Academic journal article Journal of Medical Speech - Language Pathology

Practice Patterns of Speech-Language Pathologists Assessing Intelligibility of Dysarthric Speech

Academic journal article Journal of Medical Speech - Language Pathology

Practice Patterns of Speech-Language Pathologists Assessing Intelligibility of Dysarthric Speech

Article excerpt

Keywords: dysarthria, intelligibility, assessment

Purpose: The purpose of this investigation was to determine the practice patterns of speech-language pathologists (SLPs) working in health care settings when assessing the speech of individuals with dysarthria.

Method: In two separate mailings, surveys were mailed to 1998 SLPs working in health care settings. The combined return rate was 16.1% (i.e., 322 of 1998). Of the 322 participants, only 195 (61%) reported working with individuals with dysarthria and completed the survey.

Results: Participants reported considering signal-dependent and signal-independent factors when assessing the speech intelligibility of a person with dysarthria. Assessment practices included a variety of communication partners and speech tasks, as well as estimates and ratings of intelligibility. Formal speech tests were used infrequently. The participants tried a variety of signal-dependent (e.g., increasing loudness) and signal-independent (e.g., considering the environment) strategies with patients with dysarthria during the assessment to improve speech intelligibility. The focus of the dynamic assessment appeared to be restorative rather than compensatory. Overall, the reported assessment practices appeared to be affected by time constraints and demands of the clinician's caseload.

INTRODUCTION

One of the prominent characteristics of the speech of individuals with dysarthria is not being understood by their listeners (Yorkston, Beukelman, Strand, & Hakel, 2010). McNeill and Light (2006) reported that many individuals with moderate to severe dysarthria choose to communicate orally because it is more functional and natural than other means of communicating. This underscores the importance of adequately assessing factors that may affect a speakers' ability to be understood by others.

The assessment of intelligibility is complicated by numerous variables that influence such ratings, including the clarity of the speaker's message, listener familiarity with the speaker and topic, and environmental factors (Kent, Miolo, & Bloedel, 1994). Assessment procedures need to be precise, dependable, and valid because they are often used to make clinical decisions about qualifying for services, treatment progress, or disease progression (Gordon-Brannan & Hodson, 2000). Yorkston, Strand, and Kennedy (1996) described the assessment of the speaking ability of individuals with dysarthria related to the speech signal in isolation as well as in context. Speech intelligibility measures typically attempt to focus on the speakers' ability to use spoken language to get their message across without the use of other types of cues or context. Comprehensibility details how well a speaker's message is understood in context (Barefoot, Bochner, Johnson, & von Eigen, 1993; Dowden, 1997; Yorkston et al., 1996). Yorkston et al. (1996) also described comprehensibility as "speech performance" in social situations because speaker, listener, and contextual variables are all considered as influential on how well a speaker's message is understood. Both types of measures have clinical significance as measures of functional communication. There is little disagreement about the importance of measuring speech intelligibility and comprehensibility for individuals with dysarthria; however, there is little agreement about the best methods to do so because a variety of options exist for both.

Measures of speech intelligibility usually attempt to control the variables outside the speech signal that can help listeners comprehend a spoken message. Thus, measures of speech intelligibility are often described as signal dependent because listeners are only provided with spoken messages that intentionally limit additional information such as contextual cues or knowing the topic. Speech intelligibility may be measured or described using a variety of methods, including transcribing speech to determine a percentage of words understood, ranking the level of intelligibility using an informal rating scale, estimating a percentage of intelligibility, or using descriptive adjectives such as "moderately intelligible" (Kent et al. …

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