Clinical Assessment of Communication-Related Speech Parameters in Dysarthria: The Impact of Perceptual Adaptation.

PURPOSE: In current clinical practice, intelligibility of dysarthric speech is commonly assessed by speech-language therapists (SLTs), in most cases by the therapist caring for the patient being diagnosed. Since SLTs are familiar with dysarthria in general and with the speech of the individual patient to be assessed in particular, they have an adaptation advantage in understanding the patient's utterances. We examined whether and how listeners' assessments of communication-related speech parameters vary as a function of their familiarity with dysarthria in general and with the diagnosed patients in particular. METHOD: Intelligibility, speech naturalness, and perceived listener effort were assessed in 20 persons with dysarthria (PWD). Patients' speech samples were judged by the individual treating therapists, five dysarthria experts who were unfamiliar with the patients, and crowdsourced naïve listeners. Adaptation effects were analyzed using (a) linear mixed models of overall scoring levels, (b) regression models of severity dependence, (c) network analyses of between-listener and between-parameter relationships, and (d) measures of intra- and interobserver consistency. RESULTS: Significant advantages of dysarthria experts over laypeople were found in all parameters. An overall advantage of the treating therapists over nonfamiliar experts was only seen in listening effort. Severity-dependent adaptation effects occurred in all parameters. The therapists' responses were heterogeneous and inconsistent with those of the unfamiliar experts and the naïve listeners. CONCLUSIONS: The way SLTs evaluate communication-relevant speech parameters of the PWD whom they care for is influenced not only by adaptation benefits but also by therapeutic biases. This finding weakens the validity of assessments of communication-relevant speech parameters by the treating therapists themselves and encourages the development and use of alternative methods.

Speech Naturalness in the Assessment of Childhood Dysarthria.

PURPOSE: This study investigated perceived speech naturalness estimated by adult listeners in typically developing children and children with dysarthria. We aimed to identify predictors of naturalness among auditory-perceptual parameters and to evaluate the concept of naturalness as a clinical marker of childhood dysarthria. METHOD: In a listening experiment, naive adult listeners rated speech naturalness of 144 typically developing children (3-9 years old) and 28 children with neurological conditions (5-9 years old) on a visual analog scale. Speech samples were recorded using the materials of the Bogenhausen Dysarthria Scales-Childhood Dysarthria, which also provides for auditory-perceptual judgments covering all speech subsystems. RESULTS: Children with dysarthria obtained significantly lower naturalness ratings compared to typically developing children. However, there was a substantial age effect observable in the typically developing children; that is, younger typically developing children were also perceived as somewhat unnatural. The ratings of the typically developing children were influenced by the occurrence of developmental speech features; for the children with neurological conditions, specific symptoms of dysarthria had an additional effect. In both groups, the perception of naturalness was predominantly determined by the children's articulation and intelligibility. CONCLUSIONS: Both symptoms of childhood dysarthria and developmental speech features (e.g., regarding articulation and intelligibility) were associated to some extent with unnatural speech by the listeners. Thus, perceived speech naturalness appears less suitable as a marker of dysarthria in children than in adults.

Picture Description in the Assessment of Connected Speech Intelligibility in Parkinson's Disease: A Pilot Study.

INTRODUCTION: Assessment of intelligibility in dysarthria tends to rely on oral reading of sentences or words. However, self-generated utterances are closer to a client's natural speech. This study investigated how transcription of utterances elicited by picture description can be used in the assessment of intelligibility in speakers with Parkinson's disease. METHODS: Speech samples from eleven speakers with Parkinson's disease and six neurologically healthy persons were audio-recorded. Forty-two naive listeners completed transcriptions of self-generated sentences from a picture description task and orally read sentences from the Swedish Test of Intelligibility, as well as scaled ratings of narrative speech samples. RESULTS: Intelligibility was higher in orally read than self-generated sentences and higher for content words than for the whole sentence in self-generated sentences for most of the speakers, although these within-group differences were not statistically significant at the group level. Adding contextual leads for the listeners increased intelligibility in self-generated utterances significantly but with individual variation. Although correlations between the intelligibility measures were at least moderate or strong, there was a considerable inter- and intra-speaker variability in intelligibility scores between tasks for the speakers with Parkinson's disease, indicating individual variation of factors that impact intelligibility. Intelligibility scores from neurologically healthy speakers were generally high across tasks with no significant differences between the conditions. CONCLUSION: Within-speaker variability supports literature recommendations to use multiple methods and tasks when assessing intelligibility. The inclusion of transcription of self-generated utterances elicited by picture description to the intelligibility assessment has the potential to provide additional information to assessment methods based on oral reading of pre-scripted sentences and to inform the planning of interventions.

Cross-cultural adaptation into Italian and validation of the Frenchay dysarthria assessment - 2.

BACKGROUND: A comprehensive evaluation of dysarthria is required to make an accurate differential diagnosis with other communication disorders and plan effective rehabilitation programs. The Frenchay Dysarthria Assessment-2 (FDA-2) is a valid, reliable and widely used protocol for the assessment of dysarthria. An Italian version of the FDA-2 is currently lacking. AIM: To perform a cross-cultural adaptation of the FDA-2 in Italian and to validate the Italian version of the FDA-2. DESIGN: Validation study. SETTING: Inpatient rehabilitation center. POPULATION: 69 patients with dysarthria and 112 healthy controls. METHODS: The FDA-2 was translated and cross-culturally adapted to Italian. The validation study was carried out in 4 steps: (1) 42 audio-recorded samples of FDA-2 items from 11 patients with dysarthria were independently assessed by 7 speech and language pathologists for interrater reliability and re-assessed after 6 weeks for intrarater reliability; (2) 11 patients were simultaneously assessed by 3 speech and language therapists for interrater reliability of the whole Italian version of the FDA-2 and re-assessed within 24 hours for test-retest reliability; (3) the Italian version of the FDA-2 was administered to 112 healthy volunteers to gain normative data; (4) 49 patients with different types of dysarthria were assessed using the Italian version of the FDA-2, the Therapy Outcome Measure impairment scale and the Robertson Profile for the validity analysis. RESULTS: Interrater and intrarater reliability ranged from good to excellent (ICC >0.75) except for 3 audio-recorded items. The overall protocol demonstrated excellent (ICC >0.9) inter-rater and test-retest reliability for all the sections and the total score. Normative data were gained for 6 age groups. For the validity analysis, a statistically significant difference was found between dysarthric patients and healthy subjects for all sections and the total score. The FDA-2 significantly correlated to the therapy outcome measure (r=0.75) and the Robertson Profile (r=0.81). CONCLUSIONS: The Italian version of the FDA-2 yield satisfactory reliability and validity, comparable to the psychometric properties of the original version. CLINICAL REHABILITATION IMPACT: Speech and language pathologists can rely on a valid and reliable tool in Italian for the assessment of dysarthria in both clinical and research practice.

Assessment of dysarthria with Frenchay dysarthria assessment (FDA-2) in patients with Duchenne muscular dystrophy.

PURPOSE: The purpose of this study was to test the psychometric properties of the Japanese version of Frenchay Dysarthria Assessment (FDA-2) and to use this tool to describe the features of speech in patients with Duchenne muscular dystrophy (DMD). MATERIALS AND METHODS: The Japanese version of FDA-2 was culturally adapted, and reliability and validity were examined in 22 and 50 patients, respectively. The Japanese version of FDA-2 was administered to 51 patients with DMD. Multiple regression analysis was performed to identify factors related to FDA-2 scores. RESULTS: Inter-/intra-rater reliabilities (ICCs) and internal consistency (Cronbach's α) for total scores were 0.76, 0.97, and 0.94 respectively. For construct validity, two-way ANOVA showed a significant interaction between the disorders and FDA-2 sections (p < 0.05). In DMD patients, the item of tongue at rest was most severely affected, reflecting tongue hypertrophy. Multiple regression analysis identified age, swallowing status, and ventilator use as significantly related. CONCLUSIONS: The results showed that the Japanese version of FDA-2 has satisfactory reliability and validity. The present study demonstrated the features of dysarthria and related factors in patients with DMD.Implications for rehabilitationIn Duchenne muscular dystrophy (DMD), an absent or defective dystrophin protein causes progressive weakness of respiratory and oropharyngeal muscles, both of which are crucial contributors to speech production.This study shows that the Japanese version of FDA-2 has satisfactory reliability and validity compared to original version.The Japanese version of FDA-2 characterizes dysarthria in patients with DMD in this cohort.

Web-based assessment of communication-related parameters in dysarthria: development and implementation of the KommPaS web app.

This article describes the design of KommPaS, a web-based tool for the clinical assessment of communication impairment in persons with dysarthria. KommPaS (the German acronym for Communication-related Parameters in Speech Disorders) allows clinicians to recruit laypersons via crowdsourcing for the evaluation of samples of dysarthric speech with regard to communication relevant parameters, that is, intelligibility, naturalness, perceived listener effort, and efficiency (intelligible speech units per unit time). Moreover, a communication total score describing the KommPaS profile elevation, i.e., the arithmetic mean of the normalized KommPaS scores, is provided. Based on considerations regarding the theoretical underpinnings and methodological constraints of a clinical tool for the assessment of these parameters, the article describes how each theoretically and methodologically motivated feature is translated into design principles and how these principles are implemented in a web application. The paper reports efficiency data and details the data privacy and data security provisions that are essential in such an approach.

Validation of the pediatric Radboud Dysarthria Assessment.

PURPOSE: The Radboud Dysarthria Assessment (RDA) was published in 2014. Adaptation into a pediatric version (p-RDA) was required because of relevant differences between children and adults. The purpose of this study was to assess the feasibility of the p-RDA and to test intra-rater and inter-rater reliability as well as the validity of the two severity scales (function and activity level). METHODS: Video recordings were made of 35 participants with (suspected) dysarthria (age 4 to 17 years) while being assessed using the p-RDA. Intra-rater reliability was assessed by one, and inter-rater reliability by two experiments using the Intraclass Correlation Coefficient (ICC). Validity of the severity scales was tested by correlating the consensus scores with the independently rated scores on four communication scales, three mobility scales, and one self-care scale using Spearman correlation coefficients (rs). RESULTS: The assessment was applicable for 89% of the tested sample, with good intra-rater and inter-rater reliability (ICC = 0.88-0.98 and 0.83-0.93). The p-RDA severity scales (function and activity level) correlated from substantially to strongly with the communication scales (rs = 0.69-0.82 and 0.77-0.92) and self-care scale (rs = 0.76-0.71) and correlated substantially with the mobility scales (rs = 0.49-0.60). CONCLUSION: The feasibility, reliability and validity of the p-RDA are sufficient for clinical use.

Assessment of non-progressive dysarthria: practice and attitude of speech and language therapists in Lebanon.

BACKGROUND: Non-progressive dysarthria is an acquired motor speech disorder resulting from neurological diseases such as stroke and traumatic brain injury. The evidence base for the assessment of non-progressive dysarthria remains limited with professional practices relying mainly on therapists' clinical experience. Limited information on the assessment practices of Lebanese speech and language therapists (SLTs) is available. Such information is crucial for the development of adequate therapy services for clients with non-progressive dysarthria. This study aims to explore the assessment practices and attitudes of Lebanese SLTs working with adults with non-progressive dysarthria and to investigate their adherence to the framework of the World Health Organization's International Classification of Functioning, Disability and Health (ICF). METHODS: A cross-sectional study was conducted in Lebanon between March and May 2021. Data was collected through an online survey that included information on socio-demographic characteristics, practices, and attitudes of SLTs who assess adults with non-progressive dysarthria. RESULTS: A total of 50 Lebanese SLTs responded to the survey. The majority of SLTs (78%) assessed clients with non-progressive dysarthria across all ICF domains. SLTs reported dissatisfaction with the available assessment tools (64%) and reliance on informal tools (84%). In addition, 68% of the SLTs suggested the crucial need for the development of Arabic formal assessments that can quantitatively evaluate dysarthria and determine severity. The survey also showed that the respondents demonstrated a preference for the use of impairment-based tools. CONCLUSION: It can be concluded that the assessment practices of Lebanese SLTs, generally, follow the international trend and the recommended professional guidelines. Further research initiatives should be held to develop Arabic formal assessment tools for non-progressive dysarthria.

Crowdsourcing as a tool in the clinical assessment of intelligibility in dysarthria: How to deal with excessive variation.

PURPOSE: Independent laypersons are essential in the assessment of intelligibility in persons with dysarthria (PWD), as they reflect intelligibility limitations in the most ecologically valid way, without being influenced by familiarity with the speaker. The present work investigated online crowdsourcing as a convenient method to involve lay people as listeners, with the objective of exploring how to constrain the expected variability of crowd-based judgements to make them applicable in clinical diagnostics. METHOD: Intelligibility was assessed using a word transcription task administered via crowdsourcing. In study 1, speech samples of 23 PWD were transcribed by 18 crowdworkers each. Four methods of aggregating the intelligibility scores of randomly sampled panels of 4 to 14 listeners were compared for accuracy, i.e. the stability of the resulting intelligibility estimates across different panels, and their validity, i.e. the degree to which they matched data obtained under controlled laboratory conditions ("gold standard"). In addition, we determined an economically acceptable number of crowdworkers per speaker which is needed to obtain accurate and valid intelligibility estimates. Study 2 examined the robustness of the chosen aggregation method against downward outliers due to spamming in a larger sample of 100 PWD. RESULTS: In study 1, an interworker aggregation method based on negative exponential weightings of the scores as a function of their distance from the "best" listener's score (exponentially weighted mean) outperformed three other methods (median value, arithmetic mean, maximum). Under cost-benefit considerations, an optimum panel size of 9 crowd listeners per examination was determined. Study 2 demonstrated the robustness of this aggregation method against spamming crowd listeners. CONCLUSION: Though intelligibility data collected through online crowdsourcing are noisy, accurate and valid intelligibility estimates can be obtained by appropriate aggregation of the raw data. This makes crowdsourcing a suitable method for incorporating real-world perspectives into clinical dysarthria assessment.

Assessment of dysarthria and dysphagia in patients with amyotrophic lateral sclerosis: Review of the current evidence.

Bulbar dysfunction is a common presentation of amyotrophic lateral sclerosis (ALS) and significantly impacts quality of life of people with ALS (PALS). The current paper reviews measurements of dysarthria and dysphagia specific to ALS to identify efficient and valid assessment measures. Using such assessment measures will lead to improved management of bulbar dysfunction in ALS. Measures reviewed for dysarthria in PALS are organized into three categories: acoustic, kinematic, and strength. A set of criteria are used to evaluate the effectiveness of the measures' identification of speech impairments, measurement of functional verbal communication, and clinical applicability. Assessments reviewed for dysphagia in PALS are organized into six categories: patient reported outcomes, dietary intake, pulmonary function and airway defense capacity, bulbar function, dysphagia/aspiration screens, and instrumental evaluations. Measurements that have good potential for clinical use are highlighted in both topic areas. Additionally, areas of improvement for clinical practice and research are identified and discussed. In general, no single speech measure fulfilled all the criteria, although a few measures were identified as potential diagnostic tools. Similarly, few objective measures that were validated and replicated with large sample sizes were found for diagnosis of dysphagia in PALS. Importantly, clinical applicability was found to be limited; thus, a collaborative team focused on implementation science would be helpful to improve the clinical uptake of assessments. Overall, the review highlights the need for further development of clinically viable and efficient measurements that use a multidisciplinary approach.

The Impact of Lexical and Articulatory Factors in the Automatic Selection of Test Materials for a Web-Based Assessment of Intelligibility in Dysarthria.

Purpose The clinical assessment of intelligibility must be based on a large repository and extensive variation of test materials, to render test stimuli unpredictable and thereby avoid expectancies and familiarity effects in the listeners. At the same time, it is essential that test materials are systematically controlled for factors influencing intelligibility. This study investigated the impact of lexical and articulatory characteristics of quasirandomly selected target words on intelligibility in a large sample of dysarthric speakers under clinical examination conditions. Method Using the clinical assessment tool KommPaS, a total of 2,700 sentence-embedded target words, quasirandomly drawn from a large corpus, were spoken by a group of 100 dysarthric patients and later transcribed by listeners recruited via online crowdsourcing. Transcription accuracy was analyzed for influences of lexical frequency, phonological neighborhood structure, articulatory complexity, lexical familiarity, word class, stimulus length, and embedding position. Classification and regression analyses were performed using random forests and generalized linear mixed models. Results Across all degrees of severity, target words with higher frequency, fewer and less frequent phonological neighbors, higher articulatory complexity, and higher lexical familiarity received significantly higher intelligibility scores. In addition, target words were more challenging sentence-initially than in medial or final position. Stimulus length had mixed effects; word length and word class had no effect. Conclusions In a large-scale clinical examination of intelligibility in speakers with dysarthria, several well-established influences of lexical and articulatory parameters could be replicated, and the roles of new factors were discussed. This study provides clues about how experimental rigor can be combined with clinical requirements in the diagnostics of communication impairment in patients with dysarthria.

Investigation of Different Time-Frequency Representations for Intelligibility Assessment of Dysarthric Speech.

Speech disorders linked to neurological problems affect person's ability to communicate through speech. Dysarthria is one of the speech disorders caused due to muscle weakness producing slow, slurred and less intelligible speech. Automatic intelligibility assessment of dysarthria from speech can be used as a promising clinical tool in treatment. This paper explores the use of perceptually enhanced Fourier transform spectrograms and Constant-Q transform spectrograms with CNN to assess word level and sentence level intelligibility of dysarthric speech from UA and TORGO databases. Constant-Q transform and perceptually enhanced mel warped STFT spectrograms performed better in the classification task.

Age Norms for Auditory-Perceptual Neurophonetic Parameters: A Prerequisite for the Assessment of Childhood Dysarthria.

Purpose The aim of this study was to collect auditory-perceptual data on established symptom categories of dysarthria from typically developing children between 3 and 9 years of age, for the purpose of creating age norms for dysarthria assessment. Method One hundred forty-four typically developing children (3;0-9;11 [years;months], 72 girls and 72 boys) participated. We used a computer-based game specifically designed for this study to elicit sentence repetitions and spontaneous speech samples. Speech recordings were analyzed using the auditory-perceptual criteria of the Bogenhausen Dysarthria Scales, a standardized German assessment tool for dysarthria in adults. The Bogenhausen Dysarthria Scales (scales and features) cover clinically relevant dimensions of speech and allow for an evaluation of well-established symptom categories of dysarthria. Results The typically developing children exhibited a number of speech characteristics overlapping with established symptom categories of dysarthria (e.g., breathy voice, frequent inspirations, reduced articulatory precision, decreased articulation rate). Substantial progress was observed between 3 and 9 years of age, but with different developmental trajectories across different dimensions. In several areas (e.g., respiration, voice quality), 9-year-olds still presented with salient developmental speech characteristics, while in other dimensions (e.g., prosodic modulation), features typically associated with dysarthria occurred only exceptionally, even in the 3-year-olds. Conclusions The acquisition of speech motor functions is a prolonged process not yet completed with 9 years. Various developmental influences (e.g., anatomic-physiological changes) shape children's speech specifically. Our findings are a first step toward establishing auditory-perceptual norms for dysarthria in children of kindergarten and elementary school age. Supplemental Material https://doi.org/10.23641/asha.12133380.

Development of a method for assessment of dysarthria in a foreign language: a pilot study.

Purpose: It is increasingly more common for Speech and Language Pathologists in Sweden to encounter individuals with dysarthria who speak a different language. The aim of the present pilot study was to develop and test a systematic method to be used in collaboration with an interpreter, for assessment of acquired dysarthria in people speaking a language not familiar to the Speech and Language Pathologist.Methods: Seven participants, speaking standard Arabic, were assessed by a Swedish speaking Speech and Language Pathologist using this method and with help of a certified interpreter. The participants were also assessed with equivalent test items from the Swedish "Dysarthria assessment," with instructions translated to Arabic, by a Speech and Language Pathologist speaking standard Arabic and the results were compared.Results: There were no significant differences between the assessments by the Swedish speaking Speech and Language Pathologist and the Arabic speaking Speech and Language Pathologist in the domains "Respiration and phonation," "Articulation," "Listener Comprehension" and "Severity of dysarthria." There was a significant difference between assessments in the domain "Oromotor and velopharyngeal function." Intra- and inter-rater reliability was also calculated using Intraclass Correlation Coefficient and their 95% Confidence Interval. Intra-rater reliability was excellent and inter-rater reliability was very good.Conclusion: The study indicates that a Speech and Language Pathologist, with help of an interpreter, can carry out an assessment of dysarthria in a language unknown to the Speech and Language Pathologist with results comparable to results from an assessment carried out by a Speech and Language Pathologist who speaks the foreign language.

Clinical Assessment of Characteristics of Apraxia of Speech in Primary Progressive Aphasia.

Purpose We sought to examine interrater reliability in clinical assessment of apraxia of speech (AOS) in individuals with primary progressive aphasia and to identify speech characteristics predictive of AOS diagnosis. Method Fifty-two individuals with primary progressive aphasia were recorded performing a variety of speech tasks. These recordings were viewed by 2 experienced speech-language pathologists, who independently rated them on the presence and severity of AOS as well as 14 associated speech characteristics. We calculated interrater reliability (percent agreement and Cohen's kappa) for these ratings. For each rater, we used stepwise regression to identify speech characteristics significantly predictive of AOS diagnosis. We used the overlap between raters to create a more parsimonious model, which we evaluated with multiple linear regression. Results Results yielded high agreement on the presence (90%) and severity of AOS (weighted Cohen's κ = .834) but lower agreement for specific speech characteristics (weighted Cohen's κ ranging from .036 to .582). Stepwise regression identified 2 speech characteristics predictive of AOS diagnosis for both raters (articulatory groping and increased errors with increased length/complexity). These alone accounted for ≥ 50% of the variance of AOS severity in the constrained model. Conclusions Our study adds to a growing body of research that highlights the difficulty in objective clinical characterization of AOS and perceptual characterization of speech features. It further supports the need for consensus diagnostic criteria with standardized testing tools and for the identification and validation of objective markers of AOS. Additionally, these findings underscore the need for a training protocol if diagnostic tools are to be effective when shared beyond the research teams that develop and test them and disseminated to practicing speech-language pathologists, in order to ensure consistent application.

French adaptation of the "Frenchay Dysarthria Assessment 2" speech intelligibility test.

OBJECTIVES: Speech intelligibility can be defined as "the degree to which a speaker's intended message is recovered by a listener". Loss of intelligibility is one of the most frequent complaints in patients suffering from speech disorder, impairing communication. Measurement of intelligibility is therefore an important parameter in follow-up. We developed a French version of the "Frenchay Dysarthria Assessment, 2nd edition" (FDA-2), an intelligibility test recognized internationally in its English version. The present study details the construction of the test and its preliminary validation. MATERIALS AND METHODS: We first compiled a set of words and phrases in French, based on the criteria defined in FDA-2. In a second step, we validated the test in healthy subjects in normal and noisy conditions, to check sensitivity to speech signal degradation. RESULTS: The test proved valid and sensitive, as scores were significantly lower for noise-degraded stimuli. CONCLUSION: This French-language intelligibility test can be used to evaluate speech disorder: for example, in dysarthria, head and neck cancer or after cochlear implantation.

Objective Intelligibility Assessment by Automated Segmental and Suprasegmental Listening Error Analysis.

Purpose Subjective speech intelligibility assessment is often preferred over more objective approaches that rely on transcript scoring. This is, in part, because of the intensive manual labor associated with extracting objective metrics from transcribed speech. In this study, we propose an automated approach for scoring transcripts that provides a holistic and objective representation of intelligibility degradation stemming from both segmental and suprasegmental contributions, and that corresponds with human perception. Method Phrases produced by 73 speakers with dysarthria were orthographically transcribed by 819 listeners via Mechanical Turk, resulting in 63,840 phrase transcriptions. A protocol was developed to filter the transcripts, which were then automatically analyzed using novel algorithms developed for measuring phoneme and lexical segmentation errors. The results were compared with manual labels on a randomly selected sample set of 40 transcribed phrases to assess validity. A linear regression analysis was conducted to examine how well the automated metrics predict a perceptual rating of severity and word accuracy. Results On the sample set, the automated metrics achieved 0.90 correlation coefficients with manual labels on measuring phoneme errors, and 100% accuracy on identifying and coding lexical segmentation errors. Linear regression models found that the estimated metrics could predict a significant portion of the variance in perceptual severity and word accuracy. Conclusions The results show the promising development of an objective speech intelligibility assessment that identifies intelligibility degradation on multiple levels of analysis.

A Standardized Protocol for Maximum Repetition Rate Assessment in Children.

BACKGROUND/AIMS: Maximum repetition rate (MRR) is often used in the assessment of speech motor performance in older children and adults. The present study aimed to evaluate a standardized protocol for MRR assessment in young children in Dutch. METHODS: The sample included 1,524 children of 2-7 years old with no hearing difficulties and Dutch spoken in their nursery or primary school and was representative for children in the Netherlands. The MRR protocol featured mono-, tri-, and bisyllabic sequences and was computer-implemented to maximize standardization. RESULTS: Less than 50% of the 2-year-olds could produce >1 monosyllabic sequence correctly. Children who could not correctly produce ≥2 monosyllabic sequences could not produce any of the multisyllabic sequences. The effect of instruction ("faster" and "as fast as possible") was small, and multiple attempts yielded a faster MRR in only 20% of the cases. MRRs did not show clinically relevant differences when calculated over different numbers of repeated syllables. CONCLUSIONS: The MRR protocol is suitable for children of 3 years and older. If children cannot produce at least 2 of the monosyllabic sequences, the multisyllabic tasks should be omitted. Furthermore, all fast attempts of each sequence should be analyzed to determine the fastest MRR.

Higher-Faster-Farther: Maximum Performance Tests in the Assessment of Neurogenic Speech Impairment.

BACKGROUND: Maximum performance tests are widely used in dysarthria assessment. From a theoretical perspective, the motor demands of such tasks differ from those of speaking. Therefore, their validity as measures of dysarthric impairment needs to be established empirically. PATIENTS AND METHODS: Maximum phonation time (MPT) and maximum syllable repetition rate (MRR) were compared with sentence reading/repetition tasks. In study 1, 130 patients with neurologic movement disorders and 130 healthy control participants were examined. Presence/severity of dysarthria was measured using psychometrically standardized auditory scales. In study 2, 16 healthy volunteers participated in an experiment designed to examine the intraspeaker variability of MPT, MRR, and sentence repetition across eight trials. RESULTS: Study 1: MPT made no reasonable contribution to the diagnosis of dysarthria or of any specific dimension of perceived speech impairment. MRR correlated with overall speech impairment but turned out to be an insensitive and highly unspecific statistical marker, afflicted with aetiology-specific errors. Study 2: compared with sentence repetition, both MPT and MRR demonstrated highly increased within-subject inconsistencies. CONCLUSION: The validity of MPT and MRR tasks as measures of dysarthria is still unsettled.

Assessment of Dysarthria Using One-Word Speech Recognition with Hidden Markov Models.

BACKGROUND: The gold standard in dysarthria assessment involves subjective analysis by a speech-language pathologist (SLP). We aimed to investigate the feasibility of dysarthria assessment using automatic speech recognition. METHODS: We developed an automatic speech recognition based software to assess dysarthria severity using hidden Markov models (HMMs). Word-specific HMMs were trained using the utterances from one hundred healthy individuals. Twenty-eight patients with dysarthria caused by neurological disorders, including stroke, traumatic brain injury, and Parkinson's disease were participated and their utterances were recorded. The utterances of 37 words from the Assessment of Phonology and Articulation for Children test were recorded in a quiet control booth in both groups. Patients were asked to repeat the recordings for evaluating the test-retest reliability. Patients' utterances were evaluated by two experienced SLPs, and the consonant production accuracy was calculated as a measure of dysarthria severity. The trained HMMs were also employed to evaluate the patients' utterances by calculating the averaged log likelihood (aLL) as the fitness of the spoken word to the word-specific HMM. RESULTS: The consonant production accuracy reported by the SLPs strongly correlated (r = 0.808) with the aLL, and the aLL showed excellent test-retest reliability (intraclass correlation coefficient, 0.964). CONCLUSION: This leads to the conclusion that dysarthria assessment using a one-word speech recognition system based on word-specific HMMs is feasible in neurological disorders.