Speech Production Outcomes Research Articles

Speech production skills of bilingual children using cochlear implants

Abstract Evidence is lacking on the impact of bilingualism on the speech skills of children with cochlear implants (CIs). This study described the speech production of children with CIs acquiring French and one or more additional spoken languages. Four groups of children aged 4–11 were included: bilinguals (n = 15) and monolinguals (n = 14) with CIs and bilinguals (n = 14) and monolinguals (n = 20) with typical hearing. Data were collected about the percentage of consonant correct (PCC) and vowel correct (PVC) produced in French and intelligibility in all languages they spoke. Bilingual and monolingual children with CIs had comparable speech accuracy in French, but the pattern differed, impacting PCC for bilinguals and PVC for monolinguals. Most children with CIs had accurate and intelligible speech in French, but few bilingual children with CIs were highly intelligible in their home language. Therefore, bilingualism did not impede the speech production outcomes of bilingual children with CIs in the language of the wider community.

Cochlear Implantation in Children with Meningitis: A Multicenter Study on Auditory Performance and Speech Production Outcomes.

This study aims to evaluate speech production outcomes and auditory performance in children with post-meningitis deafness who were treated with cochlear implants. Additionally, the study assesses the impact of electrode insertion depth on surgical outcomes.". We conducted a study on 66 pediatric patients with bilateral postmeningitis hearing loss who were being prepared for cochlear implantation at four tertiary referral academic institutions. The speech intelligibility rating (SIR) and categories of auditory performance (CAP) were evaluated after the first and second years following implantation. The patients were divided into two groups based on electrode insertion depth: one group had full electrode insertion (more than two-thirds), while the other had partial electrode insertion (less than two-thirds). We compared the SIR and CAP scores between the two groups to assess the impact of electrode insertion depth on outcomes. Before implantation, the median CAP score was one, but it improved significantly to six within two years after the procedure (P-value < 0.001). Similarly, the median SIR score before implantation was one, but it improved significantly to three within two years after surgery (P-value < 0.001). However, there was no significant difference between the partial and full electrode insertion groups in terms of CAP and SIR scores during the follow-up evaluations conducted after the first and second years. The study found that cochlear implantation significantly improved speech production skills and auditory performance in children with postmeningitis deafness. Importantly, the amount of electrode insertion at the time of implantation did not have a significant impact on the outcomes.

On the Benefits of Speech-Language Therapy for Individuals Born With Cleft Palate: A Systematic Review and Meta-Analysis of Individual Participant Data.

Cleft lip and/or palate (CLP) is a common birth defect, and after reconstructive surgery, about 50% of children at 5 years of age have speech deviations and are referred to speech-language therapy (SLT). The peer-reviewed evidence for the benefit of SLT has been uncertain. Our objective was to systematically review and meta-analytically summarize the benefit of SLT for individuals born with CLP. A systematic search was conducted (last search on February 19, 2021) on studies evaluating SLT with pre and post measures on speech production, language ability, intelligibility, and/or patient-reported outcomes. We sought individual participant data (IPD) and evaluated on an individual level if the outcome measure had improved to a clinically relevant degree during SLT and if the outcome measure was on a level with peers or not after SLT. Meta-analyses and meta-regressions were applied to synthesize IPD across studies. Thirty-four eligible studies were found. Nineteen studies provided IPD (n = 343) for the main analysis on speech production. The synthesized information suggests that, during SLT, speech production improved to a clinically relevant degree for many individuals (95% CI [61%, 87%]) and that speech production was on a level with peers for some individuals after SLT (95% CI [10%, 34%]). The main strength of this meta-analysis is that we evaluated on an individual level pre- and post-intervention data based on considerations of clinical relevance. This approach allowed us to conclude that many individuals benefit from SLT and that further work on evaluating SLT in this patient group is meaningful. Supplemental Material https://doi.org/10.23641/asha.17700992.

Speech dysfunction, cognition, and Parkinson's disease.

Communication difficulties are a ubiquitous symptom of Parkinson's disease and include changes to both motor speech and language systems. Communication challenges are a significant driver of lower quality of life. They are associated with decreased communication participation, social withdrawal, and increased risks for social isolation and stigmatization in persons with Parkinson's disease. Recent theoretical advances and experimental evidence underscore the intersection of cognition and motor processes in speech production and their impact on spoken language. This chapter overviews a growing evidence base demonstrating that cognitive impairments interact with motor changes in Parkinson's disease to negatively affect communication abilities in myriad ways, at all stages of the disease, both in the absence and presence of dementia. The chapter highlights common PD interventions (pharmacological, surgical, and non-pharmacological) and how cognitive influences on speech production outcomes are considered in each.

Speech sound production, speech intelligibility, and oral-motor outcomes of preterm children: Are they different from full term children?

We studied the speech sound abilities of preterm (PT) children. Thirty-one PT and twenty-nine full term (FT) children were recruited. Speech abilities were assessed in single word, story retelling, oral-motor, and intelligibility. PT group had poorer outcomes (Mean = 25.77, SD = 17.19) than FT ones (Mean = 5.9, SD = 4.97) for single word (p < 0.001). They obtained poorer results (Mean = 9.65, SD = 7.85) than FT peers (Mean = 2.95, SD = 3.34) in story retelling (p = 0.002) and intelligibility (Man-Whitney U = 89.50, p = 0.02). They obtained lower values for diadochokesis/patuku/(p < 0.001), isolated (p = 0.001), and sequenced movements (p = 0.02) but not for diadochokesis/patukejk/(p = 0.12). Significant values of correlation were found among single word scores with birth weight (r = −.54, p < .001) and gestational age (r = −0.67, p < .001) and story retelling scores with birth weight (r = −0.40, p = .013) and gestational age (r = −0.64, p < .001). The associations of single word score and maternal (r = −0.02, p = .85) and paternal education (r = −0.10, p = .41) were not significant. No significant relationships were obtained between story retelling score and maternal (r = 0.16, p = .34) and paternal education (r = 0.09, p = .59). The significant values were obtained for associations of intelligibility with isolated (r = 0.54, p = .001), sequenced movements (r = 0.59, p < .001), and diadochokesis/patukejk/(r = 0.39, p = .016) but not significant for intelligibility and diadochokesis/patuku/(r = 0.25, p = .13). Findings implied that speech abilities are weaker in PT children.

Treatment Approach Considerations for Children With Speech Sound Disorders in School-Based Settings

Clinicians providing intervention for pediatric speech sound disorders (SSDs) have many treatment approach options from which to select. Because treatment needs vary across children based on many factors including the error type(s) present and patterns of deficit noted, these factors need to be considered early in the therapeutic process to find the best-suited approach. In this article, the authors describe and contrast a traditional motor articulatory-based approach with phonologically-based approaches including cycles, contrast therapies (e.g., minimal pairs, maximal oppositions, and multiple oppositions), and complexity through presentation of hypothetical case studies, updated summaries of the evidence base for each, and a summary of current research limitations for informing clinical practice. Although children with SSDs are ubiquitous in pediatric clinical caseloads, familiarity or lack thereof with the evidence base supporting different approaches potentially limits speech production outcomes for children receiving speech services. Even so, limitations in the evidence base constrain practical application of a given approach to daily therapeutic interactions.

Speech production in young children with tongue-tie

IntroductionTongue-tie, or ankyloglossia, occurs in 4–10% of the population. Treatment of tongue-tie has increased by 420% in Australia between 2006 and 2016 and 866% in the United States between 1997 and 2012. Despite limited evidence, it has been suggested that tongue-tie can result in speech sound disorder (SSD). This study aimed to investigate tongue mobility and speech production outcomes in children with and without tongue-tie diagnoses. MethodFifty-nine children aged 2; 1 to 4; 11 years were recruited and formed three groups: treated tongue-tie (TTT), untreated tongue-tie (UTT) and no tongue-tie (NTT). Measures of lingual frenulum structure and function, tongue mobility, speech production, and parent and clinician intelligibility ratings were collected. ResultsNo statistically significant differences were found between the TTT, UTT and NTT groups for tongue mobility, speech production or intelligibility. Significantly more UTT children had a history of speech pathology attendance than participants in the NTT group. ConclusionThis study provides preliminary evidence of no difference between tongue mobility and speech outcomes in young children with or without intervention for tongue-tie during infancy. This study assists with clinical decision making and makes recommendations for families not to proceed with surgical intervention for tongue-tie during infancy, for the sole outcome of improving speech production later in life.

Cochlear implantation in children with inner ear malformation: A multicenter study on auditory performance and speech production outcomes

ObjectivesThis multicenter study evaluated the auditory performance and speech production outcomes of cochlear implantation in children with inner ear anomaly and compared the outcomes of patients with different kinds of malformation. MethodsCochlear implantation was performed in 107 children with inner ear malformation at four tertiary academic centers. The categories of auditory performance (CAP) and speech intelligibility rating (SIR) scores were evaluated preoperatively and one year and two years postoperatively. ResultsTypes of inner ear malformation and their frequencies were: incomplete partition type-I, 19 (17.8%) patients; incomplete partition type-II, 31 (29%), common cavity, 17 (15.9%), cochlear hypoplasia, 17 (15.9%), and isolated enlarged vestibular aqueduct (isolated EVA), 23 (21.5%) patients. EVA was the coexisting anomaly in 27(25.2%) subjects. The median CAP and SIR scores improved significantly during the first two years after cochlear implantation in all groups (p-values <0.001 and < 0.001, respectively). No significant difference was seen in CAP and SIR scores of children with different inner ear malformations (p-value = 0.147 and 0.570, respectively) or in patients with isolated EVA compared to coexisting EVA (p-value = 0.538 and 0.075, respectively). ConclusionThe median CAP and SIR scores two years after surgery were 5 (Understanding of common phrases without lip-reading) IQR: 4–6, and 3 (Connected speech is intelligible to a listener who concentrates and lip-reads within a known context) IQR: 3–4, respectively. Auditory performance and speech production were significantly improved in all inner ear malformation patient groups, and no significant difference was observed between the scores of patients with different types of anomaly.

The effect of input on bilingual adolescents’ long-term language outcomes in a foreign language instruction context

The aim of the current study is twofold: to examine the effects of input on bilingual adolescents’ long-term second language (L2) outcomes in a minority/foreign language context; and to understand the interaction between input and other potential predictors of L2 outcomes, specifically environmental variables, learners’ motivation and language learning aptitude. Participants included 97 Mandarin–English bilingual adolescents in Taiwan who learned English as an L2 between the ages of two to eleven. All participants completed a listening comprehension and a story-telling task in English and two standardized language learning aptitude tests. Participants and their parents filled out a detailed questionnaire providing information about family demographics and in-class and out-of-class L2 input. Correlation and multivariate regression analyses revealed that input played an important role in long-term L2 listening comprehension outcome, but not in speech production outcomes. The results also showed that environmental variables and language learning aptitude significantly predicted long-term L2 listening comprehension and speech production outcomes. Finally, out-of-class L2 input outweighed instructional input and current input outweighed early input. Since most previous research on the role of input in long-term L2 outcomes was conducted in a majority/societal language context, the present study contributes to the topic by specifying the effect of input in L2 acquisition in a minority/foreign language context.

Cochlear implantation in children with auditory neuropathy spectrum disorder: A multicenter study on auditory performance and speech production outcomes

ObjectivesTo evaluate the auditory performance and speech production outcome in children with auditory neuropathy spectrum disorder (ANSD). The effect of age on the outcomes of the surgery at the time of implantation was also evaluated. MethodsCochlear implantation was performed in 136 children with bilateral severe-to- profound hearing loss due to ANSD, at four tertiary academic centers. The patients were divided into two groups based on the age at the time of implantation; Group I: Children ≤24 months, and Group II: subjects >24 months. The categories of auditory performance (CAP) and speech intelligibility rating (SIR) scores were evaluated after the first and second years of implantation. The differences between the CAP and SIR scores in the two groups were assessed. ResultsThe median CAP scores improved significantly after the cochlear implantation in all the patients (p value < 0.001). The improvement in the CAP scores during the first year in Group II was greater than Group I (p value: 0.007), but the improvement in CAP scores tended to be significantly higher in patients who were implanted at ≤24 months (p value < 0.001). There was no significant difference between two groups in SIR scores at first-year and second-year follow-ups. The evaluation of the SIR improvement revealed significantly higher values for Group I during the second-year follow-up (p value: 0.003). ConclusionThe auditory performance and speech production skills of the children with ANSD improved significantly after cochlear implantation, and this improvement was affected by age at the time of implantation.

Examining the effects of socio-economic status and language input on adolescent English learners' speech production outcomes

Relatively little research has been devoted to examining the predictors of early foreign language learning outcomes despite the global trend of early foreign language instruction. The current study focused on two contextual predictors, learners' socio-economic status (SES) and input, both of which have been demonstrated to play a prominent role in first language development and second language (L2) development in an immersion context. The current study also investigated the relationship between SES, input and L2 learning outcomes and the mechanism through which SES influences L2 outcomes. Participants included 97 tenth and eleventh grade students from Taipei, Taiwan. All participants completed a story-telling task and a survey providing information about their language input in middle and high school. Their parents also filled out a survey providing information about their family profile and learner participants' input in preschool/kindergarten and elementary school. Results from the study showed that both SES and input played a role in adolescent learners’ speech production outcomes, but the effects differed by speech dimensions (i.e., accuracy, fluency, and complexity). Although both SES and input predicted L2 speech production outcomes, the two variables were closely related to each other, and the effect of SES was indirect and mediated by input.

Long-term Communication Outcomes for Children Receiving Cochlear Implants Younger Than 12 Months: A Multicenter Study.

Examine the influence of age at implant on speech perception, language, and speech production outcomes in a large unselected paediatric cohort. This study pools available assessment data (collected prospectively and entered into respective databases from 1990 to 2014) from three Australian centers. Children (n = 403) with congenital bilateral severe to profound hearing loss who received cochlear implants under 6 years of age (excluding those with acquired onset of profound hearing loss after 12 mo, those with progressive hearing loss and those with mild/moderate/severe additional cognitive delay/disability). Speech perception; open-set words (scored for words and phonemes correct) and sentence understanding at school entry and late primary school time points. Language; PLS and PPVT standard score equivalents at school entry, CELF standard scores. Speech Production; DEAP percentage accuracy of vowels, consonants, phonemes-total and clusters, and percentage word-intelligibility at school entry. Regression analysis indicated a significant effect for age-at-implant for all outcome measures. Cognitive skills also accounted for significant variance in all outcome measures except open-set phoneme scores. ANOVA with Tukey pairwise comparisons examined group differences for children implanted younger than 12 months (Group 1), between 13 and 18 months (Group 2), between 19 and 24 months (Group 3), between 25 and 42 months (Group 4), and between 43 and 72 months (Group 5). Open-set speech perception scores for Groups 1, 2, and 3 were significantly higher than Groups 4 and 5. Language standard scores for Group 1 were significantly higher than Groups 2, 3, 4, and 5. Speech production outcomes for Group 1 were significantly higher than scores obtained for Groups 2, 3, and 4 combined. Cross tabulation and χ2 tests supported the hypothesis that a greater percentage of Group 1 children (than Groups 2, 3, 4, or 5) demonstrated language performance within the normative range by school entry. Results support provision of cochlear implants younger than 12 months of age for children with severe to profound hearing loss to optimize speech perception and subsequent language acquisition and speech production accuracy.

AGE MATTERS, AND SO MAY RATERS

Research on the age of learning effect on second language learners’ foreign accents utilizes human judgments to determine speech production outcomes. Inferences drawn from analyses of these ratings are then used to inform theories. The present study focuses on rater differences in the age of learning effect research. Three groups of raters who differed in their native language background and language experience participated in the study: inexperienced native English speaker (NES) raters, experienced NES raters, and advanced nonnative English speaker (NNES) raters. All raters evaluated 64 speech samples taken from both NESs and NNESs who varied in their age of arrival in the second-language-speaking country. Results from the study showed that experienced NES raters were better than the other two rater groups at distinguishing NESs from NNESs. Although no rater group differences were found in scaling speakers’ foreign accents or in their interrater reliability, inexperienced NES raters were stricter in their ratings than both experienced NES raters and advanced NNES raters. Implications for research on age of learning effects are discussed.

Cochlear implants in children deafened by congenital cytomegalovirus and matched Connexin 26 peers

ObjectiveTo compare the long-term speech perception and production outcomes after cochlear implantation (CI) in children deafened by congenital cytomegalovirus (cCMV) with a matched group of Cx26-CI children by controlling for chronological age and magnetic resonance imaging (MRI) findings. MethodsRetrospective review of 12 cCMV-CI children and matched Cx26-CI children for speech perception and speech production outcomes. ResultsTwo trends were seen in our data. First, cCMV-CI children with normal MRI scans perform equally or even slightly better on speech perception tests compared to their Cx26-CI peers during the first three years. The majority of cCMV-CI children with normal MRI scans (5 out of 7), suffered from a delayed-onset SNHL. Their mean age at first implantation (2y9m, range 15–82m) was higher compared to their matched Cx26 peers (9m, range 7–12m). Before being implanted, the majority of these delayed-onset hearing impaired children had benefited from a certain period of normal hearing (with or without amplification of a hearing aid). Possibly, this input might have led to an advantage the first three years after CI. Second, results between cCMV-CI children with and cCMV-CI children without MRI abnormalities and their matched Cx26-CI counterparts tentatively suggest that, over a 5-yr follow-up period, cCMV-CI children with abnormalities on MRI scans catch up for speech perception, but lag behind for speech production. ConclusioncCMV-CI children with normal MRI scans perform equally or even slightly better on speech perception tests compared to their Cx26-CI peers during the first three years, whereas results between cCMV-CI children with and cCMV-CI children without MRI abnormalities and their matched Cx26-CI counterparts tentatively suggest that, over a 5-yr follow-up period, cCMV-CI children with abnormal MRI scans catch up for speech perception, but lag behind for speech production. In future, the inclusion of MRI results may assist in improved counseling of parents with cCMV deafened children seeking CI.

Influence of cochlear implantation on sentence intelligibility and duration

Cochlear implants (CI) allow children with hearing loss (HL) to achieve speech perception and production outcomes that make their spoken speech understandable to normal hearing adult listeners. This capability is characterize by wide variability of scores. In order to understand the factors that contribute to the overall variability, we investigated the effects of duration of cochlear implantation on speech intelligibility and sentence duration over time. Participants were 105 children implanted between the ages of 2 and 4 and tested at 2 time points there they were 8 and 16 years old. Participants repeated McGarr sentences, which vary in length from 3 to 5 to 7 syllables. Recording were analyze using acoustic software to designate the beginning and end of each sentence in listeners who only heard one sentence from one child. Speech intelligibility scores were related statistically to the duration of each sentence. Durations of sentences that approximated that of normal hearing listeners were those with high intelligibility judgment. In addition, it appears that the children with the longest experience of CI use continue to improve their intelligibility. [Sponsored by NIH.]

The Effectiveness of Bilateral Cochlear Implants for Severe-to-Profound Deafness in Adults

Assessment of the clinical effectiveness of bilateral cochlear implantation compared with unilateral cochlear implantation or bimodal stimulation, in adults with severe-to-profound hearing loss. In 2007, the National Institute for Health and Clinical Excellence (NICE) in the U.K. conducted a systematic review on cochlear implantation. This study forms an update of the adult part of the NICE review. The electronic databases MEDLINE and Embase were searched for English language studies published between October 2006 and March 2011. Studies were included that compared bilateral cochlear implantation with unilateral cochlear implantation and/or with bimodal stimulation, in adults with severe-to-profound sensorineural hearing loss. Speech perception in quiet and in noise, sound localization and lateralization, speech production, health-related quality of life, and functional outcomes were analyzed. Data extraction forms were used to describe study characteristics and the level of evidence. The effect size was calculated to compare different outcome measures. Pooling of data was not possible because of the heterogeneity of the studies. As in the NICE review, the level of evidence of the included studies was low, although some of the additional studies showed less risk of bias. All studies showed a significant bilateral benefit in localization over unilateral cochlear implantation. Bilateral cochlear implants were beneficial for speech perception in noise under certain conditions and several self-reported measures. Most speech perception in quiet outcomes did not show a bilateral benefit. The current review provides additional evidence in favor of bilateral cochlear implantation, even in complex listening situations.

Preschool Speech Error Patterns Predict Articulation and Phonological Awareness Outcomes in Children With Histories of Speech Sound Disorders

To determine if speech error patterns in preschoolers with speech sound disorders (SSDs) predict articulation and phonological awareness (PA) outcomes almost 4 years later. Twenty-five children with histories of preschool SSDs (and normal receptive language) were tested at an average age of 4;6 (years;months) and were followed up at age 8;3. The frequency of occurrence of preschool distortion errors, typical substitution and syllable structure errors, and atypical substitution and syllable structure errors was used to predict later speech sound production, PA, and literacy outcomes. Group averages revealed below-average school-age articulation scores and low-average PA but age-appropriate reading and spelling. Preschool speech error patterns were related to school-age outcomes. Children for whom >10% of their speech sound errors were atypical had lower PA and literacy scores at school age than children who produced <10% atypical errors. Preschoolers who produced more distortion errors were likely to have lower school-age articulation scores than preschoolers who produced fewer distortion errors. Different preschool speech error patterns predict different school-age clinical outcomes. Many atypical speech sound errors in preschoolers may be indicative of weak phonological representations, leading to long-term PA weaknesses. Preschoolers' distortions may be resistant to change over time, leading to persisting speech sound production problems.

Exercise for Better ALS Management?

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Cochlear Implants in Children Younger Than 6 Months

(1) To determine the long-term outcomes of cochlear implantation in children implanted younger than 6 months and (2) to evaluate auditory-based performance in very young children compared with older children, all with profound sensorineural bilateral hearing loss. Prospective cohort study. Tertiary referral center. Twelve subjects aged 2 to 6 months, 9 aged 7 to 12 months, 11 aged 13 to 18 months, and 13 aged 19 to 24 months, all with profound bilateral hearing loss, were fitted with cochlear implants and followed longitudinally for 4 years. Subjects were developmentally normal with no additional disabilities (visual, motor, or cognitive). Auditory-based communication outcomes included tests for speech perception, receptive language development, receptive vocabulary, and speech production. Age at cochlear implantation was a significant factor in most outcome measures, contributing significantly to speech perception, speech production, and language outcomes. There were no major complications and no significantly higher rates of minor complications in the younger children. This article reports an uncontrolled observational study on a small group of infants fitted with cochlear implants following personal audiological criteria and, up to now, with limited literature support due to the innovative nature of the study. This study shows, for the first time, significantly improved auditory-based outcomes in children implanted younger than 6 months and without an increased rate of complications. The data from the present study must be considered as explorative, and a more extensive study is required.

SIG 1 Perspectives Vol. 19, No. 1, January 2012

SIG 1 Perspectives Vol. 19, No. 1, January 2012