Moebius Syndrome: Measures of Observer Intelligibility with versus without Visual Cues in Bilateral Facial Paralysis

Forty Years After Hearing Lips and Seeing Voices: the McGurk Effect Revisited

Since its discovery 40 years ago, the McGurk illusion has been usually cited as a prototypical paradigmatic case of multisensory binding in humans, and has been extensively used in speech perception studies as a proxy measure for audiovisual integration mechanisms. Despite the well-established practice of using the McGurk illusion as a tool for studying the mechanisms underlying audiovisual speech integration, the magnitude of the illusion varies enormously across studies. Furthermore, the processing of McGurk stimuli differs from congruent audiovisual processing at both phenomenological and neural levels. This questions the suitability of this illusion as a tool to quantify the necessary and sufficient conditions under which audiovisual integration occurs in natural conditions. In this paper, we review some of the practical and theoretical issues related to the use of the McGurk illusion as an experimental paradigm. We believe that, without a richer understanding of the mechanisms involved in the processing of the McGurk effect, experimenters should be really cautious when generalizing data generated by McGurk stimuli to matching audiovisual speech events.

Möbius syndrome: misoprostol use and speech and language characteristics

Introduction Möbius syndrome (MS; VI and VII palsy) is a rare disease that in Brazil has a great frequency because of the use of misoprostol during pregnancy.

Objective Verify if the speech and language performance of children with MS whose mothers reported use of misoprostol (Cytotec, Pfizer, Connecticut, USA) are different from the performance of children of mothers who did not report use.

Methods The stomatognathic system beyond receptive and expressive language and speech was evaluated in children with MS, and their mothers were questioned whether they used misoprostol during the pregnancy.

Results During the interview, 61.11% of mothers reported that they took misoprostol during the pregnancy. Most of the subjects (83.3%) whose mothers took misoprostol presented bilateral palsy beyond bad mobility of the tongue (90.9%) and speech disorders (63.6%).

Conclusion The number of mothers who took misoprostol without knowing the risk for MS was great. The lack of facial expressions and speech disorders were common characteristics of the individuals with MS, whether the mothers took misoprostol during the pregnancy or not.

A novel patient-controlled bidirectional palatal lift appliance

OBJECTIVE

Palatal lift appliances have a role in management of velopharyngeal dysfunction for immobile palates of adequate length where surgery is contraindicated. Conventional appliances involve acrylic/wire work adjustment over successive appointments until they can be tolerated without gagging. A novel appliance has been developed where the lifting plate is incrementally distalized by the patient and vertically adjusted to optimize soft palate positioning.

METHOD

The design, construction, and utility of the appliance, which was developed in Dundee Dental Hospital, are described.

PARTICIPANTS

The subject was a 12-year-old boy with a variant of Moebius syndrome and velopharyngeal dysfunction. Previous pharyngoplasty had been carried out and further surgery was contraindicated.

INTERVENTIONS

The appliance is constructed and fitted and the flexible spring arm is vertically adjusted to lift the soft palate. The screw is turned incrementally at home, extending the lifting plate posteriorly. Videofluoroscopy allows visualization of the appliance and soft palate positioning.

MAIN OUTCOME MEASURES/RESULTS

The procedure improved soft palate positioning, as demonstrated by videofluoroscopy, and objective speech outcomes.

CONCLUSIONS

The appliance was well tolerated and led to improved speech outcomes for the patient. Adjustments were quick and easy for both clinician and patient. Further studies are needed to definitively determine the efficacy of the appliance.

Utilization of visual information and listener strategies in intelligibility impairment related to bilateral facial paresis

This study investigated how intelligibility scores of a speaker with bilateral facial paresis differed in auditory-only and auditory-visual presentation modes. A speech sample was collected and movies were created in both auditory-only and auditory-visual modes. These movies were presented to listeners who were unfamiliar with the speaker (n=20) with 10 of the listeners randomly assigned to the auditory-only listening mode and 10 assigned to the auditory-visual mode. Listeners transcribed what they heard and also completed a scale to determine the strategies used to understand this speaker's utterances. Results of ANOVA revealed that intelligibility in the auditory-visual condition was significantly greater than intelligibility for the auditory-only condition. Listeners reported utilizing many strategies to transcribe the speaker's utterances and listeners in the auditory-visual mode utilized cognitive strategies significantly more than listeners in the auditory-only mode. Findings of this study highlight the importance of visual information provided to listeners, as well as the types of strategies that listeners may use or be taught to use in understanding speakers with dysarthria.