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Comprehensibility of Dysarthric Speech
Abstract and Figures
This paper describes the concept of comprehensibility and how it is an important construct in the assessment and treatment of dysarthric speech. Intelligibility and comprehensibility are differentiated in terms of their definition, measurement, and approaches to treatment. Specifically, comprehensibility is defined within the World Health Organization model of chronic disease as a factor in disability affecting speech performance in physical and/or social contexts. The literature related to comprehensibility of dysarthric speech is reviewed. Clinical approaches to improving comprehensibility, including issues of candidacy, intervention planning, and treatment approaches, are discussed.
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... A compreensibilidade incorpora informação independente do sinal acústico, tal como a sintaxe, a semântica, gestos, suplementação alfabética e o contexto físico que facilitem, assim, a estimativa da adequação da comunicação na performance (desempenho), em contextos naturais(Yorkston et al., 1996). ...
O presente capítulo pretende abordar a temática da traqueostomia e das suas implicações nas funções da comunicação e deglutição e, por consequência, refletir acerca da intervenção do terapeuta da fala com a pessoa traqueostomizada. Recorrendo a uma revisão bibliográfica, composta por vários artigos publicados nos últimos 20 anos, realiza-se uma incursão teórica sobre esta temática, incidindo sobre as bases essenciais do conhecimento profissional do terapeuta da fala que inicia o seu trabalho com esta casuística. Nesta perspetiva serão abordadas questões tais como: traqueostomia e tipos de cânulas/equipamento acessório; impacto neurofisiológico da traqueostomia nas funções de fonação, respiração e deglutição e respetivas possibilidades terapêuticas e abordagens ao processo de descanulação. Não serão elencadas as temáticas relativas à área da pediatria, ventilação mecânica invasiva, assim como o procedimento de traqueostomia coadjuvante à exérese da laringe (laringectomia total), COVID 19 ou doenças neuromusculares progressivas.
Purpose
This study investigated the effects of the SPEAK OUT! & LOUD Crowd therapy program on speaking rate, percent pause time, intelligibility, naturalness, and communicative participation in individuals with Parkinson's disease (PD).
Method
Six adults with PD completed 12 individual SPEAK OUT! sessions across four consecutive weeks followed by group-based LOUD Crowd sessions for five consecutive weeks. Most therapy sessions were conducted via telehealth, with two participants completing the SPEAK OUT! portion in person. Speech samples were recorded at six time points: three baseline time points prior to SPEAK OUT!, two post–SPEAK OUT! time points, and one post–LOUD Crowd time point. Acoustic measures of speaking rate and percent pause time and listener ratings of speech intelligibility and naturalness were obtained for each time point. Participant self-ratings of communicative participation were also collected at pre- and posttreatment time points.
Results
Results showed significant improvement in communicative participation scores at a group level following completion of the SPEAK OUT! & LOUD Crowd treatment program. Two participants showed a significant decrease in speaking rate and increase in percent pause time following treatment. Changes in intelligibility and naturalness were not statistically significant.
Conclusions
These findings provide preliminary support for the effectiveness of the SPEAK OUT! & LOUD Crowd treatment program in improving communicative participation for people with mild-to-moderate hypokinetic dysarthria secondary to PD. This study is also the first to demonstrate positive effects of this treatment program for people receiving the therapy via telehealth.
We examine the provision of elective pronunciation services, such as intelligibility enhancement, to non-native speakers by speech language pathologists (SLPs). Practices associated with the 'modification' of non-native accent raise significant professionalism questions about bias for SLPs and healthcare professionals. These questions arise partly due to the socio-cultural context in which SLPs practice and their clients live, and the relational nature of communication. We argue that due to the ambiguity inherent in accent modification practices, SLPs must weigh a variety of considerations before determining the circumstances in which such services are professionally acceptable. Our argument is rooted in consideration of the complex nature of professionalism related to communication. After surveying potentially relevant models from other healthcare professions and finding them wanting, we support our position in light of current literature on topics such as accounts of functionality. We conclude by generalizing our anti-bias recommendations to interprofessional healthcare professionalism.
Purpose:
To investigate whether a novel electropalatography (EPG) therapy, underpinned by usage-based phonology theory, can improve the accuracy of target speech sounds for school-aged children and adults with persistent speech sound disorder (SSD) secondary to cleft palate +/- lip.
Method:
Six consecutively treated participants (7-27 years) with long-standing speech disorders associated with cleft palate enrolled in a multiple baseline (ABA) within-participant case series. The usage-based EPG therapy technique involved high-volume production of words. Speech was assessed on three baselines prior to therapy, during weekly therapy, at completion of therapy, and 3 months post-therapy. Percent correct of target phonemes in untreated words and continuously connected speech were assessed through acoustic phonetic transcription. Intra- and inter-transcriber agreement was determined.
Result:
Large to medium treatment effect sizes were shown for all participants following therapy (15-33 sessions). Percentage of targets correct for untreated words improved from near 0% pre-therapy, to near 100% for most target sounds post-therapy. Generalisation of target sounds to spontaneous connected speech occurred for all participants and ranged from 78.95-100% (M = 90.66; SD = 10.14) 3 months post-therapy.
Conclusion:
Clinically significant speech change occurred for all participants following therapy. Response to the novel therapeutic technique is encouraging and further research is indicated.
This is the document which associate professors must write in France to apply for full professor jobs. I wrote it in English. It reads a little like a PhD, or rather an extended multi-chapter literature review, except one has to include one's own research projects, papers, etc. wherever relevant.
This version is the corrected final version after the viva (minus the typing errors).
Few studies have investigated how individuals with partially intelligible speech choose to communicate, including how, when, and why they might use a speech-generating device (SGD). This study aimed to add to the literature by exploring how this group of individuals use different communication strategies. Qualitative interviews were carried out with 10 participants with partially intelligible speech with the aim of investigating participants' perceptions of modes of communication and communication strategies. Transcripts were analyzed using Framework Analysis to investigate the role of SGDs alongside other communication strategies. Factors that influence why, when, and how a person chooses to communicate were identified and these were interpreted as an explanatory model of communication with partially intelligible speech. Participants described how they made the decision whether to attempt to communicate at all and then which communication method to use. Decision-making was influenced by the importance of the message, how much time is available, past experience, and the communication partner. Each communication attempt adds to an individuals' experience of communicating and influences subsequent decisions. This study suggests that individuals with partially intelligible speech are at risk of reduced communication environments and networks and that current SGDs may not be designed in a way that recognizes their particular needs.
Purpose
This study assessed the intelligibility of obstruent consonants in prelingually deafened Mandarin-speaking children with cochlear implants (CIs).
Method
Twenty-two Mandarin-speaking children with normal hearing (NH) aged 3.25–10.0 years and 35 Mandarin-speaking children with CIs aged 3.77–15.0 years were recruited to produce a list of Mandarin words composed of 17 word-initial obstruent consonants in different vowel contexts. The children with CIs were assigned to chronological age–matched (CA) and hearing age–matched (HA) subgroups with reference to the NH controls. One hundred naïve NH adult listeners were recruited for a consonant identification task that consisted of a total of 2,663 stimulus tokens through an online research platform. For each child speaker, the consonant productions were judged by seven to 12 different adult listeners. An average percentage of consonants correct was calculated across all listeners for each consonant.
Results
The CI children in both the CA and HA subgroups showed lower intelligibility in their consonant productions than the NH controls. Among the 17 obstruents, both CI subgroups showed higher intelligibility for stops, but they demonstrated major problems with the sibilant fricatives and affricates and showed a different confusion pattern from the NH controls on these sibilants. Of the three places (alveolar, alveolopalatal, and retroflex) in Mandarin sibilants, both CI subgroups showed the lowest intelligibility and the greatest difficulties with alveolar sounds. For the NH children, there was a significant positive relationship between overall consonant intelligibility and chronological age. For the children with CIs, the best fit regression model revealed significant effects of chronological age and age at implantation, with their quadratic terms included.
Conclusions
Mandarin-speaking children with CIs experience major challenges in the three-way place contrasts of sibilant sounds in consonant production. Chronological age and the combined effect of CI-related time variables play important roles in the development of obstruent consonants in the CI children.
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.
Purpose:
This study investigated the effects of three clear speech variants on sentence intelligibility and speaking effort for speakers with Parkinson's disease (PD) and age- and sex-matched neurologically healthy controls.
Method:
Fourteen speakers with PD and 14 neurologically healthy speakers participated. Each speaker was recorded reading 18 sentences from the Speech Intelligibility Test in their habitual speaking style and for three clear speech variants: clear (SC; given instructions to speak clearly), hearing impaired (HI; given instructions to speak with someone with a hearing impairment), and overenunciate (OE; given instructions to overenunciate each word). Speakers rated the amount of physical and mental effort exerted during each speaking condition using visual analog scales (averaged to yield a metric of overall speaking effort). Sentence productions were orthographically transcribed by 50 naive listeners. Linear mixed-effects models were used to compare intelligibility and speaking effort across the clear speech variants.
Results:
Intelligibility was reduced for the PD group in comparison to the control group only in the habitual condition. All clear speech variants significantly improved intelligibility above habitual levels for the PD group, with OE maximizing intelligibility, followed by the SC and HI conditions. Both groups rated speaking effort to be significantly higher for both the OE and HI conditions versus the SC and habitual conditions.
Discussion:
For speakers with PD, all clear speech variants increased intelligibility to a level comparable to that of healthy controls. All clear speech variants were also associated with higher levels of speaking effort than habitual speech for the speakers with PD. Clinically, findings suggest that clear speech training programs consider using the instruction "overenunciate" for maximizing intelligibility. Future research is needed to identify if high levels of speaking effort elicited by the clear speech variants affect long-term sustainability of the intelligibility benefit.
Purpose:
This study examines the efficacy of perceptual training for improving typical listeners' identification of vowels produced by individuals with dysarthria. We examined whether training on a subset of vowels can generalize to (a) untrained vowels and (b) other speakers with similar overall intelligibility.
Method:
Sixty naive listeners completed a pretest/posttest perceptual learning task. In the pretraining test and posttraining test, participants identified nine American English monophthongs produced by two speakers with dysarthria secondary to amyotrophic lateral sclerosis (ALS). In the 20-min training task, a two-alternative forced choice (2AFC) task with feedback trained listeners on a subset of the vowels and speakers presented in the pretraining test.
Results:
Vowel identification accuracy improved overall as a function of training. However, patterns of generalization between speakers and vowel types were not symmetric. Specifically, listeners generalized training from front vowels to back vowels but not vice versa. Likewise, listeners generalized from one speaker to another but not in the opposite direction. Examination of confusion matrices for the pretraining and posttraining revealed complex patterns of vowel-specific improvement.
Conclusions:
This study demonstrates that listeners benefit from a very simple training paradigm targeting vowels. Additionally, error patterns revealed that vowels are both resistant to and responsive to perceptual learning. Implications for future research and clinical training paradigms are discussed.
descriptions are included for 19 procedures that have been, or could be, used to assess the intelligibility of pediatric subjects. Most procedures can be placed in one of the following categories, depending on the emphasis of the analysis: phonetic contrast analysis, phonological process analysis, word identification tests, phonetic indices derived from continuous speech scoring, scaling of continuous speech, and traditional word-level analysis of continuous speech. The general discussion includes an examination of the major issues to be considered in intelligibility testing and a set of criteria to be applied in test selection.
The abstract for this document is available on CSA Illumina.To view the Abstract, click the Abstract button above the document title.
Using the mutuality model as a framework, the present research project investigates the influence of syntactic and semantic context on the speech intelligibility of dysarthric speakers. Recordings were made of eight flaccid dysarthric individuals reading words and sentences from the Speech Perception in Noise (SPIN) Test. Ninety-six inexperienced listeners orthographically transcribed the recordings under four conditions: word transcription-no semantic context; word transcription with semantic context; sentence transcription-no semantic context; and sentence transcription with semantic context. A three-way ANOVA with a nested factor was used to analyze the data. The results revealed significant gains in the speech intelligibility scores of the dysarthric speakers when listeners were presented syntactic and semantic context cues. Significant interactions between semantic context and syntactic context, and syntactic context and severity of dysarthria were also recorded. The additive effects of combining both syntactic and semantic context predicted by the mutuality model were not confirmed. These results suggest that the speech intelligibility of flaccid dysarthric speakers can be significantly improved, in light of a distorted signal, by increasing listener knowledge through syntactic and semantic context. Speech intelligibility tasks that take these factors into account may provide a more realistic measure of overall functional communication.
The purpose of this study was to investigate the utility of a measure of communication efficacy, one that explicitly encompasses features of both speech and language. Toward this end the construct of comprehensibility, which has been used in the field of second-language acquisition, was adapted. Comprehensibility, operationally defined as the extent to which a listener understands utterances produced by a speaker in a communication context, was studied in relation to various dimensions of communication efficacy. Four observers evaluated the comprehensibility of utterances produced by 41 deaf young adults, using a nine-point rating scale. The reliability of the comprehensibility ratings was determined, and the ratings were studied in relation to independent assessments of the subjects' speech intelligibility, English language proficiency, speech recognition, reading comprehension, and hearing loss. The results of this investigation indicate that comprehensibility can be evaluated reliably and that comprehensibility is associated with both speech intelligibility and language proficiency. The implications of these findings for the clinical assessment of speech and language are discussed.
Ensuring effective use of communication and participation in life for adults with aphasia in their natural settings may require broader and more extensive interventions than previously envisioned or actively managed by speechlanguage pathologists. Acquired brain damage unquestionably diminishes the extent to which adults with aphasia make use of communication and participation in daily life. But optimal management of aphasia extends beyond an anatomic-physiologic basis of dysfunction or even concentrated efforts to remediate linguistic or communication disabilities. Past failures to achieve a solution to this problem may be more because of what is absent from aphasia treatment than the improper or incomplete repair or management of what currently is treated. Treatment may require inclusion and active integration of a means of managing the psychosocial handicap of the aphasia. However, with an expanded scope to aphasia treatment, the methods of inquiry must be equally appropriate for discerning pertinent facts about optimal functioning of adults with aphasia in natural settings. This topic, the epistemology of the problem, is the subject of a forthcoming publication.