# Presentation: 011870

## 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

## 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 scale
- 0 = WNL; does not exceed HN
- 			heard in regional speech
- 1 = Mild
- 2 = Moderate
- 3 = 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 judgment
- 0 = WNL/None
- 1 = 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 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

## 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_*:** *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 judgment
- 0 = WNL: _*perceptually*__ __*adequate*_* *for pressure 			consonants
- 1 = Weak; _*perceptually*__ __*inadequate*_* *for 				pressure consonants

## Substitution Errors

- Binary judgment
- 0 = WNL/None
- 1 = 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 judgment
- 0 = WNL/None
- 1 = 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, 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

## 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 judgment
- 0 = WNL/None
- 1 = 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