Articulatory characteristics of the occlusion phase of /t/ compared to /t/ in adult speech

This study used electropalatography (EPG) to investigate articulatory characteristics of /t/ and /t/ occlusion in order to provide normative data to be used for the diagnosis and treatment of individuals with speech disorders. EPG data from the EUR-ACCOR database were analysed for nonsense VCV sequences containing /t/ and /t/ in nine vowel contexts for seven English speaking adults. The main results of this study are that all speakers had a significantly more posterior placement for /t/ compared to /t/ and that placement was stable during the occlusion phase of both /t/ and /t/. For most speakers, the occlusion phase was longer for /t/ compared to /t/, the occlusion phase generally involved more EPG contact and was slightly more variable in /t/ compared to /t/, but these differences were not statistically significant for all speakers. The implications of the results for diagnosing and treating speech disorders are discussed.     

The input processing,cognitive linguistic and oro-motor skills of children with speech difficulty

Children with speech difficulty of no known etiology are a heterogeneous group. While speech errors are often attributed to auditory processing or oro-motor skill, an alternative proposal is a cognitive-linguistic processing difficulty. Research studies most often focus on only one of these aspects of the speech processing chain. This study investigated abilities in all three domains in children with speech difficulty (n = 78) and matched controls (n = 87). It was hypothesized that groups of children with speech difficulty would perform less well than controls on all tasks, but that the proportion of children with speech difficulty performing within the normal range would differ across tasks. The input processing task required children to perceive the auditory-visual illusion in speech perception, where listeners perceive when they hear presented in synchrony with the lip movements for . Diadochokinetic, isolated and sequenced movements tasks assessed oro-motor skills. Two non-verbal tasks evaluated rule derivation. The results indicated that rule derivation best discriminated typically developing and speech difficulty groups. Few children were identified as having an input or output difficulty, whereas difficulties with rule-derivation were common. The data support the notion that speech difficulty is, most often, associated with a central processing difficulty.     

Residual /s/ and /r/ distortions: the perspective of the speaker

The purpose of this study was to investigate the impact of residual distortions from the perspective of the speaker. Eighty adult speakers of Brazilian Portuguese with a distortion of the alveolar fricative /s/, the alveolar tap /[symbol: see text]/, or both, completed a questionnaire that documented their therapy history, awareness of the speech distortion, and perceived impact of the disorder. Only a small number of the participants reported that they received negative reactions to their speech and only a minority were of the opinion that their speech interfered with work or social life. Yet a considerable number were of the opinion that their speech was different from that of other people and felt insecure in speech situations. The results suggest that there is a high tolerance toward minor speech errors in present day society that may be related to the fact that such disorders are not at all rare.     

Temporal and spatial aspects concerning the realizations of the voicing contrast in German alveolar and postalveolar fricatives

This study investigates the phonetic realizations of voicing contrast in alveolar and postalveolar fricatives production in different word positions in order to understand the temporal and spatial production strategies used in the control of voicing and frication, and to provide a frame of reference for speech therapy despite the inter-speaker variation. Seven native speakers of German, originally coming from various regions, participated in the experiment. Acoustic signals were recorded onto DAT, and tongue palate contact patterns were recorded by means of electropalatography (EPG). The temporal parameters were measured using the acoustic signals and the spatial parameters were measured based on the EPG data. The corpus included real words with // occurring at word initial, medial and final positions. Temporal results showed that differences in the overall frication duration for voicing contrast occur at almost all positions (with longer duration for voiceless phonemes). However, voicing during the frication interval was a less reliable discriminator, particularly for Southern German speakers and at word final position. We found a positive correlation between the relative voicing duration and the amount of tongue palate contact for subjects who produced voicing. Especially for the postalveolars, voicing also coincides with more front articulation. Results are discussed with respect to laryngeal-oral co-ordination and aerodynamics.     

Vowel features in Turkish accented English

The present study quantified the amount of accent in English vowels produced by native adult Turkish speakers. Vowels that are present in both Turkish and English (close vowels) were compared with those that are present only in English (distant vowels). The first two formant frequencies (F1 and F2) were obtained from the 11 English monophthong vowels (/i, i, e, ε, æ, Λ, u, , o, , /) produced by 20 Turkish-accented English (TE) (10 males and 10 females) bilinguals and 20 native American English (AE) speakers. Euclidean distance (ED) was used to measure the separation between the corresponding TE and AE vowels. Perceptual experiment was also carried out to assess the amount of accent in the English produced by Turkish speakers as perceived by native monolingual English speakers. F1 and F2 values revealed that TE speakers generally were able to produce close and distant vowels comparably, with considerable amount of deviation from AE speakers. ED values for close and distant vowels were not significantly different. The amount of perceived accent indicated the precision of vowel production and was found to directly correlate with the acoustic findings.     

The quantification of place of articulation assimilation in electropalatographic data using the similarity index (SI)

The present study is concerned with an electropalatographic (EPG) and acoustic analysis of coarticulatory influences in fricative consonant clusters that span a word boundary. We aimed to test whether, as has been found for other languages and consonant-classes, final consonants are more prone to coarticulatory influences than initial ones, and also whether there is any evidence for a relationship between a consonant's susceptibility to coarticulation and the extent to which it exerts a coarticulatory influence on flanking consonants. We developed an algorithm, the similarity index (SI), which quantifies coarticulation in EPG data by measuring the extent of deviation of consonants in heterorganic clusters from their homorganic counterparts. This algorithm was applied to EPG data recorded from three native speakers of Polish producing word-pairs in a carrier sentence such that word-final and word-initial fricatives occurred across a word-boundary for all 16 possible combinations of the four fricatives []. The same data were analysed acoustically using Bark-scaled cepstral coefficients. The results showed that word-final consonants were more susceptible to coarticulatory influences than were initial ones; and there was some evidence that the alveolopalatal fricative [] was most resistant to coarticulation, and exerted the greatest coarticulatory influences.     

Behaviours Identified by South Australian Clinicians as Differentially Diagnostic of Developmental Articulatory Dyspraxia

Using a method similar to that of Williams. Packman, Ingham and Rosenthal (1980) this study aimed at identifying those characteristics used by South Australian clinicians in the differential diagnosis of developmental articulatory dyspraxia (DAD) from other childhood articulation disorders. Thirty speech pathologists currently practising in child clinics throughout South Australia participated in a survey, requiring them to classify thirty characteristics as “always”, “sometimes” or “never” associated with functional, dyspraxic and organic childhood articulation disorders. The data were subjected to three different analyses which revealed the strength of association of the characteristics with each disorder. Seven characteristics were found to be significantly associated “always” with DAD, and therefore, potential differentially diagnostic features. These characteristics include: 1) Child demonstrates struggle, groping and trial-and-error behaviours on production of some (or all) phonemes; 2) Child demonstrates inability to volitionally produce an isolated phoneme, or sequence of phonemes, that he/she has correctly produced on other occasions; 3) Child fails to achieve isolated and sequenced oral movements on command, but achieves these at an automatic level; 4) Child's speech development shows a deviant pattern; 5) Child is unable to produce the correct sequence of phonemes on the diadochokinetic task (e.g. ), although able to produce the required phonemes in isolation; 6) Child shows increased number of articulation errors with increased length of utterance; and 7) Inconsistent pattern of articulatory errors is evident in child's speech. Of these seven characteristics, analysis showed that the first three characteristics were more strongly associated with DAD, than the remaining four characteristics.     

The effect of phonotactic constraints in German-speaking children with delayed phonological acquisition: Evidence from production of word-initial consonant clusters

In this study the effect of phonotactic constraints concerning word-initial consonant clusters in children with delayed phonological acquisition was explored. Twelve German-speaking children took part (mean age 5;1). The spontaneous speech of all children was characterized by the regular appearance of the error patterns fronting, e.g., Kuh“cow” /ku:/ →[tu:], or stopping, e.g., Schaf“sheep” /a:f/ →[ta:f], which were inappropriate for their chronological age. The children were asked to produce words (picture naming task, word repetition task) with initial consonant clusters, in which the application of the error patterns would violate phonotactic sequence constraints. For instance, if fronting would apply in /kl-/, e.g., Kleid“dress”, it would be realized as the phontactically illegal consonant cluster /tl-/. The results indicate that phonotactic constraints affect word production in children with delayed phonological developments. Surprisingly, we found that children with fronting produced the critical consonants correctly significantly more often in word-initial consonant clusters than in words in which they appeared as singleton onsets. In addition, the results provide evidence for a similar developmental trajectory of acquisition in children with typical development and in children with delayed phonological acquisition.     

Parent–child interaction in motor speech therapy

Purpose: This study measures the reliability and sensitivity of a modified Parent–Child Interaction Observation scale (PCIOs) used to monitor the quality of parent–child interaction. The scale is part of a home-training program employed with direct motor speech intervention for children with speech sound disorders.

Method: Eighty-four preschool age children with speech sound disorders were provided either high- (2×/week/10 weeks) or low-intensity (1×/week/10 weeks) motor speech intervention. Clinicians completed the PCIOs at the beginning, middle, and end of treatment. Inter-rater reliability (Kappa scores) was determined by an independent speech-language pathologist who assessed videotaped sessions at the midpoint of the treatment block. Intervention sensitivity of the scale was evaluated using a Friedman test for each item and then followed up with Wilcoxon pairwise comparisons where appropriate.

Results: We obtained fair-to-good inter-rater reliability (Kappa?=?0.33–0.64) for the PCIOs using only video-based scoring. Child-related items were more strongly influenced by differences in treatment intensity than parent-related items, where a greater number of sessions positively influenced parent learning of treatment skills and child behaviors.

Conclusion: The adapted PCIOs is reliable and sensitive to monitor the quality of parent–child interactions in a 10-week block of motor speech intervention with adjunct home therapy.

• Implications for rehabilitation

• Parent-centered therapy is considered a cost effective method of speech and language service delivery. However, parent-centered models may be difficult to implement for treatments such as developmental motor speech interventions that require a high degree of skill and training.

• For children with speech sound disorders and motor speech difficulties, a translated and adapted version of the parent–child observation scale was found to be sufficiently reliable and sensitive to assess changes in the quality of the parent–child interactions during intervention.

• In developmental motor speech interventions, high-intensity treatment (2×/week/10 weeks) facilitates greater changes in the parent–child interactions than low intensity treatment (1×/week/10 weeks).

• On one hand, parents may need to attend more than five sessions with the clinician to learn how to observe and address their child’s speech difficulties. On the other hand, children with speech sound disorders may need more than 10 sessions to adapt to structured play settings even when activities and therapy materials are age-appropriate.

     

Using assistive robots to promote inclusive education

Purpose: This paper describes the development and test of physical and virtual integrated augmentative manipulation and communication assistive technologies (IAMCATs) that enable children with motor and speech impairments to manipulate educational items by controlling a robot with a gripper, while communicating through a speech generating device.

Method: Nine children with disabilities, nine regular and nine special education teachers participated in the study. Teachers adapted academic activities so they could also be performed by the children with disabilities using the IAMCAT. An inductive content analysis of the teachers’ interviews before and after the intervention was performed.

Results: Teachers considered the IAMCAT to be a useful resource that can be integrated into the regular class dynamics respecting their curricular planning. It had a positive impact on children with disabilities and on the educational community. However, teachers pointed out the difficulties in managing the class, even with another adult present, due to the extra time required by children with disabilities to complete the activities.

Conclusions: The developed assistive technologies enable children with disabilities to participate in academic activities but full inclusion would require another adult in class and strategies to deal with the additional time required by children to complete the activities.

• Implications for Rehabilitation

• Integrated augmentative manipulation and communication assistive technologies are useful resources to promote the participation of children with motor and speech impairments in classroom activities.

• Virtual tools, running on a computer screen, may be easier to use but further research is needed in order to evaluate its effectiveness when compared to physical tools.

• Full participation of children with motor and speech impairments in academic activities using these technologies requires another adult in class and adequate strategies to manage the extra time the child with disabilities may require to complete the activities.

     

Applying the World Report on Disability to children’s communication

Abstract

Purpose: The World Report on Disability is an important milestone in the recognition of people with disabilities; however, the Report acknowledges that people with communication difficulties may be underrepresented in estimates of disability. Consequently, this article applies the nine recommendations from the World Report on Disability to supporting children’s communication skills. Method: Australia is similar to most Minority World countries since it places high regard on articulate and literate communication. Recent large-scale Australian studies of children with speech, language and communication needs were reviewed to determine prevalence, impact and associated environmental and personal factors. Studies of met and unmet need were reviewed and discussed in relation to legislation and policies. Results: Recent years have seen improvements in the collection of and access to disability data about children’s communication, including the involvement of children in research about the impact of communication difficulties on their lives. The prevalence of speech and language impairment in children is high and is associated with poorer educational and social outcomes at school-age. Significant unmet need for services was noted, and there were differences in health, education and disability policies regarding access to services. Conclusions: Updated legislation, policies and practices are needed to more effectively support access to services to support children’s communication across health, education and disability sectors.

• Implications for Rehabilitation

• There is a high prevalence of speech and language impairment in Australian children.

• Childhood speech and language impairment (and associated communication disability) can impact educational, social, behavioural and occupational outcomes throughout life.

• Many Australian children do not have sufficient access to targeted services (including speech-language pathology) to ameliorate the impact of their communication disability.

• Formulation of a national strategy to support children children’s communication is required.

     

The effect of comorbid medical and psychiatric diagnoses on chronic fatigue syndrome

Abstract

Objective: To determine if presence of co-existing medically unexplained syndromes or psychiatric diagnoses affect symptom frequency, severity or activity impairment in Chronic Fatigue Syndrome.

Patients: Sequential Chronic Fatigue Syndrome patients presenting in one clinical practice.

Design: Participants underwent a psychiatric diagnostic interview and were evaluated for fibromyalgia, irritable bowel syndrome and/or multiple chemical sensitivity.

Main Measures: Structured Clinical Interview [SCID] for DSM-IV; SF-36, Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Short Form; Patient Health Questionnaire-8; Multidimensional Fatigue Inventory (MFI-20), CDC Symptom Inventory

Results: Current and lifetime psychiatric diagnosis was common (68%) increasing mental fatigue/health but no other illness variables and not with diagnosis of other medically unexplained syndromes. 81% of patients had at least one of these conditions with about a third having all three co-existing syndromes. Psychiatric diagnosis was not associated with their diagnosis. Increasing the number of these unexplained conditions was associated with increasing impairment in physical function, pain and rates of being unable to work.

Conclusions: Patients with Chronic Fatigue Syndrome should be evaluated for current psychiatric conditions because of their impact on patient quality of life, but they do not act as a symptom multiplier for the illness. Other co-existing medically unexplained syndromes are more common than psychiatric co-morbidities in patients presenting for evaluation of medically unexplained fatigue and are also more associated with increased disability and the number and severity of symptoms.

• Key messages

• When physicians see patients with medically unexplained fatigue, they often infer that this illness is due to an underlying psychiatric problem.

• This paper shows that the presence of co-existing psychiatric diagnoses does not impact on any aspect of the phenomenology of medically unexplained fatigue also known as chronic fatigue syndrome. Therefore, psychiatric status is not an important causal contributor to CFS.

• In contrast, the presence of other medically unexplained syndromes (irritable bowel syndrome; fibromyalgia and/or multiple chemical sensitivity) do impact on the illness such that the more of these that co-exist the more health-related burdens the patient has.

     

A progressive consonant-substitution pattern in a typically developing child

The purpose of this paper was to describe and explain an unusual consonant substitution (default) pattern in the early lexical repertoire of a typically developing boy. Ben was audiotape recorded monthly from age 2;2–2;8 (years; months), to follow an unusual substitution pattern, initially observed between 1;6 and 1;7 (diary notations). Data from each recording period were analysed with reference to (a) consonant repertoire, and (b) default and non-default features present. Data are presented for three periods of [l] substitution: initially, for a glide /w/ (age 1;6–1;7), next, as a substitution for word-initial fricatives /s/, /z/ and // (age 2;2–2;3), and finally, in place of /r/ in consonant + /r/ clusters, in place of /j/ in initial position, and as a between-word liaison (age 2;7–2;8). It is shown that preferences for specific features, consonant vowel interactions, and syllable positions may be implicated in motivating this [l] substitution at specific points over time. The observed pattern is explained with reference to universal and child-specific factors and adds further evidence for variability that exists among typically developing children.     

Ultrasound in dysphagia rehabilitation: a novel approach following partial glossectomy

Purpose: While the presence of dysphagia following partial glossectomy has been widely reported, there is insufficient quality evidence to guide clinical decision making about the treatment of this disorder. This study investigated a novel dysphagia rehabilitation approach using ultrasound tongue imaging for patient training.

Method: Initially, a pilot study was conducted to investigate the feasibility of ultrasound visual feedback during swallow tasks. The protocol was then replicated using a single-case experimental designed study to investigate therapeutic effect. Swallow, speech, and oromotor functions were measured across multiple baselines using an A-B-A intervention study design.

Results: During intervention, both participants were able to interpret ultrasound tongue images during swallow tasks. Following intervention, positive therapeutic effect was achieved with reduced frequency of aspiration and self-initiated swallow strategies. Generalization of intervention was evidenced by reduced bolus transit duration on videofluoroscopy and improved functional oral intake scores. Speech and oromotor functions remained stable throughout the study demonstrating experimental control.

Conclusions: This study establishes that ultrasound visual feedback is feasible in dysphagia rehabilitation following partial glossectomy. In addition, the predicted therapeutic effect specifically to swallow but not speech or oromotor functions were demonstrated.

• Implications for Rehabilitation

• Partial glossectomy results in altered tongue shape, movement, and function which negatively impact on speech and swallowing

• There is limited research evidence to support previously used speech pathology interventions (in particular, tongue range of movement exercises) to rehabilitate dysphagia following tongue cancer surgery

• The tongue, and hence oral phase of swallowing, can be viewed by placing an ultrasound probe under the chin

• Ultrasound scanning of the tongue is not invasive, can be repeated without dosage side effect. It’s also comfortable for the patient and if a portable probe and monitor are used, can be performed within a variety of clinical settings for assessment or therapy

• This study shows specific therapeutic benefit following ultrasound visual feedback along with a motor learning approach to rehabilitate swallow function following partial glossectomy

• Visual and verbal feedback that focus specifically on the motor movements undergoing adaptation (e.g., tongue wave movement, tongue elevation, bolus clearance) following partial glossectomy are recommended

• Patients who are able to see the ultrasound monitor, hear the feedback given, are cognitively able to self-evaluate tongue movement, and remember intervention goals will most benefit from ultrasound tongue visual feedback in therapy

• Clinicians also benefit from visualizing the tongue with ultrasound during assessment and therapy as a direct view reduces the subjectivity of rating task performance

     

Design and in vitro/in vivo evaluations of a multiple-drug-containing gingiva disc for periodontotherapy

In the current work, we set out to develop and evaluate a gingiva disc of cellulose acetate phthalate and poloxamer F-127 for the simultaneous delivery of multiple drugs, namely minocycline, celecoxib, doxycycline hyclate, and simvastatin, to abolish infection, impede inflammation, avert collagen destruction, and promote alveolar bone regeneration, respectively. In vitro release studies revealed the sustained release profiles of the drugs for 12 h and that they were active against Staphylococcus aureus, Escherichia coli and Streptococcus mutans. The in vivo bioactivity levels of these drugs were assessed by comparing the number of colony forming units during different phases of a study on Wistar rats, and the results showed a reduction in the number of bacterial colonies with the applied formulation. A mucosal irritation study conducted on Wistar rat gingiva confirmed the non-irritancy of the optimal gingiva disc. Hence, this customized, non-invasive polymeric gingiva disc displaying a sustained release of drugs can be a useful tool to treat acute to moderate stages of periodontitis.

A gingiva disc of cellulose acetate phthalate and poloxaner F-127 was developed for the simultaneous delivery of multiple drugs, including minocycline, to promote alveolar bone regeneration by abolishing infection, impeding inflammation and averting collagen destruction.