A Preliminary Investigation of Within-Word Silent Intervals Produced by Children With and Without Neurodevelopmental Disorders.

PURPOSE: The categorization of silent intervals during speech production is necessary for accurate measurement of articulation rate and pauses. The primary purpose of this preliminary study was to examine the within-word silent interval associated with the stop closure in word-final stop consonants produced by children with and without neurodevelopmental disorders. METHOD: Seven children diagnosed with either cerebral palsy or Down syndrome (i.e., children with neurodevelopmental disorders) and eight typically developing children produced a reading passage. Participants were between the ages of 11 and 16 years. Fifty-eight words from the reading passage were identified as having word-final stop consonants. The closure duration of the word-final stop consonant was calculated, both in absolute duration and percent pause time. The articulation rate of the entire passage was calculated. The number of closure durations that met or exceeded the minimum duration threshold to be considered a pause (150 ms) was examined descriptively. RESULTS: Children with neurodevelopmental disorders produced significantly longer closure durations and significantly slower articulation rates than typically developing children. Children with neurodevelopmental disorders produced closure durations that met or exceeded the minimum duration threshold of a pause, but typically developing children, generally, did not. CONCLUSION: These data indicate the need to examine the location of silent intervals that meet the minimum duration threshold of a pause and correct for articulatory events during the measurement of articulation rate and pauses in children with neurodevelopmental disorders.

Differential Impacts of Sentence Length on Speech Rate in Two Groups of Children With Neurodevelopmental Disorders.

PURPOSE: The primary purpose of this study was to examine the effect of sentence length on speech rate and its characteristics, articulation rate, and pauses in children with neurodevelopmental disorders. METHOD: Nine children diagnosed with cerebral palsy (CP) and seven children diagnosed with Down syndrome (DS) repeated sentences varying in length from two to seven words. Children were between the ages of 8 and 17 years. Dependent variables included speech rate, articulation rate, and proportion of time spent pausing. RESULTS: For children with CP, there was a significant effect of sentence length for speech rate and articulation rate but not for the proportion of time spent pausing. In general, the longest sentences were produced with a faster speech and articulation rate than the shortest sentences. For children with DS, there was a significant effect of sentence length for the proportion of time spent pausing but not for speech rate or articulation rate. In general, children with DS spent significantly more time pausing in the longest sentences, particularly seven-word sentences, than in any other sentence length. CONCLUSIONS: Primary findings include the following: (a) Articulation rate and pause time are differentially impacted by sentence length, and (b) children with CP and children with DS respond differently to increases in cognitive-linguistic load.

Sentence Length Effects on Intelligibility in Two Groups of Older Children With Neurodevelopmental Disorders.

PURPOSE: The purpose of this study was to examine the impact of sentence length on intelligibility in two groups of older children with neurodevelopmental disabilities. METHOD: Nine children diagnosed with cerebral palsy (CP) and eight children diagnosed with Down syndrome (DS), between the ages of 8 and 17 years, repeated sentences varying in length from two to seven words. Three hundred forty adult listeners (20 listeners per child) provided orthographic transcriptions of children's speech, which were used to calculate intelligibility scores. RESULTS: There was a significant main effect of sentence length on intelligibility for children with CP. Intelligibility significantly increased from two- and three-word sentences to four-, five-, and six-word sentences, then significantly decreased from four-, five-, and six-word sentences to seven-word sentences. There was a main effect of sentence length on intelligibility for children with DS. Intelligibility significantly increased from two-word sentences to four-, five-, and six-word sentences. CONCLUSIONS: The primary findings of this study include the following: (a) Unlike in typically developing children, sentence length continues to influence intelligibility well into adolescence for children with neurodevelopmental disorders, and (b) sentence length may influence intelligibility differently in children with CP than in children with DS; however, other factors besides the type of neurodevelopmental disorder (e.g., severity of speech motor involvement and/or cognitive-linguistic impairment) could play a role in the relationship between sentence length and intelligibility and must be investigated in future studies.

The Effects of Speech Task on Lexical Stress in Parkinson's Disease.

PURPOSE: Hypokinetic dysarthria associated with Parkinson's disease (PD) is characterized by dysprosody, yet the literature is mixed with respect to how dysprosody affects the ability to mark lexical stress, possibly due to differences in speech tasks used to assess lexical stress. The purpose of this study was to compare how people with and without PD modulate acoustic dimensions of lexical stress-fundamental frequency, intensity, and duration-to mark lexical stress across three different speech tasks. METHOD: Twelve individuals with mild-to-moderate idiopathic PD and 12 age- and sex-matched older adult controls completed three speech tasks: picture description, word production in isolation, and word production in lists. Outcome measures were the fundamental frequency, intensity, and duration of the vocalic segments of two trochees (initial stress) and two iambs (final stress) spoken in all three tasks. RESULTS: There were very few group differences. Both groups marked trochees by modulating intensity and fundamental frequency and iambs by modulating duration. Task had a significant impact on the stress patterns used by both groups. Stress patterns were most differentiated in words produced in isolation and least differentiated in lists of words. CONCLUSIONS: People with PD did not demonstrate impairments in the production of lexical stress, suggesting that dysprosody associated with PD does not impact all types of prosody in the same way. However, there were reduced distinctions in stress marking that were more apparent in trochees than iambs. In addition, the task used to assess prosody has a significant effect on all acoustic measures. Future research should focus on the use of connected speech tasks to obtain more generalizable measures of prosody in PD.

Comparison of Respiratory Calibration Methods for the Estimation of Lung Volume in Children With and Without Neuromotor Disorders.

PURPOSE: The primary purpose of this study was to validate common respiratory calibration methods for estimating lung volume in children. METHOD: Respiratory kinematic data were collected via inductive plethysmography from 81 typically developing children and nine children with neuromotor disorders. Correction factors for the rib cage and abdomen were calculated using three different methods: (a) least squares method with both rib cage and abdomen corrections (LsqRC/AB), (b) least squares method with rib cage correction only (LsqRC), and (c) a standard 2:1 rib-cage-to-abdomen ratio (Banzett). Correction factors for the LsqRC/AB and LsqRC methods were calculated with and without the use of the speech-like breathing calibration task. Lung volume estimation errors were calculated by comparing the estimated lung volumes based on the correction factors and the actual lung volumes acquired from a spirometer, normalized to each participant's vital capacity. RESULTS: For typically developing children, the LsqRC/AB method resulted in significantly smaller lung volume estimation errors compared with other methods. Lung volume estimation errors decreased as age increased for each method. For the children with neuromotor disorders, the LsqRC/AB and LsqRC methods resulted in significantly smaller lung volume estimation errors than the Banzett method but were not significantly different from one another. There were no significant differences in lung volume estimation errors for the LsqRC/AB and LsqRC methods when the correction factors were calculated with and without the speech-like breathing calibration task. CONCLUSION: The LsqRC/AB method exclusively utilizing the rest breathing calibration task is the most accurate and efficient respiratory calibration method for use with children with and without neuromotor disorders at this time.

A Descriptive Study of Speech Breathing in Children With Cerebral Palsy During Two Types of Connected Speech Tasks.

PURPOSE: This study examined speech breathing during two connected speech tasks in children with cerebral palsy (CP) and typically developing (TD) peers. Understanding how the respiratory system supports speech production during various speech tasks can help researchers construct appropriate models of speech production and clinicians remediate speech disorders effectively. METHOD: Four children with CP and four age- and sex-matched TD peers completed two speech tasks, reading and extemporaneous speech. Respiratory kinematic and acoustic data were collected. Dependent variables included utterance length, speech rate, sound pressure level, and lung volume variables. RESULTS: Based on descriptive results, children with CP and speech motor involvement demonstrated reduced utterance length and speech rate, equivalent intensity levels, and changes in lung volume variables indicative of respiratory physiological impairment as compared to their TD peers. However, children with CP and no speech motor involvement exhibited speech production and speech breathing variables in the more typical range. In relation to task effects, the majority of children (CP and TD) produced shorter utterances, slower speech rates, equivalent intensity levels, higher lung volume initiation, termination, excursion, higher percent vital capacity per syllable, and longer inspiratory duration during extemporaneous speech as compared to reading. CONCLUSIONS: Two major themes emerged from the data: (a) Children with CP, particularly those with concomitant speech motor involvement, demonstrate different speech production and speech breathing patterns than their TD peers. (b) Speech task impacts speech production and speech breathing variables in both children with CP and their TD peers, but the extemporaneous speech task did not seem to exaggerate group differences.

Longitudinal Effects of Parkinson's Disease on Speech Breathing During an Extemporaneous Connected Speech Task.

PURPOSE: A critical component to the development of any type of intervention to improve speech production in individuals with Parkinson's disease (PD) is a complete understanding of the speech impairments present at each stage of the disease and how these impairments change with disease progression. The purpose of this longitudinal study was to examine the impact of disease on speech production and speech breathing during an extemporaneous speech task in individuals with PD over the course of approximately 3.5 years. METHOD: Eight individuals with PD and eight age- and sex-matched control participants produced an extemporaneous connected speech task on two occasions (Time 1 and Time 2) an average of 3 years 7 months apart. Dependent variables included sound pressure level; utterance length; speech rate; lung volume initiation, termination, and excursion; and percent vital capacity per syllable. RESULTS: From Time 1 to Time 2, individuals with PD demonstrated decreased utterance length and lung volume initiation, termination, and excursion and increased speech rate. Control participants demonstrated decreased utterance length and lung volume termination and increased lung volume excursion and percent vital capacity per syllable from Time 1 to Time 2. CONCLUSIONS: Changes in speech production and speech breathing variables experienced by individuals with PD over the course of several years are related to their disease process and not typical aging. Changes to speech breathing highlight the need to provide intervention focused on increasing efficient respiratory patterning for speech production.

Swallowing and Motor Speech Skills in Unilateral Cerebral Palsy: Novel Findings From a Preliminary Cross-Sectional Study.

PURPOSE: Our purpose was to start examining clinical swallowing and motor speech skills of school-age children with unilateral cerebral palsy (UCP) compared to typically developing children (TDC), how these skills relate to each other, and whether they are predicted by clinical/demographic data (age, birth history, lesion type, etc.). METHOD: Seventeen children with UCP and 17 TDC (7-12 years old) participated in this cross-sectional study. Feeding/swallowing skills were evaluated using the Dysphagia Disorder Survey (DDS) and a normalized measure of mealtime efficiency (normalized mealtime duration, i.e., nMD). Motor speech was assessed via speech intelligibility and speech rate measures using the Test of Children's Speech Plus. Analyses included nonparametric bootstrapping, correlation analysis, and multiple regression. RESULTS: Children with UCP exhibited more severe (higher) DDS scores (p = .0096, Part 1; p = .0132, Part 2) and reduced speech rate than TDC (p = .0120). Furthermore, in children with UCP, total DDS scores were moderately negatively correlated with speech intelligibility (words: r = -.6162, p = .0086; sentences: r = -.60792, p = .0096). Expressive language scores were the only significant predictor of feeding and swallowing performance, and receptive language scores were the only significant predictor of motor speech skills. CONCLUSIONS: Swallowing and motor speech skills can be affected in school-age children with UCP, with wide variability of performance also noted. Preliminary cross-system interactions between swallowing, speech, and language are observed and might support the complex relationships between these domains. Further understanding these relationships in this population could have prognostic and/or therapeutic value and warrants further study.

Speech Rate Varies With Sentence Length in Typically Developing Children.

Purpose The primary purpose of this study was to examine the effect of sentence length on speech rate and its characteristics, articulation rate and pauses, in typically developing children. Method Sixty-two typically developing children between the ages of 10 and 14 years repeated sentences varying in length from two to seven words. Dependent variables included speech rate (syllables per second), articulation rate (syllables per second), and proportion of time spent pausing. Results Speech rate and articulation rate significantly increased with increases in sentence length, but proportion of time spent pausing did not increase with sentence length. There were no significant main effects of age. Conclusions This is the first study to suggest that sentence length differentially impacts the component parts of speech rate, articulation rate and pause time. Increases in sentence length led to increases in speech rate, primarily due to increases in articulation rate and not increases in pause time. Articulation rate appears to be highly sensitive to the impact of sentence length, while a higher cognitive-linguistic load may be required to see sentence length effects on pause time.

Achieving Participation-Focused Intervention Through Shared Decision Making: Proposal of an Age- and Disorder-Generic Framework.

Introduction The World Health Organization's International Classification of Functioning, Disability and Health calls on speech-language pathologists (SLPs) to provide care that impacts all aspects of an individual's experience with a communication disorder, including their participation in valued life situations. However, SLPs often report feeling unprepared to implement and document interventions that target life participation. The purpose of this article is to propose a framework to guide participation-focused intervention practices. This age- and disorder-generic framework is designed to be applicable with clients across the variety of settings in which SLPs work. Method In this clinical focus article, we draw on past research and clinical experience to propose a restructuring of World Health Organization's International Classification of Functioning, Disability and Health components such that participation is the primary focus and outcomes indicator for intervention. In this framework, a specific communicative participation situation is identified and assessed quantitatively, and a corresponding participation-focused goal is established through shared decision making. Following that, assessments are conducted and goals are established in the areas of communication skills, physical and social environments, and personal perspectives. Results The proposed framework provides a concrete organizational structure as well as assessment, goal-writing, and intervention examples to assist SLPs in translating theoretical biopsychosocial frameworks into clinical practices. Conclusions SLPs can and do provide holistic communication services to clients to help them achieve their life participation goals. This article provides an example as to how we can document the need for, as well as the value and impact of our important work, meeting the diverse life participation needs of clients. Supplemental Material https://doi.org/10.23641/asha.12360758.

The Impact of Parkinson's Disease on Breath Pauses and Their Relationship to Speech Impairment: A Longitudinal Study.

Purpose The purposes of this longitudinal study were to (a) examine the impact of Parkinson's disease (PD) progression on breath pause patterns and speech and linguistic errors and (b) determine the extent to which breath pauses and speech and linguistic errors contribute to speech impairment. Method Eight individuals with PD and eight age- and sex-matched control participants produced a reading passage on two occasions (Time 1 and Time 2) 3 years and 7 months apart on average. Two speech-language pathologists rated the severity of speech impairment for all participants at each time. Dependent variables included the location of each breath pause relative to syntax and punctuation as well as the number of disfluencies and mazes. Results At Time 1, there were no significant differences between the groups regarding breath pause patterns. At Time 2, individuals with PD produced significantly fewer breath pauses at major syntactic boundaries and periods as well as significantly more breath pauses at locations with no punctuation than control participants. Individuals with PD produced a significantly greater number of disfluencies than control participants at both time points. There were no significant differences between the groups in the number of mazes produced at either time point. Together, the number of mazes and the percentage of breath pauses at locations with no punctuation explained 50% of the variance associated with the ratings of severity of speech impairment. Conclusion These results highlight the importance of targeting both respiratory physiological and cognitive-linguistic systems in order to improve speech production in individuals with PD.

Characteristics of Speech Rate in Children With Cerebral Palsy: A Longitudinal Study.

Purpose: The purpose of this longitudinal study was to examine the effect of time and sentence length on speech rate and its characteristics, articulation rate and pauses, within 2 groups of children with cerebral palsy (CP). Method: Thirty-four children with CP, 18 with no speech motor involvement and 16 with speech motor involvement, produced sentences of varying lengths at 3 time points that were 1 year apart (mean age = 56 months at first time point). Dependent measures included speech rate, articulation rate, proportion of time spent pausing, and average number and duration of pauses. Results: There were no significant effects of time. For children with no speech motor involvement, speech rate increased with longer sentences due to increased articulation rate. For children with speech motor involvement, speech rate did not change with sentence length due to significant increases in the proportion of time spent pausing and average number of pauses in longer sentences. Conclusions: There were no significant age-related differences in speech rate in children with CP regardless of group membership. Sentence length differentially impacted speech rate and its characteristics in both groups of children with CP. This may be due to cognitive-linguistic and/or speech motor control factors.

The Impact of Expiratory Muscle Strength Training on Speech Breathing in Individuals With Parkinson's Disease: A Preliminary Study.

PURPOSE: The purpose of this study was to examine the impact of expiratory muscle strength training on speech breathing and functional speech outcomes in individuals with Parkinson's disease (PD). METHOD: Twelve individuals with PD were seen once a week for 8 weeks: 4 pretraining (baseline) sessions followed by a 4-week training period. Posttraining data were collected at the end of the 4th week of training. Maximum expiratory pressure, an indicator of expiratory muscle strength, and lung volume at speech initiation were the primary outcome measures. Secondary outcomes included lung volume at speech termination, lung volume excursion, utterance length, and vocal intensity. Data were collected during a spontaneous speech sample. Individual effect sizes > 1 were considered significant. RESULTS: Maximum expiratory pressure increased in a majority of participants after training. Training resulted in 2 main respiratory patterns: increasing or decreasing lung volume initiation. Lung volume termination and excursion, utterance length, and vocal loudness were not consistently altered by training. CONCLUSIONS: Preliminary evidence suggests that the direct physiologic intervention of the respiratory system via expiratory muscle strength training improves speech breathing in individuals with PD, with participants using more typical lung volumes for speech following treatment.

The relationship between intermittent limit cycles and postural instability associated with Parkinson's disease.

BACKGROUND: Many disease-specific factors such as muscular weakness, increased muscle stiffness, varying postural strategies, and changes in postural reflexes have been shown to lead to postural instability and fall risk in people with Parkinson's disease (PD). Recently, analytical techniques, inspired by the dynamical systems perspective on movement control and coordination, have been used to examine the mechanisms underlying the dynamics of postural declines and the emergence of postural instabilities in people with PD. METHODS: A wavelet-based technique was used to identify limit cycle oscillations (LCOs) in the anterior-posterior (AP) postural sway of people with mild PD (n = 10) compared to age-matched controls (n = 10). Participants stood on a foam and on a rigid surface while completing a dual task (speaking). RESULTS: There was no significant difference in the root mean square of center of pressure between groups. Three out of 10 participants with PD demonstrated LCOs on the foam surface, while none in the control group demonstrated LCOs. An inverted pendulum model of bipedal stance was used to demonstrate that LCOs occur due to disease-specific changes associated with PD: time-delay and neuromuscular feedback gain. CONCLUSION: Overall, the LCO analysis and mathematical model appear to capture the subtle postural instabilities associated with mild PD. In addition, these findings provide insights into the mechanisms that lead to the emergence of unstable posture in patients with PD.