Cleft audit protocol for speech (CAPS-A): a comprehensive training package for speech analysis.

BACKGROUND: The previous literature has largely focused on speech analysis systems and ignored process issues, such as the nature of adequate speech samples, data acquisition, recording and playback. Although there has been recognition of the need for training on tools used in speech analysis associated with cleft palate, little attention has been paid to this issue. AIMS: To design, execute, and evaluate a training programme for speech and language therapists on the systematic and reliable use of the Cleft Audit Protocol for Speech-Augmented (CAPS-A), addressing issues of standardized speech samples, data acquisition, recording, playback, and listening guidelines. METHODS & PROCEDURES: Thirty-six specialist speech and language therapists undertook the training programme over four days. This consisted of two days' training on the CAPS-A tool followed by a third day, making independent ratings and transcriptions on ten new cases which had been previously recorded during routine audit data collection. This task was repeated on day 4, a minimum of one month later. Ratings were made using the CAPS-A record form with the CAPS-A definition table. An analysis was made of the speech and language therapists' CAPS-A ratings at occasion 1 and occasion 2 and the intra- and inter-rater reliability calculated. OUTCOMES & RESULTS: Trained therapists showed consistency in individual judgements on specific sections of the tool. Intraclass correlation coefficients were calculated for each section with good agreement on eight of 13 sections. There were only fair levels of agreement on anterior oral cleft speech characteristics, non-cleft errors/immaturities and voice. This was explained, at least in part, by their low prevalence which affects the calculation of the intraclass correlation coefficient statistic. CONCLUSIONS & IMPLICATIONS: Speech and language therapists benefited from training on the CAPS-A, focusing on specific aspects of speech using definitions of parameters and scalar points, in order to apply the tool systematically and reliably. Ratings are enhanced by ensuring a high degree of attention to the nature of the data, standardizing the speech sample, data acquisition, the listening process together with the use of high-quality recording and playback equipment. In addition, a method is proposed for maintaining listening skills following training as part of an individual's continuing education.

Using multimedia technology to help combat the negative effects of protective isolation on patients: the Open Window project--an engineering challenge.

The Open Window project was established with the aim of creating a "virtual window" for each patient who is confined to protective isolation due to treatment for illness. This virtual window as developed provides a range of media or experiences. This paper describes the approach taken to the system design and discusses initial experiences with implementing such a system in a critical care setting. The system design was predicated on two guiding principles. Firstly it should be intuitive to use and the technology used to create the virtual window hidden from patient view. Secondly the system must be able to be installed at the point of care in a way that delivers the experience under the patient's control, without compromising the function or safety of the clinical environment. Patient acceptance of the system is being measured as part of an on-going trial and at this interim phase of data analysis 100% (n=55) of participants in the intervention group have reported that the technology was easy to use. We conclude that the system as designed and installed is an effective, robust and reliable system upon which to base a multimedia interventions in a critical care room.

Ocular microtremor measurement system: design and performance.

The frequency of ocular microtremor (OMT) is related to the functional status of the brain stem, and thus OMT may be useful in the diagnosis and management of brain stem disorders. The paper discusses the design of an OMT measurement system and reports quantitative specifications for three portable systems. All systems use a piezo-electric element as the transducer, which measures the displacement of the sclera during eye rotations. The systems differ in the manner in which the signal is recorded. All systems can detect eye movements corresponding to displacements of the sclera ranging from 12 to over 3000 nm. The frequency responses of all systems are flat (< 2 dB deviation from peak response) between 20 and 150 Hz. The phase response shows deviations (< pi) at the extremes of this range, but qualitative comparison of input and measured signals demonstrates that phase distortion is not excessive. Thus all systems are acceptable for clinical studies involving OMT.

An automated ocular microtremor feature extraction using the Gabor thresholding technique.

Ocular Microtremor (OMT) is a very fine continuous eye movement which has potential in monitoring and identifying a number of clinical conditions. There is a need for improved analysis and processing techniques to extract useful, quantifiable parameters from the OMT signal. A number of papers have shown the clinical significance of looking at the 'bursts' and 'baseling' patterns of the OMT signal. Analysis to date relies on visual inspection alone. This paper introduces an automated approach to burst/baseline identification based on a time-varying filter using the Gabor transform.