Perceptual Judgments of Resonance, Nasal Airflow, Understandability, and Acceptability in Speakers with Cleft Palate: Ordinal versus Visual Analogue Scaling

2017 ◽  
Vol 54 (1) ◽  
pp. 19-31 ◽  
Author(s):  
Sarah Castick ◽  
Rachael-Anne Knight ◽  
Debbie Sell
Keyword(s):  
Cleft Palate ◽  
Nasal Airflow ◽  
Speech And Language ◽  
Rater Reliability ◽  
Street Hospital ◽  
Perceptual Judgments ◽  
Scaling Methods ◽  
Visual Analogue Scaling ◽  
Best Fit ◽  
Nasal Resonance

Objective To investigate the reliability of ordinal versus visual analogue scaling (VAS) ratings for perceptual judgments of nasal resonance, nasal airflow, understandability, and acceptability in speakers with cleft palate. Design Within-subjects comparative study. Setting Multisite. Participants Five specialist speech and language therapists from U.K. Regional Cleft Centres. Outcome Measures Participants rated 30 audio speech samples obtained from the Speech and Language Therapy archives of Great Ormond Street Hospital. They rated the identified speech parameters using each scaling method, with 1 month between rating tasks. The model of best fit was determined to examine validity, and both intra- and inter-rater reliability were also computed. Results VAS ratings were valid for all parameters when plotted against ordinal ratings, and the model of best fit revealed only a slightly stronger curvilinear than linear relationship between the scaling methods. Intra-rater reliability was high for both rating methods across all six speech parameters. There was also high inter-rater reliability for both ordinal and VAS ratings of hypernasality, nasal emission, nasal turbulence, understandability, and acceptability, and for the ordinal ratings of hyponasality. Conclusions Perceptual judgments of nasal resonance, nasal airflow, understandability, and acceptability were similar using VAS and ordinal scaling, indicating that both scaling methods were appropriate for measuring the cleft speech parameters. VAS, however, may offer statistical advantages, and there is a growing body of evidence advocating its use for the measurement of prothetic speech parameters.

A Respirometric Technique to Evaluate Velopharyngeal Function in Speakers with Cleft Palate, with and without Prostheses

1987 ◽  
Vol 30 (2) ◽  
pp. 268-275 ◽  
Author(s):  
Harvey R. Gilbert ◽  
Carole T. Ferrand
Keyword(s):  
Cleft Palate ◽  
Nasal Airflow ◽  
Perceptual Judgments ◽  
Sentence Repetition ◽  
Air Volume ◽  
Syllable Repetition ◽  
Two Measures ◽  
Reported Data ◽  
Velopharyngeal Function ◽  
Repetition Task

There is a paucity of respirometric quotient (RQ) data on individuals with velopharyngeal inadequacy. Paesani (1964) reported data using a technique that involved separate productions of the same task to obtain the RQ. The RQ values obtained were greater than unity, which is theoretically impossible. In the present study, respirometric quotients, the ratio of oral air volume expended to total volume expended, were obtained using separate but simultaneous productions of oral and nasal airflow. RQ values were calculated for 10 speakers with cleft palate, with and without their prosthetic appliances, and 10 normal speakers. As a group, those with cleft palate and without their appliances exhibited RQ values that were significantly lower than values obtained from the normal speakers and from speakers with the appliances in place. These findings indicated that there were no statistically significant differences in RQ values when comparing sentence repetition and counting tasks. These values were lower than those obtained for the nonnasal syllable repetition tasks, with the/m/ syllable repetition task generally being associated with the lowest RQ value of any of the speech tasks. The correlation between RQ values and perceptual judgments was -.60, indicating that there was modest agreement between the two measures. As RQ values decreased, perceptual judgments of nasality increased.

Hypernasality and Velopharyngeal Impairment

1994 ◽  
Vol 31 (4) ◽  
pp. 257-262 ◽  
Author(s):  
Donald W. Warren ◽  
Rodger M. Dalston ◽  
Robert Mayo
Keyword(s):  
Airflow Rate ◽  
Nasal Airflow ◽  
Moderate Correlation ◽  
Interval Scale ◽  
Pressure Flow ◽  
Orifice Area ◽  
The Relationship ◽  
Nasal Resonance

Although the primary cause of hypernasality is impaired velopharyngeal (VP) function, a variety of other factors influence the outcome perceived by the listener. The purpose of the current study was to assess the relationship between oral-nasal resonance balance and (1) velopharyngeal orifice area; (2) nasal airflow rate; and (3) duration of nasal airflow. The pressure-flow technique was used to estimate VP area and measure nasal airflow rate and duration. Ratings of oral-nasal balance were made on a 6-point equal-appearing interval scale. Results Indicated a moderate correlation between hypernasality rating and VP area (0.66), nasal airflow (0.61), and nasal airflow duration (0.53). Adults tended to be perceived as more hypernasal than children for a given degree of VP impairment. Finally, when the degree of VP opening was small, perceived oral-nasal resonance balance appeared to be related to duration of the opening-closing movements.

Perceptual Evaluation of Speech and Velopharyngeal Function in Children with and without Cleft Palate and the Relationship to Nasal Airflow Patterns

2002 ◽  
Vol 39 (4) ◽  
pp. 409-424 ◽  
Author(s):  
Hans Dotevall ◽  
Anette Lohmander-Agerskov ◽  
Hasse Ejnell ◽  
Björn Bake
Keyword(s):  
Cleft Palate ◽  
Sensitivity And Specificity ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Strong Association ◽  
Airflow Rate ◽  
Nasal Airflow ◽  
Perceptual Evaluation ◽  
Velopharyngeal Function ◽  
The Relationship

Objectives The aim was to study the relationship between perceptual evaluation of speech variables related to velopharyngeal function and the pattern of nasal airflow during the velopharyngeal closing phase in speech in children with and without cleft palate. Participants Fourteen children with cleft lip and palate or cleft palate only and 15 controls aged 7 and 10 years. All were native Swedish speakers. Method Three experienced listeners performed a blinded perceptual speech evaluation. Nasal airflow was transduced with a pneumotachograph attached to a nasal mask. The duration from peak to 5% nasal airflow, maximum flow declination rate, and nasal airflow at selected points in time during the transition from nasal to stop consonants in bilabial and velar articulatory positions in sentences were estimated. The analysis was focused on the perceptual ratings of “velopharyngeal function” and “hypernasality.” Results A strong association was found between ratings of “velopharyngeal function” and “hypernasality” and the pattern of nasal airflow during the bilabial nasal-to-stop combination /mp/. Both the sensitivity and specificity were 1.00 for the bilabial temporal airflow measure in relation to ratings of “velopharyngeal function.” The nasal airflow rate during /p/ in /mp/ had a sensitivity of 1.00 and specificity of 0.92 to 0.96 in relation to ratings of “hypernasality.” Conclusion Assessment of the nasal airflow dynamics during the velopharyngeal closing phase in speech presents quantitative, objective data that appear to distinguish between perceptually normal and deviant velopharyngeal function with high sensitivity and specificity.

Nasalization Amplitude-Timing Characteristics of Speakers With and Without Cleft Palate

2017 ◽  
Vol 55 (1) ◽  
pp. 45-56 ◽  
Author(s):  
Youkyung Bae
Keyword(s):  
Cleft Palate ◽  
Model Fit ◽  
Temporal Domain ◽  
Temporal Relationships ◽  
Practical Guidelines ◽  
Rate Controlled ◽  
The Mean ◽  
Nasal Consonant ◽  
Accuracy Rates ◽  
Nasal Resonance

Objectives: To examine the amplitude-temporal relationships of acoustic nasalization in speakers with a range of nasality and to determine the extent to which each domain independently predicts the speaker’s perceived oral-nasal balance. Design: Rate-controlled speech samples, consisting of /izinizi/, /azanaza/, and /uzunuzu/, were recorded from 18 participants (14 with repaired cleft palate and 4 without cleft palate) using the Nasometer. The mean nasalance of the entire mid-vowel–nasal consonant–vowel (mid-VNV) sequence (amplitude-domain) and the duration of the nasalized segment of the mid-VNV sequence (temporal-domain) were obtained based on nasalance contours. Results: Strong linear and vowel-dependent relationships were observed between the 2 domains of nasalization (adjusted R2 = 71.5%). Both the amplitude- and temporal-domain measures were found to reliably predict the speaker’s perceived oral-nasal balance, with better overall model fit and higher classification accuracy rates observed in /izinizi/ and /uzunuzu/ than in /azanaza/. Despite poor specificity, the temporal-domain measure of /azanaza/ was found to have a strong correlation with the participants’ Zoo passage nasalance scores ( rs = .897, p < .01), suggesting its potential utility as a severity indicator of perceived nasality. Conclusions: With the use of relatively simple speech tasks and measurements representing the amplitude and temporal domains of nasalization, the present study provided practical guidelines for using the Nasometer in assessing patients with oral-nasal resonance imbalance. Findings suggest that both domain measures of nasalization should be examined across different vowel contexts, given that each domain may provide clinically relevant, yet different, information.

scholarly journals An Exploratory Study of Speech and Language Therapy Intervention for Children Born With Cleft Palate ± Lip

2020 ◽  
pp. 105566562095473
Author(s):  
Caroline Williams ◽  
Sam Harding ◽  
Yvonne Wren
Keyword(s):  
Decision Making ◽  
United Kingdom ◽  
Service Delivery ◽  
Cleft Palate ◽  
Speech And Language ◽  
Language Therapy ◽  
Speech And Language Therapy ◽  
Service Delivery Models ◽  
The United Kingdom ◽  
Delivery Models

Introduction: Children born with a cleft palate ± lip are at risk of developing speech and language difficulties, which may require intervention from a speech and language therapist (SLT). To date, there is no strong evidence to support one approach to intervention over another, neither is it clear which approaches or methods of provision are commonly used. Objectives: To describe the range of speech and language therapy interventions being used with children born with cleft palate in the United Kingdom up to 5 years of age. To explore the different ways, interventions are being delivered. Design: A prospective study to conduct 9 semi-structured focus groups. Iterative content analysis was completed. Setting: Regional Cleft Lip and Palate Centers in the United Kingdom. Participants: Sixty-two speech and language therapy professionals from specialist cleft teams and community services. Results: Four main codes were identified: “intervention approaches,” “service delivery models,” “decision-making and rationale,” and “patient-centered care.” Participants frequently discussed how they adopt an eclectic style when delivering intervention, the importance of an individualized approach for each child and service delivery constraints, such as a lack of resources. Conclusion: Insight into the multitude of intervention approaches used by SLTs, aspects which influence their decision-making and the variability of service delivery models were gained. Uncertainty regarding which intervention approaches and methods for delivery are most effective provides rationale for future research, to improve the effectiveness of speech and language intervention for children with cleft palate ± lip.

scholarly journals The Nature of Nasal Fricatives: Articulatory-Perceptual Characteristics and Etiologic Considerations

2015 ◽  
Vol 25 (1) ◽  
pp. 17-28 ◽  
Author(s):  
David J. Zajac
Keyword(s):  
Oral Cavity ◽  
Cleft Palate ◽  
Theoretical Framework ◽  
Nasal Airflow ◽  
Turbulent Airflow ◽  
Perceptual Characteristics

Nasal fricatives (NFs) are unusual, maladaptive articulations used by children both with and without palatal anomalies to replace oral fricatives. Nasal fricatives vary in articulatory, aerodynamic, and acoustic-perceptual characteristics with two generally distinct types recognized. One type is produced with velopharyngeal (VP) constriction that results in turbulent nasal airflow and, frequently, tissue vibration (flutter) at the VP port. Trost (1981) described these as posterior NFs that have a distinctive snorting quality. A second type of NF is produced without significant VP constriction resulting in turbulent airflow generated at the anterior liminal valve of the nose. Of importance, both types are “active” alternative articulations in that the speaker occludes the oral cavity to direct all airflow through the nose (Harding & Grunwell, 1998). It is this oral gesture that differentiates NFs from obligatory (or passive) nasal air escape that may sound similar due to incomplete VP closure. The purpose of this article is to (1) describe the articulatory, aerodynamic, and acoustic-perceptual nature of NFs, and (2) propose a theoretical framework for the acquisition of NFs by children both with and without cleft palate.

The Management of Otitis Media with Early Routine Insertion of Grommets in Children with Cleft Palate—A Systematic Review

2009 ◽  
Vol 46 (1) ◽  
pp. 30-38 ◽  
Author(s):  
Sirisha Ponduri ◽  
Rebecca Bradley ◽  
Pamela E. Ellis ◽  
Sara T. Brookes ◽  
Jonathan R. Sandy ◽  
...  
Keyword(s):  
Systematic Review ◽  
Language Development ◽  
Cleft Palate ◽  
Cohort Studies ◽  
Outcome Measures ◽  
Case Series ◽  
Secondary Outcome ◽  
Speech And Language ◽  
Historical Cohort ◽  
Speech And Language Development

Objective: To determine whether early routine grommet insertion in children with cleft palate has a beneficial effect on hearing and speech and language development compared with conservative management. Design: Systematic review of randomized controlled trials, controlled clinical trials, case series, and prospective and historical cohort studies. Main Outcome Measures: The main outcome measure was the effect of early routine grommet placement on the degree of conductive hearing loss. Secondary outcome measures included differences in hearing level, possible side effects, speech and language development, and quality of life. Results: We identified 368 citations for review. From a review of the titles, 34 potentially relevant papers were selected. Of these, 18 studies met our inclusion criteria, including eight case series, six historical cohort studies, three prospective cohort studies, and one randomized trial. Most studies were either small or of poor quality or both. The results of the studies were contradictory, with some studies suggesting early placement of grommets was beneficial and others reporting there was no benefit. Conclusions: There is currently insufficient evidence on which to base the clinical practice of early routine grommet placement in children with cleft palate.

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