Occurrence of consonant production errors in liquid phonemes in children with operated cleft lip and palate

Information about the prevalence of consonant production errors, including compensatory articulations (CA), in individuals with cleft lip and palate (CLP) who speak Brazilian Portuguese is limited, particularly regarding liquid sounds. The literature primarily reports the occurrence of CA for plosive and fricative sounds, since occurrence of CAs in sounds that require higher amounts of oral air pressure is expected. While the use of CA during liquid sound production is not expected, clinical experience suggests that individuals with CLP present with inadequate backing, elevation, and anteriorization of the tongue as well as tongue clicks during production of /r/ and /l/.

Objectives

Describe the occurrence of consonant error productions during liquid sounds for children with CLP; compare the occurrence between children operated with the Furlow and von Langenbeck techniques for palatoplasty; and compare the occurrence between children operated between 9-12 months and 15-18 months of age at primary palatoplasty.

Material and Methods

A sample of 397 children (237 males and 160 females) with operated unilateral CLP was studied. In this group, 163 underwent palatoplasty with the Furlow procedure and 234 with the modified von Langenbeck procedure. Age at palatoplasty was between 9 and 12 months for 189 children and between 15 and 18 months for 208 children. Data about production of /l/, /r/, /R/, /λ/ and consonant clusters /l/ and /r/ were obtained from speech pathology records. Speech pathologists registered the speech findings after an auditory-perceptual evaluation of the participants at the sixth year of age.

Results

The use of middorsum palatal place (MDP) of production was identified for 2% of the sample. Tongue anteriorization of the /l/ production was observed for 55% of the children. No significant difference was found related to surgical technique, but children operated earlier developed the use of the consonant cluster /r/ sooner than children operated later (p=0.040).

Conclusion

We found a low occurrence of use of cleft related CA during attempts of production of liquid phonemes, and the variable age at primary palatoplasty significantly interfered with the acquisition of consonant cluster /r/.     

Anatomic and electro-physiologic connectivity of the language system: a combined DTI-CCEP study

Here we present a novel multimodal analysis of network connectivity in the language system. We assessed connectivity of Broca's area using tractography with diffusion tensor imaging (DTI), and with cortico-cortical evoked potentials (CCEPs) to measure the spread of artificial currents applied directly to human cortex. We found that both the amplitude and latency of CCEP currents significantly correlates (r²=0.41, p<10⁻¹⁶) with the number of DTI pathways connecting the stimulation and recording loci. This strategy of relating electrical information flow with the neural architecture will likely yield new insights into cognitive processes.     

Sibilant production in Hebrew-speaking adults: Apical versus laminal

The Hebrew IPA charts describe the sibilants /s, z/ as ‘alveolar fricatives’, where the place of articulation on the palate is the alveolar ridge. The point of constriction on the tongue is not defined – apical (tip) or laminal (blade). Usually, speech and language pathologists (SLPs) use the apical placement in Hebrew articulation therapy. Some researchers and SLPs suggested that acceptable /s, z/ could be also produced with the laminal placement (i.e. the tip of the tongue approximating the lower incisors). The present study focused at the clinical level, attempting to determine the prevalence of these alternative points of constriction on the tongue for /s/ and /z/ in three different samples of Hebrew-speaking young adults (total n = 242), with typical articulation. Around 60% of the participants reported using the laminal position, regardless of several speaker-related variables (e.g. tongue-thrust swallowing, gender). Laminal production was more common in /s/ (than /z/), coda (than onset) position of the sibilant, mono- (than di-) syllabic words, and with non-alveolar (than alveolar) adjacent consonants. Experiment 3 revealed no acoustical differences between apical and laminal productions of /s/ and of /z/. From a clinical perspective, we wish to raise the awareness of SLPs to the prevalence of the two placements when treating Hebrew speakers, noting that tongue placements were highly correlated across sibilants. Finally, we recommend adopting a client-centred practice, where tongue placement is matched to the client. We further recommend selecting targets for intervention based on our findings, and separating between different prosodic positions in treatment.     

Presurgical language mapping using event-related high-gamma activity: The Detroit procedure

A number of investigators have reported that event-related augmentation of high-gamma activity at 70–110?Hz on electrocorticography (ECoG) can localize functionally-important brain regions in children and adults who undergo epilepsy surgery. The advantages of ECoG-based language mapping over the gold-standard stimulation include: (i) lack of stimulation-induced seizures, (ii) better sensitivity of localization of language areas in young children, and (iii) shorter patient participant time. Despite its potential utility, ECoG-based language mapping is far less commonly practiced than stimulation mapping. Here, we have provided video presentations to explain, point-by-point, our own hardware setting and time–frequency analysis procedures. We also have provided standardized auditory stimuli, in multiple languages, ready to be used for ECoG-based language mapping. Finally, we discussed the technical aspects of ECoG-based mapping, including its pitfalls, to facilitate appropriate interpretation of the data.     

814例舌系带过短儿童异常语音的探讨及矫治效果分析

目的探讨舌系带过短儿童的异常语音特点及矫治方法。方法采用启音博士Dr．Speech软件及四川大学华西口腔医院唇腭裂外科语音清晰表对814例确诊为舌系带过短患儿进行语音测评,对有发音障碍的575例按2～4岁、4～6岁、6岁以上分为3组,随机在3组中抽出100例单纯语训,100例单纯手术,375例手术一个月后仍有263例在语音错误,对263例进行语训,然后进行矫治和分组对比。结果舌系带过短导致言语障碍的发生率为70．6％;从发音的位置整理声母错误情况,由高至低依次为舌尖后音、舌根音、舌尖音、舌尖前音、舌面音．唇齿音．双唇音;舌系带过短患儿有语音障碍单纯语训的有效率为67．0％;单纯手术后语音自行康复率为32.0％;手术配合语训的有效率为98．5％。结论准确的干预可以帮助舌系带过短患儿更好地发展语言,手术配合语训是治疗舌系带过短患儿语音异常的最佳治疗方法。     

Anatomical study of the ligamentous attachments and articular surfaces of the trapeziometacarpal joint. Consequences on surgical management of its osteoarthrosis

In the goal to optimize conservative surgical techniques of the trapeziometacarpal joint in cases of moderate osteoarthritis, we have defined the relationships between the ligamentous attachments and the articular surfaces onto the trapezium and the first metacarpal bone on the one hand, and the dorsovolar and the transverse diameters of the articular surfaces on the other hand. Thirty-six trapeziometacarpal joints (from 18 fresh cadavers) were studied. They were separated into two groups depending on the macroscopic assessment of chondral disease. Group A included stages I to III (no osteoarthritis or moderate osteoarthritis), group B included stages IV (major cartilage destruction). The dorsovolar and transverse sizes of the articular surfaces were measured. Dorsoradial ligament (DRL), posterior oblique ligament (POL), intermetacarpal ligament (IML), ulnar collateral ligament (UCL) and anterior oblique ligament (AOL) were dissected and the distance between their attachments and the articular surfaces were measured. Group A included 17 joints (71% males) and group B included 19 joints (95% females). For the first metacarpal bone, the average ratio between the dorsovolar diameter and the transverse diameter of metacarpal articular surfaces was significantly higher in group B and the average distance between the ligamentous attachments and the articular surface was more than two millimeters, except for the DRL in group B. For the trapezium, only the posterior ligaments (DRL and POL) of group A were inserted at a mean distance more than two millimeters from the articular surfaces. Dorsovolar length of the metacarpal articular surface was higher for osteoarthritis cases. This difference can be explained by the existence of a palmar osteophyte that was always found in stage IV. Describing a map of the ligamentous attachment distance from the articular surface could help surgeons to avoid the ligamentous injury during minimal osteochondral resection.     

Three-dimensional reconstruction of joint surfaces using a microcomputer

A microcomputer was used to analyse the surface characteristics and geometry of articulating joints. Both hardware configuration and software organisation were described. Data used in this analysis were obtained by sequential resection of entire joints (elbows, metatarsophalangeal joints and knees) secured in an embedding medium. The exposed joint profile after each resection in a bone milling machine was recorded photographically. Each record of freshly cut profile was manually digitised and automatically processed with a desktop microcomputer. The complete structure of these articulating surfaces was reconstructed in three dimensions to be displayed in any desired orientation as a series of parallel, consecutive and uniformly spaced sections. These data have been used to derive information on cartilage thickness, underlying bone structure, orientation and anatomical shape of the joint surfaces. The stored surface geometry may be retrieved at any time for related studies of joint kinematics, joint sizing and prosthetic joint design.     

鼻化元音的频谱特点与过高鼻音主观判听的相关关系研究

目的通过建立声学观察指标,研究鼻化元音频谱表现和过高鼻音主观判听的相关关系,从而评价声学分析技术在腭裂语音评价中的可靠性。方法腭裂儿童98例,年龄5～12岁,平均8.30岁。单侧完全性腭裂51例,双侧完全性腭裂10例,不完全性腭裂37例。由3名从事腭裂语音研究多年的临床医师,对患者的录音进行鼻音程度判听。将患者按鼻音的严重程度分为无、轻度、中度、重度过高鼻音4组。应用Spearman相关分析统计方法,对元音/i/鼻腔共振指数NRI-i、元音/a/鼻腔共振指数NRI-a、元音/a/的能量衰减指数EDI-a与过高鼻音主观判听分数的相关关系进行统计学分析。结果元音/i/的鼻腔共振指数与过高鼻音程度呈高度正相关,相关系数r=0.85(P<0.001);元音/a/的鼻腔共振指数与过高鼻音程度呈中度负相关,相关系数r=-0.65(P<0.001);元音/a/的能量衰减指数与过高鼻音程度亦为中度负相关,相关系数r=-0.48(P<0.001)。结论鼻化元音频谱表现与过高鼻音主观判听结果有良好的相关性,过高鼻音的存在与否,与元音/i/频谱上有无额外峰的出现以及与元音/a/频谱上Fn和F1能量的相对大小关系紧密;元音频谱上鼻音共振峰能量越强,鼻音化程度越重;高频能量衰减越明显,鼻音化程度越重。鼻腔共振指数NRI和能量衰减指数(EDI)是有效的观察指标,声学分析技术是     

脑性瘫痪儿童下颌运动障碍的临床研究

目的了解不同类型脑性瘫痪(简称脑瘫)儿童下颌运动障碍情况。方法 2014年6月至2015年6月在黑龙江省小儿脑性瘫痪防治疗育中心收治的不同类型脑瘫患儿43例为观察组,其中混合型及不随意运动型18例,痉挛型25例。同期选择佳木斯市某幼儿园就读正常儿童40例为对照组。采用《下颌运动功能测评调查表》观察、测评和记录儿童的下颌运动能力。结果观察组测评得分与对照组相比差异均有统计学意义(P0.05,0.01)。混合型及不随意型组与对照组比较,各项下颌运动测评分数差异均有统计学意义(P0.05,0.01)。痉挛型组与对照组比较,除下颌前伸运动、下颌左右连续运动测评分数差异无统计学意义(P0.05)外,其他各项下颌运动测评分数差异均有统计学意义(P0.01)。混合型及不随意型组与痉挛型组相比,除下颌前伸运动测评分数差异无统计学意义(P0.05)外,其他各项下颌运动测评分数差异均有统计学意义(P0.01),且痉挛型组得分均高于混合型及不随意型组。结论下颌运动障碍是脑瘫儿童普遍存在的一种构音器官运动障碍,不同类型的患儿其下颌运动障碍的形式及严重程度也有明显差异。     

Influence of voice focus on tongue movement in speech

The present study evaluated global aspects of lingual movement during sentence production with backward and forward voice focus. Nine female participants read a sentence with a variety of consonants in a normal condition and with backward and forward voice focus. Midsagittal tongue movement was recorded with ultrasound. Tongue height over time at an anterior, a central, and a posterior measurement angle was measured. The outcome measures were speech rate, cumulative distance travelled, and average movement speed of the tongue. There were no differences in speech rate between the different conditions. The cumulative distance travelled by the tongue and the average speed indicated that the posterior tongue travelled a smaller cumulative distance and at a slower speed in the forward focus condition. The central tongue moved a larger cumulative distance and at a higher speed in the backward focus condition. The study offers first insights on how tongue movement is affected by different voice focus settings and illustrates the plasticity of tongue movement in speech.