Automated Assessment of Oral Diadochokinesis in Multiple Sclerosis Using a Neural Network Approach: Effect of Different Syllable Repetition Paradigms.

Slow and irregular oral diadochokinesis represents an important manifestation of spastic and ataxic dysarthria in multiple sclerosis (MS). We aimed to develop a robust algorithm based on convolutional neural networks for the accurate detection of syllables from different types of alternating motion rate (AMR) and sequential motion rate (SMR) paradigms. Subsequently, we explored the sensitivity of AMR and SMR paradigms based on voiceless and voiced consonants in the detection of speech impairment. The four types of syllable repetition paradigms including /ta/, /da/, /pa/-/ta/-/ka/, and /ba/-/da/-/ga/ were collected from 120 MS patients and 60 matched healthy control speakers. Our neural network algorithm was able to correctly identify the position of individual syllables with a very high average accuracy of 97.8%, with the correct temporal detection of syllable position of 87.8% for 10 ms and 95.5% for 20 ms tolerance value. We found significantly altered diadochokinetic rate and regularity in MS compared to controls across all types of investigated tasks ( ). MS patients showed slower speech for SMR compared to AMR tasks, whereas voiced paradigms were more irregular. Objective evaluation of oral diadochokinesis using different AMR and SMR paradigms may provide important information regarding speech severity and pathophysiology of the underlying disease.

Development and validation of a new scale for assessment of speech stimulability in Persian speaking children.

OBJECTIVES: Speech and language pathologists need to assess speech stimulability as a crucial component of assessment in clients with speech sound disorders. The purpose of the current survey was to develop and validate an instrument to assess speech stimulability in Persian speaking children. METHODS: The present study was accomplished in two steps. In step I, the test material was developed based on extensive literature review, and five experts were requested to make judgment on the content validity of the test. We evaluated other psychometric properties in step II. A pilot study was performed by the administration of the test on 25 children, and then the correct answer percentages of 100 participants for each item of the Persian test of speech stimulability were calculated. The participants were divided into four groups by six-month intervals. Inter-rater reliability, test-retest, and internal consistency were computed for the reliability measures. Statistical Package for the Social Sciences, version 24.0 (SPSS, Inc., Chicago, IL) was used for the statistical analysis of the data. The significance level was (P < 0.05). RESULTS: The final version of the test includes 132 items (consonant and vowel singleton words and sentences). There was no significant difference among experts' judgment in the content validity of the items (P > 0.05). All of the children could easily repeat the items in the pilot study. The participants were stimulable more than 80% for all of the consonants except/ʒ/and 100% for the vowels in the items of the final version of the Persian test of speech stimulability. All of the reliability values (inter-rater reliability, test-retest, and internal consistency) were higher than 0.8. CONCLUSION: Investigation of psychometric properties of the Persian test of speech stimulability showed that this test is a valid and reliable scale to assess the speech stimulability in Persian speaking children.

Evidence of validity and reliability of a phonological assessment tool. / Evidências de validade e fidedignidade de um instrumento de avaliação fonológica.

PURPOSE: To present evidence of the validity and reliability of a phonological assessment tool developed to assess the phonological inventory of Brazilian Portuguese. METHODS: The study included 866 children aged between 3 and 8:11 years, divided into three groups: typical, control and clinical. Participants were evaluated using a phonological assessment software, which prompted the spontaneous naming of a series of images. The children's responses were audio recorded and transcribed at the time of the assessment, by the software itself. The Cronbach's alpha coefficient was used to evaluate the internal consistency of the instrument for reliability and validity purposes. Criterion validity was examined by comparing the performance of different groups using Student's t-test for independent samples. Intra- and inter-rater agreement were investigated using Kendall's tau. Results were considered significant at p ≤ 0.05. RESULTS: The present study provided evidence of validity and reliability (internal consistency) for this phonological assessment tool, confirming the reliability of its items and demonstrating excellent agreement rates between examiners regarding its scoring (intra- and inter-rater reliability). The criterion validity assessment demonstrated that the control group outperformed the clinical group across all phonemes, showing that test scores were successful in identifying children with speech sound disorders (phonological disorders). CONCLUSION: The present findings provide strong evidence of the validity and reliability of this phonological assessment tool.

OBJETIVO: Apresentar evidências de validade e fidedignidade de um instrumento de avaliação fonológica (INFONO) desenvolvido para avaliar os fonemas do Português Brasileiro. MÉTODO: Participaram do estudo 866 crianças com idades entre 3 e 8:11 anos, divididas em grupos: típico, controle e clínico. Os participantes foram avaliados pelo INFONO por nomeação espontânea. A produção da criança foi gravada e transcrita no momento da avaliação, no próprio software. Para análise de validade e fidedignidade, foram analisadas a consistência interna a partir da técnica Alpha de Cronbach. Para a validade de critério, comparou-se o desempenho entre os grupos através do teste t de Student para amostras independentes. A fidedignidade foi analisada pela concordância intra e interavaliadores por meio do Teste de Kendall. Considerou-se significância quando p ≤0,05. RESULTADOS: O INFONO apresentou evidências de validade e fidedignidade (consistência interna), indicando uma confiabilidade satisfatória dos itens, bem como excelente concordância entre os avaliadores em relação aos escores do teste (confiabilidade intra e interavaliador). Em relação à validade de critério, o desempenho do grupo clínico para todos os fonemas foi inferior ao grupo controle, mostrando que os escores são sensíveis para identificar crianças com desvio fonológico. CONCLUSÃO: O INFONO apresentou fortes evidências de validade e fidedignidade.

Evidências de validade e fidedignidade de um instrumento de avaliação fonológica / Evidence of validity and reliability of a phonological assessment tool

RESUMO Objetivo Apresentar evidências de validade e fidedignidade de um instrumento de avaliação fonológica (INFONO) desenvolvido para avaliar os fonemas do Português Brasileiro. Método Participaram do estudo 866 crianças com idades entre 3 e 8:11 anos, divididas em grupos: típico, controle e clínico. Os participantes foram avaliados pelo INFONO por nomeação espontânea. A produção da criança foi gravada e transcrita no momento da avaliação, no próprio software. Para análise de validade e fidedignidade, foram analisadas a consistência interna a partir da técnica Alpha de Cronbach. Para a validade de critério, comparou-se o desempenho entre os grupos através do teste t de Student para amostras independentes. A fidedignidade foi analisada pela concordância intra e interavaliadores por meio do Teste de Kendall. Considerou-se significância quando p ≤0,05. Resultados O INFONO apresentou evidências de validade e fidedignidade (consistência interna), indicando uma confiabilidade satisfatória dos itens, bem como excelente concordância entre os avaliadores em relação aos escores do teste (confiabilidade intra e interavaliador). Em relação à validade de critério, o desempenho do grupo clínico para todos os fonemas foi inferior ao grupo controle, mostrando que os escores são sensíveis para identificar crianças com desvio fonológico. Conclusão O INFONO apresentou fortes evidências de validade e fidedignidade.

ABSTRACT Purpose To present evidence of the validity and reliability of a phonological assessment tool developed to assess the phonological inventory of Brazilian Portuguese. Methods The study included 866 children aged between 3 and 8:11 years, divided into three groups: typical, control and clinical. Participants were evaluated using a phonological assessment software, which prompted the spontaneous naming of a series of images. The children's responses were audio recorded and transcribed at the time of the assessment, by the software itself. The Cronbach's alpha coefficient was used to evaluate the internal consistency of the instrument for reliability and validity purposes. Criterion validity was examined by comparing the performance of different groups using Student's t-test for independent samples. Intra- and inter-rater agreement were investigated using Kendall's tau. Results were considered significant at p ≤ 0.05. Results The present study provided evidence of validity and reliability (internal consistency) for this phonological assessment tool, confirming the reliability of its items and demonstrating excellent agreement rates between examiners regarding its scoring (intra- and inter-rater reliability). The criterion validity assessment demonstrated that the control group outperformed the clinical group across all phonemes, showing that test scores were successful in identifying children with speech sound disorders (phonological disorders). Conclusion The present findings provide strong evidence of the validity and reliability of this phonological assessment tool.

Management of non-progressive dysarthria: practice patterns of speech and language therapists in the Republic of Ireland.

BACKGROUND: Dysarthria is a commonly acquired speech disorder. Rising numbers of people surviving stroke and traumatic brain injury (TBI) mean the numbers of people with non-progressive dysarthria are likely to increase, with increased challenges for speech and language therapists (SLTs), service providers and key stakeholders. The evidence base for assessment and intervention approaches with this population remains limited with clinical guidelines relying largely on clinical experience, expert opinion and limited research. Furthermore, there is currently little evidence on the practice behaviours of SLTs available. AIMS: To investigate whether SLTs in the Republic of Ireland (ROI) vary in how they assess and manage adults with non-progressive dysarthria; to explore SLTs' use of the theoretical principles that influence therapeutic approaches; to identify challenges perceived by SLTs when working with adults with non-progressive dysarthria; and to determine SLTs' perceptions of further training needs. METHODS & PROCEDURES: A 33-item survey questionnaire was devised and disseminated electronically via SurveyMonkey to SLTs working with non-progressive dysarthria in the ROI. SLTs were identified through e-mail lists for special-interest groups, SLT manager groups and general SLT mailing lists. A reminder e-mail was sent to all SLTs 3 weeks later following the initial e-mail containing the survey link. The survey remained open for 6 weeks. Questionnaire responses were analysed using descriptive statistics. Qualitative comments to open-ended questions were analysed through thematic analysis. OUTCOMES & RESULTS: Eighty SLTs responded to the survey. Sixty-seven of these completed the survey in full. SLTs provided both quantitative and qualitative data regarding their assessment and management practices in this area. Practice varied depending on the context of the SLT service, experience of SLTs and the resources available to them. Not all SLTs used principles such as motor programming or neural plasticity to direct clinical work and some requested further direction in this area. SLTs perceived that the key challenges associated with working in this area were the compliance, insight and motivation of adults with dysarthria. CONCLUSIONS & IMPLICATIONS: The use of specific treatment programmes varies amongst SLTs. A lack of resources is reported to restrict practice in both assessment and management. Ongoing research into the effectiveness of SLT interventions with adults with non-progressive dysarthria is required to guide clinical decision-making. SLTs identified further training needs which may provide direction for the development of professional training courses in the future.

Speech-language pathologists' practices regarding assessment, analysis, target selection, intervention, and service delivery for children with speech sound disorders.

A survey of 231 Australian speech-language pathologists (SLPs) was undertaken to describe practices regarding assessment, analysis, target selection, intervention, and service delivery for children with speech sound disorders (SSD). The participants typically worked in private practice, education, or community health settings and 67.6% had a waiting list for services. For each child, most of the SLPs spent 10-40 min in pre-assessment activities, 30-60 min undertaking face-to-face assessments, and 30-60 min completing paperwork after assessments. During an assessment SLPs typically conducted a parent interview, single-word speech sampling, collected a connected speech sample, and used informal tests. They also determined children's stimulability and estimated intelligibility. With multilingual children, informal assessment procedures and English-only tests were commonly used and SLPs relied on family members or interpreters to assist. Common analysis techniques included determination of phonological processes, substitutions-omissions-distortions-additions (SODA), and phonetic inventory. Participants placed high priority on selecting target sounds that were stimulable, early developing, and in error across all word positions and 60.3% felt very confident or confident selecting an appropriate intervention approach. Eight intervention approaches were frequently used: auditory discrimination, minimal pairs, cued articulation, phonological awareness, traditional articulation therapy, auditory bombardment, Nuffield Centre Dyspraxia Programme, and core vocabulary. Children typically received individual therapy with an SLP in a clinic setting. Parents often observed and participated in sessions and SLPs typically included siblings and grandparents in intervention sessions. Parent training and home programs were more frequently used than the group therapy. Two-thirds kept up-to-date by reading journal articles monthly or every 6 months. There were many similarities with previously reported practices for children with SSD in the US, UK, and the Netherlands, with some (but not all) practices aligning with current research evidence.

Phonological assessment and analysis of bilingual preschoolers' Spanish and English word productions.

PURPOSE: The major purpose of this study was to examine Spanish and English phonological productions (patterns/deviations) of typically developing bilingual preschool children. Phonological scores were compared in order to determine if significant differences exist between (a) boys and girls, (b) 4- and 5-year-olds, and/or (c) their productions of Spanish and English words. METHOD: Fifty-six bilingual 4- and 5-year-old children (27 boys and 29 girls) who attended Head Start programs named stimulus items for Spanish and English phonological assessment instruments that were similar in procedures and analyses. RESULTS: Multivariate analyses indicated no significant differences for phonological scores between boys and girls or between the 2 languages. Differences between the 4- and 5-year-olds, however, were significant, with the 5-year-olds performing better than the 4-year-olds. Liquid deviations and omissions of consonants in clusters/sequences were the most frequently occurring phonological deviations. CONCLUSIONS: Phonological score differences between typically developing bilingual Spanish-English-speaking preschool boys and girls from similar backgrounds are not likely to be significant. Better phonological scores, however, can be expected for 5-year-olds than for 4-year-olds. Moreover, phonological deviation percentage scores of typically developing bilingual children for comparable Spanish and English assessment instruments are likely to be similar.

Velopharyngeal function assessment in patients with cleft palate: perceptual speech assessment versus nasopharyngoscopy.

There is no doubt that perceptual speech assessment and instrumental examination could provide different diagnostic information on patients with cleft palate (CP), but not all patients simultaneously need the 2 examinations. So the purposes of this study were to explore a simple and effective evaluation method to assess velopharyngeal function and to investigate speech traits that affect the diagnosis of velopharyngeal function in patients with CP. The investigators implemented a retrospective study, and 247 postoperative patients with CP were selected, including 155 boys and 92 girls, with a mean (SD) age of 13 years and 2 months (7 years and 7 months). All of these patients were assessed by perceptual speech evaluation and nasopharyngoscopy after surgery, and the result was divided into velopharyngeal closure (VPC), velopharyngeal insufficiency, and marginal VPC. The number of diagnostic consistency patients was 170 (VPC, 51 patients; velopharyngeal insufficiency, 115 patients; marginal VPC, 4 patients), and the consistent ratio was 68.83%. There was no significant difference between perceptual speech assessment and nasopharyngoscopy. Furthermore, the difference in distribution of hypernasality between the consistent group and the inconsistent group was significant. In addition, the correlation analysis indicated that surgical age, hypernasality, nasal emission, and compensatory articulation were correlated with the velopharyngeal function (P < 0.05). In conclusion, perceptual speech assessment could make a correct diagnosis in the absence of instrumental examination. The severity of hypernasality might affect the diagnosis of the velopharyngeal function. Much more attention should be paid to the surgical age, the alteration of hypernasality, nasal emission, and compensatory articulation during CP therapy.

Early phonological development: creating an assessment test.

This paper describes a new protocol for assessing the phonological systems of two-year-olds with typical development and older children with delays in vocabulary acquisition. The test (Profiles of Early Expressive Phonological Skills (PEEPS), Williams & Stoel-Gammon, in preparation ) differs from currently available assessments in that age of acquisition, based on lexical norms from the MacArthur-Bates Communicative Developmental Inventories, served as the primary criterion for creating a word list. Phonetic and semantic properties of the words were also considered in selecting items for the test. Productions of words using the PEEPS protocol have been gathered from a group of children with typical development and another group with cleft lip and/or palate. By 24 months of age, the children with typical development produced more than 90% of the target words and the children with atypical development produced 73% of the words. Regarding administration, the time needed for administering the protocol decreased with age.

The "Interdisciplinary Orofacial Examination Protocol for Children and Adolescents": a resource for the interdisciplinary assessment of the stomatognatic system.

The Interdisciplinary Orofacial Examination Protocol for Children and Adolescents (Protocolo de exploración interdisciplinaria orofacial para niños y adolescents, Barcelona, 2008) is very useful in providing a fast, initial, expedient detection of possible morphological and functional disorders, and to guide the patient toward the appropriate professionals. With this tool it is possible to detect the risk factors which can negatively affect morphological and functional harmony and guide patients toward the necessary treatment as early as possible. This Protocol, developed by 4 orthodontists, 1 ENT and 3 speech language therapists, also contributes to the unification of concepts and nomenclature used by distinct specialists, thus making professional understanding easier and more dynamic.

Multidimensional assessment of phonological similarity within and between children.

Multidimensional analysis involves moving away from one-dimensional analyses such as most articulation tests to comprehensive analyses involving levels of phonological information from the word level down to segments. This article outlines one such approach that looks at four levels from words to segments, using nine phonological measures. It also presents a new methodology for comparing children across the levels (multidimensional assessment of phonological similarity (MAPS)), and demonstrates the approach through a comparison of four sibling pairs. The results show that children can differ greatly and unpredictably in their similarities and differences, and that only a multidimensional analysis can identify where these similarities and differences may occur.

Instrumental assessment of velopharyngeal closure for speech.

The presence of a palatal cleft at birth should not prevent good speech production in most children provided they have (1) appropriate surgical intervention to close the palate at or around the child's first birthday, (2) careful monitoring of speech development throughout childhood, (3) speech therapy when needed, and (4) secondary surgical or speech-prosthetic intervention when needed. When managed carefully by an experienced, well-prepared multidisciplinary team that applies the criteria listed above, ~70% of children with nonsyndromic palatal clefts will have no significant difficulties with speech intelligibility or speech quality due to velopharyngeal insufficiency by the time they enter elementary school. Speech assessment is the first step toward comprehensive team management of children with cleft palate. The purpose of this chapter is to describe the use of instrumentation in the evaluation of speech of children with palatal clefts, within the context of a multidisciplinary team. The focus of this article is on instruments that are used to supplement the perceptual assessment to document current speech status and plan management strategies.

Phonological awareness in Swedish-speaking children with complex communication needs.

BACKGROUND: Children with complex communication needs (CCN) often experience problems achieving literacy. The aim of this project was to study phonological awareness, a central predictor for literacy achievement, in children with CCN, and to compare their performance to a group of children with natural speech. METHOD: One group of 15 Swedish children with CCN and cerebral palsy (CP), and one group of 15 children with natural speech, matched for gender, linguistic age and mental age, were administered nine phonological awareness tasks, testing onset/rime and phonemic awareness. RESULTS: Overall, children with CCN showed good levels of phonological awareness. However, on the one task that did not include any verbal support from the experimenter, the children with CCN performed at a significantly lower level. CONCLUSION: Phonological awareness does not seem to depend on overt articulation, although the lack of speech might affect the children's ability to manipulate linguistic material that is not verbally presented.

Speech-language pathologists' assessment practices for children with suspected speech sound disorders: results of a national survey.

PURPOSE: This study examined assessment procedures used by speech-language pathologists (SLPs) when assessing children suspected of having speech sound disorders (SSD). This national survey also determined the information participants obtained from clients' speech samples, evaluation of non-native English speakers, and time spent on assessment. METHOD: One thousand surveys were mailed to a randomly selected group of SLPs, self-identified as having worked with children with SSD. A total of 333 (33%) surveys were returned. RESULTS: The assessment tasks most frequently used included administering a commercial test, estimating intelligibility, assessing stimulability, and conducting a hearing screening. The amount of time dedicated to assessment activities (e.g., administering formal tests, contacting parents) varied across participants and was significantly related to years of experience but not caseload size. Most participants reported using informal assessment procedures, or English-only standardized tests, when evaluating non-native English speakers. CONCLUSIONS: Most participants provided assessments that met federal guidelines to qualify children for special education services; however, additional assessment may be needed to create comprehensive treatment plans for their clients. These results provide a unique perspective on the assessment of children suspected of having SSD and should be helpful to SLPs as they examine their own assessment practices.

SISL (ScreeningsInstrument Schisis Leuven): assessment of cleft palate speech, resonance and myofunction.

This paper presents an assessment protocol for the evaluation and description of speech, resonance and myofunctional characteristics commonly associated with cleft palate and/or velopharyngeal dysfunction. The protocol is partly based on the GOS.SP.ASS'98 and adapted to Flemish. It focuses on the relevant aspects of cleft type speech necessary to facilitate assessment, adequate diagnosis and management planning in a multi-disciplinary setting of cleft team care.

Transitioning from analog to digital audio recording in childhood speech sound disorders.

Few empirical findings or technical guidelines are available on the current transition from analog to digital audio recording in childhood speech sound disorders. Of particular concern in the present context was whether a transition from analog- to digital-based transcription and coding of prosody and voice features might require re-standardizing a reference database for research in childhood speech sound disorders. Two research transcribers with different levels of experience glossed, transcribed, and prosody-voice coded conversational speech samples from eight children with mild to severe speech disorders of unknown origin. The samples were recorded, stored, and played back using representative analog and digital audio systems. Effect sizes calculated for an array of analog versus digital comparisons ranged from negligible to medium, with a trend for participants' speech competency scores to be slightly lower for samples obtained and transcribed using the digital system. We discuss the implications of these and other findings for research and clinical practise.

Phonological skills of children adopted from China: implications for assessment.

Little is known about the acquisition of English phonology by children adopted from China. Data are summarized from three recent studies with a focus on the phonological skills of children adopted from China as infants or toddlers. Two longitudinal studies (combined n = 8) described early phonological behaviors (e.g., babbling, phonetic inventories), and found substantial individual variation. In spite of this variation by 3 years of age, nearly all of the children were performing at a level comparable to nonadopted monolingual English-speaking peers. No clear relationship between the early behaviors and outcome at age 3 was found. The third study provided descriptions of the phonological skills of preschoolers ( n = 25) who had been adopted 2 or more years earlier, and found that only a few had persistent phonological delays. Errors were predominantly common developmental errors frequently observed in nonadopted monolingual English-speaking children. These findings suggest that tests and measures developed for monolingual English-speaking children may be used cautiously with children adopted as infants or toddlers who have been in their permanent homes for 2 or more years. Prior to that time, assessment should focus on independent analyses of phonological behaviors with consideration of the child's chronological age, length of exposure to English, and development in other language domains.

[Determination of oesophageal speech intelligibility using an articulation assessment]. / Intérêt d'un bilan articulatoire pour l'estimation de l'intelligibilité de la voix oesophagienne.

OBJECTIVE: We studied if articulation could determine esophageal speech's intelligibility. MATERIAL AND METHOD: To do so, we proposed 30 subjects distributed in three groups based on their speech proficiency level, two preliminary assessments: an articulation assessment and an intelligibility assessment. RESULTS: The study shows a significantly high correlation (86%) between the results of the articulation assessment and the intelligibility assessment in the whole of group studied. However, we noted differences in correlations according to the level of the subjects: in the novices' group, the percentage reaches 62%, in the medium group, 76%, and in the proficient one: 97%. CONCLUSION: We concluded that if the results of the articulation assessment is very high, intelligibility will be good. On the other hand, if this percentage is moderate, we can't evaluate intelligibility only with the articulation factor.

Standardized assessment of phonological awareness skills in low-income African American first graders.

Accurate identification of students with poor phonological awareness skills is important to providing appropriate reading instruction. This is particularly true for segments of the population, such as African American students, who have a history of reading failure. The purpose of this study was to examine the performance of a group of African American first-grade students from low-income families on a standardized test of phonological awareness. Fifty-six African American first graders were given the Test of Phonological Awareness (TOPA; J. K. Torgesen and B. R. Bryant, 1994). Mean student performance on the TOPA was significantly below expected norms and negatively skewed. However, students' mean performance on a test of basic reading skills indicated performance within normal limits. Outcomes are discussed relative to the validity and predictive power of standardized phonological assessment instruments, in this case, the TOPA, for use with African American students and the possible influence of dialect on performance.