Misarticulation caused by abnormal lingual-palatal contact in patients with cleft palate with adequate velopharyngeal function

An Ultrasound Investigation of Tongue Dorsum Raising in Children with Cleft Palate +/- Cleft Lip

OBJECTIVE

This study aimed to determine whether increased raising of the back of the tongue is evident in children with repaired cleft palate with or without cleft lip (CP+/-CL). We hypothesized that children with CP+/-CL would show increased raising of the tongue dorsum, a compensatory pattern.

METHOD

Secondary data analysis of mid-sagittal ultrasound tongue imaging data from 31 children with CP+/-CL and 29 typically developing children were used. We annotated the consonants /ʃ, t, s, k/ at the point of maximum constriction in an /aCa/ environment. Children with CP+/-CL said the tokens 10 times, typically developing children said them once. We automatically fitted splines to the tongue contour and extracted the Dorsum Excursion Index (DEI) for each consonant. This metric measures the relative use of the tongue dorsum, with more posterior consonants having higher values. We compared DEI values across groups and consonants using a linear mixed effects model. DEI was predicted by the interaction of consonant (baseline: /ʃ/) and speaker type (baseline: TD), including by-speaker random slopes for consonant and random intercepts for speaker.

RESULTS

Overall DEI was not higher in children with CP+/-CL compared to typically developing children. Between groups the only significant difference was the position of /k/ relative to /ʃ/, where the difference between these two consonants was smaller in the children with CP+/-CL.

CONCLUSIONS

There was no support for the hypothesis that increased raising of the tongue dorsum is a common characteristic in children with repaired CP+/-CL. However, individual children may present with this pattern.

Feasibility of using ultrasound visual biofeedback to treat persistent speech sound disorders in children with cleft palate- a case series

The current study aimed to assess the effectiveness of incorporating ultrasound visual biofeedback (UVB) into a treatment programme addressing persistent speech sound disorders linked to cleft palate in children who have been unresponsive to traditional therapy approaches. Materials and Methods. A single-subject multiple baseline experiment was conducted with five children aged 6:5-13:5 over a period of 16 therapy sessions. Treatment focused on providing cues from real-time ultrasound images to assist children in modifying their tongue movements. Probe data were collected before, mid, and post-treatment to assess target consonant accuracy for 50 untreated words. The results of the statistical analysis suggested participants showed a significant increase in percent target consonant accuracy as a result of intervention using UVB. Although most of the participants exhibited progress in generalising learned phonemes to untreated words, some did not show improvement in gaining generalisation from treated phonemic contexts to those untreated ones. When traditional methods fail to yield significant progress, incorporating ultrasound biofeedback into the treatment programme emerges as a viable option to enhance sound accuracy in children with persistent speech sound disorders resulting from cleft palate.

The Relationship Between Maxillary Growth and Speech in Children With a Unilateral Cleft Lip and Palate at 5 Years of Age

OBJECTIVE

This study sought to investigate the association between maxillary growth and speech outcomes for children with a repaired unilateral cleft lip and palate (UCLP) at 5 years of age.

PARTICIPANTS

In all, 521 children (180 females and 341 males) with a nonsyndromic complete UCLP, born between 2007 and 2012 in England, Wales, and Northern Ireland were included in this study.

OUTCOME MEASURES

Maxillary growth was analyzed using dental models scored by the 5-Year-Olds' index, and perceptual speech analyses were scored by the Cleft Audit Protocol for Speech - Augmented rating.

RESULTS

Forty-one percent of the children achieved good maxillary growth (scores 1 and 2 on 5-Year-Old' index). Fifty percent of the children achieved normal speech (achieving UK speech standard 1). Maxillary growth was not found to have an impact on speech outcome when described by the 3 UK National Cleft Lip and Palate Speech Audit Outcome Standards. Analysis according to individual speech parameters showed dentalizations to be less prevalent in children with good maxillary growth compared to fair and poor growth (P = .001). The remaining speech parameters within resonance, nasal airflow, and articulation categories were not significantly associated with maxillary growth.

CONCLUSION

The findings from this study suggest that children with a history of complete UCLP, who have poor maxillary growth, are not at a higher risk of having major speech errors compared to children with good or fair maxillary growth at 5 years of age.

Application of the International Classification of Functioning, Disability, and Health–Children and Youth Version (ICF-CY) to Cleft Lip and Palate

Objective

In recent health policy discussions, the World Health Organization has urged member states to implement the International Classification of Functioning, Disability, and Health: Children and Youth Version in their clinical practice and research. The purpose of this study was to identify codes from the International Classification of Functioning, Disability, and Health: Children and Youth Version relevant for use among children with cleft lip and/or palate, thereby highlighting the potential value of these codes for interprofessional cleft palate-craniofacial teams.

Design

The scope of recent published research in the area of cleft lip and/or palate was reviewed and compared with meaningful terms identified from the International Classification of Functioning, Disability, and Health: Children and Youth Version. In a five-step procedure, a consensus-based list of terms was developed that was linked separately to International Classification of Functioning, Disability, and Health: Children and Youth Version categories and codes. This provided a first draft of a core set for use in the cleft lip and/or palate field.

Conclusions

Adopting International Classification of Functioning, Disability, and Health: Children and Youth Version domains in cleft lip and/or palate may aid experts in identifying appropriate starting points for assessment, counseling, and therapy. When used as a clinical tool, it encourages health care professionals to go beyond treatment and outcome perspectives that are focused solely on the child and to include the children's environment and their familial/societal context. In order to establish improved, evidence-based interdisciplinary treatments for children with cleft lip and/or palate, more studies are needed that seek to identify all the influencing conditions of activities, children's participation, and barriers/facilitators in their environments.

Perception of Cleft Palate Speech by Japanese Listeners-an Assessment of Palatalized Articulations

To examine how people react to palatalized articulation, we used one cleft palate speech (CPS) sample of palatalized articulation that was purchased in Japan and one recorded sample of speech from a non-cleft palate individual. Study design The two speech samples were rated by 137 native listeners. Each participant rated the set of speech samples for 10 features using a 10-point scale. Alpha factor analysis was performed. Results Two factors were extracted from the entire set of features with alpha factor analysis. Conclusions Although native listeners could not distinguish between CPS and non-CPS using the psychometrical measurements applied in this study, this method of analyzing speech represents a useful technique for planning treatments in cleft disorder patients.

Tongue-Palate Contact during Selected Vowels in Normal Speech

Objective

Previous research using electropalatography has revealed that high vowels are vulnerable to articulation errors in cleft palate speech. The error involves complete tongue-palate contact, which obstructs normal airflow through the mouth and increases nasal airflow. This study used electropalatography to provide a more detailed description of typical tongue-palate contact for high vowels than currently exists.

Design

Electropalatography and acoustic data were recorded for multiple repetitions of monophthongs /i/, /u/, and /a/ and diphthongs /ai/, /oi/, and /au/.

Participants

Ten typical English-speaking adults.

Measures

Two measures were taken from electropalatography data during vowels; one identified electropalatography patterns with complete tongue-palate contact and a second calculated percentage of contact at five time points.

Results

None of the vowels had electropalatography patterns with complete tongue-palate contact. The amount of contact varied for the different vowels at the five time points throughout the vowels and also between speakers. When contact occurred, it was located in the posterior, lateral regions of the palate, forming a central groove that was free of contact.

Conclusion

Complete tongue-palate contact during vowels is not a feature of typical English speech and can be considered an error pattern. The normative date provided in this study will be useful to speech-language pathologists who use electropalatography in their clinical work. The implications of the findings are discussed in relation to the assessment of vowels in cleft palate speech.

The influence of speaking rate on nasality in the speech of hearing-impaired individuals

PURPOSE

The purpose of this study was to determine whether deliberate increases in speaking rate would serve to decrease the amount of nasality in the speech of severely hearing-impaired individuals.

METHOD

The participants were 11 severely to profoundly hearing-impaired students, ranging in age from 12 to 19 years (M = 16 years). Each participant provided a baseline speech sample (R1) followed by 3 training sessions during which participants were trained to increase their speaking rate. Following the training sessions, a second speech sample was obtained (R2). Acoustic and perceptual analyses of the speech samples obtained at R1 and R2 were undertaken. The acoustic analysis focused on changes in first (F(1)) and second (F(2)) formant frequency and formant bandwidths. The perceptual analysis involved listener ratings of the speech samples (at R1 and R2) for perceived nasality.

RESULTS

Findings indicated a significant increase in speaking rate at R2. In addition, significantly narrower F(2) bandwidth and lower perceptual rating scores of nasality were obtained at R2 across all participants, suggesting a decrease in nasality as speaking rate increases.

CONCLUSION

The nasality demonstrated by hearing-impaired individuals is amenable to change when speaking rate is increased. The influences of speaking rate changes on the perception and production of nasality in hearing-impaired individuals are discussed.

Immediate and sustained changes in tongue movement with an experimental palatal "fistula": a case study

OBJECTIVE

To determine the immediate and longer-term effect(s) on tongue movement following the placement of an experimental opening through a palatal obturator (replicate of subject's prosthesis) worn by an adult male with an unrepaired cleft of the hard and soft palate.

METHODS

Tongue movements associated with an anterior experimental opening of 20 mm(2) were examined under three conditions: a control condition in which the subject wore the experimental obturator completely occluded, a condition immediately after drilling the experimental openings through the obturator, and a condition after 5 days in which the subject wore the experimental obturator with the experimental opening. An Electromagnetic Articulograph was used for obtaining tongue movements during speech.

RESULTS

The findings partly revealed that the immediate introduction of a perturbation to the speech system (experimental fistula) had a temporary effect on tongue movement. After sustained perturbation (for 5 days), the system normalized (going back toward control condition's behavior). Perceptual data were consistent with kinematic tongue movement direction in most of the cases.

CONCLUSIONS

Although the immediate response can be interpreted as indicative of the subject's attempts to move the tongue toward the opening to compensate for air loss, the findings following a sustained perturbation indicate that with time, other physiological adjustments (such as respiratory adjustments, for example) may help reestablish the requirements of a pressure-regulating system.

Labial-lingual double articulations in speakers with cleft palate

OBJECTIVE

Labial-lingual double articulations (LLDAs) are speech errors involving simultaneous valving at the lips and in the linguapalatal region. This study investigates the frequency of LLDAs occurring for /p/, /b/, and /m/ targets and describes the linguapalatal contact patterns involved in these abnormal articulations.

DESIGN

A retrospective study involving analysis of articulatory data from all speakers with cleft palate recorded at a research center over a 10-year period.

PARTICIPANTS

Twenty-seven speakers aged 5 to 62 years (median 11 years) with compensatory speech errors associated with repaired cleft palate.

MEASURES

The lingual component of LLDAs was identified using electropalatography (EPG). EPG data were recorded simultaneously with acoustic data. Fifteen bilabial targets (/p/, /b/, /m/) per participant were analyzed. LLDAs were identified in cases where complete linguapalatal constriction (as observed from EPG data) occurred throughout the closure phase of bilabial targets. The labial component of LLDAs was identified from clinical observations of the speakers made during productions of bilabial targets.

RESULTS

Three speakers (11%) frequently produced LLDAs for bilabial targets. The configuration of tongue-palate contacts involved in the lingual component of the LLDAs differed in each of the three speakers: one speaker had velar constriction, another had alveolar constriction, and the third had simultaneous alveolar-velar constriction. LLDAs did not similarly affect bilabial targets in the three speakers. One speaker produced LLDAs for /p/ and /b/ targets only. Another produced LLDAs for all /m/ targets but inconsistently for /p/ and /b/ targets. The third speaker produced LLDAs for all /b/ targets but inconsistently for /p/ and /m/ targets.

CONCLUSION

LLDAs occurred in a minority of speakers investigated. Nevertheless, it is argued that it is important to identify LLDAs for clinical decision making and for research purposes. The results from this study add to current knowledge about abnormal articulations in cleft palate speech, but further research is needed into the precise timing of lip and tongue-palate closures and into the airflow and acoustic characteristics of LLDAs.

An electropalatographic investigation of middorsum palatal stops in an adult with repaired cleft palate

OBJECTIVE

Middorsum palatal stops are compensatory articulations that occur relatively frequently in cleft palate speech. This study used electropalatographic (EPG) and acoustic data to investigate /t/ and /k/ targets produced as middorsum palatal stops ([c]) by an adult with an articulation disorder associated with a repaired cleft palate.

RESULTS

Two novel observations were made from the instrumental data. First, although /t/ and /k/ targets were judged by phonetically trained listeners as homophonous (i.e., both produced as [c]), the EPG data revealed that the place of articulation for the [c] produced for /t/ was more anterior than the place of articulation for the [c] produced for /k/. Second, production of palatal stops involved lateral release followed by a variable period of lateral friction. Measurements made from the instrumental data quantified the temporal extent of lateral friction during the aspiration period.

CONCLUSIONS

These observations merit further systematic investigation in cleft palate speech, and the procedures reported in this study are considered appropriate for such future research.

Relationship between the lingual-palatal contact duration associated with swallowing and maxillofacial morphology with the use of electropalatography

To investigate the relationship between movement of the tongue during swallowing and malocclusion, the relationship between the lingual-palatal contact duration associated with swallowing and maxillofacial morphology was examined by electropalatography, cephalometric radiography, and dental casts. Seventy-one subjects (35 men and 36 women, 18 to 38 years of age) with normal occlusion or various types of malocclusion were used. Simple correlation analysis showed correlations between the time required for swallowing and the angles-FH-U1, L6-MP, FH-MP and Go-measured by lateral cephalometric radiography. In multiple regression analysis, five angles-FH-U1, L6-MP, FH-Occ, FH-SGna and NF-MP-measured by lateral cephalometric radiography were chosen as the independent variables, and significant regression equations and multiple correlation coefficient were obtained. It was concluded that the lingual-palatal contact duration associated with swallowing observed by electropalatography differs among persons; this is closely related to the maxillofacial morphology and significantly correlated with the measurement items representing the rotation of the lower jaw and inclination of upper incisors.

Electropalatography treatment in an adult with late repair of cleft palate

This paper describes the use of electropalatography (EPG) in the treatment of a speech disorder in a Cantonese-speaking woman who had primary repair of the palate at age 13. A multiple-baseline approach was used to document treatment efficacy using electropalatography. The client showed rapid improvement in articulatory placement, with generalization to nontarget phonemes. In addition, improvement was noted in her manner of articulation, with a reduction of nasal emission. The relationship between articulatory placement errors and nasal emission in late repair cleft is discussed. Explanations for the effectiveness of EPG with this client are offered.

Role of visual feedback treatment for defective /s/ sounds in patients with cleft palate

The role of visual feedback in the treatment of defective /s/ sounds in patients with cleft palate is described. Six patients with cleft palate who were similar in age, velopharyngeal function, and type of misarticulation were selected for this study. Treatment was provided using either visual feedback or no visual feedback. Visual feedback for tongue placement was provided by the Rion Electropalatograph (EPG). Visual feedback for frication was provided by a multi-function speech training aid (MFSTA). Improvement in /s/ sound production was assessed objectively using a method described previously (Michi et al., 1986). The results indicated that visual feedback for tongue placement and frication was especially useful in the treatment of defective /s/ sounds in patients with cleft palate who exhibited abnormal posterior tongue posturing during the production of dental or alveolar sounds.