Personalised Dysarthria Therapy for Children and Young People with Cerebral Palsy
Research type
Research Study
Full title
Personalised Speech and Language Therapy for Children and Young People with Cerebral Palsy using Acoustic and Phonological Analytics
IRAS ID
307437
Contact name
Lindsay Pennington
Contact email
Sponsor organisation
Newcastle University
Clinicaltrials.gov Identifier
N/A, N/A
Duration of Study in the UK
1 years, 11 months, 10 days
Research summary
Summary of Research:
The study will test the effects of individualising the Speech Systems Approach – a speech and language therapy programme developed to help children with cerebral palsy speak more clearly. The programme will be individualised according to children's pre-therapy speech characteristics.
I will study 15 children, aged between 5 and 19 years, with cerebral palsy who have the motor speech disorder dysarthria. Each child will receive six weeks of individual therapy, delivered online three times a week. Children's speech will be recorded pre-, during, and post-therapy. Children will be recorded repeating single words, describing pictures and producing a vowel sound ("ah").
Speech waveforms and spectrograms will be created from the recordings. Waveforms and spectrograms are visual representations of sound. A speech waveform shows the pitch and loudness of a sound. A spectrogram provides more complex information, including the voicing (the extent of vocal fold opening) and formants (represents the size and shape of the vocal tract) of a sound over time. Acoustic measures will be taken from the waveforms and spectrograms to calculate changes in the children's speech which may not yet be heard by ear. The prompts and instructions used in the intervention will be decided from analysis of these acoustic measures.
Adults who have no experience of interacting with people who have speech difficulties will act as listeners. Listeners will listen to the pre- and post-therapy recordings and transcribe the words they hear. Listeners will rate the intelligibility of the recordings using a Likert scale ranging from one (never intelligible) to seven (always intelligible). Listener transcriptions will be compared to the children's target productions. The percentage of words understood correctly (percentage intelligibility) will be determined.
Effectiveness of the therapy will be determined by comparison of children’s intelligibility pre- and post-therapy. Acoustic measures taken during therapy will show when and how children’s speech characteristics changed.Summary of Results:
Personalised Speech and Language Therapy for Children with Cerebral Palsy and DysarthriaWho carried out the research?
Researcher: Carol-Ann McConnellogue
Chief investigator: Professor Lindsay Pennington
Sponsor: Newcastle University
Funding: Dr Robert Teoh and the Henry Miller Studentship, Newcastle UniversityWhere and When the Study Took Place
The study took place in schools and charity organisations in England between 11/01/2021 and 20/03/2025.Why was the research needed?
Cerebral palsy is the most common cause of motor disorder in childhood. Around 35% of children with cerebral palsy have difficulties controlling the muscles used for speech, and their speech is difficult to understand.
Speech and language therapy targeting increased breath control and slower speech has been found to improve the speech of children with cerebral palsy and make their speech easier to understand. Children with cerebral palsy and dysarthria have responded differently to the therapy. Some children's speech changed a lot, while other children’s speech changed only a little. Children with cerebral palsy may respond better to speech and language therapy which targets their individual speech characteristics through personalised intervention.Public involvement
Parents and seven disabled young people gave advice on how to make the therapy interesting to children and keep them motivated. The young people approved of using audio recordings of children, rather than video, when measuring the outcomes of therapy, to keep participation confidential.What were the main questions studied?
1. Does personalised speech and language therapy make children with cerebral palsy and dysarthria easier to understand?
2. What are the changes in children’s speech that make them easier to understand?Who participated in the study?
Fifteen children aged 5 to 19 years with cerebral palsy and moderate to severe dysarthria.What intervention did the participants receive?
Children received personalised speech and language therapy three times a week for six-weeks. The intervention was delivered online via Microsoft Teams whilst children were at school or at home.
The therapy focused on slowing children’s speech rate and helping them produce speech at an appropriate loudness. Children were given instructions - vocal cues - based on their individual speech characteristics to help them achieve clearer speech. Vocal cues included ‘strong’, ‘loud’, ‘big mouth’, ‘slow’, ‘steady’, and ‘nice and easy’. Each child received a different combination of cues.What happened during the study?
Children were recorded saying 20 single words and five phrases 6 Weeks pre-, 1 Week pre-, 1 Week post-, and 12 weeks post-therapy. Unfamiliar adults listened to the recordings and wrote the words they heard. Percentage scores were calculated based on how many words the listeners heard correctly.What were the results of the study?
Results showed that after therapy the number of words listeners could understand in children’s speech increased by approximately 10% in single words and by 9% in phrases.
Individual results showed that children who were easier to understand pre-therapy made the greatest gains. Children with very severe dysarthria whose speech was very difficult to understand before therapy did not change.
Listeners were able to hear consonants at the beginning and end of words more clearly after therapy, but no single factor was found to account for the changes in children’s speech.
Online delivery of the intervention was accepted by schools. Children expressed their preference for in-person therapy. They said they would be better understood in person.
Most children, parents, and school staff reported positive changes in children’s speech following therapy. Children reported that their speech was clearer and slower and that listeners understood them more. Other positive feedback included increased confidence, improved reading, and interacting more with peers. Some parents and school staff reported that they observed no change in their child’s speech.How has this study helped children, clinicians and researchers?
Personalised dysarthria therapy as part of a care plan may be helpful for children with cerebral palsy and mild, moderate, and moderate-severe dysarthria. For children with severe speech impairments, speech and language therapy should focus on alternative and augmentative communication (e.g., communication devices) to support their communication.
Personalised therapy should continue to be trialled with children with cerebral palsy and mild, moderate, or moderate-severe dysarthria. Conducting a randomised controlled trial (RCT) may be warranted to evaluate its effectiveness in clinical practice.
Which vocal cues work best and for whom has not yet been established. Future research should assess the ordering and duration of vocal cues for individual children.Where can I learn more about this study?
For more information, please contact Professor Lindsay Pennington via email: lindsay.pennington@ncl.ac.ukREC name
East Midlands - Nottingham 1 Research Ethics Committee
REC reference
22/EM/0064
Date of REC Opinion
13 Apr 2022
REC opinion
Further Information Favourable Opinion