Keiko Ishikawa

Fine Motor Function and Oral-Motor Imitation Skills in Preschool-Age Children With Speech-Sound Disorders

Preschool-aged children with speech-sound disorders may be at risk for associated deficits in fine motor function. The objectives of this study were 2-fold: (1) to determine whether abnormalities in fine motor function could be detected in 2- to 5-year-old children with speech-sound disorders and (2) to determine whether there was a correlation between abnormal oral-motor imitation skills and abnormal fine motor function. Thirty-two children with speech-sound disorders (6 female, 26 male) were prospectively evaluated from July 2003 to July 2005, and the Peabody Developmental Motor Scales and the Kaufman Speech Praxis Test for Children were administered. The presence of abnormal oral-motor imitation skills as measured by the Kaufman Speech Praxis Test was associated with below-average fine motor performance. This finding has important implications for evaluation and treatment of preschool children with severe speech-sound disorders.

Inhibitory effects of hepatocyte growth factor and interleukin-6 on transforming growth factor-beta1 mediated vocal fold fibroblast-myofibroblast differentiation.

Objectives The role of myofibroblasts in vocal fold scarring has not been extensively studied, partly because of the lack of a robust in vitro model. The objective of this investigation was to develop and characterize a myofibroblast in vitro model that could be utilized to investigate the molecular mechanism of myofibroblast differentiation and function in injured vocal fold tissue. Methods Differentiation of human primary vocal fold fibroblasts (hVFFs) to myofibroblasts was stimulated with 5, 10, or 20 ng/mL of recombinant transforming growth factor-β1 (TGF-β1). Cultures were analyzed by immunofluorescence and Western blotting, with an α-smooth muscle actin (α-SMA) antibody used as a myofibroblast marker. Normal rabbit vocal folds were treated with 10 ng/mL of TGF-β1 for 7 days for in vivo corroboration. The effects of interleukin-6 (IL-6) and hepatocyte growth factor (HGF) on myofibroblast differentiation were studied with Western blots. Results The hVFFs demonstrated positive α-SMA labeling in cells stimulated by 10 and 20 ng/mL TGF-β1, indicating that hVFFs were capable of differentiation to myofibroblasts. Transforming growth factor—β1 induced the largest increase in α-SMA at 10 ng/mL on day 5 of treatment. Both HGF and IL-6 suppressed the expression of TGF-β1—induced α-SMA. Conclusions Our work characterizes a useful in vitro model of TGF-β1—mediated vocal fold fibroblast-myofibroblast differentiation. The extent of differentiation appears to be attenuated by HGF, suggesting a potential mechanism to support prior work indicating that HGF plays a protective role in reducing scar formation in vocal fold injuries. Paradoxically, IL-6, which has been shown to play a profibrotic role in dermal studies, also attenuated the TGF-β1 response.

Voice Rest versus Exercise: A Review of the Literature

Voice rest is commonly prescribed after vocal fold surgery to promote wound healing of the vocal fold. Currently, there is no standard protocol that is established based on biological evidence. In orthopedic rehabilitation, long-term rest is found to be less effective for connective tissue healing than exercise. Connective tissue healing is also an important factor for successful voice rehabilitation; however, whether this concept can be extrapolated to voice rehabilitation is unknown. The purpose of this article is to review current clinical and basic science literature to examine the effect of voice rest in postsurgical rehabilitation. First, we present a summary of clinical literature that pertains to voice rest. Second, we present description of connective tissues that are involved in orthopedic and voice rehabilitation, specifically, ligament and lamina propria, respectively, and their wound healing process. Third, a summary of the literature from orthopedic research on the effect of rest versus exercise is presented. Lastly, it summarizes in vitro and in vivo studies that examined the effect of mechanical stress on vocal fold tissue. Current literature suggests that there is a lack of clinical evidence that supports a specific type and duration of voice rest, and extrapolation of the findings from orthopedic research may be unreasonable due to the morphological and biochemical difference between the tissues. To determine the effect of voice rest, further elucidation of vocal fold wound healing process and the effect of mechanical stress on vocal fold tissue remodeling are needed.

Results of the Sensory Profile in Children with Suspected Childhood Apraxia of Speech

Speech-sound disorders are common in preschool-age children, and are characterized by difficulty in the planning and production of speech sounds and their combination into words and sentences. The objective of this study was to review and compare the results of the Sensory Profile (12) in children with a specific type of speech-sound disorder, childhood apraxia of speech (CAS), and to explore the relationship between sensory processing and sound-production deficits. Participants were identified prospectively through an interdisciplinary apraxia clinic at a tertiary care pediatric hospital, and results of the Sensory Profile were compiled and reviewed. Thirty-eight children aged 3 to 10 years with suspected CAS were evaluated from July 2003 to July 2005. The results of the Sensory Profile indicated a difference for these children in several factor clusters when compared to typical peers from the normative population of the Sensory Profile. These findings imply that children with suspected CAS may present with differences in sensory processing in addition to speech impairment. When present, these differences in sensory processing could be addressed with specific therapeutic approaches through occupational therapy or consultation with an occupational therapist.

The Effect of Background Noise on Intelligibility of Dysphonic Speech.

Purpose The aim of this study is to determine the effect of background noise on the intelligibility of dysphonic speech and to examine the relationship between intelligibility in noise and an acoustic measure of dysphonia: cepstral peak prominence (CPP). Method A study of speech perception was conducted using speech samples from 6 adult speakers with typical voice and 6 adult speakers with dysphonia. Speech samples were presented to 30 listeners with typical hearing in 3 noise conditions: quiet, signal-to-noise ratio (SNR)+5, and SNR+0. Intelligibility scores were obtained via orthographic transcription as the percentage of correctly identified words. Speech samples were acoustically analyzed using CPP, and the correlation between the CPP measurements and intelligibility scores was examined. Results The intelligibility of both typical and dysphonic speech was reduced as the level of background noise increased. The reduction was significantly greater in dysphonic speech. A strong correlation was noted between CPP and intelligibility score at SNR+0. Conclusions Dysphonic speech is relatively harder to understand in the presence of background noise as compared with typical speech. CPP may be a useful predictor of this intelligibility deficit. Future work is needed to confirm these findings with a larger number of speakers and speech materials with known predictability.

Toward clinical application of landmark-based speech analysis: Landmark expression in normal adult speech

The goal of clinical speech analysis is to describe abnormalities in speech production that affect a speakers intelligibility. Landmark analysis identifies abrupt changes in a speech signal and classifies them according to their acoustic profiles. These acoustic markers, called landmarks, may help describe intelligibility deficits in disordered speech. As a first step toward clinical application of landmark analysis, the present study describes expression of landmarks in normal speech. Results of the study revealed that syllabic, glottal, and burst landmarks consist of 94% of all landmarks, and suggest the effect of gender needs to be considered for the analysis.

Predicting Intelligibility Deficit in Dysphonic Speech with Cepstral Peak Prominence

Objectives: The aim of this study was to examine the potential of cepstral peak prominence (CPP) for predicting the intelligibility deficit in dysphonic speech. Methods: Sentences from Hearing-in-Noise Test were recorded from 18 speakers with dysphonia and 18 speakers with normal voice. These samples were presented to 60 adults with normal hearing in quiet and noise at signal to noise ratio of +0 dB. Intelligibility was measured by orthographic transcription. Cepstral peak prominence was measured for all samples. Correlation between CPP and intelligibility score was examined. Results: Intelligibility was significantly lower in dysphonic speech than normal speech in the presence of background noise. The correlation between CPP and intelligibility score was moderate when the intelligibility scores were averaged per speaker. Conclusions: Cepstral peak prominence only moderately predicts intelligibility deficit in dysphonic speech. Accordingly, CPP alone is not sufficient for describing the deficit.

Predicting intelligibility of dysphonic speech with automatic measurement of vowel related parameters

Speakers with dysphonia frequently report difficulty with being understood in noisy places. Perception of vowels plays an important role in intelligibility. Dysphonic speech is typically characterized both by shorter periodic intervals and an increased proportion of noise vs. harmonic components, potentially obscuring acoustic cues for identification of vowels. This study examined whether vowel-related acoustic measures would predict intelligibility of dysphonic speech. Sentences from the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) were recorded from 18 dysphonic speakers (6 adult females, 6 adult males, and 6 children) and 3 normal speakers (1 adult female, 1 adult male, and 1 child). These sentences were analyzed acoustically by SpeechMark® Wavesurfer plug-in version, a speech analysis tool based on the landmark theory of speech perception. The sentences were presented to 45 listeners for perceptual rating of intelligibility at 3 S/N ratios. The following output parameters were compared: ...

Automated screening for speech disorders using acoustic landmark detection

Most children effortlessly learn how to coordinate movements for normal speech production. About one in twelve preschool-aged children, however, show delays in speech production capability that may put them at risk for academic and behavioral difficulties, if not identified and treated. Automated tools that can distinguish between children with and without speech and language impairments could serve as a useful clinical tool for early identification of speech related disorders in young children. In this study, we consider measures based on detecting sequences of acoustic landmarks characteristic of normal speech production over multisyllabic words and continuous speech samples. Ten normal adults, ten typical children and ten with speech disorders recorded twenty multisyllabic words and thirty-three sentences. Acoustic landmarks patterns within utterances and syllabic clusters are examined to characterize differences in landmark sequences between normal and disordered speech. Shannon’s Entropy and ROC anal...

Application of laryngeal landmarks for characterization of dysphonic speech

Dysphonia is often a result of laryngeal pathology, which elicits greater aperiodicity and instability in a speech signal. These acoustic abnormalities likely contribute to the intelligibility deficit reported by speakers with dysphonia. Acoustic analysis is commonly used in dysphonia evaluation; however, currently available algorithms focus on describing aspects of the signal that are relevant to perception of voice quality. Signal abnormalities contributing to the intelligibility deficit may be better described by a linguistically-motivated approach. One such approach, landmark-based analysis describes a speech signal with acoustic markers that are relevant to speech production and perception. The analysis further denotes onset and offset of speech events. This study examined the utility of acoustic markers specifically designed to detect laryngeal events for differentiating normal and dysphonic speech signals. In particular, we examined three markers: two markers that detect periodic moments with diffe...