4th MSc (Speech & Language Pathology)

Student Research Seminar

Thursday, 2nd August 2018

1800hrs – 2100hrs

Poster Student Title

1. Anabella Seah Xin Yi Impact of Inspiratory Muscle Strength Training on Voice: A Pilot Study

2. Ian Shen Chuanfa Lee Silverman Voice Therapy for Individuals with Multiple System Atrophy: A single-case study on the treatment effects on speech and voice functions

3. Tan Liu Yan Claire Expiratory Muscle Strength Training for Speech in Parkinson’s Disease: A Pilot Study

4. Tan Li-Wun Kathleen Use of Autobiographical Sentence Generation to Treat Anomia: Case Studies of Two Mandarin-Speaking Bilinguals with Primary Progressive Aphasia (PPA)

5. Yao Hui’En, Valerie

Sera

The Effect of IMST on Dysphagia in Adults with Parkinson's Disease

6. Clare Isabel Ee Effects of Singing on the Voices of People with Parkinson’s Disease

7. Sim Miao Fang Cheryl Voice Care Workshops for Teachers: Video and Group Voice Workshops

8. Faith Yang Service Delivery for Preschool Teachers’ Preventive Voice Care:

Video vs Blended Workshops

9. Grace Lai En Yi Malay Cognitive-Communication Screener for Acquired Brain Injury (ABI) Population: A Normative Study and ABI Case Studies

10. Tey Jo Ching Picture Description in Malay: A Normative Study with Case Studies on the ABI Population

11. Laavanya Paramasilvam

Singapore Normative Data for the Test of Masticating and Swallowing Solids (TOMASS)

12. Francesca Ooi Developing an Assessment Battery to Profile Communication Difficulties: Case studies of Singaporean Adults

13. Hor Yiwen Shirlyn Cognitive-Communication Screener for Mandarin-Dominant Bilingual Adults

14. Liyana Low Reading and Spelling in Mandarin-Dominant Older Adults with Hearing Loss

15. Yong Hui Min, Clarice How Does Presbycusis Affect Oral Language Processing in Mandarin Speakers?

16. Ashley Tong Pei Yeng Literacy and Cognition in Adolescents with Systemic Lupus Erythematosus

17. Lam Yi Wei Yvette Verbal Abilities in Adolescents with Systemic Lupus Erythematosus

18. Chan Sim Mun Use of English Sentence Repetition for Bilingual Children in Singapore

19. Lim Yu Jia Mandarin Sentence Repetition for Assessing Language in Bilingual Children

20. Seet Xian Hui Using Sentence Repetition to Assess Language in Bilingual Children with Dyslexia

21. Chen Yu Hui Speech Outcomes in 4-to-6-Year-Old Children with Clefts

22. Ng Hui Jing Carol Conversational Acts Profiling of Children with Cleft Lip and/or Palate: Investigating relationships between Speech Intelligibility, Attitudes and Conversation Participation

23. Yeap Xiao Hui, Celine Speech and Psychosocial Outcomes in Children with Cleft Lip and/or Palate

24. Chin Kei Yu Irene Utility of an AAC Workshop for Special Education Teachers

25. Lai Weijean AAC Workshop: Its Utility for Parents of Children in Special Education

26. Chua Jia Yi Language and Communication of Children with Hearing Loss in Singapore: Case studies

27. Kerensa Chew Maine Development of English Morphosyntax in Bilingual Singaporean Preschoolers

28. Wanda Wijaya Singapore Assessment of Phonological Awareness: English-Mandarin Bilingual Norms

29. Nuraidah Mariko Binte Pathorr Rahman

Malay Morphosyntactic Development of Malay-L1 Preschoolers in Singapore

30. Sellam Rajandran Social, Emotional Processing - 4Ws1H questions on PiSCES for Children with ASD

31. Wong Ci Xin Perspective-Taking with Thought-Bubbles and PiSCES for Children with ASD

Poster 1 Impact of Inspiratory Muscle Strength Training on Voice: A Pilot Study Anabella SEAH Xin Yi Background: Reduced vocal loudness adversely affects communication in People with Parkinson’s Disease (PPD). Lee Silverman Voice Treatment (LSVT) is effective for improving vocal loudness in PPD. However, LSVT’s intensity and PPD’s cognitive, stimulability, respiration and motivation difficulties pose challenges for successful LSVT implementation. Objective: To investigate the efficacy of Inspiratory Muscle Strength Training (IMST) for improving voice and speech outcomes. Method: A multiple-baseline single-case design was used to explore the impact of IMST on respiratory muscle strength, voice outcomes, and speech intelligibility in two male participants (Participant A: 71 years old; Participant B: 77 years old) with PD. These measures were assessed at baseline, after 4-weeks of IMST (5 times weekly), and a 4-week maintenance period. Results: Participant A exhibited slight improvements in respiratory muscle strength, vocal loudness and pitch range. Modest voice improvements suggest that enhanced self-perception of voice quality was probably due to placebo effects. Data collection for participant B is ongoing. EBP Implications: This pilot study suggests that IMST has an impact on voice outcomes. Using IMST with voice exercises, or implementing larger or longer doses of IMST, may lead to larger gains in voice. Alternatively, patients with more severe voice and speech impairments may experience greater benefit from IMST. Keywords: Inspiratory Muscle Strength Training, Parkinson’s Disease, Voice, Speech Poster 2 Lee Silverman Voice Therapy for Individuals with Multiple System Atrophy: A single-case study on the treatment effects on speech and voice functions Ian SHEN Chuanfa Background: Individuals with Multiple System Atrophy (MSA) are often reported to have speech and voice deficits. These deficits are typically severe and fast deteriorating. In this study, the efficacy of Lee Silverman Voice Treatment (LSVT®), a behavioural treatment for speech and voice deficits found in people with Parkinson’s Disease (Ramig et al., 2001; Goetz, 2003, RCT study), was evaluated using a case-series design. Method: Two participants with MSA (Participant A: 65-year-old male; Participant B: 55-year-old male) and severe speech and voice deficits were recruited for LSVT®. To evaluate the efficacy of LSVT®, acoustic and perceptual outcome measures were recorded for each participant’s performances on phonation and speech tasks for three baseline assessments before one month of LSVT® (4 sessions per week), a post-treatment assessment, and a post-maintenance assessment after one month. Results & Discussion: For Participant A, improvement from pre-treatment (third baseline) to post-treatment, and from pre-treatment to post-maintenance were observed in (a) sound pressure level (SPL) in phonation and speech tasks at sentence level, (b) duration of phonation, (c) fundamental frequency range in phonation, and (d) intelligibility of speech tasks. Data collection for Participant B is ongoing. EBP Implications: The findings support LSVT® as a viable treatment option to improve speech and voice functions for MSA. Keywords: Multiple System Atrophy, Lee Silverman Voice Treatment, Communication Deficits

Poster 3 Expiratory Muscle Strength Training for Speech in Parkinson’s Disease: A Pilot Study TAN Liu Yan Claire Background: Parkinson's Disease (PD) is a progressive neurological disorder that results in significant speech deficits. While expiratory muscle strength training (EMST) has been shown to enhance speech function at the physiological level (e.g., Darling-White & Huber, 2017), improvements at the activity/participation level have not been well-established. Objective: To evaluate the effectiveness of EMST, particularly in terms of functional speech outcomes, in the PD population. Method: Two male participants with PD-related hypokinetic dysarthria, aged 61 and 70 years old, were recruited. A multiple-baseline single-case design was employed with 4 weeks of EMST, followed by a 4-week maintenance phase before re-assessment. Participants were assessed on various aerodynamic (peak expiratory flow, maximum inspiratory pressure) and acoustic measures (maximum phonation time, sound pressure level), speech intelligibility tasks at sentence, passage and conversation levels, as well as responses on a communicative effectiveness and quality of life questionnaire. Results & Discussion: Preliminary findings revealed some improvements in respiratory function, but no substantial gains in terms of phonation and speech intelligibility. Improvements in self-perceptions of communicative effectiveness and quality of life measures were also observed.

EBP Implications: Clinicians could consider using EMST in combination with other behavioural interventions to improve speech production in individuals with PD-related dysarthria. Keywords: Expiratory Muscle Strength Training, Speech, Parkinson’s Disease Poster 4 Use of Autobiographical Sentence Generation to Treat Anomia: Case Studies of Two Mandarin-Speaking Bilinguals with Primary Progressive Aphasia (PPA) TAN Li-Wun Kathleen Background: Naming treatments can improve picture-naming performance in patients with PPA, but generalisation to functional communication remains a challenge. For bilinguals with PPA, there is also limited evidence of any gains in the untreated language but Sohn Chaird, Rickard Liow and Jalil (2016) reported promising results for generalisation to conversation in a monolingual English-speaking PPA participant. Objective: The purpose of this study was to evaluate the effectiveness of autobiographical sentence generation (i.e., production of sentences related to one’s personal experiences) in facilitating improvements beyond picture-naming in the treated and untreated language. Method: Two English-Mandarin bilinguals with PPA were recruited: CB, a 51-year-old female and DC, a 54-year-old male. Both underwent 12 treatment sessions in Mandarin over a six-week period, with homework after each session. Outcome measures included picture naming of treated and untreated words, as well as performance on a picture description task, and in conversation. Participants were assessed across three baselines, immediately post-treatment and three weeks post-treatment. Results & Discussion: Preliminary findings for CB show post-treatment improvement in Mandarin for picture naming of treated words, and on a picture description task, but generalisation to conversation was limited. Cross-language transfer of treatment effects was not found. Data collection for DC is ongoing. EBP Implications: Thus far there is no clear evidence for the efficacy of autobiographical sentence generation for improving conversation, or for facilitating transfer from a treated to an untreated language in a bilingual. Keywords: Primary Progressive Aphasia, Language Rehabilitation, Anomia, Bilingualism

Poster 5 The Effect of IMST on Dysphagia in Adults with Parkinson's Disease YAO Hui’en, Valerie Sera Background: Dysphagia is a frequent development in Parkinson’s Disease (PD). For this study, the effect of Inspiratory Muscle Strength Training (IMST) on swallowing function, was evaluated. Objective: To evaluate the effectiveness of IMST as a viable treatment option for dysphagia in the local population with PD. Method: A case-series design was employed. Two male participants, aged 72 and 78, both with moderate PD and moderate dysphagia, but no untreated cardiac abnormalities and hypertension, underwent 4 weeks of IMST. Participants completed the training independently 5 times a day for 5 days each week, and swallowing function was evaluated pre- and post-treatment using the following measures: clinician ratings on the New Zealand Index for Multidisciplinary Evaluation of Swallowing (NZIMES), the Penetration-Aspiration Scale (PAS) as seen during videofluroscopy(VFSS), the Mann Assessment of Swallowing Ability (MASA), and self-ratings on the Dysphagia Handicap Index (DHI). Results: Swallowing function in Participant A improved, with lower ratings on the NZIMES, PAS and DHI, and higher ratings on MASA, post-IMST. Data collection for Participant B is ongoing. EBP Implications: Thus far, IMST appears to be a viable treatment option for people with moderate PD and moderate dysphagia but further research is needed. Keywords: Parkinson’s Disease, Dysphagia, Treatment, Inspiratory Muscle Strength Training Poster 6 Effects of Singing on the Voices of People with Parkinson’s Disease Clare Isabel EE Background: People with Parkinson’s Disease (PwPD) typically experience progressive voice deterioration which affects their ability to communicate and may decrease quality of life (QoL; Duffy, 2000). Reported improvements in speech, voice and QoL from singing therapy (e.g., Elefant, Baker, Lotan, Lagesen & Skeie, 2012) warrant further investigation in a group setting, as previous studies have focused on individual singing therapy. For this study, the effects of group singing on vocal intensity and respiratory support, QoL and self-ratings of mood and voice loudness in PwPD were assessed. Method: Eight PwPD were recruited from a local PD community based on their Voice Handicap Index (VHI)-10 scores. Haneishi’s (2002) Music Therapy Voice Protocol was adapted to suit a group setting and is being carried out over eight weekly therapy sessions with five assessment points: two baseline assessments collected pre-therapy, one assessment taken after Week 5 of intervention (mid-intervention), and two post-therapy assessments. Expected Results: Data collection and weekly therapy is ongoing. Vocal intensity, frequency range and respiratory support are expected to increase, and functional impact of voice difficulties to decrease. Participants’ self-ratings of mood and voice loudness are expected to improve post-session. EBP Implications: Results from the study will provide preliminary evidence on the utility of group singing for improving the voices of PwPD. Keywords: Parkinson’s Disease, Singing, Voice, Quality of Life

Poster 7 Voice Care Workshops for Teachers: Video and Group Voice Workshops SIM Miao Fang Cheryl Background: Teachers have increased risk of developing voice disorders, which can cause serious consequences including occupational absenteeism and occupation changes (Roy et al., 2004). Educating teachers on voice care can help prevent vocal abuse and voice disorder, yet few studies have evaluated the effectiveness of different voice care service delivery models. Objective: To evaluate the relative effectiveness of two preventive voice care workshops, compared to a control group, for kindergarten teachers: Group VI (content delivered via prepared video), Group GR (content delivered via group workshop) and Group CON (no content delivered during the duration of study). Method: 60 kindergarten teachers were recruited and allocated into one of three groups (VI, GR or CON). Each 1-hour experimental workshop (VI and GR) provided information about indirect (general vocal hygiene information) and direct (vocal function exercises and vocal modifications) preventive approaches, and were conducted within the participants' own kindergarten setting. Baseline and outcome measures include objective acoustic (jitter, shimmer, noise-to-harmonic ratio, maximum phonation time, 1-s/z ratio) measures of vocal quality and the Voice Handicap Index, a self-rating scale. Results & Discussion: Treatment and data collection are ongoing. A series of 2-way mixed ANOVAs will be conducted to investigate whether there is significant improvement in the outcome measures for the experimental groups compared to the control group, Group GR is expected to be more effective than Group VI as immediate feedback provided during the exercises is likely to be more helpful. EBP Implications: Preventive voice workshops are effective, but it depends on the service delivery model. Keywords: Teachers, Preventive Voice Care, Service Delivery Model, Voice Disorder Poster 8 Service Delivery for Preschool Teachers’ Preventive Voice Care: Video vs Blended Workshops Faith YANG Background: Research has shown increased prevalence of voice disorders in teachers (Roy et al., 2004). Paying attention to voice care can prevent voice disorders (Bovo et al., 2007) but few studies have evaluated the effectiveness of voice care service delivery models. Objective: To evaluate the relative effectiveness of two preventive voice care workshops (Group-VI with content delivered via a video, and Group-BL with content delivered via a video and a group workshop) compared to a wait-list control group (Group-CON), for improving preschool teachers’ vocal quality. Method: 60 volunteer preschool teachers were allocated into one of the three workshop groups (Group-VI, Group-BL and Group-CON). Both experimental workshops lasted about one hour and were conducted within the participants’ kindergarten settings. Each workshop provided information about indirect and direct preventive approaches. Baseline and outcome measures included objective acoustic measures (jitter, shimmer, noise-to-harmonic ratio, and s/z ratio), objective aerodynamic measures (maximum phonation time), and subjective measures of vocal quality (Voice Handicap Index). Results & Discussion: Significant improvement across outcome measures for both experimental groups compared to the control group is expected, with Group-BL > Group-VI. EBP Implications: Data collection is ongoing but preventive voice care is expected to improve teachers’ vocal quality. The effectiveness of preventive voice care is likely dependent on the service delivery model. Keywords: Teachers, Voice Disorder, Preventive Voice Care Workshop, Service Delivery Model

Poster 9 Malay Cognitive-Communication Screener for Acquired Brain Injury (ABI) Population: A Normative Study and ABI Case Studies Grace LAI En Yi Background: Cognitive-communication screeners are used to identify deficits in patients with ABI to facilitate rehabilitation. A cognitive-communicative screener (Low, 2016) with normative data is available for English-speaking adults, but there are no normative data for the Malay version. Objectives: To (1) establish normative data for Malay-speaking adults in Singapore, taking into account the possible effects of age, education background, and gender; (2) evaluate whether the Malay version of the screener is sufficiently sensitive for detecting cognitive deficits in Malay-speaking ABI patients. Method: Norms: 60 neurologically-intact Malay-speaking Singaporean participants (aged 40-80) were recruited and assessed on the Malay version of the Cognitive-Communication Screener (CSS). Cases: The progress of two ABI patients (age, gender) with cognitive deficits was tracked using the CCS from the acute to post-acute stage (10 weeks after first assessment). Expected Results: Normative data collection is ongoing but age and education background are expected to have an impact on the performance of neuro-typical Malay-speaking adults. For both cases, changes in cognitive status were observed over time, and were broadly consistent with the severity of ABI. EBP Implications: The Malay version of the CCS appears to be a sensitive tool for detecting cognitive deficits and tracking cognitive changes in ABI patients. The normative data collected will facilitate assessment prior to treatment and allow clinicians to evaluate outcomes. Keywords: Cognitive, Communication, Malay, Singapore Poster 10 Picture Description in Malay: A Normative Study with Case Studies on the ABI Population TEY Jo Ching Background: Picture description tasks are often used to elicit a language sample for subsequent discourse analysis, and they have proved useful for detecting cognitive-communication impairment in people with acquired brain injury (ABI). Objectives: (1) To collect normative data on the linguistic information and inferential processes typically elicited during spoken descriptions of four coloured pictures depicting familiar scenes for the local Malay-speaking population; (2) To establish whether the four pictures have potential clinical utility for assessing adults with ABI. Method: 60 neurologically-intact Malay-speaking adults aged between 41-60 (younger group) and 61-80 (older group), with no history of cognitive and/or communication deficits, were recruited via convenience sampling and asked to describe four coloured pictures depicting local scenes (bus stop, market, kitchen and living room) and answer three questions that require inference and/or problem-solving. For both age groups, norms were developed by scoring the number of correct information units (CIUs) produced during the picture description task and the answers to these questions. Two participants with ABI are being recruited to test the clinical utility of the four pictures. Expected Results & Discussion: Data collection is ongoing but age and educational background of the neuro-typical participants are expected to have an impact on performance and the picture description tasks are likely to prove useful for detecting cognitive-communication deficits in ABI patients. EBP Implications: This picture description task depicting local scenes promises to be an effective tool for detecting cognitive-communication impairments in Malay-speaking ABI patients. Keywords: Cognitive-Communication Impairment, Acquired Brain Injury, Picture Description, Malay Language

Poster 11 Singapore Normative Data for the Test of Masticating and Swallowing Solids (TOMASS) Laavanya PARAMASILVAM Background: Objective measures of swallowing are clinically valuable because they increase the diagnostic accuracy provided normative data are available. The Test of Masticating and Swallowing Solids (TOMASS), which was developed in New Zealand for a swallowing impairment study to assess masticatory function, has the clinical potential to objectively identify impairments in swallowing (Huckabee et al., 2018). Objective: To establish two sets of TOMASS norms (speeded and normal paced eating) of a local biscuit (cracker) by age and gender for Singaporean adults. Method: 120 healthy Singaporeans (21-80 years), stratified by gender and age, were recruited. In counter-balanced order, each participant ingested a biscuit under speeded and normal conditions. Information on the number of bites, swallows, and masticatory cycles per biscuit, as well as total time taken to eat each cracker were recorded for each participant. Expected Results: Age and gender are expected to be related to all the TOMASS measures within the local population such that older adults, especially females, will take more bites, swallows, and masticatory cycles, as well as a longer time to ingest both biscuits. EBP Implications: Results will provide local clinicians with a simple but objective method to assess the oral phase performance of swallowing, and thereby aid the management of dysphagia. Keywords: TOMASS, Singapore Normative Data, Dysphagia Management Poster 12 Developing an Assessment Battery to Profile Communication Difficulties: Case studies of Singaporean Adults Francesca OOI Background: Communication difficulties are a common consequence of injury to the brain. the Psycholinguistic Assessment of Language Processing in Aphasia (PALPA, Kay et al, 1996), has proved a useful resource for Speech and Language Pathologists (SLPs) identifying strengths and weaknesses in the communication profiles of Mandarin-speaking adults with acquired communication deficits. Objectives: The aim of this study was to assemble a battery of locally developed and locally normed assessments in Mandarin that are based on a PALPA-type cognitive neuropsychological model and to gauge their clinical utility for patients with communication difficulties. Method: Using a case-series design, five Mandarin-dominant adults (aged between 60 and 80 years) were assessed using the newly assembled battery. The subtests covered four types of oral/aural communication: Speech, language, listening, and central auditory processing. Expected Results & Discussion: Data collection is ongoing but the battery should prove useful for identifying the loci of deficits and different patterns of breakdown varying across participants. EBP Implications: This battery will enhance assessment and intervention planning for older adults in Singapore who speak Mandarin. Keywords: Communication Deficits, Language Assessment

Poster 13 Cognitive-Communication Screener for Mandarin-Dominant Bilingual Adults HOR Yiwen Shirlyn Background: Hearing loss has both social and neurological impact and it affects most older adults (Heywood et al., 2017). The relationship between hearing loss and cognitive status is still controversial, especially the role of hearing loss in contributing to cognitive decline. Objective: To establish norms for Mandarin-dominant bilingual Singaporean adults, taking into account age and education level, in order to facilitate early identification of cognitive-communication deficits in the population who are at-risk of hearing loss. Method: 30 neurologically-intact, Mandarin-dominant participants, aged 60-80 years with different levels of educational qualifications were assessed using the Singapore Orientation Questionnaire (Rickard Liow & Jalil, 2011) and the Mandarin Cognitive-communication Screener (Low, 2016). The screener comprises 11 subtests assessing attention, memory, executive function, and language. Participants’ responses were analysed qualitatively in terms of error types, and quantitatively in terms of accuracy and response time. Expected Results & Discussion: Data collection is on-going but degree of hearing loss, age and education level are all expected to have an impact on performance. Normative data by age group will be presented as reference for clinical use. EBP Implications: The Mandarin Cognitive-communication Screener is likely to prove a useful tool for early identification of deficits in Mandarin-dominant bilingual adults who have hearing loss, thereby increasing the chances of effective intervention. Keywords: Cognitive-Communication, Mandarin-Dominant, Hearing Loss Poster 14 Reading and Spelling in Mandarin-Dominant Older Adults with Hearing Loss Liyana LOW

Background: Recent research suggests a relationship between hearing loss and cognitive impairment in older adults (Loughrey et al., 2017). However, the impact of hearing loss on written language abilities in older adults has yet to be explored. Reported associations to long-term semantic memory impairment (Ronnberg et al., 2011) suggest that such deficits could adversely affect written language abilities in Mandarin, based on cognitive neuropsychological models of language processing (Plaut et al., 1996). Objective: To compare reading and spelling performances of three Mandarin-dominant groups: (i) healthy older adults, (ii) AHL with cognitive impairment, (iii) AHL with normal cognition. Method: Literate Mandarin-dominant participants, aged 60 to 80 years, will be assessed using a locally developed reading and spelling list. Hearing loss will be measured by pure-tone audiometry while cognitive abilities will be measured using the Montreal Cognitive Assessment (Nasreddine et al, 2005). Expected Results & Discussion: Reading and spelling performance are both expected to be the weakest for AHL with cognitive impairment. The reading and spelling assessment tool is expected to be valid and sensitive tool to screen written language abilities in Singapore. EBP Implications: The assessment of written language abilities among older adults with hearing loss might prove a sensitive method of early identification of deficits. Findings could further the extant research on written language processing in Mandarin. Key Words: Adults with Hearing Loss, Cognitive Impairment, Reading, Spelling, Mandarin, Singapore

Poster 15 How Does Presbycusis Affect Oral Language Processing in Mandarin Speakers? YONG Hui Min, Clarice Background: Research indicates a link between presbycusis (high frequency hearing loss) and cognitive function (Heywood et al., 2017), but it remains unclear what language processing differences speakers of tonal languages, such as Mandarin, will exhibit. Objectives: To establish normative data for older adults on two newly-devised screening tests in Mandarin, Minimal Pair Assessment (MPA) and Sentence Repetition task (SRep), and to examine the language processing differences that result from differing hearing acuity against a backdrop of limited screening tools in Singapore. Method: Mandarin-dominant older adults (aged 60-80), 30 with normal hearing (NH) functions and 10 with impaired hearing (IH) function, were tested on Pure Tone Audiometry and Montreal Cognitive Assessment (MOCA; Nasreddine et al., 2005). SRep and MPA will be presented in three test conditions (binaural, left ear, right ear) and participants’ responses will be audio-recorded for detailed analysis. Expected Results & Discussion: There will be differences between NH and IH participants on their SRep and MPA scores and the types of errors made. The test results might also reveal that Mandarin language processing does not always show a right ear advantage. EBP Implications: SRep and MPA will be useful for expanding clinicians’ awareness of how reduced auditory phonological and tonal analysis would impact Mandarin oral language processing. Keywords: Presbycusis, Elderly, Mandarin Sentence Repetition, Minimal Pair Assessment Poster 16 Literacy and Cognition in Adolescents with Systemic Lupus Erythematosus Ashley TONG Pei Yeng Background: Systemic Lupus Erythematosus (SLE) is a chronic, multisystem autoimmune disease in which the body mistakenly attacks healthy tissue. Researchers have estimated that neurocognitive impairment (NCI) is prevalent in 30-78% of childhood-onset SLE patients (cSLE), e.g., Harel et al, 2006; Sibbitt et al., 2002; Yu et al, 2006) but surprisingly few have measured language ability, and none have assessed literacy skills. Given that critical cognitive and language development occurs in adolescence, NCI is likely to have significant long-term cumulative effects on literacy and academic outcomes. Objective: To investigate the reading (fluency, comprehension), spelling, writing and visuospatial skills of adolescents with cSLE. Method: Using a matched pairs design, formal tests of literacy (Woodcock-Johnson IV Test of Achievement) and cognition (Rey-Osterrieth Complex Figure), were administered to 10 cSLE and 10 controls matched for age, gender and language background. Results & Discussion: Data collection is ongoing but the cSLE participants are expected to show deficits in both literacy and visuospatial skills. EBP Implications: The results are likely to indicate that the literacy and cognitive skills of patients with cSLE should be routinely assessed so that intervention programs aimed at supporting academic work can be implemented. Keywords: Language, Literacy, Lupus, Systemic Lupus Erythematosus, Adolescents, Children

Poster 17 Verbal Abilities in Adolescents with Systemic Lupus Erythematosus LAM Yi Wei Yvette Background: Systemic lupus erythematosus (SLE) is a chronic multi-system autoimmune disease associated with language and cognitive deficits (Hanly et al., 2007; Muscal & Brey, 2010. Childhood-onset SLE (cSLE) is typically diagnosed during mid-adolescence when academic demands are high, yet its effects on language are largely unexplored. Objective: To compare the language abilities of adolescents with cSLE with those of their healthy peer group. Method: Using a matched pairs design, 10 adolescents with cSLE and 10 demographically-matched healthy control participants aged between 11 to 18 years were assessed on language domains using the Comprehensive Assessment of Spoken Language (CASL) and Bilingual Language Assessment Battery (BLAB), and results are compared. Expected Results & Discussion: Data collection is ongoing, but results are expected to support existing findings on language deficits in people with SLE and provide additional knowledge on the specific areas of language deficits associated with adolescents with cSLE. EBP Implications: This study can contribute to the current understanding of how cSLE affects language abilities. Results can also provide evidence to inform clinical practice on earlier language screening and therapy provision for children with cSLE. Keywords: Language, Cognition, Lupus, Systemic Lupus Erythematosus, Adolescents, Children Poster 18 Use of English Sentence Repetition for Bilingual Children in Singapore CHAN Sim Mun Background: Previous research has demonstrated the value of sentence repetition (SRep) tasks as a diagnostic tool in identifying a developmental language disorder (DLD). However, few studies have addressed the use of SRep with English-Mandarin bilinguals in Singapore. The diagnostic accuracy of DLD in Singapore is further complicated by the influence of Singapore Colloquial English (SCE). Objective: To develop an English SRep test that is sensitive towards the diagnosis of LD in bilingual children exposed to SCE. Method: 30 English-Mandarin bilinguals, aged 6 to 8 years with English as their dominant language, will be assessed on SRep, nonverbal intelligence (Ravens CPM), phonological short-term and working memory (digits forwards and backwards) and core subtests of the CELF4 (UK will be employed for validation). Results: Performance on SRep test is expected to correlate with performance on the CELF4 (UK), and qualitative error analyses will identify typical responses made by bilingual children in Singapore. EBP Implications: Normative data for this new SRep Test will be useful in reducing the risk of under- or over-diagnosis of DLD in the Singapore bilingual population. Keywords: Sentence Repetition, English-Dominant, Bilingual, Primary School Children, Singapore, Language Disorder, Language Delay, Morphology, Syntax

Poster 19 Mandarin Sentence Repetition for Assessing Language in Bilingual Children LIM Yu Jia Background: There is a lack of Mandarin language assessments for Singapore bilingual children, especially for sentence-level productions. Sentence repetition (SRep) involves multiple language processes (semantics, morphosyntax, phonological short-term memory) and so SRep tests are potential clinical markers for the diagnosis of language disorders. To date, there is one study of SRep in Mandarin on Malaysian kindergarteners (Woon et al, 2014) and none in Singapore. Objective: To develop a Mandarin SRep test (SRep-M) for language assessment and collect normative data from local bilingual children. Method: 30 Mandarin-dominant bilingual children (aged 7;0 – 7;8) were recruited for the collection of normative data. The SRep-M consists of 42 items, with length and complexity varied, and was developed with reference to work on Mandarin morphosyntax development (e.g., Cheung, 2008). Preliminary Results & Discussion: Data collection is ongoing, but trends suggest that SRep-M has external validity as a measure of a Mandarin-dominant child’s language ability. Error analysis on SRep-M also provides useful information about the phonological short-term memory, receptive and expressive language abilities in bilingual children. EBP Implications: SRep-M is expected to be a useful tool as it measures many requisite skills for language and is easy and quick to administer. It is a potential screening tool that can be used by teachers to facilitate referrals to speech-language pathologists. Keywords: Mandarin Language Assessment, Sentence Repetition, Bilingual Poster 20 Using Sentence Repetition to Assess Language in Bilingual Children with Dyslexia SEET Xian Hui Background: There has been debate over whether or not children with dyslexia also have oral language difficulties (Catts et al., 2005). In Singapore, the bilingual environment and influence of Singapore Colloquial English have made it especially challenging to identify oral language difficulties. Objective: To obtain the language profile of local bilingual dyslexic children using a sentence repetition test and compare them to typically developing age peers. Method: 20 Primary 1-2 English-Mandarin bilingual children (aged 6-8 years) diagnosed with dyslexia will be assessed on their non-verbal intelligence (NVIQ, Ravens CPM), phonological short-term and working memory, WRAT4 reading and spelling subtests, BLAB English receptive vocabulary, and CELF4 (UK) core language subtests in addition to the newly developed sentence repetition (SRep) test. Expected Results & Discussion: When matched to cohort controls for NVIQ, quantitative and qualitative analyses of performance on the SRep test are expected to reveal group differences in the errors, providing support for the view that there are underlying oral language deficits common in children with dyslexia. EBP Implications: The intended outcome of this study is to identify areas for intervention with dyslexic children and to determine whether the SRep test might be a potentially useful oral language screener. Keywords: Dyslexia, Language, Sentence Repetition, Bilingual

Poster 21 Speech Outcomes in 4-to-6-Year-Old Children with Clefts Chen Yu Hui Background: Research suggests speech outcomes are related to cleft type (e.g., Hardin-Jones & Jones, 2005; Ha et al., 2014) but which cleft types lead to poorer speech outcomes remains inconclusive and worthy of further investigation. Objective: To investigate the relationship between cleft type and outcomes in terms of speech severity and intelligibility scores in 4-to-6-year-old children with non-syndromic cleft palate with and without cleft lip. Method: 22 children aged 4-6 years old with non-syndromic cleft lip and/or palate, and one respective parent were recruited (N=44). A matched-pairs design was employed to compare speech outcomes between children with cleft lip and palate (n=11) and children with cleft palate only (n=11). All participants completed the DEAP Articulation subtest (Dodd et al., 2002) and speech severity was operationalised as Percentage of Consonants Correct (PCC). Speech intelligibility was evaluated with (1) clinician rating of a conversational sample, and (2) parent rating on the Intelligibility-in-Context Scale (ICS; McLeod et al., 2012). Results & Discussion: Children with non-syndromic cleft lip and palate had significantly poorer PCC scores than children with cleft palate only. No significant difference was observed for parent- and clinician-reported speech intelligibility ratings between the two cleft types. Overall, ICS and PCC scores significantly correlated with clinician rating of speech intelligibility. EBP Implications: Difference in speech outcomes between children of different cleft types may allow for more targeted intervention planning by clinicians. Keywords: Cleft Type, Speech Severity, Speech Intelligibility Poster 22 Conversational Acts Profiling of Children with Cleft Lip and/or Palate: Investigating relationships between Speech Intelligibility, Attitudes and Conversation Participation NG Hui Jing Carol Background: Previous studies using standardised pragmatics assessments suggested children with cleft lip and/or palate (CLP) demonstrated less assertive profiles in conversation participation in comparison with typically developing peers. However, findings remain contradictory. Objective: To extend previous studies and further understanding of relationships between actual speech function, attitudes towards speaking, and conversational participation in children with CLP. Method: Twenty children with non-syndromic CLP (8;0 to 16;0 years old) will be recruited. Internationally standardised outcome measures for the cleft population will be used to evaluate speech function and attitudes towards speaking. Conversation samples will be recorded and coded as (a) “assertive” or “responsive”, (b) type of conversational acts, and (c) discourse level categories. Each child’s conversational profile will be determined. Correlations will be performed to examine the relationships between assertiveness, responsiveness, speech intelligibility and attitudes towards speaking. Expected Results & Discussion: Significant positive correlation is expected to be observed between (a) speech intelligibility and assertiveness and (b) attitudes towards speaking and assertiveness. EBP Implications: Further understanding of factors affecting conversation participation may allow clinicians to better understand the impact of speech impairment at the activity and participation level for children with CLP. Keywords: Cleft Lip and/or Palate, Conversation Participation, Attitudes towards Speech

Poster 23 Speech and Psychosocial Outcomes in Children with Cleft Lip and/or Palate YEAP Xiao Hui, Celine Background: Children with cleft lip and/or palate (CL/P) are at risk of speech impairment, leading to difficulties being understood. Preliminary studies have suggested a link between having speech impairments and poorer psychosocial functioning (Feragen, Særvold, Aukner, & Stock, 2017; Havstam, Sandberg, & Lohmander, 2011), however, further studies are required to substantiate these findings. Objective: To investigate the relationships between parent- and clinician-reported speech intelligibility, speech severity, and child-reported perceptions of speech function and distress. Method: 24 children (8-16 years) with non-syndromic CL/P and their parent (N=48) were recruited. Speech intelligibility was rated by (a) clinician, based on a 10-minute conversational sample and (b) parent, via the Intelligibility-in-Context Scale (ICS; McLeod, Harrison, & McCormack, 2012). Speech severity (PCC) was obtained using the DEAP articulation subtest (Dodd et al., 2002). Children’s perceptions were measured using the CLEFT-Q Speech Function and Speech Distress scales (Wong, Forrest, Goodacre, & Klassen, 2013). Results & Discussion: Children who reported poorer speech function also reported experiencing greater speech distress. Children’s perspectives of speech function and speech distress were significantly related to speech severity but not to speech intelligibility ratings. EBP Implications: Functional parent- and clinician-reported speech intelligibility measures should be supplemented with objective and patient-reported outcomes to better guide intervention planning. The CLEFT-Q speech function and distress scales are valuable clinical tools for more holistic care. Keywords: Cleft Lip and/or Palate, Speech Intelligibility, Psychosocial, School-Age Poster 24 Utility of an AAC Workshop for Special Education Teachers CHIN Kei Yu Irene Background: Beukelman and Mirenda’s (2013) Participation Model suggests the lack of facilitator skill, knowledge, and attitude affects the use of augmentative and alternative communication (AAC) amongst people with complex communication needs. As key facilitators, teachers in special education (SPED) setting play a central role in following through the implementation and use of AAC for students with complex communication needs. Objectives: To evaluate the efficacy of an AAC workshop aimed at (i) educating SPED teachers on the AAC assessment process, and (ii) positively changing their attitude, knowledge and skills regarding AAC. Method: 20 teachers with different levels of experience in SPED were recruited to attend a workshop which included an overview of AAC and a walkthrough on how to use an adapted version of an AAC Assessment Form. Pre- and Post- Questionnaires were given out to obtain information regarding teachers’ attitude to AAC. Post-workshop, the teachers each assessed two students using the adapted AAC form, and ratings were then compared to those of Speech Language Therapists (SLTs). Expected Results & Discussion: Data analysis is still on-going but it is expected that (i) the SPED teachers’ observations will agree with those made by SLTs, and (ii) there will be a positive change in their attitude, knowledge, and skills regarding AAC. EBP Implications: The AAC Workshop will address the SPED teachers’ lack of facilitator skill and knowledge, and also have a positive effect on their attitudes to AAC. In the longer term, the workshop will provide a common language for the team when following through the assessment process and implementation of AAC in a timely manner. Keywords: SPED, Teachers, AAC, Assessment

Poster 25 AAC Workshop: Its Utility for Parents of Children in Special Education LAI Weijean Background: Research has shown that insufficient information regarding AAC affects the skills and attitudes of parents a child’s main communication partners (Goldbart & Marshall, 2004). According to the Participation Model (Beukelman & Mirenda, 2013), these are potential opportunity barriers that influence a child’s AAC use. Objective: To evaluate the efficacy of an AAC workshop in: 1) enabling parents to provide information regarding their child for AAC-planning, and how this compares with Special Education (SPED) teachers and speech therapists (STs), and 2) eliciting a change in parents’ knowledge, skills, and attitudes towards AAC? Method: 5 parents with children in SPED attended a 3-hour AAC workshop comprising of an AAC overview and a walkthrough on using an adapted AAC Assessment Form. Pre- and post-workshop questionnaires were distributed to obtain information regarding parents’ attitudes, knowledge, and skills regarding AAC. Parents’ AAC-related observations were also collected and compared with those made by SPED teachers and STs. Results: Data analysis is ongoing but it is expected that the AAC workshop will help parents to provide qualitative AAC-related information regarding their children and elicit positive changes in the attitudes, knowledge, and skills of parents regarding AAC. EBP Implications: This study highlights the importance of educating parents in order to reduce opportunity barriers to a child’s AAC use. Keywords: AAC, Parents, SPED Poster 26 Language and Communication of Children with Hearing Loss in Singapore: Case studies CHUA Jia Yi Background: Childhood hearing loss presents challenges to the development of language, literacy, social communication skills, and socio-emotional well-being. Thus far relatively little is known about how deaf signing children acquire these skills within an inclusive education system. Objective: To profile the language, literacy, social communication skills, and socio-emotional well-being of deaf children undergoing bilingual-bicultural education in a mainstream Singapore school. Method: Six children with profound hearing loss (2 boys and 4 girls, aged 6 - 8 years) and different levels of sign experience and auditory perception, were assessed on single-word expressive and receptive language skills in both sign language and English using locally-developed multimodal assessments (oral, sign, written). Social communication skills and socio-emotional behaviours were also evaluated through school observations and reports from parents and teachers. Results & Discussion: Data collection is ongoing for the six children but it seems clear that three children have heterogeneous language and literacy profiles even though they are in the same Primary 1 classroom. Their social communication abilities are likely to show a positive relationship to language proficiency across each of the three modalities. Difficulties in peer relationships were reported by parents to be consistently affecting the socio-emotional well-being of their children. EBP Implications: Findings will have theoretical implications on how deaf children develop language and communication in bilingual-bicultural programs in mainstream settings. Profiles of the strengths and weaknesses for individual deaf children will facilitate the planning of intervention programs that will be conducted by clinicians, parents, and teachers. Keywords: Deaf, Bilingualism, Language, Communication

Poster 27 Development of English Morphosyntax in Bilingual Singaporean Preschoolers Kerensa CHEW Maine Background: Assessing bilingual children is a challenge, especially in Singapore due to linguistic diversity and tolerance (Cummins & Swain, 1986; Gupta & Chandler, 1993), limited locally developed assessment tools and normative data (Brebner, 2002; Gupta et al., 1998). This poses a risk of over- and under-diagnosis of local bilingual children with language impairment. It is thus important to identify language features and establish norms sensitive to the local population for more accurate assessment and diagnosis. Mean length of utterance, verb morphology (Bedore & Penã, 2008), subject-verb agreement (Rispens & Been, 2007) have been identified as clinical markers of Developmental Language Delay (DLD) in monolingual English-speaking children. Language sampling is used in this study as it has shown to be useful in identifying morphosyntax structures of young children (Horton-Ikard, 2010). Objective: To establish normative data on English morphosyntax development in bilingual children through conversational language samples. Method: 30 typically developing 5-year-old L1-English L2-Mandarin bilingual preschoolers were recruited and screened for non-verbal IQ using WPPSI™-IV (Wechsler, 2012), BLAB receptive and expressive single-word proficiency (Sze and Rickard Liow, 2009; Lee & Rickard Liow, 2013). The main assessment involved eliciting language samples using a picture description task showing a familiar local scene. Responses were audio-recorded and transcribed for detailed analysis. Expected Results & Discussion: Local 5-year-old children will present use of morphological structures up to Brown’s (1973) Stage V, pronouns and subject-verb agreement. Linguistic features of Singapore Colloquial English are expected to coexist, e.g., using “already” and “later” to indicate past tense, when features of Standard English are emerging. EBP Implications: Norms for morphosyntax development in 5-year-old preschool children using a language sample will provide local clinicians a useful tool to identify preschool children at risk of language impairment. Keywords: Bilingual, Morphosyntax, Language Development, English

Poster 28 Singapore Assessment of Phonological Awareness: English-Mandarin Bilingual Norms Wanda WIJAYA Background: Phonological awareness (PA) is the knowledge of the word’s sound structures (Treiman & Zukowski, 1991). The link between PA and learning to read and write is relatively well-established (Castles & Coltheart, 2004), so PA development is crucial for identifying children at-risk for later literacy difficulties. Thus far, the majority of existing PA assessments have been developed in English-speaking countries for use with relatively homogenous group of English-monolingual children so they may have limited reliability and validity for the local bilingual population. Objective: To develop a locally-appropriate PA assessment tool with accompanying norms for Singaporean bilingual children. Method: 30 K1 and 30 K2 Singaporean English-Mandarin speakers were recruited from four kindergartens. The new PA assessment tool included linguistically-appropriate high-frequency words. In addition to the PA assessment, the WPPSI-IV block design subtest and a language assessment using BLAB will be administered. Expected Results & Discussion: Previous research suggests that bilinguals learn PA differently from monolinguals (Bialystok, Majumder, & Martin, 2003; Yeong & Rickard Liow, 2012), therefore normative data might reflect a different developmental trajectory compared to that of monolinguals. EBP Implications: The findings will provide useful preliminary normative data for the development of PA in English-Mandarin bilingual children which can be used to identify children at risk for later literacy difficulties. Keywords: Phonological Awareness, Bilingual, Children

Poster 29 Malay Morphosyntactic Development of Malay-L1 Preschoolers in Singapore Nuraidah Mariko BINTE PATHORR RAHMAN Background: Language sample analysis (LSA) is one of the requisites of a comprehensive language assessment. To date, there are no norms for Malay language development in Malay-L1 English-L2 Singaporean children, and there is a lack of available standardized Speech and Language Therapy assessment tools. Objective: To establish norms that will accurately reflect the development of Malay morphosyntax in typically developing Singaporean Malay-L1 English-L2 pre-schoolers using detailed LSA. Method: 30 Kindergarten 1 and 30 Kindergarten 2 typically developing Malay-L1 English-L2 bilinguals (aged 4;3 to 6;8 years), were recruited from five preschools. Language samples in Malay were collected from each child by eliciting descriptions of two pictures of familiar scenes (park and classroom) and a short informal conversation. Responses were audio-taped, transcribed verbatim, and then collated using pre-determined categories in a Microsoft Excel spreadsheet. Expected Results & Discussion: Data collection is ongoing but it is expected that morphosyntactic features will include derivational morphemes, aspect markers, auxiliaries, negation, and possessive markers with emerging use of connectors, relative clause markers, and more complex sentence structures for the older children. EBP Implications: Normative data obtained for Malay language development could be used to better support clinicians in the early identification of language difficulties in Singaporean Malay-L1 English-L2 pre-schoolers. Keywords: Malay, Bilingual, Morphosyntax, Language Sample Poster 30 Social, Emotional Processing - 4Ws1H questions on PiSCES for Children with ASD Sellam RAJANDRAN Background: Children with Autism Spectrum Disorder (ASD) tend to have difficulties integrating information in social situations. This is often attributed to weak central coherence in children with ASD, but they do have the potential for global processing when cued (Happe & Frith, 2006). Objective: To evaluate the effectiveness of comprehension questions (4W, 1H) as cues to facilitate the identification of emotions and causal attributions in responses to picture stimuli with social context and emotional scenes (PiSCES; Teh, Yap, & Rickard-Liow, 2017). Method: A case-series design was employed with baseline, intervention, and post-intervention phases conducted over 10 weekly sessions for two boys aged 7 and 9 years. The weekly sessions progressed from a fully-guided use of “Who”, “Where”, “What”, “How” and “Why” series of questions, to fully-independent application of strategies on PiSCES pictures of high social engagement. Outcomes measured were the number of accurate emotional terms (“how”) and causal attributions (“why”) post-intervention. Results: Participants produced more (i) accurate emotional terms and more (ii) causal attributions post-intervention. Longer narratives were also observed. EBP Implications: The use of this 4WH technique could facilitate processing of social and emotional information and lead to better socialization in children with ASD. Keywords: Autism, Social, Emotional Processing, Weak Central Coherence

Poster 31 Perspective-Taking with Thought-Bubbles and PiSCES for Children with ASD WONG Ci Xin Background: Children with Autism Spectrum Disorders (ASD) often have deficits in perspective-taking which limit their ability to evaluate emotions and interpret social situations accurately. Thought-bubble training has been shown to improve performance on false belief tasks (Wellman et al., 2002) and could prove useful for teaching perspective-taking. Objective: To investigate the effects of a perspective-taking intervention programme for pre-schoolers with ASD using ‘thought-bubbles’ in contextualized pictures. Method: A case-series design was developed for two girls (5;4 and 5;9) with ASD. Baseline and post-intervention measures were taken with the same 16 pictures. Participants were then guided using thought-bubbles to verbalize the thoughts and feelings of people in a set of 30 intervention picture stimuli standardized on emotional valence, intensity, and social engagement: Pictures with Social Context and Emotional Scenes (PiSCES, Teh, Yap, & Rickard Liow, 2017). The social and emotional complexity of the stimuli was increased gradually over 8 one-hour sessions with individual participants. Results & Discussion: The number and accuracy of emotional and mental state vocabulary increased significantly, with generalization to untreated pictures. EBP Implications: The results of the study demonstrate the effectiveness of a thought-bubble intervention strategy, used with gradated pictures with a social engagement construct, as stimuli for training perspective-taking skills in children with ASD. Keywords: Autism Spectrum Disorders, Perspective-Taking, Pisces, Thought-Bubble Training