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Parameters: Definitions & Guidelines Debbie Sell PhD, FRCSLT Head, Speech & Language Therapy Department Great Ormond Street NHS Trust Honorary Senior Lecturer University of London Judith Trost-Cardamone, PhD, FASHA Professor, California State University Northridge Department of Communication Disorders & Sciences
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Parameters: Primary & Secondary Primary Parameters: speech parameters most directly related to the cleftpalate/velopharyngeal condition Secondary Parameters: speech parameters less directly related or not related to the cleft palate/velopharyngeal condition but which are frequently observed in speakers with cleft palate
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Guidelines Aim of guidelines is to provide a set of definitions to accompany the parameters, to ensure their appropriate application and interpretation Section 1 (discuss in final session of the day) Section 2 System is for reporting speech outcomes based on perceptual speech analysis; they are not intended to explain the outcome
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Primary Parameters: Speech parameters most directly related to the cleft palate/velopharyngeal condition
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Hypernasality (HN) 0-3 rating scale 0 = WNL; does not exceed HN heard in regional speech 1 = Mild 2 = Moderate 3 = Severe
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Hypernasality Increased or excessive nasal resonance heard on vowels and vocalic consonants of a language. Rated using a 4 point scale that reflects increasing severity from 0-3
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Hyponasality [HypoN] Binary judgment 0 = WNL/None 1 = Present
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Hyponasality Decreased or insufficient nasal resonance heard on nasal consonants and vocalic segments of a language. Rating based on a binary judgement of within normal limits or present. Cul-de-sac resonance is reflected in hyponasality Mixed resonance is accounted for by the combined ratings of hypernasality and hyponasality
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Audible Nasal Air Emission and/or Turbulence Binary judgment 0 = WNL/None 1 = Present [indicate pattern] intermittent and variable nasal emission and/or turbulence phoneme specific nasal emission and/or turbulence frequent/pervasive nasal emission and/or turbulence Weighted scoring for patterns
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Audible Nasal Air Emission and/or Turbulence def. Nasal air emission /turbulence that accompanies/is co-produced with and distorts any or all (oral) high pressure consonants in a language Rating based on a binary judgement of within normal limits or present Second rating is given to reflect severity/impact on speech acceptability/understandability based on the frequency and pattern of the nasal air emission/turbulence
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Intermittent and variable: nasal air emission and/or turbulence heard occasionally with various oral pressure consonants with no obvious pattern of occurrence Phoneme specific: nasal emission and/or turbulence heard consistently but only with selected oral pressure consonants e.g. sibilant fricatives and/or affricates ** Frequent/pervasive: nasal emission and/or turbulence heard with most/all high pressure consonants in the inventory ** Phoneme specific: is this correctly placed here?
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Oral Pressures Binary judgment 0 = WNL: perceptually adequate for pressure consonants 1 = Weak; perceptually inadequate for pressure consonants
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Substitution Errors Binary judgment 0 = WNL/None 1 = Present [indicate type and frequency] Six categories Weighted scoring for frequency
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Substitution Errors Def: maladaptive “compensatory misarticulations” of high pressure consonants as a result of the cleft palate/velopharyngeal inadequacy condition. Second rating based on type and frequency of occurrence for glottal stop, pharyngeal fricative/stop/affricate, palatal stop, palatal fricative, nasal fricative, atypical backing of targets to velar
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Substitution Errors: glottal and pharyngeal Glottal stop Pharyngeal: fricative, stop, affricate or any combination
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Substitution Errors: mid-dorsum palatal Mid-dorsum palatal stop Mid-dorsum palatal fricative
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Substitution Errors: backing but targets remain oral Backing of dental, alveolar and/or palatal targets to velar
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Substitution Errors continued Atypical backing of dental and alveolar targets. It includes a consonant target that is backed from its more anterior target place but is still made within the oral cavity.
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Substitution Errors: nasal fricative Nasal fricative with or without turbulence ___ phoneme specific pattern** **Is this necessary, informative?
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Substitution Errors continued Nasal fricative: def: used as a substitution/replacement for oral stops, fricatives and affricates. It is articulatory substitution that frequently takes the form of an unvoiced (bilabial, alveolar or velar) nasal
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Secondary Parameters : Speech parameters less directly related or not related to the cleft palate/velopharyngeal condition but which are frequently observed in speakers with cleft palate. They are all speech characteristics/deviations that can be seen in speakers without cleft palate.
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Secondary Parameters Binary judgment 0 = WNL/None 1 = Present Includes errors related to: Dentition, Occlusion, palatal vault Developmental delay, other articulation/phonological errors Voice/laryngeal disorders
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Secondary Speech Parameters cont. Errors related to Dentition, Occlusion, Palatal Vault Configuration such as lateralized sibilants, palatalized alveolars, dentalized/linguadental alveolar fricatives and stops Inverted labiodentals, etc.
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Secondary Speech Parameters cont. Developmental delay, other articulation/phonologic errors and voice/laryngeal disorders are self - explanatory
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X = Missing Data Could not test (e.g. child was not cooperative, inadequate speech sample) Did not test (e.g. time constraints)
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Discussion Time
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Parameters: Scales & Scoring Judith Trost-Cardamone, PhD, FASHA Professor, California State University Northridge Department of Communication Disorders & Sciences Triona Sweeney, PhD Specialist Speech & Language Therapist The Children’s Hospital Temple Street, Dublin Adjunct Professor, University of Limerick
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Hypernasality [HN] 1Mild Hypernasality Exceeds regional speech HN Assimilation nasality primarily; heard on high vowels primarily; or both; “inconsistent Socially acceptable in most circles Patient [age 10 >] or parent [age 5] mostly satisfied Would probably not recommend physical management at this time
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Hypernasality [HN] 2 Moderate Hypernasality Pervasive and draws attention to itself and away from the message Most vowels retain identity Socially unacceptable Would probably recommend physical management after instrumental assessment
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Hypernasality [HN] 3Severe Hypernasality Pervasive and interferes with speech understandability Many vowels lose identity Socially very unacceptable Would definitely recommend physical management after instrumental assessment
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Audible Nasal Air Emission and/or Turbulence Binary judgment –0 = WNL/None –1 = Impaired [indicate pattern] intermittent and variable nasal emission and/or turbulence [1] phoneme specific nasal emission and/or turbulence [2] frequent/pervasive nasal emission and/or turbulence [3] Weighted scoring for patterns
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Weighted scores intermittent and variable is nasal emission with or without turbulence that is heard occasionally with various oral pressure consonants with no obvious pattern of occurrence [1] phoneme specific is nasal emission and/or turbulence that is heard consistently but only with selected oral pressure consonants; e.g., sibilant fricatives and/or affricates [2] frequent/pervasive is nasal emission and/or turbulence that is heard with most/all high pressure consonants in the inventory [3]
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Issues Nasal emission and/or nasal turbulence as 1 parameter!! - perceptually different nasal airflow errors BUT - similar impact in terms of speech outcome Raters ability to distinguish between nasal emission and/or nasal turbulence AND nasal fricatives
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Substitution Errors Binary judgment 0 = WNL/None 1 = Present [indicate type and frequency] Six categories Weighted scoring for frequency
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Substitution Errors: glottal and pharyngeal Glottal stop [1] –Frequent [3] –Infrequent [1] Pharyngeal: fricative, stop, affricate or any combination [1] –Frequent [3] –Infrequent [1]
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Substitution Errors: mid-dorsum palatal Mid-dorsum palatal stop [1] –Frequent [2] –Infrequent [1] Mid-dorsum palatal fricative [1] –Frequent [2] –Infrequent [1]
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Substitution Errors: backing but targets remain oral Backing of dental, alveolar and/or palatal targets to velar [1] –Frequent [2] –Infrequent [1]
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Substitution Errors: nasal fricative Nasal fricative with or without turbulence [1] –Frequent [3] –Infrequent [1] ___ phoneme specific pattern [2]** **Is this necessary, informative?
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Nasal Emission/Nasal Turbulence accompanies/is co-produced with and distorts any or all [oral] high pressure consonants in a language need to distinguish from Nasal Fricative which is used as a substitution/replacement for oral fricatives and affricates –Nasal fricative: frication generated in nose –Velopharyngeal fricative/posterior nasal fricative
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Substitution Errors Frequent [2] Infrequent [1] How do we define frequency? Is it necessary to document this?
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Discussion Time
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