Doctoral education - Speech and Language Pathology
Doctoral education conclude with the award of a licentiate degree or a doctoral degree in medical science. Qualifications to be accepted as a doctoral student at KI is a degree at advanced level year one, for example a degree in Speech and Language Pathology The PhD is awarded on the submission of a thesis subject to its passing a public defence. A licentiate degree is defended at a licentiate seminar. In addition doctoral courses (some compulsory) are required.
Full information about doctoral studies can be found at the CLINTECs and KIs homepages. Contact at the Division is Head and professor Anette Lohmander who also coordinates the Doctoral programme HÖST (Hörsel Öron Språk Tal)/Hearing Otolaryngology Language Speech
Current doctoral students:
Outcomes of the Lidcombe Program in Sweden
Anita McAllister, Assistant Professor, SLP, Department of Clinical Sciences, Intervention and Technology, CLINTEC, Division of Speech and Language Pathology, Karolinska Institutet (Principal supervisor)
Elisabeth Lindström, Assistant Professor, SLP, Department of Logopedics, Åbo Akademi University, Finland (Co-supervisor)
Stuttering is a speech disorder in which the flow of speech is disrupted by involuntary repetitions and prolongations of sounds, syllables or words as well as involuntary silent pauses or blocks in which the person who stutters is unable to produce sounds. The onset of stuttering is usually between the ages of 2-5 years and about 5-8% of all preschool children stutter sometime during their speech and language development. Some children stop stuttering spontaneously, usually within the first year after stuttering onset, but the longer the child stutter the greater the chance that the condition becomes chronic. Chronic stuttering can lead to a negative impact on the individual's self-esteem and restriction of social contacts which makes early intervention important.
The Lidcombe Program is a treatment for preschool children who stutter that was developed in Australia. The program is a parent-conducted intervention based on operant methods. The treatment consists of verbal contingencies, praise for stutter-free speech and gentle corrections for stuttered speech. There are two stages in the Lidcombe Program. At stage 1 the aim is to achieve fluency and at stage 2 the aim is to maintain the fluency. The program has proven to be an effective treatment for preschool children who stutter.
The aim of this research project is to evaluate effects of the Lidcombe Program for preschool children who stutter in Sweden over time. This research aims to identify and evaluate the effects of early intervention to prevent a negative stuttering development.
The planned studies:
- Two-year follow-up of the Lidcombe Program in ten Swedish-speaking children
- Outcomes of the Lidcombe Program on children’s language use and communicative behaviour
Apraxia of speech: Prevalence, differential diagnosis, progression and relation to hand motor function and brain function after stroke.
Ellika Schalling, Assistant Professor, Department of Clinical Sciences, Intervention and Technology, CLINTEC, Division of Speech and Language Pathology, Karolinska Institutet.
Per Östberg, Associate Professor, Department of Clinical Sciences, Intervention and Technology, CLINTEC, Division of Speech and Language Pathology, Karolinska Institutet.
Påvel Lindberg, Associate Professor, Department of Clinical Sciences Danderyd Hospital Karolinska Institutet and INSERM Université Paris Descartes.
Catharina Nygren-Deboussard, MD, PhD, Department of Clinical Sciences Danderyd Hospital Karolinska Institutet.
Apraxia of speech (AOS) is a neurologic motor speech disorder that reflects an impaired ability to plan and programme sequential articulatory movements. It is characterized by groping and trial-and-error articulatory movements and abnormal prosody including slow speaking rate. The severity may vary from minor difficulties in speech production to a complete inability to communicate verbally. Stroke is considered the most common etiology, but AOS may also be caused by tumors, trauma or appear as the first sign of neurodegenerative disease. Neuroanatomic correlates of AOS as well as comorbidity with aphasia have been debated and there is still controversy about how to define and assess AOS. The understanding of the exact nature and neurobiological mechanisms of AOS is limited and prognostic factors facilitating or hindering recovery are not yet identified. The lack of generally accepted diagnostic criteria and standardized assessment tools entail that the prevalence of AOS after acquired brain injury is still uncertain. There is also debate regarding if the speech deficits in AOS could be due to a more central, modality-independent motor programming impairment.
By using a newly developed diagnostic instrument for AOS in diagnosis of a consecutive series of patients, one aim of this study is to determine the prevalence of AOS in an unselected cohort of adults with acquired brain lesion in a sub-acute phase. By combining advanced brain imaging methods including functional connectivity analyses with an extensive speech- and language assessment battery, other aims are to examine whether the speech production impairments in AOS are associated with distinctive patterns of brain injury and to identify neural correlates of recovery from AOS after stroke. In collaboration with the ongoing Pro-Hand study, a prospective longitudinal study at the Department of Clinical Sciences Danderyd Hospital, the study will also address the question if the speech deficits seen in AOS could be due to a more central, modality-independent motor programming impairment.
The planned studies:
- I) Prevalence of AOS after acquired brain injury in an unselected consecutive series of patients in a sub-acute phase
- II) Differential diagnosis: The relationship between post stroke speech and language impairments and structural and functional connectivity in speech and language networks
- III) Longitudinal outcome: Progression and predictors of recovery of motor speech control after stroke
- IV) Modality-specific and modality-independent contributions to AOS
Körner Gustafsson, Joakim
Joakim Körner Gustafsson
Voice use in Parkinson's disease studied with a portable voice accumulator.
Ellika Schalling, Department of Clinical Sciences, Intervention and Technology, CLINTEC, Division of Speech and Language Pathology, Karolinska Institutet.
Maria Södersten, Department of Clinical Sciences, Intervention and Technology, CLINTEC, Division of Speech and Language Pathology, Karolinska Institutet.
Sten Ternström, Department of Speech, Music and Hearing, School of Computer Science and Communication, KTH Royal Institute of Technology.
In addition to the general motor symptoms related to Parkinson's disease (PD), between 7090% of individuals with PD experience impaired speech and voice function. The most common perceptual speech symptoms related to PD are reduced loudness, reduced pitch variation, breathy, hoarse voice quality, imprecise articulation and variations in speech rate.
Voice use in everyday life has previously only been possible to study through subjective assessments or by speech recordings in controlled environments. Recently developed technology allows for real time registering of objective data on voice use during everyday life activities, but the data reported so far is very limited.
The goal of the present project is to obtain quantitative information on voice use in individuals with PD in reallife situations and to develop and evaluate a method to give biofeedback on voice use in everyday life for therapeutic purposes. Such information is important because it can be used as a basis for planning both therapeutic and preventive measures and to further evaluate the effect of voice therapy. The ability to provide direct feedback on voice use in everyday life is new and further development of such methods may lead to more effective intervention in the future as it can facilitate the transfer of treatment effects from the clinic to other settings, which often are the greatest challenge and the goal of all behavioral therapy.
I. Voice use in reallife and studio environments studied with a portable voice accumulator.
II. Effect of Lee Silverman Voice Treatment studied with a portable voice accumulator.
III. Principles of motor learning applied to direct feedback on voice use with a portable voice accumulator in patients with Parkinson's disease.
IV. Effect of tactile biofeedback regarding voice intensity in Parkinson's disease.
Follow-up of speech, language and communicatin in children without canonical babbling at the age of 10 months
Anette Lohmander, professor, SLP, CLINTEC, Division of Speech and Language Pathology, Karolinska Institutet (Main supervisor)
Carmela Miniscalco, docent/klinisk lektor, Inst för Neurovetenskap och Fysiologi, Göteborgs Universitet (co-supervisor)
Lisa Gustavsson, researcher, Inst of linguistics, Stockholm University (co-supervisor)
Canonical babbling (CB) is an example of a predictor of good progress in the development of speech and language. There is for example positive correlation between presence of CB and development of expressive vocabulary. Typically developing children at 10 months use CB, which also applies to children in different risk groups. Delayed start of CB and later associated difficulties in speech and language development has been described in children with hearing loss and cleft palate and indicated in children with cerebral palsy and in children later diagnosed with late language development, dyspraxia and autism. The most common consonant sounds used by children between 9 and 18 months of age are anterior oral consonants (first t / d/n, then p / b). The surrounding environment plays an important role in supporting and stimulating the child's speech and language development. Both the way parents speak and communicate are of significance for the child. A responsive behavior involves a parent's immediate response to the child's vocalizations or actions and can for example be an imitation or an interpretation of the child’s vocalization. The responsive behaviors of parents has been shown to be a predictor of multiple linguistic milestones at 3 years of age.
The project contains five studies, the first and second study are already concluded. The first study was a method study which examined the validity of observation of babbling and consonant sounds. The results show that observation is a reliable and valid method and canonical babbling, oral and anterior articulation are variables with high specificity and positive predictive value. The second study examined canonical babbling through observation in a group of children with typical development and in a clinical group and contained a comparison between the groups. The results show that children with typical development had canonical babbling and oral plosives at 10 months of age and that all variables differed significantly from children in the clinical group. The aim of the third study is to evaluate a screening procedure of canonical babbling at 10 month of age and examine if the screening can identify children with later difficulties in speech, language and communication . The fourth and fifth study focuses on parental responsiveness and examine these behaviors in parents of children without canonical babbling at 10 month compared to children who uses canonical babbling.
SLP, M Sc
Suspected Childhood apraxia of speech in 5-year-old children: Speech and language characteristics
Per Östberg, assoc. prof., SLP, CLINTEC, Division of Speech and Language Pathology, Karolinska Institutet (Main supervisor)
Anita McAllister, assoc. prof., SLP, CLINTEC, Division of Speech and Language Pathology, Karolinska Institutet (Co-supervisor)
Anette Lohmander, professor, SLP, CLINTEC, Division of Speech and Language Pathology, Karolinska Institutet (Co-supervisor)
Childhood Apraxia of Speech (CAS) is a neurological speech sound disorder (0.125 – 4.3 %) and at core an impairment in the planning and/or programming of movement sequences of speech. Typical speech characteristics are e.g. inconsistent production, sequencing difficulties, grouping, vowel errors, resonance inconsistency, substitutions and prosodic disturbance. Speech and language competence in preschool children with CAS or presenting with CAS characteristics have not been systematically described.
The project will assess and describe the speech of children diagnosed with CAS and a group of patients born with Cleft lip and Palate (CLP) of which less than half present with age appropriate articulation proficiency at age 5. Children with CLP will therefore be evaluated looking for deficits related to apraxia. Having a severe speech sound disorder can mask language deficits. Thus, all children’s language competence will also be assessed. The emerging speech and language profiles within groups and between groups will increase knowledge about the varying difficulties seen in children with CAS and CLP.
The overall aim is exploratory: to describe and improve our understanding of speech and language in children with CAS at 5 years of age. Study results can aid future intervention.
Childhood Apraxia of Speech (CAS): a survey of knowledge and experience in Swedish SLPs
Description of speech in 5-year-old children with Childhood Apraxia of Speech with or without cleft lip and palate
Orofacial function, articulation proficiency and intelligibility in 5-year-old children born with cleft lip and palate
Presence of Language deficits in 5-year-old children with Childhood Apraxia of Speech with or without cleft lip and palate
Jaw function and occlusion in children with orofacial dysfunction and motor
Anita McAllister (main supervisor) and Monica Barr Agholme (co-supervisor), Lotta Sjögreen (co-supervisor)
The jaw muscles play a significant role in early speech sound production and development. The jaw movements are more adult like compared to the movements in lip and tongue already at 12 months of age. Clinical experience show that children with eating difficulties, speech sound disorders and reduced saliva control often exhibit reduced stability and control in their jaw muscles and have undifferentiated lip and tongue movements from the jaw. Few studies have examined jaw function in children with orofacial dysfunctions. The overall aim of this PhD project is to improve knowledge
about jaw function and occlusion in children with and without orofacial dysfunction and motor speech disorder
- Is jaw function and occlusion in children with orofacial dysfunction and speech motor disorders different compared to children with typical development?
- Is jaw function related to orofacial dysfunction and motor speech disorders?
If so how?
- Is there a relation between jaw function, occlusion and speech sound deviations in children with speech motor disorders?
- Are interventions to improve jaw function effective? Does improved jaw function have a positive effect on speech production in children with motor speech disorders?
Speech and language in early childhood neurodevelopmental disability: the development during the first three years of life and the effect of treatment.
Anette Lohmander, professor, SLP, CLINTEC, Division of Speech and Language Pathology, Karolinska Institutet (Main supervisor)
Carmela Miniscalco, docent/klinisk lektor, Inst för Neurovetenskap och Fysiologi, Göteborgs Universitet (co-supervisor)
Katarina Lindström, Med. Dr., Astrid Lindgrens Barnsjukhus, Karolinska Huddinge (co-supervisor)
Children with neurodevelopmental disabilities often present with speech and language difficulties. However, longitudinal studies of speech and language development in these conditions are rare and more research is needed regarding the effects of intervention. Research on other clinical groups seem to indicate that aspects of babbling and early consonant production may be studied to predict speech and language development.
The main focus of the present research proposal is to (1) describe early speech, language and communication development in children with early neurodevelopmental disabilities; (2) to investigate the relationship between babbling at 10 and 18 months and speech and language at 36 months and, (3), to evaluate a parent implemented intervention using focused stimulation to increase vocabulary in verbal children with cerebral palsy.
Study 1 investigated babbling and consonant production in a group of infants and toddlers receiving habilitation services in Stockholm. A significant delay compared to controls was found for canonical babbling, consonant production and vocabulary. In Study 2 and 3, the speech and language development of children diagnosed with developmental delay at 6 months will be studied longitudinally from 1O to 36 months of age.
Study 2 will focus on the results of assessments at 10 and 18 months.
Study 3 will report results at 36 months, as well as correlations between babbling at 10 and 18 months and speech and language skills at 36 months.
Study 4 is an intervention study, in which an intervention technique for increasing vocabulary - focused stimulation - will be studied. In this technique, target language forms are frequently verbally modelled for the child by an adult during play or other interactions. 5-6 verbal children with cerebral palsy and speech disorder will be included.
The results from this project may provide further information on the early speech and language development of children with neurodevelopmental disabilities, thus aiding clinicians and families in decisions regarding services. Hopefully, this may lead to more children with special needs receiving early intervention. Early speech and language intervention in CP has previously often been aimed at children in need of alternative and augmentative communication (AAC). The intervention study presented here might, if proven successful, provide some evidence for another early intervention option suitable for speaking children.
Auditory, speech and language development in children with hearing loss the first three years in life
Traci Flynn, PhD, CLINTEC, Division of Speech and Language Pathology, Karolinska Institute (main supervisor)
Anette Lohmander, Professor, SLP, CLINTEC, Division of Speech and Language Pathology, Karolinska Institute (co-supervisor)
In Sweden, there are approximately 300 children born each year with a varying degree of hearing loss. Before the universal newborn hearing screening (UNHS) was introduced, many children born with hearing loss relied on visual cues to interpret spoken communication and the expectations on speech and spoken language were very low. After the UNHS was introduced in the late 20th century, the mean age for amplification in young children decreased from around 2.5 years to the possibilities of amplifying with hearing technology at 2.5 months. The implementation of UNHS opened the door to new possibilities for many children providing an earlier access to an improved auditory world of sounds and speech which is a prerequisite for developing speech through listening. Despite the early detection of hearing loss and the advancements in technology, current research is showing that there are still many children with mild to severe hearing loss who are having difficulties acquiring age-appropriate auditory, speech and language skills by the time they start school.
The purpose of my project is to examine the early auditory, speech and language development in children with mild to severe hearing loss amplified with behind-the-ear hearing aids and to investigate what factors may be related their outcomes at three years of age. The aim is to gain more knowledge on how early amplification affects auditory, speech and language development. This will be done by monitoring early auditory behaviors, functional hearing, speech and language development from the day of hearing aid fitting and every six months until the children are three years old. The project has a longitudinal prospective design and will use a contemporary control group of children with typical hearing.
Through the longitudinal monitoring of the children we can learn more about how individual factors affects the early language development over time. The results of this project could be used as a foundation for creating clinical protocols suggesting when in time chosen methods can be performed in the early intervention for the children and their families. The outcome data of the children may also act as guidance to parents regarding expectations for the individual child´s speech and language development.
Speech sound disorders in children; Differential diagnosis, comorbidity and intervention in Childhood Apraxia of Speech
Anita McAllister, docent, leg. logoped, Enheten för logopedi, Karolinska Institutet
Kristina Hansson, docent, leg. logoped, Avdelningen för Logopedi, Foniatri och Audiologi, Lunds Universitet
Edythe Strand, professor, leg. logoped, Department of Neurology, Mayo Clinic Rochester, USA
Children with severe speech sound disorders (SSD) may be completely unintelligible or difficult to understand. The etiologie for SSD is different depending on the affected level of speech production and a thorough assessment is crusial to determine if it is the linguistic/phonologic level or the motor speech level or both, that is impaired. Differential diagnosis is important since intervention strategies need to address the affected level(s) of impairment. Several children with severe speech impairment also display difficulties in sensory, motor or attention abilities. These difficulties may affect their independence, activities and participation. Comorbidity may also affect the child’s motivation and ability to benefit from the intervention program.
The purpose of this PhD project is:
- to develop a test to use in the process of differential diagnosis in suspected Childhood Apraxia of Speech (CAS) and collect reference data (Dynamisk Motorisk Talbedömning, DYMTA (Rex et al, 2016))
- to systematically describe speech and language in a group of 50 children, age 3 to 9 years old, with SSD and CAS
- to investigate comorbidity in the group of 50 children with SSD and CAS
- to evaluate intervention in children with CAS
Stuttering in young women and men
Ellika Schalling, Assistant Professor, SLP, Department of Clinical Sciences, Intervention and Technology, CLINTEC, Division of Speech and Language Pathology, Karolinska Institutet.
Agneta Herlitz, Professor in Psychology, Department of Clincal Neuroscience, Division of Psychology, Karolinska Institutet.
Elisabeth Lindström, Assistant Professor, SLP, Department of Logopedics, Åbo Akademi University, Finland.
Stuttering is a speech fluency disorder characterized by repetitions, prolongations of sounds or syllables or words, hesitations or pauses that disrupt the rhythmic flow of speech. The manifestation and the experience of stuttering may however vary greatly between individuals. In some cases it is not the actual speech behavior that determines if stuttering is a problem for the individual; it is the experience of stuttering.
The prevalence of stuttering among pre-school girls and boys is fairly equal at onset. Research suggests that females are more likely to recover, and prevalence of stuttering in adult men is higher than in adult women. However, studies show varied results regarding sex ratio, from 2:1 to 10:1 (m:f). Different factors may contribute to this variance such as errors in the sampling or reporting procedure, more pronounced symptoms for men than for women, socio-cultural roles determining how men and women seek health care, and/or medical tradition systematically ignoring or dismissing symptoms based on cultural values and norms of gender.
The overall aim of this project is to explore the prevalence of stuttering and the symptomatology in adolescent girls and boys, diagnosed with stuttering in early childhood. How do they experience and cope with stuttering in their teenage years? In a follow up study, with semi-structured interviews, the prevalence of stuttering will be investigated. Personal experiences of stuttering, choices of coping strategies, and the incentive for the choices, will be explored in in-depth interviews. To further explore different profiles regarding experience of stuttering, and the effect on quality of life for stuttering boys and girls in their school age and teens, self reported data from a questionnaire measuring subjective overall impact of stuttering will be analyzed. Finally, an investigation of attitudes to stuttered speech will be included, via qualitative content analysis of non-stuttering teenagers’ attitude to stuttered speech in young women and men, using data from focus group interviews.
- Stuttering symptoms from a gender perspective - a follow-up study of adolescents, diagnosed with stuttering in early childhood.
- Strategies to avoid overt stuttering among adolescents: A phenomenological analysis.
- Gender related analysis of the overall impact of stuttering – an examination of the results on the Overall Assessment of the Speaker’s Experience of Stuttering for school-children and teenagers (OASES-S-S; OASES-T-S).
- Adolescents’ attitudes to stuttered speech in young men and women.
Syntaktisk komplexitet som prediktor av Alzheimers sjukdom: en prospektiv longitudinell kohortstudie
Per Östberg, Associate Professor, SLP, Clinical Science Intervention and Technology, CLINTEC, Division of Speech and Language Pathology, Karolinska Institutet
Marco Kuhlmann, Associate Professor of Computer Science, Department of Computer and Information Science, Linköping University
Vesna Jelic, MD, PhD, Department of Neurobiology, Care Science and Society, Division of Clinical Geriatrics, Karolinska Institutet
Alzheimer’s disease (AD) is a neurodegenerative disease in which damage to the central nervous system accumulates over a long period of time and leads to impairments in several cognitive domains, for example episodic memory. Language impairments, including writing disorders, are also common. The complexity of spoken and written language is reduced and a correlation between low syntactic complexity and cognitive decline has been observed in retrospective studies. A prospective, longitudinal study is needed to evaluate syntactic complexity as a clinical marker of AD and to investigate the relationships between syntactic complexity, neuroradiological changes and neurocognitive functions.
The overall aim of the project is to evaluate the connection between syntactic complexity measured by computer-based, automated analysis methods and cognitive decline in AD. Participants with 'mild cognitive impairment' and 'subjective cognitive impairment' are of primary interest in this study as possible prodromes of AD; they have subjective and/or objective cognitive symptoms but do not fulfill the diagnostic criteria for dementia. A longitudinal follow-up is planned after approximately four years to evaluate syntactic complexity as a predictor of cognitive decline in AD. Neuroradiological correlates in two stratified groups (high vs low syntactic complexity) will be investigated and the validity of the syntactic complexity measurements will be evaluated based on the possible correlation with measures of cognitive function.
Decision-making ability and reasoning with regard to participation in medical research in impaired cognitive function
Ing-Mari Tallberg, Assoc Prof.
Maria Eriksdotter Jönhagen, Assoc Prof.
Erik Sundström, Assoc Prof.
The risk of developing dementia increases with age and as an aging population is calculated the proportion of diagnosed dementia is probably increasing. Alzheimers disease (AD) is the most common type of dementia and is characterized by gradual decline in function which significantly affects the person's everyday life. The impairment required for diagnosis is impaired memory and declining function in at least one other function such as aphasia, apraxia, agnosia and / or executive function. Language and communication difficulties that can be seen in AD are for example poor speech content, nonsense expressions and inability to follow context in a conversation. Even in mild AD there can be seen a significant decline in the ability to understand complex syntax of spoken and written language. A debated issue in research is the ethical dilemma of obtaining informed consent from people with impaired cognitive ability. Impaired cognitive function may affect different abilities that are considered relevant to the ability of making a decision. The overall aim of the PhD project is to investigate how language and cognitive functions affect the ability of people with MCI and AD to make a decision, express this verbally and be able to evaluate risk and benefit. Research on languages role in the ability to formulate and justify a decision and the relationship between current and premorbid cognitive level is considered important to clarify the complexity of decision-making ability
Facilitating participation in a disintegrating world - enhancing communication for people with dementia
Huvudhandledare: Ing-Mari Tallberg
Bihandledare: Eric Sundström, Katarina Mühlenbock
In health and social care contexts also cognitively impaired persons need to make vital decisions between treatment opportunities and life changes, e.g. acceptance of help or moving to a nursing home. During a dementia disease all cognitive domains, including language, will decline and thus aggravate the person’s ability to engage in conversations and express their views. The demented person’s impaired communicative capacity reduces the interlocutor’s possibility to understand the view of the demented person and thereby increase distress. Previous research has shown that cognitive impairment renders difficulties in understanding what possible risks and benefits different courses of action have. This includes reduced ability to give an informed consent for a clinical trial. It is a challenge in health care to give the best possible care regarding communication difficulties. One important thing is to help the patients expressing their views regarding decisions about their own person. Another is to make sure no patients are included or excluded from clinical trials due to limited communication skills. The purpose of this PhD project is:
- to evaluate two ways (one by supporting a conversation with a picture-method, one by making texts easily readable) for enhancing the demented person's ability to understand a situation, make a decision and also to enable the patient to express his or hers views in a intelligible way
- to develop and validate a clinical applicable test which addresses a patient’s medical decision-making capacity