About

Kristie A. Spencer, Ph.D., CCC-SLP, is a Professor and Associate Chair in the Department of Speech & Hearing Sciences at the University of Washington. She serves as the Graduate Program Coordinator and specializes in the assessment and treatment of neurogenic motor speech disorders, with a particular focus on motor speech disorders in adults and cognitive-communication disorders. Dr. Spencer earned her Ph.D. in Speech Pathology from the University of Washington in 2003, her M.S. in Speech Pathology from the University of Pittsburgh in 1992, and her B.A. in Speech & Hearing Science from the University of Pittsburgh in 1990. Her research areas include motor speech disorders, neurodegenerative diseases, and auditory perception, and she has contributed to the understanding and management of conditions such as dysarthria, aphasia, and speech impairments related to neurological injuries. Dr. Spencer is actively involved in teaching courses related to neurogenic motor speech disorders, dementia, traumatic brain injury, and clinical speech-language pathology, and she has published extensively on topics related to speech pathology and neurodegenerative diseases.

Research topics

• Psychology
• Audiology
• Cognitive psychology
• Medicine
• Physical medicine and rehabilitation

Selected publications

• Examining the perspectives of augmentative and alternative communication (AAC) specialists on conducting AAC evaluations with people with amyotrophic lateral sclerosis via telehealth

  Augmentative and Alternative Communication · 2025-01-16 · 1 citations

  article

  The purpose of this study was to explore what speech-language pathologists (SLPs) who are AAC specialists see as advantages and disadvantages of providing AAC services via telehealth, how well tele-AAC assessments align with guidelines for in-person assessments, and how SLPs' perspectives of tele-AAC services changed post-COVID. Fifteen SLPs who are AAC specialists and experienced working with people with amyotrophic lateral sclerosis watched videos of speech generating device (SGD) assessments conducted via telehealth for eight people with amyotrophic lateral sclerosis. Using a checklist based on the AAC Clinical Assessment Project (AAC-CAP), the SLPs rated how comparable remote assessment was to in-person assessment, and described advantages and challenges. Across checklist elements, most participants rated AAC assessment via telemedicine as "same/comparable" to in-person assessment. The most common advantages of tele-AAC assessment were that tele-AAC was more functional, increased care partner availability, and increased clients' comfort at home. The most common challenges were technical difficulties and a limited comprehensive assessment due to the remote modality. Tele-AAC should be considered a viable assessment option as it may increase equitable access to care for more people with amyotrophic lateral sclerosis. Tools such as the AAC-CAP may help generalist SLPs increase their comfort and proficiency providing AAC services.

  PublisherDOI

• Management of Velopharyngeal Impairment in Adults With Dysarthria: A Systematic Review

  American Journal of Speech-Language Pathology · 2024-12-03

  review1st authorCorresponding

  PURPOSE: Velopharyngeal impairment (VPI) is a common manifestation of dysarthria, yet there is uncertainty regarding the evidence for treatment options. The aim of this systematic review was to identify and evaluate published intervention studies of VPI and to update the original Practice Guidelines for VPI, as part of the Dysarthria Writing Group of the Evidence-Based Clinical Research Committee of the Academy of Neurologic Communication Disorders and Sciences. METHOD: Four electronic databases were searched for articles published through September 2022 in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards. Multiple indices of methodological quality and risk of bias were used to evaluate studies. RESULTS: = 7), with four additional studies reporting unconventional approaches (e.g., use of medication). No single treatment approach garnered strong evidence. However, converging moderate evidence suggests positive treatment outcomes for prosthetic approaches for moderate-severe speakers with flaccid/spastic dysarthria and behavioral treatment approaches for speakers spanning a range of nonprogressive dysarthrias. CONCLUSIONS: There is a critical need for well-controlled treatment studies of VPI that incorporate comprehensive and systematic description of baseline speech function, treatment protocols, and operationally defined outcome measures, particularly related to social validity and participation goals. Suggestions for how clinicians can apply extant research findings to practice are provided. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.27655566.

  PublisherDOI

• An Examination of Cognitive Heterogeneity in Parkinson Disease: The Dual-Syndrome Hypothesis

  Journal of Speech Language and Hearing Research · 2024-03-06 · 5 citations

  article

  PURPOSE: Cognitive impairment is one of the most debilitating nonmotor symptoms in Parkinson disease (PD), and its presentation is heterogeneous. One proposed model to explain cognitive variability in PD is the dual-syndrome hypothesis. This hypothesis delineates two cognitive profiles, a "fronto-striatal" profile and a "posterior cortical" profile according to symptom presentation, associated motor phenotype, and risk for dementia. The current study examined the dual-syndrome hypothesis in individuals with idiopathic PD to evaluate the existence of these profiles, determine the association with the motor phenotype (tremor dominant vs. postural instability/gait disorder), and assess the relative risk for dementia. METHOD: A retrospective examination was conducted using data from the Parkinson's Progression Markers Initiative database at baseline (within 2 years of diagnosis) and 5 years after baseline. Descriptive categorizations, cluster analyses, generalized linear mixed models, and logistic regressions were used to address the research questions. RESULTS: There was emerging evidence of cognitive profiles; however, these were not fully supported by cluster analyses. Baseline cognitive profile was associated with later motor phenotype, and as predicted, dementia risk was greatest in persons with baseline posterior cortical impairments. CONCLUSION: The current results provide mixed support for the dual-syndrome hypothesis, with some evidence that the posterior cortical cognitive profile is associated with postural instability and gait disorder as well as greater dementia risk.

  PublisherDOI

• Differences in spontaneous speech fluency between Parkinson's disease and spinocerebellar ataxia type 3

  Frontiers in Neurology · 2023-05-05 · 7 citations

  articleOpen access

  Background: The basal ganglia and cerebellum both have a role in speech production although the effect of isolated involvement of these structures on speech fluency remains unclear. Objective: The study aimed to assess the differences in the articulatory pattern in patients with cerebellar vs. basal ganglia disorders. Methods: A total of 20 individuals with Parkinson's disease (PD), 20 with spinocerebellar ataxia type 3 (SCA3), and 40 controls (control group, CG) were included. Diadochokinesis (DDK) and monolog tasks were collected. Results: The only variable that distinguished SCA3 carriers from the CG was the number of syllables in the monolog, with SCA3 patients of a significantly lower number. For patients with PD, the number of syllables, phonation time, DDK, and monolog were significantly lower than for CG. Patients with PD were significantly worse compared to patients with SCA3 in the number of syllables and phonation time in DDK, and phonation time in monolog. Additionally, there was a significant correlation between the number of syllables in the monolog and the MDS-UPDRS III for participants with PD, and the Friedreich Ataxia Rating Scale for participants with SCA3 suggesting a relationship between speech and general motor functioning. Conclusion: The monolog task is better at discriminating individuals with cerebellar vs. Parkinson's diseases as well as differentiating healthy control and was related to the severity of the disease.

  PublisherOA PDFDOI

• The efficacy of acoustic-based articulatory phenotyping for characterizing and classifying four divergent neurodegenerative diseases using sequential motion rates

  Journal of Neural Transmission · 2022-10-28 · 12 citations

  articleOpen access
  PublisherOA PDFDOI

• Investigating Perceptual Subgroups in Speakers With Ataxic Dysarthria: An Auditory Free Classification Approach

  American Journal of Speech-Language Pathology · 2022-11-23 · 3 citations

  article1st authorCorresponding

  PURPOSE: Ataxic dysarthria has presented with considerable heterogeneity in the presentation of speech characteristics. Converging evidence supports the existence of subgroups, specifically related to the instability and inflexibility of motor patterns as a possible explanation of this variability. METHOD: To further examine the alignment of the speech characteristics of ataxic dysarthria with the instability/inflexibility framework, 23 graduate student listeners participated in an auditory free classification task and a guided classification task. Listeners grouped 15 speakers with ataxic dysarthria based on their judgment of the most salient perceptual characteristics during two speaking tasks: alternating motion rates (AMRs) and connected speech (one to two sentences). Listener ratings were then compared with a priori determinations of speakers who fit the instability subgroup profile and the inflexibility subgroup profile. RESULTS: Results of both the free classification and guided classification listening paradigms provided supportive evidence of subgroups, particularly for the AMR task, in the context of strong inter- and intrarater reliability. CONCLUSION: This study adds to the growing evidence of the existence of instability and inflexibility subgroups in ataxic dysarthria and serves as a proof of concept for use of the auditory free classification paradigm in dysarthria subgroup research.

  PublisherDOI

• Effect of Noise on Speech Intelligibility and Perceived Listening Effort in Head and Neck Cancer

  American Journal of Speech-Language Pathology · 2021-02-25 · 7 citations

  articleOpen accessSenior author

  Purpose This study (a) examined the effect of different levels of background noise on speech intelligibility and perceived listening effort in speakers with impaired and intact speech following treatment for head and neck cancer (HNC) and (b) determined the relative contribution of speech intelligibility, speaker group, and background noise to a measure of perceived listening effort. Method Ten speakers diagnosed with nasal, oral, or oropharyngeal HNC provided audio recordings of six sentences from the Sentence Intelligibility Test. All speakers were 100% intelligible in quiet: Five speakers with HNC exhibited mild speech imprecisions (speech impairment group), and five speakers with HNC demonstrated intact speech (HNC control group). Speech recordings were presented to 30 inexperienced listeners, who transcribed the sentences and rated perceived listening effort in quiet and two levels (+7 and +5 dB SNR) of background noise. Results Significant Group × Noise interactions were found for speech intelligibility and perceived listening effort. While no differences in speech intelligibility were found between the speaker groups in quiet, the results showed that, as the signal-to-noise ratio decreased, speakers with intact speech (HNC control) performed significantly better (greater intelligibility, less perceived listening effort) than those with speech imprecisions in the two noise conditions. Perceived listening effort was also shown to be associated with decreased speech intelligibility, imprecise speech, and increased background noise. Conclusions Speakers with HNC who are 100% intelligible in quiet but who exhibit some degree of imprecise speech are particularly vulnerable to the effects of increased background noise in comparison to those with intact speech. Results have implications for speech evaluations, counseling, and rehabilitation.

  PublisherOA PDFDOI

• The Relationship Between Motor Subtype and Cognition in Idiopathic Parkinson's Disease

  Archives of Physical Medicine and Rehabilitation · 2021-09-27

  articleSenior author
  PublisherDOI

• An Examination of Cognitive Heterogeneity in Parkinson disease: The Dual-Syndrome Hypothesis

  Archives of Physical Medicine and Rehabilitation · 2021-09-27

  articleSenior author
  PublisherDOI

• The Relationship Between Speech Characteristics and Motor Subtypes of Parkinson's Disease

  American Journal of Speech-Language Pathology · 2020-09-30 · 15 citations

  articleSenior author

  Purpose The aim of this study was to examine whether acoustic dysarthria characteristics align with overall motor profile in individuals with Parkinson's disease (PD). Potential speech differences between tremor-dominant and non–tremor-dominant subtypes are theoretically motivated but empirically inconclusive. Method Twenty-seven individuals with dysarthria from PD provided a contextual speech sample. Participants were grouped into non–tremor-dominant ( n = 12) and tremor-dominant ( n = 15) motor subtypes according to the Unified Parkinson Disease Rating Scale. Dependent speech variables included fundamental frequency range, average pause duration, cepstral peak prominence, stuttering dysfluencies, and maze dysfluencies. Results There were no significant differences between the speech of the tremor-dominant and non–tremor-dominant groups. High within-group variability existed across parameters and motor subtypes. Conclusion Speech characteristics across the areas of phonation, prosody, and fluency did not differ appreciably between PD motor subtypes.

  PublisherDOI

Recent grants

• NIH Grant R03DC007066

  NIH · $229k · 2010

Frequent coauthors

• Diane L. Kendall

  University of Washington

  24 shared

• Kathryn M. Yorkston

  University of Washington

  22 shared

• Malcolm R. McNeil

  University of Pittsburgh

  15 shared

• Rebecca Hunting Pompon

  10 shared

• Katherine Brown

  Speech Pathology Australia

  7 shared

• Patrick J. Doyle

  Harvard University

  6 shared

• Dale Summers

  University of Washington

  6 shared

• Janelle Sanchez

  Children's Hospital of Orange County

  5 shared

Labs

• Motor Speech & Cognitive Disorders LabPI

Education

• MS, Communication Sciences and Disorders

  University of Pittsburgh

• BS, Communication Sciences and Disorders

  University of Pittsburgh

• PhD, Speech and Hearing Sciences

  University of Washington