Assessment of adult speech disorders: current situation and needs in French-speaking clinical practice

Abstract

Introduction

Speech assessment methods used in clinical practice are varied and mainly perceptual and motor. Reliable assessment of speech disorders is essential for the tailoring of the patient’s treatment plan.

Objective

To describe current clinical practices and identify the shortcomings and needs reported by French-speaking clinicians regarding the assessment of speech disorders in adult patients.

Methods

Data were collected using an online questionnaire for French-speaking speech and language pathologists (SLPs) in Belgium, France, Switzerland, Luxembourg, and Maghreb. Forty-nine questions were grouped into six domains: participant data, educational and occupational background, experience with speech disorders, patient population, tools and tasks for speech assessment, and possible lacks regarding the current assessment of speech disorders.

Results

Responses from 119 clinicians were included in the analyses. SLPs generally use “à la carte” assessment with a large variety of tasks and speech samples. About one quarter of them do not use existing assessment batteries. Those who do mostly use them partially. Pseudo-words are rarely used and are absent from standardized batteries, in contrast to the major use of words and sentences. Perceptual evaluation largely prevails (mainly overall ratings of speech “intelligibility”, “severity,” and “comprehensibility” and percent-correct phonemes), whereas the recording equipment for acoustic measures is not standardized and only scarcely described by the SLPs. The most commonly used questionnaire to assess the functional impact of the speech disorder is the Voice Handicap Index; one quarter of the SLPs does not use any questionnaire. Overall, the available tools are considered only moderately satisfactory. The main reported shortcomings are a lack of objectivity and reproducibility of speech measures; exhaustiveness and consideration of specific speech parameters (prosody, speech rate, and nasality); practicality of the assessment tools.

Conclusion

This study highlights a lack of standardization of the speech assessment in French-speaking adults and the need to offer new reliable tools for an optimized, accurate speech assessment. The automation of these tools would allow for rapid, reproducible, and accurate measures.

Keywords:

• Speech
• assessment
• French
• survey

Acknowledgments

The authors thank all the volunteers who gave their time to participate in this survey.

Ethical approval

All procedures performed involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Disclosure statement

All authors declare that there is no conflict of interest.

Notes

1 See the ASHA Practice Portal for a classification of speech sound disorders: https://www.asha.org/practice-portal/clinical-topics/articulation-and-phonology/

2 https://enquetes.univ-tlse3.fr/index.php/622914?lang=fr

3 In the BECD, for example, intelligibility is described as "the degree of precision with which the message is understood by the listener" (quoting Yorkston and Beukelman, 1980). The "intelligibility score" task is based on word and sentence reading, as well as on "spontaneous" speech (sic), and thus appears to target comprehensibility more closely (in addition, the sub-tests are labelled "word comprehension" and "sentence comprehension").

4 Note, however, that the BECD was available until at least 2012 and has been remarketed in October 2019.

5 It should be noted that the notions of "quantification" and "objectivity" are sometimes confused. A quantitative assessment is not necessarily objective.

Additional information

Funding

 

Notes on contributors

Timothy Pommée

Timothy Pommée received a master’s degree in Speech and Language Pathology, specialized in Voice Therapy, at the University of Liège (Belgium). He is since 2018 a PhD student in computer sciences and telecommunications at the Institut de Recherche en Informatique de Toulouse (Université Toulouse III Paul Sabatier) in Toulouse (France). His research interests focus on the clinical relevance of speech intelligibility measures.

Mathieu Balaguer

Mathieu Balaguer graduated as a speech-language pathologist in 2007 at the Université Toulouse III Paul Sabatier in Toulouse (France). He has then worked as a private practitioner for two years, after what he worked as an employed SLP in hospital settings until 2019. He then received a master’s degree in Clinical Epidemiology in 2018. He is since 2018 a PhD student in computer sciences and telecommunications at the Institut de Recherche en Informatique de Toulouse (Université Toulouse III Paul Sabatier) in Toulouse (France). His research interests focus on the automatic assessment of the functional impact of speech disorders on daily communication acts in patients treated for cancer of the oral cavity or oropharynx. He is also involved in education and training of SLP students as lecturer and internships coordinator in the Faculty of Medicine Toulouse-Rangueil since 2010.

Julie Mauclair

Julie Mauclair received a PhD at the Laboratoire d’Informatique de l’Université du Mans in 2006, entitled “Confidence measures in speech processing and applications”. From 2007 to 2009, she was a postdoc in Ireland (UCD) working within the CNGL project addressing the adaptation of digital content to culture, locale and linguistic environment at high volume, speed and quality. Since 2009 she is an assistant professor, first at the University Paris Descartes within the LIPADE laboratory, then in the SAMoVA team at the Institut de Recherche en Informatique de Toulouse. Her research interests focus on characterizing the speech and voice of people presenting with various disorders, using automatic technologies.

Julien Pinquier

Julien Pinquier received a PhD (computer science specialty) in 2004, related to audio indexing and structuring by search of primary components: speech, music and keysounds. He received the HDR diploma of the University of Toulouse in 2014: this work was based on audio segmentation (speech, music and environmental sounds) and audiovisual segmentation. Since 2005, he is an assistant professor at the Université Toulouse III Paul Sabatier where he works in the Institut de Recherche en Informatique de Toulouse. His objectives relate to the combination of the audio and the video, the multimedia indexing for automatic structuring of audiovisual documents. He is the author of more than 120 scientific publications. He is the team leader of the SAMoVA team of IRIT. He is now focusing on speech intelligibility measurements.

Virginie Woisard

Virginie Woisard is a phoniatrician and Associate Professor in ENT and Phoniatrics. She is working in the Voice and Swallowing Unit in the ENT department of the Rangueil-Larrey University Hospital in Toulouse, a unit she founded in 1992. She created the Oncorehabilitation Unit at the Cancer Institute of Toulouse in 2014 and is also the head of the Rehabilitaion center for laryngectomized patients at the University Hospital of Toulouse.Author and co-author of numerous publications regarding the assessment and rehabilitation of oropharyngeal dysphagia and speech disorders, she actively participates in the promotion of research on this topic. Involved in several scientific societies (ENT, Phoniatrics, laryngology and dysphagia), she is also a devoted teacher and leader of the University Logopedic Training Center of Toulouse. Her research, as a member of Octogone-Lordat, Jean Jaurès University Toulouse II, mainly focuses on the fields of speech disorders. She is the General secretary of the French Phoniatricians Society since 2015.