A cleft care workshop for speech and language pathologists in resource-limited countries : the participants' experiences about cleft care in Uganda and satisfaction with the training effect

Objectives: workshops and specialized training programs are often inaccessible for speech and language pathologists (SLPs) based in resource-limited countries given the lack of supply, the long travel distances and the excessive participation fees. To stimulate life-long learning opportunities for all, this study described and measured the effect of a free, two-day cleft care workshop for SLPs in Uganda. The workshop included different topics related to the assessment and treatment of children with a cleft of the palate with or without a cleft of the lip (CP +/- L). Methods: The participants who presented during the two-day course were asked to complete a pre- and postworkshop questionnaire to evaluate their satisfaction. The pre-workshop form also included some questions concerning cleft care in Uganda. Both the pre- and post-workshop forms included three visual analogue scales to investigate the evolution of the participants' estimation of their knowledge regarding speech in patients with a CP +/- L and to assess the changes in their self-confidence in the diagnosis and treatment of this population. Results: seventeen SLPs completed the pre- and post-workshop questionnaires. In general, the participants were highly satisfied with the different themes covered in the program. After the training course, the participants rated their general knowledge about CP +/- L and their self-confidence in the diagnosis and treatment of children with a CP +/- L significantly higher than before the workshop. Conclusion: the vast majority of the SLPs reported that cleft care was not easily accessible in Uganda. The most commonly reported obstacle for cleft care was a lack of knowledge about this matter in the SLPs themselves highlighting the importance of the organization of additional education opportunities. The participants reported a significantly higher level of self-confidence in diagnosing and treating children with a CP +/- L after the workshop. The content of this workshop can form the basis for future learning opportunities for SLPs based in resource-limited countries

Perceptual judgment of hypernasality and audible nasal emission in cleft palate speakers

Objective: The purpose of this study is to determine whether a novel, user-friendly rating system, visual sort and rate (VSR) provides comparable ratings to the currently used direct magnitude estimation (DME) rating system for rating perceptions of audible nasal emission (ANE) and hypernasality in cleft palate speakers. Methods: Twelve naïve listeners rated 152 speech samples of speakers with cleft palate across four conditions: rating hypernasality and ANE using either a VSR or DME rating scale. Raters were provided with a short training session, prior to rating each day. Inter- and intra-rater reliabilities, as well the line of best fit between scores using VSR and scores using DME was calculated to determine usability of VSR as a novel rating system. Results: Direct magnitude estimation resulted in the highest levels of inter-rater reliability, when rating hypernasality (DME r= .48; VSR r=.14), as well as ANE (DME r= .27; VSR r=.15). Most raters demonstrated high intra-rater reliabilities across conditions. A curvilinear line of best fit most accurately captured the relationship between DME and VSR scores when rating hypernasality (r=.64) and ANE (r=.66). Conclusions: A curvilinear relationship between ratings suggests that both variables are prothetic, and therefore, best captured using a DME rating scale (Eadie & Doyle, 2002). The use of DME is supported for continued use rating hypernasality, even amongst naïve listeners given a training session. Rating ANE was difficult, as ratings yielded low inter-rater reliabilities, regardless of the scale used. Further research regarding perceptions of audible nasal emission is warranted

Perceptual judgment of hypernasality and audible nasal emission in cleft palate speakers

Objective: The purpose of this study is to determine whether a novel, user-friendly rating system, visual sort and rate (VSR) provides comparable ratings to the currently used direct magnitude estimation (DME) rating system for rating perceptions of audible nasal emission (ANE) and hypernasality in cleft palate speakers. Methods: Twelve naïve listeners rated 152 speech samples of speakers with cleft palate across four conditions: rating hypernasality and ANE using either a VSR or DME rating scale. Raters were provided with a short training session, prior to rating each day. Inter- and intra-rater reliabilities, as well the line of best fit between scores using VSR and scores using DME was calculated to determine usability of VSR as a novel rating system. Results: Direct magnitude estimation resulted in the highest levels of inter-rater reliability, when rating hypernasality (DME r= .48; VSR r=.14), as well as ANE (DME r= .27; VSR r=.15). Most raters demonstrated high intra-rater reliabilities across conditions. A curvilinear line of best fit most accurately captured the relationship between DME and VSR scores when rating hypernasality (r=.64) and ANE (r=.66). Conclusions: A curvilinear relationship between ratings suggests that both variables are prothetic, and therefore, best captured using a DME rating scale (Eadie & Doyle, 2002). The use of DME is supported for continued use rating hypernasality, even amongst naïve listeners given a training session. Rating ANE was difficult, as ratings yielded low inter-rater reliabilities, regardless of the scale used. Further research regarding perceptions of audible nasal emission is warranted

Spectral correlates of hypernasality in consonants

A dissertation submitted in partial fulfilment of the requirements for the Bachelor of Science (Speech and Hearing Sciences), The University of Hong Kong, June 30, 2005.Also available in print.Thesis (B.Sc)--University of Hong Kong, 2005.published_or_final_versionSpeech and Hearing SciencesBachelorBachelor of Science in Speech and Hearing Science

Speech nasality and nasometry in cleft lip and palate

AbstractIntroductionPerceptual evaluation is considered the gold standard to evaluate speech nasality. Several procedures are used to collect and analyze perceptual data, which makes it susceptible to errors. Therefore, there has been an increasing desire to find methods that can improve the assessment.ObjectiveTo describe and compare the results of speech nasality obtained by assessments of live speech, the Test of Hypernasality (THYPER), assessments of audio recorded speech, and nasometry.MethodsA retrospective study consisting of 331 patients with operated unilateral cleft lip and palate. Speech nasality was assessed by four methods of assessment: live perceptual judgement, THYPER, audio-recorded speech sample judgement by multiple judges, and nasometry. All data were collected from medical records of patients, with the exception of the speech sample recording assessment, which was carried out by multiple judges.ResultsThe results showed that the highest percentages of absence of hypernasality were obtained from judgements performed live and from the THYPER, with equal results between them (79%). Lower percentages were obtained from the recordings by judges (66%) and from nasometry (57%).ConclusionThe best results among the four speech nasality evaluation methods were obtained for the ones performed live (live nasality judgement by a speech pathologist and THYPER)

Acoustic correlates of hypernasal fricatives

Thesis (B.Sc)--University of Hong Kong, 2006.Also available in print."A dissertation submitted in partial fulfilment of the requirements for the Bachelor of Science (Speech and Hearing Sciences), The University of Hong Kong, June 30, 2006."published_or_final_versionSpeech and Hearing SciencesBachelorBachelor of Science in Speech and Hearing Science

Master of Science

thesisThe purpose of this study was to examine the speech/language skills of children with cleft palate and their noncleft peers at 39 months, profile the speech/language outcomes of children with cleft palate at 39 months, and extend previous studies examining pre- and postsurgery speech/language skills that predict later speech/language outcomes of children with cleft palate at 39 months. Participants included 66 children, 43 children with cleft palate and 23 noncleft children. Spontaneous speech/language samples were collected at 9 months, postsurgery (approximately 13 months), 21 months, and 39 months of age in the child's home during an interaction with the caregiver. Speech and language measures were calculated using computer software programs and hand calculations. Children were classified into one of the four speech/language outcome profiles using descriptive statistics. Results of the between-group comparisons revealed the children with cleft palate had fewer consonant sounds, produced less accurate consonants for the majority of the place and manner categories, and had lower mean length of utterances than their noncleft peers. Within-group comparisons revealed the risk factors gender, maternal education, and resonance were associated with poorer speech outcomes for children with cleft palate at 39 months. The profile normal velopharyngeal mechanism and delayed speech and/or language had the highest membership (41%). Correlations between pre- and postsurgery measures and later speech/language outcomes at 39 months revealed negative correlations between 9 month predictors and all outcome measures. All other predictors were positively correlated with the speech outcome measures at 39 months. True consonant inventory and stop production measures at 21 months were the best predictors of the profile normal velopharyngeal mechanism and normal speech/language. These results suggest that children with cleft palate have poorer speech/language outcomes than noncleft peers at 39 months of age. There is a need for children with cleft palate to receive earlier speech/language intervention to help them catch up with their noncleft peers. Finally, the strongest correlations were found between true consonant inventory and stop production at age 21 months, suggesting that 21 months is the best predictive age for speech and language outcomes at 39 months

The effects of stimulus and modulus on perceptual rating of hypernasality

Also available in print.Thesis (B.Sc)--University of Hong Kong, 2004."A dissertation submitted in partial fulfilment of the requirements for the Bachelor of Science (Speech and Hearing Sciences), The University of Hong Kong, December 31, 2004."published_or_final_versionSpeech and Hearing SciencesBachelorBachelor of Science in Speech and Hearing Science