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Scarmagnani RH, Lohmander A, Salgado MH, Fukushiro AP, Trindade IEK, Yamashita RP. Models for Predicting Velopharyngeal Competence Based on Speech and Resonance Errors and Velopharyngeal Area Estimation. Cleft Palate Craniofac J 2024; 61:965-975. [PMID: 36594481 DOI: 10.1177/10556656221149516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE To develop tools for predicting velopharyngeal competence (VPC) based on auditory-perceptual assessment and its correlation with objective measures of velopharyngeal orifice area. DESIGN Methodological study. PARTICIPANTS AND METHODS Sixty-two patients with repaired cleft palate, aged 6 to 45 years, underwent aerodynamic evaluation by means of the pressure-flow technique and audiovisual recording of speech samples. Three experienced speech-language pathologists analysed the speech samples by rating the following resonance, visual, and speech variables: hypernasality, audible nasal air emission, nasal turbulence, weak pressure consonants, facial grimacing, active nonoral errors, and overall velopharyngeal competence. The correlation between the perceptual speech variables and velopharyngeal orifice area estimates was analysed with Spearman's correlation coefficient. Two statistical models (discriminant and exploratory) were used to predict VPC based on the orifice area estimates. Sensitivity and specificity analyses were performed to verify the clinical applicability of the models. RESULTS There was a strong correlation between VPC (based on the orifice area estimates) and each speech variable. Both models showed 88.7% accuracy in predicting VPC. The sensitivity and specificity for the discriminant model were 92.3% and 97.2%, respectively, and 96.2% and 94.4% for the exploratory model. CONCLUSION Two predictor models based on ratings of resonance, visual, and speech variables and a simple calculation of a composite variable, SOMA (Eng. "sum"), were developed and found to be efficient in predicting VPC defined by orifice estimates categories based on aerodynamic measurements. Both tools may contribute to the diagnosis of velopharyngeal dysfunction in clinical practice.
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Affiliation(s)
- Rafaeli Higa Scarmagnani
- Laboratory of Physiology, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, São Paulo, Brazil
| | - Anette Lohmander
- Division of Speech and Language Pathology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, and Speech-Language Pathology Unit, Karolinska University Hospital, Stockholm, Sweden
| | | | - Ana Paula Fukushiro
- Laboratory of Physiology, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, São Paulo, Brazil
- Department of Speech and Hearing Pathology, Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
| | - Inge Elly Kiemle Trindade
- Laboratory of Physiology, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, São Paulo, Brazil
- Department of Speech and Hearing Pathology, Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
| | - Renata Paciello Yamashita
- Laboratory of Physiology, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, São Paulo, Brazil
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Ren Z, Shang F, Zheng Y, Wu N, Ma L, Zhou X. The Role of EGG in Identifying Prevocalic Glottal Stop. J Voice 2024:S0892-1997(24)00020-1. [PMID: 38402112 DOI: 10.1016/j.jvoice.2024.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/26/2024] [Accepted: 01/26/2024] [Indexed: 02/26/2024]
Abstract
OBJECTIVE The aim of the study is to investigate the use of incidences and characteristics of Prevocalic Electroglottographic Signal (PVES) derived from electroglottography (EGG) in characterizing glottal stops (GS) in cleft palate speech. METHODS Mandarin nonaspirated monosyllabic first-tone words were used for the speech sampling procedure. A total of 1680 utterances (from 83 patients with repaired cleft palates) were divided into three categories based on the results of auditory-perceptual evaluation of recorded speech sounds by three independent reviewers: [Category A (absence of GS agreed by all three reviewers) (n = 1192 tokens), Category B (two out of three reviewers agreed on the presence of a GS) (n = 181 tokens) and Category C (all three reviewers agreed on the presence of a GS) (n = 307 tokens)]. The EGG signals of the 1680 utterances were analyzed using a MATLAB program to automatically mark the instances of PVES (amplitude and time-interval) in the GS utterances. RESULTS The result showed that the incidence of EGG PVES presented good positive correlation with auditory-perceptual evaluation (r = 0.703, P<0.000). Statistical analysis revealed a significant difference in mean PVES amplitude among different groups (P<0.05). There was a significant distinction in the time interval between groups A and B, as well as in groups A and C (P<0.05). CONCLUSIONS The study suggests PVES can be an objective means of identifying GS in cleft palate speech. It also indicates that proportion of amplitude and time interval of PVES tend to be positively correlate with subjective assessment.
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Affiliation(s)
- Zhen Ren
- Department of Oral & Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Feifei Shang
- Department of Oral & Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Yafeng Zheng
- Department of Oral & Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Nankai Wu
- Department of Chinese Language and Literature, Jinan University, Guangzhou, China
| | - Lian Ma
- Department of Oral & Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Xia Zhou
- Department of Oral & Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China.
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Mason KN. Magnetic Resonance Imaging for Assessing Velopharyngeal Function: Current Applications, Barriers, and Potential for Future Clinical Translation in the United States. Cleft Palate Craniofac J 2024; 61:235-246. [PMID: 36039513 PMCID: PMC9971336 DOI: 10.1177/10556656221123916] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The use of magnetic resonance imaging (MRI) in the assessment process for children with cleft/craniofacial conditions remains uncommon, particularly for velopharyngeal assessments. The purpose of this study was to analyze the perceived clinical utility of MRI for cleft/craniofacial providers and identify barriers that exist for clinical translation of this imaging modality to this population of patients. METHODS A 38-item survey was disseminated to craniofacial team providers. Workplace context and demographics, MRI as a research and clinical tool, access and barriers for use of MRI, and needs for successfully establishing MRI protocols at clinical sites were investigated. Descriptive statistics were used to identify differences in the clinical use of MRI across disciplines. Chi-square analyses were conducted to determine how different specialties perceived potential barriers. RESULTS Respondents reported that MRI is likely to be beneficial for clinical assessments (93.5%) and that this imaging modality is available for use (83.8%). However, only 11.8% of providers indicated the use of MRI in their clinical assessments. This discrepancy highlights a potential disconnect between perceived use and implementation of this imaging methodology on cleft and craniofacial teams. A number of barriers were identified by providers. Challenges and opportunities for clinical translation of MRI protocols were highlighted. CONCLUSION Results may guide the development for improved clinical feasibility and implementation of MRI for clinical planning in this population of patients. Reported barriers highlight additional areas for translational research and the potential for the development of clinical tools related to MRI assessment and protocol implementation.
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Affiliation(s)
- Kazlin N. Mason
- Department of Human Services, University of Virginia, Charlottesville, VA, 22903
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Tran T, Perry J, Blemker S, Mason K. Simulation of Velopharyngeal Biomechanics Identifies Differences in Sphincter Pharyngoplasty Outcomes: A Matched Case-Control Study. Cleft Palate Craniofac J 2024; 61:339-349. [PMID: 35996316 PMCID: PMC9943793 DOI: 10.1177/10556656221122634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The purpose of this study was to develop a framework for 3D subject-specific computational models capable of simulating velopharyngeal biomechanics for anatomic changes that occur following pharyngoplasty and to gain insight into biomechanical factors that may lead to different speech/surgical outcomes. Patient-specific models for two, matched participants with differing speech/surgical outcomes were developed: one with a successful pharyngoplasty outcome and one with a failed pharyngoplasty outcome. Surgical scenarios were simulated to model pharyngoplasty location, identify LVP muscle biomechanics, and identify an optimal pharyngoplasty location for each participant. These simulations illustrate the potential for optimizing pharyngoplasties based on patient-specific geometry.
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Affiliation(s)
- Thanh Tran
- Department of Biomedical Engineering, University of Virginia
| | - Jamie Perry
- Department of Communication Sciences & Disorders, Eastern Carolina University
| | - Silvia Blemker
- Department of Biomedical Engineering, University of Virginia
| | - Kazlin Mason
- Department of Human Services, University of Virginia
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Alighieri C, Meerschaert S, Van Lierde K. Do Adult Naïve Listeners Perceive Differences in Speech Before and After Therapy for Cleft Palate Speech Disorders? A Reliability Study of Perceptual Speech Ratings. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2024; 67:116-125. [PMID: 37992413 DOI: 10.1044/2023_jslhr-23-00291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
PURPOSE This study compared the interrater reliability of adult naïve listeners' perceptual assessments of different speech variables in children with a cleft palate with or without a cleft lip (CP ± L). In addition, the study investigated whether the listeners were able to perceive differences in these speech variables before and after speech therapy for cleft palate speech disorders. METHOD Thirty-four speech samples of 14 children with a CP ± L (14 samples collected immediately before 10 hr of speech intervention, 14 samples collected immediately after speech intervention, and six randomly selected samples that were duplicated to assess intrarater reliability) were perceptually assessed by 26 adult naïve listeners. The listening panel consisted of nine men and 17 women (age range: 18-51 years). The speech variables included speech understandability, speech acceptability, hypernasality, hyponasality, nasal airflow, and articulation, which were assessed on a visual analog scale. Furthermore, the need for speech therapy was assessed. RESULTS Good to very good interrater reliability was observed for the naïve listeners' ratings of all speech variables. A significant time effect was found for the pre- and postevolution of the speech variables "speech understandability," "speech acceptability," "nasal airflow," and "articulation." This time effect indicates an improvement of these variables postintervention. According to the naïve listeners, children were less in need of additional speech therapy after the 10-hr intervention period compared to assessments before this intervention period. CONCLUSIONS Adult naïve listeners perceptually identified an improvement in different speech variables after 10 hr of cleft palate speech therapy. These findings confirm previous assessments of expert speech-language pathologists and suggest that speech improvements after cleft palate speech therapy can also be perceived by communication partners outside the therapy room. Perceptual ratings of naïve listeners can, thus, be used to add life-situation significance to the assessments of experts. Future research could include both expert raters and caregivers or relatives of children with a CP ± L in listening panels, as previous knowledge on craniofacial anomalies may lead to different results.
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Affiliation(s)
- Cassandra Alighieri
- Department of Rehabilitation Sciences, Centre of Speech and Language Sciences, Ghent University, Belgium
| | - Silke Meerschaert
- Department of Rehabilitation Sciences, Centre of Speech and Language Sciences, Ghent University, Belgium
| | - Kristiane Van Lierde
- Department of Rehabilitation Sciences, Centre of Speech and Language Sciences, Ghent University, Belgium
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Koh KS, Jung S, Park BR, Oh TS, Kim YC, Ha S. Speech Outcomes in 5-Year-Old Korean Children with Bilateral Cleft Lip and Palate. Arch Plast Surg 2024; 51:80-86. [PMID: 38425862 PMCID: PMC10901596 DOI: 10.1055/a-2175-1893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 08/26/2023] [Indexed: 03/02/2024] Open
Abstract
Background Among the cleft types, bilateral cleft lip and palate (BCLP) generally requires multiple surgical procedures and extended speech therapy to achieve normal speech development. This study aimed to describe speech outcomes in 5-year-old Korean children with BCLP and examine whether normal speech could be achieved before starting school. Methods The retrospective study analyzed 52 children with complete BCLP who underwent primary palatal surgery at a tertiary medical center. Three speech-language pathologists made perceptual judgments on recordings from a speech follow-up assessment of 5-year-old children. They assessed the children's speech in terms of articulation, speech intelligibility, resonance, and voice using the Cleft Audit Protocol for Speech-Augmented-Korean Modification. Results The results indicated that at the age of five, 65 to 70% of children with BCLP presented articulation and resonance within normal or acceptable ranges. Further, seven children with BCLP (13.5%) needed both additional speech therapy and palatal surgery for persistent velopharyngeal insufficiency and speech problems even at the age of five. Conclusion This study confirmed that routine follow-up speech assessments are essential as a substantial number of children with BCLP require secondary surgical procedures and extended speech therapy to achieve normal speech development.
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Affiliation(s)
- Kyung S. Koh
- Department of Plastic and Reconstructive Surgery, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Seungeun Jung
- Division of Speech Pathology and Audiology, Audiology and Speech Pathology Research Institute, Hallym University, Chuncheon, Korea
| | - Bo Ra Park
- Department of Rehabilitation Medicine, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Tae-Suk Oh
- Department of Plastic and Reconstructive Surgery, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Young Chul Kim
- Department of Plastic and Reconstructive Surgery, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Seunghee Ha
- Division of Speech Pathology and Audiology, Audiology and Speech Pathology Research Institute, Hallym University, Chuncheon, Korea
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Del Risco AC, Dunworth K, Sharif-Askary B, Suárez AH“B, Nyswonger J, Ford M, Kern J, Jones C, Raynor E, Allori AC. Exploration of the Utility of the Generic ICHOM Standard Set Measures in Evaluating the Speech of Patients with Cleft Lip/Palate. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5519. [PMID: 38250212 PMCID: PMC10798731 DOI: 10.1097/gox.0000000000005519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 11/08/2023] [Indexed: 01/23/2024]
Abstract
Background The International Consortium of Health Outcome Measurements (ICHOM) standard set for cleft care appraisal recommends clinicians assess articulation with percentage consonants correct (PCC) and velopharyngeal function with velopharyngeal competency rating (VPC-R). This study explores the utility and limitations of these generic measures in detecting cleft speech sound disorders by comparing them with two cleft-specific speech-rating systems, cleft audit protocol of speech-augmented Americleft modification (CAPS-A-AM) and Pittsburgh weighted speech scale (PWSS). Methods Consecutive children with repaired, nonsyndromic cleft lip/palate, aged 5 years or older (n = 27) underwent prospective speech evaluations conducted at a single academic institution. These evaluations were conducted, recorded, and evaluated by blinded speech-language pathologists experienced with all tools. Results When comparing measures of articulation, PCC scores correlated better with scores for relevant subcomponents of CAPS-A-AM than PWSS. When comparing measures of velopharyngeal function, VPC-R scores correlated well with relevant components of both scales. Using a "screening test versus diagnostic test" analogy, VPC-R ratings were 87.5% sensitive and 73.7% specific for detecting velopharyngeal dysfunction according to subcomponents of CAPS-A-AM, and 70.6% sensitive and 100% specific according to subcomponents of PWSS. Conclusions This exploratory study demonstrates that PCC and VPC-R perform moderately well in detecting articulatory and velopharyngeal dysfunction in patients with cleft lip/palate; however, these tools cannot describe nuances of cleft speech sound disorder. Thus, although PCC and VPC-R adequately track basic minimum outcomes, we encourage teams to consider extending the standard set by adopting a cleft-specific measurement system for further evaluation of the tools.
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Affiliation(s)
- Amanda C. Del Risco
- From the Department of Otolaryngology, Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, N.C
| | - Kristina Dunworth
- From the Department of Otolaryngology, Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, N.C
| | - Banafsheh Sharif-Askary
- From the Department of Otolaryngology, Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, N.C
| | - Arthur H. “Barron” Suárez
- Department of Otolaryngology, Head and Neck Surgery, & Communication Sciences, Duke University Health System, Durham, N.C
| | - Jillian Nyswonger
- Department of Otolaryngology, Head and Neck Surgery, & Communication Sciences, Duke University Health System, Durham, N.C
| | - Matthew Ford
- Division of Plastic, Maxillofacial, and Oral Surgery, Department of Surgery, Duke University Health System, Durham, N.C
| | - Jennifer Kern
- Department of Otolaryngology, Head and Neck Surgery, & Communication Sciences, Duke University Health System, Durham, N.C
| | - Carlee Jones
- Duke Cleft & Craniofacial Center, Duke Children’s Hospital, Durham, N.C
- Division of Plastic, Maxillofacial, and Oral Surgery, Department of Surgery, Duke University Health System, Durham, N.C
| | - Eileen Raynor
- From the Department of Otolaryngology, Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, N.C
- Department of Otolaryngology, Head and Neck Surgery, & Communication Sciences, Duke University Health System, Durham, N.C
- Duke Cleft & Craniofacial Center, Duke Children’s Hospital, Durham, N.C
| | - Alexander C. Allori
- From the Department of Otolaryngology, Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, N.C
- Duke Cleft & Craniofacial Center, Duke Children’s Hospital, Durham, N.C
- Division of Plastic, Maxillofacial, and Oral Surgery, Department of Surgery, Duke University Health System, Durham, N.C
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Jahangard A, Ashrafi M. Wideband Tympanometry (WBT) Features in Children with Cleft Palate and Otitis Media with Effusion Before and After Cleft Palate Surgery. Indian J Otolaryngol Head Neck Surg 2023; 75:3590-3595. [PMID: 37974839 PMCID: PMC10646051 DOI: 10.1007/s12070-023-04059-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 07/01/2023] [Indexed: 11/19/2023] Open
Abstract
Aims In some cases, children with cleft palate undergo unnecessary tympanostomy along with palatoplasty because of inaccurate evaluations in determining the level of otitis media with effusion (OME). Recent studies have shown that wideband tympanometry (WBT) significantly contributes to the accurate evaluation of the middle ear status in children with cleft palate. Therefore, this study aimed to investigate WBT and auditory brainstem response (ABR) indices before and after cleft palate repair surgery. Materials and Methods The study involved 88 children with cleft palate, and ABR and WBT energy absorbance indices were measured in two phases. The first phase was conducted three months and three days prior to cleft palate repair surgery, and the second phase was carried out one, three, and six months after surgery. Results In the first phase, the energy absorbance index of low frequencies was below the normal range in all children, within the normal range at high frequencies in 78 children, and below the normal range in only 10 children three months before cleft palate surgery. In the second phase, the energy absorbance index and hearing thresholds at low frequencies after surgery showed a significant difference compared with the preoperative index (p = 0.001). Conclusion Monitoring WBT indices and hearing thresholds in children with cleft palate is effective in determining the appropriate surgery for children with otitis media with effusion (OME). Furthermore, the WBT plays a crucial role in accurately assessing middle ear function after cleft palate surgery.
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Affiliation(s)
- Ali Jahangard
- Student Research Committee, Department of Audiology, Faculty of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Majid Ashrafi
- Department of Audiology, Faculty of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Mao Q, Li J, Yin X. Pearls and pitfalls in contemporary management of marginal velopharyngeal inadequacy among children with cleft palate. Front Pediatr 2023; 11:1187224. [PMID: 37609363 PMCID: PMC10440703 DOI: 10.3389/fped.2023.1187224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 06/29/2023] [Indexed: 08/24/2023] Open
Abstract
Marginal velopharyngeal inadequacy (MVPI) is a particular status of velopharyngeal closure after cleft palate repair. The physiological and phonological characteristics of patients with MVPI are significantly different from those with typical velopharyngeal insufficiency. The pathological mechanisms and diagnostic criteria of MVPI are still controversial, and there is limited evidence to guide the selection of surgical and non- surgical management options and a lack of recognized standards for treatment protocols. Based on a systematic study of the relevant literatures, this review identifies specific problems that are currently under-recognized in the diagnosis and treatment of MVPI and provides guidelines for further exploration of standardized and reasonable intervention protocols for MVPI.
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Affiliation(s)
- Qirong Mao
- Department of Oral and Maxillofacial Surgery, State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Jingtao Li
- Department of Oral and Maxillofacial Surgery, State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xing Yin
- Department of Orthodontics, State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
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Mirihagalla Kankanamalage I, Cleland J, Cohen W. Translation and validation of the Intelligibility in Context Scale into Sinhala for adolescents in Sri Lanka with cleft lip and palate. CLINICAL LINGUISTICS & PHONETICS 2023; 37:398-414. [PMID: 36093956 DOI: 10.1080/02699206.2022.2120417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 07/29/2022] [Accepted: 08/22/2022] [Indexed: 05/20/2023]
Abstract
The Intelligibility in Context Scale (ICS) is a parent-report screening tool used to measure parents' perceptions of children's functional intelligibility. This tool has been translated into over 60 languages and found to have a good reliability and validity. The purpose of the current study was to translate the ICS into Sinhala (the ICS-SIN), the main language spoken by the Sinhalese people in Sri Lanka, and to validate it with both typically developing (TD) children and children with repaired cleft lip and/or palate (CLP). The translation process followed the forward-backward-forward method. A total of 88 parents of TD children and children with CLP aged 12-15 years old (TD n = 50, CLP n = 38) completed the ICS-SIN questionnaire. Parents of TD and CLP children reported their children's speech as most intelligible to parents and least intelligible to strangers. The ICS-SIN had high internal consistency for both groups (TD α = 0.87, p < 0.05, CLP α = 0.97, p < 0.05). The ICS-SIN total scores and item scores showed significant correlations, indicating a good construct validity. TD participant group's ICS-SIN average mean scores (M = 4.88, SD = 0.29) were significantly higher compared to the CLP ICS-SIN average mean scores (M = 4.64, SD = 0.67) and varied according to gender in both groups, suggesting good discriminant validity. The ICS-SIN has overall good psychometric properties. Therefore, this tool has the potential to be used as a valid parent-rating screening tool for clinical and research purposes in Sri Lanka.
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Affiliation(s)
| | - Joanne Cleland
- Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - Wendy Cohen
- Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
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Phippen G. Articulating the issues: speech assessment and intervention in cleft lip and palate. Br Dent J 2023; 234:912-917. [PMID: 37349440 DOI: 10.1038/s41415-023-5954-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 04/26/2023] [Accepted: 04/27/2023] [Indexed: 06/24/2023]
Abstract
This paper describes the impact of cleft lip and palate on speech. It provides an overview for the dental clinician of the key issues affecting speech development and clarity. The paper summarises the complex speech mechanism and cleft-related factors that affect speech, including palatal, dental and occlusal anomalies. It outlines the framework for speech assessment throughout the cleft pathway and provides a description of cleft speech disorder, as well as describing treatment approaches for cleft speech and velopharyngeal dysfunction.This is followed by a spotlight on speech prosthetics for treating nasal speech, with an emphasis on joint management by the Speech and Language Therapist and Consultant in Restorative Dentistry. This includes the core multidisciplinary approach, clinician and patient-reported outcome measures, and brief discussion of national developments in this area.The importance of multidisciplinary cleft care is highlighted and, within this, the essential interaction between speech and dental clinicians in providing routine care, as well as in delivering a highly specialist speech prosthetics service.
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Affiliation(s)
- Ginette Phippen
- Lead Speech & Language Therapist, The Spires Cleft Centre, Salisbury NHS Foundation Trust/Oxford University Hospitals NHS Foundation Trust, United Kingdom.
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12
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Mason KN, Black J. Incorporating Velopharyngeal MRI into the Clinical Decision-Making Process for a Patient Presenting with Velopharyngeal Dysfunction Following a Failed Palatoplasty. Cleft Palate Craniofac J 2023:10556656231173500. [PMID: 37143294 PMCID: PMC10624648 DOI: 10.1177/10556656231173500] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
This clinical report describes the implementation of magnetic resonance imaging (MRI) to evaluate a patient with long-standing velopharyngeal dysfunction. She was referred to the craniofacial clinic at age 10 with no prior surgical history and subsequently completed a Furlow palatoplasty due to a suspected submucous cleft palate. However, results were unfavorable with minimal improvement in speech or resonance. The clinical presentation, treatment, outcomes, and contributions from MRI for secondary surgical planning are described. Addition of MRI into the clinical workflow provided insights into the anatomy and physiology of the velopharyngeal mechanism that were unable to be obtained from nasendoscopy and speech evaluation alone.
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Affiliation(s)
- Kazlin N. Mason
- Department of Human Services, University of Virginia, Charlottesville, VA, 22903
| | - Jonathan Black
- University of Virginia Health System, Division of Plastic Surgery, Charlottesville, VA, 22903
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Fujiki RB, Kostas G, Thibeault SL. Relationship Between Auditory-Perceptual and Objective Measures of Resonance in Children with Cleft Palate: Effects of Intelligibility and Dysphonia. Cleft Palate Craniofac J 2023:10556656231162238. [PMID: 36890706 DOI: 10.1177/10556656231162238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023] Open
Abstract
To investigate the relationship between auditory-perceptual ratings of resonance and nasometry scores in children with cleft palate. Factors which may impact this relationship were examined including articulation, intelligibility, dysphonia, sex, and cleft-related diagnosis. Retrospective, observational cohort study. Outpatient pediatric cranio-facial anomalies clinic. Four hundred patients <18 years of age identified with CP ± L, seen for auditory-perceptual and nasometry evaluations of hypernasality as well as assessments of articulation and voice. Relationship between auditory-perceptual ratings of resonance and nasometry scores. Pearson's correlations indicated that auditory-perceptual resonance ratings and nasometry scores were significantly correlated across oral-sound stimuli on the picture-cued portion of the MacKay-Kummer SNAP-R Test (r values .69 to.72) and the zoo reading passage (r = .72). Linear regression indicated that intelligibility (p ≤ .001) and dysphonia (p = .009) significantly impacted the relationship between perceptual and objective assessments of resonance on the Zoo passage. Moderation analyses indicated that the relationship between auditory-perceptual and nasometry values weakened as severity of speech intelligibility increased (P < .001) and when children presented with moderate dysphonia (p ≤ .001). No significant impact of articulation testing or sex were observed. Speech intelligibility and dysphonia alter the relationship between auditory-perceptual and nasometry assessments of hypernasality in children with cleft palate. SLPs should be aware of potential sources of auditory-perceptual bias and shortcomings of the Nasometer when following patients with limited intelligibility or moderate dysphonia. Future study may identify the mechanisms by which intelligibility and dysphonia affect auditory-perceptual and nasometry evaluations.
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Affiliation(s)
| | - George Kostas
- Department of Surgery, 5228University of Wisconsin Madison, Madison, WI, USA
| | - Susan L Thibeault
- Department of Surgery, 5228University of Wisconsin Madison, Madison, WI, USA
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Everaert E, Selten I, Boerma T, Houben M, Vorstman J, de Wilde H, Derksen D, Haverkamp S, Wijnen F, Gerrits E. The Language Profile of Preschool Children With 22q11.2 Deletion Syndrome and the Relationship With Speech Intelligibility. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:128-144. [PMID: 36512754 DOI: 10.1044/2022_ajslp-21-00328] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
PURPOSE Young children with 22q11.2 deletion syndrome (22q11DS) often have impaired language development and poor speech intelligibility. Here, we report a comprehensive overview of standardized language assessment in a relatively large sample of preschool-aged children with 22q11DS. We furthermore explored whether speech ability explained variability in language skills. METHOD Forty-four monolingual Dutch preschoolers (3-6 years) with a confirmed genetic 22q11DS diagnosis participated in this prospective cohort study. Standardized tests (Clinical Evaluation of Language Fundamentals Preschool-2-NL and Peabody Picture Vocabulary Test-III-NL) were administered. Speech intelligibility was rated by two expert speech and language therapists using a standardized procedure. RESULTS Most children had impaired language skills across all tested domains. The composite score for expressive language was significantly lower than that for receptive language, but the two were strongly correlated. Only small differences between the mean scores on the various subtests were observed, with the lowest scores for expressive morphosyntactic skills. Language scores showed a moderate positive relation with speech intelligibility, but language abilities varied greatly among the children with intelligible speech. CONCLUSIONS We show that the majority of preschool children with 22q11DS have a broad range of language problems. Other than the relatively larger impairment in expressive than in receptive language skills, our results do not show a clearly delineated language profile. As many of the children with intelligible speech still had below-average language scores, we highlight that language problems require a broad assessment and care in all young children with 22q11DS. Future research using spontaneous language and detailed speech analysis is recommended, to provide more in-depth understanding of children's language profile and the relationship between speech and language in 22q11DS.
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Affiliation(s)
- Emma Everaert
- Utrecht Institute of Linguistics OTS, Utrecht University, the Netherlands
- Department of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, the Netherlands
| | - Iris Selten
- Utrecht Institute of Linguistics OTS, Utrecht University, the Netherlands
- Department of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, the Netherlands
| | - Tessel Boerma
- Utrecht Institute of Linguistics OTS, Utrecht University, the Netherlands
- Department of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, the Netherlands
| | - Michiel Houben
- Department of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, the Netherlands
| | - Jacob Vorstman
- Program in Genetics and Genome Biology, SickKids Research Institute, Department of Psychiatry, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Ontario, Canada
| | - Hester de Wilde
- Speech and Language Therapy, Wilhelmina Children's Hospital, University Medical Center Utrecht, the Netherlands
| | - Desiree Derksen
- Speech and Language Therapy, Wilhelmina Children's Hospital, University Medical Center Utrecht, the Netherlands
| | - Sarah Haverkamp
- Speech and Language Therapy, Wilhelmina Children's Hospital, University Medical Center Utrecht, the Netherlands
| | - Frank Wijnen
- Utrecht Institute of Linguistics OTS, Utrecht University, the Netherlands
| | - Ellen Gerrits
- Utrecht Institute of Linguistics OTS, Utrecht University, the Netherlands
- Research Group Speech and Language Therapy - Participation is Communication, HU University of Applied Sciences, Utrecht, the Netherlands
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15
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Nachmani A, Biadsee A, Masalha M, Kassem F. Compensatory Articulation Errors in Patients With Velopharyngeal Dysfunction and Palatal Anomalies. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:2518-2539. [PMID: 35858260 DOI: 10.1044/2022_jslhr-21-00679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE The aim of this study was to assess the frequency and types of compensatory articulations (CAs) in nonsyndromic patients with velopharyngeal dysfunction (VPD) and various palatal anomalies and to determine the relationship between the frequency of CAs, type of palatal anomaly, and phonological errors. METHOD A total of 783 nonsyndromic, Hebrew-speaking patients with VPD and various palatal anomalies (cleft lip and palate [CLP], cleft palate [CP], submucous CP [SMCP], occult submucous CP [OSMCP], or non-CP) were studied retrospectively. Perceptual VPD tests, including articulation and phonological assessment, were conducted. CAs were described as below the level of the defect in the vocal tract (abnormal backing of oral targets to post-uvular place) or in front of it within the oral cavity (palatalization) and at the velopharyngeal port. RESULTS Among 783 patients, 213 (27.2%) had CAs. Most CAs (18.4%) occurred below the level of the defect, followed by CAs at the velopharyngeal port (12.0%) or in front of it (4.9%). No differences were found in the frequency of CAs between patients with CP (47.8%) or CLP (52.6%) and between those with non-CP (13.6%) or OSMCP (14.7%). SMCP patients had lower frequency of CAs (29.8%) than CP (p = .003) and CLP (p = .002) patients but higher frequency than OSMCP (p = .002) and non-CP (p = .002) patients did. Among the 783 patients, 247 (31.5%) had phonological errors. A higher frequency of phonological errors was found in patients with CAs (55.4%) compared to those without (22.6%) and in all palatal anomaly groups except CLP (31.4% vs. 23.9%). CONCLUSIONS CAs in nonsyndromic patients with VPD remained relatively high in all age groups, up to adulthood. CAs are influenced by inadequate velar length following palatal repair, as well as by oral structural abnormalities, whereas poor muscle function due to OSMCP and/or abnormal size and/or shape of nasopharynx has less influence. Errors produced in front of the velopharyngeal port are influenced by the structural anomaly of CLP. This information may contribute to general phonetic and phonological theories and genetic investigations about CP anomalies.
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Affiliation(s)
- Ariela Nachmani
- Faculty of Communication Disorders, Hadassah Academic College, Jerusalem, Israel
- Department of Communication Disorders, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Ameen Biadsee
- Department of Otolaryngology-Head and Neck Surgery, Meir Medical Center, Kfar Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Israel
- Department of Otolaryngology-Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Muhamed Masalha
- Department of Otolaryngology-Head and Neck Surgery, Emek Medical Center, Afula, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Firas Kassem
- Department of Otolaryngology-Head and Neck Surgery, Meir Medical Center, Kfar Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Israel
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16
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Liu Y, Lee SAS, Chen W. The Correlation Between Perceptual Ratings and Nasalance Scores in Resonance Disorders: A Systematic Review. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:2215-2234. [PMID: 35500290 DOI: 10.1044/2022_jslhr-21-00588] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Assessment of resonance characteristics is essential in research and clinical practice in individuals with velopharyngeal impairment. The purpose of this study was to systematically review correlations between auditory-perceptual ratings and nasalance scores obtained by a nasometer in individuals with resonance disorders and to identify factors that affected the correlations between these two measures. METHOD Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic search was conducted for studies reporting a correlation between nasality ratings and nasalance scores using six electronic databases based on predefined inclusion and exclusion criteria. RESULTS A total of 27 studies were included in this systematic review. Characteristics of study components including participants, types of assessment and stimuli, correlation coefficients, and reliability values of each study were identified, and a narrative synthesis was conducted. The methodological quality of each study was also appraised. The correlation level between nasalance values and nasality ratings varied from nonsignificant to strong (r = .92). The quality rating scores of the selected studies ranged from 44% to 94%, with an average score of 75%. DISCUSSION Factors that did or did not affect the varied correlation between nasality ratings and nasalance scores were discussed. Speech stimuli and the listeners' background were associated with correlations between the two measures. In addition, the sex of the speakers could be a factor affecting its correlation. However, the types of perceptual scales and listening conditions did not influence its correlations between the two measures. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.19653207.
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Affiliation(s)
- Yilan Liu
- PhD Program in Rehabilitation Science, Texas Tech University Health Sciences Center, Lubbock
- Department of Speech-Language-Hearing Sciences, Texas Tech University Health Sciences Center, Lubbock
| | - Sue Ann S Lee
- PhD Program in Rehabilitation Science, Texas Tech University Health Sciences Center, Lubbock
- Department of Speech-Language-Hearing Sciences, Texas Tech University Health Sciences Center, Lubbock
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Malmenholt A, McAllister A, Lohmander A, Östberg P. Speech feature profiles in Swedish 5-year-olds with speech sound disorder related to suspected childhood apraxia of speech or cleft palate. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 24:156-167. [PMID: 34496681 DOI: 10.1080/17549507.2021.1968951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Purpose: To study the occurrence of speech features commonly associated with Childhood Apraxia of Speech (CAS) in Swedish children with suspected CAS (sCAS) or Speech Sound Disorder (SSD) related to Cleft Palate and/or Lip (CP ± L).Method: Thirty-four children (4.10-5.11) with SSD related to sCAS (n = 15) or repaired CP ± L (n = 19) participated. Consensus judgement of presence/absence of CAS features in single words were based on a checklist with operationalised definitions. Speech sound production measures were based on semi-narrow phonetic transcription. Intra- and inter-transcriber agreement was determined.Result: Twelve participants (ten with sCAS (67%) and two with CP ± L (11%)) shared a CAS profile of phonemic speech inconsistency for consonants and vowels and a set of four features: vowel error, voicing error, difficulty achieving initial articulatory configurations or transitionary movement gestures and stress errors. The most frequent speech difficulties in children with non-CAS CP ± L (n = 17) were consonant distortion (88%) and hypernasal resonance (76%). Prosodic impairment was rare.Conclusion: A distinct CAS speech feature profile was found for children with CAS, differing in number and distribution compared to children with CP ± L and SSD. CAS was found more frequently in CP ± L and SSD compared to reported estimates of clinical prevalence.
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Affiliation(s)
- Ann Malmenholt
- Division of Speech and Language Pathology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
- Speech and Language Pathology, Medical Unit, Karolinska University Hospital, Stockholm, Sweden
| | - Anita McAllister
- Division of Speech and Language Pathology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
- Speech and Language Pathology, Medical Unit, Karolinska University Hospital, Stockholm, Sweden
| | - Anette Lohmander
- Division of Speech and Language Pathology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
- Speech and Language Pathology, Medical Unit, Karolinska University Hospital, Stockholm, Sweden
| | - Per Östberg
- Division of Speech and Language Pathology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
- Speech and Language Pathology, Medical Unit, Karolinska University Hospital, Stockholm, Sweden
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18
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Bertucci V, Stevens K, Sidhu N, Suri S, Bressmann T. The Impact of Fan-Type Rapid Palatal Expanders on Speech in Patients With Unilateral Cleft Lip and Palate. Cleft Palate Craniofac J 2022:10556656221084541. [PMID: 35249395 DOI: 10.1177/10556656221084541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Rapid palatal expanders (RPEs) are commonly used in patients with cleft lip and palate (CLP) prior to secondary alveolar bone grafting (SABG). Their position and size can impede tongue movement and affect speech. This study assessed changes in perception and production of speech over the course of RPE treatment. Prospective longitudinal. Tertiary university-affiliated hospital. Twenty-five patients with unilateral CLP treated with Fan-type RPEs, and their parents. Patient and parent speech questionnaires and patient speech recordings were collected at baseline before RPE insertion (T1), directly after RPE insertion (T2), during RPE expansion (T3), during RPE retention (T4), directly after RPE removal but before SABG (T5), and at short-term follow-up after RPE removal and SABG (T6). Ratings for patient and parent questionnaires, first (F1) and second (F2) formants for vowels /a/, /i/, and /u/, and nasalance scores for non-nasal and nasal sentences, were obtained and analyzed using mixed model analyses of variance. Ratings worsened at T2. For the vowel /a/, F1 and F2 were unchanged at T2. For the vowel /i/, F1 increased and F2 decreased at T2. For the vowel /u/, F1 was unchanged and F2 decreased at T2. Nasalance was unchanged at T2. All outcome measures returned to T1 levels by T4. RPE insertion resulted in initial adverse effects on speech perception and production, which decreased to baseline prior to removal. Information regarding transient speech dysfunction and distress may help prepare patients for treatment.
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Affiliation(s)
- Virginia Bertucci
- Department of Orthodontics, 70374Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
| | - Kyle Stevens
- Division of Orthodontics, Department of Dentistry, 7979The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Nicole Sidhu
- Division of Orthodontics, Department of Dentistry, 7979The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sunjay Suri
- Department of Orthodontics, 70374Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada.,Division of Orthodontics, Department of Dentistry, 7979The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Tim Bressmann
- Department of Speech-Language Pathology, 12366Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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19
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Sand A, Hagberg E, Lohmander A. On the Benefits of Speech-Language Therapy for Individuals Born With Cleft Palate: A Systematic Review and Meta-Analysis of Individual Participant Data. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:555-573. [PMID: 34990556 DOI: 10.1044/2021_jslhr-21-00367] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE Cleft lip and/or palate (CLP) is a common birth defect, and after reconstructive surgery, about 50% of children at 5 years of age have speech deviations and are referred to speech-language therapy (SLT). The peer-reviewed evidence for the benefit of SLT has been uncertain. Our objective was to systematically review and meta-analytically summarize the benefit of SLT for individuals born with CLP. METHOD A systematic search was conducted (last search on February 19, 2021) on studies evaluating SLT with pre and post measures on speech production, language ability, intelligibility, and/or patient-reported outcomes. We sought individual participant data (IPD) and evaluated on an individual level if the outcome measure had improved to a clinically relevant degree during SLT and if the outcome measure was on a level with peers or not after SLT. Meta-analyses and meta-regressions were applied to synthesize IPD across studies. RESULTS Thirty-four eligible studies were found. Nineteen studies provided IPD (n = 343) for the main analysis on speech production. The synthesized information suggests that, during SLT, speech production improved to a clinically relevant degree for many individuals (95% CI [61%, 87%]) and that speech production was on a level with peers for some individuals after SLT (95% CI [10%, 34%]). CONCLUSIONS The main strength of this meta-analysis is that we evaluated on an individual level pre- and post-intervention data based on considerations of clinical relevance. This approach allowed us to conclude that many individuals benefit from SLT and that further work on evaluating SLT in this patient group is meaningful. Supplemental Material https://doi.org/10.23641/asha.17700992.
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Affiliation(s)
- Anders Sand
- Division of Speech and Language Pathology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Emilie Hagberg
- Division of Speech and Language Pathology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Medical Unit Speech and Language Pathology and Stockholm Craniofacial Team, Karolinska University Hospital, Stockholm, Sweden
| | - Anette Lohmander
- Division of Speech and Language Pathology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Medical Unit Speech and Language Pathology and Stockholm Craniofacial Team, Karolinska University Hospital, Stockholm, Sweden
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20
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Alighieri C, Bettens K, Verhaeghe S, Van Lierde K. Speech diagnosis and intervention in children with a repaired cleft palate: A qualitative study of Flemish private community speech-language pathologists' practices. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 24:53-66. [PMID: 34229538 DOI: 10.1080/17549507.2021.1946153] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Purpose: This study investigated the practice patterns of private community speech-language pathologists (SLPs) when treating children with a repaired cleft of the palate with or without a cleft of the lip (CP ± L). Practices were explored in terms of diagnostics and treatment focus, treatment dosage and experienced difficulties when treating children with a CP ± L.Method: Eleven female private community SLPs, who lived in Flanders (i.e. the northern part of Belgium) and were aged between 23 and 62 years participated in this study. Data were collected from semi-structured face-to-face interviews. The qualitative software program NVivo 12 was used for data analysis. The interviews were analysed using an inductive thematic approach.Result: SLPs reported a lack of available information on speech-related cleft care. SLPs expressed the need to receive a referral letter from the hospital in order to make an adequate speech diagnosis. Most therapists reported that they performed an articulatory assessment combined with a language assessment. Most SLPs used a hybrid treatment model including a variety of intervention techniques. These techniques were not always in line with available scientific evidence. SLPs reported the desire to receive practical step-by-step guidelines on how to provide speech intervention to children with a CP ± L. In contrast, there was a strong consensus among the therapists that an individualised treatment plan is necessary.Conclusion: The results of this study have revealed gaps in the dissemination and implementation of scientific evidence relevant to speech services for children with a CP ± L (i.e. a research-practice gap) in Flanders. Research evidence needs to be adequately translated into clinical practice by providing concrete and practical guidelines.
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Affiliation(s)
| | - Kim Bettens
- Department of Rehabilitation Sciences, Ghent University, Gent, Belgium
| | - Sofie Verhaeghe
- Department of Public Health and Primary Care, Ghent University, Gent, Belgium
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21
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Kallambettu V, Bae Y, Carrau R. Velopharyngeal Function Post Head and Neck Cancer: A Review. EAR, NOSE & THROAT JOURNAL 2022:1455613211070895. [PMID: 35081810 DOI: 10.1177/01455613211070895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Velopharyngeal dysfunction (VPD) in head and neck cancer is frequently clinically reported, affecting both speech and swallowing function. This review sought to identify the tumor subsites and treatment modalities reported in association with VPD and summarize the current reporting methodology of VPD-related speech and swallowing outcomes in patients following head and neck cancer treatment. METHODS A literature search was conducted through December 2020 using electronic databases and a total of 15 studies were included in review. RESULTS Reported VPD was largely secondary to palate resections. Large variability in reporting methodology was noted with heavy reliance on speech-related perceptual measures and swallowing-related patient-reported outcomes over imaging and instrumental evaluations. CONCLUSIONS This review revealed inconsistencies in evaluating and reporting VPD, which likely translates into inconsistencies in clinical management. Further attention to VPD secondary to other head and neck malignancies would provide a broader perspective on VPD through head and neck cancer treatment.
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Affiliation(s)
- Veena Kallambettu
- Department of Speech and Hearing Science, Ringgold: 215745The Ohio State University, Columbus, OH, USA
- Ringgold: 12306The Ohio State University Wexner Medical Center- The James Comprehensive Cancer Center, Columbus, OH, USA
| | - Youkyung Bae
- Department of Speech and Hearing Science, Ringgold: 215745The Ohio State University, Columbus, OH, USA
| | - Ricardo Carrau
- Ringgold: 12306The Ohio State University Wexner Medical Center- The James Comprehensive Cancer Center, Columbus, OH, USA
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22
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Eshghi M, Connaghan KP, Gutz SE, Berry JD, Yunusova Y, Green JR. Co-Occurrence of Hypernasality and Voice Impairment in Amyotrophic Lateral Sclerosis: Acoustic Quantification. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:4772-4783. [PMID: 34714698 PMCID: PMC9150680 DOI: 10.1044/2021_jslhr-21-00123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 07/22/2021] [Accepted: 07/23/2021] [Indexed: 05/31/2023]
Abstract
PURPOSE Hypernasality and atypical voice characteristics are common features of dysarthric speech due to amyotrophic lateral sclerosis (ALS). Existing acoustic measures have been developed to primarily target either hypernasality or voice impairment, and the effects of co-occurring hypernasality-voice problems on these measures are unknown. This report explores (a) the extent to which acoustic measures are affected by concurrent perceptually identified hypernasality and voice impairment due to ALS and (b) candidate acoustic measures of early indicators of hypernasality and voice impairment in the presence of multisystem involvement in individuals with ALS. METHOD Two expert listeners rated severity of hypernasality and voice impairment in sentences produced by individuals with ALS (n = 27). The samples were stratified based on perceptual ratings: voice/hypernasality asymptomatic, predominantly hypernasal, predominantly voice impairment, and mixed (co-occurring hypernasality and voice impairment). Groups were compared using established acoustic measures of hypernasality (one-third octave analysis) and voice (cepstral/spectral analysis) impairment. RESULTS The one-third octave analysis differentiated all groups; the cepstral peak prominence differentiated all groups except asymptomatic versus mixed, whereas the low-to-high spectral ratio did not differ among groups. Additionally, one-third octave analyses demonstrated promising speech diagnostic potential. CONCLUSIONS The results highlight the need to consider the validity of measures in the context of multisubsystem involvement. Our preliminary findings further suggest that the one-third octave analysis may be an optimal approach to quantify hypernasality and voice abnormalities in the presence of multisystem speech impairment. Future evaluation of the diagnostic accuracy of the one-third octave analysis is warranted.
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Affiliation(s)
- Marziye Eshghi
- Speech and Feeding Disorders Lab, MGH Institute of Health Professions, Boston, MA
| | - Kathryn P. Connaghan
- Speech and Feeding Disorders Lab, MGH Institute of Health Professions, Boston, MA
| | - Sarah E. Gutz
- Program in Speech and Hearing Bioscience and Technology, Harvard University, Boston, MA
| | - James D. Berry
- Sean M. Healey and AMG Center for ALS, Department of Neurology, Massachusetts General Hospital, Boston
| | - Yana Yunusova
- Department of Speech-Language Pathology, Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Toronto Rehabilitation Institute (KITE), University Health Network, Ontario, Canada
| | - Jordan R. Green
- Speech and Feeding Disorders Lab, MGH Institute of Health Professions, Boston, MA
- Program in Speech and Hearing Bioscience and Technology, Harvard University, Boston, MA
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23
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Morrison MM, Mason NT, Forde BL, Stone PR, Fowler PV, Thompson JMD. Speech Outcomes of a National Cohort of Children with Orofacial Cleft at 5 and 10 Years of age. Cleft Palate Craniofac J 2021; 59:1400-1412. [PMID: 34672811 DOI: 10.1177/10556656211044939] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess speech outcomes at five and ten years of age in a nationwide study of children with orofacial cleft. DESIGN Prospective study. PARTICIPANTS Children born with orofacial cleft and having primary surgery in New Zealand. Speech samples were available for 151 five-year-old, and 163 ten-year-old children. MAIN OUTCOME MEASURES Intelligibility, Acceptability, Velopharyngeal function, Hypernasality, Hyponasality, severity of airflow evaluated by perceptual speech assessment (using the standardised Rhinocleft assessment), and overall assessment of requirement for clinical intervention. RESULTS A large proportion of five-year-old children had speech that was considered to be not completely intelligible, was not acceptable, and had inadequate velopharyngeal function. The noted deficiencies led to a clinical judgement that further speech and/or surgical intervention was required in 85% with cleft lip and palate, 65% with cleft palate and 26% with cleft lip. The proportion of children with poor speech outcomes in the ten-year-old children was lower, though of clinical importance, further intervention required for 25% with CLP, 15% with CP and 3% with CL. The number of sound production errors in both age groups followed the same pattern with fewest in those with CL and most in those with CLP. CONCLUSIONS A significant proportion of children with orofacial cleft were found to have poor speech outcomes requiring further treatment. The outcomes are poor compared to centres reported in the UK and Scandinavia. New Zealand requires a review of the current services for individuals born with cleft to improve speech outcomes and interdisciplinary care.
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Affiliation(s)
- Maeve M Morrison
- Department of Allied Health, 1400Middlemore Hospital, Counties Manukau District Health Board.,Department of Plastics, 1400Middlemore Hospital, Counties Manukau District Health Board
| | - Nicola T Mason
- Speech Language Therapy, 67587Christchurch Hospital, Canterbury District Health Board
| | - Bryony L Forde
- Speech Language Therapy, 161292Hutt Valley Hospital, Hutt Valley District Health Board
| | - Peter R Stone
- Department of Obstetrics and Gynaecology, 1415University of Auckland, Auckland, New Zealand
| | | | - John M D Thompson
- Department of Obstetrics and Gynaecology, 1415University of Auckland, Auckland, New Zealand.,Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
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Alighieri C, Bettens K, Verhaeghe S, Van Lierde K. From excitement to self-doubt and insecurity: Speech-language pathologists' perceptions and experiences when treating children with a cleft palate. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2021; 56:739-753. [PMID: 34048135 DOI: 10.1111/1460-6984.12624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 03/02/2021] [Accepted: 04/01/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Speech disorders in children with a cleft palate with or without a cleft lip (CP±L) are complex given the magnitude of influencing factors. Providing intervention to eliminate these speech errors is often challenging. Speech-language pathologists (SLPs) might have negative perceptions of the treatment of children with a CP±L. AIMS To explore how community SLPs perceive and experience the provision of speech intervention to children with a CP±L. METHODS & PROCEDURES A total of 18 female community SLPs, aged between 23 and 62 years, were included in this study. Semi-structured interviews were conducted. The interviews were analysed using an inductive thematic approach aiming to identify themes driven by the data. Trustworthiness of the data was achieved by including researcher triangulation (involving three researchers with different research backgrounds) and deviant case analysis of two cases. OUTCOMES & RESULTS Initial responses demonstrated that the community SLPs were excited and enthusiastic to treat children with a CP±L. Expanding on these initial reports, however, they revealed that their excitement turned into professional self-doubt and insecurity when confronted with the treatment challenges inherent with this population. To cope with this self-doubt, they outlined several responsibilities for the cleft team SLPs. They expressed a strong desire to receive confirmation and approval on their treatment practices from more experienced SLPs (i.e., the cleft team SLPs). Their perceptions were dominated by a polarized thinking pattern. Treatment approaches were divided in categories as 'right' or 'wrong' and 'good' or 'bad'. CONCLUSIONS & IMPLICATIONS The community SLPs are lacking professional confidence when treating children with a CP±L. They put themselves in a subordinate position towards the cleft team SLPs and expect the latter to provide ready-made answers to problems and questions. This expectation can perhaps be explained by their fear of making mistakes during therapy preventing treatment progress. If they handle in accordance with the experts' advice, they cannot blame themselves in cases where no treatment progress is seen. Educational programmes need to pay more attention to gaining professional confidence (in the search for the most optimal treatment approach for each individual patient) rather than merely focusing on competency-based learning tools. WHAT THIS PAPER ADDS What is already known on the subject Speech disorders in children with a cleft palate with or without a cleft lip (CP±L) are complex given the magnitude of influencing factors. Providing intervention to eliminate these speech errors is often challenging. What this paper adds to existing knowledge This study explored how community SLPs' perceive and experience the provision of speech intervention to children with a CP±L. The perceptions of community SLPs are dominated by a polarized thinking pattern. Treatment approaches are divided into categories as "right" or "wrong" and "good" or "bad". They lack professional confidence when they treat children with a CP±L. The community SLPs put themselves in a subordinate position towards the cleft team SLPs and expect the latter to provide ready-made answers to problems and questions. What are the potential or actual clinical implications of this work? Educational programs in speech-language pathology need to pay more attention to gaining professional confidence rather than merely focusing on competency-based learning tools.
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Affiliation(s)
- Cassandra Alighieri
- Department of Rehabilitation Sciences, Centre for Speech and Language Sciences (CESLAS), Ghent University, Gent, Belgium
| | - Kim Bettens
- Department of Rehabilitation Sciences, Centre for Speech and Language Sciences (CESLAS), Ghent University, Gent, Belgium
| | - Sofie Verhaeghe
- Department of Public Health and Primary Care, Ghent University, Gent, Belgium
| | - Kristiane Van Lierde
- Department of Rehabilitation Sciences, Centre for Speech and Language Sciences (CESLAS), Ghent University, Gent, Belgium
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Pereira VJ, Tuomainen J, Lee KYS, Tong MCF, Sell DA. A perceptual outcome measure of velopharyngeal function based on the Cleft Audit Protocol for Speech-Augmented (CAPS-A VPC-Sum): Validation through a speech osteotomy study. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2021; 56:754-767. [PMID: 34022774 DOI: 10.1111/1460-6984.12625] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 03/31/2021] [Accepted: 04/01/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND The status of the velopharyngeal mechanism can be inferred from perceptual ratings of specified speech parameters. Several studies have proposed the measure of an overall velopharyngeal composite score based on these perceptual ratings and have reported good validity. The Cleft Audit Protocol for Speech-Augmented (CAPS-A) is a validated and reliable perceptual framework for the assessment of cleft speech and velopharyngeal function used by all Regional Cleft Services in the UK and Ireland. An overall velopharyngeal composite summary score based on the CAPS-A would serve as an important surgical outcome measure of speech. AIMS To develop and validate a velopharyngeal composite summary score based on perceptual ratings made on the CAPS-A (CAPS-A VPC-Sum) using data from a maxillary osteotomy (MO) study. METHODS & PROCEDURES There were two surgical groups: a cleft lip and palate (CLP) (N = 20) group and a non-CLP group (N = 10), and a normal control group (N = 20). Participants in groups 1 and 2 were seen for perceptual and instrumental assessments of speech and velopharyngeal function preoperatively (T1), 3 months (T2) and 12 months (T3) postoperatively. Perceptual speech data were collected and rated by independent listeners using CAPS-A. OUTCOMES & RESULTS Moderate to strong interrater reliability for perceptual data (rs = 0.503-1.000, all p < 0.01) and strong to very strong reliability for videofluoroscopic measurements (rs = 0.746-0.947) were found. Construct validity of the CAPS-A VPC-Sum was shown by an increase in postoperative scores for the CLP group only ϰ2 (2) = 9.769, p = 0.008 and significant differences between the CLP and the other two groups at T2 and T3 using independent t-tests. Convergent and divergent validity was indicated by a positive moderate correlation with related parameters (e.g., hypernasality rs = 0.869, p < 0.01) and a weak correlation with unrelated parameters (e.g., amount of forward advancement rs = 0.160, p = 0.526). Criterion validity was found by a moderate correlation between closure ratio rs = -0.541, p = 0.020 and CAPS-A VPC-Sum. CONCLUSIONS & IMPLICATIONS A velopharyngeal composite score based on perceptually rated parameters serves as an important surgical speech outcome measure. The CAPS-A VPC-Sum is a useful, reliable and valid outcome measure of velopharyngeal function. There are added positive implications for other clinicians using geographically and language-specific adapted versions of the CAPS-A internationally. WHAT THIS PAPER ADDS What is already known on this subject Velopharyngeal composite scores based on perceptually rated speech parameters have been shown to have both clinical and research utility, serving as a useful surgical outcome measure. However, such a composite score must be specifically validated on the perceptual speech framework upon which it is based, as there are differences in measurement methods and terminology across cleft speech perceptual frameworks internationally. What this paper adds to existing knowledge The CAPS-A is a nationally used tool in the UK and Ireland for audit and research purposes with validated and adapted international versions. This paper reports on the validation of the derived velopharyngeal composite score measure based on the CAPS-A and an English-speaking sample, providing evidence of its validity through a speech osteotomy study. What are the potential or actual clinical implications of this work? This work provides CLP teams who use CAPS-A with a validated surgical speech outcome measure of velopharyngeal function. It has positive implications also for adapted versions of the CAPS-A internationally.
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Affiliation(s)
- Valerie J Pereira
- Department of Otorhinolaryngology, Head & Neck Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jyrki Tuomainen
- Speech, Hearing and Phonetic Sciences, Division of Psychology & Language Sciences, University College London, London, UK
| | - Kathy Y S Lee
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Michael C F Tong
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Debbie A Sell
- Illness and Disability (ORCHID), Centre for Outcomes and Experience Research in Children's Health, London, UK
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Zajac DJ, Vallino LD, Baylis AL, Adatorwovor R, Preisser JS, Vivaldi D. Emergence of Prevocalic Stop Consonants in Children With Repaired Cleft Palate. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:30-39. [PMID: 33444099 PMCID: PMC8608139 DOI: 10.1044/2020_jslhr-20-00282] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 08/10/2020] [Accepted: 09/23/2020] [Indexed: 06/05/2023]
Abstract
Purpose This study determined the time course of the emergence of prevocalic stop consonants in young children with cleft palate following surgical repair. Method A total of 120 children in four cohorts from three institutions were followed from 12 to 24 months of age: (a) 24 with repaired cleft lip and palate (CLP), (b) 36 with repaired cleft palate only (CP), (c) 33 without clefts but with histories of frequent otitis media and ventilation tubes (OM), and (d) 27 typically developing (TD) children without clefts or OM. Emergence of prevocalic stops and symbolic language skills were determined during administration of the Communication and Symbolic Behavioral Scales Developmental Profile. Parametric survival models were fitted with and without covariates-recruitment site, gender, maternal education level, middle ear status, language ability, and age at surgery for children with clefts-to describe the time course of the emergence of prevocalic stops. Results The estimated age at which 80% of children demonstrated prevocalic stop emergence was 15.0, 15.3, 18.9, and 21.8 months for TD, OM, CP, and CLP groups, respectively (p < .001, unadjusted model). Both CP and CLP cohorts had a significantly longer time to stop emergence than either the TD or OM cohorts, even after adjusting for covariates. Abnormal middle ear status, lower symbolic language ability, and older age at palatal surgery were significantly associated with delayed stop emergence. Conclusions Survival model estimates show that four out of five children with repaired cleft palate will achieve emergence of prevocalic stop consonants by 19-22 months of age, corresponding to 9-12 months following palate repair. Clinical implications are discussed.
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Affiliation(s)
- David J. Zajac
- Craniofacial Center, Division of Craniofacial and Surgical Care, Adams School of Dentistry, University of North Carolina at Chapel Hill
| | - Linda D. Vallino
- Center for Pediatric Auditory and Speech Sciences, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE
| | - Adriane L. Baylis
- Department of Plastic Surgery, Nationwide Children's Hospital, College of Medicine, The Ohio State University, Columbus
| | - Reuben Adatorwovor
- Department of Biostatistics, College of Public Health, University of Kentucky, Lexington
| | - John S. Preisser
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Daniela Vivaldi
- Department of Dental Ecology, Adams School of Dentistry, University of North Carolina at Chapel Hill
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Jawalekar R, Jawalekar S. Speech assessment and recording by orthodontist in patients with cleft lip and palate. JOURNAL OF THE INTERNATIONAL CLINICAL DENTAL RESEARCH ORGANIZATION 2021. [DOI: 10.4103/jicdro.jicdro_7_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Marino VCDC, Dutka JDCR, Manicardi FT, Gifalli G, Silva PP, Pegoraro-Krook MI. Influence of speech stimuli in the auditory perceptual identification of hypernasality in individuals with cleft lip and palate. Codas 2020; 32:e20190269. [PMID: 33331425 DOI: 10.1590/2317-1782/20202019269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 02/11/2020] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To investigate the influence of speech stimuli in the auditory perceptual identification of hypernasality in individuals with Cleft Lip and Palate (CLP). METHODS Speech samples from 80 individuals with operated unilateral CLP, ages ranged from nine to 17 years (the mean age of: 12y7m), both genders, were edited for this study. Samples were recorded over the production of nine different speech stimuli, including counting and short sentences characterized by oral sounds, one loaded with low pressure consonants and seven loaded with high pressure consonants. Three speech-language pathologists rated the presence or absence of hypernasality while analyzing 864 recordings (80 individuals X 9 stimuli + 144 repeated recordings, for measuring the intra-rater agreement). Intra-rater and inter-rater indexes of agreement were established for all nine stimulus conditions. The indexes of inter-rater agreement were compared using the Z test (p<0.005), with samples comprising significant indexes of agreement interpreted as better stimuli for identifying the hypernasality in these individuals. RESULTS Intra-rater agreement for high pressure stimuli with voiced consonants were significantly lower than indexes for other stimuli. Inter-rater agreement between each pair of SLPs ranged from 0.11 (plosive voicing stimuli) to 0.57 (12 short sentences, one of each high pressure consonant). The values of mean inter-rater agreement between all SLPs was 0.47 indicating moderate agreement for identifying hypernasal speech. CONCLUSION Speech recordings obtained over the production of longer speech samples including 12 short sentences, for instance one for each high pressure consonant, may favor inter-rater agreement for identifying hypernasality.
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Affiliation(s)
| | - Jeniffer de Cássia Rillo Dutka
- Hospital de Reabilitação de Anomalias Craniofaciais, Universidade de São Paulo - USP - Bauru (SP), Brasil.,Departamento de Fonoaudiologia, Faculdade de Odontologia de Bauru, Universidade de São Paulo - USP - Bauru (SP), Brasil
| | - Flora Taube Manicardi
- Universidade Estadual Paulista "Júlio de Mesquita Filho" - UNESP - Marília (SP), Brasil
| | - Giovana Gifalli
- Hospital de Reabilitação de Anomalias Craniofaciais, Universidade de São Paulo - USP - Bauru (SP), Brasil
| | - Patrick Pedreira Silva
- Hospital de Reabilitação de Anomalias Craniofaciais, Universidade de São Paulo - USP - Bauru (SP), Brasil
| | - Maria Inês Pegoraro-Krook
- Hospital de Reabilitação de Anomalias Craniofaciais, Universidade de São Paulo - USP - Bauru (SP), Brasil.,Departamento de Fonoaudiologia, Faculdade de Odontologia de Bauru, Universidade de São Paulo - USP - Bauru (SP), Brasil
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Kasthurirathne R, Forrest K, Ross J, Patel R. Nasalance in adolescents with autism spectrum disorders. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 22:517-525. [PMID: 31775529 DOI: 10.1080/17549507.2019.1691263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Purpose: Listener judgments indicate atypical nasal resonance in individuals with Autism Spectrum Disorders (ASD); however, listener perceptions are susceptible to bias and may give unreliable information about a speaker's production of nasal resonance. The current study used Nasometry to obtain an objective estimation of nasal resonance among adolescents with ASD and neurotypical controls.Method: The Nasometer II 6450 (PENTAX Medical, Lincoln Park, New Jersey) was used to collect nasalance from adolescents aged 15-17 years with ASD (n = 11) and matched controls (n = 11) across two separate speech tasks: (1) passage reading and (2) spontaneous speech.Result: Adolescents with ASD evidenced significantly higher nasalance scores compared to controls, particularly in the passage loaded with bilabial plosives and some nasals (Bobby) as well as non-nasal words extracted from spontaneous speech. In addition, adolescents with ASD had significantly higher nasalance ratios than controls. Significant group differences were driven by a subset of participants with ASD.Conclusion: Perceptual judgements of nasality noted in previous autism studies are quantified by an increase in nasal energy compared to oral energy. The current data suggest hypernasality is present in a subset of people with ASD rather than being a general feature of speech in autism.
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Affiliation(s)
- Rachel Kasthurirathne
- Department of Speech & Hearing Sciences, Indiana University Bloomington, Bloomington, IN, USA
| | - Karen Forrest
- Department of Speech & Hearing Sciences, Indiana University Bloomington, Bloomington, IN, USA
| | - Jared Ross
- Department of Speech & Hearing Sciences, Indiana University Bloomington, Bloomington, IN, USA
| | - Rita Patel
- Department of Speech & Hearing Sciences, Indiana University Bloomington, Bloomington, IN, USA
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Brown MN, Grames LM, Skolnick GB. Augmentative and Alternative Communication (AAC) Use Among Patients Followed by a Multidisciplinary Cleft and Craniofacial Team. Cleft Palate Craniofac J 2020; 58:324-331. [PMID: 32783478 DOI: 10.1177/1055665620947606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To establish preliminary data describing the number of patients who visit a multidisciplinary cleft and craniofacial team who use augmentative and alternative communication (AAC) supports. DESIGN This retrospective study consisted of chart reviews for all patients who visited a single site's multidisciplinary cleft and craniofacial team for 1 calendar year. SETTING A single multidisciplinary craniofacial team at a tertiary teaching hospital. PARTICIPANTS Four hundred sixty-four patients met the inclusion criteria for this study. Of these, 59.9% (n = 278) were male and 40.1% (n = 186) were female. RESULTS Of the sample population, 6.9% (n = 32) were AAC users as they received AAC intervention in a therapeutic context, while 93.1% (n = 432) were not. The AAC group had a mean age of 5.1 years (standard deviation [SD]: 4.2) and was 68.8% (n = 22) male. The non-AAC group had a mean age of 6.3 (SD: 4.9) and was 59.3% (n = 256) male. Within the AAC group, 40.6% (n = 13) were found to have an identified syndromic diagnosis in comparison to 17.6% (n = 76) of the non-AAC group (P = .003). CONCLUSIONS This is the first study to report the prevalence of AAC use among patients in the care of multidisciplinary cleft and craniofacial teams. Our findings suggest that a subset of craniofacial team patients may have complex communication disorders that require AAC supports. Craniofacial teams should be aware of resources available for these patients so that the patients' communication needs are met in the hospital, in school, and in the community.
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Affiliation(s)
| | | | - Gary B Skolnick
- 12275Washington University School of Medicine, St Louis, MO, USA.,Division of Plastic and Reconstructive Surgery, Department of Surgery, 7548Washington University in St Louis School of Medicine, The Cleft Palate-Craniofacial Institute, St Louis Children's Hospital, MO, USA
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Pereira VJ, Tuomainen J, Hay N, Mars M, Suchak A, Sell DA. Effect of Maxillary Osteotomy on Speech in Cleft Lip and Palate: Instrumental Outcomes of Velopharyngeal Function. Cleft Palate Craniofac J 2020; 57:1320-1331. [DOI: 10.1177/1055665620947626] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: To investigate the effect of maxillary osteotomy on velopharyngeal function in cleft lip and palate (CLP) using instrumental measures. Design: A prospective study. Participants: A consecutive series of 20 patients with CLP undergoing maxillary osteotomy by a single surgeon were seen at 0 to 3 months presurgery (T1), 3 months (T2), and 12 months (T3) post-surgery. Interventions: Nasalance was measured on the Nasometer II 6400. For videofluoroscopy and nasendoscopy data, visual perceptual ratings, for example, palatal lift angle (PLAn), and quantitative ratiometric measurements, for example, closure ratio (CRa), were made using a validated methodology and computer software. Reliability studies were undertaken for all instrumental measures. Main Outcome Measures: Repeated measures analysis of variance (with time at 3 levels) for nasalance and each velar parameter. Planned comparisons across pairs of time points (T1-T2, T1-T3, and T2-T3) including effect sizes. Results: A significant difference over time was found for nasalance ( P = .001) and planned comparisons across pairs of time points were significant between T1 and T2 ( P = .008), T1 and T3 ( P = .002), but not between T2 and T3 ( P = .459) providing evidence that maxillary osteotomy can impact on nasalance adversely and that the changes seen are permanent and stable. There were also significant differences over time for PLAn ( P = .012) and CRa ( P = −.059) and planned comparisons for both velar parameters reflected similar findings to those of nasalance. Conclusions: Maxillary osteotomy can adversely affect velopharyngeal function in patients with CLP. The study provides evidence for a much earlier post-surgery review even as early as 3 months after surgery.
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Affiliation(s)
- Valerie J. Pereira
- Division of Speech Therapy, Department of Otorhinolaryngology, Head & Neck Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Jyrki Tuomainen
- Division of Psychology & Language Sciences, Speech, Hearing and Phonetic Sciences, University College London, London, UK
| | - Norman Hay
- North Thames Cleft Lip and Palate Team, Great Ormond Street Hospital for Children Foundation Trust, London, UK
| | - Michael Mars
- Formerly Lead Consultant Orthodontist, North Thames Cleft Lip and Palate Team, Great Ormond Street Hospital for Children Foundation Trust, London, UK
| | - Archna Suchak
- Formerly Senior Registrar in Orthodontics, Royal London Hospital and Great Ormond Street Hospital for Children Foundation Trust, London, UK
| | - Debbie A. Sell
- Centre for Outcomes and Experience Research in Children’s Health, Illness and Disability (ORCHID), London, UK
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Saxon M, Tripathi A, Jiao Y, Liss J, Berisha V. Robust Estimation of Hypernasality in Dysarthria with Acoustic Model Likelihood Features. IEEE/ACM TRANSACTIONS ON AUDIO, SPEECH, AND LANGUAGE PROCESSING 2020; 28:2511-2522. [PMID: 33748328 PMCID: PMC7978228 DOI: 10.1109/taslp.2020.3015035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Hypernasality is a common characteristic symptom across many motor-speech disorders. For voiced sounds, hypernasality introduces an additional resonance in the lower frequencies and, for unvoiced sounds, there is reduced articulatory precision due to air escaping through the nasal cavity. However, the acoustic manifestation of these symptoms is highly variable, making hypernasality estimation very challenging, both for human specialists and automated systems. Previous work in this area relies on either engineered features based on statistical signal processing or machine learning models trained on clinical ratings. Engineered features often fail to capture the complex acoustic patterns associated with hypernasality, whereas metrics based on machine learning are prone to overfitting to the small disease-specific speech datasets on which they are trained. Here we propose a new set of acoustic features that capture these complementary dimensions. The features are based on two acoustic models trained on a large corpus of healthy speech. The first acoustic model aims to measure nasal resonance from voiced sounds, whereas the second acoustic model aims to measure articulatory imprecision from unvoiced sounds. To demonstrate that the features derived from these acoustic models are specific to hypernasal speech, we evaluate them across different dysarthria corpora. Our results show that the features generalize even when training on hypernasal speech from one disease and evaluating on hypernasal speech from another disease (e.g., training on Parkinson's disease, evaluation on Huntington's disease), and when training on neurologically disordered speech but evaluating on cleft palate speech.
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Affiliation(s)
- Michael Saxon
- Arizona State Univ., Sch. of Elect., Comput., & Energy Eng., Tempe, Arizona, USA
| | - Ayush Tripathi
- Arizona State Univ., Sch. of Elect., Comput., & Energy Eng., Tempe, Arizona, USA
| | - Yishan Jiao
- Arizona State Univ., Sch. of Elect., Comput., & Energy Eng., Tempe, Arizona, USA
| | - Julie Liss
- Arizona State Univ., Sch. of Elect., Comput., & Energy Eng., Tempe, Arizona, USA
| | - Visar Berisha
- Arizona State Univ., Sch. of Elect., Comput., & Energy Eng., Tempe, Arizona, USA
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Cronin A, McLeod S, Verdon S. Holistic Communication Assessment for Young Children With Cleft Palate Using the International Classification of Functioning, Disability and Health:Children and Youth. Lang Speech Hear Serv Sch 2020; 51:914-938. [PMID: 32697920 DOI: 10.1044/2020_lshss-19-00122] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Purpose Children with a cleft palate (± cleft lip; CP±L) can have difficulties communicating and participating in daily life, yet speech-language pathologists typically focus on speech production during routine assessments. The International Classification of Functioning, Disability and Health: Children and Youth Version (ICF-CY; World Health Organization, 2007) provides a framework for holistic assessment. This tutorial describes holistic assessment of children with CP±L illustrated by data collected from a nonclinical sample of seven 2- to 3-year-old children, 13 parents, and 12 significant others (e.g., educators and grandparents). Method Data were collected during visits to participants' homes and early childhood education and care centers. Assessment tools applicable to domains of the ICF-CY were used to collect and analyze data. Child participants' Body Functions including speech, language, and cognitive development were assessed using screening and standardized assessments. Participants' Body Structures were assessed via oral motor examination, case history questionnaires, and observation. Participants' Activities and Participation as well as Environmental and Personal Factors were examined through case history questionnaires, interviews with significant others, parent report measures, and observations. Results Valuable insights can be gained from undertaking holistic speech-language pathology assessments with children with CP±L. Using multiple tools allowed for triangulation of data and privileging different viewpoints, to better understand the children and their contexts. Several children demonstrated speech error patterns outside of what are considered cleft speech characteristics, which underscores the importance of a broader assessment. Conclusion Speech-language pathologists can consider incorporating evaluation of all components and contextual factors of the ICF-CY when assessing and working with young children with CP±L to inform intervention and management practices.
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Affiliation(s)
- Anna Cronin
- School of Teacher Education, Charles Sturt University, Bathurst, New South Wales, Australia
| | - Sharynne McLeod
- School of Teacher Education, Charles Sturt University, Bathurst, New South Wales, Australia
| | - Sarah Verdon
- School of Community Health, Charles Sturt University, Albury, New South Wales, Australia
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Bae Y, Perta K, Obert K, Kalmar E. Contracted Extravelar Segments of the Levator Veli Palatini Muscle: A Magnetic Resonance Imaging Morphometric Study. Cleft Palate Craniofac J 2020; 58:118-125. [PMID: 32551942 DOI: 10.1177/1055665620933472] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To provide detailed descriptions of contraction-induced morphometric changes in the extravelar segments of the levator veli palatini (LVP) muscle using 3-dimensional (3-D) magnetic resonance imaging (MRI). DESIGN Three-dimensional MRI data were acquired at rest and during "silent /i/" from 4 singers. During silent /i/, participants voluntarily sustained velar elevation while breathing orally for the entire scan time. Focusing on the extravelar segments, LVP length, angle of the muscle origin, and cross-sectional area (CSA), measurements were obtained and compared between tasks. RESULTS Three of the 4 participants exhibited the expected patterns of change following concentric contraction of the LVP muscle. Consistent changes from the resting to the contracted state included reductions in LVP length by 13.5% and angle of the muscle origin by 9.8%, as well as increases in CSAs by 22.1%, on average. CONCLUSIONS This study presented high-resolution data of the LVP muscle behavior with the first in vivo 3-D measurements of the contracted LVP muscle, which can be useful for the validation of computational models that aim at describing biomechanical properties of the LVP muscle in future research. The active behavior of the extravelar LVP muscle also provides some insight on optimal LVP muscle geometry to consider during cleft palate repair.
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Affiliation(s)
- Youkyung Bae
- Department of Speech and Hearing Science, 215745The Ohio State University, Columbus, OH, USA
| | - Karen Perta
- Department of Speech and Hearing Science, 215745The Ohio State University, Columbus, OH, USA
| | - Kerrie Obert
- Department of Otolaryngology, 215745The Ohio State University, Columbus, OH, USA
| | - Eileen Kalmar
- Department of Biomedical Education and Anatomy, 12305The Ohio State University, Columbus, OH, USA
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Bettens K, Alighieri C, Bruneel L, De Meulemeester L, Van Lierde K. Peer attitudes toward children with cleft (lip and) palate related to speech intelligibility, hypernasality and articulation. JOURNAL OF COMMUNICATION DISORDERS 2020; 85:105991. [PMID: 32470866 DOI: 10.1016/j.jcomdis.2020.105991] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 03/18/2020] [Accepted: 03/19/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND AND AIMS In addition to anatomical and physiological problems, children with a cleft (lip and) palate (CP ± L) often face psychosocial difficulties. A complex interaction between patient and environment may induce these problems. Based on the literature, speech disorders may negatively influence a listener's judgement of a speaker. Therefore, the aim of the present study was to investigate the attitudes of peers toward the speech of children with CP ± L. METHOD Sixty-nine typically-developing children (7-12 years, 34 boys, 35 girls) judged audio-recorded speech samples of nine children with CP ± L and three control children based on three attitude components, i.e. cognitive, affective and behavioral. A speech intelligibility percentage was determined for each speaker based on transcriptions by 23 naïve adult listeners. Furthermore, two speech-language pathologists perceptually rated the degrees of hypernasality, nasal airflow and articulation errors. A correlation was calculated between the attitude components and the speech intelligibility percentage, and the attitude components and perceptual judgements. Additionally, the possible influence of age and gender of the listeners on their attitudes was explored. RESULTS A significantly positive correlation was found between the speech intelligibility percentage and the attitude components: when a child was understood better, more positive attitudes were measured. A significantly negative correlation was found between perceptual judgements and all attitudes components: presence of more hypernasality, nasal airflow or articulation errors resulted in more negative attitudes. Furthermore, boys and younger children seem to have more negative attitudes compared to girls and older children. CONCLUSION This study provides additional evidence that peers show more negative attitudes toward children with more speech disorders due to CP ± L. Further research may explore the possible impact of age and gender on attitudes of peers. Intervention should focus on, changing the cognitive, affective and behavioral attitudes of peers in a more positive direction and encouraging the psychosocial development of children with CP ± L.
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Affiliation(s)
- Kim Bettens
- Department of Rehabilitation Sciences, Speech and Language, Ghent University, Ghent, Belgium.
| | - Cassandra Alighieri
- Department of Rehabilitation Sciences, Speech and Language, Ghent University, Ghent, Belgium
| | - Laura Bruneel
- Department of Rehabilitation Sciences, Speech and Language, Ghent University, Ghent, Belgium
| | - Lara De Meulemeester
- Department of Rehabilitation Sciences, Speech and Language, Ghent University, Ghent, Belgium
| | - Kristiane Van Lierde
- Department of Rehabilitation Sciences, Speech and Language, Ghent University, Ghent, Belgium; Department of Speech-Language Therapy and Audiology, University of Pretoria, Pretoria, South Africa
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Ferreira GZ, Bressmann T, de Cássia Rillo Dutka J, Whitaker ME, de Boer G, de Castro Marino VC, Pegoraro-Krook MI. Analysis of oral-nasal balance after intensive speech therapy combined with speech bulb in speakers with cleft palate and hypernasality. JOURNAL OF COMMUNICATION DISORDERS 2020; 85:105945. [PMID: 31607437 DOI: 10.1016/j.jcomdis.2019.105945] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 09/06/2019] [Accepted: 09/24/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To evaluate the efficacy of the combination of a speech bulb with an intensive speech therapy program in hypernasal participants with cleft palate. METHODS Twenty hypernasal speakers with cleft palate (12 females and 8 males, median age 28.45 years), who were wearing speech bulbs underwent an intensive speech therapy program of 45 sessions over 3 weeks. Three experienced speech-language pathologists rated the participants' speech recordings before and after intensive speech therapy, with and without the speech bulb. Nasometric recordings and long-term averaged spectra were also analyzed using repeated-measures ANOVAs. RESULTS The ANOVA of the hypernasality ratings showed significant effects of therapy [F (1,19) = 15.97; p < .001], speech bulb [F(1,190 = 28.54, p < .001] and a therapy -speech bulb interaction effect [F(1.19) = 22.30, p < 0.001]. The most favorable listener ratings of hypernasality were obtained post-therapy when participants were wearing their speech bulbs. Without the speech bulb, intensive speech therapy by itself did not result in a significant improvement. With speech bulb, nasalance scores for high [F (1,19) = 14.07, p < .001] and low pressure [F (1,19) = 14.84, p < .001] sentences were significantly lower post-therapy, providing preliminary evidence that an intensive speech therapy program may enhance the effect of a speech bulb. Before and after comparisons of individual nasalance profiles demonstrated variable improvement in 15 participants, no progress in 2 participants and more severe hypernasality after therapy in 3 participants. Long-term averaged spectra corroborated the findings of the perceptual analysis. Based on a frequency bin from 201 to 300 Hz, there was a significant within-subject effect for with and without speech bulb [F(1, 18) = 4.54, p = .047] as well as for before vs. after session [F (1,18) = 7.14, p = .015]. CONCLUSION The speech bulb in combination with intensive speech therapy resulted in improved oral-nasal balance for the majority of participants. More research is needed to investigate long-term outcomes as well as individual factors contributing to therapy success.
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Affiliation(s)
- Gabriela Zuin Ferreira
- Speech-Language and Audiology Department, Faculdade de Odontologia de Bauru and Graduate Programs at the Universidade de São Paulo (USP), 9-75 Alameda Octávio Pinheiro Brisolla, Bauru, SP, CEP 17012-901, Brazil.
| | - Tim Bressmann
- Department of Speech-Language Pathology, University of Toronto (UofT), University Ave, 500, Toronto, ON, M5G 1V7, Canada.
| | - Jennifer de Cássia Rillo Dutka
- Speech-Language and Audiology Department, Faculdade de Odontologia de Bauru and Graduate Programs at the Universidade de São Paulo (USP), 9-75 Alameda Octávio Pinheiro Brisolla, Bauru, SP, CEP 17012-901, Brazil; Palatal Prosthesis Services, Hospital for the Rehabilitation of Craniofacial Anomalies, University of São Paulo (HRAC/USP), Rua Sílvio Marchione, 3-20, Vila Universitária, Bauru, SP, CEP 17012-900, Brazil.
| | - Melina Evangelista Whitaker
- Palatal Prosthesis Services, Hospital for the Rehabilitation of Craniofacial Anomalies, University of São Paulo (HRAC/USP), Rua Sílvio Marchione, 3-20, Vila Universitária, Bauru, SP, CEP 17012-900, Brazil.
| | - Gillian de Boer
- Department of Speech-Language Pathology, University of Toronto (UofT), University Ave, 500, Toronto, ON, M5G 1V7, Canada.
| | - Viviane Cristina de Castro Marino
- Department of Speech-Language Pathology and Audiology, São Paulo State University (UNESP), Faculdade de Filosofia e Ciências, Campus de Marília, Av. Higino Muzzi Filho, 737, Marília, SP, CEP 17525-900, Brazil.
| | - Maria Inês Pegoraro-Krook
- Speech-Language and Audiology Department, Faculdade de Odontologia de Bauru and Graduate Programs at the Universidade de São Paulo (USP), 9-75 Alameda Octávio Pinheiro Brisolla, Bauru, SP, CEP 17012-901, Brazil; Palatal Prosthesis Services, Hospital for the Rehabilitation of Craniofacial Anomalies, University of São Paulo (HRAC/USP), Rua Sílvio Marchione, 3-20, Vila Universitária, Bauru, SP, CEP 17012-900, Brazil.
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The Correlation Between Consonant Articulation and Velopharyngeal Function in Patients With Unoperated Submucous Cleft Palate. J Craniofac Surg 2020; 31:1070-1073. [PMID: 32149969 DOI: 10.1097/scs.0000000000006300] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Submucous cleft palate (SMCP) is a congenital condition related to abnormal muscle attachments within the soft palate. Even though hypernasality and nasal emission, the primary symptom of SMCP, have been well-documented, research on articulation errors is currently lacking. The object of this study was to examine the consonant articulation in patients with unoperated SMCP and its possible correlation with the velopharyngeal function. This study analyzed the perceptual speech assessment and nasopharyngoscopy data of 338 patients with unoperated SMCP between years 2008 and 2016 retrospectively. The mean age of the patients was 13.27 years. About 125 patients showed velopharyngeal competence (VPC), 174 velopharyngeal incompetence (VPI), and 39 marginal VPI (MVPI). Among the 338 patients, 137 presented normal articulation, 124 consonant omission, 25 compensatory articulation, 36 consonant weakening, 51 consonant substitution, and 36 posterior placement. About 70.40% VPC patients, 17.24% VPI patients, and 48.72% MVPI patients demonstrated normal articulation. About 59.20% VPI patients showed consonant omission. The results demonstrated that consonant articulation varied among patients with unoperated SMCP and was correlated with their velopharyngeal functions, while consonant omission was the most common articulation error. Velopharyngeal closure pattern was not associated with either velopharyngeal function or consonant articulation.
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Persson C, Pedersen NH, Hayden C, Bowden M, Aukner R, Vindenes HA, Åbyholm F, Withby D, Willadsen E, Lohmander A. Scandcleft Project Trial 3: Comparison of Speech Outcomes in Relation to Sequence in 2-Stage Palatal Repair Procedures in 5-Year-Olds With Unilateral Cleft Lip and Palate. Cleft Palate Craniofac J 2020; 57:352-363. [PMID: 31928085 DOI: 10.1177/1055665619896637] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To compare speech outcome following different sequencing of hard and soft palate closure between arms and centers within trial 3 and compare results to peers without cleft palate. DESIGN A prospective randomized clinical trial. SETTING Two Norwegian and 2 British centers. PARTICIPANTS One hundred thirty-six 5-year-olds with unilateral cleft lip and palate were randomized to either lip and soft palate closure at 3 to 4 months and hard palate closure at 12 months (arm A) or lip and hard palate closure at 3 to 4 months and soft palate closure at 12 months (arm D). MAIN OUTCOME MEASURES A composite measure of velopharyngeal competence (VPC), overall assessment of VPC from connected speech (VPC-Rate). Percentage of consonants correct (PCC), active cleft speech characteristics (CSCs), subdivided by oral retracted and nonoral errors, and developmental speech characteristics (DSCs). RESULTS Across the trial, 47% had VPC, with no statistically significant difference between arms within or across centers. Thirty-eight percent achieved a PCC score of >90%, with no difference between arms or centers. In one center, significantly more children in arm A produced ≥3 active CSCs (P < .05). Across centers, there was a statistically significant difference in active CSCs (arm D), oral retracted CSCs (arm D), and DSCs (arms A and D). CONCLUSIONS Less than half of the 5-year-olds achieved VPC and around one-third achieved age-appropriate PCC scores. Cleft speech characteristics were more common in arm A, but outcomes varied within and across centers. Thus, outcome of the same surgical method can vary substantially across centers.
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Affiliation(s)
- Christina Persson
- Institute of Neuroscience and Physiology, Speech and Language Pathology Unit, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Speech and Language Pathology/ENT, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | | | - Melanie Bowden
- Greater Manchester Cleft Unit, Royal Manchester Children's Hospital, Manchester, United Kingdom
| | - Ragnhild Aukner
- Department of Speech and Language Disorders, Statped sørøst, Oslo, Norway
| | - Hallvard A Vindenes
- Center for Cleft Lip and Palate, Bergen University Hospital Haukeland, Bergen, Norway
| | - Frank Åbyholm
- Department of Plastic and Reconstructive Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - David Withby
- Greater Manchester Cleft Unit, Royal Manchester Children's Hospital, Manchester, United Kingdom
| | - Elisabeth Willadsen
- Department of Nordic Studies and Linguistics, University of Copenhagen, Copenhagen, Denmark
| | - Anette Lohmander
- Division of Speech and Language Pathology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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Aghdam H, Qaranizade K, Jafari A, Farahmand M, Shooshtari L. Cephalometric evaluation of soft palate changes after maxillary advancement in lip and palate cleft patients. JOURNAL OF CLEFT LIP PALATE AND CRANIOFACIAL ANOMALIES 2020. [DOI: 10.4103/jclpca.jclpca_6_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Nyberg J, Hagberg E, Havstam C. "She Sounds Like a Small Child or Perhaps She has Problems"-Peers' Descriptions of Speech in 7-Year-Olds Born With Cleft Palate. Cleft Palate Craniofac J 2019; 57:707-714. [PMID: 31818136 DOI: 10.1177/1055665619890785] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The aim of this study was to explore how 7-year-olds describe speech in children born with cleft palate in their own words and to investigate whether they perceive signs of velopharyngeal incompetence (VPI) and articulation errors, and if so, which terminology they use. METHODS/PARTICIPANTS Twenty 7-year-olds participated in 6 focus group interviews where they listened to 8 speech samples with different types of cleft speech characteristics and described what they heard. The same speech samples had been assessed by speech-language pathologists and comprised normal speech, different degrees of VPI, oral articulation disorders, and glottal articulation. The interviews were analyzed with qualitative content analysis. RESULTS The analysis resulted in 4 interlinked categories: descriptions of speech, thoughts on personal traits, consequences for communication, and emotional reactions and associations. Each category contains 4 to 5 subcategories with the children's descriptions and reflections. Glottal articulation and severe signs of VPI caused the most negative emotional reactions and were described as sounding scary and incomprehensible and the children speculated on the risk of social rejection of the speakers. Retracted oral articulation was also noted and described but with a vocabulary similar to the professionals. Minor signs of VPI were not noted. CONCLUSIONS Seven-year-olds are direct and straightforward in their reactions to cleft palate speech characteristics. More pronounced signs of VPI and articulatory difficulties, also minor ones, are noted. Clinically, articulatory impairments may be more important to treat than minor signs of VPI.
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Affiliation(s)
- Jill Nyberg
- Division of Speech and Language Pathology, Department of Clinical Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Emilie Hagberg
- Division of Speech and Language Pathology, Department of Clinical Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.,Stockholm Craniofacial Team, Patient Area Craniofacial Disorders and Functional Area Speech and Language Pathology, Karolinska University Hospital, Stockholm, Sweden
| | - Christina Havstam
- Division of Speech-Language Pathology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institute of Neuroscience and Physiology/Speech-Language Pathology Unit, Sahlgrenska Academy at University of Gothenburg, Sweden
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Rong P. The Effect of Tongue-Jaw Coupling on Phonetic Distinctiveness of Vowels in Amyotrophic Lateral Sclerosis. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2019; 62:3248-3264. [PMID: 31433712 DOI: 10.1044/2019_jslhr-s-19-0058] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Purpose The aim of this study was to determine the relation of tongue-jaw coupling to phonetic distinctiveness of vowels in persons at different stages (i.e., early, middle, late) of bulbar motor involvement in amyotrophic lateral sclerosis (ALS) and healthy controls. Method The pattern of spatial tongue-jaw coupling was derived from 11 individuals with ALS and 11 healthy controls using the parallel factor analysis. Two articulatory components, which correspond to tongue displacement independent of the jaw (iTongue) and jaw contribution to tongue displacement (cJaw), were extracted from the composite tongue-jaw displacement. These articulatory components were correlated with F1 (i.e., height) and F2-F1 (i.e., advancement) of 4 vowels (/i/, /u/, /æ/, and /ɔ/) across all participants in each group. In addition, a comprehensive index of functional tongue-jaw coupling was derived as the ratio of cJaw/(iTongue + cJaw), and an acoustic index of vowel distortion (VowelDis) was derived to quantify the overall disease-related changes in phonetic distinctiveness of vowels. Based on these indices, disease-related changes in tongue-jaw coupling and phonetic distinctiveness of vowels were examined in individuals at the early, middle, and late stages of the disease. Results For healthy controls, both iTongue and cJaw contributed to F2-F1, while only cJaw contributed to F1. For individuals with ALS, both iTongue and cJaw contributed to F1, whereas only cJaw contributed to F2-F1. Disease-related changes in tongue-jaw coupling included (a) an overall decrease of the percent contribution of the tongue to the composite tongue-jaw displacement accompanied by an increase of percent contribution of the jaw and (b) several changes in the direction of tongue and jaw displacements occurred at different stages of the disease. These disease-related changes in tongue-jaw coupling had various impacts on phonetic distinctiveness of vowels, resulting in (a) a backward shift of front vowels and reduced front-back vowel contrasts, which occurred early and throughout the disease stages; (b) raising of all vowels during the middle stage of the disease; and (c) reduced high-low vowel contrasts during the late stage of the disease. Overall, phonetic distinctiveness of vowels deteriorated progressively throughout the disease course. Conclusions Different from healthy controls who established optimal functional coupling between the tongue and the jaw during vowel productions, individuals at the early-to-middle stages of bulbar ALS showed various adaptive changes in tongue-jaw coupling in response to the disease-related biomechanical and muscular changes in the articulators (particularly in the tongue). These adaptive changes in tongue-jaw coupling were found to be partially effective in mitigating the negative effect of articulatory involvement on phonetic distinctiveness of vowels. As the disease progressed to the late stage, such adaptations appeared to be no longer evident, resulting in a substantial overall reduction of vowel contrasts.
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Affiliation(s)
- Panying Rong
- Department of Speech-Language-Hearing: Sciences & Disorders, University of Kansas, Lawrence
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42
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Sell D, Sweeney T. Percent Consonant Correct as an Outcome Measure for Cleft Speech in an Intervention Study. Folia Phoniatr Logop 2019; 72:143-151. [DOI: 10.1159/000501095] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 05/21/2019] [Indexed: 11/19/2022] Open
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Cleland J, Lloyd S, Campbell L, Crampin L, Palo JP, Sugden E, Wrench A, Zharkova N. The Impact of Real-Time Articulatory Information on Phonetic Transcription: Ultrasound-Aided Transcription in Cleft Lip and Palate Speech. Folia Phoniatr Logop 2019; 72:120-130. [PMID: 31129664 DOI: 10.1159/000499753] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 03/19/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE This study investigated whether adding an additional modality, namely ultrasound tongue imaging (UTI), to perception-based phonetic transcription impacted on the identification of compensatory articulations and on interrater reliability. PATIENTS AND METHODS Thirty-nine English-speaking children aged 3-12 years with cleft lip and palate (CLP) were recorded producing repetitions of /aCa/ for all places of articulation with simultaneous audio recording and probe-stabilized ultrasound (US). Three types of transcriptions were performed: (1) descriptive observations from the live US by the clinician recording the data, (2) US-aided transcription (UA) by two US-trained clinicians, and (3) traditional phonetic transcription by two CLP specialists from audio recording. We compared the number of consonants identified as in error by each transcriber and then classified errors into eight different subcategories. RESULTS Both UA and traditional transcription yielded similar error detection rates; however, these were significantly higher than the observations recorded live in the clinic. Interrater reliability for the US transcribers was substantial (κ = 0.65) compared to moderate (κ = 0.47) for the traditional transcribers. US transcribers were more likely to identify covert errors such as double articulations and retroflexion than the audio-only transcribers. CONCLUSION UTI is a useful complement to traditional phonetic transcription for CLP speech.
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Affiliation(s)
- Joanne Cleland
- Department of Speech and Language Therapy, University of Strathclyde, Glasgow, United Kingdom,
| | - Susan Lloyd
- Department of Speech and Language Therapy, University of Strathclyde, Glasgow, United Kingdom.,Speech and Hearing Sciences, Queen Margaret University, Edinburgh, United Kingdom
| | - Linsay Campbell
- Dental Hospital and School, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - Lisa Crampin
- Dental Hospital and School, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - Juha-Pertti Palo
- Department of Speech and Language Therapy, University of Strathclyde, Glasgow, United Kingdom.,Speech and Hearing Sciences, Queen Margaret University, Edinburgh, United Kingdom
| | - Eleanor Sugden
- Department of Speech and Language Therapy, University of Strathclyde, Glasgow, United Kingdom
| | - Alan Wrench
- Articulate Instruments Ltd., Edinburgh, United Kingdom
| | - Natalia Zharkova
- Speech and Language Sciences, Newcastle University, Newcastle, United Kingdom
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Lo ESC, Wong AWK, Tse ACY, Ma EPM, Whitehill TL, Masters R. Effects of Error Experience on Learning to Lower Speech Nasalance Level. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2019; 28:448-455. [PMID: 31136230 DOI: 10.1044/2018_ajslp-18-0033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Purpose This research aims to examine the effects of error experience when learning to speak with lowered nasalance level. Method A total of 45 typical speakers were instructed to learn to lower speech nasalance level in either an errorless (restricted possibility for committing errors) or an errorful (unrestricted possibility for committing errors) learning condition. The nasality level of the participants' speech was measured by a nasometer and quantified by nasalance scores (in percent). Errorless learners practiced producing speech with lowered nasalance level with a threshold nasalance score of 50% (the easiest target) at the beginning, which gradually decreased to a threshold of 10% (the most difficult target) at the end. The same set of threshold targets was presented to errorful learners, but in reverse order. Errors were defined by the proportion of speech, with a nasalance score exceeding the threshold. Retention and transfer tests were administered. Results Errorless learners displayed fewer errors and lower mean nasalance scores than errorful learners during the acquisition phase. Furthermore, errorless learners achieved lower mean nasalance scores than errorful learners in the retention and transfer tests. Conclusion These results suggest that errorless learning is more effective than errorful learning and that error experience has a detrimental effect on the acquisition of a novel speech motor task that requires minimization of the nasality level. Errorless learning may be a useful paradigm for the intervention and management of hypernasality in clinical settings where behavioral treatments are needed.
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Affiliation(s)
- Eric Siu-Chung Lo
- Nam Shan Psychology Laboratory, Department of Social and Behavioural Sciences, City University of Hong Kong, Hong Kong SAR, China
| | - Andus Wing-Kuen Wong
- Nam Shan Psychology Laboratory, Department of Social and Behavioural Sciences, City University of Hong Kong, Hong Kong SAR, China
| | - Andy Choi-Yeung Tse
- Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong SAR, China
| | - Estella Pui-Man Ma
- Division of Speech and Hearing Sciences, University of Hong Kong, Hong Kong SAR, China
| | - Tara L Whitehill
- Division of Speech and Hearing Sciences, University of Hong Kong, Hong Kong SAR, China
| | - Rich Masters
- Te Huataki Waiora Faculty of Health, Sport and Human Performance, University of Waikato, Hamilton, New Zealand
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Bruneel L, Bettens K, Van Lierde K. The relationship between health-related quality of life and speech in patients with cleft palate. Int J Pediatr Otorhinolaryngol 2019; 120:112-117. [PMID: 30776568 DOI: 10.1016/j.ijporl.2019.02.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 02/04/2019] [Accepted: 02/05/2019] [Indexed: 11/18/2022]
Abstract
INTRODUCTION In health-care, current efforts focus on providing patient-centered care. Specifically for patients with velopharyngeal insufficiency, and by extent patients with cleft palate, the Velopharyngeal Insufficiency (VPI) Effects on Life Outcomes (VELO) questionnaire (Skirko et al., 2012; 2013) allows the clinician to map the impact of speech and swallowing difficulties on the patient's health-related quality of life (HRQoL). The current study evaluated the hypothesized association between this speech-related HRQoL measure and perceptually and instrumentally assessed speech variables, to provide evidence for the construct validity of the Dutch version of the VELO questionnaire. MATERIALS AND METHODS Thirty participants, twenty-five patients with cleft palate and five controls, were enrolled. Perceptual speech assessment was conducted following the recently developed Belgian Dutch outcome tool for perceptual speech assessment in patients with cleft palate. In addition, nasalance values and the Nasality Severity Index (NSI) 2.0 were determined. The relationship between these speech outcomes and the scores on the VELO parent report was determined using Spearman rank-order correlation coefficients. RESULTS Moderate to strong correlations were found between the total score on the VELO parent report and five speech variables: the VPC-SUM score (rs = -0.476), speech understandability (rs = -0.657), passive CSC's (rs = -0.654), speech acceptability (rs = -0.591) and the need for C(L)P-related speech therapy (rs = -0.711). Furthermore, these variables were associated with at least one subscale of the VELO questionnaire. DISCUSSION AND CONCLUSION Correlations between speech outcomes and the Dutch version of the VELO questionnaire provide evidence for the construct validity of this version of the instrument. Furthermore, insights in these associations may lead the way to efficient therapy approaches, targeting speech features with the greatest impact on the patient's health-related quality of life.
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Affiliation(s)
- Laura Bruneel
- Ghent University, Department of Rehabilitation Sciences, Speech-language Pathology/Audiology, Research Group, Ghent, Belgium.
| | - Kim Bettens
- Ghent University, Department of Rehabilitation Sciences, Speech-language Pathology/Audiology, Research Group, Ghent, Belgium
| | - Kristiane Van Lierde
- Ghent University, Department of Rehabilitation Sciences, Speech-language Pathology/Audiology, Research Group, Ghent, Belgium; University of Pretoria, Faculty of Humanities, Department of Speech-Language Pathology and Audiology, Pretoria, South Africa
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Boyce JO, Raj S, Sanchez K, Marazita ML, Morgan AT, Kilpatrick N. Speech Phenotyping in Unaffected Family Members of Individuals With Nonsyndromic Cleft Lip With or Without Palate. Cleft Palate Craniofac J 2019; 56:867-876. [PMID: 30696259 DOI: 10.1177/1055665618823936] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Subclinical phenotypes of nonsyndromic cleft lip with or without cleft palate (CL ± P) may be identified from clinically "unaffected" relatives and could be associated with specific cleft-related gene mutations. It has been hypothesized that velopharyngeal insufficiency (VPI) may be a subclinical phenotype of interest in this population, but this has not been explored quantitatively with appropriate control cohorts. The aim of this case-control study was to compare VPI in at-risk clinically unaffected relatives of individuals with nonsyndromic CL ± P with a low-risk matched normative Australian cohort. PARTICIPANTS Clinically unaffected (ie, with no overt cleft) first-degree relatives of a proband with nonsyndromic CL ± P (n = 189) and noncleft controls (n = 207). MAIN OUTCOME MEASURE(S) Perceptual measures of VPI encompassing resonance, nasal emission, and articulation were evaluated using the Great Ormond Street Speech Assessment. Quantitative measures of VPI were obtained from the Nasometer II using standardized adult and pediatric speech stimuli. RESULTS Both perceptual and instrumental measures showed no significant difference (P > .01) between the VPI in unaffected relatives and the noncleft comparison group. Mean nasalance scores for both groups were calculated and reported according to speech stimuli, age, and sex. CONCLUSIONS Results suggest that VPI, measured through speech, is not a significant subclinical phenotype of nonsyndromic CL ± P. Therefore, further familial genetic investigations exploring VPI may not yield meaningful results. Exploration across multiple subclinical phenotypes in larger cohorts may enable researchers to better understand the multifaceted nature of this complex and heterogeneous anomaly.
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Affiliation(s)
- Jessica O Boyce
- 1 Department of Audiology and Speech Pathology, The University of Melbourne, Carlton, VIC, Australia.,2 Speech and Language Group, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Supriya Raj
- 3 Musculoskeletal Group, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Katherine Sanchez
- 1 Department of Audiology and Speech Pathology, The University of Melbourne, Carlton, VIC, Australia.,2 Speech and Language Group, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Mary L Marazita
- 4 Center for Craniofacial and Dental Genetics, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA, USA.,5 Department of Human Genetics, Graduate School of Public Health, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Angela T Morgan
- 1 Department of Audiology and Speech Pathology, The University of Melbourne, Carlton, VIC, Australia.,2 Speech and Language Group, Murdoch Children's Research Institute, Parkville, VIC, Australia.,6 Speech Pathology Department, Royal Children's Hospital, Parkville, VIC, Australia
| | - Nicky Kilpatrick
- 7 Plastic and Maxillofacial Surgery, Royal Children's Hospital, Parkville, VIC, Australia.,8 Facial Sciences Group, Murdoch Children's Research Institute, Parkville, VIC, Australia
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Særvold TK, Hide Ø, Feragen KB, Aukner R. Associations Between Hypernasality, Intelligibility, and Language and Reading Skills in 10-Year-Old Children With a Palatal Cleft. Cleft Palate Craniofac J 2019; 56:1044-1051. [DOI: 10.1177/1055665618824432] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: This study investigated the associations between hypernasality and intelligibility, and language and reading skills in 10-year old children with a cleft palate ± lip. Design: Cross-sectional data collected during routine assessments of speech and language in a centralized treatment setting. Participants: Children aged 10, born with cleft palate ± lip from 4 birth cohorts (N = 123). Outcome Measures: Hypernasality and intelligibility: Swedish Articulation and Nasality Test-N; language: Language 6-16 (Sentence recall, Serial recall, Vocabulary); reading: word chain test and reading comprehension test. Results: A total of 71.3% of the children had no occurrence of hypernasality and 82.8% had intelligibility scores within the normal range. For all children with hypernasality and intelligibility within the normal range, reading and language scores were also within normal ranges. Children with presence of hypernasality had significantly lower language skills, with mean scores within the lower normal range. Children with reduced intelligibility had lower scores on reading comprehension. Conclusions: The findings highlight a possible association between hypernasality and language skills, and intelligibility and reading skills. Cleft teams should consider routine assessments of language and reading skills in children with speech impairment, in order to identify potential needs for intervention as early as possible.
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Affiliation(s)
- Tone Kristin Særvold
- Department of Speech and Language Disorders, Statped – National Service for Special Needs Education, Oslo, Norway
| | - Øydis Hide
- Department of Speech and Language Disorders, Statped – National Service for Special Needs Education, Oslo, Norway
| | | | - Ragnhild Aukner
- Department of Speech and Language Disorders, Statped – National Service for Special Needs Education, Oslo, Norway
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Effect of One-Stage versus Two-Stage Palatoplasty on Hypernasality and Fistula Formation in Children with Complete Unilateral Cleft Lip and Palate: A Randomized Controlled Trial. Plast Reconstr Surg 2018; 142:42e-50e. [PMID: 29652768 DOI: 10.1097/prs.0000000000004486] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Is one-stage or two-stage palatoplasty more effective for preventing fistula formation and hypernasality in patients with complete unilateral cleft lip and palate? METHODS This parallel blocked randomized controlled trial included 100 patients with nonsyndromic complete unilateral cleft lip and palate with a repaired cleft lip, divided into two equal groups. Group A had one-stage palatoplasty patients at age 12 to 13 months while group B had two-stage palatoplasty patients with soft palatoplasty at age 12 to 13 months and hard palatoplasty at age 24 to 25 months. Presence of a fistula was tested clinically at 3 years and speech was tested using nasometry and perceptual analyses at 6 years. Group C consisted of noncleft controls (n = 20, age 6 years) for speech using nasometry. Fistula rates, hypernasality ratings, and nasalance scores were compared between groups A and B. Nasometry recordings of groups A and B were compared with control group C. RESULTS There was no difference in fistula rates between groups A and B (p = 0.409; 95 percent CI, 0.365 to 11.9). Mean nasalance scores of group A showed higher nasalance than group B (p = 0.006; 95 percent CI, 1.16 to 6.53). Perceptual analysis showed no difference between groups A and B (p = 0.837 and p = 1.000). Group A showed higher mean nasalance than group C (p = 0.837 and p = 1.000), whereas group B showed no difference (p = 0.088; 95 percent CI, -0.14 to 2.02). CONCLUSIONS There was no difference in fistula rates between groups. Nasalance was slightly higher in patients in the one-stage palatoplasty group than two-stage palatoplasty group, but the difference was not clinically significant. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, II.
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Bettens K, Bruneel L, Maryn Y, De Bodt M, Luyten A, Van Lierde KM. Perceptual evaluation of hypernasality, audible nasal airflow and speech understandability using ordinal and visual analogue scaling and their relation with nasalance scores. JOURNAL OF COMMUNICATION DISORDERS 2018; 76:11-20. [PMID: 30071470 DOI: 10.1016/j.jcomdis.2018.07.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 07/04/2018] [Accepted: 07/20/2018] [Indexed: 06/08/2023]
Abstract
PURPOSE Perceptual assessments remain the most commonly utilized procedure to diagnose and evaluate resonance disorders. However, the discussion continues about which rating scale has to be applied. Therefore, this study aimed to compare the reliability and validity of ordinal and visual analogue scales to rate hypernasality, audible nasal airflow and speech understandability. METHODS Four experienced speech-language pathologists rated 35 speech samples of children with a range of hypernasality, audible nasal airflow and speech understandability, using an ordinal scale and a visual analogue scale. Intraclass correlations coefficients determined intra- and inter-rater reliability. The model of best fit was determined by plotting both rating scales against each other. A Pearson correlation coefficient verified the relationship between both rating scales and nasalance scores determined by a Nasometer. RESULTS Good intra- and inter-rater reliability was found for both rating scales. A multiple regression analysis revealed a curvilinear relationship between both rating scales, indicating a slight preference to rate all parameters by a visual analogue scale. Comparable correlations with nasalance scores were found. CONCLUSIONS This study confirms that visual analogue scale ratings form a reliable and valid alternative for ordinal ratings in the perceptual judgments of hypernasality, audible nasal airflow and speech understandability. A combination of both rating scales may even combine the advantages and eliminate their limitations. However, further research is necessary to verify how this new approach can be implemented in available protocols for clinical practice, audits and research.
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Affiliation(s)
- Kim Bettens
- Department of Speech, Language and Hearing Sciences, Ghent University, Ghent, Belgium.
| | - Laura Bruneel
- Department of Speech, Language and Hearing Sciences, Ghent University, Ghent, Belgium
| | - Youri Maryn
- Department of Speech, Language and Hearing Sciences, Ghent University, Ghent, Belgium; Department of Otorhinolaryngology, Speech-Language Pathology, Sint-Augustinus General Hospital, Wilrijk, Antwerp, Belgium; Department of Speech-Language Therapy and Audiology, Faculty of Education, Health and Social Work, University College Ghent, Ghent, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Marc De Bodt
- Department of Speech, Language and Hearing Sciences, Ghent University, Ghent, Belgium; Rehabilitation Centre for Communication Disorders, Antwerp University Hospital, Wilrijk, Belgium
| | - Anke Luyten
- Department of Speech, Language and Hearing Sciences, Ghent University, Ghent, Belgium
| | - Kristiane M Van Lierde
- Department of Speech, Language and Hearing Sciences, Ghent University, Ghent, Belgium; Department of Speech-Language Therapy and Audiology, University of Pretoria, Pretoria, South Africa
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Bettens K, de Boer G, Bressmann T, Bruneel L, Van Lierde K. Clinical Application of a New Approach to Identify Oral-Nasal Balance Disorders Based on Nasalance Scores. Cleft Palate Craniofac J 2018; 56:628-638. [PMID: 30134743 DOI: 10.1177/1055665618796012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE A new approach to classify oral-nasal balance disorders based on instrumental measurements was developed based on linear discriminant analysis (LDA) of nasalance scores of simulated oral-nasal balance disorders by de Boer and Bressmann. The current study aimed to apply the newly developed functions to clinical data to investigate the applicability of this new approach. DESIGN Retrospective diagnostic accuracy study. SETTING Tertiary university hospital. PARTICIPANTS Fifty-five Dutch-speaking Flemish children (age 4-12 years) with normal (n = 20), hypernasal (n = 18), hyponasal (n = 12), or mixed nasality (n = 5). INTERVENTIONS Nasalance scores of an oral and a nasal text were used to calculate 3 sets of LDA function scores. Predicted classification was consecutively based on the function values of the group centroids originally determined by de Boer and Bressmann and adapted LDA functions and group centroids based on clinical data. MAIN OUTCOME MEASURES Discriminatory power of the linear discriminant formulas. RESULTS Based on the original LDA functions, 56% of the speech samples matched the perceptual classification. Applying a correction factor for age and language differences resulted in a 67% correct classification, although 83% of the hyponasal samples were ranked as "normal resonance." Rederivation of the LDA functions based on current clinical data resulted in an 80% correct classification. CONCLUSIONS The new approach of classifying oral-nasal balance disorders based on a combination of nasalance scores was promising. However, further clinical research is needed to refine the LDA functions and group centroids before clinical application is possible.
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Affiliation(s)
- Kim Bettens
- 1 Department of Speech, Language and Hearing Sciences, Ghent University, Ghent, Belgium
| | - Gillian de Boer
- 2 Department of Speech-Language Pathology, University of Toronto, Toronto, Ontario, Canada
| | - Tim Bressmann
- 2 Department of Speech-Language Pathology, University of Toronto, Toronto, Ontario, Canada
| | - Laura Bruneel
- 1 Department of Speech, Language and Hearing Sciences, Ghent University, Ghent, Belgium
| | - Kristiane Van Lierde
- 1 Department of Speech, Language and Hearing Sciences, Ghent University, Ghent, Belgium.,3 Department of Speech-Language Therapy and Audiology, University of Pretoria, Pretoria, South Africa
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