Final Flashcards
Single Word intelligibility test
% words correct (by listener) is severity indicator/explanatory power (w/ phonetic contrast analysis); reliability: Zajac 6-12 words/50 word set; Computer Mediated Speech Assessment System: + reliability (.92-.95) found CL/P group 67% intelligible (peer 85%)
Phonetic contrast findings for intelligibility CLP
78% (control 93%); their error: alveolar (velar stops, palatal fricatives), fricative (affricative), liquid (glide w)
Causes of VPI
Cleft palate/SMCP (20% post surgery); congenital short palate/deep pharynx; mechanical obstruction (tonsils, adenoids, posterior pillar web); Ablative palatal lesions (cancer, trauma); Neuromotor (dysarthria); Motor Planning (Apraxia); Sensorineural hearing loss; maxillary advancement
VPI terms (VPI, insufficiency, incompetency)
inability to separate oral and nasal cavities during speech; lack of tissue; neuromuscular)
Obligatory Speech Characteristics
active; usually w/ LARGE VP gap; nasalized plosives, hyper nasal, reduced loudness, nasal air emission (especially voiceless stops), weak oral pressure (Po reduced)
Compensatory speech characteristics
learning; compensate for VPI/other structural anomaly; PLACE changed to preserve MANNER of artic; pharyngeal fricative and glottal stop (comp for VPI valve), mid dorsum palatal stop (comp for palatal anomaly such as ONF, teeth, arch); 25-30% children w/ CLP, more prevalent in bilateral CLP
Speech characteristics of VPI
hypernasalisty, audible nasal air emission (esp voiceless consonants), weak pressure consonants, compensatory articulators
Cul-de-sac resonance
pharyngeal cavity; due to obstruction (e.g., large tonsils, small jaw & glossoptosis, VPI & anterior nasal blockage)
Hypernasality
excessive nasal resonance that affects VOWELS and VOICED consonants
Nasal cavity air mass can resonate due to
direct coupling via VP gap; sympathetic coupling via structures (e.g., vibrating velum)
Denasality
total nasal airway obstruction
Hyponasality
reduced nasal resonance on NASAL CONSONANTS and VOWELS; obstruction in nasal cavity/nasopharynx; “head cold” sound
Mixed resonance
hyper & hypo w/in same utterance; often w/ pharyngeal flaps
Vowel type & perceived nasality
low vowels more nasal than high vowels for non-cleft; high vowels (ee, i, oo, uh) more nasal than low vowels (a, aye) for cleft (High vowels have greater velar height)
Hypernasal perceptual judgment scales: Equal Appearing Interval (EAI)
equal interval squares
Hypernasal perceptual judgment scales: Direct Magnitude Estimation (DME)
Judment relative to “modulus” w/ has assigned (arbitrary) value; ratio judgment relative to modulus
Prothetic stimuli
changes in QUANTITY or MAGNITUDE; eg, loudness; DME scales better (If DME and EAI scales are NON-LINEAR, stimulus is prothetic)
Metathetic
stimuli changes in QUALITY; SUBSTITUTIVE can use EAI or DME
Hyper nasality may be ______ in nature, so _____ scale is best
Prothetic; DME
Nasal Air Emission determined by
Respiratory effort (Po); size VP gap; potency of nasal cavity (snot)
Nasal Air Emission detection
visible (mirror–> VP gap, ONF); audible (forced exhalation on plosives); turbulent (nasal rustle due to small VP gap plosives/sibilants)
Kummer theory: Nasal Air Emission
Nasal rustle (turbulence) caused by airflow through small VP gap resulting in bubbling of secretions
Zajac theory: Nasal Air Emission
velar flutter caused by vibration of velar/pharyngeal tissue accompanied by turbulent airflow (maybe secretions too)
Types of compensatory misarticulations
MANNER maintained, PLACE is POSTERIOR; glottal stop for /b/, pharyngeal stop for /k, g/, pharyngeal fricative for sibilant, affricates (e.g. /s/), mid-dorsum palatal stop for /t, k/; velar fricative for sibilant fricatives (s, z, sh, zh); posterior nasal (VP) fricative w/ audible NAE; nasal fricative- nasal snort, voiceless nasal consonant for oral stop
Cause of compensatory misarticulations
early phonetic development before surgery, tx: surgery before onset of meaningful speech
Dental/alveolar anomalies cause of mid-dorsum stops b/c
CPO kids show only glottal stops; CLP kids glottal stops, mid-dorsum, pharyngeal fricative & stops
Other unusual articulations in children w/ CLP
clicks, sibilants on inhalation, nasal grimace
Articulation error patterns in CP
omissions & substitutions most frequent; fricative/affricate (s most common) > plosives . gildes; frequent /l, r/ errors (maxillary/palatal anomalies; voiceless > voiced (higher pressure, VPI leads to voicing)
CP changes vowel production
extra nasal formant below F1, extra formants above F1, increased frequency F1; Reduced amplitude and frequency of F2; increased formant bandwidths
Tonge position changes in CLP
HIGH and RETRACTED; increases oral impedance & nasality; reduce frequency of F1 & F2
Speaking rate & CP
adults read slower; decreased word production time REDUCED nasality (faster rate for hearing impaired individuals also decreased nasality rating, narrowed F2 bandwidths, less VP contact @ slow rate, decreased compliance of vocal tract walls –> narrower bandwidths
Developmental factors on nasality in young children w/ CLP
INCREASED nasality due to longer vowel duration, and INCREASED ANE due to longer consonant durations, higher oral pressure, smaller nasopharyngeal cavity; possible REDUCTION in symptoms w/ age
Voice disorders in CP
high prevalence- perceptual, vocal fold nodules; “Soft Voice Syndrome” to disguise nasality?; laryngeal hyper functioning due to strategy to increase effort/close VP, ST?;
Stuttering in CP
low prevalence; delay linguistic maturity, accepting parents, aerodynamic of vocal tract???
Clinical Assessment of VPI
GLOBAL judgment of resonance (hyo/hyper), Audible nasal emission, Arctic (intelligibility? developmental/dental errors, compensatory misartic), vocal quality & prosody from spontaneous speech sample (or elicited: counting, CV syllables, sentences) ; can manipulate rate or LOUDNESS; ask: child usually like this?
Nasal Emission Testing (regular (school) clinic)
mirror (con- poor time measurement); test nasal breating, CV syllable, sentences, gauge consitent? reduced/absent nasals? *Test /ki/ is anterior ONF
Nasal Emission Testing: SeeScape
Pro: good for feedback or oral airflow; Con: may encourage nasal emission
Do mirror testing _______ perceptual testing for Audible Nasal Emissions (time)
AFTER (sometimes emissions but not perceptual, don’t bias)
Clinical assessment during elicited speech samples
isolated vowels: high vowels- open vs pinched nostrils (change?- if goes to cul-de-sac, VPI; no change- adequate VP closure)
Oral Peripheral Exam for CP
Check hard palate/alveolar ridge for: ONFs, cleft, height of palatal vault, scarring; check soft palate for: length, symmetry on phonation, SMCP, LPW movement; tonsils (size, obstructing?)/adenoids; Dental occlusion/corssbites/missing or extra teeth; Tongue lips & mandible- size/sphage, ROM, strength; CN function test
Articulation testing for CP
Audio record, use standardized test, transcribed w/ diacritics; Intelligibility- global (mild, mod, severe), % from conversation, % single word (Unbiased, objective outcome measure); arctic errors may be: developmental, due to dentition, dyspraxia/dysarthria, due to VPI (obligatory, compensatory)
Assessment: Nasal Emission
visible, audible? (Audible NE vs nasal turbulence, or combo); consistent? or phoneme specific
VP function assessment
WNL: NO visible nasal emission, normal resonance; ADEQUATE: mild nasality, Visiblie, sometimes audible nasal emissions; MARGINAL: consistent Aud/Visible NE; mild-mod nasality; reduces loudness/vocal dysfunction/some compensatory errors possible; INADEQUATE: consistent visible and aud NE; mod-severe nasality; reduced Po & loudness/vocal dysfunction/compensatory and nasal substitutions likely
VP Inadequacy recommendations
instrumental assessment; surgical management; prosthetic management
VP Marginal recommendations
stimuable? resonance- rate, loudness, mouth opening manipulation; NE- contact pressure “quick & light” manipulation, feedback; Artic- stumble for anterior placements if based?
ST appropriate for children with marginal VP function IF
stimuable l for resonance/NE (CPAP?); stimuable for arctic - tx for placement (could reduce nasality, improve VP function)
How to determine status of stimuli on perceptual rating scales
linear=metathetic; curved=prothetic
Obligatory (passive) nasal emission
generated @ anterior nasal valve- hissing/turbulent sound w/ stops & fricatives, large VP gap; generated @ VP valve- raspberry/periodic sound, small VP gap
Active nasal fricatives
generated @ anterior nasal valve- hissing/turbulent sound REPLACES stops & fricatives, oral cavity occluded, large VP gap; generated @ posterior VP valve- raspberry/periodic sound, oral cavity occluded, small VP gap
Acoustic nasometry
OBJECTIVE measure of resonance called nasalance, moderately correlated w/ perceived resonance; Fletcher, 1970
Nasometer equipment
headset w/ nasal & oral mics, sound separator place; acoustic processor- bandpass filter, A/D converter, software
Acoustic nasometry
gives % NASALANCE= nasal dB/(total (oral + nasal) dB) x 100 (eg, 100% nasalance for /m/, 0% for eeee); in practice, acoustic CROSSOVER occurs
Nasometer filtering
bandwidth; 350 to 650 Hz to capture nasal formant, centered at 500Hz; poor slope of filter (24dB/octave);
Nasalance norms
zoo passage: 15%, rainbow (11% nasal): 35%; nasal sentences: 61%; vary by geographical dialect