Quantitative Assessment of Speech in Cerebellar Ataxia Using Magnitude and Phase Based Cepstrum.

The clinical assessment of speech abnormalities in Cerebellar Ataxia (CA) is time-consuming and inconsistent. We have developed an automated objective system to quantify CA severity and thereby facilitate remote monitoring and optimisation of therapeutic interventions. A quantitative acoustic assessment could prove to be a viable biomarker for this purpose. Our study explores the use of phase-based cepstral features extracted from the modified group delay function as a complement to the features obtained from the magnitude cepstrum. We selected a combination of 15 acoustic measurements using RELIEF feature selection algorithm during the feature optimisation process. These features were used to segregate ataxic speakers from normal speakers (controls) and objectively assess them based on their severity. The effectiveness of our study has been experimentally evaluated through a clinical study involving 42 patients diagnosed with CA and 23 age-matched controls. A radial basis function kernel based support vector machine (SVM) classifier achieved a classification accuracy of 84.6% in CA-Control discrimination [area under the ROC curve (AUC) of 0.97] and 74% in the modified 3-level CA severity estimation (AUC of 0.90) deduced from the clinical ratings. The strong classification ability of selected features and the SVM model supports this scheme's suitability for monitoring CA related speech motor abnormalities.

Importance of glottis landmarks for the assessment of cleft lip and palate speech intelligibility.

The present work explores the acoustic characteristics of articulatory deviations near g(lottis) landmarks to derive the correlates of cleft lip and palate speech intelligibility. The speech region around the g landmark is used to compute two different acoustic features, namely, two-dimensional discrete cosine transform based joint spectro-temporal features, and Mel-frequency cepstral coefficients. Sentence-specific acoustic models are built using these features extracted from the normal speakers' group. The mean log-likelihood score for each test utterance is computed and tested as the acoustic correlates of intelligibility. Derived intelligibility measure shows significant correlation (ρ = 0.78, p < 0.001) with the perceptual ratings.

Systematic Review: Online Crowdsourcing to Assess Perceptual Speech Outcomes.

BACKGROUND: Speech is integral for human interaction and development. Speech assessments are critical in the growing child, especially in the surgical evaluation of patients undergoing cleft palate and speech surgeries. Online crowdsourcing enables layperson raters, allowing rapid and large-scale data collection. This systematic review analyzes the utility of online crowdsourcing to evaluate perceptual speech outcomes. METHODS: Terms related to "crowdsourcing" and "speech" were searched on PubMed, Scopus, CINAHL, Cochrane CENTRAL, and PsycINFO on August 16, 2017, returning 2812 unique articles. Inclusion and exclusion criteria concentrated on online crowdsourcing of perceptual speech outcomes: titles led to 140 abstracts that yielded 35 full-text articles, of which eight articles met criteria for analysis. RESULTS: All studies used Amazon Mechanical Turk for online crowd raters, and one used an additional crowdsourcing site (CrowdFlower). Disordered speech was provided by 376 speakers, for which 2203 crowd workers produced over 700,000 unique ratings. Five studies compared crowdsourced assessments to gold standards and found high concordances. Data collection time ranged from 59 min to 23 h, with worker payments ranging from $0.05 to $2.00 per task. Studies examined child pronunciation of the /r/ sound, dysarthria in Parkinson's speech, and articulation of English words produced by non-English speakers learning English. CONCLUSIONS: Online crowdsourcing for perceptual speech outcomes provides high-quality data consistent with previous speech-assessment standards in a rapid, cost-effective manner. This novel methodology incorporates lay perspective of speech intelligibility and has the potential to revolutionize surgical speech outcome assessments, including cleft palate and speech surgery.

Cost analysis of a speech pathology synchronous telepractice service for patients with head and neck cancer.

BACKGROUND: The purpose of this study is to report the economic outcomes of a new synchronous telepractice service providing speech pathology intervention to patients with head and neck cancer at nonmetropolitan facilities. METHODS: A multisite randomized controlled trial comparing standard care versus a new synchronous telepractice model was conducted within a large Australian public cancer service. Data pertaining to health service costs (staff wages, equipment, and patient travel reimbursement), patient +/- carer costs (travel and wages), and patient-reported quality of life (Assessment of Quality of Life questionnaire 4D) were collected. RESULTS: Eighty-two referrals (39 standard care and 43 synchronous telepractice care) were managed. The new telepractice service reported average cost savings of 12% (P < .0058) for the health service and $40.05 saving per patient per referral. An equivalent positive increase in quality of life (0.04) was reported for both groups. CONCLUSION: The synchronous telepractice service provides cost efficiencies over standard care for providing remote specialist speech pathology head and neck cancer intervention.

Assessment of nasalance and nasality in patients with a repaired cleft palate.

In patients with a repaired cleft palate, nasality is typically diagnosed by speech language pathologists. In addition, there are various instruments to objectively diagnose nasalance. To explore the potential of nasalance measurements after cleft palate repair by NasalView®, we correlated perceptual nasality and instrumentally measured nasalance of eight speech items and determined the relationship between sensitivity and specificity of the nasalance measures by receiver-operating characteristics (ROC) analyses and AUC (area under the curve) computation for each single test item and specific item groups. We recruited patients with a primarily repaired cleft palate receiving speech therapy during follow-up. During a single day visit, perceptive and instrumental assessments were obtained in 36 patients and analyzed. The individual perceptual nasality was assigned to one of four categories; the corresponding instrumental nasalance measures for the eight specific speech items were expressed on a metric scale (1-100). With reference to the perceptual diagnoses, we observed 3 nasal and one oral test item with high sensitivity. However, the specificity of the nasality indicating measures was rather low. The four best speech items with the highest sensitivity provided scores ranging from 96.43 to 100%, while the averaged sensitivity of all eight items was below 90%. We conclude that perceptive evaluation of nasality remains state of the art. For clinical follow-up, instrumental nasalance assessment can objectively document subtle changes by analysis of four speech items only. Further studies are warranted to determine the applicability of instrumental nasalance measures in the clinical routine, using discriminative items only.

Assessment of individual cognitive changes after deep brain stimulation surgery in Parkinson's disease using the Neuropsychological Test Battery Vienna short version.

Long-term therapy of Parkinson's disease with L­DOPA is associated with a high risk of developing motor fluctuations and dyskinesia. Deep brain stimulation (DBS) of the subthalamic nucleus (STN) can improve these motor complications. Although the positive effect on motor symptoms has been proven, postoperative cognitive decline has been documented. To tackle the impact of DBS on cognition, 18 DBS patients were compared to 25 best medically treated Parkinson's patients, 24 patients with mild cognitive impairment (MCI) and 12 healthy controls using the Neuropsychological Test Battery Vienna short version (NTBV-short) for cognitive outcome 12 months after the first examination. Reliable change index methodology was used. Roughly 10% of DBS patients showed cognitive decline mainly affecting the domains attention and executive functioning (phonemic fluency). Further research is needed to identify the mechanisms that lead to improvement or deterioration of cognitive functions in individual cases.

Portable mTBI Assessment Using Temporal and Frequency Analysis of Speech.

This paper shows that extraction and analysis of various acoustic features from speech using mobile devices can allow the detection of patterns that could be indicative of neurological trauma. This may pave the way for new types of biomarkers and diagnostic tools. Toward this end, we created a mobile application designed to diagnose mild traumatic brain injuries (mTBI) such as concussions. Using this application, data were collected from youth athletes from 47 high schools and colleges in the Midwestern United States. In this paper, we focus on the design of a methodology to collect speech data, the extraction of various temporal and frequency metrics from that data, and the statistical analysis of these metrics to find patterns that are indicative of a concussion. Our results suggest a strong correlation between certain temporal and frequency features and the likelihood of a concussion.

Velopharyngeal Structural and Functional Assessment of Speech in Young Children Using Dynamic Magnetic Resonance Imaging.

OBJECTIVE: The purpose of this study was to demonstrate a novel method for examining the velopharyngeal mechanism using static and dynamic magnetic resonance imaging (MRI) at the sentence-level production in young children with normal anatomy. This study examined whether velopharyngeal events occurring in the midsagittal plane are correlated to muscle events occurring along the plane of velopharyngeal closure. Adenoid involvement in velopharyngeal function was also explored. METHODS: A high-resolution, T2-weighted turbo-spin-echo three-dimensional anatomical scan was used to acquire static velopharyngeal data and a fast-gradient echo fast low angle shot multishot spiral technique (15.8 frames per second) was used to acquire dynamic data on 11 children between 4 and 9 years old. RESULTS: Changes in velar knee height from rest to the bilabial /p/ production was strongly correlated with changes in the velar configuration (r = 0.680, P = .021) and levator muscle contraction (r = 0.703, P = .016). Velar configuration was highly correlated to levator muscle changes (r = 0.685, P = .020). Mean alpha angle during bilabial /p/ production was 176°, which demonstrated that subjects achieve velopharyngeal closure at or just below the palatal plane. Subjects with a larger adenoid pad used significantly less (r = -0.660, P = .027) levator muscle contraction compared with individuals with smaller adenoids. CONCLUSIONS: This study demonstrates a potentially useful technique in dynamic MRI that does not rely on cyclic repetitions or sustained phonation. This study lends support to the clinical potential of dynamic MRI methods for cleft palate management.

Speech and Communication Changes Reported by People with Parkinson's Disease.

BACKGROUND: Changes in communicative functions are common in Parkinson's disease (PD), but there are only limited data provided by individuals with PD on how these changes are perceived, what their consequences are, and what type of intervention is provided. AIM: To present self-reported information about speech and communication, the impact on communicative participation, and the amount and type of speech-language pathology services received by people with PD. METHODS: Respondents with PD recruited via the Swedish Parkinson's Disease Society filled out a questionnaire accessed via a Web link or provided in a paper version. RESULTS: Of 188 respondents, 92.5% reported at least one symptom related to communication; the most common symptoms were weak voice, word-finding difficulties, imprecise articulation, and getting off topic in conversation. The speech and communication problems resulted in restricted communicative participation for between a quarter and a third of the respondents, and their speech caused embarrassment sometimes or more often to more than half. Forty-five percent of the respondents had received speech-language pathology services. CONCLUSIONS: Most respondents reported both speech and language symptoms, and many experienced restricted communicative participation. Access to speech-language pathology services is still inadequate. Services should also address cognitive/linguistic aspects to meet the needs of people with PD.

Tools for the assessment of childhood apraxia of speech.

PURPOSE: This study systematically reviews the literature on the main tools used to evaluate childhood apraxia of speech (CAS). RESEARCH STRATEGY: The search strategy includes Scopus, PubMed, and Embase databases. SELECTION CRITERIA: Empirical studies that used tools for assessing CAS were selected. DATA ANALYSIS: Articles were selected by two independent researchers. RESULTS: The search retrieved 695 articles, out of which 12 were included in the study. Five tools were identified: Verbal Motor Production Assessment for Children, Dynamic Evaluation of Motor Speech Skill, The Orofacial Praxis Test, Kaufman Speech Praxis Test for Children, and Madison Speech Assessment Protocol. There are few instruments available for CAS assessment and most of them are intended to assess praxis and/or orofacial movements, sequences of orofacial movements, articulation of syllables and phonemes, spontaneous speech, and prosody. CONCLUSION: There are some tests for assessment and diagnosis of CAS. However, few studies on this topic have been conducted at the national level, as well as protocols to assess and assist in an accurate diagnosis.

Instrumentos para avaliação de apraxia de fala infantil / Tools for the assessment of childhood apraxia of speech

RESUMO Objetivo: Revisar sistematicamente na literatura os principais instrumentos utilizados para avaliação da apraxia de fala infantil. Estratégia de pesquisa: Realizou-se busca nas bases Scopus, PubMed e Embase Critérios de seleção: Foram selecionados estudos empíricos que utilizaram instrumentos de avaliação da apraxia de fala infantil. Análise dos dados: A seleção dos artigos foi realizada por dois pesquisadores independentes. Resultados: Foram encontrados 695 resumos. Após a leitura dos resumos, foram selecionados 12 artigos completos. Foi possível identificar cinco instrumentos: Verbal Motor Production Assessment for Children, Dynamic Evaluation of Motor Speech Skill , The Orofacial Praxis Test , Kaufman Speech Praxis Test for children e o Madison Speech Assessment Protocol . São poucos os instrumentos utilizados para identificação da apraxia de fala infantil e a maioria destina-se à avaliação da realização de praxias e/ou movimentos orofaciais, sequências de movimentos orofaciais, articulação de fonemas simples, fonemas complexos e sílabas, fala espontânea, além da adequação da prosódia. Conclusões: Percebe-se que existem instrumentos que se propõem a avaliar e diagnosticar a apraxia de fala infantil. No entanto, ainda são escassos os estudos sobre esse tema em nível nacional, bem como protocolos padronizados e validados para a população brasileira que avaliem e ajudem em um diagnóstico preciso.

ABSTRACT Purpose: This study systematically reviews the literature on the main tools used to evaluate childhood apraxia of speech (CAS). Research strategy: The search strategy includes Scopus, PubMed, and Embase databases. Selection criteria: Empirical studies that used tools for assessing CAS were selected. Data analysis: Articles were selected by two independent researchers. Results: The search retrieved 695 articles, out of which 12 were included in the study. Five tools were identified: Verbal Motor Production Assessment for Children, Dynamic Evaluation of Motor Speech Skill, The Orofacial Praxis Test, Kaufman Speech Praxis Test for Children, and Madison Speech Assessment Protocol. There are few instruments available for CAS assessment and most of them are intended to assess praxis and/or orofacial movements, sequences of orofacial movements, articulation of syllables and phonemes, spontaneous speech, and prosody. Conclusion: There are some tests for assessment and diagnosis of CAS. However, few studies on this topic have been conducted at the national level, as well as protocols to assess and assist in an accurate diagnosis.

The impact of demographic and socio-economic conditions on the prevalence of speech disorders in preschool children in Bitola.

INTRODUCTION: Speech development in preschool children should be consistent with a child's overall development. However, disorders of speech in childhood are not uncommon. OBJECTIVE: The purpose of the study was to determine the impact of demographic and socio-economic conditions on the prevalence of speech disorders in preschool children in Bitola. METHODS: The study is observational and prospective with two years duration. During the period from May 2009 to June 2011, 1607 children aged 3 and 5 years, who came for regular examinations, were observed. The following research methods were applied: pediatric examination, psychological testing (Test of Chuturik), interviews with parents and a questionnaire for behavior of children (Child Behavior Checklist - CBCL). RESULTS: 1,607 children were analyzed, 772 aged three years, 835 aged five years, 51.65% male and 49.35% female.The prevalence of speech disorders was 37.65%. Statistical analysis showed that these disorders were more frequent in three years old children, males living in rural areas and in larger families.They did not have their own rooms at home, they were using mobile phones and were spending many hours per day watching television, (p<0.01). Also, children whose parents had lower levels of education and were engaged in agriculture, often had significant speech disorders, (p<0.01). CONCLUSION: Speech disorders in preschool children in Bitola have a high prevalence. Because of their influence on later cognitive development of children, the process requires cooperation among parents, children, speech and the audiologist with the significant role in prevention, early detection and treatment.

Validity and Reliability of Visual Analog Scaling for Assessment of Hypernasality and Audible Nasal Emission in Children With Repaired Cleft Palate.

OBJECTIVE: To investigate the validity and reliability of multiple listener judgments of hypernasality and audible nasal emission, in children with repaired cleft palate, using visual analog scaling (VAS) and equal-appearing interval (EAI) scaling. DESIGN: Prospective comparative study of multiple listener ratings of hypernasality and audible nasal emission. SETTING: Multisite institutional. PARTICIPANTS: Five trained and experienced speech-language pathologist listeners from the Americleft Speech Project. MEASURES: Average VAS and EAI ratings of hypernasality and audible nasal emission/turbulence for 12 video-recorded speech samples from the Americleft Speech Project. Intrarater and interrater reliability was computed, as well as linear and polynomial models of best fit. RESULTS: Intrarater and interrater reliability was acceptable for both rating methods; however, reliability was higher for VAS as compared to EAI ratings. When VAS ratings were plotted against EAI ratings, results revealed a stronger curvilinear relationship. CONCLUSIONS: The results of this study provide additional evidence that alternate rating methods such as VAS may offer improved validity and reliability over EAI ratings of speech. VAS should be considered a viable method for rating hypernasality and nasal emission in speech in children with repaired cleft palate.

Velopharyngeal incompetence in patients with cleft palate, flexible video pharyngoscopy and perceptual speech assessment: a correlational pilot study.

OBJECTIVES: To assess the role of video endoscopy in evaluating velopharyngeal incompetence and investigate a possible relationship between velopharyngeal incompetence type and speech defect in cleft palate patients. METHODS: A prospective study of 28 pre- or post-operative cleft palate patients with speech defects who attended Plastic Surgery-Cleft Palate and ENT out-patient clinics was performed. The velar defect type was determined using a flexible endoscope and findings were video recorded. Speech pathology was assessed using the cleft palate audit protocol for speech. RESULTS: A significant, clinically relevant relationship was noted between the perceived characteristics of hypernasality and velopharyngeal insufficiency type. Hypernasal speech was a definite clinical indicator of velopharyngeal incompetence, and the type 1 velopharyngeal defect was most common. Type 1 velopharyngeal coronal-type dysfunction was strongly associated with hypernasality (p < 0.05). When speech substitution was noted, type 2 velopharyngeal (or sagittal) incompetence could be predicted (p < 0.05). CONCLUSION: In the management of cleft palate patients, it is important that surgical correction of the defect and achieving velopharyngeal competency for speech are performed simultaneously. Pre-operative velopharyngeal endoscopy with speech assessment will define the anatomical and functional bases for velopharyngeal correction and assist in planning and tailoring the pharyngeal flap.

Living through a computer voice: a personal account.

Alan Martin, the first author of this paper, has cerebral palsy and uses a voice output communication aid (VOCA) to speak, and this paper describes the personal experience of living 'through' a computer voice (or VOCA) in the form of an interview of Mr Martin conducted by Dr Newell. The interview focuses on the computerized voice output rather than other features of the VOCA. In presenting a first-hand account of the experience of actually using VOCA, the intention is that both everyday, practical issues of the technology and broader imaginative, philosophical, and sociological implications will be explored. Based upon the interview, the authors offer an informal set of design requirements and recommendations for the development of future VOCAs.

A motor speech assessment for children with severe speech disorders: reliability and validity evidence.

PURPOSE: In this article, the authors report reliability and validity evidence for the Dynamic Evaluation of Motor Speech Skill (DEMSS), a new test that uses dynamic assessment to aid in the differential diagnosis of childhood apraxia of speech (CAS). METHOD: Participants were 81 children between 36 and 79 months of age who were referred to the Mayo Clinic for diagnosis of speech sound disorders. Children were given the DEMSS and a standard speech and language test battery as part of routine evaluations. Subsequently, intrajudge, interjudge, and test-retest reliability were evaluated for a subset of participants. Construct validity was explored for all 81 participants through the use of agglomerative cluster analysis, sensitivity measures, and likelihood ratios. RESULTS: The mean percentage of agreement for 171 judgments was 89% for test-retest reliability, 89% for intrajudge reliability, and 91% for interjudge reliability. Agglomerative hierarchical cluster analysis showed that total DEMSS scores largely differentiated clusters of children with CAS vs. mild CAS vs. other speech disorders. Positive and negative likelihood ratios and measures of sensitivity and specificity suggested that the DEMSS does not overdiagnose CAS but sometimes fails to identify children with CAS. CONCLUSIONS: The value of the DEMSS in differential diagnosis of severe speech impairments was supported on the basis of evidence of reliability and validity.

The invisible brain injury: the importance of identifying deficits following brain injury in children with intellectual disability.

INTRODUCTION: Traumatic brain injury (TBI) is common during childhood. However, most of the extant literature about outcomes following childhood TBI is based on children who were functioning "normally" prior to the injury event. But, with the increasing community integration of children with Intellectual Disability (ID) there is an urgent need for specific information regarding problems following TBI for this group. METHOD: Using a case study, this paper presents an overview of problems faced by these children who subsequently experience a TBI event, and examines questions pertinent to this dual diagnosis. OUTCOMES: In the case study presented, despite supposedly having access to an internationally acclaimed comprehensive no fault accident compensation and rehabilitation system, a lack of assessment, intervention and support was evident for both the child and the family following a severe TBI because he had pre-existing ID. CONCLUSIONS: This case study highlights the need for clinicians to consider the impact of TBI for children with ID, to avoid incorrectly attributing TBI symptoms to pre-existing problems. Children with ID are at increased risk; appropriate treatment plans are vital to maximize quality of life for them and their caregivers.

Assessment of orofacial dysfunctions, salivary cortisol levels and oral health related quality of life (ORHQoL) in young adults.

OBJECTIVE: To investigate the relationship of orofacial dysfunction and salivary cortisol levels with oral health quality of life (ORHQoL) in young adults. DESIGN: Thirty individuals of both genders (22.93±2.42 years) participated. The orofacial dysfunction was evaluated using the Nordic Orofacial Test-Screening (NOT-S) and the ORHQoL using the Oral Health Impact Profile (OHIP-49). Saliva samples were collected during three days, at waking up and 30 min after, obtaining the awakening cortisol response - ACR. The data were analysed by Mann-Whitney test, Spearman's correlation and multiple linear regression (α=0.05). The NOT-S scores and ACR (µg/dl) were dichotomized by the median (2.0 and 0.15, respectively). RESULTS: NOT-S and ACR showed similar values between genders (P>0.05). The individuals with NOT-S scores above the median presented values of "physical pain" domain significantly higher than the individuals with scores bellow or equal to the median. Significant correlations were found between the OHIP-49 domains "physical pain" and "physical disability" and NOT-S scores. In multiple linear regression, significant values were observed between NOT-S and OHIP-49 and the domains physical pain, physical disability, psychological disability, social disability and handicap, with determination coefficients ranging from 0.09 to 0.15. There was not association with the ACR. CONCLUSIONS: Individuals with orofacial dysfunction presented impairment in ORHQoL, but not enough to change salivary cortisol levels. Furthermore, gender did not have influence on ORHQoL in the studied sample.

Assessment of breathing patterns and respiratory muscle recruitment during singing and speech in quadriplegia.

OBJECTIVES: To explore how respiratory impairment after cervical spinal cord injury affects vocal function, and to explore muscle recruitment strategies used during vocal tasks after quadriplegia. It was hypothesized that to achieve the increased respiratory support required for singing and loud speech, people with quadriplegia use different patterns of muscle recruitment and control strategies compared with control subjects without spinal cord injury. DESIGN: Matched, parallel-group design. SETTING: Large university-affiliated public hospital. PARTICIPANTS: Consenting participants with motor-complete C5-7 quadriplegia (n=6) and able-bodied age-matched controls (n=6) were assessed on physiologic and voice measures during vocal tasks. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Standard respiratory function testing, surface electromyographic activity from accessory respiratory muscles, sound pressure levels during vocal tasks, the Voice Handicap Index, and the Perceptual Voice Profile. RESULTS: The group with quadriplegia had a reduced lung capacity (vital capacity, 71% vs 102% of predicted; P=.028), more perceived voice problems (Voice Handicap Index score, 22.5 vs 6.5; P=.046), and greater recruitment of accessory respiratory muscles during both loud and soft volumes (P=.028) than the able-bodied controls. The group with quadriplegia also demonstrated higher accessory muscle activation in changing from soft to loud speech (P=.028). CONCLUSIONS: People with quadriplegia have impaired vocal ability and use different muscle recruitment strategies during speech than the able-bodied. These findings will enable us to target specific measurements of respiratory physiology for assessing functional improvements in response to formal therapeutic singing training.

Validation of items for a speech intelligibility assessment scale.

BACKGROUND: speech intelligibility evaluation. AIM: to develop and validate items for a speech intelligibility assessment scale based on the speech of individuals with phonological disorder (PD) who present common phonological repair strategies (RS) in the Brazilian Portuguese language (BP), through the testing of its effectiveness in classifying the speech of these subjects. Also to observe the speech intelligibility generated by the use of RS and possible interference of factors such as gender, age, literacy and contact of the judges with children. METHOD: spontaneous narratives of five children with typical PD and one control subject were recorded in a compact disc (CD) and presented to 103 judges, with normal hearing abilities, with ages ranging from 18 to 39 years and with elementary, high-school and undergraduate backgrounds. RESULTS: results indicate the statistical validity of the scale and that the type of RS if fundamental for speech intelligibility. There was no statistical interference of the investigated variables of gender, age, literacy and contact with children in the performed judgments. CONCLUSION: the scale items were validated and demonstrated efficacy in the assessment of speech intelligibility of the studied cases.