Development of a holistic communication score (HoCoS) in patients treated for oral or oropharyngeal cancer: Preliminary validation.

BACKGROUND: In head and neck cancer, many tools exist to measure speech impairment, but few evaluate the impact on communication abilities. Some self-administered questionnaires are available to assess general activity limitations including communication. Others are not validated in oncology. These different tools result in scores that does not provide an accurate measure of the communication limitations perceived by the patients. AIM: To develop a holistic score measuring the functional impact of speech disorders on communication in patients treated for oral or oropharyngeal cancer, in two steps: its construction and its validation. METHODS & PROCEDURES: Patients treated for oral/oropharyngeal cancer filled six self-questionnaires: two about communicative dynamics (ECVB and DIP), two assessing speech function (PHI and CHI) and two relating to quality of life (EORTC QLQ-C30 and EORTC QLQ-H&N35). A total of 174 items were initially collected. A dimensionality reduction methodology was then applied. Face validity analysis led to eliminate non-relevant items by surveying a panel of nine experts from communication-related disciplines (linguistics, medicine, speech pathology, computer science). Construct validity analysis led to eliminate redundant and insufficiently variable items. Finally, the holistic communication score was elaborated by principal component factor and validated using cross-validation and latent profile analysis. OUTCOMES & RESULTS: A total of 25 patients filled the questionnaires (median age = 67 years, EIQ = 12; 15 men, 10 women; oral cavity = 14, oropharynx = 10, two locations = 1). After face validity analysis, 44 items were retained (κ > 0.80). Four additional items were excluded because of a very high correlation (r > 0.90) with other items presenting a better dispersion. A total of 40 items were finally included in the factor analysis. A post-analysis score prediction was performed (mean = 100; SD = 10). A total of 24 items are finally retained for the construction of the holistic communication score (HoCoS): 19 items from questionnaires assessing communicative dynamics (13 from the ECVB and six from the DIP), four items from a perceived speech impairment questionnaire (PHI) and one from a quality-of-life questionnaire (EORTC QLQ-H&N35). The reliability is good (five-fold cross-validation: rs = 0.91) and the complementary latent profile analysis shows a good validity of the HoCoS, clustering subjects by level of communication performance. CONCLUSIONS & IMPLICATIONS: A global score allowing a measure of the impact of the speech disorder on communication was developed. It fills the lack of this type of score in head and neck oncology and allows the better understanding of the functional and psychosocial consequences of the pathology in the patients' follow-up. WHAT THIS PAPER ADDS: What is already known on the subject Because of their anatomical location, head and neck cancer degrades the speech abilities. Few tools currently allow the assessment of the impact of the speech disorder on communication abilities. In ENT oncology, self-administered questionnaires are available to assess activity limitations and participation restrictions (International Classification of Functioning (ICF)-WHO). Other tools from the field of neurology allow an evaluation of communication dynamics. But these different tools, constructed by items, give global additive or averaged scores. This implies an identical weighting of each item, resulting in global scores that are not very representative of the communication limitations really perceived by the patients. What this paper adds to existing knowledge A new global holistic score allowing a measurement of the impact of speech impairment on communication after treatment of oral or oropharyngeal cancer has been developed. The methodology of its construction allows a better reflection of the symptomatological, pragmatic and psychosocial elements leading to a degradation of communication abilities. What are the potential or actual clinical implications of this work? The developed HoCoS score fills the gap in the absence of this type of tool in head and neck oncology. It may allow a better understanding of the factors involved in the functional and psychosocial limitations of these patients, and better customize their follow-up.

Functional Improvements of Speech, Feeding, and Sleep After Lingual Frenectomy Tongue-Tie Release: A Prospective Cohort Study.

Recent studies suggest that speech, solid feeding, and sleep difficulties may be linked to restricted tongue function. Children with tongue restrictions and speech, feeding, and sleep issues underwent lingual frenectomies with a CO2 laser, paired with myofunctional exercises. Questionnaires were completed before, 1 week after, and 1 month following treatment. Thirty-seven patients participated in the study (mean age 4.2 years [range 13 months to 12 years]). Overall, speech improved in 89%, solid feeding improved in 83%, and sleep improved in 83% of patients as reported by parents. Fifty percent (8/16) of speech-delayed children said new words after the procedure (P = .008), 76% (16/21) of slow eaters ate more rapidly (P < .001), and 72% (23/32) of restless sleepers slept less restlessly (P < .001). After tongue-tie releases paired with exercises, most children experience functional improvements in speech, feeding, and sleep. Providers should screen for oral restrictions in children and refer for treatment when functions are impaired.

Speech difficulties and patient health communication mediating effects on worry and health-related quality of life in children, adolescents, and young adults with Neurofibromatosis Type 1.

The objective was to investigate the serial mediating effects of speech difficulties, patient health communication, and disease-specific worry in the relationship between neurofibromatosis (NF) symptoms (pain and skin symptoms) and total generic health-related quality of life (HRQOL) in children, adolescents, and young adults with NF Type 1 (NF1) from the patient perspective. The Speech, Communication, Worry, Pain, Skin Itch Bother, and Skin Sensations Scales from the Pediatric Quality of Life Inventory (PedsQL) NF1 Module and the PedsQL 4.0 Generic Core Scales were completed in a multi-site national study by 305 patients ages 5-25 years. A serial multiple mediator model analysis was conducted to test the hypothesized sequential mediating effects of speech difficulties, health communication, and worry as intervening variables in the association between NF1 symptoms and HRQOL. Symptoms predictive effects on total generic HRQOL were serially mediated by speech difficulties, patient health communication, and worry. In predictive analytics models utilizing hierarchical multiple regression analyses with age and gender demographic covariates, the pain, skin itch bother, and skin sensations multiple mediator models accounted for 61%, 59%, and 56% of the variance in generic HRQOL (p < .001), reflecting large effect sizes. Speech difficulties, patient health communication, and disease-specific worry explain in part the mechanism of symptoms predictive effects on total generic HRQOL in pediatric patients with NF1. Identifying NF1-specific predictors and serial mediators of total generic HRQOL in pediatric patients with NF1 from the patient perspective enables a patient-centered comprehensive care approach for children, adolescents, and young adults with NF1.

Hypophonia as a sign of thalamus lesion: a case report.

Hypophonia is a neurological sign usually seen after brainstem or peripheral damage, either at the recurrent laryngeal nerve or vocal cord level. However, it has been described as a sign of supratentorial strokes in a few studies, specifically when anterior and ventral thalamic involvement is reported. In addition, it is a prominent sign of other neurological disorders such as Parkinson disease and other extrapyramidal conditions. We describe a case of hypophonia secondary to a left thalamic hemorrhage, after a careful search of other potential causes of this deficit, and we discuss the underlying neuroanatomical circuits.

The Impact of Expiratory Muscle Strength Training on Speech Breathing in Individuals With Parkinson's Disease: A Preliminary Study.

PURPOSE: The purpose of this study was to examine the impact of expiratory muscle strength training on speech breathing and functional speech outcomes in individuals with Parkinson's disease (PD). METHOD: Twelve individuals with PD were seen once a week for 8 weeks: 4 pretraining (baseline) sessions followed by a 4-week training period. Posttraining data were collected at the end of the 4th week of training. Maximum expiratory pressure, an indicator of expiratory muscle strength, and lung volume at speech initiation were the primary outcome measures. Secondary outcomes included lung volume at speech termination, lung volume excursion, utterance length, and vocal intensity. Data were collected during a spontaneous speech sample. Individual effect sizes > 1 were considered significant. RESULTS: Maximum expiratory pressure increased in a majority of participants after training. Training resulted in 2 main respiratory patterns: increasing or decreasing lung volume initiation. Lung volume termination and excursion, utterance length, and vocal loudness were not consistently altered by training. CONCLUSIONS: Preliminary evidence suggests that the direct physiologic intervention of the respiratory system via expiratory muscle strength training improves speech breathing in individuals with PD, with participants using more typical lung volumes for speech following treatment.

Acquired Apraxia of Speech: The Relationship Between Awareness of Errors in Word Productions and Treatment Outcomes.

PURPOSE: Awareness of errors has been considered a clinical feature of acquired apraxia of speech (AOS). However, there is limited research examining error awareness in speakers with AOS. The purpose of this investigation was to examine awareness of errors and explore the relationship between awareness of errors and treatment outcomes in speakers with AOS. METHOD: Twenty speakers with AOS and aphasia produced mono- and multisyllabic words in a repetition task. Following each production, speakers were asked to judge the accuracy of their production (i.e., correct or incorrect). Then, speakers received Sound Production Treatment. RESULTS: Judgment accuracy of productions for the group ranged from 20% to 96%. There was a weak relationship between judgment accuracy and probe performance at posttreatment (r = .47) and a moderate relationship between judgment accuracy and probe performance at follow-up (r = .53). CONCLUSION: Findings indicate that speakers with AOS varied in their ability to judge the accuracy of their productions. For some speakers, the ability to judge the accuracy of their productions did not coincide with their production accuracy of treatment stimuli at posttreatment and at follow-up. Further research is needed to explore the relationship between error awareness and treatment outcomes.

A qualitative case study in the social capital of co-professional collaborative co-practice for children with speech, language and communication needs.

BACKGROUND: Effective co-practice is essential to deliver services for children with speech, language and communication needs (SLCN). The necessary skills, knowledge and resources are distributed amongst professionals and agencies. Co-practice is complex and a number of barriers, such as 'border disputes' and poor awareness of respective priorities, have been identified. However social-relational aspects of co-practice have not been explored in sufficient depth to make recommendations for improvements in policy and practice. Here we apply social capital theory to data from practitioners: an analytical framework with the potential to move beyond descriptions of socio-cultural phenomena to inform change. AIMS: Co-practice in a local authority site was examined to understand: (1) the range of social capital relations extant in the site's co-practice; (2) how these relations affected the abilities of the network to collaborate; (3) whether previously identified barriers to co-practice remain; (4) the nature of any new complexities that may have emerged; and (5) how inter-professional social capital might be fostered. METHODS & PROCEDURES: A qualitative case study of SLCN provision within one local authority in England and its linked NHS partner was completed through face-to-face semi-structured interviews with professionals working with children with SLCN across the authority. Interviews, exploring barriers and facilitators to interagency working and social capital themes, were transcribed, subjected to thematic analysis using iterative methods and a thematic framework derived. OUTCOMES & RESULTS: We identified a number of characteristics important for the effective development of trust, reciprocity and negotiated co-practice at different levels of social capital networks: macro-service governance and policy; meso-school sites; and micro-intra-practitioner knowledge and skills. Barriers to co-practice differed from those found in earlier studies. Some negative aspects of complexity were evident, but only where networked professionalism and trust was absent between professions. Where practitioners embraced and services and systems enabled more fluid forms of collaboration, then trust and reciprocity developed. CONCLUSIONS & IMPLICATIONS: Highly collaborative forms of co-practice, inherently more complex at the service governance, macro-level, bring benefits. At the meso-level of the school and support team network there was greater capacity to individualize co-practice to the needs of the child. Capacity was increased at the micro-level of knowledge and skills to harness the overall resource distributed amongst members of the inter-professional team. The development of social capital, networks of trust across SLCN support teams, should be a priority at all levels-for practitioners, services, commissioners and schools.

Characteristics and occurrence of speech impairment in Huntington's disease: possible influence of antipsychotic medication.

Although motor speech impairment is a common manifestation of Huntington's disease (HD), its description remains limited. The aim of the current study was therefore to estimate the occurrence and characteristics of speech disorder in HD and to explore the influence of antipsychotic medication on speech performance. Speech samples, including reading passage and monologue, were acquired from 40 individuals diagnosed with HD and 40 age- and sex-matched healthy controls. Objective acoustic analyses were used to evaluate key aspects of speech including vowel articulation, intensity, pitch and timing. A predictive model was constructed to detect the occurrence and most prominent patterns of speech dysfunction in HD. We revealed that 93% of HD patients manifest some degree of speech impairment. Decreased number of pauses, slower articulation rate, imprecise vowel articulation and excess intensity variations were found to be the most salient patterns of speech dysfunction in HD. We further demonstrated that antipsychotic medication may induce excessive loudness and pitch variations perceptually resembling excess patterns of word stress, and may also accentuate general problems with speech timing. Additionally, antipsychotics induced a slight improvement of vowel articulation. Specific speech alterations observed in HD patients indicate that speech production may reflect the pathophysiology of the disease as well as treatment effects, and may therefore be considered a valuable marker of functional disability in HD.

Psychiatric symptom versus neurocognitive correlates of diminished expressivity in schizophrenia and mood disorders.

Diminished expressivity is a poorly understood, but important construct for a range of mental diseases. In the present study, we employed computerized acoustic analysis of natural speech to understand diminished expressivity in patients with schizophrenia and mood disorders. We were interested in the degree to which speech characteristics tapping alogia (i.e., average pause duration) and blunted affect (i.e., prosody computed from fundamental frequency and intensity) reflected psychiatric symptoms (i.e., depression, anxiety, paranoia and bizarre behavior) versus neurocognitive deficits. Twenty-six subjects with schizophrenia and 22 subjects with mood disorders provided speech samples in response to a variety of laboratory stimuli and completed neuropsychological batteries assessing a range of abilities. For both the schizophrenia and mood disorder groups, attentional coding deficits were significantly correlated with increased pause time (at large effect size levels) and, for the schizophrenia group only, reduced prosody (also at a large effect size level). For the mood disorder but not the schizophrenia group, increased average pause time was also significantly associated with neurocognitive deficits on a range of other tests (medium to large effect size levels). Psychiatric symptoms were not significantly associated with speech characteristics for either group (generally, negligible effect sizes). These results suggest that there is a link between expressivity and neurocognitive dysfunctions for both patients with schizophrenia and mood disorders. Implications and future research directions are discussed.

Use of the Patient Concerns Inventory to identify speech and swallowing concerns following treatment for oral and oropharyngeal cancer.

BACKGROUND AND AIMS: The Patient Concerns Inventory is a holistic, self-reported screening tool for detecting unmet needs in head and neck cancer patients. This study aimed to assess its value in screening for self-perceived swallowing and speech concerns, and in facilitating multidisciplinary supportive care. METHODS: The Patient Concerns Inventory and the University of Washington Quality of Life questionnaire were completed by 204 post-treatment patients attending routine out-patient review clinics, and those with speech or swallowing issues were identified. RESULTS: Swallowing and speech issues were respectively reported by 21 and 7 per cent of University of Washington questionnaire respondents and by 17 and 13 per cent of Patient Concerns Inventory respondents. The two surveys combined indicated that speech or swallowing issues arose in 39 per cent of consultations (n = 178), involving 48 per cent of patients (n = 97). Of these 97 patients, 74 were known to the speech and language therapist. The remaining 23 patients had their concerns discussed in the clinic; three were referred on, and were assessed by the speech and language therapist and given appropriate interventions. CONCLUSION: The use of both surveys concurrently enabled all patients with swallowing or speech issues to discuss these concerns in the clinic and to access appropriate multidisciplinary interventions.

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.

A one-page orofacial myofunctional assessment form: a proposal.

The author presents her own proposal of a one-page orofacial myofunctional assessment and for each item on the list a brief rationale is provided. The protocol is an easy but comprehensive form that can be faxed or emailed to referral sources as needed. As science provides more objective assessment and evaluation tools, this one-page form can be easily modified.

Sample of a client intake information protocol: a synopsis and rationale.

The utilization of standardized comprehensive forms in the field of orofacial myology is crucial as this profession continues to grow and establish assessment and treatment protocols. This article formally presents a comprehensive health history intake form currently in use, and highlights the rationale for each particular question within this form in an effort to explore the evidence-based theory behind each question utilized. Highlighting the importance of obtaining a thorough health history as it pertains to our profession, personally allows the clinician to ultimately best plan a therapeutic strategy and assess the individual criteria necessary for successful orofacial myofunctional habituation.

[Micro-current reflexotherapy in the rehabilitative treatment of the speech function disorders in children with cerebral palsy].

The objective of the present paper was to study the influence of microcurrent reflexotherapy on the compromised speech functions in children (n = 84) presenting with cerebral palsy in comparison with the control group comprised of children (n = 56) with the same problems treated by medicamental therapy. The microcurrent reflexotherapy was shown to be instrumental in the restoration of the compromised speech function. Moreover, it promoted positive dynamics of locomotor and cognitive disorders.

Phonological recoding, visual short-term store and the effect of unattended speech: evidence from a case of slowly progressive anarthria.

Phonological processing and short-term memory were investigated in a patient with slowly progressive anarthria. The patient, who had an auditory-verbal span in the lower unimpaired range, showed preserved phonological similarity and word length effects with auditory presentation. These phonological effects of immediate retention were absent with visual input. The patient was also unable to perform phonological judgments on written verbal material. Under unattended speech interference her visual span improved, with an increase of visual confusion errors. In the light of a model including a main auditory-verbal storage component (the phonological short-term input store, STS), and a rehearsal process, that, after phonological recoding, conveys visually presented verbal material to the phonological STS, the patient's pattern of impairment is interpreted as a selective deficit in the process of phonological recoding. This prevents visual-verbal material from accessing the phonological STS, that is, therefore, insulated from visual inputs.

[Conception and realisation of a prosody test battery]. / Konzeption und Realisierung einer Prosodie-Testbatterie.

BACKGROUND: Prosody reflects rhythmic and melodic aspects in speech and is one of the quality measures that shows--apart from pure speech understanding--a rising interest in the assessment of technical hearing aids, especially of cochlear implants. At present, there is no adequate test battery for the German speaking population. The test battery presented in this study aims to fill this gap. METHODS: The test battery consists of four different modules addressing different prosodic cues, namely duration, question vs statement, sentence stress, and speaker gender. One part of the test battery aims at reflecting everyday situations and was realized with six different speakers representing various pitch frequencies and speak rates. Another goal of the tests is to detect very small differences in prosody perception. Therefore, natural utterances were artificially modified by changing the underlying acoustic parameters (e.g. duration, fundamental frequency). Measurements were performed with 12 normal listeners in order to investigate the properties of the tests. RESULTS: As expected, the normal listeners revealed discrimination rates of close to 100% in that part of the test battery using natural utterances. For the part with the modified stimuli, all four modules revealed very steep discrimination functions indicating that the normal listeners were able to use very small changes in the acoustic parameters as cues for prosody perception. Moreover, the slope of the discrimination function revealed very low variability. CONCLUSIONS: Together with preliminary data from cochlear implant recipients who clearly showed different psychometric functions, the test battery seems suitable for a comprehensive evaluation of prosody perception. This facilitates future examinations of speech processing beyond the pure understanding of speech.

Application of the ICF and ICF-children and youth in children with speech impairment.

Children with speech impairment form a significant part of many speech language pathology caseloads. Traditionally, assessment and intervention with these children has focused on the level of the impairment. However, the World Health Organization's International Classification of Functioning, Disability and Health (ICF) and ICF- version for Children and Youth provide a framework by which such children can be managed in an holistic manner, with due consideration given to the body structures and functions affected by their impairment, as well as the impact on children's activities and participation. The ICF acknowledges the individuality of each child with a speech impairment, through consideration of barriers and facilitators stemming from environmental and personal factors. In this article, assessment and intervention for speech impairment is described using each component of the ICF. A case study illustrating the use of the ICF with a child who has a speech impairment is provided.

Apraxia of speech: an overview.

Apraxia of speech (AOS) is a motor speech disorder that can occur in the absence of aphasia or dysarthria. AOS has been the subject of some controversy since the disorder was first named and described by Darley and his Mayo Clinic colleagues in the 1960s. A recent revival of interest in AOS is due in part to the fact that it is often the first symptom of neurodegenerative diseases, such as primary progressive aphasia and corticobasal degeneration. This article will provide a brief review of terminology associated with AOS, its clinical hallmarks and neuroanatomical correlates. Current models of motor programming will also be addressed as they relate to AOS and finally, typical treatment strategies used in rehabilitating the articulation and prosody deficits associated with AOS will be summarized.