Long-lasting speech and oral-motor deficiencies following oral cancer surgery: a retrospective study

Rehabilitation of speech disorders following glossectomy, based on ultrasound visual illustration and feedback

Intraoral surgery for tongue cancer usually induces speech disorders that have a negative impact on communication and quality of life. Studies have documented the benefit of tongue ultrasound imaging as a visual articulatory feedback for speech rehabilitation. This study aims to assess specifically the complementary contribution of visual feedback to visual illustration (i.e. the display of ultrasound video of target language movements) for the speech rehabilitation of glossectomised patients. Two therapy conditions were used alternately for ten glossectomised French patients randomly divided into two cohorts. The IF cohort benefitted from 10 sessions using illustration alone (IL condition) followed by 10 sessions using illustration supplemented by visual feedback (IL+F condition). The FI cohort followed the opposite protocol, i.e. the first 10 sessions with the IL+F condition, followed by 10 sessions with the IL condition. Phonetic accuracy (Percent Consonants Correct) was monitored at baseline (T0, before the first series) and after each series (T1 and T2) using clinical speech-language assessments. None of the contrasts computed between the two conditions, using logistic regression with random effects models, were found to be statistically significant for the group analysis of assessment scores. Results were significant for a few individuals, with balanced advantages in both conditions. In conclusion, the use of articulatory visual feedback does not seem to bring a decisive advantage over the use of visual illustration, though speech therapists and patients reported that ultrasound feedback was useful at the beginning. This result should be confirmed by similar studies involving other types of speech disorders.

Study of tongue-palate pressure patterns during the hold phase in the production of French denti-alveolar and velar stops

The hold phase of the stop consonants is crucial for a successful production of the release and the acoustic burst. Concurrently, it is also associated with weak acoustic energy and minimal movement, so that conventional acoustic and kinematic approaches are not relevant to investigate motor control. This paper presents an innovative experimental method to study speech motor control during this phase, based on meticulous measurement of the time variation of the mechanical pressure exerted by the tongue against the palate and also characterizing tongue-palate interaction. The concept is based on using miniature transducers with enhanced response characteristics inserted in different locations of the complete denture of edentulous subjects without perturbing the articulation. The study was done with a French-speaking adult whose maxillary denture was duplicated and mounted with six strain gauge transducers. The experiment was done with denti-alveolar and velar stop consonants with two vowel contexts. The results illustrate the potential of such device to analyse speech motor control when contact constrains tongue movements.

Speech production after glossectomy: methodological aspects

This article focuses on methodological issues related to quantitative assessments of speech quality after glossectomy. Acoustic and articulatory data were collected for 8 consonants from two patients. The acoustic analysis is based on spectral moments and the Klatt VOT. Lingual movements are recorded with ultrasound without calibration. The variations of acoustic and articulatory parameters across pre- and post-surgery conditions are analyzed in the light of perceptual evaluations of the stimuli. A parameter is considered to be relevant if its variation is congruent with perceptual ratings. The most relevant acoustic parameters are the skewness and the Center of Gravity. The Klatt VOT explains differences that could not be explained by spectral parameters. The SNTS ultrasound parameter provides information to describe impairments not accounted for by acoustical parameters. These results suggest that the combination of articulatory, perceptual and acoustic data provides comprehensive complementary information for a quantitative assessment of speech after glossectomy.

Speech after radial forearm free flap reconstruction of the tongue: a longitudinal acoustic study of vowel and diphthong sounds

The purpose of this study was to use acoustic analyses to describe speech outcomes over the course of 1 year after radial forearm free flap (RFFF) reconstruction of the tongue. Eighteen Canadian English-speaking females and males with reconstruction for oral cancer had speech samples recorded (pre-operative, and 1 month, 6 months, and 1 year post-operative). Acoustic characteristics of formants (F1, F2), fundamental frequency (F0), and duration of 699 vowel and diphthong tokens were analysed. Furthermore, the changes in size of the vowel space area were studied, as well as the effects of radiation therapy (RT) and inclusion of the floor of the mouth (FOM) in the reconstruction. RFFF reconstruction was found to affect several characteristics in males, and a minimal number of variables in females. General signs of reduced ability to articulate were not observed. RT and FOM had no differing effects compared to non-RT or non-FOM. There were individual differences between patients.

Increased midsagittal tongue velocity as indication of articulatory compensation in patients with lateral partial glossectomies

BACKGROUND

The purpose of this study was to describe the impact of partial lateral glossectomy on midsagittal tongue movement during speech.

METHODS

Using B-mode ultrasound, the midsagittal tongue movement of 10 patients with lateral partial glossectomy during a standardized reading passage was analyzed before and after surgery. Six normal adults served as control speakers. The main outcome measure was the tongue velocity during speech. The technique of defect reconstruction (local vs flap) was included as a covariate in the analysis.

RESULTS

Following the surgery, all patients significantly increased the velocity of the midsagittal tongue movements during the reading passage.

CONCLUSION

The results demonstrated that the patients with partial glossectomy compensated for the lateral tongue resections by increasing the velocity of the residual tongue during speech. The study provides first insights into the biomechanical aspects of spontaneous articulatory compensation following lateral tongue resections.