European Archives of Oto-Rhino-Laryngology

, Volume 273, Issue 12, pp 4493–4500 | Cite as

Articulation handicap index: an instrument for quantifying psychosocial consequences of impaired articulation

  • Annerose Keilmann
  • Uwe Konerding
  • Constantin Oberherr
  • Tadeus Nawka
Head and Neck


Structural, neurological and muscular diseases can lead to impairments of articulation. These impairments can severely impact social life. To judge health status comprehensively, this impact must be adequately quantified. For this purpose, the articulation handicap index (AHI) has been developed. Psychometric analyses referring to this index are presented here. The AHI was completed by 113 patients who had undergone treatment of tumours of the head or neck. The patients also gave a general self-assessment of their impairments due to articulation problems. Furthermore, tumour size, tumour location and kind of therapy were recorded. Missing data were analysed and replaced by multiple imputation. Internal structure was investigated using principal component analysis (PCA); reliability using Cronbach’s alpha. Validity was investigated by analysing the relationship between AHI and general self-assessment of impairments. Moreover, the relationships with tumour size, tumour location and kind of therapy were analysed. Only 0.12 % of the answers to the AHI were missing. The Scree test performed with the PCA results suggested one-dimensionality with the first component explaining 49.6 % of the item variance. Cronbach’s alpha was 0.96. Kendall’s tau between the AHI sum score and the general self-assessment was 0.69. The intervals of AHI sum scores for the self-assessment categories were determined with 0–13 for no, 14–44 for mild, 46–76 for moderate, and 77–120 for severe impairment. The AHI sum score did not systematically relate to tumour size, tumour location or kind of therapy. The results are evidence for high acceptance, reliability and validity.


Articulation handicap index AHI Self-assessment categories Speech disorder Quality of life Oral cancer 


Compliance with ethical standards

We received no funding for this study.

All authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the ethical committee of the Federal Medical Association.

All procedures performed were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Annerose Keilmann
    • 1
  • Uwe Konerding
    • 2
  • Constantin Oberherr
    • 3
  • Tadeus Nawka
    • 4
  1. 1.Voice Care CentreBad RappenauGermany
  2. 2.Trimberg Research AcademyUniversity of BambergBambergGermany
  3. 3.Department for Communication DisordersUniversity Medical Center MainzMainzGermany
  4. 4.Department of Audiology and PhoniatricsCharité, Universitätsmedizin BerlinBerlinGermany

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