Speech-language Pathology Graduate Students Research Articles

Speech-Language Pathology Graduate Students’ Experiences with the Use of Case-Based Learning to Develop Skills for Evidence-Based Practice

Speech-Language Pathology Graduate Students’ Experiences with the Use of Case-Based Learning to Develop Skills for Evidence-Based Practice

The Acquisition of Static and Dynamic Intervention Skills by Graduate Speech-Language Pathology Students.

Speech-language pathology programs use simulated learning experiences (SLEs) to teach graduate student clinicians about fidelity to therapeutic interventions, including static skills (clinical actions that are delivered in a prespecified way regardless of the client's behavior) and dynamic skills (contingent responses formulated in response to a client's behavior). The purpose of this study was to explore student learning of static and dynamic skills throughout SLEs and live clinical practice. Thirty-three speech-language pathology graduate students participated in this study. Students were first trained to deliver an intervention before having their treatment fidelity measured at three time points: an initial SLE, actual clinical practice, and a final SLE. Treatment fidelity was first summarized using an overall accuracy score and then separated by static and dynamic skills. We hypothesized that (a) overall accuracy would increase from the initial simulation to treatment but remain steady from treatment to the final simulation and that (b) students would acquire dynamic skills more slowly than static skills. In line with our hypotheses, students' overall accuracy improved over time. Although accuracy for static skills was mostly established after the first simulation, dynamic skills remained less accurate, with a slower acquisition timeline. These results demonstrate that SLEs are efficacious in teaching students the clinical skills needed for actual clinical practice. Furthermore, we show that dynamic skills are more difficult for students to learn and implement than static skills, which suggests the need for greater attention to dynamic skill acquisition during clinical education.

An Exploration of Associations Between Self-Care Practices and Clinical Self-Efficacy in Speech-Language Pathology Graduate Students

Purpose: Previous studies have suggested that many speech-language pathology graduate students experience significant levels of stress throughout their programs. If not effectively mitigated, these stressors could negatively impact students' academic and clinical development. Self-care practices are one potential option that could help address the stressors students encounter throughout their graduate programs. The purpose of this research was to explore potential associations between self-care practices and clinical self-efficacy in speech-language pathology graduate students. Method: This topic was explored using a nonexperimental research design that included descriptive and correlational analyses. A survey that included demographic questions, the Mindful Self-Care Scale–Standard, and a modified version of the Clinical Self-Efficacy Appraisal Inventory was completed by 68 students who were enrolled in a speech-language pathology graduate program. Results: Small positive and significant correlational associations were observed between Mindful Awareness and total Mindful Self-Care Scale–Standard scores and all measured aspects of clinical self-efficacy. The associations between Supportive Relationships and Supportive Structure subscale scores and some aspects of clinical self-efficacy also reached significance. No significant associations were observed between Mindful Relaxation, Physical Care, or Self-Compassion and Purpose subscale scores and any measured domain of clinical self-efficacy. Conclusion: While limitations exist due to the exploratory nature of this study, the results provide an initial examination of associations between self-care practices and clinical self-efficacy.

Read the Feed: High-Emotion Simulation of Preterm Feeding to Enhance Graduate-Level Training.

Therapeutic bottle feeding is a critical skill for speech-language pathologists (SLPs) managing the increasing and medically complex neonatal intensive care unit (NICU) and early intervention caseloads. Thus, we explored the role of a high-emotion preterm simulator, known as "Paul," to increase knowledge, skills, and confidence related to infant feeding management for speech-language pathology graduate students. A randomized controlled study compared learning outcomes of 27 participants following either a 1-hr lecture or 1-hr training with a preterm simulator. Outcomes included knowledge demonstrated on written examination, accuracy in identifying stress cues during simulated feeding, and self-reported anxiety levels related to clinically assessing infant feeding. No baseline group differences were found on written examination or during a simulated bottle feeding. Both groups improved in written examination scores and identification of stress cues (p < .001). Gains in written examination scores did not significantly differ between groups; however, after training, the simulator group correctly identified more stress cues during a simulated bottle feeding (p < .001), and the lecture group reported reduced anxiety related to clinically evaluating infant feeding compared to simulator-trained students (p < .05). All students demonstrated gains in written knowledge and identification of stress cues; however, simulation-based training was superior in developing the feeders' ability to identify stress cues during a hands-on simulated bottle-feeding scenario. Lecture-based training may have inflated students' perceptions in their clinical skills as they were less accurate in identifying stress cues during a simulated feeding but reported significantly reduced anxiety for administering a clinical evaluation of infant feeding compared to simulation-trained students. Hands-on training using high-fidelity simulation may capitalize on experiential learning to better build clinical feeding skills for future SLPs who may serve in NICU and early intervention settings, while eliminating the risk of potential errors during learning that could affect fragile neonates.

Reflecting on Relationally Focused Critical Incidents: Investigating the Use of Reflective Writing to Support Conflict-Handling Skills During Speech-Language Pathology Student Internships

Purpose: Handling conflict successfully is an important professional competency. This study examined whether integrating relationally focused critical-incident reflections into graduate speech-language pathology student internships improved conflict-handling skills. The study also analyzed the breadth and depth of reflections and identified student variables associated with improved conflict handling. Method: Participants were a convenience sample of 49 graduate speech-language pathology students. A quasi-experimental design was used to compare participant conflict-handling skills at baseline, after a 7-week control period, and after 7 weeks of biweekly reflections. Students were provided with an orientation and writing prompt to guide their reflections. Relationships were examined between participant conflict-handling abilities, reflective capacity, emotional intelligence, number of reflections completed, and years of speech-language pathology–related experience. Results: Significant changes did not occur in conflict-handling skills after completing 7 weeks of relationally focused critical-incident reflections. Students demonstrated measurable ability to reflect on their experiences but appeared unable to achieve deep reflection. Significant correlations were revealed between emotional intelligence, number of reflections completed, and changes in conflict handling. Students with 2–4 years of prior speech-language pathology–related experience appeared to increase their conflict-handling skills during the clinical internship. Conclusions: Students were unable to critically reflect with guided questions and a training session alone. Reflection did not result in changes to conflict-handling skills, although individual student variables did impacted conflict handing. Implications for clinical education are discussed.

Does Implicit Racial Bias Affect Auditory-Perceptual Evaluations of Dysphonic Voices?

PurposeThe purpose of this study was to understand the role of implicit racial bias in auditory-perceptual evaluations of dysphonic voices by determining if a biasing effect exists for novice listeners in their auditory-perceptual ratings of Black and White speakers. MethodThirty speech-language pathology graduate students at Boston University listened to audio files of 20 Black speakers and 20 White speakers of General American English with voice disorders. Listeners rated the overall severity of dysphonia of each voice heard using a 100-unit visual analog scale and completed the Harvard Implicit Association Test (IAT) to measure their implicit racial bias. ResultsBoth Black and White speakers were rated as less severely dysphonic when their race was labeled as Black. No significant relationship was found between Harvard IAT scores and differences in severity ratings by race-labeling condition. ConclusionsThese findings suggest a minimizing bias in the evaluation of dysphonia for Black patients with voice disorders. These results contribute to the understanding of how a patient’s race may impact their visit with a clinician. Further research is needed to determine the most effective interventions for implicit bias retraining and the additional ways that implicit racial bias impacts comprehensive voice evaluations.

Three-Year Program Evaluation of a University-Public School Collaborative Partnership.

This clinical focus article reports on an innovative program that provides classroom-based speech and language services to school children receiving speech-language therapy while addressing the need for clinical placements for graduate students in speech-language pathology. This program evaluation report centers around the logic model used to develop and implement the program. The program was implemented in partnership between a university program in speech-language pathology and a nearby school district. The program took place in two different schools within the district, each with one state licensed and American Speech-Language-Hearing Association-certified speech-language pathologist (SLP) who supervised two or three graduate student interns per year of the project for a total of 17 graduate students over 3 years. Data sources for this program evaluation included child-level data collected by graduate student interns, teacher satisfaction surveys, and semistructured interviews. Program stakeholders including graduate student interns, speech-language pathology supervisors, and the school district administrator provided converging positive feedback about the program implementation. This was corroborated by favorable ratings from teachers who collaborated with graduate student interns and an increase in the number of classroom-based intervention hours for school children receiving speech-language services. The short-, medium-, and long-term outcomes of the program's logic model were achieved in part or fully as supported by data sources used for program evaluation procedures. Clinical implications are provided about the need for innovation in school-based services with a focus on collaborative classroom-based intervention.

The Impact of Treating Bilingual Clients on Speech-Language Pathology Students' Cultural Responsiveness.

Graduate programs often use practicum experience with clients from nonmajority cultures to improve students' cultural responsiveness. Yet, it is not clear whether simply working with a client from a nonmajority culture actually confers this benefit or whether students are thinking about how to include culturally responsive behaviors when they are considering how to address a clinical case. Twenty first-year speech-language pathology graduate students (10 Spanish-English bilinguals, 10 monolingual English speakers) were split into three groups: monolingual experimental (n = 4), bilingual experimental (n = 4), and control (n = 12). The experimental groups completed a structured practicum with bilingual Hispanic/Latino clients. They received a 1-hr training in cultural responsiveness and then implemented a systematic language intervention in English or Spanish. Changes to cultural responsiveness were measured via think-aloud cases, and changes to confidence were measured with published, self-report scales. Reflective journal entries revealed what aspects of the clinical practicum students found most salient. Experience working with bilingual clients did not have a substantial effect on students' confidence in their cultural competence. No substantial change was found in cultural responsiveness on the think-aloud for any group. Cultural responsiveness did not appear to be top-of-mind for the students. Simply working with clients from nonmajority cultures does not create a scenario where cultural responsiveness is likely to improve. Additional targeted, purposeful training in cultural responsiveness is necessary.

Undergraduate Nursing Application of the Rapid Aspiration Screening Tool (RAS-3): An Interprofessional Swallow Screen Simulation

BackgroundSwallow screenings for patients with suspected stroke may increase early identification of aspiration risk potentially reducing the incidence of pneumonia, length of stay, hospital costs, and patient mortality (Benfield et al., 2020; Daniels et al., 2016; Murray et al., 2021; Sherman et al., 2021). A simulation activity including graduate speech-language pathology (SLP) students and nursing students facilitates an experiential learning opportunity that paves the way for future knowledge and professional collaboration. MethodsThis study utilized an interdisciplinary swallow screen (Rapid Aspiration Screening [RAS-3]) lab, which included a standardized training protocol and simulation activity using standardized patients. The archival dataset included assessment data of 72 students from two programs, an accelerated undergraduate nursing (RN) program and SLP program within the same university. ResultsRN and SLP students obtained similar swallow screen interpretation results (e.g., x2 [1, 97] = 0.01, p = .92). Overall competency scores increased from pretraining (Mean = 82.4, N = 72) to posttraining (Mean = 96.5, N = 71). Twenty-six RN students and 23 SLP students (Mean difference = 19.2 and 25.2, respectively) scored higher after the RAS-3 training (Mean rank = 30.1). A significant difference in pretraining competency scores between RN students (Mean rank = 43.6, N = 48) and SLP students (Mean rank = 22.4, N = 24) (U = 236.5, z = -4.16, p < .00) was also observed, with a moderate effect size (r = -0.49). Furthermore, using the RAS-3 Lab Follow-up Questionnaire, 75.9% indicated they strongly felt that standardized patients helped them prepare for clinical practice. ConclusionBy providing a structured training program and then supporting the didactic material with an experiential, interdisciplinary activity, RN students were able to achieve results comparable to SLP students when performing the RAS3 swallow screen (Table 4).

Interprofessional education on autism and intellectual disabilities: Program description and initial evaluation.

Project INTERprofessional Autism Collaborative Training (INTERACT) is an interprofessional education program designed to prepare graduate students in psychology, special education, and speech-language pathology to work with autistic children with moderate to severe intellectual disabilities. The rising prevalence of autism, coupled with increased appreciation for interprofessional approaches to service delivery, indicates the need for university training programs to prepare graduate students to work interprofessionally with this population; yet descriptions of such programs and their effectiveness are not reported in the literature. In this article, we explain the process through which an interprofessional faculty team developed Project INTERACT, describe the sequence of coursework and team-based clinical experiences that comprise the program, and present preliminary data regarding its effectiveness. Twenty-four graduate students in psychology, special education, and speech-language pathology participated in this quantitative study. We report results from three rating scales that participants completed at program entry, midpoint, and program exit. Participants endorsed positive attitudes toward interprofessional practice and demonstrated high levels of knowledge about autism. Self-rated knowledge and abilities in interprofessional practice increased significantly by program exit. Project INTERACT scholars developed knowledge and skills related to understanding, assessing, and treating autistic children with intellectual disabilities, through the lens of team-based interprofessional collaboration. We discuss implications for practice with Project INTERACT. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

How does training format and clinical education model impact fidelity and confidence in a speech-language pathology rotation?

Clinical education rotations typically involve an initial training phase followed by supervised clinical practice. However, little research has explored the separate contributions of each component to the development of student confidence and treatment fidelity. The dual purpose of this study was to compare the impact of clinical training format (synchronous vs. asynchronous) and education model (traditional vs. collaborative) on student confidence and treatment fidelity. Thirty-six speech-language pathology graduate students completed this two-phase study during a one-term clinical rotation. Phase 1 investigated the impact of training condition (synchronous, asynchronous guided, asynchronous unguided) on student confidence and treatment fidelity. Phase 2 explored the impact of education model (traditional vs. collaborative) on student confidence and treatment fidelity. Treatment fidelity was measured at the conclusion of Phases 1 and 2. Students rated their confidence at six-time points throughout the study. Our results indicate that training condition did not differentially impact student confidence or treatment fidelity; however, education model did: students in the collaborative education model reported increased confidence compared to students in the traditional education model. Students in the collaborative education model also trended towards having higher treatment fidelity than students in the traditional education model. These results demonstrate that pre-clinical trainings can be effective in several different formats provided they cover the discrete skills needed for the clinical rotation. While preliminary, our results further suggest that students may benefit from working with peers during their clinical rotations.

Perceptions of Racism and White Privilege Among White Graduate Students in Audiology and Speech-Language Pathology.

In the White-dominated fields of audiology and speech-language pathology, graduate students should demonstrate awareness of racism and racial privilege to begin developing cultural humility. A 2013 survey of graduate students in audiology and speech-language pathology indicated that White students demonstrated minimal awareness of White privilege (Ebert, 2013). This study builds on Ebert (2013) by investigating changes in White students' perceptions of White privilege over time and by adding characterization of their perceptions of systemic racism. A web-based survey was distributed to graduate students in audiology and speech-language pathology programs across the country. The survey combined repeat questions from the work of Ebert (2013) with novel questions on systemic racism within the fields. For this study, only responses from White students were analyzed. The majority of White respondents (n = 104) acknowledged White privilege and systemic racism, though colorblindness and denial were still present among student responses. Significant increases in acknowledgment of White privilege from the Ebert (2013) results were observed across all questions. In qualitative analyses, the most common themes were the impact of White privilege and systemic racism on quality of services, access and opportunities, and clinician-client mismatch. Among White audiology and speech-language pathology graduate students, awareness of White privilege has increased over the past decade and most students acknowledge this privilege, as well as systemic racism. However, additional steps should be taken by students, graduate training programs, and practicing clinicians to continue confronting racial inequities in the fields. https://doi.org/10.23641/asha.22714222.

Self-Efficacy for Clinical Tasks Among Speech-Language Pathology Graduate Students

Purpose: The purpose of this study was to determine the effect of the first semester of a speech-language pathology (SLP) graduate program on the level of student self-efficacy for a set of clinical tasks across a variety of communication disorders. Method: In this study, 60 SLP graduate students participated. They were in two sections of a required first-semester course at a single university. They completed a custom-made self-efficacy scale at the beginning and end of their first semester of graduate school. The self-efficacy scale was administered as a Qualtrics survey, with participant ratings of 14 clinical skills for 12 communication disorders. As part of both administrations of the survey, the participants also provided their number of evaluation and treatment observation hours as well as their evaluation and treatment practicum hours. Descriptive statistics and mixed-effects regression models were used to analyze the data. Results: The data indicated that a semester of graduate school and clinical practice increased the students' self-efficacy across all 12 communication disorders. The regression analysis confirmed that all of the clinical tasks differed significantly by when the survey was completed, with the higher self-efficacy scores occurring at the end of the semester. It also revealed that student self-efficacy scores increased by 1 point with each clinical diagnostic hour the students completed. Conclusions: Completing a semester of graduate school resulted in increased self-efficacy in this group of students. The increased self-efficacy spread across a range of disorder types and across a variety of evaluation and treatment tasks.

Structured Ethics Education in Speech-Language Pathology Graduate Students

This investigation compared the effect of ethics training embedded within a curriculum to structured ethics training regarding the ethics knowledge and self-reported comfort levels of first-year graduate students in speech-language pathology. Two equal, non-randomized groups of participants completed an ethics test and survey at three different times over the course of the investigation. The test and survey were administered prior to and after structured ethics training and ethics training embedded within the curriculum. The results of this study showed a significant difference in ethics knowledge after completion of the structured ethics training module for both groups. After receiving structured ethics training, there was no difference between groups regarding comfort in identifying and solving ethics problems. These findings add to the literature regarding the need for structured ethics training for graduate students in healthcare professions. Structured ethics training in speech-language pathology graduate students increased the knowledge of ethical foundations and decision-making models prior to clinical practice in the field.

Exploring the attitudes and practices among student clinicians in India on multilingual issues in the field of speech-language pathology.

Student clinicians (graduates and undergraduates) in speech-language pathology deal with various multilingual issues while providing clinical services to individuals with language impairments. This study explores the attitudes and practices of undergraduate and graduate speech-language pathology students in India towards multilingualism and handling these issues. One hundred and twenty-eight students (71 graduates and 57 undergraduates) participated in the study. Phase 1 of the study included the development of a questionnaire to explore the attitudes and practices of student clinicians in speech-language pathology. The questionnaire was converted into an online survey in Phase 2. Phase 3 comprised data and statistical analysis to summarize and interpret collected data. Graduate and undergraduate students significantly differed in their attitudes and perception toward multilingual issues (p<0.05). Most clinicians demanded a change in the current views on assessment/intervention, considering the linguistic background of the patient/caregivers. Other issues surrounding multilingualism included parents' education levels, lack of sufficient assessment tools, unavailability of translators/interpreters, and poor linguistic competency of clinicians. These findings assist academic programs in planning and developing modules to aid students in handling the major multilingual issues encountered during clinical interactions.

Ultrasound Visual Biofeedback Training for Speech Language Pathology Students: A Single Case Design

This study examined the effectiveness of an ultrasound visual biofeedback (UVB) training on speech-language pathology (SLP) students’ assessment of sonographic tongue configuration. This study examined the presence of a functional relation between an ultrasound visual biofeedback (UVB) training within the Participatory Adult Teaching Strategy framework and speech-language pathology (SLP) students’ assessment of sonographic tongue configuration. Method: This study employed a multiple baseline, single-case design across participants and behaviors for data collection and analysis. Four graduate and three undergraduate level SLP students participated. Results: Percentage of goal obtained indicated that training was effective across participants and behaviors for teaching SLP students in the assessment of sonographic tongue shape for remediation of speech sound errors. Differences were found between undergraduate and graduate SLP students in the accuracy of assessment of sonographic tongue section configuration. Conclusions: The study establishes preliminary effectiveness of UVB training for SLP students. Although results demonstrate the effectiveness, special considerations should be applied when training graduate and undergraduate students in implementation of UVB training in order to accommodate knowledge and clinical experience differences between graduate and undergraduate students.

Improving the Clinician-Client Relationship in Children’s Speech-Language Treatment: An Exploratory Online Training Study

Introduction: Clinician-client relationships impact treatment outcomes in speech-language pathology. Training clinicians to improve these relationships might therefore improve treatment outcomes but has not been examined in the field. This study is a preliminary investigation of whether training student clinicians can enhance clinician-client relationships in children’s speech-language treatment. Methods: The study followed a single-subject multiple baseline design. Five graduate student clinicians completed a web-based training on clinician-client relationships, which was implemented as a series of three modules discussing goals, tasks, and bond. The training’s impact on the student’s relationships with their child clients was examined through weekly ratings completed by the students, their supervisor, and some parents and children. Intervention effects were measured by visual analysis of baseline versus intervention phases and by Tau-U effect sizes. Results: Visual analyses supported change in just under half the possible opportunities, but improvements in the relationship were also present in many of the baseline phases. Tau-U effects that corrected for baseline trend reached significance in 18 of 29 instances, providing support for the effects of the intervention. Conclusions: This study provides initial evidence that clinician-client relationship training can be effective for speech-language pathology graduate students. Clinician-client relationship training is a promising area for future investigation.

Speech-Language Pathology Graduate Students' Perception of Satisfaction, Confidence, and Interpersonal Skill Development During Simulated Experiences Amid COVID-19

Purpose: This quantitative survey correlational study aimed to examine the satisfaction, confidence, and interpersonal skills of speech-language pathology (SLP) graduate students after participating in simulated learning experiences (SLEs) during the COVID-19 pandemic. The research questions addressed (a) How do SLP graduate students perceive satisfaction, confidence, interpersonal skills, and strengths and challenges of this learning after participating in SLEs? and (b) How do SLP graduate students perceive satisfaction, confidence, and interpersonal skills across the number of hours of the SLE, the number of courses that utilize simulation, and the types of simulation experiences? Method: We invited a total of 72 Midwest clinic directors to distribute the survey to students in their respective programs. The final sample included 327 SLP students. Participants responded to questions on satisfaction, confidence, and interpersonal skills after participating in SLEs. Results: Key findings included a positive correlation among student perceptions, including satisfaction, confidence, and interpersonal skills, but no correlations between student perceptions and the number of courses that integrated SLEs and number of hours of simulation experience. Simulation types were analyzed and showed significant differences in interpersonal skill development such that virtual patient simulation is associated with more positive interpersonal skills among all types. A summary of strengths and challenges from the SLP graduate student perspective was also synthesized. Conclusions: Findings necessitate further exploration as they relate to the SLP graduate clinical experiences. This study revealed moderate to positive feedback on SLEs (instead of overall positive feedback) regarding satisfaction, confidence, and interpersonal skill development; however, previous studies noted positive outcomes. Further research should include comparing face-to-face experiences with SLEs and replicating this survey after the COVID-19 pandemic subsides and graduate programs can return to normal operations.

“Getting Back Into School Mode”: Experiences of Former Speech-Language Pathology Assistants in Graduate School

Purpose: The purpose of this article is to describe the speech-language pathology master's program experience for two groups of students: students with former speech-language pathology assistant (SLPA) experience (fSLPA) and students without SLPA experience (nSLPA). Results are relevant to current SLPAs who are considering attending graduate school and university faculty members involved in program design. Method: A survey was distributed electronically to students nationwide. The survey included both Likert-style questions and open-ended responses. A total of 85 student responses were included in data, 43 fSLPAs and 42 nSLPAs. Qualitative and quantitative results were analyzed separately and then synthesized together in a mixed-methods analysis. Results: Although the study was not designed to directly measure stressors, bottom-up qualitative analysis resulted in a framework of internal and external stressors, internal and external supports, and learning and growing. Stressors and supports were described by participants as intertwined, and a given event (e.g., the start of clinical rotations) did not map neatly to stressors or supports for all participants. fSLPAs reported higher perceptions of clinical success, feeling different than their peers, and the perception that fSLPAs were more successful in graduate school. Taken together, these results converged to develop seven findings. For instance, one finding was that, although both groups reported external and internal stressors, the specific stressors somewhat varied by group. Conclusions: Findings are discussed in relation to transformational learning theory and prior works on stress within the field. Implications for program development and prospective speech-language pathology graduate students are discussed.

Speech Impairment in Cerebellar Ataxia Affects Naturalness More Than Intelligibility.

The purpose of this analysis was to document intelligibility and naturalness in ataxia, a neurological condition that results from cerebellar damage. The cerebellum is important for normal speech production to scale and coordinate articulatory and laryngeal movements. The disruption of these cerebellar mechanisms has unique implications for how intelligibility and naturalness are affected in ataxia. The results of research on speech in ataxia have important clinical implications for assessment and treatment of individuals with ataxic dysarthria. Speech samples from 27 participants with ataxia and 28 age- and sex-matched control participants were assessed by nine speech-language pathology graduate students for intelligibility and naturalness. Intelligibility was measured as the percentage of words transcribed correctly, and naturalness was assessed as a subjective rating on a seven-point interval scale. Both intra- and inter-rater reliability were moderate to high for both intelligibility and naturalness. Speech intelligibility and naturalness were robustly decreased in the ataxia group compared to the control group; however, the difference was greater for measures of speech naturalness. There were robust relationships among dysarthria severity, length of diagnosis, and speech naturalness in speakers with ataxia, but there were no other robust effects for age, sex, or impact on quality of life for intelligibility or naturalness. Speech naturalness was more impaired than intelligibility in speakers with ataxia. Impaired naturalness can have debilitating consequences for communicative participation, effectiveness, and quality of life. Assessment and treatment for ataxic dysarthria should include aspects of prosodic control for speech naturalness.