Purpose The gold standard for diagnosing childhood apraxia of speech (CAS) is expert judgment of perceptual features. The aim of this study was to identify a set of objective measures that differen...

Differential Diagnosis of Children with Suspected Childhood Apraxia of Speech

Tabby Talks

Purpose: A systematic search and review of published studies was conducted on the use of automated speech analysis (ASA) tools for analysing and modifying speech of typically-developing children learning a foreign language and children with speech sound disorders to determine (i) types, attributes, and purposes of ASA tools being used; (ii) accuracy against human judgment; and (iii) performance as therapeutic tools.Method: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were applied. Across nine databases, 32 articles published between January 2007 and December 2016 met inclusion criteria: (i) focussed on children’s speech; (ii) tools used for speech analysis or modification; and (iii) reporting quantitative data on accuracy.Result: Eighteen ASA tools were identified. These met the clinical threshold of 80% agreement with human judgment when used as predictors of intelligibility, impairment severity, or error category. Tool accuracy was typically <80% accurac...

Automated speech analysis tools for children's speech production: A systematic literature review.

Purpose: To assist in remote treatment, speech-language pathologists (SLPs) rely on mobile games, which though entertaining, lack feedback mechanisms. Games integrated with automatic speech recognition (ASR) offer a solution where speech productions control gameplay. We therefore performed a feasibility study to assess children's and SLPs' experiences towards speech-controlled games, game feature preferences and ASR accuracy. Method: Ten children with childhood apraxia of speech (CAS), six typically developing (TD) children and seven SLPs trialled five games and answered questionnaires. Researchers also compared the results of ASR to perceptual judgment. Result: Children and SLPs found speech-controlled games interesting and fun, despite ASR-human disagreements. They preferred games with rewards, challenge and multiple difficulty levels. Automatic speech recognition-human agreement was higher for SLPs than children, similar between TD and CAS and unaffected by CAS severity (77% TD, 75% CAS - incorrect; 51% TD, 47% CAS, 71% SLP - correct). Manual stop recording yielded higher agreement than automatic. Word length did not influence agreement. Conclusion: Children's and SLPs' positive responses towards speech-controlled games suggest that they can engage children in higher intensity practice. Our findings can guide future improvements to the ASR, recording methods and game features to improve the user experience and therapy adherence.

Speech-driven mobile games for speech therapy: User experiences and feasibility

Purpose Despite having distinct etiologies, acquired apraxia of speech (AOS) and childhood apraxia of speech (CAS) share the same central diagnostic challenge (i.e., isolating markers specific to an impairment in speech motor planning/programming). The purpose of this review was to evaluate and compare the state of the evidence on approaches to differential diagnosis for AOS and CAS and to identify gaps in each literature that could provide directions for future research aimed to improve clinical diagnosis of these disorders. Method We conducted a scoping review of literature published between 1997 and 2019, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. For both AOS and CAS, literature was charted and summarized around four main methodological approaches to diagnosis: speech symptoms, quantitative speech measures, impaired linguistic-motor processes, and neuroimaging. Results Results showed that similar methodological approaches have been used to study differential diagnosis of apraxia of speech in adults and children; however, the specific measures that have received the most research attention differ between AOS and CAS. Several promising candidate markers for AOS and CAS have been identified; however, few studies report metrics that can be used to assess their diagnostic accuracy. Conclusions Over the past two decades, there has been a proliferation of research identifying potential diagnostic markers of AOS and CAS. In order to improve clinical diagnosis of AOS and CAS, there is a need for studies testing the diagnostic accuracy of multiple candidate markers, better control over language impairment comorbidity, more inclusion of speech-disordered control groups, and an increased focus on translational work moving toward clinical implementation of promising measures.

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Differential Diagnosis of Apraxia of Speech in Children and Adults: A Scoping Review

We present a multi-tier system for the remote administration of speech therapy to children with apraxia of speech. The system uses a client-server architecture model and facilitates task-oriented remote therapeutic training in both in-home and clinical settings. Namely, the system allows a speech therapist to remotely assign speech production exercises to each child through a web interface, and the child to practice these exercises on a mobile device. The mobile app records the child's utterances and streams them to a back-end server for automated scoring by a speech-analysis engine. The therapist can then review the individual recordings and the automated scores through a web interface, provide feedback to the child, and adapt the training program as needed. We validated the system through a pilot study with children diagnosed with apraxia of speech, and their parents and speech therapists. Here we describe the overall client-server architecture, middleware tools used to build the system, the speech-analysis tools for automatic scoring of recorded utterances, and results from the pilot study. Our results support the feasibility of the system as a complement to traditional face-to-face therapy through the use of mobile tools and automated speech analysis algorithms.

Architecture of an automated therapy tool for childhood apraxia of speech

This paper introduces a pronunciation verification method to be used in an automatic assessment therapy tool of child disordered speech. The proposed method creates a phonebased search lattice that is flexible enough to cover all probable mispronunciations. This allows us to verify the correctness of the pronunciation and detect the incorrect phonemes produced by the child. We compare between two different acoustic models, the conventional GMM-HMM and the hybrid DNN-HMM. Results show that the hybrid DNNHMM outperforms the conventional GMM-HMM for all experiments on both normal and disordered speech. The total correctness accuracy of the system at the phoneme level is above 85% when used with disordered speech.

A Comparison of GMM-HMM and DNN-HMM Based Pronunciation Verification Techniques for Use in the Assessment of Childhood Apraxia of Speech

We present a multitier system for the remote administration of speech therapy to children with apraxia of speech. The system uses a client-server architecture model and facilitates task-oriented remote therapeutic training in both in-home and clinical settings. The system allows a speech language pathologist (SLP) to remotely assign speech production exercises to each child through a web interface and the child to practice these exercises in the form of a game on a mobile device. The mobile app records the child's utterances and streams them to a back-end server for automated scoring by a speech-analysis engine. The SLP can then review the individual recordings and the automated scores through a web interface, provide feedback to the child, and adapt the training program as needed. We have validated the system through a pilot study with children diagnosed with apraxia of speech, their parents, and SLPs. Here, we describe the overall client-server architecture, middleware tools used to build the system, speech-analysis tools for automatic scoring of utterances, and present results from a clinical study. Our results support the feasibility of the system as a complement to traditional face-to-face therapy through the use of mobile tools and automated speech analysis algorithms.

Development of a Remote Therapy Tool for Childhood Apraxia of Speech

There is continuing debate about the origins of productive morphological errors in children with speech sound disorders. This is the case for children with theorised phonetic and motor disorders, s...

Jacqueline McKechnie

Papers

Tabby Talks

Architecture of an automated therapy tool for childhood apraxia of speech

A Comparison of GMM-HMM and DNN-HMM Based Pronunciation Verification Techniques for Use in the Assessment of Childhood Apraxia of Speech

Development of a Remote Therapy Tool for Childhood Apraxia of Speech

Comorbid morphological disorder apparent in some children aged 4-5 years with childhood apraxia of speech: findings from standardised testing.