ASHAWire
Advanced search
Skip main navigation
Close Drawer MenuOpen Drawer Menu
No AccessJournal of Speech, Language, and Hearing ResearchResearch Article17 May 2018

Auditory–Perceptual Assessment of Fluency in Typical and Neurologically Disordered Speech

    https://doi.org/10.1044/2018_JSLHR-S-17-0326

    Abstract

    Purpose

    The aim of this study is to investigate how speech fluency in typical and atypical speech is perceptually assessed by speech-language pathologists (SLPs). Our research questions were as follows: (a) How do SLPs rate fluency in speakers with and without neurological communication disorders? (b) Do they differentiate the speaker groups? and (c) What features do they hear impairing speech fluency?

    Method

    Ten SLPs specialized in neurological communication disorders volunteered as expert judges to rate 90 narrative speech samples on a Visual Analogue Scale (see Kempster, Gerratt, Verdolini Abbott, Barkmeier-Kraemer, & Hillman, 2009; p. 127). The samples—randomly mixed—were from 70 neurologically healthy speakers (the control group) and 20 speakers with traumatic brain injury, 10 of whom had neurogenic stuttering (designated as Clinical Groups A and B).

    Results

    The fluency rates were higher for typical speakers than for speakers with traumatic brain injury; however, the agreement among the judges was higher for atypical fluency. Auditory–perceptual assessment of fluency was significantly impaired by the features of stuttering and something else but not by speech rate. Stuttering was also perceived in speakers not diagnosed as stutterers. A borderline between typical and atypical fluency was found.

    Conclusions

    Speech fluency is a multifaceted phenomenon, and on the basis of this study, we suggest a more general approach to fluency and its deviations that will take into account, in addition to the motor and linguistic aspects of fluency, the metalinguistic component of expression as well. The results of this study indicate a need for further studies on the precise nature of borderline fluency and its different disfluencies.

    References

    • Ambrose, N., & Yairi, E. (1999). Normative disfluency data for early childhood stuttering.Journal of Speech, Language, and Hearing Research, 42, 895–909.
      LinkGoogle Scholar
    • Bailey, D., Blombgren, M., DeLong, C., Berggren, K., & Wambaugh, J. (2017). Quantification and systematic characterization of stuttering-like disfluencies in acquired apraxia of speech.American Journal of Speech-Language Pathology, 26, 641–648.
      LinkGoogle Scholar
    • Basso, A. (2003). Aphasia and its therapy. Oxford, United Kingdom: Oxford University Press.
      Google Scholar
    • Bellaire, K., Yorkston, K., & Beukelman, D. (1986). Modification of breath patterning to increase naturalness of a mildly dysarthric speaker.Journal of Communication Disorders, 19, 271–280.
      CrossrefMedlineGoogle Scholar
    • Benson, D. (1967). Fluency in aphasia: Correlation with radioactive scan localization.Cortex, 3, 373–394.
      CrossrefGoogle Scholar
    • Biddle, K., McCabe, A., & Bliss, L. (1996). Narrative skills following traumatic brain injury in children and adults.Journal of Communication Disorders, 29(6), 447–468.
      CrossrefMedlineGoogle Scholar
    • Boersma, P., & Weenink, D. (2005). Praat: Doing phonetics by computer. Retrieved from http://www.fon.hum.uva.nl/praat/
      Google Scholar
    • Bortfeld, H., Leon, S., Bloom, J., Schober, M., & Brennan, S. (2001). Disfluency rates in conversation: Effects of age, relationship, topic, role, and gender.Language and Speech, 44(2), 123–147.
      CrossrefMedlineGoogle Scholar
    • Bothe, A. (2008). Identification of children's stuttered and nonstuttered speech by highly experienced judges: Binary judgements and comparisons with disfluency-types definitions.Journal of Speech, Language, and Hearing Research, 51, 867–878.
      LinkGoogle Scholar
    • Brainbridge, L., Stavros, C., Ebrahimian, M., Wang, Y., & Ingham, R. J. (2015). The efficacy of stuttering measurement training: Evaluating two training programs.Journal of Speech, Language, and Hearing Research, 58, 278–286.
      LinkGoogle Scholar
    • Brown, S., Ingham, R. J., Ingham, J. C., Laird, A., & Fox, P. (2005). Stuttered and fluent speech production: An ALE meta-analysis of functional neuroimaging studies.Human Brain Mapping, 25, 105–117.
      CrossrefMedlineGoogle Scholar
    • Brundage, S., Bothe, A., Lengeling, A., & Evans, J. (2006). Comparing judgments of stuttering made by students, clinicians and highly experienced judges.Journal of Fluency Disorders, 31, 271–283.
      CrossrefMedlineGoogle Scholar
    • Campbell, J., & Hill, D. (1994). Systematic disfluency analysis. Evanston, IL: Northwestern University.
      Google Scholar
    • Cannito, M., Burch, A., Watts, C., Rappold, P., Hood, S., & Sherrard, K. (1997). Disfluency in spasmodic dysphonia: A multivariate analysis.Journal of Speech, Language, and Hearing Research, 40, 627–641.
      LinkGoogle Scholar
    • Canter, G. (1971). Observations on neurogenic stuttering: A contribution to differential diagnosis.British Journal of Communication Disorders, 6, 139–143.
      CrossrefMedlineGoogle Scholar
    • Chan, K., & Yiu, E. (2002). The effect of anchors and training on the reliability of perceptual voice evaluation.Journal of Speech, Language, and Hearing Research, 45, 111–126.
      LinkGoogle Scholar
    • Conture, E. G. (1990). Childhood stuttering: What is it and who does it?.ASHA Reports, 18, 2–14.
      Google Scholar
    • Cordes, A. K., & Ingham, R. J. (1995). Judgements of stuttered and nonstuttered intervals by recognized authorities in stuttering research.Journal of Speech and Hearing Research, 38, 33–41.
      LinkGoogle Scholar
    • Cucchiarini, C., Strik, H., & Boves, L. (2000). Quantitative assessment of second language learners' fluency by means of automatic speech recognition technology.The Journal of the Acoustical Society of America, 107(2), 989–999.
      CrossrefMedlineGoogle Scholar
    • Dagenais, P., Watts, C., Turnage, L., & Kennedy, S. (1999). Intelligibility and acceptability of moderately dysarthric speech by three different types of listeners.Journal of Medical Speech-Language Pathology, 7, 91–96.
      Google Scholar
    • De Jong, N. H., & Wempe, T. (2009). Praat script to detect syllable nuclei and measure speech rate automatically.Behavior Research Methods, 41(2), 385–390.
      CrossrefMedlineGoogle Scholar
    • de Lacy Costello, A., & Warrington, E. K. (1989). Dynamic aphasia. The selective impairment of verbal planning.Cortex, 25, 103–114.
      CrossrefMedlineGoogle Scholar
    • Deger, K., & Ziegler, W. (2002). Speech motor programming in apraxia of speech.Journal of Phonetics, 30(3), 321–335.
      CrossrefGoogle Scholar
    • Derwing, T., Rossiter, M., Munro, M., & Thomson, R. (2004). Second language fluency: Judgments on different tasks.Language Learning, 54, 655–679.
      CrossrefGoogle Scholar
    • Duffy, J. R. (2005). Motor speech disorders. St. Louis, MO: Elsevier Mosby.
      Google Scholar
    • Eadie, T., Stroka, A., Wright, D. R., & Merati, A. (2011). Does knowledge of medical diagnosis bias auditory–perceptual judgments of dysphonia?.Journal of Voice, 25(4), 420–429.
      CrossrefMedlineGoogle Scholar
    • Feyereisen, P., Verbeke-Dewitte, C., & Seron, X. (1986). On fluency measures in aphasic speech.Journal of Clinical and Experimental Neuropsychology, 8(4), 393–404.
      CrossrefMedlineGoogle Scholar
    • Finn, P., Ingham, R., Ambrose, N., & Yairi, E. (1997). Children recovered from stuttering without formal treatment: Perceptual assessment of speech normalcy.Journal of Speech, Language, and Hearing Research, 40(4), 867–876.
      LinkGoogle Scholar
    • Fox Tree, J. (1995). The effects of false starts and repetitions on the processing of subsequent words in spontaneous speech.Journal of Memory and Language, 34, 709–738.
      CrossrefGoogle Scholar
    • Gerratt, B. R., Till, J. A., Rosenbek, J. C., Wertz, R. T., & Boysen, A. E. (1991). Use and perceived value of perceptual and instrumental measures in dysarthria management.In C. A. Moore, K. M. Yorkston, & D. R. Beukelman (Eds.), Dysarthria and apraxia of speech: Perspectives on management (pp. 77–93). Baltimore, MD: Brookes.
      Google Scholar
    • Goodglass, H., & Kaplan, E. (1983). The assessment of aphasia and related disorders. Philadelphia, PA: Lea & Febiger.
      Google Scholar
    • Gordon, J. (1998). The fluency dimension in aphasia.Aphasiology, 12(7), 673–688.
      CrossrefGoogle Scholar
    • Gordon, J. (2006). A quantitative production analysis of picture description.Aphasiology, 20(2), 188–204.
      CrossrefGoogle Scholar
    • Green, J. R., Beukelman, D. R., & Ball, L. J. (2004). Algorithm estimation of pauses in extended speech samples of dysarthric and typical speech.Journal of Medical Speech-Language Pathology, 12(4), 149–154.
      MedlineGoogle Scholar
    • Gregory, H. (1993). A clinician's perspective: Comment of identification of stuttering, prevention and early intervention.Journal of Fluency Disorders, 18, 389–402.
      CrossrefGoogle Scholar
    • Guenther, F. H., Gosh, G. H., Nieto-Castanon, A., & Tourville, J. A. (2006). A neural model of speech production.In J. Harrington & M. Tabain (Eds.), Speech production: Models, phonetic processes and techniques (pp. 27–40). New York, NY: Psychology Press.
      Google Scholar
    • Guitar, B. (2006). Stuttering: An integrated approach to its nature and treatment. Baltimore, MD: Lippincott, Williams & Wilkins.
      Google Scholar
    • Haley, K. L., Jacks, A., de Riesthal, M., Abou-Khalil, R., & Roth, H. L. (2012). Toward a quantitative basis for assessment and diagnosis of apraxia of speech.Journal of Speech, Language, and Hearing Research, 55, 1502–1517.
      LinkGoogle Scholar
    • Harmon, T. G., Jacks, A., Haley, K. L., & Faldowski, R. A. (2015). Listener perceptions of simulated fluent speech in non-fluent aphasia.Aphasiology, 30(8), 922–942.
      CrossrefGoogle Scholar
    • Hoffman, L., Wilson, L., Copley, A., Hewat, S., & Lim, V. (2014). The reliability of a severity rating scale to measure stuttering in an unfamiliar language.International Journal of Speech and Language Pathology, 16(3), 317–326.
      CrossrefMedlineGoogle Scholar
    • Jacks, A., & Haley, K. (2015). Auditory masking effects on speech fluency in apraxia of speech and aphasia: Comparison to altered auditory feedback.Journal of Speech, Language, and Hearing Research, 58, 1670–1686.
      LinkGoogle Scholar
    • Johns, D., & Darley, F. (1970). Phonemic variability in apraxia of speech.Journal of Speech and Hearing Research, 13, 556–583.
      LinkGoogle Scholar
    • Kempster, G. B., Gerratt, B. R., Verdolini Abbott, K., Barkmeier-Kraemer, J., & Hillman, R. E. (2009). Consensus auditory-perceptual evaluation of voice: Development of a standardized clinical protocol.American Journal of Speech-Language Pathology, 18, 124–132.
      LinkGoogle Scholar
    • Kent, R. D. (1996). Hearing and believing: Some limits to the auditory–perceptual assessment of speech and voice disorders.American Journal of Speech-Language Pathology, 5(3), 7–23.
      LinkGoogle Scholar
    • Kent, R. D. (2000). Research on speech motor control and its disorders: A review and prospective.Journal of Communication Disorders, 33, 391–428.
      CrossrefMedlineGoogle Scholar
    • Kerschensteiner, M., Poeck, K., & Brunner, E. (1972). The fluency-non fluency dimension in the classification of aphasic speech.Cortex, 8(2), 233–247.
      CrossrefMedlineGoogle Scholar
    • Korpijaakko-Huuhka, A.-M., & Aulanko, R. (1994). Auditory and acoustic analysis of prosody in the clinical evaluation of narrative speech.In R. Aulanko & A.-M. Korpijaakko-Huuhka (Eds.), Proceedings of the Third Congress of the International Clinical Phonetics and Linguistic Association (pp. 91–98). Helsinki, Finland: Publications of the Department of Phonetics, University of Helsinki.
      Google Scholar
    • Korpijaakko-Huuhka, A.-M., & Lind, M. (2012). The impact of aphasia on textual coherence: Evidence from two typologically different languages.Journal of Interactional Research in Communication Disorders, 3(1), 47–70.
      CrossrefGoogle Scholar
    • Kreiman, J., Gerratt, B. R., Kempster, G. B., Erman, A., & Berke, G. S. (1993). Perceptual evaluation of voice quality: Review, tutorial, and a framework for future research.Journal of Speech and Hearing Research, 36, 21–40.
      LinkGoogle Scholar
    • Kreiman, J., Gerratt, B. R., & Precoda, K. (1990). Listener experience and perception of voice quality.Journal of Speech and Hearing Research, 33, 103–115.
      LinkGoogle Scholar
    • Kreindler, A., Mihailescu, L., & Fradis, A. (1980). Speech fluency in aphasics.Brain and Language, 9(2), 199–205.
      CrossrefMedlineGoogle Scholar
    • Krishnan, G., & Tiwari, S. (2013). Differential diagnosis in developmental and acquired neurogenic stuttering: Do fluency-enhancing conditions dissociate the two?.Journal of Neurolinguistics, 26(2), 252–257.
      CrossrefGoogle Scholar
    • Laine, M., Koivuselkä-Sallinen, P., Hänninen, R., & Niemi, J. (1997). Bostonin nimentätesti. Helsinki, Finland: Psykologien Kustannus.
      Google Scholar
    • Lehtonen, J. (1976). On the problems of measuring fluency.AFinLAn vuosikirja, 8(23), 53–68.
      Google Scholar
    • Lennon, P. (1990). Investigating fluency in EFL: A quantitative approach.Language Learning, 3, 387–417.
      CrossrefGoogle Scholar
    • Love, L., & Jeffress, L. (1971). Identification of brief pauses in the fluent speech of stutterers and nonstutterers.Journal of Speech and Hearing Research, 14(2), 229–240.
      LinkGoogle Scholar
    • Lundgren, K., Helm-Estabrooks, N., & Klein, R. (2010). Stuttering following acquired brain damage: A review of the literature.Journal of Neurolinguistics, 23(5), 447–454.
      CrossrefMedlineGoogle Scholar
    • Lundie, M., Erasmus, Z., Zsilavecz, U., & van der Linde, J. (2014). Compilation of a preliminary checklist for the differential diagnosis of neurogenic stuttering.South African Journal of Communication Disorders, 61(1), 1–10.
      CrossrefGoogle Scholar
    • Luria, A. R. (1973). The working brain. New York, NY: Basic Books.
      Google Scholar
    • Mazzucchi, A., Moretti, G., Carpeggiani, P., Parma, M., & Paini, P. (1981). Clinical observations on acquired stuttering.British Journal of Disorders of Communication, 16(1), 19–30.
      CrossrefMedlineGoogle Scholar
    • McCauley, R. (1989). Measurement as a dangerous activity.Journal of Speech-Language Pathology and Audiology, 13, 29–32.
      Google Scholar
    • McDonald, S., Togher, L., & Code, C. (1999). Communication problems following traumatic brain injury.In S. McDonald, L. Togher, & C. Code (Eds.), Communication problems following traumatic brain injury (pp. 1–18). Hove, United Kingdom: Psychology Press.
      Google Scholar
    • McNeil, M., & Copland, D. (2011). Aphasia theory, models and classification.In L. L. LaPointe (Ed.), Handbook of aphasia and brain-based cognitive-language disorders (pp. 27–47). New York, NY: Thieme.
      Google Scholar
    • Meyers, S. (1986). Qualitative and quantitative differences and patterns of variability in disfluencies emitted by preschool stutterers and nonstutterers during dyadic conversations.Journal of Fluency Disorders, 11, 293–306.
      CrossrefGoogle Scholar
    • Myers, F., Bakker, K., St. Louis, K., & Raphael, L. (2012). Disfluencies in cluttered speech.Journal of Fluency Disorders, 37, 9–19.
      CrossrefMedlineGoogle Scholar
    • Mossholder, K. W., Settoon, R. P., Harris, S. G., & Armenakis, A. A. (1995). Measuring emotion in open-ended survey responses: An application of textual data analysis.Journal of Management, 21(2), 335–355.
      CrossrefGoogle Scholar
    • Nicolosi, L., Harryman, E., & Kresheck, J. (1987). Terminology of communication disorders: Speech-language-hearing (2nd ed.). Baltimore, MD: Lippincott, Williams & Wilkins.
      Google Scholar
    • Park, H., Rogalski, Y., Rodriguez, A. D., Zlatar, Z., Benjamin, M., Harnish, S., … Reilly, J. (2011). Perceptual cues used by listeners to discriminate fluent from non-fluent narrative discourse.Aphasiology, 25, 998–1015.
      MedlineGoogle Scholar
    • Pietilä, M.-L., Lehtihalmes, M., Klippi, A., & Lempinen, M. (2005). Western Aphasia Battery. Käsikirja. Helsinki, Finland: Psykologien Kustannus.
      Google Scholar
    • Quesal, R. W. (1988). Inexact use of “disfluency” and “dysfluency” in stuttering research.Journal of Speech and Hearing Disorders, 53, 349–350.
      LinkGoogle Scholar
    • Rohrer, J., Rossor, M., & Warren, J. (2010). Syndromes of non-fluent primary progressive aphasia. A clinical and neurolinguistic analysis.Neurology, 75(7), 603–610.
      CrossrefMedlineGoogle Scholar
    • Rosen, K., Murdoch, B., Folker, J., Vogel, A., Cahill, L., Delatycki, M., & Corben, L. (2010). Automatic method of pause measurement for normal and dysarthric speech.Clinical Linguistics & Phonetics, 24(2), 141–154.
      CrossrefMedlineGoogle Scholar
    • Rosenbek, J. (1980). Apraxia of speech—Relationship to stuttering.Journal of Fluency Disorders, 5, 233–235.
      CrossrefGoogle Scholar
    • Segalowitz, N. (2010). Cognitive bases of second language fluency. New York, NY: Routledge.
      CrossrefGoogle Scholar
    • Shriberg, L. D., Green, J. R., Campbell, T. F., McSweeny, J. L., & Scheer, A. R. (2003). A diagnostic marker for childhood apraxia of speech: The coefficient of variation ratio.Clinical Linguistics & Phonetics, 17(7), 575–595.
      CrossrefMedlineGoogle Scholar
    • St. Louis, K., Myers, F., Faragasso, K., Townsend, P., & Gallaher, A. (2004). Perceptual aspects of cluttered speech.Journal of Fluency Disorders, 29, 213–235.
      CrossrefMedlineGoogle Scholar
    • Susca, M., & Healey, E. (2001). Perceptions of simulated stuttering and fluency.Journal of Speech, Language, and Hearing Research, 44(1), 61–72.
      LinkGoogle Scholar
    • Tani, T., & Sakai, Y. (2011). Analysis of five cases with neurogenic stuttering following brain injury in the basal ganglia.Journal of Fluency Disorders, 36, 1–16.
      CrossrefMedlineGoogle Scholar
    • Van Borsel, J. (1997). Neurogenic stuttering: A review.Journal of Clinical Speech and Language Studies, 7, 16–33.
      Google Scholar
    • Van Borsel, J. (2014). Acquired stuttering: A note on terminology.Journal of Neurolinguistics, 27, 41–49.
      CrossrefGoogle Scholar
    • Van Borsel, J., & Taillieu, C. (2001). Neurogenic stuttering versus developmental stuttering: An observer judgement study.Journal of Communication Disorders, 34, 385–395.
      CrossrefMedlineGoogle Scholar
    • van Lieshout, P., Bose, A., Square, P., & Steele, C. (2007). Speech motor control in fluent and dysfluent speech production of an individual with apraxia of speech and Broca's aphasia.Clinical Linguistics & Phonetics, 21(3), 159–188.
      CrossrefMedlineGoogle Scholar
    • Weismer, G., & Martin, R. (1992). Acoustic and perceptual approaches to the study of intelligibility.In R. D. Kent (Ed.), Intelligibility in speech disorders: Theory, measurement and management (pp. 68–118). Amsterdam, the Netherlands: Benjamins.
      Google Scholar
    • Xu, Y. (2005–2010). ProsodyPro.praat. Retrieved from http://www.phon.ucl.ac.uk/home/yi/ProsodyPro/
      Google Scholar
    • Yaruss, J. S. (1997). Clinical measurement of stuttering behaviors.Contemporary Issues in Communication Science and Disorders, 24, 33–44.
      LinkGoogle Scholar
    • Yorkston, K., Hammen, V., Beukelman, D., & Traynor, C. (1990). The effect of rate control on the intelligibility and naturalness of dysarthric speech.Journal of Speech and Hearing Disorders, 55, 550–561.
      LinkGoogle Scholar
    • Young, M. A. (1984). Identification of stuttering and stutterers.In R. F. Curlee & W. H. Perkins (Eds.), Nature and treatment of stuttering: New directions (pp. 13–30). San Diego, CA: College-Hill.
      Google Scholar

    Additional Resources