Changes in variability during intervention for childhood apraxia of speech: implications for therapy.

Typically developing children are variable in their speech production with decreasing variability indicating mastery of speech. Excessive variability which does not change over time may be an indication of unstable motor plans as often seen in children with childhood apraxia of speech (CAS). Dynamic Systems Theory (DST) provides a framework for understanding the role of variability in speech development and disorder. There are few studies that explore the impact of therapy on speech variability. This work explores the impact of therapy on perceptual speech production variability. It is a post-hoc analysis of data collected in two intervention studies of a motor-based treatment approach with children with CAS and explores DST variability effects in speech skill acquisition based on the case data from those studies. There were six participants in total across the two studies. Findings were mixed showing some non-linear changes in variability with larger changes in variability observed in participants who engaged in more extensive therapy. However, the pattern of variability change was not consistent across the participants. These findings suggest that targeting variability in therapy may be an effective way to improve the speech of children with CAS. A model for utilising variability in therapy is presented.

Acoustic characteristics of fricatives, amplitude of formants and clarity of speech produced without and with a medical mask.

BACKGROUND: Previous research has found that high-frequency energy of speech signals decreased while wearing face masks. However, no study has examined the specific spectral characteristics of fricative consonants and vowels and the perception of clarity of speech in mask wearing. AIMS: To investigate acoustic-phonetic characteristics of fricative consonants and vowels and auditory perceptual rating of clarity of speech produced with and without wearing a face mask. METHODS & PROCEDURES: A total of 16 healthcare workers read the Rainbow Passage using modal phonation in three conditions: without a face mask, with a standard surgical mask and with a KN95 mask (China GB2626-2006, a medical respirator with higher barrier level than the standard surgical mask). Speech samples were acoustically analysed for root mean square (RMS) amplitude (ARMS ) and spectral moments of four fricatives /f/, /s/, /ʃ/ and /z/; and amplitude of the first three formants (A1, A2 and A3) measured from the reading passage and extracted vowels. Auditory perception of speech clarity was performed. Data were compared across mask and non-mask conditions using linear mixed models. OUTCOMES & RESULTS: The ARMS of all included fricatives was significantly lower in surgical mask and KN95 mask compared with non-mask condition. Centre of gravity of /f/ decreased in both surgical and KN95 mask while other spectral moments did not show systematic significant linear trends across mask conditions. None of the formant amplitude measures was statistically different across conditions. Speech clarity was significantly poorer in both surgical and KN95 mask conditions. CONCLUSIONS & IMPLICATIONS: Speech produced while wearing either a surgical mask or KN95 mask was associated with decreased fricative amplitude and poorer speech clarity. WHAT THIS PAPER ADDS: What is already known on the subject Previous studies have shown that the overall spectral levels in high frequency ranges and intelligibility are decreased for speech produced with a face mask. It is unclear how different types of the speech signals that is, fricatives and vowels are presented in speech produced with wearing either a medical surgical or KN95 mask. It is also unclear whether ratings of speech clarity are similar for speech produced with these face masks. What this paper adds to existing knowledge Speech data collected using a real-world, clinical and non-laboratory-controlled settings showed differences in the amplitude of fricatives and speech clarity ratings between non-mask and mask-wearing conditions. Formant amplitude did not show significant differences in mask-wearing conditions compared with non-mask. What are the potential or actual clinical implications of this work? Wearing a surgical mask or a KN95 mask had different effects on consonants and vowels. It appeared from the findings in this study that these masks only affected fricative consonants and did not affect vowel production. The poorer speech clarity in these mask-wearing conditions has important implications for speech perception in communication between clinical staff and between medical officers and patients in clinics, and between people in everyday situations. The impact of these masks on speech perception may be more pronounced in people with hearing impairment and communication disorders. In voice evaluation and/or therapy sessions, the effects of wearing a medical mask can occur bidirectionally for both the clinician and the patient. The patient may find it more challenging to understand the speech conveyed by the clinician while the clinician may not perceptually assess patient's speech and voice accurately. Given the significant correlation between clarity ratings and fricative amplitude, improving fricative signals would be useful to improve speech clarity while wearing these medical face masks.

Outcomes of semantic feature analysis treatment for aphasia with and without apraxia of speech.

BACKGROUND: To date, studies have not explored whether a dual diagnosis of aphasia plus apraxia of speech (AOS) versus aphasia alone (APH) affects the response to language-based naming treatments. AIMS: To compare the effects of semantic feature analysis (SFA) treatment for individuals with APH versus aphasia plus AOS, and to test if the presence of AOS impacted the effects of treatment. METHODS AND PROCEDURES: A non-randomized experimental group study was conducted to explore the treatment, generalization and maintenance effects between the AOS and APH groups. Participants included nine individuals with aphasia and 11 with concomitant aphasia and AOS. Dependent measures included lexical accuracy, number of sound-level distortions, and lexical stress and syllable segmentation errors. OUTCOMES AND RESULTS: Both groups showed significantly improved naming accuracy of trained items for up to 2 months post-treatment. Improvement on naming accuracy of untrained items post-treatment, both semantically related and unrelated to trained items, was lower in magnitude. That this may have been due to effects of repeated probing (which included target repetition) or regression to the mean cannot be excluded. There was a tendency for the AOS group to respond slightly better to treatment than the APH group overall, which was not correlated with aphasia severity. Also, measures of phonetic accuracy and fluency improved for both groups, with no main effect of group. Treatment effects did not generalize to formal measures of (untrained) picture naming or expression of correct information units in discourse in a story retelling task. CONCLUSIONS AND IMPLICATIONS: Findings indicate that individuals with aphasia plus AOS can gain equivalent benefits in word retrieval and production from the language-based SFA treatment as individuals with aphasia alone. This may be, in part, due to the tendency for SFA to incorporate principles of practice that are known to support motor learning in AOS, such as high intensity, random stimulus presentation and variable practice. Findings provide further support for high-intensity practice and use of self-generated features to facilitate maintenance of effects. What this paper adds What is already known on the subject SFA treatment is the most common intervention for word-finding difficulties for individuals with aphasia. AOS is a common concomitant disorder to aphasia. However, it is not clear whether the effects of language-based SFA treatment are mitigated by the presence of AOS, which tends to respond well to treatments focused on articulatory-kinematic aspects of speech movement. What this paper adds to the existing knowledge This study compares the effects of SFA in a group of individuals with aphasia alone and a group with similar severity of aphasia but with concomitant AOS, ranging from mild to moderate-severe. Overall, AOS did not have a negative effect on response to the treatment. What are the potential or actual clinical implications of this work? Individuals with aphasia plus AOS can be expected to benefit to a similar degree from SFA as people with aphasia alone. It is likely that the use of practice principles of high intensity, random stimulus presentation and varied practice are important components of the protocol.

Academic achievement and productivity losses associated with speech, language and communication needs.

BACKGROUND: Childhood speech, language and communication needs (SLCN) impose a significant burden on individuals, families and society. There are explicit costs related to increased health utilization and expenditure. Additionally, there may be indirect costs associated with a child's employment prospects in the long term because of the child's low literacy and numeracy, which in turn affects adult labour force participation (LFP). Several reviews have identified that there is paucity of published evidence on the costs of SLCN. Motivated by broad policy implications, and the lack of prior research in this area, this paper calculates the indirect costs and workplace productivity losses of children with SLCN. AIMS: To estimate the indirect costs of SLCN associated with a child's reduced long-term productivity. METHODS & PROCEDURES: Using 12 years of data from a longitudinal study of Australian children, we employed a panel fixed-effects model to estimate academic achievement at 14-15 years of age. Using these estimates, we employed a human capital approach (HCA) to estimate the projected LFP for children with SLCN, measured by workforce participation and foregone wages. LFP is estimated by extrapolating a child's academic achievement at 14-15 years of age to adulthood outcomes. OUTCOMES & RESULTS: The results showed that a 1 SD (standard deviation) decrease in SLCN is equivalent to 0.19 (95% confidence interval (CI) = 0.09, 0.30) SD decrease in academic achievement at 14-15 years, 0.79% (95% CI = 0.37, 1.21) decrease in work participation and A$453 (95% CI = A$207, A$674) per annum in lost wages. The average work participation penalty across all level of SLCN (-3, -2, -1) is A$628 (95% CI = A$236, A$894) per person per year. Based on the prevalence of 8.3% from our sample, this equates to lifetime costs of A$21.677 billion (US$14.28 billion, €13.08 billion, £11.66 billion) for children with SLCN in Australia. Speech pathology treatment appears to have a positive impact on work participation and wages. On average A$355 (95% CI = A$346, A$355) per person per year could be saved through treatment or identification (the difference in lost wages for children with and without speech pathology treatment at each SLCN level (-1, -2 ,-3) calculated as a weighted average). This equates to lifetime savings of A$5.22 billion (US$3.44 billion, €3.15 billion, £2.81 billion) for children with SLCN in Australia. CONCLUSIONS & IMPLICATIONS: Overall, the findings showed that SLCN are associated with increased indirect costs through reduced workforce participation. The evidence from this study can be used to inform policies on the societal costs of SLCN. What this paper adds What is already known on this subject Childhood SLCN impose significant burden on individuals, families and society. There are explicit costs related to increased health utilization and expenditure. Additionally, there may be indirect costs associated with a child's employment prospects in the long term because of the child's low literacy and numeracy, which in turn affects adult LFP. Several reviews have identified that there is paucity of published evidence on the costs of SLCN. Motivated by broad policy implications, and the lack of prior research in this area, this paper calculates the indirect costs and workplace productivity losses of children with SLCN. What this paper adds to existing knowledge This study estimates the academic achievement and indirect costs of SLCN associated with a child's reduced long-term productivity. Using 12 years of data from a longitudinal study of Australian children, we employed a panel fixed-effects model to estimate academic achievement at 14-15 years of age. Using these estimates, we used a human capital approach to estimate the projected LFP for children with SLCN, measured by workforce participation and foregone wages. LFP is estimated by extrapolating a child's academic achievement at 14-15 years of age to adulthood outcomes. What are the potential or actual clinical implications of this work? SLCN are associated with increased indirect costs through reduced workforce participation. The evidence from this study provides one of the first indirect cost estimates of how SLCN impacts LFP through educational achievement. Early identification, intervention and screening for SLCN may be useful offsets to reduce the economic effects identified here.

A framework to support the development of quality simulation-based learning programmes in speech-language pathology.

BACKGROUND: Simulation-based learning provides students with a safe learning environment, guaranteed exposure to specific clinical scenarios and patients, time for reflection and repetition of tasks, and an opportunity to receive feedback from multiple sources. Research including studies specific to allied health training programmes have demonstrated that simulation-based learning also helps increase learners' confidence and reduces anxiety related to clinical environments, activities and skills. Such evidence, together with increasing challenges in provision of workplace clinical education, has supported an expansion of integrating simulation-based learning into university curricula. AIMS: To provide detailed information about the processes and considerations involved in the development of a simulation-based learning programme for speech-language pathology. METHODS & PROCEDURES: Through reflection on the development process of a 5-day simulation-based learning programme, and in light of existing research in simulation, this paper outlines the important steps and considerations required for the development of a simulation-based learning programme to support student competency development in adult speech pathology range of practice areas. MAIN CONTRIBUTION: A proposed framework for the development of future simulation-based learning programmes in speech-language pathology. CONCLUSIONS & IMPLICATIONS: The framework can be applied to simulation-based learning for university programmes and/or workplace training in speech-language pathology and across several other health disciplines.

Protocol for the Connected Speech Transcription of Children with Speech Disorders: An Example from Childhood Apraxia of Speech.

OBJECTIVE: While it is known that connected speech has different features to single-word speech, there are currently few recommendations regarding connected speech transcription. This research therefore aimed to develop a clinically feasible protocol for connected speech transcription. The protocol was then used to assist with description of the connected speech of children with childhood apraxia of speech (CAS), as little is known about their connected speech characteristics. PARTICIPANTS AND METHODS: Following a literature review, the Connected Speech Transcription Protocol (CoST-P) was iteratively developed and trialled. The CoST-P was then used to transcribe 50 connected utterances produced by 12 children (aged 6-13 years) with CAS. The characteristics of participants' connected speech were analysed to capture independent and relational analyses. RESULTS: The CoST-P was developed, trialled, and determined to have adequate reliability and fidelity. The frequency of inter-word segregation (mean = 29) was higher than intra-word segregation (mean = 4). Juncture accuracy was correlated with intelligibility metrics such as percentage of consonants correct. CONCLUSION: Connected speech transcription is challenging. The CoST-P may be a useful resource for speech-language pathologists and clinical researchers. Use of the CoST-P assisted in displaying CAS speech characteristics unique to connected speech (e.g., inter-word segregation and juncture).

Look at Mummy: challenges in training parents to deliver a home treatment program for childhood apraxia of speech in a rural Canadian community.

INTRODUCTION: Children requiring speech pathology services in rural and remote locations face many barriers in accessing adequate services. This has particular consequences for children who need intensive treatment for therapy to be effective, such those with childhood apraxia of speech (CAS). Parent training has been used to overcome speech pathology service delivery barriers for a range of other communication disorders. However, the effectiveness of training parents to deliver a motor-based treatment for CAS within rural and remote contexts has not been evaluated. This study examined the effectiveness and feasibility of training parents in a rural community to use the treatment approach of dynamic temporal and tactile cueing (DTTC) in order to provide more intensive treatment sessions at home. METHODS: The study used an experimental single case across behaviours design and parent interviews to evaluate outcomes both quantitatively and qualitatively. The study included four parent-child dyads from a mixed socioeconomic rural community in Canada. Child participants ranged in age from 3 years to 8 years. Child treatment outcomes were measured using an improvement rate difference (IRD) calculation based on percentage of phonemes correct. Fidelity to the treatment protocol was measured using a fidelity score. RESULTS: All parents reported challenges in carrying out the program due to social and behavioural challenges. Parents also reported benefits such as being able to spend more time with their child and learning some useful cueing techniques. Only one of the four participants had a moderate effect size for his target words (IRD=57%). CONCLUSION: While training parents to deliver DTTC may be effective for some parent-child dyads, clinicians are advised that parent training may not be suitable for all families, and parents in rural and remote communities may face particular social circumstances that make following through with an intensive treatment program difficult.

Clinical predictors for oropharyngeal dysphagia and laryngeal dysfunction after lung and heart transplantation.

BACKGROUND: Oropharyngeal dysphagia and laryngeal dysfunction are two lesser known complications after lung and heart transplantation. The presence of these features places this immunocompromised population at high risk of pulmonary complications and subsequent medical deterioration. Early identification of swallowing and voice dysfunction would be beneficial to optimize management. AIMS: To examine the association between patient risk factors and postoperative outcomes with referral to speech pathology (SP) following signs of swallowing and voice dysfunction. METHODS & PROCEDURES: A retrospective review was conducted on demographic data, patient risk factors and postoperative course in 284 patients following lung and/or heart transplantation between 2010 and 2013. Variables were analysed for any association between pre- and postoperative factors and SP referral. OUTCOMES & RESULTS: A total of 24% were referred to SP with a mean age of 47 years. Binary logistic regression identified a statistically significant association between the number of intubations (odds ratio (OR) = 2.066, p = 0.028), intubation duration (OR = 1.004, p < 0.01), length of stay in the intensive care unit (ICU) (OR = 1.068, p < 0.01), and number of ICU admissions (OR = 1.384, p = 0.046) and SP referral. Intubation time and the total days in ICU were greater for patients referred to SP. Mortality also increased for these variables and for the numbers of reintubations and readmissions. Analysis of pre-operative risk factors revealed cerebrovascular disease to be a significant predictor of SP referral (OR = 6.747, p = 0.032). CONCLUSIONS & IMPLICATIONS: This study demonstrates significant clinical indicators for referral to SP for the management of oropharyngeal dysphagia and laryngeal dysfunction in patients after lung or heart transplantation. Further studies are needed to investigate the most efficacious intervention approaches to manage swallowing and voice dysfunction in these patients.

Tongue shapes for rhotics in school-age children with and without residual speech errors.

Speakers of North American English use variable tongue shapes for rhotic sounds. However, quantifying tongue shapes for rhotics can be challenging, and little is known about how tongue shape complexity corresponds to perceptual ratings of rhotic accuracy in children with residual speech sound errors (RSE). In this study, 16 children aged 9-16 with RSE and 14 children with typical speech (TS) development made multiple productions of 'Let Robby cross Church Street'. Midsagittal ultrasound images were collected once for children with TS and twice for children in the RSE group (once after 7 h of speech therapy, then again after another 7 h of therapy). Tongue contours for the rhotics in the four words were traced and quantified using a new metric of tongue shape complexity: the number of inflections. Rhotics were also scored for accuracy by four listeners. During the first assessment, children with RSE had fewer tongue inflections than children with TS. Following 7 h of therapy, there were increases in the number of inflections for the RSE group, with the cluster items cross and Street reaching tongue complexity levels of those with TS. Ratings of rhotic accuracy were correlated with the number of inflections. Therefore, the number of inflections in the tongue, an index of tongue shape complexity, was associated with perceived accuracy of rhotic productions.

The boundaries of auditory perception for within-word syllable segregation in untrained and trained adult listeners.

Syllable segregation is among the core diagnostic features of both childhood apraxia of speech and acquired apraxia of speech; however, little is known about the limen of perception of syllable segregation. The purpose of this research was therefore to explore adult listeners' auditory perception of within-word syllable segregation in trained and untrained adult listeners. Two experimental design studies, each with two phases, were conducted. Study one included 40 untrained listeners (aged 18-28 years), and study two included 5 trained listeners (10-25 years of experience). Recorded audio samples of multisyllabic non-words were manipulated to insert gaps of increasing length to simulate syllable segregation. All stimuli were anchored against an unaltered control sample. In each phase, 32 stimuli were randomly presented twice in a free-field listening task with listeners making Yes/No decisions to record their perception of segregation. At a 90% accuracy threshold, the untrained listeners' limen was 90ms, while the trained listeners' was 85ms. At an 80% accuracy threshold, both sets of listeners had a limen of 80ms. Overall, there were no significant differences in accuracy between the two listening groups. Gap duration was positively correlated with accurate perception across both studies. Both groups demonstrated good intra-rater reliability and excellent inter-rater reliability, with no significant differences between the untrained and trained listeners. These findings have implications for developing a standardised criteria for rating syllable segregation in clinical contexts. No evidence was found for the hypothesis that training makes a difference in listeners' accuracy or reliability when rating syllable segregation.

Telehealth delivery of Rapid Syllable Transitions (ReST) treatment for childhood apraxia of speech.

BACKGROUND: Rapid Syllable Transitions (ReST) treatment uses pseudo-word targets with varying lexical stress to target simultaneously articulation, prosodic accuracy and coarticulatory transitions in childhood apraxia of speech (CAS). The treatment is efficacious for the acquisition of imitated pseudo-words, and generalization of skill to untreated pseudo-words and real words. Despite the growing popularity of telehealth as a method of service delivery, there is no research into the efficacy of telehealth treatments for CAS. Telehealth service delivery is associated with compromised audio and visual signal transmission that may affect the efficacy of treatment. AIMS: To conduct a phase 1 efficacy study of telehealth delivery of ReST treatment for CAS, and to discuss the efficacy with reference to face-to-face ReST treatment. METHODS & PROCEDURES: Using a multiple baseline across participants design, five children aged 5-11 years with CAS received ReST treatment four times a week for 3 weeks via video conferencing with Adobe Connect. The children's ability to imitate new pseudo-words, generalize the skills to untreated pseudo-words and real word items, and maintain the skills following treatment were assessed. Both visual and statistical analyses were utilized. OUTCOMES & RESULTS: All five children significantly improved with their production of the imitated treated pseudo-word items and significantly generalized to similar untreated pseudo-words and real words. Additionally, two of the children showed significant generalization to imitated phrases with the treatment items. Four of the children maintained their treatment gains up to 4 months post-treatment. Telehealth delivery produced similar acquisition of pseudo-words and generalization to untreated behaviours as face-to-face delivery; however, in the 4 months following treatment, the children showed stable rather than improving speech skills. The intra- and inter-judge reliability was similar in telehealth delivery for face-to-face delivery. Caregivers and clinicians were satisfied with the telehealth treatment. CONCLUSIONS & IMPLICATIONS: This phase 1 study provides promising indications of the efficacy of ReST treatment when delivered four times per week via telehealth, and warrants further large-scale investigation.

Using ultrasound visual feedback to remediate velar fronting in preschool children: A pilot study.

Anecdotally, velar fronting can be difficult to remediate in some children. This pilot study examined the use of ultrasound visual feedback in remediating velar fronting in typically developing children. A single-case, multiple-baseline across-subjects experimental design was used to examine acquisition, retention and generalisation of velar treatment targets. Two otherwise typically developing children (P1, aged 4;0; P3, aged 4;11) completed the study. The productions of /k/ and /É¡/ at syllable level were targeted during treatment. P1 improved her productions of /k/ and /É¡/ at syllable level during the treatment period and achieved correct production at word level during follow-up. P3 made no improvements in his productions of velar targets. This study suggests that ultrasound visual feedback may be an option for remediating velar fronting in some preschoolers. Further study is required.

Limited acquisition and generalisation of rhotics with ultrasound visual feedback in childhood apraxia.

Ultrasound visual feedback of the tongue is one treatment option for individuals with persisting speech sound errors. This study evaluated children's performance during acquisition and generalisation of American English rhotics using ultrasound feedback. Three children aged 10-13 with persisting speech sound errors associated with childhood apraxia of speech (CAS) were treated for 14 one-hour sessions. Two of the participants increased the accuracy of their rhotic production during practise trials within treatment sessions, but none demonstrated generalisation to untreated words. Lack of generalisation may be due to a failure to acquire the target with sufficient accuracy during treatment, or to co-existing linguistic weaknesses that are not addressed in a motor-based treatment. Results suggest a need to refine the intervention procedures for CAS and/or a need to identify appropriate candidates for intervention to optimise learning.

The Effect of Clinician Feedback Type on the Acquisition of a Vocal Siren.

OBJECTIVE: To compare the effects of different types of clinician feedback (auditory knowledge of performance, KP, kinaesthetic KP and knowledge of results, KR) on the production of a voice task during acquisition. KP conditions directed attention to auditory or kinaesthetic cues. KR feedback was provided as to how close the speaker's production was to a model. PATIENTS AND METHODS: A factorial multivariate 3 × 8 design was used. Thirty-six females were randomly assigned to 3 different feedback groups and trained in the production of a vocal siren. The production of sirens was measured by variants of vocal intensity, cepstral peak prominence, phonation time and pitch phase compliance. RESULTS: All groups showed significant improvement over time in measures of vocal intensity, timing of pitch change and phonation time. The KP group (auditory and kinaesthetic combined) showed significantly more improvement over time in vocal intensity than the KR group. The kinaesthetic KP group maintained better control of vocal clarity across attempts while reducing vocal intensity than the auditory KP group. CONCLUSION: Optimal feedback paradigms during acquisition may be different depending on the parameters of voicing being trained. Learners may benefit from KP feedback to control intensity, and kinaesthetic cues to control vocal clarity.

A single case experimental design study using an operationalised version of the Kaufman Speech to Language Protocol for children with childhood apraxia of speech.

PURPOSE: A Phase I study was conducted to examine the treatment effectiveness of the Kaufman Speech to Language Protocol using a research-operationalised protocol. It was hypothesised that articulatory accuracy would improve as a result of the treatment and that these improvements would be maintained after treatment was discontinued. METHOD: A single case experimental design was used to evaluate the effectiveness of the Kaufman Speech to Language Protocol. Four children with a confirmed childhood apraxia of speech diagnosis were included in this study. Each child received 12 individual 1 hr treatment sessions that each consisted of an approximation setting phase and a practice phase. Probe data was collected during treatment and at post-treatment time points to measure treatment effectiveness and to measure changes in the untreated words. Untreated (control) sounds were included to test whether recorded improvements in articulatory accuracy could be attributed to the Kaufman Speech to Language Protocol. RESULT: Two of the four children demonstrated a response to the intervention and maintenance of these changes, while the two remaining children demonstrated some generalisation in the absence of improved target (treatment) words. No specific child factors were clearly associated with positive treatment outcomes. CONCLUSION: This study replicated the findings of an earlier pilot study and found that the operationalised protocol for the Kaufman Speech to Language Protocol is effective in improving articulatory accuracy for some children with childhood apraxia of speech. Additional replication with a further refined treatment protocol and a larger sample size is needed to support a recommendation of clinical use of the Kaufman Speech to Language Protocol.

A systematic scoping review of the literacy skills of children with childhood apraxia of speech: Recommendations for best practice and further research.

PURPOSE: Little is known about the literacy skills of children with childhood apraxia of speech (CAS) or effective methods for teaching them to read. This systematic scoping review aimed to synthesise what is known about this issue. METHOD: Nine databases were searched to identify relevant articles. Included articles were categorised by study design, quality, and confidence of CAS diagnosis. RESULT: Twenty-three articles were included, 17 described literacy skills of children with CAS and six trialled literacy interventions. Children with CAS had early skills deficits that manifest as literacy difficulties in the later school years and beyond. They frequently had poorer outcomes compared with both typical readers and children with other speech disorders. Both the extent of literacy impairment and responsiveness to intervention appear to be related to the severity of speech impairment. Four literacy interventions for children with CAS were identified. CONCLUSIONS: Children with CAS are at high risk of literacy difficulty and may require early literacy intervention to help them attain academic success. Further research is warranted to determine the longer-term literacy outcomes of children with CAS, appropriate means of assessment, and whether a systematic synthetic phonics approach is an effective form of literacy instruction for this population.

The mycovirus CHV1 disrupts secretion of a developmentally regulated protein in Cryphonectria parasitica.

Infection of the chestnut blight fungus Cryphonectria parasitica with Cryphonectria hypovirus 1 (CHV1) causes disruption of virulence, pigmentation, and sporulation. Transcriptional downregulation of key developmentally regulated fungal genes occurs during infection, but vegetative growth is unaffected. Previous studies showed that CHV1 utilizes trans-Golgi network (TGN) secretory vesicles for replication. In this study, the fungal cell surface hydrophobin cryparin was chosen as a marker to follow secretion in virally infected and noninfected strains. Subcellular fractionation, cryparin-green fluorescent protein (GFP) fusion, and Western blot studies confirmed that vesicles containing cryparin copurify with the same fractions previously shown to contain elements of the viral replication complex and the TGN resident endoprotease Kex2. This vesicle fraction accumulated to a much greater concentration in the CHV1-infected strains than in noninfected strains. Pulse-chase analysis showed that the rates and amount of cryparin being secreted by the CHV1 containing strains was much lower than in noninfected strains, and the dwell time of cryparin within the cell after labeling was significantly greater in the CHV1-infected strains than in the noninfected ones. These results suggest that the virus perturbs a specific late TGN secretory pathway resulting in buildup of a key protein important for fungal development.

The reliability of methodological ratings for speechBITE using the PEDro-P scale.

BACKGROUND: speechBITE (http://www.speechbite.com) is an online database established in order to help speech and language therapists gain faster access to relevant research that can used in clinical decision-making. In addition to containing more than 3000 journal references, the database also provides methodological ratings on the PEDro-P (an adapted version of the PEDro) scale to assist clinicians in identifying the scientific quality of randomized (RCTs) and non-randomized control trials (NRCTs). While reliability of the PEDro scale has been established by similar allied health databases, the reliability of the PEDro-P scale has yet to be reported. AIMS: To examine the reliability of PEDro-P scale ratings undertaken by raters on the speechBITE database and benchmark these results to the published reliability for the original PEDro scale. Both the total score (out of ten) as well as each of the 11 scale items were included in this analysis. METHODS & PROCEDURES: speechBITE's volunteer rater network of 17 members rated the first 100 RCTs and NRCTs on the website. The criterion and overall scores for these ratings were compared with previously published reliability studies using the PEDro scale. Intra-class correlations and per cent agreement measures were used to establish and benchmark reliability. OUTCOMES & RESULTS: The speechBITE PEDro-P ratings ranged from fair to excellent for both the total score and for each of the 11 scale items. Furthermore, reliability was equal to that of other databases. CONCLUSIONS & IMPLICATIONS: speechBITE users can be confident of the reliability of ratings published on the website. Further analysis of differences between this study and previous PEDro scale reliability studies are discussed.

"I still have issues with pronunciation of words": A mixed methods investigation of the psychosocial and speech effects of Childhood Apraxia of Speech in adults.

PURPOSE: Adolescents with Childhood Apraxia of Speech (CAS) are likely to have persistent speech errors compared to non-CAS peers (Lewis et al., 2018) and may have ongoing psychosocial issues (e.g. Carrigg, Parry, Baker, Shriberg, & Ballard, 2016). Beyond this, little is known about the long-term consequences of CAS in adulthood. This study explored whether adults who were reported to have had CAS as children have ongoing psychosocial or speech impacts. METHOD: A cross-sectional descriptive design, with mixed-method analyses of demographic, psychosocial, and speech data was used. Data were collected via a four-part online survey. Part one consisted of questions about demographic information and participants' self-reported performance in speech, language and literacy. Parts two and three investigated the psychosocial impacts of CAS using the Brief Fear of Negative Evaluation Scale - Revised (BFNE- R) and The State-Trait Anxiety Inventory (STAI). Part four collected single word and connected speech data via an online audio recording, which was then transcribed following the Connected Speech Transcription Protocol (CoST-P). Analyses of speech characteristics reported in CAS was completed using Phon software. RESULT: There were 17 participants in part one, 16 in parts two and three, and six in part four. Participants reported elevated levels of state (p = 0.01) and trait (p = 0.0001) anxiety compared to normative data. Ongoing segmental and suprasegmental speech errors were observed, with a significant difference between percent phonemes correct in single words versus connected speech (p = 0.03). Participants who provided a speech sample had difficulty with correct stress, use of juncture, and had increased intra- and inter-word segregation. Participants with better speech reported less anxiety. CONCLUSION: Psychosocial effects and speech characteristics associated with CAS in childhood appear to persist into adulthood. Confirmation of these results and research to determine treatment and psychosocial support needs past early childhood is warranted.

A survey of interventions used by speech-language pathologists for children with speech sound disorders in the Middle East.

PURPOSE: While many examples of speech pathology intervention approaches for children with speech sound disorders (SSDs) exist in English and some other European languages, approaches with children in other languages are largely unknown. The aim was to determine current speech-language pathologists (SLPs) intervention practices with children with SSDs in the ME, and to then compare these with international practices. METHODS: Data were collected by online questionnaire using Qualtrics. One hundred and eighty-nine SLPs completed the survey. Participants were required to be Arabic first language speaking SLPs practicing in the ME (e.g. Kuwait, Saudi Arabia, UAE, and Egypt), working with children with SSDs. RESULTS: The respondents reported a frequent use of phonological awareness, traditional articulation therapy, auditory discrimination, minimal pairs, and whole language therapy approaches in the treatment of children with SSDs, like their counterparts in Australia, the USA, UK, and Portugal. Gaps between research recommendations for evidence-based practice and actual clinical practice are identified, and discussed. CONCLUSIONS: Future research should investigate the efficacy of speech-therapy approaches to improve service delivery for Arabic-speaking children with SSDs in the ME.