Dysarthria is a common postoperative sequela of glossectomy and can greatly impact daily function and Quality of Life (QOL). It is important to study the anatomic and physiological factors that influence speech function, even with the challenges of conducting clinical research during the COVID pandemic. Therefore, our study aims to 1) display the feasibility of using a telecare platform to conduct clinical research; 2) analyze speech outcomes of patients who underwent hemiglossectomy with radial forearm free flap (RFFF) tongue reconstruction.
Protocolo de tratamento motor para o desenvolvimento motor da falaPaula Lins
This study examined the effects of a Motor Speech Treatment Protocol (MSTP) on five children ages 3;2 to 3;5 with severe to profound speech sound disorders and motor speech difficulties. The MSTP integrated concepts from PROMPT and DTTC motor speech therapies and principles of motor learning. Children received 45-minute individual therapy sessions twice per week for 10 weeks. Outcome measures included visual and auditory ratings of speech accuracy on probe words, as well as standardized speech intelligibility assessments. Results showed significant improvements in speech accuracy and motor control for all children except one, indicating the MSTP may positively impact speech production for children with developmental motor speech disorders.
LANGUAGE CHARACTERISTICS SUPPORTING EARLY ALZHEIMER'S DIAGNOSIS THROUGH MACHI...hiij
Alzheimer's dementia (AD) is the most common incurable neurodegenerative disease worldwide. Apart from memory loss, AD leads to speech disorders. Timely diagnosis is crucial to halt the progression of the disease. However, current diagnostic procedures are costly, invasive, and distressing. Early-stage AD manifests itself in speech disorders, which implies examining those. Machine Learning (ML) represents a promising instrument in this context.
Nevertheless, no genuine consensus on the language characteristics to be analyzed exists. To counteract this deficit and provide topic-related researchers with a better basis for decision-making, we present, based on a literature review, favourable speech characteristics for the appliance toward AD detection via ML. Research trends to apply spontaneous speech, gained from image descriptions, as analysis basis, and points out that the combined use of acoustic, linguistic, and demographic features positively influences recognition accuracy. In total, we have identified 97 overarching acoustic, linguistic and demographic features.
LANGUAGE CHARACTERISTICS SUPPORTING EARLY ALZHEIMER'S DIAGNOSIS THROUGH MACHI...hiij
Alzheimer's dementia (AD) is the most common incurable neurodegenerative disease worldwide. Apart
from memory loss, AD leads to speech disorders. Timely diagnosis is crucial to halt the progression of the
disease. However, current diagnostic procedures are costly, invasive, and distressing. Early-stage AD
manifests itself in speech disorders, which implies examining those. Machine Learning (ML) represents a
promising instrument in this context.
Nevertheless, no genuine consensus on the language characteristics to be analyzed exists. To counteract
this deficit and provide topic-related researchers with a better basis for decision-making, we present,
based on a literature review, favourable speech characteristics for the appliance toward AD detection via
ML. Research trends to apply spontaneous speech, gained from image descriptions, as analysis basis, and
points out that the combined use of acoustic, linguistic, and demographic features positively influences
recognition accuracy. In total, we have identified 97 overarching acoustic, linguistic and demographic
features.
This document reviews the role of speech in orthognathic surgery. It discusses how malocclusions like Class II and III can cause errors in sounds requiring specific lip and tongue positioning. Orthognathic surgery aims to correct the underlying skeletal deformities and restore normal occlusion, which has the potential to improve speech errors by realigning the lips and teeth. The document summarizes several studies that found speech generally improved or did not change after orthognathic surgery, though a small number of patients saw deterioration. The type and timing of post-surgical speech changes differed depending on the specific jaw surgery and pre-existing malocclusion. Overall, orthognathic surgery can help speech by creating a better oral environment
Research in speech, language, and hearing focuses on understanding normal and impaired human communication as well as developing new assessment and treatment techniques. This research informs clinical practice and aims to improve quality of life for those with communication disorders. Key areas of research include the effects of traumatic brain injury on language, developing reading skills in youth, speech processing in elderly patients, the relationship between language and hearing loss, and treatments for speech-related diseases. Research is conducted in universities, hospitals, and dedicated institutes around the world.
Deaf Speech Assessment Using Digital Processing Techniquessipij
The document analyzes deaf speech to increase speech recognition rates. It discusses analyzing pitch (fundamental frequency) and resonant frequencies (formants) of deaf speech, which exhibit unusual characteristics compared to normal speech. The document presents a pitch detection algorithm using subharmonic-to-harmonic ratio to estimate pitch in deaf speech. Formants are also extracted from deaf speech using linear predictive coding. Results show greater variation in pitch and formants for deaf speakers compared to normal speakers, making these features unsuitable for deaf speech recognition but possible for speaker classification.
This study developed and tested a non-language specific speech test using made-up syllables to evaluate speech in cleft patients from different cultural and language backgrounds. The test was administered to 41 cleft patients and 39 non-cleft individuals from Germany, Iran, and India. Two speech pathologists independently rated audio recordings of the tests and found significant differences in hypernasality, nasal emissions, and consonant errors between cleft patients and non-cleft controls from the same language group. While inter-rater agreement was poor, the test was able to distinguish speech characteristics between cleft and non-cleft individuals across different languages and cultures.
The document discusses factors that affect second language (L2) listening comprehension. It summarizes research showing that individual listener characteristics like working memory capacity and use of metacognitive strategies influence comprehension. Familiarity with the L2, vocabulary size, and background knowledge also impact listening ability. Passage characteristics such as information density, redundancy, syntactic complexity, inclusion of pragmatic constructs, and speaker accent further determine difficulty. The organization of ideas in a passage, including orality and use of discourse markers, additionally affects L2 listening comprehension. However, more research is still needed to fully understand these complex interactions among various influencing factors.
Protocolo de tratamento motor para o desenvolvimento motor da falaPaula Lins
This study examined the effects of a Motor Speech Treatment Protocol (MSTP) on five children ages 3;2 to 3;5 with severe to profound speech sound disorders and motor speech difficulties. The MSTP integrated concepts from PROMPT and DTTC motor speech therapies and principles of motor learning. Children received 45-minute individual therapy sessions twice per week for 10 weeks. Outcome measures included visual and auditory ratings of speech accuracy on probe words, as well as standardized speech intelligibility assessments. Results showed significant improvements in speech accuracy and motor control for all children except one, indicating the MSTP may positively impact speech production for children with developmental motor speech disorders.
LANGUAGE CHARACTERISTICS SUPPORTING EARLY ALZHEIMER'S DIAGNOSIS THROUGH MACHI...hiij
Alzheimer's dementia (AD) is the most common incurable neurodegenerative disease worldwide. Apart from memory loss, AD leads to speech disorders. Timely diagnosis is crucial to halt the progression of the disease. However, current diagnostic procedures are costly, invasive, and distressing. Early-stage AD manifests itself in speech disorders, which implies examining those. Machine Learning (ML) represents a promising instrument in this context.
Nevertheless, no genuine consensus on the language characteristics to be analyzed exists. To counteract this deficit and provide topic-related researchers with a better basis for decision-making, we present, based on a literature review, favourable speech characteristics for the appliance toward AD detection via ML. Research trends to apply spontaneous speech, gained from image descriptions, as analysis basis, and points out that the combined use of acoustic, linguistic, and demographic features positively influences recognition accuracy. In total, we have identified 97 overarching acoustic, linguistic and demographic features.
LANGUAGE CHARACTERISTICS SUPPORTING EARLY ALZHEIMER'S DIAGNOSIS THROUGH MACHI...hiij
Alzheimer's dementia (AD) is the most common incurable neurodegenerative disease worldwide. Apart
from memory loss, AD leads to speech disorders. Timely diagnosis is crucial to halt the progression of the
disease. However, current diagnostic procedures are costly, invasive, and distressing. Early-stage AD
manifests itself in speech disorders, which implies examining those. Machine Learning (ML) represents a
promising instrument in this context.
Nevertheless, no genuine consensus on the language characteristics to be analyzed exists. To counteract
this deficit and provide topic-related researchers with a better basis for decision-making, we present,
based on a literature review, favourable speech characteristics for the appliance toward AD detection via
ML. Research trends to apply spontaneous speech, gained from image descriptions, as analysis basis, and
points out that the combined use of acoustic, linguistic, and demographic features positively influences
recognition accuracy. In total, we have identified 97 overarching acoustic, linguistic and demographic
features.
This document reviews the role of speech in orthognathic surgery. It discusses how malocclusions like Class II and III can cause errors in sounds requiring specific lip and tongue positioning. Orthognathic surgery aims to correct the underlying skeletal deformities and restore normal occlusion, which has the potential to improve speech errors by realigning the lips and teeth. The document summarizes several studies that found speech generally improved or did not change after orthognathic surgery, though a small number of patients saw deterioration. The type and timing of post-surgical speech changes differed depending on the specific jaw surgery and pre-existing malocclusion. Overall, orthognathic surgery can help speech by creating a better oral environment
Research in speech, language, and hearing focuses on understanding normal and impaired human communication as well as developing new assessment and treatment techniques. This research informs clinical practice and aims to improve quality of life for those with communication disorders. Key areas of research include the effects of traumatic brain injury on language, developing reading skills in youth, speech processing in elderly patients, the relationship between language and hearing loss, and treatments for speech-related diseases. Research is conducted in universities, hospitals, and dedicated institutes around the world.
Deaf Speech Assessment Using Digital Processing Techniquessipij
The document analyzes deaf speech to increase speech recognition rates. It discusses analyzing pitch (fundamental frequency) and resonant frequencies (formants) of deaf speech, which exhibit unusual characteristics compared to normal speech. The document presents a pitch detection algorithm using subharmonic-to-harmonic ratio to estimate pitch in deaf speech. Formants are also extracted from deaf speech using linear predictive coding. Results show greater variation in pitch and formants for deaf speakers compared to normal speakers, making these features unsuitable for deaf speech recognition but possible for speaker classification.
This study developed and tested a non-language specific speech test using made-up syllables to evaluate speech in cleft patients from different cultural and language backgrounds. The test was administered to 41 cleft patients and 39 non-cleft individuals from Germany, Iran, and India. Two speech pathologists independently rated audio recordings of the tests and found significant differences in hypernasality, nasal emissions, and consonant errors between cleft patients and non-cleft controls from the same language group. While inter-rater agreement was poor, the test was able to distinguish speech characteristics between cleft and non-cleft individuals across different languages and cultures.
The document discusses factors that affect second language (L2) listening comprehension. It summarizes research showing that individual listener characteristics like working memory capacity and use of metacognitive strategies influence comprehension. Familiarity with the L2, vocabulary size, and background knowledge also impact listening ability. Passage characteristics such as information density, redundancy, syntactic complexity, inclusion of pragmatic constructs, and speaker accent further determine difficulty. The organization of ideas in a passage, including orality and use of discourse markers, additionally affects L2 listening comprehension. However, more research is still needed to fully understand these complex interactions among various influencing factors.
This document discusses the development of a questionnaire to identify common errors made by audiology students during clinical training. The questionnaire covers 8 areas of routine audiology assessments. Student errors will be categorized based on feedback from audiology preceptors. Identifying these common errors will help in developing formative feedback modules for a new high-fidelity simulated learning environment in audiology education. Future work includes validating the questionnaire, identifying the most common errors, and integrating them into the simulated learning environment training.
This systematic review examined the effects of intensity of treatment and constraint-induced language therapy (CILT) for individuals with stroke-induced aphasia. Ten studies met the inclusion criteria of investigating intensity or CILT for measures of language impairment or communication ability. The studies were evaluated for methodological quality and classified by research stage. For chronic aphasia, studies provided modest evidence for more intensive treatment and the positive effects of CILT on language and communication outcomes. One study of high-intensity treatment for acute aphasia also reported positive effects, but no studies examined CILT for acute aphasia. The results were considered preliminary due to the limited evidence. More high-quality research is needed to draw firm conclusions about treatment intensity
Norman paradigm shift—orofacial myofunctional therapy the new comprehensiv...associazione ipertesto
The document proposes a paradigm shift in how speech language pathologists examine the oral motor system. Currently, SLPs conduct examinations that are considered comprehensive but do not fully evaluate risks for obstructed airways and other oral myofunctional disorders. The authors argue for developing a new, more comprehensive examination tool that considers additional structures and functions. This would allow SLPs to more properly diagnose and treat issues impacting speech, swallowing, and beyond. Example areas to examine more extensively include tongue position, frenulums, tonsils, facial profile, and tooth correlations. The goal is for this expanded examination to become the standard practiced and taught in the US.
Accent And Television Journalism Evidence For The Practice Of Speech Languag...Jim Jimenez
This document analyzes listener preferences and attitudes toward regional versus softened accents in Brazilian television journalism. Recordings were made of news presenters reading phrases and a standard text using their regional accent and a softened accent. 105 listeners then listened to word pairs and sentences from the recordings and evaluated whether they perceived a difference between the accents and which accent they preferred. Listeners preferred the softened accent and perceived it more positively. The study provides evidence that listeners in Brazil prefer television journalists to use a softened accent over their regional accent.
Accent And Television Journalism Evidence For The Practice Of Speech Languag...Ashley Hernandez
This document analyzes listener preferences and attitudes toward regional versus softened accents in Brazilian television journalism. Recordings were made of news presenters reading phrases and a standard text using their regional accent and a softened accent. 105 listeners then listened to word pairs and sentences from the recordings and evaluated whether they perceived a difference between the accents and which accent they preferred. Listeners preferred the softened accent for news presenters and viewed it more positively. The study provides evidence that listeners in Brazil prefer news presenters to use a softened accent over their regional accent.
This document contains abstracts from 9 sources related to speech and language development and disorders in children. The abstracts cover topics such as language skills in bilingual children with cleft lip/palate, speech and language delays in children with neurofibromatosis type 1, the impact of child-directed speech, language delays in foster children, screening tools for detecting speech and language delays, outcomes for very preterm infants, early childhood vocabulary development, and issues related to diagnosing language disorders in bilingual children.
This document contains 14 abstracts from research studies and review articles on topics related to speech and language development, delays, and disorders in children. The abstracts cover a range of topics including studies comparing language skills in children with cleft lip/palate to typically developing children; assessing speech and language in children with neurofibromatosis type 1; the impact of child-directed speech; language delays in foster children; screening tools for detecting speech and language delay; and factors influencing language outcomes in preterm infants.
This document discusses voice therapy for the management of benign voice disorders. It summarizes a study of 30 patients who underwent voice therapy with or without surgical procedures for conditions like vocal nodules, polyps, muscle tension dysphonia, sulcus vocalis, and others. Pre-therapy and post-therapy comparisons found improvements in voice quality ratings, patient quality of life measures, and laryngeal images. Voice therapy techniques discussed include vocal hygiene, exercises, massage, and various approaches. The study found voice therapy to be an effective non-surgical treatment for many benign voice disorders and helps prevent recurrence when used with surgery.
Voice Therapy: Management Of Benign Voice DisordersAakanksha Rathor
This document discusses voice therapy for the management of benign voice disorders. It summarizes a study of 30 patients with various benign voice disorders who underwent voice therapy with or without surgery. The patients received voice therapy including vocal hygiene education, behavioral voice therapy exercises, and laryngeal massage. Pre-therapy and post-therapy comparisons found improvements in auditory-perceptual ratings, quality of life measures, and laryngeal images. Voice therapy was found to be an effective non-surgical treatment for many benign voice disorders and helped prevent recurrence when used after surgery. Common voice therapy techniques discussed include resonant voice, chewing exercises, and accent method.
This study analyzed the voice onset time (VOT) of stop consonants in 20 Hindi-speaking children aged 6-8 years, including 10 with cerebral palsy (CP) and 10 typical developing children. VOT measurements were obtained from voice recordings using PRAAT software. Results showed significantly longer VOT durations in CP children compared to controls, indicating delayed voicing onset in CP children. VOT values varied significantly between groups for most stop consonants, suggesting CP affects the timing and coordination of stop production. The findings provide insights into speech difficulties in CP that may help develop more effective speech therapy interventions.
- The document discusses a retrospective study of 27 children referred for suspected sleep-disordered breathing who were found to have non-syndromic short lingual frenulums.
- The children showed anatomical changes associated with enlarged tonsils and abnormal orofacial growth. Treatment including tonsillectomy, frenectomy, and orthodontics improved but did not fully resolve abnormal breathing.
- Short lingual frenulums can impair orofacial development early in life by altering tongue position, leading to increased risk of sleep disordered breathing. Early recognition and treatment of short frenulums may improve normal development.
Value of early intervention for hearing impairment on speech and language aqu...Dr.Ebtessam Nada
The document discusses the critical period for language acquisition in deaf children and the effects of early intervention. It summarizes a study that assessed language and speech outcomes in 58 deaf children who received hearing aids or cochlear implants at different ages. The study found that children who were amplified before 6 months of age achieved significantly higher language scores than those amplified between 6-12 months or 12-24 months. Children who received cochlear implants after 12-24 months showed better outcomes than those receiving hearing aids only, indicating electrical stimulation can still support language acquisition past the critical period. The document concludes early detection before 6 months is best for language outcomes, and cochlear implants may provide benefits even after 24 months.
This document provides a clinical practice guideline for managing otitis media with effusion (OME), which is fluid in the middle ear without signs of acute ear infection. It is an update of a 2004 guideline. Key changes include adding consumer advocates, incorporating new evidence from clinical practice guidelines and studies, emphasizing patient education and shared decision making, and new/expanded recommendations regarding diagnosis, management of chronic/at-risk cases, and assessing outcomes of OME resolution or improved hearing/quality of life. The guideline provides 11 action statements with strong or recommended approaches to diagnosing and managing OME in children ages 2 months to 12 years.
standard
deviation;
CPQ:
Child
Perceptions
Questionnaire;
OHIP:
Oral
Health
Impact
Profile;
NR:
not
reported;
NA:
not
applicable.
Study
Study
design
Sample
size
Age
(years)
Sex
(M/F)
Type of
treatment
OHRQoL
instrument
Time of
assessment
Results
Benson
et al.
(2005)
Cohort
27
11-18
NR
Fixed
appliances
CPQ 11-14
Before and
after
treatment
This study evaluated the effectiveness of pentoxifylline versus placebo in treating oral submucous fibrosis (OSF). 75 patients with OSF were divided into two groups - group A received placebo and group B received 400 mg of pentoxifylline daily for 7 months. Improvement was measured using symptom and sign scores. Group B showed significantly greater improvement in total scores compared to group A, indicating pentoxifylline was more effective at reducing symptoms and improving mouth opening. Pentoxifylline may help OSF by improving microcirculation and reducing inflammation. The study demonstrates pentoxifylline is superior to placebo for OSF treatment.
This document discusses the treatment of anterior open bite malocclusions through either orthodontic treatment alone or combined orthodontic and surgical treatment.
It describes how anterior open bites in children are usually caused by thumb sucking and can be treated by removing the habit and expanding the maxilla with orthodontics. For adolescents and adults, open bites are often due to excessive vertical growth of the maxilla and require either orthodontic treatment alone using vertical mechanics or combined orthodontic and surgical treatment with Le Fort I maxillary osteotomy.
Presurgical orthodontics should align the maxillary teeth but not attempt to close the bite. The goal of surgery is to superiorly reposition the maxilla to an
This document describes a Delphi consensus study conducted to identify criteria for language impairments in children. A panel of 59 experts from various disciplines and countries participated in a two-round online Delphi process. In the first round, the panel rated statements on relevance and validity. Their responses were analyzed and revised statements were sent back for a second round, where consensus of 80% or more was reached for most statements. The resulting consensus criteria and commentary are presented, with the goal of improving identification of children who would benefit from language intervention services. However, some disagreements remained around terminology and conceptualization of language difficulties between professions.
This document summarizes Tim McNamara's presentation on occupation-specific language assessments. It discusses two studies conducted as part of a larger research project on developing language proficiency standards for non-native English speaking health professionals.
The first study identified criteria used by health professionals to evaluate clinical communication skills through analyzing feedback on interactions between trainees and patients. It found that criteria valued by health professionals differ from traditional linguistic criteria assessed in language tests.
The second study investigated applying these newly identified, interaction-focused criteria to the speaking component of the Occupational English Test (OET). It found assessors could reliably apply the new criteria and they capture a different but related dimension of competence compared to existing criteria. Implementation would change pass
Effects of Nonlinear Frequency Compression on Performance of Individuals Who ...Arun Joshi
The study investigated the effects of nonlinear frequency compression (NLFC) amplification on speech recognition and preferences of Mandarin Chinese speakers with hearing loss. Seven participants with mild to severe hearing loss were fit with hearing aids and completed speech recognition tests in quiet and noise in English and Mandarin, as well as tone identification and phoneme perception tests, with NLFC on or off. On average, there were no significant differences in performance between the two amplification schemes. Subjectively, most participants had no preference, but two preferred traditional amplification and one preferred NLFC. The results suggest NLFC does not hinder or benefit Mandarin speakers with hearing loss.
The document discusses the stability of open bite treatment. It finds that:
1) Relatively few scientific studies have evaluated the stability of open bite treatment. The studies that do exist show that 35-60% of non-surgically treated patients experience a relapse of their open bite.
2) Various therapies have been proposed to improve stability, such as crib therapy and myofunctional therapy, but no long-term studies conclusively prove their effectiveness.
3) While early treatment is generally indicated for open bites depending on severity, age, etc., stability remains a clinical problem as about 20-40% of patients, both surgically and non-surgically treated, will experience a relapse.
Anemia is a common condition of cancer patients. This is because cancers cause inflammation that decrease red blood cell production. In addition, many chemotherapies are myelosuppressive, meaning they slow down the production of new blood cells by the bone marrow.
Drug Repurposing: Recent Advancements, Challenges, and Future Therapeutics fo...JohnJulie1
Cancer is a prime public health burden that accounts for approximately 9.9 million deaths worldwide. Despite recent advances in treatment regimen and huge capital investment in the pharmaceutical sector, there has been little success in improving the chances of survival of cancer patients.
More Related Content
Similar to Analyzing Speech Outcomes in Hemiglossectomy Patients Using Telecare Platform
This document discusses the development of a questionnaire to identify common errors made by audiology students during clinical training. The questionnaire covers 8 areas of routine audiology assessments. Student errors will be categorized based on feedback from audiology preceptors. Identifying these common errors will help in developing formative feedback modules for a new high-fidelity simulated learning environment in audiology education. Future work includes validating the questionnaire, identifying the most common errors, and integrating them into the simulated learning environment training.
This systematic review examined the effects of intensity of treatment and constraint-induced language therapy (CILT) for individuals with stroke-induced aphasia. Ten studies met the inclusion criteria of investigating intensity or CILT for measures of language impairment or communication ability. The studies were evaluated for methodological quality and classified by research stage. For chronic aphasia, studies provided modest evidence for more intensive treatment and the positive effects of CILT on language and communication outcomes. One study of high-intensity treatment for acute aphasia also reported positive effects, but no studies examined CILT for acute aphasia. The results were considered preliminary due to the limited evidence. More high-quality research is needed to draw firm conclusions about treatment intensity
Norman paradigm shift—orofacial myofunctional therapy the new comprehensiv...associazione ipertesto
The document proposes a paradigm shift in how speech language pathologists examine the oral motor system. Currently, SLPs conduct examinations that are considered comprehensive but do not fully evaluate risks for obstructed airways and other oral myofunctional disorders. The authors argue for developing a new, more comprehensive examination tool that considers additional structures and functions. This would allow SLPs to more properly diagnose and treat issues impacting speech, swallowing, and beyond. Example areas to examine more extensively include tongue position, frenulums, tonsils, facial profile, and tooth correlations. The goal is for this expanded examination to become the standard practiced and taught in the US.
Accent And Television Journalism Evidence For The Practice Of Speech Languag...Jim Jimenez
This document analyzes listener preferences and attitudes toward regional versus softened accents in Brazilian television journalism. Recordings were made of news presenters reading phrases and a standard text using their regional accent and a softened accent. 105 listeners then listened to word pairs and sentences from the recordings and evaluated whether they perceived a difference between the accents and which accent they preferred. Listeners preferred the softened accent and perceived it more positively. The study provides evidence that listeners in Brazil prefer television journalists to use a softened accent over their regional accent.
Accent And Television Journalism Evidence For The Practice Of Speech Languag...Ashley Hernandez
This document analyzes listener preferences and attitudes toward regional versus softened accents in Brazilian television journalism. Recordings were made of news presenters reading phrases and a standard text using their regional accent and a softened accent. 105 listeners then listened to word pairs and sentences from the recordings and evaluated whether they perceived a difference between the accents and which accent they preferred. Listeners preferred the softened accent for news presenters and viewed it more positively. The study provides evidence that listeners in Brazil prefer news presenters to use a softened accent over their regional accent.
This document contains abstracts from 9 sources related to speech and language development and disorders in children. The abstracts cover topics such as language skills in bilingual children with cleft lip/palate, speech and language delays in children with neurofibromatosis type 1, the impact of child-directed speech, language delays in foster children, screening tools for detecting speech and language delays, outcomes for very preterm infants, early childhood vocabulary development, and issues related to diagnosing language disorders in bilingual children.
This document contains 14 abstracts from research studies and review articles on topics related to speech and language development, delays, and disorders in children. The abstracts cover a range of topics including studies comparing language skills in children with cleft lip/palate to typically developing children; assessing speech and language in children with neurofibromatosis type 1; the impact of child-directed speech; language delays in foster children; screening tools for detecting speech and language delay; and factors influencing language outcomes in preterm infants.
This document discusses voice therapy for the management of benign voice disorders. It summarizes a study of 30 patients who underwent voice therapy with or without surgical procedures for conditions like vocal nodules, polyps, muscle tension dysphonia, sulcus vocalis, and others. Pre-therapy and post-therapy comparisons found improvements in voice quality ratings, patient quality of life measures, and laryngeal images. Voice therapy techniques discussed include vocal hygiene, exercises, massage, and various approaches. The study found voice therapy to be an effective non-surgical treatment for many benign voice disorders and helps prevent recurrence when used with surgery.
Voice Therapy: Management Of Benign Voice DisordersAakanksha Rathor
This document discusses voice therapy for the management of benign voice disorders. It summarizes a study of 30 patients with various benign voice disorders who underwent voice therapy with or without surgery. The patients received voice therapy including vocal hygiene education, behavioral voice therapy exercises, and laryngeal massage. Pre-therapy and post-therapy comparisons found improvements in auditory-perceptual ratings, quality of life measures, and laryngeal images. Voice therapy was found to be an effective non-surgical treatment for many benign voice disorders and helped prevent recurrence when used after surgery. Common voice therapy techniques discussed include resonant voice, chewing exercises, and accent method.
This study analyzed the voice onset time (VOT) of stop consonants in 20 Hindi-speaking children aged 6-8 years, including 10 with cerebral palsy (CP) and 10 typical developing children. VOT measurements were obtained from voice recordings using PRAAT software. Results showed significantly longer VOT durations in CP children compared to controls, indicating delayed voicing onset in CP children. VOT values varied significantly between groups for most stop consonants, suggesting CP affects the timing and coordination of stop production. The findings provide insights into speech difficulties in CP that may help develop more effective speech therapy interventions.
- The document discusses a retrospective study of 27 children referred for suspected sleep-disordered breathing who were found to have non-syndromic short lingual frenulums.
- The children showed anatomical changes associated with enlarged tonsils and abnormal orofacial growth. Treatment including tonsillectomy, frenectomy, and orthodontics improved but did not fully resolve abnormal breathing.
- Short lingual frenulums can impair orofacial development early in life by altering tongue position, leading to increased risk of sleep disordered breathing. Early recognition and treatment of short frenulums may improve normal development.
Value of early intervention for hearing impairment on speech and language aqu...Dr.Ebtessam Nada
The document discusses the critical period for language acquisition in deaf children and the effects of early intervention. It summarizes a study that assessed language and speech outcomes in 58 deaf children who received hearing aids or cochlear implants at different ages. The study found that children who were amplified before 6 months of age achieved significantly higher language scores than those amplified between 6-12 months or 12-24 months. Children who received cochlear implants after 12-24 months showed better outcomes than those receiving hearing aids only, indicating electrical stimulation can still support language acquisition past the critical period. The document concludes early detection before 6 months is best for language outcomes, and cochlear implants may provide benefits even after 24 months.
This document provides a clinical practice guideline for managing otitis media with effusion (OME), which is fluid in the middle ear without signs of acute ear infection. It is an update of a 2004 guideline. Key changes include adding consumer advocates, incorporating new evidence from clinical practice guidelines and studies, emphasizing patient education and shared decision making, and new/expanded recommendations regarding diagnosis, management of chronic/at-risk cases, and assessing outcomes of OME resolution or improved hearing/quality of life. The guideline provides 11 action statements with strong or recommended approaches to diagnosing and managing OME in children ages 2 months to 12 years.
standard
deviation;
CPQ:
Child
Perceptions
Questionnaire;
OHIP:
Oral
Health
Impact
Profile;
NR:
not
reported;
NA:
not
applicable.
Study
Study
design
Sample
size
Age
(years)
Sex
(M/F)
Type of
treatment
OHRQoL
instrument
Time of
assessment
Results
Benson
et al.
(2005)
Cohort
27
11-18
NR
Fixed
appliances
CPQ 11-14
Before and
after
treatment
This study evaluated the effectiveness of pentoxifylline versus placebo in treating oral submucous fibrosis (OSF). 75 patients with OSF were divided into two groups - group A received placebo and group B received 400 mg of pentoxifylline daily for 7 months. Improvement was measured using symptom and sign scores. Group B showed significantly greater improvement in total scores compared to group A, indicating pentoxifylline was more effective at reducing symptoms and improving mouth opening. Pentoxifylline may help OSF by improving microcirculation and reducing inflammation. The study demonstrates pentoxifylline is superior to placebo for OSF treatment.
This document discusses the treatment of anterior open bite malocclusions through either orthodontic treatment alone or combined orthodontic and surgical treatment.
It describes how anterior open bites in children are usually caused by thumb sucking and can be treated by removing the habit and expanding the maxilla with orthodontics. For adolescents and adults, open bites are often due to excessive vertical growth of the maxilla and require either orthodontic treatment alone using vertical mechanics or combined orthodontic and surgical treatment with Le Fort I maxillary osteotomy.
Presurgical orthodontics should align the maxillary teeth but not attempt to close the bite. The goal of surgery is to superiorly reposition the maxilla to an
This document describes a Delphi consensus study conducted to identify criteria for language impairments in children. A panel of 59 experts from various disciplines and countries participated in a two-round online Delphi process. In the first round, the panel rated statements on relevance and validity. Their responses were analyzed and revised statements were sent back for a second round, where consensus of 80% or more was reached for most statements. The resulting consensus criteria and commentary are presented, with the goal of improving identification of children who would benefit from language intervention services. However, some disagreements remained around terminology and conceptualization of language difficulties between professions.
This document summarizes Tim McNamara's presentation on occupation-specific language assessments. It discusses two studies conducted as part of a larger research project on developing language proficiency standards for non-native English speaking health professionals.
The first study identified criteria used by health professionals to evaluate clinical communication skills through analyzing feedback on interactions between trainees and patients. It found that criteria valued by health professionals differ from traditional linguistic criteria assessed in language tests.
The second study investigated applying these newly identified, interaction-focused criteria to the speaking component of the Occupational English Test (OET). It found assessors could reliably apply the new criteria and they capture a different but related dimension of competence compared to existing criteria. Implementation would change pass
Effects of Nonlinear Frequency Compression on Performance of Individuals Who ...Arun Joshi
The study investigated the effects of nonlinear frequency compression (NLFC) amplification on speech recognition and preferences of Mandarin Chinese speakers with hearing loss. Seven participants with mild to severe hearing loss were fit with hearing aids and completed speech recognition tests in quiet and noise in English and Mandarin, as well as tone identification and phoneme perception tests, with NLFC on or off. On average, there were no significant differences in performance between the two amplification schemes. Subjectively, most participants had no preference, but two preferred traditional amplification and one preferred NLFC. The results suggest NLFC does not hinder or benefit Mandarin speakers with hearing loss.
The document discusses the stability of open bite treatment. It finds that:
1) Relatively few scientific studies have evaluated the stability of open bite treatment. The studies that do exist show that 35-60% of non-surgically treated patients experience a relapse of their open bite.
2) Various therapies have been proposed to improve stability, such as crib therapy and myofunctional therapy, but no long-term studies conclusively prove their effectiveness.
3) While early treatment is generally indicated for open bites depending on severity, age, etc., stability remains a clinical problem as about 20-40% of patients, both surgically and non-surgically treated, will experience a relapse.
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2. yngology specifically, certain telehealth assessments have been
shown to allow for quicker examinations without compromising
the communication of crucial information from the patient to the
physician, or vice versa [4]. Otolaryngologists and speech-lan-
guage pathologists have rapidly adopted telemedicine to provide
adequate care to their patients.
Patients with advanced tongue cancer undergo glossectomy with
free flap reconstruction, with or without post-operative radiation
therapy [5-8]. One of the most common postoperative sequelae of
treatment of tongue cancer is dysarthria. Though reduced post-sur-
gical speech intelligibility has long been observed using clinical
assessments relying on impressionistic phonetic transcription and
acoustic measures, no study has systematically identified the ana-
tomical and physiological patterns that underlie the impairment of
lingual function that reduces speech intelligibility due to anatomic
disruption of the tongue [6, 9]. Because such patterns have not
been identified, the anatomical and physiological changes that give
rise to improved speech intelligibility over the course of rehabil-
itation also remain unknown. Speech plays a primary role in dai-
ly communication, and dysarthria greatly impacts Quality of Life
(QOL). Despite the prevalence of dysarthria in this patient popu-
lation, there are limited studies that evaluate their postoperative
speech outcomes using both objective and subjective measures
[10, 11]. Conducting such clinical research is more challenging
during the COVID pandemic due to limited in-person visits. The
goals of the current study are 1) to determine the feasibility of
conducting clinical research using telecare platform; 2) to analyze
speech outcomes in hemiglossectomy patients who underwent Ra-
dial Forearm Free Flap (RFFF) tongue reconstruction.
3. Materials and Methods
This is a prospective cohort study, with a total of 20 patients who
all underwent hemiglossectomy with primary tongue reconstruc-
tion using Radial Forearm Free Flap (RFFF). We implemented
this careful method of patient selection in order to minimize the
variability in speech outcomes that may be introduced with dif-
ferent types of glossectomy and/or flaps. Surgery was the primary
method of treatment for all participants, and each patient received
postoperative Speech-Language Pathologist (SLP) evaluation. All
participants, as well as respective family members (except one),
completed the Speech Handicap Index (SHI). Cohorts were based
on site of tongue resection (oral tongue, base of tongue, overlap-
ping sites), early versus late tumor stage (T1/2 vs T3/4), and pres-
ence of nodal spread (N0 or N+). All participants interacted with
two experienced speech-language pathologists (BV, MO). This
study was approved by the University of Southern California In-
stitutional Review Board.
3.1. Telemedicine SLP Evaluations
All patients received formal Speech-Language Pathologist (SLP)
evaluation through telemedicine appointments via the video-call
application Zoom, because in-person evaluations have been se-
verely limited during the COVID-19 pandemic. These SLP evalu-
ations consisted of objective measures of speech, including tongue
range of motion, speech clarity, and diadochokinetic rate, as de-
tailed below.
3.2. Tongue Range of Motion (ROM) Assessment Scale
Tongue ROM was assessed using the Tongue ROM Severity Rat-
ing Scale by Lazarus et al [12]. There are four sub-categories for
ROM: protrusion, left lateralization, right lateralization, and ele-
vation. The scores for protrusion and lateralization (left and right)
are as follows: 100 - normal, 50 - mild to moderately impaired, 25
- severely impaired, and 0 - totally impaired. The scores for eleva-
tion are: 100 - normal, 50 - moderately impaired, and 0 - severely
impaired. Total tongue ROM score was subsequently obtained by
calculating the mean of the four sub-category scores. Possible total
tongue ROM scores ranged from 0 to 100, with lower scores indi-
cating a greater degree of impairment to tongue range of motion.
3.3. Speech Clarity
Level of speech clarity was evaluated, both during conversation
and reading, based on ASHA National Outcomes Measurement
System (NOMS) guidelines for Spoken Language Expression and
for Reading, respectively [13]. Reading and conversation clarity
were graded from level 1 to 7, with increasing clarity. Please refer
to Supplementary Table S1 for detailed descriptions of each level.
Supplementary Table S1: ASHA National Outcomes Measurement System (NOMS) guidelines for Reading and for Spoken Language Expression
[13].
Level Reading Clarity
1 Attends to printed material, but does not recognize even single letters or common words
2 Reads single letters and common words with consistent maximal cueing
3
Reads single letters and common words, with consistent moderate cueing, and can read some words that are less familiar, longer, and more
complex
4
Reads words and phrases related to routine daily activities, and words that are less familiar, longer, and more complex; requires moderate
cueing to read sentences of approximately 5-7 words
5
Reads sentence-level material containing some complex words; occasionally requires minimal cueing to read more complex sentences and
paragraph-level material; occasionally uses compensatory strategies
6
Successfully able to read most material but some limitations are apparent in vocational, avocational, and social activities; rarely requires
minimal cueing to read complex material; reading is successful, but may take longer to read the material; usually uses compensatory
strategies when encountering difficulty
clinicsofoncology.com 2
Volume 4 Issue 3 -2021 Research Article
3. 7
Successfully and independently participates in vocational, avocational, and social activities and is not limited by reading skills;
independent functioning may occasionally include compensatory strategies
Level Conversation Clarity
1 Attempts to speak, but verbalizations are not meaningful to familiar or unfamiliar communication partners at any time
2
Attempts to speak, although few attempts are accurate or appropriate; partner must assume responsibility for structuring communication
exchange; with consistent and maximal cueing, the individual can only occasionally produce automatic and/or imitative words and phrases
that are rarely meaningful in context
3
Communication partner must assume responsibility for structuring communication exchange; with consistent and moderate cueing,
individual can produce words and phrases that are appropriate and meaningful in context
4
Successfully able to initiate communication using spoken language in simple, structured conversations in routine daily activities with
familiar partners; usually requires moderate cueing, but able to demonstrate simple sentences and rarely uses complex sentences/messages
5
Successfully able to initiate communication using spoken language in structured conversations with both familiar and unfamiliar partners;
occasionally requires minimal cueing to frame more complex sentences; occasionally self-cues when encountering difficulty;
6
Successfully able to communicate in most activities, but some limitations in spoken language are apparent in vocational, avocational, and
social activities; rarely requires minimal cueing to frame complex sentences; usually self-cues when encountering difficulty;
7
Successfully and independently participate in vocational, avocational, and social activities; not limited by spoken language skills;
independent functioning may occasionally include use of self-cueing
3.4. Diadochokinetic Rate
Diadochokinetic (DDK) rate measures the repetition rate of a set
of syllables. In our study, it was calculated by counting the number
of times the participant was able to repeat the syllables “/p/ /t/ /k/”
within a 15 second interval. DDK rate is considered a stable mea-
surement of maximum performance in speech evaluations [14].
3.5. Speech Handicap Index (SHI)
The SHI is a survey specifically designed to analyze speech in pa-
tients with oral or oropharyngeal cancer [15]. It is composed of
thirty questions that address patient speech function and how their
speech is perceived. Each question may be answered as never (0),
almost never (1), sometimes (2), almost always (3), and always
(4). The responses are added for a total score that ranges from 0
to 120. Total scores are categorized as follows: 0-29 excellent, 30-
69 good, 70-99 average, and 100-120 bad [10]. There are also 2
SHI subcategories: speech domain and psychosocial domain [10].
14 statements focused on the patients’ speech itself, and 14 oth-
er statements primarily assessed psychosocial problems related to
speech impairments.
Participants were asked to personally complete the SHI, sent to
them via email. They were also asked to distribute a separate SHI
to a close family member or friend in order to assess how others
perceive the participant’s speech function.
3.6. Statistical Analysis
Data analysis was performed using statistical software R v.3.6.3.
Because the data did not follow a normal distribution, non-para-
metric tests were used to compare patient subgroups as well as
patient and family SHI scores. Patient data on tongue range of
motion and speech clarity were analyzed using the Mann-Whit-
ney U-test (for comparison between two patient subgroups) and
the Kruskall-Wallis test (for comparing three or more subgroups).
In addition, the correlation between patients’ SHI speech domain
and psychosocial domain, and the correlation between patient total
SHI score and family total SHI score were assessed using Spear-
man’s rank correlation coefficient.
4. Results
4.1. Patient Population
There was a total of 20 participants included in this study, with a
mean (SD) age of 60 (+14) years (Table 1). The male to female
ratio was 1.5:1 and a majority was Caucasian (55%). The rest of
the patients were Hispanic (10%), Asian (5%), or Other (30%).
All patients grew up in Southern California and spoke English as
their primary language. Though all patients underwent hemiglos-
sectomy, varying anatomical sites of tongue were resected: 20%
of participants had only their Oral Tongue Cancer (OTC) resected,
30% had their Base of Tongue (BOT) resected, and 50% had Over-
lapping Sites (OLS) resected. More than half (55%) had radiation
therapy in the past and/or as part of their current cancer treatment.
A majority (65%) had T1/T2 disease, and the remainder (35%) had
T3/T4 disease. Most participants (60%) had no nodal spread. All
patients completed their cancer treatment 1-5 years ago.
Table 1: Patient Characteristics
Category No. (%)
Ethnicity
Caucasian 11 (55%)
African-American 0 (0%)
Hispanic/Latino 2 (10%)
Asian 1 (5%)
Other 6 (30%)
Age
Mean (SD) 60 (14) years
T stage
T1 8 (40%)
T2 5 (25%)
T3 6 (30%)
T4 1 (5%)
N stage
N0 12 (60%)
N1 3 (15%)
N2 4 (20%)
N3 1 (5%)
Site of Tongue Resection
Oral tongue 4 (20%)
Base of tongue 6 (30%)
Overlapping sites 10 (50%)
Radiation therapy (XRT)
Yes 11 (55%)
No 9 (45%)
clinicsofoncology.com 3
Volume 4 Issue 3 -2021 Research Article
4. 4.2. Participation in Telecare Platform
All patients used the Zoom platform to communicate and be eval-
uated by SLPs.
4.3. Range of Motion
All 20 patients scored between 25 and 100 for each subcategory of
tongue range of motion (Table 2). Each subcategory had a varied
distribution of scores, except for tongue elevation, for which all 20
patients were able to elevate their tongue tip but without contact
with the upper alveolar ridge.
When analyzing ROM based on site of resection, OTC patients
experienced the most difficulty. When protruding the tongue, a
higher percentage of OTC patients (25%) could not reach past the
upper lip margin, compared to BOT (15%) and OLS (20%) pa-
tients. When lateralizing the tongue, half of the OTC and BOT
participants had >50% reduction; but there was one BOT patent
who was able to reach the corner of the mouth, a task that none of
the OTC participants were able to achieve.
Table 2: Results of Objective and Subjective Speech Outcome Measures
*statistically significant relationship
Speech Measure Patient Characteristic
Oral Tongue Base of Tongue Overlapping Sites of Tongue
Range of Motion
Protrusion 43.8 (12.5) 45.8 (10.2) 45.0 (10.5)
Lateralization 37.5 (14.4) 45.8 (29.2) 42.5 (12.1)
Elevation 50.0 (0.0) 50.0 (0.0) 50 (0.0)
Total 42.2 (9.4) 46.9 (15.7) 45.0 (8.2)
Clarity
Reading 6.5 (0.6) 6.2 (0.8) 5.9 (1.1)
Conversation 6.5 (0.6) 5.8 (1.0) 6.0 (1.1)
Diadochokinetic
Rate 26.8 (8.5) 24.2 (5.5) 22.9 (6.4)
Speech Handicap Index
Total 20.0 (8.04) 24.8 (20.9) 28.5 (19.7)
Speech Domain 11.8 (17.0) 13.0 (10.1) 15.3 (8.8)
Psychosocial Domain 7.0 (6.1) 9.1 (9.2) 11.2 (9.8)
T1/T2 T3/T4
Range of Motion
Protrusion 46.2 (9.4) 42.9 (12.2)
Lateralization* 48.1 (19.0) 32.1 (12.2)
Elevation 50.0 (0.0) 50.0 (0.0)
Total 48.1 (10.9) 39.3 (7.8)
Clarity
Reading 6.2 (1.0) 6.0 (0.8)
Conversation 6.2 (0.9) 5.9 (1.1)
Diadochokinetic
Rate 24.8 (6.4) 22.7 (6.7)
Speech Handicap Index
Total* 20.9 (18.1) 34.5 (14.7)
Speech Domain 11.7 (8.3) 18.0 (6.5)
Psychosocial Domain 7.8 (8.9) 13.2 (8.0)
N0 N-positive
Range of Motion
Protrusion 43.8 (11.3) 46.9 (8.8)
Lateralization 45.8 (20.9) 37.5 (13.4)
Elevation 50.0 (0.0) 50.0 (0.0)
Total 46.4 (12.3) 43.0 (7.8)
Clarity
Reading 5.9 (1.0) 6.4 (0.7)
Conversation 5.9 (0.9) 6.3 (1.0)
Diadochokinetic
Rate 24.4 (6.2) 23.5 (7.0)
Speech Handicap Index
Total 25.2 (20.4) 26.4 (14.6)
Speech Domain 13.6 (9.5) 14.3 (6.2)
Psychosocial Domain 7.8 (8.9) 13.2 (8.0)
clinicsofoncology.com 4
Volume 4 Issue 3 -2021 Research Article
5. No XRT XRT
Range of Motion
Protrusion 44.4 (11.0) 45.5 (10.1)
Lateralization 50.0 (21.7) 36.4 (13.1)
Elevation 50.0 (0.0) 50.0 (0.0)
Total 48.6 (12.8) 42.0 (8.0)
Clarity
Reading 6.3 (0.9) 5.9 (0.9)
Conversation 6.4 (0.7) 5.7 (1.0)
Diadochokinetic
Rate* 26.9 (5.9) 21.7 (6.0)
Speech Handicap Index
Total 23.2 (20.5) 27.7 (16.3)
Speech Domain 12.8 (9.3) 14.7 (7.4)
Psychosocial Domain 8.4 (9.7) 10.8 (8.2)
Patients with early T stage performed better than those with late T
stage across all range of motion subcategories, particularly during
tongue lateralization. Most (77%) early T stage participants were
able to lateralize their tongue to the corner of their mouths or had
<50% reduction in movement, whereas most (71%) late T stage
participants had >50% reduction in movement (p=0.03). Further-
more, those with no nodal spread performed better than those with
nodal spread during lateralization, though the association was not
as strong.
Patients who did not undergo XRT generally performed better than
those who received XRT. A larger percentage (55%) of patients
who received XRT had >50% reduction in lateralization, com-
pared to those who did not undergo XRT (22%).
4.4. Total ROM
OTC patients had the lowest mean total ROM score (42.2) com-
pared to BOT (46.9) and OLS patients (45.0) (p=0.87). Early T
stage and lack of nodal spread had a higher mean total ROM score
than those with late T stage (p=0.06) and nodal spread (p=0.6),
respectively. Additionally, participants who underwent XRT had a
lower mean total tongue ROM score (42.0) than those who did not
receive XRT (48.6) (p=0.22).
4.5. Diadochokinetic (DDK) Rate
OTC patients had slightly higher mean DDK rates (26.8) than
BOT (24.2) and OLS (22.9) patients (p=0.7). Those with early T
stage and no nodal invasion had higher DDK rates than those with
late T stage (p=0.5) and nodal invasion (p=0.6), respectively. XRT
had a significantly negative relationship with DDK rate, with XRT
patients having a mean rate of 21.7 and non-XRT patients a mean
rate of 26.9 (p=0.04).
4.6. Speech Clarity
All 20 patients scored between 4 and 7 in reading clarity, meaning
they were able to read without consistent cueing. They also scored
between 4 and 7 in conversation clarity, with all patients being able
to at least successfully initiate communication (Figure 1 and 2).
OTC patients performed best and were able to read and converse
at the highest level (7), when compared to BOT and OLS patients,
though the differences in mean levels were minimal. Similarly, a
higher percentage of participants with early T stage and no nod-
al spread were able to achieve the level 7 clarity during reading
and conversation, compared to those with late T stage and nodal
spread, respectively. Additionally, more XRT patients had lower
clarity levels than patients who did not receive XRT.
4.7. Speech Handicap Index (SHI)
4.7.1. Patient SHI: Those with early T stage had a mean (SD) total
SHI score of 20.9 (18.12) whereas late T stage patients had a mean
score of 34.5 (14.7), indicating better subjective outcomes for the
former. Even when speech (p=0.05) and psychosocial (p=0.06)
SHI domains were evaluated separately, the early T stage cohort
had better scores than the late T stage cohort. Site of resection,
nodal stage, and exposure to radiation did not show similar as-
sociations with total, speech, or psychosocial SHI scores [Table
2]. Overall, patients’ respective speech domain and psychosocial
domain scores were highly correlated with each other (p<0.001)
(Figure 3).
4.7.2. Patient vs Family SHI: All 20 patients submitted a com-
plete SHI, but one patient was unable to have a family member
or close friend complete an SHI. On average, patients gave them-
selves higher SHI scores (25.7) than their family counterparts (21),
with higher scores indicating greater impairment (p=0.39). There
is a similar trend when analyzing the speech domain (p=0.53) and
psychosocial domain (p=0.64) SHI scores separately. There ap-
pears to be greater agreement between patient and family when
patient SHI scores are low, with larger discrepancies between the
two respective parties as patient SHI scores increase (Figure 4).
5. Discussion
5.1. Anatomic Site of Tongue Resection
Our results showed identifiable patterns in postoperative tongue
range of motion based on site of tongue resection. Oral tongue
participants had larger impairments in each tongue ROM sub-cat-
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Volume 4 Issue 3 -2021 Research Article
6. egory (except elevation) (Table 2). These trends are in line with
other findings in existing literature. Studies have shown that those
with oral cavity tumors have worse speech intelligibility than
those with oropharyngeal tumors [11, 16]. The greater severity
of dysarthria in oral glossectomy patients is likely due to the al-
teration of oral cavity articulators that work to produce intelligible
speech, including the anterior tongue and its direct role in conso-
nant articulation (i.e. plosives, fricatives) [10, 17]. The pliability
and complex mobility of the anterior tongue are difficult to restore,
even with flap reconstruction, so oral tongue resection often leads
to greater speech impairment [17]. Resection of base of tongue
(oropharyngeal) can lead to altered resonance, but reconstruction
can restore adequate function [17].
5.2. Tumor Stage
In our study, late T stage was significantly correlated with de-
creased tongue lateralization (Table 2). This is likely explained
by the fact that treatment of advanced disease requires larger area
of resection and reconstruction, though the heavier tumor burden
may be affecting adjacent sites and not primarily the tongue [18].
The resulting decrease in range of motion may lead to greater dif-
ficulty producing intelligible speech. Additionally, the discrepancy
in tongue range of motion may have been more prominent during
lateralization, due to the multidimensional (anterior and lateral)
movements required to successfully lateralize the tongue. Partic-
ipants with advanced T stage did not have notably lower speech
clarity ratings during SLP evaluation, but their significantly worse
SHI scores suggest dysarthria that is severe enough to be detected
in their daily lives. Our findings align with previous studies that
have also emphasized the relationship between tumor stage and
speech outcomes [10, 11, 16, 18].
Figure 1: The distribution of reading clarity levels based on site of tongue resection (top left), tumor stage (top right), nodal stage (bottom left), and
radiation therapy (bottom right).
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7. Figure 2: The distribution of conversation clarity levels based on site of tongue resection (top left), tumor stage (top right), nodal stage (bottom left),
and radiation therapy (bottom right)
Figure 3: Comparison between patient speech and psychosocial domain
scores from the Speech Handicap Index (SHI) Figure 4: Comparisons between respective patient and family scores for
speech domain (left) and psychosocial domain (right) scores from the
Speech Handicap Index (SHI)
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8. 5.3. Radiation Therapy
Our results show that DDK rate is significantly lower for those
who underwent radiation therapy, though tongue range of motion
and clarity levels are not significantly related (Table 2). These
results suggest that XRT has a greater impact on tongue control
and coordination than on tongue ROM. This would lead to greater
speech impairments during rapid and repetitive tasks that require
high levels of tongue coordination (i.e. DDK), more so than during
slower tasks such as regular reading and conversation. Shin et al
also suggested a similar theory when they found that radiotherapy
patients had significantly higher DDK rates than those who only
underwent surgery, with no large differences in tongue mobility
[19]. The significantly diminished functional outcomes in XRT
therapy patients are likely due to greater tissue fibrosis induced by
radiation exposure [9, 19]. Thus, it is imperative to consider which
treatment modalities a patient will undergo when managing expec-
tations and planning for functional rehabilitation.
5.4. Speech vs Psychosocial SHI Domains
Our results show that there is a strong correlation between the
speech and psychosocial domains of SHI (p<0.001). Though it is
difficult to determine the direction of this relationship, it is appar-
ent that the two are closely intertwined. Patients who self-perceive
more dysarthria may feel a greater psychosocial burden as a result
of their impairments. Conversely, patients with less psychosocial
support may achieve lower levels of functional rehabilitation. Our
results are in line with other studies that have also emphasized
the importance of a biopsychosocial approach to rehabilitation of
patients with dysarthria and other speech impairments [20, 21].
Further research is required in order to better understand the rela-
tionship between speech and psychosocial outcomes, in order to
better guide the functional rehabilitation process of post-glossec-
tomy patients.
5.5. Patient Versus Family SHI
To our knowledge, this is the first study to compare patient and
family SHI scores in glossectomy patients. Overall, patient and
family scores are similar, but patients with greater impairments
(higher SHI) appear to have larger discrepancies between their
own scores and their families’ scores. Further research is required
in order to ascertain the reasons for this trend. It is important to
consider both the patient and family’s understanding of the pa-
tient’s dysarthria during speech rehabilitation, since family mem-
bers are often the primary communication partners and support
network [22]. Previous studies on rehabilitation of aphasia patients
have shown that SLPs are in favor of family involvement, and re-
sults support some degree of family participation [22, 23].
Future direction of telemedicine for speech therapy research
With the onset of the pandemic, the use of telemedicine in clini-
cal research has become a highly relevant topic. More specifically,
one of the concerns that have arisen is the practicality of conduct-
ing speech and swallow evaluations through telemedicine. There
are limited studies on the role of telemedicine in research, but our
study is the first to analyze the feasibility of conducting clinical re-
search entirely through video speech evaluation [24, 25]. It is also
the first to use telemedicine to analyze speech outcomes in hemi-
glossectomy patients who have undergone RFFF tongue recon-
struction. Our project design and results suggest that telemedicine
platforms can be used effectively for SLP evaluations and prospec-
tive studies. The authors who collected data stated that all twenty
patients were assessed to the same caliber as they would have been
through an in-person evaluation. Additionally, all our participants
endorsed feeling well-supported throughout the duration of these
evaluations. During a pandemic, when in-person assessments have
been severely limited, it is important to consider the future direc-
tions of clinical research via telecare platforms. There will likely
continue to be increased involvement of telemedicine in future
clinical and research settings.
5.6. Limitations
One of the limitations of our study was our small sample size. This
was largely due to the fact that we are conducting research during
a pandemic, and patients are less inclined to enroll in research
studies, whether or not they are performed through a virtual medi-
um. Additionally, it is possible that participants’ responses to the
Speech Handicap Index were influenced by the pandemic. COVID
precautions have led to fewer social interactions for many, so this
may have affected both the participant and family’s perceptions of
patient speech.
6. Conclusion
Dysarthria is a common sequela of glossectomy that can have
large impacts on patients’daily functioning and quality of life. Our
data has shown that the degree of speech impairment, as measured
by both objective and subjective speech measures, can be affected
by a variety of factors, particularly tumor stage and inclusion of
radiation therapy. Speech function is also closely correlated with
psychosocial factors, underlining the importance of a more biopsy-
chosocial approach to rehabilitation. Future projects with larger
sample sizes are required in order to further analyze the factors
that influence dysarthria in glossectomy patients, a population that
is frequently afflicted by speech dysfunction. Furthermore, our
study highlights the fact that telecare is an effective platform to
conduct such clinical research.
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