Improving Speech Intelligibility in Adults

Connie Porcaro, PhD, CCC-SLP is an Associate Professor in the Department of Communication Sciences and Disorders at Florida Atlantic University (FAU), where she instructs courses covering Voice, Speech, and Swallowing disorders in adults, and lectures annually for future physicians at the FAU Medical School on the topics of adult neurogenic speech and language disorders. Dr. Porcaro is certified by the American Speech-Language-Hearing Association and has worked as a speech-language pathologist for more than 25 years with clients of all ages. Her main area of research is focused on intelligibility in patients with speech and voice disorders and how speakers and listeners can have improved communication. . Dr. Porcaro is a frequent presenter at the Annual Convention of the American Speech-Language and Hearing Association and state association conventions as an invited speaker on the topic of intelligibility. She has received grant funding from the FAU Healthy Aging Research Initiative to investigate voice and swallowing changes in healthy elderly individuals, and she has received grant funding from the Parkinson Voice Project to facilitate training for graduate students who provide free-of-cost speech therapy for individuals with Parkinson's disease.

reface
Acknowledgements
Dedication



Chapter 1. Introduction of Intelligibility and Related Concepts

Key Points

Definitions of Intelligibility, Comprehensibility, and Related Measures

Intelligibility

Comprehensibility

Efficiency

Naturalness

Communication Participation

Components of a Communication Exchange

Theories of Communication

Feedback

Communication Channels

Communication Noise

Physical Noise

Physiological Noise

Psychological Noise

Semantic Noise

Shared Experiences between Communicators

Impaired Communication

Consideration of Function and Disability Related to Intelligibility

Integrating Science and Clinical Practice to Improve Intelligibility

Using Evidence-Based Practice for Clinical Decisions

Exploring our Role in Bridging Research to Clinical Practice

Utilizing Technology Appropriately for Best Practice

Summary

Case Study Introduction

References

Appendix 1-1 References for ICF Application to Specific Disorders Related to Reduced Intelligibility



Chapter 2. Impact of Speaker-related Factors on Intelligibility

Key Points

Speech Subsystems and Effect on Intelligibility

Intelligibility Issues Related to Speakers with Dysarthria

Respiration

Phonation

Resonance

Articulation

Prosody/Rate

Intelligibility Issues Related to Speakers with Acquired Apraxia of Speech

Respiration, Phonation, and Resonance

Articulation and Fluency

Prosody and Rate

Intelligibility Issues Related to Speakers with Voice Disorders

Voice Disorders Related to Neurologic Etiology

Voice Disorders Related to Functional Etiology

Voice Disorders Related to Organic Etiology

Voice Disorders Related to Head and Neck Cancer

Influence of Head and Neck Cancer Treatment on Voice

Electrolaryngeal Speech

Esophageal Speech

Tracheoesophageal Speech

Effect of Face Masks and Social Distancing on Intelligibility

Summary

Dysarthria Case

Voice Disorders Case

References



Chapter 3. Assessment of Speaker Structures and Functions: Subsystem Evaluation to Determine Contributions to Reduced Intelligibility

Key Points

Case History Questions

Standardized Tests and Rating Scales for Speech and Voice Assessment

Patient Reported Outcome Measures

Published Dysarthria Measures

Published Adult Apraxia of Speech Measures

Published Voice Disorders Measures

Factors Related to Collecting Recorded Samples

Options for Recording Virtually

Considerations of Recording with Face Masks

Auditory-Perceptual Evaluation

Evaluation of Respiration

Posture and Body Movement Observation

Duration Measures

Breath Group Measures

Conversational and Reading Measures Related to Respiration

Evaluation of Phonation

Measures of Loudness

Measures of Pitch

Measures of Quality

Evaluation of Resonance

Evaluation of Articulation

Speech-like Movements and Rates

Speech Sound Inventory

Connected Speech Sample

Evaluation of Prosody

Summary

Dysarthria Case

Voice Disorder Case

References

Appendix 3-1 Communicative Effectiveness Survey - Revised (CESR)

Appendix 3-2 The Communication Participation Item Bank - General Short Form



Chapter 4. Factors Related to Meaningful Assessment of Intelligibility

Key Points

Clinician's Use and Perceptions of Intelligibility Measures

Intelligibility Assessment

Subjective Intelligibility Measurement Tasks

Objective Intelligibility Measurement Tasks

Influences on Intelligibility Measures

Factors Related to the Speaker

Severity

Speech Rate

Personal Speaker Factors

Factors Related to the Message

Type of Message

Predictability of Message

Presentation Mode of Message

Factors Related to Listeners

Individual Listener Variability

Listener Task

Experience

Familiarity with Speaker

Familiarity with Message

Age

Factors Related to the Communicative Environment

Recording Equipment

Auditory-Only versus Auditory-Visual Presentation Mode

Listening Conditions

Assessment of Comprehensibility, Efficiency, and Naturalness

Intelligibility Measures Related to Voice Disorders and Head and Neck Cancer

Use of Technology in Intelligibility Assessment

Summary

Dysarthria Case

Voice Disorders Case

References

Appendix 4-1 Medical Research Council Institute of Hearing Research Audio-Visual Adaptive Sentence Lists

Appendix 4-2 Hearing in Noise Test Sentence Lists

Appendix 4-3 Checklist for Considerations Related to Assessment of Intelligibility



Chapter 5 Speaker Subsystem Management Strategies to Improve Intelligibility

Key Points

Guiding Frameworks for Management Decisions

International Classification of Function

Evidence-Based Practice

Subsystem Contribution and Management

Respiration

Diaphragmatic-Abdominal Breathing

Increasing Upper Body Tone

Body Positioning

Controlling Exhalation

Generating Appropriate Loudness Levels

Muscle Strength Training

Using Optimal Breath Groups

Inspiratory Checking

Phonation

Using Effortful Closure

Timing Phonation with Exhalation

Low Impact Voicing

Utilizing Relaxation Techniques

Speaking with High Phonatory Effort

Phonation Resistance Training Exercises (PhoRTE)

Using Holistic Voice Therapy Programs

Implementing Vocal Hygiene

Enhancing Loudness with Prosthetics

Resonance

Articulation

Modifying Habitual Speech: Clear and Loud Speech

Deciding on use of Nonspeech Oral Motor Exercises (NSOME)

Prosody

Modifying Speech Rate

Marking Stress Patterns

Using Intonation

Management Related to Specific Communication Disorders

Adult Apraxia of Speech

Head and Neck Cancer

Using Outcome Measures During Management

Summary

Dysarthria Case

Voice Disorder Case

References



Chapter 6 Speaker Management Strategies to Improve Intelligibility and Functional Communication

Key Points

Speaker-Related Strategies

Slowing Speech Rate

Making Speech Clear

Message-Related Strategies

Using the Most Effective Message Length and Type

Choosing Predictable Messages

Communication-Related Strategies

Gaining Listener Attention Before Speaking

Setting Ground Rules for Communication

Providing the Topic for a Conversation

Signaling Changes in Topic

Using Gestures to Provide Added Information

Providing Cues with Alphabet Supplementation

Watching for Signs of Listener Comprehension

Scheduling Important Discussions

Repairing Communication Breakdowns

Incorporating All Useful Modalities

Considering the Impact of a Face Mask on Communication

Strategies Specific to Speakers with Voice or Head and Neck Cancer

Intervention Objectives to be Facilitated by the Clinician

Dysarthria Case

Voice Disorders Case

References

Appendix 6-1 Checklist for Speaker Strategies to Maximize Functional Communication



Chapter 7 Listener Strategies to Improve Intelligibility and Functional Communication

Key Points

The Importance of Collaborative Efforts

Factors Related to Listener Inclusion in Management

Listener Variability

Listener Age

Listener Cognitive Abilities

Perceived Listener Effort

Listener Adaptability

Listener Experience with Speech Disorders

Listener Familiarization

Communication Entrainment

Listener Barriers and Categories of Strategies

Functional Listener Strategies

Using Active Listening Skills

Watching for Signals That a Conversation is Starting

Gaining Topic Knowledge

Utilizing Visual Information

Using All Available Information

Setting Yourself Up to Be the Best Listener You Can Be

Discussing Rules for Interaction with the Speaker

Providing Feedback and Encouragement

Specific Strategies Related to Communicating with Individuals with Voice or Head and Neck Cancer

Listener Strategies for Speakers with Dysphonia

Listener Strategies for Speakers Following Head and Neck Cancer Treatment

Effect of Unsuccessful Communication on Speakers

Summary

Dysarthria Case

Voice Disorders Case

References

Appendix 7-1 Checklist for Listener Strategies to Maximize Understanding



Chapter 8 Strategies to Alter the Communication Environment for Better Understanding

Key Points

Identifying Environmental Barriers

Approaches for Dealing with Communicative Noise

Physiological Noise

Psychological Noise

Semantic Noise

Physical Noise

Adaptation to Environment

Environmental Modification

Improving Proximity Between Speakers and Listeners

Reducing or Eliminating Background Noise

Improving Access to Visual Information

Reducing or Eliminating Distractions

Using External Aids

Speaking Clearly When Wearing Face Masks

Using the Phone Effectively

Adjusting Audio Settings for Video Chat Communication

ZOOM Audio Settings

Smart Phone or Tablet Audio Settings

Skype Audio Settings

Impact of Communicative Environment on Speakers with Head and Neck Cancer

Summary

Dysarthria Case

Voice Disorders Case

References

Appendix 8-1 Situational Intelligibility Survey

Appendix 8-2 Checklist to Maximize Communication Potential by Modifying the Environment

Index