Improving Speech Intelligibility in Adults: Clinical Application of Evidence-Based Strategies

First Edition

Connie K. Porcaro

Details: 200 pages, B&W, Softcover, 7" x 10"

ISBN13: 978-1-63550-357-9

© 2023 | Coming Soon

Release Date: 10/10/2022


Available for purchase starting 09/09/2022

Print Book: $89.95
eBook: $89.95

Being intelligible to a listener means getting your message across and improving speech intelligibility is one of the most common goals for clients working with a speech-language pathologist (SLP). Improving Speech Intelligibility in Adults: Clinical Application of Evidence-Based Strategies is a professional resource for practicing SLPs working with adults with communication disorders, such as dysarthria, acquired apraxia of speech, and voice disorders. 

This book incorporates current research findings to support the use of evidence-based strategies in clinical situations. While other books may focus on “drilling” and “practicing” a list of words, sentences, and topics to use with a client to change their behaviors, Improving Speech Intelligibility in Adults uniquely focuses on the speaker and the listener in tandem. The author takes a noteworthy approach in how the listener can change behaviors to assist with understanding. The text presents a comprehensive approach to improving speech intelligibility by including ways to enhance the communication environment during in-person or teletherapy exchanges to enhance understanding between speaker and listener.




Chapter 1. Introduction of Intelligibility and Related Concepts 

            Key Points

            Definitions of Intelligibility, Comprehensibility, and Related Measures





                        Communication Participation

            Components of a Communication Exchange

                        Theories of Communication


                        Communication Channels

                        Communication Noise

                                    Physical Noise

                                    Physiological Noise

                                    Psychological Noise

                                    Semantic Noise

                        Shared Experiences between Communicators

            Impaired Communication

            Consideration of Function and Disability Related to Intelligibility

            Integrating Science and Clinical Practice to Improve Intelligibility

                        Using Evidence-Based Practice for Clinical Decisions

                        Exploring our Role in Bridging Research to Clinical Practice

                        Utilizing Technology Appropriately for Best Practice


Case Study Introduction


Appendix 1-1 References for ICF Application to Specific Disorders Related to Reduced Intelligibility


Chapter 2. Impact of Speaker-related Factors on Intelligibility 

            Key Points

            Speech Subsystems and Effect on Intelligibility

            Intelligibility Issues Related to Speakers with Dysarthria






            Intelligibility Issues Related to Speakers with Acquired Apraxia of Speech

                        Respiration, Phonation, and Resonance

                        Articulation and Fluency

                        Prosody and Rate

            Intelligibility Issues Related to Speakers with Voice Disorders

                        Voice Disorders Related to Neurologic Etiology

                        Voice Disorders Related to Functional Etiology

                        Voice Disorders Related to Organic Etiology

                        Voice Disorders Related to Head and Neck Cancer

                                    Influence of Head and Neck Cancer Treatment on Voice

                                    Electrolaryngeal Speech

                                    Esophageal Speech

                                    Tracheoesophageal Speech

            Effect of Face Masks and Social Distancing on Intelligibility


            Dysarthria Case

            Voice Disorders Case



Chapter 3. Assessment of Speaker Structures and Functions: Subsystem Evaluation to Determine Contributions to Reduced Intelligibility

            Key Points

            Case History Questions

            Standardized Tests and Rating Scales for Speech and Voice Assessment

                        Patient Reported Outcome Measures

                        Published Dysarthria Measures

                        Published Adult Apraxia of Speech Measures

                        Published Voice Disorders Measures

            Factors Related to Collecting Recorded Samples

                        Options for Recording Virtually

                        Considerations of Recording with Face Masks

            Auditory-Perceptual Evaluation

                        Evaluation of Respiration

                                    Posture and Body Movement Observation

                                    Duration Measures

                                    Breath Group Measures

                                    Conversational and Reading Measures Related to Respiration

                        Evaluation of Phonation

                                    Measures of Loudness

                                    Measures of Pitch

                                    Measures of Quality

                        Evaluation of Resonance

                        Evaluation of Articulation

                                    Speech-like Movements and Rates

                                    Speech Sound Inventory

                                    Connected Speech Sample

                        Evaluation of Prosody


            Dysarthria Case

            Voice Disorder Case


            Appendix 3-1 Communicative Effectiveness Survey – Revised (CESR)

            Appendix 3-2 The Communication Participation Item Bank – General Short Form


Chapter 4. Factors Related to Meaningful Assessment of Intelligibility

            Key Points

            Clinician’s Use and Perceptions of Intelligibility Measures

            Intelligibility Assessment

                        Subjective Intelligibility Measurement Tasks

                        Objective Intelligibility Measurement Tasks

            Influences on Intelligibility Measures

                        Factors Related to the Speaker


                                    Speech Rate

                                    Personal Speaker Factors

                        Factors Related to the Message

                                    Type of Message

                                    Predictability of Message

                                    Presentation Mode of Message

                        Factors Related to Listeners

                                    Individual Listener Variability

                                    Listener Task


                                    Familiarity with Speaker

                                    Familiarity with Message


                        Factors Related to the Communicative Environment

                                    Recording Equipment

                                    Auditory-Only versus Auditory-Visual Presentation Mode

                                    Listening Conditions

            Assessment of Comprehensibility, Efficiency, and Naturalness

            Intelligibility Measures Related to Voice Disorders and Head and Neck Cancer

            Use of Technology in Intelligibility Assessment


            Dysarthria Case

            Voice Disorders Case


Appendix 4-1 Medical Research Council Institute of Hearing Research Audio-Visual Adaptive Sentence Lists

            Appendix 4-2 Hearing in Noise Test Sentence Lists

            Appendix 4-3 Checklist for Considerations Related to Assessment of Intelligibility


Chapter 5 Speaker Subsystem Management Strategies to Improve Intelligibility

            Key Points

            Guiding Frameworks for Management Decisions

                        International Classification of Function

                        Evidence-Based Practice

            Subsystem Contribution and Management


                                    Diaphragmatic-Abdominal Breathing

                                    Increasing Upper Body Tone

                                    Body Positioning

                                    Controlling Exhalation

                                    Generating Appropriate Loudness Levels

                                    Muscle Strength Training

                                    Using Optimal Breath Groups

                                    Inspiratory Checking


                                    Using Effortful Closure

                                    Timing Phonation with Exhalation

                                    Low Impact Voicing 

                                    Utilizing Relaxation Techniques

                                    Speaking with High Phonatory Effort

                                    Phonation Resistance Training Exercises (PhoRTE)

                                    Using Holistic Voice Therapy Programs

                                    Implementing Vocal Hygiene

                                    Enhancing Loudness with Prosthetics



                                    Modifying Habitual Speech: Clear and Loud Speech

                                    Deciding on use of Nonspeech Oral Motor Exercises (NSOME)


                                    Modifying Speech Rate

                                    Marking Stress Patterns

                                    Using Intonation

            Management Related to Specific Communication Disorders

                        Adult Apraxia of Speech

                        Head and Neck Cancer

            Using Outcome Measures During Management


            Dysarthria Case

            Voice Disorder Case



Chapter 6 Speaker Management Strategies to Improve Intelligibility and Functional Communication

            Key Points

            Speaker-Related Strategies

                        Slowing Speech Rate

                        Making Speech Clear

            Message-Related Strategies

                        Using the Most Effective Message Length and Type

                        Choosing Predictable Messages

            Communication-Related Strategies

                        Gaining Listener Attention Before Speaking

                        Setting Ground Rules for Communication

                        Providing the Topic for a Conversation

                        Signaling Changes in Topic

                        Using Gestures to Provide Added Information

                        Providing Cues with Alphabet Supplementation

                        Watching for Signs of Listener Comprehension

                        Scheduling Important Discussions

                        Repairing Communication Breakdowns

                        Incorporating All Useful Modalities

                        Considering the Impact of a Face Mask on Communication

            Strategies Specific to Speakers with Voice or Head and Neck Cancer

            Intervention Objectives to be Facilitated by the Clinician

            Dysarthria Case

            Voice Disorders Case


            Appendix 6-1 Checklist for Speaker Strategies to Maximize Functional Communication


Chapter 7 Listener Strategies to Improve Intelligibility and Functional Communication

            Key Points

            The Importance of Collaborative Efforts

            Factors Related to Listener Inclusion in Management

            Listener Variability

                        Listener Age

                        Listener Cognitive Abilities

                        Perceived Listener Effort

                        Listener Adaptability

                        Listener Experience with Speech Disorders

Listener Familiarization

            Communication Entrainment

            Listener Barriers and Categories of Strategies

            Functional Listener Strategies

                        Using Active Listening Skills

                        Watching for Signals That a Conversation is Starting

                        Gaining Topic Knowledge

                        Utilizing Visual Information

                        Using All Available Information

                        Setting Yourself Up to Be the Best Listener You Can Be

                        Discussing Rules for Interaction with the Speaker

                        Providing Feedback and Encouragement

Specific Strategies Related to Communicating with Individuals with Voice or Head and Neck Cancer

Listener Strategies for Speakers with Dysphonia

Listener Strategies for Speakers Following Head and Neck Cancer Treatment

            Effect of Unsuccessful Communication on Speakers


            Dysarthria Case

            Voice Disorders Case


            Appendix 7-1 Checklist for Listener Strategies to Maximize Understanding


Chapter 8 Strategies to Alter the Communication Environment for Better Understanding 

            Key Points

            Identifying Environmental Barriers

            Approaches for Dealing with Communicative Noise

                        Physiological Noise

                        Psychological Noise

                        Semantic Noise

                        Physical Noise

            Adaptation to Environment

            Environmental Modification

                        Improving Proximity Between Speakers and Listeners

                        Reducing or Eliminating Background Noise

                        Improving Access to Visual Information

                        Reducing or Eliminating Distractions

                        Using External Aids

                        Speaking Clearly When Wearing Face Masks

                        Using the Phone Effectively

                        Adjusting Audio Settings for Video Chat Communication

                                    ZOOM Audio Settings

                                    Smart Phone or Tablet Audio Settings

                                    Skype Audio Settings

            Impact of Communicative Environment on Speakers with Head and Neck Cancer


            Dysarthria Case

            Voice Disorders Case


            Appendix 8-1 Situational Intelligibility Survey

            Appendix 8-2 Checklist to Maximize Communication Potential by Modifying the Environment


Connie K. Porcaro

Connie K. Porcaro, PhD, CCC-SLP, is an Associate Professor in the Department of Communication Sciences and Disorders at Florida Atlantic University (FAU), where she instructs courses covering voice, speech, and swallowing disorders in adults, and lectures annually for future physicians at the FAU Medical School on the topics of adult neurogenic speech and language disorders. Dr. Porcaro is certified by the American Speech-Language-Hearing Association and has worked as a speech-language pathologist for more than 25 years with clients of all ages. Her main area of research is focused on intelligibility in patients with speech and voice disorders and how speakers and listeners can have improved communication. Dr. Porcaro is a frequent presenter at the Annual Convention of the American Speech-Language-Hearing Association and state association conventions as an invited speaker on the topic of intelligibility. She has received grant funding from the FAU Healthy Aging Research Initiative to investigate voice and swallowing changes in healthy elderly individuals, and she has received grant funding from the Parkinson Voice Project to facilitate training for graduate students who provide free-of-cost speech therapy for individuals with Parkinson’s disease.

Learn More

Here's How to Do Accent Modification: A Manual for Speech-Language Pathologists

First Edition

Robert (Bob) McKinney

Details: 306 pages, B&W, Softcover, 8.5" x 11"

ISBN13: 978-1-63550-007-3

© 2019 | Available

Cases in Head and Neck Cancer: A Multidisciplinary Approach

First Edition

Bari Hoffman, Henry Ho, Christine Sapienza, Jeffrey J. Lehman

Details: 304 pages, Full Color, Hardcover, 8.5" x 11"

ISBN13: 978-1-59756-715-2

© 2016 | Available

Patient-Provider Communication: Roles for Speech-Language Pathologists and Other Health Care Professionals

First Edition

Sarah W. Blackstone, David R. Beukelman, Kathryn M. Yorkston

Details: 352 pages, B&W, Softcover, 7" x 10"

ISBN13: 978-1-59756-574-5

© 2015 | Available

Head and Neck Cancer: Treatment, Rehabilitation, and Outcomes

Second Edition

Elizabeth C. Ward, Corina J. van As-Brooks

Details: 640 pages, Full Color, eBook

ISBN13: 978-1-59756-659-9

© 2014 | Available

Communication and Swallowing in Parkinson Disease

First Edition

Deborah Theodoros, Lorraine Ramig

Details: 256 pages, B&W, Softcover, 7" x 10"

ISBN13: 978-1-59756-205-8

© 2011 | Available

Assessment of Motor Speech Disorders

First Edition

Anja Lowit, Raymond D. Kent

Details: 371 pages, B&W With Color Insert, Softcover, 7" x 10"

ISBN13: 978-1-59756-367-3

© 2011 | Available

Motor Speech Disorders

First Edition

Gary Weismer

Details: 315 pages, B&W, Hardcover, 7" x 10"

ISBN13: 978-1-59756-115-0

© 2007 | Available

Inpatient Functional Communication Interview: Screening, Assessment, and Intervention

First Edition

Robyn O'Halloran, Linda Worrall, Deborah Toffolo, Chris Code

Details: 170 pages, B&W, Spiral Bound, 8.5" x 11"

ISBN13: 978-1-63550172-8

© 2020 | Available

Assessment of Communication Disorders in Adults: Resources and Protocols

Third Edition

M.N. Hegde, Don Freed

Details: 446 pages, B&W, Softcover, 8.5" x 11"

ISBN13: 978-1-63550-263-3

© 2022 | Available