L5 - Speech Intelligibility

Question 1

What is Speech Intelligibility?

Answer 1

• The degree to which the acoustic signal is understood by the listener
• A measure of severity of speech involvement
• Depend on the listener, environment and the nature of message (i.e, novel versus predictable message)

Question 2

How is speech intelligibility in practice measured? (2)

Answer 2

• Transcription: % correct (# of words understood/ # of total words)
• Scaling (on a 5-point scale)

Question 3

What are 3 Speech Intelligibility Tests?

Answer 3

1. Word Intelligibility Test:
   - Correct score plus points to where the difficulty occurs (e.g., voicing contrast, fricative-affricate, nasal, etc.)
2. Speech Intelligibility Test:
   - Sentence: Speech Intelligibility, Speaking Rate and Communication Efficiency
   - Word: single word intelligibility, percent of accurate vowels/consonants, additional scoring for stops, fricatives, affricates, semi-vowels, nasal and pressure
   - Random Sentence/Word Generation
3. FDA-2

Question 4

What does Speech Effectiveness refer to?

Answer 4

• Disability at the activity level
• Rate at which intelligible information is conveyed

Question 5

What are the subparts of Speech Effectiveness?

Answer 5

1. Speaking rate - # of words/duration of the speaking task (sentences), words per minute (WPM)
2. Rate of intelligible speech = # of correctly transcribed words/duration of the speaking sample
3. Communication efficiency ratio = rate of intelligible speech/ 190 (=the mean rate of intelligible speech produced by normal speakers)

Question 6

What is Speech Comprehensibility?

Answer 6

• Disability at the activity level
• Degree to which the listener understands speech based on the quality of the signal and all other information available (e.g., knowing about place, time, topic, purpose, gestures, facial expressions)

Question 7

Are intelligibility and comprehensibility the same?

Answer 7

They are related but not the same thing

Question 8

What are the tasks for perceptual speech assessments?

Answer 8

1. Sustained vowel/phonation
2. Diadochokinesis (DDK)
   - Alternating/sequential motion rates (AMRs/SMRs)
3. Contextual speech
   - Conversation and narratives
4. Stress testing
5. Assessing motor programming capacity
   - E.g. articulatory substitutions or omissions

Question 9

______________ and ______________ are most useful tasks for evaluating the integrated function of all aspects of speech. Such as open-ended questions about family, work or hobbies or picture descriptions.

Answer 9

Conversation;
Narratives

Question 10

Contextual Speech:

Reading standard passage can provide sample of ____________ speech.
- Grandfather, Rainbow
- Beware: Neurologically intact adults’ ability to read aloud varies widely

Answer 10

Connected

Question 11

What are the steps for the perceptual assessment: stress testing?

Answer 11

1. Instruct the patient to read aloud or count for 2-4 minutes
2. Assess strength before and after the task
   - Look for significant deterioration in voice quality, resonance, or articulation = consistent with myasthenia gravis (flaccid dysarthria), especially if improvement occurs after a few minutes of rest

Question 12

What are the perceptual assessment tasks summary?

Answer 12

1. Sustained vowel/phonation
2. Diadochokinesis
3. Contextual speech
4. Stress testing
5. Assessing speech motor programming capacities

Question 13

What are published tests for Dysarthria?

Answer 13

1. Frenchay Dysarthria Assessment-2 (FDA-2)
2. Dysarthria Examination Battery (DEB)
3. Newcastle Dysarthria Assessment (NDAT), Newcastle and Hunter region

Question 14

Explain the Frenchay Dysarthria Assessment-2 (FDA-2). What is it?

Answer 14

• Publishes test for Dysarthria
• 5-point rating scale applied to patient-provided information
• Observations of oral structures and functions (OME), and speech

Question 15

Explain the Dysarthria Examination Battery (DEB). What is it?

Answer 15

• Published Tests for Dysarthria
• Structured assessment of dysarthric speech across multiple subsystems, focusing on the identification and classification of dysarthria type
• Provides severity ratings for respiration, phonation, resonance, articulation, and prosody, with supplementary measures for intelligibility
• Especially useful for distinguishing dysarthria subtypes based on patterns of subsystem involvement

Question 16

Explain the Newcastle Dysarthria Assessment (NDAT), Newcastle and Hunter region SLPs. What is it?

Answer 16

• Published Tests for Dysarthria
• Uses structured tasks to evaluate speech subsystems. Easy to use.
• Employs a rating scale with descriptive anchors to capture both impairment-level features and their functional impact
• Designed to provide both diagnositc information (subtypes classification) and practical treatment planning data (impact on communication effectiveness). Nice checklists of speech characteristics link to dysarthria types

Question 17

What are the Assessment Measures: Scales for Functional Communication & Psychosocial Impact:

Answer 17

1. ASHA Functional Communication Measures - Motor Speech Scale
2. Communicative Effectiveness Survey
3. Dysarthria Impact Profile
4. Living with Dysarthria

Question 18

Describe the ASHA Functional Communication Measures - Motor Speech Scale:

Answer 18

• Considered intensity & frequency of cueing & compensatory strategies for functional, independent communication

Question 19

Describe the Communicative Effectiveness Survey:

Answer 19

• Questionnaire completed by speakers & important listeners

Question 20

Describe the Dysarthria Impact Profile assessment measure:

Answer 20

• Scale completed by speaker; assess psychosocial impact, acceptance of disorder, perception of others’ reactions, etc.

Question 21

Describe the Living with Dysarthria assessment measure:

Answer 21

• Self assessment measure about speech, limitations imposed by dysarthria, effects of speech on other factors (e.g., fatigue) and coping strategies

Question 22

What is the Communication Participation Bank (CPIB)? What are its psychometric properties?

Answer 22

Item bank calibration and development of a disorder-generic short form.

1. Unidimensionality → All items measure the same single underlying construct (communicative participation).
2. Local independence → Responses to one item don’t depend on responses to another (each item adds unique information).
3. Good measurement precision → The scale gives accurate, reliable scores across different severity levels.
4. Differential item function (DIF) analysis  no meaningful differences across diagnostic groups.
   - E.g. Someone with Parkinson’s vs a stroke did not
   answer differently just because of their diagnosis

Question 23

What does the ‘Mayo Clinic System’ state about dysarthria?

Answer 23

1. Dysarthrias are recognized y how they sound
2. They can be distinguished from normal speech and non-neurological speech disorders
3. Not all people with dysarthria sound the same and the differences go beyond variations in severity
4. When they sound the same, similarities logically reflect lesion loci and presumably, common underlying pathophysiology

Question 24

What did the Original DAB studies (1969 a, b) find?

Answer 24

Types of dysarthria can be distinguished by their auditory-perceptual characteristics.

Question 25

What are the 7 types of initial dysarthrias:

Answer 25

1. Flaccid 2. Spastic 3. Hypokinetic 4. Hyperkinetic (chorea) 5. Hyperkinetic (dystonia) 6. Ataxic 7. Mixed (spastic-flaccid as in ALS)

Question 26

What are the 8 DAB dysarthria clusters?

Answer 26

1. Articulatory inaccuracy: imprecise consonants, irregular articulatory breakdown, distorted vowel 2. Prosodic excess: equal & excess stress, low rate 3. Phonatory-prosodic insufficiency: harsh voice, monoloudness, monopitch 4. Prosodic insufficiency: monopitch, monoloudness, reduced stress, short phrases 5. Articulatory-resonatory incompetence: imprecise consonants, distorted vowels, hypernasality 6. Phonatory incompetence: breathiness, short phrases, audible inspiration' 7. Resonatory incompetences: hypernasality, imprecise consonants, nasal emission, short phrases 8. Phonatory stenosis: low pitch, harshness, strain-strangled voice, pitch breaks, short phrases, slow rate

Question 27

Identification of the dysarthria type =

Answer 27

Identification of a pattern

Question 28

What is the full diagnostic loop used today in dysarthria identification:

Answer 28

1. Listen (perceptual features) 2. Localize (which controls circuits/subsystems are impaired) 3. Explain (physiologic base) 4. Plan treatment (target physiologic deficit)