Factors affecting consonant production accuracy in children with cochlear implants: Expressive vocabulary and maternal education.

BACKGROUND: Despite the ability of cochlear implants (CIs) to provide children with access to speech, there is considerable variability in spoken language outcomes. Research aimed at identifying factors influencing speech production accuracy is needed. AIMS: To characterize the consonant production accuracy of children with cochlear implants (CWCI) and an age-matched group of children with typical hearing (CWTH) and to explore several factors that potentially affect the ability of both groups to accurately produce consonants. METHODS & PROCEDURES: We administered the Bankson-Bernthal Test of Phonology (BBTOP) to a group of 25 CWCI (mean age = 4;9, SD = 1;6, range = 3;2-8;5) implanted prior to 30 months of age with a mean duration of implant usage of 3;6 and an age-matched group of 25 CWTH (mean age = 5;0, SD = 1;6, range = 3;1-8;6). The recorded results were transcribed, and the accuracy of the target consonants was determined. Expressive vocabulary size estimates were obtained from a language sample using the number of different words (NDW). A parent questionnaire provided information about maternal education, duration of CIs experience and other demographic characteristics of each child. OUTCOMES & RESULTS: The CWCI group demonstrated some similarities to, and some differences from, their hearing peers. The CWCI demonstrated poorer consonant production accuracy overall and in various phonetic categories and word positions. However, both groups produced initial consonants more accurately than final consonants. Whilst CWCI had poorer production accuracy than CWTH for all phonetic categories (stops, nasals, fricatives, affricates, liquids and glides and consonant clusters), both groups exhibited similar error patterns across categories. For CWCI, the factors most related to consonant production accuracy when considered individually were expressive vocabulary size, followed by duration of CI experience, chronological age, maternal education and gender. The combination of maternal education and vocabulary size resulted in the best model of consonant production accuracy for this group. For the CWTH, chronological age followed by vocabulary size were most related to consonant production accuracy. No combination of factors yielded an improved model for the CWTH. CONCLUSIONS & IMPLICATIONS: Whilst group differences in production accuracy between the CWCI and CWTH were found, the pattern of errors was similar for the two groups of children, suggesting that the children are at earlier stages of overall consonant production development. Although duration of CI experience was a significant covariate in a single-variable model of consonant production accuracy for CWCI, the best multivariate model of consonant production accuracy for these children was based on the combination of expressive vocabulary size and maternal education. WHAT THIS PAPER ADDS: What is already known on the subject Research has shown that a range of factors is associated with consonant production accuracy by CWCIs, including factors such as the age at implant, duration of implant use, gender, other language skills and maternal education. Despite numerous studies that have examined speech sound production in these children, most have explored a limited number of factors that might explain the variability in scores obtained. Research that examines the potential role of a range of child-related and environmental factors in the same children is needed to determine the predictive role of these factors in speech production outcomes. What this paper adds to the existing knowledge Whilst the consonant production accuracy was lower for the CWCIs than for their typically hearing peers, there were some similarities suggesting that these children are experiencing similar, but delayed, acquisition of consonant production skills to that of their hearing peers. Whilst several factors are predictive of consonant production accuracy in children with implants, vocabulary diversity and maternal education, an indirect measure of socio-economic status, were the best combined predictors of consonant production accuracy. What are the potential or actual clinical implications of this work? Understanding the factors that shape individual differences in CWCI speech production is important for effective clinical decision-making and intervention planning. The present findings point to two potentially important factors related to speech sound production beyond the duration of robust hearing in CWCI, namely, a lexical diversity and maternal education. This suggests that intervention is likely most efficient that addresses both vocabulary development and speech sound development together. The current findings further suggest the importance of parental involvement and commitment to spoken language development and the importance of receiving early and consistent intervention aimed both at skill development and parental efficacy.

Contrastive stress production by children with cochlear implants: Accuracy and acoustic characteristics.

The aim of this study was to examine the abilities of eight early-implanted children with cochlear implants (mean age 7.1 years) to produce contrastive stress and to compare their use of amplitude, duration, and fundamental frequency, to an age-matched group of children with typical hearing (mean age 6.11 years). A set of 16 utterances were elicited in which the child was required to stress either an adjective or noun in a short phrase. Although both groups of children produced similar proportions of utterances with stress patterns perceived by hearing listeners as accurate, they employed different strategies for achieving contrastive stress.

Auditory Perception and Production of Speech Feature Contrasts by Pediatric Implant Users.

OBJECTIVE: The aim of the present research is to examine the relations between auditory perception and production of specific speech contrasts by children with cochlear implants (CIs) who received their implants before 3 years of age and to examine the hierarchy of abilities for perception and production for consonant and vowel features. The following features were examined: vowel height, vowel place, consonant place of articulation (front and back), continuance, and consonant voicing. DESIGN: Fifteen children (mean age = 4;0 and range 3;2 to 5;11) with a minimum of 18 months of experience with their implants and no additional known disabilities served as participants. Perception of feature contrasts was assessed using a modification of the Online Imitative Speech Pattern Contrast test, which uses imitation to assess speech feature perception. Production was examined by having the children name a series of pictures containing consonant and vowel segments that reflected contrasts of each feature. RESULTS: For five of the six feature contrasts, production accuracy was higher than perception accuracy. There was also a significant and positive correlation between accuracy of production and auditory perception for each consonant feature. This correlation was not found for vowels, owing largely to the overall high perception and production scores attained on the vowel features. The children perceived vowel feature contrasts more accurately than consonant feature contrasts. On average, the children had lower perception scores for Back Place and Continuance feature contrasts than for Anterior Place and Voicing contrasts. For all features, the median production scores were 100%; the majority of the children were able to accurately and consistently produce the feature contrasts. The mean production scores for features reflect greater score variability for consonant feature production than for vowel features. Back Place of articulation for back consonants and Continuance contrasts appeared to be the most difficult features to produce, as reflected in lower mean production scores for these features. CONCLUSIONS: The finding of greater production than auditory perception accuracy for five of the six features examined suggests that the children with CIs were able to produce articulatory contrasts that were not readily perceived through audition alone. Factors that are likely to play a role in the greater production accuracy in addition to audition include the lexical and phonetic properties of the words elicited, a child's phonological representation of the words and motor abilities, and learning through oro-tactile, visual, proprioceptive, and kinesthetic perception. The differences among the features examined, and between perception and production, point to the clinical importance of evaluating these abilities in children with CIs. The present findings further point to the utility of picture naming to establish a child's production accuracy, which in turn is necessary if using imitation as a measure of auditory capacity.

Assessing speech perception in children with cochlear implants using a modified hybrid visual habituation procedure.

OBJECTIVES: The objectives of this research were to determine whether an adapted version of a Hybrid Visual Habituation procedure could be used to assess speech perception of phonetic and prosodic features of speech (vowel height, lexical stress, and intonation) in individual pre-school-age children who use cochlear implants. DESIGN: Nine children ranging in age from 3;4 to 5;5 participated in this study. Children were prelingually deaf and used cochlear implants and had no other known disabilities. Children received two speech feature tests using an adaptation of a Hybrid Visual Habituation procedure. RESULTS: Seven of the nine children demonstrated perception of at least one speech feature using this procedure using results from a Bayesian linear regression analysis. At least one child demonstrated perception of each speech feature using this assessment procedure. CONCLUSIONS: An adapted version of the Hybrid Visual Habituation Procedure with an appropriate statistical analysis provides a way to assess phonetic and prosodicaspects of speech in pre-school-age children who use cochlear implants.

Inverse filtering of nasalized vowels using synthesized speech.

The present study examines the extent to which increased nasal coupling affects estimates of glottal parameters derived from inverse filtering based on an all-pole assumption of the vocal tract. A series of steady-state tokens for five Swedish vowels were synthesized using the HLsyn quasi-articulatory synthesizer (Sensimetrics, Malden, MA). For each vowel, the parameter controlling the cross-sectional area of the nasal aperture, an, was systematically varied, while the other HLsyn parameters were kept constant. The resultant pressure signal for each utterance was subsequently inverse filtered, and estimates were made of five glottal source parameters (EE, RG, RA, RK, and OQ) derived from fitting the Liljencrants and Fant source model to the inverse filtered signal. The results show that when analyzing nasalized vowels using inverse filtering based on an all-pole assumption of the vocal tract, the RA parameter estimate--a main determinant of the source spectral slope--can be adversely affected by nasal coupling. The errors in our estimates were particularly high for the high vowels: this was true not only for RA, but for all the parameters measured. However, with the exception of the distortion in the RA estimate, the effects were relatively small, regardless of the degree of nasal coupling.

The AuD Program at Gallaudet University.

Gallaudet University was among the first universities to address the American Speech-Language-Hearing Association mandate to universities to convert the entry level clinical audiology degree from a master's degree to a clinical doctoral (AuD) degree. The Gallaudet AuD program was approved in 1998 and graduated its first AuD class in 2002. The purpose of this article is to describe the Gallaudet AuD program, the process of converting from a master's program to an AuD program, the impact of converting the program, and current challenges. It is hoped that this description will be useful to those who are currently developing AuD programs.