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PubMed2004

Methodology for perceptual assessment of speech in patients with cleft palate: a critical review of the literature.

OBJECTIVE AND DESIGN: This review of 88 articles in three international journals was undertaken for the purpose of investigating the methodology for perceptual speech assessment in patients with cleft palate. The articles were published between 1980 and 2000 in the Cleft Palate-Craniofacial Journal, the International Journal of Language and Communication Disorders, and Folia Phoniatrica et Logopaedica. RESULTS AND CONCLUSIONS: The majority of articles (76) were published in the Cleft Palate-Craniofacial Journal, with an increase in articles during the 1990s and 2000. Information about measures or variables was clearly given in all articles. However, the review raises several major concerns regarding method for collection and documentation of data and method for measurement. The most distressing findings were the use of a cross-sectional design in studies of few patients with large age ranges and different types of clefts, the use of highly variable speech samples, and the lack of information about listeners and on reliability. It is hoped that ongoing national and international collaborative efforts to standardize procedures for collection and analysis of perceptual data will help to eliminate such concerns and thus make comparison of published results possible in the future.

Cleft Palate↗
PubMed2005

Perceptual evaluation of hypernasality compared to HONC measures: the role of experience.

OBJECTIVES: Nasality ratings from experienced and inexperienced listeners were compared to accelerometric measures using the Horii Oral Nasal Coupling (HONC) Index to determine if one group's ratings are more closely related to the HONC Index measures. The reliability of listener ratings was studied to determine if experienced listeners had better reliability than inexperienced listeners. The influence of phonetic content was analyzed to learn if ratings of sentences with stop consonants yielded higher correlations with HONC scores than sentences containing glides. DESIGN: Experienced and inexperienced listeners' ratings of hypernasality were correlated to the HONC measures for two nonnasal sentence productions. Analysis of variance compared experienced versus inexperienced listener ratings. PARTICIPANTS: Ten listeners who were speech-language pathologists with at least 10 years of experience in assessing hypernasality and 10 listeners who were graduate students in communicative disorders with less than 1 year of experience. Speech samples were acquired from 13 children with varying degrees of hypernasality and 5 children with normal nasality. RESULTS: Correlations between ratings of hypernasality and HONC scores were .60 for the experienced group and .52 for the inexperienced group. In general, the experienced listeners rated the hypernasality of the speakers as less severe. Both groups had similar intrajudge reliability. Hypernasality ratings were not influenced by sentence context. CONCLUSIONS: Hypernasality can be rated in a reliable fashion regardless of listener experience. The correlations between the objective measure of nasalization (HONC) and the perceptual ratings were not as high as expected. Factors contributing to obtaining only moderate correlations will be discussed.

Adolescent↗
PubMed1996

Novel stimuli for obtaining nasalance measures from young children.

The use of novel stimuli for obtaining nasalance measures in young children was the focus of this study. The subjects were 20 children without a history of communication disorders and 20 children at risk for velopharyngeal insufficiency (VPI). Each subject recited three passages; the standard Zoo Passage, and two novel stimuli that were named the Turtle Passage and the Mouse Passage. Like the Zoo Passage, the Turtle Passage contained no normally nasal consonants. The Mouse Passage was about 11% nasal consonants, which is similar to the Rainbow Passage. Statistical analysis showed no significant difference between the mean nasalance for the Zoo Passage and the Turtle Passage for either the subjects without risk of VPI (15.4% vs 15.7%) or for those at risk (30.4% vs 28.8%). Nasalance measures for the Mouse Passage were significantly higher than for either the Zoo Passage or the Turtle Passage. Listeners rated the stimuli on a 5-point equal-appearing intervals scale. The correlation coefficient between listener judgments of hypernasality and nasalance was significant for the Zoo Passage (r = 0.70) and for the Turtle Passage (r = 0.51) but not significant for the Mouse Passage (r = 0.32). Using cut-off scores of 22% for nasalance and 2.25 for hypernasality, the sensitivity for the Zoo Passage was 0.72, and for the Turtle Passage, 0.83.

Child↗
PubMed1998

Velopharyngeal function in nonsyndromic cleft palate: relevance of surgical technique, age at repair, and cleft type.

OBJECTIVE: The goal of this study was to determine the relative importance of surgical technique, age at repair, and cleft type for velopharyngeal function. DESIGN: This was a retrospective study of patients operated on by two surgeons using different techniques (von Langenbeck and Veau-Wardill-Kilner [VY]) at Children's Hospital, Boston, MA. PATIENTS: We included 228 patients who were at least 4 years of age at the time of review. Patients with identifiable syndromes, nonsyndromic Robin sequence, central nervous system disorders, communicatively significant hearing loss, and inadequate speech data were excluded. MAIN OUTCOME MEASURE: Need for a pharyngeal flap was the measure of outcome. RESULTS: Pharyngeal flap was necessary in 14% of von Langenbeck and 15% of VY repaired patients. There was a significant linear association (p = .025) between age at repair and velopharyngeal insufficiency (VPI). Patients with an attached vomer, soft cleft palate (SCP), and unilateral cleft lip/palate (UCLP) had a 10% flap rate, whereas those with an unattached vomer, hard/soft cleft palate (HSCP), and bilateral cleft lip/palate (BCLP) had a 23% flap rate (p = .03). Age at repair was critical for the unattached-vomer group (p = .03) but was not statistically significant for the attached-vomer group (p = .52). CONCLUSIONS: Surgical technique was not a significant variable either in aggregate or for the Veau types. Patients in the earliest repair group (8-10 months) were the least likely to require a pharyngeal flap. Early repair was more critical for HSCP and BCLP patients. There was no correlation between velopharyngeal insufficiency and Veau hierarchy. The attached vomer/levator muscle complex may be a more important predictor of surgical success than the anatomic extent of cleft.

Age Factors↗
PubMed1998

Nasalance and nasality in low pressure and high pressure speech.

OBJECTIVE: This study compared nasalance measures and nasality ratings in low pressure (LP) and high pressure (HP) speech. SUBJECTS: The subjects for this study were 25 children ranging in age from 5 to 13 years. Twenty of the subjects were patients followed by a craniofacial team, and five had no history of communication disorder. RESULTS: The mean nasalance for the LP speech was 29.98% (SD, 16.16), and the mean nasalance for the HP speech was 30.28% (SD, 15.35). The mean nasality rating for the LP speech was 2.31, and the mean nasality rating for the HP speech was 2.59. Separate paired t tests revealed no significant difference between the LP or the HP speech for either the nasalance scores or the nasality ratings. The correlation coefficient between nasalance and nasality for the LP speech was r = 0.78, and for the HP speech r = 0.77. Using a cutoff of 26% for nasalance and 2.0 for nasality, Nasometer test sensitivity was 0.84 and test specificity was 0.88. CONCLUSIONS: In general, clinicians may obtain valid measures of nasalance and/or ratings of nasality using either an LP stimulus or an HP stimulus. Sensitivity and specificity scores indicated that the Nasometer was reasonably accurate in distinguishing between normal and hypernasal speech samples.

Adolescent↗
PubMed1999

Effect of stimulus length on nasalance scores.

OBJECTIVE: Nasalance measures were compared for speech stimuli of four different lengths. DESIGN: The standard for comparison was a 44-syllable passage. The 44-syllable passage was compared to a 17-syllable passage, a 6-syllable sentence, and a 2-syllable word. All stimuli were devoid of nasal consonants and were composed only of low pressure consonants and vowels. SETTING: Academic and clinical craniofacial center. SUBJECTS: The subjects were 20 children at risk for velopharyngeal dysfunction and 5 children without history of communication disorder. MAIN OUTCOME MEASURE(S): The main outcome measures were the nasalance scores associated with speech samples of different lengths. RESULTS: The results showed that comparable measures of nasalance can be obtained using stimuli as short as a six-syllable sentence. Both the 17-syllable and the 6-syllable stimulus achieved high criterion validity, indicating that stimuli of that length could be substituted for the longer 44-syllable passage. The two-syllable word, however, had significantly lower criterion validity and could not be used to obtain valid estimates of nasalance. CONCLUSION: Valid assessment of nasalance can be achieved with speech samples as short as six syllables.

Adolescent↗
PubMed2000

The effect of vowels on nasalance scores.

OBJECTIVE: Nasalance scores were compared for nine different speech stimuli with vowel content controlled. DESIGN: The nine speech stimuli included four vowels spoken in isolation and five sentences. The four vowels were /i/, /u/, /ae/, and /a/. Four of the five sentences were loaded with High Front, High Back, Low Front, or Low Back vowels, and the fifth sentence contained a mixture of vowel types. SETTING: Academic and clinical craniofacial center. SUBJECTS: The subjects were 19 children with velopharyngeal dysfunction (VPD) and 19 children without history of communication disorder. MAIN OUTCOME MEASURES: The main outcome measures were the nasalance scores associated with the nine different speech stimuli for two groups of subjects. RESULTS: For the VPD group, analysis of variance procedures revealed that nasalance scores for high-vowel sentences and the mixed-vowel sentence were significantly higher than the nasalance scores for the two low-vowel sentences. This pattern was the same for the non-VPD group except for the High Back/Low Back contrast, which was not significant. In both groups, nasalance scores for sustained vowels were significantly higher for the High Front vowel /i/ than for any other vowel, and nasalance was significantly higher for the High Back vowel /u/ than for either of the Low vowels /ae/ or /a/. There was no significant difference between Low vowels. CONCLUSION: Nasalance scores may be affected by the vowel content of the speech stimulus. This should be taken into consideration on a clinical basis and for research purposes.

Adolescent↗
PubMed1978

Elimination of echolalic responding to questions through the training of a generalized verbal response.

Echolalia, the parroting of the speech of others, is a severe communication disorder frequently associated with childhood schizophrenia and mental retardation. Two echolalic children, one schizophrenic and one retarded, were treated in a multiple-baseline design across subjects. Each child was taught to make an appropriate, non-echolalic verbal response (i.e., "I don't know") to a small set of previously echoed questions. After such training, this response generalized across a broad set of untrained questions that had formerly been echoed. The results obtained were the same irrespective of the specific experimenter who presented the questions. Further, each child discriminated appropriately between those questions that had previously been echoed and those that had not. Followup probes showed that treatment gains were maintained one month later. The procedure is economical, in that it produces a rapid and widespread cessation of echolalic responding.

Adolescent↗
PubMed1993

The application of naturalistic conversation training to speech production in children with speech disabilities.

The purpose of this experiment was to test the effectiveness of including speech production into naturalistic conversation training for 2 children with speech production disabilities. A multiple baseline design across behaviors (target phonemes) and across subjects (for the same phoneme) indicated that naturalistic conversation training resulted in improved spontaneous speech production. The implications of these findings are discussed relative to existing models of speech production training and other aspects of communication disorders.

Articulation Disorders↗
PubMed1993

Embolic cerebral infarction: MR findings in the first 3 hours after onset.

OBJECTIVE: MR imaging has a high sensitivity for detecting ischemic brain parenchyma. The aim of this study was to evaluate the changes in the signal intensity of infarcted brain parenchyma on MR images obtained within the first 3 hr after the onset of signs and symptoms in patients with embolic cerebral infarction. MATERIALS AND METHODS: We studied MR images of 16 patients who had a diagnosis of embolic cerebral infarction (highly probable according to criteria of the National Institute of Neurological and Communicative Disorders and Stroke). T1-weighted, T2-weighted, and proton density-weighted MR images were obtained within 3 hr after the onset of symptoms. Two neuroradiologists who had no knowledge of the diagnoses reviewed the MR images of these 16 patients and 20 control subjects in random order and evaluated signal-intensity changes in the gray and white matter. RESULTS: On proton density-weighted images, the central and cortical gray matter showed increased signal intensity in 63-69% and 88-94% of the patients, respectively. No abnormalities of the brain parenchyma were apparent on T1-weighted and T2-weighted images obtained within 3 hr after the onset of symptoms. The adjacent white matter appeared hyperintense on long TR images in only a few cases. CONCLUSION: An increased signal intensity in the gray matter on proton density-weighted images was the most characteristic parenchymal change seen on MR images of the brain obtained within 3 hr after embolic cerebral infarction.

Aged↗
PubMed1985

Psychological scaling of speech by students in training compared to that by experienced speech-language pathologists.

Direct magnitude estimation was the psychological rating technique for obtaining ratings of severity of the speech of 16 cerebral palsied dysarthric speakers. The ratings of students in training (inexperienced) were compared to those of experienced speech-language pathologists. For this method and this communication disorder, students' ratings were comparable to those of the professionals.

Clinical Competence↗
PubMed1994

Changes in maternal attitudes and perceptions and children's communication skills.

The present investigation had two purposes: (a) to assess significant changes in the attitudes and perceptions of mothers of young children who were enrolled in 15 wk. of individual speech-language therapy and (b) to compare changes in mothers' attitudes and perceptions with university supervisors' ratings of children's over-all communication skills and speech intelligibility. 17 children, ages 2;10 to 5;8, and their mothers were participants. Mothers received speech-language services and counseling from graduate-student clinicians and university clinical supervisors but no special counseling was provided to alter their attitudes and perceptions concerning the intervention process. The typical child in the intervention program received 24 individual speech and language therapy sessions. Mothers and supervisors completed questionnaires before and after the 15-wk. intervention. Neither group was made aware of the purpose of the investigation. Analysis showed a pattern of significant changes in mothers' pre- and postrankings of questionnaire items and significant changes in the total communication and speech intelligibility rankings made by supervisors. Significant relationships were found for changes in attitudes and perceptions of mothers and changes in the children's communication skills. The results bolster the need for use of family-based therapy approaches in intervention programs for young children's communication disorders.

Adult↗
PubMed2003

Relation of orientation, verbal aggression, and physical aggression to compliance in speech-language therapy for adults with traumatic brain injury.

20 subjects with traumatic brain injury were tested over a 4-wk. period for aggressive behaviors; orientation to place, person, and time; and compliance in speech-language therapy sessions. Analysis showed significant correlations from .63 to .75 over the four sessions between orientation and compliance in speech-language therapy and suggest that orientation training could be a prerequisite to the formal treatment of other behavioral or communication disorders.

Adolescent↗
PubMed1998

Risk factors and Alzheimer's disease: a comparative study of two communities.

OBJECTIVE: To determine the association between demographic, lifestyle and medical history factors to Alzheimer's disease (AD), we studied samples of two community dwelling populations with significantly different prevalence rates of AD in Indianapolis, USA (6.24%) and Ibadan, Nigeria (1.4%). METHODS: The samples were drawn from African-American community dwelling residents 65 years of age and over in Indianapolis, and Yoruba community-dwelling residents 65 years of age and over in Ibadan. A two-stage epidemiological design was used in which diagnosis of AD was by National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association criteria. RESULTS: In Indianapolis, age (odds ratio [OR] = 1.16; 95% confidence interval [CI] = 1.11-1.21), family history of dementia (OR = 5.40; 95% CI = 1.99-14.62), low education (0-6 years, OR = 3.49; 95% CI = 1.06-11.48) and rural residence (OR = 2.49; 95% CI = 1.05-5.88) were associated with a higher risk of AD. In Ibadan, age (OR = 1.15; 95% CI = 1.12-1.18) and female gender (OR = 13.9; 95% CI = 3.85-50.28) were associated with a higher risk of AD. CONCLUSIONS: The remarkably similar odds ratios between age and AD between sites suggest that biological processes associated with ageing are essential elements in the development of AD but that genetic and environmental risk factors may alter age-specific rates. In our longitudinal study, we intend to investigate in more depth the interaction between these ageing, genetic and environmental factors.

Aged↗
PubMedDate not supplied

Time-related sequelae of TBI in patients with prolonged post-comatose unawareness (PC-U) state.

Seventy-two patients who were in a post-comatose unawareness state for periods longer than 1 month following traumatic brain injury recovered consciousness thereafter. The incidence of residual sequelae of brain trauma in relation to duration of unawareness was studied. The incidence of motor disability, communication disorders, cognitive disturbances and malbehaviour was studied in the patients recovering consciousness after 1, 2, 3 and 6 months. It was found that no significant differences were found in the incidence of the above-mentioned residual sequelae of brain-damaged patients in relation to duration of post-comatose unawareness. However, 76.1% (51/67) of the patients who recovered consciousness and survived the first year following injury were living at home. Most of these were patients who recovered consciousness within the first 3 months following trauma. None of the patients who were in post-comatose unawareness longer than 6 months did so, Five patients (6.9%) died during the first year. Motor disability, independence in activities of daily living, vocational outcome and place of living were significantly related to duration of prolonged unawareness state whereas the disturbances in high mental functions did not. Although the vocational outcome of patients with post-comatose unawareness is not good, the fact that most of them are still able to live at home, having an acceptable quality of survival, justifies, according to our experience, the comprehensive rehabilitation programme.

Activities of Daily Living↗
PubMed1978

A simple portable voiced, unvoiced and "s" indicator.

This unit is called a V.S.F. indicator, the initials V.S.F. denoting Voiced "s" and Fricative indicator. It has been developed by the R.N.I.D. as an economical and portable speech training aid. A microphone is plugged into the device which classifies speech sounds on 3 lamps arranged vertically. The upper red lamp denotes voiced sounds. An amber light, centre, deonotes fricative sounds except "s" sounds which are indicated on the lower greeen lamp. The operation of the green light depends on the low frequency energy, while the amber and green lights are controlled by the rate of zero crossings. Informal trials in a variety of different types of special clinics have indicated that the most useful areas seem to be with profoundly deaf children and adults, although speech therapists have also reported promising reactions from children with a variety of communication disorders.

Humans↗
PubMed1997

Historical issues in intervention research: hidden knowledge and facilitating techniques in Denmark.

Facilitating techniques have recently both gained wider popularity and stirred considerable controversy. They are usually assumed to originate in Australia but the present paper documents that similar techniques created a major public event in Denmark and appeared occasionally in the USA in the 1960s and 1970s. However, in spite of the dramatic claims made by proponents of the techniques, their use did not spread widely and the international network has remained tenuous. It is argued that the "discovery' of facilitating techniques as a means to disclose unexpected literacy depends on the use of hand guidance and a context of professional beliefs where responses of unclear origin may be attributed to the person whose hand is being guided.

Autistic Disorder↗
PubMed1998

The measurement of psychological well-being in the person with aphasia.

This paper will introduce the construct of psychological well-being and discuss its relevance to speech and language therapy. Measures of psychological well-being are used routinely in psychological contexts, both as diagnostic and research indicators, and also as outcome measures. There is not a tradition of measuring psychological well-being in the speech and language therapy context, yet the clinical significance of well-being to therapeutic outcome is recognised. This paper will evaluate the existing measures available and discuss the development and validation of the Visual Analogue Self Esteem Scale for use with aphasic speakers (Brumfitt and Sheeran, 1998). Problems inherent in evaluating self-knowledge in communicatively disordered speakers will be discussed.

Aphasia↗