Use of electropalatography in the treatment of speech disorders in children with Down syndrome: a randomized controlled trial.

BACKGROUND: Electropalatography (EPG) records details of the location and timing of tongue contacts with the hard palate during speech. It has been effective in treating articulation disorders that have failed to respond to conventional therapy approaches but, until now, its use with children and adolescents with intellectual/learning disabilities and speech disorders has been limited. AIMS: To evaluate the usefulness of EPG in the treatment of speech production difficulties in children and adolescents with Down syndrome (DS) aged 8-18 years. METHODS & PROCEDURES: A total of 27 children with DS were assessed on a range of cognitive and speech and language measures and underwent additional EPG assessment. Participants were randomly allocated to one of three age-matched groups receiving either EPG therapy, EPG-informed conventional therapy or 'treatment as usual' over a 12-week period. The speech of all children was assessed before therapy using the Diagnostic Evaluation of Articulation and Phonology (DEAP) and reassessed immediately post- and 3 and 6 months post-intervention to measure percentage consonants correct (PCC). EPG recordings were made of the DEAP assessment items at all time points. Per cent intelligibility was also calculated using the Children's Speech Intelligibility Measure (CSIM). OUTCOMES & RESULTS: Gains in accuracy of production immediately post-therapy, as measured by PCC, were seen for all groups. Reassessment at 3 and 6 months post-therapy revealed that those who had received therapy based directly on EPG visual feedback were more likely to maintain and improve on these gains compared with the other groups. Statistical testing showed significant differences between groups in DEAP scores across time points, although the majority did not survive post-hoc evaluation. Intelligibility across time points, as measured by CSIM, was also highly variable within and between the three groups, but despite significant correlations between DEAP and CSIM at all time points, no statistically significant group differences emerged. CONCLUSIONS & IMPLICATIONS: EPG was an effective intervention tool for improving speech production in many participants. This may be because it capitalizes on the relative strength of visual over auditory processing in this client group. The findings would seem to warrant an increased focus on addressing speech production difficulties in current therapy.

An EPG analysis of /t/ in young people with Down's syndrome.

Many studies have pointed to impaired speech intelligibility in young people with Down's syndrome (DS). Some have attributed these problems to delayed phonological development, while others have identified disordered speech patterns, which could be related to a dyspraxic element in their speech. This study uses electropalatography (EPG) to examine the speech of 25 young people with DS, focusing on their production of the obstruent /t/. For the EPG analysis, participants produced the target obstruent in the word 'toe', repeated 10 times. An investigative analysis was carried out. A new descriptive taxonomy of EPG error patterns was developed and these errors were related to perceptually based transcriptions. The measures are discussed in relation to current knowledge of the anatomical and physiological characteristics of DS.

The effectiveness of traditional methods and altered auditory feedback in improving speech rate and intelligibility in speakers with Parkinson's disease.

Communication problems are a frequent symptom for people with Parkinson's disease (PD) which can have a significant impact on their quality-of-life. Deciding on the right management approach can be problematic though, as, with the exception of LSVT, very few studies have been published demonstrating the effectiveness of treatment techniques. The aim of this study was to compare traditional rate reduction methods with altered auditory feedback (AAF) with respect to their effectiveness to reduce speech rate and improve intelligibility in speakers with PD. Ten participants underwent both types of treatments in once weekly sessions for 6 weeks. Outcomes measures were speech rate for passage reading as well as intelligibility on both a passage reading and a monologue task. The results showed that, as a group, there was no significant change in either speech rate or intelligibility resulting from either treatment type. However, individual speakers showed improvements in speech performance as a result of each therapy technique. In most cases, these benefits persisted for at least 6 months post-treatment. Possible reasons for the variable response to treatment, as well as issues to consider when planning to use AAF devices in treatment are discussed.

Relationship between speech, oromotor, language and cognitive abilities in children with Down's syndrome.

BACKGROUND: Children and young people with Down's syndrome present with deficits in expressive speech and language, accompanied by strengths in vocabulary comprehension compared with non-verbal mental age. Intelligibility is particularly low, but whether speech is delayed or disordered is a controversial topic. Most studies suggest a delay, but no studies explore the relationship between cognitive or language skills and intelligibility. AIMS: This study sought to determine whether severity of speech disorder correlates with language and cognitive level and to classify the types of errors, developmental or non-developmental, that occur in the speech of children and adolescents with Down's syndrome. METHODS & PROCEDURES: Fifteen children and adolescents with Down's syndrome (aged 9-18 years) were recruited. Participants completed a battery of standardized speech, language and cognitive assessments. The phonology assessment was subject to phonological and phonetic analyses. Results from each test were correlated to determine relationships. OUTCOME & RESULTS: Individuals with Down's syndrome present with deficits in receptive and expressive language that are not wholly accounted for by their cognitive delay. Receptive vocabulary is a strength in comparison with expressive and receptive language skills, but it was unclear from the findings whether it is more advanced compared with non-verbal cognitive skills. The majority of speech errors were developmental in nature, but all of the children with Down's syndrome showed at least one atypical or non-developmental speech error. CONCLUSIONS & IMPLICATIONS: Children with Down's syndrome present with speech disorders characterized by atypical, and often unusual, errors alongside many developmental errors. A lack of correlation between speech and cognition or language measures suggests that the speech disorder in Down's syndrome is not simply due to cognitive delay. Better differential diagnosis of speech disorders in Down's syndrome is required, allowing interventions to target the specific disorder in each individual.

A perceptual and electropalatographic study of /integral/ in young people with Down's syndrome.

Speech production in young people with Down's syndrome has been found to be variable and inconsistent. Errors tend to be more in the production of sounds that typically develop later, for example, fricatives and affricates, rather than stops and nasals. It has been suggested that inconsistency in production is a result of a motor speech deficit. Late acquired fricatives such as /s/ and /integral/ are complex articulations, which may require more precise motor programming and may therefore show highly inconsistent productions. Other factors potentially affecting speech production in this population are abnormal palatal structure, hearing loss, and hypotonia. A group of 20 young people with Down's syndrome were recorded using Electropalatography (EPG), reading a wordlist containing the phrase 'a sheep'. The wordlist contained seven other phrases and was repeated 10 times. Eight typically developing, cognitively matched children and eight adults were also recorded producing the same data set. Articulatory (EPG pattern analysis) and perceptual analyses of the 10 productions of /integral/ were carried out. /integral/ production was found to be inconsistent in the young people with Down's syndrome, with more errors both in the auditory analysis and articulatory analysis than in the typical sample, which may be due to a motor programming or motor control problem. There were a greater number of errors in the EPG analysis than in the perceptual analysis. This suggests that some young people with DS were able to produce perceptually acceptable /integral/ with atypical EPG patterns. The use of typical, adult-modelled /integral/ EPG patterns in therapy may be inappropriate for some children with DS who present with atypical palatal structures.

Electropalatographic therapy for children and young people with Down's syndrome.

Articulation disorders in Down's syndrome (DS) are prevalent and often intractable. Individuals with DS generally prefer visual to auditory methods of learning and may therefore find it beneficial to be given a visual model during speech intervention, such as that provided by electropalatography (EPG). In this study, participants with Down's syndrome, aged 10:1 to 18:9, received 24 individualized therapy sessions using EPG. Simultaneous acoustic and EPG recordings were made pre- and post-intervention during 10 repetitions of a word list containing lingua-palatal consonants. Participants also completed the DEAP phonology sub-test at both time points. Post-treatment, all participants showed qualitative and quantifiable differences in EPG patterns and improvements in DEAP percentage consonants correct. EPG assessment and therapy appears a positive approach for identifying and improving articulatory patterns in children with DS.

The use of electropalatography (EPG) in the assessment and treatment of motor speech disorders in children with Down's syndrome: evidence from two case studies.

BACKGROUND: Many children experience significant difficulties in developing key aspects of speech. For some, these communication difficulties are compounded by co-occurring intellectual disabilities. METHOD: This paper presents two case studies from a larger on-going longitudinal study of the effectiveness of using electropalatography (EPG) to address the intelligibility problems experienced by many children and young people with Down's syndrome (DS). EPG, an innovative computer-based tool for assessing and treating speech motor difficulties, enables the speaker to 'see' the placement of his or her tongue during speech and to attempt to correct any lingual palatal errors. RESULTS: This visual supplementation of auditory feedback offers potential therapeutic benefits for children with intellectual disabilities, many of whom show relative strengths in visual vs. auditory and simultaneous vs. sequential processing. EPG also provides therapists with an objective measure of articulatory ability. CONCLUSIONS: Findings from these two case studies demonstrate the potential utility of EPG in both the assessment and treatment of speech motor disorders in DS.