Speech And Language Assessment Research Articles

Automatic Screening for Children with Speech Disorder Using Automatic Speech Recognition: Opportunities and Challenges

Speech is a fundamental aspect of human life, crucial not only for communication but also for cognitive, social, and academic development. Children with speech disorders (SD) face significant challenges that, if unaddressed, can result in lasting negative impacts. Traditionally, speech and language assessments (SLA) have been conducted by skilled speech-language pathologists (SLPs), but there is a growing need for efficient and scalable SLA methods powered by artificial intelligence. This position paper presents a survey of existing techniques suitable for automating SLA pipelines, with an emphasis on adapting automatic speech recognition (ASR) models for children’s speech, an overview of current SLAs and their automated counterparts to demonstrate the feasibility of AI-enhanced SLA pipelines, and a discussion of practical considerations, including accessibility and privacy concerns, associated with the deployment of AI-powered SLAs.

Features of culturally and linguistically relevant speech-language assessments for Indigenous children: A scoping review.

Indigenous children may be at higher risk of being misdiagnosed with speech-language difficulties due to Eurocentric practices in health care and education. The use of conventional speech pathology assessment practices contributes to inappropriate disorder identification, further stigmatising a vulnerable population. Few resources are available for speech pathologists, which examine the cultural and linguistic relevance of assessments for this population. To provide important features for speech pathologists to account for when building assessment plans for Indigenous children. This comprehensive scoping literature review was completed using the Arksey and O'Malley 6-step methodological framework, including the optional consultation exercise, and reported using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. To be included, studies needed to have been published since 2000, discuss speech-language assessments and involve a significant proportion of Indigenous participants under 7 years old. Three features were extracted from 32 studies that discussed First Nations, Métis, Inuit, Native American, Aboriginal and Torres Strait Islander communities: using a battery of resources including alternative approaches, ensuring authenticity and cultural relevance, and considering a child's linguistic characteristics. While there remains a need to adapt according to a specific child's reality, this study provides a guideline for all allied health clinicians when they are building their culturally and linguistically relevant assessment plans.

Socioeconomic Deprivation Detrimentally Influences Language Outcomes in Toddlers With Cleft Palate.

The purpose of this study was to examine the influence of socioeconomic deprivation on language and developmental outcomes in toddlers with cleft palate with or without cleft lip (CP ± L). Other factors known to influence language outcomes were also considered, including home language history, history of hearing problems, syndromic diagnoses, and sex. A multicenter, cross-sectional study design was conducted. Data for 566 16-month-old toddlers with CP ± L were collected from 17 outpatient cleft palate clinics located throughout the United States. Outcome measures included the MacArthur-Bates Communicative Development Inventories, LENA Developmental Snapshot, age at first word as reported by the caregiver, and the Ages and Stages Questionnaires-Third Edition (ASQ-3). Multivariable linear or logistic regression was used to determine the influence of socioeconomic deprivation, as measured by the Area Deprivation Index, on language and developmental outcomes. Greater socioeconomic deprivation significantly predicted poorer language outcomes in toddlers with CP ± L, including receptive vocabulary words (p = .02), expressive vocabulary words (p = .02), and late-developing gestures (p = .02). Additionally, toddlers from less affluent neighborhoods produced their first words significantly later than their counterparts living in more affluent areas (p < .01). Lower maternal education levels predicted significantly increased risk for problem solving delays (p < .01), and patients with subsidized insurance were at significantly increased risk for personal-social delays on the ASQ-3 (p < .01). Children with CP ± L are susceptible to developmental delays associated with socioeconomic deprivation. These findings have implications for identifying a child's individual risk factors for developmental language disorders when conducting speech-language assessments. Future study should examine how inequities in care can be mitigated and addressed.

Characterization of Speech and Language Deficits in the Postanesthesia Care Unit: A Novel, Qualitative Cognitive Assessment

BACKGROUND: Assessing recovery after general anesthesia is complicated because patients must be sufficiently arousable to pay attention to the verbal instructions probing cognitive function. All delirium screens that have been used in the postanesthesia care unit (PACU) rely heavily on a patient’s ability to process language information and respond appropriately. However, postanesthesia effects on speech-language functions have not been specifically evaluated. Here we present a novel, qualitative PACU evaluation for cognitive domains critical for speech-language functions, and we compare this assessment against a multidomain neurocognitive examination: Telephonic Montreal Cognitive Assessment (t-MoCA). This may be used to identify trajectories of neurocognitive recovery after surgery with general anesthesia and provide neuroanatomic correlates for specific deficits. METHODS: We investigated 48 patients undergoing general anesthesia for noncardiac and nonneurologic elective surgeries. Preoperatively, participants were administered our PACU speech-language assessment (PACU-SLA) and t-MoCA. Both assessments were again administered postoperatively in the PACU. Different versions of PACU-SLA were administered pre- versus postoperatively. Twenty-three participants randomly received the same t-MoCA versions (group AA), and 25 participants received different versions (group AB), pre- versus postoperatively. Assessments were administered ≥30 minutes after PACU arrival, and before PACU discharge. Statistical analysis was performed using Wilcoxon-signed-rank tests for nonnormally distributed paired data, analysis of covariance for assessing the impact of group (AA versus AB) and preoperative scores on postoperative scores, and χ2 tests for unpaired categorical data (P &lt; .05 indicating significance). RESULTS: After adjusting for preoperative scores, the postoperative t-MoCA scores of group AB were significantly lower than group AA (F[1–46] = 21.7, P &lt; .001). Similarly, the t-MoCA scores of episodic-memory (delayed-recall) decreased in group AB (F[1–46] = 48.6, P &lt; .001). For PACU-SLA, there were no postoperative changes in auditory-comprehension and object-naming scores, but a decrease was observed in (1) scores of a 9-point narrative-production task of expressive-fluency (n = 48; median [25th–75th]; preoperative: 9[9–9], postoperative: 7[7–8], P &lt; .001), and (2) total words generated in 2 30-second tasks of verbal-fluency (n = 48; median[25th–75th]: preoperative: 23[12.5–33.5], postoperative: 16.5[9.5–26.5], P &lt; .001). Scores on a 4-point sentence-repetition task were also noted to decrease postoperatively (n = 48; median[25th–75th]; preoperative: 4[3–4], postoperative: 4[3–4], P = .04). When grouping participants by preoperative cognitive status (pMCI, n = 9; preoperative normal, n = 39), both groups showed postoperative changes in verbal-fluency (F[1–46] = 6.97, P = .01) and narrative-production scores (F[1–46] = 5.51, P = .02). CONCLUSIONS: The PACU-SLA revealed lower fluency (hypophonia) with relatively intact comprehension, naming, and repetition, during recovery from general anesthesia. These deficits share features with transcortical motor aphasia.

Children’s reformulations during speech-language assessment

In speech and language therapy it is common to do an assessment of a child’s speech and language abilities. During the assessment, the child does not solely carry out the assigned task, but also does repair work to achieve intersubjectivity in order to perform well in the test activity. The aim of the present study was to investigate how children with Developmental Language Disorder (DLD) design and initiate repair during assessment. Sixteen children with DLD aged between 7;05 (7 years and 5 months) to 10;00 years were included. The data consist of video recordings of the children and a researcher made during the test activities, and conversation analysis is used to analyse the data. Findings show how the children initiate several kinds of repair during the test activities, with several types of reformulations presenting candidate understandings. The reformulations occurred just after the task-setting turn (TST), and they indicate that the children displayed an understanding of what was expected of them during the test activities. By using reformulations, the children thus revealed pragmatic skills and demonstrated competence in being a test taker. These findings may have clinical implications when assessing pragmatic skills.

Conceptions and Misconceptions: What Do School-Based Speech-Language Pathologists Think About Dyslexia?

The purpose of this exploratory study was to evaluate speech-language pathologists' (SLPs') conceptions and misconceptions about dyslexia. Participants were 86 school-based SLPs. They completed an online survey on which they rated their agreement and disagreement with true and false statements related to the scientific evidence about the nature of dyslexia and interventions for dyslexia, as well as common misconceptions about dyslexia. There was considerable variability among SLPs' agreement and disagreement with the statements. Critically, despite abundant contrary evidence in the literature, many SLPs believe that dyslexia involves a visual processing deficit. These findings suggest that many school-based SLPs hold misconceptions about dyslexia, especially those related to dyslexia being a visual disorder. The identified misconceptions may contribute to some SLPs' reluctance to incorporate reading and prereading skills into speech-language assessment and intervention. SLPs need greater knowledge of dyslexia to provide more effective evaluations and intervention services.

Language Impairment in Vascular Dementia: A Clinical Review.

Vascular cognitive impairment (VCI) encompasses a wide range of conditions, including cognitive impairment associated with stroke or vascular brain injury, mild vascular cognitive impairment, and vascular dementia (VD). Knowledge of language impairment associated with VD is far less extensive than that of Alzheimer's disease. Although not prevalent in VD, impairment in language skills has been reported. A better understanding of the neurolinguistic features associated with the different presentations of VD could facilitate medical diagnosis. In this article, we report data on language impairment in VD, with particular attention to their primary or secondary functional origin. To better appreciate this functional origin, we also outline the main characteristics of impairment in other cognitive functions. Key elements that should be considered in the speech-language assessment of individuals with possible or proven VD are also highlighted.

The development of a digital story-retell elicitation and analysis tool through citizen science data collection, software development and machine learning.

In order to leverage the potential benefits of technology to speech and language therapy language assessment processes, large samples of naturalistic language data must be collected and analysed. These samples enable the development and testing of novel software applications with data relevant to their intended clinical application. However, the collection and analysis of such data can be costly and time-consuming. This paper describes the development of a novel application designed to elicit and analyse young children's story retell narratives to provide metrics regarding the child's use of grammatical structures (micro-structure) and story grammar (macro-structure elements). Key aspects for development were (1) methods to collect story retells, ensure accurate transcription and segmentation of utterances; (2) testing the reliability of the application to analyse micro-structure elements in children's story retells and (3) development of an algorithm to analyse narrative macro-structure elements. A co-design process was used to design an app which would be used to gather story retell samples from children using mobile technology. A citizen science approach using mainstream marketing via online channels, the media and billboard ads was used to encourage participation from children across the United Kingdom. A stratified sampling framework was used to ensure a representative sample was obtained across age, gender and five bands of socio-economic disadvantage using partial postcodes and the relevant indices of deprivation. Trained Research Associates (RA) completed transcription and micro and macro-structure analysis of the language samples. Methods to improve transcriptions produced by automated speech recognition were developed to enable reliable analysis. RA micro-structure analyses were compared to those generated by the digital application to test its reliability using intra-class correlation (ICC). RA macro-structure analyses were used to train an algorithm to produce macro-structure metrics. Finally, results from the macro-structure algorithm were compared against a subset of RA macro-structure analyses not used in training to test its reliability using ICC. A total of 4,517 profiles were made in the app used in data collection and from these participants a final set of 599 were drawn which fulfilled the stratified sampling criteria. The story retells ranged from 35.66 s to 251.4 s in length and had word counts ranging from 37 to 496, with a mean of 148.29 words. ICC between the RA and application micro-structure analyses ranged from 0.213 to 1.0 with 41 out of a total of 44 comparisons reaching 'good' (0.70-0.90) or 'excellent' (>0.90) levels of reliability. ICC between the RA and application macro-structure features were completed for 85 samples not used in training the algorithm. ICC ranged from 0.5577 to 0.939 with 5 out of 7 metrics being 'good' or better. Work to date has demonstrated the potential of semi-automated transcription and linguistic analyses to provide reliable, detailed and informative narrative language analysis for young children and for the use of citizen science based approaches using mobile technologies to collect representative and informative research data. Clinical evaluation of this new app is ongoing, so we do not yet have data documenting its developmental or clinical sensitivity and specificity.

Characterization of feeding skills and clinical markers of preterm newborns with gastroschisis in a neonatal therapy unit.

To describe the clinical and feeding findings of premature infants with gastroschisis (GTQ) in a neonatal intensive care unit and compare them to preterm infants (NBs) without congenital anomalies. A retrospective case-control study was conducted with 50 premature NBs (25 with GTQ and 25 without comorbidities - control group). The NBs were compared regarding demographic and clinical data: risk of mortality and speech-language assessment (nonnutritive and nutritive sucking). Subsequently, a multiple logistic regression model was applied to determine the variables associated with the negative speech therapy outcome (speech therapy discharge after more than 7 days considering the first speech therapy evaluation). The results of the first analysis indicated that there was a difference between the GTQ and the CG for the following variables: total time in days of hospitalization; use of mechanical ventilation (invasive x noninvasive); days of life on the date of the first speech-language assessment; use of alternative feeding route; and the GTQ group had worse results. The results of the multiple logistic regression indicated that the diagnosis of GTQ, the use of invasive mechanical ventilation, and the absence of adequate intraoral pressure during the first speech-language evaluation were risk factors for a negative speech-language outcome. The feeding skills of preterm infants with QTG are related to the severity of the condition (gastrointestinal tract complications), requiring longer hospitalization, use of invasive mechanical ventilation, prolonged use of alternative feeding route and requiring more speech therapy to start oral feeding.

Longitudinal changes in functional connectivity in speech motor networks in apraxia of speech after stroke.

The cerebral substrates of apraxia of speech (AOS) recovery remain unclear. Resting state fMRI post stroke can inform on altered functional connectivity (FC) within cortical language networks. Some initial studies report reduced FC between bilateral premotor cortices in patients with AOS, with lowest FC in patients with the most severe AOS. However, longitudinal FC studies in stroke are lacking. The aims of the present longitudinal study in early post stroke patients with AOS were (i) to compare connectivity strength in AOS patients to that in left hemisphere (LH) lesioned stroke patients without a speech-language impairment, (ii) to investigate the relation between FC and severity of AOS, aphasia and non-verbal oral apraxia (NVOA) and (iii) to investigate longitudinal changes in FC, from the subacute phase to the chronic phase to identify predictors of AOS recovery. Functional connectivity measures and comprehensive speech-language assessments were obtained at 4 weeks and 6 months after stroke in nine patients with AOS after a LH stroke and in six LH lesioned stroke patients without speech-language impairment. Functional connectivity was investigated in a network for speech production: inferior frontal gyrus (IFG), anterior insula (aINS), and ventral premotor cortex (vPMC), all bilaterally to investigate signs of adaptive or maladaptive changes in both hemispheres. Interhemispheric vPMC connectivity was significantly reduced in patients with AOS compared to LH lesioned patients without speech-language impairment. At 6 months, the AOS severity was associated with interhemispheric aINS and vPMC connectivity. Longitudinal changes in FC were found in individuals, whereas no significant longitudinal change in FC was found at the group level. Degree of longitudinal AOS recovery was strongly associated with interhemispheric IFG connectivity strength at 4 weeks. Early interhemispheric IFG connectivity may be a strong predictor of AOS recovery. The results support the importance of interhemispheric vPMC connection in speech motor planning and severity of AOS and suggest that also bilateral aINS connectivity may have an impact on AOS severity. These findings need to be validated in larger cohorts.

Chronic tracheostomy care of ventilator-dependent and -independent children: Clinical practice patterns of pediatric respirologists in a publicly funded (Canadian) healthcare system.

To describe the current clinical practice patterns of Canadian pediatric respirologists at pediatric tertiary care institutions regarding chronic tracheostomy tube care and management of home invasive ventilation. A pediatric respirologist/pediatrician with expertise in tracheostomy tube care and home ventilation was identified at each Canadian pediatric tertiary care center to complete a 59-item survey of multiple choice and short answer questions. Domains assessed included tracheostomy tube care, caregiver competency and home monitoring, speaking valves, medical management of tracheostomy complications, decannulation, and long-term follow-up. The response rate was 100% (17/17) with all Canadian tertiary care pediatric centers represented and heterogeneity of practice was observed in all domains assessed. For example, though most centers employ Bivona™ (17/17) and Shiley™ (15/17) tracheostomy tubes, variability was observed around tube change, re-use, and cleaning practices. Most centers require two trained caregivers (14/17) and recommend 24/7 eyes on care and oxygen saturation monitoring. Discharge with an emergency tracheostomy kit was universal (17/17). Considerable heterogeneity was observed in the timing and use of speaking valves and speech-language assessment. Inhaled anti-pseudomonal antibiotics are employed by most centers (16/17) though the indication, agent, and protocol varied by center. Though decannulation practices varied considerably, the requirement of upper airway patency was universally required to proceed with decannulation (17/17) independent of ongoing ventilatory support requirements. Considerable variability in pediatric tracheostomy tube care practice exists across Canada. These results will serve as a starting point to standardize and evaluate tracheostomy tube care nationally.

DYSPHAGIA OCCURRENCE IN COVID-19-POSITIVE PATIENTS IN TWO HOSPITALS IN BRAZIL.

COVID-19 comprises a respiratory infection resulting from contamination by SARS-CoV-2, with acute respiratory failure being one of its main characteristics, leading to a high frequency of orotracheal intubation (OTI), which in turn increases the risk for dysphagia. Since this can lead to pulmonary impairment, knowing the real occurrence of dysphagia in part of the Brazilian population and its associations allows early and effective clinical management of the multidisciplinary team in relation to patients. To verify the occurrence of dysphagia in COVID-19-positive adult patients in two Brazilian reference hospitals in the care of the pandemic. This was a prospective, longitudinal observational study carried out in two private hospitals in Brazil, both references in the care of patients with coronavirus isolation. Data were initially collected by consulting the medical records of each patient. Information was collected regarding sex, age, previous diseases, COVID-19 testing, and the OTI period. After data collection, the clinical speech-language assessment of swallowing for each patient was carried out using the adapted Gugging Swallowing Screen (GUSS), the ASHA NOMS and the Functional Oral Intake Scale (FOIS). A total of 129 participants were evaluated, with a mean age of 72 years. According to the GUSS scale, 9.3% of the patients presented normal/functional swallowing, while 90.7% presented dysphagia, with mild dysphagia in 17.05%, moderate dysphagia in 33.33%, and severe dysphagia in 37.98%. As for the results of the ASHA NOMS, the majority (36.5%) of the patients were at level 1, which represents the patient who is not able to receive his or her food supply orally, having the need to use tube feedings. This is in line with the results observed with the FOIS scale, whereby most patients (42.1%) were classified as Level I, when food intake occurs exclusively through feeding tubes, with no oral supply. Of the 129 participants, 59% of them required OTI. When comparing the time of OTI and the severity of dysphagia, there was a statistically significant difference, with more severe dysphagia, the longer the patient remained intubated. There is a high incidence of oropharyngeal dysphagia in patients with COVID-19, with increased severity during longer periods of OTI.

Swallowing Disorders in Patients with Chiari Malformation Type I After Decompression Neurosurgery

The present study aimed to investigate postoperative swallowing disorders in patients diagnosed with CM I after decompression neurosurgery. We selected 54 patients after decompression neurosurgery procedure for CM I from January 2017 to December 2019. We evaluated the speech-language assessment (CSLSA) 24 h after post-surgical extubation. CSLSA observed aspects of posture, sensitivity, tone, and extraoral and intraoral mobility of the FAO and visualizing the functions of breathing, phonation, articulation, chewing, and swallowing. We correlated the severity of the dysphagia and the presence of associated malformations in the CM I patients. In our study, 39 patients were female (mean age 41.3 ± 47.1 years). Thirty-seven patients had associated malformations (p = 0.0243): 21 patients syringomyelia, 11 basilar invagination, and 5 syringomyelia and basilar invagination. Dysphagia was present in 37 of the cases (68.5%; p = 0.0016). Dysphonia in 13 (24.1%; p = 0.4785) and dysarthria in 3 (5.6%; p = 0.0042). We observed in the CSLSA: orofacial hypomobility (29 patients — 53.7%; p = 0.0204), orofacial hyposensitivity (26 patients — 48.1%; p = 0.3023), reduced GAG reflex (24 patients — 44.5%; p = 0.1041), ineffective cough (19 patients — 35.2%; p = 0.0022), ineffective saliva swallowing (18 patients — 33.3%; p = 0.0396), dyspnea (13 patients — 24.1%; p = 0.4785), orofacial hypotonia (11 patients — 20.4%; p = 0.0004), altered cervical auscultation (10 patients — 18.5%; p = 0.0003), and dysarthria (3 patients — 9.3%; p = 0.0042). The presence of associated malformations significantly influenced the appearance of swallowing disorders, the severity of oropharyngeal dysphagia, the post-surgical complications (17 patients — 31.5%; p < 0.001), and the clinical outcomes (p = 0.0029) of patients with CM type I. Decompressive neurosurgery for CM I had low rates of post-surgical complications overall. However, there was a high incidence of dysphagia. The presence of associated malformations is related with poorer prognosis and greater severity of oropharyngeal dysphagia in patients with CM I.

A Review of the Effect of Classroom Sound-Field Amplification on Children in Primary School.

Being able to hear the teacher clearly is an important factor for children's learning. However, classrooms often have suboptimal listening conditions. Sound-field amplification systems (SFAS) can help improve classroom listening conditions by increasing the level of the teacher's speech compared to the background noise throughout the classroom. The aim of this review article was to review the effect of SFAS on children in primary school. A comprehensive search of four online databases (ERIC, PubMed, Scopus, and Web of Science) was conducted. The search terms were classroom sound-field amplification and classroom amplified distribution system. Twenty-one articles were deemed relevant for the review plus an additional six from their references. Most articles were published between 1996 and 2015. Only one article was published since 2016. A range of child populations were studied including typically developing children and children with difficulties and disabilities such as hearing loss, developmental language disorders, attention-deficit/hyperactivity disorder, emotional and behavior disorders, Down syndrome, and developmental disabilities. There were several different measures that were used to evaluate the effectiveness of SFAS including speech perception assessments, language assessments, academic and comprehension assessments, classroom observations, interviews, and questionnaires. Improvements with SFAS were found for speech perception, listening comprehension and auditory analysis, language outcomes, academic outcomes, and behavior. SFAS can benefit children's listening and learning; however, the child's background, classroom reverberation time (limit to < 1 s), and layout and type of learning activities, especially in modern classrooms, need to be taken into consideration.

The Cognitive and Language Profile of Dementia with Lewy Bodies

Dementia with Lewy bodies (DLB) is a major neurocognitive disorder (MNCD) that is primarily characterized by motor, cognitive, and behavioral symptoms. Although not dominant in the clinical portrait of DLB, impairments affecting language processing have been reported. It is sometimes challenging to differentiate DLB from Alzheimer’s disease and dementia associated with Parkinson’s disease in clinical practice. Therefore, a better comprehension of the typical clinical presentation of DLB may be useful to ease the medical diagnosis. In this article, current data on cognitive and language disorders in DLB are reported, with special attention paid to their primary or secondary functional origin. The main elements that should be considered for the neuropsychological and speech-language assessment of individuals with possible or proven DLB are also highlighted. Additional studies are needed, especially for language impairment, to obtain a more accurate portrait of the clinical presentation of DLB and characterize its progression.

Examining Risk of Speech-Language Disorders in Children With Cleft Lip.

Although it is well-established that children with cleft palate are at high risk for communication disorders, little is known about the speech-language profiles of children with cleft lip (with or without cleft alveolus), who do not have an overt cleft palate. The purpose of this study was to determine the prevalence of speech-language disorders in a consecutively evaluated group of children with cleft lip, with or without cleft alveolus (CL ± A) from a single cleft lip and palate center in the United States. We also explored the types of speech and language disorders in this cohort and examined the impact of co-occurring syndromes and other diagnoses (eg, submucous cleft palate). Eighty-six children (58 males, 28 females) with CL ± A, evaluated between the ages of 12 and 72 months, were included in the study. Forty children had cleft lip and alveolus; 46 children had isolated cleft lip. We examined the proportion of children with CL ± A who received team care, speech-language evaluations, and audiograms, as well as the number of children with CL ± A diagnosed with a communication disorder. Fifty-three percent (n = 46) of children with CL ± A had received at least 1 speech-language evaluation. Approximately 40% of children with CL ± A who underwent evaluation by a speech-language pathologist were diagnosed with some type of communication disorder. Nine children (21%) with CL ± A displayed an articulation disorder and 12 (27%) presented with a language delay/disorder. Statistical analysis examined the potential impact of comorbid diagnoses such as submucous cleft palate and other congenital anomalies, and results were essentially unchanged. Results of this study are congruent with past reports suggesting children with CL ± A have a higher risk of communication disorders than the general pediatric population. Surgeons should be aware of the growing body of evidence that children with CL ± A benefit from cleft team care, which should include routine speech-language assessments starting at an early age to ensure identification of conditions warranting intervention.

Transitioning Speech-Language Assessment to a Virtual Environment: Lessons Learned From the ELLA Study.

Purpose The COVID-19 pandemic has necessitated a quick shift to virtual speech-language services; however, only a small percentage of speech-language pathologists (SLPs) had previously engaged in telepractice. The purpose of this clinical tutorial is (a) to describe how the Early Language and Literacy Acquisition in Children with Hearing Loss study, a longitudinal study involving speech-language assessment with children with and without hearing loss, transitioned from in-person to virtual assessment and (b) to provide tips for optimizing virtual assessment procedures. Method We provide an overview of our decision making during the transition to virtual assessment. Additionally, we report on a pilot study that calculated test-retest reliability from in-person to virtual assessment for a subset of our preschool-age participants. Results Our pilot study revealed that most speech-language measures had high or adequate test-retest reliability when administered in a virtual environment. When low reliability occurred, generally the measures were timed. Conclusions Speech-language assessment can be conducted successfully in a virtual environment for preschool children with hearing loss. We provide suggestions for clinicians to consider when preparing for virtual assessment sessions. Supplemental Material https://doi.org/10.23641/asha.14787834.

Assessment of children with speech sound disorders in otolaryngology outpatient clinics.

To analyze the utility of Ankara Articulation Test (AAT) for the diagnosis of Speech Sound Disorders (SSD) in children by an Otolaryngologist independent of Speech-Language Pathologist (SLP). In this prospective single-center study, 83 children comprising 45 boys (54.2%) and 38 girls (45.8%) were enrolled. AAT was applied to the children aged 3-12years with primary SSD who presented to the otolaryngology outpatient service. Video recording was carried out while testing and the responses to the test were evaluated by another otolaryngologist and SLP. A perfectly significant agreement was found between the speech-language pathologist and otolaryngologist's assessments (Cronbach's Alpha > 0.80). Otolaryngologists could evaluate SSD with the help of AAT as well as an SLP analysis. Standardized visual tests, such as the AAT, assist the otolaryngologist in the diagnosis of SSD in outpatient clinics.

Narrative comprehension skills of Indigenous and non-Indigenous Australian children in their first year of school

Purpose: The suitability of existing speech-language pathology assessments for Australian Aboriginal and Torres Strait Islander (Indigenous) children is questioned in the literature. There is emerging evidence that the differences reported between Indigenous and non-Indigenous Australian children on standardised assessment are diminished on more naturalistic assessments such as narrative production (macrostructure and microstructure). Little is documented, however, about the narrative comprehension skills of Australian children. This study explores the narrative comprehension skills of 40 typically developing Indigenous and non-Indigenous Australian children in their first year of school. Method: A cross-sectional comparative research design was used. Three non-standardised narrative assessments incorporating comprehension-production protocols were administered. Question responses were scored for accuracy and categorised according to story grammar targeted and inference (literal vs. non-literal). In addition, all participants completed the Peabody Picture Vocabulary Test fourth edition (PPVT-4). Result: A repeated-measures ANOVA was used to compare response accuracy to comprehension questions between cultural groups and across narrative protocols. While there was a significant difference in PPVT-4 scores, no significant differences were identified between response accuracy for the Indigenous and non-Indigenous children. Furthermore, response accuracy to comprehension questions was correlated with PPVT-4 scores for the non-Indigenous children only. Conclusion: Findings support the use of naturalistic assessment strategies such as narrative comprehension with Indigenous Australian children.

Neuropsychological and Linguistic Outcomes after Gunshot Injury to Cerebellum: A Case Report

AbstractCraniocerebral gunshot injuries (CGIs) are highly fatal and mostly seen in the military settings. CGIs to the posterior cortical regions and cerebellum in civilian population are uncommon. Cerebellum once thought to be mediating the motor and vestibular functions is increasingly seen as an important structure for human cognition and affect. We present a case of a 53-year-old police inspector who sustained a gunshot injury in the suboccipital region with resulting damage to predominantly left cerebellum and right occipital lobe. Patient presented with complaints of neck pain, reduced clarity of speech, and mild forgetfulness for day-to-day affairs after 7 months of injury. A comprehensive neuropsychological assessment revealed impairments in motor speed, processing speed, sustained attention, executive functions (verbal fluency, working memory), and encoding component of memory functions. The speech–language assessment revealed mild dysarthria and mild word finding difficulties. His profile with mild to moderate deficits in neuropsychological and speech language functioning was partly congruent with the cerebellar cognitive affective syndrome or Schmahmann’s syndrome. The spontaneous recovery and extent of damage to cerebellum may explain the milder form of the syndrome. The case highlights the need to routinely screen for cognitive-affective disturbances in patients with traumatic lesions to cerebellum.