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Objective: To develop tools for predicting velopharyngeal competence (VPC) based on auditory-perceptual assessment and its correlation with objective measures of velopharyngeal orifice area. Design: Methodological study. Participants and Methods: Sixty-two patients with repaired cleft palate, aged 6 to 45 years, underwent aerodynamic evaluation by means of the pressure-flow technique and audiovisual recording of speech samples. Three experienced speech-language pathologists analysed the speech samples by rating the following resonance, visual, and speech variables: hypernasality, audible nasal air emission, nasal turbulence, weak pressure consonants, facial grimacing, active nonoral errors, and overall velopharyngeal competence. The correlation between the perceptual speech variables and velopharyngeal orifice area estimates was analysed with Spearman's correlation coefficient. Two statistical models (discriminant and exploratory) were used to predict VPC based on the orifice area estimates. Sensitivity and specificity analyses were performed to verify the clinical applicability of the models. Results: There was a strong correlation between VPC (based on the orifice area estimates) and each speech variable. Both models showed 88.7% accuracy in predicting VPC. The sensitivity and specificity for the discriminant model were 92.3% and 97.2%, respectively, and 96.2% and 94.4% for the exploratory model. Conclusion: Two predictor models based on ratings of resonance, visual, and speech variables and a simple calculation of a composite variable, SOMA (Eng. "sum"), were developed and found to be efficient in predicting VPC defined by orifice estimates categories based on aerodynamic measurements. Both tools may contribute to the diagnosis of velopharyngeal dysfunction in clinical practice. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 10-year-old Asian boy who was admitted to Emergency Department with three weeks of unexplained left knee pain and swelling, intermittent headaches, and diarrhea. Diagnosis studies were conducted, computed tomography of head without contrast was performed. He was diagnosed with spontaneous bifrontal epidural hemorrhage secondary to vitamin C deficiency or scurvy and was treated accordingly.

The study aimed at evaluating the diadochokinetic (DDK) skills of Greek-speaking preschool children with phonological disorder (PD) by means of a structured evaluation protocol and at proposing cut-off points for children at risk of speech impairment. The participants were 36 children with PD and 60 typically developing (TD) peers. The groups were matched on age and gender. The PD group performed significantly slower than the TD group in all speech DDK tasks but not in the oral-motor tasks. The ROC analysis showed a statistically significant positive discrimination for all speech tasks. The internal consistency of the protocol was excellent (Cronbach's α =.844), while complex stimuli showed a better discriminatory ability. The obtained results agree with Dodd's classification for speech sound disorders (SSDs). Different types of speech stimuli must be included in the evaluation of DDK performance as a clinical predictor for preschoolers with SSDs who face difficulties in speech maturation. [ABSTRACT FROM AUTHOR]

Objective: To determine whether timing of palatoplasty (early, standard, or late) is associated with speech and language outcomes in children with cleft palate. Design: Retrospective case series. Setting: Tertiary care children's hospital. Participants: Records from 733 children born between 2005 and 2015 and treated at the Cleft Craniofacial Clinic of a tertiary children's hospital were retrospectively reviewed. Exclusion criteria were cleft repair at an outside hospital, intact secondary palate, absence of postpalatoplasty speech evaluation, syndromes, staged palatoplasty, and introduction to clinic after 12 months of age. Data from 232 children with cleft palate ± cleft lip were analyzed. Interventions: Palatoplasty. Main Outcome Measures: Speech/language delays and disorders at 20 months and 5 years of age based on formal hospital or community-based testing or screening evaluation in the Cleft Craniofacial Clinic; additional speech surgery. Results: Median age at palatoplasty was 12.6 months (range: 8.8-21.9 months). Age at palatoplasty was classified as early (<11 months, n = 28), standard (11-13 months, n = 158), or late (>13 months, n = 46). Late palatoplasty was associated with increased odds of speech/language delays and speech therapy at 20 months, and language delays at 5 years, compared with standard or early palatoplasty (P <.05 for all comparisons). However, speech sound production disorders, velopharyngeal incompetence, tube replacement, and hearing loss were not significantly associated with age at palatoplasty. Conclusions: Late palatoplasty may be associated with short- and long-term delays in speech/language development. Future studies with standardized surgical technique/timing and outcome measures are required to more definitively describe the impact of age at palatoplasty on speech/language development. [ABSTRACT FROM AUTHOR]

Intervention with children with speech and language difficulties has been proven beneficial compared with no treatment yet, knowing what type of intervention to provide remains a challenge. Studies of English-speaking children indicate that intervention targeting the production of morphological targets may have a positive effect on phonological aspects and vice versa. However, studies have not reported on generalization effects to untreated morphemes and little is yet known about morphological intervention in the context of a highly inflected language. The purpose of the current intervention case study was to investigate the effect of intervention in relation to phonological and morphological targets in Greek, a language characterized by complex inflectional morphology. A single subject research design was used with pre- and post-intervention assessment carried out. The participant was a four-year-old Greek-speaking boy with speech difficulties. The production of /s/, a phoneme used in multiple phonological and morphological contexts was targeted with alternating focus of intervention between phonological and morphological targets. Assessment took place at two levels: macro-assessment to monitor broad changes in speech; micro-assessment to measure therapy-specific changes in the production of treated targets and generalization to untreated targets and control items. There were four phases of intervention with a total of 24 hours of therapy. Significant improvement in performance accuracy was found between assessment scores immediately pre- and post-intervention. Intervention targeting the production of a phoneme in the word stem was not sufficient to accomplish the accurate production of morphemes requiring the same phoneme; intervention directly targeting morphemes was successful. Within-domain generalization was observed in both domains. Improved naming accuracy was observed post-intervention that was maintained at follow-up. The present study supports the case for morphophonological intervention. Morphological elements should be addressed in a comprehensive intervention for speech sound disorders. [ABSTRACT FROM AUTHOR]

Objective: To compare reliability in auditory-perceptual assessment of hypernasality for 3 different methods and to explore the influence of language background. Design: Comparative methodological study. Participants and Materials: Audio recordings of 5-year-old Swedish-speaking children with repaired cleft lip and palate consisting of 73 stimuli of 9 nonnasal single-word strings in 3 different randomized orders. Four experienced speech-language pathologists (2 native speakers of Brazilian–Portuguese and 2 native speakers of Swedish) participated as listeners. After individual training, each listener performed the hypernasality rating task. Each order of stimuli was analyzed individually using the 2-step, VISOR and Borg centiMax scale methods. Main Outcome Measures: Comparison of intra- and inter-rater reliability, and consistency  for each method within language of the listener and between listener languages (Swedish and Brazilian–Portuguese). Results: Good to excellent intra-rater reliability was found within each listener for all methods, 2-step: κ = 0.59-0.93; VISOR: intraclass correlation coefficient (ICC) = 0.80-0.99; Borg centiMax (cM) scale: ICC = 0.80-1.00. The highest inter-rater reliability was demonstrated for VISOR (ICC = 0.60-0.90) and Borg cM-scale (ICC = 0.40-0.80). High consistency within each method was found with the highest for the Borg cM scale (ICC = 0.89-0.91). There was a significant difference in the ratings between the Swedish and the Brazilian listeners for all methods. Conclusions: The category-ratio scale Borg cM was considered most reliable in the assessment of hypernasality. Language background of Brazilian–Portuguese listeners influenced the perceptual ratings of hypernasality in Swedish speech samples, despite their experience in perceptual assessment of cleft palate speech disorders. [ABSTRACT FROM AUTHOR]

Background: Attention-deficit hyperactivity disorder (ADHD) is one of the most common childhood neuropsychiatric disorders and is highly comorbid with speech, language and communication difficulties (SLCDs). However, it is unclear how often SLCDs are identified in ADHD referrals in routine practice and whether there are unidentified SLCDs within this population. Method: A thematic analysis was conducted on a random sample of case notes from 18 referrals for ADHD made to a child and adolescent mental health service (CAMHS) in London, United Kingdom. Analyses aimed to identify (a) the types of SLCDs detected during assessment, (b) at which point of the episode of care these SLCDs were suspected and (c) whether a referral or consultation was made to a speech and language therapist (SLT) for further evaluation. Results: Out of 18 cases investigated, 15 were found to have possible SLCDs based on case notes and reports provided by external agencies. However, only four were referred by CAMHS for further assessment. It is unclear what, if any, steps other external agencies took. Themes describing types of SLCDs, comorbidities and the process of identification are discussed. Conclusion: The analysis of this service’s case notes revealed a range of different routes to the identification of SLCDs, and it was unclear what steps were taken as a result of assessment. A limitation is that this is just one service and the results may not generalise. However, given the similarity in practitioner training received across the country and that practitioners move from service to service, there are grounds for repeating the study in other services. We recommend a more structured approach to identifying SLCDs and recording assessment and treatment decisions made. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to develop and evaluate a model for teaching transcervical laryngeal injections. Methods: A 3-dimensional printer was used to create a laryngotracheal framework based on de-identified computed tomography images of a human larynx. The arytenoid cartilages and intrinsic laryngeal musculature were created in silicone from clay casts and thermoplastic molds. The thyroarytenoid (TA) muscle was created with electrically conductive silicone using metallic filaments embedded in silicone. Wires connected TA muscles to an electrical circuit incorporating a cell phone and speaker. A needle electrode completed the circuit when inserted in the TA during simulated injection, providing real-time feedback of successful needle placement by producing an audible sound. Face validation by the senior author confirmed appropriate tactile feedback and anatomical realism. Otolaryngologists pilot tested the model and completed presimulation and postsimulation questionnaires. Results: The high-fidelity simulation model provided tactile and audio feedback during needle placement, simulating transcervical vocal fold injections. Otolaryngology residents demonstrated higher comfort levels with transcervical thyroarytenoid injection on postsimulation questionnaires. Conclusion: This is the first study to describe a simulator for developing transcervical vocal fold injection skills. The model provides real-time tactile and auditory feedback that aids in skill acquisition. Otolaryngologists reported increased confidence with transcervical injection after using the simulator. [ABSTRACT FROM AUTHOR]

Objective: Mutations in the transient receptor potential vanilloid 4 gene (TRPV4) can induce a great diversity of neuropathies. Together with these neuropathies, hearing loss can occur. This study is focused on providing an audiometric phenotype description of a Dutch family with spinal muscular atrophy caused by a mutation in TRPV4. Methods: A neurological examination was repeated and pure tone and speech audiometry were performed. Results: A large variety in neurological symptoms as well as variation in audiometric characteristics was observed. The severity of hearing loss is mild to moderate and the audiogram configuration is highly variable. The hearing loss of these patients has a progressive nature in general. The frequencies that deteriorate significantly differ between family members. When compared to presbyacusis patients, speech recognition scores of patients with a TRPV4 mutation are not clearly different. Conclusion: The function of TRPV4 in the inner ear is still elusive but it is suggested that TRPV4 is required for maintenance of cochlear function in stress conditions, like acoustic injury. We can neither confirm nor reject this based on the results obtained in this family. Therefore, one might consider advising patients with a TRPV4 mutation to avoid exposure to environmental influences such as noise exposure. [ABSTRACT FROM AUTHOR]

Objective: To investigate the phonetic and phonological parameters of speech production associated with cleft palate in single words and in sentence repetition in order to explore the impact of connected speech processes, prosody, and word juncture on word production across contexts. Participants: Two boys (aged 9 years 5 months and 11 years 0 months) with persisting speech impairments related to a history of unilateral cleft lip and palate formed the main focus of the study; three typical adult male speakers provided control data. Method: Audio, video, and electropalatographic recordings were made of the participants producing single words and repeating two sets of sentences. The data were transcribed and the electropalatographic recordings were analyzed to explore lingual-palatal contact patterns across the different speech conditions. Acoustic analysis was used to further inform the perceptual analysis and to make specific durational measurements. Results: The two boys' speech production differed across the speech conditions. Both boys showed typical and atypical phonetic features in their connected speech production. One boy, although often unintelligible, resembled the adult speakers more closely prosodically and in his specific connected speech behaviors at word boundaries. The second boy produced developmentally atypical phonetic adjustments at word boundaries that appeared to promote intelligibility at the expense of naturalness. Conclusior.: For older children with persisting speech impairments, it is particularly important to examine specific features of connected speech production, including word juncture and prosody. Sentence repetition data provide useful information to this end, but further investigations encompassing detailed perceptual and instrumental analysis of real conversational data are warranted. [ABSTRACT FROM AUTHOR]

The current study was designed to examine the relationships between performance on a nonverbal phoneme deletion task administered in a dynamic assessment format with performance on measures of phoneme deletion, word-level reading, and speech sound production that required verbal responses for school-age children with speech sound disorders (SSDs). The study adds to existing literature by administering the nonverbal task to children with SSDs, and by incorporating the use of an error-specific prompting system in a dynamic assessment format to inform instructional decisions. Ten school-age children with various degrees of speech sound disorders participated in the study. Speech production, phonological awareness, and word-level reading skills were examined. Performance on measures of verbal and nonverbal phoneme deletion were significantly correlated; however, the measure of nonverbal phoneme deletion was not related to performance on measures of speech sound production. Both measures were related to word-level reading. [ABSTRACT FROM AUTHOR]

The purpose of this study was to explore the parent adaptation process for parents of children with childhood apraxia of speech (CAS). Professionals widely recognize the importance of parental involvement in achieving successful outcomes for children with disabilities, however, few studies have explored parents’ views and perspectives, in particular those of parents of children with speech and language disorders. The topic of how parents’ adapt to their child’s diagnosis is an exploratory topic among all disabilities and disorders, however, it is absent from the literature on CAS. Thus, this study sought to explore the parent adaptation experience when a child is diagnosed with CAS. If professionals understand what parents are thinking and feeling, it follows that they will be able to work more effectively in their treatment collaborations with parents of children with CAS. [ABSTRACT FROM AUTHOR]

Presents a letter to the editor about conversion disorder in a patient with diffuse axonal injury.