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Research projects - Speech and Language Pathology

Early speech, language, and auditory development

in children with hearing impairment

Traci Flynn, postdoc

Through universal newborn hearing screening, children are being identified with a hearing impairment early in life with the purpose of developing age-appropriate speech and language skills. However, research has focused on children with moderate to severe sensori-neural hearing loss. Children with conductive hearing impairment's development also needs to be assessed. Only two studies to date have documented the speech and language skills of childrenwith a conductive hearing loss fit with amplification at an early age. More evidence is required to establish best clinical practice for these children.

The areas included in this project are:

  1. Identifying measures to reliabily measure speech, language, and auditory development in early childhood.
  2. Assessing the speech, language, and auditory skills of children with conductive hearing impairment when fitted with amplification.

The aims of the project include:

  1. Develop and evaluate a protocol for assessment of speech, language, and auditory skills for children aged 0-3 years of age with a hearing impairment.
  2. Design a clinical practise protocol for amplification as an intervention for children with congenital or long-standing conductive hearing loss based on evidence gathered during the project.

Evaluation of speech at velopharyngeal insufficiency and oral motor dysfunction

Gunilla Henningsson, associate professor

Velopharyngeal dysfunction which can be both structural (such as cleft palate) and functional (neurological disease/trauma) results in deviant speech and resonance with air leakage to the nose, i.e extensive communication problems. Since secondary surgery (pharyngeal flap) is usually not recommended in this group of patients, palatal lift might be an option. The treatment effect of an individually designed palatal lift in adults with hypernasal speech caused by neurological diseases will be evaluated.

A diagnostic assessment instrument for evaluation of oral motor disorders and is used clinically is under development and validation

Identification of risk factors for voice problem

- individual factors and noisy work environment

Maria Södersten, associate professor

In modern societies about 1/3 of the working force belong to occupations where the voice is an essential tool, e.g., teachers, pre-school teachers, artists, callcenter personel and salespersons. Individuals with voice intensive work are at risk for vocal fold damages due to high vocal loading. Women seem to be especially exposed. Hoarseness, weak voice and vocal fatigue are common voice symptoms resulting in reduced work capacity and sometimes periods of sick leave. Voice disorders are caused by several factors related to the individual and work environment. To be heard in high background noise speakers increase voice intensity resulting in a hyperfunctional vocal behaviour causing mechanical stress on the vocal folds. The purpose is to explore if voice disorders are caused by vocal loading during work or by the individual’s physiological prerequisites, and to what extent vocal loading is caused by environmental noise. Voice activity is studied for 30-40 men and women who have sought medical help for voice disorders and gender-matched controls from similar working places. A new portable voice accumulator, Voxlog, has been developed to measure both the speaker’s voice activity and level of the background noise. Voice data and the speakers’ ratings of voice symptoms are collected during work and leisure time for 1-2 weeks. Because of ethical and practical reasons, only relevant voice data and not the actual sound are saved for analysis. Data are stored in a data base so that the relationships between voice activity, noise levels and subjective ratings of voice symptoms can be mapped out using statistical methods. Results will form the basis for voice ergonomic recommendations and work safety regulations regarding how much or how little the voice should be used for optimal function. Researchers from different universities in Sweden are cooperating. A pilot study was carried out during 2011 to test the measuring system and data collection is ongoing.

Language profiles in children with autism spectrum disorders

Lisen Kjellmer, Ph.D., speech and language pathologist

Language impairments in children with autism spectrum disorders (ASD) are increasingly recognized and researchers indicate that the linguistic features of such impairments are more complex than described in the diagnostic criteria. In an interdisciplinary project we follow the language development in a representative group of 208 preschool children (176 boys; 32 girls) with ASD in the Stockholm county. The project includes several studies assessing language abilty in relation to cognition, type and degree of autism, adaptive functioning, as well as type of intervention. In a first study of the whole group, we described the general language delay seen in the population as well as the large variability of language ability. The next study examined how cognition, degree of autism sypmtoms, and adaptive function contributed to the variability in receptive and expressive language ability as well as non-verbal communicative ability. We have also assessed language comprehension in the children who did not exhibit intellectual disability (ID) at age 4 to 6. Further studies will examine the development of receptive and expressive vocabulary over time in the whole group as well as language profiles and pragmatic ability in the children without ID. In addition, we are planning a follow-up study of the language abilities of the children in the latter group when they are 12 years old. The projects are conducted in collaboration with Gilberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg.

Speech Development and Speech Disorders related to Cleft Palate

Anette Lohmander, professor, SLP

Development from babbling to speech in children with cleft palate and typically developing children is longitudinally investigated with the purpose to find predictors for the development of speech disorders. Impact of type and timing of palatal surgery (Scandcleft and Timing of Primary Surgery in cleft palate, TOPS) and hearing loss (Tidig Utveckling av Tal och Hörsel, TUTH) on the development is investigated. Screening for early identification of risk factors for later speech disorders. Development of efficient intervention procedures (surgical, audiological, speech/communicative) in order to predict or minimize the impact of the structural defect of dysfunction on speech and the impact of speech deviances on communicative activity and participation. The area comprise:

  1. Speech development and speech and language disorders in individuals born with cleft palate, and the impact of surgical procedure & timing, and ear and hearing problems.
  2. Early identification of individuals at risk for speech disorders related to cleft palate, hearing impairment or other adverse conditions.
  3. Assessment methods: screening, documentation and analysis (perceptual, acoustic and physiological) including cross-linguistics aspects.
  4. Treatment strategies for speech disorders

Aims of the projects are to:

  • Describe the development and disorders from babbling to speech including characteristics, intelligibility, self-reported attitude to speech and communication) in individuals born with cleft palate.
  • Develop methods for assessment of structural or neurological speech and communication disorders.
  • Explore early precursors and prevention possibilities for later speech disorders in individuals with cleft palate (surgical, audiological).
  • Trial a screening procedure for early identification of risk factors for speech disorders in children with cleft palate, hearing loss or cerebral palsy.
  • Develop and evaluate treatment methods for persistent speech and communication disorders.

Speech, voice and language in progressive neurologic disease

Ellika Schalling, assistant professor, speech and language pathologist

Most individuals affected with progressive neurologic disease also suffer from impaired speech, voice and language functions. Speech, and voice impairment in individuals with spinocerebellar ataxia, SCA are described with both acoustic and perceptual methodology and studied longitudinally. Language and cognition in individuals with SCA are also studied. In collaboration with University of Gothenburg and Umeå University speech and voice outcomes as well as communicative function after Deep Brain Stimulation, DBS, in individuals with Parkinson’s disease are also studied. Voice use in everyday situations and effects of feedback regarding voice sound level are studied with a new portable voice accumulator (VoxLog) in individuals with Parkinson’s disease. Other projects include evaluation of treatment effects on speech, voice and communicative function in individuals with multiple sclerosis or high cervical spinal cord injuries. Methods include computer-based acoustic and perceptual analys, self-report questionnaires for assessment of communicative function as well as neuropsychological and linguistic assessments. Validation of instruments for assessment of how the speech impairment affects communicative participation is ongoing, as well as questionnaire-studies about self-reported communication difficulties and SLP-services received by individuals with different kinds of neurological disorders.

Voice, speech and oral motor function

Anita McAllister, associate professor

Noisy environments affect voice use and hearing. Several studies has found high noixe levels in preshools. In collaboration with researchers in Finland and Iceland a project, “How does it work? Voice, speech and communication”, interviewing children and preshool teachers in the three contries is conducted. The interviewes focus on the participants thoughts on communication, noise and sound environment at the preschool and if, and in that case how, this affects them . Valdís Jónsdóttir, Island is project leader. The project is finanzed by Nordplus Horizon. The data collection will be conducted during 2013.

Evaluating intervention outcome is important as a basis for evidence based methods in speech and language pathology. In collaboration with Professor Susanna Simberg, Åbo Academy and the county healthcare in Östergötland a randomized controlled trial is studying the effects of two types of voice therapy for individuals with functional or functiona/organic voice disorders. The project also includes a single-case study. The data-collection has finnished and is now being analyzed. Communication of results is planned during 2014. The projects has been finanzed by local research funds from the county council Östergötland and grants from Åbo Academy.

Speech production may be influenced by language or speech motor problems. The cause of the problem may influence intervention. It is therefore important to develop valid and reliable clinical assessment methods. In cooperation with a researcher at the University of Lund and Susanne Rex, clinical SLP at Skåne University Hospital in Lund a project is in progress aiming at developing a Swedish dynamic assessment instrument to aid clinicians in differential diagnosis of speech disorders and Childhood Apraxia of Speech. There is also a cooperation with associate professor, SLP Edythe Strand, Mayo Clinic, USA who first proposed the dynamic assessment method. The project is finansed by the Sunnerdahl Fund and and local funds.