Parameters: Definitions & Guidelines

1. Parameters: Definitions &Guidelines Debbie Sell PhD, FRCSLT Head, Speech & Language Therapy Department Great Ormond Street NHS Trust Honorary Senior Lecturer University of London Judith Trost-Cardamone, PhD, FASHA Professor, California State University Northridge Department of Communication Disorders & Sciences

2. 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

3. 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

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

5. Hypernasality (HN) • 0-3 rating scale • 0 = WNL; does not exceed HN heard in regional speech • 1 = Mild • 2 = Moderate • 3 = Severe

6. 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

7. Hyponasality [HypoN] • Binary judgment • 0 = WNL/None • 1 = Present

8. 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

9. Audible Nasal Air Emission and/or Turbulence • Binary judgment • 0 = WNL/None • 1 = 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

10. 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

11. Intermittent and variable: nasal air emission and/or turbulence heard occasionally withvarious oral pressure consonants with no obvious pattern of occurrence Phoneme specific:nasal emission and/or turbulence heard consistently but only withselected 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?

12. Oral Pressures • Binary judgment • 0 = WNL: perceptuallyadequatefor pressure consonants • 1 = Weak; perceptuallyinadequatefor pressure consonants

13. Substitution Errors • Binary judgment • 0 = WNL/None • 1 = Present [indicate type and frequency] • Six categories • Weighted scoring for frequency

14. 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 frequencyof occurrence for glottal stop, pharyngeal fricative/stop/affricate, palatal stop, palatal fricative, nasal fricative, atypical backing of targets to velar

15. Substitution Errors: glottal and pharyngeal • Glottal stop • Pharyngeal: fricative, stop, affricate or any combination

16. Substitution Errors: mid-dorsum palatal • Mid-dorsum palatal stop • Mid-dorsum palatal fricative

17. Substitution Errors:backing but targets remain oral • Backingof dental, alveolar and/or palatal targetsto velar

18. 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.

19. Substitution Errors: nasal fricative • Nasal fricative with or without turbulence ___ phoneme specific pattern** **Is this necessary, informative?

20. 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

21. Secondary Parameters:Speech parameters less directly related or not related to the cleft palate/velopharyngeal conditionbut whicharefrequently observed in speakers with cleft palate.They are all speech characteristics/deviations that can be seen in speakers without cleft palate.

22. Secondary Parameters • Binary judgment • 0 = WNL/None • 1 = Present • Includes errors related to: • Dentition, Occlusion, palatal vault • Developmental delay, other articulation/phonological errors • Voice/laryngeal disorders

23. 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.

24. Secondary Speech Parameters cont. • Developmental delay, other articulation/phonologic errors and voice/laryngeal disorders are self - explanatory

25. X = Missing Data • Could not test (e.g. child was not cooperative, inadequate speech sample) • Did not test (e.g. time constraints)

26. DiscussionTime

27. Parameters: Scales & Scoring Judith Trost-Cardamone, PhD, FASHA Professor, California State University Northridge Department of Communication Disorders & Sciences Triona Sweeney, PhD Specialist Speech & Language Therapist The Children’s Hospital Temple Street, Dublin Adjunct Professor, University of Limerick

28. 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

29. Hypernasality [HN] • 2Moderate 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

30. Hypernasality [HN] • 3Severe Hypernasality • Pervasive and interferes with speech understandability • Many vowels lose identity • Socially very unacceptable • Would definitely recommend physical management after instrumental assessment

31. 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

32. 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 withmost/all high pressure consonants in the inventory [3]

33. 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

34. Substitution Errors • Binary judgment • 0 = WNL/None • 1 = Present [indicate type and frequency] • Six categories • Weighted scoring for frequency

35. Substitution Errors: glottal and pharyngeal • Glottal stop [1] • Frequent [3] • Infrequent [1] • Pharyngeal: fricative, stop, affricate or any combination [1] • Frequent [3] • Infrequent [1]

36. Substitution Errors: mid-dorsum palatal • Mid-dorsum palatal stop [1] • Frequent [2] • Infrequent [1] • Mid-dorsum palatal fricative[1] • Frequent [2] • Infrequent [1]

37. Substitution Errors:backing but targets remain oral • Backingof dental, alveolar and/or palatal targetsto velar[1] • Frequent [2] • Infrequent [1]

38. Substitution Errors: nasal fricative • Nasal fricative with or without turbulence[1] • Frequent [3] • Infrequent [1] ___ phoneme specific pattern [2]** **Is this necessary, informative?

39. 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

40. Substitution Errors • Frequent [2] • Infrequent [1] How do we define frequency? Is it necessary to document this?

41. DiscussionTime