Neural Changes in Children With Residual Speech Sound Disorder After Ultrasound Biofeedback Speech Therapy.

PURPOSE: Children with residual speech sound disorders (RSSD) have shown differences in neural function for speech production, as compared to their typical peers; however, information about how these differences may change over time and relative to speech therapy is needed. To address this gap, we used functional magnetic resonance imaging (fMRI) to examine functional activation and connectivity on adaptations of the syllable repetition task (SRT-Early Sounds and SRT-Late Sounds) in children with RSSD before and after a speech therapy program. METHOD: Sixteen children with RSSD completed an fMRI experiment before (Time 1) and after (Time 2) a speech therapy program with ultrasound visual feedback for /ɹ/ misarticulation. Progress in therapy was measured via perceptual ratings of productions of untreated /ɹ/ word probes. To control for practice effects and developmental change in patterns of activation and connectivity, 17 children with typical speech development (TD) completed the fMRI at Time 1 and Time 2. Functional activation was analyzed using a region-of-interest approach and functional connectivity was analyzed using a seed-to-voxel approach. RESULTS: Children with RSSD showed a range of responses to therapy. After correcting for multiple comparisons, we did not observe any statistically significant cross-sectional differences or longitudinal changes in functional activation. A negative relationship between therapy effect size and functional activation in the left visual association cortex was on the SRT-Late Sounds after therapy, but it did not survive correction for multiple comparisons. Significant longitudinal changes in functional connectivity were observed for the RSSD group on SRT-Early Sounds and SRT-Late Sounds, as well as for the TD group on the SRT-Early Sounds. RSSD and TD groups showed connectivity differences near the left insula on the SRT-Late Sounds at Time 2. CONCLUSION: RSSD and treatment with ultrasound visual feedback may thus be associated with neural differences in speech motor and visual association processes recruited for speech production.

A Qualitative Analysis of Clinician Perspectives of Ultrasound Biofeedback for Speech Sound Disorders.

PURPOSE: Ultrasound biofeedback therapy (UBT) is a relatively new type of technology-assisted speech-language therapy and has shown promise in remediating speech sound disorders. However, there is a current lack of understanding of the barriers and benefits that may influence the usage behavior and clinical decision making for the implementation of UBT from a clinician perspective. In this qualitative study, we explore the perspectives of speech-language pathologists (SLPs) who have used ultrasound biofeedback in programs of speech sound therapy using the unified theory of acceptance and use of technology (UTAUT) model. METHOD: Seven SLPs who had clinical experience treating speech sound disorders with UBT participated. Semistructured in-depth interviews were conducted and video-recorded. Two coders coded and categorized the transcribed data, with consensus established with a third coder. Using thematic analysis, the data were exploratorily grouped into themes along components of the UTAUT model. RESULTS: The highest number of codes was sorted into the "effort expectancy" theme, followed by "performance expectancy," "social influence," and "facilitating conditions" themes of the UTAUT model. Clinicians identified multiple perceived barriers and benefits to the use of ultrasound technology. The top identified barrier was limited accessibility, and the top benefit was the ability to visualize a client's articulatory response to cues on a display. CONCLUSIONS: Clinicians prioritized "effort expectancy" and "performance expectancy" when reflecting on the use of ultrasound biofeedback for speech sound disorders. Clinicians spoke favorably about using UBT for speech sound disorder treatment but acknowledged institutional barriers and limitations at organizational and social levels.

Hospital bed replacement for acute care of children at home during the COVID-19 pandemic through a Hospital-in-the-Home programme.

OBJECTIVES: During the COVID-19 pandemic, we expanded our Hospital-in-the-Home (HITH) programme to increase capacity and manage COVID-19-positive children. We aimed to assess impact on overall HITH activity and COVID-19-positive outcomes. DESIGN: Prospective comparative cohort study. SETTING: The largest paediatric HITH in Australasia, at The Royal Children's Hospital Melbourne. PATIENTS: Children 0-18 years admitted to HITH during the pandemic. INTERVENTION: We developed a COVID-19 responsive service, and a guideline for COVID-19-positive patients. We compared overall activity prior to and during the pandemic, and COVID-19-positive admissions with different variants. MAIN OUTCOMES: We compared outcomes for all HITH patients before and during the pandemic, and for COVID-19-positive patients admitted first to hospital versus directly to HITH. RESULTS: HITH managed 7319 patients from March 2020 to March 2022, a 21% increase to previously, with a 132% telehealth increase. 421 COVID-19-positive patients (3 days-18.9 years) were admitted to HITH, predominantly high risk (63%) or moderately unwell (33%). Rates of childhood infection in Victoria, with proportion admitted to HITH were: original/alpha variant-3/100 000/month, 0.7%; delta-92/100 000/month, 0.8%; omicron-593/100 000/month, 0.3%. Eligible parents of only 29 of 71 (41%) high-risk children were vaccinated. COVID-19-positive children admitted directly to HITH were less likely to receive COVID-19-specific treatment than those admitted to hospital first (14 of 113 (12%) vs 33 of 46 (72%), p<0.001), reflecting more severe respiratory, but not other features in inpatients. 15 of 159 (10%) were readmitted to hospital, but none deteriorated rapidly. CONCLUSIONS: COVID-19-positive children at high risk or with moderate symptoms can be managed safely via HITH at home, the ideal place for children during the pandemic.

Characterizing Speech Sound Productions in Bilingual Speakers of Jamaican Creole and English: Application of Durational Acoustic Methods.

PURPOSE: This study examined the speech acoustic characteristics of Jamaican Creole (JC) and English in bilingual preschoolers and adults using acoustic duration measures. The aims were to determine if, for JC and English, (a) child and adult acoustic duration characteristics differ, (b) differences occur in preschoolers' duration patterns based on the language spoken, and (c) relationships exist between the preschoolers' personal contextual factors (i.e., age, sex, and percentage of language [%language] exposure and use) and acoustic duration. METHOD: Data for this cross-sectional study were collected in Kingston, Jamaica, and New York City, New York, United States, during 2013-2019. Participants included typically developing simultaneous bilingual preschoolers (n = 120, ages 3;4-5;11 [years;months]) and adults (n = 15, ages 19;0-54;4) from the same linguistic community. Audio recordings of single-word productions of JC and English were collected through elicited picture-based tasks and used for acoustic analysis. Durational features (voice onset time [VOT], vowel duration, whole-word duration, and the proportion of vowel to whole-word duration) were measured using Praat, a speech analysis software program. RESULTS: JC-English-speaking children demonstrated developing speech motor control through differences in durational patterns compared with adults, including VOT for voiced plosives. Children's VOT, vowel duration, and whole-word duration were produced similarly across JC and English. The contextual factor %language use was predictive of vowel and whole-word duration in English. CONCLUSIONS: The findings from this study contribute to a foundation of understanding typical bilingual speech characteristics and motor development as well as schema in JC-English speakers. In particular, minimal acoustic duration differences were observed across the post-Creole continuum, a feature that may be attributed to the JC-English bilingual environment. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.21760469.

Classification of accurate and misarticulated /ɑr/ for ultrasound biofeedback using tongue part displacement trajectories.

Ultrasound biofeedback therapy (UBT), which incorporates real-time imaging of tongue articulation, has demonstrated generally positive speech remediation outcomes for individuals with residual speech sound disorder (RSSD). However, UBT requires high attentional demands and may therefore benefit from a simplified display of articulation targets that are easily interpretable and can be compared to real-time articulation. Identifying such targets requires automatic quantification and analysis of movement features relevant to accurate speech production. Our image-analysis program TonguePART automatically quantifies tongue movement as tongue part displacement trajectories from midsagittal ultrasound videos of the tongue, with real-time capability. The present study uses such displacement trajectories to compare accurate and misarticulated American-English rhotic /ɑr/ productions from 40 children, with degree of accuracy determined by auditory perceptual ratings. To identify relevant features of accurate articulation, support vector machine (SVM) classifiers were trained and evaluated on several candidate data representations. Classification accuracy was up to 85%, indicating that quantification of tongue part displacement trajectories captured tongue articulation characteristics that distinguish accurate from misarticulated production of /ɑr/. Regression models for perceptual ratings were also compared. The simplest data representation that retained high predictive ability, demonstrated by high classification accuracy and strong correlation between observed and predicted ratings, was displacements at the midpoint of /r/ relative to /ɑ/ for the tongue dorsum and blade. This indicates that movements of the dorsum and blade are especially relevant to accurate production of /r/, suggesting that a predictive parameter and biofeedback target based on this data representation may be usable for simplified UBT.

Home Care for Bronchiolitis: A Systematic Review.

CONTEXT: Bronchiolitis is the leading cause of pediatric hospital admissions. Hospital-at-Home (HAH) delivers hospital-level care at home, relieving pressure on the hospital system. OBJECTIVES: We aimed to review the feasibility, acceptability, and safety of HAH for bronchiolitis, and assess the cost-impact to hospitals and society. DATA SOURCES: Ovid Medline, Embase, Pubmed, Cochrane Library, CINAHL, and Web of Science. STUDY SELECTION: Studies (randomized control trials, retrospective audits, prospective observational trials) of infants with bronchiolitis receiving HAH (oxygen, nasogastric feeding, remote monitoring). Studies were limited to English language since 2000. DATA EXTRACTION: We reviewed all studies in duplicate for inclusion, data extraction, and risk of bias. RESULTS: Ten studies met inclusion criteria, all for home oxygen therapy (HOT). One abstract on nasogastric feeding did not meet full inclusion criteria. No studies on remote monitoring were found. HOT appears feasible in terms of uptake (70%-82%) and successful completion, both at altitude and sea-level. Caregiver acceptability was reported in 2 qualitative studies. There were 7 reported adverse events (0.6%) with 0 mortality in 1257 patients. Cost studies showed evidence of savings, although included costs to hospitals only. LIMITATIONS: Small number of studies with heterogenous study design and quality. No adequately powered randomized control studies. CONCLUSIONS: Evidence exists to support HOT as feasible, acceptable, and safe. Evidence of cost-effectiveness remains limited. Further research is needed to understand the relevant impact of HAH versus alternative interventions to reduce oxygen prescribing. Other models of care looking at nasogastric feeding support and remote monitoring should be explored.

Baseline Stimulability Predicts Patterns of Response to Traditional and Ultrasound Biofeedback Treatment for Residual Speech Sound Disorder.

PURPOSE: This study aimed to identify predictors of response to treatment for residual speech sound disorder (RSSD) affecting English rhotics. Progress was tracked during an initial phase of traditional motor-based treatment and a longer phase of treatment incorporating ultrasound biofeedback. Based on previous literature, we focused on baseline stimulability and sensory acuity as predictors of interest. METHOD: Thirty-three individuals aged 9-15 years with residual distortions of /ɹ/ received a course of individual intervention comprising 1 week of intensive traditional treatment and 9 weeks of ultrasound biofeedback treatment. Stimulability for /ɹ/ was probed prior to treatment, after the traditional treatment phase, and after the end of all treatment. Accuracy of /ɹ/ production in each probe was assessed with an acoustic measure: normalized third formant (F3)-second formant (F2) distance. Model-based clustering analysis was applied to these acoustic measures to identify different average trajectories of progress over the course of treatment. The resulting clusters were compared with respect to acuity in auditory and somatosensory domains. RESULTS: All but four individuals were judged to exhibit a clinically significant response to the combined course of treatment. Two major clusters were identified. The "low stimulability" cluster was characterized by very low accuracy at baseline, minimal response to traditional treatment, and strong response to ultrasound biofeedback. The "high stimulability" group was more accurate at baseline and made significant gains in both traditional and ultrasound biofeedback phases of treatment. The clusters did not differ with respect to sensory acuity. CONCLUSIONS: This research accords with clinical intuition in finding that individuals who are more stimulable at baseline are more likely to respond to traditional intervention, whereas less stimulable individuals may derive greater relative benefit from biofeedback. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.20422236.

An Approach to the Treatment of Children With COVID-19.

There are limited data to guide treatment recommendations for children with acute, symptomatic coronavirus disease 2019 (COVID-19). This review outlines a proposed management approach for children based on the published evidence to date and the approval of medications through drug regulatory agencies, as well as the known safety profile of the recommended drugs in this age group.

Secretion Bubbling as the Sound Mechanism for Nasal Rustle: A Perceptual Study.

PURPOSE: Secretion bubbling on the superior aspect of the velopharyngeal (VP) valve typically occurs with a small VP opening during production of oral pressure consonants. The use of high-speed nasopharyngoscopy has shown correlation between the bubbling frequency and the acoustics captured with the nasal microphone of the nasometer. The purpose of this study was to investigate if the sound generated by the bubbling process is perceived as nasal rustle (also known as nasal turbulence). METHOD: Speech samples were extracted from the data of patients who were diagnosed with nasal rustle (five boys and five girls, ranging in age from 5 to 10 years old). A customized filter was used to remove the sound generated by the secretion bubbling. Six experienced listeners were asked to rate the perception of nasal rustle in each speech stimuli before and after the filtering process. RESULTS: Rating values for the perception of nasal rustle were overall reduced in all cases after the filtering process. Furthermore, the perception of nasal rustle was eliminated in 40% of the cases. Rating reliability was excellent before the filtering process and moderate to good after filtering. CONCLUSION: Reducing the perception of nasal rustle using spectral filtering based on the bubbling frequencies supports the hypothesis that undesired sound in the nasal cavity is generated from the interaction of the turbulent airflow with the secretion bubbling. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.19111544.

Assessment of Intelligibility in Children with Velopharyngeal Insufficiency: The Relationship between Intelligibility in Context Scale and Experimental Measures.

PURPOSE: The purpose of this study was to investigate the clinical application of the Intelligibility in Context Scale (ICS) instrument in children with velopharyngeal insufficiency (VPI). This study investigated the relationship between clinical speech outcomes and parental reports of speech intelligibility across various communicative partners. METHODS: The ICS was completed by the parents of 20 English-speaking children aged 4-12 years diagnosed with VPI. The parents were asked to rate their children's speech intelligibility across communication partners using a 5-point scale. Clinical metrics obtained using standard clinical transcription on the Picture-Cued SNAP-R Test were: (1) percentage of consonants correct (PCC), (2) percentage of vowels correct (PVC), and (3) percentage of phonemes correct (PPC). Nasalance from nasometer data was included as an indirect measure of nasality. Intelligibility scores obtained from naive listener's transcriptions and speech-language pathologists' (SLP) ratings were compared with the ICS results. RESULT: Greater PCC, PPC, PVC, and transcription-based intelligibility values were significantly associated with higher ICS values, respectively (r[20] = 0.84, 0.82, 0.51, and 0.70, respectively; p < 0.05 in all cases). There was a negative and significant correlation between ICS mean scores and SLP ratings of intelligibility (r = -0.74; p < 0.001). There was no significant correlation between ICS values and nasalance scores (r[20] = -0.28; p = 0.22). CONCLUSION: The high correlations obtained between the ICS with PCC and PPC measures indicate that articulation accuracy has had a great impact on parents' decision-making regarding intelligibility in this population. Significant agreement among ICS scores with naive listener transcriptions and clinical ratings supports use of the ICS in practice.

Neuroimaging of the Syllable Repetition Task in Children With Residual Speech Sound Disorder.

Purpose This study investigated phonological and speech motor neural networks in children with residual speech sound disorder (RSSD) during an overt Syllable Repetition Task (SRT). Method Sixteen children with RSSD with /ɹ/ errors (6F [female]; ages 8;0-12;6 [years;months]) and 16 children with typically developing speech (TD; 8F; ages 8;5-13;7) completed a functional magnetic resonance imaging experiment. Children performed the SRT ("SRT-Early Sounds") with the phonemes /b, d, m, n, ɑ/ and an adapted version ("SRT-Late Sounds") with the phonemes /ɹ, s, l, tʃ, ɑ/. We compared the functional activation and transcribed production accuracy of the RSSD and TD groups during both conditions. Expected errors were not scored as inaccurate. Results No between-group or within-group differences in repetition accuracy were found on the SRT-Early Sounds or SRT-Late Sounds tasks at any syllable sequence length. On a first-level analysis of the tasks, the TD group showed expected patterns of activation for both the SRT-Early Sounds and SRT-Late Sounds, including activation in the left primary motor cortex, left premotor cortex, bilateral anterior cingulate, bilateral primary auditory cortex, bilateral superior temporal gyrus, and bilateral insula. The RSSD group showed similar activation when correcting for multiple comparisons. In further exploratory analyses, we observed the following subthreshold patterns: (a) On the SRT-Early Sounds, greater activation was found in the left premotor cortex for the RSSD group, while greater activation was found in the left cerebellum for the TD group; (b) on the SRT-Late Sounds, a small area of greater activation was found in the right cerebellum for the RSSD group. No within-group functional differences were observed (SRT-Early Sounds vs. SRT-Late Sounds) for either group. Conclusions Performance was similar between groups, and likewise, we found that functional activation did not differ. Observed functional differences in previous studies may reflect differences in task performance, rather than fundamental differences in neural mechanisms for syllable repetition.

Auditory-perceptual acuity in rhotic misarticulation: baseline characteristics and treatment response.

The rhotic sound /r/ is one of the latest-emerging sounds in English, and many children receive treatment for residual errors affecting /r/ that persist past the age of 9. Auditory-perceptual abilities of children with residual speech errors are thought to be different from their typically developing peers. This study examined auditory-perceptual acuity in children with residual speech errors affecting /r/ and the relation of these skills to production accuracy, both before and after a period of treatment incorporating visual biofeedback. Identification of items along an /r/-/w/ continuum was assessed prior to treatment. Production accuracy for /r/ was acoustically measured from standard/r/stimulability probes elicited before and after treatment. Fifty-nine children aged 9-15 with residual speech errors (RSE) affecting /r/ completed treatment, and forty-eight age-matched controls who completed the same auditory-perceptual task served as a comparison group. It was hypothesized that children with RSE would show lower auditory-perceptual acuity than typically developing speakers and that higher auditory-perceptual acuity would be associated with more accurate production before treatment. It was also hypothesized that auditory-perceptual acuity would serve as a mediator of treatment response. Results indicated that typically developing children have more acute perception of the /r/-/w/ contrast than children with RSE. Contrary to hypothesis, baseline auditory-perceptual acuity for /r/ did not predict baseline production severity. For baseline auditory-perceptual acuity in relation to biofeedback efficacy, there was an interaction between auditory-perceptual acuity and gender, such that higher auditory-perceptual acuity was associated with greater treatment response in female, but not male, participants.

Nasal rustle: The retrospective and prospective investigation of effects of bubbling of secretions on speech.

OBJECTIVE: "Nasal rustle" is a type of nasal emission associated with a small velopharyngeal (VP) gap and distracting loud noise. Currently, the mechanisms behind noise generation are unclear. In this study, we use a combination of retrospective and prospective data to test the hypotheses that bubbling of secretions could be a source of audible noise. DESIGN: Retrospective: Nasopharyngoscopy records of 151 patients with nasal rustle were reviewed to determine if bubbling occurred during their nasopharyngoscopy examination. Prospective: Nine children with nasal rustle and bubbling of secretions were suctioned with the scope in place to assure removal of secretions. The Nasometer II was used to record the children's production of oral sentences prior to and post suctioning. All sentences were analyzed for the presence or absence of noise, nasalance scores, and Cepstral Peak Prominence (CPP). Intra-and inter-judge reliability of coding was high. RESULTS: Retrospective: 70% of the patients with nasal rustle had bubbling of secretions during nasopharyngoscopy. Prospective: Percentages of audible noise were reduced significantly post suctioning (Friedman's Test, Chi-square = 24.5, p = 0.001) with the greatest decrease in syllables with fricatives and bilabial stops (p < 0.05). The average CPP and nasalance scores pre-vs post-suctioning showed no significant differences (p = 0.91, 0.29). CONCLUSIONS: Retrospective: The high percentage of patients with nasal rustle had bubbling of secretions when producing speech in nasopharyngoscopy evaluations. Prospective: The incidence of audible noise was reduced as a result of suctioning. This suggests that the presence of secretions contributes to the production of nasal rustle.

Impact of expanding a paediatric OPAT programme with an antimicrobial stewardship intervention.

BACKGROUND: As treatment out of hospital with outpatient parenteral antimicrobial therapy (OPAT) increases, so too does the risk for patients of being less visible, with potential for suboptimal care. OBJECTIVES: We aimed to compare pre-expansion and post-expansion (1) successful completion, complications and (2) the impact of an OPAT-specific antimicrobial stewardship (AMS) intervention to mitigate inappropriate antibiotic prescribing. DESIGN: A prospective longitudinal study during two consecutive 12-month periods: period A (1 August 2012 to 31 July 2013) and period B (1 August 2013 to 31 July 2014). SETTING: The Hospital-in-the-Home (HITH) programme at The Royal Children's Hospital Melbourne. PARTICIPANTS: All patients who received OPAT during the study period. INTERVENTIONS: Between the two periods, the programme expanded from 16 to 32 patients/day. To coincide with this, a combined AMS intervention was introduced: (1) OPAT-specific guidelines and (2) active review of OPAT prescriptions and input by Paediatric Infectious Diseases. MAIN OUTCOMES: Successful completion of OPAT, OPAT-related complications, readmission, length of stay and antibiotic appropriateness. RESULTS: Over 2 years, 646 patients (47% female, median age 7 years) were treated via OPAT for 754 episodes. Patient episodes increased from 254 in period A to 500 in period B, with proportional increases in infants under 1 month and immunocompromised patients. OPAT was successfully completed in 245/251 (98%) versus 473/482 (98%) (OR 1.8, 95% CI 0.7 to 4.5, p=0.3). OPAT-related complications remained low: intravenous catheter-associated complications 16/138 (12%) versus 41/414 (10%), and antibiotic-associated complications 0/254 (0%) versus 2/500 (0.4%). Despite the increase in activity, with the AMS intervention, overall appropriate antibiotic prescribing remained high: 71% versus 76%. Inappropriately long durations reduced from 30/312 (10%) to 37/617 (6%) (OR 0.6, 95% CI 0.4 to 0.99, p=0.04), and median number of days on broad-spectrum antibiotics from 11 (IQR 8-24.5) to 8 (IQR 5-11). CONCLUSION: During a period of substantial expansion, we maintained clinical outcomes. A modest AMS intervention reduced some but not all aspects of inappropriate antibiotic prescribing.

Speech exemplar and evaluation database (SEED) for clinical training in articulatory phonetics and speech science.

One challenge faced by teachers of phonetics, speech science, and clinical speech disorders courses is providing meaningful instruction that closes the theory to practice gap. One barrier to providing this type of deep learning experience is the lack of publicly available examples of speech recordings that illustrate comparisons between typical and disordered speech production across a broad range of disorder populations. Data of this type exist, but are typically collected for specific research projects under narrowly written IRB protocols that do not allow for release of even de-identified speech recordings to other investigators or teachers. As a partial corrective to this problem, we have developed an approved publicly available database of speech recordings that provides illustrative examples of adult and child speech production from individuals with and without speech disorders. The recorded speech materials were designed to illustrate important clinical concepts, and the recordings were collected under controlled conditions using high-quality equipment. The ultimate goal of creating this corpus is to improve practitioners' and scientists' understanding of the scientific bases of knowledge in our profession and improve our ability to develop clinical scientists and young researchers in the field.

Effects of velopharyngeal openings on flow characteristics of nasal emission.

Nasal emission is a speech disorder where undesired airflow enters the nasal cavity during speech due to inadequate closure of the velopharyngeal valve. Nasal emission is typically inaudible with large velopharyngeal openings and very distorting with small openings. This study aims to understand how flow characteristics in the nasal cavity change as a function of velopharyngeal opening using computational fluid dynamics. The model is based on a subject who was diagnosed with distorting nasal emission and a small velopharyngeal opening. The baseline geometry was delineated from CT scans that were taken, while the subject was sustaining a sibilant sound. Modifications to the model were done by systematically widening or narrowing the velopharyngeal opening while keeping the geometry constant elsewhere. Results show that if the flow resistance across the velopharyngeal valve is smaller than resistance across the oral constriction, flow characteristics such as velocity and turbulence are inversely proportional to the size of the opening. If flow resistance is higher across the velopharyngeal valve than the oral constriction, turbulence in the nasal cavity will be reduced at a higher rate. These findings can be used to generalize that the area ratio of the velopharyngeal opening to the oral constriction is a factor that determines airflow characteristics and subsequently its sound during production of sibilant sound. It implies that the highest level of turbulence in the nasal cavity, and subsequently the sound that will likely be perceived as the most severe nasal emission is produced when the size of openings is equal.

Application of a Landmark-Based Method for Acoustic Analysis of Dysphonic Speech.

AIM: Speakers with dysphonia often report difficulty with maintaining intelligibility in noisy environments; however, there is no objective method for characterizing this difficulty. Landmark-based analysis is a linguistically-motived, knowledge-based speech analysis technique, which may serve as the basis of acoustic tool for describing the intelligibility deficit. As the first step toward development of such a tool, this study examined whether Landmark-based analysis could describe acoustic differences between normal and dysphonic speech. METHOD: The recordings subjected to the Landmark-based analysis were the first sentence of the Rainbow Passage from 33 speakers with normal voice and 36 speakers with dysphonia. These recordings were selected from the Kay Elemetrics Database of Disordered Voice. The between-group difference was evaluated based on counts of certain Landmarks (LM). RESULTS: The average counts of all LMs were significantly greater in normal speech, t(66.85) = 2.36, P = 0.02. When the group-difference was examined for each LM, dysphonic speech had more [g] and [b] LMs and fewer [s] LMs than normal speech (P < 0.01 for all cases). A classification tree model identified [+s] and [+b] LMs are the primary predictors for the dysphonic speech. The model's misclassification rate was 7.24%. CONCLUSIONS: This preliminary investigation demonstrates that LM-based analysis is capable of differentiating dysphonic speech from normal speech. This encouraging result rationalizes future examinations of LM analysis in other areas of interest. For example, LM-based measures could conceivably be used as to quantify general intelligibility, and/or provide insight into underlying mechanisms of intelligibility deficits.

Understanding Nasal Emission During Speech Production: A Review of Types, Terminology, and Causality.

There are several different types of nasal emission that can occur during speech due to either velopharyngeal dysfunction or abnormal articulation in the pharynx. Nasal emission can be inaudible or very loud and distracting, depending on the size of the velopharyngeal opening and the physics of the flow. Nasal emission can be obligatory and/or compensatory (due to abnormal structure) or it can be caused by a misarticulation that results in a substitution of a pharyngeal sound for an oral sound, despite normal velopharyngeal structure. Nasal emission can occur on all pressure-sensitive phonemes or it can be phoneme-specific. Although it is generally recognized that the loud and distracting form of nasal emission (called nasal turbulence or nasal rustle) is due to a small velopharyngeal opening, the causality of the distracted sound is debated. This article provides a brief review of the types of nasal emission, the terms used to describe it, and the potential causes. This article also stresses the need for further research to clarify the causality of the sound generated by a small velopharyngeal opening.

Using High-Speed Nasopharyngoscopy to Quantify the Bubbling Above the Velopharyngeal Valve in Cases of Nasal Rustle.

OBJECTIVE: The loud and severely distorting form of audible nasal emission (commonly known as nasal turbulence or nasal rustle) typically occurs with a small velopharyngeal opening during production of pressure-sensitive consonants. The purpose of this study was to determine whether bubbling of the secretions, which commonly occurs on the superior aspect of the velopharyngeal port when there is a small opening, is a periodic process that can generate sound in the nasal cavity. PARTICIPANTS: Ten pediatric patients were included in the study. All participants had normal articulation and resonance but exhibited audible nasal emission characterized as nasal rustle. MEASURES: For each participant, high-speed video (HSV) nasopharyngoscopy and acoustic signals were recorded simultaneously. The acoustic recordings were captured in a manner similar to nasometry using nasal and oral microphones connected to a separation plate. Spectral analysis of the audio recordings and the HSV images was used to determine correlation between the acoustic and visual measurements. RESULTS: This study showed that secretion bubbling is a periodic process and its frequency, measured from the HSV data, was also captured by the acoustic measurements. The nasal acoustic signal correlated more strongly with the video of bubbling than the oral acoustic signal in the majority of the cases where bubbling occurred. CONCLUSION: These findings are strong evidence that secretion bubbling plays a significant role in the mechanism that generates undesired sound in the nasal cavity. Further work is needed to determine whether this sound is perceived as nasal rustle.