Improving Speech Intelligibility in Adults: Clinical Application of Evidence-Based Strategies

Being intelligible to a listener means getting your message across and improving speech intelligibility is one of the most common goals for clients working with a speech-language pathologist (SLP). Improving Speech Intelligibility in Adults: Clinical Application of Evidence-Based Strategies is a professional resource for practicing SLPs working with adults with communication disorders, such as dysarthria, acquired apraxia of speech, and voice disorders. This book incorporates current research findings to support the use of evidence-based strategies in clinical situations. While other books may focus on "drilling" and "practicing" a list of words, sentences, and topics to use with a client to change their behaviors, Improving Speech Intelligibility in Adults uniquely focuses on the speaker and the listener in tandem. The author takes a noteworthy approach in how the listener can change behaviors to assist with understanding. The text presents a comprehensive approach to improving speech intelligibility by including ways to enhance the communication environment during in-person or teletherapy exchanges to enhance understanding between speaker and listener.

Table of Contents:
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

About the Author :
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.