Dose frequency randomized controlled trial for Dynamic Temporal and Tactile Cueing (DTTC) treatment for childhood apraxia of speech: protocol paper.

BACKGROUND: Childhood apraxia of speech (CAS) is a pediatric motor-based speech sound disorder that requires a specialized approach to intervention. The extant literature on the treatment of CAS commonly recommends intensive treatment using a motor-based approach, with some of the best evidence supporting the use of Dynamic Temporal and Tactile Cueing (DTTC). To date, a rigorous and systematic comparison of high and low dose frequency (i.e., frequency of therapy sessions) has not been undertaken for DTTC, resulting in a lack of evidence to guide decisions about the optimal treatment schedule for this intervention. The current study aims to fill this gap in knowledge by comparing treatment outcomes when dose frequency is varied. METHODS: A randomized controlled trial will be conducted to examine the efficacy of low versus high dose frequency on DTTC treatment outcomes in children with CAS. A target of 60 children, 2;6-7;11 years of age, will be recruited to participate in this study. Treatment will be provided in the community setting by speech-language pathologists who have completed specialized training administering DTTC in a research reliable manner. True randomization with concealed allocation will be used to assign children to either the low or high dose frequency group. Treatment will be administered in 1-h sessions either 4 times per week over a 6-week period (high dose) or 2 times per week over a 12-week period (low dose). To measure treatment gains, probe data will be collected before treatment, during treatment, and 1 day, 1 week, 4 weeks, and 12 weeks post-treatment. Probe data will consist of customized treated words and a standard set of untreated words to assess generalization of treatment gains. The primary outcome variable will be whole word accuracy, encompassing segmental, phonotactic, and suprasegmental accuracy. DISCUSSION: This will be the first randomized controlled trial to evaluate dose frequency for DTTC treatment in children with CAS. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT05675306, January 6, 2023.

Total Eyelid Transplantation in a Face Transplant: Analysis of Postoperative Periorbital Function.

BACKGROUND: Prolonged impairment of protective ocular functions can compromise vision and lead to blindness if uncorrected. Several facial transplants have incorporated periorbital structures with variable eyelid preservation, but objective assessment of post-transplant periorbital function has been limited. MATERIALS AND METHODS: Kinematic data were collected from a full-face recipient that included the fist total eyelid transplantation at 5 separate pre-transplant (PRE) and post-transplant time points (T1-T4). Using optical facial tracking, eyelid movements were tracked during involuntary blinking and compared with controls. RESULTS: There was significant improvement in right eye aperture from PRE to T1 (ß = 5.54, P < 0.001), with no change between T1 and T4. Aperture fluctuated in the left eye, with a temporary decrease between T2 and T3 corresponding with revision brow lift (ß = -4.57, P < 0.001). Although improved from the pre-transplantation, right and left eye apertures remained significantly smaller than controls at T1 and T4 (P < 0.001). Similarly, spatial coupling increased from PRE to T1 (ß = 0.63, P < 0.001) and remained high at T4, albeit significantly less than controls (P < 0.001). Temporal coupling improved from PRE to T2 (ß = 2.29, P < 0.02) and was sustained at subsequent time points, with no difference relative to controls at T4. Considerable improvement was observed on clinical examination, with full functional status. CONCLUSIONS: Application of a novel method for assessing functional eyelid recovery using facial tracking technology to the first total eyelid transplantation in the setting of a full facial transplant shows clear functional improvement after transplantation and suggests revisions can be performed safely to optimize aesthetic outcomes without permanent negative functional impact.

Communication Efficiency in a Face Transplant Recipient: Determinants and Therapeutic Implications.

We longitudinally assessed speech intelligibility (percent words correct/pwc), communication efficiency (intelligible words per minute/iwpm), temporal control markers (speech and pause coefficients of variation), and formant frequencies associated with lip motion in a 41-year-old face transplant recipient. Pwc and iwpm at 13 months post-transplantation were both higher than preoperative values. Multivariate regression demonstrated that temporal markers and all formant frequencies associated with lip motion were significant predictors (P < 0.05) of communication efficiency, highlighting the interplay of these variables in generating intelligible and effective speech. These findings can guide us in developing personalized rehabilitative approaches in face transplant recipients for optimal speech outcomes.

Changes in movement transitions across a practice period in childhood apraxia of speech.

This study examined changes in speech motor control across a movement transition between sounds within a motor learning task in children with apraxia of speech (CAS) and typical development (TD). It was investigated whether oral articulator movement was refined with practice and whether practice gains generalized to words not included in the practice session. A total of 16 children (ages 5-6) with CAS (n = 8) and TD (n = 8) participated in this study. Novel and real word tokens were produced at three time points. Kinematic data was collected using facial motion tracking at each time point. Children completed a practice session following baseline data collection session that integrated motor learning principles. Three tokens were included in the practice session and the remaining stimuli assessed carryover of practice gains. Kinematic data was then collected immediately following practice and 3 days later. Kinematic analyses were conducted on the movement gesture for the first syllable of each word. Narrow transcription analyses examined speech production accuracy. Children in the CAS group displayed increased consonant and vowel accuracy only for the practised tokens. Adjustments to spatial control and movement variability were observed in the CAS group, though only for practised words. Children in the TD group altered spatial and temporal domains of movement and variability across both practised and non-practised tokens. Interestingly, the CAS group displayed a pattern of increased displacement along with decreased variability, which was not observed in the TD group. The degree to which these findings reflect facilitative or maladaptive changes are discussed. Results are also interpreted in relation to vowel properties, novel/real word status and variable practice of novel and real words.

Effects of Speaking Rate Changes on Speech Motor Variability in Adults.

The relationship between speaking rate and speech motor variability was examined in three groups of neurotypical adults, n = 40; 15 young adults (18-30 years), 13 adults (31-40 years), and 12 middle-aged adults (41-50 years). Participants completed a connected speech task at three speaking rates (habitual, fast, and slow) where kinematic (lower lip movement) and acoustic data were obtained. Duration and variability were measured at each speaking rate. Findings revealed a complex relationship between speaking rate and variability. Adults from the middle age range (31-40 years) demonstrated shorter acoustic and kinematic durations compared with the oldest age group (41-50 years) during the habitual speaking rate condition. All adults demonstrated the greatest variability in the slow speaking rate condition, with no significant differences in variability between habitual and fast speaking rates. Interestingly, lip aperture variability was significantly lower in the youngest age group (18-30 years) compared with the two older groups during the fast speaking rate condition. Differences in measures of acoustic variability were not observed across the age levels. Strong negative correlations between kinematic/acoustic duration and lip aperture/acoustic variability in the youngest age group were revealed. Therefore, while a slow speaking rate does result in greater variability compared with habitual and fast speaking rates, longer durations of productions by the different age groups were not linked to higher spatiotemporal index (STI) values, suggesting that timing influences speech motor variability, but is not the sole contributor.

Dynamic Temporal and Tactile Cueing in Young Children With Childhood Apraxia of Speech: A Multiple Single-Case Design.

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.

Research Priorities for Childhood Apraxia of Speech: A Long View.

This article introduces the Journal of Speech, Language, and Hearing Research Special Issue: Selected Papers From the 2022 Apraxia Kids Research Symposium. The field of childhood apraxia of speech (CAS) has developed significantly in the past 15 years, with key improvements in understanding of basic biology including genetics, neuroscience, and computational modelling; development of diagnostic tools and methods; diversity of evidence-based interventions with increasingly rigorous experimental designs; and understanding of impacts beyond impairment-level measures. Papers in this special issue not only review and synthesize the some of the substantial progress to date but also present novel findings addressing critical research gaps and adding to the overall body of knowledge. A second aim of this prologue is to report the current research needs in CAS, which arose from symposium discussions involving researchers, clinicians, and Apraxia Kids community members (including parents of children with CAS). Four primary areas of need emerged from discussions at the symposium. These were: (a) What questions should we ask? (b) Who should be in the research? (c) How do we conduct the research? and (d) How do we move from research to practice? Across themes, symposium attendees emphasized the need for CAS research to better account for the diversity of people with CAS and improve the timeliness of implementation of high-level evidence-based practice across the lifespan. It is our goal that the articles and prologue discussion in this special issue provide an appreciation of advancements in CAS research and an updated view of the most pressing needs for future research.

Naive Listener Ratings of Speech Intelligibility Over the Course of Motor-Based Intervention in Children With Childhood Apraxia of Speech.

PURPOSE: The aim of this study was to describe changes in speech intelligibility and interrater and intrarater reliability of naive listeners' ratings of words produced by young children diagnosed with childhood apraxia of speech (CAS) over a period of motor-based intervention (dynamic temporal and tactile cueing [DTTC]). METHOD: A total of 120 naive listeners (i.e., listeners without experience listening to children with speech and/or language impairments; age range: 18-45 years) orthographically transcribed single-word productions by five children (age range: 2;6-3;11 [years;months]) across three time points over an intervention period (baseline, post-treatment, maintenance). Changes in intelligibility and interrater and intrarater reliability were examined within and across time points. RESULTS: Speech intelligibility significantly increased in children with CAS over the course of treatment, and these gains were also maintained at 6 weeks posttreatment. There was poor-to-fair consistency between listeners (interrater reliability) and excellent consistency within listeners (intrarater reliability) in ratings of speech intelligibility within and across time points. CONCLUSIONS: Motor-based intervention increases speech intelligibility following a period of DTTC treatment. Variability among naive listeners of speech intelligibility was also present, with intrarater reliability (within listeners) yielding greater consistency than interrater reliability (between listeners). The implications for including naive listeners as raters of speech intelligibility for research and clinical purposes are discussed.

The Multilevel Word Accuracy Composite Scale: A Novel Measure of Speech Production in Childhood Apraxia of Speech.

PURPOSE: The Multilevel word Accuracy Composite Scale (MACS) is a novel whole-word measure of speech production accuracy designed to evaluate behaviors commonly targeted in motor-based intervention for childhood apraxia of speech (CAS). The MACS yields a composite score generated through ratings of segmental accuracy, word structure maintenance, prosody, and movement transition. This study examined the validity of the MACS through comparison to established measures of speech accuracy. Reliability was also examined within and between practicing speech-language pathologists (SLPs). METHOD: The MACS was used to rate 117 tokens produced by children with severe CAS. Ratings were performed in the laboratory setting by two expert raters and by practicing SLPs (N = 19). Concurrent validity was estimated through comparison of expert MACS ratings (i.e., MACS score and each component rating) to measures of speech accuracy (percent phoneme correct and the 3-point scale) using correlational analyses. Reliability was examined between expert raters and across SLP raters using the intraclass correlation coefficient to examine interrater reliability of expert ratings, in addition to inter- and intrarater reliability of SLP ratings. RESULTS: Correlation analyses between MACS ratings (i.e., MACS score and component ratings) and existing measures of speech accuracy revealed small to large positive correlations between measures. Reliability analyses revealed moderate to excellent reliability for MACS ratings performed by expert raters and between (interrater) and within (intrarater) SLP raters. CONCLUSIONS: Analyses of concurrent validity indicate that the MACS aligns with established measures, yet contributes novel elements for rating speech accuracy. Results further support the MACS as a reliable measure for rating speech accuracy in children with severe speech impairment for ratings performed by expert raters and practicing clinicians.

Dynamic Temporal and Tactile Cueing: Quantifying Speech Motor Changes and Individual Factors That Contribute to Treatment Gains in Childhood Apraxia of Speech.

PURPOSE: Speech motor skill is refined over the course of practice, which is commonly reflected by increased accuracy and consistency. This research examined the relationship between auditory-perceptual ratings of word accuracy and measures of speech motor timing and variability at pre- and posttreatment in children with childhood apraxia of speech (CAS). Furthermore, the degree to which individual patterns of baseline probe word accuracy, receptive language, and cognition predicted response to treatment was explored. METHOD: Probe data were collected from seven children with CAS (aged 2;5-5;0 [years;months]) who received 6 weeks of Dynamic Temporal and Tactile Cueing (DTTC) treatment. Using a multidimensional approach to measuring speech performance, auditory-perceptual (whole-word accuracy), acoustic (whole-word duration), and kinematic (jaw movement variability) analyses were conducted on probe words produced pre- and posttreatment. Standardized tests of receptive language and cognition were administered pretreatment. RESULTS: There was a negative relationship between auditory-perceptual measures of word accuracy and movement variability. Higher word accuracy was associated with lower jaw movement variability following intervention. There was a strong relationship between word accuracy and word duration at baseline, which became less robust posttreatment. Furthermore, baseline word accuracy was the only child-specific factor to predict response to DTTC treatment. CONCLUSIONS: Following a period of motor-based intervention, children with CAS appeared to refine speech motor control in conjunction with improvements in word accuracy. Those who demonstrated the poorest performance at treatment onset displayed the greatest degree of gains. Taken together, these results reflect a system-wide change following motor-based intervention.

Interarticulatory Coordination of the Lips and Jaw in Childhood Apraxia of Speech.

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

The relationship between inexperienced listeners' perceptions and acoustic correlates of children's /r/ productions.

This study examined inexperienced listeners' perceptions of children's naturally produced /r/ sounds with reference to levels of accuracy determined by consensus between two expert clinicians. Participants rated /r/ sounds as fully correct, distorted or incorrect/non-rhotic. Second and third formant heights were measured to explore the relationship between acoustic cues and perceptual judgments. Inexperienced listeners' agreement was greater for correct productions than for distorted or incorrect/non-rhotic productions. In addition, inexperienced listeners' differentiation of intermediate versus fully incorrect /r/ had lower sensitivity and specificity relative to an acoustically defined threshold than experienced listeners' classification. These findings are consistent with results of previous studies highlighting the difficulty in identifying gradations of correctness in misarticulated /r/, and they suggest that this ability may be influenced by clinical experience. Additionally, all listeners were noted to be more consistent in rating vocalic /r/ than consonantal /r/. Implications for clinician training and treatment planning are discussed.

Speech-Language Pathologists' Ratings of Speech Accuracy in Children With Speech Sound Disorders.

PURPOSE: Forming accurate and consistent speech judgments can be challenging when working with children with speech sound disorders who produce a large number and varied types of error patterns. Rating scales offer a systematic approach to assessing the whole word rather than individual sounds. Thus, these scales can be an efficient way for speech-language pathologists (SLPs) to monitor treatment progress. This study evaluated the interrater reliability of an existing 3-point rating scale using a large group of SLPs as raters. METHOD: Utilizing an online platform, 30 SLPs completed a brief training and then rated single words produced by children with typical speech patterns and children with speech sound disorders. Words were closely balanced across the three rating categories of the scale. The interrater reliability of the SLPs ratings to a consensus judgment was examined. RESULTS: The majority of SLPs (87%) reached substantial interrater reliability to a consensus judgment using the 3-point rating scale. Correct productions had the highest interrater reliability. Productions with extensive errors had higher agreement than those with minor errors. Certain error types, such as vowel distortions, were especially challenging for SLPs to judge. CONCLUSIONS: This study demonstrated substantial interrater reliability to a consensus judgment among a large majority of 30 SLPs using a 3-point rating. The clinical implications of the findings are discussed along with proposed modifications to the training procedure to guide future research.

The Effect of Practice on Variability in Childhood Apraxia of Speech: A Multidimensional Analysis.

Purpose Variability has been interpreted in differing ways according to context (e.g., development, speech impairment, and learning). A challenge arises when interpreting variability in the context of learning for children with speech impairment characterized by high movement variability, as in childhood apraxia of speech (CAS). The objective of this study is to investigate changes in variability in CAS with practice in comparison to patterns seen in children with non-CAS speech sound disorders (SSD) and typical development. Method Speech production variability was examined in 24 children (5-6 years of age) with CAS, non-CAS SSD, and typical development in production of nonwords of varied motoric complexity. Multidimensional analyses were performed using measures of token-to-token speech consistency (percent word consistency), acoustic variability (acoustic spatiotemporal index), and movement variability (lip aperture spatiotemporal index). Changes in variability were examined in each group of children by comparing the first half to the last half of nonword tokens in the same data collection session. The impact of token complexity on practice effects was also explored across groups of children. Results All children displayed increased speech consistency within this practice period (p = .01). Only children with CAS displayed increased movement variability following practice (p = .01). Differences in acoustic and kinematic variability were observed across complexity levels in all groups, though these did not interact with practice effects. Discussion These findings suggest that increased movement variability in children with CAS might be facilitating perceptual consistency. It is believed that this finding reflects an inefficient strategy adapted by children with CAS in the absence of motor-based cueing and feedback to guide speech performance with practice.

Perceptual and Articulatory Changes in Speech Production Following PROMPT Treatment.

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

The relationship between articulatory control and improved phonemic accuracy in childhood apraxia of speech: a longitudinal case study.

Jaw movement patterns were examined longitudinally in a 3-year-old male with childhood apraxia of speech (CAS) and compared with a typically developing control group. The child with CAS was followed for 8 months, until he began accurately and consistently producing the bilabial phonemes /p/, /b/, and /m/. A movement tracking system was used to study jaw duration, displacement, velocity, and stability. A transcription analysis determined the percentage of phoneme errors and consistency. Results showed phoneme-specific changes which included increases in jaw velocity and stability over time, as well as decreases in duration. Kinematic parameters became more similar to patterns seen in the controls during final sessions where tokens were produced most accurately and consistently. Closing velocity and stability, however, were the only measures to fall within a 95% confidence interval established for the controls across all three target phonemes. These findings suggest that motor processes may differ between children with CAS and their typically developing peers.

A Framework of Motoric Complexity: An Investigation in Children With Typical and Impaired Speech Development.

Introduction The current work presents a framework of motoric complexity where stimuli differ according to movement elements across a sound sequence (i.e., consonant transitions and vowel direction). This framework was then examined in children with childhood apraxia of speech (CAS), other speech sound disorders (SSDs), and typical development (TD). Method Twenty-four children (CAS, n = 8; SSD, n = 8; TD, n = 8), 5-6 years of age, participated in this study. The children produced words that varied in motoric complexity while transcription, acoustic, and kinematic data were collected. Multidimensional analyses were conducted to examine speech production accuracy, speech motor variability, and temporal control. Results Analyses revealed poorer accuracy, longer movement duration, and greater speech motor variability in children with CAS than TD (across all measures) and other SSDs (accuracy and variability). All children demonstrated greater speech motor variability and longer duration as movement demands increased within the framework of motoric complexity. Diagnostic grouping did not mediate performance on this task. Conclusions Results of this study are believed to reveal gradations of complexity with increasing movement demands, thereby supporting the proposed framework of motoric complexity. This work also supports the importance of considering motoric properties of sound sequences when evaluating speech production skills and designing experimental and treatment stimuli.

Lexical stress in childhood apraxia of speech: acoustic and kinematic findings.

Purpose: This study investigated the acoustic and articulatory movement parameters underlying lexical stress production in children with apraxia of speech (CAS), children with articulation/phonological delay (i.e. speech delay, SD), and children with typical speech-language development (TD). We examined whether there were group differences in these instrumental measures of stress production.Method: Participants were 24 children (seven CAS, eight SD, nine TD) between three and seven years of age. Acoustic and kinematic measures, including acoustic duration, peak and average fundamental frequency, and jaw movement duration and displacement, were taken from perceptually accurate productions of a strong-weak form. Relative stress analyses were conducted using the Pairwise Variability Index (PVI).Result: There was a significant difference between the CAS and TD groups in the PVI for movement duration, with the CAS group showing a smaller movement duration contrast between stressed and unstressed syllables. There were no significant group differences for displacement or any of the acoustic variables.Conclusion: The kinematic findings suggest reduced temporal control for lexical stress production in children with CAS. This finding surfaced during analyses of perceptually accurate productions but suggests a possible basis for lexical stress errors in CAS that could be explored in future studies.

Changes in articulator movement variability during phonemic development: a longitudinal study.

PURPOSE: The present study explored articulator movement variability during voicing contrast acquisition. The purpose was to examine whether oral articulator movement trajectories associated with the production of voiced/voiceless bilabial phonemes in children became less variable over time. METHOD: Jaw, lower lip, and upper lip movements were recorded longitudinally in six, 19 month-old children as they began producing the voiceless phoneme /p/. Displacement signals were time and amplitude normalized. The spatiotemporal index (A. Smith, L. Goffman, H. Zelaznik, S. Ying, & C. McGillem, 1995) was computed to examine the variability in movement trajectories across repeated productions of target utterances. RESULTS: Spatiotemporal variability of lip and jaw movements significantly decreased as children began producing the voiceless phoneme /p/. A significant negative correlation between the STI and the length of voice onset time (VOT) was also found in the voiceless productions in 4 of the 6 participants. CONCLUSIONS: Oral articulator movement variability is reduced in children across the stabilization of voicing contrast acquisition. Further, the relationship between VOT contrast production and movement variability suggests that a coordinate system between the oral and laryngeal articulators may be refined as children acquire the voicing contrast.

Changes in Articulatory Control Pre- and Post-Facial Transplant: A Case Report.

Purpose Facial transplantation involves partial or total replacement of neuromuscular and skeletal structures of the face, head, and neck using donor tissues and is among the most extensive facial reconstructive procedures. This case report compares changes in speech production and articulator movement in a 44-year-old man from pretransplant to a 13-month posttransplant period. Method Speech production and articulator movement data were examined at 5 time points, once pretransplant and 4 times posttransplant (4, 7, 10, and 13 months), and compared to 4 healthy controls. A motion capture system was used to track jaw and vertical/horizontal lip movement during nonspeech and speech tasks. Speech intelligibility, jaw displacement, lip aperture, and movement variability were measured. Results Speech intelligibility varied across the study period and was restored to control status by 7 months posttransplant. Jaw displacement and lip aperture in the vertical plane significantly increased over time for nonspeech and speech tasks. Changes in horizontal lip movements over time were minimal. Jaw and lip movement variability fluctuated over time and was greater than the controls by 13 months posttransplant. Discussion Findings quantify changes in articulator movement and contributions to improved speech production following facial transplant. Changes reflect the adaptability of the speech motor system and are discussed in relation to pretransplant speech motor control patterns.