An Ultrasound Investigation of Tongue Dorsum Raising in Children with Cleft Palate +/- Cleft Lip

Clinicians' Perspectives on Using Ultrasound Visual Biofeedback for Research and Practice with People with Cleft Palate ± Cleft Lip

ObjectiveUltrasound visual biofeedback has the potential to be a useful tool in cleft palate ± lip care but there is little research on its effectiveness, nor on clinicians' views on using it in research and practice. This study reports on cleft-specialist speech and language therapists' (SLTs) views on the acceptability of the technique in clinical practice and on their readiness to contribute to future clinical trials of its effectiveness.DesignA qualitative design comprising semi-structured focus groups/interviews.SettingClinicians reflected on how easy it would be to use ultrasound in their regional cleft services.ParticipantsClinicians were recruited via invitation to a UK-wide list of cleft-specialist SLTs. Eleven participants took part over 2 focus groups and 2 interviews.AnalysisFocus groups/interviews were recorded, transcribed verbatim, and an inductive thematic analysis was undertaken. Once complete, a deductive analysis using the theoretical framework of acceptability was conducted to summarise the findings.ResultsFour themes emerged: (1) value of ultrasound as an approach; (2) intrinsic drawbacks of acquiring and utilising ultrasound; (3) competence in effective performance within a clinical trial; and (4) incentives for clinicians and patients in participation in research.ConclusionsParticipants were positive about the benefits of ultrasound for visualising the articulators and improving patient outcomes. Barriers to adoption included the cost of the equipment and the time to travel to appointments. Across clinical and research uses of ultrasound the need for high-quality training and networking within a community of practice was highlighted.

The Application of Ultrasound Evaluation of Swallowing to the Analysis of Hyoid Kinematics in Healthy Swallows

PURPOSE

Using ultrasound as an adjunct tool for swallowing assessment has gained significant momentum in recent years, with research gaps in areas such as speech and language therapist-driven protocol and measurement methods. This study outlines the recording protocol of Ultrasound Evaluation of Swallowing (USES). Additionally, a set of multidimensional measurements capturing the hyoid kinematics in typical swallows was compared with previous studies to evaluate the current protocol and to develop an ultrasound database of healthy swallows to further the clinical implementation of USES.

METHOD

Swallowing data were acquired from 41 healthy participants. Both discrete swallows (5- and 10-ml) and continuous swallows (100-ml) were analyzed. Automatic tracking of the hyoid and mandible positions using a deep neural net was applied. Six swallowing events of interest were identified for each swallow (beginning hyoid position, maximal hyoid position, hyoid advancement, hyoid retraction, peak forward velocity, and peak backward velocity), and a series of hyoid parameters characterizing the amplitude, velocity, and timing of the movement were calculated and compared across different types of swallows.

RESULTS

Results showed significant differences between continuous and discrete swallows. Continuous swallows were characterized by shorter maximal hyoid displacement, a shorter duration between the start of the swallow and the maximal displacement, a shorter total swallow duration, and lower peak velocity in both forward and backward hyoid movement. No significant difference was observed between the 5- and 10-ml swallows in hyoid movement amplitude, velocity, or duration.

CONCLUSIONS

The quantification of hyoid kinematics in swallowing through the current USES recording protocol, combined with the semi-automatic extraction of hyoid function by applying a deep neural net and feature-finding algorithms, provides initial evidence to support its clinical utility in swallowing assessment. Further studies, including those of different clinical populations, to evaluate the sensitivity of the hyoid metrics in detecting changes to swallowing would support the clinical translation.

Ultrasound Tongue Imaging in Research and Practice with People with Cleft Palate ± Cleft Lip

Ultrasound tongue imaging is becoming popular as a tool for both phonetic research and biofeedback for treating speech sound disorders. Despite this, it has not yet been adopted into cleft palate ± cleft lip care. This paper explores why this might be the case by highlighting recent research in this area and exploring the advantages and disadvantages of using ultrasound in cleft palate ± cleft lip care. Research suggests that technological advances have largely overcome some of the difficulties of employing ultrasound with this population and we predict a future increase in the clinical application of the tool.

Feasibility of using ultrasound visual biofeedback to treat persistent speech sound disorders in children with cleft palate- a case series

The current study aimed to assess the effectiveness of incorporating ultrasound visual biofeedback (UVB) into a treatment programme addressing persistent speech sound disorders linked to cleft palate in children who have been unresponsive to traditional therapy approaches. Materials and Methods. A single-subject multiple baseline experiment was conducted with five children aged 6:5-13:5 over a period of 16 therapy sessions. Treatment focused on providing cues from real-time ultrasound images to assist children in modifying their tongue movements. Probe data were collected before, mid, and post-treatment to assess target consonant accuracy for 50 untreated words. The results of the statistical analysis suggested participants showed a significant increase in percent target consonant accuracy as a result of intervention using UVB. Although most of the participants exhibited progress in generalising learned phonemes to untreated words, some did not show improvement in gaining generalisation from treated phonemic contexts to those untreated ones. When traditional methods fail to yield significant progress, incorporating ultrasound biofeedback into the treatment programme emerges as a viable option to enhance sound accuracy in children with persistent speech sound disorders resulting from cleft palate.

Tongue dorsum activity in children with velopharyngeal insufficiency vs. typically developing children

To investigate whether children with velopharyngeal insufficiency (VPI) exhibit increased elevation and retraction of the tongue dorsum. Two quantitative metrics of tongue dorsum activity: Dorsum excursion Index (DEI) and Tongue Constraint Position Index (TCPI) were captured using mid-sagittal images of the tongue obtained from Ultrasound Tongue Imaging. Participants: Six children with velopharyngeal insufficiency (VPI), six children with palate (w/wo cleft lip) without velopharyngeal insufficiency (wo VPI) and ten typically developing children aged 6-15 repeated six different consonants in aCa and iCi contexts five times. A linear mixed-effect model was used to examine the response variables across three groups. Overall, DEI was not significantly higher in the VPI group than in the other two groups. Also, TCPI was not significantly lower in the cleft palate group (VPI and wo VPI). However, significant differences were detected between certain phonetic contexts in the VPI group. In addition, a significant interaction between group and consonant was found in the context of /i/. These findings suggest that the presence of VPI may not lead to a uniform increase in tongue dorsum elevation or retracted position across all speech sounds. Rather, the articulatory behaviours of children with VPI may be influenced by the specific phonetic context and individual variability.