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Background and Purpose  The aim of the study was to compare transcription-based speech intelligibility and scaled speech severity for the detection of mild speech impairments, by studying these metrics across talkers with Parkinson's disease (PD), age- and sex-matched older adults, and younger adults. An additional aim was to determine the impact of listener experience on these clinical measures. Methods  Fifteen speakers from each experimental group were asked to read aloud 11 randomly generated sentences from the Speech Intelligibility Test at their typical speaking rate and loudness. Two groups of four listeners each, stratified as experienced or inexperienced listeners based on their clinical experience, judged the sentence samples. To estimate intelligibility, both listener groups were asked to orthographically transcribe exactly what they heard for each sentence. For severity estimates, the listener groups were asked to rate the sentences for overall quality based on voice, resonance, articulation, and prosody, using a visual analog scale. Results  Transcription-based intelligibility and scaled severity scores of the PD group differed significantly from those of the older and younger adults. Between-age group differences in intelligibility and scaled severity were not observed. Listener experience had an impact on scaled speech severity, but not speech intelligibility. Between-group differences in speech severity were driven by the inexperienced group and not the experienced listener group. Implications  Both transcription-based intelligibility and scaled severity estimates appear to be sensitive to relatively mild speech impairments in PD. Obtaining scaled severity is less labor intensive than transcription; therefore, visual analog scaling may be the preferred paradigm for clinical use. However, listener experience and training are important considerations for scaling techniques to be implemented clinically. [ABSTRACT FROM AUTHOR]

Most residual speech errors (RSEs) involve abnormal positioning or movement of the tongue. However, it is not possible under normal circumstances to view directly the actions of the tongue during production of these distorted articulations. The visually inaccessible location of the tongue can often make precise diagnosis difficult in cases of RSEs, and intervention can be a particular challenge for clinicians when speech errors persist in older children and adults. Electropalatography (EPG) is a technique that can provide objective and clinically relevant data about details of tongue articulation during speech. Furthermore, biofeedback with EPG offers the possibility of an effective intervention for RSEs. This tutorial provides an overview of EPG and describes how the technique can contribute to our knowledge and treatment of abnormal tongue-palate contact in older children and adults with RSEs. An illustrative case study of a child with RSEs affecting fricatives and affricates is included. [ABSTRACT FROM AUTHOR]

In this article, setting-specific challenges and recent ethical concerns relating to speech-language pathology service provision in skilled nursing/long-term care are discussed in the context of implementing evidence-based practice (EBP). The American Speech-Language-Hearing Association's four-step EBP process is reviewed, and barriers to and limitations of EBP are considered. Resources established by experts in various domains for accessing and efficiently evaluating evidence are provided. Guiding principles of medical ethics are reviewed as foundational elements of patient-centered care, and systematic treatment design practices are offered as means of generating practice-based evidence, which allows for assessment of intervention efficacy and complements the EBP process. Last, the integration of all steps of the EBP model is illustrated in a case study of a patient with moderate to severe hypokinetic dysarthria and comorbidities. It is hoped that these resources, principles, and practices will be of use to clinicians specifically in the skilled nursing facility/ long-term care setting in the provision of high-quality speech-language pathology interventions. [ABSTRACT FROM AUTHOR]

Background: According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, diagnosis of speech sound disorder (SSD) requires a determination that it is not the result of other congenital or acquired conditions, including hearing loss or neurological conditions that may present with similar symptomatology. Purpose: To examine peripheral and central auditory function for the purpose of determining whether a peripheral or central auditory disorder was an underlying factor or contributed to the child's SSD. Research Design: Central auditory processing disorder clinic pediatric case reports. Study Sample: Three clinical cases are reviewed of children with diagnosed SSD who were referred for audiological evaluation by their speech-language pathologists as a result of slower than expected progress in therapy. Results: Audiological testing revealed auditory deficits involving peripheral auditory function or the central auditory nervous system. These cases demonstrate the importance of increasing awareness among professionals of the need to fully evaluate the auditory system to identify auditory deficits that could contribute to a patient's speech sound (phonological) disorder. Conclusions: Audiological assessment in cases of suspected SSD should not be limited to pure-tone audiometry given its limitations in revealing the full range of peripheral and central auditory deficits, deficits which can compromise treatment of SSD. [ABSTRACT FROM AUTHOR]

This article reviews the occurrence of motor speech disorders of dysarthria and apraxia of speech following closed head injury and other traumatic brain injuries in adults as they apply to sport concussion and related trauma. Athletic sideline and speech-language pathology screenings are considered. Procedures for clinical assessment and diagnosis of motor speech disorder, most particularly dysarthria, are discussed with special reference to closed head injury. Included are the evaluation components of cranial nerve and speech mechanism examination, nonspeech musculature examination, perceptual and instrumental assessment procedures, quasi-standardized testing for dysarthria, and the determination of restrictions of participation in everyday life activities. The resultant output of such an evaluation is described in depth. Future directions for clinical research on motor speech disorders following sports concussion are also briefly considered. [ABSTRACT FROM AUTHOR]

The presence of a palatal cleft at birth should not prevent good speech production in most children provided they have (1) appropriate surgical intervention to close the palate at or around the child's first birthday, (2) careful monitoring of speech development throughout childhood, (3) speech therapy when needed, and (4) secondary surgical or speech-prosthetic intervention when needed. When managed carefully by an experienced, well-prepared multidisciplinary team that applies the criteria listed above, ~70% of children with nonsyndromic palatal clefts will have no significant difficulties with speech intelligibility or speech quality due to velopharyngeal insufficiency by the time they enter elementary school. Speech assessment is the first step toward comprehensive team management of children with cleft palate. The purpose of this chapter is to describe the use of instrumentation in the evaluation of speech of children with palatal clefts, within the context of a multidisciplinary team. The focus of this article is on instruments that are used to supplement the perceptual assessment to document current speech status and plan management strategies. [ABSTRACT FROM AUTHOR]

Cleft lip is an anomaly that primarily affects aesthetics, whereas cleft palate is an anomaly that primarily affects function, particularly speech. In fact, the main reason for repairing the palate is to provide adequate structure and function for normal speech production. Despite undergoing palatoplasty surgery, 20 to 30% of children with repaired cleft palate will demonstrate some degree of velopharyngeal dysfunction, resulting in abnormal speech. Velopharyngeal dysfunction is also seen in individuals without a history of cleft palate for various reasons. Because the symptoms of velopharyngeal dysfunction have a variety of causes, a comprehensive evaluation is very important to make the appropriate recommendations for treatment. The purpose of this article is to discuss the clinical assessment of velopharyngeal function for speech, using low-tech and ''no-tech'' procedures. [ABSTRACT FROM AUTHOR]

Clinical evaluation of velopharyngeal function relies heavily on auditory perceptual judgments that can be supported by instrumental examination of the velopharyngeal valve. Many of the current instrumental techniques are difficult to interpret, expensive, and/or unavailable to clinicians. Proposed in this report is a minimally invasive and inexpensive approach to evaluating velopharyngeal function that has been used successfully in our laboratory for several potentially difficult- to-test clients. The technique is an aeromechanical approach that involves the sensing of nasal ram pressure (N-RamP), a local pressure sensed at the anterior nares, using a two-pronged nasal cannula. By monitoring the N-RamP signal, it is possible to determine the status of the velopharyngeal port (open or closed) during speech production. Four case examples are presented to support its clinical value. [ABSTRACT FROM AUTHOR]