Speech-language pathology Student Participation in Verbal Reflective Practice Groups: perceptions of development, value and group condition differences.

The aim of this study was to determine whether significant differences in perceptions of reflective practice were present across two groups of students engaged in standard practice and experimental group conditions. Twenty-seven undergraduate speech-language pathology students participated in the study. A two-condition, non-randomised, pre-test post-test design was employed with two groups (a standard practice condition and an experimental practice condition, utilizing structured activities and prompts). Participants took part in weekly reflective practice groups over a six week period, in which discussion centered on students’ clinical experiences. Pre and post intervention, the students completed a questionnaire designed to examine perceptions of reflective practice in the differing conditions. Overall, students’ perceptions of reflective practice as a learning tool were positive. In contrast to our hypotheses, students’ perceptions of reflective practice did not change significantly over time. Furthermore, there was no differences in perceptions in the experimental practice (i.e., structured activities and prompts) group as compared to the standard practice group. Students perceive verbal reflective practice as a positive learning experience regardless of the discussion format utilized. Implications for clinical teaching are discussed

Environmental exposure to polychlorinated biphenyls and p,p\u27-DDE and sperm sex-chromosome disomy

Background: Chromosomal abnormalities contribute substantially to reproductive problems, but the role of environmental risk factors has received little attention. Objectives: We evaluated the association of polychlorinated biphenyl (PCB) and dichlorodiphenyldichloroethylene (p,p´-DDE) exposures with sperm sex-chromosome disomy. Methods: We conducted a cross-sectional study of 192 men from subfertile couples. We used multiprobe fluorescence in situ hybridization (FISH) for chromosomes X, Y, and 18 to determine XX, YY, XY, and total sex-chromosome disomy in sperm nuclei. Serum was analyzed for concentrations of 57 PCB congeners and p,p´-DDE. Poisson regression models were used to calculate incidence rate ratios (IRRs) for disomy by exposure quartiles, controlling for demographic characteristics and semen parameters. Results: The median percent disomy was 0.3 for XX and YY, 0.9 for XY, and 1.6 for total sex-chromosome disomy. We observed a significant trend of increasing IRRs for increasing quartiles of p,p´-DDE in XX, XY, and total sex-chromosome disomy, and a significant trend of increasing IRRs for increasing quartiles of PCBs for XY and total sex-chromosome disomy; however, there was a significant inverse association for XX disomy. Conclusions: Our findings suggest that exposure to p,p´-DDE may be associated with increased rates of XX, XY, and total sex-chromosome disomy, whereas exposure to PCBs may be associated with increased rates of YY, XY, and total sex-chromosome disomy. In addition, we observed an inverse association between increased exposure to PCBs and XX disomy. Further work is needed to confirm these findings

A programme for risk assessment and minimisation of progressive multifocal leukoencephalopathy developed for vedolizumab clinical trials

Introduction Over the past decade, the potential for drug-associated progressive multifocal leukoencephalopathy (PML) has become an increasingly important consideration in certain drug development programmes, particularly those of immunomodulatory biologics. Whether the risk of PML with an investigational agent is proven (e.g. extrapolated from relevant experience, such as a class effect) or merely theoretical, the serious consequences of acquiring PML require careful risk minimisation and assessment. No single standard for such risk minimisation exists. Vedolizumab is a recently developed monoclonal antibody to α4β7 integrin. Its clinical development necessitated a dedicated PML risk minimisation assessment as part of a global preapproval regulatory requirement. Objective The aim of this study was to describe the multiple risk minimisation elements that were incorporated in vedolizumab clinical trials in inflammatory bowel disease patients as part of the risk assessment and minimisation of PML programme for vedolizumab. Methods A case evaluation algorithm was developed for sequential screening and diagnostic evaluation of subjects who met criteria that indicated a clinical suspicion of PML. An Independent Adjudication Committee provided an independent, unbiased opinion regarding the likelihood of PML. Results Although no cases were detected, all suspected PML events were thoroughly reviewed and successfully adjudicated, making it unlikely that cases were missed. Conclusion We suggest that this programme could serve as a model for pragmatic screening for PML during the clinical development of new drugs

Acoustic and perceptual consequences of speech cues for children with dysarthria

Purpose: Reductions in articulatory working space and vocal intensity have been linked to intelligibility deficits in children with dysarthria due to cerebral palsy. However, few studies have examined the outcomes of behavioral treatments aimed at these underlying impairments or investigated which treatment cues might best facilitate improved intelligibility. This study assessed the effects of cues targeting clear speech (i.e., “Speak with your big mouth”) and greater vocal intensity (i.e., “Speak with your strong voice”) on acoustic measures of speech production and intelligibility. Method: Eight children with spastic dysarthria due to cerebral palsy repeated sentence- and word-level stimuli across habitual, big mouth, and strong voice conditions. Acoustic analyses were conducted, and 48 listeners completed orthographic transcription and scaled intelligibility ratings. Results: Both cues resulted in significant changes to vocal intensity and speech rate although the degree of change varied by condition. In a similar manner, perceptual analysis revealed significant improvements to intelligibility with both cues; however, at the single-word level, big mouth outperformed strong voice. Conclusion: Children with dysarthria are capable of changing their speech styles differentially in response to cueing. Both the big mouth and strong voice cues hold promise as intervention strategies to improve intelligibility in this population. Supplemental Material: https://doi.org/10.23641/asha.511684

Perceptual and acoustic effects of dual-focus speech treatment in children with dysarthria

Purpose: Children with dysarthria secondary to cerebral palsy (CP) 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 three-week summer camp-like 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 (BASE), immediate post-treatment (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. Conclusion: 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

Environmental Exposure to Polychlorinated Biphenyls and p,p´-DDE and Sperm Sex-Chromosome Disomy

Background: Chromosomal abnormalities contribute substantially to reproductive problems, but the role of environmental risk factors has received little attention

The effects of intensive speech treatment on conversational intelligibility in Spanish speakers with Parkinson’s disease

Purpose: To examine the effects of intensive speech treatment on the conversational intelligibility of Castilian Spanish speakers with Parkinson’s disease (PD), as well as on the speakers’ self-perceptions of disability. Method: Fifteen speakers with a medical diagnosis of PD participated in this study. Speech recordings were completed twice before treatment, immediately post-treatment and at a one-month follow-up session. Conversational intelligibility was assessed in two ways—transcription accuracy scores and intelligibility ratings on a 9-point Likert scale. The Voice Handicap Index (VHI) was administered as a measure of self-perceived disability. Results: Group data revealed that transcription accuracy and median ease-of-understanding ratings increased significantly immediately post-treatment, with gains maintained at the one-month follow-up. The functional subscale of the VHI decreased significantly post-treatment, suggesting a decrease in perceived communication disability after speech treatment. Conclusion: These findings support the implementation of intensive voice treatment to improve conversational intelligibility in Spanish speakers with PD with dysarthria as well as to improve the speakers' perception of their daily communicative capabilities. Clinical and theoretical considerations are discussed

Articulation entropy: An unsupervised measure of articulatory precision

Articulatory precision is a critical factor that influences speaker intelligibility. In this paper, we propose a new measure we call ‘articulation entropy’ that serves as a proxy for the number of distinct phonemes a person produces when he or she speaks. The method is based on the observation that the ability of a speaker to achieve an articulatory target, and hence clearly produce distinct phonemes, is related to the variation of the distribution of speech features that capture articulation - the larger the variation, the larger the number of distinct phonemes produced. In contrast to previous work, the proposed method is completely unsupervised, does not require phonetic segmentation or formant estimation, and can be estimated directly from continuous speech. We evaluate the performance of this measure with several experiments on two data sets: a database of English speakers with various neurological disorders and a database of Mandarin speakers with Parkinson’s disease. The results reveal that our measure correlates with subjective evaluation of articulatory precision and reveals differences between healthy individuals and individuals with neurological impairment

Acoustic and perceptual speech characteristics of native Mandarin speakers with Parkinson Disease

This study examines acoustic features of speech production in speakers of Mandarin with Parkinson's disease (PD) and relates them to intelligibility outcomes. Data from 11 participants with PD and 7 controls are compared on several acoustic measures. In speakers with PD, the strength of association between these measures and intelligibility is investigated. Speakers with PD exhibited significant differences in fundamental frequency, pitch variation, vowel space, and rate relative to controls. However, in contrast to the English studies, speech rate was consistently slow and most strongly correlated with intelligibility. Thus, acoustic cues that strongly influence intelligibility in PD may vary cross-linguistically

The CogniAid trial. The impact of two hearing aid signal processing strategies on cognition

BackgroundUntreated hearing loss is a risk factor for age-related cognitive decline and hearing aids have been shown to slow cognitive decline in a population at risk for dementia. This double-blind multiple site randomized trial tested the hypothesis that for older adults with below-average cognition, a “Simple” hearing aid fitting strategy (based on linear amplification with output limiting compression signal processing) would improve hearing and cognition more than a “Standard” approach (adaptive compression-based processing).MethodsTwo hundred and fifty-six adults aged over 65 were screened for cognitive function using the NIH toolbox cognitive battery. Participants with below median age-adjusted fluid composite cognitive scores (<100) were eligible to participate (n = 104). Sixty-seven eligible participants proceeded to trial and were randomized 1:1 to a simple or standard hearing aid fitting. Participants in the Standard group were fitted with hearing aids matched to non-linear real-ear prescription targets (either NAL-NL1 or NL2), while participants in the Simple group were fitted with hearing aids matched to linear prescription targets (NAL-R). Participants and researchers not fitting the hearing aids were blinded to allocation.ResultsForty-eight participants completed assessments in 12 months. The Standard hearing aid group improved on measures of fluid cognition and hearing. There was a statistically significant difference in fluid cognition scores between groups. The fluid cognition composite score for participants receiving the Simple fitting changed by 3.5 points. Those with the Standard fitting improved by 10.3 points. Hearing outcomes for each group were improved by the same amount.ConclusionThis is the first study to show that hearing aid fitting strategies using markedly different signal processing result in significantly different cognitive outcomes after 12 months of use. The Standard fitting resulted in greater improvement in cognition than the Simpler fitting which was the opposite result to what had been hypothesized. The results reinforce findings indicating hearing aid benefits for the elderly and that they improve cognition