The project is being implemented with the support of UNICEF Ukraine and with financial support from the Government of Norway.
Implemented by: Partner:
Area Clinica di Neuroscienze
Neuroriabilitazione Santa Marinella
Luigi Marotta
luigi.marotta@opbg.net
Topic 1 (30 minutes)
Verbal and non-verbal communication. Language and communication deficits after other injuries.
Topic 2 (30 minutes)
Evaluation procedures and assestment tools. Receptive abilities.
Topic 3 (30 minutes)
Evaluation procedures and assestment tools. Expressive abilities.
Topic 4 (30 minutes)
Guidelines and care needs. Augmentative Alternative Communication strategies.
Topic 1 (30 minutes)
Verbal and non-verbal communication. Language and communication deficits after other injuries.
Topic 2 (30 minutes)
Evaluation procedures and assestment tools. Receptive abilities.
Topic 3 (30 minutes)
Evaluation procedures and assestment tools. Expressive abilities.
Topic 4 (30 minutes)
Guidelines and care needs. Augmentative Alternative Communication strategies.
The complete battery consists of 18 tests, but not all of them need to be administered.
We use an initial protocol, to which additional in-depth tests are added if necessary.
The following slides illustrate the methodology.
1. uditive discrimination (couple of word)
2. lexical comprehension (single words)
3. grammatical comprehension (sentences)
4. lexical production (single words)
5. grammatical production (repetition of words, non-words and sentences)
6. spontaneous narration (from pictures)
1. lexical production (single words)
2. grammatical production (repetition of words, non-words and sentences)
3. spontaneous narration (from pictures)
1. lexical production (single words)
2. grammatical production (repetition of words, non-words and sentences)
3. spontaneous narration (from pictures)
access to vocabulary and articulation
Task: naming ad repetition
Stimuli: drawings of everyday objects, clothing, means of transport, animals, fruit, colours or actions (77 for preschoolers; 67 for schoolers)
• the child has 10 seconds to answer
• after 5 consecutive wrong answers the test is terminated
Now, I will show you a picture and you will have to tell me what it is called.
2 points Correct naming and articulation on the first attempt.
1 point: Correct naming after repetition by the adult.
0 points: Does not answer or repeat correctly, even after repetition by the examiner.
In each case, marks are awarded for correct articulation and phonetic errors are analysed.
Deepening
Semantic and phonological fluency
Phonological discrimination
Repetition of words and non-words
Lexical comprehension
Narrative speech: produced words, phonological errors, semantic and phonological paraprhases, false starts, lexical informativeness....
1. lexical production (single words)
2. grammatical production (repetition of words, non-words and sentences)
3. spontaneous narration (from pictures)
What
word perception and repetition (phonological memory)
Task: repetition of 15 words high-frequency
content
Stimuli: mono-bi-tri-pentasyllabic weighted by frequency of use and articulatory difficulty
What it assesses:
uditive perception and repetition (phonological memory)
Task: repetition of 15 non-words
Stimuli: mono-bi-tri-pentasyllabic weighted by frequency of use and articulatory difficulty
Task: repetition of 20 sentences
Stimuli: sentences of increasing length and complexity for preschoolers and schoolers children
• the child has 10 seconds to answer
• after 5 consecutive wrong answers the test is terminated
• 1 point for each correct answer
Ability to perceive words or articulate them correctly
Phonological memory
Planning the motor pattern to translate it into a motor act
Narrative Eloquence (phonological errors and fluency)
1. lexical production (single words)
2. grammatical production (repetition of words, non-words and sentences)
3. spontaneous narration (from pictures)
Task: description of a picture description of a story
Stimuli:
1 picture and 1 story of 6 vignettes
Productivity
Words
Fluency average
Length of utterance
Lexical processing
Phonological errors
Semantic-lexical errors
Grammatical processing
Syntactic completeness
Textual processing
Coherence errors
Functional evaluation
Lexical informativeness
Narrative skills encompass all linguistic skills: perceptual, articulatory, phonetic, phonological, expressive, lexical, grammatical, pragmatic, metalinguistic and social abilities. For this reason, narrative tests provide an accurate measure of a child's real communicative ability.
Communicative effectiveness is based on the principles of quantity, quality, relevance and modality (Grice, 1975).
In verbal communication, quality and modality also depend on intelligibility, i.e. the degree to which a speech signal is understood.
Intelligibility increases significantly between the ages of four and six years, so monitoring it is crucial for identifying early communication difficulties.
The level of intelligibility is generally assigned according to the following parameters (Robertson, 1982):
No observable alteration
Slight difficulty, but still intelligible
Generally intelligible, but the listener must be very careful
Often unintelligible, but can be understood with more careful repetition
Mostly unintelligible
But while there is substantial agreement on the instruments to be used for the assessment of lexical, formal and pragmatic aspects this is not the case with regard speech intelligibility
In our clinical practice, after the repetition tests already mentioned from the BVL Battery, we propose an ad hoc test based on the inconsistency tests used in the CAS evaluation (Iuzzini-Siegel et al, 2017).
We use the inconsistency criterion
inconsistency speech criterion is where the child produces words differently on each occasion they attempt a word.
A high degree of variability in verbal production indicates difficulty controlling the articulatory and phonological aspects of speech, which reduces intelligibility.
Our task provided for the repetition of a list of 43 words, realized by choosing those present in the BVL battery, as they respect criteria of high frequency of use and high imaginability.
These were varied by:
• length (bisyllabic, trisyllabic, quadrisyllabic)
• articulatory complexity
• lexical accent (altered or not altered)
• syllabic structure (reduced or not reduced).
Administer the list of target words three times, with a 10-minute break between each administration.
Elicit a spontaneous response by asking: “What is it?”.
If the child is having difficulty, you can provide assistance with double choice or imitation.
Note
DC = double choice
I = imitation
Score: 0 = if all the answers are the same 1 = if the answers are different
The inconsistency score is calculated by dividing the total score by the total number of words and multiplying by 100.
A total score of 10 or more (40%) is considered inconsistent.
However, it is important to note that the results of this test can be influenced by the subjective interpretation of an inexperienced examiner.
For this reason, the use of AI-supported devices is being investigated.
In emergency situations, an empirical method that is not scientifically based is often used.
Speech quality is checked to see if it is sufficient to activate speech devices based on large language models (LLM), such as Alexa, Siri or Cortana, which are used for specific languages.
But after all, it is a first step towards making an objective assessment of speech intelligibility.
This is for the purpose of communication in everyday life.
Bloch, S., & Wilkinson, R. (2011). Acquired dysarthria in conversation: Methods of resolving understandability problems. International Journal of Language & Communication Disorders, 46(5), 510-523.
Fabbro, F., Tavano, A., Cristofori, G., & Borgatti, R. (2021). NREM sleep after very early brain lesions. Neurogenic Language Disorders in Children, 1, 65.
Ivarsson, M., Danielsson, H., Almqvist, L., & Imms, C. (2025). Enhancing cognitive accessibility in assessments for children with neurodisability: development and implementation of an adaptation tracking questionnaire. Disability and Rehabilitation, 1-10.
Iuzzini-Seigel, J., & Murray, E. (2017). Speech assessment in children with childhood apraxia of speech. Perspectives of the ASHA Special Interest Groups, 2(2), 47-60.
Mangani, G., Barzacchi, V., Bombonato, C., Barsotti, J., Beani, E., Menici, V., ... & Del Lucchese, B. (2024). Feasibility of a Virtual Reality System in Speech Therapy: From Assessment to Tele-Rehabilitation in Children with Cerebral Palsy. Children, 11(11), 1327.
Marini, A., Galetto, V., Zampieri, E., Vorano, L., Zettin, M., & Carlomagno, S. (2011).
Narrative language in traumatic brain injury. Neuropsychologia, 49(10), 2904-2910.
Robertson, S. J. (1982). Dysarthria Profile: background and development. College of Speech Therapists Bulletin, 359(3).
Il presente documento Ë stato elaborato in n.xx slide da Ospedale Pediatrico Bambino Ges˘ il xxxxxx.
I contenuti sono strettamente riservati; Ë vietata la riproduzione e la divulgazione, anche solo parziale, senza il benestare scritto di Ospedale Pediatrico Bambino Ges˘.