Background: Oral senorimotor development is the basis for several vital functions for the child, hence orofacial dysfunction may be severely disabling. Recently, a comprehensive screening instrumen ...
PURPOSE To describe the types of talking tracheostomy tubes available, present four case studies of critically ill patients who used a specialized tracheostomy tube to improve speech, discuss their advantages and disadvantages, propose patient selection criteria, and provide practical recommendations for medical care providers. METHODS Retrospective chart review of patients who underwent tracheostomy in 2010. RESULTS Of the 220 patients who received a tracheostomy in 2010, 164 (74.55%) received a percutaneous tracheostomy and 56 (25.45%) received an open tracheostomy. Among the percutaneous tracheostomy patients, speech-language pathologists were consulted on 113 patients, 74 of whom were on a ventilator. Four of these 74 patients received a talking tracheostomy tube, and all four were able to speak successfully while on the mechanical ventilator even though they were unable to tolerate cuff deflation. CONCLUSIONS Talking tracheostomy tubes allow patients who are unable to tolerate-cuff deflation to achieve phonation. Our experience with talking tracheostomy tubes suggests that clinicians should consider their use for patients who cannot tolerate cuff deflation.
Cochlear implants (CI) have demonstrated success in improving young deaf children's speech and low-level speech awareness across a range of auditory functions, but this success is highly variable, and how this success correlates to high-level language development is even more variable. Prevalence on the success rate of CI as an outcome for language development is difficult to obtain because studies vary widely in methodology and variables of interest, and because not all cochlear implant technology (which continues to evolve) is the same. Still, even if the notion of treatment failure is limited narrowly to those who gain no auditory benefit from CI in that they cannot discriminate among ambient noises, the reported treatment failure rate is high enough to call into question the current lack of consideration of alternative approaches to ensure young deaf children's language development. Recent research has highlighted the risks of delaying language input during critical periods of brain development with concomitant consequences for cognitive and social skills. As a result, we propose that before, during, and after implantation deaf children learn a sign language along with a spoken language to ensure their maximal language development and optimal long-term developmental outcomes.
The present study examined pausing patterns in spontaneous speech as a measure of the effect of deep brain stimulation (DBS) of the subthalamic nucleus (STN) on parkinsonian speech. Pauses reflect various aspects of speech and language processes, including motor initiation and linguistic planning. Relatively little attention has been given to pauses in determining the effect of STN-DBS. An examination of pausing may be helpful to understanding how this form of therapy affects these behaviors. Seven individuals with Parkinson's disease who received surgery for bilateral STN-DBS participated. Spontaneous speech samples were elicited in both the ON and OFF STN-DBS condition. Findings indicated that long pauses (250-3000 ms) in spontaneous speech were significantly shorter and more frequent in the STN-DBS ON condition. Furthermore, the proportion of nonlinguistic boundary pauses was significantly greater with stimulation. The findings support previous studies suggesting that speech motor control and lexical retrieval may be affected by STN-DBS.
This case describes the course of a patient who was admitted to an acute care hospital with pneumonia and odynophagia and found to have severe, idiopathic oropharyngeal dysphagia. The assessment, treatment, and outcome are reported alongside suggestions for best practice in the treatment of dysphagia in hospital settings. Timely instrumental assessment, interdisciplinary management, and post-discharge follow-up were needed to provide optimum care and to achieve a positive outcome for this patient with life-threatening dysphagia.
BACKGROUND:A systematic review of the use of stroboscopy as a treatment outcome measure of vocal fold function in patients treated for laryngeal cancer is presented.METHODS:Computerized literature searches were performed. Eligible articles were admitted when stroboscopy was used to measure vocal fold function before and after treatment in patients with laryngeal cancer. Data extracted included: tumor stage and location, treatment modality, stroboscopy parameters, parameter scale, number of raters, rater reliability, methodology, and level of evidence.RESULTS:Of 520 articles retrieved, 11 studies met inclusion criteria. A total of twenty-four parameters were reported. Rating scales and rater reliability varied.DISCUSSION:Major methodological differences exist in studies using stroboscopic findings as voice outcome measures in patients' post-cancer treatment. These differences lead to equivocal findings when assessing the utility of stroboscopy as an outcome measure. Standardized, reliable scoring and reporting systems for laryngeal stroboscopic examinations are needed.
PURPOSE:The goal of this exploratory study was to investigate longitudinally the changes in facial kinematics, vowel formant frequencies, and speech intelligibility in individuals diagnosed with bulbar amyotrophic lateral sclerosis (ALS). This study was motivated by the need to understand articulatory and acoustic changes with disease progression and their subsequent effect on deterioration of speech in ALS.METHOD:Lip and jaw movements and vowel acoustics were obtained for four individuals with bulbar ALS during four consecutive recording sessions with an average interval of three months between recordings. Participants read target words embedded into sentences at a comfortable speaking rate. Maximum vertical and horizontal mouth opening and maximum jaw displacements were obtained during corner vowels. First and second formant frequencies were measured for each vowel. Speech intelligibility and speaking rate score were obtained for each session as well.RESULTS:Transient, non-vowel-specific changes in kinematics of the jaw and lips were observed. Kinematic changes often preceded changes in vowel acoustics and speech intelligibility.CONCLUSIONS:Nonlinear changes in speech kinematics should be considered in evaluation of the disease effects on jaw and lip musculature. Kinematic measures might be most suitable for early detection of changes associated with bulbar ALS.
In Parkinson's Disease (PD), qualitative speech changes such as decreased variation in pitch and loudness are common, but quantitative vocal changes are not well documented. The variability of fundamental frequency (F0) in 32 individuals (23 male) with PD both ON and OFF levodopa medication was compared with 32 age-matched healthy controls (23 male). Participants read a single paragraph and estimates of fundamental frequency (F0) variability were determined for the entire reading passage as well as for the first and last sentences of the passage separately. F0 variability was significantly increased in controls relative to both PD groups and PD patients showed significantly higher F0 variability while ON medication relative to OFF. No significant effect of group was seen in the change in F0 variability from the beginning to the end of the reading passage. Female speakers were found to have higher F0 variability than males. F0 variability was both significantly reduced in PD relative to controls and significantly increased in patients with PD during use of dopaminergic medications. F0 variability changes over the course of reading a paragraph may not be indicative of PD but rather dependent on non-disease factors such as the linguistic characteristics of the text.
features of apraxia of speech (AOS) include phoneme distortions and dysprosody. Descriptions of dysprosody have focused on lexical stress, specifically equalization of stress across syllables within words. However, lexical stress is a feature of stress-timed languages such as English but not syllable-timed languages such as French. This study aimed to make an acoustic comparison of lexical stress production in healthy and apraxic speakers of Australian English or French to ask whether measures of lexical stress are useful for AOS diagnosis cross-linguistically. Eight French (four AOS speakers and four control participants) and 18 Australian English (nine AOS speakers and nine control participants) speakers were recorded repeating 40 two and three syllable words that, in English, receive first or second syllable stress. All words occurred in both languages (e.g., habitat). The pairwise variability index (PVI) of vowel duration was used to quantify degree of variation across syllables within words. For each of the four word types, the AOS groups had lower PVI values than the control participants. Overall, AOS speakers had mean PVI values closer to zero than the control participants. Both control and AOS French speakers had PVI values closer to zero than that of Australian control participants. In conclusion, AOS speakers in both languages demonstrated signs of dysprosody at the lexical level with difficulty controlling relative vowel duration.
BACKGROUND:Initial shortening of stem vowels in three-word derivational paradigms (e.g., zip, zipper, zippering) was studied in persons with Parkinson's disease (PWPD) with and without deep brain stimulation (DBS), and in normal speakers.METHOD:Seven PWPD without DBS, 7 PWPD with DBS ON (DBSN) or OFF (DBSF), and 6 healthy control (CON) persons were studied. Stimuli were 7 three-word paradigms consisting of a stem word and two derived longer forms created by adding the suffixes er (+1), and er+ing (+2).RESULTS:Vowel durations decreased across word forms of increasing length (initial shortening) for DBSF, DBSN, PWPD, and CON. Vowel shortening did not interact with group. For each word form, CON vowel duration was shorter than those for PWPD, DBSN and DBSF but word duration did not differ between groups. DBS did not have a significant effect on either vowel or word duration.CONCLUSION:These results agree with previous findings for a PWPD with accelerated speech and faster rates of speech in DBS-ON. Observations that vowel duration patterns are maintained in subcortical and cerebellar but not left hemisphere damage suggest that cortical control factors play a primary role in relational timing.
Exaggerated and redundant prosodic cue use has been noted among adults with dysarthria secondary to cerebral palsy (CP) (Patel, 2004; van Doorn & Sheard, 2001). A possible explanation may be that speakers heighten prosodic contrasts to increase intelligibility. The current work examined whether children with dysarthria due to CP also produce exaggerated prosodic contours and if so, how prosodic cue use in these speakers impacts intelligibility. Acoustic analyses were conducted on a previously collected dataset of 2-7 word utterances produced by fourteen children with CP (7 with dysarthria and 7 without) (Hustad, Gorton & Lee, 2010). The dataset also included sentence-level transcriptions obtained from five listeners per speaker. Word intelligibility scores were derived from these transcripts and used to determine whether prosodic modulation differed for words with high versus low intelligibility. Although mean fundamental frequency (F0) and intensity range were similar across groups, words produced by children with dysarthria were slower and more variable in F0 than the group without dysarthria. Moreover, intelligibility decreased when children with dysarthria increased F0 and duration beyond the range used by children without dysarthria. Thus findings suggest that interventions targeting appropriate prosody may be beneficial in improving intelligibility in children with dysarthria and CP.
PURPOSE:We investigated the contribution of vowel space, articulation rate, maximum utterance length, and language skills to intelligibility in 30-36 month old children with CP. We also examined differences among variables for 3 subgroups of children with CP and a small group of typically developing (TD) children.METHOD:Nineteen children with CP and 5 TD children provided speech samples, and 120 listeners transcribed the speech samples. Acoustic analysis of temporal and vowel spectral measures was completed on single-word productions.RESULTS:Vowel space was the only variable that made a significant and independent contribution to intelligibility, though all variables collectively accounted for 74% of the variance in intelligibility scores. TD children tended to have larger vowel spaces, than children with CP, even among children with CP who had intelligibility scores within the range of TD children.CONCLUSIONS:Of children with CP who were able to talk at 30-36 months of age, 60% had clinical speech or language deficits. Production of vowels appears to make an important contribution to intelligibility; and for many children with CP, considerable deficits in intelligibility may be evident by the age of 3. Early interventions targeting both speech and language may improve intelligibility and functional communication skills.
Background: The purpose of this single-subject study was to investigate if phonologic placement treatment seated in spontaneous discourse would improve phonetic accuracy and increase intelligibility in an individual with postencephalitic parkinsonism resulting in apraxia of speech. Methods: The participant was a 60-year-old male with postencephalitic parkinsonism, oral and speech apraxia, and dysarthria. A single-subject ABAB design using pre- and posttesting and repeated measurement of phonemes during baseline and treatment was used. Phonological and visual supports were embedded within conversational discourse related to current events. Data were analyzed using visual inspection and effect sizes. Results: Results showed a treatment effect for all targeted phonemes as well as posttest measures of overall intelligibility. Assessment of Intelligibility of Dysarthric Speech scores rose from 0% to 24% intelligible at the single word level. Large effect sizes were found for all target phonemes, /b/ (d = 2.89), /m/ (d = 4.76), In (d = 1.18) and /n/ (d = 1.94). Conclusions: A phonologically based treatment embedded in discourse was effective in facilitating basic verbal communication in a previously nonverbal individual.
Understanding the clinical relationship of otolaryngology and speech-language pathology is important in optimizing care for people with voice and swallowing disorders. Previous surveys of otolaryngologists addressed such areas as treatment of benign vocal fold lesions, acute and chronic vocal nodules in both children and adults, and diagnostic use of videostroboscopy. There have been no such surveys investigating dysphagia. A 20-item questionnaire was mailed to 498 otolaryngologists within five states in the southeastern United States regarding clinical practice and perceptions. A 20.8% response rate was obtained. Descriptive data are presented with regard to both their preferred methods of managing dysphonia and dysphagia and their perceptions of speech-language pathology services for these disorders. Specific suggestions are offered to speech-language pathologists (SLPs) based on the survey data collected.
Relationships between direct measures of intelligibility obtained from word identification and several segmental and word measures of speech sound accuracy obtained from phonetic transcription were examined to determine which measure of speech sound accuracy was the best predictor of speech intelligibility scores. Measures were based on audio recordings of Test of Children's Speech Plus (TOCS+) imitated word and sentence samples (Hodge, Daniels, & Gotzke, 2009) obtained from 12 children with dysarthria and cerebral palsy. Phonetic transcription incorporated a subset of diacritics from the extIPA that could be transcribed with acceptable reliability. Percent consonants correct (PCC) had the strongest correlation with intelligibility scores for the word samples (r = 0.53), and PCC and PCC revised had the strongest correlation for the sentence samples (r = 0.93). Although PCC rank ordered the children in a very similar way to the intelligibility scores on the TOCS+ sentence recordings, the magnitude of the difference between PCC and intelligibility scores varied substantially by severity of speech disorder, with the greatest difference for children with the lowest intelligibility scores. No phonetic measure provided a stable estimate of intelligibility scores on a child-by-child basis for the severity range of children studied.
Apraxia of speech (AOS) is an acquired motor speech disorder characterized by difficulty producing speech sounds caused by deficits in motor planning. Various tools exist to examine the physiologic aspects of articulation. Unfortunately, very few physiologic studies of AOS have been conducted. Electropalatography (EPG) is one method for examining the tongue's role in articulation by measuring tongue-to-palate contact. However, there is limited research examining the articulatory changes that are attributable to repeated exposure with wearing the pseudopalate as well as desensitization to the pseudopalate. The purpose of this investigation was to examine the impact of repeated measurement using EPG with and without desensitization. Three speakers with AOS and three with normal speech production participated in this study. Stimuli were composed of vowel consonant vowel nonsense words with four stop consonants /t, d, k, g/. Data were collected on three sampling occasions with a period of desensitization after the initial sampling occasion. EPG data analyses included maximal contact and variability index to compare performance across time and between populations. Overall, speakers with AOS exhibited greater variability for both measures compared with normal speakers. Findings indicate that desensitization did not result in any obvious changes in EPG measures on subsequent sampling occasions.
Compromised speech intelligibility often is a consequence of hypokinetic dysarthria associated with Parkinson's disease (PD) (Adams, Dykstra, Jenkins, & Jog, 2008). A relatively unexplored area of research is the evaluation of conversational intelligibility in speakers with hypophonia as a primary speech symptom. Evidence suggests that hypophonia may be most evident during conversational speech tasks (Adams, Dykstra, Abrams, Winnell, Jenkins, & Jog, 2006a). This study evaluated the impact of background noise on the conversational speech intelligibility of control participants and those with hypophonia associated with PD. Thirty individuals with hypophonia and PD and 15 healthy control participants participated in conversation with various levels of background noise. Results revealed nonsignificant differences between groups when conversational intelligibility was assessed in a no background noise condition. Significant results were found when conversational intelligibility was assessed in the presence of three intensity levels of background noise. The results of this study demonstrate that participants with hypophonia have significant deficits in conversational speech intelligibility even in relatively low levels of background noise. Furthermore, deficits in speech intelligibility are exacerbated with increasing levels of background noise. Assessing speech intelligibility using conversational speech tasks that are obtained in different levels of background noise appears to provide an ecologically valid estimate of intelligibility and may be a useful indicator of the disability associated with hypophonia in PD.
The primary aim of this investigation was to determine rate-related changes in tongue movement in dysarthric talkers after traumatic brain injury (TBI). Participants produced target consonants /t/ and /k/ embedded in syllable and sentence repetitions at typical as well as fast speaking rates. Tongue movement distance, velocity, acceleration, and deceleration were measured during the approach and release phases of target consonant production in the two rate conditions. Healthy talkers were observed to truncate tongue movements for syllable repetitions at a fast speaking rate. On the other hand, individuals with TBI modified the kinematic parameters associated with tongue movement speed. Task-based differences were evident across groups with the healthy talkers making rate-related changes only during syllable repetitions and the TBI group displaying alterations to tongue movement speed for both sentence and syllable tasks. Truncating articulatory gestures for syllable repetitions may reflect a speaker-selected strategy to economize effort. An increase in acceleration, deceleration, and velocity may reflect a strategy by dysarthric talkers to increase articulatory effort and avoid articulatory undershoot.
This study compared data obtained from throat and head microphone evaluations of conversational speech intensity in a group of 17 individuals with hypophonia caused by Parkinson's disease (PD) and 14 control participants. The two microphones were connected to a personal digital assistant (PDA) system that recorded the participants'. conversational speech intensity during five randomly presented levels of multi-talker background noise (50, 55, 60, 65, and 70 dB SPL). Both the throat and head microphone data were associated with a significant increase in speech intensity with increases in the intensity of the background noise. In contrast, only the head microphone data were associated with a significant difference between reduced intensity of the PD participants and higher intensity of the control participants. A linear regression analysis comparing the throat and head data found a significant difference between the slope values for the PD and control participants. It is proposed that these slope results may be related to differences in how the PD and control participants used the size of mouth opening to modulate speech intensity. In general, the results of this study suggest that for conversations that are recorded in various levels of background noise, a head microphone placed close to the mouth may be a more sensitive instrument for measuring hypophonia in PD than a throat microphone.
