Parameters: Definitions

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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

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Parameters Primary Secondary

• Primary Parameters speech parameters most
• directly related to the cleftpalate/velopharyngea
  l 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

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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

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Primary Parameters Speech parameters most
directly related to the cleft palate/velopharyngea
l condition
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Hypernasality (HN)

• 0-3 rating scale
• 0 WNL does not exceed HN
• heard in regional speech
• 1 Mild
• 2 Moderate
• 3 Severe

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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

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Hyponasality HypoN

• Binary judgment
• 0 WNL/None
• 1 Present

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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

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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

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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

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• 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?
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Oral Pressures

• Binary judgment
• 0 WNL perceptually adequate for pressure
  consonants
• 1 Weak perceptually inadequate for
  pressure consonants

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Substitution Errors

• Binary judgment
• 0 WNL/None
• 1 Present indicate type and frequency
• Six categories
• Weighted scoring for frequency

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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

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Substitution Errors glottal and pharyngeal

• Glottal stop
• Pharyngeal fricative, stop, affricate
• or any combination

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Substitution Errors mid-dorsum palatal

• Mid-dorsum palatal stop
• Mid-dorsum palatal fricative

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Substitution Errorsbacking but targets remain
oral

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

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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.

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Substitution Errors nasal fricative

• Nasal fricative with or without turbulence
• ___ phoneme specific pattern
• Is this necessary, informative?

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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

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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/dev
iations that can be seen in speakers without
cleft palate.
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Secondary Parameters

• Binary judgment
• 0 WNL/None
• 1 Present
• Includes errors related to
• Dentition, Occlusion, palatal vault
• Developmental delay, other articulation/phonologic
  al errors
• Voice/laryngeal disorders

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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.

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Secondary Speech Parameters cont.

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

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X Missing Data

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

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Discussion Time
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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 Childrens Hospital Temple Street, Dublin
• Adjunct Professor, University of Limerick

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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 gt or parent age 5 mostly
  satisfied
• Would probably not recommend physical management
  at this time

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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

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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

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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

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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

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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

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Substitution Errors

• Binary judgment
• 0 WNL/None
• 1 Present indicate type and frequency
• Six categories
• Weighted scoring for frequency

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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 Errorsbacking but targets remain
oral

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

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Substitution Errors nasal fricative

• Nasal fricative with or without turbulence 1
• Frequent 3
• Infrequent 1
• ___ phoneme specific pattern 2
• Is this necessary, informative?

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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

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Substitution Errors

• Frequent 2
• Infrequent 1
• How do we define frequency?
• Is it necessary to document this?

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Discussion Time