Feature-driven classification reveals potential comorbid subtypes within childhood apraxia of speech.

BACKGROUND: Childhood apraxia of speech (CAS) is a neurodevelopmental disorder with heterogeneous communication and other comorbid manifestations. While previous studies have characterized speech deficits associated with CAS, few studies have examined variability in reading and language and/or other developmental comorbidities. We sought to identify comorbid subgroups within CAS that could be clinically relevant as well as genetically distinctive. METHODS: In a group of 31 children with CAS and 8 controls, we performed hierarchical cluster analysis utilizing measures of articulation, vocabulary, and reading. We also conducted a chart review of the children with CAS to examine other clinical characteristics in these children and their association with subgroup membership. RESULTS: We identified 3 comorbid subgroups within CAS of varying severity. The high severity subgroup was characterized by poor reading and vocabulary, and the moderate severity subgroup by poor reading and non-word repetition but average vocabulary, compared to the mild severity subgroup. Subgroups were indistinguishable with respect to speech sound production, the hallmark of CAS, all demonstrating poor articulation. Children in the most severe subgroup were more likely to have early problems feeding (p = 0.036). CONCLUSIONS: Children with CAS may potentially be classified into comorbidity groups based on performance on vocabulary and reading measures, providing additional insight into the heterogeneity within CAS with implications for educational interventions.

Data-driven subclassification of speech sound disorders in preschool children.

PURPOSE: The purpose of the study was to determine whether distinct subgroups of preschool children with speech sound disorders (SSD) could be identified using a subgroup discovery algorithm (SUBgroup discovery via Alternate Random Processes, or SUBARP). Of specific interest was finding evidence of a subgroup of SSD exhibiting performance consistent with atypical speech motor control. METHOD: Ninety-seven preschool children with SSD completed speech and nonspeech tasks. Fifty-three kinematic, acoustic, and behavioral measures from these tasks were input to SUBARP. RESULTS: Two distinct subgroups were identified from the larger sample. The 1st subgroup (76%; population prevalence estimate = 67.8%-84.8%) did not have characteristics that would suggest atypical speech motor control. The 2nd subgroup (10.3%; population prevalence estimate = 4.3%-16.5%) exhibited significantly higher variability in measures of articulatory kinematics and poor ability to imitate iambic lexical stress, suggesting atypical speech motor control. Both subgroups were consistent with classes of SSD in the Speech Disorders Classification System (SDCS; Shriberg et al., 2010a). CONCLUSION: Characteristics of children in the larger subgroup were consistent with the proportionally large SDCS class termed speech delay; characteristics of children in the smaller subgroup were consistent with the SDCS subtype termed motor speech disorder-not otherwise specified. The authors identified candidate measures to identify children in each of these groups.

Physics-based deformable tongue visualization.

In this paper, a physics-based framework is presented to visualize the human tongue deformation. The tongue is modeled with the Finite Element Method (FEM) and driven by the motion capture data gathered during speech production. Several novel deformation visualization techniques are presented for in-depth data analysis and exploration. To reveal the hidden semantic information of the tongue deformation, we present a novel physics-based volume segmentation algorithm. This is accomplished by decomposing the tongue model into segments based on its deformation pattern with the computation of deformation subspaces and fitting the target deformation locally at each segment. In addition, the strain energy is utilized to provide an intuitive low-dimensional visualization for the high-dimensional sequential motion. Energy-interpolation-based morphing is also equipped to effectively highlight the subtle differences of the 3D deformed shapes without any visual occlusion. Our experimental results and analysis demonstrate the effectiveness of this framework. The proposed methods, though originally designed for the exploration of the tongue deformation, are also valid for general deformation analysis of other shapes.

Consonant accuracy after severe pediatric traumatic brain injury: a prospective cohort study.

PURPOSE: The authors sought to describe longitudinal changes in Percentage of Consonants Correct-Revised (PCC-R) after severe pediatric traumatic brain injury (TBI), to compare the odds of normal-range PCC-R in children injured at older and younger ages, and to correlate predictor variables and PCC-R outcomes. METHOD: In 56 children injured between age 1 month and 11 years, PCC-R was calculated over 12 monthly sessions beginning when the child produced ≥ 10 words. At each session, the authors compared odds of normal-range PCC-R in children injured at younger (≤ 60 months) and older (> 60 months) ages. Correlations were calculated between final PCC-R and age at injury, injury mechanism, gender, maternal education, residence, treatment, Glasgow Coma Score, and intact brain volume. RESULTS: PCC-Rs varied within and between children. Odds of normal-range PCC-R were significantly higher for the older than for the younger group at all sessions but the first; odds of normal-range PCC-R were 9 to 33 times higher in the older group in sessions 3 to 12. Age at injury was significantly correlated with final PCC-R. CONCLUSION: Over a 12-month period, severe TBI had more adverse effects for children whose ages placed them in the most intensive phase of PCC-R development than for children injured later.

Distinct developmental profiles in typical speech acquisition.

Three- to five-year-old children produce speech that is characterized by a high level of variability within and across individuals. This variability, which is manifest in speech movements, acoustics, and overt behaviors, can be input to subgroup discovery methods to identify cohesive subgroups of speakers or to reveal distinct developmental pathways or profiles. This investigation characterized three distinct groups of typically developing children and provided normative benchmarks for speech development. These speech development profiles, identified among 63 typically developing preschool-aged speakers (ages 36-59 mo), were derived from the children's performance on multiple measures. These profiles were obtained by submitting to a k-means cluster analysis of 72 measures that composed three levels of speech analysis: behavioral (e.g., task accuracy, percentage of consonants correct), acoustic (e.g., syllable duration, syllable stress), and kinematic (e.g., variability of movements of the upper lip, lower lip, and jaw). Two of the discovered group profiles were distinguished by measures of variability but not by phonemic accuracy; the third group of children was characterized by their relatively low phonemic accuracy but not by an increase in measures of variability. Analyses revealed that of the original 72 measures, 8 key measures were sufficient to best distinguish the 3 profile groups.

Perception and production of /r/ allophones improve with hearing from a cochlear implant.

Tongue shape can vary greatly for allophones of /r/ produced in different phonetic contexts but the primary acoustic cue used by listeners, lowered F3, remains stable. For the current study, it was hypothesized that auditory feedback maintains the speech motor control mechanisms that are constraining acoustic variability of F3 in /r/; thus the listener's percept remains /r/ despite the range of articulatory configurations employed by the speaker. Given the potential importance of auditory feedback, postlingually deafened speakers should show larger acoustic variation in /r/ allophones than hearing controls, and auditory feedback from a cochlear implant could reduce that variation over time. To test these hypotheses, measures were made of phoneme perception and of production of tokens containing /r/, stop consonants, and /r/+stop clusters in hearing controls and in eight postlingually deafened adults pre- and postimplant. Postimplant, seven of the eight implant speakers did not differ from the control mean. It was also found that implant users' production of stop and stop+/r/ blend improved with time but the measured acoustic contrast between these was still better in the control speakers than for the implant group even after the implant users had experienced a year of improved auditory feedback.

Effects of short- and long-term changes in auditory feedback on vowel and sibilant contrasts.

PURPOSE: To assess the effects of short- and long-term changes in auditory feedback on vowel and sibilant contrasts and to evaluate hypotheses arising from a model of speech motor planning. METHOD: The perception and production of vowel and sibilant contrasts were measured in 8 postlingually deafened adults prior to activation of their cochlear implant speech processors, 1 month postactivation, and 1 year postactivation. Measures were taken postactivation both with and without auditory feedback. Contrast measures were also made for a group of speakers with reportedly normal hearing speaking with masked and unmasked auditory feedback. RESULTS: Vowel and sibilant contrasts, measured in the absence of auditory feedback after 1 month of prosthesis use, were diminished compared with their values measured before prosthesis. Contrasts measured in the absence of auditory feedback after 1 year's experience with the prosthesis were increased compared with their values after 1 month's experience. In both time samples, contrasts were enhanced when auditory feedback was restored. CONCLUSION: The provision of prosthetic hearing to postlingually deafened adults impaired their phonemic contrasts at first, as their auditory feedback had novel characteristics. Once auditory feedback became recalibrated with prosthesis use, it could, in turn, revise feedforward commands that control the contrasts in its absence.

Interactions of speaking condition and auditory feedback on vowel production in postlingually deaf adults with cochlear implants.

This study investigates the effects of speaking condition and auditory feedback on vowel production by postlingually deafened adults. Thirteen cochlear implant users produced repetitions of nine American English vowels prior to implantation, and at one month and one year after implantation. There were three speaking conditions (clear, normal, and fast), and two feedback conditions after implantation (implant processor turned on and off). Ten normal-hearing controls were also recorded once. Vowel contrasts in the formant space (expressed in mels) were larger in the clear than in the fast condition, both for controls and for implant users at all three time samples. Implant users also produced differences in duration between clear and fast conditions that were in the range of those obtained from the controls. In agreement with prior work, the implant users had contrast values lower than did the controls. The implant users' contrasts were larger with hearing on than off and improved from one month to one year postimplant. Because the controls and implant users responded similarly to a change in speaking condition, it is inferred that auditory feedback, although demonstrably important for maintaining normative values of vowel contrasts, is not needed to maintain the distinctiveness of those contrasts in different speaking conditions.

Time course of speech changes in response to unanticipated short-term changes in hearing state.

The timing of changes in parameters of speech production was investigated in six cochlear implant users by switching their implant microphones off and on a number of times in a single experimental session. The subjects repeated four short, two-word utterances, /dV1n#SV2d/ (S = /s/ or /S/), in quasi-random order. The changes between hearing and nonhearing states were introduced by a voice-activated switch at V1 onset. "Postural" measures were made of vowel sound pressure level (SPL), duration, F0; contrast measures were made of vowel separation (distance between pair members in the formant plane) and sibilant separation (difference in spectral means). Changes in parameter values were averaged over multiple utterances, lined up with respect to the switch. No matter whether prosthetic hearing was blocked or restored, contrast measures for vowels and sibilants did not change systematically. Some changes in duration, SPL and F0 were observed during the vowel within which hearing state was changed, V1, as well as during V2 and subsequent utterance repetitions. Thus, sound segment contrasts appear to be controlled differently from the postural parameters of speaking rate and average SPL and F0. These findings are interpreted in terms of the function of hypothesized feedback and feedforward mechanisms for speech motor control.

On the structure of phoneme categories in listeners with cochlear implants.

PURPOSE: To describe cochlear implant users' phoneme labeling, discrimination, and prototypes for a vowel and a sibilant contrast, and to assess the effects of 1 year's experience with prosthetic hearing. METHOD: Based on naturally produced clear examples of "boot," "beet," "said," and "shed" by 1 male and 1 female speaker, continua with 13 stimuli were synthesized for each contrast. Seven hearing controls labeled those stimuli and assigned them goodness ratings, as did 7 implant users at 1-month postimplant. One year later, these measures were repeated, and within category discrimination, d', was assessed. RESULTS: Compared with controls, implant users' vowel and sibilant labeling slopes were substantially shallower but improved over 1 year of prosthesis use. Their sensitivity to phonetic differences within phoneme categories was about half that of controls. The slopes of their goodness rating functions were shallower and did not improve. Their prototypes for the sibilant contrast (but not the vowels) were closer to one another and did not improve by moving apart. CONCLUSIONS: Implant users' phoneme labeling and within-category perceptual structure were anomalous at 1-month postimplant. After 1 year of prosthesis use, phoneme labeling categories had sharpened but within category discrimination was well below that of hearing controls.

Effects of masking noise on vowel and sibilant contrasts in normal-hearing speakers and postlingually deafened cochlear implant users.

The role of auditory feedback in speech production was investigated by examining speakers' phonemic contrasts produced under increases in the noise to signal ratio (N/S). Seven cochlear implant users and seven normal-hearing controls pronounced utterances containing the vowels /i/, /u/, /e/ and /ae/ and the sibilants /s/ and /I/ while hearing their speech mixed with noise at seven equally spaced levels between their thresholds of detection and discomfort. Speakers' average vowel duration and SPL generally rose with increasing N/S. Average vowel contrast was initially flat or rising; at higher N/S levels, it fell. A contrast increase is interpreted as reflecting speakers' attempts to maintain clarity under degraded acoustic transmission conditions. As N/S increased, speakers could detect the extent of their phonemic contrasts less effectively, and the competing influence of economy of effort led to contrast decrements. The sibilant contrast was more vulnerable to noise; it decreased over the entire range of increasing N/S for controls and was variable for implant users. The results are interpreted as reflecting the combined influences of a clarity constraint, economy of effort and the effect of masking on achieving auditory phonemic goals-with implant users less able to increase contrasts in noise than controls.