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Background: Visual biofeedback using electropalatography (EPG) has been beneficial in the treatment of some cases of lateral /s/ misarticulation. While EPG intervention is motorically based, studies have not commonly employed a motor learning approach to treatment. Furthermore, treatment success is measured primarily by change to EPG tongue-palate contact patterns and listener ratings conducted by speech-language therapists. Studies have not commonly measured articulatory change without the palate in-situ using acoustic analysis and non-professional listeners. Aims: To determine if an intensive treatment programme including both visual biofeedback (EPG) and traditional articulation techniques within a motor learning paradigm would result in functional improvement to /s/ articulation in an 11-year-old girl with persistent lateral misarticulation. Methods & Procedures: Treatment involved 12 sessions of therapist-delivered treatment over 4 weeks followed by a 6-week home programme. Outcomes of the treatment programme were measured primarily using naïve listener ratings and acoustic analysis of /s/ spectra. Outcomes & Results: Improvements to both the perceptual and spectral characteristics of /s/ articulation occurred following the treatment programme. Conclusions: The study highlighted the benefit of an intensive approach to intervention incorporating both visual biofeedback and traditional articulation approaches. The inclusion of a 6-week structured home-programme was beneficial and resulted in consolidation of treatment gains. [ABSTRACT FROM AUTHOR]

Previous studies have indicated that consonant imprecision in Parkinson's disease (PD) may result from a reduction in amplitude of lingual movements or articulatory undershoot. While this has been postulated, direct measurement of the tongue's contact with the hard palate during speech production has not been undertaken. Therefore, the present study aimed to use electropalatography (EPG) to determine the exact nature of tongue-palate contact in a group of individuals with PD and consonant imprecision (n = 9). Furthermore, the current investigation also aimed to compare the results of the participants with PD to a group of aged (n = 7) and young (n = 8) control speakers to determine the relative contribution of ageing of the lingual musculature to any articulatory deficits noted. Participants were required to read aloud the phrase 'I saw a _ today' with the artificial palate in-situ. Target words included the consonants /l/, /s/ and /t/ in initial position in both the /i/ and /a/ vowel environments. Phonetic transcription of phoneme productions and description of error types was completed. Furthermore, representative frames of contact were employed to describe the features of tongue-palate contact and to calculate spatial palatal indices. Results of the perceptual investigation revealed that perceived undershooting of articulatory targets distinguished the participant group with PD from the control groups. However, objective EPG assessment indicated that undershooting of the target consonant was not the cause of the perceived articulatory errors. It is, therefore, possible that reduced pressure of tongue contact with the hard palate, sub-lingual deficits or impaired articulatory timing resulted in the perceived undershooting of the target consonants. [ABSTRACT FROM AUTHOR]

Purpose: Up to 90% of people with Parkinson's disease (PD) develop communication difficulties over the course of the disease. While the negative effect of dysarthria on communicative participation has been well-documented, the impact of the occurrence of acquired stuttered disfluencies on communication in different speech situations is unknown. This study aimed to determine if the frequency of occurrence of stuttered disfluencies affects communicative participation in individuals with PD, and whether such a relationship is mediated by examiner- and self-rated measures of disease severity., Method: Conversational speech samples were collected from 100 people with PD aged 53-91 years to calculate the frequency of occurrence of stuttered disfluencies. Participants completed the Communicative Participation Item Bank to assess participation in communicative situations. Information on overall speech, cognitive, and motor performance was collected using both self-rated and examiner-rated methods., Results: Participants with PD presented with 0.2%-9.9% stuttered disfluencies during conversation. Overall, participants with PD reported their communicative participation to be impacted "a little" (19.5 ± 7.0), but there was considerable interindividual variation. A higher frequency of stuttered disfluencies was associated with significantly lower communicative participation (ρ = -0.32, p < .01). In addition, examiner-rated frequency of stuttered disfluencies ( p < .01), speech ( p < .01), and motor severity ( p = .04) were all significant predictors of communicative participation. Using self-ratings, speech ( p < .01) and cognitive ( p < .01) measures significantly predicted communicative participation., Conclusions: In people with PD, communicative participation was significantly worse for those with a higher frequency of stuttered disfluencies. Examiner- and self-rated measures of disease severity contributed different information related to communicative constraints. Together, these results highlight the importance of individualized and holistic speech therapy that considers a wide variety of symptoms, including stuttered disfluencies, to ensure positive functional outcomes., Supplemental Material: https://doi.org/10.23641/asha.26850169.

Purpose: Engaging in reflective practice (RP) and demonstrating reflective abilities is an essential graduate skill for speech-language pathologists (SLPs), yet limited studies have examined the perspectives of practicing SLPs and how and why they engage in RP. This qualitative study aimed to examine SLPs' experiences and perspectives of RP in diverse workplaces., Method: Individual semi-structured interviews were conducted with 30 SLPs working in health, education, or private practice sectors. Interviews were analysed using thematic analysis., Result: Three themes were developed from the data, describing what SLPs use RP for, what SLPs perceive as important in order to engage in RP in the workplace, as well as the barriers they have identified, and how SLPs have observed a change in engaging in RP as they have progressed in their careers., Conclusion: SLPs described that RP is valued in the workplace for supporting client focused care, problem-solving, and lifelong learning. SLPs wanted time to be protected for RP at all stages of their career and valued the relationships with others as contributing positively to RP. Perceptions of and engagement in RP changed in relation to SLPs' clinical experience. Implications for clinical practice are discussed.

Purpose: Reduced speech intelligibility is often a hallmark of children with dysarthria secondary to cerebral palsy (CP), but effects of speech strategies for increasing intelligibility are understudied, especially in children who speak languages other than English. This study examined the effects of (the Korean translation of) two cues, "speak with your big mouth" and "speak with your strong voice," on speech acoustics and intelligibility of Korean-speaking children with CP., Method: Fifteen Korean-speaking children with CP repeated words and sentences in habitual, big mouth, and strong voice conditions. Acoustic analyses were performed and intelligibility was assessed by means of 90 blinded listeners' ease-of-understanding (EoU) ratings and percentage of words correctly transcribed (PWC)., Results: In response to both cues, children's vocal intensity and utterance duration increased significantly and differentially, whereas their vowel space area gains did not reach statistical significance. EoU increased significantly in the big mouth condition at word, but not sentence, level, whereas in the strong voice condition, EoU increased significantly at both levels. PWC increases were not statistically significant. Considerable variability in children's responses to cues was noted overall., Conclusions: Korean-speaking children with CP modify their speech styles differentially when provided with cues aimed to increase their articulatory working space and vocal intensity. The results provide preliminary support for the use of the strong voice cue, in particular, to increase EoU. While the findings do not offer conclusive evidence of the intelligibility benefits of these cues, investigation with a larger sample size should provide further insight into optimal cueing strategies for increasing intelligibility in this population. Implications for language-specific versus language-independent treatment approaches are discussed., Supplemental Material: https://doi.org/10.23641/asha.25521052.

Purpose: While communication changes associated with Parkinson's disease (PD) have been documented, research on the impact of these changes on family members is just beginning to emerge. With this new focus on family, questions arise as to how well speech-language pathology services address their needs communicating with their loved one with PD. The purpose of this study was to explore the experiences of family members of people with PD (PwPD) and their recommendations for speech-language pathology services that incorporated their needs., Method: Seventeen spouses/partners of PwPD participated in focus groups that were recorded, transcribed, and analyzed using thematic analyses., Results: Three themes emerged, all focusing around the central tenet that the experiences of family members, and hence their need for speech-language pathology support, transitioned through the stages of PD progression. Theme 1 summarized increasing burdens on family to manage communication as PD progressed beyond a brief period of independent strategy use by PwPD. Theme 2 highlighted multifactorial contributors to communication burdens on families, with cognitive impairments being the most underrecognized. Theme 3 illustrated how families wanted more intervention options from speech-language pathologists (SLPs) that included them, but with a tailored approach for PD stages and personal preferences., Conclusions: When SLPs provide families with either generic communication strategies or strategies that do not fit the individualized needs of PwPD and their families, we may inadvertently be increasing the burden on families. There is a need for systematic, evidence-based, family-centered interventions that include, but go beyond, current speech-focused interventions to meet the shared communication needs of PwPD and their families.

Purpose: The purpose of this study was to examine selected baseline acoustic features of hypokinetic dysarthria in Spanish speakers with Parkinson's disease (PD) and identify potential acoustic predictors of ease of understanding in Spanish., Method: Seventeen Spanish-speaking individuals with mild-to-moderate hypokinetic dysarthria secondary to PD and eight healthy controls were recorded reading a translation of the Rainbow Passage. Acoustic measures of vowel space area, as indicated by the formant centralization ratio (FCR), envelope modulation spectra (EMS), and articulation rate were derived from the speech samples. Additionally, 15 healthy adults rated ease of understanding of the recordings on a visual analogue scale. A multiple linear regression model was implemented to investigate the predictive value of the selected acoustic parameters on ease of understanding., Results: Listeners' ease of understanding was significantly lower for speakers with dysarthria than for healthy controls. The FCR, EMS from the first 10 s of the reading passage, and the difference in EMS between the end and the beginning sections of the passage differed significantly between the two groups of speakers. Findings indicated that 67.7% of the variability in ease of understanding was explained by the predictive model, suggesting a moderately strong relationship between the acoustic and perceptual domains., Conclusions: Measures of envelope modulation spectra were found to be highly significant model predictors of ease of understanding of Spanish-speaking individuals with hypokinetic dysarthria associated with PD. Articulation rate was also found to be important (albeit to a lesser degree) in the predictive model. The formant centralization ratio should be further examined with a larger sample size and more severe dysarthria to determine its efficacy in predicting ease of understanding.

Background: Written reflective practice (WRP) is a teaching tool used across speech-language therapy (SLT) clinical education programmes. The process aims to support the development of reflective skills required for the workplace (e.g., problem-solving and self-evaluation)., Aims: This cross-sectional and repeated-measures study design investigated students' demonstration of breadth of WRP across the clinical education programme., Methods & Procedures: The participants were 77 undergraduate SLT students in their first, second or final professional year of the clinical programme. Participants wrote critical reflections following an interaction with a client/s as part of their clinical education experiences. Formative feedback was provided after each written reflection (WR). In total four WRs per participant were coded for breadth of WRP using a modification of Plack et al.'s coding schema from 2005. This was completed for each of the four time points across the academic year for each professional year., Outcomes & Results: There was a statistically significant association between time (i.e., professional year of the programme) and likelihood of demonstration of breadth of reflection for the lower level reflective element of 'attend' and higher level reflective element of 're-evaluate'. A positive trend between time and likelihood of demonstration of breadth of reflection was seen for the lower level element of 'reflection-for-action'. Final-professional-year students exhibited significant enhancements in the higher level elements (e.g., 'premise') compared with first- and second-professional-year students., Conclusions & Implications: This group of SLT students exhibited significant change in breadth of WRP across the degree programme. This finding has positive implications for facilitating WRP with students and using the current coding framework in clinical programmes., What This Paper Adds: What is already known on this subject WRP is one form of reflective practice (RP) used in SLT, allied health, medical and nursing clinical education programmes. Researchers have suggested that RP skills develop over time for students. Previously, studies examining WRP have focused on one off assessment of skill or over a timeframe of 6-10 weeks. Here, we examine SLT students' WRP skills across the degree programme. What this paper adds to existing knowledge SLT students exhibited significant positive change in breadth of WRP across the degree programme as their clinical experience increased. Our results provide quantitative information in support of using RP as a learning tool throughout clinical education programmes for SLT. What are the potential or actual clinical implications of this work? This study offers support for educators of SLT students; for example, how educators can assess WRP, and how educators can foster SLT student skill development with formative feedback and reflective questioning. This study also offers support for student SLT, for example, describing how WRP can be part of their individualized learning approach and provide a purposeful examination of self and clinical skill development., (© 2022 The Authors. International Journal of Language & Communication Disorders published by John Wiley & Sons Ltd on behalf of Royal College of Speech and Language Therapists.)

Background: Parkinson's disease frequently causes communication impairments, but knowledge about the occurrence of new-onset stuttering is limited., Objectives: To determine the presence of acquired neurogenic stuttering and its relationship with cognitive and motor functioning in individuals with Parkinson's disease., Method: Conversation, picture description, and reading samples were collected from 100 people with Parkinson's disease and 25 controls to identify the presence of stuttered disfluencies (SD) and their association with neuropsychological test performance and motor function., Results: Participants with Parkinson's disease presented with twice as many stuttered disfluencies during conversation (2.2% ± 1.8%SD) compared to control participants (1.2% ± 1.2%SD; P  < 0.01). 21% of people with Parkinson's disease ( n  = 20/94) met the diagnostic criterion for stuttering, compared with 1/25 controls. Stuttered disfluencies also differed significantly across speech tasks, with more disfluencies during conversation compared to reading ( P  < 0.01). Stuttered disfluencies in those with Parkinson's disease were associated with longer time since disease onset ( P  < 0.01), higher levodopa equivalent dosage ( P  < 0.01), and lower cognitive ( P  < 0.01) and motor scores ( P  < 0.01)., Conclusion: One in five participants with Parkinson's disease presented with acquired neurogenic stuttering, suggesting that speech disfluency assessment, monitoring and intervention should be part of standard care. Conversation was the most informative task for identifying stuttered disfluencies. The frequency of stuttered disfluencies was higher in participants with worse motor functioning, and lower cognitive functioning. This challenges previous suggestions that the development of stuttered disfluencies in Parkinson's disease has purely a motoric basis., (© 2023 The Authors. Movement Disorders Clinical Practice published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.)

Objectives: It is vital health services have systems in place for staff mandatory training to meet safe quality health outcomes. The aim of this review is to identify enablers supporting staff attendance at mandatory training (including BLS) and barriers that pose challenges for staff participation in mandatory training that will be used to inform the development of a structured mandatory staff training program in an IPE environment., Design: An integrative literature review was sought to answer the question: What are the enablers and barriers that influence health professional attendance and successful completion of mandatory training (including BLS) in an IPE environment?, Data Sources: An international literature search was undertaken using advance search of the databases: Medline, CINAHL, Google Scholar and Web of Science (WoS). English language, peer reviewed articles published from 2010 to 2022 were retrieved and screened for relevance., Review Methods: An integrative review of papers included systematic reviews, a case study, quantitative and qualitative studies, RCT, mixed method studies and expert opinion papers., Results: Only 34 articles were eligible for inclusion in the review based on their relevance to staff attendance at mandatory training (including BLS). Analysis of literature identified four key themes: 'mandatory training' and 'certification'; 'knowledge and skills'; 'enablers' and 'barriers' for 'mandatory training (including BLS) attendance' and 'IPE'. The literature highlighted that IPE is an appropriate means of delivering a redesign education/training process that may increase attendance at mandatory training with recommendations for increased inclusivity and interactivity as well as providing useful logistic information., Conclusion: The outcome of the review can inform development of an IPE Implementation Strategy in a health service aiming to improve staff attending and engaging in mandatory training. The findings are valuable to other health services seeking to improve and achieve mandatory and accreditation targets., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Purpose: This study investigated the effects of intensive voice treatment on subjective and objective measures of speech production in Mandarin speakers with hypokinetic dysarthria., Method: Nine Mandarin speakers with hypokinetic dysarthria due to Parkinson's disease received 4 weeks of intensive voice treatment (4 × 60 min per week). The speakers were recorded reading a passage before treatment (PRE), immediately after treatment (POST), and at 6-month follow-up (FU). Listeners ( n = 15) rated relative ease of understanding (EOU) of paired speech samples on a visual analogue scale. Acoustic analyses were performed. Changes in EOU, vocal intensity, global and local fundamental frequency ( f o ) variation, speech rate, and acoustic vowel space area (VSA) were examined., Results: Increases were found in EOU and vocal intensity from PRE to POST and from PRE to FU, with no change found from POST to FU. Speech rate increased from PRE to POST, with limited evidence of an increase from PRE to FU and no change from POST to FU. No changes in global or local f o variation or in VSA were found., Conclusions: Intensive voice treatment shows promise for improving speech production in Mandarin speakers with hypokinetic dysarthria. Vocal intensity, speech rate, and, crucially, intelligibility, may improve for up to 6 months posttreatment. In contrast, f o variation and VSA may not increase following the treatment., Supplemental Material: https://doi.org/10.23641/asha.19529017.

Purpose: Automatic muscle segmentation is critical for advancing our understanding of human physiology, biomechanics, and musculoskeletal pathologies, as it allows for timely exploration of large multi-dimensional image sets. Segmentation models are rarely developed/validated for the pediatric model. As such, autosegmentation is not available to explore how muscle architectural changes during development and how disease/pathology affects the developing musculoskeletal system. Thus, we aimed to develop and validate an end-to-end, fully automated, deep learning model for accurate segmentation of the rectus femoris and vastus lateral, medialis, and intermedialis using a pediatric database., Methods: We developed a two-stage cascaded deep learning model in a coarse-to-fine manner. In the first stage, the U 2 -Net roughly detects the muscle subcompartment region. Then, in the second stage, the shape-aware 3D semantic segmentation method SASSNet refines the cropped target regions to generate the more finer and accurate segmentation masks. We utilized multifeature image maps in both stages to stabilize performance and validated their use with an ablation study. The second-stage SASSNet was independently run and evaluated with three different cropped region resolutions: the original image resolution, and images downsampled 2× and 4× (high, mid, and low). The relationship between image resolution and segmentation accuracy was explored. In addition, the patella was included as a comparator to past work. We evaluated segmentation accuracy using leave-one-out testing on a database of 3D MR images (0.43 × 0.43 × 2 mm) from 40 pediatric participants (age 15.3 ± 1.9 years, 55.8 ± 11.8 kg, 164.2 ± 7.9 cm, 38F/2 M)., Results: The mid-resolution second stage produced the best results for the vastus medialis, rectus femoris, and patella (Dice similarity coefficient = 95.0%, 95.1%, 93.7%), whereas the low-resolution second stage produced the best results for the vastus lateralis and vastus intermedialis (DSC = 94.5% and 93.7%). In comparing the low- to mid-resolution cases, the vasti intermedialis, vastus medialis, rectus femoris, and patella produced significant differences (p = 0.0015, p = 0.0101, p < 0.0001, p = 0.0003) and the vasti lateralis did not (p = 0.2177). The high-resolution stage 2 had significantly lower accuracy (1.0 to 4.4 dice percentage points) compared to both the mid- and low-resolution routines (p value ranged from < 0.001 to 0.04). The one exception was the rectus femoris, where there was no difference between the low- and high-resolution cases. The ablation study demonstrated that the multifeature is more reliable than the single feature., Conclusions: Our successful implementation of this two-stage segmentation pipeline provides a critical tool for expanding pediatric muscle physiology and clinical research. With a relatively small and variable dataset, our fully automatic segmentation technique produces accuracies that matched or exceeded the current state of the art. The two-stage segmentation avoids memory issues and excessive run times by using a first stage focused on cropping out unnecessary data. The excellent Dice similarity coefficients improve upon previous template-based automatic and semiautomatic methodologies targeting the leg musculature. More importantly, with a naturally variable dataset (size, shape, etc.), the proposed model demonstrates slightly improved accuracies, compared to previous neural networks methods., (© 2021 American Association of Physicists in Medicine. This article has been contributed to by US Government employees and their work is in the public domain in the USA.)

Purpose Children with dysarthria secondary to cerebral palsy may experience reduced speech intelligibility and diminished communicative participation. However, minimal research has been conducted examining the outcomes of behavioral speech treatments in this population. This study examined the effect of Speech Intelligibility Treatment (SIT), a dual-focus speech treatment targeting increased articulatory excursion and vocal intensity, on intelligibility of narrative speech, speech acoustics, and communicative participation in children with dysarthria. Method American English-speaking children with dysarthria ( n = 17) received SIT in a 3-week summer camplike setting at Columbia University. SIT follows motor-learning principles to train the child-friendly, dual-focus strategy, "Speak with your big mouth and strong voice." Children produced a story narrative at baseline, immediate posttreatment (POST), and at 6-week follow-up (FUP). Outcomes were examined via blinded listener ratings of ease of understanding ( n = 108 adult listeners), acoustic analyses, and questionnaires focused on communicative participation. Results SIT resulted in significant increases in ease of understanding at POST, that were maintained at FUP. There were no significant changes to vocal intensity, speech rate, or vowel spectral characteristics, with the exception of an increase in second formant difference between vowels following SIT. Significantly enhanced communicative participation was evident at POST and FUP. Considerable variability in response to SIT was observed between children . Conclusions Dual-focus treatment shows promise for improving intelligibility and communicative participation in children with dysarthria, although responses to treatment vary considerably across children. Possible mechanisms underlying the intelligibility gains, enhanced communicative participation, and variability in treatment effects are discussed.

Purpose This study examined the relationship between measurements derived from spontaneous speech and participants' scores on the Montreal Cognitive Assessment. Method Participants ( N = 521) aged between 64 and 97 years completed the cognitive assessment and were prompted to describe an early childhood memory. A range of acoustic and linguistic measures was extracted from the resulting speech sample. A least absolute shrinkage and selection operator approach was used to model the relationship between acoustic, lexical, and demographic information and participants' scores on the cognitive assessment. Results Using the covariance test statistic, four important variables were identified, which, together, explained 16.52% of the variance in participants' cognitive scores. Conclusions The degree to which cognition can be accurately predicted through spontaneously produced speech samples is limited. Statistically significant relationships were found between specific measurements of lexical variation, participants' speaking rate, and their scores on the Montreal Cognitive Assessment.

Soft tissue balancing while crucial for a successful total knee arthroplasty (TKA) is incompletely defined and the subject of broad recommendations. We analyzed 69 unilateral computer-assisted surgery posterior stabilized (PS) TKA subjects who postoperatively scored ≥36 out of a possible 40 points on the satisfaction section of the American Knee Society score (2011). We examined a range of postoperative coronal plane laxity parameters and the correlation between preoperative and postoperative laxity. Total postoperative coronal laxity arcs at maximum extension and 20 degrees of flexion varied between 2 and 12 and 3 and 13 degrees, respectively. Depending on the position of measurement, medial laxity was between 0.5 and 9.5 degrees and lateral laxity between 1 and 12 degrees. The change in laxity between maximum extension and 90 degrees of flexion demonstrated a range of 7 degrees medially and 12 degrees laterally. The total coronal arc of movement did not affect functional outcomes. A moderate correlation of 0.452 and 0.424 was seen between initial and postoperative total coronal laxity arcs in maximum extension and 20 degrees of flexion, respectively. The individual variability for each measured parameter within our cohort demonstrates TKA satisfaction is not as simple as producing a narrow range of coronal laxity parameters and that as with many body systems considerable variation is still consistent with excellent function. Our findings help to define acceptable balance parameters for PS TKA. It does not appear necessary to closely match postoperative laxity to that present preoperatively., Competing Interests: S.L.W. reports other from Stryker Corp, outside the submitted work., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

Purpose: Our clinical understanding of the relationship between 3D bone morphology and knee osteoarthritis, as well as our ability to investigate potential causative factors of osteoarthritis, has been hampered by the time-intensive nature of manually segmenting bone from MR images. Thus, we aim to develop and validate a fully automated deep learning framework for segmenting the patella and distal femur cortex, in both adults and actively growing adolescents., Methods: Data from 93 subjects, obtained from on institutional review board-approved protocol, formed the study database. 3D sagittal gradient recalled echo and gradient recalled echo with fat saturation images and manual models of the outer cortex were available for 86 femurs and 90 patellae. A deep-learning-based 2D holistically nested network (HNN) architecture was developed to automatically segment the patella and distal femur using both single (sagittal, uniplanar) and 3 cardinal plane (triplanar) methodologies. Errors in the surface-to-surface distances and the Dice coefficient were the primary measures used to quantitatively evaluate segmentation accuracy using a 9-fold cross-validation., Results: Average absolute errors for segmenting both the patella and femur were 0.33 mm. The Dice coefficients were 97% and 94% for the femur and patella. The uniplanar, relative to the triplanar, methodology produced slightly superior segmentation. Neither the presence of active growth plates nor pathology influenced segmentation accuracy., Conclusion: The proposed HNN with multi-feature architecture provides a fully automatic technique capable of delineating the often indistinct interfaces between the bone and other joint structures with an accuracy better than nearly all other techniques presented previously, even when active growth plates are present., (© 2019 International Society for Magnetic Resonance in Medicine.)

Purpose: Research on the prevalence of communication disability among community living older adults is scant, and often suffers from limitations. Using a national database, this study presents an epidemiological profile of communication disability in older community residents within New Zealand and examines whether ethnic populations are disproportionately represented. Method: Since 2012, all New Zealand community care recipients have undergone a standardised needs assessment, which includes questions directed at expressive and receptive language abilities. Those assessed between 1 September 2012 and 31 January 2016, aged ≥65 years, and who provided consent were included. Directly standardised prevalence estimates were calculated and logistic regression used to investigate age, sex and ethnic differences. Result: Overall, 71 859 people were eligible (mean age = 82.7 years, 61% female, 89.2% European/other), with 30.6% and 36.2% exhibiting at least some expression and comprehension communication disability, respectively. Māori, Pasifika and Asian people, males and those who were older were more likely to have at least some communication disability compared to their European/other, female and younger counterparts. Conclusion: Communication disability is common among older adults. With the increased provision of home-based integrated models of care, the impact of communication disability on service seeking and delivery must be recognised and accommodated.

Aged residential care (ARC) admission needs are increasing beyond the available capacity in many countries, including New Zealand. Therefore, identifying modifiable factors which may prevent or delay ARC admissions is of international importance. Hearing impairment is common among older adults and thought to be an important predictor, although the current evidence-base is equivocal. Using the largest national database to date, competing-risk regression analysis was undertaken on 34,277 older adults having standardised home care assessments between 1 July 2012 and 31 May 2014, aged ≥65 years, and still living in the community 30 days after that assessment. Minimal hearing difficulty was reported by 10,125 (29.5%) participants, moderate difficulty by 5,046 (14.7%), severe difficulty/no hearing by 1,334 (3.9%), while 17,769 (51.8%) participants reported adequate hearing. By 30 June 2014, the study end-point, 6,389 (18.6%) participants had an ARC admission while 6,082 (17.7%) had died. In unadjusted competing-risk regression analyses, treating death as a competing event, hearing ability was significantly associated with ARC admission (p < 0.001). However, in adjusted analyses, this relationship was completely confounded by other variables (p = 0.67). This finding implies that screening for hearing loss among community-living older adults is unlikely to impact on ARC admission rates.

Purpose This study investigated the effects of cueing for increased loudness and reduced speech rate on scaled intelligibility and acoustics of speech produced by Mandarin speakers with hypokinetic dysarthria due to Parkinson's disease (PD). Method Eleven speakers with PD read passages in habitual, loud, and slow speaking conditions. Fifteen listeners rated ease of understanding (EOU) of the speech samples on a visual analog scale. Effects of the cues on EOU, vocal loudness, pitch range, pause duration and frequency, articulation rate, and vowel space, as well as relationships between EOU gains and acoustic features, were analyzed. Results EOU increased significantly in the loud condition only. The loud cue resulted in increased intensity, and the slow cue resulted both in reduced articulation rate and increased pause frequency. In the loud condition, EOU increased significantly as intensity increased and vowel centralization decreased. In the slow condition, EOU tended to increase as intensity increased and vowel centralization decreased but did not reach statistical significance. Conclusion Cueing for loud speech may yield greater EOU gains than cueing for slow speech in Mandarin speakers with PD. Theoretical and clinical implications are discussed, although further investigations with more participants and a larger range of dysarthria severity are warranted.

Background: Computer navigation and image-derived instrumentation (IDI) are technology-based methods developed to improve outcomes and potentially reduce revision total knee arthroplasty (TKA). IDI refers to the use of manufactured, patient-specific surgical jigs. Conflicting reports exist on IDI-associated improvements in outcomes. The primary aim of the current study was to compare the rates of revision among TKA cases in which components were initially implanted with use of IDI, computer navigation, or neither of these methods ("other" TKA). The secondary aim was to determine whether the outcomes of IDI differed for specific subgroups., Methods: Data were obtained from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) for the 3 TKA groups: IDI, computer-navigated, and other TKA. The study period was from the first IDI procedure recorded by the AOANJRR (April 2010) to December 31, 2016. The analysis was restricted to primary TKA cases undertaken for osteoarthritis and involving patellar resurfacing and the use of a cross-linked polyethylene insert. Subanalyses were performed to evaluate the effects of age, sex, implantation method, IDI manufacturer, prosthetic design, and prosthesis type on the rates of revision. Kaplan-Meier estimates of survivorship described the time to first revision. Hazard ratios (HRs, Cox proportional hazards models) with adjustment for age and sex were used to compare revision rates., Results: IDI was used in 5,486 primary TKA procedures. There was no significant difference among the groups in the cumulative percent revision (CPR) at 5 years: 3.3% (95% confidence interval [CI], 2.4% to 4.6%) for IDI, 2.4% (95% CI, 2.2% to 2.7%) for the computer-navigated group, and 2.5% (95% CI, 2.3% to 2.7%) for other TKA. Posterior-stabilized TKA with use of the IDI method had a significantly higher rate of revision at >3 months (HR, 1.45 [95% CI, 1.02 to 2.04]; p = 0.036), as did IDI TKA in the ≤65-year-old patient cohort (HR, 1.52 [95% CI, 1.10 to 2.09]; p = 0.010), compared with computer-navigated TKA. Patellar revision was significantly more likely in the IDI group., Conclusions: IDI TKA demonstrated no overall difference in early to mid-term revision rates compared with standard implantation methods. However, elevated rates of revision were seen with posterior-stabilized TKA, in patients ≤65 years of age, and for patellar revision, meaning that this method should be used with some caution and requires further study., Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Accurate and automated prostate whole gland and central gland segmentations on MR images are essential for aiding any prostate cancer diagnosis system. Our work presents a 2-D orthogonal deep learning method to automatically segment the whole prostate and central gland from T2-weighted axial-only MR images. The proposed method can generate high-density 3-D surfaces from low-resolution ( z axis) MR images. In the past, most methods have focused on axial images alone, e.g., 2-D based segmentation of the prostate from each 2-D slice. Those methods suffer the problems of over-segmenting or under-segmenting the prostate at apex and base, which adds a major contribution for errors. The proposed method leverages the orthogonal context to effectively reduce the apex and base segmentation ambiguities. It also overcomes jittering or stair-step surface artifacts when constructing a 3-D surface from 2-D segmentation or direct 3-D segmentation approaches, such as 3-D U-Net. The experimental results demonstrate that the proposed method achieves 92.4 % ± 3 % Dice similarity coefficient (DSC) for prostate and DSC of 90.1 % ± 4.6 % for central gland without trimming any ending contours at apex and base. The experiments illustrate the feasibility and robustness of the 2-D-based holistically nested networks with short connections method for MR prostate and central gland segmentation. The proposed method achieves segmentation results on par with the current literature.

Objective: In the perceptual assessment of dysarthria, various approaches are used to examine the accuracy of listeners' speech transcriptions and their subjective impressions of speech disorder. However, less attention has been given to the effort and cognitive resources required to process speech samples. This study explores the relationship between transcription accuracy, comprehensibility, subjective impressions of speech, and objective measures of reaction time (RT) to further examine the challenges involved in processing dysarthric speech., Patients and Methods: Sixteen listeners completed 3 experimental listening tasks: a sentence transcription task, a rating scale task, and an RT task that required responses to veracity statements. In each task, the speech stimuli included speech from 8 individuals with dysarthria., Results: Measurements from the 3 tasks were significantly related, with a correlation coefficient of -0.94 between average RT and transcription-based intelligibility scores and -0.89 between RT and listener ratings of dysarthria. Interrater reliability of RT measurements was relatively low when considering a single person's response to stimuli. However, reliability reached an acceptable level when a mean was taken from 8 listeners., Conclusions: RT tasks could be developed as a reliable adjunct in the assessment of listener effort and speech processing., (© 2019 S. Karger AG, Basel.)

Introduction: Balanced soft tissues are important to total knee arthroplasty (TKA) outcomes. Surgical algorithms for balancing are potentially varied in varus and valgus osteoarthritic (OA) knees. While coronal plane varus knee laxity has been documented, no study has objectively defined the medial and lateral laxity of the valgus OA knee. The lower limb was manipulated at the time of TKA using computer navigation, prior to surgical releases, to allow the limb weight-bearing axis to pass through the knee center in maximum extension, 20° and 90° of flexion. The hip-knee-ankle-angle was documented at this position. Coronal plane laxity was then measured in 30 valgus (7.9 ± 4.0°) knees as medial and lateral displacement from this point and compared to published values for healthy subjects. In maximum knee extension, lateral contracture was present in 26.6% (8/30) of subjects, and abnormally lax medial tissue was present in 46.6% (14/30). Six patterns of medial versus lateral laxity were documented in maximum extension. In maximum knee extension, mean medial laxity was 7.1° (±3.8°) compared to 2.7° (±2.7°) laterally. In 20° of knee flexion, mean medial laxity was 8.5° (±3.5°) compared to 3.0° (±2.6°) laterally. In 90° of knee flexion, mean medial laxity was 3.7° (±1.3°) and 7.5° (±3.0°) laterally. A highly significant difference ( p < 0.0001) in mean laxity was demonstrated when comparing medial versus lateral values at each measurement angle and for medial versus medial and lateral versus lateral values for maximum extension and 90° of flexion. The valgus knee at the time of TKA demonstrates significant preoperative mediolateral and flexion-extension imbalance. In maximum extension, medial tissue is significantly laxer whereas in flexion this reverses and the lateral tissue is significantly laxer. We documented more patterns of medial and lateral laxity in maximum extension than advocated in prior subjective grading systems. These findings demonstrate the challenges of valgus OA knee balancing during TKA but provide, for the first time, objective measures for the starting point of this process.

Competing Interests: Competing interests: None declared.

Purpose: Across the treatment literature, behavioral speech modifications have produced variable intelligibility changes in speakers with dysarthria. This study is the first of two articles exploring whether measurements of baseline speech features can predict speakers' responses to these modifications., Methods: Fifty speakers (7 older individuals and 43 speakers with dysarthria) read a standard passage in habitual, loud, and slow speaking modes. Eighteen listeners rated how easy the speech samples were to understand. Baseline acoustic measurements of articulation, prosody, and voice quality were collected with perceptual measures of severity., Results: Cues to speak louder and reduce rate did not confer intelligibility benefits to every speaker. The degree to which cues to speak louder improved intelligibility could be predicted by speakers' baseline articulation rates and overall dysarthria severity. Improvements in the slow condition could be predicted by speakers' baseline severity and temporal variability. Speakers with a breathier voice quality tended to perform better in the loud condition than in the slow condition., Conclusions: Assessments of baseline speech features can be used to predict appropriate treatment strategies for speakers with dysarthria. Further development of these assessments could provide the basis for more individualized treatment programs.

Purpose: Behavioral speech modifications have variable effects on the intelligibility of speakers with dysarthria. In the companion article, a significant relationship was found between measures of speakers' baseline speech and their intelligibility gains following cues to speak louder and reduce rate (Fletcher, McAuliffe, Lansford, Sinex, & Liss, 2017). This study reexamines these features and assesses whether automated acoustic assessments can also be used to predict intelligibility gains., Method: Fifty speakers (7 older individuals and 43 with dysarthria) read a passage in habitual, loud, and slow speaking modes. Automated measurements of long-term average spectra, envelope modulation spectra, and Mel-frequency cepstral coefficients were extracted from short segments of participants' baseline speech. Intelligibility gains were statistically modeled, and the predictive power of the baseline speech measures was assessed using cross-validation., Results: Statistical models could predict the intelligibility gains of speakers they had not been trained on. The automated acoustic features were better able to predict speakers' improvement in the loud condition than the manual measures reported in the companion article., Conclusions: These acoustic analyses present a promising tool for rapidly assessing treatment options. Automated measures of baseline speech patterns may enable more selective inclusion criteria and stronger group outcomes within treatment studies.

Accurate automatic segmentation of the prostate in magnetic resonance images (MRI) is a challenging task due to the high variability of prostate anatomic structure. Artifacts such as noise and similar signal intensity of tissues around the prostate boundary inhibit traditional segmentation methods from achieving high accuracy. We investigate both patch-based and holistic (image-to-image) deep-learning methods for segmentation of the prostate. First, we introduce a patch-based convolutional network that aims to refine the prostate contour which provides an initialization. Second, we propose a method for end-to-end prostate segmentation by integrating holistically nested edge detection with fully convolutional networks. Holistically nested networks (HNN) automatically learn a hierarchical representation that can improve prostate boundary detection. Quantitative evaluation is performed on the MRI scans of 250 patients in fivefold cross-validation. The proposed enhanced HNN model achieves a mean ± standard deviation. A Dice similarity coefficient (DSC) of [Formula: see text] and a mean Jaccard similarity coefficient (IoU) of [Formula: see text] are used to calculate without trimming any end slices. The proposed holistic model significantly ([Formula: see text]) outperforms a patch-based AlexNet model by 9% in DSC and 13% in IoU. Overall, the method achieves state-of-the-art performance as compared with other MRI prostate segmentation methods in the literature.

Purpose: There is direct literature conflict regarding coronal plane contracture or laxity in the end-stage varus osteoarthritic knee. Understanding the preoperative soft tissue status is important for optimizing the soft tissue envelope during total knee arthroplasty (TKA)., Methods: The lower limb was manipulated using computer navigation, prior to surgical releases, to allow the limb weight-bearing axis to pass through the knee centre in maximum extension and 20° of flexion. Coronal plane laxity was measured in 78 varus (-7.7° ± 2.8°) knees as medial and lateral displacement from this point and compared to published values for healthy subjects., Results: Medial contracture was present in 12.8% (10/78) of the knees. Of these 10 knees, 5 displayed abnormal lateral laxity. Knees with a contracture in maximum extension also displayed a significant decrease ( p < 0.0001) in medial laxity at 20° of flexion compared to non-contracted knees. In maximum extension, 19.2% (15/78) of knees had abnormally increased lateral laxity, 10 did not have a medial contracture. The remaining five knees with increased lateral laxity or 6.4% (5/78) of the total cohort also displayed a medial contracture. Lateral laxity increased significantly with increasing varus deformity. Medial laxity did not significantly decrease when comparing varus deformity of 5-10° versus >10°., Conclusion: The majority of varus knees with deformity of up to 15° have neither a medial contracture nor abnormal lateral laxity when referenced to the individualized neutral axis of the knee. Surgical releases during TKA should be uncommon. Medial contracture when present is influenced by both posterior and medial structures. Lateral laxity is a more consistent feature of the varus knee. The patterns of contracture and laxity are variable with limited correlation to deformity.

Purpose: Communication disorders associated with Parkinson's disease (PD) often lead to restricted participation in life roles, yet there is a limited understanding of influencing factors and few quantitative measurement tools available. This study aimed to identify variables associated with communicative participation in PD and to examine the relationship between the Communicative Participation Item Bank (CPIB) and existing health-related quality-of-life (HRQoL) measures., Method: Self-report data from 378 participants with PD from the US and New Zealand were analysed. Data included responses to the CPIB, PD Questionnaire-8, sub-scales of the Global Health instrument from the Patient Reported Outcomes Measurement Information System (PROMIS) and additional self-report instruments., Result: Greater perceived speech disorder, lower levels of speech usage, fatigue, cognitive and emotional problems and swallowing difficulties were associated with lower levels of communicative participation. Participants' age significantly influenced findings, interacting with country of residence, sex and speech usage. Scores on the CPIB were moderately correlated with HRQoL measures., Conclusion: Communicative participation in PD is complex and influenced by both demographic and disease-based variables, necessitating a broader view of the communicative experiences of those with PD. Measurement of communicative participation as a separate construct to existing HRQoL measures is recommended.

Purpose: Reductions in articulatory working space and vocal intensity have been linked to intelligibility deficits in children with dysarthria due to cerebral palsy. However, few studies have examined the outcomes of behavioral treatments aimed at these underlying impairments or investigated which treatment cues might best facilitate improved intelligibility. This study assessed the effects of cues targeting clear speech (i.e., "Speak with your big mouth") and greater vocal intensity (i.e., "Speak with your strong voice") on acoustic measures of speech production and intelligibility., Method: Eight children with spastic dysarthria due to cerebral palsy repeated sentence- and word-level stimuli across habitual, big mouth, and strong voice conditions. Acoustic analyses were conducted, and 48 listeners completed orthographic transcription and scaled intelligibility ratings., Results: Both cues resulted in significant changes to vocal intensity and speech rate although the degree of change varied by condition. In a similar manner, perceptual analysis revealed significant improvements to intelligibility with both cues; however, at the single-word level, big mouth outperformed strong voice., Conclusion: Children with dysarthria are capable of changing their speech styles differentially in response to cueing. Both the big mouth and strong voice cues hold promise as intervention strategies to improve intelligibility in this population., Supplemental Material: https://doi.org/10.23641/asha.5116843.

Medial and lateral coronal soft tissue laxity in 90 degrees of flexion in the varus osteoarthritic (OA) knee at the time of total knee arthroplasty (TKA) is unknown, meaning, key information as to how the flexion gap should be addressed by surgery is not available. The purpose of this study was to define the coronal plane medial and lateral laxity in 90 degrees of flexion in the end-stage OA knee. Computer assisted surgery (CAS) displays and direct joint observations were used to manipulate the knee to its neutral position in 90 degrees of flexion prior to any surgical releases. Laxity was measured as medial and lateral displacement from the neutral axis of the knee and compared with literature values for healthy subjects. The 72 knees examined had a mean varus deformity, measured in maximum extension, of -7.9 ± 3.1 degrees (-0.5 to -15 degrees). At 90 degrees of flexion, mean medial and lateral laxity as measured by displacement from the neutral axis of the knee was 3.8 ± 1.4 degrees and 4.7 ± 2 degrees respectively. This medial laxity was significantly greater -1.7 degrees (95% CI, -3.1 to -0.3 degrees) than that seen in healthy knees ( p  < 0.0001) whereas the measured lateral laxity displayed a nonsignificant difference compared with healthy knees. The mean difference in medial-lateral laxity was 1.5 ± 1.1 degrees. A medial-lateral difference of ≤2.5 degrees was present in 91.6% of knees. We found no evidence of contractures in the coronal plane tissue of the end-stage OA knee at the time of TKA. Absolute medial-lateral balance is not typical of the end-stage OA knee in 90 degrees of flexion with a small medial-lateral difference typically present. Careful examination of the soft tissues in flexion at the commencement of TKA may help guide surgery to optimize the coronal plane soft tissue envelope. Our findings would suggest that large releases during either a gap-balanced or a measured-resection TKA would not typically be necessary, and that releases that increase laxity in flexion may increase often already lax medial tissue or increase laxity within lateral tissues that typically already have physiological tension., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

This study examines acoustic features of speech production in speakers of Mandarin with Parkinson's disease (PD) and relates them to intelligibility outcomes. Data from 11 participants with PD and 7 controls are compared on several acoustic measures. In speakers with PD, the strength of association between these measures and intelligibility is investigated. Speakers with PD exhibited significant differences in fundamental frequency, pitch variation, vowel space, and rate relative to controls. However, in contrast to the English studies, speech rate was consistently slow and most strongly correlated with intelligibility. Thus, acoustic cues that strongly influence intelligibility in PD may vary cross-linguistically.

Purpose: The aim of this study was to examine the effect of loud and slow speech cues on younger and older listeners' comprehension of dysarthric speech, specifically, (a) whether one strategy, as opposed to the other, promoted greater intelligibility gains for different speaker groups; (b) whether older and younger listeners' understandings were differentially affected by these strategies; and (c) which acoustic changes best predicted intelligibility gain in individual speakers., Method: Twenty younger and 40 older listeners completed a perceptual task. Six individuals with dysarthria produced phrases across habitual, loud, and slow conditions. The primary dependent variable was proportion of words correct; follow-up acoustic analyses linked perceptual outcomes to changes in acoustic speech features., Results: Regardless of dysarthria type, the loud condition produced significant intelligibility gains. Overall, older listeners' comprehension was reduced relative to younger listeners. Follow-up analysis revealed considerable interspeaker differences in intelligibility outcomes across conditions. Although the most successful speaking mode varied, intelligibility gains were strongly associated with the degree of change participants made to their vowel formants., Conclusions: Perceptual outcomes vary across speaking modes, even when speakers with dysarthria are grouped according to similar perceptual profiles. Further investigation of interspeaker differences is needed to inform individually tailored intervention approaches.

Purpose: The strength of the relationship between vowel centralization measures and perceptual ratings of dysarthria severity has varied considerably across reports. This article evaluates methods of acoustic-perceptual analysis to determine whether procedural changes can strengthen the association between these measures., Method: Sixty-one speakers (17 healthy individuals and 44 speakers with dysarthria) read a standard passage. To obtain acoustic data, 2 points of formant extraction (midpoint and articulatory point) and 2 frequency measures (Hz and Bark) were trialed. Both vowel space area and an adapted formant centralization ratio were calculated using first and second formants of speakers' corner vowels. Twenty-eight listeners rated speech samples using different prompts: one with a focus on intelligibility, the other on speech precision., Results: Perceptually, listener ratings of speech precision provided the best index of acoustic change. Acoustically, the combined use of an articulatory-based formant extraction point, Bark frequency units, and the formant centralization ratio was most effective in explaining perceptual ratings. This combination of procedures resulted in an increase of 17% to 27% explained variance between measures., Conclusions: The procedures researchers use to assess articulatory impairment can significantly alter the strength of relationship between acoustic and perceptual measures. Procedures that maximize this relationship are recommended.

This study examined the relationship between average vowel duration and spectral vowel quality across a group of 149 New Zealand English speakers aged 65 to 90 yr. The primary intent was to determine whether participants who had a natural tendency to speak slowly would also produce more spectrally distinct vowel segments. As a secondary aim, this study investigated whether advancing age exhibited a measurable effect on vowel quality and vowel durations within the group. In examining vowel quality, both flexible and static formant extraction points were compared. Two formant measurements, from selected [ɐ:], [ i:], and [ o:] vowels, were extracted from a standard passage and used to calculate two measurements of vowel space area (VSA) for each speaker. Average vowel duration was calculated from segments across the passage. The study found a statistically significant relationship between speakers' average vowel durations and VSA measurements indicating that, on average, speakers with slower speech rates produced more acoustically distinct speech segments. As expected, increases in average vowel duration were found with advancing age. However, speakers' formant values remained unchanged. It is suggested that the use of a habitually slower speaking rate may assist speakers in maintaining acoustically distinct vowels.

Purpose: To determine how increased vocal loudness and reduced speech rate affect listeners' cognitive-perceptual processing of hypokinetic dysarthric speech associated with Parkinson's disease., Method: Fifty-one healthy listener participants completed a speech perception experiment. Listeners repeated phrases produced by 5 individuals with dysarthria across habitual, loud, and slow speaking modes. Listeners were allocated to habitual ( n = 17), loud ( n = 17), or slow ( n = 17) experimental conditions. Transcripts derived from the phrase repetition task were coded for overall accuracy (i.e., intelligibility), and perceptual error analyses examined how these conditions affected listeners' phonemic mapping (i.e., syllable resemblance) and lexical segmentation (i.e., lexical boundary error analysis)., Results: Both speech conditions provided obvious perceptual benefits to listeners. Overall, transcript accuracy was highest in the slow condition. In the loud condition, however, improvement was evidenced across the experiment. An error analysis suggested that listeners in the loud condition prioritized acoustic-phonetic cues in their attempts to resolve the degraded signal, whereas those in the slow condition appeared to preferentially weight lexical stress cues., Conclusions: Increased loudness and reduced rate exhibited differential effects on listeners' perceptual processing of dysarthric speech. The current study highlights the insights that may be gained from a cognitive-perceptual approach.

Purpose: To examine the cross-cultural applicability of the Communicative Participation Item Bank (CPIB) through a comparison of respondents with Parkinson's disease (PD) from the United States and New Zealand., Method: A total of 428 respondents-218 from the United States and 210 from New Zealand-completed the self-report CPIB and a series of demographic questions. Differential item functioning (DIF) analyses were conducted to examine whether response bias was present across the 2 groups., Results: No items were identified as having statistically significant DIF across the U.S. and N.Z. cohorts., Conclusion: The current CPIB items and scoring parameters are also suitable for use with respondents from New Zealand.

Automatic prostate segmentation in MR images is a challenging task due to inter-patient prostate shape and texture variability, and the lack of a clear prostate boundary. We propose a supervised learning framework that combines the atlas based AAM and SVM model to achieve a relatively high segmentation result of the prostate boundary. The performance of the segmentation is evaluated with cross validation on 40 MR image datasets, yielding an average segmentation accuracy near 90%.

An interactive navigation system for virtual bronchoscopy is presented, which is based solely on GPU based high performance multi-histogram volume rendering.

This study examined younger (n = 16) and older (n = 16) listeners' processing of dysarthric speech-a naturally occurring form of signal degradation. It aimed to determine how age, hearing acuity, memory, and vocabulary knowledge interacted in speech recognition and lexical segmentation. Listener transcripts were coded for accuracy and pattern of lexical boundary errors. For younger listeners, transcription accuracy was predicted by receptive vocabulary. For older listeners, this same effect existed but was moderated by pure-tone hearing thresholds. While both groups employed syllabic stress cues to inform lexical segmentation, older listeners were less reliant on this perceptual strategy. The results were interpreted to suggest that individuals with larger receptive vocabularies, with their presumed greater language familiarity, were better able to leverage cue redundancies within the speech signal to form lexical hypothesis-leading to an improved ability to comprehend dysarthric speech. This advantage was minimized as hearing thresholds increased. While the differing levels of reliance on stress cues across the listener groups could not be attributed to specific individual differences, it was hypothesized that some combination of larger vocabularies and reduced hearing thresholds in the older participant group led to them prioritize lexical cues as a segmentation frame.

This investigation examined perceptual learning of dysarthric speech. Forty listeners were randomly assigned to one of two identification training tasks, aimed at highlighting either the linguistic (word identification task) or indexical (speaker identification task) properties of the neurologically degraded signal. Twenty additional listeners served as a control group, passively exposed to the training stimuli. Immediately following exposure to dysarthric speech, all three listener groups completed an identical phrase transcription task. Analysis of listener transcripts revealed remarkably similar intelligibility improvements for listeners trained to attend to either the linguistic or the indexical properties of the signal. Perceptual learning effects were also evaluated with regards to underlying error patterns indicative of segmental and suprasegmental processing. The findings of this study suggest that elements within both the linguistic and indexical properties of the dysarthric signal are learnable and interact to promote improved processing of this type and severity of speech degradation. Thus, the current study extends support for the development of a model of perceptual processing in which the learning of indexical properties is encoded and retained in conjunction with linguistic properties of the signal.

The National Database for Autism Research (NDAR) is a secure research data repository designed to promote scientific data sharing and collaboration among autism spectrum disorder investigators. The goal of the project is to accelerate scientific discovery through data sharing, data harmonization, and the reporting of research results. Data from over 25,000 research participants are available to qualified investigators through the NDAR portal. Summary information about the available data is available to everyone through that portal.

This investigation evaluated the familiarisation conditions required to promote subsequent and more long-term improvements in perceptual processing of dysarthric speech and examined the cognitive-perceptual processes that may underlie the experience-evoked learning response. Sixty listeners were randomly allocated to one of three experimental groups and were familiarised under the following conditions: (1) neurologically intact speech (control), (2) dysarthric speech (passive familiarisation), and (3) dysarthric speech coupled with written information (explicit familiarisation). All listeners completed an identical phrase transcription task immediately following familiarisation, and listeners familiarised with dysarthric speech also completed a follow-up phrase transcription task 7 days later. Listener transcripts were analysed for a measure of intelligibility (percent words correct), as well as error patterns at a segmental (percent syllable resemblance) and suprasegmental (lexical boundary errors) level of perceptual processing. The study found that intelligibility scores for listeners familiarised with dysarthric speech were significantly greater than those of the control group, with the greatest and most robust gains afforded by the explicit familiarisation condition. Relative perceptual gains in detecting phonetic and prosodic aspects of the signal varied dependent upon the familiarisation conditions, suggesting that passive familiarisation may recruit a different learning mechanism to that of a more explicit familiarisation experience involving supplementary written information. It appears that decisions regarding resource allocation during subsequent processing of dysarthric speech may be informed by the information afforded by the conditions of familiarisation.

Differences in perceptual strategies for lexical segmentation of moderate hypokinetic dysarthric speech, apparently related to the conditions of the familiarization procedure, have been previously reported [Borrie et al., Language and Cognitive Processes (2012)]. The current follow-up investigation examined whether this difference was also observed when familiarization stimuli highlighted syllabic strength contrast cues. Forty listeners completed an identical transcription task following familiarization with dysarthric phrases presented under either passive or explicit learning conditions. Lexical boundary error patterns revealed that syllabic strength cues were exploited in both familiarization conditions. Comparisons with data previously reported afford further insight into perceptual learning of dysarthric speech.

Purpose: Older adults exhibit difficulty understanding speech that has been experimentally degraded. Age-related changes to the speech mechanism lead to natural degradations in signal quality. We tested the hypothesis that older adults with hearing loss would exhibit declines in speech recognition when listening to the speech of older adults, compared with the speech of younger adults, and would report greater amounts of listening effort in this task., Method: Nineteen individuals with age-related hearing loss completed speech recognition and listening effort scaling tasks. Both were conducted in quiet, when listening to high- and low-predictability phrases produced by younger and older speakers, respectively., Results: No significant difference in speech recognition existed when stimuli were derived from younger or older speakers. However, perceived effort was significantly higher when listening to speech from older adults, as compared with younger adults., Conclusions: For older individuals with hearing loss, natural degradations in signal quality may require greater listening effort. However, they do not interfere with speech recognition-at least in quiet. Follow-up investigation of the effect of speaker age on speech recognition and listening effort under more challenging noise conditions appears warranted.

Purpose: This review article provides a theoretical overview of the characteristics of perceptual learning, reviews perceptual learning studies that pertain to dysarthric populations, and identifies directions for future research that consider the application of perceptual learning to the management of dysarthria., Method: A critical review of the literature was conducted that summarized and synthesized previously published research in the area of perceptual learning with atypical speech. Literature related to perceptual learning of neurologically degraded speech was emphasized with the aim of identifying key directions for future research with this population., Conclusions: Familiarization with unfamiliar or ambiguous speech signals can facilitate perceptual learning of that same speech signal. There is a small but growing body of evidence that perceptual learning also occurs for listeners familiarized with dysarthric speech. Perceptual learning of the dysarthric signal is both theoretically and clinically significant. In order to establish the efficacy of exploiting perceptual learning paradigms for rehabilitative gain in dysarthria management, research is required to build on existing empirical evidence and develop a theoretical framework for learning to better recognize neurologically degraded speech.