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

Lookup NU author(s): Professor Lindsay Pennington, Dr Ian Steen, Emeritus Professor Nick Miller



This is the authors' accepted manuscript of an article that has been published in its final definitive form by John Wiley & Sons Ltd, 2018.

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Background: The speech intelligibility of children with dysarthria and cerebral palsy has been observed to increase following therapy focussing on respiration and phonation.Aims: To determine if speech intelligibility change following intervention is associated with change in acoustic measures of voice. Methods and Procedures: We recorded 16 young people with cerebral palsy and dysarthria (9 girls; mean age 14 years, SD 2; 9 spastic type, 2 dyskinetic, 4 mixed; 1 Worster Drought) producing speech in two conditions (single words, connected speech) twice before and twice after therapy focusing on respiration, phonation and rate. In both single word and connected speech we measured vocal intensity (RMS), period-to-period variability (Shimmer APQ, Jitter RAP and PPQ) and harmonics to noise ratio (HNR). In connected speech we also measured mean fundamental frequency, utterance duration in seconds and speech and articulation rate (syllables per second with and without pauses respectively). All acoustic measures were made using Praat. Intelligibility was calculated in previous research.Outcomes & Results: In single words statistically significant but very small reductions were observed in period-to-period variability following therapy: Shimmer APQ -0.15 (95% CI -0.21 to -0.09); Jitter RAP -0.08 (95% CI -0.14 to -0.01); Jitter PPQ -0.08 (95% CI -0.15 to -0.01). No changes in period-to-period perturbation across phrases in connected speech were detected. However, changes in connected speech were observed in phrase length, rate and intensity. Following therapy, mean utterance duration increased by 1.11 seconds (95% CI 0.37 to 1.86) when measured with pauses and by 1.13 seconds (95% CI 0.40 to 1.85) when measured without pauses. Articulation rate increased by 0.07 syllables per second (95% CI 0.02 to 0.13); speech rate increased by 0.06 syllables per second (95% CI <0.01 to 0.12); and intensity increased by 0.03 Pascals (95% CI 0.02 to 0.04). There was a gradual reduction in mean fundamental frequency across all time points (-11.85 Hz, 95% CI -19.84 to -3.86). Only increases in the intensity of single words (0.37 Pascals, 95% CI 0.10 to 0.65) and reductions in fundamental frequency (-0.11 Hz, 95% CI -0.21 to -0.02) in connected speech were associated with gains in intelligibility. Conclusions & Implications: Mean reductions in impairment in vocal function following therapy observed were small and most are unlikely to be clinically significant. Changes in vocal control did not explain improved intelligibility.

Publication metadata

Author(s): Pennington L, Lombardo E, Steen N, Miller N

Publication type: Article

Publication status: Published

Journal: International Journal of Language & Communication Disorders

Year: 2018

Volume: 53

Issue: 1

Pages: 182-195

Print publication date: 01/01/2018

Online publication date: 17/07/2017

Acceptance date: 13/06/2017

Date deposited: 22/06/2017

ISSN (print): 1368-2822

ISSN (electronic): 1460-6984

Publisher: John Wiley & Sons Ltd


DOI: 10.1111/1460-6984.12336


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