Apraxia World: Deploying a Mobile Game and Automatic Speech Recognition for Independent Child Speech Therapy

Children with speech sound disorders typically improve pronunciation quality by undergoing speech therapy, which must be delivered frequently and with high intensity to be effective. As such, clinic sessions are supplemented with home practice, often under caregiver supervision. However, traditional home practice can grow boring for children due to monotony. Furthermore, practice frequency is limited by caregiver availability, making it difficult for some children to reach therapy dosage. To address these issues, this dissertation presents a novel speech therapy game to increase engagement, and explores automatic pronunciation evaluation techniques to afford children independent practice. Children with speech sound disorders typically improve pronunciation quality by undergoing speech therapy, which must be delivered frequently and with high intensity to be effective. As such, clinic sessions are supplemented with home practice, often under caregiver supervision. However, traditional home practice can grow boring for children due to monotony. Furthermore, practice frequency is limited by caregiver availability, making it difficult for some children to reach therapy dosage. To address these issues, this dissertation presents a novel speech therapy game to increase engagement, and explores automatic pronunciation evaluation techniques to afford children independent practice. The therapy game, called Apraxia World, delivers customizable, repetition-based speech therapy while children play through platformer-style levels using typical on-screen tablet controls; children complete in-game speech exercises to collect assets required to progress through the levels. Additionally, Apraxia World provides pronunciation feedback according to an automated pronunciation evaluation system running locally on the tablet. Apraxia World offers two advantages over current commercial and research speech therapy games; first, the game provides extended gameplay to support long therapy treatments; second, it affords some therapy practice independence via automatic pronunciation evaluation, allowing caregivers to lightly supervise instead of directly administer the practice. Pilot testing indicated that children enjoyed the game-based therapy much more than traditional practice and that the exercises did not interfere with gameplay. During a longitudinal study, children made clinically-significant pronunciation improvements while playing Apraxia World at home. Furthermore, children remained engaged in the game-based therapy over the two-month testing period and some even wanted to continue playing post-study. The second part of the dissertation explores word- and phoneme-level pronunciation verification for child speech therapy applications. Word-level pronunciation verification is accomplished using a child-specific template-matching framework, where an utterance is compared against correctly and incorrectly pronounced examples of the word. This framework identified mispronounced words better than both a standard automated baseline and co-located caregivers. Phoneme-level mispronunciation detection is investigated using a technique from the second-language learning literature: training phoneme-specific classifiers with phonetic posterior features. This method also outperformed the standard baseline, but more significantly, identified mispronunciations better than student clinicians

The Electrophysiology of Resting State fMRI Networks

Traditional research in neuroscience has studied the topography of specific brain functions largely by presenting stimuli or imposing tasks and measuring evoked brain activity. This paradigm has dominated neuroscience for 50 years. Recently, investigations of brain activity in the resting state, most frequently using functional magnetic resonance imaging (fMRI), have revealed spontaneous correlations within widely distributed brain regions known as resting state networks (RSNs). Variability in RSNs across individuals has found to systematically relate to numerous diseases as well as differences in cognitive performance within specific domains. However, the relationship between spontaneous fMRI activity and the underlying neurophysiology is not well understood. This thesis aims to combine invasive electrophysiology and resting state fMRI in human subjects to better understand the nature of spontaneous brain activity. First, we establish an approach to precisely coregister intra-cranial electrodes to fMRI data (Chapter 2). We then created a novel machine learning approach to define resting state networks in individual subjects (Chapter 3). This approach is validated with cortical stimulation in clinical electrocorticography (ECoG) patients (Chapter 4). Spontaneous ECoG data are then analyzed with respect to fMRI time-series and fMRI-defined RSNs in order to illustrate novel ECoG correlates of fMRI for both local field potentials and band-limited power (BLP) envelopes (Chapter 5). In Chapter 6, we show that the spectral specificity of these resting state ECoG correlates link classic brain rhythms with large-scale functional domains. Finally, in Chapter 7 we show that the frequencies and topographies of spontaneous ECoG correlations specifically recapitulate the spectral and spatial structure of task responses within individual subjects

A Curriculum-Based Approach for Social-Cognitive Skills Training: an Intervention Targeting Aggression in Head Start Preschoolers.

The present study was designed to evaluate the effectiveness of a social-cognitive skills training curriculum targeting aggression in Head Start preschoolers. Developmental psychopathology research clearly suggests that early intervention with aggressive preschoolers is critical. Despite the fact that aggressive behavior becomes stable by the elementary school years, there has been relatively little interest in intervening with preschool-aged children. In the present study, the COMPASS program is a 12-session curriculum teaching basic individual social skills (e.g., sharing, questioning, listening). Following the work of Mize and Ladd (1983; 1990), the curriculum was puppet-facilitated and employed the components of instruction, modeling, rehearsal, and evaluation feedback. Two Head Start centers comprised the treatment group and two centers comprised the control group, with a total of 80 preschoolers participating. Assessments were made at pre-treatment, post-treatment, and three-month follow-up. The assessment battery consisted of the Social Skills Rating System-Teacher Form, teacher-rated relational aggression, Aggression subscale of the Achenbach Caregiver-Teacher Report Form, peer ratings of acceptance, and the Enactive Social Knowledge Interview. It was hypothesized that aggression would decrease, while prosocial skills and peer acceptance would increase, more so in the treatment than the control group. The SSRS-T, relational aggression ratings, and aggregate peer acceptance ratings had significant site differences at pre-treatment, which were controlled for statistically. No significant results emerged with respect to aggression and social skill levels. With respect to peer acceptance ratings, both the treatment and control groups decreased between post-treatment and follow-up, although the treatment group decreased slightly, but significantly, more than the control group. Several post-hoc hypotheses are offered as explanation for the generally null findings, including applicability of the Mize and Ladd model to a Head Start population, inability to adequately control for site differences, length of the treatment, and difficulty adding to the effectiveness of the Head Start program alone. Several directions for future research are discussed, including the addition of more sessions to the curriculum, a parent-involvement component, and a contingency management program. It would also be helpful to evaluate COMPASS in a larger number of Head Start centers and to extend follow-up assessment beyond three months

Pediatric Nurses\u27 Perceptions of Continuing Professional Development Opportunities

With the growth in healthcare research and rapid changes in technology, nurses\u27 participation in lifelong learning is a critical factor in providing excellent patient care. However, many nurses encounter difficulties engaging in continuing professional development (CPD) activities. The purpose of this case study was to understand pediatric nurses\u27 perceptions of CPD opportunities at a tertiary, freestanding, children\u27s hospital in Southern California. Social cognitive theory was the framework for the study. Interviews and focus groups were conducted with a purposeful sample of 39 nurses comprised of day- and night-shift nurses plus nurse managers. The data were coded into categories and themes to explain the findings; the resulting 7 themes illustrated how these nurses perceived CPD. The nurses identified motivators and barriers that influenced their involvement in CPD activities. Most nurses reported that they were able to incorporate new knowledge into their practice and produce excellent patient outcomes but some nurses expressed instances of resistance and practice not supported with evidence-based approaches to care. Although the nurses found the programs adequate, they recommended ideas for improvement, including a need for leadership and management development. A project aimed at providing nurse managers with professional development in leadership was created to improve CPD. The project could improve the nursing profession by helping educators enhance CPD to support nurses in delivering high-quality patient care, thus supporting the healing and well-being of children under their care

Models and analysis of vocal emissions for biomedical applications

This book of Proceedings collects the papers presented at the 3rd International Workshop on Models and Analysis of Vocal Emissions for Biomedical Applications, MAVEBA 2003, held 10-12 December 2003, Firenze, Italy. The workshop is organised every two years, and aims to stimulate contacts between specialists active in research and industrial developments, in the area of voice analysis for biomedical applications. The scope of the Workshop includes all aspects of voice modelling and analysis, ranging from fundamental research to all kinds of biomedical applications and related established and advanced technologies