Objective: We examined whether perceived voice quality is altered in a group of children with cerebral palsy (CP) following an intervention focusing on respiration and phonation, and whether possible improvements might be associated with increased intelligibility levels. Methods: Sixteen individuals with CP and dysarthria (9 girls, mean age 14 years, SD = 2; 9 with spastic type CP, 2 dyskinetic, 4 mixed, 1 Worster-Drought syndrome) completed intelligibility assessments on separate days twice before intervention, at termination of treatment and at 6-week follow-up using 50 words from the Children's Speech Intelligibility Measure lists, and describing cartoon strips. Experienced speech-language pathologists rated voice quality employing GRBAS scales. Results: There was no clear evidence that change in voice quality pre-post intervention was large compared with change in the pre-intervention or post-intervention periods. Asthenia demonstrated largest improvement (effect size of 0.4). Intelligibility correlated weakly with Grade, Breathiness and Asthenia, but not with Roughness or Strain. A deterioration of 1 unit on the Grade and Asthenia scales was associated with an approximately 11% decrease in intelligibility. Conclusion: Perceived changes in voice quality were small compared to changes in intelligibility. Further investigations must examine other variables potentially associated with intelligibility gain to better understand the links between the respiratory-phonatory intervention and improved intelligibility.

Andersen E, Fledelius HC, Fons M, Haugsted R: An epidemiological study of disability in 4-year-old children from a birth cohort in Frederiksborg County, Denmark. Dan Med Bull 1990;37:182-185.
Stanley F, Blair E, Alberman E: Cerebral Palsy: Epidemiology and Causal Pathways. London, MacKeith Press, 2000.
Bax M, Tydeman C, Flodmark O: Clinical and MRI correlates of cerebral palsy: the European Cerebral Palsy study. JAMA 2006;296:1602-1608.
Kennes J, Rosenbaum P, Hanna SE, Walter S, Russell D, Raina P, Bartlett D, Galuppi B: Health status of school-aged children with cerebral palsy: information from a population-based sample. Dev Med Child Neurol 2002;44:240-247.
Levin K: Babbling in infants with cerebral palsy. Clin Linguist Phon 1999;13:249-267.
Pennington L, Miller N, Robson S: Speech therapy for children with dysarthria acquired before three years of age. Cochrane Database Syst Rev 2009;4:006937.
De Bodt MS, Huici M, Van De Heyning PH: Intelligibility as a linear combination of dimensions in dysarthric speech. J Commun Disord 2002;35:283-292.
Cannito MP, Suiter DM, Beverly D, Chorna L, Wolf T, Pfeiffer RM: Sentence intelligibility before and after voice treatment in speakers with idiopathic Parkinson's disease. J Voice 2012;26:214-219.
Lee T, McCann C: A phonation therapy approach for Mandarin-English bilingual clients with dysarthria. Clin Linguist Phon 2009;23:762-779.
Fox CM, Ramig LO, Ciucci MR, Sapir S, McFarland DH, Farley BG: The science and practice of LSVT/LOUD: neural plasticity-principled approach to treating individuals with Parkinson disease and other neurological disorders. Semin Speech Lang 2006;27:283-299.
Patel R, Campellone P: Acoustic and perceptual cues to contrastive stress in dysarthria. J Speech Lang Hear Res 2009;52:206-222.
Ballard KJ, Djaja D, Arciuli J, James DGH, van Doorn J: Developmental trajectory for production of prosody: lexical stress contrastivity in children ages 3 to 7 years and in adults. J Speech Lang Hear Res 2012;55:1822-1835.
Tjaden K, Wilding GE: Rate and loudness manipulations in dysarthria: acoustic and perceptual findings. J Speech Lang Hear Res 2004;47:766-783.
Darling M, Huber JE: Changes to articulatory kinematics in response to loudness cues in individuals with Parkinson's disease. J Speech Lang Hear Res 2011;54:1247-1259.
Neel AT: Effects of loud and amplified speech on sentence and word intelligibility in Parkinson disease. J Speech Lang Hear Res 2009;52:1021-1033.
Pennington L, Miller N, Robson S, Steen N: Intensive speech and language therapy for older children with cerebral palsy: a systems approach. Dev Med and Child Neurol 2010;52:337-344.
Pennington L, Smallman C, Farrier F: Intensive dysarthria therapy for older children with cerebral palsy: findings from six cases. Child Lang Teach Ther 2006;22:255-273.
Pennington L, Roelant E, Thompson V, Robson S, Steen N, Miller N: Intensive dysarthria therapy for younger children with cerebral palsy. Dev Med Child Neurol 2013;55:464-471.
Fox C, Boliek C: Intensive voice treatment (LSVT LOUD) for children with spastic cerebral palsy and dysarthria. J Speech Lang Hear Res 2012;55:930-945.
Karnell M, Melton S, Childes J, Coleman T, Dailey S, Hoffman H: Reliability of clinician-based and patient-based documentation of voice disorder. J Voice 2007;21:576-590.
Palisano R, Rosenbaum P, Bartlett D, Livingston M: Gross Motor Function Classification System Expanded and Revised. Toronto, CanChild Centre for Childhood Disability Research, McMaster University, 2007.
Wilcox K, Morris S: Children's Speech Intelligibility Measure. San Antonio, Psychological Corporation, 1999.
Wenke R, Cornwell P, Theodoros D: Changes to articulation following LSVT® and traditional dysarthria therapy in non-progressive dysarthria. Int J Speech Lang Pathol 2010;12:203-220.
Wenke R, Theodoros D, Cornwell P: The short- and long-term effectiveness of the LSVT for dysarthria following TBI and stroke. Brain Inj 2008;22:339-352.
D'Innocenzo J, Tjaden K, Greenman G: Intelligibility in dysarthria: effects of listener familiarity and speaking condition. Clin Linguist Phon 2006;20:659-675.
Kim Y, Kuo C: Effect of level of presentation to listeners on scaled speech intelligibility of speakers with dysarthria. Folia Phoniatr Logop 2012;64:26-33.
Hustad KC, Sassano K: Effects of rate reduction on severe spastic dysarthria in cerebral palsy. J Med Speech Lang Pathol 2002;10:287-292.
Yorkston K, Hammen V, Beukelman D, Traynor C: The effect of rate control on the intelligibility and naturalness of dysarthric speech. J Speech Hear Disord 1990;55:550-560.
Patel R: Acoustic characteristics of the question-statement contrast in severe dysarthria due to cerebral palsy. J Speech Lang Hear Res 2003;46:1401-1415.
Kim H, Hasegawa-Johnson M, Perlman A: Vowel contrast and speech intelligibility in dysarthria. Folia Phoniatr Logop 2011;63:187-194.
Sapir S, Spielman J, Ramig L, Story B, Fox C: Effects of intensive voice treatment (LSVT®) on vowel articulation in dysarthric individuals with idiopathic Parkinson disease: acoustic and perceptual findings. J Speech Lang Hear Res 2007;50:899-912.
Bunton K, Kent R, Duffy J, Rosenbek J, Kent J: Listener agreement for auditory-perceptual ratings of dysarthria. J Speech Lang Hear Res 2007;50:1481-1495.
Bhuta T, Patrick L, Garnett J: Perceptual evaluation of voice quality and its correlation with acoustic measurements. J Voice 2004;18:299-304.
Kelchner L, Brehm S, Weinrich B, Middendorf J, deAlarcon A, Levin L, Elluru R: Perceptual evaluation of severe pediatric voice disorders: rater reliability using the consensus auditory perceptual evaluation of voice. J Voice 2010;24:441-449.
Webb A, Carding P, Deary I, MacKenzie K, Steen N, Wilson J: Reliability of 3 perceptual evaluation scales for dysphonia. Eur Arch Otorhinolaryngol 2004;261:429-434.
Stevens S, Galanter E: Ratio scales and category scales for a dozen perceptual continua. J Exp Psychol 1957;54:377-411.
Kreiman J, Gerratt B, Ito M: When and why listeners disagree in voice quality assessment tasks. J Acoust Soc Am 2007;122:2354-2364.
Zraick R, Wendel K, Smith-Olinde L: The effect of speaking task on perceptual judgment of the severity of dysphonic voice. J Voice 2005;19:574-581.
Zraick R, Marshall W, Smith-Olinde L, Montague J: The effect of task on determination of habitual loudness. J Voice 2004;18:176-182.
Kreiman J, Gerratt B: Comparing two methods for reducing variability in voice quality measurements. J Speech Lang Hear Res 2011;54:803-812.
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