An Ultrasound Investigation of Tongue Dorsum Raising in Children with Cleft Palate +/- Cleft Lip.

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

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.

The Impact of Real-Time Articulatory Information on Phonetic Transcription: Ultrasound-Aided Transcription in Cleft Lip and Palate Speech.

OBJECTIVE: This 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. PATIENTS AND METHODS: 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. RESULTS: 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. CONCLUSION: UTI is a useful complement to traditional phonetic transcription for CLP speech.

22q11 deletion syndrome: Parents' and children's experiences of educational and healthcare provision in the United Kingdom.

22q11 deletion syndrome (22q11DS) is a genetic syndrome, prevalence around 1:4000-1:6000 live births, with a complex array of associated features, impacting on healthcare and educational support. This study reports the perceptions of families and individuals with 22q11DS in relation to these needs. Individuals and families of those with 22q11DS were approached though two national charities - the Max Appeal and 22Crew. An initial observational survey design was used to gather views via questions probing access to healthcare and educational experiences. Thirty-four responses were received and the data subjected to descriptive analysis. Over half of the respondents were diagnosed before the age of 1. Ninety-one percent reported ongoing difficulties with learning at school, compounded by school attendance being compromised as a result of medical interventions. Individuals reported engaging heavily with educational support and a high number of health professions (mean 9.5; mode 10). Age of diagnosis of 22q11DS ranged from birth to nine years. Families had ongoing concerns about aspects of education and healthcare services, and lack of knowledge and awareness of the difficulties faced by individuals with 22q11DS was raised. Healthcare and education providers should be aware of the range of services individuals required on a regular basis so as to provide a more holistic approach to care.

Clicks produced as compensatory articulations in two adolescents with velocardiofacial syndrome.

OBJECTIVE: To report perceptual and dynamic articulatory electropalatography data on clicks produced as compensatory articulations by two adolescents (S1 and S2) with velocardiofacial syndrome and velopharyngeal dysfunction. RESULTS: The perceptual analysis showed that both speakers produced click substitutions for English targets /t/, /d/, /k/, /g/, and S2 additionally produced clicks for /p/, /b/, and /tintegral/, //. The adolescents produced a range of clicks, which varied in placement (bilabial, dental, alveolar, palatal), voicing (voiced, voiceless), and nasality (nasal, nonnasal). Measurements from the electropalatography data for lingual clicks revealed two articulatory closures, one in the anterior and another in the posterior region of the hard palate. The data revealed how the two closures were timed precisely to produce the click sound. The clicks involved a complex and highly coordinated sequence of tongue maneuvers similar to clicks in some southern African languages. CONCLUSIONS: Clicks are interpreted as compensatory articulations enabling some speakers with velopharyngeal dysfunction to produce plosive and affricate sounds with perceptually salient acoustic bursts in the oral cavity. Clicks as compensatory articulations merit further systematic investigation, and the procedures reported in this study are considered appropriate for such research.

Tongue-palate contact during selected vowels in children with cleft palate.

This study reports tongue-palate contact recorded using electropalatography (EPG) during five vowels /i/, /theta/, /I/, /o/ and /backwards c/ spoken by school-aged children with cleft palate and a group of normal speakers. All the children had articulation disorders affecting consonants but none had obvious vowel errors. Two measures were taken from the EPG data at the temporal midpoint of the vowels. The first identified the percentage of vowels produced with complete coronal constriction and the second calculated amount of contact. The results showed that children with cleft palate frequently produced the high vowel /i/ with complete constriction, with 40% of /i/ targets articulated in this way. There were lower percentages for /theta/ and /I/ and no complete constrictions during the lower vowels /o/ and /backwards c/. None of the normal speakers produced any vowels with complete constriction. In terms of amount of contact, the vowels ranked /i/>/theta/>/I/>/o/>/backwards c/, with /i/ having the most and /backwards c/ the least contact. Although this ranking held for both groups, the cleft group had more contact than normal speakers, especially during high vowels. Complete constriction is viewed as a clinically relevant phenomenon that blocks oral airflow and as a result increases nasal airflow during vowels.

Articulatory placement for /t/, /d/, /k/ and /g/ targets in school age children with speech disorders associated with cleft palate.

This study used electropalatography (EPG) to identify place of articulation for lingual plosive targets /t/, /d/, /k/ and /g/ in the speech of 15 school age children with repaired cleft palate. Perceptual judgements indicated that all children had correct velar placement for /k/, /g/ targets, but /t/, /d/ targets were produced as errors involving palatalization or velar placement. An EPG classification scheme identified alveolar, palatal and velar placement. Articulations involving contact in alveolar and velar regions simultaneously were identified as alveolar velar double articulations (AVDAs). The classification revealed that AVDAs were relatively frequent, with 28% of alveolar and 12% of velar targets affected, and ten out of the 15 children produced one or more of these abnormal articulations. The majority of children had variable placements, with alveolar more variable than velar targets. The positive finding from the EPG data revealed that most children with perceptual errors for /t/, /d/ were able to make closure in the alveolar region during at least some of their attempts to articulate these targets. It is argued that appropriate analysis and interpretation of EPG data provide clinically relevant information about tongue placement in cleft palate speech.

Labial-lingual double articulations in speakers with cleft palate.

OBJECTIVE: Labial-lingual double articulations (LLDAs) are speech errors involving simultaneous valving at the lips and in the linguapalatal region. This study investigates the frequency of LLDAs occurring for /p/, /b/, and /m/ targets and describes the linguapalatal contact patterns involved in these abnormal articulations. DESIGN: A retrospective study involving analysis of articulatory data from all speakers with cleft palate recorded at a research center over a 10-year period. PARTICIPANTS: Twenty-seven speakers aged 5 to 62 years (median 11 years) with compensatory speech errors associated with repaired cleft palate. MEASURES: The lingual component of LLDAs was identified using electropalatography (EPG). EPG data were recorded simultaneously with acoustic data. Fifteen bilabial targets (/p/, /b/, /m/) per participant were analyzed. LLDAs were identified in cases where complete linguapalatal constriction (as observed from EPG data) occurred throughout the closure phase of bilabial targets. The labial component of LLDAs was identified from clinical observations of the speakers made during productions of bilabial targets. RESULTS: Three speakers (11%) frequently produced LLDAs for bilabial targets. The configuration of tongue-palate contacts involved in the lingual component of the LLDAs differed in each of the three speakers: one speaker had velar constriction, another had alveolar constriction, and the third had simultaneous alveolar-velar constriction. LLDAs did not similarly affect bilabial targets in the three speakers. One speaker produced LLDAs for /p/ and /b/ targets only. Another produced LLDAs for all /m/ targets but inconsistently for /p/ and /b/ targets. The third speaker produced LLDAs for all /b/ targets but inconsistently for /p/ and /m/ targets. CONCLUSION: LLDAs occurred in a minority of speakers investigated. Nevertheless, it is argued that it is important to identify LLDAs for clinical decision making and for research purposes. The results from this study add to current knowledge about abnormal articulations in cleft palate speech, but further research is needed into the precise timing of lip and tongue-palate closures and into the airflow and acoustic characteristics of LLDAs.