Effects of subthalamic nucleus deep brain stimulation on the speech of Spanish-speaking Parkinson's disease patients during the first year of treatment.

PURPOSE: To describe the effects of subthalamic nucleus deep brain stimulation (STN-DBS) on the speech of Spanish-speaking Parkinson's disease (PD) patients during the first year of treatment. METHODS: The speech measures (SMs): maximum phonation time, acoustic voice measures, speech rate, speech intelligibility measures, and oral diadochokinesis rates of nine Colombian idiopathic PD patients (four females and five males; age = 63 ± 7 years; years of PD = 10 ± 7 years; UPDRS-III = 57 ± 6; H&Y = 2 ± 0.3) were studied in OFF and ON medication states before and every three months during the first year after STN-DBS surgery. Praat software and healthy native listeners' ratings were used for speech analysis. Statistical analysis tried to find significant differences in the SMs during follow-up (Friedman test) and between medication states (Wilcoxon paired test). Also, a pre-surgery variation interval (PSVI) of reference for every participant and SM was calculated to make an individual analysis of post-surgery variation. RESULTS: Non-significative post-surgery or medication state-related differences in the SMs were found. Nevertheless, individually, based on PSVIs, the SMs exhibited: no variation, inconsistent or consistent variation during post-surgery follow-up in different combinations, depending on the medication state. CONCLUSION: As a group, participants did not have a shared post-surgery pattern of change in any SM. Instead, based on PSVIs, the SMs varied differently in every participant, which suggests that in Spanish-speaking PD patients, the effects of STN-DBS on speech during the first year of treatment could be highly variable.

[Vowel articulation and intelligibility of speech in Spanish speakers with Parkinson's disease treated with deep brain stimulation of the subthalamic nucleus]. / Articulación de las vocales e inteligibilidad del habla en hispanohablantes con enfermedad de Parkinson tratados con estimulación cerebral profunda del núcleo subtalámico.

INTRODUCTION: Parkinson's disease (PD) can affect the intelligibility of speech. Although studies of vowel production are useful for measuring this impairment, they do not exist in Spanish speakers with the disease who have been treated with subthalamic nucleus deep brain stimulation (STN-DBS). STN-DBS is an effective treatment for the classic signs of PD, but with varied effects on speech. PATIENTS AND METHODS: Data from two individuals with PD treated with STN-DBS were studied: one (P1) had impairment and the other (P2) had stable speech intelligibility after STN-DBS implantation. The triangular vowel space area (tVSA) and the vowel articulation index (VAI) were measured and compared before the implantation surgery, and at three, six and nine months after surgery. These measurements were compared with measurements of speech intelligibility (percentage of words correctly identified and degree of intelligibility). RESULTS: Both participants presented variations in measurements of vowel articulation after surgery. In P1, the reduction in the tVSA, but not the post-surgical change in the VAI, was consistent with reduced speech intelligibility. However, in P2, both measurements (tVSA and VAI) reflected stable speech intelligibility after surgery. CONCLUSIONS: Reduced speech intelligibility in Spanish speakers with PD after STN-DBS implantation may be reflected in a reduced tVSA.

TITLE: Articulación de las vocales e inteligibilidad del habla en hispanohablantes con enfermedad de Parkinson tratados con estimulación cerebral profunda del núcleo subtalámico.Introducción. La enfermedad de Parkinson (EP) puede alterar la inteligibilidad del habla. Aunque los estudios de la producción de las vocales son útiles para medir esta afectación, no existen en hispanohablantes con la enfermedad que hayan sido tratados con estimulación cerebral profunda del núcleo subtalámico (STN-DBS). La STN-DBS es un tratamiento efectivo para los signos clásicos de la EP, pero con variados efectos en el habla. Pacientes y métodos. Se estudiaron los datos de dos personas con EP tratadas con STN-DBS: uno (P1) con deterioro y el otro (P2) con estabilidad de la inteligibilidad del habla después de la implantación de la STN-DBS. Se calcularon y compararon medidas de espacio vocálico acústico triangular (tVSA) e índice de articulación de las vocales (VAI) antes de la cirugía de implantación y a los tres, seis y nueve meses de la intervención. Estas medidas se contrastaron con medidas de inteligibilidad del habla (porcentaje de palabras correctamente identificadas y grado de inteligibilidad). Resultados. Ambos participantes mostraron variación de las medidas de articulación de las vocales después de la cirugía. En P1, la reducción del tVSA, pero no el cambio posquirúrgico del VAI, correspondió con disminución de la inteligibilidad del habla. Por el contrario, en P2, el comportamiento de ambas medidas (tVSA y VAI) reflejó la estabilidad de la inteligibilidad del habla después de la cirugía. Conclusiones. La reducción de la inteligibilidad del habla en hispanohablantes con EP después de la implantación de la STN-DBS puede reflejarse en la reducción del tVSA.

Speech-Language Outcomes in the COVID-19 Milieu for Multilingual Jamaican Preschoolers and Considerations for Telepractice Assessments.

PURPOSE: The purpose of this study was to characterize the communicative participation and functional speech intelligibility (i.e., how children use communication and how well they are understood across everyday life) of typically developing (TD) bilingual Jamaican preschoolers and those with functionally defined speech sound disorders (fSSDs) in the COVID-19 milieu. Findings were also compared to an existing corpus of baseline data to document and explore differences in children's speech-language outcomes secondary to pandemic-related social restrictions. METHOD: Thirty bilingual Jamaican preschoolers, 21 TD and nine with fSSDs, were assessed during the pandemic via telepractice. Association and univariate mean testing were completed to characterize children's communicative participation and functional speech intelligibility. Data were then compared to an existing corpus of baseline data (collected in person between 2013 and 2019), which included direct child assessment and parent reports and consisted of TD (n = 226) Jamaican Creole-English-speaking preschoolers and those with fSSDs (n = 39) to compare performance profiles across data sets. All participants attended schools in Kingston, Jamaica. RESULTS: Measures of communicative participation remained stable in the context of the COVID-19 milieu for children in the TD and fSSD groups, but functional speech intelligibility outcomes for children with fSSDs deviated between in-person findings collected from children pre-pandemic. Between-groups differences were also found on measures of speech production accuracy but were no longer significant when considering telepractice as a covariate. CONCLUSIONS: Findings from this investigation serve to characterize the communicative participation and functional speech intelligibility of TD bilingual Jamaican preschoolers and those with fSSDs in the COVID-19 milieu. By extension, the results comparing data from preschoolers collected during the pandemic to an existing corpus of baseline data from a different group of preschoolers provide critical insights about multilingual children's speech-language outcomes in the context of acutely changing environmental circumstances. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.25461505.

Cochlear implantation outcomes in children with multiple disabilities: a topic that's worth revisiting.

OBJECTIVES: To determine the benefits of cochlear implantation in hearing loss children with multiple disabilities (MD) in terms of auditory outcomes, speech performance, and their quality of life. METHODS: This was a cross sectional study from January 2019 to December 2020 in which thirty-one children with hearing loss and multiple disabilities were evaluated. Their improvement in auditory and speech performances were assessed using Categories of Auditory Performance version II (CAP-II) and the Speech Intelligibility Rating (SIR) scales. The assessment was done at 6-month intervals, with the baseline evaluation done at least six months after activation of the implant. Parents were asked to fill the Parents Evaluation of Aural/Oral Performance of Children (PEACH) diary and Perceived Benefit Questionnaire (PBQ) to evaluate the child's quality of life. RESULTS: All 31 children have Global Developmental Delay (GDD), with 11 having an additional disability. Both mean CAP-II and SIR scores showed significant improvement with increased hearing age (p < 0.05) after 6-month intervals. In addition, 20 out of 31 children (64.5%) have achieved verbal communication after implantation. The mean PEACH score in quiet was significantly better than in noise (p = 0.007) and improved with the increased of hearing age. The majority of parents (96%‒100%) perceived a cochlear implant as beneficial to their child in terms of auditory response, awareness, interaction, communication, and speech development. CONCLUSIONS: Cochlear implantation had shown benefits in children with multiple disabilities. Outcome measures should not only focus on auditory and speech performances but the improvement in quality of life. Hence, individualized each case with realistic expectation from families must be emphasized in this group of children. LEVEL OF EVIDENCE: Level 3.

Tecnologia auditiva assistiva em usuários de implante coclear em ambientes reverberantes com múltiplas fontes de ruído / Assistive listening technology in cochlear implant users in reverberant environments with multiple noise sources

RESUMO Objetivo Avaliar a contribuição da tecnologia de escuta assistida em usuários de implante coclear (IC) em situações de reverberação e ruído. Métodos Estudo transversal prospectivo aprovado pelo Comitê de Ética Institucional (CAAE 8 3031418.4.0000.0068). Foram selecionados adolescentes e adultos usuários de IC com surdez pré ou pós-lingual. Para usuários bilaterais, cada orelha foi avaliada separadamente. O reconhecimento de fala foi avaliado por meio de listas gravadas de palavras dissílabas apresentadas a 65 dBA a 0° azimute com e sem o Mini Microfone2 (Cochlear™) conectado ao processador de fala Nucleus®6. A reverberação da sala foi medida como 550 ms. Para avaliar a contribuição do dispositivo de escuta assistida (DEA) em ambiente reverberante, o reconhecimento de fala foi avaliado no silêncio. Para avaliar a contribuição do DEA em reverberação e ruído, o reconhecimento de fala foi apresentado a 0° azimute com o ruído proveniente de 8 alto-falantes dispostos simetricamente a 2 metros de distância do centro com ruído de múltiplos falantes usando relação sinal-ruído de +10dB. Para evitar viés de aprendizado ou fadiga, a ordem dos testes foi randomizada. A comparação das médias foi analisada pelo teste t para amostras pareadas, adotando-se nível de significância de p<0,005. Resultados Dezessete pacientes com idade média de 40 anos foram convidados e concordaram em participar, sendo 2 participantes bilaterais, totalizando 19 orelhas. Houve contribuição positiva significante do Mini Mic2 na reverberação e ruído+reverberação (p<0,001). Conclusão DEA foi capaz de melhorar o reconhecimento de fala de usuários de IC tanto em situações de reverberação quanto ruidosas.

ABSTRACT Purpose This study aimed to evaluate the contribution of assistive listening technology with wireless connectivity in cochlear implant (CI) users in reverberating and noise situations. Methods Prospective cross-sectional study approved by the Institutional Ethics Committee (CAAE 8 3031418.4.0000.0068). Adolescents and adults CI users with pre- or post-lingual deafness were selected. For bilateral users, each ear was assessed separately. Speech recognition was assessed using recorded lists of disyllabic words presented at 65 dBA at 0° azimuth with and without the Wireless Mini Microphone 2 (Cochlear™) connected to the Nucleus®6 speech processor. Room reverberation was measured as 550 ms. To assess the contribution of the assistive listening device (ALD) in a reverberating environment, speech recognition was assessed in quiet. To assess the contribution of the ALD in reverberation and noise, speech recognition was presented at 0° azimuth along with the noise coming from 8 loudspeakers symmetrically arranged 2 meters away from the center with multi-talker babble noise using signal to noise ratio of +10dB. To avoid learning bias or fatigue, the order of the tests was randomized. Comparison of means was analyzed by t test for paired samples, adopting significance level of p <0.005. Results Seventeen patients with a mean age of 40 years were invited and agreed to participate, with 2 bilateral participants, totaling 19 ears assessed. There was a significant positive contribution from the Mini Mic2 in reverberation, and noise+reverberation (p <0.001). Conclusion ALD was able to improve speech recognition of CI users in both reverberation and noisy situations.

Multisensory effects of mask wearing on speech intelligibility and the benefit of multilingualism.

PURPOSE: Due to the pandemic of the Covid-19 disease, it became common to wear masks on some public spaces. By covering mouth and nose, visual-related speech cues are greatly reduced, while the auditory signal is both distorted and attenuated. The present study aimed to analyze the multisensory effects of mask wearing on speech intelligibility and the differences in these effects between participants who spoke 1, 2 and 3 languages. METHODS: The study consisted of the presentation of sentences from the SPIN test to 40 participants. Participants were asked to report the perceived sentences. There were four conditions: auditory with mask; audiovisual with mask; auditory without mask; audiovisual without mask. Two sessions were conducted, one week apart, each with the same stimuli but with a different signal-to-noise ratio. RESULTS: Results demonstrated that the use of the mask decreased speech intelligibility, both due to a decrease in the quality of auditory stimuli and due to the loss of visual information. Signal-to-noise ratio largely affects speech intelligibility and higher ratios are needed in mask-wearing conditions to obtain any degree of intelligibility. Those who speak more than one language are less affected by mask wearing, as are younger listeners. CONCLUSION: Wearing a facial mask reduces speech intelligibility, both due to visual and auditory factors. Older people and people who only speak one language are affected the most.

Characterizing Communicative Participation in Multilingual Jamaican Preschoolers.

PURPOSE: This study characterized communicative participation and related aspects of functional communication for Jamaican Creole (JC)-English-speaking preschoolers with and without functionally defined speech sound disorders (fSSDs). This study included parent reports and direct assessment measures from an existing corpus of baseline data collected prior to the COVID-19 pandemic. METHOD: The communicative participation of typically developing (TD; n = 226) bilingual JC-English-speaking preschoolers and those with fSSDs (n = 39) was documented using the Focus on the Outcomes of Communication Under Six (FOCUS). Functional speech intelligibility was recorded using the Intelligibility in Context Scale (ICS) in English and JC (ICS-JC). Objective measures of speech production were collected through direct child assessment in both languages and then transcribed and calculated for percent of consonants (PCC), vowels (PVC), and phonemes correct (PPC). Within-group relationships were explored using association testing, and differences between groups were explored through multivariate analyses. RESULTS: FOCUS scores and ICS and ICS-JC scores were found to be minimally to moderately related for Jamaican preschoolers in the TD group (r = .28-.34, p < .002) and strongly related in the fSSD group (r = .56-.60, p < .002). No relations were observed between the FOCUS scores and PCC/PVC/PPC in either language. There was a statistically significant difference between all FOCUS scores for Jamaican preschoolers in the TD and fSSD groups (p ≤ .002). CONCLUSIONS: These findings provide additional evidence for using the FOCUS beyond documenting change in communicative participation to support clinical decision-making in planning and developing speech-language interventions. This study also documents an important characterization of JC-English-speaking children with and without fSSDs, offering data on children's abilities that can be used in future comparisons of communicative participation and speech functioning observed during the COVID-19 pandemic and beyond.

Singing and Speaking Ability in Parkinson's Disease and Spinocerebellar Ataxia.

PURPOSE: This study examined spontaneous, spoken-to-a-model, and two sung modes in speakers with Parkinson's disease (PD), speakers with cerebellar disease (CD), and healthy controls. Vocal performance was measured by intelligibility scores and listeners' perceptual ratings. METHOD: Participants included speakers with hypokinetic dysarthria secondary to PD, those with ataxic dysarthria secondary to CD, and healthy speakers. Participants produced utterances in four vocal modes: spontaneous speech, spoken-to-a-model, sung-to-a-model, and spontaneous singing. For spoken-to-a-model and sung-to-a-model modes, written material was provided the model. For spontaneous singing, participants sang songs that they endorsed as familiar. DEPENDENT VARIABLES: In Experiment I, listeners orthographically transcribed the audio samples of the first three vocal modes. In Experiment IIa, raters evaluated the accuracy of the pitch and rhythm of the spontaneous singing of familiar songs. Finally, familiar songs and sung-to-a-model utterances were rated on a competency scale by a second group of raters (Experiment IIb). RESULTS: Results showed increases in intelligibility during the spoken-to-a-model mode compared with the spontaneous mode in both PD and CD groups. Singing enhanced the vocal output of speakers with PD more than in speakers with CD, as measured by percent intelligibility. PD participants' pitch and rhythm accuracy and competency in singing familiar songs was rated more favorably than those produced by CD participants. CONCLUSIONS: The findings reveal a vocal task effect for spoken utterances in both groups. Sung exemplars, more impaired in CD, suggest a significant involvement of the cerebellum in singing. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.21809544.

Parâmetros e tipos de avaliação da disartria na esclerose lateral amiotrófica / Parameters and types of dysarthria assessment in amyotrophic lateral sclerosis

RESUMO Objetivo identificar estudos a respeito dos parâmetros e dos tipos de avaliação utilizados para avaliar a disartria na esclerose lateral amiotrófica (ELA). Estratégia de pesquisa estudo de revisão integrativa da literatura realizada nas bases de dados LILACS, SciELO, PubMed, Web of Science, CINAHL, Scopus e Cochrane, por meios dos descritores, em português e em inglês, "Avaliação AND Disartria AND Esclerose Lateral Amiotrófica". Critérios de seleção os critérios de inclusão foram: artigos que abordavam estudos sobre avaliação da disartria na ELA, nas línguas inglesa, espanhola e portuguesa, disponíveis na íntegra, no período de 2015 a 2022. Resultados do total de 38 estudos, apenas 3 usaram um único tipo de avaliação da disartria. A maior parte dos estudos utilizou mais de um tipo de avaliação variando de 2 a 4. Foram 3 os tipos de avaliação mais utilizados, com o intuito de avaliar o grau de inteligibilidade de fala: avaliação perceptivo-auditiva (31 estudos), avaliação acústica (18 estudos) e avaliação do movimento (27 estudos). Conclusão a avaliação da disartria na ELA é realizada por diferentes procedimentos e com vários parâmetros de análise, em especial pela avaliação perceptivo-auditiva e do movimento.

ABSTRACT Purpose to identify studies regarding the parameters and types of assessment used to evaluate dysarthria in amyotrophic lateral sclerosis (ALS). Research strategy an integrative literature review study was conducted on the LILACS, SciELO, PubMed, Web of Science, CINAHL, Scopus, and Cochrane databases using the descriptors "Assessment AND Dysarthria AND Amyotrophic Lateral Sclerosis" in both Portuguese and English. Selection criteria the inclusion criteria consisted of articles that addressed studies on dysarthria assessment in ALS, written in English, Spanish, and Portuguese, which should be available in full, and published from 2015 to 2022. Results: out of the total of 38 studies, only 3 used a single type of dysarthria assessment. Most studies employed more than one type of assessment, ranging from 2 to 4 types. Three assessment types were predominantly used to assess the degree of speech intelligibility: auditoryperceptual assessment (31 studies), acoustic assessment (18 studies), and movement assessment (27 studies). Conclusion dysarthria assessment in ALS is conducted through various procedures and with multiple analysis parameters, notably through auditory-perceptual and movement assessments.

Updating sentences lists for assessment speech perception. / Adaptação de listas de sentenças para avaliação da percepção da fala.

PURPOSE: Adapt a list of sentences for a speech intelligibility test. METHODS: A speech material data base consisting of 200 phonetically balanced sentences was analyzed and partially updated. In the first stage, 60 reviewers, specialists in linguistics and speech and hearing science, analyzed the sentences in relation to the parameters of familiarity, meaning and predictability using an on-line questionnaire. Cronbach's Alpha coefficient was used to analyze the internal consistency of the questionnaire. In the second stage, the reviewers analyzed whether they were in accordance with the criteria indicated by the literature for the construction of sentences. RESULTS: In the first stage, the responses of 15 reviewers who completed the entire questionnaire were analyzed. Agreement between reviewers was high for all criteria. 71 sentences were recommended for modification in the first stage, with predictability being the most indicated parameter as requiring change. In the second stage, 28 more sentences were selected for adjustment, with the presence of a proper name in the sentence being the most frequently cited criterion. CONCLUSION: It was possible to adapt a list of sentences in order to provide speech language therapists with a free of charge speech perception protocol. It is hoped that this new test can assist in standardizing assessment for normal hearing adults and individuals with hearing loss in Brazilian Portuguese.

OBJETIVO: Adaptar listas de sentenças para avaliar o reconhecimento de fala em adultos. MÉTODO: Foram atualizadas 200 sentenças balanceadas foneticamente que passaram por duas etapas de revisão. Na primeira etapa, foi enviado um questionário on-line para 60 juízes analisarem as sentenças em relação aos critérios de familiaridade, significado e previsibilidade. Para análise da consistência interna do questionário foi aplicado coeficiente Alfa de Cronbach. Na segunda etapa, três juízes especialistas analisaram se as mesmas estavam de acordo com os parâmetros indicados pela literatura para a construção de sentenças e organizaram em 10 listas de 20 sentenças cada, a fim de facilitar a avaliação clínica do reconhecimento de fala. Foi realizado um estudo piloto com três indivíduos jovens e normo-ouvintes. RESULTADOS: Na primeira etapa foram analisadas as respostas de 15 juízes que preencheram todo o questionário. Verificou-se que a concordância entre os juízes foi alta para todos os critérios. Foram indicadas 71 sentenças para serem modificadas na primeira etapa, sendo a previsibilidade o critério que teve maior ocorrência de modificação. Na segunda etapa foram identificadas mais 28 sentenças passíveis de ajustes, sendo a presença de nome próprio o critério mais frequente. No estudo piloto os jovens apresentaram alto índice de reconhecimento de fala. CONCLUSÃO: Concluiu-se que a maioria das modificações realizadas nas sentenças deste estudo possibilitou a criação de um material fidedigno para a prática clínica fonoaudiológica que contribuirá na padronização da avaliação da percepção da fala de indivíduos normo-ouvintes e com perda auditiva.

Speech and swallowing function following microsurgical reconstruction of palatal defects in a series of six pediatric patients.

BACKGROUND: Reconstruction of extensive palatal defects in growing patients aims to restore speech intelligibility and swallowing function while avoiding excessive scarring formation that may cause growth disturbances in the palate and midface region. Free flaps transfer healthy, well-vascularized tissue to the defect area, and their combination with pharyngeal flaps allow for restoration of the velopharyngeal function. We examined speech and swallowing after microsurgical palate reconstruction in a series of six pediatric patients. METHODS: Radial forearm free flaps were used in all cases, in combination with a superiorly based pharyngeal flap in five cases. Mean age at surgery was 10.7 years. Etiologies included recurrent oronasal fistula due to failed primary cleft palate repair (n = 4), embryonal rhabdomyosarcoma of the maxilla (n = 1), and inflammatory fibrous hyperplasia (n = 1). Speech evaluations (with the Hirose standard and listener ratings) and swallowing assessments (based on videofluoroscopy swallowing studies and patient-reported swallowing and diet) were performed in average 44 months postoperatively. RESULTS: All flaps survived without major postoperative complications. Speech intelligibility was graded as "excellent" in four patients and "moderate" in two. Hypernasality and nasal obstruction were each judged as "none/minimal" in five cases and "moderate" in one case. All patients tolerated oral diet without significant nasal regurgitation. In five of six patients, the swallowing assessment showed good motion and velopharyngeal closure. CONCLUSION: Microsurgical reconstruction of extensive palatal defects using radial forearm free flap, with or without a superiorly based pharyngeal flap, is a reliable technique that can deliver substantial improvement of speech and swallowing in pediatric patients.

Randomized Trial to Increase Speech Sound Differentiation in Infants Born Preterm.

OBJECTIVE: To test whether infant-directed foreign language active learning would specifically increase speech sound differentiation to the intervention language while not decreasing differentiation in response to English. STUDY DESIGN: Pilot randomized controlled trial of stable infants born preterm in the newborn intensive care unit with normal auditory brainstem responses, whose parents spoke only English and had no musical training or familial hearing abnormality. Assignment was to 1 of 3 groups: passive exposure to English infant-directed lullabies and readings (English-enrichment, control group) and contingent exposure by active sucking on a sensor-equipped pacifier to either infant-directed French lullabies and readings (English environment, French-contingent learning group) or infant-directed Mandarin lullabies and readings (English environment, Chinese-contingent learning group). The main outcome measures were preintervention and postintervention event-related potentials (ERPs) in response to standardized speech syllables in each language. RESULTS: Forty-one subjects completed the study, including 15 in the English-enrichment control group and 13 each in the French-contingent and Chinese-contingent groups. The median gestational age at birth was 34 weeks (IQR, 8.75 weeks); postmenstrual age at intervention ranged from 36 to 46 weeks and was similar across the 3 groups. Postintervention mean ERP amplitude to pairs of English speech sounds did not differ across the 3 groups; however, ERP amplitude in French sound differentiation was greater in the French-contingent group than in the Chinese-contingent or English-enrichment groups, and ERP amplitude greater in Chinese sound differentiation was greater in the Chinese-contingent group compared with the other 2 groups. CONCLUSION: Contingent infant-directed foreign language exposure increased speech sound differentiation specific to the intervention language and did not decrease differentiation in response to English. TRIAL REGISTRATION: ClinicalTrials.gov: NCT03232931.

Effects of hearing protector devices on speech intelligibility: the importance of individualized assessment.

Objectives. This study aimed to compare speech intelligibility in noise with and without hearing protection devices (HPDs). Methods. Fifty-one workers were distributed into three groups: noise-induced hearing loss group (NIHLG), normally hearing noise-exposed group (NG) and normally hearing non-exposed to noise group (CG). A free field system was used to emit monosyllables (65, 70 and 75 dB) and pink noise in different signal-to-noise ratios (SNRs) (0, -5, -10 and -15). Results. In situations with HPDs, all groups showed a decrease in the percentage of correct responses with an increase in noise level. The HPD had little effect on speech intelligibility in the NIHLG and NG. Considering the effect caused by the HPD on speech intelligibility, it was observed that the group with the greatest loss was the CG for SNRs of -5, -10 and -15. Conclusion. Although speech intelligibility is influenced by the hearing threshold, the noise level and SNR are crucial for good speech intelligibility, either with or without an HPD. It is highlighted that the NG had worse results when compared with the CG, which may indicate changes in the auditory pathway resulting from continuous noise exposure, even in the absence of changes in the audiometric thresholds.

Long-term functional outcomes and quality of life after partial glossectomy for T2 squamous cell carcinomas.

INTRODUCTION: Partial glossectomy and reconstruction strategy for malignant tongue tumors influences speech and swallowing. OBJECTIVE: The aim of this retrospective study was to evaluate long-term functional outcomes after partial glossectomy for pT2 mobile tongue carcinomas with a maximum dimension between 2 and 3cm. Different reconstruction strategies (with or without pedicled flap) were compared. METHODS: Twenty-two patients with at least 12 months followup were included. Clinician-based and self-reported instruments were used to analyze tongue motility, speech intelligibility and articulation, swallowing, and quality of life. RESULTS: Patients with a higher tongue motility had better articulation and lower dysphagia. Avoiding pedicled flap reconstruction seemed to guarantee lower impairment of speech and swallowing. Worse functional outcomes induced a lower quality of life. CONCLUSION: Partial glossectomy results in tongue motility impairment and consequently alterations of oral functions. Since the type of reconstruction impacts long-term outcomes, it should be adequately planned before surgery.

Produção da fala de crianças e adolescentes de um programa de reabilitação auditiva / Speech production of children and adolescents from an auditory rehabilitation program

RESUMO Objetivo caracterizar a produção da fala de crianças e adolescentes usuários de aparelho de amplificação sonora individual (AASI) ou implante coclear (IC) de um programa de reabilitação auditiva. Métodos estudo observacional transversal. Foram analisadas amostras de fala de 15 participantes de um programa de reabilitação auditiva, que consistiam na prova de fonologia do ABFW (ABFW - Teste de Linguagem Infantil nas Áreas de Fonologia, Vocabulário, Fluência e Pragmática) e na fala espontânea, adaptada do Protocolo de Avaliação de Voz do Deficiente Auditivo. Foi aplicado o teste de Wilcoxon para comparar os índices de Porcentagem de Consoantes Corretas (PCC) e Porcentagem de Consoantes Corretas revisado (PCC-r) das provas de fonologia e o teste de Mann-Whitney para comparar os referidos índices, em relação aos graus de inteligibilidade da fala espontânea. Também foi analisada a variabilidade de produção dos fonemas das provas de fonologia. Resultados verificou-se desvio leve nos índices de PCC e PCC-r para as provas de fonologia, com escores superiores para o PCC-r. Os participantes com médias maiores que 85% alcançaram inteligibilidade "Boa" e participantes com médias entre 85% e 50% apresentaram inteligibilidade "Regular/Insuficiente". Os usuários de AASI não produziram adequadamente os fonemas /s/, /z/, /Ʒ/ /ɲ/, /l, /ʎ/, arquifonema /S/ e arquifonema /R/ e os usuários de IC, os fonemas /ʎ/ e arquifonema /R/. Conclusão o grupo estudado apresentou desvio leve nos índices de PCC e PCC-r, com médias superiores, quando considerada a distorção como acerto. Participantes com inteligibilidade "Boa" apresentaram maiores escores de PCC e PCC-r. Usuários de AASI não produziram fonemas fricativos adequadamente. Foram observadas produções com variação linguística social e regional.

ABSTRACT Purpose To characterize the speech production of children and adolescents from an auditory rehabilitation program who use hearing aids (HA) or cochlear implant (CI). Methods Cross-sectional observational study. Speech samples from 15 participants of a hearing rehabilitation program were analyzed through the phonology test of the ABFW Test and spontaneous conversation, which were adapted from the Protocol for the Evaluation of Voice in Subjects with Hearing Impairment. The Wilcoxon test was used to compare the Percentage of Consonants Correct (PCC) and the Percentage of Consonants Correct-revised (PCC-r) indexes of the phonology test, and the Mann-Whitney test was used to compare these indexes to the degrees of intelligibility of spontaneous conversation. The variability of production of the phonemes of the phonology tests was also analyzed. Results There was a mild deviation in the PCC and PCC-r indexes for the phonology tests, with higher scores for the PCC-r. Participants with averages greater than 85% achieved "Good" intelligibility, and participants with averages between 85% and 50% had "Regular/Insufficient" intelligibility. The HA users did not properly produce the phonemes /s/, /z/, /Ʒ/ /ɲ/, /l, /ʎ/, the archiphoneme /S/, and the archiphoneme /R/. The CI users did not properly produce the phonemes /ʎ/ and the archiphoneme /R/. Conclusion The group had a mild deviation in the PCC and PCC-r indexes, with higher means when the distortion was considered correct. Participants with "Good" intelligibility had higher PCC and PCC-r scores. HA users did not produce fricative phonemes properly. There were productions with a social and regional linguistic variation.

Eficácia de terapia de fala em grupo para pacientes com a doença de Machado Joseph: uma série de casos / Effectiveness of group speech therapy for patients with Machado Joseph Disease: a series of cases / Eficiencia de la terapia del habla en grupo para pacientes con Enfermedad de Machado Joseph: una serie de casos

Objetivo: Verificar o benefício de terapia fonoaudiológica em grupo na inteligibilidade de fala de pacientes com Doença de Machado Joseph (DMJ). Método: Realizou-se uma série de casos, com pacientes atendidos em um ambulatório de fonoaudiologia para adultos neurodegenerativos em um hospital de referência no sul do Brasil. Foram incluídos pacientes com o diagnóstico molecular de DMJ. Realizaram-se coletas de fala pré e pós-intervenção. Posteriormente, os trechos de fala passaram por análise perceptiva-auditiva por 3 fonoaudiólogas treinadas e calibradas a um índice Kappa ≥ 0.90, cegas às coletas de fala e por análise acústica no software Praat. A terapia fonoaudiológica foi realizada em grupo, composta por quatro sessões semanais de cinquenta minutos. Cada sessão foi dividida entre exercícios de fala e orientação sobre estratégias para otimizar a comunicação. Resultados: A amostra foi composta por 5 pacientes com média de idade de 39,8 anos (±16,51) e tempo de doença de 10 anos (±8,15). Quatro (80%) participantes receberam diagnóstico fonoaudiológico inicial de disartria leve e um (20%) de disartria moderada. Após a intervenção, não houve melhora no diagnóstico de disartria, contudo verificou-se que 60% (n=3) dos participantes apresentaram melhora na articulação, 40% (n=2) na prosódia e ressonância e 40% (n=2) apresentaram piora na respiração. Na análise acústica observou-se melhora no tempo máximo de fonação (TMF) em 3 (60%) dos 5 pacientes. Conclusão: Verificou-se melhora na funcionalidade da fala através da análise perceptiva auditiva, porém com pouca melhora em parâmetros específicos da análise acústica.

Objective: To verify the benefit of group speech therapy in speech intelligibility of patients with Machado Joseph's disease (MJD). Methods: A series of cases was carried out, with patients seen in a speech therapy clinic for neurodegenerative adults in a referral hospital in southern Brazil. Patients with the molecular diagnosis of MJD were included. Speech recordings were performed before and after the intervention. Subsequently, the speech excerpts underwent auditory-perceptual analysis by 3 trained speech therapists and calibrated to a Kappa index ≥ 0.90, blind to speech collections and acoustic analysis in the Praat software. Speech therapy was performed in a group, consisting of four weekly sessions of fifty minutes. Each session was divided between speech exercises and guidance on strategies to optimize communication. Results: The sample consisted of 5 patients with a mean age of 39.8 years (± 16.51) and disease duration of 10 years (± 8.15). Four (80%) participants received an initial speech therapy diagnosis of mild dysarthria and one (20%) of moderate dysarthria. After the intervention, there was no improvement in the diagnosis of dysarthria, however it was found that 60% (n = 3) of the participants showed improvement in the speech motor bases: articulation, 40% (n = 2), prosody and resonance and 40% (n = 2) worsened in breathing. The acoustic analysis showed an improvement in maximum phonation time (MPT) in 3 (60%) of the 5 patients. Conclusion: Despite the little improvement in specific parameters of the acoustic analysis, there was an improvement in speech functionality from the auditory perceptual analysis, improving the speech intelligibility of this sample.

Objetivo: Verificar el beneficio de la logopedia grupal en la inteligibilidad del habla de pacientes con enfermedad de Machado Joseph (EMJ). Metodos: Se realizó una serie de casos, con pacientes atendidos en una clínica de logopedia para adultos neurodegenerativos en un hospital de referencia en el sur de Brasil. Se incluyeron pacientes con diagnóstico molecular de EMJ. Se realizaron grabación del habla antes y después de la intervención. Posteriormente, los extractos del habla se sometieron a un análisis auditivo-perceptivo por 3 logopedas capacitados y calibrados con un índice Kappa ≥ 0,90, ciegos a las grabación del habla y al análisis acústico en el software Praat. La logopedia se realizó en grupo, consistente en cuatro sesiones semanales de cincuenta minutos. Cada sesión se dividió entre ejercicios de habla y orientación sobre estrategias para optimizar la comunicación. Resultados: La muestra estuvo formada por 5 pacientes con una edad media de 39,8 años (± 16,51) y una duración de la enfermedad de 10 años (± 8,15). Cuatro (80%) participantes recibieron un diagnóstico inicial de terapia del habla de disartria leve y uno (20%) de disartria moderada. Tras la intervención, no hubo mejoría en el diagnóstico de disartria, sin embargo se encontró que el 60% (n = 3) de los participantes mostró mejoría en las bases motoras del habla: articulación, 40% (n = 2), prosodia y resonancia. y el 40% (n = 2) empeoró en la respiración. El análisis acústico mostró una mejora en el tiempo máximo de fonación (TMF) en 3 (60%) de los 5 pacientes. Conclusion: A pesar de la pequeña mejora en los parámetros específicos del análisis acústico, hubo una mejora en la funcionalidad del habla a partir del análisis de percepción auditiva, mejorando la inteligibilidad del habla de esta muestra.

Speech Intelligibility Index and the Ling 6(HL) test: correlations in pediatric hearing aid users. / Índice de inteligibilidade de fala e teste Ling-6 (HL): correlações em escolares usuários de próteses auditivas.

PURPOSE: To evaluate speech audibility in schoolchildren hearing aids users and correlate the Speech Intelligibility Index to phonemes detecion. METHODS: 22 children and adolescents hearing aids users, underwent audiological evaluation, in situ verification (and consequent obtaining the Speech Intelligibility Index - SII - for conditions with and without hearing aids) and detection thresholds for phonemes by Ling-6 (HL) test. RESULTS: The average value for the SII was 25.1 without hearing aids and 68.9 with amplification (p <0.001 *). The phoneme detection thresholds in free field, in dBHL, were, without amplification /m/ = 29.9, /u/ = 29.5, /a/ = 35.5, /i/ = 30.8, /∫/ = 44.2 e /s/ = 44.9, and with amplification /m/ = 13.0, /u/ = 11.5 /a/ = 14.3, /i/ = 15.4, /∫/ = 20.4 e /s/ = 23.1 (p<0.001*). There was a negative correlation between SII and the thresholds of all phonemes in the condition without hearing aids (p≤0.001*) and between SII and the /s/ threshold with hearing aids (p = 0.036*). CONCLUSION: The detection thresholds for all phonemes are lower than without hearing aids. There is a negative correlation between SII and the thresholds of all phonemes in the situation without hearing aids and between SII and the detection threshold of the phoneme / s / in the situation with hearing aids.

OBJETIVO: Avaliar a audibilidade de fala em crianças usuárias de próteses auditivas e correlacionar o Índice de Inteligibilidade de Fala à detecção de fonemas. MÉTODO: 22 crianças e adolescentes usuários de próteses auditivas passaram por avaliação audiológica básica, verificação in situ (e consequente obtenção do Índice de Inteligibilidade de Fala - SII - para condições com e sem próteses auditivas) e pesquisa dos limiares de detecção para fonemas por meio do teste Ling-6(HL). RESULTADOS: O SII médio foi 25,1 sem próteses auditivas e 68,9 com amplificação (p <0,001*). Os limiares de detecção de fonemas em campo livre, em dBNA, foram, sem amplificação /m/=29,9, /u/=29,5, /a/=35,5, /i/=30,8, /∫/=44,2 e /s/=44,9, e com amplificação /m/=13,0, /u/=11,5 /a/=14,3, /i/=15,4, /∫/=20,4 e /s/=23,1 (p <0,001*). Houve correlação negativa entre SII e os limiares de todos os fonemas na condição sem próteses (p≤0,001*) e entre SII e o limiar do /s/ com próteses (p = 0,036*). CONCLUSÃO: Os limiares de detecção de todos os fonemas são menores do que na condição sem próteses. Há correlação negativa entre SII e os limiares de todos os fonemas na situação sem próteses e entre SII e o limiar de detecção do fonema /s/ na situação com próteses auditivas.

Effects of Task Demands on Neural Correlates of Acoustic and Semantic Processing in Challenging Listening Conditions.

Purpose Listeners shift their listening strategies between lower level acoustic information and higher level semantic information to prioritize maximum speech intelligibility in challenging listening conditions. Although increasing task demands via acoustic degradation modulates lexical-semantic processing, the neural mechanisms underlying different listening strategies are unclear. The current study examined the extent to which encoding of lower level acoustic cues is modulated by task demand and associations with lexical-semantic processes. Method Electroencephalography was acquired while participants listened to sentences in the presence of four-talker babble that contained either higher or lower probability final words. Task difficulty was modulated by time available to process responses. Cortical tracking of speech-neural correlates of acoustic temporal envelope processing-were estimated using temporal response functions. Results Task difficulty did not affect cortical tracking of temporal envelope of speech under challenging listening conditions. Neural indices of lexical-semantic processing (N400 amplitudes) were larger with increased task difficulty. No correlations were observed between the cortical tracking of temporal envelope of speech and lexical-semantic processes, even after controlling for the effect of individualized signal-to-noise ratios. Conclusions Cortical tracking of the temporal envelope of speech and semantic processing are differentially influenced by task difficulty. While increased task demands modulated higher level semantic processing, cortical tracking of the temporal envelope of speech may be influenced by task difficulty primarily when the demand is manipulated in terms of acoustic properties of the stimulus, consistent with an emerging perspective in speech perception.

Speech intelligibility in people with Amyotrophic Lateral Sclerosis (ALS). / Inteligibilidade de fala em pessoas com Esclerose Lateral Amiotrófica (ELA).

PURPOSE: To evaluate speech intelligibility and dysarthria, correlated to the functional assessment of Amyotrophic Lateral Sclerosis (ALS). METHODS: Quantitative-descriptive study approved by REC under No. CAAE 62912416.4.0000.5404, comprised of 19 individuals with sporadic or familiar ALS. Data were collected using the Dysarthria Protocol and the Revised Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS-Re). We used visual analogue scale (VAS) to assess speech intelligibility and summary measures; and Spearman's coefficients of correlation for the instruments with significance level of 5%. RESULTS: Speech intelligibility is compromised (41.37±39.73) in varied degrees with positive correlation with the general degree of dysarthria (p=<.0001), and with all the analyzed speech parameters, indicating impact on the speech deterioration of the studied group. There is negative correlation between speech intelligibility and the results of the bulbar sections - speech and deglutition (p=0.0166), arm - activities with the upper limb (p=0.0064) and leg - activities with the lower limb (p=0.0391). Breathing (p=0.0178), phonation (p=0.0334) and resonance (p=0.0053) parameters showed a negative correlation with the item "speech" of the ALSFRS-Re. CONCLUSION: Results show impaired speech intelligibility and dysarthria, and evidence breathing, phonation and resonance as important markers of the disease progression. A thorough and early evaluation of the oral motor production allows for a better management of alterations in ALS.

OBJETIVO: Avaliar a inteligibilidade de fala e disartria, correlacionando com a avaliação funcional da ELA. MÉTODO: Estudo quantitativo-descritivo aprovado pelo CEP, sob nº CAAE 62912416.4.0000.5404, constituído por 19 pessoas com ELA, esporádica ou familiar. Para coleta, aplicou-se o Protocolo de Disartria e Escala de Avaliação Funcional da Esclerose Lateral Amiotrófica (ALSFRS-Re). Para análise, foi utilizada escala visual analógica para inteligibilidade de fala e medidas de resumo e correlação dos instrumentos pelo Coeficiente de Spearman com nível de significância de 5%. RESULTADOS: A inteligibilidade de fala está comprometida (41,37±39,73) em graus variados com correlação positiva com o grau geral de disartria (p=<,0001) e com todos os parâmetros de fala analisados, indicando impacto na deterioração da fala do grupo estudado. Há correlação negativa entre inteligibilidade de fala e resultados das seções bulbar ­ fala e deglutição (p=0,0166), braço ­ atividades com membro superior (p=0,0064) e perna ­ atividades com membro inferior (p=0,0391). Os parâmetros de respiração (p=0,0178), fonação (p=0,0334) e ressonância (p=0,0053) apresentaram correlação negativa com o item "fala" do ALSFRS-Re. CONCLUSÃO: Os achados mostram prejuízo da inteligibilidade de fala e disartria e evidenciam respiração, fonação e ressonância como importantes marcadores da progressão da doença. Uma avaliação criteriosa e precoce da produção motora oral permite melhor gerenciamento das alterações na ELA.

Intelligibility in Context Scale: Sensitivity and specificity in the Jamaican context.

The present study investigated the sensitivity and specificity of the English Intelligibility in Context Scale (ICS) and the ICS-Jamaican Creole (ICS-JC) translation with bilingual preschool-aged Jamaican children. Participants in this study were 262 English-Jamaican Creole simultaneous bilingual children (aged 3;3 to 6;3, M = 4;11, SD = 7.8). The ICS and ICS-JC were administered to parents in auditory form, rather than written form. Although recent evidence has demonstrated the validity and reliability of the ICS as an assessment tool in various languages, further data are needed to determine diagnostic accuracy of the ICS and ICS-JC in Jamaican children. The sensitivity and specificity of both tools were high in this cohort of children, indicating that in the Jamaican context, these versions of the ICS could be used as screening tools to identify children who require further assessment of speech sound disorders. A cut-off score of 4.12 was used for both tools to achieve high sensitivity (0.84) and specificity (0.70) values for the ICS, as well as high sensitivity (0.84) and specificity (0.71) for the ICS-JC. The results of this study also demonstrate that administration of the auditory ICS is a valid way of collecting parent reports about children's speech intelligibility, which has implications for use of the ICS in languages with no written form or with parents who have a low level of literacy in the languages they use. This investigation is relevant not only to this underserved population but broadens knowledge of research-based tools for working with bilingual children.