Accuracy of Speech Sound Analysis: Comparison of an Automatic Artificial Intelligence Algorithm With Clinician Assessment.

PURPOSE: Automatic speech analysis (ASA) and automatic speech recognition systems are increasingly being used in the treatment of speech sound disorders (SSDs). When utilized as a home practice tool or in the absence of the clinician, the ASA system has the potential to facilitate treatment gains. However, the feedback accuracy of such systems varies, a factor that may impact these gains. The current research analyzes the feedback accuracy of a novel ASA algorithm (Amplio Learning Technologies), in comparison to clinician judgments. METHOD: A total of 3,584 consonant stimuli, produced by 395 American English-speaking children and adolescents with SSDs (age range: 4-18 years), were analyzed with respect to automatic classification of the ASA algorithm, clinician-ASA agreement, and interclinician agreement. Further analysis of results as related to phoneme acquisition categories (early-, middle-, and late-acquired phonemes) was conducted. RESULTS: Agreement between clinicians and ASA classification for sounds produced accurately was above 80% for all phonemes, with some variation based on phoneme acquisition category (early, middle, late). This variation was also noted for ASA classification into "acceptable," "unacceptable," and "unknown" (which means no determination of phoneme accuracy) categories, as well as interclinician agreement. Clinician-ASA agreement was reduced for misarticulated sounds. CONCLUSIONS: The initial findings of Amplio's novel algorithm are promising for its potential use within the context of home practice, as it demonstrates high feedback accuracy for correctly produced sounds. Furthermore, complexity of sound influences consistency of perception, both by clinicians and by automated platforms, indicating variable performance of the ASA algorithm across phonemes. Taken together, the ASA algorithm may be effective in facilitating speech sound practice for children with SSDs, even in the absence of the clinician.

Artificial Intelligence-Assisted Speech Therapy for /ɹ/: A Single-Case Experimental Study.

PURPOSE: This feasibility trial describes changes in rhotic production in residual speech sound disorder following ten 40-min sessions including artificial intelligence (AI)-assisted motor-based intervention with ChainingAI, a version of Speech Motor Chaining that predicts clinician perceptual judgment using the PERCEPT-R Classifier (Perceptual Error Rating for the Clinical Evaluation of Phonetic Targets). The primary purpose is to evaluate /ɹ/ productions directly after practice with ChainingAI versus directly before ChainingAI and to evaluate how the overall AI-assisted treatment package may lead to perceptual improvement in /ɹ/ productions compared to a no-treatment baseline phase. METHOD: Five participants ages 10;7-19;3 (years;months) who were stimulable for /ɹ/ participated in a multiple (no-treatment)-baseline ABA single-case experiment. Prepractice activities were led by a human clinician, and drill-based motor learning practice was automated by ChainingAI. Study outcomes were derived from masked expert listener perceptual ratings of /ɹ/ from treated and untreated utterances recorded during baseline, treatment, and posttreatment sessions. RESULTS: Listeners perceived significantly more rhoticity in practiced utterances after 30 min of ChainingAI, without a clinician, than directly before ChainingAI. Three of five participants showed significant generalization of /ɹ/ to untreated words during the treatment phase compared to the no-treatment baseline. All five participants demonstrated statistically significant generalization of /ɹ/ to untreated words from pretreatment to posttreatment. PERCEPT-clinician rater agreement (i.e., F1 score) was largely within the range of human-human agreement for four of five participants. Survey data indicated that parents and participants felt hybrid computerized-clinician service delivery could facilitate at-home practice. CONCLUSIONS: This study provides evidence of participant improvement for /ɹ/ in untreated words in response to an AI-assisted treatment package. The continued development of AI-assisted treatments may someday mitigate barriers precluding access to sufficiently intense speech therapy for individuals with speech sound disorders. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.26662807.

Shared characteristics of intervention techniques for oral vocabulary and speech comprehensibility in preschool children with co-occurring features of developmental language disorder and speech sound disorder: a systematic review with narrative synthesis.

OBJECTIVES: To descriptively compare and contrast intervention techniques for preschool children with features of developmental language disorder (outcome: oral vocabulary) and speech sound disorder (outcome: speech comprehensibility) and analyse them in relation to effectiveness and theory. DESIGN: This is a systematic review with narrative synthesis. The process was supported by an expert steering group consisting of relevant professionals and people with lived experience. DATA SOURCES: Ovid Emcare, MEDLINE Complete, CINAHL, APA PsycINFO, ERIC, and Communication Source from January 2012 were searched. Relevant studies were obtained from an initial published review (up to January 2012). ELIGIBILITY CRITERIA: Interventions for preschool children (80% aged 2:0-5:11 years) with idiopathic speech or language needs; outcomes relating to either oral vocabulary or speech comprehensibility. DATA EXTRACTION AND SYNTHESIS: Searches were conducted on 27 January 2023. Two independent researchers screened at abstract and full-text levels. Data regarding intervention content (eg, techniques) and format/delivery (eg, dosage, location) were extracted. Data were synthesised narratively according to the methods of Campbell et al. RESULTS: 24 studies were included: 18 for oral vocabulary and 6 for speech comprehensibility. There were 11 randomised controlled trials, 2 cohort studies and 11 case series. Similarities included a focus on input-related techniques and similar therapy activities. Speech studies were more likely to be professional-led and clinic-led, rather than at home and through a parent. Analysis was restricted by heterogeneity in study design and terminology, as well as gaps within intervention reporting. Information deemed important to the expert steering group was missing. CONCLUSIONS: Similarities and differences between intervention techniques for oral vocabulary and speech comprehensibility have been identified and synthesised. However, analysis of effectiveness was limited due to issues with study design and heterogeneity within studies. This has implications for the progression of the evidence base within the field. PROSPERO REGISTRATION NUMBER: CRD42022373931.

Whole Genome Analysis in Consanguineous Families Reveals New Loci for Speech Sound Disorder (SSD).

Speech is the most common means of communication in humans. Any defect in accurate speech production ability results in the development of speech sound disorder (SSD), a condition that can significantly impair an individual's academic performance, social interactions, and relationships with peers and adults. This study investigated the genetic basis of SSD in three Pakistani families. We performed family-based genome-wide parametric linkage analysis and homozygosity mapping in three consanguineous families with SSD from the Punjab province of Pakistan. The Test for Assessment of Articulation and Phonology in Urdu (TAAPU) was used to analyze the speech articulation data and determine the Percentage Correct Consonants (PCC) score. The PCC score defined the affected and unaffected individuals in each family. Parametric linkage analysis revealed a linkage to chromosome 5 (5q21.3-5q23.1) with a significant logarithm of the odds (LOD) score of 3.13 in a Pakistani family with specific language impairment-97 (PKSLI-97) under an autosomal recessive mode of inheritance. The other two families showed a suggestive linkage at 6p22.1, 14q12, and 16q12.1 under the recessive mode of inheritance. Interestingly, homozygosity mapping showed a loss of heterozygosity in the linkage region at 5q15-5q23.1, shared among seven affected (mostly in the younger generation) and one unaffected individual of PKSLI-97. Our analysis identified the 6p22 locus previously implicated in dyslexia, childhood apraxia of speech (CAS), and language impairment, confirming the role of KIAA0319 and DCDC2 in this locus. These findings provide statistical evidence for the genomic regions associated with articulation disorder and offer future opportunities to further the role of genes in speech production.

Design and evaluation of a serious video game to treat preschool children with speech sound disorders.

Speech sound disorder (SSD) is one of the most common communication disorders in children, which must be diagnosed and treated in childhood to prevent its negative psychological, occupational, and social consequences in adulthood. The use of serious games is one technology that could help treat SSD. This study aims to design and evaluate the usability of a digital game for 3-6-year-old children. This developmental study was carried out in three main stages: determining information requirements, designing and developing a digital game, and evaluating the usability of the designed game. In the first stage, the consonants, syllables, words, and sentences that should be used in the game were determined through focus group sessions and a questionnaire completed by 30 speech-language pathologists (SLPs) in two Delphi rounds. In the designing and developing stage, the game design document was first written, and then sketches and wireframes were drawn based on this document. Then, the game was developed in the second phase using Java programming language. In the third stage, the usability of the designed game was evaluated by six experts and 22 SLPs using Nielsen's usability heuristics and the Post-Study System Usability Questionnaire (PSSUQ), respectively. Also, the usability of the game was evaluated by ten children. To determine the information requirements, SLPs confirmed 23 consonants, 138 syllables, 564 words, and 69 sentences to teach children the game. According to Nielsen's usability heuristics, the designed game had 23 unique usability problems with a mean severity of 2.29. "User control and freedom," with five usability problems, was the most frequently identified problem, and "error prevention," with a mean severity of 3.83, was the most severe problem. The results of the SLPs' evaluation also showed that the "interface quality" of the designed game obtained the highest score, with a mean score of 6.25 out of 7. Also, 100% of children stated that the game was designed beautifully, and 90% of children also liked the game. A serious game designed for children with SSDs achieved satisfactory results in usability evaluation. Therefore, this smartphone-based game can be easily used among these children to provide fun therapy sessions under the supervision of parents.

Phonological assessment for Greek (PAel) test: Reliability and validity in 4-to 6-year-old preschool children.

Single-word phonological tests are widely used for detecting children at risk for Speech Sound Disorders (SSDs). However, specific conceptual and operational criteria should be evaluated to ensure that these assessments are valid and reliable and can serve as diagnostic tools. The current study aimed to investigate the validity and reliability of the screener of a phonological Greek instrument, named the Phonological Assessment for Greek (PAel) comparing the phonological performance of typically developing (TD) children and children with SSDs, aged 4 to 6 years. The participants were 20 TD children and 40 children with SSDs. All participants completed the screener of PAel, the 70-word list of the standardised Test of Phonetic and Phonological Development (TPPD), and a language test, namely the Action Picture Test. Participants who scored below the 25th percentile on the language test were excluded. Phonological analysis revealed that PAel has high content validity. The participants who had received a diagnosis of SSDs presented restricted consonant and cluster inventories and significantly lower whole-word match levels in comparison to their TD peers. The overall Spearman's correlation coefficients between PAel and TPPD were 0.611 for TD children (p < 0.001) and 0.875 for children with SSDs (p < 0.001), indicating good criterion validity. The tool demonstrated strong test-retest reliability and inter-rater reliability with Spearman values exceeding 0.85, and Intra-class correlation coefficients over 0.90. Overall, the results suggest that PAel has satisfactory reliability and validity and can be used as an assessment tool to detect children at risk for SSDs.

Acoustic Analyses of Tone Productions in Sequencing Contexts Among Cantonese-Speaking Preschool Children With and Without Childhood Apraxia of Speech.

PURPOSE: Pitch variations (tone productions) have been reported as a measure to differentiate Cantonese-speaking children with and without childhood apraxia of speech (CAS). This study aims to examine fundamental frequency (F0) changes within syllables and the effects of syllable structure, lexical status, and syllable positions on F0 in Cantonese-speaking preschool children with and without CAS. METHOD: Six children with CAS, six children with non-CAS speech sound disorder plus language disorder (S&LD), 22 children with speech sound disorder only (SSD), and 63 children with typical speech-language development (TD) performed the tone sequencing task (TST). Growth curve analysis was employed to analyze and compare the F0 values within syllables with three Cantonese tones (high level, high rising, and low falling). The analysis considered the effects of syllable structure (vowel and consonant-vowel), lexical status (word and nonword), and syllable position (initial, medial, and final) on F0, as well as comparisons within and between groups. RESULTS: Within each group, the effects of syllable structure and position on F0 values were found with different patterns. Between-group comparisons showed that the CAS group had reduced F0 contrasts. The CAS group could be differentiated from the control groups based on interactions of F0 with syllable structure and position, but not lexical status. The dissimilarity of F0 values detected between the CAS and SSD/TD groups was more prominent than that observed between the CAS and S&LD groups. CONCLUSIONS: This study demonstrated that Cantonese-speaking children with CAS had difficulty in varying F0 within syllables as compared to those without CAS, suggesting pitch variation difficulty and language-specific impairment profiles in CAS. Future investigations of objective measures for identifying Cantonese speakers with CAS and cross-linguistic investigations using growth curve analysis and the TST are suggested.

Outcome measures for children with speech sound disorder: an umbrella review.

OBJECTIVE: Speech sound disorder (SSD) describes a 'persistent difficulty with speech sound production that interferes with speech intelligibility or prevents verbal communication'. There is a need to establish which care pathways are most effective and efficient for children with SSD. Comparison of care pathways requires clearly defined, evidence-based, interventions and agreement on how to measure the outcomes. At present, no definitive list of assessments, interventions or outcomes exists. The objective of this umbrella review paper is to provide a rigorous and detailed list of assessments, interventions and outcomes which target SSD in children. DESIGN: In December 2022, a systematic search of Ovid Medline, OVID Embase, CINAHL, PsycInfo and Cochrane and a number of grey literature platforms were undertaken. 18 reviews were included, and subsequently 415 primary research articles were assessed for data related to assessments, interventions or outcomes. The AMSTAR (Assessing the Methodological Quality of Systematic Reviews) framework was used to assess the quality of the retained reviews. SETTING: Reviews were retained which took place in any setting. PARTICIPANTS: The population is children of any age with a diagnosis of SSD of unknown origin. PRIMARY AND SECONDARY OUTCOME MEASURES: Reviews reporting outcomes, assessment and interventions for children with SSD. RESULTS: Extraction and analysis identified 37 assessments, 46 interventions and 30 outcome measures used in research reporting of SSD. Not all of the listed outcomes were linked to specific outcome measurement tools, but these were measurable through the use of one or more of the assessments extracted from the retained reviews. CONCLUSIONS: The findings of this review will be used to develop a Core Outcome Set for children with SSD. The findings are part of a rigorous process essential for advancing healthcare research and practice in the specific area of speech and language therapy for children with SSD. PROSPERO REGISTRATION NUMBER: CRD42022316284.

Speech-Language Outcomes in the COVID-19 Milieu for Multilingual Jamaican Preschoolers and Considerations for Telepractice Assessments.

PURPOSE: The purpose of this study was to characterize the communicative participation and functional speech intelligibility (i.e., how children use communication and how well they are understood across everyday life) of typically developing (TD) bilingual Jamaican preschoolers and those with functionally defined speech sound disorders (fSSDs) in the COVID-19 milieu. Findings were also compared to an existing corpus of baseline data to document and explore differences in children's speech-language outcomes secondary to pandemic-related social restrictions. METHOD: Thirty bilingual Jamaican preschoolers, 21 TD and nine with fSSDs, were assessed during the pandemic via telepractice. Association and univariate mean testing were completed to characterize children's communicative participation and functional speech intelligibility. Data were then compared to an existing corpus of baseline data (collected in person between 2013 and 2019), which included direct child assessment and parent reports and consisted of TD (n = 226) Jamaican Creole-English-speaking preschoolers and those with fSSDs (n = 39) to compare performance profiles across data sets. All participants attended schools in Kingston, Jamaica. RESULTS: Measures of communicative participation remained stable in the context of the COVID-19 milieu for children in the TD and fSSD groups, but functional speech intelligibility outcomes for children with fSSDs deviated between in-person findings collected from children pre-pandemic. Between-groups differences were also found on measures of speech production accuracy but were no longer significant when considering telepractice as a covariate. CONCLUSIONS: Findings from this investigation serve to characterize the communicative participation and functional speech intelligibility of TD bilingual Jamaican preschoolers and those with fSSDs in the COVID-19 milieu. By extension, the results comparing data from preschoolers collected during the pandemic to an existing corpus of baseline data from a different group of preschoolers provide critical insights about multilingual children's speech-language outcomes in the context of acutely changing environmental circumstances. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.25461505.

Evidence of validity and reliability of the Compressed Speech Test with Figures. / Evidências de validade e fidedignidade do Teste de Fala Comprimida com Figuras.

PURPOSE: To seek evidence of validity and reliability for the Compressed Speech Test with Figures. METHODS: The study was subdivided into three stages: construct validation, criteria and reliability. All participants were aged between 6:00 and 8:11. For the construct, Compressed Speech with Figures and the gold standard Adapted Compressed Speech test were applied to children with typical phonological development. For criterion analysis, Compressed Speech with Figures was applied in two groups, with typical (G1) and atypical (G2) phonological development. Finally, the application protocols underwent analysis by two Speech Therapists, with experience in the area of Central Auditory Processing, seeking to obtain an inter-evaluator reliability analysis. RESULTS: The correlation test indicated an almost perfect construct (correlation 0.843 for the right ear and 0.823 for the left ear). In the criterion analysis, it was noticed that both groups presented satisfactory results (G1 = 99.6 to 100%; G2 = 96 to 96.5%). The reliability analysis demonstrated that the protocol is easy to analyze, as both professionals presented unanimous responses. CONCLUSION: It was possible to obtain evidence of validity and reliability for the Compressed Speech with Figures instrument. The construct analysis showed that the instrument measures the same variable as the gold standard test, with an almost perfect correlation. In the criterion analysis, both groups presented similar performance, demonstrating that the instrument does not seem to differentiate populations with and without mild phonological disorder. The inter-evaluator reliability analysis demonstrated that the protocol is easy to analyze and score.

OBJETIVO: Buscar evidências de validade e fidedignidade para o Teste de Fala Comprimida com Figuras. MÉTODO: O estudo foi subdividido em três etapas: validação de construto, critério e fidedignidade. Todos os participantes tinham idade entre 6:00 e 8:11. Para o construto, aplicou-se o Fala Comprimida com Figuras e o teste padrão ouro Fala Comprimida Adaptado em crianças com desenvolvimento fonológico típico. Para análise de critério, aplicou-se o Fala Comprimida com Figuras em dois grupos, com desenvolvimento fonológico típico (G1) e atípico (G2). Por fim, os protocolos de aplicação passaram pela análise de duas Fonoaudiólogas, com experiência na área do Processamento Auditivo Central, buscando obter uma análise de fidedignidade interavaliadores. RESULTADOS: O teste de correlação indicou um construto quase perfeito (Rho=0,843 para orelha direita e Rho=0,823 para orelha esquerda). Na análise de critério, percebeu-se que ambos os grupos apresentaram resultados satisfatórios (G1 = 99,6 a 100%; G2 = 96 a 96,5%). Já a análise de fidedignidade demonstrou que o protocolo é de fácil análise, pois ambos os profissionais apresentaram respostas unânimes. CONCLUSÃO: Foi possível obter evidências de validade e fidedignidade para o instrumento de Fala Comprimida com Figuras. A análise de construto evidenciou que o instrumento mede a mesma variável que o teste padrão outro, com correlação quase perfeita. Na análise de critério, ambos os grupos apresentaram desempenho semelhante, demonstrando que o instrumento não parece diferenciar populações com e sem transtorno fonológico leve. A análise de fidedignidade interavaliador demonstrou que o protocolo é de fácil análise e pontuação.

Development of the Digital Speech Assessment Instrument.

OBJECTIVE: This study aimed to develop a Digital Speech Assessment Instrument to evaluate the phonological and motor speech skills of Brazilian Portuguese-speaking children and adolescents through six tasks: (a) word naming, (b) word imitation, (c) pseudoword imitation, (d) word repetition, (e) pseudoword repetition, and (f) diadochokinesis. METHOD: The assessment instrument was developed and validated in a seven-step process, beginning with stimulus selection and ending with Pilot Study 1 (involving children and adolescents with typical speech development) and Pilot Study 2 (involving children and adolescents with speech sound disorders [SSDs]). Participants of the study included expert and nonexpert judges, children, and adolescents. RESULTS: The Digital Speech Assessment Instrument contains 91 real words (61 in the naming task, 51 in the imitation task, and five in the repetition task), 26 pseudowords (26 in the imitation task and four in the repetition task), and six stimuli for diadochokinesis. The test contains stimuli in the form of images as well as audio and video recordings and allows for the analysis and storage of participant data in a virtual database. CONCLUSIONS: This study described the development of the Digital Speech Assessment Instrument, available in Brazilian Portuguese for the evaluation of several aspects of speech production (including word and pseudoword naming, imitation, and repetition and diadochokinesis). The test was developed for children aged 2;0 (years;months) to 17;11 and is administered fully online. In the future, the instrument can be used to provide a timely and accurate diagnosis of SSDs.

Evaluating acoustic representations and normalization for rhoticity classification in children with speech sound disorders.

The effects of different acoustic representations and normalizations were compared for classifiers predicting perception of children's rhotic versus derhotic /ɹ/. Formant and Mel frequency cepstral coefficient (MFCC) representations for 350 speakers were z-standardized, either relative to values in the same utterance or age-and-sex data for typical /ɹ/. Statistical modeling indicated age-and-sex normalization significantly increased classifier performances. Clinically interpretable formants performed similarly to MFCCs and were endorsed for deep neural network engineering, achieving mean test-participant-specific F1-score = 0.81 after personalization and replication (σx = 0.10, med = 0.83, n = 48). Shapley additive explanations analysis indicated the third formant most influenced fully rhotic predictions.

Comparing online versus laboratory measures of speech perception in older children and adolescents.

Given the increasing prevalence of online data collection, it is important to know how behavioral data obtained online compare to samples collected in the laboratory. This study compares online and in-person measurement of speech perception in older children and adolescents. Speech perception is important for assessment and treatment planning in speech-language pathology; we focus on the American English /ɹ/ sound because of its frequency as a clinical target. Two speech perception tasks were adapted for web presentation using Gorilla: identification of items along a synthetic continuum from rake to wake, and category goodness judgment of English /ɹ/ sounds in words produced by various talkers with and without speech sound disorder. Fifty typical children aged 9-15 completed these tasks online using a standard headset. These data were compared to a previous sample of 98 typical children aged 9-15 who completed the same tasks in the lab setting. For the identification task, participants exhibited smaller boundary widths (suggestive of more acute perception) in the in-person setting relative to the online setting. For the category goodness judgment task, there was no statistically significant effect of modality. The correlation between scores on the two tasks was significant in the online setting but not in the in-person setting, but the difference in correlation strength was not statistically significant. Overall, our findings agree with previous research in suggesting that online and in-person data collection do not yield identical results, but the two contexts tend to support the same broad conclusions. In addition, these results suggest that online data collection can make it easier for researchers connect with a more representative sample of participants.

What works, how and in which contexts when supporting parents to implement intensive speech and language therapy at home for children with speech sound disorder? A protocol for a realist review.

INTRODUCTION: Speech and language therapists (SLTs) worldwide report challenges with providing recommended, evidence-based intervention intensity for children with speech sound disorder (SSD). Challenges such as service constraints and/or family contexts impact on access to optimal therapy intensity. Existing research indicates that empowering and training parents to deliver intervention at home, alongside SLT support, offers one possible solution to increasing the intensity of intervention children with SSD receive. Digital health could increase accessibility to intensive home practice and help sustain engagement with therapy activities. Further exploration is needed around what makes parent-implemented interventions for children with SSD effective, for who and in which situations. This paper outlines the protocol for a realist review which aims to explore the active ingredients and contextual factors of effective digital parent-led interventions. METHODS AND ANALYSIS: A realist review will explore the research question, following six stages. The scope of the review will be determined, and initial programme theories will be developed about what works in digital parent-implemented interventions for SSD, for whom, how, why and in what circumstances. Relevant secondary data, identified through a formal search strategy, will be selected, appraised, analysed and synthesised using realist principles to test and further refine the initial programme theories. This process will develop refined underpinning explanatory theories which capture the interaction between contexts, mechanisms and outcomes of the intervention. An expert steering group will provide insight to inform explanatory theories, searches, and dissemination. ETHICS AND DISSEMINATION: Ethical approval is not required for this review. The refined programme theories from the review will inform the next stages of a wider study. A subsequent realist evaluation will test and further refine theories with key stakeholders. Following this, the underpinning programme theory will be used to coproduce a digital tool, to support parents to deliver home intervention alongside SLT support.

22q13.33 duplication involving SHANK3 gene: a boy and his mother with "persistent" language and speech sound disorder.

Patients carrying 22q13.33 duplication present variable neurodevelopmental phenotype. Among these, patients with genetic alteration disrupting SHANK3 gene are very rare and they also present neurodevelopmental disorder such as autism spectrum disorder and intellectual disability. The real incidence is unknown because mild and variable phenotype could cause reduction in diagnosed cases. We describe the first case of 22q13.33 microduplication disrupting SHANK3 gene, inherited from mother to son, that presents a "persistent" language and speech sound disorder as main symptom without intellectual disability and autism spectrum disorder. More clinical reports with accurate phenotype description are needed to better define the profile of carriers of this genetic alteration.

Phonological awareness training and phonological therapy approaches for specific language impairment children with speech sound disorders: a comparative outcome study.

PURPOSE: Children with specific language impairment (SLI) might present with speech sound disorder (SSD) and phonological awareness (PA) deficits which put them at risk of potential reading problems. This work aimed to organize an intervention program in Arabic for phonological training and to assess the effect of PA training versus the phonological therapy (PT) for children with SLI and SSD. METHODS: The study was carried out on 60 children with comorbid SLI and SSD, aged 5-7 years. Children were equally divided into two groups; each group received language therapy combined with (PT or PA training). Measures of language development, phonological output, and PA were taken before therapy and at 4 month post-therapy for all children. RESULTS: The two therapy groups made nearly the same amount of progress in the development of language and phonological production, with no significant differences regarding language age and percent of consonants correct (PCC). The PA training group progressed more on the PA skills than children who received PT over the same time. CONCLUSIONS: PA training could facilitate the development of phonological skills by targeting the child's awareness of phonemes and improving the production of sound patterns.

Intervention for residual speech errors in adolescents and adults: A systematised review.

When speech sound errors persist beyond childhood they are classified as residual speech errors (RSE) and may have detrimental impacts on an individual's social, educational and employment participation. Despite this, individuals who present with RSE are usually not prioritised on large caseloads. The aim of this literature review was to examine what intervention approaches are available in remediating RSE, and how effective are they for adolescents and adults? A systematised review was undertaken. Comprehensive and systematic searching included search of terms across seven databases, forward and reverse citation searching, and key author contact. Thirty articles underwent critical appraisal before data extraction. Inductive thematic analysis was done before completion of a narrative review. Twenty-three (76.6%) of the articles were from the US and most studies involved intervention for 'r' (90%). Intervention approaches for RSE involved traditional articulation therapy, auditory perceptual training, instrumental approaches, and approaches based on principles of motor learning. Twenty-one studies (70%) investigated the use of more than one intervention approach. Measures of intervention efficacy varied between studies; however, any intervention approach tended to be more successful if delivered in a more intensive schedule. A variety of approaches can be used for RSE, but a combination of high intensity, traditional therapy with adjunctive instrumental biofeedback may be most effective, especially with highly motivated individuals. Unfortunately, this usually requires costly equipment and training to implement. More information about the best dosage and intensity intervention for RSE, evaluated for a larger number of phonemes across other languages and dialects is required.

Alterações pragmáticas em crianças com Transtorno Fonológico: uma revisão sistemática / Pragmatic disorders in children with Phonological Disorder: a systematic review / Alteraciones pragmáticas en niños con Trastorno Fonológico: una revisión sistemática

Introdução: A pragmática é definida como o uso social da linguagem e a fonologia diz respeito à organização fonêmica e silábica. No Transtorno Fonológico são observadas alterações nessa organização, sendo possível também afetar a pragmática. Objetivo: Compreender e demonstrar se há alterações pragmáticas em crianças com Transtorno Fonológico. Metodologia: A busca por estudos foi realizada utilizando as bases de dados eletrônicas: Embase, Google Scholar, Portal Biblioteca Virtual em Saúde (BVS) - (LILACS), PubMed, SciELO, Scopus, Web of Science, e Base de Dados de Teses e Dissertações. Foram utilizados os descritores: "child", "speech sound disorder", "language tests", "verbal behavior", "social communication disorder" e "observational studies as topic" e seus sinônimos. Os artigos selecionados atendiam aos seguintes critérios: amostra composta por crianças de 4 a 10 anos com Transtorno Fonológico e dentro do desenvolvimento padrão, apresentar avaliações da pragmática dessas crianças, e delineamento observacional. A análise dos artigos foi feita pela leitura na íntegra e os dados foram extraídos para a avaliação da qualidade metodológica e dos achados. Resultados: Foram encontrados seis artigos, sendo quatro nacionais e dois internacionais. Discussão: Cinco estudos demonstraram haver alterações pragmáticas em crianças com Transtorno Fonológico, enquanto um concluiu que não havia relação. Considerações finais: A presente revisão sistemática revelou que estudos evidenciam alterações pragmáticas em crianças com Transtorno Fonológico, especialmente acerca da inteligibilidade de fala e de como isso afeta as iniciativas de comunicação. Todavia, devido ao baixo número de estudos, são necessárias futuras pesquisas na temática para dados com evidências mais robustas. (AU)

Introduction: Pragmatics is defined as the social use of language while phonology looks to phonemic and syllabic organization. In the phonological disorder, problems are observed in this organization being possible to affect the pragmatics too. Objective: To understand and demonstrate if there are pragmatic alterations in children with Phonological Disorder. Methodology: The search for studies was carried out using electronic databases: Embase, Google Scholar, BVS - (LILACS), PubMed, SciELO, Scopus, Web of Science and The Theses and Dissertations Database. The descriptors used were: "child", "speech sound disorder", "language tests", "verbal behavior", "social communication disorder" and "observational studies as topic" and their synonyms. The selected articles met the following criteria: sample composed of children aged 4 to 10 with phonological disorder and within standard development, evaluations of the pragmatics of these children, and observational design. The articles were analyzed by reading them in their entirety and the data were extracted to evaluate the methodological quality and the findings. Results: Six articles were found, four national and two international. Discussion: Five studies showed that there were pragmatic alterations in children with phonological disorder and one concluded that there was no relationship. Final considerations: The present systematic review revealed that the studies show pragmatic alterations in children with phonological disorder, especially regarding the intelligibility of their speech and how this may affect communication initiatives. However, due to the low number of studies, there seems to be a need for future research relating the two subjects for such evidence to be more robust. (AU)

Introducción: La pragmática se define como el uso social del lenguaje y la fonología como la organización fonémica y silábica. En el Trastorno Fonológico, hay cambios en esta organización, y es posible afectar la pragmática. Objetivo: Comprender y demostrar si existen cambios pragmáticos en niños con Trastorno Fonológico. Metodología: Búsqueda de estudios realizados en bases de datos electrónicas: Embase, Google Scholar, Portal Biblioteca Virtual en Salud (BVS) - (LILACS), PubMed, SciELO, Scopus, Web of Science y Banco de Tesis y Disertaciones. Fueron utilizados los siguientes descriptores: "niño", "trastorno de los sonidos del habla", "pruebas de lenguaje", "conducta verbal", "trastorno de la comunicación social" y "estudios observacionales como tema" y sus sinónimos. Los artículos seleccionados cumplieron con los siguientes criterios: muestra compuesta por niños de 4 a 10 años con Trastorno Fonológico y dentro del desarrollo estándar, valoraciones de la pragmática de estos niños y diseño observacional. Los artículos fueron analizados mediante lectura comprensiva y se extrajeron datos para evaluar la calidad metodológica de los hallazgos. Resultados: Se encontraron seis artículos, cuatro nacionales y dos internacionales. Discusión: Cinco estudios mostraron cambios pragmáticos en niños con Trastorno Fonológico y uno concluyó que no había relación. Consideraciones finales: Esta revisión sistemática reveló que los estudios muestran alteraciones pragmáticas en niños con Trastorno Fonológico, especialmente en cuanto a la inteligibilidad de su habla y cómo esto puede afectar las iniciativas de comunicación. Sin embargo, debido al bajo número de estudios, se necesita más investigación sobre el tema para que la evidencia sea más sólida. (AU)

Subtract Before You Add: Toward the Development of a De-Implementation Approach in School-Based Speech Sound Therapy.

PURPOSE: It is often difficult for school-based speech-language pathologists (SLPs) to prioritize implementing new practices for children with speech sound disorders (SSDs), given burgeoning caseloads and the myriad of other workload tasks. We propose that de-implementation science is equally as important as implementation science. De-implementation science is the recognition and identification of areas that are of "low-value and wasteful." Critically, the idea of de-implementation suggests that we first remove something from a clinician's workload before requesting that they learn and implement something new. METHOD: Situated within the Sustainability in Healthcare by Allocating Resources Effectively (SHARE) framework, we review de-implementation science and current speech sound therapy literature to understand the mechanisms behind continuous use of practices that are no longer supported by science or legislation. We use vignettes to highlight real-life examples that clinicians may be facing in school-based settings and to provide hypothetical solutions, resources, and/or next steps to these common challenges. RESULTS: By focusing on Phase 1 of the SHARE framework, we identified four primary practices that can be de-implemented to make space for new evidence-based techniques and approaches. These four practices were determined based on an in-depth review of SLP-based survey research: (a) overreliance on speech sound norms for eligibility determinations, (b) the omission of phonological processing skills within evaluations, (c) homogeneity of service delivery factors, and (d) the use of only one treatment approach for all children with SSDs. CONCLUSIONS: De-implementation will take work and may lead to some difficult discussions. Implementing a framework, such as SHARE, can guide SLPs toward a reduction in workloads and improved outcomes for children with SSDs.

Linguagem e funcionalidade pela CIF e grupo fonoaudiológico na percepção de pessoas com Doença de Parkinson / Lenguaje y funcionalidade por la CIF y grupo fonoaudiológico en la percepción de personas con Enfermedad de Parkinson / Language, functioning by ICF and SLP group intervention in the perception of people with Parkinson Disease

Introdução: O envelhecimento e a presença de doenças crônicas como a Doença de Parkinson (DP) podem gerar incapacidade e afetar a vida da pessoa, sendo que a Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF), na perspectiva biopsicossocial, permite conhecer a funcionalidade na DP. Objetivo: Investigar a funcionalidade de pessoas com Doença de Parkinson em atendimento fonoaudiológico grupal, tomando a CIF como base conceitual. Método: Pesquisa transversal, aprovada pelo CEP, com 10 participantes com DP, em atendimento fonoaudiológico grupal. Foi elaborado roteiro de entrevista para coleta do perfil sociodemográfico e questionário autoaplicável para coleta da autopercepção nas categorias da CIF em entrevistas com os participantes em três encontros grupais videogravados, com duração de 35 minutos cada. Para estabelecimento de parâmetros de referência, duas juízas fonoaudiólogas classificaram as respostas nas mesmas categorias. Resultados: Os participantes relataram prejuízos em Funções do Corpo (voz, articulação, fluência e do ritmo da fala, movimentos involuntários), dificuldades em Atividades e Participação (fala, conversação, uso fino da mão, andar, vestir-se, realização de tarefas domésticas, e recreação e lazer) e barreiras nos Fatores Ambientais. Em 60% dos casos a concordância entre participantes e juízas foi discreta, 30% regular, e em um caso (10%) foi forte. Conclusão: Os resultados mostram as dificuldades de linguagem e de funcionalidade na percepção das próprias pessoas com DP, conferindo um caráter original à pesquisa por dar voz a elas e trazer subsídios para o cuidado centrado na pessoa, transpondo, assim, a visão biomédica da atenção centrada na doença. (AU)

ntroduction: Aging and the presence of chronic diseases such as Parkinson's Disease (PD) can generate disability and affect a person's life, and the International Classification of Functioning, Disability and Health (ICF), from a biopsychosocial perspective, allows studying the functioning in PD. Objective: To investigate the functioning of people with PD in a speech-language pathology (SLP) group, taking the ICF as a conceptual basis. Method: Cross-sectional study, approved by the Ethics Committee, with 10 participants with PD, in SLP group. An interview script was developed to collect the sociodemographic profile and a self-administered questionnaire to collect self- perception in the ICF categories in interviews with participants in three videotaped group meetings, lasting 35 minutes each. To establish a reference parameter, two SLP with experience in the ICF (judges) classified the answers in the same categories. Results: Participants reported impairments in Body Functions (voice, articulation, fluency and rhythm of speech, involuntary movements), difficulties in Activities and Participation (speech, conversation, fine use of the hand, walking, dressing, performing household chores, and recreation and leisure) and barriers in Environmental Factors. In 60% of the cases, the agreement between participants and judges was slight, 30% regular, and in one case (10%) it was strong. Conclusion: The results showed language and functioning difficulties in the perception of people with PD, giving an original character to the research by giving them a voice and bringing subsidies to person-centered care, thus transposing the biomedical view of disease-centered care. (AU)

Introducción: El envejecimiento y la presencia de enfermedades crónicas como la Enfermedad de Parkinson (EP) pueden generar incapacidad y afectar a la vida de la persona, siendo que en la Clasificación Internacional del Funcionamiento, Incapacidad y Salud (CIF), en la perspectiva biopsicosocial, permite conocer el funcionamiento en la EP. Objetivo: Investigar el funcionamiento de personas con EP en la intervención fonoaudiológica grupal, tomando la CIF como base conceptual. Método: Estudio transversal aprobado por el CEP (Comité de Ética) con 10 participantes con EP, en tratamiento fonoaudilógico grupal. Se elaboró un guion de entrevista para colección de perfil sociodemográfico y un cuestionario autoaplicable para recopilar la autopercepción en las categorías de la CIF en entrevistas con los participantes en tres encuentros grupales videograbados, con una duración promedio de 35 minutos cada uno. Para establecer parámetros de referencia, dos juezas fonoaudiólogas clasificaron las respuestas en las mismas categorías. Resultados: Los participantes informaron déficit en las Funciones del Cuerpo (voz, articulación, fluidez y ritmo del habla, movimientos involuntarios), dificultades en las Actividades y Participación (habla, conversación, uso fino de la mano, caminar, vestirse, realizar las tareas domésticas, y recreación y ocio) y barreras en Factores Ambientales. En el 60% de los casos la concordancia entre participantes y juezas fue discreta, en el 30% fue regular y en un caso (10%) fue fuerte. Conclusión: Los resultados mostraron las dificultades de lenguaje y funcionamiento en la percepción de las propias personas con EP, dando un carácter original al estudio por darles voz y traer subsidios para el cuidado centrado en la persona, transponiendo así, la visión biomédica de la atención centrada en la enfermedad. (AU)