Nasalance and nasality at experimental velopharyngeal openings in palatal prosthesis: a case study

Influence of speech aid prosthesis with speech therapy on speech outcomes in adult patients with persisting velopharyngeal insufficiency: A retrospective analysis

STATEMENT OF PROBLEM

Prosthetic intervention with a speech aid prosthesis (SAP) along with speech therapy has been reported to improve speech outcomes in patients with persisting velopharyngeal insufficiency (VPI). However, little is known regarding the impact of this treatment on different speech parameters over time in adult patients with VPI.

PURPOSE

The purpose of this retrospective study was to evaluate the change in speech parameters after rehabilitation with an SAP and speech therapy in adult patients with VPI using subjective and objective tests.

MATERIAL AND METHODS

Patients above 16 years of age who had received prosthetic treatment for VPI and had complete speech assessment records between 2017 and 2020 were included in the analysis. After completion of the prosthetic treatment, speech therapy comprising 2 sessions per week of 45 minutes was provided by a speech pathologist. Speech evaluation was performed using tests that included speech intelligibility calculation, nasal pinch test, audible nasal air emissions, acoustic analysis, and the nasalance check. Assessments were done at 4 time intervals: T0: without an SAP; T1: 1 week with an SAP; T2: 1 month with an SAP; and T3: 3 months with an SAP. A descriptive analysis was followed by a comparison between groups using the Friedman test for subjective assessments and repeated measures ANOVA for objective tests (α=.05).

RESULTS

Of 10 individuals who had received an SAP, 5 participants, 2 men and 3 women with a mean age of 38 years were included in the analysis. Statistically significant improvement in mean scores was observed from T0 to T3 concerning speech intelligibility (P<.001), hypernasality (P<.001), audible nasal air emission (P<.001), mean fundamental frequency (P=.034), shimmer percentage (P=.004), and nasalance (P=.004). Improvement in jitter percentage was not statistically significant (P=.218).

CONCLUSIONS

An SAP along with speech therapy should be considered as a conservative and effective treatment option for addressing speech issues in adult patients with VPI.

Passavant's ridge during speech production with and without pharyngeal bulb

The objective of this study was to investigate the occurrence of Passavant's ridge in patients with history of cleft palate presenting with velopharyngeal insufficiency (VPI) after primary palatal surgery. Twenty-five adult patients (mean age of 32 years), who wore a pharyngeal bulb prosthesis to correct VPI after primary palatoplasty participated in the study. Presence of Passavant's ridge was investigated in four conditions: prior to pharyngeal bulb for treatment of VPI (C1); during the molding of the pharyngeal bulb (C2); six months after the use of the pharyngeal bulb, but with the prosthesis removed (C3), and six months after the use of the pharyngeal bulb, but with the prosthesis in place (C4). Images of nasoendoscopic assessment of velopharyngeal function were obtained under all conditions were analyzed by speech-pathologists to identify the occurrence of Passavant's ridge during speech production. The results revealed a significant difference between molding condition (C2: 40%) and six months of bulb use (C4: 68%) (p = 0.028). The pharyngeal bulb may elicit the Passavant`s ridge in patients with history of cleft palate presenting with VPI.

Outcomes of Palatal Lift Prosthesis on Dysarthric Speech

PURPOSE

This study was designed to investigate the effect of palatal lift prosthesis (PLP) on the speech of individuals with different types of dysarthria.

PARTICIPANTS

Thirty (19 males and 11 females) native speakers of Jordanian Arabic with dysarthria participated in the study. The age of the participants ranged from 8 to 67 years with an average of 34.1 years. Traumatic brain injury was the most common etiology of dysarthria among 12 participants, stroke among 11, multiple sclerosis among 3, and pseudobulbar palsy among 2; 1 participant had Parkinson disease, and another participant had amyotrophic lateral sclerosis.

METHODS

Five acoustic and aerodynamic measures were evaluated to determine the speech outcomes including nasalance scores, sequential motion rate, speech rate, vital capacity, and sound pressure level. The acoustic measures were obtained from the participants in PLP-out and PLP-in conditions.

RESULTS

Results showed statistically significant decrease in the nasalance scores of the syllable repetition, vowel prolongation, and sentence repetition tasks in the PLP-in condition below the 28% cutoff score. Furthermore, results revealed statistically significant increase in sequential motion rate, speech rate, vital capacity, and sound pressure level (P = 0.000).

CONCLUSION

The use of PLP is an effective treatment option of dysarthric speech. Besides nasalance scores, the sequential motion rate, speech rate, vital capacity, and sound pressure level are considered reliable speech measures that may be used to evaluate the effect of PLP on dysarthria.

Can osteopathic manipulative treatment modify the posture in elderly people? - a single-case study

In this research, we have studied the consequences of three consecutive osteopathic manipulative sessions (OMS) on postural control by using a single-case research (SCR) design. The patient was a 77 years old woman complaining of altered balance and low-back pain. OMS were delivered by a single practitioner. The pain level was self-rated by using a visual Borg scale. The posture was monitored on a force platform. Postural parameters were deduced from the analysis of the centre of foot pressure (CoP) displacement. The statistical significance of the observed differences was established by using an SCR-related effect size indicator (i.e. Taunovlap). Our results indicate that OMS decrease the patient's pain, modify CoP mean position and decreased the length and velocity of the CoP displacement. Furthermore, modifications of the body oscillations were observed after OMS. This work indicates that OMS can improve body balance and that SCR allows the objective evaluation of the consequences of OMS.