Assessing children's speech intelligibility and oral structures, and functions via an Internet-based telehealth system.

We examined the validity and reliability of an Internet-based telehealth system for screening speech intelligibility and oro-motor structure, and function in children with speech disorders. Twenty children aged 4-9 years were assessed by a clinician in the conventional, face-to-face (FTF) manner; simultaneously, they were assessed by a second clinician via the videoconferencing system using a 128-kbit/s Internet connection. Speech intelligibility in conversation was rated and an informal assessment of oro-motor structure and function was conducted. There was a high level of agreement between the online and FTF speech intelligibility ratings, with 70% exact agreement and 100% close agreement (within ± point on a 5-point scale). The weighted kappa statistic revealed very good agreement between raters (kappa = 0.86). Data for online and FTF ratings of oro-motor function revealed overall exact agreement of 73%, close agreement of 96%, moderate or good strength of agreement for six variables (kappa = 0.48-0.74), and poor to fair agreement for six variables (kappa = 0.12-0.36). Intra- and inter-rater reliability measures (ICCs) were similar between the online and FTF assessments. Low levels of agreement for some oro-motor variables highlighted the subjectivity of this assessment. However, the overall results support the validity and reliability of Internet-based screening of speech intelligibility and oro-motor function in children with speech disorders.

Differentiating profiles of speech impairments in Friedreich's ataxia: a perceptual and instrumental approach.

BACKGROUND: The speech disorder associated with Friedreich's ataxia (FRDA) is classically described as ataxic dysarthria. However, variable neuropathology beyond the cerebellum, which may include the corticospinal and corticobulbar tracts, means that the dysarthria can be mixed rather than a pure ataxic dysarthria. AIMS: To characterize physiological features of the dysarthria associated with FRDA and identify differential patterns of deviation that may occur across the subsystems of the speech-production mechanism in a series of seven case studies. METHODS & PROCEDURES: The assessment battery included a perceptual analysis of a speech sample using an interval rating scale, and a range of instrumental measures to investigate the respiratory, laryngeal, velopharyngeal and articulatory systems. OUTCOMES & RESULTS: The results demonstrated the variability that exists in the dysarthria associated with FRDA, highlighting the existence of differential profiles of speech impairment. A particular distinction was observed between the presence of hypernasality and phonatory dysfunction, as evidenced by the instrumental results. CONCLUSIONS & IMPLICATIONS: The distinct profiles of dysarthria associated with FRDA indicate that approaches that address multiple subsystems are necessary for the accurate characterization and quantification of the motor speech disorder. Further research is required to investigate the decline in speech function as the disease progresses, as changes in speech function over time may be a good indicator of neurological decline in FRDA.

Articulatory kinematics in the dysarthria associated with Friedreich's ataxia.

Electromagnetic articulography (EMA) was used to investigate the tongue kinematics in the dysarthria associated with Friedreich's ataxia (FRDA). The subject group consisted of four individuals diagnosed with FRDA. Five nonneurologically impaired individuals, matched for age and gender, served as controls. Each participant was assessed using the AG-200 EMA system during six repetitions of the tongue tip sentence Tess told Dan to stay fit and the tongue back sentence Karl got a croaking frog. Results revealed reduced speed measures (i.e., maximum acceleration / deceleration / velocity), greater movement durations and increased articulatory distances for the approach phases of consonant productions. The approach phase, involving movement up to the palate, was more affected than the release phase. It is suggested that deviant lingual kinematics could be the outcome of disturbances to cerebellar function, or possibly in combination with disturbances to upper motor neuron systems.

Measures of spectral change and their application to habitual, slow, and clear speaking modes.

Spectral measures are sensitive to dysarthric speech. However, it is unclear whether the spectral differences in dysarthric and healthy speech are due to slow articulation rate or reflect other qualitative changes in speech. Spectral measures were used to detect differences between habitual, slow, and "clear" speaking modes in 12 healthy speakers. Matched t-tests were used to determine differences in the rate and degree of spectral change between the speaking modes. Pearson's correlation coefficients were calculated to assess how well rate of spectral change predicts articulation rate (syllables per second). Clear speech had a significantly higher degree of spectral change than habitual speech, and slow speech had a significantly slower rate of spectral change than habitual and clear speaking modes. These differences occurred in all 12 speakers. The rate of spectral change was correlated with articulation rate across all speakers (range of r = .8-.9 within individual speaking modes) and therefore is a gross predictor of articulation rate. These results suggest that measures of the degree and rate of spectral change together can be used to detect changes between clear, slow, and habitual speaking modes, and hold potential as performance measures.

Kinematic analysis of lingual movements during consonant productions in dysarthric speakers with Friedreich's ataxia: A case-by-case analysis.

Articulatory kinematics were investigated using electromagnetic articulography (EMA) in four dysarthric speakers with Friedreich's ataxia (FRDA). Specifically, tongue-tip and tongue-back movements were recorded by the AG-200 EMA system during production of the consonants /t/ and /k/ as produced within a sentence utterance and during a rapid syllable repetition task. The results obtained for each of the participants with FRDA were individually compared to those obtained by a control group (n = 10). Results revealed significantly greater movement durations and increased articulatory distances, most predominantly during the approach phase of consonant production. A task difference was observed with lingual kinematics more disturbed during the syllable repetition task than during the sentence utterance. Despite expectations of slowed articulatory movements in FRDA dysarthria, the EMA data indicated that the observed prolongation of consonant phase durations was generally associated with greater articulatory distances, rather than slowed movement execution.

Spectral measures of the effects of Friedreich's ataxia on speech.

This study identifies two measures of the effects of Friedreich's ataxia (FRDA) on speech motor control. Speech samples of 17 healthy controls and 37 speakers with dysarthria associated with FRDA were recorded during one structured and one unstructured speaking task. Two measures of spectral variation were used that relate to the rate and range of changes that occur in the spectral envelope. Linear mixed models revealed significant effects of GROUP, TASK, and GROUP*TASK. FRDA speech samples had slower rate of spectral change and reduced spectral range. Healthy speakers produced faster rates of spectral change in read text compared to conversation, but speakers with dysarthria did not. The results suggest that structured speaking tasks which demand large spectral variation may be particularly useful in assessing the dysarthria. It is concluded that the rate of spectral change is a useful measure of dysarthria associated with FRDA.

Differentiating impairment levels in temporal versus spatial aspects of linguopalatal contacts in Friedreich's ataxia.

Electropalatography (EPG) was used to describe the pattern of linguopalatal contact and the consonant phase durations exhibited by a group of seven individuals with dysarthria associated with Friedreich's ataxia (FRDA). A group of 14 non-neurologically impaired individuals served as controls. The Reading Electropalatograph (EPG3) system was used to record linguopalatal contact during production of the target consonants (/t/, /l/, /s/, /k/) elicited in five words of CV and CVC construction, with the target consonants in word initial position. These words were embedded into short sentences and repeated five times by each participant. The FRDA group exhibited significantly increased consonant durations compared with the controls while maintaining normal linguopalatal contact patterns. These findings suggest that the articulatory impairment in FRDA manifests as a temporal rather than spatial disturbance.

Assessment of children's literacy via an Internet-based telehealth system.

OBJECTIVE: Interactive telehealth applications have potential for the assessment of reading disability in school-aged children. However, there is currently a lack of research on the validity of such applications. The aim of this study was to investigate the validity and reliability of an Internet-based videoconferencing system for the assessment of children's literacy on a battery of standardized assessments. MATERIALS AND METHODS: Twenty children aged 8-13 years were simultaneously assessed in real-time both face-to-face and over a 128-Kbps Internet link. The assessments included eight subtests of the Queensland University Inventory of Literacy (QUIL), the South Australian Spelling Test, and the Neale Analysis of Reading Ability, 3rd edition (Neale-3). RESULTS: The limits of agreement for the majority of raw scores fell within predetermined clinical criteria, with the exception of the QUIL nonword reading and nonword spelling measures and the rate score of the Neale-3. Weighted kappa analyses on the tests' scaled scores indicated very good agreement for all parameters (kappa 0.92-1.00). Percentage levels of agreement were adequate (above 80%) for most measures except for the nonword reading raw score of the QUIL and the reading error classification component of the Neale-3. Very good intra- and interrater reliability was determined for all online parameters (intraclass correlation coefficient 0.98-1.00). CONCLUSIONS: As issues with audio latency, break-up, and echo were observed, some modifications to the technology may improve system effectiveness and usability. However, the overall positive results of this study support the validity and reliability of the assessment of children's literacy skills via telehealth.

Internet-based telehealth assessment of language using the CELF-4.

PURPOSE: Telehealth has the potential to improve children's access to speech-language pathology services. Validation of telehealth applications, including the assessment of childhood language disorders, is necessary for telehealth to become an accepted alternative mode of service provision. The aim of this study was to validate an Internet-based telehealth system for assessing childhood language disorders. METHOD: Twenty-five children ages 5 to 9 years were assessed using the core language subtests of the Clinical Evaluation of Language Fundamentals--4th Edition (CELF-4; Semel, Wiig, & Secord, 2003). Each participant was simultaneously assessed online and face-to-face (FTF). Assessments were administered by either an online or an FTF speech-language pathologist (SLP), but were simultaneously rated by both SLPs. RESULTS: No significant difference was found between the online and FTF total raw scores and scaled scores for each subtest. Weighted kappas revealed very good agreement on the individual items, total raw scores, scaled scores, core language score, and severity level. Intra- and interrater reliability were determined for a sample of online ratings, with intraclass correlation analysis revealing very good agreement on all measures. CONCLUSION: The results of this study support the validity and reliability of scoring the core language subtests of the CELF-4 via telehealth.

An Internet-based telerehabilitation system for the assessment of motor speech disorders: a pilot study.

PURPOSE: This pilot study explored the feasibility and effectiveness of an Internet-based telerehabilitation application for the assessment of motor speech disorders in adults with acquired neurological impairment. METHOD: Using a counterbalanced, repeated measures research design, 2 speech-language pathologists assessed 19 speakers with dysarthria on a battery of perceptual assessments. The assessments included a 19-item version of the Frenchay Dysarthria Assessment (FDA; P. Enderby, 1983), the Assessment of Intelligibility of Dysarthric Speech (K. M. Yorkston & D. R. Beukelman, 1981), perceptual analysis of a speech sample, and an overall rating of severity of the dysarthria. One assessment was conducted in the traditional face-to-face manner, whereas the other assessment was conducted using an online, custom-built telerehabilitation application. This application enabled real-time videoconferencing at 128 kb/s and the transfer of store-and-forward audio and video data between the speaker and speech-language pathologist sites. The assessment methods were compared using the J. M. Bland and D. G. Altman (1986, 1999) limits-of-agreement method and percentage level of agreement between the 2 methods. RESULTS: Measurements of severity of dysarthria, percentage intelligibility in sentences, and most perceptual ratings made in the telerehabilitation environment were found to fall within the clinically acceptable criteria. However, several ratings on the FDA were not comparable between the environments, and explanations for these results were explored. CONCLUSIONS: The online assessment of motor speech disorders using an Internet-based telerehabilitation system is feasible. This study suggests that with additional refinement of the technology and assessment protocols, reliable assessment of motor speech disorders over the Internet is possible. Future research methods are outlined.

Articulatory function following traumatic brain injury in childhood: a perceptual and instrumental analysis.

PRIMARY OBJECTIVE: To investigate the articulatory function of a group of children with traumatic brain injury (TBI), using both perceptual and instrumental techniques. RESEARCH DESIGN: The performance of 24 children with TBI was assessed on a battery of perceptual (Frenchay Dysarthria Assessment, Assessment of Intelligibility of Dysarthric Speech and speech sample analysis) and instrumental (lip and tongue pressure transduction systems) assessments and compared with that of 24 non-neurologically impaired children matched for age and sex. MAIN OUTCOMES: Perceptual assessment identified consonant and vowel imprecision, increased length of phonemes and over-all reduction in speech intelligibility, while instrumental assessment revealed significant impairment in lip and tongue function in the TBI group, with rate and pressure in repetitive lip and tongue tasks particularly impaired. Significant negative correlations were identified between the degree of deviance of perceptual articulatory features and decreased function on many non-speech measures of lip function, as well as maximum tongue pressure and fine force tongue control at 20% of maximum tongue pressure. Additionally, sub-clinical articulatory deficits were identified in the children with TBI who were non-dysarthric. CONCLUSION: The results of the instrumental assessment of lip and tongue function support the finding of substantial articulatory dysfunction in this group of children following TBI. Hence, remediation of articulatory function should be a therapeutic priority in these children.

An evaluation of continuous positive airway pressure (CPAP) therapy in the treatment of hypernasality following traumatic brain injury: a report of 3 cases.

OBJECTIVE: To evaluate the effectiveness of continuous positive airway pressure (CPAP) therapy in the treatment of hypernasality following traumatic brain injury (TBI). DESIGN: An A-B-A experimental research design. Assessments were conducted prior to commencement of the program, midway, immediately posttreatment, and 1 month after completion of the CPAP therapy program. PARTICIPANTS: Three adults with dysarthria and moderate to severe hypernasality subsequent to TBI. OUTCOME MEASURES: Perceptual evaluation using the Frenchay Dysarthria Assessment, the Assessment of Intelligibility of Dysarthric Speech, and a speech sample analysis, and instrumental evaluation using the Nasometer. RESULTS: Between assessment periods, varying degrees of improvement in hypernasality and sentence intelligibility were noted. At the 1-month post-CPAP assessment, all 3 participants demonstrated reduced nasalance values, and 2 exhibited increased sentence intelligibility. CONCLUSIONS: CPAP may be a valuable treatment of impaired velopharyngeal function in the TBI population.

Perceptual and instrumental evaluation of voice and tongue function after carotid endarterectomy.

OBJECTIVE: Laryngeal and tongue function was assessed in 28 patients to evaluate the presence, nature, and resolution of superior recurrent laryngeal and hypoglossal nerve damage resulting from standard open primary carotid endarterectomy (CEA). METHODS: The laryngeal and tongue function in 28 patients who underwent CEA were examined prospectively with various physiologic (Aerophone II, laryngograph, tongue transducer), acoustic (Multi-Dimensional Voice Program), and perceptual speech assessments. Measures were obtained from all participants preoperatively, and at 2 weeks and at 3 months postoperatively. RESULTS: The perceptual speech assessment indicated that the vocal quality of "roughness" was significantly more apparent at the 2-week postoperative assessment than preoperatively. However, by the 3-month postoperative assessment these values had returned to near preoperative levels, with no significant difference detected between preoperative and 3-month postoperative levels or between 2-week and 3-month postoperative levels. Both the instrumental assessments of laryngeal function and the acoustic assessment of vocal quality failed to identify any significant difference on any measure across the three assessment periods. Similarly, no significant impairment in tongue strength, endurance, or rate of repetitive tongue movements was detected at instrumental assessment of tongue function. CONCLUSIONS: No permanent changes to vocal or tongue function occurred in this group of participants after primary CEA. The lack of any significant long-term laryngeal or tongue dysfunction in this group suggests that the standard open CEA procedure is not associated with high rates of superior recurrent and hypoglossal nerve dysfunction, as previously believed.

Perceptual and instrumental analysis of laryngeal function after traumatic brain injury in childhood.

OBJECTIVE: To investigate laryngeal function and phonatory disturbance in children with traumatic brain injury (TBI), using both perceptual and instrumental techniques. DESIGN AND PARTICIPANTS: The performance of 16 individuals with moderate to severe TBI acquired in childhood and 16 nonneurologically impaired control subjects was compared on a battery of perceptual (Frenchay Dysarthria Assessment, speech sample analysis) and instrumental (Aerophone II, laryngograph) assessments. RESULTS AND CONCLUSIONS: As a group, the children with TBI demonstrated normal, or only minimally impaired laryngeal function, when compared with the control group, which contrasts with the significant laryngeal impairment noted in adults after TBI. Several reasons for the different findings in relation to laryngeal function in adults and children after TBI are postulated: (1) differing types of injury usually incurred by adults and children may result in a relatively decreased degree of neurologic impairment in these children, (2) differences in recovery potential between adults and children, and (3) the pediatric larynx is still developing, hence it may be better able to compensate for any impairment incurred.

Perceptual analysis of speech following traumatic brain injury in childhood.

PRIMARY OBJECTIVE: To investigate perceptually the speech dimensions, oromotor function, and speech intelligibility of a group of individuals with traumatic brain injury (TBI) acquired in childhood. RESEARCH DESIGN: The speech of 24 children with TBI was analysed perceptually and compared with that of a group of non-neurologically impaired children matched for age and sex. MAIN OUTCOME AND RESULTS: The 16 dysarthric TBI subjects were significantly less intelligible than the control subjects, and demonstrated significant impairment in 12 of the 33 speech dimensions rated. In addition, the eight non-dysarthric TBI subjects were significantly impaired in many areas of oromotor function on the Frenchay Dysarthria Assessment, indicating some degree of pre-clinical speech impairment. CONCLUSION: The results of the perceptual analysis are discussed in terms of the possible underlying pathophysiological bases of the deviant speech features identified, and the need for a comprehensive instrumental assessment, to more accurately determine the level of breakdown in the speech production mechanism in children following TBI.