Speech Intelligibility Measurement for Deaf and Hard-of-Hearing Children: A Systematic Review with an ICF-CY Focus

Abstract

Introduction: The biopsychosocial model of disability suggests that illness and disability cannot be explained solely by biological factors (Gentry et al., 2021). The International Classification of Functioning, Disability and Health (ICF; World Health Organization [WHO], 2001, 2007) is built on this model which considers that an individual’s experience of disability results from the interactions between Body Structures, Body Functions, Activities and Participation, Environmental Factors, and Personal Factors (WHO, 2001, 2007). The ICF-CY can be used by researchers, clinicians, and educators to document disability and functioning, and to plan intervention (WHO, 2007) and in a central component of the practice of speech-language pathologists (e.g., American Speech-Language-Hearing Association [ASHA], 2016). Children who are d/Deaf and hard of hearing (DHH) may experience delays in development of language and speech (Bobsin & Houston, 2015; Freeman et al., 2017), including developing intelligible speech (Chin et al., 2003), which describes to what extent a listener understands the message a speaker is conveying (Ertmer, 2011). While the speech intelligibility of DHH children can be assessed through the lens of the ICF (e.g., Dykstra et al., 2007), this has not been done previously.Aim: This thesis investigates how the measurement of the speech intelligibility of DHH children in prior research aligns with the ICF-CY (WHO, 2007). The purpose of this investigation is to make recommendations for researchers, clinicians, and educators about how their chose of speech intelligibility measurement methods can align their work more closely with the ICF-CY framework.Method: A systematic review was conducted, following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines (Moher et al., 2015). A systematic literature search and supplementary searches were conducted. Nine databases were searched in May 2021 and results were screened in Covidence (Veritas Health Innovation, 2021). Two supplemental searches were conducted, a table of contents search of 17 journals, and a grey literature search of 25 websites/databases. Double-blind screening of record titles and abstracts and then full-text screening was conducted. Data was extracted for article, participant, listener, study, speech intelligibility, and psychometric characteristics. Extracted data were mapped onto ICF-CY codes. Results: Data were extracted from 203 studies, published between 2001 and 2021, and conducted in 27 different countries. Body Structure of participants relevant to hearing were explicitly described in 22.7% of studies. The Body Functions most commonly considered were Hearing functions (b230; 100.0%), Articulation functions (b320; 100.0%), and Speech discrimination (b2304; 28.1%). Speaking (d330), an Activities and Participation Factors, was considered in all studies (100.0%), but other factors were rarely considered. Environmental Factors most often reported were Assistive products and technology for communication (e1251; 99.5%) and Health services (e5800, 72.4%). Personal Factors mentioned included the location (99.0%), language (90.6%), and sex (67.0%) of participants. Conclusions: Speech intelligibility is an important aspect of effective communication for DHH children and has far-reaching impacts (Ertmer, 2011; Freeman et al., 2017; Necula et al., 2013). Previous research on the speech intelligibility of DHH children is largely lacking in a broader perspective of functioning. Clinicians and educators of DHH children should consider including Activities and Participation Factors, and Environmental and Personal Factors when assessing speech intelligibility.

Inngangur: Samkvæmt lífsálfélagslegu líkani er fötlun ekki eingöngu útskýrð af líffræðilegum þáttum (Gentry o.fl., 2021). Alþjóðlega flokkunarkerfið um færni, fötlun og heilsu (ICF (Alþjóðaheilbrigðismálastofnunin [WHO], 2001, 2007) byggir á þessu líkani þar sem fötlun kemur fram vegna víxlverkunar líkamsbyggingar, líkamsstarfsemi, þátttöku, umhverfisþátta og persónulegra þátta (WHO, 2001, 2007). ICF flokkunarkerfið nýtist í rannsóknum, klínískri vinnu og við skólastarf til að skrásetja fötlun og þátttöku og einnig fyrir markmiðasetningu og þjálfunaráætlun (WHO, 2007). Þetta er mikilvægt fyrir talmeinafræðinga (American Speech-Language Hearing Association [ASHA], 2016). Börn með heyrnarskerðingu geta verið eftir á í tal- og málþroska (Bobsin og Houston, 2015; Freeman o.fl., 2017), þar á meðal í þróun skýrleika tals (Chin o.fl., 2003), þ.e. að hvaða marki hlustandi skilur skilaboð frá viðmælanda (Ertmer, 2011). Skýrleiki tals barna með heyrnarskerðingu væri hægt að meta í gegnum ICF (sjá t.d. Dykstra o.fl., 2007) en það hefur ekki verið gert áður. Markmið: Þessi ritgerð rannsakar hvernig skýrleikamælingar tals barna með heyrnarskerðingu í fyrri greinum fellur að ICF-CY flokkunarkerfinu (WHO, 2007). Markmið rannsóknarinnar er að ráðleggja talmeinafræðingum og kennurum hvernig mæla megi skýrleika tals barna með heyrnarskerðingu svo það samsamist ICF-CY. Aðferð: Kerfisbundið yfirlit var framkvæmt samkvæmt Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) viðmiðum (Moher o.fl., 2015). Leit greina var framkvæmd í tveimur skrefum: Kerfisbundin leit og viðbótarleit. Kerfisbundin leit var framkvæmd í níu gagnagrunnum maí 2021 og skimun fór fram í forritinu Covidence (Veritas Health Innovation, 2021). Tvær viðbótarleitir voru framkvæmdar, handvirk leit af efnisyfirliti 17 vísindatímarita og leit utan hefðbundinna gagnagrunna. Skimun titla og greina var tvíblind. Gögn voru dregin úr greinum varðandi greinar, þátttakendur, hlustendur, rannsókn, mælitæki skýrleika tals og próffræðilega eiginleika. Gögn voru síðan kortlögð í samræmi við ICF kóða. Niðurstöður: Gögn voru dregin úr 203 rannsóknum sem birtar voru frá 2001-2021 og framkvæmdar í 27 löndum. Líkamsbygging þátttakenda sem við kom heyrn var lýst í 22,7% greina. Líkamsstarfssemi oftast lýst var heyrn (b230, 100%), framburður (b320, 100%) og talskynjun (b2304, 28,08%). Tal (d330, 100%) var helsti þátttökuliður sem tekið var tillit til. Helstu umhverfisþættir voru aðstoðartæki fyrir samskipti (e1251, 99,51%) og heilbrigðisþjónusta (e5800, 72,4%). Helstu persónulegir þættir voru staðsetning (99%), tungumál (90,6%) og kyn (67%). Ályktun: Skýrleiki tals hefur víðtæk áhrif á börn með heyrnarskerðingu (sjá t.d. Freeman o.fl., 2017; Necula o.fl., 2013). Heildræn sýn á færni og þátttöku barna með heyrnarskerðingu er ábótavant í fyrri rannsóknum um skýrleika tals barna með heyrnarskerðingu. Talmeinafræðingar og kennarar barna með heyrnarskerðingu ættu að íhuga að taka tillit til þátttöku-, umhverfis- og persónulegra þátta þegar skýrleiki tals er mældur.