Perceptual assessment - Ping-Pong

WORKSHOP 160315
Perceptual Analysis
Motor Speech Disorders
Ellika Schalling,
Division of SLP
Karolinska Institutet
14/03/2016
Ellika Schalling
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Motor Speech Disorders
Body structure
and function
(impairment)
Activity
(activitiy
limitations)
Participation
(participation
restriction)
Focus
respiration,
phonation, oralmotor function,
articulation
Prosody,
intelligibility
Communicative
participation
Assessment
Instrumental
Assessment of
methods (e g
speech
acoustic analysis) intelligibility
Clinical test
(perceptual
analysis)
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Ellika Schalling
Questionnaires
Selfevaluation…
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ASSESSMENT IN MOTOR SPEECH DISORDERS
Different approaches
Physiological analysis
Acoustic analysis
Perceptual analysis
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Perceptual approach:
Includes:
oromotor assessment
perceptual analysis of speech sample
assessment of intelligibility
(conversation and reading words and sentences)
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Oromotor assessment
(informal)
Assess each component of the oral mechanism
Cranial nerve and muscle function
Structure, size (symmetry etc)
Strenght, tone
Range, speed, accuracy
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Perceptual analysis
Trained listeners rating of how the speech sounds.
Descriptions based on defined parameters/
”symptoms”
- often rated on scale
Most used ”clinical tool” for assessment
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Perceptual analysis
Advantages:
Advanced technical equipment not needed
(although recording helps…)
Also gives information about intelligibility and about
how speech works in communication
Can be done ”online” by trained listener
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perceptual analysis
Disadvantages:
Requires training to achieve good inter- and intrarater reliability
May be perceived as subjective
No direct feedback to patients in the clinic
(terminology etc, has to be explained…)
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Measures to optimize validity:
Training of listeners
Reference samples
Consensus on definitions of speech parameters
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Perceptual analysis
Subjective listener judgement of a speech sample
Scales:
Equal-Appearing Interval Scale (EAIS)
A scale value is assigned to each speech
characteristic,
e g 1-7, 1-5, 0-4.
Visual Analog Scale (VAS)
usually 100 mm graphic scale, ratings by marking
anywhere along the line
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Good and bad:
EAIS:
 Easy to use, most commonly used
 Number of intervals may be too small to allow subtle
discriminations.
 We don’t know that speech and voice features are
perceived in equal magnitude steps.
 Listeners tend to avoid scale extremes which reduces
the scale
(Reporting agreement with plus or minus one
scale value using five-point scale with listeners
avoiding scale extremes may mean that chance
levels are unacceptably high)
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Direct Magnitude Estimation, DME:
DME – assign a value in direct relation to a
previously presented stimuli
May introduce problems with listener reliability
and comparisons between studies
May be especially suitable for rating of nasality
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Example of rating-form for perceptual assessment (VAS)
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Perceptuell parameter
Förekommer Förekommer Förekommer Förekommer i
inte
i liten grad
i måttlig grad hög grad
FONATION
Skrap/knarr
Instabil röst
läckage
press
tremor
ARTIKULATION
Oprecisa konsonanter
Oprecisa vokaler
PROSODI
Monotoni
Förlängda fonem
Förlängda pauser
Korta fraser
Utjämnad betoning
NASALERING
Hyponasal klang
Hypernasal klang
Blandad nasalering
TILLÄGG
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Exemples of perceptual
symptoms (MSD)
respiration:
Short phrases
Audible inspiration
”Grunts” (at the end of expiration)
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Exemples of perceptual
symptoms (MSD), cont’d
Phonation:
Breathy voice
Strained-strangled voice
Change in pitch level
Voice tremor
Pitch breaks
Harsh voice
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Exemples of perceptual
symptoms (MSD), cont’d
Velopharyngeal system:

Hypernasality

Hyponasality

Nasal emission
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Exemples of perceptual
symptoms (MSD), cont’d
Articulatory system:
Imprecise consonants
Distorted vowels
Prolonged phonemes
Irregular articulatory breakdown
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38 speech dimensions/characteristics (Darley et al.)
Phonatory and respiratory system:
pitch level
pitch breaks
monopitch
voice tremor
monoloudness
excess loudness variation
loudness decay
alternating loudness
loudness (overall)
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38 speech dimensions, cont’d
Phonatory and respiratory system:
harsh voice
hoarse (wet) voice
breathy voice (continous)
breathy voice (transient)
strained-strangled voice
voice stoppages
forced inspiration-expiration
audible inspiration
grunt at the end of expiration
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38 speech dimensions, cont’d
Articulatory system:
rate
short phrases
increased rate per segments
increase of rate overall
reduced stress
variable rate
prolonged intervals
inappropriate silence
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38 speech dimensions, cont’d
Articulatory system
short rushes of speech
excess and equal stress
imprecise consonants
prolonged phonemes
phonemes repeated
irregular articulatory breakdown
distorted vowels
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38 speech dimensions, cont’d
Velopharyngeal system:
hypernasality
hyponasality
nasal emission
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38 speech dimensions, cont’d
Overall impression:
intelligibility (overall)
bizarreness (overall)
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Speech sample for perceptual assessment
 Sustained /a/ (voice quality)
 Sentences (articulation)
 Repetition of syllables (AMR/SMR):
/pa-pa-pa/, /ta-ta-ta/, /ka-ka-ka/, /pa-ta-ka/
 Paragraph for text-reading (perceptual analysis, speech rate)
 Spontaneous speech sample (perceptual analysis, speech rate)
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Ett svårt fall
Ett svårt fall
En pojke kom en dag inspringande på en bondgård och undrade,
om han kunde få låna en spade. När bonden frågade, vad han
skulle ha den till, svarade pojken att hans bror hade ramlat i ett
träsk och att han måste gräva upp honom.
- Hur djupt har han ramlat i? frågade bonden.
- Upp till vristerna, blev svaret.
- Men då han han väl gå därifrån utan din hjälp. Då behöver du väl
ingen spade?
Pojken såg förtvivlad ut och sa:
- Jo, men ni förstår, han ramlade i med huvet först
No. of words = 89
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Time = 30-40 secs
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Paragraph for reading aloud
Eg: Grandfather passage:
You wish to know all about my grandfather. Well, he is nearly
ninety years old, yet he still thinks as swiftly as ever. He
dresses himself in an old black frock coat, usually several
buttons missing. A long beard clings to his chin, giving those
who observe him a pronounced feeling of the utmost
respect. Twice each day he plays skillfully and with zest
upon a small organ. Except in the winter when the snow or
ice prevents, he slowly takes a short walk in the open air
each day. We have often urged him to walk more and
smoke less, but he always answers, “Banana oil!”.
Grandfather likes to be modern in his language.
No. of words = 115
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Time = 35-45 secs
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”Ett svårt fall”
Not sufficient demands on:
- Articulation
- Speech breathing
- prosody
- endurance
… hence, the need for a new text to elicit speech
samples for assessment of MSD
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Ny text för bedömning av röst och tal:
From farm to circus.
Construction of a text for reading aloud for assessment of
voice and speech function and speech breathing
(Morris och Zetterman, 2011)
Based on following criteria:
(with reference to ”the Caterpillar” Patel et al., 2010)
Text with a complete phonological inventory, articulatory
sequencing with different levels of difficulty, consonant clusters,
diadochokinesis, repetitions
Increased demands on speech breathing (phrases of
varying lenght)
Larger prosodic variation
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The Caterpillar:
A Novel Reading Passage for Assessment of Motor Speech Disorders
Do you like amusement parks? Well, I sure do. To amuse myself, I went
twice last spring. My most memorable moment was riding on the
Caterpillar, which is a gigantic rollercoaster high above the ground. When
I saw how high the Caterpillar rose into the bright blue sky I knew it was
for me. After waiting in line for thirty minutes, I made it to the front where
the man measured my height to see if I was tall enough. I gave the man
my coins, asked for change, and jumped on the cart. Tick, tick, tick, the
Caterpillar climbed slowly up the tracks. It went SO high I could see Lake
Michigan. Boy was I SCARED! I thought to myself, “There’s no turning
back now.” People were so scared they screamed as we swiftly zoomed
fast, fast, and faster along the tracks. As quickly as it started, the
Caterpillar came to a stop. Unfortunately, it was time to pack the car and
drive home. That night I dreamt of the wild ride on the Caterpillar. Taking
a trip to the amusement park and riding on the Caterpillar was my MOST
memorable moment ever!
~ Patel,Cleveland,Edsall,Olsen,Ramage,Tyler,Russell ~
Innehåll
Fonologi
Struktur
Kravspecifikation
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meningslängd:
Varierad, med både korta och långa meningar. Genomsnittlig meningslängd
ej längre än befintliga texters
interpunktion:
Två långa meningar avsedda att utmana talandningen; en som inte inbjuder
till pausering, en som har många pausmöjligheter
ordlängd:
Varierad, med stavelsemässigt korta, medellånga och långa (>6 tecken) ord
läsbarhetsindex (LIX):
30-40 lättläst, motsvarande skönlitteratur, populärtidningar
textens längd:
samtliga svenska fonem:
Jämförbar med ”The Caterpillar”
17 vokalfonem, 4 sänkta allofoner, och allofon för obetonad vokal samt 18
konsonanter och 5 supradentaler
konsonantkluster:
Samtliga initiala trekonsonantkluster. God representation av övriga initiala,
mediala och finala kluster
diadochokinesi:
Ett multiflerstavigt ord motsvarande pataka, exempelvis ”tekopp”
annan komplex art.:
Artikulatoriskt komplexa ord och ordserie med ökad ordlängd, exempelvis
katt, kattmat, kattmatsburk
repetition:
Flerfaldig upprepning av en och samma sekvens, t ex ” hjälp, hjälp, hjälp”
resonans:
En mening med tryckstarka orala ljud, samt en mening med samtliga nasaler
prosodi:
Ord med varierande betoningsmönster, olika satstyper: påstående, fråga,
utrop. För att testa röstaspekter och pragmatiska aspekter
tidlöst:
I tema och ordval, allmängiltig. Köns- åldersneutral
läsnivå:
emotionell nivå:
Motsvarande årskurs 6
Exempelvis spänning, överraskning, besvikelse, för att testa röstaspekter
och pragmatiska aspekter
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New text ”The circus” was constructed based on the criteria
Analysis with reference to specifications
Tested on 34 healthy speakers
Revised, based on the analysis of healthy speakers
E g, exclusion of words like ”manegen”,
”trippelsaltomortal”
New version: ”The trapeze artist”
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Trapetskonstnären
Cirkusen var i stan. Förtjust tittade jag på affischen med
en flygande trapetskonstnär. Morfar böjde sig mot mig:
– Vill du gå på cirkus?
– Får jag det? Tack, tack, tack!
På ängen hade man rest ett enormt tält.
Vi var först i kön och fick platserna längst fram.
När ljuset dämpades spratt jag till av förväntan.
Orkestern spelade upp och föreställningen började.
Nummer efter nummer följde: farliga tigrar, jonglörer,
ormmänniskor, strutsar, magiker, svärdslukare,
spjutkastare och sjölejon som skvätte vatten på
publiken.
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Trapetskonstnären, forts
Höjdpunkten kom när cirkusdirektören presenterade
trapetskonstnärens nummer. Utan säkerhetslina skulle
hon göra en trippelvolt högt uppe under taket. Hon tog
fart och kastade sig ut. Graciöst voltade hon genom luften
men när hon greppade den andra trapetsen trodde vi
allihop att hon skulle tappa taget. Någon skrek:
Hon faller!
I sista ögonblicket lyckades hon klamra sig fast.
Stort jubel utbröt.
Dagen efter hade cirkusen dragit vidare och ängen
var tom. Kvar fanns bara ett minne för livet.
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Norms for speech rate, n=100 (from the Dysarthria test, 2015)
(based on Johansson & Samuelsson, 2012)
”Ett svårt fall”
”Trapetskonstnären”
Standard deviation Mean
Standard deviation
Group
Mean
Younger women
187,07
29,01
131,33
17,69
Younger men
180,00
11,20
127,47
9,59
Middle age
women
Middle age men
168,27
13,77
121,67
11,88
182,07
20,20
132,60
12,47
Older women
154,65
17,89
111,50
10,35
Older men
169,05
32,07
121,95
19,01
Total
172,35
24,58
123,65
15,60
Validation of the text ”The trapeze artist”
- Validation of the text “the Trapeze Artist"
- Analysis of reading
aloud by people with motor speech disorders and healthy
control subjects
(Gauding och Wesselhof, 2014)
Validated on 43 speakers with mild-moderate or moderate-severe motor
speech disorders + 10 neurologically healthy controls.
Studied with regards to:
- Articulation rate
- Phrase length
- Misarticulation
- Pauses
-Placement of breathing in the longest speech phrase of the sentence
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Validation of the text ”The trapeze artist”
Differences between speakers with moderate-severe MSD and
other speakers regarding all speech parameters (articulation
rate, phrase-length, misarticulations, pauses)
 More misarticulations for individuals with mild-moderate MSD
compared to controlls
 Speakers with MSD inhaled more often in the longest phrase
compared to healthy speakers
 Conclusions: The text has good validity, is more demanding
with regards to articulatory complexity and speech breathing
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Validation of the text ”The trapeze artist”
Ett svårt fall versus Trapetskonstnären: Comparison
between different groups of speakers’ performance in
paragraph reading of two texts
(Jansson, 2015)
Spekers diagnosed with stuttering, acquired apraxia of
speech, cervical spinal cord injury and hypokinetic
dysarthria, (experimental group, 21 participants)
And speakers with no speech or breathing impairment
(controls, 11 participants)
Performance in different groups regarding phrase length,
articulation rate, misarticulations and pauses?
Comparisons between The trapeze artist and ”Ett svårt fall”
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Validation of the text ”The trapeze artist”
Speakers in the experimental group:
 Significantly lower articulation rate
 Higher number of misarticulations compared to the controls
(both texts)
 Speakers with acquired apraxia of speech had lower
speech rate, more misarticulations and took more pauses
(both texts)
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Comparison between the experimental group
and the contol group
Trapetskonstnären
22,5
Experimentgruppen
Kontrollgruppen
18,3
12,6*
9,6*
6,00
4,0
4,6
4,4
FRASLÄNGD ARTIKULATIONSTEMPO FELLÄSNINGAR
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PAUSER
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Comparison between the experimental group
and the contol group
Ett svårt fall
27,4
19,6 *
8,9*
5,2
8,0
6,5
4,7
4,7
FRASLÄNGD ARTIKULATIONSTEMPO FELLÄSNINGAR
Experimentgruppen
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Ellika Schalling
PAUSER
Kontrollgruppen
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Conclusions:
”the trapeze artist” – more articulatorily demanding (more
misarticulations). Considered to have good content validity
Differences could be shown between the experimental group
and the control group
Only the group with acquired apraxia of speech could be
separated from other groups with MSD in the experimental
group based on the analysis
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Perceptual assessment
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Study of perceptual assessment with different
levels of detail
Background:
- Perceptual assessment – common clinical tool.
- Time consuming to perform detailed perceptual
assessment.
- Critique of reliability, validity and diagnostic precision
(e g Kent, 1996; Zyski & Weisiger, 1987)
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Method:
”detailed protocol” (30 dimensions, based on DAB)
”overal protocol” (5 domains)
Twenty speakers with dysarthria, rated with both
protocols by five SLPs with long experience with
MSD
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Domain
0
No
deviaiton
1
Mild
deviation
2
Moderate
deviation
3
Severe
deviation
Overall degree of
deviation
articulation
Resonance
Prosody
Phonation and
respiration
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0
detailed protocol
1
2
3
övergripande grad av avvikelse
Allmänt intryck av talet
Röst och andning
Sänkt röstläge
Förhöjt röstläge
Instabilt röstläge
Tremor
Svag röststyrka
Stark röststyrka
Varierande röststyrka
osv…..
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Results:
Perceptual symptoms were identified within the same
domains with ”the overall protocol” (but no specific
information about perceptual characteristica)
Higher inter- and intrarater reliability with the overell
protocol
Conclusion:
Overall protocol is suffient for identification of problem
areas and degree of severity, but has to be
complemented with specific descrition of sympomts
and rating of intelligibility
(Wannberg, Schalling & Hartelius, 2015)
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