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Methods for assigning impairment
Published in Ramar Sabapathi Vinayagam, Integrated Evaluation of Disability, 2019
Articulation functions refer to a process of generating sounds to produce speech (59). The normal person speaks with clear and distinct sounds and brief speech. In dysarthria, there is defective articulation function resulting in inability/difficulty to use language function. The impairment of articulation includes flaccid dysarthria in lower motor neuron lesion, spastic dysarthria in upper motor neuron lesion, ataxic dysarthria in the cerebellar lesion, hypo/hyperkinetic dysarthria in the extrapyramidal lesion, and mixed dysarthria in combined upper and lower motor neuron lesion. The evaluator directs the person to listen and repeat the underlying words. The examiner identifies any deviation in the articulation of speech sounds. The deviation in the articulation of “Papa” or “Mama” indicates labial dysarthria in the facial nerve lesion, articulation of “La, La, La” indicates lingual dysarthria in the hypoglossal nerve lesion, and articulation of “Ha, Ha, Ha” reveals guttural dysarthria in the vagus nerve lesion. A deviation in pronouncing “British constitution, Westminster street, Baby hippopotamus” indicates ataxic dysarthria in the cerebellar lesion. Monotonous speech while reciting a poem or a verse point to an extrapyramidal lesion, and stiff voice with reduced volume while pronouncing “Ah Ah Ah” continuously for 30 seconds indicates spastic dysarthria in the bilateral pyramidal lesion. The nasal tone of all vowels and oral consonant sounds suggests bulbar and pseudobulbar lesions.
Vocal Motor Disorders *
Published in Rolland S. Parker, Concussive Brain Trauma, 2016
Inability to close the velopharynx “drains” subglottal air pressure, reduces loudness, and causes hypernasality (nasal emission) that distorts oral consonant production. When the speaker runs out of air, it results in an increased respiratory effort, which compounds the problems, especially when vital capacity is also reduced (Netsell, 1998). There can be changes in the force that are expressed by different portions of the tongue or lips (Jaeger et al., 2000). One half of a group of TBI patients had velopharyngeal airway resistance (VAR). Those with mild or absent dysarthria typically had no velopharyngeal deficits, while those with severe dysarthria had very low velopharyngeal resistance. VAR deficit was associated with perceived hypernasality. Discrepancies between VAR and perceived hypernasality may be caused by intelligibility or speaking style (McHenry, 1998). VAR and orifice area are associated with the perception of nasality. False positives were associated with a slow speaking rate (McHenry, 1999).
Performance of Swedish children on a dynamic motor speech assessment
Published in International Journal of Speech-Language Pathology, 2021
Susanne Rex, Kristina Hansson, Edythe Strand, Anita McAllister
Swedish phonotactics and prosodic rules are quite complex due to a large phoneme inventory and intricate prosody. Swedish has 18 consonants roughly distributed over four places of articulation (labial, dental/alveolar, palatal/velar, glottal), five manners of articulation (stops: /p, b, t, d, k, g/, nasals: /m, n, ŋ/, fricatives: /f, v, s, ɕ, ɧ, h/, liquids /l, r/, approximant /j/) and the distinction voiced-voiceless, (i.e. /b, d, g/ versus /p, t, k/). Voiceless stops are aspirated before a stressed vowel, except after /s/ (i.e. kaka [khɑ:ka] (cookie)). All consonants except /s, r/ are established by the age of 5 and all but /s/ by 6 years (Blumenthal & Lundeborg Hammarström, 2014). Lohmander et al. report 77% mean oral consonant correct by the age of 3 and 96% by the age of 5 (Lohmander, Lundeborg, & Persson, 2017). The Swedish vowel inventory displays an interplay between spectral dimensions (tongue height (F1), front-back tongue position (F2) and lip rounding) and temporal dimensions (vowel length in relation to consonant length) resulting in 18 vowels in most dialects (McAllister, Flege, & Piske, 2002). According to results presented by Blumenthal & Lundeborg Hammarström (2014) all vowels, but /ɪ/ the front rounded /ʏ/ and /ө/, are established by the age of 3 and at 4 years all vowels are mastered. Consonant – Vowel (CV), VC, CVC are early developing syllable structures in Swedish, followed by CCV, VCC, CCCV and VCCC syllables.
Nasalance in adolescents with autism spectrum disorders
Published in International Journal of Speech-Language Pathology, 2020
Rachel Kasthurirathne, Karen Forrest, Jared Ross, Rita Patel
The current study used instrumental assessment to obtain objective measures of nasalance among a group of adolescents with ASD and their NT peers. As predicted, the group of adolescents with ASD had significantly higher mean nasalance than NT, a result which could not be explained by group differences in oral opening, speaking rate, or fundamental frequency. The ASD group generated significantly higher nasalance scores than controls when producing speech with predominantly oral consonants in two out of four speaking tasks: non-nasal words extracted from spontaneous speech (fly, bear(s)) and the mixed passage loaded with bilabial plosives and nasals (Bobby). Group differences for Zoo and Suzy passages did not reach significance but did show increased nasalance in adolescents with ASD compared to NT. Elevated nasalance was driven mostly by a subset of three speakers with ASD whose scores fell in the mild range for hypernasality (i.e. Nasalance values between 30.5 and 33.5%; Smith & Kuehn, 2007). Further examination of these three speakers relative to the group mean for the Bobby passage does not indicate that these speakers are outliers; rather, we suggest that clinical levels of hypernasality mostly affect a subset of people with ASD (27%). These findings are consistent with research promoting subtypes of ASD that are seen in various domains (e.g. Heaton, Williams, Cummins, & Happé, 2008).
Speech in 5-year-olds born with unilateral cleft lip and palate: a Prospective Swedish Intercenter Study
Published in Journal of Plastic Surgery and Hand Surgery, 2019
Kristina Klintö, Karin Brunnegård, Christina Havstam, Malin Appelqvist, Emilie Hagberg, Ann-Sofie Taleman, Anette Lohmander
Furthermore, although no statistically significant differences among centres regarding speech were revealed in this study, the proportion of children rated as having competent/sufficient PVPF varied largely among centres. The prevalence of rupture/fistulas varied from 0 to 6, and the rate of velopharyngeal flaps from 0 to 4. It was not the case that the centre, undertaking the most secondary speech improving surgery before 5 years of age, had the best speech results. No differences were found in the Scandcleft trials either, except for higher prevalence of oral consonant errors in the group with later timing of hard palate repair (3 years) compared to earlier (1 year) [2,3]. The non-significant differences in this study may be true also even if the group sizes were larger. However, it is possible that significant differences had been detected if the group sizes were larger. According to Williams et al. [31], studies have shown clear advantages in speech outcomes for children who were operated by surgeons who do large numbers of palatal surgery. Thus, individual surgical skill and learning curve are potential important factors that may influence speech results.