https://doi.org/10.23641/asha.5116843.

Background: Articulatory excursion and vocal intensity are reduced in many children with dysarthria due to cerebral palsy (CP), contributing to the children's intelligibility deficits and negatively affecting their social participation. However, the effects of speech-treatment strategies for improving intelligibility in this population are understudied, especially for children who speak languages other than English. In a cueing study on English-speaking children with dysarthria, acoustic variables and intelligibility improved when the children were provided with cues aimed to increase articulatory excursion and vocal intensity. While French is among the top 20 most spoken languages in the world, dysarthria and its management in French-speaking children are virtually unexplored areas of research. Information gleaned from such research is critical for providing an evidence base on which to provide treatment. Aims: To examine acoustic and perceptual changes in the speech of French-speaking children with dysarthria, who are provided with speech cues targeting greater articulatory excursion (French translation of 'speak with your big mouth') and vocal intensity (French translation of 'speak with your strong voice'). This study investigated whether, in response to the cues, the children would make acoustic changes and listeners would perceive the children's speech as more intelligible. Methods & Procedures: Eleven children with dysarthria due to CP (six girls, five boys; ages 4;11-17;0 years; eight with spastic CP, three with dyskinetic CP) repeated pre-recorded speech stimuli across three speaking conditions (habitual, 'big mouth' and 'strong voice'). Stimuli were sentences and contrastive words in phrases. Acoustic analyses were conducted. A total of 66 Belgian-French listeners transcribed the children's utterances orthographically and rated their ease of understanding on a visual analogue scale at sentence and word levels.Outcomes & Results: Acoustic analyses revealed significantly longer duration in response to the big mouth cue at sentence level and in response to both the big mouth and strong voice cues at word level. Significantly higher vocal sound-pressure levels were found following both cues at sentence and word levels. Both cues elicited significantly higher first-formant vowel frequencies and listeners' greater ease-of-understanding ratings at word level. Increases in the percentage of words transcribed correctly and in sentence ease-of-understanding ratings, however, did not reach statistical significance. Considerable variability between children was observed. Conclusions & Implications: Speech cues targeting greater articulatory excursion and vocal intensity yield significant acoustic changes in French-speaking children with dysarthria. However, the changes may only aid listeners' ease of understanding at word level. The significant findings and great inter-speaker variability are generally consistent with studies on English-speaking children with dysarthria, although changes appear more constrained in ...

Purpose Children with dysarthria secondary to cerebral palsy may experience reduced speech intelligibility and diminished communicative participation. However, minimal research has been conducted examining the outcomes of behavioral speech treatments in this population. This study examined the effect of Speech Intelligibility Treatment (SIT), a dual-focus speech treatment targeting increased articulatory excursion and vocal intensity, on intelligibility of narrative speech, speech acoustics, and communicative participation in children with dysarthria. Method American English–speaking children with dysarthria ( n = 17) received SIT in a 3-week summer camplike setting at Columbia University. SIT follows motor-learning principles to train the child-friendly, dual-focus strategy, “Speak with your big mouth and strong voice.” Children produced a story narrative at baseline, immediate posttreatment (POST), and at 6-week follow-up (FUP). Outcomes were examined via blinded listener ratings of ease of understanding ( n = 108 adult listeners), acoustic analyses, and questionnaires focused on communicative participation. Results SIT resulted in significant increases in ease of understanding at POST, that were maintained at FUP. There were no significant changes to vocal intensity, speech rate, or vowel spectral characteristics, with the exception of an increase in second formant difference between vowels following SIT. Significantly enhanced communicative participation was evident at POST and FUP. Considerable variability in response to SIT was observed between children . Conclusions Dual-focus treatment shows promise for improving intelligibility and communicative participation in children with dysarthria, although responses to treatment vary considerably across children. Possible mechanisms underlying the intelligibility gains, enhanced communicative participation, and variability in treatment effects are discussed.

A 36-year-old female with severe spastic dysarthria participated in this study. She received 4 weeks of individual intensive voice-focused treatment. Voice recordings were conducted at three baseline points, immediately posttreatment, and at a 4-month follow-up. The primary outcome variables were selected acoustic measures of vocal function: sound pressure level (SPL), mean fundamental frequency (F0), maximum phonation time (MPT), jitter, shimmer, noise-to-harmonics ratio (NHR), and maximum phonation frequency range (MPFR). Significant pre-to-posttreatment changes ( p < .05) were found for most acoustic variables. All acoustic gains, except for MPFR, were maintained at the 4-month follow-up. The significant posttreatment changes in the majority of the acoustic measures analyzed suggest that intensive voice-focused treatment may have the potential to improve vocal function in adults with severe spastic dysarthria secondary to cerebral palsy (CP). Evidence-based treatment options for voice disorders in adults with CP are limited. Results emphasize the need for more studies with this population.

Cerebral palsy (CP) is the most common motor disability in childhood and can severely impact speech intelligibility. However, sparse evidence exists on which to base treatment. The current study examined the acoustic outcomes of Speech-Systems-Intelligibility-Treatment (Levy, 2014), a speech treatment aimed at enhancing intelligibility by targeting increased articulatory-working-space and vocal intensity through child-friendly prompts. Thirteen American-English speaking children with spastic dysarthria due to CP were assigned to a speech treatment group or a control group. Before and after treatment, participants repeated pre-recorded minimal pair nonsense words contrasting only in the initial consonant. Acoustic analysis of the children’s nonsense word productions indicated that on average, duration and sound-pressure-level (SPL) increased for the speech group post-treatment. Similar increases were observed in the control group’s SPL and duration, but to a lesser extent. Thus, preliminary results suggest promising treatment effects on speech acoustics for repeated words. Analyses of fricative-affricate contrasts, and F2 slope changes shed additional light on stability and changes in the speech of children with dysarthria in response to treatment. Additionally, changes in connected speech without a model talker may point to possible transfer of new skills to more spontaneous speech.