Panendoscopic feedback in the study of voluntary velopharyngeal movements

Analysis of oral-nasal balance after intensive speech therapy combined with speech bulb in speakers with cleft palate and hypernasality

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.

Effects of biofeedback in phonatory disorders and phonatory performance: a systematic literature review

The purpose of this article was to systematically review the literature on the effects of biofeedback therapy in the domain of phonatory disorders and phonatory performance, using studies in peer-reviewed journals. An extensive definition of biofeedback is given and its place in voice treatment is defined. Eighteen group or case studies or reports considering the effects of electromyographic, laryngoscopic and acoustic biofeedback in dysphonic patients (hyperfunctional voice disorders, hypofunctional voice disorders, psychogenic voice disorder, laryngeal trauma, total laryngectomy, vocal cord dysfunction) and participants with normal voices are included and an analysis of procedure as well as research design and results is presented. The usefulness of biofeedback in phonatory disorders and performance was to be interpreted based on tendencies, since there is a lack of randomized controlled efficacy studies. In only 3 of 18 studies (16.7%) did biofeedback therapy fail to improve voice quality or not result in better results than other forms of therapy. Recommendations for improved methodologies are made, which include the use of acoustic voice quality parameters.

The effect of nasopharyngoscopic biofeedback in patients with cleft palate and velopharyngeal dysfunction

OBJECTIVE

To evaluate the immediate, long-term, and carry-over effects of nasopharyngoscopic biofeedback therapy in patients with cleft palate who exhibit velopharyngeal dysfunction (VPD).

DESIGN

Pre- versus posttreatment and follow-up comparisons.

SETTING

Cleft palate center of the Heidelberg University Hospital, Heidelberg, Germany.

SUBJECTS

Eleven patients with VPD who had received conventional speech therapy without showing significant improvement.

INTERVENTIONS

A four-stage feedback procedure. The patients watched and evaluated their velopharyngeal (VP) valving during speech by an endoscopic image displayed on a video monitor. Two feedback sessions took place for every target sound.

MAIN OUTCOME MEASURES

Mean occurrence of VP closure during speech sound production on different linguistic levels. Patients' self-perception was assessed by a questionnaire and speech diary.

RESULTS

Significant improvement and stability of VP closure was noted. Mean occurrence of VP closure was 5% before therapy, 91% after two biofeedback sessions, and 86% in the follow-up after 6 months. Velopharyngeal dysfunction associated with compensatory articulation proved to be equally well trained as VPD on sounds with good articulatory placement. No significant difference was observed in the degree of improvement between phoneme-specific VPD and generalized VPD. The transfer to the level of words and sentences was successful and showed significant stability. The stability of VP closure for vowels was less than the stability for fricatives and stop sounds. Patients gained improved auditory and kinesthetic self-perception of their articulation.

CONCLUSIONS

Nasopharyngoscopic biofeedback therapy proves to be a quick and effective method to change VPD. It shows stable results and carry-over effects.

Oral endoscopy in prosthodontic management of the soft palate defect

Telescopic oral endoscopy is an effective aid in the construction and modification of a speech aid prosthesis. The method is noninvasive and easy to perform, permits the prosthodontist to achieve the goal of functional effectiveness in prosthesis construction while keeping the weight and size of the pharyngeal extension at a minimum, decreases the number and length of patient visits required for modification, and when coupled to a fiberoptic teaching arm or a video camera and recording system, it becomes an excellent aid in teaching, patient education and orientation, and record keeping.

Visual training for velopharyngeal closure in cleft palate patients; a fibrescopic procedure (preliminary report)

Velopharyngeal closure in various tasks was examined in 59 cleft palate patients with persistent velopharyngeal incompetence using nasopharyngeal fibrescopic (NPF) examination. The degree of velopharyngeal closure was analyzed according to the categories reported previously by Yamaoka (1973) and Matsuya et al. (1979). The NPF self-training system was developed and applied to those patients so as to investigate a longitudinal effect of the NPF in velopharyngeal closure mechanism. The training was performed every two weeks for nearly one year. The results indicated that the patient who showed complete velopharyngeal closure during blowing and/or several productions of speech samples could attain a much better improvement in all speech samples after one year of self-training. On the other hand, the patients who did not show complete velopharyngeal closure during all tasks, failed to improve the velopharyngeal closing mechanism. The ability to close the velopharynx during swallowing was seen in all patients examined. However, it appeared to have nothing to do with the prognosis of velopharyngeal closure. The data suggested that the NPF self-training system provided a strong neuro-muscular signal for velopharyngeal movement. Besides, it was considered that the NPF was a useful tool for activation of velopharyngeal activity by way of visual feed-back control.

Biofeedback theory and application in allied health: speech pathology

The implementation of biofeedback procedures represents a new approach to clinical management of speech disorders. Thus far, results of experiments utilizing biofeedback techniques have suggested positive effects in the remediation of speech disorders. The purpose of this paper is to provide the reader with the principles of biofeedback; to survey areas of clinical application including voice, fluency, and other clinical disorders; and to explore potential applications of biofeedback procedures for the speech and language pathologist.