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Entwicklungsverläufe kindlicher Dysarthrien: Auditive Profile und Verständlichkeit
Abstract
Zusammenfassung Trotz der hohen Prävalenz kindlicher Dysarthrien ist bislang über das klinische Bild, mögliche Entwicklungsverläufe sowie resultierende Verständlichkeitseinschränkungen nur wenig bekannt. In der vorliegende Längsschnittstudie werden auditive Profile und Verständlichkeitsdaten von 14 Kindern mit neurologischen Erkrankungen vor dem Hintergrund der typischen sprechmotorischen Entwicklung dargestellt. Grundlage für die Analysen war das BoDyS-KiD Material, welches die Elizitierung standardisierter Sprechproben sowie eine Altersnormierung erlaubt. Es zeigte sich, dass sich die Kinder mit neurologischen Erkrankungen hinsichtlich der auditiven Profile relativ konstant entwickelten, während für die Verständlichkeit deutlich mehr Variabilität der individuellen Verläufe zu sehen war. Zuletzt wurde ein starker Zusammenhang zwischen der Entwicklung der Verständlichkeit und auditiven Urteilen zur Artikulation gefunden. Schlüsselwörter: Kindliche Dysarthrie, Entwicklungsverläufe, Verständlichkeit
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Purpose
Despite extensive research into communication-related parameters in dysarthria, such as intelligibility, naturalness, and perceived listener effort, the existing evidence has not been translated into a clinically applicable, comprehensive, and valid diagnostic tool so far. This study addresses Communication-Related Parameters in Speech Disorders (KommPaS), a new web-based diagnostic instrument for measuring indices of communication limitation in individuals with dysarthria through online crowdsourcing. More specifically, it answers questions about the construct validity of KommPaS.
In the first part, the interrelationship of the KommPaS variables intelligibility, naturalness, perceived listener effort, and speech rate were explored in order to draw a comprehensive picture of a patient's limitations and avoid the collection of redundant information. Second, the influences of motor speech symptoms on the KommPaS variables were studied in order to delineate the structural relationships between two complementary diagnostic perspectives.
Method
One hundred persons with dysarthria of different etiologies and varying degrees of severity were examined with KommPaS to obtain layperson-based data on communication-level parameters, and with the Bogenhausen Dysarthria Scale (BoDyS) to obtain expert-based, function-level data on dysarthria symptoms. The internal structure of the KommPaS variables and their dependence on the BoDyS variables were analyzed using structural equation modeling.
Results
Despite a high multicollinearity, all KommPaS variables were shown to provide complementary diagnostic information and their mutual interconnections were delineated in a path graph model. Regarding the influence of the BoDyS scales on the KommPaS variables, separate linear regression models revealed plausible predictor sets. A complete path model of KommPaS and BoDyS variables was developed to map the complex interplay between variables at the functional and the communication levels of dysarthria assessment.
Conclusion
In validating a new clinical tool for the diagnostics of communication limitations in dysarthria, this study is the first to draw a comprehensive picture of how auditory-perceptual characteristics of dysarthria interact at the levels of expert-based functional and layperson-based communicative assessments.
Purpose
This article describes the developmental trajectories of four communication-related parameters (i.e., intelligibility, articulation rate, fluency, and communicative efficiency) in a cross-sectional study of typically developing children between 3 and 9 years. The four target parameters were related to auditory-perceptual parameters of speech function.
Method
One hundred forty-four typically developing children (ages 3;0–9;11 [years;months]; 72 girls and 72 boys) participated. Speech samples were collected using the materials of the Bogenhausen Dysarthria Scales for Childhood Dysarthria, a German assessment tool for childhood dysarthria, and analyzed following established auditory-perceptual criteria on relevant speech functions. To assess intelligibility, naïve listeners transcribed sentences repeated by the children. Articulation rate and fluency were measured by acoustic analyses; communicative efficiency was determined by multiplying the proportion of correctly transcribed syllables by speech rate.
Results
Intelligibility showed a steep developmental trajectory, with the majority of children obtaining a proportion of intelligible syllables close to 1.0 at the age of 5 years. Articulation rate demonstrated a flatter trajectory, with high variability still within the older children. Disfluencies, on the contrary, occurred only in the youngest children. By definition, communicative efficiency shared the characteristics of intelligibility and rate curves. A principal component analysis revealed, among other findings, strong connections between intelligibility and articulation, as well as between communicative efficiency, articulation, and rate measures.
Conclusions
While children speak intelligibly, in terms of the applied assessment, at a comparably young age, other communication-relevant parameters show a slower developmental progress. Knowledge on the typical development of communication-related parameters and on their complex relationships with functional speech variables is crucial for the clinical assessment of childhood dysarthria.
Supplemental Material
https://doi.org/10.23641/asha.14880285
Purpose
The aim of this longitudinal study was to describe developmental courses of childhood dysarthria against the background of typical speech motor development by collecting auditory-perceptual data.
Method
Fourteen children (four girls, 10 boys; 5;1–8;4 [years;months] at Time 1) with neurological conditions (CNC) and 14 typically developing children (CTD) matched for age and gender were assessed at three points in time over an 18-month period. Speech samples were collected using the Bogenhausener Dysarthrie Skalen–Kindliche Dysarthrien (BoDyS-KiD; in English: Bogenhausen Dysarthria Scales–Childhood Dysarthria), a German tool for the assessment of childhood dysarthria, and analyzed by means of nine perceptual scales covering all clinically relevant speech components. Age normalization was performed according to a method published recently. Data from the matched controls were used to estimate whether the gradients of the CNC group's developmental trajectories exceeded those of typical development.
Results
The children with neurological conditions presented heterogeneous speech profiles with a wide range of severity. At the group level, relatively stable trajectories of the age-normalized dysarthria total score were found over the observation period. The nine perceptual scales showed more or less parallel developments. All patients except two followed the growth curve describing the developmental course of the typically developing children.
Conclusions
Most children took advantage of the developmental dynamics as they developed parallel to the age norm. With its comprehensive description of the developmental courses of 14 children with neurological conditions, this study may contribute to a more valid, statistically verified clinical assessment of the course of childhood dysarthria.
Purpose
The aim of this study was to collect auditory-perceptual data on established symptom categories of dysarthria from typically developing children between 3 and 9 years of age, for the purpose of creating age norms for dysarthria assessment.
Method
One hundred forty-four typically developing children (3;0–9;11 [years;months], 72 girls and 72 boys) participated. We used a computer-based game specifically designed for this study to elicit sentence repetitions and spontaneous speech samples. Speech recordings were analyzed using the auditory-perceptual criteria of the Bogenhausen Dysarthria Scales, a standardized German assessment tool for dysarthria in adults. The Bogenhausen Dysarthria Scales (scales and features) cover clinically relevant dimensions of speech and allow for an evaluation of well-established symptom categories of dysarthria.
Results
The typically developing children exhibited a number of speech characteristics overlapping with established symptom categories of dysarthria (e.g., breathy voice, frequent inspirations, reduced articulatory precision, decreased articulation rate). Substantial progress was observed between 3 and 9 years of age, but with different developmental trajectories across different dimensions. In several areas (e.g., respiration, voice quality), 9-year-olds still presented with salient developmental speech characteristics, while in other dimensions (e.g., prosodic modulation), features typically associated with dysarthria occurred only exceptionally, even in the 3-year-olds.
Conclusions
The acquisition of speech motor functions is a prolonged process not yet completed with 9 years. Various developmental influences (e.g., anatomic–physiological changes) shape children's speech specifically. Our findings are a first step toward establishing auditory-perceptual norms for dysarthria in children of kindergarten and elementary school age.
Supplemental Material
https://doi.org/10.23641/asha.12133380
Purpose
We examined growth between 5 and 7 years in speech intelligibility, speech rate, and intelligible words per minute (IWPM) in 3 groups of children: those who were typically developing (TD), those with cerebral palsy (CP) and clinical speech motor impairment (SMI), and those with CP and no SMI (NSMI).
Method
Twenty-six children with CP, 16 with SMI, and 10 with NSMI were each seen at 5, 6, and 7 years of age. A cross-sectional group of 30 age-matched TD children, 10 in each age group, were included as controls. All children produced a corpus of utterances of 2–7 words.
Results
All groups of children showed increases in intelligibility and IWPM between 5 and 7 years. Only children with SMI showed increases in speech rate over time. Patterns of change were similar for children in the TD and NSMI groups but different for children in the SMI group.
Conclusions
The window of time between 5 and 7 years is an important period of growth for the production of connected speech where nearly all children, regardless of group, made significant changes in speech intelligibility and IWPM. Interventions focusing specifically on enhancing intelligibility in this age range may help facilitate even further growth in children with SMI, who still had marked intelligibility reductions at 7 years of age.
Purpose
Children with cerebral palsy (CP) are at risk for significant communication problems. Reduced speech intelligibility is common, even for those who do not have speech motor deficits. Development of intelligibility has not been comprehensively quantified in children with CP; as a result, we are currently unable to predict later speech outcomes. Such information would advance treatment decision making. We sought to examine growth in speech intelligibility among children with CP using a prospective longitudinal design, with a focus on age of crossing target intelligibility thresholds, age of greatest intelligibility growth, and how well intelligibility at 36 months predicted intelligibility at 96 months.
Method
Sixty-nine children with CP were followed longitudinally between 24 and 96 months of age. A total of 566 time points were examined across children (M = 8.2 time points per child, SD = 2.6). We fitted a nonlinear random effects model for longitudinal observations and then used the fitted model trajectories to generate descriptive analyses of growth. We used results of the model to generate a set of simulations, which we analyzed to determine how well 36-month intelligibility data predicted 96-month data.
Results
Half of children crossed 25% and 50% intelligibility thresholds at 36 and 49 months of age, respectively. Slightly more than half of children did not reach 75% intelligibility by 96 months of age. Age of crossing 25%, 50%, and 75% intelligibility thresholds was highly negatively correlated with intelligibly at 96 months. Children had the steepest intelligibility growth at 36 months, followed by 48 and 60 months. Intelligibility at 36 months was highly predictive of intelligibility at 96 months.
Conclusions
The developmental window from 3 to 5 years constitutes a time of rapid growth in speech intelligibility in children with CP. Children who cross intelligibility thresholds of 25%, 50%, and 75% at earlier ages have better outcomes when they are older; early performance is highly predictive of later speech intelligibility outcomes. Children with CP as a group have delayed speech intelligibility development but are still growing through 96 months of age.
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.
Purpose
The objectives of this study were to identify acoustic characteristics of connected speech that differentiate children with dysarthria secondary to cerebral palsy (CP) from typically developing children and to identify acoustic measures that best detect dysarthria in children with CP.
Method
Twenty 5-year-old children with dysarthria secondary to CP were compared to 20 age- and sex-matched typically developing children on 5 acoustic measures of connected speech. A logistic regression approach was used to derive an acoustic model that best predicted dysarthria status.
Results
Results indicated that children with dysarthria secondary to CP differed from typically developing children on measures of multiple segmental and suprasegmental speech characteristics. An acoustic model containing articulation rate and the F2 range of diphthongs differentiated children with dysarthria from typically developing children with 87.5% accuracy.
Conclusion
This study serves as a first step toward developing an acoustic model that can be used to improve early identification of dysarthria in children with CP.
We investigated the contribution of vowel space, articulation rate, maximum utterance length, and language skills to intelligibility in 30-36 month old children with CP. We also examined differences among variables for 3 subgroups of children with CP and a small group of typically developing (TD) children.
Nineteen children with CP and 5 TD children provided speech samples, and 120 listeners transcribed the speech samples. Acoustic analysis of temporal and vowel spectral measures was completed on single-word productions.
Vowel space was the only variable that made a significant and independent contribution to intelligibility, though all variables collectively accounted for 74% of the variance in intelligibility scores. TD children tended to have larger vowel spaces, than children with CP, even among children with CP who had intelligibility scores within the range of TD children.
Of children with CP who were able to talk at 30-36 months of age, 60% had clinical speech or language deficits. Production of vowels appears to make an important contribution to intelligibility; and for many children with CP, considerable deficits in intelligibility may be evident by the age of 3. Early interventions targeting both speech and language may improve intelligibility and functional communication skills.
Purpose
Speech acoustic characteristics of children with cerebral palsy (CP) were examined with a multiple speech subsystems approach; speech intelligibility was evaluated using a prediction model in which acoustic measures were selected to represent three speech subsystems.
Method
Nine acoustic variables reflecting different subsystems, and speech intelligibility, were measured in 22 children with CP. These children included 13 with a clinical diagnosis of dysarthria (speech motor impairment [SMI] group) and 9 judged to be free of dysarthria (no SMI [NSMI] group). Data from children with CP were compared to data from age-matched typically developing children.
Results
Multiple acoustic variables reflecting the articulatory subsystem were different in the SMI group, compared to the NSMI and typically developing groups. A significant speech intelligibility prediction model was obtained with all variables entered into the model (adjusted R² = .801). The articulatory subsystem showed the most substantial independent contribution (58%) to speech intelligibility. Incremental R² analyses revealed that any single variable explained less than 9% of speech intelligibility variability.
Conclusions
Children in the SMI group had articulatory subsystem problems as indexed by acoustic measures. As in the adult literature, the articulatory subsystem makes the primary contribution to speech intelligibility variance in dysarthria, with minimal or no contribution from other systems.
To evaluate how involvement in life situations (participation) in children with cerebral palsy varies with type and severity of impairment and to investigate geographical variation in participation.
Cross sectional study. Trained interviewers visited parents of children with cerebral palsy; multilevel multivariable regression related participation to impairments, pain, and sociodemographic characteristics.
Eight European regions with population registers of children with cerebral palsy; one further region recruited children from multiple sources.
1174 children aged 8-12 with cerebral palsy randomly selected from the population registers, 743 (63%) joined in the study; the further region recruited 75 children.
Children's participation assessed by the Life-H questionnaire covering 10 main areas of daily life. Scoring ignored adaptations or assistance required for participation.
Children with pain and those with more severely impaired walking, fine motor skills, communication, and intellectual abilities had lower participation across most domains. Type of cerebral palsy and problems with feeding and vision were associated with lower participation for specific domains, but the sociodemographic factors examined were not. Impairment and pain accounted for up to a sixth of the variation in participation. Participation on all domains varied substantially between regions: children in east Denmark had consistently higher participation than children in other regions. For most participation domains, about a third of the unexplained variation could be ascribed to variation between regions and about two thirds to variation between individuals.
Participation in children with cerebral palsy should be assessed in clinical practice to guide intervention and assess its effect. Pain should be carefully assessed. Some European countries facilitate participation better than others, implying some countries could make better provision. Legislation and regulation should be directed to ensuring this happens.
Kindliche Dysarthrien stellen ein häufiges Störungsbild dar. Trotzdem existieren kaum geeignete Untersuchungsmethoden. Dieser Beitrag erläutert spezifische Herausforderungen in der Diagnostik kindlicher Dysarthrien und stellt ein neues Untersuchungsmaterial vor. Dieses ermöglicht es, kindgerecht und motivierend standardisierte Sprechproben von Kindern mit Dysarthrie zu elizitieren und stellt so die Basis für umfassende auditive Analysen dar.
Childhood dysarthria is a common disorder. However, specific assessment tools are scarce. The current paper illustrates challenges related to the assessment of childhood dysarthria and introduces assessment materials that allow for the elicitation of standardized speech samples from children with dysarthria in a child-oriented and motivating way. Thus, it provides the basis for comprehensive auditory-perceptual analyses.
The present study used a population-based sample of children with cerebral palsy (CP) to estimate the prevalence of motor speech impairment and its association with activity and participation. A sample of 79 Victorian children aged 4 years 11 months to 6 years 5 months was recruited through the Victorian CP Register. The presence of motor speech impairment was recorded using the Viking Speech Scale (VSS). Activity and participation outcomes included speech intelligibility (the National Technical Institute for the Deaf rating scale, NTID), the Functional Communication Classification System (FCCS) and Communication Function Classification System (CFCS). A parent completed rating scale was used to examine the association between motor speech impairment and participation. Ninety per cent (71/79) of children demonstrated a motor speech impairment. Strong associations were found between the VSS and NTID (< .001), CFCS (< .001), and FCCS levels (<.001). VSS levels III-IV were significantly associated with restrictions in home, school, and community-based participation as perceived by parents. Although some diversity in activity and participation outcomes was observed within specific VSS levels, the results of this study suggested that children with mild motor speech impairments are more likely to demonstrate superior activity and participation outcomes compared to children with moderate or severe deficits.
Typescript. Thesis (Ph. D.)--University of Wisconsin--Madison, 1986. Vita. Includes bibliographical references (leaves 138-141).
Speech features were perceptually analyzed in two groups of children. The first group (n = 6) had undergone cerebellar tumor resection, and the second group (n = 6) included children with brainstem tumors. Children belonging to the first group became dysarthric after a postoperative mute phase. Slow speech rate was a specific feature, but scanning speech and irregular articulatory breakdown (i.e., prominent characteristics in adult ataxic dysarthria) were not observed. In the second group, hypernasality was a prominent characteristic and resembled flaccid dysarthria in adults. These findings suggest that acquired childhood dysarthria needs a proper classification.
Unlabelled:
Speech samples of 79 dysarthric patients (native speakers of English) were judged by two experienced judges by means of a perceptual rating scale covering the four main dimensions of speech production: voice quality, articulation, nasality and prosody as well as overall intelligibility. In order to determine the relative influence of the four basic dimensions on intelligibility in this study group, a multiple regression model was applied. This model shows that intelligibility can be expressed as a linear combination of weighted perceptual dimensions (R2 = 0.89). This expression reveals the relative importance of the individual dimensions on overall intelligibility. Articulation is shown to be the strongest contributor to intelligibility. A group of 16 dysarthric patients (native speakers of Dutch) was used as a control group in order to evaluate the validity of the expression. Judged and calculated ratings (within the 95% prediction intervals) were in agreement for 75% of the patients. These findings may contribute in the construction of a better balanced measure of functional intelligibility.
Learning outcomes:
2. The impact of articulation on intelligibility is dominant but inclusion of the dimensions "nasality", "voice" and "prosody" results in a more balanced estimation of intelligibility.
Magnetic resonance imaging (MRI) findings have been reported for specific clinical cerebral palsy (CP) subgroups or lesion types but not in a large population of children with all CP subtypes. Further information about the causes of CP could help identify preventive strategies.
To investigate the correlates of CP in a population sample and compare clinical findings with information available from MRI brain studies.
Cross-sectional, population-based investigative study conducted in 8 European study centers (North West London and North East London, England; Edinburgh, Scotland; Lisbon, Portugal; Dublin, Ireland; Stockholm, Sweden; Tübingen, Germany; and Helsinki, Finland).
Five hundred eighty-five children with CP were identified who had been born between 1996 and 1999; 431 children were clinically assessed and 351 had a brain MRI scan.
Standardized clinical examination results, parental questionnaire responses, MRI results, and obstetric, genetic, and metabolic data from medical records.
Important findings include the high rate of infections reported by mothers during pregnancy (n = 158 [39.5%]). In addition, 235 children (54%) were born at term while 47 children (10.9%) were very preterm (<28 weeks). A high rate of twins was found, with 51 children (12%) known to be from a multiple pregnancy. Clinically, 26.2% of children had hemiplegia, 34.4% had diplegia, 18.6% had quadriplegia, 14.4% had dyskinesia, 3.9% had ataxia, and 2.6% had other types of CP. Brain MRI scans showed that white-matter damage of immaturity, including periventricular leukomalacia (PVL), was the most common finding (42.5%), followed by basal ganglia lesions (12.8%), cortical/subcortical lesions (9.4%), malformations (9.1%), focal infarcts (7.4%), and miscellaneous lesions (7.1%). Only 11.7% of these children had normal MRI findings. There were good correlations between the MRI and clinical findings.
These MRI findings suggest that obstetric mishaps might have occurred in a small proportion of children with CP. A systematic approach to identifying and treating maternal infections needs to be developed. Multiple pregnancies should be monitored closely, and the causes of infant stroke need to be investigated further so preventive strategies can be formulated. All children with CP should have an MRI scan to provide information on the timing and extent of the lesion.
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