Purpose: The Everyday Speech Production Assessment Measure (E-SPAM) is a novel test for assessing changes in clients‟ speech production skills after intervention. This study provides information on reliability and validity for the test and overviews its clinical application. Method & Procedures: E-SPAM, oral reading, and sequential motion rate tasks were administered to 15 participants with motor speech disorders (MSDs). E-SPAM responses were scored using a 5-point system by four graduate students to assess inter-scorer and temporal reliability and to determine validity for E-SPAM. Results: Findings of this study indicate that the E-SPAM can be scored with sufficient reliability for clinical use, yields stable scores on repeat administrations, and that its results correlate highly with other accepted measures of speech production ability, specifically sentence intelligibility and severity. Conclusions: While the results of this study must be considered preliminary because of the small sample size, it does appear that the E-SPAM can provide information about aspects of speech production such as intelligibility, efficiency, and speech naturalness, that are important when treatment focuses on improving speech. The E-SPAM also appears to be a “clinician-friendly” test as it is quick to administer and score and can be administered to patients across the severity continuum.

Autism affects 1 in 88 children (Center for Disease Control, 2009), approximately 50% of whom will not develop speech (Seal & Bonvillian, 1997). Some researchers hypothesize that these difficulties in developing oral speech reflect underlying motor speech deficits (Prizant, 1996; Seal & Bonvillian, 1997; Szypulski, 2003; Andrianopoulos, Boucher, Velleman & colleagues 2007-2010). This investigation sought to identify the presence or absence of specific motor speech markers in ASD through an innovative best-practice protocol for assessing the speech, prosody, and voice quality of individuals with ASD. The study focused on apraxic-like motor planning/programming features and dysarthric-like motor execution features in imitated, elicited, and spontaneous speech in 15 children with ASD between 4;0 and 12;11 years as compared to 15 children who were NTD. Speech analyses included imitated speech tasks for [f] and [a] prolongation, the short phrase "pea tea key" and AMRs and SMRs; elicited speech tasks for Counting 1-10 and singing Happy Birthday; along with spontaneous speech tasks for telling two stories based on wordless picture stories and discussing a topic of interest. Results indicated that children with ASD presented with significantly decreased Maximum Phonation Times; lower formant values; lower pitch values; decreased rate of speech characterized by increased utterance, pause and vowel durations; reduced number of syllable repetitions in AMR and SMR tasks; variable and/or inconsistent performance across tasks; and a mildly deviant voice, further characterized by mildly deviant levels of roughness and strain, atypical production of prosody and inconsistent nasality. Based on the results of this empirical investigation, an acoustic-perceptual and motor speech profile for a sample population of children with an autism spectrum disorder can be determined by six tasks: prolongation of [f] and [a], articulation of AMRs and SMRs, Counting 1-10, and telling a story based on a wordless picture book. These objective measures can empirically determine the presence, prevalence, and nature of speech, phonatory, and prosodic deficits in this sample population. They support that intervention for children with ASD should not only focus on pragmatics, MLU, and vocabulary, as is often the case. Rather, voice and motor speech intervention protocols should be incorporated as appropriate to individuals with autism.

abstract: Speech intelligibility measures how much a speaker can be understood by a listener. Traditional measures of intelligibility, such as word accuracy, are not sufficient to reveal the reasons of intelligibility degradation. This dissertation investigates the underlying sources of intelligibility degradations from both perspectives of the speaker and the listener. Segmental phoneme errors and suprasegmental lexical boundary errors are developed to reveal the perceptual strategies of the listener. A comprehensive set of automated acoustic measures are developed to quantify variations in the acoustic signal from three perceptual aspects, including articulation, prosody, and vocal quality. The developed measures have been validated on a dysarthric speech dataset with various severity degrees. Multiple regression analysis is employed to show the developed measures could predict perceptual ratings reliably. The relationship between the acoustic measures and the listening errors is investigated to show the interaction between speech production and perception. The hypothesize is that the segmental phoneme errors are mainly caused by the imprecise articulation, while the sprasegmental lexical boundary errors are due to the unreliable phonemic information as well as the abnormal rhythm and prosody patterns. To test the hypothesis, within-speaker variations are simulated in different speaking modes. Significant changes have been detected in both the acoustic signals and the listening errors. Results of the regression analysis support the hypothesis by showing that changes in the articulation-related acoustic features are important in predicting changes in listening phoneme errors, while changes in both of the articulation- and prosody-related features are important in predicting changes in lexical boundary errors. Moreover, significant correlation has been achieved in the cross-validation experiment, which indicates that it is possible to predict intelligibility variations from acoustic signal. / Dissertation/Thesis / Doctoral Dissertation Speech and Hearing Science 2019

La paralysie cérébrale est la pathologie motrice la plus commune dans l’enfance, elle engendre tous types de troubles principalement moteurs. La parole peut notamment être touchée affectant parfois profondément les capacités communicatives des enfants. Les thérapies pour pallier les troubles moteurs de la parole manquent d’efficacité. C’est dans ce cadre que le logiciel RePliCa a été développé afin de rendre leur rééducation plus efficiente. Une variable, encore peu documentée dans le cadre de la rééducation, est identifiée comme influençant grandement les progrès, il s’agitde l’engagement. L’engagement est considéré comme malléable et sensible aux changements environnementaux et pourrait donc être influencé par l’introduction d’un logiciel dans la rééducation. La première partie de cette thèse était consacrée à l’optimisation de cet outil. Dans cet objectif, une série d’études expérimentales a été menée auprès d’enfants au développement typique et a permis l’intégration d’un certain nombre de caractéristiques relatives à l’interface influençant positivement l’engagement. Une grille d’observation a ensuite été créée afin d’évaluer l’engagement des enfants paralysés cérébraux dans la rééducation lors du programme pilote avec le logiciel. L’étude clinique montre des résultats encourageants, l’engagement semblant se maintenir au cours des séances. Ces résultats sont mis en perspectives dans le cadre d’un modèle de l’engagement. / Cerebral Palsy is the most common physical disability in early childhood, resulting in multiple disorders, primarily of motor skills. Speech especially can be impacted and deeply affects children’s communicative abilities. The RePliCa software wasdeveloped to improve the efficiency of motor speech therapy. One variable, engagement, has not been fully researched in the field of rehabilitation but has been identified influential for children’s progress. Engagement is presumed to bemalleable and sensitive to environmental changes and therefore could be influenced by the introduction of software in rehabilitation. The first part of this thesis was devoted to its optimization. To this end, a series of experimental studies wereconducted, enabling the integration of a number of features on the interface in order to promote engagement. Once the software was implemented, engagement in rehabilitation was examined in a clinical study. Results showed encouraging results: engagement can be maintained over time. Results are put in perspective using an engagement model framework

Parkinson's disease is a degenerative neurological condition which affects motor control, in almost all cases involving speech, and is frequently of many years duration. Much is known about speech production but less of the psychosocial consequences of the speech impairment (dysarthria). Accounts of people with dysarthria have shown that its impact on quality of social participation can be varied and profound. However, level of participation has not been investigated. Reduction in social activity and social networks has been found following onset of other neurogenic communication disorders. In Parkinson's disease there is some evidence of social activity reduction but this has not been studied in relation to severity of dysarthria. Social anxiety has been found to be raised in speakers with other speech production impairments and this may be a contributor to reduction in social engagement. Investigation of social variables is of importance in understanding relationships within a biopsychosocial model of health which underpins intervention for therapies for communication disorders. Aims The study aimed to investigate the impact of dysarthria on social participation and whether presence of dysarthria in Parkinson's disease (PD) resulted in changes to social anxiety, social networks and social activity. It further sought to investigate whether severity of dysarthria resulted in changes to the same variables. Method A group of 43 mild-moderately dysarthric speakers with PD were recruited. Exclusion criteria were applied to control for cognitive impairment, depression, apathy, movement disability and co-occurring neurological and communication impairment. A group of 30 non-neurologically impaired participants were recruited matched for age, sex, socioeconomic status and educational attainment. Participants with PD were further grouped using measures of sentence intelligibility and motor speech impairment into higher and lower functioning groups. All participants completed a social anxiety questionnaire, a social activity checklist and detailed their social network. Group data were compared to address the research questions. Semi-structured interviews were carried out with all participants to explore change to social life and perceptions of causes of change. Results Participants reported a range of changes to interaction and social engagement arising from speech and other impairments and also from intra and interpersonal contextual factors. Quantitative data showed that presence of dysarthria was associated with social anxiety and avoidance but not changes to social activity level or social network size. Greater severity of dysarthria was associated with deterioration in social activities and social network. There was wide individual variation on these variables. Outcomes Impact of dysarthria may be significant and unrelated to severity of impairment and satisfaction with level of activity is low in dysarthric speakers. Mild - moderately dysarthric speakers with PD may experience social anxiety in particular types of social situation. Moderately dysarthric speakers may experience loss of social capital in terms of quantitative changes in social networks and social activities. Motor speech impairment was a better predictor of social functioning than intelligibility in this sample. It is possible that a threshold for change lies at a more severe level of speech involvement. How speakers with PD perceive and experience their social interactions is discussed and limitations to the research are considered. The implications of the findings are discussed in relation to the ICF framework and the concept of social capital.

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The overarching goal of this dissertation was to assess a set of sensorimotor, acoustic, and functional speech measures to inform the understanding of the mechanisms underlying two common speech disorders with evidence of disrupted sensory function: hyperfunctional voice disorders (HVDs) and hypokinetic dysarthria resulting from Parkinson’s disease (PD). The purpose of the first and second study was to elucidate the mechanisms underlying speech symptoms in HVDs. The aim of the first study was to examine whether auditory discrimination and vocal responses to altered auditory feedback (indicative of vocal motor control) differed in a large set of speakers with HVDs (N = 62) compared to controls (N = 62). The results directly implicate disrupted auditory processing in impairments to vocal motor control in HVDs. Building on this finding, the second study sought to compare the same auditory and vocal motor control measures in speakers with HVDs pre- and post-therapy (N = 11) to assess whether successful therapy (i.e., voice symptom improvement) resulted in improvements to auditory-motor function. On average, vocal motor control improved after therapy but there were little changes to measures of auditory processing, which suggests that therapeutic improvements in HVDs may be compensatory rather than a result of resolving the underlying auditory processing deficits. The collective findings from the first and second study improve the understanding of the development of HVDs and highlight the need to consider auditory processing in assessment and treatment of HVDs. The third and fourth study objectives were to characterize auditory-motor control and longitudinal changes to speech acoustics in PD. In the third study, auditory-motor control of both voice and articulatory parameters of speech were assessed in speakers with PD on medication (N = 28) compared to controls (N = 28) and compared to measures of speech function (intelligibility and naturalness ratings). No group differences were found in auditory-motor measures, regardless of speech domain. These results, which describe findings from the largest sample of PD patients completing auditory-motor tasks to-date (N=28), suggest that auditory-motor control is intact in individuals with PD on their typical medication cycle. This work also provided the first evidence that auditory-motor measures reflect measures of speech function (speech intelligibility and naturalness). The fourth and final study in this dissertation examined whether longitudinal changes to speech acoustics in PD were associated with the specific time (in months) between speech samples. Although prior work has examined speech decline in PD, no study to-date has assessed whether speech acoustics are sensitive to disease progression within an individual with PD. The current study examined acoustic speech samples collected from speakers with PD (N = 30) at two separate time points. Longitudinal changes to speech acoustics were examined by time between speech samples, motor phenotype and sex assigned at birth, to shed light on the relationships between acoustic measures of speech, disease progression, motor symptoms, and sex. The study revealed that longitudinal decline in second formant slope, articulation rate (syllables per second) across The Rainbow Passage, and relative fundamental frequency offset values were all associated with increased time between sessions within a speaker. In addition, longitudinal increases in percent pause time in conversational speech were more likely in the PIGD motor phenotype, and longitudinal increases mean fo across conversational speech were more likely in males compared to females with PD. This work provides the first report of acoustic measures of speech that reflect the specific time, in months, of PD progression, as well as acoustic measures of speech that appear to be differentially impacted over time by motor phenotype and by sex. The findings provide evidence that three acoustic measures of speech show promise as measures of PD progression in months and support the notion that speech symptom decline differs by motor phenotype and by sex assigned at birth, which should be considered when planning therapeutic interventions. / 2026-08-31T00:00:00Z

The purpose of this study was to examine how a critical principle of motor learning, practice amount (high number of trials versus a low number of trials), affects speech motor learning in childhood apraxia of speech (CAS). It also sought to contribute to the literature base regarding using an integral stimulation approach for these children. Currently, a limited evidence base exists for decision-making regarding practice amount in CAS treatment. Using a single-case experimental design with two participants, three target sets of utterances (High Amount, Low Amount, and Control) received different amounts of treatment. Outcomes were compared in terms of retention. Targets were scored regarding perceptual (prosodic and segmental) accuracy. Effect sizes were computed to quantify the extent of treatment effects. For both participants, results show some evidence suggesting a higher amount of practice is advantageous and leads to greater learning. A low amount of treatment did not show clear differences compared to not receiving any treatment. Caution should be taken when interpreting these findings due to its small sample size and modest effects. Results suggest that the integral stimulation approach may only be effective if provided with a significantly high amount of practice. Further research is needed to examine how the principles of motor learning and the integral stimulation approach should be sensibly and systematically applied to promote best outcomes for this population. / Communication Sciences

Avhandlingens övergripande syfte var att undersöka fonologisk medvetenhet och skriftspråklig förmåga hos talande eller icke-talande barn, med lässvårigheter eller motoriska talsvårigheter. De huvudsakliga fynden i denna avhandling var: (1) För barn med lässvårigheter som befinner sig på en tidig nivå i sin läsutveckling bör intervention kring läs- och skrivförmågor fokusera på barnets svaghet snarare än styrkan vad gäller ordavkodning. (2) För barn med lässvårigheter hade såväl fonologisk som ortografisk intervention effekt på förmågan att läsa och skriva. Fonologisk intervention hade effekt även på barnen med lägst läsförmåga. (3) För barn med motoriska talsvårigheter var det signifikanta skillnader mellan de bästa och de sämsta läsarna vad gäller auditiv fonemdiskrimination och generella språkförmågor. (4) För barn med motoriska talsvårigheter hade fonologisk intervention effekt på förmågan att stava ord men inte på läsförmågan. (5) I en analys av nonsensord undersöktes stavfel hos en flicka med anartri. Fler stavfel återfanns i längre ord och en högre grad av fel återfanns i mitten av ord, vilket tyder på svårigheter med arbetsminne och med att segmentera ord. Fynden diskuteras i relation till fonologisk informationsbearbetning inom fyra delområden: fonologiska representationer, fonologisk produktion, fonologiskt minne och fonologisk medvetenhet. Talets betydelse för läs- och skrivförmågan är komplex. Även ett gravt avvikande tal kan ge fonologisk återkoppling och för barn med anartri tycks bristen på tal spela en viss roll. Denna avhandling har ett handikappvetenskapligt synsätt och bidrar till den övergripande förståelsen av fonologisk medvetenhet och skriftspråklig förmåga. Flera av fynden är direkt applicerbara i kliniska sammanhang. / The general aim of this thesis was to explore phonological awareness and written language in the presence and absence of speech in children with reading impairments and children with motor speech impairments. The main findings of the present thesis were: (1) For children with reading impairments who are at an early stage of reading development, interventions targeting reading and spelling should focus on their weakness rather than their strength in word decoding. (2) For children with reading impairments, phonological as well as orthographic intervention had effects on reading and spelling. The children with the lowest reading performance also showed effects of phonological intervention. (3) For children with motor speech impairments, significant differences were shown between low level readers and high level readers in the areas of auditory phoneme discrimination skills and general language skills. (4) For children with motor speech impairments, phonological intervention had effect on word spelling skills but not on reading skills. (5) In an analysis of non-word spelling errors of a girl with anarthria, more spelling errors were found on longer words, and a higher proportion of spelling errors were found in medial letter positions, implying deficit in segmentation of spoken words and working memory. The findings were discussed in relation to four subfields of phonological processing: phonological representations, phonological production, phonological memory and phonological awareness. The contributions of speech to reading and spelling are complex. Even a severely distorted speech can serve as a phonological feedback and for children with anarthria, the lack of speech does seem to play a role. The present thesis has a disability research approach and is a contribution to the overall understanding of phonological awareness and written language. Many of the findings are directly applicable to the clinical context.