Post on 02-Jan-2016
description
Parameters: Definitions & Guidelines
Debbie Sell PhD, FRCSLTHead, Speech & Language Therapy Department
Great Ormond Street NHS Trust
Honorary Senior Lecturer University of London
Judith Trost-Cardamone, PhD, FASHAProfessor, California State University Northridge
Department of Communication Disorders & Sciences
Parameters: Primary & Secondary
Primary Parameters: speech parameters most directly related to the cleftpalate/velopharyngeal condition
Secondary Parameters: speech parameters less directly related or not related to the cleft palate/velopharyngeal condition but which are frequently observed in speakers with cleft palate
Guidelines
• Aim of guidelines is to provide a set of definitions to accompany the parameters, to ensure their appropriate application and interpretation
• Section 1 (discuss in final session of the day)• Section 2 System is for reporting speech
outcomes based on perceptual speech analysis; they are not intended to explain the outcome
Primary Parameters: Speech parameters most directly related to the cleft palate/velopharyngeal condition
Hypernasality (HN)
• 0-3 rating scale0 = WNL; does not exceed HN
heard in regional speech
1 = Mild2 = Moderate3 = Severe
Hypernasality
• Increased or excessive nasal resonance heard on vowels and vocalic consonants of a language.
• Rated using a 4 point scale that reflects increasing severity from 0-3
Hyponasality
• Decreased or insufficient nasal resonance heard on nasal consonants and vocalic segments of a language.
• Rating based on a binary judgement of within normal limits or present.
• Cul-de-sac resonance is reflected in hyponasality
• Mixed resonance is accounted for by the combined ratings of hypernasality and hyponasality
Audible Nasal Air Emission and/or Turbulence
• Binary judgment0 = WNL/None1 = Present [indicate pattern]
• intermittent and variable nasal emission and/or turbulence
• phoneme specific nasal emission and/or turbulence
• frequent/pervasive nasal emission and/or turbulence
• Weighted scoring for patterns
Audible Nasal Air Emission and/or Turbulence
• def. Nasal air emission /turbulence that accompanies/is co-produced with and distorts any or all (oral) high pressure consonants in a language
• Rating based on a binary judgement of within normal limits or present
• Second rating is given to reflect severity/impact on speech acceptability/understandability based on the frequency and pattern of the nasal air emission/turbulence
• Intermittent and variable: nasal air emission and/or turbulence heard occasionally with
various oral pressure consonants with no obvious pattern of occurrence
• Phoneme specific: nasal emission and/or turbulence heard consistently but only with selected oral pressure consonants e.g. sibilant fricatives and/or affricates **
• Frequent/pervasive: nasal emission and/or turbulence heard with most/all high pressure consonants in the inventory
** Phoneme specific: is this correctly placed here?
Oral Pressures
• Binary judgment0 = WNL: perceptually adequate for pressure
consonants1 = Weak; perceptually inadequate for
pressure consonants
Substitution Errors
• Binary judgment0 = WNL/None1 = Present [indicate type and frequency]
• Six categories
• Weighted scoring for frequency
Substitution Errors• Def: maladaptive “compensatory
misarticulations” of high pressure consonants as a result of the cleft palate/velopharyngeal inadequacy condition.
• Second rating based on type and frequency of occurrence for glottal stop, pharyngeal fricative/stop/affricate, palatal stop, palatal fricative, nasal fricative, atypical backing of targets to velar
Substitution Errors: glottal and pharyngeal
• Glottal stop
• Pharyngeal: fricative, stop, affricate
or any combination
Substitution Errors:backing but targets remain oral
• Backing of dental, alveolar and/or palatal targets to velar
Substitution Errors continued
• Atypical backing of dental and alveolar targets. It includes a consonant target that is backed from its more anterior target place but is still made within the oral cavity.
Substitution Errors: nasal fricative
• Nasal fricative with or without turbulence
___ phoneme specific pattern**
**Is this necessary, informative?
Substitution Errors continued
• Nasal fricative: def: used as a substitution/replacement for oral stops, fricatives and affricates. It is articulatory substitution that frequently takes the form of an unvoiced (bilabial, alveolar or velar) nasal
Secondary Parameters: Speech parameters less directly related or not related to the cleft palate/velopharyngeal condition but which are frequently observed in speakers with cleft palate.
They are all speech characteristics/deviations that can be seen in speakers without cleft palate.
Secondary Parameters
• Binary judgment0 = WNL/None1 = Present
• Includes errors related to:• Dentition, Occlusion, palatal vault• Developmental delay, other
articulation/phonological errors• Voice/laryngeal disorders
Secondary Speech Parameters cont.
• Errors related to Dentition, Occlusion, Palatal Vault Configuration such as lateralized sibilants, palatalized alveolars, dentalized/linguadental alveolar fricatives and stops
• Inverted labiodentals, etc.
Secondary Speech Parameters cont.
• Developmental delay, other articulation/phonologic errors and voice/laryngeal disorders are self - explanatory
X = Missing Data
• Could not test (e.g. child was not cooperative, inadequate speech sample)
• Did not test (e.g. time constraints)
Parameters: Scales & Scoring
Judith Trost-Cardamone, PhD, FASHAProfessor, California State University Northridge
Department of Communication Disorders & Sciences
Triona Sweeney, PhDSpecialist Speech & Language Therapist
The Children’s Hospital Temple Street, Dublin
Adjunct Professor, University of Limerick
Hypernasality [HN]
• 1 Mild Hypernasality• Exceeds regional speech HN• Assimilation nasality primarily; heard on high
vowels primarily; or both; “inconsistent• Socially acceptable in most circles• Patient [age 10 >] or parent [age 5] mostly
satisfied • Would probably not recommend physical
management at this time
Hypernasality [HN]
• 2 Moderate Hypernasality• Pervasive and draws attention to itself and
away from the message• Most vowels retain identity• Socially unacceptable• Would probably recommend physical
management after instrumental assessment
Hypernasality [HN]
• 3 Severe Hypernasality• Pervasive and interferes with speech
understandability• Many vowels lose identity• Socially very unacceptable• Would definitely recommend physical
management after instrumental assessment
Audible Nasal Air Emission and/or Turbulence
• Binary judgment– 0 = WNL/None– 1 = Impaired [indicate pattern]
• intermittent and variable nasal emission and/or turbulence [1]
• phoneme specific nasal emission and/or turbulence [2]
• frequent/pervasive nasal emission and/or turbulence [3]
• Weighted scoring for patterns
Weighted scores
• intermittent and variable is nasal emission with or without turbulence that is heard occasionally with various oral pressure consonants with no obvious pattern of occurrence [1]
• phoneme specific is nasal emission and/or turbulence that is heard consistently but only with selected oral pressure consonants; e.g., sibilant fricatives and/or affricates [2]
• frequent/pervasive is nasal emission and/or turbulence that is heard with most/all high pressure consonants in the inventory [3]
Issues
• Nasal emission and/or nasal turbulence as 1 parameter!!- perceptually different nasal airflow errors
BUT- similar impact in terms of speech outcome
• Raters ability to distinguish between nasal emission and/or nasal turbulence AND nasal fricatives
Substitution Errors
• Binary judgment0 = WNL/None1 = Present [indicate type and frequency]
• Six categories
• Weighted scoring for frequency
Substitution Errors: glottal and pharyngeal
• Glottal stop [1]– Frequent [3]– Infrequent [1]
• Pharyngeal: fricative, stop, affricate
or any combination [1]– Frequent [3]– Infrequent [1]
Substitution Errors: mid-dorsum palatal
• Mid-dorsum palatal stop [1]– Frequent [2]– Infrequent [1]
• Mid-dorsum palatal fricative [1]– Frequent [2]– Infrequent [1]
Substitution Errors:backing but targets remain oral
• Backing of dental, alveolar and/or palatal targets to velar [1]– Frequent [2]– Infrequent [1]
Substitution Errors: nasal fricative
• Nasal fricative with or without turbulence [1]– Frequent [3]– Infrequent [1]
___ phoneme specific pattern [2]**
**Is this necessary, informative?
Nasal Emission/Nasal Turbulence
• accompanies/is co-produced with and distorts any or all [oral] high pressure consonants in a language
• need to distinguish from Nasal Fricative which is used as a substitution/replacement for oral fricatives and affricates– Nasal fricative: frication generated in nose– Velopharyngeal fricative/posterior nasal fricative
Substitution Errors
• Frequent [2]
• Infrequent [1]
How do we define frequency?
Is it necessary to document this?