1. Children
with
CP
have
Smaller
Vowel
Spaces
than
their
TD
Peers
• This
finding
replicates
previous
findings
(Higgins
&
Hodge,
2001;
Hustad
et
al.,
2010)
• May
be
due
to
the
movement
deficits
observed
in
the
CP
group,
causing
decreased
intelligibility
OAI
Predicts
Acous<c
Vowel
Space
• Larger
mouth
openings
are
associated
with
greater
vowel
contrast
• Increased
vowel
contrast
improves
intelligibility
(Lee
et
al.,
2013)
Rela<onship
Between
OAI
and
Vowel
Space
Differs
Between
Children
with
CP
and
their
TD
Peers
• Changes
in
mouth
shape
have
a
more
pronounced
effect
on
vowel
contrast
in
children
with
CP
than
their
TD
peers
• Vowel
contrast
is
dependent
on
arLculatory
movements,
parLcularly
the
tongue
• Speakers
with
CP
have
reduced
tongue
control
(Rong
et
al.,
2012)
and
increased
jaw
movements
(Nip,
2012;
Rong
et
al.,
2012;
Ward
et
al.,
2013),
suggesLng
that
increased
jaw
movements
may
be
a
compensatory
strategy
• Children
with
CP
who
have
high
OAIs
can
compensate
for
reduced
tongue
control
by
making
greater
use
of
their
lips
and
jaw
• In
contrast,
children
with
CP
who
have
low
OAIs
cannot
compensate
for
the
reduced
tongue
control,
leading
to
reduced
vowel
contrast
Future
Direc<ons
• Examine
OAI
and
vowel
space
in
connected
speech
(e.g.,
sentences,
conversaLon)
• Direct
comparison
of
OAI
to
intelligibility
• Larger
number
of
parLcipants
• Examine
tongue
movement
data
INTRODUCTION
AcousLc
Changes
Due
to
Impaired
Speech
Movements
in
Children
with
Cerebral
Palsy
TaLana
Zozulya,
Lindsay
Kempf,
Alyssa
Yee,
&
IgnaLus
S.
B.
Nip
School
of
Speech,
Language,
and
Hearing
Sciences
-­‐
San
Diego
State
University
Data
Analysis
• Vowel
formant
frequencies
(F1,
F2)
were
obtained
using
TF32
(Milenkovic,
2010)
and
ploaed
(F2
by
F1)
to
obtain
acousLc
vowel
space
(Hz2)
• The
distance
between
the
upper
and
lower
lip
markers
(height)
and
the
distance
between
the
leb
and
right
corners
of
the
mouth
(width)
were
measured
at
the
midpoint
of
each
vowel.
Each
vowel
was
ploaed
(height
by
width)
to
obtain
the
oral
area
index
(OAI;
mm2)
• Repeated-­‐measures
mixed
model
was
conducted
to
evaluate
the
effect
of
Group
(CP,
TD)
and
oral
area
index
on
acousLc
vowel
space
while
controlling
for
age.
Par<cipants
• 8
children
with
CP
(2F,
7M)
and
8
age-­‐and
sex-­‐matched
typically
developing
peers
(TD;
2F,
7M),
aged
4
to
15
years
• All
parLcipants
passed
a
hearing
screening
(ASHA,
1997)
at
.5,
1,
2,
and
4
kHz
in
at
least
one
ear
Speaking
Tasks
• ParLcipants
produced
10
repeLLons
of
the
vowels
/i,
a,
u/
Data
Collec<on
• KinemaLc
recordings
from
8-­‐camera
opLcal
moLon
capture
system
(MoLon
Analysis,
Ltd.)
with
simultaneous
audio
recording
(16-­‐bit,
44.1
KHz)
• Fibeen
markers
were
placed
on
the
face
to
track
lip
and
jaw
movement
DISCUSSION
American
Speech-­‐Language-­‐Hearing
AssociaLon.
(1997).
Guidelines
for
Audiologic
Screening.
In
ASHA
PracLce
Policy.
Retrieved
February
17,
2012,
from
hap://www.asha.org/docs/html/GL1997-­‐00199.html.
Higgins,
C.M.,
&
Hodge,
M.M.
(2001).
F2/F1
vowel
quadrilateral
area
in
young
children
with
and
without
dysarthria.
Journal
of
the
Canadian
Acous6cal
Associa6on,
29
(3),
66-­‐67.
Hodge,
M.
&
Daniels,
J.
(2007).
TOCS+
Intelligibility
Measures.
Edmonton,
AB:
University
of
Alberta
Hustad,
K.C.,
Gorton,
K.,
Lee,
J.
(2010).
ClassificaLon
of
speech
and
language
profiles
in
4-­‐year-­‐old
children
with
cerebral
palsy:
a
prospecLve
preliminary
study.
Journal
of
Speech,
Language,
and
Hearing
Research,
53,
1496-­‐1513.
Hustad,
K.C.,
Schueler,
B.,
Schultz,
L.,
DuHadway,
C.
(2012)
Intelligibility
of
4-­‐Year-­‐Old
Children
With
and
Without
Cerebral
Palsy.
Journal
of
Speech,
Language,
and
Hearing
Research,
55,
1177-­‐1189.
Lee,
J.,
&
Hustad,
K.C.
(2013).
A
preliminary
invesLgaLon
of
longitudinal
changes
in
speech
producLon
over
18
months
in
young
children
with
cerebral
palsy.
US
Na6onal
Library
of
Medicine
Na6onal
Ins6tutes
of
Health,
65
(1).
Lee,
J.,
Hustad,
K.C.,
&
Weismer,
G.
(2014).
PredicLng
speech
intelligibility
with
a
mulLple
speech
subsystems
approach
in
children
with
cerebral
palsy.
Journal
of
Speech,
Language
and
Hearing
Research,
57,
1666-­‐1678.
Milenkovic,
P.
(
2002).
TF32
[Computer
soLware].
Retrieved
fromhap://userpages.chorus.net/cspeech/
Nip,
I.S.B.
(2012).
KinemaLc
characterisLcs
of
speaking
rate
in
individuals
with
Cerebral
Palsy:
A
preliminary
study.
Journal
of
Medical
Speech-­‐Language
Pathology,
20,
88-­‐94.
Nip,
I.S.B.
in
press.
InterarLculator
coordinaLon
in
children
with
and
without
cerebral
palsy.
Developmental
Neurorehabilita6on.
Parkes,
J.,
Hill,
N.,
Plaa,
J.,
&
Donnelly,
C.
(2010).
Oromotor
dysfuncLon
and
communicaLon
impairments
in
children
with
cerebral
palsy:
a
register
study.
Developmental
Medicine
&
Child
Neurology,
52
(12),
1113-­‐1119.
Plaa,
L.J.,
Andrews,
G.,
Young,
M.,
&
Qurinn,
P.T.
(1980).
Dysarthria
of
Adult
Cerebral
Palsy:
Intelligibility
and
ArLculatory
Impairment.
Journal
of
Speech,
Language,
and
Hearing
Research,
23,
28-­‐40.
Rong,
P.,
Loucks,
T.,
Kim,
H.,
Hasegawa-­‐Johnson,
M.
(2012).
RelaLonship
between
kinemaLcs,
F2
slope,
and
speech
intelligibility
in
dysarthria
due
to
cerebral
palsy.
Clinical
Linguis6cs
&
Phone6cs,
26
(9)
806-­‐822.
Semel,
E.,
Wiig,
E.
H.,
&
Secord,
W.
A.
(2003).
Clinical
Evalua6on
of
Language
Fundamentals
(4th
ed.).
San
Antonio,
TX:
PsychCorp.
Stevens,
K.
N.
(1989).
On
the
quantal
nature
of
speech.
Journal
of
Phone6cs,
17,
3–45.
Ward,
R.,
Strauss,
G.,
&
Leitao,
S.
(2013).
KinemaLc
changes
in
jaw
and
lip
control
of
children
with
cerebral
palsy
following
parLcipaLon
in
a
motor-­‐speech
(PROMPT)
intervenLon.
Interna6onal
Journal
of
Speech-­‐Language
Pathology,
15(2),
136-­‐155
Yorkston,
K.
M.,
Beukelman,
D.
R.,
Hakel,
M.,
&
Dorsey,
M.
(2007).
Speech
Intelligibility
Test
[Computer
sobware].
Lincoln,
NE:
InsLtute
for
RehabilitaLon
Science
and
Engineering
at
Madonna
RehabilitaLon
Hospital.
METHOD
Acknowledgments:
This
study
was
funded
by
NIH-­‐NIDCD
(R03-­‐DC012135),
the
American
Speech-­‐Language-­‐Hearing
Founda6on,
and
the
SDSU
University
Grants
Program.
Thank
you
to
par6cipants
and
their
families
as
well
as
Sara
Benjamin,
Amy
Boyer,
Katherine
Bristow,
Anne
Coleman,
Lauren
Coyne,
Julie
Cunningham,
Erica
J.
Greenberg,
Brennan
Hefner,
Adeena
Homampour,
Lucia
Kearney,
David
Kremp,
Anne
Merkel,
Stefanie
Opdycke,
Frances
Ramos,
Casey
Rockmore,
Grace
Si_on,
Danielle
Torrez,
Carina
Valdivieso,
and
Kris6n
Wilfon
for
their
assistance
with
data
collec6on
and
data
analysis.
Thank
you
to
Irina
Potapova
for
her
helpful
comments
on
this
poster.
Children
with
Cerebral
Palsy
have
Oral
Movement
Deficits
• Cerebral
Palsy
(CP)
is
a
group
of
disorders
caused
by
perinatal
damage
to
the
central
nervous
system
resulLng
in
movement,
sensory,
communicaLon,
and
cogniLve
impairments
(Rosenbaum
et
al.,
2007)
• Speech
difficulLes
in
children
with
CP
include:
• Oral
motor
deficits
are
present
in
half
of
this
populaLon
(Parkes
et
al.,
2010)
• Intelligibility
is
reduced
for
all
groups
of
children
with
CP
relaLve
to
typically-­‐developing
(TD)
children
(Hustad
et
al.,
2012)
Acous<c
Measure
Differences
Affect
Intelligibility
• AcousLc
measures
(F1,
F2,
vowel
duraLon)
affect
speech
intelligibility
(Lee
et
al.,
2014)
• PosiLve
correlaLon
between
intelligibility
and
vowel
space
noted
for
children
with
CP
(Lee
et
al.,
2013)
• Children
with
dysarthria
have
smaller
vowel
space
than
those
of
their
age-­‐matched
TD
peers
(Higgins
&
Hodge,
2001)
• Individuals
with
CP
produce
corner
vowels
(/i,
a,
u/)
less
accurately
due
to
impaired
movements
(Plaa
et
al.,
1980)
Impaired
Movements
Impact
the
Resultant
Acous<cs
and
Intelligibility
• Children
with
CP
who
have
dysarthria
have
markedly
reduced
speech
intelligibility
(Hustad
et
al.,
2012)
• ReducLons
of
F2
slope
and
intelligibility
in
speakers
with
CP
are
related
to
reduced
tongue-­‐Lp
displacements
(Rong
et
al.,
2012)
• Speakers
with
CP
have
increased
jaw
range
of
movement
(Nip,
2012;
Rong
et
al.,
2012)
resulLng
in
a
larger
verLcal
mouth
opening
(Ward
et
al.,
2013)
• CoordinaLon
of
arLculators
is
posiLvely
associated
with
intelligibility
in
children
with
CP
(Nip,
in
press)
Theore<cal
and
Clinical
Implica<ons
• Models
of
speech
producLon
posit
that
oral
movements
shape
the
resultant
acousLc
signal
(Stevens,
1989);
therefore
the
impaired
movements
observed
in
this
populaLon
may
negaLvely
impact
acousLc
variables,
such
as
vowel
space
• Understanding
the
relaLon
between
movement
and
acousLc
variables
may
provide
insight
for
assessments
and
intervenLons
targeLng
intelligibility
in
this
populaLon
Research
Ques<ons
• How
do
movement
characterisLcs
(oral
area
index)
relate
to
acousLc
outcomes
(vowel
space)
in
children
with
CP
and
their
age-­‐and
sex-­‐
matched
typically-­‐developing
(TD)
peers?
• Does
this
relaLonship
differ
between
children
with
CP
and
their
TD
peers?
Fig
1:
Marker
set
up
and
3-­‐D
model
of
a
parCcipant
RESULTS
Table 1: Participant demographic information
Speaker
Age
Sex
CP
Type
GMFCS
Dysarthria
Word
Intelligibility
Sentence
Intelligibility
CELF-­‐4
Std
Score
Age
of
TD
Peer
1
4;8
F
SpasLc
Quadriplegia
V
SpasLc
23%
16%
106
4;7
2
6;6
M
SpasLc
Diplegia
III
SpasLc
72%
83%
106
6;2
3
7;5
F
SpasLc
Hemiplegia
III
Mild
68%
65%
102
7;4
4
8;2
M
SpasLc
Diplegia
II
Mild
80%
72%
98
8;4
5
9;9
M
SpasLc
Hemiplegia
III
Mild
81%
66%
67
9;4
6
10;7
M
SpasLc
Quadriplegia
IV
/r/
error
85%
96%
127
10;11
7
12;4
M
SpasLc
Diplegia
II
None
91%
95%
112
13;2
8
15;0
F
SpasLc
Diplegia
II
None
82%
93%
129
15;7
Age
[F(1,
90)
=
81.78,
p
<
.001]
Group
[F(1,
90)
=
23.27,
p
<
.001],
CP
<
TD
Oral
Area
Index
[F(1,
90)
=
29.78,
p
<
.0001]
Group
x
Oral
Area
Index
=
[F(1,
92)
=
8.71,
p
<
.01]
CP
TD
Oral
Area
Index
(mm2)
24.27
(15.71)
16.47
(7.33)
Vowel
Space
(Hz2)
706483.60
(137072.23)
137072.23
(91412.38)
REFERENCES
Fig
3:
Oral
Area
Index
of
a
parCcipant
Fig
2:
Vowel
Space
triangle
of
a
parCcipant