Department of Otorhinolaryngology, Head and Neck Surgery and Communication Disorders, University Hospital of Antwerp, Edegem, Belgium.
Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Antwerp, Belgium.
Int J Lang Commun Disord. 2021 Mar;56(2):271-282. doi: 10.1111/1460-6984.12595. Epub 2021 Jan 23.
The articulatory accuracy of patients with dysarthria is one of the most affected speech dimensions with a high impact on speech intelligibility. Behavioural treatments of articulation can either involve direct or indirect approaches. The latter have been thoroughly investigated and are generally appreciated for their almost immediate effects on articulation and intelligibility. The number of studies on (short-term) direct articulation therapy is limited.
To investigate the effects of short-term, boost articulation therapy (BArT) on speech intelligibility in patients with chronic or progressive dysarthria and the effect of severity of dysarthria on the outcome.
METHODS & PROCEDURES: The study consists of a two-group pre-/post-test design to assess speech intelligibility at phoneme and sentence level and during spontaneous speech, automatic speech and reading a phonetically balanced text. A total of 17 subjects with mild to severe dysarthria participated in the study and were randomly assigned to either a patient-tailored, intensive articulatory drill programme or an intensive minimal pair training. Both training programmes were based on the principles of motor learning. Each training programme consisted of five sessions of 45 min completed within one week.
OUTCOMES & RESULTS: Following treatment, a statistically significant increase of mean group intelligibility was shown at phoneme and sentence level, and in automatic sequences. This was supported by an acoustic analysis that revealed a reduction in formant centralization ratio. Within specific groups of severity, large and moderate positive effect sizes with Cohen's d were demonstrated.
CONCLUSIONS & IMPLICATIONS: BArT successfully improves speech intelligibility in patients with chronic or progressive dysarthria at different levels of the impairment. What this paper adds What is already known on the subject Behavioural treatment of articulation in patients with dysarthria mainly involves indirect strategies, which have shown positive effects on speech intelligibility. However, there is limited evidence on the short-term effects of direct articulation therapy at the segmental level of speech. This study investigates the effectiveness of BArT on speech intelligibility in patients with chronic or progressive dysarthria at all severity levels. What this paper adds to existing knowledge The intensive and direct articulatory therapy programmes developed and applied in this study intend to reduce the impairment instead of compensating it. This approach results in a significant improvement of speech intelligibility at different dysarthria severity levels in a short period of time while contributing to exploit and develop all available residual motor skills in persons with dysarthria. What are the potential or actual clinical implications of this work? The improvements in intelligibility demonstrate the effectiveness of a BArT at the segmental level of speech. This makes it to be considered a suitable approach in the treatment of patients with chronic or progressive dysarthria.
构音障碍患者的发音准确性是受影响最严重的言语维度之一，对言语可懂度有很大影响。构音的行为治疗可以包括直接或间接的方法。后者已经得到了彻底的研究，并且通常因其对发音和可懂度的即时影响而受到赞赏。关于（短期）直接构音治疗的研究数量有限。
研究短期、增强型构音治疗（BArT）对慢性或进行性构音障碍患者言语可懂度的影响，以及构音障碍严重程度对结果的影响。
本研究采用前后测试设计的两组设计，评估语音和句子水平的言语可懂度，以及自发言语、自动言语和朗读语音平衡文本时的言语可懂度。共有 17 名轻度至重度构音障碍患者参加了研究，并随机分配到患者定制的强化发音训练计划或强化最小对训练。这两种训练计划都基于运动学习的原则。每个训练计划都包括五个 45 分钟的课程，在一周内完成。
治疗后，在语音和句子水平以及自动序列上，平均组可懂度显示出统计学上的显著增加。这得到了声学分析的支持，该分析显示了构音中心性比率的降低。在特定的严重程度组中，显示出较大和中等的阳性效应大小，Cohen's d 为。
BArT 成功地提高了不同损伤程度的慢性或进行性构音障碍患者的言语可懂度。本文增加了什么 关于这个主题的已知内容 构音障碍患者的发音行为治疗主要涉及间接策略，这些策略已显示出对言语可懂度的积极影响。然而，关于短期的直接构音治疗对言语的音段水平的影响的证据有限。本研究调查了 BArT 在所有严重程度的慢性或进行性构音障碍患者中对言语可懂度的有效性。本文对现有知识的贡献 本研究中开发和应用的强化和直接发音治疗计划旨在减少损伤，而不是补偿损伤。这种方法在短时间内显著提高了不同构音障碍严重程度患者的言语可懂度，同时有助于利用和开发构音障碍患者所有可用的残余运动技能。这项工作有什么潜在或实际的临床意义？ 可懂度的提高证明了 BArT 在言语的音段水平上的有效性。这使其成为治疗慢性或进行性构音障碍患者的一种合适方法。
