Van Nuffelen (2011)

CRITIQUE OF UNSUPPORTED PROCEDURAL DESCRIPTIONS

KEY:

C = clinician

DAF = delayed auditory feedback

P = patient or participant

pmh = Patricia Hargrove, blog developer

SLP = speech-language pathologist

Source: Van Nuffelen, G. (2011). Speech prosody in dysarthria. In V. Stojanovik & J. Setter (Eds.), Speech prosody in atypical populations: Assessment and remediation (pp. 147- 167). Surry, UK: J & R Press.

 

Reviewer(s): pmh

 

Date: September 21, 2014

 

Overall Assigned Grade (because there are no primary supporting data, the highest grade will be F): F

 

Level of Evidence: F = Expert Opinion, no supporting evidence for the effectiveness of the intervention although the author may provide secondary evidence supporting components of the intervention.

 

Take Away: As the author notes, despite the common perception of dysarthria as an adult issue, children also can exhibit one or more forms of dysarthria. The   focus of this chapter was on using prosody to improve intelligibility (ability of a listen to understand a verbal message without context) and comprehensibility (ability of a listen to understand a verbal message in context) in adults or children with dysarthria.

The author provides background information about prosody’s relevance to speech-language pathology and analyzes assessment procedures (these will be reviewed in this blog at a later date when we add a section on assessment issues.) This review is concerned with the recommendations for using prosody to improve intelligibility and/or comprehensibility. Prior to working on expressive prosody, the author recommends that receptive prosody be targeted if assessment suggests this is skill is a challenge. The author provides techniques and content for treating intonation, stress, and rate as they relate to intelligibility/comprehensibility.

    

  1. Was there review of the literature supporting components of the intervention? Narrative Review

 

  1. Were the specific procedures/components of the intervention tied to the reviewed literature? Yes

 

  1. Was the intervention based on clinically sound clinical procedures? Yes
  1. Did the author(s) provide a rationale for components of the intervention? Yes
  1. Description of outcome measures:
  • Outcome #1: to improve receptive prosody
  • Outcome #2: to improve stress and intonation by chunking utterances into appropriate syntactic units
  • Outcome #3: to increase the length of breath groups that correspond with syntactic units
  • Outcome #4: to use stress to differentiate word classes
  • Outcome #5: to use stress to emphasize appropriately a word in an utterance
  • Outcome #6: to use intonation to differentiate speech acts
  • Outcome #7– to produce utterance with appropriate affective prosody
  • Outcome #8– to produce a speaking rate that optimizes intelligibility/comprehensibility

 

  1. Was generalization addressed? No

 

  1. Was maintenance addressed? No

 

 

SUMMARY OF INTERVENTION

 

Description of Intervention #1to improve receptive prosody (specific intervention procedures and content were not provided)

 

POPULATION: Dysarthria; Adult, Child

TARGETS: to differentiate acceptable and unacceptable productions of examples of prosodic patterns

TECHNIQUES: feedback from C (clinician)

STIMULI: auditory, audio-recordings

 

ADMINISTRATOR: SLP

 

PROCEDURES

  1. C plays audio recordings of examples of prosodic patterns.
  2. P (patient) judges if the example is correct or incorrect.
  3. C provides feedback to the P regarding the accuracy of the judgment.

RATIONALE/SUPPORT FOR INTERVENTION: The author cited research indicating that receptive prosody is co-located in the brain with certain forms of dysarthria. Accordingly, there is a possibility that some speakers with dysarthria such as those with spastic dysarthria or upper motor neuron dysarthria may also have a receptive prosodic problem. There is only limited research about the receptive prosodic skills of speakers with dysarthria so it is important to insure that receptive prosodic skills are intact. Also, among children with high-functioning autism, there is a significant correlation between receptive and expressive prosody. (Logical support)

Description of Intervention #2 to improve stress and intonation by chunking utterances into appropriate syntactic units

 

POPULATION: Dysarthria; Adult, Child

 

TARGETS: matching of the production of breath units with syntactic units.

TECHNIQUES: behavioral instruction/metalinguistics, modeling, visual feedback

STIMULI: auditory, visual

 

ADMINISTRATOR: SLP

 

PROCEDURES:

  • The following are general ideas for treating prosody and specific ideas for treating chunking/phrasing listed in the chapter.

– C identifies the typical length of P’s breath group

– C guides P to produce utterances with pauses associated with a breath group at a syntactic boundaries.

– C uses the following techniques:

  1. behavioral descriptions/metalinguistics
  2. modeling

iii. visual feedback using instruments that acoustically measure pauses.

RATIONALE/SUPPORT FOR INTERVENTION: Speakers with dysarthria can have short breath groups. If pausing to breath does not correspond with a syntactic boundary, intelligibility problems can occur. (Logical support)

Description of Intervention #3— to increase the length of breath groups that correspond with syntactic units

 

POPULATION: Dysarthria; Adult, Child

 

TARGETS: breath units

TECHNIQUES: behavioral descriptions/metalinguistics, modeling, visual feedback using instruments that acoustically measure duration.

STIMULI: auditory, visual

 

ADMINISTRATOR: SLP

 

PROCEDURES:

  • The following are general ideas for treating prosody and specific ideas for lengthening breath groups listed in the chapter.

– C identifies the typical length of P’s breath group

– C guides P to produce longer breath groups.

– C uses the following techniques:

  1. behavioral descriptions/metalinguistics
  2. modeling

iii. visual feedback using instruments that acoustically measure duration.

RATIONALE/SUPPORT FOR INTERVENTION: Speakers with dysarthria can have short breath groups. Increasing the length of breath groups can increase the length of utterances and, perhaps, intelligibility/comprehensibility. (Logical support)

Description of Intervention #4—to use stress to differentiate word classes

 

POPULATION: Dysarthria; Adult, Child

 

TARGETS: production of lexical stress (e.g., ob JECT versus OB ject)

TECHNIQUES: behavioral descriptions/metalinguistics; modeling; contrastive stress drills; visual feedback using instruments that acoustically measure intensity, frequency, duration.

STIMULI: auditory, visual

 

ADMINISTRATOR: SLP

 

PROCEDURES:

  • The following are general ideas for treating prosody and specific ideas for improving lexical stress listed in the chapter.

– C presents contrastive stress drills in which minimal pair words for P to produce that differ only in location of stress (“RE ject” versus “re JECT”)

– C uses the following techniques:

  1. behavioral descriptions/metalinguistics
  2. modeling

iii. visual feedback using instruments that acoustically measure duration, intensity, pause, and frequency.

RATIONALE/SUPPORT FOR INTERVENTION: Improving lexical stress assists the listener in understanding what the speaker is intending. (Logical support)

Description of Intervention #5–to use stress to emphasize appropriately a word in an utterance

 

POPULATION: Dysarthria; Adult, Child

 

TARGETS: phrasal/sentence stress

TECHNIQUES: behavioral descriptions/metalinguistics; modeling; contrastive stress drills; visual feedback using instruments that acoustically measure intensity, frequency, and duration.

STIMULI: auditory, visual

 

ADMINISTRATOR: SLP

 

PROCEDURES:

  • The following are general ideas for treating prosody and specific ideas for improving phrasal stress listed in the chapter.

– C presents contrastive stress drills in which minimal pair sentences which P will produce will differ only in location of stress (e.g., “DAVID took the money” versus “David took the MONEY”)

– C uses the following techniques:

  1. behavioral descriptions/metalinguistics
  2. modeling

iii. visual feedback using instruments that acoustically measure duration, intensity, pause, and frequency.

RATIONALE/SUPPORT FOR INTERVENTION: The speaker should stress the word that he/she believes is the most important word in the sentence for the listener. (Logical support)

Description of Intervention #6—to use intonation to differentiate speech acts

 

POPULATION: Dysarthria; Adult, Child

 

TARGETS: intonation, intonation terminal contour

TECHNIQUES: behavioral descriptions/metalinguistics; modeling; contrastive stress drills; visual feedback using instruments that acoustically measure frequency

STIMULI: auditory, visual

 

ADMINISTRATOR: SLP

 

PROCEDURES:

  • The following are general ideas for treating prosody and specific ideas for improving intonation listed in the chapter.

– C presents contrastive stress drills in which minimal pair sentences which P will produce will differ only in the intonation (terminal contour) signaling different speech acts (e.g., “David took the money.” versus “David took the money?”)

– C uses the following techniques:

  1. behavioral descriptions/metalinguistics
  2. modeling

iii. visual feedback using instruments that acoustically measure frequency.

Description of Intervention #7– to produce utterance with appropriate affective prosody

 

POPULATION: Dysarthria; Adult, Child

 

TARGETS: affective prosody

TECHNIQUES: behavioral descriptions/metalinguistics; modeling; contrastive stress drills; visual feedback using instruments that acoustically measure frequency, intensity, pause, and duration

STIMULI: auditory, visual

 

ADMINISTRATOR: SLP

 

PROCEDURES:

  • The following are general ideas for treating prosody and specific ideas for improving affective prosody listed in the chapter.

– C presents contrastive stress drills in which minimal pair sentences which P will produce will differ only in the intonation (terminal contour) signaling different emotions (e.g., happy, sad, angry)

– C uses the following techniques:

  1. behavioral descriptions/metalinguistics
  2. modeling

iii. visual feedback using instruments that acoustically measure frequency.

Description of Intervention #8– to produce a speaking rate that optimizes intelligibility/comprehensibility

 

POPULATION: Dysarthria; Adult, Child

 

TARGETS: rate, intelligibility, comprehensibility

TECHNIQUES: behavioral description/metalingustics, speaking slower on demand, pacing, alphabet board, hand or finger tapping, delayed auditory feedback

STIMULI: auditory, visual, tactile/kinesthetic

 

ADMINISTRATOR:

 

PROCEDURES:

  • To reduce the rate of speech, the clinician may focus on
  1. reducing articulation rate
  2. inserting additional, syntactically appropriate pauses
  3. increasing the length/duration of pauses
  • The author described several approaches for slowing speech rate”
  1. Speaking slower on demand—C instructs P to talk at a specific percentage of his/her typical speaking rate (e.g., one-third P’s normal rate).
  1. Pacing – C directs P’s attention to a device (e.g., pacing board, metronome, Facilitator of Metronomic Pacing by Key Elemetrics, or the computer software Pacer) and asks P to talk saying a word or syllable for each square on the pacing board or in time with the metronome or computer program.
  1. Alphabet Board – P points to the first letter of each word when speaking.
  1. Hand or Finger Tapping – P taps for each intended syllable when speaking.
  1. Delayed Auditory Feedback (DAF) –C identifies the optimal delay time and then directs P to talk while wearing the DAF device..

RATIONALE/SUPPORT FOR INTERVENTION: Logical—

  • Rather than normalizing the rate of speech, the target should be to produce speech at a rate that optimizes intelligibility/comprehensibility. At this point, there is no strategy that has been identified as superior for all Ps. Rather, Cs should identify the strategy that works for the individual P insuring that it improves intelligibility/comprehensibility.
  • Of the approaches for reducing rate, the author presented the following rationales:
  1. reducing articulation rate—a number of studies support that this increases articulatory precision (distinctiveness) but research is contradictory as to whether reducing rate increases intelligibility
  2. inserting additional, syntactically appropriate pauses—this may improve comprehensibility by highlighting syntactic and/or word boundaries or by giving the listener additional time to interpret the utterance
  3. increasing the length/duration of pauses–—this may improve comprehensibility by highlighting syntactic and/or word boundaries or by giving the listener additional time to interpret the utterance
  • The author presented the following support for the techniques for slowing speech rate”
  1. Speaking slower on demand—The author cited research to support this approach but her own previously reported research did not yield significant changes in articulation rate, pause duration, or pause frequency.
  2. Pacing –The author cited her own previously reported research indicating a significant decrease articulation in rate and significant increases in total pause duration and pause frequency.
  3. Alphabet Board –The author cited her own previously reported research indicating significant decreases in articulation rate and pause frequency and significant increases in mean and total pause duration.
  4. Hand or Finger Tapping – The author cited her own previously reported research indicating a significant a decrease articulation in rate and a significant increase pause frequency.
  5. Delayed Auditory Feedback (DAF) – The author cited her own previously reported research indicating a significant decrease articulation rate.

 

CONTRAINDICATIONS FOR USE OF THE INTERVENTION—see above

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: