Speech characteristics after palatal closure in subjects with isolated clefts : an exploration in Uganda

Cleft lip and/or palate (CL/P) is a congenital craniofacial defect that arises on average in 1.7 per 1000 live births. This anomaly causes atypical facial appearance, hearing problems, malocclusions and speech disorders. Outcomes in terms of speech are influenced by timing of surgical cleft closure. In the Comprehensive Rehabilitation Services in Uganda (CoRSU) hospital, closure of the entire cleft during a single surgery prior to the age of 6 months is preferred in view of reducing default rates for second surgery and decreasing risks for malnutrition and death. However, some patients arrive the first time at the hospital in later childhood, youth or adulthood. No information about satisfaction and speech outcome was yet available for these Ugandan patients. Moreover, only few, if any studies systematically assessed satisfaction and speech following similar surgical timing protocols. Therefore, in view of searching for the optimal surgical treatment for patients with CL/P, the general aim of the current doctoral thesis was to verify satisfaction and speech in Ugandan patients with CL/P repaired in CoRSU by one experienced surgeon using the Sommerlad technique for palatal closure. In view of clinics and further research, normative nasalance values were first obtained in Ugandan English-speaking males and females (age: 2;7 to 13;5 years) without craniofacial anomalies. No significant age and gender differences were observed. Second, parental satisfaction was studied in Ugandan children with unilateral or bilateral cleft lip and palate (CLP) following synchronous lip and palatal closure. Overall high levels of satisfaction were noted for appearance of lip, nose and face, despite lower satisfaction levels for teeth appearance and speech. Comparison with an age- and gender-matched non-cleft control group revealed significant higher parental dissatisfaction for speech and appearance of teeth and nose in Ugandan patients with CLP. Third, articulation and resonance characteristics of Ugandan patients with early synchronous closure of C(L)P (≤ 6 months) were assessed. Comparison with an age- and gender-matched non-cleft control group revealed various deviations from normal speech development. The Ugandan CP group showed significantly smaller consonant inventories as well as significantly more phonetic disorders, phonological processes and nasal emission/turbulence compared to the control group. In addition, Ugandan patients with C(L)P were compared to a Belgian CP group (matched for cleft type, age and gender) who underwent palatal repair after the age of 6 months. A Ugandan and Belgian age- and gender-matched non-cleft control group was included to control for language, culture and other environmental factors. Comparison of the Ugandan and Belgian CP group revealed at least similar articulation and resonance characteristics. No significant group differences were obtained for perceptual evaluation of resonance, mean nasalance values of oral speech samples, consonant inventories and most phonetic errors and phonological processes. However, the Belgian CP group showed significantly more distortions due to higher occurrence frequencies for (inter)dental articulation of apico-alveolar consonants. Finally, articulation and resonance characteristics as well as patients’ satisfaction with speech were verified in Ugandan patients following delayed one-stage soft and hard palatal closure (≥ 8 years). Comparison with an age- and gender-matched non-cleft control group revealed overall low satisfaction with speech and severely disordered articulation and resonance. The patient group showed significantly smaller consonant inventories, more phonetic and phonological disorders, more hypernasality and nasal emission/turbulence as well as higher mean nasalance values for oral and oronasal speech samples compared to the control group. When findings of the current doctoral thesis are placed within a broader framework, early closure of the entire cleft during a single surgery seems to be an appropriate surgical timing protocol for resource-poor countries. However, prior to application in northern countries, more information on maxillofacial growth disturbances is required. Furthermore, when youngsters and adults present with untreated clefts, delayed cleft repair might be of value, although speech outcomes are poor

Effectiveness of manual gesture treatment on residual /r/ articulation errors

The functional speech sound disorder, American English /r/ articulation errors, presents a unique and confounding clinical challenge as therapy resistant residual errors persist into adolescence and adulthood in many cases. Finding paucity of empirical research for /r/ treatment, evidence-based practice (EBP) exploration in motor-related disorders informed clinical practice and research directions. This study investigated the efficacy of manual mimicry (a kinesthetic, gestural, and visual cue) in treating intractable /r/ errors in a young adult using a single subject ABAB design. Perceptual accuracy judgments of three types of listeners (experts, graduate clinician, and naïve listeners) indicated a positive treatment effect of manual mimicry cueing on vocalic /r/ sound productions. Electropalatograpy (EPG) outcome measures showed limited ability to accurately reflect perceptual changes quantitatively. These findings from an exploratory study provide initial evidence that perceptual saliency of /r/ productions may be potentially remediated using a kinesthetic, gestural, and visual cue during treatment

Tutorial : Speech assessment for multilingual children who do not speak the same language(s) as the speech-language pathologist

Purpose: The aim of this tutorial is to support speech-language pathologists (SLPs) undertaking assessments of multilingual children with suspected speech sound disorders, particularly children who speak languages that are not shared with their SLP. Method: The tutorial was written by the International Expert Panel on Multilingual Children’s Speech, which comprises 46 researchers (SLPs, linguists, phoneticians, and speech scientists) who have worked in 43 countries and used 27 languages in professional practice. Seventeen panel members met for a 1-day workshop to identify key points for inclusion in the tutorial, 26 panel members contributed to writing this tutorial, and 34 members contributed to revising this tutorial online (some members contributed to more than 1 task). Results: This tutorial draws on international research evidence and professional expertise to provide a comprehensive overview of working with multilingual children with suspected speech sound disorders. This overview addresses referral, case history, assessment, analysis, diagnosis, and goal setting and the SLP’s cultural competence and preparation for working with interpreters and multicultural support workers and dealing with organizational and government barriers to and facilitators of culturally competent practice. Conclusion: The issues raised in this tutorial are applied in a hypothetical case study of an English-speaking SLP’s assessment of a multilingual Cantonese- and English-speaking 4-year-old boy. Resources are listed throughout the tutorial

The Effect of Attention to Self-Regulation of Speech Sound Productions on Speech Fluency in Oral Reading

Purpose: This study ultimately sought to test whether a condition of heightened attention to speech sound production during connected speech serves to trigger increased disfluencies. Disfluencies, or disruptions in the flow of speech, are highly variable in form and location, both within and across individuals and situations. Research to identify conditions that can predictably trigger disfluencies has the potential to provide insight into their elusive nature. A review of related literature covered the cognitive-linguistic theories related to speech fluency and stuttering. This review of previous literature also served as the foundation for why it was proposed that disfluencies would be triggered by heightened self-monitoring attention to how speech sounds are made during connected speech. Methods: Participants included 10 male and 10 female normally fluent adult college students. Their tasks included a baseline oral reading of a 330-word passage, learning of two new speech sounds, followed by an experimental reading of the same passage again. During the experimental reading, target sounds, which were indicated by highlighted locations within the passage, had to be replaced with the newly learned speech sounds. Participants indicated much greater attention was given to how speech sounds were produced during the experimental oral reading than in the baseline oral reading, to support and validate the nature of the task. Results: Disfluencies and oral reading rates were examined using descriptive statistics and analyzed by means of the negative binomial distribution model. Secondary analyses of oral reading rates were conducted with the Wilcoxon’s Signed Rank test. The results revealed that the experimental reading task was associated with a significant increase in Stuttering-Like Disfluency (SLD) and Other Disfluency (OD), and a significant decrease in oral reading rate. Furthermore, SLDs increased significantly more than ODs from the first to the second reading. Discussion: Results supported the hypothesis that disfluency, especially SLD, can be triggered by a condition of increased attention to self-monitoring how speech sounds are produced during connected speech. These findings support theories explaining disfluencies as a symptom of a speaker’s cognitive-linguistic speech planning processes being over-burdened. Implications are raised for specific populations that may be at risk-for more disfluencies: young children learning language, second-language learners, and children in speech therapy. Future research directions are recommended to better understand how to prevent disfluencies in at-risk populations and clarify the enigmatic relationship among attentional processes, phonological production planning, and stuttering

Informed Songwriting Practice For Music Therapy Treatment OF Childhood Speech Sound Disorders

Developmental speech sound disorders (SSDs) are characterized by impairment of the production of speech sounds that form words for verbal communication, either due to flawed articulatory or phonological processes. The purpose of this study was to investigate the nexus of music therapy and specific speech-language therapy interventions to treat children with speech sound disorders. Using the Neurologic Music Therapy Transformational Design Model and considerations for strategic songwriting, the researcher has developed a process for strategic songwriting in music therapy treatment of childhood SSDs. Two originally composed songs and their clinical applications are presented

Phonological complexity and language learnability

Purpose: To extend formal models of language learnability to applications in clinical treatment of children with functional phonological delays. Method: The focus of the narrative review is on phonological complexity. This follows from learnability theory, whereby complexity in the linguistic input to children has been shown to trigger language learning. Drawing from the literature, phonological complexity is defined from epistemic, ontological, and functional perspectives, with specific emphasis on the application of language universals in the selection of target sounds for treatment. Results: The cascading effects of phonological complexity on children's generalization learning are illustrated, and frequently asked questions about complexity in treatment are addressed. Conclusion: The role of complexity in cognitive development is introduced to demonstrate the apparent robustness of effects.National Institutes of Health DC00433, RR7031K, DC00076, DC001694 (PI: Gierut

An integrated theory of language production and comprehension

Currently, production and comprehension are regarded as quite distinct in accounts of language processing. In rejecting this dichotomy, we instead assert that producing and understanding are interwoven, and that this interweaving is what enables people to predict themselves and each other. We start by noting that production and comprehension are forms of action and action perception. We then consider the evidence for interweaving in action, action perception, and joint action, and explain such evidence in terms of prediction. Specifically, we assume that actors construct forward models of their actions before they execute those actions, and that perceivers of others' actions covertly imitate those actions, then construct forward models of those actions. We use these accounts of action, action perception, and joint action to develop accounts of production, comprehension, and interactive language. Importantly, they incorporate well-defined levels of linguistic representation (such as semantics, syntax, and phonology). We show (a) how speakers and comprehenders use covert imitation and forward modeling to make predictions at these levels of representation, (b) how they interweave production and comprehension processes, and (c) how they use these predictions to monitor the upcoming utterances. We show how these accounts explain a range of behavioral and neuroscientific data on language processing and discuss some of the implications of our proposal

Towards a complete multiple-mechanism account of predictive language processing [Commentary on Pickering & Garrod]

Although we agree with Pickering & Garrod (P&G) that prediction-by-simulation and prediction-by-association are important mechanisms of anticipatory language processing, this commentary suggests that they: (1) overlook other potential mechanisms that might underlie prediction in language processing, (2) overestimate the importance of prediction-by-association in early childhood, and (3) underestimate the complexity and significance of several factors that might mediate prediction during language processing

The neurocognition of developmental disorders of language

Developmental disorders of language include developmental language disorder, motor-speech disorders such as articulation disorder and stuttering, and dyslexia. These disorders have been explained by various accounts, which generally focus on their behavioral rather than neural characteristics, their processing rather than learning impairments, and each disorder separately rather than together, despite their commonalities and comorbidities. Here we update and review a unifying neurocognitive account, the Procedural circuit Deficit Hypothesis (PDH). The PDH posits that abnormalities of brain structures underlying procedural memory (learning and memory that relies on the basal ganglia and associated circuitry) can explain numerous brain and behavioral characteristics, across learning and processing, in multiple disorders, including both commonalities and differences. We describe procedural memory, examine its role in multiple aspects of language, and then present the PDH and relevant evidence across language-related disorders. The PDH has substantial explanatory power, and both basic research and translational implications