Parameters: Definitions & Guidelines

Debbie Sell PhD, FRCSLTHead, Speech & Language Therapy Department

Great Ormond Street NHS Trust

Honorary Senior Lecturer University of London

Judith Trost-Cardamone, PhD, FASHAProfessor, California State University Northridge

Department of Communication Disorders & Sciences

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

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

Primary Parameters: Speech parameters most directly related to the cleft palate/velopharyngeal condition

Hypernasality (HN)

• 0-3 rating scale0 = WNL; does not exceed HN

heard in regional speech

1 = Mild2 = Moderate3 = Severe

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

Hyponasality [HypoN]

• Binary judgment0 = WNL/None1 = Present

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

Audible Nasal Air Emission and/or Turbulence

• Binary judgment0 = WNL/None1 = 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

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

• 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?

Oral Pressures

• Binary judgment0 = WNL: perceptually adequate for pressure

consonants1 = Weak; perceptually inadequate for

pressure consonants

Substitution Errors

• Binary judgment0 = WNL/None1 = Present [indicate type and frequency]

• Six categories

• Weighted scoring for frequency

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

Substitution Errors: glottal and pharyngeal

• Glottal stop

• Pharyngeal: fricative, stop, affricate

or any combination

Substitution Errors: mid-dorsum palatal

• Mid-dorsum palatal stop

• Mid-dorsum palatal fricative

Substitution Errors:backing but targets remain oral

• Backing of dental, alveolar and/or palatal targets to velar

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.

Substitution Errors: nasal fricative

• Nasal fricative with or without turbulence

___ phoneme specific pattern**

**Is this necessary, informative?

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

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.

Secondary Parameters

• Binary judgment0 = WNL/None1 = Present

• Includes errors related to:• Dentition, Occlusion, palatal vault• Developmental delay, other

articulation/phonological errors• Voice/laryngeal disorders

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.

Secondary Speech Parameters cont.

• Developmental delay, other articulation/phonologic errors and voice/laryngeal disorders are self - explanatory

X = Missing Data

• Could not test (e.g. child was not cooperative, inadequate speech sample)

• Did not test (e.g. time constraints)

Discussion Time

Parameters: Scales & Scoring

Judith Trost-Cardamone, PhD, FASHAProfessor, California State University Northridge

Department of Communication Disorders & Sciences

Triona Sweeney, PhDSpecialist Speech & Language Therapist

The Children’s Hospital Temple Street, Dublin

Adjunct Professor, University of Limerick

Hypernasality [HN]

• 1 Mild 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

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

Hypernasality [HN]

• 3 Severe Hypernasality• Pervasive and interferes with speech

understandability• Many vowels lose identity• Socially very unacceptable• Would definitely recommend physical

management after instrumental assessment

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

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]

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

Substitution Errors

• Binary judgment0 = WNL/None1 = Present [indicate type and frequency]

• Six categories

• Weighted scoring for frequency

Substitution Errors: glottal and pharyngeal

• Glottal stop [1]– Frequent [3]– Infrequent [1]

• Pharyngeal: fricative, stop, affricate

or any combination [1]– Frequent [3]– Infrequent [1]

Substitution Errors: mid-dorsum palatal

• Mid-dorsum palatal stop [1]– Frequent [2]– Infrequent [1]

• Mid-dorsum palatal fricative [1]– Frequent [2]– Infrequent [1]

Substitution Errors:backing but targets remain oral

• Backing of dental, alveolar and/or palatal targets to velar [1]– Frequent [2]– Infrequent [1]

Substitution Errors: nasal fricative

• Nasal fricative with or without turbulence [1]– Frequent [3]– Infrequent [1]

___ phoneme specific pattern [2]**

**Is this necessary, informative?

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

Substitution Errors

• Frequent [2]

• Infrequent [1]

How do we define frequency?

Is it necessary to document this?

Discussion Time