Having your cake and eating it: The apparent paradox of long-term outcomes of SLI

The primary objective of this study was to determine the effectiveness of electropalatography (EPG) home training using a portable training unit (PTU) for clients with residual articulation disorders. The participants were five Japanese children with cleft lip and palate ranging in age from 8 to 13 years when they began EPG home training. These children had residual articulation disorders caused by abnormal tongue-palate contact, although four of them had received conventional speech therapy for 3 to 8 years before starting EPG training. The WinEPG system (Articulate Instruments, Edinburgh) was used to make recordings during the initial assessment and the monthly follow-up. The participants received EPG training sessions when they attended for their monthly recordings. A training programme was developed for each participant, and they were instructed to carry out their homework assignments using the PTU. After 7 to 9 months of home training, marked changes in the EPG patterns and “centre of gravity” values were observed in four of the five participants. The remaining one participant, who had not experienced speech therapy before, needed a longer period of EPG training to achieve good results. Our preliminary data suggested that EPG home training was effective in school-aged participants who had residual articulation disorders.     

Generalised EPG treatment effect in a cochlear implant user maintained after 2 years

Purpose: The aim of this study was to evaluate speech therapy using electropalatography (EPG) in home training of persistent articulation errors in a cochlear implant user with hearing impairment. There was a particular focus on aspects of maintenance of training effects and possible transfer to connected speech.

Method: The participant was a young woman, deaf from early childhood and a cochlear implant user from pre-school age. Treatment effects were evaluated using a single-subject design with multiple measures.

Result: Instrumental and perceptual outcome measures showed a clear improvement in the production of the treatment target /ɡ/ in single words and sentences after 4 months of therapy (17 hours). The results were maintained at 3, 6 and 24 months after intervention. Also, /ɡ/ in connected speech, consisting of text reading and spontaneous speech, showed a significant difference between before and after treatment and at long-term follow-up.

Conclusion: The results show that EPG used in home training can be an efficient method for treating persistent speech disorders associated with hearing impairment and that the treatment effect appears to maintain.     

多媒体技术在腭裂修补术后语音治疗中的应用

目的 :利用计算机多媒体技术辅助腭裂患者术后语音治疗 ,在较短时间内强化训练 ,激励患者的训练积极性。方法 :利用实时语音工作站软件和MicrosoftPowerpoint软件为 2 1例患者进行较系统的语音训练 ,制作图文并茂的幻灯片 (带有音乐效果 ) ,用汉语输入法找出患者发音须纠正的系列字、词组 ,对被训练患者进行语音清晰度的检测及训练前后录音对比。结果 :2 1例患者经过 5天的强化训练 ,语音清晰度从平均 5 4.2 %提高到 94.7%。平均提高了 40 .5 %。结论 :利用多媒体辅助腭裂患者术后语音治疗 ,可激发其训练兴趣 ,强化针对性语音训练确能在较短时间内达到提高语音清晰度 ,改善语音功能的目的。     

双唇音构音障碍的临床特点和语音训练

目的探讨双唇音构音障碍的临床特点和训练方法。方法分析92 例功能性构音障碍(FAD)患者和85 例腭裂术后构音障碍患者双唇音构音障碍的特点;再各选择20 例有双唇音构音障碍的患者进行语音训练。结果FAD患者中/p/置换成/b/占同类患者有双唇音构音错误总人数的78.8%,腭裂术后构音障碍患者中/b/脱落和置换分别占30.2%和60.4%。经过语音训练,两类患者双唇音构音错误的个数显著减少(P<0.001)。结论双唇音构音障碍在FAD患者中主要为/p/音的不送气化,在腭裂术后构音障碍患者中主要表现为/b/音的脱落和置换;语音训练效果显著。     

腭裂术后患儿言语治疗的效果观察

目的观察言语治疗对腭裂术后患儿构音障碍恢复的效果。方法对28例腭裂术后患儿于术后4周开始进行言语训练,3个月为1个疗程,共训练1～3个疗程。训练前后分别进行腭咽闭合功能和语音清晰度测评。结果治疗后,鼻漏气率由（50.64±13.10）%降低到（23.36±13.14）%,8例语音达到正常水平,总有效率100%。结论言语治疗能使腭裂术后患儿构音障碍明显改善。     

腭裂修复术后语音训练介入时机的研究

目的　探讨腭裂术后患者接受语音训练的最佳时机 ,研究语音训练介入时机对语音功能改善的作用。方法　对 5 6例接受腭裂修补术的患者进行术前、术后 1,2 ,3周、术后 1个月鼻音化率的比较研究 ,并对其中 14例患者在术后 1个月进行早期语音训练 ,通过与未接受语音训练组的对比研究 ,找出语音训练的最佳时机。结果　腭裂术前与术后 1,2 ,3周鼻音化率的均值比较 ,差异无显著性意义 (P >0 .0 5 )。腭裂术前与术后 1个月鼻音化率的均值比较 ,差异有显著性意义 (P <0 .0 5 )。腭裂术后 1个月接受语音训练组与未接受语音训练组比较 ,二者差异有非常显著性意义 (P <0 .0 1)。结论　腭裂术后 1个月内进行语音训练对腭裂语音的改善无明显作用 ;接受腭裂手术 1个月后 ,腭部肌肉运动、腭咽结构及功能渐渐恢复 ,在此期间进行语音训练对改善腭裂术后腭裂语音功能有至关重要的作用。     

Tongue-palate contact patterns for Japanese speakers with and without cleft lip and palate

Abstract

Purpose: Visual feedback therapy, using electropalatography (EPG), has been used to remedy residual articulation errors associated with cleft palate. The tongue-palate contact patterns of typical speakers without cleft palate are usually used as a model. However, it is questionable whether these model patterns are adequate for clients with repaired cleft palate, as their dento-palatal morphology is different from non-cleft speakers. The objective of this study was to investigate the differences in tongue-palate contact patterns between typical speakers with and without cleft palate.

Method: EPG data were recorded for alveolar consonants in 15 participants with repaired unilateral cleft lip and palate (UCLP) whose speech was perceptually assessed as typical Japanese. The cumulative templates for each consonant were generated from the maximum contact frame; quantitative analyses (centre of gravity [CoG], variability index) were performed. Fifteen typical Japanese speakers without cleft served as a control group.

Result: EPG patterns for each consonant were generally similar between groups. The CoG value of the UCLP group was significantly lower only for /s/. The average variability index was higher for every consonant but the comparisons did not reach significance.

Conclusion: The typical tongue-palate contact patterns can be used as a model of visual feedback therapy.     

The role of theory in clinical practice: Reflections on model building

Although previous studies have demonstrated the benefits of using electropalatography (EPG) for treating therapy-resistant articulation errors associated with cleft palate, until recently access to this form of treatment has been limited. For the past 10 years, however, the CLEFTNET Scotland project has provided individuals with cleft palate access to EPG therapy. CLEFTNET Scotland represented a novel form of EPG service delivery—it linked the cleft palate centres throughout Scotland to Queen Margaret University College (QMUC) in Edinburgh through an electronic network. EPG data collected in the centres were sent to QMUC, where experts conducted detailed analysis leading to a precise diagnosis of each individual's specific articulation difficulty and suggested therapy guidelines to the specialist speech-language therapists based on their analysis. This form of service delivery has recently extended to include England, Wales and Northern Ireland to form CLEFTNET UK. This paper describes the CLEFTNET projects, discusses orthodontic issues relevant to EPG therapy for individuals with cleft palate, and presents a case study to illustrate how therapy guidelines for speech-language therapists are derived from data analysis.     

腭裂术后语音训练方法的探讨

目的探讨患儿腭裂术后语音训练方法。方法通过对腭裂术后的患儿及家长以个体健康教育辅导语音训练的形式,根据每个患儿发音的不同特点,采用代偿性语音习惯矫正法、会厌闭合音矫正法和下颌异常前伸矫正训练法围绕汉语中重点几个不同辅音,有计划,循序渐进逐步完成从辅音→音节→词组→短句→自然交流或对话的语音训练。结果32例不同年龄阶段的患儿通过个体语音训练辅导后,语言清晰度提高有效率达96%,15例基本恢复正常语言,16例语音训练有效,1例无效。结论通过三种语音训练方法,能在较短时间里达到提高语音清晰度,改变语音的功能。     

Communication attitude and speech in 10-year-old children with cleft (lip and) palate: An ICF perspective

Many children born with cleft palate have impaired speech during their pre-school years, but usually the speech difficulties are transient and resolved by later childhood. This study investigated communication attitude with the Swedish version of the Communication Attitude Test (CAT-S) in 54 10-year-olds with cleft (lip and) palate. In addition, environmental factors were assessed via parent questionnaire. These data were compared to speech assessments by experienced listeners, who rated the children's velopharyngeal function, articulation, intelligibility, and general impression of speech at ages 5, 7, and 10 years. The children with clefts scored significantly higher on the CAT-S compared to reference data, indicating a more negative communication attitude on group level but with large individual variation. All speech variables, except velopharyngeal function at earlier ages, as well as the parent questionnaire scores, correlated significantly with the CAT-S scores. Although there was a relationship between speech and communication attitude, not all children with impaired speech developed negative communication attitudes. The assessment of communication attitude can make an important contribution to our understanding of the communicative situation for children with cleft (lip and) palate and give important indications for intervention.     

Communication attitude and speech in 10-year-old children with cleft (lip and) palate: an ICF perspective

Many children born with cleft palate have impaired speech during their pre-school years, but usually the speech difficulties are transient and resolved by later childhood. This study investigated communication attitude with the Swedish version of the Communication Attitude Test (CAT-S) in 54 10-year-olds with cleft (lip and) palate. In addition, environmental factors were assessed via parent questionnaire. These data were compared to speech assessments by experienced listeners, who rated the children's velopharyngeal function, articulation, intelligibility, and general impression of speech at ages 5, 7, and 10 years. The children with clefts scored significantly higher on the CAT-S compared to reference data, indicating a more negative communication attitude on group level but with large individual variation. All speech variables, except velopharyngeal function at earlier ages, as well as the parent questionnaire scores, correlated significantly with the CAT-S scores. Although there was a relationship between speech and communication attitude, not all children with impaired speech developed negative communication attitudes. The assessment of communication attitude can make an important contribution to our understanding of the communicative situation for children with cleft (lip and) palate and give important indications for intervention.     

成年功能性构音障碍患者的语音训练及临床特点分析

目的探讨成年功能性构音障碍（FAD）患者的临床特点与语音训练方法。 方法对37例成年FAD患者进行语音评估,分析其临床特点并进行针对性的语音训练。 结果37例成年FAD患者主要的构音错误类型为置换、歪曲,其次为脱落。构音错误方式有舌前音化（19例）、非送气化（11例）、侧化构音（10例）、舌后音化（7例）、辅音脱落（7例）、混合型（4例）、唇齿音化（3例）、舌面音化（2例）。经过1～5个疗程的语音训练,28例治愈,8例好转,1例无效,训练后的语音清晰度测定值［（91.22±10.10）%］较训练前［（56.03±14.71）%］提高,差异有统计学意义（P<0.05）。 结论成年FAD患者主要的构音错误类型是置换和歪曲,基于构音错误方式开展针对性语音训练是治疗成年FAD的有效措施。     

The efficacy of speech intervention using electropalatography with an 18-year-old deaf client: A single case study

This single case study explored the use of EPG as a therapeutic tool for treating inaccurate articulation of the voiceless alveolar plosive /t/. The participant (M) is an 18-year-old deaf adult who consistently uses hearing aids, and who communicates using a combination of English, Sign Supported English and British Sign Language (BSL). M received traditional phonological therapy targeting his production of /t/ prior to EPG therapy, but without success. He requested further therapy and EPG was offered as an alternative approach. Pre-EPG therapy, M made tongue placement errors for both /t/ and the voiced alveolar plosive /d/. Based on perceptual analysis by M's speech and language therapist, the first author, his productions were inconsistent, though generally perceived as voiceless and voiced velar plosives respectively. The EPG therapy consisted of six bi-weekly therapy sessions, each lasting for 1 hour, targeting M's production of /t/ in familiar words, using the visual feedback from the EPG display. Trained and untrained listeners perceptually analysed audio recordings of words and sentences collected at three assessment points. Improvements, both over the course of the EPG therapy and during the follow-up period, were found to be statistically significant. Significantly, M was able to generalize his production skills to untaught words containing both /t/ and /d/. Equally significant was the lack of change in M's production of a control sound, the voiceless dental fricative /θ/. More globally, an improvement was observed in ratings of M's intelligibility in sentences and in his voice quality (assessed impressionistically).     

The short-time articulation index

In this paper we introduce the concept of the short-time articulation index. This is a procedure for calculating a time-varying articulation index from data on a block-by-block basis. The short-time articulation index can be used to give a running measure of the speech intelligibility for an adaptive noise-cancellation system as it converges. We present an algorithm for calculating the short-time articulation index and give some examples of its use.     

Sommerlad提肌重建术修复不完全性腭裂

目的探讨Sommerlad提肌重建术修复不完全性腭裂的临床效果。方法对31例不完全性腭裂患儿采用Sommerlad提肌重建术修复。结果所有患儿术后均获6个月～3年随访。所有患儿语音清晰度及腭咽闭合的水平均得到了不同程度的改善。咽腔造影显示14例（45.2%）获得了完全的腭咽闭合。结论 Sommerlad提肌重建术是目前较理想的不完全性腭裂修复方法,具有良好的临床应用前景。     

婴儿腭裂术后的早期干预

目的：评价婴儿腭裂术后的早期干预效果。方法：对２４例,１０～１８个月广州地区的腭裂术后患儿进行评价,其中７５％伴有听力障碍、７９％语言发育迟缓。术后１个月进行听力、语言训练及有关构音器官运动训练。结果：经过６个月治疗,８８．９％的听力障碍患儿恢复正常,８４．２％的语言发育迟缓患儿达到正常,大部分患儿能控制气流从口中呼出。结论：在患儿开始语音训练前进行相关功能的评估及治疗是十分有意义的。     

Temporal and spatial aspects concerning the realizations of the voicing contrast in German alveolar and postalveolar fricatives

This study investigates the phonetic realizations of voicing contrast in alveolar and postalveolar fricatives production in different word positions in order to understand the temporal and spatial production strategies used in the control of voicing and frication, and to provide a frame of reference for speech therapy despite the inter-speaker variation. Seven native speakers of German, originally coming from various regions, participated in the experiment. Acoustic signals were recorded onto DAT, and tongue palate contact patterns were recorded by means of electropalatography (EPG). The temporal parameters were measured using the acoustic signals and the spatial parameters were measured based on the EPG data. The corpus included real words with // occurring at word initial, medial and final positions. Temporal results showed that differences in the overall frication duration for voicing contrast occur at almost all positions (with longer duration for voiceless phonemes). However, voicing during the frication interval was a less reliable discriminator, particularly for Southern German speakers and at word final position. We found a positive correlation between the relative voicing duration and the amount of tongue palate contact for subjects who produced voicing. Especially for the postalveolars, voicing also coincides with more front articulation. Results are discussed with respect to laryngeal-oral co-ordination and aerodynamics.     

Evaluating a new clinical palatometry system

EPG (Electropalatography) is a visual feedback device designed for clinical and research applications centered on articulation in terms of tongue-to-hard palate contact. EPG has been shown to be effective for a range of speech sound disorders. Several EPG systems have been marketed. One factor that has limited access to EPG treatment, especially in a clinical setting, is the cost of manufacturing the pseudopalates. A new EPG system from Logometrix utilizes a glued on strip of electrodes rather than individually placed electrodes, significantly reducing production expense. Clinical use of the new EPG system is reviewed for 13 clients with varying speech sound disorders, for whom EPG was beneficial in phonetic treatment. Two children were unable to tolerate the pseudopalates, suggesting that practice palates without electrodes be utilized.     

Normal adult speakers' tongue palate contact patterns for alveolar oral and nasal stops

This study compared tongue palate contact patterns for oral stops (/t/, /d/) with those for the nasal stop /n/ in order to provide normative data for diagnosing and treating individuals with speech disorders. Electropalatographic (EPG) data were recorded from 15 English speaking adults for word initial /t/, /d/ and /n/ in a high and a low vowel context. EPG frames were classified according to three criteria: (1) anterior constriction; (2) bilateral constriction; and (3) zero posterior central contact. Total amount of contact and variability were also measured. The results showed that almost all (99%) stops met Criteria 1 and 3, with fewer articulations (88% of /t/; 83% of /d/ and 55% of /n/) meeting Criterion 2. Although all stops had similar spatial patterns, /t/ and /d/ had more contact and were more likely to have bilateral constriction than /n/. There were no differences in variability between /t/, /d/ and /n/, however. The clinical implications of the results for the management of individuals with speech disorders are discussed.     

听觉辨别训练对儿童构音障碍的疗效

目的 观察听觉辨别训练对儿童构音障碍的康复治疗效果。方法 2017年7月至2019年7月,选取本院构音障碍患儿43例,随机分为对照组(n = 21)和治疗组(n = 22)。对照组每天行常规语言训练30 min,治疗组用其中10 min行听觉辨别训练,共4周。治疗前后行构音检查和言语清晰度测试。结果 治疗组治疗后辅音正确率和言语清晰度均显著提高(t > 7.919, P < 0.001),对照组仅辅音正确率显著提高( t = 7.047, P < 0.001)。 结论 听觉辨别训练可提高构音障碍患儿的治疗效果,可作为儿童构音障碍训练的常规内容。