Speech-language pathologists and audiologists are called to serve an increasingly diverse patient population in the United States. This increased diversity highlights the need for clinicians to be ...educated early in their careers about best practices to serve patients and clients from diverse backgrounds. In this clinical focus article, the authors present the development, implementation, and preliminary perceptions of a culturally responsive clinical experience for speech-language pathology graduate students designed to engage them early in their learning career.
The pilot program was based on pillars of experiential learning and community engagement. Graduate students attended trainings aligned with a model of culturally relevant care to prepare them to conduct speech and language screenings and small group language enrichment in English and Spanish.
Preliminary analyses of student reflections indicated themes of positive perceptions about the experience and provided preliminary support for students learning about working with culturally and linguistically diverse populations in an early, intentional, and focused experience.
Early personnel preparation to culturally responsive care is crucial to meet the needs of future caseloads. Further research into the effectiveness of this kind of program is necessary to identify which variables may have the most impact on a student's cultural sensitivity, awareness, knowledge, and skills.
Purpose: Patients with voice problems commonly report increased vocal effort, regardless of the underlying pathophysiology. Previous studies investigating vocal effort and voice production have used ...a range of methods to quantify vocal effort. The goals of the current study were to use the Borg CR100 effort scale to (a) demonstrate the relation between vocal intensity or vocal level (dB) and tasked vocal effort goals and (b) investigate the repeated measure reliability of vocal level at tasked effort level goals. Method: Three types of speech (automatic, read, and structured spontaneous) were elicited at four vocal effort level goals on the Borg CR100 scale (2, 13, 25, and 50) from 20 participants (10 females and 10 males). Results: Participants' vocal level reliably changed approximately 5 dB between the elicited effort level goals; this difference was statistically significant and repeatable. Biological females produced a voice with consistently less intensity for a vocal effort level goal compared to biological males. Conclusions: The results indicate the utility of the Borg CR100 in tracking effort in voice production that is repeatable with respect to vocal level (dB). Future research will investigate other metrics of voice production with the goal of understanding the mechanisms underlying vocal effort and the external environmental influences on the perception of vocal effort.
Purpose: Recent studies have shown that an acoustic measure, relative fundamental frequency (RFF), has potential for the assessment of excessive laryngeal tension and vocal effort associated with ...functional and neurological voice disorders. This study presents an analysis of the test-retest reliability of RFF in individuals with healthy voices and a comparison of reliability between RFF and conventional measures of voice. Method: Acoustic and aerodynamic measurements and Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) were performed on 28 individuals with healthy voices on 5 consecutive days. Participants produced RFF stimuli, a sustained /?/, and a reading passage to allow for extraction of acoustic measures and CAPE-V ratings; /pa/ trains were produced to allow for extraction of aerodynamic measures. Results: Moderate reliabilities (intraclass correlation coefficient ICC = 0.64-0.71) were found for RFF values. Mean vocal fundamental frequency, smoothed cepstral peak prominence, shimmer, harmonics-to-noise ratio, and mean airflow rate exhibited good-to-excellent reliabilities (ICC = 0.76-0.99). ICCs for jitter and phonation threshold pressure were moderately reliable (ICC = 0.67-0.74). ICCs for subglottal pressure estimates and all CAPE-V parameters showed poor reliabilities (ICC = 0.31-0.58). Conclusion: RFF has comparable reliability to conventional measures of voice. This expands the potential for clinical application of RFF.
Objective:
Music and speech are complex signals containing regularities in how they unfold in time. Similarities between music and speech/language in terms of their auditory features, rhythmic ...structure, and hierarchical structure have led to a large body of literature suggesting connections between the two domains. However, the precise underlying mechanisms behind this connection remain to be elucidated.
Method:
In this theoretical review article, we synthesize previous research and present a framework of potentially shared neural mechanisms for music and speech rhythm processing. We outline structural similarities of rhythmic signals in music and speech, synthesize prominent music and speech rhythm theories, discuss impaired timing in developmental speech and language disorders, and discuss music rhythm training as an additional, potentially effective therapeutic tool to enhance speech/language processing in these disorders.
Results:
We propose the processing rhythm in speech and music (PRISM) framework, which outlines three underlying mechanisms that appear to be shared across music and speech/language processing: Precise auditory processing, synchronization/entrainment of neural oscillations to external stimuli, and sensorimotor coupling. The goal of this framework is to inform directions for future research that integrate cognitive and biological evidence for relationships between rhythm processing in music and speech.
Conclusion:
The current framework can be used as a basis to investigate potential links between observed timing deficits in developmental disorders, impairments in the proposed mechanisms, and pathology-specific deficits which can be targeted in treatment and training supporting speech therapy outcomes. On these grounds, we propose future research directions and discuss implications of our framework.
Key Points
Question:
The current article investigates whether shared mechanisms underlying rhythm processing in music and speech can be used to better understand speech and language processing in developmental disorders and to develop programs for treatment.
Findings:
We propose a new framework suggesting three common mechanisms underlying music and speech rhythm processing: Precise auditory timing, synchronization/entrainment of neural oscillations to external rhythmic stimuli, and sensorimotor coupling.
Importance:
The identification of these underlying mechanisms allows for a more targeted approach to future research investigating music and speech rhythm processing in typically developing children/adults and those with developmental speech and language impairments.
Next Steps:
We outline a number of avenues for future research, including the need to incorporate multiple sources of evidence for the investigation of potential links between music and speech rhythm processing, and different approaches to apply the current framework to speech and language disorders.
Background
Electropalatography (EPG) records details of the location and timing of tongue contacts with the hard palate during speech. It has been effective in treating articulation disorders that ...have failed to respond to conventional therapy approaches but, until now, its use with children and adolescents with intellectual/learning disabilities and speech disorders has been limited.
Aims
To evaluate the usefulness of EPG in the treatment of speech production difficulties in children and adolescents with Down syndrome (DS) aged 8–18 years.
Methods & Procedures
A total of 27 children with DS were assessed on a range of cognitive and speech and language measures and underwent additional EPG assessment. Participants were randomly allocated to one of three age‐matched groups receiving either EPG therapy, EPG‐informed conventional therapy or ‘treatment as usual’ over a 12‐week period. The speech of all children was assessed before therapy using the Diagnostic Evaluation of Articulation and Phonology (DEAP) and reassessed immediately post‐ and 3 and 6 months post‐intervention to measure percentage consonants correct (PCC). EPG recordings were made of the DEAP assessment items at all time points. Per cent intelligibility was also calculated using the Children's Speech Intelligibility Measure (CSIM).
Outcomes & Results
Gains in accuracy of production immediately post‐therapy, as measured by PCC, were seen for all groups. Reassessment at 3 and 6 months post‐therapy revealed that those who had received therapy based directly on EPG visual feedback were more likely to maintain and improve on these gains compared with the other groups. Statistical testing showed significant differences between groups in DEAP scores across time points, although the majority did not survive post‐hoc evaluation. Intelligibility across time points, as measured by CSIM, was also highly variable within and between the three groups, but despite significant correlations between DEAP and CSIM at all time points, no statistically significant group differences emerged.
Conclusions & Implications
EPG was an effective intervention tool for improving speech production in many participants. This may be because it capitalizes on the relative strength of visual over auditory processing in this client group. The findings would seem to warrant an increased focus on addressing speech production difficulties in current therapy.
Purpose: This study examined the effects of lexical tone contour on the intelligibility of Mandarin sentences in quiet and in noise. Method: A text-to-speech synthesis engine was used to synthesize ...Mandarin sentences with each word carrying the original lexical tone, flat tone, or a tone randomly selected from the 4 Mandarin lexical tones. The synthesized speech signals were presented to 11 normal-hearing listeners for recognition in quiet and in speech-shaped noise at 0 dB signal-to-noise ratio. Results: Normal-hearing listeners nearly perfectly recognized the Mandarin sentences produced with modified tone contours in quiet; however, performance declined substantially in noise. Conclusions: Consistent with previous findings to some extent, the present findings suggest that lexical tones are relatively redundant cues for Mandarin sentence intelligibility in quiet and that other cues could compensate for the distorted lexical tone contour. However, in noise, the results provide direct evidence that lexical tone contour is important for the recognition of Mandarin sentences.
Purpose: Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease that affects bulbar functions including speech and voice. Voice onset time (VOT) was examined in speakers with ALS in early ...and late stages to explore the coordination of the articulatory and phonatory systems during speech production. Method: VOT was measured in nonword /bap/ produced by speakers with early-stage ALS (n = 11), late-stage ALS (n = 6), and healthy controls (n = 13), and compared with speech performance decline (a marker of disease progression) in ALS. Results: Overall comparison of the VOT values among the three groups showed a significant difference, F(2,27) = 11.71, p < 0.01. Speakers in late-stage ALS displayed longer voicing lead (negative VOT) than both healthy speakers and speakers in early-stage ALS. VOT was also significantly negatively correlated with speech performance (i.e., Intelligible Speaking Rate), r(15) = 0.74, p < 0.01. Conclusions: Speakers with more severe ALS showed greater occurrence of voicing lead and longer voicing lead. Findings show voicing precedes articulatory onset with disease progression in the production of bilabial stops, which suggests that the relative timing of coordination between the supralaryngeal structures and the phonatory system is affected in the late stage of ALS.
A growing body of research suggests that cases of speech sound errors that have not responded to previous intervention can sometimes be eliminated through speech therapy incorporating visual ...biofeedback. Aside from considerations related to the specific biofeedback type, acquisition and generalization of a motor plan may be linked to treatment intensity. Several researchers have raised the possibility that inadequate dosage levels may present a significant barrier to success. Thus, the current study aimed to assess the relationship between treatment intensity and treatment outcomes. Twenty-nine articles reporting the use of visual biofeedback intervention for speech sound disorder were identified and coded for treatment intensity using the cumulative intervention index and outcomes using mean level difference scores. Findings reveal small but significant relationships between measures of treatment intensity and efficacy, which should be interpreted with caution given the preliminary nature of this review. Further research in this area is necessary, as inconsistencies in reporting intensity and outcomes across studies underscore the need for more systematic terminology and reporting methods.
Purpose: The purpose of this study was to describe normative and validation data on the Intelligibility in Context Scale (ICS; McLeod, Harrison, & McCormack, 2012c) for English-speaking children. ...Method: The ICS is a 7-item, parent-report measure of children's speech intelligibility with a range of communicative partners. Data were collected from the parents of 803 Australian English-speaking children ranging in age from 4;0 (years;months) to 5;5 (37.0% were multilingual). Results: The mean ICS score was 4.4 (SD = 0.7) out of a possible total score of 5. Children's speech was reported to be most intelligible to their parents, followed by their immediate family, friends, and teachers; children's speech was least intelligible to strangers. The ICS had high internal consistency (alpha = 0.94). Significant differences in scores were identified on the basis of sex and age but not on the basis of socioeconomic status or the number of languages spoken. There were significant differences in scores between children whose parents had concerns about their child's speech (M = 3.9) and those who did not (M = 4.6). A sensitivity of 0.82 and a specificity of 0.58 were established as the optimal cutoff. Test-retest reliability and criterion validity were established for 184 children with a speech sound disorder. There was a significant low correlation between the ICS mean score and percentage of phonemes correct (r = 0.30), percentage of consonants correct (r = 0.24), and percentage of vowels correct (r = 0.30) on the Diagnostic Evaluation of Articulation and Phonology (Dodd, Hua, Crosbie, Holm, & Ozanne, 2002). Thirty-one parents completed the ICS related to English and another language spoken by their child with a speech sound disorder. The significant correlations between the scores suggest that the ICS may be robust between languages. Conclusions: This article provides normative ICS data for English-speaking children and additional validation of the psychometric properties of the ICS. The robustness of the ICS was suggested because mean ICS scores were not affected by socioeconomic status, number of languages spoken, or whether the ICS was completed in relation to English or another language. The ICS is recommended as a screening measure of children's speech intelligibility.
Objective
To describe the results of two reliability studies and to assess the effect of training on interrater reliability scores.
Design
The first study (1) examined interrater and intrarater ...reliability scores (weighted and unweighted kappas) and (2) compared interrater reliability scores before and after training on the use of the Cleft Audit Protocol for Speech–Augmented (CAPS-A) with British English-speaking children. The second study examined interrater and intrarater reliability on a modified version of the CAPS-A (CAPS-A Americleft Modification) with American and Canadian English-speaking children. Finally, comparisons were made between the interrater and intrarater reliability scores obtained for Study 1 and Study 2.
Participants
The participants were speech-language pathologists from the Americleft Speech Project.
Results
In Study 1, interrater reliability scores improved for 6 of the 13 parameters following training on the CAPS-A protocol. Comparison of the reliability results for the two studies indicated lower scores for Study 2 compared with Study 1. However, this appeared to be an artifact of the kappa statistic that occurred due to insufficient variability in the reliability samples for Study 2. When percent agreement scores were also calculated, the ratings appeared similar across Study 1 and Study 2.
Conclusion
The findings of this study suggested that improvements in interrater reliability could be obtained following a program of systematic training. However, improvements were not uniform across all parameters. Acceptable levels of reliability were achieved for those parameters most important for evaluation of velopharyngeal function.
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