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Elizabeth Nemedez, B.S. & Abbie Olszewski, PhD, CCC-­‐SLP University of Nevada, Reno Case Scenario §  First year CFY at local high school §  Referral for transfer student from another district §  16;2 year old male with history of ADHD, OCD, Tourette’s Syndrome, Asperger’s Syndrome §  Recent diagnosis of dysarthria §  Parents and student’s priority is to increase intelligibility in a natural way. PICO Question Does an alphabet board (I) compared to deliberate pauses following short phrases(C) improve speech intelligibility as measured by reduced speech rate (O) better for individuals who have dysarthria (P)? Introduction Table of Studies Authors Hanson, Yorkston, & Beukelman, (2004) Systematic Review Participants N = 90 Adults Purpose Dependent Variables Results Review the evidence in regards to the effects of speech supplementation on dysarthric speech, which included SI: Alphabet supplementation resulted in the greatest Speech intelligibility alphabet cues, semantic or topic cues, perceptual ratings of speech intelligibility as measured by (SI) syntax cues, and gestures for adults accuracy of transcription by independent listeners with dysarthria. The study compared the effectiveness of aided (alphabet board supplementation) and unaided SI: alphabet board supplementation resulted in an average SI (iconic hand gestures) strategies to perceptual increase of intelligibility of 31.93% increase speech intelligibility for adults with dysarthria. Methods Search terms: speech rate control and dysarthria, metered rate control and dysarthria, rigid rate control and dysarthria, rhythmic rate control and dysarthria, alphabet board and dysarthria treatment, pausing and dysarthria treatment, and dysarthria and speech rate control and/to increase intelligibility Databases: ASHA, PsycINFO, CINAHL, ERIC, Academic Search Premier, and Web of Science Appraisal: §  10 articles were selected based on inclusion/
exclusion criteria for appraisal §  Appraisal included a 13 point CATE format and a 12 point CASM form. §  Inter-­‐rater reliability of ≥ 90% was achieved for all articles §  6 articles directly related to PICO included §  Humans are social beings who communicate to Hustad & Garcia N = 3 interact with others socially. (2005) §  Humans who have dif^iculty with Experimental Adults communication may feel isolated from social opportunities. Discussion §  Congenital or acquired neurogenic diseases and This study examined underlying SI SI: average perceptual increase of intelligibility of 15% disorders commonly cause communication speech production changes Rate Rate: Mean speech rate decrease of 44.17 wpm External Evidence: Based on the review of the Hustad &
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ee N =
1
2 disturbance that makes communication dif^icult associated with intelligibility gains Word duration Word duration: increase in word duration p = .002 external evidence, alphabet board supplementation (2008) (Duffy, 2012). when participants used an alphabet Vowel duration Vowel duration: increase in vowel duration p = .031 resulted in the greatest increase of speech Experimental Adults board as compared to no condition Pause duration Pause: Mean pause duration increase to 2,600.34 ms §  The most common type of communication intelligibility b
y r
educing s
peech r
ate. S
peaker for adults with dysarthria. Pause frequency Frequency: Mean pause frequency increased to 1.05 disturbance caused by a neurogenic disease or implemented pauses did increase intelligibility by disorder are motor speech disorders (Duffy, decreasing rate of speech while preserving the 2012). The purpose of this study was to SI: Increase of intelligibility 10 – 32% natural rhythm of speech. §  Dysarthria is the most common type of motor investigate whether speaker-­‐
Speech Rate: Reduced to 31.65 wpm SI implemented deliberate pausing or compared to 68.6 (controls) Hustad & N = 2 speech disorder affecting 53% of individuals Speech rate Internal Evidence to Patient/Clinic: The patient digitally c
ued p
auses t
o s
low s
peech Average a
rticulation r
ate: o
f .
95 s
econds Sassano (
2002) with an acquired neurogenic communication Articulation rate and parents requested a technique that would not rate w
ould i
ncrease s
peech compared t
o 5
1 s
econds (
controls) Experimental Adults disturbance (Duffy, 2013). Pause frequency cause the patient to stand out, but rather ^it in more intelligibility for adults with Average pause frequency: per utterance was 6.5 §  Dysarthria often impacts speech intelligibility, dysarthria. compared to .483 (controls) naturally with peers, so pausing is considered to be but research and treatment options are limited an effective strategy to accomplish this. Determine whether individuals with despite dysarthria’s prevalence. (Beukelman, mild to severe dysarthria and normal Fager, Hakel, & Yorkston, 2007). Clinical decision based on PICO: The clinician will speakers d
iffer i
n t
he v
ariability o
f Speech r
ate §  Rate of speech reduction is a recommended N = 18 Speech rate: Reduced rate, p = .0001 implement the speaker implemented deliberate speech movements across different McHenry (2003) treatment method that is empirically supported Variability of speech movements: More variability, Experimental speech rate conditions including fast Variability of speech pausing strategy as it is a proven method to Adults p = .002 to “allow the speaker to hit articulatory targets, movements pauses , pauses/breaks, and increase speech intelligibility while preserving coordinate the different physiologic components stretched speech for adults with speech naturalness. In addition, it does not require of speech, [and] give the listener more time to dysarthria. the use of tools, which will allow the student to process a distorted speech signal, and thus, The purpose of implement the strategy without detection. Van N
uffelen, increase the perception of this study was to compare seven rate DeBodt, intelligibility” (Yorkston, Beukelman, Strand, & control methods on speech N = 27 Vanderwegen, SI: alphabet board supplementation increased SI by an intelligibility, speaking rate, SI Hagel, 2010). Van de Heying, & average of 50% articulation rate, and pause Adults §  Rigid/metered rate control or rhythmic rate Wuyts (2010) characteristics for adults with control are two common methods recommended Experimental dysarthria. to slow speech rate for individuals who have dysarthria. §  Alphabet board is recognized as a rigid/metered References Beukelman, D. R., Fager, S., Hakel, M., & Yorkston, K. M. (2007). Evidence for effecFveness of treatment of loudness, rate, or prosody in dysarthria: A systemaFc review. Journal of Medical Speech -­‐ Language Pathology, 15(2), xi -­‐ xxxvi. Retrieved from hOp:// rate control strategy while pausing is considered go.galegroup.com/innopac.library.unr.edu a rhythmic rate control strategy. Duffy, J. R. (2012). Motor speech disorders: Substrates, differen?al diagnosis and management (3rd ed). St. Louis, MI: Mosby Yearbook, Inc. Hanson, E. K., Yorkston, K. M., & Beukelman, D. R. (2004). Speech supplementaFon techniques for dysarthria: A systemaFc review. Journal of Medical Speech-­‐Language Pathology, 12(2), ix – xxix. Retrieved from hOp://go.galegroup.com/innopac.library.unr.edu §  The purpose of this review is to determine Hustad, K. C. & Garcia, J. M. (2005). Aided and unaided speech supplementaFon strategies: Effect of alphabet cues and iconic hand gestures on dysarthric speech. Journal of Speech, Language, and Hearing Research 48(5), 996 – 1012. doi: 10.1044/1092-­‐4388(2005/068) whether an alphabet board or pausing after Hustad, K. C. & Lee, J. (2008). Changes in speech producFon associated with alphabet supplementaFon. Journal of speech, language and hearing research, 51(6), 1438 – 1450. doi: 10.1044/1092-­‐4388(2008/07-­‐0185) short phrases would increase speech Hustad, K. C. & Sassano, K. (2002). Effects of rate reducFon on severe spasFc dysarthria in cerebral palsy. Journal of Medical Speech-­‐Language Pathology, 10(4), 287 – 292. Retrieved from hOp://go.galegroup.com/innopac.library.unr.edu Language, and Hearing Research, 46(3), 702 – 710. doi: 10.1044/1092-­‐4388(2003/055). intelligibility more ef^iciently by slowing speech McHenry, M. A. (2003). The effect of pacing strategies on the variability of speech movement sequences in dysarthria. Journal of Speech, Yorkston, K. M., Beukelman, D. R., Strand, E. A., & Hakel, M. (2010). Management of motor speech disorders in children and adults (3rd ed.). AusFn, TX: Pro-­‐Ed, Inc. rate. Van Nuffelen, G., DeBodt, M., Vanderwegen, J., Van de Heying, P., & Wuyts F. (2010), Effects of rate control on speech producFon and intelligibility in dysarthria. Folia Phoniatricia Et Logopaedica, 62(3), 110 – 119. doi: 10.1159/000287209