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BACKGROUND: With a rapidly aging population in mainland China, dysphagia has become one of the common geriatric disorders which creates a huge demand on speech and language therapists (SLTs). The major challenge is the shortage of SLTs in China. In addition, frontline practitioners in mainland China may not be well equipped with the knowledge and practical skills in dysphagia management due to lack of systematic training and the work nature. AIMS: This study evaluates the self-perceived effectiveness and feasibility of an online training program that aims to enhance the self-assessed knowledge and skills of SLTs providing dysphagia care in residential aged care homes. METHODS AND PROCEDURES: Sixteen SLTs working in a residential aged care homes in mainland China attended a three-hour pilot online training program which consists of didactic lecture and practical skills activity components. A total of 10 participants completed an online questionnaire one month after the training to evaluate the feasibility and effectiveness of this online training program. OUTCOMES AND RESULTS: The preliminary results demonstrated participants' self-perception of high training effectiveness in theoretical knowledge and practical skills. A majority of the participants perceived that the training enhanced their theoretical knowledge and all of them perceived that they acquired practical skills. All respondents were satisfied with the online training approach. They also highlighted the advantage and challenges of the online training approach. CONCLUSIONS AND IMPLICATIONS: Online training is an effective and feasible approach for theoretical knowledge and practical skills transfer in SLT training and could ultimately benefit the delivery of services for individuals with dysphagia in mainland China. WHAT THIS PAPER ADDS: What is already known on the subject Previous studies have shown that online training approach is as effective as face-to-face training in increasing professional knowledge. Online training programs may be more cost efficient and time efficient when compared with face-to-face training. What this study adds The present study provided preliminary evidence to support the feasibility and effectiveness of using online training on dysphagia for speech and language therapists working in residential aged care homes in mainland China. What are the clinical implications of this work? From the participants' perception, online training approach is effective and feasible in delivering theoretical knowledge and practical skills. It may be a better training approach for mainland China considering the lack of expertise and accessibility to training.
Subject(s)
Deglutition Disorders , Language Therapy , Humans , Aged , Language Therapy/methods , Speech Therapy/methods , Deglutition Disorders/therapy , Feasibility Studies , Needs AssessmentABSTRACT
This case report explores clinical treatment efficacy in a Cantonese-speaking child with 22q11.2 Deletion Syndrome where diagnosis and management of velopharyngeal dysfunction can be considered late. All treatment sessions were undertaken via telepractice during the peak of the COVID-19 pandemic in Hong Kong. A hybrid of specialized cleft palate speech treatment techniques and traditional treatment approaches in Speech Sound Disorders were utilized. Treatment intensity components including dose, dose form, session duration, and total intervention duration were documented.
Subject(s)
COVID-19 , Cleft Palate , DiGeorge Syndrome , Velopharyngeal Insufficiency , Child , Humans , DiGeorge Syndrome/diagnosis , DiGeorge Syndrome/therapy , Velopharyngeal Insufficiency/diagnosis , Velopharyngeal Insufficiency/genetics , Velopharyngeal Insufficiency/therapy , Speech , Delayed Diagnosis/adverse effects , Pandemics , COVID-19/complications , Cleft Palate/diagnosis , Cleft Palate/therapy , Cleft Palate/complications , COVID-19 TestingABSTRACT
INTRODUCTION: This study aims at exploring the feasibility of applying a computer-based language test to young children aged 2-4 years. METHODS: Thirty-two Cantonese-speaking children, aged 2-4 years, were recruited from local kindergartens. All participants underwent assessment using both the computer-based and paper-pencil versions of the Macau Cantonese Language Screening Scale for Preschool Children, following a crossover study design. A short break of 15-30 minutes was provided between the two assessments. The data were analysed at three levels: the overall test, subcategory, and individual item levels. At the overall test and subcategory levels, data were analysed using the paired samples t-test and ICC. At the item level, the percentage of agreement and Cohen's kappa value were selected to assess the agreement of the two test formats. RESULTS: Excellent agreement was found for the overall test level, and good agreement was observed for four of the five subcategories. At the individual item level, 28 of the 35 items showed more than 80% agreement, and 16 items showed substantial to almost perfect agreement. CONCLUSION: These results suggest that the two test formats give similar total scores and subcategory scores for children aged 2-4. For children older than 2 years, 6 months, the agreement for matching items is as high as 83.68% (1318/1575). The computer-based test is thus highly recommended for this group of children. For children younger than 2 years, 6 months, a modified computer-based test is suggested to accommodate their needs.
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Childhood apraxia of speech (CAS) is a paediatric motor speech disorder. We investigated the lexical tone perception and production abilities of children with CAS and the relationships between the two. Three children with CAS, aged between 3;7 and 5;8, were given the Cantonese Tone Identification Test (CANTIT) and the Hong Kong Cantonese Articulation Test (HKCAT) for assessment of tone perception and production, respectively. Accuracy and error patterns were investigated based on their performance on the two tests. Correlation analysis was performed on children's perception and production scores. Two children scored at the lowest rank on the CANTIT, while one child obtained a Z score of 0. All children scored three standard deviations below the mean on the HKCAT. No statistical differences were found among the six tones with respect to perception accuracy, H(5) = 3.731, p = 0.589. Error analysis showed that children with CAS demonstrated more confusion on perceiving tones compared with TD peers. There were no main effects for task (F(1,2) = 0.040, p = 0.859) or tone (F(5,10 = 0.997, p = 0.467); nor were there task or tone interaction effects on perception versus production accuracy (F(5,10) = 1.772, p = 0.206). Tone perception and production accuracy were not significantly correlated (r2 = 0.181, p = 0.078). Tone perception deficits were evident in two out of three children with CAS, while all children had lexical tone production difficulties. In this small sample, tone production was more universally affected than tone perception.
Subject(s)
Speech Perception , Speech , Child , Humans , Child, Preschool , Pilot Projects , Hong Kong , Speech Production MeasurementABSTRACT
INTRODUCTION: Abnormal facial growth is a recognized outcome in cleft lip and palate (CLP), resulting in a concave profile and a class III occlusal status. Maxillary osteotomy (MO) is undertaken to correct this facial deformity, and the surgery can impact speech articulation, although the evidence remains limited and ill-defined for the CLP population. AIMS: The aim of the study was to investigate the impact of MO on the production of the fricatives /f/ and /s/, using perceptual and acoustic analyses, and to explore the nature of speech changes. METHODS: Twenty participants with CLP were seen 0-3 months pre-operatively (T1) and 3 months (T2) and 12 months (T3) after MO. A normal group (N = 20) was similarly recruited. Perceptual speech data was collected according to a validated framework and ratings made on audio and audio-video recordings (VIDRat). Spectral moments were centre of gravity (CG), standard deviation (SD), skewness (SK) and kurtosis (KU). Reliability studies were carried out for all speech analyses. RESULTS: For the CLP group, VIDRat identified dentalization/interdentalization as the main type of pre-operative error for /s/ with a statistically significant improvement over time, χ2(2) = 6.889, p = 0.032. Effect sizes were medium between T1 and T3 (d = 0.631) and small between T2 and T3 (d = 0.194). For the acoustic data, effect sizes were similarly medium between T1 and T2 (e.g., SK, /f/ d = 0.579, /s/ d = 0.642) and small between T1 and T3 across all acoustic parameters. Independent t tests showed mainly statistically significant differences between both groups at all time points with large effect sizes (e.g., T2 CG, t = -4.571, p < 0.001, d =1.581), indicating that /s/ was not normalized post-operatively. For /f/, differences tended to be at T1 with large effect sizes (e.g., CG, t = -2.307, p = 0.028, d = 0.797), reflecting normalization. CONCLUSIONS AND IMPLICATIONS: This is the first speech acoustic study on /f/ for individuals with CLP undergoing MO. The surgery has a positive impact on /f/ and /s/, which appear to stabilize 3 months post-operatively. Speech changes are an automatic and a direct consequence of the physical changes brought about by MO, effecting articulatory re-organization. The results of the study have direct clinical implications for the clinical care pathway for patients with CLP undergoing MO.
Subject(s)
Cleft Lip , Cleft Palate , Maxillary Osteotomy , Acoustics , Cleft Lip/surgery , Cleft Palate/surgery , Humans , Speech , Treatment OutcomeABSTRACT
BACKGROUND: The status of the velopharyngeal mechanism can be inferred from perceptual ratings of specified speech parameters. Several studies have proposed the measure of an overall velopharyngeal composite score based on these perceptual ratings and have reported good validity. The Cleft Audit Protocol for Speech-Augmented (CAPS-A) is a validated and reliable perceptual framework for the assessment of cleft speech and velopharyngeal function used by all Regional Cleft Services in the UK and Ireland. An overall velopharyngeal composite summary score based on the CAPS-A would serve as an important surgical outcome measure of speech. AIMS: To develop and validate a velopharyngeal composite summary score based on perceptual ratings made on the CAPS-A (CAPS-A VPC-Sum) using data from a maxillary osteotomy (MO) study. METHODS & PROCEDURES: There were two surgical groups: a cleft lip and palate (CLP) (N = 20) group and a non-CLP group (N = 10), and a normal control group (N = 20). Participants in groups 1 and 2 were seen for perceptual and instrumental assessments of speech and velopharyngeal function preoperatively (T1), 3 months (T2) and 12 months (T3) postoperatively. Perceptual speech data were collected and rated by independent listeners using CAPS-A. OUTCOMES & RESULTS: Moderate to strong interrater reliability for perceptual data (rs = 0.503-1.000, all p < 0.01) and strong to very strong reliability for videofluoroscopic measurements (rs = 0.746-0.947) were found. Construct validity of the CAPS-A VPC-Sum was shown by an increase in postoperative scores for the CLP group only Ï°2 (2) = 9.769, p = 0.008 and significant differences between the CLP and the other two groups at T2 and T3 using independent t-tests. Convergent and divergent validity was indicated by a positive moderate correlation with related parameters (e.g., hypernasality rs = 0.869, p < 0.01) and a weak correlation with unrelated parameters (e.g., amount of forward advancement rs = 0.160, p = 0.526). Criterion validity was found by a moderate correlation between closure ratio rs = -0.541, p = 0.020 and CAPS-A VPC-Sum. CONCLUSIONS & IMPLICATIONS: A velopharyngeal composite score based on perceptually rated parameters serves as an important surgical speech outcome measure. The CAPS-A VPC-Sum is a useful, reliable and valid outcome measure of velopharyngeal function. There are added positive implications for other clinicians using geographically and language-specific adapted versions of the CAPS-A internationally. WHAT THIS PAPER ADDS: What is already known on this subject Velopharyngeal composite scores based on perceptually rated speech parameters have been shown to have both clinical and research utility, serving as a useful surgical outcome measure. However, such a composite score must be specifically validated on the perceptual speech framework upon which it is based, as there are differences in measurement methods and terminology across cleft speech perceptual frameworks internationally. What this paper adds to existing knowledge The CAPS-A is a nationally used tool in the UK and Ireland for audit and research purposes with validated and adapted international versions. This paper reports on the validation of the derived velopharyngeal composite score measure based on the CAPS-A and an English-speaking sample, providing evidence of its validity through a speech osteotomy study. What are the potential or actual clinical implications of this work? This work provides CLP teams who use CAPS-A with a validated surgical speech outcome measure of velopharyngeal function. It has positive implications also for adapted versions of the CAPS-A internationally.
Subject(s)
Cleft Lip , Cleft Palate , Velopharyngeal Insufficiency , Cleft Lip/surgery , Cleft Palate/surgery , Humans , Osteotomy , Reproducibility of Results , Speech , Speech Disorders , Treatment Outcome , Velopharyngeal Insufficiency/diagnosis , Velopharyngeal Insufficiency/surgeryABSTRACT
BACKGROUND: Maxillary hypoplasia is a common skeletal condition in cleft lip and palate (CLP). Maxillary osteotomy is typically used to reposition the maxilla in CLP with maxillary hypoplasia. Previous studies have suggested that vowel articulations are adjusted postsurgically due to altered vocal tract configuration and articulatory reorganization. This acoustic study aims to investigate whether vowels are normalized postoperatively and to explore the nature of articulatory reorganization. METHODS AND PROCEDURES: A prospective study was conducted to examine the vowel production of a group of individuals with CLP (Nâ=â17) undergoing maxillary osteotomy and a group of normal controls (Nâ=â20), using speech acoustic data. The data were collected at 0 to 3âmonths presurgery (T1), 3-months (T2), and 12-months (T3) postsurgery. General linear model repeated measures and independent t-tests were undertaken on F1, F2, and vowel space area. RESULTS: General linear model repeated measures revealed no main effects of time for F1 (F [2, 22]â=â1.094, Pâ=â0.352), F2 (F [2, 22]â=â1.269, Pâ=â0.301), and vowel space area (F [2, 28]â=â0.059, Pâ=â0.943). Independent t-tests showed statistically significant differences (Pâ<â0.05) for all acoustic parameters and all vowels between the CLP and the normal groups at all time points. CONCLUSIONS: Vowels were not normalized after maxillary osteotomy despite positive anatomical changes within the oral cavity. Individuals with CLP tended to adjust their vowel articulatory gestures to match presurgical patterns. The nature of articulatory reorganization appears to be prompt, sensory-driven, complete, and permanent.
Subject(s)
Cleft Lip , Cleft Palate , Acoustics , Cleft Lip/surgery , Cleft Palate/surgery , Humans , Maxilla/surgery , Maxillary Osteotomy , Osteotomy, Le Fort , Prospective StudiesABSTRACT
In Hong Kong, students are expected to speak fluent Cantonese, Putonghua, and English. However, the curriculum does not include Cantonese studies, as children are expected to have already acquired Cantonese by the age of school entry. This study examined the language outcomes of Cantonese-speaking deaf or hard-of-hearing children who attend primary schools within the Hong Kong educational system and considered whether the system currently meets the needs of these children. The Hong Kong Cantonese Oral Language Assessment Scale, which comprises six subtests, was used to assess 98 children with mild to profound hearing loss. A regression analysis was used to examine the influences of various variables on oral language performance in these children. Notably, 41% of the participants had achieved age-appropriate oral language skills, while 18% and 41% exhibited mild-to-moderate or severe oral language impairment, respectively. The degree of hearing loss and the use of speech therapy were identified as significant negative predictors of oral language performance. The issues of a relatively late diagnosis and device fitting, as well as the very poor oral language outcomes, strongly emphasize the need for policy makers to reconsider the existing educational approaches and support for deaf or hard-of-hearing children.
Subject(s)
Child Language , Deafness , Adolescent , Child , Child, Preschool , Hong Kong , Humans , Multilingualism , Schools , Severity of Illness IndexABSTRACT
Cantonese is a tone language, in which the variation of the fundamental frequency contour of a syllable can change meaning. There are six different lexical tones in Cantonese. While research with Western languages has shown an association between stuttering and syllabic stress, nothing is known about whether stuttering in Cantonese speakers is associated with one or more of the six lexical tones. Such an association has been reported in conversational speech in Mandarin, which is also a tone language, but which varies markedly from Cantonese. Twenty-four native Cantonese-speaking adults who stutter participated in this study, ranging in age from 18-33 years. There were 18 men and 6 women. Participants read aloud 13 Cantonese syllables, each of which was produced with six contrastive lexical tones. All 78 syllables were embedded in the same carrier sentence, to reduce the influence of suprasegmental or linguistic stress, and were presented in random order. No significant differences were found for stuttering moments across the six lexical tones. It is suggested that this is because lexical tones, at least in Cantonese, do not place the task demands on the speech motor system that typify varying syllabic stress in Western languages: variations not only in fundamental frequency, but also in duration and intensity. The findings of this study suggest that treatments for adults who stutter in Western languages, such as speech restructuring, can be used with Cantonese speakers without undue attention to lexical tone.
Subject(s)
Language , Phonetics , Stuttering , Adult , China , Female , Humans , Linguistics , MaleABSTRACT
Speaking rhythmically, also known as syllable-timed speech (STS), has been known for centuries to be a fluency-inducing condition for people who stutter. Cantonese is a tonal syllable-timed language and it has been shown that, of all languages, Cantonese is the most rhythmic (Mok, 2009). However, it is not known if STS reduces stuttering in Cantonese as it does in English. This is the first study to investigate the effects of STS on stuttering in a syllable-timed language. Nineteen native Cantonese-speaking adults who stutter were engaged in conversational tasks in Cantonese under two conditions: one in their usual speaking style and one using STS. The speakers' percentage syllables stuttered (%SS) and speech rhythmicity were rated. The rhythmicity ratings were used to estimate the extent to which speakers were using STS in the syllable-timed condition. Results revealed a statistically significant reduction in %SS in the STS condition; however, this reduction was not as large as in previous studies in other languages and the amount of stuttering reduction varied across speakers. The rhythmicity ratings showed that some speakers were perceived to be speaking more rhythmically than others and that the perceived rhythmicity correlated positively with reductions in stuttering. The findings were unexpected, as it was anticipated that speakers of a highly rhythmic language such as Cantonese would find STS easy to use and that the consequent reductions in stuttering would be great, even greater perhaps than in a stress-timed language such as English. The theoretical and clinical implications of the findings are discussed.
Subject(s)
Speech Production Measurement , Speech Therapy/methods , Speech/physiology , Stuttering/therapy , Adult , Female , Hong Kong , Humans , Language , Male , Young AdultABSTRACT
OBJECTIVES: The ability to recognize tones is vital for speech perception in tonal languages. Cantonese has six tones, which are differentiated almost exclusively by pitch cues (tones 1 to 6). The differences in pitch contours among the tones are subtle, making Cantonese a challenging language for cochlear implant users. The addition of a hearing aid has been shown to improve speech perception in nontonal languages and in Mandarin Chinese. This study (1) investigates the Cantonese tone perception ability of children who use a cochlear implant and a hearing aid in opposite ears; (2) evaluates the effect of varying pitch height and pitch contour cues on Cantonese tone perception for these children; and (3) compares the Cantonese tone perception ability for using a hearing aid and a cochlear implant together versus an implant alone. DESIGN: Eight native Cantonese speaking children using a cochlear implant and a hearing aid in opposite ears were assessed for tone perception and word identification. The tone perception test involved discriminating and ranking tone pairs from natural and artificially manipulated Cantonese tones with various pitch heights and/or pitch contours. The word identification test involved identifying Cantonese words in a four-alternative forced-choice task. All tests were performed in two device conditions: (1) cochlear implant and hearing aid together and (2) implant alone. RESULTS: Seven of the 8 subjects performed significantly above chance in both tests using the cochlear implant alone. Results showed that both pitch height and/or pitch direction were important perceptual cues for implant users. Perception for some tones was improved by increasing the pitch height differences between the tones. The ability to discriminate and rank the tone 2/tone 5 contrast and the tone 4/tone 6 contrast was poor, as the tones in these contrasts are similar in pitch contours and onset frequencies. No significant improvement was observed after artificially increasing the pitch offset differences between the tones in the tone 2/tone 5 and the tone 4/tone 6 contrasts. Tone perception results were significantly better with the addition of the hearing aid in the nonimplanted ear compared with using the implant alone; however, word identification results were not significantly different between using the implant alone and using both the hearing aid and the implant together. None of the subjects performed worse in tone perception or in word identification when the hearing aid was added. CONCLUSIONS: Reduced ability to perceive pitch contour cues, even when artificially exaggerated, may explain some of the difficulties in Cantonese word recognition for implant users. The addition of a contralateral hearing aid could be beneficial for Cantonese tone perception for some individuals with a unilateral implant. The results encouraged Cantonese speakers to trial a hearing aid in the nonimplanted ear when using a cochlear implant.
Subject(s)
Cochlear Implantation , Hearing Aids , Hearing Loss, Bilateral/rehabilitation , Pitch Perception/physiology , Speech Perception/physiology , Adolescent , Child , Child, Preschool , Cochlear Implants , Cues , Female , Hearing Loss, Bilateral/physiopathology , Hong Kong , Humans , Language , MaleABSTRACT
OBJECTIVE: Applying Rasch analysis to evaluate the internal structure of a lexical tone perception test known as the Cantonese Tone Identification Test (CANTIT). DESIGN: A 75-item pool (CANTIT-75) with pictures and sound tracks was developed. Respondents were required to make a four-alternative forced choice on each item. A short version of 30 items (CANTIT-30) was developed based on fit statistics, difficulty estimates, and content evaluation. Internal structure was evaluated by fit statistics and Rasch Factor Analysis (RFA). STUDY SAMPLE: 200 children with normal hearing and 141 children with hearing impairment were recruited. RESULTS: For CANTIT-75, all infit and 97% of outfit values were < 2.0. RFA revealed 40.1% of total variance was explained by the Rasch measure. The first residual component explained 2.5% of total variance in an eigenvalue of 3.1. For CANTIT-30, all infit and outfit values were < 2.0. The Rasch measure explained 38.8% of total variance, the first residual component explained 3.9% of total variance in an eigenvalue of 1.9. CONCLUSIONS: The Rasch model provides excellent guidance for the development of short forms. Both CANTIT-75 and CANTIT-30 possess satisfactory internal structure as a construct validity evidence in measuring the lexical tone identification ability of the Cantonese speakers.
Subject(s)
Audiometry, Speech/methods , Hearing Loss/diagnosis , Persons With Hearing Impairments/psychology , Phonetics , Pitch Perception , Psychoacoustics , Recognition, Psychology , Speech Acoustics , Speech Perception , Acoustic Stimulation , Age Factors , Attention , Auditory Threshold , Case-Control Studies , Child , Child Behavior , Child, Preschool , Cochlear Implants , Female , Hearing , Hearing Aids , Hearing Loss/physiopathology , Hearing Loss/psychology , Hearing Loss/rehabilitation , Humans , Male , Persons With Hearing Impairments/rehabilitation , Predictive Value of Tests , Reproducibility of ResultsABSTRACT
OBJECTIVE: This is the first study to investigate the behavioral nature (topography) of stuttering in Cantonese. Cantonese, a Sino-Tibetan language, is both tonal and syllable-timed. Previous studies of stuttering topography have mainly been in Western languages, which are mainly stress-timed. METHODS: Conversational speech samples were collected from 24 native Cantonese-speaking adults who stuttered. Six consecutive stuttering moments from each participant were analyzed using the Lidcombe behavioral data language (LBDL). A complexity analysis based on the LBDL was developed to indicate the proportion of multiple-behavior stuttering moments for each participant. RESULTS: There was no significant difference in the frequency of the 7 LBDL behaviors. Almost half the stuttering moments across participants were reported as complex, containing more than 1 stuttering behavior, and stuttering complexity correlated significantly with stuttering severity. CONCLUSIONS: These preliminary findings require replication because of their important theoretical and clinical implications. Differences in topography across languages have the potential to contribute to our understanding of the nature of stuttering. Clinically, the recognition of such differences may assist practitioners in identifying stuttering, for example when screening for early stuttering. The LBDL complexity score developed in this study has the potential to be used in other languages.
Subject(s)
Stuttering/physiopathology , Adolescent , Adult , Asian People , Behavior , Female , Humans , Language , Male , Movement , Phonation/physiology , Posture , Video Recording , Young AdultABSTRACT
Background: Exercise-based swallowing training (EBST) and transcutaneous neuromuscular electrical stimulation (TNMES) are common modalities used to treat late dysphagia after radiotherapy for nasopharyngeal carcinoma (NPC). We aimed to investigate and compare the efficacies of EBST and TNMES as proactive treatments administered early after radiotherapy. Methods: Patients with early post-radiotherapy NPC (n = 120) underwent either TNMES or EBST. Flexible endoscopic evaluation of swallowing (FEES), quality of life (QOL), and swallowing function questionnaires were completed before the intervention as well as immediately, 6, and 12 months after the intervention. Outcome measures included the scores for the swallowing function score (SFS), penetration and aspiration scale (PAS), dynamic imaging grade of swallowing toxicity (DIGEST), functional oral intake scale (FOIS), swallowing performance status scale (SPSS), pharyngeal motor impairment (PMI), pharyngeal function impairment (PFI), and functional assessment after cancer therapy-nasopharyngeal (FACT-NP) questionnaire. Results: Three months after radiotherapy, 31 and 34 patients underwent TNMES and EBST, respectively, and completed swallowing assessments at all four assessment timepoints. All patients showed post-radiotherapy impairments in the SFS, PAS, DIGEST, PMI, and PFI. Compared with the EBST group, the TNMES group showed significant improvements in the PFI and PMI scores, with small-to-medium effect sizes. Additionally, compared with the EBST group, the TNMES group demonstrated a trend toward slightly better improvements in the PAS, DIGEST, FOIS, and SPSS scores immediately and 6 months after the intervention. The SFS scores improved from baseline in both groups; however, the TNMES group showed an earlier improvement. Finally, the TNMES group showed better QOL according to the FACT-NP than the EBST group. Conclusion: Proactive TMNES and EBST are safe and feasible modalities for improving swallowing in patients with NPC when administered early after radiotherapy. Although TNMES showed better results than EBST, these results should be interpreted with caution given the study limitations. Level of evidence: 1B.
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This study examined the early pragmatic language skills in typically developing (TD) preschool-age children, children with language impairment (LI) and children with autism spectrum disorder (ASD). Two hundred and sixty-two TD children, 73 children with LI, and 16 children with ASD were compared on early pragmatics through direct assessment (DA). Post hoc analysis revealed that children in two clinical groups displayed significant pragmatic language deficits. Children in the ASD group who were older exhibited comparable degree of impairments as their LI peers, suggesting a relatively stagnant development of pragmatic language skills in children with ASD. Findings also supported the use of DA in identifying pragmatic language deficits, which have implications for the adoption of this assessment approach in clinical settings.
Subject(s)
Autism Spectrum Disorder , Language Development Disorders , Aptitude , Child , Child, Preschool , Humans , Language , Language Development Disorders/diagnosisABSTRACT
Introduction Pitch variation, which refers to one's ability to vary fundamental frequency (F0) within or between syllables when speaking, has not been investigated in children with childhood apraxia of speech (CAS). However, pitch variation plays an important role in tone languages, as varying F0 patterns communicate different lexical meanings. This study investigated pitch variation abilities in individuals with CAS via the tone-sequencing tasks (TSTs), focusing on task performance and the effects of syllable structure, lexical status, and tones. Method Three Cantonese-speaking children with CAS (aged 3;7-5;8 [years;months]) and six children without CAS participated in the study. Children without CAS were divided into two control groups, comprising those with speech and/or language impairment or typical development. TSTs consisted of 56 sets of five repetitions of stimuli. The stimuli varied in syllable structure, lexical status, and tones. Percentage of tones correct (PTC), consistency scores, F0 values, and acoustic repetition duration were measured. Results The CAS group performed more poorly than the control groups on the TST with respect to tone accuracy, consistency, and repetition duration. No interaction effects between group and syllable structure or group and lexical status were found. No significant difference was found on F0 values across time between Tone 1 and Tone 2 syllables in the CAS group. However, interaction effects between group and time points of F0 values on Tone 2 syllables were found. Discussion The results suggest that children with CAS have difficulty with pitch variation, which was revealed on the TST with respect to tone accuracy, consistency, and repetition duration. Moreover, children with CAS have difficulty in varying F0 values to produce high-rising tones and tend to use high-level tones to substitute. Clinically, the TST may be useful to assist in the diagnosis of CAS. Isolated vowel stimuli may be useful to test young children or children with severe impairment. Future investigations and development of a normed tool for children with CAS are suggested.
Subject(s)
Apraxias , Speech Perception , Acoustic Stimulation , Apraxias/diagnosis , Child , Child, Preschool , Humans , Language , Pitch Perception , Speech , Speech AcousticsABSTRACT
BACKGROUND: Voice Handicap Index (VHI) has been used extensively in research and clinical settings. It has been suggested to be used as a diagnostic tool in the literature. However, little is known if it could be applied as a diagnostic tool to the Cantonese-speaking population. The study aims to establish cutoff points and the diagnostic accuracy for VHI-30 and VHI-10 to discriminate between Cantonese-speaking dysphonic and nondysphonic individuals. METHODS: Data from 256 adults from Hong Kong were extracted from a database at a local institution. There were a total of 91 nondysphonic individuals and 165 dysphonic individuals. Receiver operating characteristics curve analysis was conducted to establish cutoff points for VHI-30 and VHI-10. Diagnostic accuracy statistics such as sensitivity, specificity, positive, and negative predicted values (PPV and NPV) and likelihood ratios (LRs) were also reported. RESULTS: The dysphonic group scored higher than the nondysphonic group on the mean scores of both versions of VHI. Receiver operating characteristics curve analysis revealed a moderate to strong area under curve of 0.89 in both VHI-30 and VHI-10. A cutoff point of 18.5 point was yielded for VHI-30 (Sensitivity = 86.1%, Specificity = 81.3%, PPV = 89.3%, NPV = 76.3%, LR+ = 4.60, LR- = 0.17) and a cutoff point of 7.5 point was yielded for VHI-10 (Sensitivity = 80.6%, Specificity = 87.9%, PPV = 92.4%, NPV = 71.4%, LR+ = 6.66, LR- = 0.22). CONCLUSIONS: Both the Chinese VHI-30 and VHI-10 for Cantonese speakers showed promising diagnostic accuracy. VHI can be used as adjunct to clinical diagnosis and treatment outcome measures for voice disorders in the Cantonese-speaking population.
Subject(s)
Voice Disorders , Voice Quality , Adult , Disability Evaluation , Hong Kong , Humans , Predictive Value of Tests , Reproducibility of Results , Severity of Illness Index , Surveys and Questionnaires , Voice Disorders/diagnosisABSTRACT
OBJECTIVES: This study investigated the effects of implant experience and age at implantation on the Cantonese tone production of children with cochlear implants. The study also examined whether there was a particular age at which children were more responsive to acquiring tones. METHODS: The study included 45 children who had received unilateral cochlear implants at a mean age of 65.56 months. The subjects were grouped according to their age at cochlear implantation and were assessed annually for 5 years thereafter. A picture-naming task was used to measure their tone production performance. RESULTS: A simple effect of age at implantation was significant at all testing intervals except at the preoperative data point. Children who were younger than 4 years of age when they received their implants scored significantly higher than did the 2 older groups at various testing intervals. A significant simple effect of implant experience was also found. Progress was most striking in children who received their implants before the age of 4 years. CONCLUSIONS: For the most effective acquisition of Cantonese lexical tones, children should undergo early cochlear implantation. For children who receive implants before the age of 4 years, benefits are noted in tone production ability in terms of a faster rate of improvement within a shorter period of time.
Subject(s)
Cochlear Implants , Hearing Loss/congenital , Hearing Loss/therapy , Language Development , Adolescent , Age Factors , Child , Child, Preschool , Female , Humans , Infant , Male , Pitch PerceptionABSTRACT
Purpose Childhood apraxia of speech (CAS), a motor-based speech disorder, has been well studied in English contexts. However, there is a limited understanding of the applicability of its features to other languages. Thus, this study sought to determine the applicability of the features identified in the English CAS literature to Cantonese CAS. Method A two-round modified Delphi survey of experts was used to identify the clinical features of CAS in Cantonese speakers. Ten Cantonese-speaking qualified speech therapists were recruited as experts. In Round 1, the experts were asked an open-ended question about the clinical features of Cantonese CAS. In Round 2, the experts were asked to rate the importance of the proposed clinical features for making differential diagnoses of Cantonese CAS on a 5-point Likert scale ranging from 1 (very important) to 5 (not important at all). Results In Round 1, the expert panel identified 79 clinical features in nine domains. Sixty-two features (78.5%) were consistent with English CAS. Three English features were not identified in this study, while three features specifically related to Cantonese phonology were identified. In Round 2, 29 clinical features across six domains were found to meet the statistical criteria and were therefore regarded as important for making differential diagnoses of CAS among Cantonese speakers. Conclusions The results suggest that the clinical features identified in the English CAS literature are applicable to Cantonese CAS. The consistency of the findings implies that core and possible co-occurring features are shared between English and Cantonese CAS. The six features that were not common in both languages were discussed. Further investigation of CAS in and between different languages is recommended. This study is not the end point. Future studies can empirically examine the lexical tones or pitch variations to develop a possible objective measure for CAS.
Subject(s)
Apraxias , Speech , Apraxias/diagnosis , Child , Humans , Language , Linguistics , Speech Production MeasurementABSTRACT
The global 2019 novel coronavirus disease (COVID-19) pandemic has had devastating effects not only on healthcare systems worldwide but also on different aspects of the care provided to nursing home residents. Dysphagia management is a crucial component of the care provided to many nursing home residents. This article presents the dysphagia management strategies applied in Hong Kong during the COVID-19 pandemic and the related experiences. A two-tier protection system was implemented wherein residents were categorised according to their contact and hospitalisation histories. The provided swallowing management and personal protective equipment level differed between the two tiers. The article also discusses the referral and prioritisation of clinical services for residents requiring swallowing management, as well as the adaptations of swallowing assessment and management during the pandemic. The possible effects of COVID-19 on mealtime arrangements in nursing homes, the implications of the pandemic on the use of personal protective equipment and the use of telepractice in nursing homes were also discussed. This article has summarised the actions taken in this regard and may serve as a reference to clinicians who are responsible for swallowing assessments and dysphagia management in nursing homes.