Protocol for SonoSpeech Cleft Pilot : a mixed-methods pilot randomized control trial of ultrasound visual biofeedback versus standard intervention for children with cleft lip and palate

Background: Children with cleft lip and palate can continue to have problems producing clear speech after surgery. This can lead to social, emotional, and educational challenges. Typical treatment involves teaching children the correct tongue movements to produce speech sounds. This is known as articulation intervention. However, this intervention is challenging because the tongue is hidden from view and movements are difficult to see and describe. This pilot randomized control trial will try a new treatment, ultrasound visual biofeedback (U-VBF) versus standard articulatory intervention for children with cleft lip and palate, as comparison. Feasibility outcomes will be determined. Methods/design: The Sonospeech project will enroll up to 40 children with cleft lip and palate aged 4;6 to 16 in a mixed-methods randomized controlled trial with blinded assessors. Children will receive either six sessions of U-VBF or articulation intervention. The primary goals of this pilot are to assess the feasibility and inform the design of a full-scale RCT of U-VBF for children with cleft speech characteristics. This will be achieved by determining the following outcome measures: recruitment/attrition rates; measures of pre-post follow-up completion; and acceptability of the randomization and interventions to families. Discussion: Larger trials of speech interventions for children with cleft lip and palate are needed. This pilot/feasibility study will determine whether a larger randomized control trial comparing ultrasound and articulation interventions is feasible. Trial registration: ISRCTN, ISRCTN17441953. Registered 22 March 2021. See Table 2 in Appendix 1 for all items

An ultrasound investigation of tongue dorsum raising in children with cleft palate +/- cleft lip

Objective: This study aimed to determine whether overuse of the tongue dorsum, or back, is evident in children with repaired cleft palate with or without cleft lip (CP+/-CL). We hypothesized that children with CP+/-CL would show overuse 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 overuse of the tongue dorsum is a common characteristic in children with repaired CP+/-CL. However, individual children may present with this pattern

Visualising speech: Identification of atypical tongue-shape patterns in the speech of children with cleft lip and palate using ultrasound technology

Susan lloyd - ORCID: 0000-0003-4338-3630 https://orcid.org/0000-0003-4338-3630Item deposited in University of Strathclyde (Strathprints) repositpory on 30 April 2018, available at: https://strathprints.strath.ac.uk/id/eprint/63886Previous research by Gibbon (2004) shows that at least 8 distinct error types can be identified in the speech of people with cleft lip and palate (CLP) using electropalatography (EPG), a technique which measures tongue-palate contact. However, EPG is expensive and logistically difficult. In contrast, ultrasound is cheaper and arguably better equipped to image the posterior articulations (such as pharyngeals) which are common in CLP. A key aim of this project is to determine whether the eight error types made visible with EPG in CLP speech described by Gibbon (2004) can be also be identified with ultrasound. This paper will present the first results from a larger study developing a qualitative and quantitative ultrasound speech assessment protocol. Data from the first 20 children aged 3 to 18 with CLP will be presented. Data are spoken materials from the CLEFTNET protocol. We will present a recording format compatible with CAPS-A to record initial observations from the live ultrasound (e.g. double articulations, pharyngeal stops). Two Speech and Language Therapists analysed the data independently to identify error types. Results suggest that all of the error types, for example fronted placement and double articulations can be identified using ultrasound, but this is challenging in real-time. Ongoing work involves quantitative analysis of error types using articulatory measures.http://craniofacialsociety.co.uk

Improving the reliability of phonetic transcription in cleft lip and palate using ultrasound tongue imaging

Objective: This study investigated whether adding an additional modality, namely ultrasound tongue imaging, to perception-based phonetic transcription impacted on the identification of compensatory articulations and inter-rater reliability. Patients and Methods: Thirty-six children aged 3 to 12 with CLP were recorded producing repetitions 5 of /aCa/ for all places of articulation with simultaneous audio and probe-stabilised ultrasound. Three types of transcriptions were performed: 1. Traditional phonetic transcription by a CLP specialist from 7 audio recording; 2. Qualitative observations from the live ultrasound by the clinician recording the data; and, 3. Qualitative ultrasound-aided transcription by two ultrasound-trained clinicians. We compared the number of consonants identified as in error by each transcriber and then classified 10 errors into eight different subcategories. Results: Both the ultrasound-aided and traditional transcriptions yielded similar error-detection rates, however these were significantly higher than the observations recorded live in the clinic. Inter-rater reliability for the ultrasound transcribers was substantial, compared to moderate for the traditional transcribers. Ultrasound-aided transcribers were more likely to identify covert errors such as double articulations and retroflexion than the audio-only transcribers. Conclusion: Ultrasound-tongue imaging is a useful complement to traditional phonetic transcription

SonoSpeech cleft pilot : a pilot randomised control trial of ultrasound visual biofeedback versus standard intervention for children with cleft lip and palate

Background Children with cleft lip and palate often have speech production and intelligibility difficulties that may affect their educational outcomes (Grewal et al. 2021). Speech therapy treatment usually involves articulatory intervention, which teaches the child the correct position and movement of their articulators. This type of intervention may be challenging as large portions of the articulators are hidden from view and may be hard to describe. Recent ultrasound tongue imaging studies have shown promising results but only one study has focused on children with cleft lip and palate (Roxburgh et al. 2016). Aim This pilot randomised control trial will assess the feasibility of running a large-scale randomised control trial comparing a new treatment, speech therapy involving ultrasound visual biofeedback, to traditional articulatory therapy for children with cleft lip and palate. The study aims to determine the recruitment, attrition, and outcome measure completion rates, as well as the acceptability of the new treatment and of randomisation to the children and their families. Methods Forty children, aged 4;6-16, will be randomised to either 6 sessions of ultrasound intervention or articulatory intervention, stratified by age. Their percentage of correct consonants will be measured by assessors blind to their treatment groups, based on auditory recordings, taken before, during, and after treatment. Patient reported outcome measures on quality of life and experience of service will also be used. Results The study is in its recruitment stage and preliminary results will be presented at the conference, including case studies of children in both groups. Conclusions Ultrasound visual biofeedback is a potentially useful tool in speech sound therapy of children with cleft lip and palate and more research in required to test its effectiveness

A Mixed-Methods Pilot Randomised Control Trial of Ultrasound Visual Biofeedback versus Standard Intervention for Children with Cleft Palate +/- Cleft Lip: Parents’ and Children’s Perspectives.

Background: Ultrasound visual biofeedback has the potential to be useful for the treatment of compensatory errors in speakers with Cleft Palate +/- Lip, but there is little research on its effectiveness, nor on how acceptable families find the technique. This study reports on parents’ and children’s perspectives on taking part in a pilot randomised control trial of ultrasound visual biofeedback compared to articulation intervention. Aims: To determine the acceptability of randomisation, ultrasound visual biofeedback, and articulation intervention to families. We set feasibility criteria of at least 75% of responses rated as acceptable or positive in order to determine progression from a pilot to full randomised control trial. Methods & Procedures: 19 families who received ultrasound visual biofeedback therapy (11 families) and articulation intervention (8 families) were invited to participate. Mixed methods were employed: two questionnaires to determine the acceptability of ultrasound visual biofeedback and articulation intervention respectively; and semi-structured focus groups/interviews. Questionnaires were analysed for frequency of positive versus negative acceptability, and the focus groups/interviews were analysed using thematic analysis and coded using the theoretical framework of acceptability. Outcomes & Results: More than 75% of families rated randomisation as acceptable and more than 75% of families rated both interventions as acceptable, with the caveat that half of participants did not wish to continue articulation intervention after the study. Six families (3 in each intervention) volunteered to take part in the focus groups/interviews. Results showed more positive than negative themes regarding acceptability, particularly affective attitude where high levels of enjoyment were expressed, although some participants found the articulation intervention “boring”. In both groups there was a considerable burden involved in travelling to the hospital location. Conclusions & Implications: Randomisation in a clinical trial is acceptable to families; ultrasound visual biofeedback and articulation intervention are acceptable and indeed enjoyable. The burden of the additional outcome measures required for a clinical trial are manageable, although there is a travel burden for participants. Future studies should seek to mitigate travel burden by considering additional locations for intervention

Visualising speech : identification of atypical tongue-shapes in cleft lip and palate using ultrasound

Background: Speech is of key importance in cleft lip and palate (CLP) from a quality of life and surgical outcome perspective, yet assessment relies on subjective perceptual methods. CLP speech is known to be vulnerable to imperceptible error types, such as double articulations which can only be identified with instrumental techniques. Previous research by Gibbon (2004) shows that at least eight distinct error types can be identified in CLP using electropalatography (EPG). However, EPG is expensive and logistically difficult. In contrast, ultrasound is cheaper and arguably better equipped to image the posterior articulations (such as pharyngeals) which are common in CLP. Purpose: To develop an ultrasound-based diagnostic assessment for identifying imperceptible speech errors in children with cleft palate. Research questions were: 1. Which of the eight CLP error types can be visualised and quantified with ultrasound measures? 2. Does ultrasound assessment confirm or refute perceptual evaluation? Method: Thirty children aged 3 to 18 with CLP were recorded with simultaneous audio and probe-stabilised ultrasound during spontaneous counting, elicitation of all consonants in /aCa/, and sentences from GOS.SP.ASS. 98. Two types of analyses were performed: 1. Phonetic transcription to identify overt speech errors; 2. Ultrasound analysis to identify auditorily imperceptible errors. The ultrasound analysis was further subdivided into real-time qualitative observations from ultrasound (to identify e.g. double articulations, pharyngeal stops); and quantitative ultrasound analysis using a variety of measures from the literature (e.g. Dorsum Excursion Index to identify increased contact). Results: Results of the phonetic transcription show a range of typical (normalised) speech, compensatory articulations, and developmental errors, consistent with the literature. Qualitative analysis in most cases confirms the perceptual analysis but provides additional information about imperceptible errors including those previously reported by Gibbon (2004) such as double articulations and errors not previously reported in the EPG literature such as retroflexed productions. Conclusions: Ultrasound Tongue Imaging shows promise as clinically useful diagnostic tool for speech disorders associated with CLP

Gold inlaid contacts in new edge connectors

From PubMed via Jisc Publications RouterHistory: received 2018-10-15, accepted 2019-03-19Publication status: aheadofprintThis study investigated whether adding an additional modality, namely ultrasound tongue imaging (UTI), to perception-based phonetic transcription impacted on the identification of compensatory articulations and on interrater reliability. Thirty-nine English-speaking children aged 3-12 years with cleft lip and palate (CLP) were recorded producing repetitions of /aCa/ for all places of articulation with simultaneous audio recording and probe-stabilized ultrasound (US). Three types of transcriptions were performed: (1) descriptive observations from the live US by the clinician recording the data, (2) US-aided transcription (UA) by two US-trained clinicians, and (3) traditional phonetic transcription by two CLP specialists from audio recording. We compared the number of consonants identified as in error by each transcriber and then classified errors into eight different subcategories. Both UA and traditional transcription yielded similar error detection rates; however, these were significantly higher than the observations recorded live in the clinic. Interrater reliability for the US transcribers was substantial (κ = 0.65) compared to moderate (κ = 0.47) for the traditional transcribers. US transcribers were more likely to identify covert errors such as double articulations and retroflexion than the audio-only transcribers. UTI is a useful complement to traditional phonetic transcription for CLP speech. [Abstract copyright: © 2019 S. Karger AG, Basel.