Dysarthria in Adults With Cerebral Palsy: Clinical Presentation and Impacts on Communication

Schölderle, Theresa; Staiger, Anja; Lampe, Renée; Strecker, Katrin; Ziegler, Wolfram

doi:10.1044/2015_jslhr-s-15-0086

Cited by 54 publications

(40 citation statements)

References 60 publications

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“…The question of what (combination of ) factors explain the change in intelligibility observed therefore remains. Lee et al (2014) and Schölderle et al (2016) have demonstrated the impact of articulatory precision on intelligibility for children and adults who have dysarthria and cerebral palsy. The potential effect of the therapy on articulatory skill and ability to produce easily perceived speech contrasts therefore warrants further attention.…”

Section: Discussionmentioning

confidence: 99%

“…However, acoustic analysis suggest that phonetic contrasts such as fricative-affricate and voice-voiceless contrasts may be marked but not perceived by listeners (Ansel and Kent 1992), possibly because of the weak aero-acoustic signal. Recent research suggests that articulatory, respiratory and prosodic impairment are most strongly associated with intelligibility for children and adults with cerebral palsy who have dysarthria , Schölderle et al 2016.…”

Section: Introductionmentioning

confidence: 99%

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Acoustic changes in the speech of children with cerebral palsy following an intensive program of dysarthria therapy*

Pennington

Lombardo

Steen

et al. 2017

Intl J Lang & Comm Disor

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Background: The speech intelligibility of children with dysarthria and cerebral palsy has been observed to increase following therapy focusing on respiration and phonation. Aims: To determine if speech intelligibility change following intervention is associated with change in acoustic measures of voice. Methods & Procedures:We recorded 16 young people with cerebral palsy and dysarthria (nine girls; mean age 14 years, SD = 2; nine spastic type, two dyskinetic, four mixed; one Worster-Drought) producing speech in two conditions (single words, connected speech) twice before and twice after therapy focusing on respiration, phonation and rate. In both single-word and connected speech we measured vocal intensity (root mean square-RMS), period-to-period variability (Shimmer APQ, Jitter RAP and PPQ) and harmonics-to-noise ratio (HNR). In connected speech we also measured mean fundamental frequency, utterance duration in seconds and speech and articulation rate (syllables/s with and without pauses respectively). All acoustic measures were made using Praat. Intelligibility was calculated in previous research. Outcomes & Results:In single words statistically significant but very small reductions were observed in period-toperiod variability following therapy: Shimmer APQ -0.15 (95% CI = -0.21 to -0.09); Jitter RAP -0.08 (95% CI = -0.14 to -0.01); Jitter PPQ -0.08 (95% CI = -0.15 to -0.01). No changes in period-to-period perturbation across phrases in connected speech were detected. However, changes in connected speech were observed in phrase length, rate and intensity. Following therapy, mean utterance duration increased by 1.11 s (95% CI = 0.37-1.86) when measured with pauses and by 1.13 s (95% CI = 0.40-1.85) when measured without pauses. Articulation rate increased by 0.07 syllables/s (95% CI = 0.02-0.13); speech rate increased by 0.06 syllables/s (95% CI = < 0.01-0.12); and intensity increased by 0.03 Pascals (95% CI = 0.02-0.04). There was a gradual reduction in mean fundamental frequency across all time points . Only increases in the intensity of single words (0.37 Pascals, 95% CI = 0.10-0.65) and reductions in fundamental frequency (-0.11 Hz, 95% CI = -0.21 to -0.02) in connected speech were associated with gains in intelligibility. Conclusions & Implications:Mean reductions in impairment in vocal function following therapy observed were small and most are unlikely to be clinically significant. Changes in vocal control did not explain improved intelligibility.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Acoustic changes in the speech of children with cerebral palsy following an intensive program of dysarthria therapy*

Pennington

Lombardo

Steen

et al. 2017

Intl J Lang & Comm Disor

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show abstract

“…Furthermore, slowed speaking rate tends to be a characteristic of dysarthria post-stroke (Mackenzie, 2011), which may not significantly impact intelligibility (Blanchet & Snyder, 2010) and, therefore, may not be targeted or prioritized in management. Conversely, Schölderle, Staiger, Lampe, Strecker and Ziegler (2016) reported respiration and phonation as subsystems most prominently affected in CP; however, given that only 10 respondents had patients with CP on their current caseload, management practices for CP are unlikely to be overtly reflected in the survey results. The use of instrumentation was noted to be limited, consistent with Conway and Walshe (2015).…”

Section: Discussionmentioning

confidence: 92%

A survey of speech-language pathology treatment for non-progressive dysarthria in Australia

2020

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Aim: To identify management practices of Australian speech-language pathologists (SLPs) in the treatment of non-progressive dysarthria using a subsystem approach, and to explore SLPs’ consideration and implementation of the theoretical underpinnings of non-progressive dysarthria management. Method: A 39-item online survey was distributed to Australian SLPs, with 80 responses suitable for data analysis. Results: Practices of SLPs were variable for the management of the speech subsystems. The Lee Silverman Voice Treatment (LSVT®) was the most commonly used manualised treatment program, and was employed by 63.77% of respondents. Almost all SLPs (>88%) provided strategies to improve functional communication. There was no clear preference for low tech alternative and augmentative communication (AAC) devices. Speech generating devices were the most commonly employed high tech device. Almost two-thirds of respondents used non-speech oral motor exercises (NSOMEs) in treatment. SLPs had varied frequencies and models of service delivery for intervention. SLPs valued interventions targeting the activity and participation domains of the ICF, however this was restricted by the treatment context and resources available. The majority of SLPs (92.06%) were aware of the principles of motor learning, however many were unsure regarding the specifics of implementation. Conclusion: There is a clear need for further research into the efficacy of treatment techniques to guide decision-making.

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“…The speech presentations of children with dysarthria secondary to CP are diverse, some presenting with only a mild dysarthria and others presenting with anarthria, resulting in no functional verbal communication (Hustad, Gorton, & Lee, 2010). Even speakers with CP who have similar intelligibility levels can have widely varying perceptual and acoustic speech features (Allison & Hustad, 2018;Schölderle, Staiger, Lampe, Strecker, & Ziegler, 2016). Despite this heterogeneity, variations in profiles of abnormal speech features have not been well characterized in children with CP.…”

mentioning

confidence: 99%

Data-Driven Classification of Dysarthria Profiles in Children With Cerebral Palsy

Allison

Hustad

2018

J Speech Lang Hear Res

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Purpose The objectives of this study were to examine different speech profiles among children with dysarthria secondary to cerebral palsy (CP) and to characterize the effect of different speech profiles on intelligibility. Method Twenty 5-year-old children with dysarthria secondary to CP and 20 typically developing children were included in this study. Six acoustic and perceptual speech measures were selected to quantify a range of segmental and suprasegmental speech characteristics and were measured from children's sentence productions. Hierarchical cluster analysis was used to identify naturally occurring subgroups of children who had similar profiles of speech features. Results Results revealed 4 naturally occurring speech clusters among children: 1 cluster of children with typical development and 3 clusters of children with dysarthria secondary to CP. Two of the 3 dysarthria clusters had statistically equivalent intelligibility levels but significantly differed in articulation rate and degree of hypernasality. Conclusion This study provides initial evidence that different speech profiles exist among 5-year-old children with dysarthria secondary to CP, even among children with similar intelligibility levels, suggesting the potential for developing a pediatric dysarthria classification system that could be used to stratify children with dysarthria into meaningful subgroups for studying speech motor development and efficacy of interventions.

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Dysarthria in Adults With Cerebral Palsy: Clinical Presentation and Impacts on Communication

Cited by 54 publications

References 60 publications

Acoustic changes in the speech of children with cerebral palsy following an intensive program of dysarthria therapy*

Acoustic changes in the speech of children with cerebral palsy following an intensive program of dysarthria therapy*

A survey of speech-language pathology treatment for non-progressive dysarthria in Australia

Data-Driven Classification of Dysarthria Profiles in Children With Cerebral Palsy

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