Showing papers in "Folia Phoniatrica Et Logopaedica in 2021"

Evaluation of an Automatic Speech Recognition Platform for Dysarthric Speech

Abstract: Introduction The use of commercially available automatic speech recognition (ASR) software is challenged when dysarthria accompanies a physical disability. To overcome this issue, a mobile and personal speech assistant (mPASS) platform was developed, using a speaker-dependent ASR software. Objective The aim of this study was to evaluate the performance of the proposed platform and to compare mPASS recognition accuracy to a commercial speaker-independent ASR software. In addition, secondary aims were to investigate the relationship between severity of dysarthria and accuracy and to explore people with dysarthria perceptions on the proposed platform. Methods Fifteen individuals with dysarthric speech and 20 individuals with nondysarthric speech recorded 24 words and 5 sentences in a clinical environment. Differences in recognition accuracy between the two systems were evaluated. In addition, mPASS usability was assessed with a technology acceptance model (TAM) questionnaire. Results In both groups, mean accuracy rates were significantly higher with mPASS compared to the commercial ASR for words and for sentences. mPASS reached good levels of usefulness and ease of use according to the TAM questionnaire. Conclusions Practical applicability of this technology is realistic: the mPASS platform is accurate, and it could be easily used by individuals with dysarthria.

Self-Reported Changes in Cognition, Communication and Swallowing in Multiple Sclerosis: Data from the Swedish Multiple Sclerosis Registry and from a National Survey

Abstract: Purpose The aim of this study was to investigate self-reported cognition, speech, communication and swallowing changes in a large sample of individuals with multiple sclerosis (MS) in Sweden. A second aim was to update information about speech and language pathology (SLP) services received by people with MS (pwMS). Method Self-ratings of cognition, speech/communication and swallowing registered by pwMS between 2012 and 2018 were retrieved from the Swedish MS Registry. In addition, more detailed information about speech, communication, swallowing and provision of SLP services was collected using an online survey distributed via a national patient organization. Results In total, entries from 5,289 pwMS were retrieved from the MS Registry. Nearly two thirds of the respondents reported that cognition was affected to some degree, whereas approximately one third perceived some difficulties with speech/communication. A smaller group reported swallowing problems. The majority of those who reported problems with speech/communication also reported problems with cognition. Among the 440 individuals who responded to the MS survey, word-finding difficulties were the most frequently self-reported problem related to communication, and the second most common problem was getting off topic. In all, close to four out of five respondents experienced at least one symptom related to speech and communication, such as speech-related fatigue or imprecise articulation. Swallowing difficulties were reported by one out of four respondents in the MS survey. As a result of their speech difficulties, up to one in three experienced changes in professional or social roles and participation. A limited number of respondents had received SLP services, the most common intervention being voice training. Conclusions In MS, changes associated with cognition as well as speech/communication are frequent, cognitive-linguistic symptoms being the most common. Swallowing difficulties are also relatively prevalent. Access to SLP services seems to be insufficient compared to prevalence of perceived symptoms. Considering that the majority of pwMS are part of the working-age population, access to SLP services must be more highly prioritized and must address cognitive-linguistic problems as well as voice, speech and swallowing dysfunction.

Patients with Head-and-Neck Cancer: Dysphagia and Affective Symptoms.

Abstract: Objective Affective symptoms are common in patients with head-and-neck cancer. This study determined the association between the presence of aspiration and symptoms of anxiety and depression, as well as patient characteristics in patients with head-and-neck cancer and dysphagia. Methods Eighty-four patients with head-and-neck cancer and dysphagia completed the Hospital Anxiety and Depression Scale and underwent a standardized fiberoptic endoscopic evaluation of swallowing. Linear regression analysis was performed to explore the associations. Results Fifty-two (61.9%) patients presented clinically relevant symptoms of anxiety or depression. Forty-eight (57.1%) patients presented with aspiration during fiberoptic endoscopic evaluation of swallowing. A significant negative association was found between the presence of aspiration and affective (anxiety and depression) symptoms (p = 0.04). Male patients presented significantly lower symptom scores of anxiety compared to females (p = 0.04). Conclusions Clinically relevant affective symptoms were present in more than half of all patients with head-and-neck cancer and dysphagia. Surprisingly, a significant negative association was found between the presence of aspiration and these affective symptoms. Gender was also significantly associated with affective symptoms. These results suggest that there is a need for further investigation into the impact of psychological distress on patients with head-and-neck cancer and dysphagia.

The Usefulness of Auditory Perceptual Assessment and Acoustic Analysis as a Screening Test for Voice Problems.

Abstract: Background/aims The aims of study were (1) to determine the cut-off values of parameters related to auditory perceptual assessment (visual analog scale [VAS]) and acoustic analysis (cepstral peak prominence [CPP], low-frequency/high-frequency [L/H] ratio, CPP SD, L/H ratio SD, acoustic voice quality index [AVQI], and cepstral spectral index of dysphonia [CSID]) for predicting voice problems within a Korean population, and (2) to verify the discriminative power of these cut-off values. Methods 1,113 voice samples were analyzed in this study. Perceptual assessments (VAS) were performed by 5 speech-language pathologists. For the acoustic analysis, cepstral parameters, CSID, and AVQI were calculated. The cut-off values of parameters predicting voice problems were obtained using receiver operating characteristic (ROC) analysis. Additionally, the sensitivity, specificity, and area under the ROC curve (AUC) were measured. Results High reliabilities were observed for the perceptual assessments. The cut-off values of parameters had a high sensitivity, specificity, and AUC. Of these, CSID was the parameter with the highest AUC values. Conclusion Each parameter demonstrated a high discriminative power for classifying the presence or absence of voice problems. The results of this study could be used as an objective criterion for screening voice problems.

Promoting Speech Intelligibility in Autism Spectrum Disorder through the Implementation of Phonologically Similar Stimuli.

Abstract: Objectives The study focused on promoting expressive phonological skills in 1 Greek-speaking child with autism spectrum disorder (ASD) and comorbid speech sound disorder (SSD). Based on the phonological neighborhood density framework, it was hypothesized that the experimental manipulation through clinical implementation of phonologically overlapping stimuli would yield positive expressive phonology gains relevant to ASD. Participant and Methods: A multiple-baseline single-subject design was implemented. Three baseline sessions measured expressive phonology variables. Sixteen biweekly 30-min intervention sessions were carried out for a period of 2 months. Dependent variables included phonetic inventory size, proportion of consonants correct, occurrences of phonological processes, and percentage of whole word matches elicited via specific word probe stimuli. The Intelligibility in Context Scale was completed by the child's teacher prior to the initiation of intervention and at a follow-up session. Experimental stimuli were grouped together in phonologically dense cohorts. Results Comparison between pre-test and post-test measures revealed expressive phonology gains across all measured variables. Follow-up session results showed generalization of expressive phonology gains on untreated targets. Conclusions Significant expressive phonology gains were achieved through the implementation of phonologically similar word stimuli within a systematic intervention protocol with the implementation of specific word-level variables. The findings supported this treatment approach for a child with ASD and SSD, while providing evidence for the phonological density advantage from a cross-linguistic perspective.

Screen Time and Children with Autism Spectrum Disorder.

Abstract: Background Research is increasingly raising concerns regarding the negative consequences of children's use of screens. Summary This article reviews the literature on the benefits and risks of screen time with attention to explaining possible reasons that children with autism are more at risk for the negative effects of screen time. Based on the science of learning literature, a framework for choosing appropriate digital media for children with autism is described. The 3-component framework considers the characteristics of the child, the context in which digital media are used, and the content of the media. Key Message: Using the framework, the speech-language pathologist will be better able to select appropriate digital media content for children with autism that is engaging (while not being distracting), encourages the child to be actively involved with the media, is meaningful in the child's life, and incorporates social interactions with others.

Randomised Controlled Trial Evaluating Active versus Passive Waiting for Speech-Language Pathology.

Abstract: Introduction High demand for speech-language pathology means children sometimes wait over 12 months for services, missing out on timely support. Waiting can be a time of stress, concern, and powerlessness for caregivers. Provision of information via a website may support families and encourage active waiting. Objective The aim of this study was to compare children's speech, intelligibility, language, and literacy outcomes, and caregivers' satisfaction and empowerment in active versus passive waiting conditions. Methods Ninety-seven preschool-aged children referred to a community health speech-language pathology service in Australia were screened for eligibility. Eligible children (n =42) with speech/language difficulties were randomly allocated to: (a) active waiting (provision of a purpose-built website; n = 20), or (b) passive waiting (control group; n = 22). Pre- and post-assessments (after 6 months on a waiting list) were completed with children and caregivers by a speech-language pathologist blinded to group allocations. Results Intention to treat (n =36) and per-protocol analyses (n =30) were conducted to measure group differences in child and caregiver outcomes at post-assessment using one-way ANCOVA, controlling for baseline scores. There were no statistically significant differences between groups for children's speech, intelligibility, language, and literacy, or caregivers' empowerment and satisfaction. Children in both groups made minimal gains over 6 months. Conclusions Provision of an active waiting website did not lead to statistically significant change in child or caregiver outcomes, and children in both groups made little progress over a 6-month period. Early speech-language pathology intervention delivered with appropriate dosage is needed to optimise children's outcomes. Until timely and effective speech-language pathology intervention can be provided for all who need it, provision of early assessments may be beneficial. There remains a need for effective ways to support children and families on waiting lists.

Can You Understand Your Child? Reliability and Validity of a Parent Questionnaire: The Intelligibility in Context Scale: Italian.

Abstract: Introduction The Intelligibility in Context Scale (ICS) is a parent-report scale by which parents can rate their child's functional speech intelligibility according to seven different communicative partners. Translations, linguistic adaptations, and psychometric and norming data for ICS have been achieved in different languages. Objective To evaluate the psychometric properties of the Italian version of the ICS (ICS-I) in terms of internal consistency, test-retest reliability, criterion validity (correlation with speech measures), and construct validity, and to investigate potential differences between mothers' and fathers' subjective ratings in ICS-I. Methods Italian-speaking children aged 3.0-5.11 years (n = 364), without major developmental impairment, were recruited in kindergartens. All children were independently rated by their mothers (ICS-Im) and fathers (ICS-If). A subsample of parents (n = 127) rated ICS-I twice after 3 weeks (test-retest reliability). Children were administered a naming and a word repetition task, by which speech measures were calculated: percentage of phonemes correct (PPC), percentage of consonants correct (PCC), and percentage of vowels correct (PVC). Results High internal consistency (α = 0.92) and good test-retest reliability (rs = 0.78) were found. A high (r > 0.67) correlation between the ICS-I total scores and single-item scores was found (construct validity), except for parental perception in ICS-Im and ICS-If. Moderate correlations (rs > 0.38) between the ICS-I and the PPC and PCC tasks suggested adequate criterion validity. Mothers' and fathers' ratings showed an appropriate agreement in the items acquaintances and teachers, but overall parent ratings were significantly different, with higher mean scores in ICS-Im (median = 4.57) than in ICS-If (median = 4.46), Z = -2.852, p Conclusions As for other previous international studies, ICS-I presents good psychometric properties, but some differences in mothers' and fathers' scores suggest a potential parental influence in rating a child's intelligibility. Findings support cross-linguistic research, and further investigation could promote the application of ICS-I as an outcome measure in children with speech sound disorders.

Musical Intervals in Infants' Spontaneous Crying over the First 4 Months of Life.

Abstract: Introduction Perception and memorizing of melody and rhythm start about the third trimester of gestation. Infants have astonishing musical predispositions, and melody contour is most salient for them. Objective To longitudinally analyse melody contour of spontaneous crying of healthy infants and to identify melodic intervals. The aim was 3-fold: (1) to answer the question whether spontaneous crying of healthy infants regularly exhibits melodic intervals across the observation period, (2) to investigate whether interval events become more complex with age and (3) to analyse interval size distribution. Methods Weekly cry recordings of 12 healthy infants (6 females) over the first 4 months of life were analysed (6,130 cry utterances) using frequency spectrograms and pitch analyses (PRAAT). A preselection of utterances containing a well-identifiable, noise-free and undisturbed melodic contour was applied to identify and measure melodic intervals in the final subset of 3,114 utterances. Age-dependent frequency of occurrence of melodic intervals was statistically analysed using generalized estimating equations. Results 85.3% of all preselected melody contours (n = 3,114) either contained single rising or falling melodic intervals or complex events as combinations of both. In total 6,814 melodic intervals were measured. A significant increase in interval occurrence was found characterized by a non-linear age effect (3 developmental phases). Complex events were found to significantly increase linearly with age. In both calculations, no sex effect was found. Interval size distribution showed a maximum of the minor second as the prevailing musical interval in infants' crying over the first 4 months of life. Conclusion Melodic intervals seem to be a regular phenomenon of spontaneous crying of healthy infants. They are suggested to be a further candidate for developing an early risk marker of vocal control in infants. Subsequent studies are needed to compare healthy infants and infants at risk for respiratory-laryngeal dysfunction to investigate the diagnostic value of the occurrence of melodic intervals and their age-depending complexification.

US Pilot Curriculum for Transitioning Students with Autism Spectrum Disorders from High School to College and the Workforce.

Abstract: Objectives Few, evidence-based programs have been developed to prepare social skills for students with autism spectrum disorder (ASD) transitioning to the workplace or college setting. This article describes a pilot curriculum developed for Tarrant County College (TCC) to address the transitional needs of high school students with ASD to a vocation or college. Methods TCC enrolled 123 high school students across the ASD who were taught a 2-h, 2-semesters course on how to apply for college as well as employment applications, job interviews, and interpersonal skills. Work preparation and college preparatory skills such as communicating with professors regarding specific student learning accommodations were also included. Publicly available enrollment TCC data were utilized to describe the curricular program outcomes. Program Outcomes: No statistically significant success rate increase was identified among enrolled ASD students obtaining college acceptance by participating in the TCC program. However, 14 students were successful in attaining employment. TCC enrollment data also showed that 1 course addressing high school ASD students' transitional needs to a vocation or college is not enough to ensure student success. Ongoing mentorship and advising should play a major role in the development of several semester long transitional courses to assist ASD students as they seek employment or a college program. Such a curriculum should include parental support and ongoing employer and college advisor communication regarding curriculum expectations for long-term success in the lives of ASD students, as they gain the skills requisite for independent living.

Functional Communication Profiles of Children and Youth with Autism: A Roadmap to Therapeutic and Educational Interventions.

Abstract: Background Autism spectrum disorder (ASD) entails varied developmental pathways along the entire lifespan, demanding early and ongoing diverse and responsive interventions to children's needs. This study examined in situ education and development attained by children and youth with ASD in a school with a therapeutic and educational curriculum. Objectives (1) Construct individual communication profiles in educational and developmental aspects. (2) Examine for associations between variables. (3) Demonstrate the clinical and educational utility of including cognitive-linguistic integrative variables. (4) Showcase how the profiles guide interventions tailored to students' individual needs. Methods Functional communication profiles (FCPs) of 21 students, aged 5.0-16.8 years, mostly from bilingual middle-high socioeconomic status families, were constructed with input from their educational and therapeutic staff. Students' performance was examined with an array of instruments and tasks, including person and clock drawings, false belief, and bouba-kiki metaphor screens. Qualitative and quantitative analyses were performed to uncover associations, weaknesses, and strengths. Results The profiles revealed associations between cognitive, linguistic, social, and educational abilities, indicating that some abilities from different domains tend to co-occur. Conclusions Including cognitive linguistic integrative variables was a novelty that revealed additional aspects of the children's abilities. Staff feedback confirmed the utility of FCPs in providing "a roadmap" to needed individual and common curriculum adjustments.

Vocal and Nonvocal Habits among Vedic Chanters.

Abstract: Objectives The objective of the present study was to explore the voice concerns and vocal and nonvocal habits of Vedic chanters. Participants and method A cross-sectional design was used to study 200 Vedic chanters using a 36-item questionnaire. This questionnaire was developed and administered to explore their voice concerns and vocal and nonvocal habits. Descriptive statistics were used to summarize the findings and K-means cluster analysis was carried out to identify clusters concerning voice quality and influence of habits. Results The majority of Vedic chanters were involved in certain vocal habits such as use of loud voice while chanting and frequent throat clearing. Further, approximately half of the chanters expressed a concern towards their voice, while a vast majority experienced vocal fatigue. Cluster analysis helped in identification of 4 clusters: Vedic chanters with (1) good lifestyle and good voice characteristics (n = 107), (2) good lifestyle but bad voice characteristics (n = 15), (2) poor lifestyle and good voice characteristics (n = 51), and (4) poor lifestyle leading to bad voice characteristics (n = 27). Conclusion The findings of the present study provide useful information on voice concern and vocal and nonvocal habits among a unique population of individuals. The current study of Vedic chanters highlights the need to have a detailed understanding of their specific voice usage, demands, and voice characteristics.

Effects of Resistive Jaw-Opening Exercise with Elastic Resistance Bands on Suprahyoid Muscle Activation and Tongue Strength in the Elderly: A Pilot Study

Abstract: Background The jaw-opening exercise (JOE) is designed to strengthen the suprahyoid muscles. However, it is difficult to apply this strength-training exercise to subjects in a systematic fashion. Objective This study examined the effect of resistive JOE on suprahyoid muscle activity and tongue strength in the elderly through the use of an elastic band. Methods Eight elderly people aged ≥65 years participated in this study. Participants wore an elastic loop around their head and mandible. The strength of the elastic loop used was adjusted based on the participant's sex, and the same strength loop was used for 8 weeks. Participants were required to open their jaw maximally, maintain the position for 10 s, and then rest for 10 s. This process was repeated for 10 min. There was then a rest period of 2 min before subjects began another 10-min exercise set. All participants performed the exercise twice weekly for 8 weeks. All subjects were tested for suprahyoid muscle activation during typical/effortful swallowing as well as isometric tongue pressures and endurances at baseline and at 9 weeks. Results After 8 weeks of exercise, the isometric maximum tongue-base pressure and tongue endurance were significantly improved. However, the swallowing tongue pressure and suprahyoid muscle activation levels had not changed significantly. Conclusion This study confirmed that consistent resistance, which provides the same resistance throughout a resistive JOE exercise, is inadequate to reliably improve the muscle strength of swallowing-related muscles. Subsequent research should consider this and plan more efficient exercise programs.

Evaluation of Noise Reduction Interventions in a School.

Abstract: INTRODUCTION Noise in the school environment has been a major concern in many countries around the world. Students need a favorable signal-to-noise ratio in the classroom to ensure adequate speech intelligibility, which is directly dependent on the acoustics of the classroom and favorable noise levels in these environments. OBJECTIVE To evaluate the effectiveness of physical, organizational, and educational interventions to achieve noise reduction in a school. METHODS Presentations on the effects of noise were made to school administrators, teachers, and students (educational activities), and also to the students' families. Then, thermoacoustic treatment, changes in break times, equipment maintenance, and scheduling of students' departure were applied. Sound pressure levels were measured before and after interventions for the unoccupied and occupied classroom conditions (n = 11 classrooms) and of the school's outside areas (n = 4). Self-administered printed pre- and postintervention multiple-choice questionnaires were completed by the students in the classroom. Measures of the signal-to-noise ratio of the teachers' voice before and after the interventions were also conducted (n = 3 classrooms). The interventions included installation of an acoustic ceiling, installation of air-conditioning, and replacement of the existing furniture with wood furniture. RESULTS Comparing the pre- and postintervention questionnaires, the Annoyance Index was reduced from 0.78 to 0.59. The tinnitus reported by the individuals increased significantly in the postintervention questionnaire (p < 0.001). Significant reductions in noise levels in both unoccupied and occupied classrooms were observed. There was also an improvement in the mean signal-to-noise ratio in the evaluated classrooms (n = 3) from +7.5 to +8.4 dB. CONCLUSION Subjective measures and objective assessments demonstrated that both physical and educational interventions had a positive effect on short-term changes in habits and noise reduction in the school environment.

An Exploration into Mothers' Experiences of Feeding Children with Autism Spectrum Disorder in South Africa.

Abstract: OBJECTIVES To explore the experiences of mothers feeding their children with autism spectrum disorder (ASD) in South Africa as well as to better understand the impact of context and culture on feeding disorders. PARTICIPANTS AND METHODS A qualitative research design was employed. Seven mothers of 8 children (1 mother had twins), aged 4-9 years, who were diagnosed with ASD and who had associated feeding difficulties participated in the study. Semi-structured interviews were conducted, and data were transcribed and analysed using inductive thematic analysis. RESULTS Findings indicated that children with ASD and feeding difficulties increase parental stress and anxiety. Novel findings pertaining to context and culture showed the negative impact feeding difficulties have on the siblings, the role taken on by the mother as the caregiver and the provider, and an additional financial burden associated with feeding a child with ASD. CONCLUSIONS Findings add to the field of speech therapy by providing awareness of the challenges experienced by these mothers as well as those that are unique to the South African context. In addition, the current study provides insight into the experiences of mothers from different contexts and cultural backgrounds to those reported in previous literature.

Validation of the Dutch Version of the M.D. Anderson Dysphagia Inventory for Neurogenic Patients.

Abstract: Background/Aim: The aim of this study was to validate the Dutch-language version of the M.D. Anderson Dysphagia Inventory (MDADI) for patients with neurogenic oropharyngeal dysphagia (OD). Methods: One hundred and seventy-eight patients with neurogenic OD and 92 healthy control subjects completed the MDADI and the Dutch version of the Swallowing Quality-of-Life Questionnaire (SWAL-QOL-NL). Exclusion criteria were: suffering from a concurrent head-and-neck oncological disease, scoring below 23 on a Mini Mental State Examination, being older than 85 years, and being illiterate or blind. None of the patients was in a palliative state of disease. Floor and ceiling effects, known-groups validity, internal consistency, construct validity, and criterion validity were assessed. Results: The MDADI total score showed no floor or ceiling effects for the patient group. Known-groups validity was confirmed by group differences in score distributions between patients and healthy control subjects. The internal consistency showed Cronbach’s α-values ranging from 0.77 to 0.92. Correlations between the MDADI subscales and SWAL-QOL-NL domains were moderate to strong: 0.71, 0.70, and 0.62 (convergent construct validity). Correlations between the MDADI scores and the SWAL-QOL-NL domains general burden, food selection, eating duration, communication, mental health, social functioning, and frequency of symptoms were moderate to strong, ranging from 0.41 to 0.75. Weak correlations (<0.4) were found between the MDADI scores and the SWAL-QOL-NL domains eating desire, sleep, and fatigue. Conclusion: The results of this study show that the Dutch translation of the MDADI is a psychometrically validated and suitable dysphagia-specific quality-of-life questionnaire for patients with neurogenic OD.

Pausing and sentence stress in children with dysarthria due to cerebral palsy

Abstract: Introduction: Children with dysarthria due to cerebral palsy (CP) can experience problems manipulating intensity, fundamental frequency and duration to signal sentence stress in an utterance. Pauses have been identified as a potential additional cue for stress marking, which could compensate for this deficit. Objective: This study aimed to determine whether children use pauses to signal stress placement, and whether this differs between typically-developing children and those with CP. Methods: Six children with CP and eight typically developing children produced utterances with stress on target words in two different positions. Pauses before and after the stressed target words were analyzed in terms of number, location and duration. Results: Results showed that both groups inserted pauses into their utterances. However, neither group used pause location or duration in a systematic manner to signal the position of stressed words. Conclusions: The results suggest that pausing was not used strategically by either group to signal sentence stress. Further research is necessary to explore the value of pausing as a cue to stress marking in general and as a potential compensatory strategy for speakers with dysarthria.

One-Year Follow-Up of a Vocal Hygiene Program for School-Age Children.

Abstract: Objective This study investigated the effects of a school-based vocal hygiene education program "Green Voice for School" on promoting knowledge of healthy voice use for primary school students. Methods Thirty-nine grade 4 and 5 students from local primary schools participated in the "Green Voice for School" program. Students received 6 weekly vocal hygiene training sessions with the aim of enhancing their voice care knowledge. Their voice care knowledge was assessed by a 15-item questionnaire. Students' voice care knowledge was examined before training, immediately after, and 1 year after completion of the program. Results Students showed significant improvements in their voice care knowledge immediately after they received the vocal hygiene training sessions. Such improvements were maintained 1 year after the students completed training. Conclusions The results suggest that "Green Voice for School", a school-based vocal hygiene education program, can be effective in promoting long-term improvements of voice care knowledge in school-age children.

Effects of Practice Variability on Second-Language Speech Production Training.

Abstract: BACKGROUND Mastering the phonetics of a second language (L2) involves a component of speech-motor skill, and it has been suggested that L2 learners aiming to achieve a more native-like pronunciation could benefit from practice structured in accordance with the principles of motor learning. PARTICIPANTS AND METHODS This study investigated the influence one such principle, high versus low variability in practice, has on speech-motor learning for Korean adults seeking to acquire native-like production of English rhotics. Practice incorporated a commercially available intraoral placement device ("R Buddy," Speech Buddies Inc.). In a single-subject across-behaviors design, 8 participants were pseudorandomly assigned to practice rhotic targets in a low-variability (single word) or high-variability (multiple words) practice condition. RESULTS The hypothesized advantage for high-variability over low-variability practice was observed in the short-term time frame. However, long-term learning was limited in nature for both conditions. CONCLUSION These results suggest that future research should incorporate high-variability practice while identifying additional manipulations to maximize the magnitude of long-term generalization learning.

Associations and Dissociations among Phonological Processing Skills, Language Skills and Nonverbal Cognition in Individuals with Autism Spectrum Disorder.

Abstract: Aims The purpose of this study was to examine the nature of phonological processing in individuals with autism spectrum disorder (ASD) as it pertains to their nonverbal cognitive and linguistic abilities. Methods Twenty-one participants between the ages of 9 and 21 years were administered a nonverbal cognitive assessment (Raven test), a language measure that requires receptive and expressive knowledge of semantics, syntax and morphology, as well as the integration across these language domains (CELF-4), and a measure of phonological processing (CTOPP). Results Results show that performance on nonword repetition (NWR) that reflects an aspect of phonological memory was significantly low, whereas performance on phoneme reversal, phoneme elision, blending words and memory for digits was within the normal range. Hierarchical regressions with age, nonverbal intelligence (Raven test) and receptive language (CELF) as predictors showed that for NWR and phoneme elision the receptive part of the CELF was the main significant -predictor, after controlling for age. For phoneme reversal and memory for digits, however, the Raven score was the significant predictor, suggesting that cognitive nonverbal ability is the main factor explaining variability in these tasks. Conclusions A deficit in phonological memory characterizes individuals in the autistic population. This deficit may influence language acquisition in this population consistent with other populations of children with language impairments. Other tasks of phonological awareness, however, might be preserved especially when they do not involve memory for long phonological sequences and when the cognitive abilities are within the norm.

Does the Acoustic Voice Quality Index (AVQI) Correlate with Perceived Creak and Strain in Normophonic Young Adult Finnish Females

Abstract: BACKGROUND The Acoustic Voice Quality Index (AVQI) is a correlate of dysphonia. It has been found to differentiate between dysphonic and normophonic speakers and to indicate the effects of voice therapy. This study investigates how the AVQI reacts towards creak and strain, which are common in normophonic speakers. METHODS The material was obtained from an earlier study on 104 Finnish female university students (mean age 24.3 years, SD 6.3 years) with no known pathology of voice or hearing and a perceptually normal voice (G = 0 in GRBAS), who were recorded while reading aloud a standard text and sustaining the vowel [a:]. Perceptual analysis for the amount of creak and strain was carried out by 2 expert listeners. In this study, the AVQI v03.01 was analyzed and correlated with perceptual evaluations. Samples with low and high amounts of creak and strain were compared with t tests. RESULTS On average, the AVQI was below the threshold value of dysphonia in the Finnish population. The AVQI (ρ = 0.35, p = 0.000) and its subparameters, smoothed cepstral peak prominence (CPPS; ρ = -0.35, p = 0.000) and harmonics-to-noise ratio (HNR; ρ = -0.30, p = 0.002) showed low but significant correlations with creak. Strain had low but significant correlations with spectral Slope (ρ = 0.38, p = 0.000) and Tilt (ρ = -0.40, p = 0.009). The AVQI was lower (better) in samples that were evaluated as having a high amount of strain, but the difference was not significant. Only CPPS differentiated significantly between low and high amounts of creak. CONCLUSION The AVQI does not seem to differentiate between high and low amounts of creak and strain in normophonic speakers.

The Effect of Clear Speech on Cantonese Alaryngeal Speakers' Intelligibility.

Abstract: Background/aim The purpose of this study was to provide preliminary data concerning the effect of clear speech (CS) on Cantonese alaryngeal speakers' intelligibility. Methods Voice recordings of 11 sentences randomly selected from the Cantonese Sentence Intelligibility Test (CSIT) were obtained from 31 alaryngeal speakers (9 electrolarynx [EL] users, 10 esophageal speakers and 12 tracheoesophageal [TE] speakers) in habitual speech (HS) and CS. Two naive listeners orthographically transcribed a total of 1,364 sentences. Results Significant effects of speaking condition on speaking rate and CSIT scores were observed, but no significant effect of alaryngeal communication methods was noted. CS was significantly slower than HS by 0.78 syllables/s. Esophageal speakers demonstrated the slowest speech rate when using CS, while EL users demonstrated the largest decrease in speaking rate when using CS compared to HS. TE speakers had the highest CSIT scores in HS (listener 1 = 81.4%; listener 2 = 81.3%), and esophageal speakers had the highest CSIT scores in CS (listener 1 = 87.5%; listener 2 = 89.7%). EL users experienced the largest increase in intelligibility while using CS compared to HS (9.1%) followed by esophageal speakers (8.9%) and TE speakers (1.4%). Conclusion Preliminary data indicate that CS may significantly affect Cantonese alaryngeal speakers' speaking rate and intelligibility. However, intelligibility appeared to vary considerably across speakers. Further research involving larger, heterogeneous groups of speakers and listeners alongside longer and more refined CS training protocols should be conducted to confirm that CS can improve Cantonese alaryngeal speakers' intelligibility.

Impact of Oral Myofunctional Therapy on Orofacial Myofunctional Status and Tongue Strength in Patients with Tongue Thrust.

Abstract: Introduction Tongue thrust is a frequent clinical condition characterized by abnormal patterns of movements and altered tongue posture on the mouth floor. It might contribute to determining alterations in the maxillofacial morphology and in the development of malocclusion. Several therapeutic options are available for treatment. In particular, the orofacial myofunctional therapy (OMT) is frequently adopted even if only few studies have analyzed its efficacy using validated instruments and no information is available regarding the effect of dentition on the results obtained with OMT. Objective To evaluate the effect of OMT through a validated instrument and explore the role of dentition on its efficacy. Methods A total of 22 consecutive patients with tongue thrust were enrolled. According to the presence of mixed or complete dentition, the cohort of patients was divided into 2 groups. Each patient underwent OMT according to the Garliner method (10 weekly sessions of 45 min each in hospital and daily exercises at home). The efficacy of OMT was evaluated using the Orofacial Myofunctional Evaluation with Scores (OMES), a validated protocol developed for the assessment of orofacial myofunctional disorders, and the Iowa Oral Performance Instrument (IOPI) to measure the peak isometric pressure exerted by the anterior and posterior part of the tongue. Both OMES and IOPI were administered before and at the end of the treatment. Results A significant improvement in the OMES scores was demonstrated after OMT. No significant differences between the patients with intermediate and mixed dentition obtained in both the pre- and post-treatment conditions were demonstrated in the OMES scores. Similarly, a significant increase in the peak isometric tongue pressure in both the anterior and posterior parts of the tongue was demonstrated after OMT in the groups. No differences between the two groups in both the pre- and post-treatment conditions were demonstrated in the IOPI scores. Conclusions OMT improves orofacial motricity and tongue strength in patients with tongue thrust regardless of the type of dentition.

Introduction of the Objective Structured Clinical Examination in Speech and Language Therapy Education: Student Perspectives.

Abstract: Background/aims The Objective Structured Clinical Examination (OSCE) has an established history of assessing clinical competence for medical and allied healthcare professionals. No research has investigated the use of the OSCE within speech and language therapy undergraduate education. This study aimed to evaluate undergraduate speech and language therapy students' perceptions of the OSCE and to determine if perceptions differed depending on stage of undergraduate education. Methods An online survey was distributed to second- and final-year students in a 4-year undergraduate speech and language therapy university programme after completing an OSCE. Quantitative survey data were analysed descriptively and statistically using Fisher's exact tests. Thematic analysis was used to analyse narrative survey comments. Results The response rate was 80%. The students perceived the OSCE to be a fair (95%) and meaningful way (97%) of assessing clinical competencies, which provided them with greater confidence for practice (91%). The OSCE was deemed to be less stressful than a written exam (65%). No significant differences were observed between second- and fourth-year students' perceptions. Five major themes included clarity of expectations, time allocated, consistency between examiners, influence on student learning, and personal impact. Discussion The survey findings suggest that undergraduate speech and language therapy students across different stages of education and different clinical contexts perceive the OSCE as a fair and meaningful assessment approach. This study provides initial evidence that the OSCE is suitable for assessing clinical competencies specific to the profession of speech and language therapist.

Oral Myofunctional and Articulation Disorders in Children with Malocclusions: A Systematic Review.

Abstract: BACKGROUND Relationships between malocclusion and orofacial myofunctional disorders (OMD), as well as malocclusions and articulation disorders (AD) have been described, though the exact relationships remain unclear. Given the high prevalence of these disorders in children, more clarity is needed. SUMMARY The purpose of this study was to determine the association between OMD (specifically, bruxism, deviate swallowing, caudal resting tongue posture, and biting habits), AD, and malocclusions in children and adolescents aged between 3 and 18 years. To conduct a systematic review, 4 databases were searched (MEDLINE, Embase, Web of Science, and Scopus). The identified articles were screened for the eligibility criteria. Data were extracted from the selected articles and quality assessment was performed using the tool of Munn et al. [Int J Health Policy Manag. 2014;3:123-81] in consensus. Using the search strategy, the authors identified 2,652 articles after the removal of duplicates. After reviewing the eligibility criteria, 17 articles were included in this study. One of the included articles was deemed to have an unclear risk of bias, whereas all other articles were considered to have a low risk of bias. The articles showed a relationship between anterior open bite and apico-alveolar articulatory distortions, as well as between anterior open bite and deviate swallowing. For the biting habits, bruxism, and low tongue position no clear conclusions could be drawn. Key Messages: The current review suggests a link between specific types of malocclusion and OMD and AD. However, more high-quality evidence (level 1 and level 2, Oxford Levels of Evidence) is needed to clarify the cooccurrence of other OMD, AD, and malocclusions.

Assessment of Intelligibility in Children with Velopharyngeal Insufficiency: The Relationship between Intelligibility in Context Scale and Experimental Measures.

Abstract: PURPOSE The purpose of this study was to investigate the clinical application of the Intelligibility in Context Scale (ICS) instrument in children with velopharyngeal insufficiency (VPI). This study investigated the relationship between clinical speech outcomes and parental reports of speech intelligibility across various communicative partners. METHODS The ICS was completed by the parents of 20 English-speaking children aged 4-12 years diagnosed with VPI. The parents were asked to rate their children's speech intelligibility across communication partners using a 5-point scale. Clinical metrics obtained using standard clinical transcription on the Picture-Cued SNAP-R Test were: (1) percentage of consonants correct (PCC), (2) percentage of vowels correct (PVC), and (3) percentage of phonemes correct (PPC). Nasalance from nasometer data was included as an indirect measure of nasality. Intelligibility scores obtained from naive listener's transcriptions and speech-language pathologists' (SLP) ratings were compared with the ICS results. RESULT Greater PCC, PPC, PVC, and transcription-based intelligibility values were significantly associated with higher ICS values, respectively (r[20] = 0.84, 0.82, 0.51, and 0.70, respectively; p < 0.05 in all cases). There was a negative and significant correlation between ICS mean scores and SLP ratings of intelligibility (r = -0.74; p < 0.001). There was no significant correlation between ICS values and nasalance scores (r[20] = -0.28; p = 0.22). CONCLUSION The high correlations obtained between the ICS with PCC and PPC measures indicate that articulation accuracy has had a great impact on parents' decision-making regarding intelligibility in this population. Significant agreement among ICS scores with naive listener transcriptions and clinical ratings supports use of the ICS in practice.

The Lidcombe Program for Early Stuttering in Non-English-Speaking Countries: A Systematic Review.

Abstract: BACKGROUND The Lidcombe Program is a stuttering treatment approach for children between the ages of 3 and 6 years. Most papers about the Lidcombe Program, however, are based on studies conducted in native English-speaking countries. The aim of this paper is to systematically review the delivery and implementation of the Lidcombe Program in non-native English-speaking countries. SUMMARY A resource search was conducted between October and November 2019. Scopus, PubMed, ASHA, Cochrane Library, ERIC, Google Scholar, and SpeechBITE databases and reference lists of relevant papers were searched for the identification process. Joanna Briggs Institute tools were used for the appraisal of the studies. The search yielded 8 studies conducted in non-native English-speaking countries. The Lidcombe Program is efficacious in non-native English-speaking countries when delivered to both preschool and young school age children who stutter. It is reported to be delivered with minor changes and challenges. The number of weekly clinic visits and the total time needed to reach zero or near-zero stuttering levels with the Lidcombe Program can be up to 3 times greater in non-native English-speaking countries than in native English-speaking countries, mostly due to the increased time needed to introduce the parental verbal contingencies. Key Messages: Speech and language therapists practicing in non-native English-speaking countries are encouraged to use the Lidcombe Program for both preschool and young school age children who stutter, although this can take more time than that reported in native English-speaking countries. Further investigation to explore the therapy process with children and parents in non-native English-speaking countries is needed.

English Nasalance Values of Chinese Learners of English.

Abstract: Introduction Although a number of studies have been conducted to investigate nasalance scores of speakers of different languages, little research has examined the nasalance characteristics of second language learners. Objective The goal of the current study was to examine whether English nasalance values of Mandarin Chinese speakers are similar to those of native English speakers, examining the potential effect of the first language on the nasalance scores of the second language production. Methods Thirty-two adults (16 Mandarin Chinese speakers and 16 native English speakers) with a normal velopharyngeal anatomy participated. Nasalance scores of various speech stimuli were obtained using a nasometer and compared between the 2 groups. Results and conclusions Chinese learners of English produced higher nasalance scores than native English speakers on prolonged vowel /i/ and /a/, the syllable "nin," and non-nasal sentences and passages. The first language effect on nasalance of the second language found in the current study suggests the importance of linguistic consideration in the clinical evaluation of resonance.