부산대학교 도서관

The Unified Huntigton Disease Rating Scale (UHDRS) is widely used by medical, nursing, and allied-health professionals in the management and study of patients with Huntington disease (HD), who sometimes present with decreased speech intelligibility. As such, examining the reliability of speech intelligibility ratings using the UHDRS is critical in evaluating its utility as an instrument for identifying and documenting the nature of the speech deficits. Previous research has suggested that the reliability of speech intelligibility ratings made by neurologists using rating scales such as the UHDRS is questionable, perhaps due to vague written instructions for obtaining a valid nonstandardized speech sample. Furthermore, there is no literature to date that reports the reliability of expert speech-language pathologists' ratings of speech intelligibility using the UHDRS, nor how those ratings might compare to those of medical experts. The purpose of this study, therefore, was to determine the interrater and intrarater reliability of speech intelligibility ratings made by medical and nonmedical experts using a standardized speech protocol and expanded rating criteria for the Speech item of the Motor Examination subscale of the UHDRS. Three medical experts (a neurologist with expertise in movement disorders, a senior resident in neurology, and a registered nurse with experience with movement-disordered patients) and three certified speech-language pathologists with expertise in motor speech disorders rated the audiotape recorded speech of 13 subjects with mild-moderate HD. For the sample of mildly dysarthric speech obtained for this study, interrater reliability for both the medical experts and the speech-language pathologists was greater than .80 (p < .05), and for the two physicians it was greater than .90 (p < .01). Mean intrarater reliability for all listeners was .96, for the medical experts it was .95, and for the speech-language pathologists it was .97 (p < .01). These findings suggest that with the use of a standardized speech protocol and modified rating criteria, the Speech item in the Motor Examination subscale of the UHDRS can be used reliably by medical experts and speech-language pathologists to assess the speech intelligibility of patients with mild-moderate HD.