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Background: While maximum isometric pressure (MIP) is widely used in clinical and research settings, reduced lingual swallow pressure (LSP) has been observed in patients with dysphagia and in older healthy adults. However, limited evidence exists on the test–retest reliability of LSP across different bolus consistencies. Objective: This study assessed the test–retest reliability of LSP measurements in both younger and older adults with healthy swallowing function to identify factors influencing oral swallowing pressure. Methods: Participants 18–40 years (younger) and 60+ years (older) were assessed across four separate sessions. Bolus types included trials of saliva, thin, mildly thick and extremely thick water, randomised across study visits. Two-way mixed effects models with absolute agreement were used to calculate intraclass correlation coefficients (ICCs) and evaluate test–retest reliability of LSP for each swallow type (regular or effortful) and bolus type. Linear mixed effects regression modelling was used to examine the factors influencing LSP. Results: A total of 51 participants were included. Test–retest reliability for LSP ranged from good to excellent across both groups (ICC = 0.79–0.98). Reliability was non-significantly higher in the older group (ICC = 0.96) and during effortful swallows (ICC = 0.94). Effort level significantly influenced LSP estimates, with effortful swallows producing about 1.83 times more lingual pressure than regular swallows. There were no significant effects of age, sex, or bolus type on LSP. Conclusion: These findings suggest that LSP measurements are reliable across measurement time points in nondysphagic participants, regardless of age, effort level, or bolus type. Only swallow effort level significantly influenced LSP estimates. © 2025 John Wiley & Sons Ltd.

Nasopharyngoscopy is a minimally invasive endoscopic procedure that allows visual observation and analysis of the velopharyngeal mechanism during speech. It can be used to assess both anatomic and physiologic abnormalities of the velopharyngeal valve. In cases of suspected velopharyngeal insufficiency (VPI), nasopharyngoscopy is particularly useful in determining the size, location, and cause of the velopharyngeal opening. This information is very important for surgical planning. Nasopharyngoscopy is also useful in the assessment of secondary surgery that was done for VPI. It can help determine the need for revision and the type of revision surgery that is most likely to be successful. The purpose of the chapter is to explain how nasopharyngoscopy is used in the evaluation of velopharyngeal function. This chapter includes specific tips for achieving a successful examination in children as young as age 3. Finally, important observations from nasopharyngoscopy are described. © 2025 The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG.

PURPOSE: Autistic adults consistently report difficulties understanding speech in adverse listening environments, which may be related to differences in social communication and participation. Research examining masked-speech recognition in autistic adults is limited, particularly in competing speech backgrounds with high degrees of informational masking. This work characterizes speech-in-speech and speech-in-noise recognition in young adults on the autism spectrum, as well as evaluates self-reported functional listening abilities and listening-related fatigue. METHOD: Masked-speech recognition was evaluated in both autistic (n = 20) and non-autistic (n = 20) young adults with normal hearing. Speech reception thresholds were adaptively measured in two-talker speech and speech-shaped noise using target sentences that were either semantically meaningful or anomalous. Functional listening abilities and listening-related fatigue were assessed using the Speech, Spatial, and Qualities of Hearing Scale and the Vanderbilt Fatigue Scale for Adults. Autism characteristics and social communication experiences were quantified using the Social Responsiveness Scale-Second Edition. RESULTS: Autistic adults displayed significantly poorer speech-in-speech recognition than their non-autistic peers, while speech-in-noise recognition did not differ between groups. Functional listening difficulties in daily life and listening-related fatigue were significantly higher for autistic participants. Autism characteristics strongly predicted functional listening abilities and listening-related fatigue in both groups. CONCLUSIONS: Autistic young adults experience objective speech-in-speech recognition difficulties that correspond with listening challenges in daily life. Autism characteristics and social communication experiences predict functional listening abilities reported by both autistic and non-autistic young adults with normal hearing. Speech-in-speech recognition difficulties observed here may amplify social communication challenges for adults on the autism spectrum. Future work must prioritize improved awareness of autistic listening differences.

Narrative language samples can be used to measure language development in children, but research on narrative development in deaf and hard-of-hearing (DHH) children is scarce, limiting knowledge of developmental stages and best practices for collection and analysis. This scoping review included 39 articles that explored recent methodologies and achievements in oral or signed narratives of DHH children, including comparisons with hearing peers and within-group analyses of early auditory experience, device use, and other measures. Articles featured DHH participants aged < 4 to 18 years, varying in device use, communication modalities, and educational settings. Most studies utilized story generation tasks with early elementary-aged children and analyzed either microstructure or macrostructure. Mixed results in comparisons with hearing children emphasized the need to consider individual differences (e.g., speech perception and age of spoken language access) in DHH narrative assessments. Findings also suggest that comparability across studies would be improved by more consistent terminology and procedures in narrative collection/analysis.

Frequency importance functions quantify the contribution of spectral frequencies to perception. Frequency importance has been well-characterized for speech recognition in quiet and steady-state noise. However, it is currently unknown whether frequency importance estimates generalize to more complex conditions such as listening in a multi-talker masker or when targets and maskers are spatially separated. Here, frequency importance was estimated by quantifying associations between local target-to-masker ratios at the output of an auditory filterbank and keyword recognition accuracy for sentences. Unlike traditional methods used to measure frequency importance, this technique estimates frequency importance without modifying the acoustic properties of the target or masker. Frequency importance was compared across sentences in noise and a two-talker masker, as well as sentences in a two-talker masker that was either co-located with or spatially separated from the target. Results indicate that frequency importance depends on masker type and spatial configuration. Frequencies above 5 kHz had lower importance and frequencies between 600 and 1900 Hz had higher importance in the presence of a two-talker masker relative to a noise masker. Spatial separation increased the importance of frequencies between 600 Hz and 5 kHz. Thus, frequency importance functions vary across listening conditions.

Purpose: This longitudinal study investigated the trajectory of Spanish article accuracy in Spanish–English dual language learners (DLLs) from preschool to first grade, addressing the need for longitudinal data on the variability of Spanish grammatical skills in DLLs in English immersion classrooms. Method: Language sample analysis was conducted on 336 Spanish and English narrative retells elicited from 31 Spanish–English DLLs (range: 45–85 months). Growth curve models captured within- and between-individual change in article accuracy from the beginning of preschool to the end of first grade. Results: As a group, DLLs did not exhibit significant positive or negative growth in Spanish article accuracy over time. On average, article accuracy remained stable at 76% from preschool throughout first grade. Participants exhibited significant variability in article accuracy that was partly explained by changes in Spanish proficiency. Spanish article accuracy was lower for DLLs with lower Spanish proficiency indexed by measures from the Spanish language samples, while English proficiency indexed by the English language samples did not affect Spanish article accuracy. Conclusions: These findings suggest that expectations for Spanish grammatical performance in DLLs need to be adjusted to account for the possible impact of not receiving Spanish support in English immersion school settings. DLLs in these instructional programs do not exhibit article accuracy at a level expected for monolingual Spanish speakers. Significant individual differences in both individual status and growth rates of Spanish article accuracy highlight the broad variability in Spanish language skills of DLLs in the United States.

Purpose: This qualitative study explored the practices of hospital-based speech-language pathologists (SLPs) conducting modified barium swallow studies (MBS) for infants at risk for dysphagia. Specifically, this research aimed to determine whether or not SLPs use side-lying position during MBS, to examine possible differences in the use of positioning, and to better understand SLPs' perceptions and experiences in this practice. Using a constructivist view, research questions guiding this inquiry were as follows: What is the current practice of hospital-based pediatric SLPs in regard to the use of side-lying position during infant MBS? What is the experience of the hospital-based SLP in their use of side-lying position during MBS? How do SLPs report perceived barriers or benefits to using side-lying position during MBS? Method: Employing a purposive-convenience sampling technique, data were collected using semistructured interviews of SLPs serving at-risk infants with dysphagia. All participants were practicing in Level-III or -IV neonatal intensive care units. Interviews were recorded, transcribed, loaded into NVivo, and coded using initial and consensus coding. Themes achieved saturation following six interviews. Results: Three themes emerged from the analysis: (a) variations in practice patterns, (b) factors influencing clinical practice, and (c) items that SLPs identified as needs to facilitate change in their clinical practice. Conclusions: Although SLPs acknowledged the importance of MBS replicating an infant's typical feeding, some SLPs who consistently use side-lying position during feeding do not assess feeding in side-lying position during MBS. This inconsistency in practice results from SLPs' perceived barriers, including lack of experience, concern over interdisciplinary conflict, need for MBS protocols, and lack of research on the potential impacts of side-lying positioning on swallowing. Participants reported the need for research to determine whether side-lying position alters, possibly improves, swallow functions and safety (e.g., airway protection) for at-risk infants.

Purpose: Generalization has been defined and instantiated in a variety of ways over the last half-century, and this lack of consistency has created challenges for speech-language pathologists to plan for, implement, and measure generalization in aphasia treatment protocols. This tutorial provides an overview of generalization with a focus on how it relates to aphasia intervention, including a synthesis of existing principles of generalization and examples of how these can be embedded in approaches to aphasia treatment in clinical and research settings. Method: Three articles collectively listing 20 principles of generalization formed the foundation for this tutorial. The seminal work of Stokes and Baer (1977) focused attention on generalization in behavioral change following treatment. Two aphasia-specific resources identified principles of generalization in relation to aphasia treatment (Coppens & Patterson, 2018; Thompson, 1989). A selective literature review was conducted to identify evidence-based examples of each of these 20 principles from the extant literature. Results: Five principles of generalization were synthesized from the original list of 20. Each principle was supported by studies drawn from the aphasia treatment literature to exemplify its application. Conclusions: Generalization is an essential aspect of meaningful aphasia intervention. Successful generalization requires the same dedication to strategic planning and outcome measurement as the direct training aspect of intervention. Although not all people with aphasia are likely to benefit equally from each of the principles reviewed herein, our synthesis provides information to consider for maximizing generalization of aphasia treatment outcomes. Supplemental Material: https://doi.org/10.23641/asha.24714399

Assessments of oral reading are widely used for screening, progress monitoring, and comprehensive evaluations. Despite the utility and technical adequacy of these tools, there are subgroups of students for whom measures of oral reading may be inappropriate. The first section of this article focuses on how tests of oral reading may underestimate word reading ability and reading fluency among four subgroups of students with speech, language, or learning difficulties. These include school-age students who demonstrate word-finding difficulties (which are common among students with a learning disability or developmental language disorder), developmental stuttering, childhood apraxia of speech, and pediatric dysarthria. The second section offers practical recommendations for more accurate assessment procedures, correct placement decisions, relevant professional learning activities, and strategic interdisciplinary teaming. © Hammill Institute on Disabilities 2023.

Older adults with hearing loss have greater difficulty recognizing target speech in multi-talker environments than young adults with normal hearing, especially when target and masker speech streams are perceptually similar. A difference in fundamental frequency (f0) contour depth is an effective stream segregation cue for young adults with normal hearing. This study examined whether older adults with varying degrees of sensorineural hearing loss are able to utilize differences in target/masker f0 contour depth to improve speech recognition in multi-talker listening. Speech recognition thresholds (SRTs) were measured for speech mixtures composed of target/masker streams with flat, normal, and exaggerated speaking styles, in which f0 contour depth systematically varied. Computational modeling estimated differences in energetic masking across listening conditions. Young adults had lower SRTs than older adults; a result that was partially explained by differences in audibility predicted by the model. However, audibility differences did not explain why young adults experienced a benefit from mismatched target/masker f0 contour depth, while in most conditions, older adults did not. Reduced ability to use segregation cues (differences in target/masker f0 contour depth), and deficits grouping speech with variable f0 contours likely contribute to difficulties experienced by older adults in challenging acoustic environments.

Speech-in-speech recognition can be challenging, and listeners vary considerably in their ability to accomplish this complex auditory-cognitive task. Variability in performance can be related to intrinsic listener factors as well as stimulus factors associated with energetic and informational masking. The current experiments characterized the effects of short-term audibility of the target, differences in target and masker talker sex, and intrinsic listener variables on sentence recognition in two-talker speech and speech-shaped noise. Participants were young adults with normal hearing. Each condition included the adaptive measurement of speech reception thresholds, followed by testing at a fixed signal-to-noise ratio (SNR). Short-term audibility for each keyword was quantified using a computational glimpsing model for target+masker mixtures. Scores on a psychophysical task of auditory stream segregation predicted speech recognition, with stronger effects for speech-in-speech than speech-in-noise. Both speech-in-speech and speech-in-noise recognition depended on the proportion of audible glimpses available in the target+masker mixture, even across stimuli presented at the same global SNR. Short-term audibility requirements varied systematically across stimuli, providing an estimate of the greater informational masking for speech-in-speech than speech-in-noise recognition and quantifying informational masking for matched and mismatched talker sex.

Purpose: Changes in voice quality after consuming food or drink have been used as a clinical indicator of dysphagia during the clinical swallowing evaluation (CSE); however, there is conflicting evidence of its efficacy. This study investigated if dysphonia and/or voice change after swallowing are valid predictors of penetration, aspiration, or pharyngeal residue. Our approach aimed to improve current methodologies by collecting voice samples in the fluoroscopy suite, implementing rater training to improve interrater reliability and utilizing continuous measurement scales, allowing for regression analyses. Method: In this prospective study, 30 adults (aged 49–97 years) referred for a videofluoroscopic swallowing study (VFSS) were audio-recorded completing a sustained /i/ prior to VFSS and again after swallowing each bolus during the VFSS. Swallowing function was measured using the reorganized Penetration–Aspiration Scale and the Normalized Residue Ratio Scale. Following listener training, 84 voice samples were perceptually rated using the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V). Ordinal and logistic regression were used to determine whether voice quality and voice quality change after swallowing were predictors of airway invasion and pharyngeal clearance. Results: Results indicated that the presence of dysphonia at baseline during a sustained /i/ task as measured by the CAPE-V predicted airway invasion but not pharyngeal residue. Voice change after swallowing associated with vowel /i/ production as measured by the CAPE-V did not predict either dysphagia measure. Conclusion: These results indicate that voice change during a sustained /i/ after swallowing appears unrelated to airway invasion or pharyngeal residue; however, in the absence of known laryngeal pathology, dysphonia prior to a CSE should alert speech-language pathologists of a possible comorbid dysphagia.

Quantifying the factors that predict variability in speech-in-speech recognition represents a fundamental challenge in auditory science. Stimulus factors associated with energetic and informational masking (IM) modulate variability in speech-in-speech recognition, but energetic effects can be difficult to estimate in spectro-temporally dynamic speech maskers. The current experiment characterized the effects of short-term audibility and differences in target and masker location (or perceived location) on the horizontal plane for sentence recognition in two-talker speech. Thirty young adults with normal hearing (NH) participated. Speech reception thresholds and keyword recognition at a fixed signal-to-noise ratio (SNR) were measured in each spatial condition. Short-term audibility for each keyword was quantified using a glimpsing model. Results revealed that speech-in-speech recognition depended on the proportion of audible glimpses available in the target + masker keyword stimulus in each spatial condition, even across stimuli presented at a fixed global SNR. Short-term audibility requirements were greater for colocated than spatially separated speech-in-speech recognition, and keyword recognition improved more rapidly as a function of increases in target audibility with spatial separation. Results indicate that spatial cues enhance glimpsing efficiency in competing speech for young adults with NH and provide a quantitative framework for estimating IM for speech-in-speech recognition in different spatial configurations. © 2023 Acoustical Society of America.

Aphasia is a language disorder that occurs as a result of brain damage. It affects auditory comprehension, verbal expression, reading, and writing due to the disruption of specific language components such as phonology, semantics, and/or syntax. A hallmark characteristic of aphasia is anomia, or impaired word retrieval. This may occur in the context of fluent speech (normal rate, rhythm and prosody) or nonfluent speech (hesitant and agrammatic verbal output). Other characteristics of aphasia vary depending on the specific location and extent of brain damage. Alexia and agraphia are acquired impairments in reading and writing, respectively. These deficits may occur in isolation but more commonly co-occur with aphasia. Assessment and treatment of aphasia, alexia, and agraphia focuses on identifying and restoring impaired function as well as determining the impact of the impairment of quality of life and developing compensatory strategies to manage persisting deficits. This article describes the symptoms associated with aphasia, alexia, and agraphia, the subtypes and neurological correlates of each impairment, the general trajectory of recovery, and assessment and treatment approaches. © 2023 Elsevier Inc. All rights reserved.

The aim of this study is to describe a measured return to instrumental dysphagia assessments for our vulnerable surgical patient population, such that best practice patterns could be resumed and our staff kept safe from transmission of COVID-19. A retrospective medical record review provided data on clinical practice patterns of swallowing assessment in an at-risk surgical patient population. Outcomes of this study support protocols that allow clinicians to safely resume the use of instrumental assessment and return to best practice in dysphagia assessment for our surgical patient population.

Purpose This study examined the language skills and the type and frequency of disfluencies in the spoken narrative production of typically developing Spanish-English bilingual children. Method A cross-sectional sample of 106 bilingual children (50 boys; 56 girls) enrolled in kindergarten through Grade 4, produced a total of 212 narrative retell language samples in English and Spanish. A specialized fluency coding system was implemented to index the percentage of total (%TD) and stuttering-like disfluencies (%SLD) in each language. Large-scale reference databases were used to classify children’s dual language proficiency profiles (balanced, English dominant, Spanish dominant) based on language sample analysis measures of morphosyntax and lexical diversity. Results The bilingual Spanish-English children in this study did not demonstrate significant cross-linguistic differences for mean %TD or %SLD. However, the mean %TD and %SLD in both languages exceeded the risk threshold based on monolingual English-speaking norms. English dominant bilingual children demonstrated significantly lower %TD in English than Spanish. Spanish dominant children demonstrated significantly lower %SLD in Spanish than English. Conclusions This study included the largest sample size of bilingual Spanish-English children investigated to date from a fluency perspective. The frequency of disfluencies was found to be variable across participants and change dynamically as a function of grade and dual language proficiency profiles, indicating the need for studies that employ larger sample sizes and longitudinal designs.

This investigation assessed the effect of side-lying position on infant oropharyngeal swallow physiology. Infant modified barium swallow studies (MBS) recordings were retrospectively examined in matched-pairs comparing at-risk infants swallowing in both an upright/cradled position and a side-lying position. Swallow parameters were measured independently and through a consensus coding approach. Infants fed in side-lying position showed a decrease in airway invasion severity as compared with when those same infants were fed in an upright/cradled position (P = .009). Bolus location at the time of swallow initiation was higher when infants were fed in side-lying position as compared with cradle position (P = .024), representing decreased risk of airway invasion. Infants fed in side-lying position demonstrated fewer swallows per breaths (P = .032). This pilot study validates the need for additional research to further define the mechanisms related to this improvement, and to determine how diagnosis and medical stability moderate these findings.

Background Patients with schizophrenia present with both cognitive impairment as well as language difficulties. There are similarities in the language output of patients with schizophrenia and patients with aphasia, thus a differential diagnosis of patients who present with a question of dual diagnoses can be a clinical challenge. This case report highlights the importance of an interdisciplinary approach to a patient with schizophrenia who benefitted from intervention from both psychiatry and speech–language pathology services due to the patient's unique verbal output. Aims The primary aim of this case report is to highlight the critical importance of interdisciplinary collaboration in this patient population. The secondary aim is to disseminate an interesting and unique clinical phenomenon whereby the patient demonstrated an awareness of two distinct speech patterns and the unique ability to ‘code switch’ between them, something not commonly appreciated in this clinical population. Methods & Procedures This case report describes a patient seen as part of routine clinical care. Information shared was solely observational and involved dissemination of information regarding case history, assessment and treatment plan. No interventions were implemented as a part of this study. Outcomes & Results Interprofessional communication was critical in order to diagnose a patient with schizophrenia with an atypical speech pattern. The patient's language output did not manifest as a true aphasia but rather as two distinct language patterns that the patient could use at will. This ability to ‘code switch’ between languages is a unique clinical profile that is atypical of patients with schizophrenia. WHAT THIS PAPER ADDS What is already known on this subject Contemporary literature discusses the similarities between the language patterns of patients with aphasia and those with schizophrenia. There has been debate about how to classify and identify the mechanism of schizophrenic language. It is unclear whether the tangential press of speech in schizophrenia is a consequence of a formal thought disorder, or whether it constitutes an actual disorder or expressive language. Additionally, the mechanism for this speech pattern is not well defined in the literature as there is no consensus on whether it is a breakdown in linguistic processing or simply a patient's disordered thoughts being put into words. A less robust literature exists that suggests that there is a cognitive mechanism responsible for these speech patterns, as tangential speech has been linked to poor goal maintenance in other types of cognitive tasks. What this paper adds to existing knowledge This study adds an important discussion about the critical importance of interprofessional collaboration when differentially diagnosing this complex patient population. It highlights the importance of the clinical exchange of information between the two disciplines of psychiatry and speech–language pathology about a patient population where clinical information is intertwined in the way described above. Regardless of the cause of the disordered output, what is lacking in the literature is evidence of how to address the complexities of the output of these patients and how to best manage the care of the patient. This study adds a practical clinical approach to collaborating on the assessment and management of this complex patient population. Importantly, it adds a description of a clinical manifestation of the language output of a patient with schizophrenia that we do not believe to have been previously published in the literature. What are the potential or actual clinical implications of this work? Implications of this study include a much-needed shift in the field in two regards. First, to include this patient population in the groups of patients that can benefit from interprofessional collaboration for differential diagnosis and consideration for speech and language therapy. Second, it offers a practical clinical approach to inter-professional management in this patient population, something the literature is currently lacking. Additionally, publication of this unique clinical manifestation provides foundational knowledge for other clinicians appreciating similar clinical patterns of language output. To our knowledge, this is the first published case in which a patient could volitionally inhibit certain speech characteristics and thus this case study may assist in future differential diagnosis of patients with schizophrenia.