RESUMEN

AIM: To examine speech impairment severity classification over time in a longitudinal cohort of children with cerebral palsy (CP). METHOD: A total of 101 children (58 males, 43 females) between the ages of 4 and 10 years with CP participated in this longitudinal study. Speech severity was rated using the Viking Speech Scale (VSS), a four-level classification rating scale, at 4, 6, 8, and 10 years (age 4 years: mean = 52 months [3 SD]; age 6 years: mean = 75 months [2 SD]; age 8 years: mean = 100 months [4 SD]; age 10 years: mean = 125 months [5 SD]). We used Bayesian mixed-effects ordinal logistic regression to model (1) the extent to which speech severity changed over time and (2) patterns of change across age groups and classification rating group levels. RESULTS: VSS ratings decreased (speech severity became less severe) between 4 and 10 years of age. Children who were first classified in VSS levels I, II, or III at age 4 years had a high probability of staying at, or improving to, VSS level I by 10 years. Children who were first classified in VSS level IV at 4 years had a high probability of remaining in VSS level IV at 10 years. INTERPRETATION: Early speech performance is highly predictive of later childhood speech abilities. Children with any level of speech impairment at age 4 years should be receiving speech therapy. Those with more severe speech impairments should be introduced to augmentative and alternative communication as soon as possible. WHAT THIS PAPER ADDS: Children with early Viking Speech Scale (VSS) ratings below level IV have a good prognosis for speech improvement. Children with early VSS level IV ratings are likely to remain at VSS level IV over time. Children did not show worsening of VSS level between the ages of 4 and 10 years.

Cambio longitudinal en la clasificación del habla entre los 4 y 10 años en niños con parálisis cerebral OBJETIVO: Examinar la clasificación de la gravedad del deterioro del habla a lo largo del tiempo en una cohorte longitudinal de niños con parálisis cerebral (PC) entre las edades de 4 y 10 años. MÉTODO: Un total de 101 niños (58 varones, 43 mujeres) con PC participaron en este estudio longitudinal. La gravedad del habla se evaluó utilizando la Viking Speech Scale (VSS), una escala de calificación de clasificación de cuatro niveles, a los 4, 6, 8 y 10 años (edad 4 años: media = 52 meses [3 DE]; edad 6 años: media = 75 meses [2 DE]; edad 8 años: media = 100 meses [4 DE]; edad 10 años: media = 125 meses [5 DE]). Utilizamos la regresión logística ordinal de efectos mixtos bayesianos para modelar (1) la medida en que la severidad del habla cambió con el tiempo y (2) los patrones de cambio entre los grupos de edad y los niveles de clasificación de los grupos. RESULTADOS: Las calificaciones de VSS disminuyeron (la severidad del habla se volvió menos severa) entre los 4 y los 10 años de edad. Los niños que fueron clasificados por primera vez en los niveles I, II o III de VSS a los 4 años tenían una alta probabilidad de permanecer en el nivel I de VSS o mejorar al nivel I de VSS a los 10 años. Los niños que fueron clasificados por primera vez en el nivel IV de VSS a los 4 años tenían una alta probabilidad de permanecer en el nivel IV de VSS a los 10 años. INTERPRETACIÓN: El desempeño temprano del habla es altamente predictivo de las habilidades del habla en la niñez posterior. Los niños con cualquier nivel de discapacidad del habla a la edad de 4 años deben recibir terapia del habla. Aquellos con impedimentos del habla más severos deben ser introducidos a la comunicación aumentativa y alternativa tan pronto como sea posible.

Mudança longitudinal na classificação da fala entre 4 e 10 anos em crianças com paralisia cerebral OBJETIVO: Analisar a classificação da gravidade do comprometimento da fala ao longo do tempo em uma coorte longitudinal de crianças com paralisia cerebral (PC) entre 4 e 10 anos. MÉTODO: Um total de 101 crianças (58 meninos, 43 meninas) com PC participaram deste estudo longitudinal. A gravidade da fala foi avaliada usando a Viking Speech Scale (VSS), uma escala de classificação de quatro níveis, aos 4, 6, 8 e 10 anos (idade 4 anos: média = 52 meses [3 DP]; idade 6 anos: média = 75 meses [2 DP]; idade 8 anos: média = 100 meses [4 DP]; idade 10 anos: média = 125 meses [5 DP]). Usamos a regressão logística ordinal Bayesiana de efeitos mistos para modelar (1) a extensão em que a gravidade da fala mudou ao longo do tempo e (2) padrões de mudança entre as faixas etárias e os níveis de classificação do grupo. RESULTADOS: As classificações de VSS diminuíram (a gravidade da fala tornou-se menos grave) entre 4 e 10 anos de idade. As crianças que foram classificadas pela primeira vez nos níveis VSS I, II ou III aos 4 anos de idade tiveram uma alta probabilidade de permanecer ou melhorar para o nível VSS I em 10 anos. As crianças que foram classificadas pela primeira vez em VSS nível IV aos 4 anos tiveram alta probabilidade de permanecer no VSS nível IV aos 10 anos. INTERPRETAÇÃO: O desempenho precoce da fala é altamente preditivo de habilidades de fala na infância posteriormente. Crianças com qualquer nível de deficiência de fala aos 4 anos de idade devem receber terapia da fala. Aqueles com deficiências de fala mais graves devem ser introduzidos à comunicação aumentativa e alternativa o mais rápido possível.

Asunto(s)

RESUMEN

Purpose We extended our earlier study on normative growth curves for intelligibility development in typical children from 30 to 119 months of age. We also determined quantile-specific age of steepest growth and growth rates. A key goal was to establish age-specific benchmarks for single-word and multiword intelligibility. Method This cross-sectional study involved collection of in-person speech samples from 538 typically developing children (282 girls and 256 boys) who passed speech, language, and hearing screening measures. One thousand seventy-six normal-hearing naïve adult listeners (280 men and 796 women) orthographically transcribed children's speech. Speech intelligibility was measured as the percentage of words transcribed correctly by naive adults, with single-word and multiword intelligibility outcomes modeled separately. Results The age range for 50% single-word intelligibility was 31-47 months (50th-5th percentiles), the age range for 75% single-word intelligibility was 49-87 months, and the age range for 90% intelligibility for single words was 83-120+ months. The same milestones were attained for multiword intelligibility at 34-46, 46-61, and 62-87 months, respectively. The age of steepest growth for the 50th percentile was 30-31 months for both single-word and multiword intelligibility and was later for children in lower percentiles. The maximum growth rate was 1.7 intelligibility percentage points per month for single words and 2.5 intelligibility percentage points per month for multiword intelligibility. Conclusions There was considerable variability in intelligibility development among typical children. For children in median and lower percentiles, intelligibility growth continues through 9 years. Children should be at least 50% intelligible by 48 months. Supplemental Material https://doi.org/10.23641/asha.16583426.

Asunto(s)

RESUMEN

Purpose Accurate measurement of speech intelligibility is essential for children with speech production deficits, but wide variability exists in the measures and protocols used. The current study sought to examine relationships among measures of speech intelligibility and the capacity of different measures to capture change over time. Method Forty-five children with cerebral palsy (CP) with and without speech motor impairment were observed at ages 6, 7, and 8 years. The speech performance of each child was rated using four measures at each time point: standardized articulation test scores, multiword intelligibility scores obtained from naïve listeners, parent ratings of intelligibility, and percent intelligible utterances obtained from language transcripts. We analyzed the correlations of measures within each age and within three different severity groups, and we analyzed how these measures changed year over year in each severity group. Results For children with CP who have mild and moderate speech deficits, different measures of speech production were weakly associated, and for children with CP with severe speech impairment, these measures showed stronger associations. The four measures also differed in their ability to capture change over time. Finally, results from standardized assessments of articulation were not found to inform overall speech intelligibility for children with mild and moderate speech deficits. Conclusions Results suggest that speech production is not fully described by any single clinical measure. In order to adequately describe functional speaking abilities and to capture change over time, multiple levels of measurement are required.

Asunto(s)

RESUMEN

Purpose We sought to establish normative growth curves for intelligibility development for the speech of typically developing children as revealed by objectively based orthographic transcription of elicited single-word and multiword utterances by naïve listeners. We also examined sex differences, and we compared differences between single-word and multiword intelligibility growth. Method One hundred sixty-four typically developing children (92 girls, 72 boys) contributed speech samples for this study. Children were between the ages of 30 and 47 months, and analyses examined 1-month age increments between these ages. Two different naïve listeners heard each child and made orthographic transcriptions of child-produced words and sentences (n = 328 listeners). Average intelligibility scores for single-word productions and multiword productions were modeled using linear regression, which estimated normal-model quantile age trajectories for single- and multiword utterances. Results We present growth curves showing steady linear change over time in 1-month increments from 30 to 47 months for 5th, 10th, 25th, 50th, 75th, 90th, and 95th percentiles. Results showed that boys did not differ from girls and that, prior to 35 months of age, single words were more intelligible than multiword productions. Starting at 41 months of age, the reverse was true. Multiword intelligibility grew at a faster rate than single-word intelligibility. Conclusions Children make steady progress in intelligibility development through 47 months, and only a small number of children approach 100% intelligibility by this age. Intelligibility continues to develop past the fourth year of life. There is considerable variability among children with regard to intelligibility development. Supplemental Material https://doi.org/10.23641/asha.12330956.

Asunto(s)

RESUMEN

Purpose We evaluated the effects of a speech supplementation strategy to reduce rate and improve intelligibility in children with cerebral palsy. Method Twenty-five children with cerebral palsy (M age = 12.08 years) completed a structured speaking task in 2 speech conditions: habitual speech and slow speech. Fifteen children had mild intelligibility deficits; 10 had moderate-severe intelligibility deficits. In each condition, children repeated utterances of 2-7 words in length. In the habitual speech condition, children used their natural and unaltered speaking rate. In the slow speech condition, children were cued to insert pauses between words. Intelligibility ratings were obtained from orthographic transcriptions by unfamiliar adult listeners (n = 100). Speech rate, in words per minute, was measured for each utterance. Results All children, regardless of severity group, were able to reduce their rate of speech when implementing the slow speech strategy. Only children in the moderate-severe group showed an improvement in intelligibility when implementing the slow speech strategy. Although there was considerable individual variability, there was a greater improvement in intelligibility for longer utterances compared to shorter ones. Conclusion A slow speech strategy may be beneficial for children with moderate-severe intelligibility deficits who speak in longer utterances. Future studies should seek to further examine the clinical feasibility of slow speech for children with reduced intelligibility.

Asunto(s)

RESUMEN

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.

Asunto(s)

RESUMEN

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.

Asunto(s)