Reduced Speech Intelligibility Research Articles

Acoustic vowel analysis and speech intelligibility in young adult Hebrew speakers: Developmental dysarthria versus typical development.

Developmental dysarthria is a motor speech impairment commonly characterized by varying levels of reduced speech intelligibility. The relationship between intelligibility deficits and acoustic vowel space among these individuals has long been noted in the literature, with evidence of vowel centralization (e.g., in English and Mandarin). However, the degree to which this centralization occurs and the intelligibility-acoustic relationship is maintained in different vowel systems has yet to be studied thoroughly. In comparison with American English, the Hebrew vowel system is significantly smaller, with a potentially smaller vowel space area, a factor that may impact upon the comparisons of the acoustic vowel space and its correlation with speech intelligibility. Data on vowel space and speech intelligibility are particularly limited for Hebrew speakers with motor speech disorders. To determine the nature and degree of vowel space centralization in Hebrew-speaking adolescents and young adults with dysarthria, in comparison with typically developing (TD) peers, and to correlate these findings with speech intelligibility scores. Adolescents and young adults with developmental dysarthria (secondary to cerebral palsy (CP) and other motor deficits, n = 17) and their TD peers (n = 17) were recorded producing Hebrew corner vowels within single words. For intelligibility assessments, naïve listeners transcribed those words produced by speakers with CP, and intelligibility scores were calculated. Acoustic analysis of vowel formants (F1, F2) revealed a centralization of vowel space among speakers with CP for all acoustic metrics of vowel formants, and mainly for the formant centralization ratio (FCR), in comparison with TD peers. Intelligibility scores were correlated strongly with the FCR metric for speakers with CP. The main results, vowel space centralization for speakers with CP in comparison with TD peers, echo previous cross-linguistic results. The correlation of acoustic results with speech intelligibility carries clinical implications. Taken together, the results contribute to better characterization of the speech production deficit in Hebrew speakers with motor speech disorders. Furthermore, they may guide clinical decision-making and intervention planning to improve speech intelligibility. What this paper adds What is already known on the subject Speech production and intelligibility deficits among individuals with developmental dysarthria (e.g., secondary to CP) are well documented. These deficits have also been correlated with centralization of the acoustic vowel space, although primarily in English speakers. Little is known about the acoustic characteristics of vowels in Hebrew speakers with motor speech disorders, and whether correlations with speech intelligibility are maintained. What this paper adds to existing knowledge This study is the first to describe the acoustic characteristics of vowel space in Hebrew-speaking adolescents and young adults with developmental dysarthria. The results demonstrate a centralization of the acoustic vowel space in comparison with TD peers for all measures, as found in other languages. Correlation between acoustic measures and speech intelligibility scores were also documented. We discuss these results within the context of cross-linguistic comparisons. What are the potential or actual clinical implications of this work? The results confirm the use of objective acoustic measures in the assessment of individuals with motor speech disorders, providing such data for Hebrew-speaking adolescents and young adults. These measures can be used to determine the nature and severity of the speech deficit across languages, may guide intervention planning, as well as measure the effectiveness of intelligibility-based treatment programmes.

Speech intelligibility loss due to amyotrophic lateral sclerosis: the effect of tongue movement reduction on vowel and consonant acoustic features

ABSTRACT The purpose of this study was to identify aspects of impaired tongue motor performance that limit the ability to produce distinct speech sounds and contribute to reduced speech intelligibility in individuals with dysarthria secondary to amyotrophic lateral sclerosis (ALS). We analyzed simultaneously recorded tongue kinematic and acoustic data from 22 subjects during three target words (cat, dog, and took). The subjects included 11 participants with ALS and 11 healthy controls from the X-ray microbeam dysarthria database (Westbury, 1994). Novel measures were derived based on the range and speed of relative movement between two quasi-independent regions of the tongue – blade and dorsum – to characterize the global pattern of tongue dynamics. These “whole tongue” measures, along with the range and speed of single tongue regions, were compared across words, groups (ALS vs. control), and measure types (whole tongue vs. tongue blade vs. tongue dorsum). Reduced range and speed of both global and regional tongue movements were found in participants with ALS relative to healthy controls, reflecting impaired tongue motor performance in ALS. The extent of impairment, however, varied across words and measure types. Compared with the regional tongue measures, the whole tongue measures showed more consistent disease-related changes across the target words and were more robust predictors of speech intelligibility. Furthermore, these whole tongue measures were correlated with various word-specific acoustic features associated with intelligibility decline in ALS, suggesting that impaired tongue movement likely contributes to reduced phonetic distinctiveness of both vowels and consonants that underlie speech intelligibility decline in ALS.

Short report on the effects of SARS-CoV-2 face protective equipment on verbal communication.

ObjectiveTo predict the impact of face personal protective equipment on verbal communication during the SARS-CoV-2 pandemic.DesignWe assessed the effect of common types and combinations of face personal protective equipment on speech intelligibility in quiet and in a simulated noisy environment.ResultsWearing face personal protective equipment impairs transmission of middle-to-high voice frequencies and affects speech intelligibility. Surgical masks are responsible for up to 23.3% loss of speech intelligibility in noisy environments. The effects are larger in the condition of advanced face personal protective equipment, accounting for up to 69.0% reduction of speech intelligibility.ConclusionThe use of face personal protective equipment causes significant verbal communication issues. Healthcare workers, school-aged children, and people affected by voice and hearing disorders may represent specific at-risk groups for impaired speech intelligibility.

Speech intelligibility enhancement in elderly with high-frequency hearing loss through visual speech perception

Background: Pathological and physiological disabilities of human auditory receptors reduce speech intelligibility under hearing loss (HL) at high frequencies. Objectives: The objective of the study is to investigate the speech-intelligibility-enhancement (SIE) in elderly with high-frequency HL (HFHL) through visual-speech-perception (VSP). The hypothesis is that the VSP of spondee words (two-syllable words with equal stress on both syllables) is properly recognized and reproduced with HFHL. Also; to decide the statistical relevance of the precise significant difference in speech discrimination (SD) with VSP on the subjected ear. Methods: Observational and descriptive studies of SIE with VSP on 12 elderly listeners (24 clear ears; without wax impaction) with progressive and bilateral HFHL were examined. The entire experimental records were checked for distribution with normal (Gaussian) using the Shapiro–Wilk's and paired Student's t-test (parametric test) had the 5% (0.05) significance level (α). Results: We analyzed, improved, and better performance in SIE with HFHL through VSP. The statistical P (probability) measure was calculated nothing, i.e., 0 (P

Speech intelligibility in auralized classrooms when the talker is wearing a face mask

This study explored the effects of wearing face masks on classroom communication. We evaluated the effects of three different types of face masks (fabric, surgical and N95 masks) on speech intelligibility presented to college students in auralized classrooms. To simulate realistic classroom conditions, speech stimuli were presented in the presence of speech-shaped noise with a signal-to-noise ratio of + 3 dB under two different reverberation times (0.4 s and 3.1 s). The use fabric masks yielded significantly greater reduction in speech intelligibility compared to the other masks. Therefore, surgical masks or N95 masks are strongly recommended in teaching environments.

Language, speech, and oromotor function in children with Pompe disease

Advances in the treatment of Pompe disease have improved life expectancy and quality of life, but speech and oromotor function remain significantly affected. The purpose of this study was to expand on existing data and present new findings of speech acoustic and physiologic outcomes in Pompe disease. A retrospective analysis was carried out on results of speech, language and oromotor tests carried out in 14 children diagnosed with Pompe disease. The assessment battery included standardized tests of language, picture naming, maximum performance tests, and oromotor resistance tasks. Speech production was scored with respect to intelligibility, hypernasality, and articulatory accuracy. Language delays ranged from mild to severe in 1/3 of the children. Reduced speech intelligibility, disordered articulation, and hypernasality were present in at least 2/3 of the children. Maximum performance tests all fell at least 1 SD below normative means. Significant correlations were identified between maximum phonation time and articulation and between the S/Z ratio and intelligibility. Positive correlations were also found between tongue strength and articulation. Results confirm previous reports of speech and language function in Pompe disease. Clinical acoustic measures provide important insights into the speech deficits in this group of children and suggest possible treatment strategies.

Cognitive Linguistic Profile Post Road Traffic Accident

In India the incidence of Road Traffic accidents is reported to be 4,64,910 in 2017 among which 1,47,913 lives were dead and 4,70,975 persons were injured.Road traffic accidents result in various complications which will affect the person’s quality of life. One such complication is cognitive linguistic deficit. This case study is about a young man who has cognitive linguistic deficit which is a result of road traffic accident. The patient exhibited several complex cognitive- linguistic issues during the assessment. This includes reduced semantic memory, spared generative memory, reduced speech intelligibility, extensive surgical management and other behavioural problems. And he has speech and language difficulties such as reduced speech intelligibility, paraphasia, circumlocutions were present.

Assessing Parkinson's disease severity using speech analysis in non-native speakers

BackgroundSpeech disorder is a common manifestation of Parkinson's disease with two main symptoms, dysprosody and dysphonia. Previous research studying objective measures of speech symptoms involved patients and examiners who were native language speakers. Measures such as cepstral separation difference (CSD) features to quantify dysphonia and dysprosody accurately distinguish the severity of speech impairment. Importantly CSD, together with other speech features, including Mel-frequency coefficients, fundamental-frequency variation, and spectral dynamics, characterize speech intelligibility in PD. However, non-native language speakers transfer phonological rules of their mother language that tamper speech assessment. ObjectivesThis paper explores CSD's capability: first, to quantify dysprosody and dysphonia of non-native language speakers, Parkinson patients and controls, and secondly, to characterize the severity of speech impairment when Parkinson's dysprosody accompanies non-native linguistic dysprosody. MethodsCSD features were extracted from 168 speech samples recorded from 19 healthy controls, 15 rehabilitated and 23 not-rehabilitated Parkinson patients in three different clinical speech tests based on Unified Parkinson's disease rating scale motor-speech examination. Statistical analyses were performed to compare groups using analysis of variance, intraclass correlation, and Guttman correlation coefficient µ2. Random forests were trained to classify the severity of speech impairment using CSD and the other speech features. Feature importance in classification was determined using permutation importance score. ResultsResults showed that the CSD feature describing dysphonia was uninfluenced by non-native accents, strongly correlated with the clinical examination (µ2>0.5), and significantly discriminated between the healthy, rehabilitated, and not-rehabilitated patient groups based on the severity of speech symptoms. However, the feature describing dysprosody did not correlate with the clinical examination but significantly distinguished the groups. The classification model based on random forests and selected features characterized the severity of speech impairment of non-native language speakers with high accuracy. Importantly, the permutation importance score of the CSD feature representing dysphonia was the highest compared to other features. Results showed a strong negative correlation (µ2<-0.5) between L-dopa administration and the CSD features. ConclusionsAlthough non-native accents reduce speech intelligibility, the CSD features can accurately characterize speech impairment, which is not always possible in the clinical examination. Findings support using CSD for monitoring Parkinson's disease.

Performance in Noise: The Relationship Between Workload And Situation Awareness in Navy Tactical Teams

The relationship between workload and situation awareness (SA) has been researched generally; however, the relationship between measures of SA and workload, SPAM and NASA TLX respectively, has not been established. This study was completed using a tactical military scenario in which two participants acted as they would standing watch on a US Navy ship. One participant, the Tactical Action Officer (TAO) had reduced speech intelligibility in some trials. The results showed that the relationship between workload and SA differed by role (TAO or CICWO) and by the speech intelligibility level. This work shows the complex relationship between workload and SA and shows the need further investigation in this area, especially in teams.

Automatic hypernasality grade assessment in cleft palate speech based on the spectral envelope method.

Due to velopharyngeal incompetence, airflow overflows from the oral cavity to the nasal cavity, which results in hypernasality. Hypernasality greatly reduces speech intelligibility and affects the daily communication of patients with cleft palate. Accurate assessment of hypernasality grades can provide assisted diagnosis for speech-language pathologists (SLPs) in clinical settings. Utilizing a support vector machine (SVM), this paper classifies speech recordings into four grades (normal, mild, moderate and severe hypernasality) based on vocal tract characteristics. Linear prediction (LP) analysis is widely used to model the vocal tract. Glottal source information may be included in the LP-based spectrum. The stabilized weighted linear prediction (SWLP) method, which imposes the temporal weights on the closed-phase interval of the glottal cycle, is a more robust approach for modeling the vocal tract. The extended weighted linear prediction (XLP) method weights each lagged speech signal separately, which achieves a finer time scale on the spectral envelope than the SWLP method. Tested speech recordings were collected from 60 subjects with cleft palate and 20 control subjects, and included a total of 4640 Mandarin syllables. The experimental results showed that the spectral envelope of normal speech decreases faster than that of hypernasal speech in the high-frequency part. The experimental results also indicate that the SWLP- and XLP-based methods have smaller correlation coefficients between normal and hypernasal speech than the LP method. Thus, the SWLP and XLP methods have better ability to distinguish hypernasal from normal speech than the LP method. The classification accuracies of the four hypernasality grades using the SWLP and XLP methods range from 83.86% to 97.47%. The selection of the model order and the size of the weight function are also discussed in this paper.

First responder communication in CBRN environments: FIRCOM-CBRN study

IntroductionRecent terror attacks and assassinations involving highly toxic chemical weapons have stressed the importance of sufficient respiratory protection of medical first responders and receivers. As full-face respirators cause perceptual-motor impairment,...

Mice heterozygous for the Cdh23/Ahl1 mutation show age-related deficits in auditory temporal processing

A mutation in the Cdh23 gene is implicated in both syndromic and nonsyndromic hearing loss in humans and age-related hearing loss in C57BL/6 mice. It is generally assumed that human patients (as well as mouse models) only have a hearing loss phenotype if the mutation is homozygous. However, a major complaint for patients with a hearing disability is a reduced speech intelligibility that may be related to temporal processing deficits rather than just elevated thresholds. In this study, we used the amplitude modulation following response (AMFR) to test whether mice heterozygous for Cdh23735A > G have an auditory phenotype that includes temporal processing deficits. The hearing of mice heterozygous for the Cdh23735A > G mutation was compared with age-matched mice homozygous for either the mutation or the wild type in 3 cohorts of mice of both sexes at 2-3, 6, and 12 months of age. The AMFR technique was used to generate objective hearing thresholds for all mice across their range of hearing and to test their temporal processing. We found a genotype-dependent hearing loss in mice homozygous for the mutation starting at 5–11 weeks of age, an age when mice on the C57BL/6 background are often presumed to have normal hearing. The heterozygous animals retained normal hearing thresholds up to one year of age. Nevertheless, the heterozygous animals showed a decline in temporal processing abilities at one year of age that was independent of their hearing thresholds. These results suggest that mice heterozygous for the Cdh23 mutation do not have truly normal hearing.

Longitudinal Growth in Single Word Intelligibility Among Children With Cerebral Palsy From 24 to 96 Months of Age: Predicting Later Outcomes From Early Speech Production.

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.

CCi-MOBILE: Design and Evaluation of a Cochlear Implant and Hearing Aid Research Platform for Speech Scientists and Engineers.

Hearing loss is an increasingly prevalent condition resulting from damage to the inner ear which causes a reduction in speech intelligibility. The societal need for assistive hearing devices has increased exponentially over the past two decades; however, actual human performance with such devices has only seen modest gains relative to advancements in digital signal processing (DSP) technology. A major challenge with clinical hearing technologies is the limited ability to run complex signal processing algorithms requiring high computation power. The CCi-MOBILE platform, developed at UT-Dallas, provides the research community with an open-source, flexible, easy-to-use, software-mediated, powerful computing research interface to conduct a wide variety of listening experiments. The platform supports cochlear implants (CIs) and hearing aids (HAs) independently, as well as bimodal hearing (i.e., a CI in one ear and HA in the contralateral ear). The platform is ideally suited to address hearing research for: both quiet and naturalistic noisy conditions, sound localization, and lateralization. The platform uses commercially available smartphone/tablet devices as portable sound processors and can provide bilateral electric and acoustic stimulation. The hardware components, firmware, and software suite are presented to demonstrate safety to the speech scientist and CI/HA user, highlight user-specificity, and outline various applications of the platform for research.

Effect of Dysphonia and Cognitive-Perceptual Listener Strategies on Speech Intelligibility

There is a high prevalence of dysphonia among professional voice users and the impact of the disordered voice on the speaker is well documented. However, there is minimal research on the impact of the disordered voice on the listener. Considering that professional voice users include teachers and air-traffic controllers, among others, it is imperative to determine the impact of a disordered voice on the listener. To address this, the objectives of the current study included: (1) determine whether there are differences in speech intelligibility between individuals with healthy voices and those with dysphonia; (2) understand whether cognitive-perceptual strategies increase speech intelligibility for dysphonic speakers; and (3) determine the relationship between subjective voice quality ratings and speech intelligibility. Sentence stimuli were recorded from 12 speakers with dysphonia and four age- and gender-matched typical, healthy speakers and presented to 129 healthy listeners divided into one of three strategy groups (ie, control, acknowledgement, and listener strategies). Four expert raters also completed a perceptual voice assessment using the Consensus Assessment Perceptual Evaluation of Voice for each speaker. Results indicated that dysphonic voices were significantly less intelligible than healthy voices (P ≤ 0.001) and the use of cognitive-perceptual strategies provided to the listener did not significantly improve speech intelligibility scores (P = 0.602). Using the subjective voice quality ratings, regression analysis found that breathiness was able to predict 41% of the variance associated with number of errors (P = 0.008). Overall results of the study suggest that speakers with dysphonia demonstrate reduced speech intelligibility and that providing the listener with specific strategies may not result in improved intelligibility.

Mitigating the effects of reverberation and noise in cochlear implants

In listening environments with room reverberation and background noise, cochlear implant (CI) users experience substantial difficulties in understanding speech. Because everyday environments have different combinations of reverberation and noise, there is a need to develop algorithms that can mitigate both effects to improve speech intelligibility. Desmond et al. (2014) developed a machine learning approach to mitigate the adverse effects of late reverberant reflections of speech signals by using a classifier to detect and remove affected segments in CI pulse trains. In this study, we investigate the robustness of the reverberation mitigation algorithm in environments with both reverberation and noise. We conducted sentence recognition tests in normal hearing listeners using vocoded speech with unmitigated and mitigated reverberant-only or noisy reverberant speech signals, across different reverberation times and noise types. Improvements in speech intelligibility were observed in mitigated reverberant-only conditions. However, mixed results were obtained in the mitigated noisy reverberant conditions as a reduction in speech intelligibility was observed for noise types whose spectra were similar to that of anechoic speech. Based on these results, the focus of future work will be to develop a context-dependent approach that activates different mitigation strategies for different acoustic environments. [Research supported by NIH grant R01DC014290-03.]

Phase Entrainment of Brain Oscillations Causally Modulates Neural Responses to Intelligible Speech

SummaryDue to their periodic nature, neural oscillations might represent an optimal “tool” for the processing of rhythmic stimulus input [1, 2, 3]. Indeed, the alignment of neural oscillations to a rhythmic stimulus, often termed phase entrainment, has been repeatedly demonstrated [4, 5, 6, 7]. Phase entrainment is central to current theories of speech processing [8, 9, 10] and has been associated with successful speech comprehension [11, 12, 13, 14, 15, 16, 17]. However, typical manipulations that reduce speech intelligibility (e.g., addition of noise and time reversal [11, 12, 14, 16, 17]) could destroy critical acoustic cues for entrainment (such as “acoustic edges” [7]). Hence, the association between phase entrainment and speech intelligibility might only be “epiphenomenal”; i.e., both decline due to the same manipulation, without any causal link between the two [18]. Here, we use transcranial alternating current stimulation (tACS [19]) to manipulate the phase lag between neural oscillations and speech rhythm while measuring neural responses to intelligible and unintelligible vocoded stimuli with sparse fMRI. We found that this manipulation significantly modulates the BOLD response to intelligible speech in the superior temporal gyrus, and the strength of BOLD modulation is correlated with a phasic modulation of performance in a behavioral task. Importantly, these findings are absent for unintelligible speech and during sham stimulation; we thus demonstrate that phase entrainment has a specific, causal influence on neural responses to intelligible speech. Our results not only provide an important step toward understanding the neural foundation of human abilities at speech comprehension but also suggest new methods for enhancing speech perception that can be explored in the future.

USING MACHINE LEARNING TO MITIGATE THE EFFECTS OF REVERBERATION AND NOISE IN COCHLEAR IMPLANTS.

In listening environments with room reverberation and background noise, cochlear implant (CI) users experience substantial difficulties in understanding speech. Because everyday environments have different combinations of reverberation and noise, there is a need to develop algorithms that can mitigate both effects to improve speech intelligibility. Desmond et al. (2014) developed a machine learning approach to mitigate the adverse effects of late reverberant reflections of speech signals by using a classifier to detect and remove affected segments in CI pulse trains. This study aimed to investigate the robustness of the reverberation mitigation algorithm in environments with both reverberation and noise. Sentence recognition tests were conducted in normal hearing listeners using vocoded speech with unmitigated and mitigated reverberant-only or noisy reverberant speech signals, across different reverberation times and noise types. Improvements in speech intelligibility were observed in mitigated reverberant-only conditions. However, mixed results were obtained in the mitigated noisy reverberant conditions as a reduction in speech intelligibility was observed for noise types whose spectra were similar to that of anechoic speech. Based on these results, the focus of future work is to develop a context-dependent approach that activates different mitigation strategies for different acoustic environments.

Spatial Release From Informational Masking: Evidence From Functional Near Infrared Spectroscopy.

Informational masking (IM) can greatly reduce speech intelligibility, but the neural mechanisms underlying IM are not understood. Binaural differences between target and masker can improve speech perception. In general, improvement in masked speech intelligibility due to provision of spatial cues is called spatial release from masking. Here, we focused on an aspect of spatial release from masking, specifically, the role of spatial attention. We hypothesized that in a situation with IM background sound (a) attention to speech recruits lateral frontal cortex (LFCx) and (b) LFCx activity varies with direction of spatial attention. Using functional near infrared spectroscopy, we assessed LFCx activity bilaterally in normal-hearing listeners. In Experiment 1, two talkers were simultaneously presented. Listeners either attended to the target talker (speech task) or they listened passively to an unintelligible, scrambled version of the acoustic mixture (control task). Target and masker differed in pitch and interaural time difference (ITD). Relative to the passive control, LFCx activity increased during attentive listening. Experiment 2 measured how LFCx activity varied with ITD, by testing listeners on the speech task in Experiment 1, except that talkers either were spatially separated by ITD or colocated. Results show that directing of auditory attention activates LFCx bilaterally. Moreover, right LFCx is recruited more strongly in the spatially separated as compared with colocated configurations. Findings hint that LFCx function contributes to spatial release from masking in situations with IM.

The Impact of Reduced Speech Intelligibility on Reaction Time in a Naval Combat Environment

Despite attempts to limit noise exposure, noise-induced hearing loss remains prevalent in the military. Both hearing loss and the noise itself can lead to communication issues which could negatively impact operational performance. This study builds upon a series of experiments examining the relationship between reduced speech intelligibility and performance in a naval command and control environment by equipping Navy watch standers with hearing loss simulators that control speech intelligibility in real time as they were engaged in a simulated operational scenario. This effort focused on the effects that a Sailor with impaired hearing might have on unimpaired shipmates and how the mission might specifically be impacted. Results showed that as speech intelligibility decreased for the impaired watch stander perceived workload increased in an unimpaired shipmate and the latency of the crew to respond to incoming missile threats and a direct order to kill an enemy ship increased significantly.