Evaluation of a modular palatal lift prosthesis with a silicone velar lamina for hypernasal patients.

STATEMENT OF PROBLEM: Speech bulbs and palatal lift prostheses are used to improve oral-nasal balance in speakers with hypernasality resulting from velopharyngeal dysfunction. Fabricating such speech prostheses is often a protracted process, and the nasopharyngeal impression can be uncomfortable for the client. PURPOSE: The purpose of this study was to develop and test a modular palatal lift prosthesis with a silicone velar lamina that can be fabricated without a nasopharyngeal impression. MATERIAL AND METHODS: Six adult participants with different etiologies were treated with both a conventional palatal lift prosthesis and the new prosthesis. The outcome measures were nasalance scores, speech acceptability ratings, and participant responses on a questionnaire. Inferential statistical analyses were conducted with nonparametric Friedman tests and 2-tailed paired Wilcoxon signed ranks tests. The probability was set at P<.1. RESULTS: Among the 3 speaking conditions (no prosthesis, acrylic resin prosthesis, modular silicone palatal lift prosthesis), no differences were found in nasalance scores for the oral stimuli. For the nasal sentences, a numerically greater reduction was observed for the silicone than for the acrylic resin prosthesis. Speech acceptability was better with the modular silicone palatal lift prosthesis (z=2.032, P<.05) and the acrylic resin prosthesis (z=1.753, P<.1) than with no prosthesis. The questionnaire showed better subjective speech acceptability with the acrylic resin prosthesis (z=1.706, P<.05) and the modular silicone palatal lift prosthesis (z=1.706, P<.05) than with no prosthesis. Swallowing comfort was also numerically better for the acrylic resin prosthesis than for the modular silicone palatal lift prosthesis. CONCLUSIONS: This study demonstrates the feasibility of a new design for a flexible and modular palatal lift prosthesis. The functional outcomes were comparable to those of the traditional design. Although the overall results in this study favored the traditional prosthesis, the new design may be viable for patients who require alternative treatment solutions.

A simplified palatal lift prosthesis for neurogenic velopharyngeal incompetence.

Velopharyngeal incompetence is a contributing factor to speech disorders and implies the presence of hypernasality, inappropriate nasal escape, and decreased air pressure during speech. One prosthetic treatment is a rehabilitative procedure employing a palatal lift prosthesis (PLP), which reduces hypernasality by approximating the incompetent soft palate to the posterior pharyngeal wall and consists of two parts, the anterior denture base and the palatal lifting plate, which are connected with steel wires; however, it seems difficult to reproduce the mobility of the soft palate in speaking, and it is therefore likely that the palatal lifting plate stimulates or oppresses the tissue of the soft palate and hinders rather than assists articulatory function. To avoid these disturbances we devised an adjustable PLP with a flexible conjunction between the denture base and the palatal lifting plate to obtain the optimal vertical lifting angle. The palatal plate was adapted to conform in a passive manner to the soft palate with light-cured resin. The designed PLP simplified the procedure and reduced the number of adjustments and visits.

Implant-supported palatal lift prosthesis in a patient with velopharyngeal incompetence: a case report.

OBJECTIVE: To describe the use of dental implants in the treatment of velopharyngeal incompetence. BACKGROUND: Velopharyngeal incompetence is characterized by the inability to contract the tissues of the soft palate. The most common causes are neuromuscular problems resulting from concussion and degenerative conditions of the central nervous system. MATERIALS AND METHODS: The treatment using palatal lift prosthesis is well established in the literature; however, reports on the use of osseointegrated implants are scarce. Rehabilitation using only this type of fibromucosal support is difficult in edentulous patients, since the prosthesis has a palatal lift extension. RESULTS: The implants provided retention and stability to the prosthesis, improving swallowing and speech and contributing to improve the patient's quality of life. CONCLUSION: This article reports the rehabilitation of a patient with a totally edentulous maxilla with velopharyngeal incompetence using an implant-retained palatal lift prosthesis.

Effects of EPG treatment for English consonant contrasts on L2 perception and production.

Links between perception and production were investigated for two adult native speakers of Korean who participated in electropalatographic (EPG) treatment designed to teach phonological and articulatory contrasts between English /s/ - /ʃ/, /z/ - /ʤ/, and /l/ - /ɹ/. Participants were successful in learning to produce the English contrasts. Perception of English consonants was tested pre- and post-treatment. Post-treatment perception improved somewhat for treated consonants but not for untreated consonants, although perception was not directly trained.

Horns, whistles, bite blocks, and straws: a review of tools/objects used in articulation therapy by Van Riper and other traditional therapists.

The use of tools and other objects in articulation therapy has been bundled into new groups of activities called "nonspeech oral motor exercises" (NSOME) and 'nonspeech oral motor treatments' (NSOMT) by some authors. The purveyors of these new terms suggest that there is no proof that such objects aid speech learning, and they have cautioned students and professionals about their use. Speech-language pathologists are trying to reconcile these cautions with basic Van Riper type therapy routines. The purpose of this literature review was to summarize the ways in which tools/objects were used by Van Riper and other speech professionals between 1939 and 1968. Fourteen textbooks were selected for review. Van Riper and other developers of traditional articulation therapy regularly used a wide variety of tools/objects in articulation therapy. Tools/objects were used when other auditory, linguistic, and cognitive means failed to stimulate correct phoneme productions. To call these activities "non-speech" methods seems to misrepresent the historic purpose objects have served in articulation therapy. More empirical research is required in this area.

Electropalatography in the description and treatment of speech disorders in five children with cerebral palsy.

Some children with cerebral palsy have articulation disorders that are resistant to conventional speech therapy. The aim of this study was to investigate whether the visual feedback method of electropalatography (EPG) could be an effective tool for treating five children (mean age of 9.4 years) with dysarthria and cerebral palsy and to explore whether training improved the posteriorly placed articulation of the Swedish dental/alveolar target consonants /t/, /d/, /n/ and /s/ produced in different positions. An EPG analysis was conducted and some of the data were combined with a perceptual analysis. A more anterior placement was seen after treatment for the target sounds. Features of diagnostic importance revealed were unusual tongue-palate contacts, such as double articulation and abnormally retracted articulation. A possible change in stop closure duration was indicated. The results suggest that EPG could be of potential benefit for diagnosing, treating and describing articulation errors associated with cerebral palsy.

Palatal training appliances in children with mild to moderate oral dysfunctions.

OBJECTIVE: The objective of the study was to evaluate the efficacy of palatal training appliances on speech articulation and orofacial functions in children undergoing speech therapy. STUDY DESIGN: The material consisted of 134 boys and 34 girls who were referred by speech and language therapists to the Public Dental Health Service in Vantaa due to mild to moderate problems with speech articulation or in oral motor skills. The mean age of the children at the start of the palatal plate therapy was 6.4 years (SD 1.9). The articulation assessment was performed by five speech and language therapist while the palatal plate therapy was carried out by an experienced dentist. The mean treatment time with the oral plates was 4.4 months (SD 2.3). RESULTS: An improvement in speech articulation was observed by the speech and language therapists in 51% of the children. Tongue movements improved in 47%, and lip closure in 38% of the participants. Drooling decreased in 54% of the cases. A multiple logistic regression model revealed that with respect to speech articulation the best improvement was found in children with /r/-disorder and in those with a crossbite. CONCLUSIONS: Palatal training appliances during speech therapy seemed to be an efficient way to improve speech articulation and tongue movements in children with mild to moderate problems in orofacial functions.

Management of velopharyngeal disorders. A case series.

Patients with acquired defects or congenital malformations of the palate exhibit disturbances in speech, including hypernasality, nasal emission, and decreased intelligibility of speech. Maxillofacial prosthetic treatment can reestablish the palatopharyngeal integrity to provide the potential for acceptable speech. This article describes a case series of patients with palatopharyngeal disorders and their treatment approaches.

Reconstruction of the soft palate in oral cancer to repair an operative defect with speech aid prosthesis: a case report.

A soft palate defect may result from surgical resection, and its consequences could include hypernasal speech and nasal regurgitation of food and liquids. A speech aid prosthesis fabricated for patients can improve nasal emission during speech, and assist in preventing nasal regurgitation of food. This article presents a case of the reconstruction of a soft palate defect by prosthetic obturation.

Obturators for cleft palate and other speech appliances.

An outline is given of palato-pharyngeal function in the cleft palate patient and how it may be expected to vary from that of the non-cleft subject. The procedure of obturator moulding is described and the functioning of palatal training appliances and palatal supports explained.

Relationship between clinical and instrumental assessment of the tongue in healthy young adults.

PURPOSE: To verify the association of tongue clinical evaluation aspects with quantitative evaluation of tongue force. METHODS: A cross-sectional study was conducted with 48 healthy adults, 13 men and 35 women (ages 20-44 years; mean - M=24.8 years; standard deviation - SD=5.3 years). By clinical evaluation, the following aspects were checked: tongue force, alternate movements, snap, suction and vibration of the tongue. The evaluator also checked if the floor of the mouth elevated during tasks of tongue elevation and sucking tongue on palate and the occurrence of lingual tremor. Quantitative evaluation was accomplished using the FORLING instrument. It is composed of a piston/cylinder assembly attached to a mouthguard and to a drive shaft. The force applied by the tongue to the drive shaft is hydraulically transmitted to a pressure sensor. Mann-Whitney's test was used to verify whether there were differences in average and maximum forces according to the characteristics assessed. The test was performed at a 5% level of significance. RESULTS: The aspects with the most frequent alteration were sucking tongue on palate and tongue vibration. Tremor had a higher occurrence during tongue movements. Elevation of the floor of the mouth in sucking tongue on palate was the only aspect associated with quantitative evaluation. CONCLUSION: The association between elevation of the floor of the mouth during sucking tongue on palate and quantitative evaluation can provide insight into the higher participation of the suprahyoid muscles in some participants in both tasks.

Electropalatography and the Linguagraph system.

This paper describes the technique of electropalatography and the development of Linguagraph, which is a user-friendly, clinical instrument, for measurement of tongue/palate contact, during speech. Linguagraph allows objective assessment of tongue function; appropriate targeting of therapy is therefore possible. Visual feedback is also provided, for therapy, and an objective measurement of outcome is easily obtained. Linguagraph was used, for both therapy and assessment, in a clinical trial. Technical aspects of Linguagraph and of the trial results are presented here. These suggest that the instrument will prove useful in the assessment and management of many speech disorders. Full clinical details of the trial are reported elsewhere.

Using visible speech to train perception and production of speech for individuals with hearing loss.

The main goal of this study was to implement a computer-animated talking head, Baldi, as a language tutor for speech perception and production for individuals with hearing loss. Baldi can speak slowly; illustrate articulation by making the skin transparent to reveal the tongue, teeth, and palate; and show supplementary articulatory features, such as vibration of the neck to show voicing and turbulent airflow to show frication. Seven students with hearing loss between the ages of 8 and 13 were trained for 6 hours across 21 weeks on 8 categories of segments (4 voiced vs. voiceless distinctions, 3 consonant cluster distinctions, and 1 fricative vs. affricate distinction). Training included practice at the segment and the word level. Perception and production improved for each of the 7 children. Speech production also generalized to new words not included in the training lessons. Finally, speech production deteriorated somewhat after 6 weeks without training, indicating that the training method rather than some other experience was responsible for the improvement that was found.

Electropalatography in the treatment of articulation/phonological disorders.

Treatment using electropalatography (EPG) is described. Speech learners wear a custom-made appliance called a pseudopalate in order to view their tongue-to-palate (lingual palatal) contacts on a computer monitor. The results from studies with children who have either articulation or phonology-based problems are discussed. Assessments of contact patterns used by articulation-impaired children suggests that they may produce more atypical articulatory contacts than are noted perceptually. Remediation, using electropalatography, showed that the children benefited from learning new articulatory gestures rather than learning to correct isolated errors. Studies with phonologically-impaired children have shown that perceptually neutralized (or non-contrasted) sounds may actually be produced with consistent articulatory contrasts. This knowledge could assist in identifying sounds that might soon emerge and be more responsive to therapy. Training studies with phonologically-impaired children have shown that a motor approach using sound contrasts to teach a phonetic inventory is an effective way to assist these children. Considerations for candidacy for EPG training are also discussed.

Survey of patented anti-stuttering devices.

Various types of devices have been patented to alleviate stuttering. Some prevent certain physical actions, such as clamping of the teeth, improper movement of the tounge and improper breathing. Others strengthen or incapacitate certain muscles. The devices and their alleged action on the body are described. United States as well as foreign patents are included. No attempt has been made to evaluate said devices

The use of a prosthetic speech aid for a laryngectomized esophageal speaker with right hemiparesis of the tongue: a case report.

A dental-palatal prosthetic device, which had been demonstrated to aid laryngectomees who use the glossal press method of esophageal speech, was used on a patient whose primary method of air charging was bilabial plosive injection and who had a right hemiparesis of the tongue. Cointervention of a prosthodontist and a speech pathologist is described.

Prosthetic rehabilitation of the cleft palate patient.

This article is a brief overview of prosthodontic and restorative methods used in the treatment of unilateral and bilateral cleft palate patients. Some past, present, and future methods of rehabilitation are discussed.

Speech aid prosthesis.

Velopharyngeal defects are common problem encountered in dentistry, different prosthetic designs can be used; however, the prosthesis should be comfortable and function properly. Surgical treatment is the treatment of choice, but there are few patients who are not able to receive the surgical intervention; in such cases prosthetic management is considered using speech bulb prosthesis to overcome nasal twang and nasal regurgitation.