Department of Neurology, Faculty of Medicine, RWTH Aachen University, Germany.
Clinical Neuropsychology Research Group, Institute for Phonetics and Speech Processing, Ludwig Maximilian University of Munich, Germany.
J Speech Lang Hear Res. 2023 Aug 3;66(8):2622-2642. doi: 10.1044/2023_JSLHR-23-00105. Epub 2023 Jul 24.
In current clinical practice, intelligibility of dysarthric speech is commonly assessed by speech-language therapists (SLTs), in most cases by the therapist caring for the patient being diagnosed. Since SLTs are familiar with dysarthria in general and with the speech of the individual patient to be assessed in particular, they have an adaptation advantage in understanding the patient's utterances. We examined whether and how listeners' assessments of communication-related speech parameters vary as a function of their familiarity with dysarthria in general and with the diagnosed patients in particular.
Intelligibility, speech naturalness, and perceived listener effort were assessed in 20 persons with dysarthria (PWD). Patients' speech samples were judged by the individual treating therapists, five dysarthria experts who were unfamiliar with the patients, and crowdsourced naïve listeners. Adaptation effects were analyzed using (a) linear mixed models of overall scoring levels, (b) regression models of severity dependence, (c) network analyses of between-listener and between-parameter relationships, and (d) measures of intra- and interobserver consistency.
Significant advantages of dysarthria experts over laypeople were found in all parameters. An overall advantage of the treating therapists over nonfamiliar experts was only seen in listening effort. Severity-dependent adaptation effects occurred in all parameters. The therapists' responses were heterogeneous and inconsistent with those of the unfamiliar experts and the naïve listeners.
The way SLTs evaluate communication-relevant speech parameters of the PWD whom they care for is influenced not only by adaptation benefits but also by therapeutic biases. This finding weakens the validity of assessments of communication-relevant speech parameters by the treating therapists themselves and encourages the development and use of alternative methods.
在当前的临床实践中，言语语言治疗师（SLT）通常通过评估言语的可理解度来评估构音障碍患者的言语清晰度，在大多数情况下，评估由负责诊断患者的治疗师进行。由于 SLT 通常熟悉构音障碍，并且特别熟悉要评估的个体患者的言语，因此他们在理解患者的言语方面具有适应优势。我们研究了听众对与交流相关的语音参数的评估是否以及如何随其对构音障碍的熟悉程度而变化，特别是对所诊断患者的熟悉程度。
我们评估了 20 名构音障碍患者（PWD）的言语可懂度、言语自然度和感知到的聆听者费力程度。个体治疗师、五位不熟悉患者的构音障碍专家以及众包的非专业听众对患者的语音样本进行了判断。使用（a）总体评分水平的线性混合模型、（b）严重程度依赖性的回归模型、（c）听者之间和参数之间关系的网络分析以及（d）观察者内和观察者间一致性的度量来分析适应效应。
在所有参数中，构音障碍专家的得分均明显优于非专业听众。仅在聆听费力方面，治疗师的总体得分优于不熟悉的专家。在所有参数中都存在与严重程度相关的适应效应。治疗师的反应是异质的，与不熟悉的专家和非专业听众的反应不一致。
SLT 评估他们所照顾的构音障碍患者与交流相关的语音参数的方式不仅受到适应优势的影响，还受到治疗偏倚的影响。这一发现削弱了治疗师自己评估与交流相关的语音参数的有效性，并鼓励开发和使用替代方法。
