Effects of Speech Cues on Acoustics and Intelligibility of Korean-Speaking Children With Cerebral Palsy.

PURPOSE: Reduced speech intelligibility is often a hallmark of children with dysarthria secondary to cerebral palsy (CP), but effects of speech strategies for increasing intelligibility are understudied, especially in children who speak languages other than English. This study examined the effects of (the Korean translation of) two cues, "speak with your big mouth" and "speak with your strong voice," on speech acoustics and intelligibility of Korean-speaking children with CP. METHOD: Fifteen Korean-speaking children with CP repeated words and sentences in habitual, big mouth, and strong voice conditions. Acoustic analyses were performed and intelligibility was assessed by means of 90 blinded listeners' ease-of-understanding (EoU) ratings and percentage of words correctly transcribed (PWC). RESULTS: In response to both cues, children's vocal intensity and utterance duration increased significantly and differentially, whereas their vowel space area gains did not reach statistical significance. EoU increased significantly in the big mouth condition at word, but not sentence, level, whereas in the strong voice condition, EoU increased significantly at both levels. PWC increases were not statistically significant. Considerable variability in children's responses to cues was noted overall. CONCLUSIONS: Korean-speaking children with CP modify their speech styles differentially when provided with cues aimed to increase their articulatory working space and vocal intensity. The results provide preliminary support for the use of the strong voice cue, in particular, to increase EoU. While the findings do not offer conclusive evidence of the intelligibility benefits of these cues, investigation with a larger sample size should provide further insight into optimal cueing strategies for increasing intelligibility in this population. Implications for language-specific versus language-independent treatment approaches are discussed. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.25521052.

Impact of an International Training on Interventionists' Expertise in Cleft Palate Speech: Results From Oaxaca, Mexico.

PURPOSE: International cleft lip and palate surgical charities recognize that speech therapy is essential for successful care of individuals after palate repair. The challenge is how to ensure that cleft speech interventionists (i.e., speech-language pathologists and other speech therapy providers) provide quality care. This exploratory study investigated effects of a two-stage cleft training in Oaxaca, Mexico, aimed at preparing speech interventionists to provide research-based services to individuals born with cleft palate. Changes in the interventionists' content knowledge and clinical skills were examined. METHOD: Twenty-three cleft speech interventionists from Mexico, Guatemala, and Nicaragua participated in a hybrid two-stage training, completing an online Spanish cleft speech course and a 5-day in-person training in Oaxaca. In-person training included a didactic component and supervised clinical practice with 14 individuals with repaired cleft palates. Testing of interventionists' content knowledge and clinical skills via questionnaires occurred before the online course (Test 1), immediately before in-person training (Test 2), and immediately after in-person training (Test 3). Qualitative data on experience/practice were also collected. RESULTS: Significant increases in interventionists' overall content knowledge and clinical skills were found posttraining. Knowledge and clinical skills increased significantly between Tests 1 and 2. Clinical skills, but not knowledge, showed further significant increases between Tests 2 and 3. Posttraining, interventionists demonstrated greater expertise in research-based treatment, and fewer reported they would use nonspeech oral motor exercises (NSOME). CONCLUSIONS: Findings provide preliminary support for such two-stage international trainings in preparing local speech interventionists to deliver high-quality speech services to individuals born with cleft palate. While content knowledge appears to be acquired primarily from the online course, the two-stage training incorporating in-person supervised practice working with individuals born with cleft palate may best enhance continued clinical skill development, including replacement of NSOME with evidence-based speech treatment. Such trainings contribute to building capacity for sustainable quality services for this population in underresourced regions.

Revisiting Dysarthria Treatment Across Languages: The Hybrid Approach.

PURPOSE: Ten years after Miller and Lowit's (2014) groundbreaking book providing a cross-linguistic perspective on motor speech disorders, we ask where we are regarding dysarthria treatment across languages in two specific populations: adults with Parkinson's disease (PD) and children with cerebral palsy (CP). METHOD: In this commentary, we consider preliminary evidence for both language-independent and language-specific approaches to treatment and propose a hybrid approach to speech treatment across languages, centered on the individual with dysarthria who speaks any given language. CONCLUSIONS: Treatment research on individuals with dysarthria secondary to PD and CP is advancing, but several areas remain to be explored. Next steps are suggested for addressing the paucity and complexity of cross-linguistic speech treatment research.

Acoustic Predictors of Ease of Understanding in Spanish Speakers With Dysarthria Associated With Parkinson's Disease.

PURPOSE: The purpose of this study was to examine selected baseline acoustic features of hypokinetic dysarthria in Spanish speakers with Parkinson's disease (PD) and identify potential acoustic predictors of ease of understanding in Spanish. METHOD: Seventeen Spanish-speaking individuals with mild-to-moderate hypokinetic dysarthria secondary to PD and eight healthy controls were recorded reading a translation of the Rainbow Passage. Acoustic measures of vowel space area, as indicated by the formant centralization ratio (FCR), envelope modulation spectra (EMS), and articulation rate were derived from the speech samples. Additionally, 15 healthy adults rated ease of understanding of the recordings on a visual analogue scale. A multiple linear regression model was implemented to investigate the predictive value of the selected acoustic parameters on ease of understanding. RESULTS: Listeners' ease of understanding was significantly lower for speakers with dysarthria than for healthy controls. The FCR, EMS from the first 10 s of the reading passage, and the difference in EMS between the end and the beginning sections of the passage differed significantly between the two groups of speakers. Findings indicated that 67.7% of the variability in ease of understanding was explained by the predictive model, suggesting a moderately strong relationship between the acoustic and perceptual domains. CONCLUSIONS: Measures of envelope modulation spectra were found to be highly significant model predictors of ease of understanding of Spanish-speaking individuals with hypokinetic dysarthria associated with PD. Articulation rate was also found to be important (albeit to a lesser degree) in the predictive model. The formant centralization ratio should be further examined with a larger sample size and more severe dysarthria to determine its efficacy in predicting ease of understanding.

Speech treatment for Hebrew-speaking adolescents and young adults with developmental dysarthria: A comparison of mSIT and Beatalk.

BACKGROUND: Individuals with developmental dysarthria typically demonstrate reduced functioning of one or more of the speech subsystems, which negatively impacts speech intelligibility and communication within social contexts. A few treatment approaches are available for improving speech production and intelligibility among individuals with developmental dysarthria. However, these approaches have only limited application and research findings among adolescents and young adults. AIMS: To determine and compare the effectiveness of two treatment approaches, the modified Speech Intelligibility Treatment (mSIT) and the Beatalk technique, on speech production and intelligibility among Hebrew-speaking adolescents and young adults with developmental dysarthria. METHODS & PROCEDURES: Two matched groups of adolescents and young adults with developmental dysarthria participated in the study. Each received one of the two treatments, mSIT or Beatalk, over the course of 9 weeks. Measures of speech intelligibility, articulatory accuracy, voice and vowel acoustics were assessed both pre- and post-treatment. OUTCOMES & RESULTS: Both the mSIT and Beatalk groups demonstrated gains in at least some of the outcome measures. Participants in the mSIT group exhibited improvement in speech intelligibility and voice measures, while participants in the Beatalk group demonstrated increased articulatory accuracy and gains in voice measures from pre- to post-treatment. Significant increases were noted post-treatment for first formant values for select vowels. CONCLUSIONS & IMPLICATIONS: Results of this preliminary study are promising for both treatment approaches. The differentiated results indicate their distinct application to speech intelligibility deficits. The current findings also hold clinical significance for treatment among adolescents and young adults with motor speech disorders and application for a language other than English. WHAT THIS PAPER ADDS: What is already known on the subject Developmental dysarthria (e.g., secondary to cerebral palsy) is a motor speech disorder that negatively impacts speech intelligibility, and thus communication participation. Select treatment approaches are available with the aim of improving speech intelligibility in individuals with developmental dysarthria; however, these approaches are limited in number and have only seldomly been applied specifically to adolescents and young adults. What this paper adds to existing knowledge The current study presents preliminary data regarding two treatment approaches, the mSIT and Beatalk technique, administered to Hebrew-speaking adolescents and young adults with developmental dysarthria in a group setting. Results demonstrate the initial effectiveness of the treatment approaches, with different gains noted for each approach across speech and voice domains. What are the potential or actual clinical implications of this work? The findings add to the existing literature on potential treatment approaches aiming to improve speech production and intelligibility among individuals with developmental dysarthria. The presented approaches also show promise for group-based treatments as well as the potential for improvement among adolescents and young adults with motor speech disorders.

The Effects of Intensive Voice Treatment in Mandarin Speakers With Parkinson's Disease: Acoustic and Perceptual Findings.

PURPOSE: This study investigated the effects of intensive voice treatment on subjective and objective measures of speech production in Mandarin speakers with hypokinetic dysarthria. METHOD: Nine Mandarin speakers with hypokinetic dysarthria due to Parkinson's disease received 4 weeks of intensive voice treatment (4 × 60 min per week). The speakers were recorded reading a passage before treatment (PRE), immediately after treatment (POST), and at 6-month follow-up (FU). Listeners (n = 15) rated relative ease of understanding (EOU) of paired speech samples on a visual analogue scale. Acoustic analyses were performed. Changes in EOU, vocal intensity, global and local fundamental frequency (f o) variation, speech rate, and acoustic vowel space area (VSA) were examined. RESULTS: Increases were found in EOU and vocal intensity from PRE to POST and from PRE to FU, with no change found from POST to FU. Speech rate increased from PRE to POST, with limited evidence of an increase from PRE to FU and no change from POST to FU. No changes in global or local f o variation or in VSA were found. CONCLUSIONS: Intensive voice treatment shows promise for improving speech production in Mandarin speakers with hypokinetic dysarthria. Vocal intensity, speech rate, and, crucially, intelligibility, may improve for up to 6 months posttreatment. In contrast, f o variation and VSA may not increase following the treatment. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.19529017.

Differences in perceptual assimilation following training.

Learning to perceive non-native speech sounds is difficult for adults. One method to improve perception of non-native contrasts is through a distributional learning paradigm. Three groups of native-English listeners completed a perceptual assimilation task in which they mapped French vowels onto English vowel categories: Two groups (bimodal, unimodal distribution) completed a perceptual learning task for the French /œ/-/o/ contrast and a third completed no training. Both trained groups differed from the untrained group, but participants in the bimodal group showed a different perceptual mapping for the targeted /œ/ vowel, suggesting that the bimodal condition may maximize perception of non-native contrasts.

Speech Treatment Effects on Narrative Intelligibility in French-Speaking Children With Dysarthria.

Purpose This study examined the effects of Speech Intelligibility Treatment (SIT) on intelligibility and naturalness of narrative speech produced by francophone children with dysarthria due to cerebral palsy. Method Ten francophone children with dysarthria were randomized to one of two treatments, SIT or Hand-Arm Bimanual Intensive Therapy Including Lower Extremities, a physical therapy (PT) treatment. Both treatments were conducted in a camp setting and were comparable in dosage. The children were recorded pre- and posttreatment producing a story narrative. Intelligibility was measured by means of 60 blinded listeners' orthographic transcription accuracy (percentage of words transcribed correctly). The listeners also rated the children's naturalness on a visual analogue scale. Results A significant pre- to posttreatment increase in intelligibility was found for the SIT group, but not for the PT group, with great individual variability observed among the children. No significant changes were found for naturalness ratings or sound pressure level in the SIT group or the PT group posttreatment. Articulation rate increased in both treatment groups, although not differentially across treatments. Conclusions Findings from this first treatment study on intelligibility in francophone children with dysarthria suggest that SIT shows promise for increasing narrative intelligibility in this population. Acoustic contributors to the increased intelligibility remain to be explored further. Supplemental Material https://doi.org/10.23641/asha.14161943.

Perceptual and Acoustic Effects of Dual-Focus Speech Treatment in Children With Dysarthria.

Purpose Children with dysarthria secondary to cerebral palsy may experience reduced speech intelligibility and diminished communicative participation. However, minimal research has been conducted examining the outcomes of behavioral speech treatments in this population. This study examined the effect of Speech Intelligibility Treatment (SIT), a dual-focus speech treatment targeting increased articulatory excursion and vocal intensity, on intelligibility of narrative speech, speech acoustics, and communicative participation in children with dysarthria. Method American English-speaking children with dysarthria (n = 17) received SIT in a 3-week summer camplike setting at Columbia University. SIT follows motor-learning principles to train the child-friendly, dual-focus strategy, "Speak with your big mouth and strong voice." Children produced a story narrative at baseline, immediate posttreatment (POST), and at 6-week follow-up (FUP). Outcomes were examined via blinded listener ratings of ease of understanding (n = 108 adult listeners), acoustic analyses, and questionnaires focused on communicative participation. Results SIT resulted in significant increases in ease of understanding at POST, that were maintained at FUP. There were no significant changes to vocal intensity, speech rate, or vowel spectral characteristics, with the exception of an increase in second formant difference between vowels following SIT. Significantly enhanced communicative participation was evident at POST and FUP. Considerable variability in response to SIT was observed between children. Conclusions Dual-focus treatment shows promise for improving intelligibility and communicative participation in children with dysarthria, although responses to treatment vary considerably across children. Possible mechanisms underlying the intelligibility gains, enhanced communicative participation, and variability in treatment effects are discussed.

The effects of intensive speech treatment on intelligibility in Parkinson's disease: A randomised controlled trial.

BACKGROUND: More than 6,000,000 individuals worldwide are diagnosed with Parkinson's disease (PD). Nearly 90% develop speech signs that may substantially impair their speech intelligibility, resulting in losses in their communication and quality of life. Benefits of intensive speech treatment have been documented for a range of speech signs. However, the critical question of whether speech is more intelligible after treatment has not been investigated in a randomised controlled trial (RCT). We hypothesised that intensive speech treatment would improve speech intelligibility in PD. METHOD: Sixty-four patients with hypokinetic dysarthria secondary to PD participated in this single-centre, parallel arm, statistically-powered RCT. Reporting follows CONSORT guidelines for non-pharmacological treatment. Patients were recruited from US clinics and randomised using a statistician-derived minimisation algorithm, to intensive speech treatment (16 1-hour sessions/1 month) targeting voice (voice group) or targeting articulation (articulation group) or to an untreated group (no treatment group). Speech treatments were delivered by speech clinicians who specialised in treating patients with PD. Trial design minimised bias and supported equipoise. For intelligibility assessment, blinded listeners (n = 117) orthographically transcribed 57 patients' recorded, self-generated narrative speech samples, randomly presented in multi-talker babble noise. Listeners were American-English speakers, ages 18-35 years, with normal hearing. The primary outcome was baseline (pre-treatment) to post-treatment change in transcription accuracy (TA), recognised as the most objective measure of intelligibility. TA was defined as the percentage of words transcribed correctly. Listeners, data collectors, and data managers were blinded to treatment conditions and groups. Reliability was evaluated using intraclass correlation coefficients and differences amongst groups were evaluated by mixed-effects models, in accordance with the intention-to-treat approach.This trial was registered with ClinicalTrials.gov Identifier: NCT00123084. FINDINGS: Between June 23, 2016 and August 14, 2017, blinded listeners transcribed baseline and post-treatment speech samples for intelligibility assessment of 57 patients in the voice (n = 19), articulation (n = 19) and no treatment (n = 19) groups. Between-group differences (d) in changes from baseline to post-treatment in TA indicated significantly greater increases following treatment targeting voice than treatment targeting articulation (d = 26·2%, 95% CI 1·5 - 51·0; p = 0·04; ES=1·0). Differences between TA changes in the treatment targeting voice and in the no treatment group were significant (d = 42·8%, 95% CI 22·4 - 63·2; p = 0·0002; ES=1·8). Differences between TA changes in the treatment targeting articulation and in the no treatment group were not significant (d = 16·5%, 95% CI -6·1 - 39·2; p = 0·147; ES=0·9). INTERPRETATION: These findings provide the first RCT evidence that intensive speech treatment targeting voice improves speech intelligibility in PD. Thus, this evidence-based treatment may positively impact health-related quality of life for patients with PD globally when it is included in patient management.

Vowel Acoustics and Speech Intelligibility in Young Adults With Down Syndrome.

Purpose Speech production deficits and reduced intelligibility are frequently noted in individuals with Down syndrome (DS) and are attributed to a combination of several factors. This study reports acoustic data on vowel production in young adults with DS and relates these findings to perceptual analysis of speech intelligibility. Method Participants were eight young adults with DS as well as eight age- and gender-matched typically developing (TD) controls. Several different acoustic measures of vowel centralization and variability were applied to tokens of corner vowels (/ɑ/, /æ/, /i/, /u/) produced in common English words. Intelligibility was assessed for single-word productions of speakers with DS, by means of transcriptions from 14 adult listeners. Results Group differentiation was found for some, but not all, of the acoustic measures. Low vowels were more acoustically centralized and variable in speakers with DS than TD controls. Acoustic findings were associated with overall intelligibility scores. Vowel formant dispersion was the most sensitive measure in distinguishing DS and TD formant data. Conclusion Corner vowels are differentially affected in speakers with DS. The acoustic characterization of vowel production and its association with speech intelligibility scores within the DS group support the conclusion of motor control deficits in the overall speech impairment. Implications are discussed for effective treatment planning.

Effects of speech cues in French-speaking children with dysarthria.

BACKGROUND: Articulatory excursion and vocal intensity are reduced in many children with dysarthria due to cerebral palsy (CP), contributing to the children's intelligibility deficits and negatively affecting their social participation. However, the effects of speech-treatment strategies for improving intelligibility in this population are understudied, especially for children who speak languages other than English. In a cueing study on English-speaking children with dysarthria, acoustic variables and intelligibility improved when the children were provided with cues aimed to increase articulatory excursion and vocal intensity. While French is among the top 20 most spoken languages in the world, dysarthria and its management in French-speaking children are virtually unexplored areas of research. Information gleaned from such research is critical for providing an evidence base on which to provide treatment. AIMS: To examine acoustic and perceptual changes in the speech of French-speaking children with dysarthria, who are provided with speech cues targeting greater articulatory excursion (French translation of 'speak with your big mouth') and vocal intensity (French translation of 'speak with your strong voice'). This study investigated whether, in response to the cues, the children would make acoustic changes and listeners would perceive the children's speech as more intelligible. METHODS & PROCEDURES: Eleven children with dysarthria due to CP (six girls, five boys; ages 4;11-17;0 years; eight with spastic CP, three with dyskinetic CP) repeated pre-recorded speech stimuli across three speaking conditions (habitual, 'big mouth' and 'strong voice'). Stimuli were sentences and contrastive words in phrases. Acoustic analyses were conducted. A total of 66 Belgian-French listeners transcribed the children's utterances orthographically and rated their ease of understanding on a visual analogue scale at sentence and word levels. OUTCOMES & RESULTS: Acoustic analyses revealed significantly longer duration in response to the big mouth cue at sentence level and in response to both the big mouth and strong voice cues at word level. Significantly higher vocal sound-pressure levels were found following both cues at sentence and word levels. Both cues elicited significantly higher first-formant vowel frequencies and listeners' greater ease-of-understanding ratings at word level. Increases in the percentage of words transcribed correctly and in sentence ease-of-understanding ratings, however, did not reach statistical significance. Considerable variability between children was observed. CONCLUSIONS & IMPLICATIONS: Speech cues targeting greater articulatory excursion and vocal intensity yield significant acoustic changes in French-speaking children with dysarthria. However, the changes may only aid listeners' ease of understanding at word level. The significant findings and great inter-speaker variability are generally consistent with studies on English-speaking children with dysarthria, although changes appear more constrained in these French-speaking children. What this paper adds What is already known on the subject According to the only study comparing effects of speech-cueing strategies on English-speaking children with dysarthria, intelligibility increases when the children are provided with cues aimed to increase articulatory excursion and vocal intensity. Little is known about speech characteristics in French-speaking children with dysarthria and no published research has explored effects of cueing strategies in this population. What this paper adds to existing knowledge This paper is the first study to examine the effects of speech cues on the acoustics and intelligibility of French-speaking children with CP. It provides evidence that the children can make use of cues to modify their speech, although the changes may only aid listeners' ease of understanding at word level. What are the potential or actual clinical implications of this work? For clinicians, the findings suggest that speech cues emphasizing increasing articulatory excursion and vocal intensity show promise for improving the ease of understanding of words produced by francophone children with dysarthria, although improvements may be modest. The variability in the responses also suggests that this population may benefit from a combination of such cues to produce words that are easier to understand.

Acoustic and Perceptual Consequences of Speech Cues for Mandarin Speakers With Parkinson's Disease.

Purpose This study investigated the effects of cueing for increased loudness and reduced speech rate on scaled intelligibility and acoustics of speech produced by Mandarin speakers with hypokinetic dysarthria due to Parkinson's disease (PD). Method Eleven speakers with PD read passages in habitual, loud, and slow speaking conditions. Fifteen listeners rated ease of understanding (EOU) of the speech samples on a visual analog scale. Effects of the cues on EOU, vocal loudness, pitch range, pause duration and frequency, articulation rate, and vowel space, as well as relationships between EOU gains and acoustic features, were analyzed. Results EOU increased significantly in the loud condition only. The loud cue resulted in increased intensity, and the slow cue resulted both in reduced articulation rate and increased pause frequency. In the loud condition, EOU increased significantly as intensity increased and vowel centralization decreased. In the slow condition, EOU tended to increase as intensity increased and vowel centralization decreased but did not reach statistical significance. Conclusion Cueing for loud speech may yield greater EOU gains than cueing for slow speech in Mandarin speakers with PD. Theoretical and clinical implications are discussed, although further investigations with more participants and a larger range of dysarthria severity are warranted.

Voluntary Cough and Clinical Swallow Function in Children with Spastic Cerebral Palsy and Healthy Controls.

Dysphagia and resulting pulmonary sequelae are frequently observed in children with spastic cerebral palsy (SCP). However, physiological evidence regarding airway protective behaviors (specifically swallowing and cough function) in these children is sparse. The aim of this investigation was to quantify specific feeding, swallowing, and cough impairments in children with SCP compared to controls. Eleven children with SCP (mean age: 7 ± 2 years; GMFCS: I-V; MACS: I-V) and 10 age-matched controls participated. Clinical feeding and swallowing performance was evaluated with the dysphagia disorder survey (DDS) using standardized liquid, puree, and chewable solid consistencies. Suprahyoid muscle activity and respiratory-swallow patterns were assessed with simultaneous surface electromyography and respiratory inductance plethysmography as children swallowed the various consistencies. Voluntary cough airflow measures were also obtained. Nonparametric tests were used for group comparisons and correlational analyses. Compared to controls, children with SCP demonstrated more signs of clinical feeding and swallowing impairment (p < 0.0001, η2 = 0.771), heightened suprahyoid muscle activity for puree (p = 0.014, η2 = 0.305) and chewable solids (p = 0.001, η2 = 0.528), more frequent post-swallow inhalation across liquid (p = 0.005, η2 = 0.401), puree (p = 0.014, η2 = 0.304), and chewable solids (p = 0.035, η2 = 0.223), and lower cough volume acceleration (p = 0.019, η2 = 0.289). Post-swallow inhalation for chewable solids was correlated with the DDS Part 1 (rs = 0.734, p = 0.010), DDS Part 2 (rs = 0.610, p = 0.046) and the DDS Total scores (rs = 0.673, p = 0.023). This study is the first to provide evidence of specific physiological deficits of both swallowing and voluntary cough in children with SCP. Potential hypotheses explaining these deficits and implications for physiologically driven management are explored.

Perception of American-English Vowels by Early and Late Spanish-English Bilinguals.

Increasing numbers of Hispanic immigrants are entering the US and learning American-English (AE) as a second language (L2). Previous studies investigating the relationship between AE and Spanish vowels have revealed an advantage for early L2 learners for their accuracy of L2 vowel perception. Replicating and extending such previous research, this study examined the patterns with which early and late Spanish-English bilingual adults assimilated naturally-produced AE vowels to their native vowel inventory and the accuracy with which they discriminated the vowels. Twelve early Spanish-English bilingual, 12 late Spanish-English bilingual, and 10 monolingual listeners performed perceptual-assimilation and categorical-discrimination tasks involving AE /i,ɪ,ɛ,ʌ,æ,ɑ,o/. Early bilinguals demonstrated similar assimilation patterns to late bilinguals. Late bilinguals' discrimination was less accurate than early bilinguals' and AE monolinguals'. Certain contrasts, such as /æ-ɑ/, /ʌ-ɑ/, and /ʌ-æ/, were particularly difficult to discriminate for both bilingual groups. Consistent with previous research, findings suggest that early L2 learning heightens Spanish-English bilinguals' ability to perceive cross-language phonetic differences. However, even early bilinguals' native-vowel system continues to influence their L2 perception.

The Effects of Intensive Speech Treatment on Conversational Intelligibility in Spanish Speakers With Parkinson's Disease.

Purpose: The purpose of this study was to examine the effects of intensive speech treatment on the conversational intelligibility of Castilian Spanish speakers with Parkinson's disease (PD), as well as on the speakers' self-perceptions of disability. Method: Fifteen speakers with a medical diagnosis of PD participated in this study. Speech recordings were completed twice before treatment, immediately posttreatment, and at a 1-month follow-up session. Conversational intelligibility was assessed in 2 ways-transcription accuracy scores and intelligibility ratings on a 9-point Likert scale. The Voice Handicap Index (Núñez-Batalla et al., 2007) was administered as a measure of self-perceived disability. Results: Group data revealed that transcription accuracy and median ease-of-understanding ratings increased significantly immediately posttreatment, with gains maintained at the 1-month follow-up. The functional subscale of the Voice Handicap Index decreased significantly posttreatment, suggesting a decrease in perceived communication disability after speech treatment. Conclusion: These findings support the implementation of intensive voice treatment to improve conversational intelligibility in Spanish speakers with PD with dysarthria as well as to improve the speakers' perception of their daily communicative capabilities. Clinical and theoretical considerations are discussed.

Acoustic and Perceptual Consequences of Speech Cues for Children With Dysarthria.

Purpose: Reductions in articulatory working space and vocal intensity have been linked to intelligibility deficits in children with dysarthria due to cerebral palsy. However, few studies have examined the outcomes of behavioral treatments aimed at these underlying impairments or investigated which treatment cues might best facilitate improved intelligibility. This study assessed the effects of cues targeting clear speech (i.e., "Speak with your big mouth") and greater vocal intensity (i.e., "Speak with your strong voice") on acoustic measures of speech production and intelligibility. Method: Eight children with spastic dysarthria due to cerebral palsy repeated sentence- and word-level stimuli across habitual, big mouth, and strong voice conditions. Acoustic analyses were conducted, and 48 listeners completed orthographic transcription and scaled intelligibility ratings. Results: Both cues resulted in significant changes to vocal intensity and speech rate although the degree of change varied by condition. In a similar manner, perceptual analysis revealed significant improvements to intelligibility with both cues; however, at the single-word level, big mouth outperformed strong voice. Conclusion: Children with dysarthria are capable of changing their speech styles differentially in response to cueing. Both the big mouth and strong voice cues hold promise as intervention strategies to improve intelligibility in this population. Supplemental Material: https://doi.org/10.23641/asha.5116843.

Acoustic and perceptual speech characteristics of native Mandarin speakers with Parkinson's disease.

This study examines acoustic features of speech production in speakers of Mandarin with Parkinson's disease (PD) and relates them to intelligibility outcomes. Data from 11 participants with PD and 7 controls are compared on several acoustic measures. In speakers with PD, the strength of association between these measures and intelligibility is investigated. Speakers with PD exhibited significant differences in fundamental frequency, pitch variation, vowel space, and rate relative to controls. However, in contrast to the English studies, speech rate was consistently slow and most strongly correlated with intelligibility. Thus, acoustic cues that strongly influence intelligibility in PD may vary cross-linguistically.

Children's perception of conversational and clear American-English vowels in noise.

PURPOSE: Much of a child's day is spent listening to speech in the presence of background noise. Although accurate vowel perception is important for listeners' accurate speech perception and comprehension, little is known about children's vowel perception in noise. Clear speech is a speech style frequently used by talkers in the presence of noise. This study investigated children's identification of vowels in nonsense words in noise and examined whether adults' use of clear speech would result in the children's more accurate vowel identification. METHOD: Two female American-English (AE) speaking adults were recorded producing the nonsense word /gəbVpə/ with AE vowels /ɛ-æ-ɑ-ʌ/ in phrases in conversational and clear speech. These utterances were presented to 15 AE-speaking children (ages 5.0-8.5 years) at a signal-to-noise ratio of -6 dB. The children repeated the utterances. RESULTS: Clear-speech vowels were repeated significantly more accurately (87%) than conversational-speech vowels (59%), suggesting that clear speech aids children's vowel identification. Children repeated one talker's vowels more accurately than the other's, and front vowels more accurately than central and back vowels. CONCLUSION: The findings support the use of clear speech for enhancing adult-to-child communication in AE in noisy environments.

Implementing two treatment approaches to childhood dysarthria.

The paucity of evidence and detail in the literature regarding speech treatment for children with dysarthria due to cerebral palsy (CP) renders it difficult for researchers to replicate studies and make further inroads into this area in need of exploration. Furthermore, for speech-language pathologists (SLPs) wishing to follow treatments that the literature indicates have promise, little guidance is available on the details of the treatments that yielded the positive results. The present article details the implementation of two treatment approaches in speech treatment research for children with dysarthria: Speech Systems Intelligibility Treatment (SSIT) and the Lee Silverman Voice Treatment LOUD (LSVT LOUD). Specific strategies, primarily for treatment, but also for outcome measurement and acoustic analysis of dysarthric speech, are described. These techniques are provided for researchers and clinicians to consider implementing in order to advance speech treatment for this population. New data from research using these approaches are presented, including findings of acoustic vowel space changes following both speech treatments.