ComDis 711 Motor Speech Disorders

Speech Severity, Rate and Intelligibility and Treatment

Jenna Sargent, Natalie Brickner, Olivia Bergman, Shandra Lock

Objective: To analyze speech intelligibility in order to generate speech production

treatment goals.
I.

I. Speech Evaluation
Item 1: Data analysis
Severity
Primary Auditory
7 point
Attributes
scale
MAYO List
6
(usually
unintelligible
)

Speech Rate
Words per
Minute
(WPM)
Reading: 43
WPM
Sentences: 41.5
WPM

-Imprecise articulation
(distorted vowels and
consonants)
-Prolonged intervals
(syllables)
-Monopitch
-Monoloudness
-Reduced rate

Intelligibility %
Correct
41% (102.5/250 words)

Item 2: Reading and Intelligibility Results

Speech is primarily characterized by imprecise articulation, reduced rate, monopitch and
monoloudness. Articulatory errors are characterized by distorted consonants and vowels,
consonant substitutions (e.g., t/k, b/v, w/r), consonant cluster reductions (e.g., s-/st, p-/pl,
p-/pr), and consonant omissions (e.g., d, s, k). Speech rate was severely reduced during oral
reading of a passage (43 WPM) and single sentences (41.5 WPM). In addition to overall
reduced rate, patient prolongs syllables in words during speech which occasionally improves
listener comprehension. However, imprecise articulation and reduced rate significantly
affects intelligibility. Speech was intelligible 41% of the time during oral reading of single
sentences (6/7 Severity 7 Point Scale).
Item 3: CAPE-V Data Analysis
Results from the Consensus Auditory Perceptual Evaluation of Voice (CAPE-V) revealed mildmoderate dysphonia (22/100). Vocal quality was characterized by mild strain (10/100), mildmoderate monopitch (35/100), and mild-moderate monoloudness (35/100). Intermittent
hyponasality was also noted. All other characteristics of voice were judged to be normal.
Item 4: Articulation Results
Errors Consistent in Sentence Intelligibility & Articulation Test
Listener Judges Sentence
Intelligibility
(AIDS)
It is fukile ko hope that...

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Phoneti
c Error

Position
of
words

Speaker Production
(Articulation Test)

Place
k/t

Initial
Medial

-Substituted k/t in initial position (telephone)

-Substituted k/t in medial position (guitar)
- Produced /t/ in final position (carrot)

ComDis 711 Motor Speech Disorders

Speech Severity, Rate and Intelligibility and Treatment
Jenna Sargent, Natalie Brickner, Olivia Bergman, Shandra Lock

We saw free deer and a

badger.

Place
f/th

Initial
Medial
Final

We are sill surrounded by

mysteries here on Earth.

Manner
s-/st

Initial

-Substituted s-/st in initial position (stars)

Theres no admission karge.

Place
Manner
k/ch

Initial

-Substituted k/ch in initial position (chair)

When a pwaywright starts

writing propaganda...

Manner
pw/pl

Initial

-Substituted pw/pl initial position (plane)

Gose things are only as good

as the people who use them.

Place
Manner
g/thvoiced

Initial

-Substituted g/th-voiced initial position (this)

But gonations are accepted.

Place
g/d

Initial
Medial

-Substituted g/d initial position (duck)

-Produced g/d in the medial position
(window)

That haunted us for monfs.

-Substituted f/th in initial position (thumb)

-Substituted f/th in medial position (bathtub)
-Substituted f/th in final position (bath)

He rewarded the ape wif

peanuts.

Peanuts and oran-es for its

work

Errors Not Consistent in Sentence Intelligibility & Articulation Test

Listener Judges Sentence
Intelligibility
(AIDS)
The results were bery
disappointing.
The waiting list is seben to ten
years long.
Postal wates have stopped
wising.
We are still suwounded by
mystewies.
Up to a day before servin.

Phoneti
c Error

Position
of
words

Speaker Production
(Articulation Test)

Place
Manner
b/v

Initial
Medial

-Produced /v/ in the initial position (vacuum)

-Produced /v/ in medial position (shovel)
-Omitted /v/ in medial position
-Produced /v/ in final position (five)

Place
Manner
w/r

Initial
Medial

-Produced /r/ in initial position (rabbit)

-Produced /r/ in medial position (carrot)
-Omitted /r/ in final position (car)

Place
n/ing

Final

-Substituted g/ing (swimming)

II. Treatment
Item 5: Treatment Plan
1.Treatment goal for this patient
Will produce words with precise articulatory agility during communication activities of daily
living.
2. Specific articulation treatment objective
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ComDis 711 Motor Speech Disorders

Speech Severity, Rate and Intelligibility and Treatment
Jenna Sargent, Natalie Brickner, Olivia Bergman, Shandra Lock

a.

Will produce target words using contrastive stress during oral sentence reading with
75% accuracy (e.g., I am going to run.)
b. Will produce target words with articulatory agility during oral sentence reading with
60% accuracy (e.g., I am going to run.)

3. Specific treatment task associated with this objective

a.
target words
b.
target words

Will produce a scripted sentence with primary stress on monosyllablic

containing /r/ in the initial position of words (e.g., I have a rabbit.)
Will produced a scripted sentence with primary stress on monosyllabic
containing /v/ in the initial position of words (e.g., Im buying a van.)

4. Provide specific instructions

Pre-Practice:
You are going to work on saying /r/ at the beginning of words in sentences. I am going to
ask you three questions. You will respond with the sentence that is written on the notecard
that I provide you. You need to produce the underlined word in the sentence that begins
with /r/ so that it is accurate and stressed. This will help you convey meaning by placing
emphasis on the key words that begin with your target sound. Here is the first sentence
[clinician gives patient note card and models production (e.g., Im going to run.)]. Now
you say the sentence (clinician gives appropriate feedback and practice).
Practice:
I am going to ask you three questions. Respond with the sentence we practiced,
emphasizing the word that begins with /r/.
Example:
Clinician: Are you going to walk?
Client: Im going to run.
Clinician: Are you going to swim?
Client: Im going to run.
Clinician: Are you going to skip?
Client: Im going to run.
5. Provide stimuli (10 items) and rationale for choosing these items
Contrastive stress treatment, which focuses on prosody and articulation, was selected for this
patient to improve intelligibility. In this treatment, the patient produces utterances with primary
stress on words containing articulatory targets. However, this treatment approach is only
appropriate after articulatory skill has been demonstrated for the targeted phoneme (Yorkston et. al,
2010). The stimuli were chosen based on the results from the Goldman Fristoe Test of Articulation
and the Articulation Index of Dysarthria Speech (AIDS). The patient accurately produced initial /r/
and /v/ during the Goldman Fristoe Test of Articulation, however errors in initial /r/ and /v/ were
noted by listeners during oral reading of sentences (AIDS). Specifically, the patient substituted b/v in
the initial (i.e, berry/verry) and medial (i.e., seben/seven) positions of words, and w/r in the initial
(i.e.., wising/rising) and medial (i.e., suwounded/surrounded) positions of words. It was also noted
that as length and complexity of words increased, articulatory accuracy decreased. Therefore,
monosyllabic initial /r/ and /v/ words were chosen for initial treatment targets.

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ComDis 711 Motor Speech Disorders

Speech Severity, Rate and Intelligibility and Treatment
Jenna Sargent, Natalie Brickner, Olivia Bergman, Shandra Lock

Articulatory Focus

Clinician Question

Sentence Context
with Stressed
Target

Initial /r/
Run

Are you going to walk?

Are you going to swim?
Are you going to skip?

Im going to run.

Red

Is your shirt blue?

Is your car yellow?
Is the apple green?

It is red.

Read

Do you write books?

Do you color books?
Do you throw books?

I read books.

Rice

Is the pizza hot?

Is the spaghetti hot?
Is the tea hot?

The rice is hot.

Road

Where is the dog?

Where is the car?
Where is the truck?

Its on the road.

Initial /v/
Van

Do you drive a car?

Do you drive a truck?
Do you drive a motorcycle?

I drive a van.

Vine

Do tomatoes grow on a tree?

Do grapes grow in the ground?
Do peppers grow on a tree?

They grow on a vine.

Vet

Where is the dog?

Where is the cat?
Where is the bird?

Its at the vet.

Vote

Do you sleep at the town hall?

Do you buy groceries at the town
hall?
Do you live at town hall?

I vote at the town

hall.

Vase

Is it a cup?
Is it a bowl?
Is it a bottle?

It is a vase.

6. Define specific type of practice for the task and provide rationale for your
design
Massed & Modified - Blocked
Massed practice was selected for the patient to maximize his motor performance (e.g.,
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ComDis 711 Motor Speech Disorders

Speech Severity, Rate and Intelligibility and Treatment
Jenna Sargent, Natalie Brickner, Olivia Bergman, Shandra Lock

accuracy of movement within a training session) of /r/ and /v/ in the initial position of words
in sentences. Distributed practice typically results in slower learning, so until the
articulatory targets are consistently trained, massed practice would be more beneficial for
the client.
Modified - blocked practice was selected to facilitate the acquisition of accurate movement
without sacrificing motor learning. For example, the patient will practice initial /r/ stimulus
items 15 times (i.e., 3x/5 words) before moving on to initial /v/ stimulus items for 15 trials
(i.e., 3x/5 words). At this point in his treatment, random practice would not allow the
patient enough time to accurately produce target words.
7. Define type of feedback and the rationale for that type of feedback
Because the immediate goal is articulatory accuracy and stress of the target words,
providing feedback after every production would decrease the number of total trials within
a session. Therefore, the clinician will provide performance feedback after each set of 3
questions. If the patient is inaccurate within a set, then performance feedback would be
given immediately following the error to increase the patients articulatory accuracy and
awareness.
8. Define scoring metric and the rationale for scoring
Binary scoring was selected for this treatment approach. The patient will receive 1 point
for accurate production of the target sound (e.g., run) and 1 point for contrastive stress of
the target word (e.g., run) within a sentence. Binary scoring will allow the clinician to
easily determine when articulatory targets have been met and when contrastive stress has
been used appropriately. This will inform the clinician when to alter the treatment plan.
Stimulus

Initial /r/
Articulatory
Accuracy

Initial /r/
Contrastive
Stress

Total

Run

3/3

3/3

6/6

Red

1/3

3/3

4/6

Read

2/3

3/3

5/6

Rice

3/3

3/3

6/6

Road

3/3

1/3

4/6

Total

12/15, 80%

13/15, 86%

25/30, 83%

Stimulus

Initial /v/
Articulatory
Accuracy

Initial /v/
Contrastive
Stress

Total

Van

2/3

2/3

4/6

Vine

1/3

1/3

2/6

Vest

2/3

3/3

5/6

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ComDis 711 Motor Speech Disorders

Speech Severity, Rate and Intelligibility and Treatment
Jenna Sargent, Natalie Brickner, Olivia Bergman, Shandra Lock

Vote

1/3

3/3

4/6

Vase

2/3

3/3

5/6

Total

8/15, 53%

12/15, 80%

20/30, 66%,

Reference:
(YBSH) Yorkston, K.M., Beukelman, D.R., Strand, E.A, & Hakel, M. (2010). Management of
motor speech disorders in children and Adults. (3rd Ed.). Austin: Pro-Ed.

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