Assessment Methods and Intervention Strategies for Cleft-Related Lateral Misarticulation in Chinese-Speaking Children.

The aim of this study was to analyze the characteristics and error speech features of cleft-related lateral misarticulation and provide a basis for clinical evaluation and rational intervention. Participants who were diagnosed with lateral misarticulation after cleft palate repairment were 126 children aged 4, 6 to 16, and 11, and they had complete palatopharyngeal closure, no abnormalities in their speech organs and occlusion, and no hearing or intellectual impairments. The Chinese standard pronunciation clarity word list, the American KAY CSL4500, the Beijing Yangchen YF-16 computer speech analysis workstation, soundproof rooms, Wechsler scales of intelligence-fourth edition, and audiometers were used to evaluate the cleft-related lateral misarticulation. Statistical analysis was performed on the age, gender, error rate, corner of the mouth deviation direction, comorbidity, duration of intervention, period of treatment, and therapeutic effect of concentrated or normal intervention group in different patients. Our results showed that 2 to 3 straight stripes were visible at the onset of consonants /ti:/ /t'i:/, and 3 clear straight lines were visible in /tʂ/, indicating that the lateralized sound had 2 or 3 bursts and lasted for 1 to 2 ms. The onset age of lateralized sound was mostly below 12 years old. Chinese lateralized sound mainly occurred in vowel /i:/, and the occurrence rate of consonants with tongue surface /tɕ]/ /tɕ'/ /ɕ/ was the highest. In addition, the corner of the mouth deviation was also an indicator of lateralization sound, and other types of speech disorders mostly accompanied it. There was a significant difference in the improvement of speech clarity between the concentrated intervention group and the normal group before and after treatment. The 2 groups' average duration and course of treatment were not significantly different. Still, the period of concentrated intervention was shortened considerably, and the speech clarity of both groups of children after treatment exceeded 96%, reaching a normal level.

Non-Oral Compensatory Misarticulations Revisited.

Non-oral compensatory misarticulation patterns are often associated with the speech of children with cleft palate. Despite their saliency, the etiology, frequency, and treatment of these misarticulations have not been studied extensively. The purpose of this commentary is to review what we know about these atypical patterns of articulation and address clinical assumptions regarding their etiology and treatment.

Oral Myofunctional and Articulation Disorders in Children with Malocclusions: A Systematic Review.

BACKGROUND: Relationships between malocclusion and orofacial myofunctional disorders (OMD), as well as malocclusions and articulation disorders (AD) have been described, though the exact relationships remain unclear. Given the high prevalence of these disorders in children, more clarity is needed. SUMMARY: The purpose of this study was to determine the association between OMD (specifically, bruxism, deviate swallowing, caudal resting tongue posture, and biting habits), AD, and malocclusions in children and adolescents aged between 3 and 18 years. To conduct a systematic review, 4 databases were searched (MEDLINE, Embase, Web of Science, and Scopus). The identified articles were screened for the eligibility criteria. Data were extracted from the selected articles and quality assessment was performed using the tool of Munn et al. [Int J Health Policy Manag. 2014;3:123-81] in consensus. Using the search strategy, the authors identified 2,652 articles after the removal of duplicates. After reviewing the eligibility criteria, 17 articles were included in this study. One of the included articles was deemed to have an unclear risk of bias, whereas all other articles were considered to have a low risk of bias. The articles showed a relationship between anterior open bite and apico-alveolar articulatory distortions, as well as between anterior open bite and deviate swallowing. For the biting habits, bruxism, and low tongue position no clear conclusions could be drawn. Key Messages: The current review suggests a link between specific types of malocclusion and OMD and AD. However, more high-quality evidence (level 1 and level 2, Oxford Levels of Evidence) is needed to clarify the cooccurrence of other OMD, AD, and malocclusions.

Topological properties of the resting-state functional network in nonsyndromic cleft lip and palate children after speech rehabilitation.

Speech therapy has been widely used as an essential therapy for compensatory articulation errors in nonsyndromic cleft lip and palate patients. We sought to identify potential biomarkers of nonsyndromic cleft lip and palate children after speech rehabilitation based on resting-state fMRI and graph theory techniques. We scanned 28 nonsyndromic cleft lip and palate and 28 typically developing children for resting-state fMRI on a 3T MRI scanner. Functional networks were constructed, and their topological properties were obtained for assessing between-group differences (two-sample t-tests). Also, language clear degree scale scores were obtained for correlation analysis with the topological features in nonsyndromic cleft lip and palate patients. Significant between-group differences of local properties were detected in brain regions involved in higher-order language and social cognition. There were no significant correlations between topological feature differences and language clear degree scale scores in nonsyndromic cleft lip and palate patients. Graph theory provided valuable insight into the neurobiological mechanisms of speech rehabilitation in nonsyndromic cleft lip and palate patients. The global network features, small-world index, nodal clustering coefficient, and nodal shortest path length may represent potential imaging biomarkers for the estimation of effective speech rehabilitation.

Longitudinal study of the development of obstruent correctness from ages 3 to 5 years in 108 Danish children with unilateral cleft lip and palate: a sub-study within a multicentre randomized controlled trial.

BACKGROUND: Speech-sound development in preschoolers with unilateral cleft lip and palate (UCLP) as a group is delayed/disordered, and obstruents comprise the most vulnerable sound class. AIMS: To evaluate the development of obstruent correctness (PCC-obs) and error types (cleft speech characteristics (CSCs) and developmental speech characteristics (DSCs)) from ages 3-5 and to investigate possible predictors (error types, velopharyngeal dysfunction (VPD) and gender) of PCC-obs at age 5 in two groups of children with UCLP. METHODS & PROCEDURES: Subgroup analysis was conducted within a multicentre randomized controlled trial (RCT) of primary surgery (Scandcleft Project). A total of 125 Danish children with UCLP received lip and soft palate repair around 4 months of age and early hard palate closure at 12 months (EHPC group) or late hard palate closure at 36 months (LHPC group). Audio and video recordings of a naming test were available for 108 children at ages 3 and 5, and recordings were transcribed phonetically by blinded raters. OUTCOMES & RESULTS: PCC-obs scores increased significantly from ages 3-5 in both groups, but with small effect sizes in the EHPC group that had higher scores at age 3 than the LHPC group. DSCs decreased in both groups whereas CSCs only decreased in the LHPC group that had more CSCs at age 3 than the EHPC group. The frequency of CSCs at age 3 was a significant predictor of PCC-obs scores at age 5 in both groups. DSCs significantly improved the logistic regression model in the EHPC group, whereas VPD and gender did not significantly improve the model in either group. CONCLUSIONS & IMPLICATIONS: Although PCC-obs developed significantly from ages 3 to 5, children with UCLP as a group did not catch up to typically developing Danish children at age 5. Furthermore, the LHPC group at age 5 did not reach the 3-year level of the EHPC group, which means that delaying hard palate closure until age 3 is detrimental to obstruent development. Both CSCs and DSCs at age 3 were important predictors of PCC-obs at age 5 and should be considered when determining need for intervention.

Effects of Age on Voice Onset Time and Variability in Children with Repaired Cleft Palate.

OBJECTIVE: To examine the effect of age on voice onset time (VOT) and VOT variability in children with repaired cleft palate. METHODS: Twenty-two children with repaired cleft palate were allocated into two age groups: younger children (YC: n = 13) and older children (OC: n = 9). VOT measurements from monosyllabic words (/pɑ/, /tɑ/, and /kɑ/) and intraspeaker VOT variability estimated by coefficients of variation (CoV) of two age groups were compared. RESULTS: Age was found to have a statistically significant effect on VOT and VOT variability. Specifically, OC had significantly longer VOT (F(1,66) = 4.196, p < 0.05) and less VOT variability (F(1,66) = 6.007, p < 0.05) for English voiceless stops than YC. No statistically significant main effect for speech sample or age by speech sample interaction was observed. CONCLUSIONS: Our data supplement the existing literature by adding VOT and VOT variability information for older children/adolescents with repaired cleft palate. Findings from the study suggest VOT patterns acquired at younger age appear to be further exaggerated and stabilized during the adolescent period among children with repaired cleft palate. A future study is necessary to determine different sources of VOT variability in children with a history of cleft palate, which may have clinical therapeutic implications.

Percent Consonant Correct as an Outcome Measure for Cleft Speech in an Intervention Study.

BACKGROUND/AIMS: Percent consonant correct (PCC) was originally described by Shriberg and Kwiatkowski [J Speech Hear Disord. 1982 Aug;47(3):256-70] as a severity metric for phonological speech disorders, and has been adapted and used in many studies on speech sound disorders. It is well-recognized that cleft speech is complex, consisting of several interacting parameters assessed simultaneously, with error sounds not in the listener's own language. In speech outcome studies, narrow phonetic transcription and the reporting of intra- and inter-rater reliability are acknowledged as the gold standard. However, cleft speech brings special challenges to this task, as complex speech disorders are known to be associated with low transcriber agreement. Recent studies informed the decision to use PCC as the primary outcome measure in a cleft speech intervention study, given its common usage and familiarity. The aim was to specifically evaluate the intra- and inter-rater reliability of PCC in an intervention study, in contrast to other types of speech outcome studies. METHODS: Two trained and experienced listeners analyzed 119 recordings, randomly selected from five data points before, during, and following intervention. The PCC score was separately calculated for words and sentences/phrases. RESULTS: Using intraclass correlations (ICCs), Phase 1 results showed poor reliability for targets elicited for words (ICC = 0.07) and sentences/phrases (ICC = 0.42). Differences in classification of errors as glottal stops and consonant deletion accounted for this. Following further training, a second reliability study was undertaken showing improvement in the number of targets elicited in words (ICC = 0.85) and sentences/phrases (ICC = 0.94). There was very good inter-rater reliability for the PCC score on the word dataset (ICC = 0.9) and the sentence dataset (ICC = 0.88). Very good intra-rater reliability (ICC = 1.0) was found for the PCC score in both words and sentences/phrases for each listener. One listener consistently gave higher modified PCC scores. CONCLUSIONS: In cleft speech intervention studies, reliability of the number of targets elicited should be reported. Listeners need to distinguish between glottal articulation and consonant deletion, in order that the PCC score is meaningful. Attention should be paid to where listeners are reliable, but their pattern of scores consistently differs but in a consistent way. More research is needed on measuring the resolution of articulation difficulties in cleft intervention studies.

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.

Exploring the speech and language of individuals with non-syndromic submucous cleft palate: a preliminary report.

BACKGROUND: Submucous cleft palate (SMCP) has a heterogeneous presentation and is often identified late or misdiagnosed. Diagnosis is prompted by speech, resonance or feeding symptoms associated with velopharyngeal insufficiency. However, the broader impacts of SMCP on communication have rarely been examined and therefore are poorly understood. AIM: To describe the communicative profile of individuals with non-syndromic SMCP by examining speech, language and pragmatics (social language). METHODS & PROCEDURES: Fifteen participants with SMCP aged 5;1-12;8, without a genetic diagnosis, participated in the study. Participants completed standardized assessments examining language, resonance, speech and non-verbal intellect. Parents also completed the Children's Communication Checklist (CCC-2), which provided a measure of overall communicative ability, including pragmatic skills. Formal language outcomes were compared with two cohorts: 36 individuals with overt non-syndromic clefts and 129 individuals with no history of clefting. OUTCOMES & RESULTS: Speech intelligibility was reduced secondary to hypernasality, disordered articulation and/or impaired phonology (n = 7) in children with SMCP. Poorer overall language outcomes were observed for children with SMCP compared with both those with overt clefts and no history of clefting (p < 0.001). Language scores for children with SMCP ranged from impaired (n = 6) to above the standardized mean (n = 4). Receptive and expressive language performance were independently correlated with non-verbal IQ (p < 0.01). Those with severe language impairment (n = 4) also had borderline or impaired non-verbal IQ. Parents reported that speech and semantics were the most affected sub-domains of communication, while scores were the highest for the initiation domain. Speech and language skills were correlated strongly with pragmatics (r = 0.877, p < 0.01). CONCLUSIONS & IMPLICATIONS: Overall, performance was variable within the SMCP group across speech, language and pragmatic assessments. In addition to well-documented speech difficulties, children with SMCP may have language or pragmatic impairments, suggesting that further neurodevelopmental influences may be at play. As such, for individuals with SMCP, additional clinical screening of language and pragmatic abilities may be required to ensure accurate diagnosis and guide both cleft and non-cleft related therapy programmes.

Not all phonological awareness deficits are created equal: evidence from a comparison between children with Otitis Media and poor readers.

Children with reading difficulties and children with a history of repeated ear infections (Otitis Media, OM) are both thought to have phonological impairments, but for quite different reasons. This paper examines the profile of phonological and morphological awareness in poor readers and children with OM. Thirty-three poor readers were compared to individually matched chronological age and reading age controls. Their phonological awareness and morphological awareness skills were consistently at the level of reading age matched controls. Unexpectedly, a significant minority (25%) of the poor readers had some degree of undiagnosed mild or very mild hearing loss. Twenty-nine children with a history of OM and their matched controls completed the same battery of tasks. They showed relatively small delays in their literacy and showed no impairment in morphological awareness but had phonological awareness scores below the level of reading age matched controls. Further analysis suggested that this weakness in phonological awareness was carried by a specific weakness in segmenting and blending phonemes, with relatively good performance on phoneme manipulation tasks. Results suggest that children with OM show a circumscribed deficit in phoneme segmentation and blending, while poor readers show a broader metalinguistic impairment which is more closely associated with reading difficulties.

Investigating the effect of STN-DBS stimulation and different frequency settings on the acoustic-articulatory features of vowels.

INTRODUCTION: Parkinson's disease (PD) is the second most frequent progressive neuro-degenerative disorder. In addition to motor symptoms, nonmotor symptoms and voice and speech disorders can also develop in 90% of PD patients. The aim of our study was to investigate the effects of DBS and different DBS frequencies on speech acoustics of vowels in PD patients. METHODS: The study included 16 patients who underwent STN-DBS surgery due to PD. The voice recordings for the vowels including [a], [e], [i], and [o] were performed at frequencies including 230, 130, 90, and 60 Hz and off-stimulation. The voice recordings were gathered and evaluated by the Praat software, and the effects on the first (F1), second (F2), and third formant (F3) frequencies were analyzed. RESULTS: A significant difference was found for the F1 value of the vowel [a] at 130 Hz compared to off-stimulation. However, no significant difference was found between the three formant frequencies with regard to the stimulation frequencies and off-stimulation. In addition, though not statistically significant, stimulation at 60 and 230 Hz led to several differences in the formant frequencies of other three vowels. CONCLUSION: Our results indicated that STN-DBS stimulation at 130 Hz had a significant positive effect on articulation of [a] compared to off-stimulation. Although there is not any statistical significant stimulation at 60 and 230 Hz may also have an effect on the articulation of [e], [i], and [o] but this effect needs to be investigated in future studies with higher numbers of participants.

Influence of timing of delayed hard palate closure on articulation skills in 3-year-old Danish children with unilateral cleft lip and palate.

BACKGROUND: Differing results regarding articulation skills in young children with cleft palate (CP) have been reported and often interpreted as a consequence of different surgical protocols. AIMS: To assess the influence of different timing of hard palate closure in a two-stage procedure on articulation skills in 3-year-olds born with unilateral cleft lip and palate (UCLP). Secondary aims were to compare results with peers without CP, and to investigate if there are gender differences in articulation skills. Furthermore, burden of treatment was to be estimated in terms of secondary surgery, hearing and speech therapy. METHODS & PROCEDURES: A randomized controlled trial (RCT). Early hard palate closure (EHPC) at 12 months versus late hard palate closure (LHPC) at 36 months in a two-stage procedure was tested in a cohort of 126 Danish-speaking children born with non-syndromic UCLP. All participants had the lip and soft palate closed around 4 months of age. Audio and video recordings of a naming test were available from 113 children (32 girls and 81 boys) and were transcribed phonetically. Recordings were obtained prior to hard palate closure in the LHPC group. The main outcome measures were percentage consonants correct adjusted (PCC-A) and consonant errors from blinded assessments. Results from 36 Danish-speaking children without CP obtained previously by Willadsen in 2012 were used for comparison. OUTCOMES & RESULTS: Children with EHPC produced significantly more target consonants correctly (83%) than children with LHPC (48%; p < .001). In addition, children with LHPC produced significantly more active cleft speech characteristics than children with EHPC (p < .001). Boys achieved significantly lower PCC-A scores than girls (p = .04) and produced significantly more consonant errors than girls (p = .02). No significant differences were found between groups regarding burden of treatment. The control group performed significantly better than the EHPC and LHPC groups on all compared variables.

Deliberate Practice: Preliminary Results of a Useful Strategy for Correcting Articulation in Children With Cleft Palate.

Children with cleft palate frequently show speech and language disorders. In the related scientific literature, several reports have described the use of different strategies for treating speech disorders in children with cleft palate. However, only a few studies have addressed the use of these strategies within a meaningful linguistic context.Deliberate practice is a procedure or strategy, which proposes that the key for achieving high levels of expert performance is dedicating long time for practice. Deliberate practice has been studied mainly in the areas of sports and intellectual games. The purpose of this article is to study whether the use of a strategy originally designed for achieving expert performance in sports and intellectual games, can be useful for the speech intervention of children with cleft palate.For this project, 32 children with cleft palate were studied. The children were randomly assigned to 2 independent groups. Both groups received speech therapy based on the principles of the Whole Language Model. In addition, deliberate practice was used in the children included in the active group.After a speech intervention, although both groups of children demonstrated significant improvement in articulation placement, the active group demonstrated a significantly higher improvement as compared with the control group.In conclusion, these preliminary results seem to suggest that the use of deliberate practice can be effective for enhancing articulation in children with cleft palate.

Speech Production Skills in Children With Cleft Palate Who Were Internationally Adopted.

OBJECTIVE: The objective of this study was to investigate the impact of international adoption (IA), age at palatoplasty (PR age), and velopharyngeal sufficiency (VPS) on articulation outcomes. DESIGN: This was a cross-sectional, prospective, observational study. SETTING: Outpatient hospital clinic. PARTICIPANTS: Fifty-one IA and 65 not-adopted (NA) children between the ages of 3 and 9 with nonsyndromic cleft palate with or without cleft lip. MAIN OUTCOME MEASURE(S): The Goldman-Fristoe Test of Articulation-2nd Edition (GFTA-2) standard score and cleft-related articulation errors (CREs). RESULTS: Articulation impairment was observed for 40% to 76% of NA children and 71% to 92% IA children, depending on age. PR age mean IA = 2.07 (0.86) years; NA = 1.23 (0.71) years. Children who were IA had poorer performance on the GFTA-2 ( B = -13.82, P = .015). Children who were IA were not significantly more likely to make CRE; rather, age at the time of assessment ( B = -.10, P = .002) and VPS ( B = .24, P = .021) were associated with CRE. CONCLUSIONS: Children who were IA demonstrated poorer articulation skills. Although primary palatoplasty was accomplished later among children who were IA, age at assessment and VP status (not PR age) were significantly correlated with articulation outcomes. Implications for timing of surgical intervention are discussed.

Production of two Nasal Sounds by Speakers with Cleft Palate.

Many speakers with cleft palate develop atypical consonant productions, especially for pressure consonants such as plosives, fricatives, and affricates. The present study investigated the nature of nasal sound errors. The participants were eight female and three male speakers with cleft palate between the ages of 6 to 20. Speakers were audio-recorded, and midsagittal tongue movement was captured with ultrasound. The speakers repeated vowel-consonant-vowel with the vowels /α/, /i/, and /u/ and the alveolar and velar nasal consonants /n/ and /η/. The productions were reviewed by three listeners. The participants showed a variety of different placement errors and insertions of plosives, as well as liquid productions. There was considerable error variability between and within speakers, often related to the different vowel contexts. Three speakers co-produced click sounds. The study demonstrated the wide variety of sound errors that some speakers with cleft palate may demonstrate for nasal sounds. Nasal sounds, ideally in different vowel contexts, should be included in articulation screenings for speakers with cleft palate, perhaps more than is currently the case.

Influence of Oral Morphology on Speech Production in Subjects Wearing Maxillary Removable Partial Dentures with Major Connectors.

BACKGROUND/AIMS: Speech impairment during the initial phase of removable partial denture (RPD) treatment can prevent patient adaptation to RPDs. This study was undertaken to investigate the influence of oral morphology on speech production in subjects wearing RPDs with major connectors. METHODS: Two types of connectors were fabricated for 17 subjects with normal dentitions: covering the middle palate (M-bar) and the anterior/posterior palate (AP-bar). Four target sounds ([∫i], [t∫i], [çi], and [ki]) were evaluated under 3 recording conditions: no connector, M-bar, and AP-bar. The mean appearance ratios of correct labels (MARCs) were calculated as parameters representing speech production accuracy with the speech evaluation system. Subgroup analysis was conducted based on palate height, dental arch width, and front space volume of the oral cavity. RESULTS: Based on the multiple linear regression test, a significant association was found between the MARCs of [∫i] with M-bar and front space (p = 0.036). In the subgroup analysis, the AP-bar had a significant effect on the MARCs of [∫i] among subjects with high palate (p = 0.026), narrow arch (p = 0.004), and small front space (p = 0.014). CONCLUSION: RPDs with major connectors could disturb speech production among patients with high palates, narrow arches, and small front spaces.

Pacifiers, Thumb Sucking, Breastfeeding, and Bottle Use: Oral Sucking Habits of Children with and without Phonological Impairment.

AIMS: The aim of this study was to describe the nutritive and non-nutritive oral sucking habits (breastfeeding, bottle use, pacifier/dummy/soother use, thumb/finger sucking) of preschoolers with and without phonological impairment, and to determine whether oral sucking habits are associated with the presence and severity of phonological impairment. METHODS: We conducted a cross-sectional study of 199 Australian English-speaking preschoolers with and without phonological impairment. Preschoolers' speech was directly assessed, and parents/caregivers completed a questionnaire. Chi-square (χ2) tests were used to examine relationships between oral sucking habits and the presence and severity of phonological impairment. RESULTS: Based on caregiver reports, 79.9% of participants had been breastfed (33.3% for >12 months), 58.3% had used a pacifier (74.2% for ≥12 months), 83.9% had used a bottle (73.4% for > 12 months), and 15.1% sucked their thumb/fingers. There was no association between a history of oral sucking and the presence and severity of phonological impairment. CONCLUSION: The majority of preschoolers had been breastfed and bottle-fed, and more than half had used a pacifier. The findings support an understanding that phonological impairment is not associated with a history of nutritive and non-nutritive sucking habits. Research is needed to examine the association between oral sucking habits and other types of speech sound disorders.

Articulation handicap index: an instrument for quantifying psychosocial consequences of impaired articulation.

Structural, neurological and muscular diseases can lead to impairments of articulation. These impairments can severely impact social life. To judge health status comprehensively, this impact must be adequately quantified. For this purpose, the articulation handicap index (AHI) has been developed. Psychometric analyses referring to this index are presented here. The AHI was completed by 113 patients who had undergone treatment of tumours of the head or neck. The patients also gave a general self-assessment of their impairments due to articulation problems. Furthermore, tumour size, tumour location and kind of therapy were recorded. Missing data were analysed and replaced by multiple imputation. Internal structure was investigated using principal component analysis (PCA); reliability using Cronbach's alpha. Validity was investigated by analysing the relationship between AHI and general self-assessment of impairments. Moreover, the relationships with tumour size, tumour location and kind of therapy were analysed. Only 0.12 % of the answers to the AHI were missing. The Scree test performed with the PCA results suggested one-dimensionality with the first component explaining 49.6 % of the item variance. Cronbach's alpha was 0.96. Kendall's tau between the AHI sum score and the general self-assessment was 0.69. The intervals of AHI sum scores for the self-assessment categories were determined with 0-13 for no, 14-44 for mild, 46-76 for moderate, and 77-120 for severe impairment. The AHI sum score did not systematically relate to tumour size, tumour location or kind of therapy. The results are evidence for high acceptance, reliability and validity.

Speech rate in Parkinson's disease: A controlled study. / Estudio controlado del ritmo del habla en la enfermedad de Parkinson.

INTRODUCTION: Speech disturbances will affect most patients with Parkinson's disease (PD) over the course of the disease. The origin and severity of these symptoms are of clinical and diagnostic interest. PURPOSE: To evaluate the clinical pattern of speech impairment in PD patients and identify significant differences in speech rate and articulation compared to control subjects. Speech rate and articulation in a reading task were measured using an automatic analytical method. PATIENTS: A total of 39 PD patients in the 'on' state and 45 age-and sex-matched asymptomatic controls participated in the study. None of the patients experienced dyskinesias or motor fluctuations during the test. RESULTS: The patients with PD displayed a significant reduction in speech and articulation rates; there were no significant correlations between the studied speech parameters and patient characteristics such as L-dopa dose, duration of the disorder, age, and UPDRS III scores and Hoehn & Yahr scales. CONCLUSION: Patients with PD show a characteristic pattern of declining speech rate. These results suggest that in PD, disfluencies are the result of the movement disorder affecting the physiology of speech production systems.