studies). The strength of evidence was assessed by the evidence grading system developed by the GRADE collaboration as described in the Cochrane Handbook for Systematic Reviews of Interventions. RESULTS: The search identified 283 results. 269 articles were excluded based on their title and abstract after evaluation against the inclusion criteria. 14 articles were assessed in full text. Finally, 7 papers were included in the qualitative analysis. The included studies were 5 cohort studies and 2 randomized clinical studies. 332 patients were examined in the included studies. There were 195 females and 137 males. 191 patients were treated using clear aligner therapy (CAT) while 122 patients were treated using labial fixed appliances and 19 patients were treated using lingual orthodontic treatment. Out of the 191 patients who were treated using CAT, 179 patients were treated using Invisalign (Santa Clara, CA, USA) while 12 patients were treated using Smile Align (Mumbai, India). All seven selected studies examined speech dysfunction. The speech difficulty was assessed through two tools - semiobjective assessment by speech pathologists and professionals and subjective evaluations by the patients themselves through a patient questionnaire that assess the effects of aligners on speech. The risk of bias assessment revealed that two studies had moderate risk of bias while five articles had serious risk of bias. Meta-analysis was not performed due to the high heterogeneity of the included studies. The level of evidence was assessed as low due to the methodological insufficiencies and risk of bias in the included studies. The results showed that both CAT and fixed appliances (FA) resulted in speech difficulties in terms of clarity and delivery of speech that include speech alteration, slurring of words, lisping, and nasality. Some patients who were treated using CAT reported impairment in the lingual space that affected their speech. Lingual FA resulted in more speech difficulty when compared to labial FA and CAT. Aligners caused errors in the articulation of /s/,/z/,/zh/,/sh/,/th/,/ch/. Acoustic analysis revealed /s/ sound appeared most affected. Aligners had an effect on speech while reading, with patients slowing down to their speed to better articulate. The above-mentioned speech difficulties were transient. The included patients normalized their speech within 7-14 days from start of treatment while few patients took 30-60 days to recover. CONCLUSIONS: Although the likelihood of speech difficulties would be high with CAT, the current evidence states that speech difficulties shown with CAT are similar to those found with FA. However, the patients who were treated using CAT adapt quickly and speech recovers within a few weeks. Time to recovery varied greatly, ranging from a week to two months in certain cases.
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Trastornos del Habla , Humanos , Femenino , Masculino , Trastornos del Habla/terapia , Trastornos del Habla/etiología , Técnicas de Movimiento Dental/instrumentación , Técnicas de Movimiento Dental/métodos , Adolescente , Niño , Adulto , Estudios TransversalesRESUMEN
PURPOSE: This study compared the interrater reliability of adult naïve listeners' perceptual assessments of different speech variables in children with a cleft palate with or without a cleft lip (CP ± L). In addition, the study investigated whether the listeners were able to perceive differences in these speech variables before and after speech therapy for cleft palate speech disorders. METHOD: Thirty-four speech samples of 14 children with a CP ± L (14 samples collected immediately before 10 hr of speech intervention, 14 samples collected immediately after speech intervention, and six randomly selected samples that were duplicated to assess intrarater reliability) were perceptually assessed by 26 adult naïve listeners. The listening panel consisted of nine men and 17 women (age range: 18-51 years). The speech variables included speech understandability, speech acceptability, hypernasality, hyponasality, nasal airflow, and articulation, which were assessed on a visual analog scale. Furthermore, the need for speech therapy was assessed. RESULTS: Good to very good interrater reliability was observed for the naïve listeners' ratings of all speech variables. A significant time effect was found for the pre- and postevolution of the speech variables "speech understandability," "speech acceptability," "nasal airflow," and "articulation." This time effect indicates an improvement of these variables postintervention. According to the naïve listeners, children were less in need of additional speech therapy after the 10-hr intervention period compared to assessments before this intervention period. CONCLUSIONS: Adult naïve listeners perceptually identified an improvement in different speech variables after 10 hr of cleft palate speech therapy. These findings confirm previous assessments of expert speech-language pathologists and suggest that speech improvements after cleft palate speech therapy can also be perceived by communication partners outside the therapy room. Perceptual ratings of naïve listeners can, thus, be used to add life-situation significance to the assessments of experts. Future research could include both expert raters and caregivers or relatives of children with a CP ± L in listening panels, as previous knowledge on craniofacial anomalies may lead to different results.
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Labio Leporino , Fisura del Paladar , Trastornos de la Voz , Masculino , Adulto , Niño , Humanos , Femenino , Adolescente , Adulto Joven , Persona de Mediana Edad , Fisura del Paladar/complicaciones , Fisura del Paladar/terapia , Habla , Reproducibilidad de los Resultados , Medición de la Producción del Habla/métodos , Trastornos del Habla/etiología , Trastornos del Habla/terapia , Labio Leporino/complicaciones , Labio Leporino/terapiaRESUMEN
OBJECTIVES: Deep brain stimulation (DBS) of the subthalamic nucleus (STN) for Parkinson's disease (PD) has an ambiguous relation to speech. Speech impairment can be a stimulation-induced side effect, and parkinsonian dysarthria can improve with STN-DBS. Owing to the lack of an up-to-date and evidence-based approach, DBS reprogramming for speech impairment is largely blind and greatly relies on the physician's experience. In this study, we aimed to establish an evidence- and experience-based algorithm for managing speech impairment in patients with PD treated with STN-DBS. MATERIALS AND METHODS: We performed a single-center retrospective study to identify patients with STN-DBS and speech impairment. Onset of speech impairment, lead localization, and assessment of DBS-induced nature of speech impairment were collected. When DBS settings were adjusted for improving speech, the magnitude and duration of effect were collected. We also performed a systematic literature review to identify studies describing the effects of parameter adjustments aimed at improving speech impairment in patients with PD receiving STN-DBS. RESULTS: In the retrospective study, 245 of 631 patients (38.8%) with STN-DBS had significant speech impairment. The probability of sustained marked improvement upon reprogramming was generally low (27.9%). In the systematic review, 23 of 662 identified studies were included. Only two randomized controlled trials have been performed, providing evidence for interleaving-interlink stimulation only. Considerable methodologic heterogeneity precluded the conduction of a meta-analysis. CONCLUSIONS: Speech impairment in STN-DBS for PD is frequent, but high-quality evidence regarding DBS parameter adjustments is scarce, and the probability of sustained improvement is low. To improve this outcome, we propose an evidence- and experience-based approach to address speech impairment in STN-DBS that can be used in clinical practice.
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Estimulación Encefálica Profunda , Enfermedad de Parkinson , Núcleo Subtalámico , Humanos , Habla , Enfermedad de Parkinson/complicaciones , Enfermedad de Parkinson/terapia , Núcleo Subtalámico/fisiología , Estudios Retrospectivos , Trastornos del Habla/etiología , Trastornos del Habla/terapiaRESUMEN
Since telepractice regulation does not yet exist in Japan, we assessed telepractice efficacy and the level of satisfaction with telepractice versus that with face-to-face practice (FTFP) in speech therapy to establish effective telepractice in Japan. Changes in the number of therapy sessions and therapy levels were compared between telepractice and FTFP sessions conducted during the study period. Additionally, the patients' parents completed a questionnaire survey regarding telepractice. The mean number of sessions was not significantly different between the two types of therapy; the therapy levels, according to stepwise speech therapy, either increased or remained unchanged. The survey showed satisfaction with telepractice among all parents. Telepractice for cleft palate speech was delivered successfully with complete parental satisfaction.
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COVID-19 , Telemedicina , Humanos , COVID-19/epidemiología , Pandemias , Trastornos del Habla/terapia , LogopediaRESUMEN
BACKGROUND: While expert consensus recommendations support the use of speech and language therapy (SLT) for patients with functional speech disorder (FND-speech), there are limited published data on clinical outcomes. OBJECTIVE: To retrospectively report the treatment outcomes and clinical characteristics of patients with FND-speech that attended outpatient SLT as part of a multidisciplinary program for functional neurological disorder (FND). METHODS: In this case series, we included adult patients with FND-speech that consecutively participated in outpatient SLT at our institution between October 2014 and September 2021. Baseline demographic and neuropsychiatric characteristics were extracted from the medical records, along with data on FND-speech phenotypes, number of treatment sessions received, and clinician-determined outcomes. Only descriptive statistics were used to report findings. RESULTS: Twenty patients met inclusion criteria; ages ranged from 21-77, with a mean of 51.6±16.2 years. 85% of the cohort presented with mixed FND-speech symptoms. Patients attended a range of 2-37 visits, with an average of 9.2±8.0 visits over 4.4±3.5 months. At the last treatment session, 3 patients were asymptomatic, 15 had improved, and 2 had not improved; 8 individuals that improved received video telehealth interventions. CONCLUSION: This case series lends additional support for outpatient SLT in the assessment and management of individuals with FND-speech, and may help clarify patient and provider treatment expectations. Additional prospective research is needed to investigate baseline predictors of treatment response and further define the optimal frequency, intensity, duration, and clinical setting for SLT delivery in this population.
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Terapia del Lenguaje , Habla , Adulto , Humanos , Adulto Joven , Persona de Mediana Edad , Anciano , Estudios Prospectivos , Estudios Retrospectivos , Logopedia , Trastornos del Habla/etiología , Trastornos del Habla/terapiaRESUMEN
BACKGROUND: Speech therapy is highly effective for patients with Parkinson's disease (PD) who have speech difficulties; however, its accessibility is limited. Online video-call speech therapy has been explored as an alternative option for PD patients. OBJECTIVES: To evaluate the feasibility and efficacy of video-call speech therapy for PD patients. METHODS: This prospective, comparative study was conducted between July and September 2022. PD patients with speech difficulties were divided into two groups, online speech therapy via video call and in-person therapy at hospital, based on their willingness to visit the hospital frequently. The patients underwent 12 sessions of speech therapy, focusing on respiration and phonation. Acoustic assessments, auditory-perceptual assessment, and voice handicap index (K-VHI10) were evaluated at baseline, post-therapy, and follow-up. RESULTS: Eleven patients were enrolled in the study, though one patient from the online group withdrew. Ten patients completed the therapy (five in each group) without missing a session. The baseline acoustic measurements did not differ between the two groups. After therapy, both group showed an increase in voice intensity and improvement in overall loudness. The post-therapy change from baseline in the acoustic measurements was not significantly different between the two groups. The effect of therapy were maintained in the follow-up evaluation in both groups. The K-VHI10 decreased significantly from baseline to post-therapy and further at follow-up in both groups, with no significant difference between two groups. CONCLUSION: The online speech therapy via video call is feasible in PD patients with speech difficulties and as effective as in-person therapy.
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Enfermedad de Parkinson , Trastornos de la Voz , Humanos , Logopedia , Trastornos de la Voz/etiología , Trastornos de la Voz/terapia , Enfermedad de Parkinson/complicaciones , Enfermedad de Parkinson/terapia , Estudios Prospectivos , Estudios de Factibilidad , Trastornos del Habla/etiología , Trastornos del Habla/terapiaRESUMEN
BACKGROUND: A survey study on clinical practice not only provides insight into the implementation of knowledge, but also informs future investigations. There is a limited understanding of childhood apraxia of speech (CAS) in Cantonese speakers. This study examined the clinical practice of CAS in Hong Kong and discussed future directions of research for better evidence-based practice. METHODS: Qualified Hong Kong pediatric speech-language pathologists (SLPs) completed the online questionnaire, which had a total of 48 questions regarding their knowledge of and experience with CAS in Cantonese speakers, including assessment, diagnosis, and treatment. RESULTS: Seventy-seven responses were received from Hong Kong SLPs. Most of the SLPs (83.2%) rated their understanding of CAS as either "a little" or "fair". About half (53.2%) of the respondents had worked with children with CAS. No standardized assessment or objective/quantitative measures were used clinically. Instead, seven assessment tasks, including imitation of polysyllabic words and speech and language samples were used commonly. Perceptual judgment of clinical features is still the most popular approach for diagnosis, with a variety of lists in use. Of concern was that, in addition to using some evidence-based approaches, local SLPs treated CAS using approaches that have limited evidence, in the context of less treatment frequency, targeting both speech and language skills within the same session, and with only partial implementation of the approaches. CONCLUSIONS: The results suggest that the understanding of CAS among local SLPs requires attention. One reason for this is that evidence regarding the assessment, diagnosis, and treatment of Cantonese speakers with CAS is still limited. Future investigations are needed.
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Apraxias , Patología del Habla y Lenguaje , Humanos , Niño , Trastornos del Habla/diagnóstico , Trastornos del Habla/terapia , Habla , Hong Kong , Patología del Habla y Lenguaje/métodos , Apraxias/diagnóstico , Apraxias/terapia , Encuestas y Cuestionarios , InternetRESUMEN
BACKGROUND: Compensatory cleft speech disorders can severely impact speech understandability and speech acceptability. Speech intervention is necessary to eliminate these disorders. There is, however, currently no consensus on the most effective speech therapy approach to eliminate the different subtypes of compensatory cleft speech disorders. AIMS: To compare the immediate, short- and long-term effects of three well-defined speech intervention approaches (i.e., a motor-phonetic approach, a linguistic-phonological approach and a combined phonetic-phonological approach) on the speech and health-related quality of life (HRQoL) in Belgian Dutch-speaking children with cleft palate with or without cleft lip (CP±L) and different subtypes of compensatory speech disorders (i.e., anterior oral cleft speech characteristics (CSCs), posterior oral CSCs or non-oral CSCs). Besides, the perceived acceptability of these three speech intervention approaches will be investigated from the perspectives of caregivers and children with a CP±L. METHODS & PROCEDURES: A two-centre longitudinal randomized sham-controlled trial was used. Children were randomly assigned to one of the three intervention programmes and received 10 h of speech intervention divided over 2 weeks. Block randomization was used, stratified by age and gender. Primary outcome measures included perceptual speech outcomes. Secondary outcome measures included patient-reported outcomes. OUTCOMES & RESULTS: The results of this trial will provide speech-language pathologists evidence-based guidelines to better tailor intervention approaches to the specific needs of a child with a defined compensatory speech disorder. WHAT THIS PAPER ADDS: What is already known on this subject Speech therapy approaches to address cleft palate speech disorders are broadly divided into two categories: motor-phonetic interventions and linguistic-phonological interventions. Some limited evidence demonstrated the positive effects of these approaches in eliminating compensatory cleft speech disorders. Different studies have reported inter-individual variation, suggesting that one child may benefit more from a particular intervention approach than the other child. Perhaps this variation can be attributed to the specific subtype of compensatory speech disorder (i.e., anterior oral CSC, posterior oral CSC or non-oral CSC). What this paper adds to existing knowledge This paper describes a randomized sham-controlled trial that compared the immediate, short- and long-term effects of three well-defined speech intervention approaches (i.e., a motor-phonetic approach, a linguistic-phonological approach and a combined phonetic-phonological approach) on the speech and HRQoL in Belgian Dutch-speaking children with CP±L and different subtypes of compensatory cleft speech disorders (i.e., anterior oral CSCs, posterior oral CSCs or non-oral CSCs) measured by perceptual and psychosocial outcome measures. Besides, the experienced acceptability of these three speech intervention approaches were investigated from the perspectives of caregivers and children. What are the potential or actual clinical implications of this work? This project provides evidence-based knowledge on patient-tailored cleft speech intervention considering both scientific evidence and the perspectives of caregivers and children. The results aid SLPs in better tailoring intervention approaches to the needs of a child with a specific type of compensatory cleft speech disorder.
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Labio Leporino , Fisura del Paladar , Niño , Humanos , Fisura del Paladar/complicaciones , Habla , Calidad de Vida , Trastornos de la Articulación/terapia , Trastornos de la Articulación/complicaciones , Trastornos del Habla/terapia , Trastornos del Habla/complicaciones , Labio Leporino/complicaciones , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
Typically developing children are variable in their speech production with decreasing variability indicating mastery of speech. Excessive variability which does not change over time may be an indication of unstable motor plans as often seen in children with childhood apraxia of speech (CAS). Dynamic Systems Theory (DST) provides a framework for understanding the role of variability in speech development and disorder. There are few studies that explore the impact of therapy on speech variability. This work explores the impact of therapy on perceptual speech production variability. It is a post-hoc analysis of data collected in two intervention studies of a motor-based treatment approach with children with CAS and explores DST variability effects in speech skill acquisition based on the case data from those studies. There were six participants in total across the two studies. Findings were mixed showing some non-linear changes in variability with larger changes in variability observed in participants who engaged in more extensive therapy. However, the pattern of variability change was not consistent across the participants. These findings suggest that targeting variability in therapy may be an effective way to improve the speech of children with CAS. A model for utilising variability in therapy is presented.
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Apraxias , Habla , Niño , Humanos , Apraxias/terapia , Trastornos del Habla/terapia , Medición de la Producción del Habla , LogopediaRESUMEN
Electropalatography (EPG) has been used in the past 50 years for studying the patterns of contact between the tongue and the palate during speech production in typical speakers and those with speech disorders due to different causes. At the 7th EPG Symposium in Japan that was held online on 24 January 2021 (see: https://epg-research.sakura.ne.jp/), a panel of invited experts discussed their views regarding further developments and application of the technique. This paper provides a summary of this discussion. EPG offers information on articulation which cannot be replaced by other instrumental measures of speech. Identified areas for further hardware development are thinner EPG plates, better dental and palatal coverage, wireless connectivity, and sensors that provide additional articulatory information (e.g. tongue pressure, tongue-palate distance). EPG can serve as a resource for teaching speech disorders and phonetics. Furthermore, EPG therapy can be combined with telepractice in the speech therapy of clients with speech disorders.
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Hueso Paladar , Lengua , Humanos , Presión , Trastornos del Habla/terapia , Habla , FonéticaRESUMEN
The purpose of this analysis was to document intelligibility and naturalness in ataxia, a neurological condition that results from cerebellar damage. The cerebellum is important for normal speech production to scale and coordinate articulatory and laryngeal movements. The disruption of these cerebellar mechanisms has unique implications for how intelligibility and naturalness are affected in ataxia. The results of research on speech in ataxia have important clinical implications for assessment and treatment of individuals with ataxic dysarthria. Speech samples from 27 participants with ataxia and 28 age- and sex-matched control participants were assessed by nine speech-language pathology graduate students for intelligibility and naturalness. Intelligibility was measured as the percentage of words transcribed correctly, and naturalness was assessed as a subjective rating on a seven-point interval scale. Both intra- and inter-rater reliability were moderate to high for both intelligibility and naturalness. Speech intelligibility and naturalness were robustly decreased in the ataxia group compared to the control group; however, the difference was greater for measures of speech naturalness. There were robust relationships among dysarthria severity, length of diagnosis, and speech naturalness in speakers with ataxia, but there were no other robust effects for age, sex, or impact on quality of life for intelligibility or naturalness. Speech naturalness was more impaired than intelligibility in speakers with ataxia. Impaired naturalness can have debilitating consequences for communicative participation, effectiveness, and quality of life. Assessment and treatment for ataxic dysarthria should include aspects of prosodic control for speech naturalness.
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Ataxia Cerebelosa , Disartria , Humanos , Disartria/etiología , Disartria/diagnóstico , Habla , Reproducibilidad de los Resultados , Calidad de Vida , Trastornos del Habla/etiología , Trastornos del Habla/terapia , Inteligibilidad del Habla , AtaxiaRESUMEN
BACKGROUND: Progressive ataxias frequently lead to speech disorders and consequently impact on communication participation and psychosocial wellbeing. Whilst recent studies demonstrate the potential for improvements in these areas, these treatments generally require intensive input which can reduce acceptability of the approach. A new model of care-ClearSpeechTogether-is proposed which maximises treatment intensity whilst minimising demands on clinician. This study aimed to establish feasibility and accessibility of this approach and at the same time determine the potential benefits and adverse effects on people with progressive ataxias. METHOD: This feasibility study targeted people with progressive ataxia and mild-moderate speech and gross motor impairment. ClearSpeechTogether consisted of four individual sessions over 2 weeks followed by 20 patient-led group sessions over 4 weeks. All sessions were provided online. Quantitative and qualitative data were collected for evaluation. RESULTS: Nine participants completed treatment. Feasibility and acceptability were high and no adverse effects were reported. Statistical tests found significantly reduced vocal strain, improved reading intelligibility and increased participation and confidence. Participant interviews highlighted the value of group support internalisation of speech strategies and psycho-social wellbeing. DISCUSSION: ClearSpeechTogether presented a feasible, acceptable intervention for a small cohort of people with progressive ataxia. It matched or exceeded the outcomes previously reported following individual therapy. Particularly notable was the fact that this could be achieved through patient led practice without the presence of a clinician. Pending confirmation of our results by larger, controlled trials, ClearSpeechTogether could represent an effective approach to manage speech problems in ataxia.
Asunto(s)
Habla , Degeneraciones Espinocerebelosas , Humanos , Estudios de Factibilidad , Trastornos del Habla/etiología , Trastornos del Habla/terapia , Ataxia/terapiaRESUMEN
PURPOSE: Adolescents with Childhood Apraxia of Speech (CAS) are likely to have persistent speech errors compared to non-CAS peers (Lewis et al., 2018) and may have ongoing psychosocial issues (e.g. Carrigg, Parry, Baker, Shriberg, & Ballard, 2016). Beyond this, little is known about the long-term consequences of CAS in adulthood. This study explored whether adults who were reported to have had CAS as children have ongoing psychosocial or speech impacts. METHOD: A cross-sectional descriptive design, with mixed-method analyses of demographic, psychosocial, and speech data was used. Data were collected via a four-part online survey. Part one consisted of questions about demographic information and participants' self-reported performance in speech, language and literacy. Parts two and three investigated the psychosocial impacts of CAS using the Brief Fear of Negative Evaluation Scale - Revised (BFNE- R) and The State-Trait Anxiety Inventory (STAI). Part four collected single word and connected speech data via an online audio recording, which was then transcribed following the Connected Speech Transcription Protocol (CoST-P). Analyses of speech characteristics reported in CAS was completed using Phon software. RESULT: There were 17 participants in part one, 16 in parts two and three, and six in part four. Participants reported elevated levels of state (p = 0.01) and trait (p = 0.0001) anxiety compared to normative data. Ongoing segmental and suprasegmental speech errors were observed, with a significant difference between percent phonemes correct in single words versus connected speech (p = 0.03). Participants who provided a speech sample had difficulty with correct stress, use of juncture, and had increased intra- and inter-word segregation. Participants with better speech reported less anxiety. CONCLUSION: Psychosocial effects and speech characteristics associated with CAS in childhood appear to persist into adulthood. Confirmation of these results and research to determine treatment and psychosocial support needs past early childhood is warranted.
Asunto(s)
Apraxias , Habla , Niño , Adolescente , Preescolar , Humanos , Adulto , Trastornos del Habla/terapia , Estudios Transversales , Apraxias/terapia , LogopediaRESUMEN
To examine the impact of stepwise speech rehabilitation exercise therapy in the treatment of patients with Parkinson speech problems under psychological intervention on clinical results and cognitive functioning. Parkinson speech disorder patients who met the inclusion criteria were selected and divided into a control group and an observation group for training respectively. The control group used conventional nursing methods, including training in orofacial movement, vocalization, pitch, volume and breath control. The observation group used stepwise speech rehabilitation exercise intervention combined with psychotherapy nursing programme. In the statistical analysis, independent sample t-test and chi-square test were used to test the significance of the data processing methods. In the statistical analysis of baseline functional level (Pâ >â .05). The difference was not statistically significant. After 7 weeks of training, the mFDA level and speech intelligibility increased in both the observation and control groups. From the situation analysis of "modified drinking test" and the comparison of UPDRS-I scores, it can be seen that dysphagia and Parkinson dysphasia were reduced in both groups after training. The observation group spontaneous speech dimension was greater than the control group by around 0.07 in the aphasia comparison. Both groups displayed an upward trend in their MMSE and Montreal Cognitive Assessment (MoCA) when measuring cognitive function; the evaluation of P300, constructive function, and quality of life revealed this. The observation group P300 potential score was 0.13 points higher than that of the control group. The therapeutic training of stepped speech rehabilitation exercise care combined with psychological intervention has significant nursing effects on patients with Parkinson disease speech disorders, and the patients' cognitive functions have been effectively improved.
Asunto(s)
Enfermedad de Parkinson , Humanos , Enfermedad de Parkinson/complicaciones , Enfermedad de Parkinson/psicología , Habla , Calidad de Vida , Intervención Psicosocial , Trastornos del Habla/etiología , Trastornos del Habla/terapia , CogniciónRESUMEN
PURPOSE: This study aimed to evaluate whether long-term averaged spectrum (LTAS) descriptors for reading and monologue are suitable to detect worsening of dysarthria in patients with Parkinson's disease (PD) treated with subthalamic nucleus deep brain stimulation (STN-DBS) with potential effect of ON and OFF stimulation conditions and types of connected speech. METHOD: Four spectral moments based on LTAS were computed for monologue and reading passage collected from 23 individuals with PD treated with bilateral STN-DBS and 23 age- and gender-matched healthy controls. Speech performance of patients with PD was compared in ON and OFF STN-DBS conditions. RESULTS: All LTAS spectral moments including mean, standard deviation, skewness, and kurtosis across both monologue and reading passage were able to significantly distinguish between patients with PD in both stimulation conditions and control speakers. The spectral mean was the only LTAS measure sensitive to capture better speech performance in STN-DBS ON, as compared to the STN-DBS OFF stimulation condition (p < .05). Standardized reading passage was more sensitive compared to monologue in detecting dysarthria severity via LTAS descriptors with an area under the curve of up to 0.92 obtained between PD and control groups. CONCLUSIONS: Our findings confirmed that LTAS is a suitable approach to objectively describe changes in speech impairment severity due to STN-DBS therapy in patients with PD. We envisage these results as an important step toward a continuum development of technological solutions for the automated assessment of stimulation-induced dysarthria. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.21644798.
Asunto(s)
Estimulación Encefálica Profunda , Enfermedad de Parkinson , Núcleo Subtalámico , Humanos , Núcleo Subtalámico/fisiología , Enfermedad de Parkinson/complicaciones , Enfermedad de Parkinson/terapia , Estimulación Encefálica Profunda/métodos , Disartria/etiología , Disartria/terapia , Trastornos del Habla/terapiaRESUMEN
Currently, not all children that need speech therapy have access to a therapist. With the current international shortage of speech-language pathologists (SLPs), there is a demand for online tools to support SLPs with their daily tasks. Several online speech therapy (OST) systems have been designed and proposed in the literature; however, the implementation of these systems is lacking. The technical knowledge that is needed to use these programs is a challenge for SLPs. There has been limited effort to systematically identify, analyze and report the findings of prior studies. We provide the results of an extensive literature review of OST systems for childhood speech communication disorders. We systematically review OST systems that can be used in clinical settings or from home as part of a treatment program for children with speech communication disorders. Our search strategy found 4481 papers, of which 35 were identified as focusing on speech therapy programs for speech communication disorders. The features of these programs were examined, and the main findings are extracted and presented. Our analysis indicates that most systems which are designed mainly to support the SLPs adopt and use supervised machine learning approaches that are either desktop-based or mobile-phone-based applications. Our findings reveal that speech therapy systems can provide important benefits for childhood speech. A collaboration between computer programmers and SLPs can contribute to implementing useful automated programs, leading to more children having access to good speech therapy.