Methodology for Speech Assessment in the Scandcleft Project—An International Randomized Clinical Trial on Palatal Surgery: Experiences from a Pilot Study

Abstract

Objective:

To present the methodology for speech assessment in the Scandcleft project and discuss issues from a pilot study.

Design:

Description of methodology and blinded test for speech assessment. Speech samples and instructions for data collection and analysis for comparisons of speech outcomes across five included languages were developed and tested.

Participants and Materials:

Randomly selected video recordings of 10 5-year-old children from each language (n = 50) were included in the project. Speech material consisted of test consonants in single words, connected speech, and syllable chains with nasal consonants. Five experienced speech and language pathologists participated as observers.

Main Outcome Measures:

Narrow phonetic transcription of test consonants translated into cleft speech characteristics, ordinal scale rating of resonance, and perceived velopharyngeal closure (VPC). A velopharyngeal composite score (VPC-sum) was extrapolated from raw data. Intra-agreement comparisons were performed.

Results:

Range for intra-agreement for consonant analysis was 53% to 89%, for hypernasality on high vowels in single words the range was 20% to 80%, and the agreement between the VPC-sum and the overall rating of VPC was 78%.

Conclusions:

Pooling data of speakers of different languages in the same trial and comparing speech outcome across trials seems possible if the assessment of speech concerns consonants and is confined to speech units that are phonetically similar across languages. Agreed conventions and rules are important. A composite variable for perceptual assessment of velopharyngeal function during speech seems usable; whereas, the method for hypernasality evaluation requires further testing.

Keywords

cleft palate composite score cross-linguistic multicenter comparison speech assessment speech outcome measures

References

ÜberBrøndsted

, Grunwell

, Henningsson

, Jansonius

, Karling

, Meijer

, Ording

, Sell

, Vermeij-Zieverink

, Wyatt

. A phonetic framework for the cross-linguistic analysis of cleft palate speech. Clin Linguist Phon. 1994; 8: 109–125.

Coussé

, Gillis

, Kloots

, Swerts

. The influence of the labeller's regional background on phonetic transcriptions: implications for the evaluation of spoken language resources. In: Proceedings of the International Conference on Language Resources and Evaluation. Lisbon, Portugal, 2004: 1447–1450.

Dalston

R.M.

, Marsh

J.L.

, Vig

K.W.

, Witzel

M.A.

, Bumsted

R.M.

. Minimal standards for reporting the results of surgery on patients with cleft lip, cleft palate, or both: a proposal. Cleft Palate J. 1988; 25: 3–7.

Dotevall

, Lohmander

, Ejnell

, Bake

. Perceptual evaluation of speech and velopharyngeal function in children with and without cleft palate and the relationship to nasal airflow patterns. Cleft Palate Craniofac J. 2002; 39: 409–424.

EUROCRAN Speech Project. Available at: http://www.eurocran.org. Accessed February 11, 2008.

Fletcher

S.G.

, Bishop

M.E.

. Measurement of nasality with TONAR. Cleft Palate J. 1970; 7: 610–621.

Fujiwara

, Henningsson

, Ainoda

. A review of Japanese articles on perceptual assessment of speech sounds in individuals with cleft palate. Jpn J Logoped Phoniatr. 2006; 47: 252–257.

Gooch

J.L.

, Hardin-Jones

, Chapman

K.L.

, Trost-Cardamone

J.E.

, Sussman

. Reliability of listener transcriptions of compensatory articulations. Cleft Palate Craniofac J. 2001; 38: 59–67.

Grunwell

, Sell

, Harding

. Describing cleft palate speech. In: Grunwell

, ed. Analysing Cleft Palate Speech. London: Whurr; 1993.

10.

Harding

, Grunwell

. Active versus passive cleft-type characteristics: implications for surgery and therapy. Int J Lang Commun Disord. 1998; 33: 329–352.

11.

Harding

, Harland

, Razzell

. Cleft Audit Protocol for Speech (CAPS). Broomfield, Chelmsford, Essex: St. Andrew's Plastic Surgery Centre; 1997.

12.

Havstam

, Lohmander

, Dahlgren Sandberg

, Elander

. Speech and satisfaction with treatment outcome in young adults with unilateral or bilateral complete clefts: answers to a patient questionnaire compared to speech assessments. Scand J Plast Reconstr Surg Hand Surg. 2008; 42: 182–189.

13.

Henningsson

, Hutters

. Perceptual speech assessment of cleft palate speech—with special reference to minimum standards for inter-centre comparisons of speech outcome. In: Transactions of the 8th International Congress on Cleft Palate and Related Craniofacial Anomalies. Singapore; 1997: xxxiii–xxxvii.

14.

Henningsson

, Isberg

. Oronasal fistulas and speech production. In: Bardach

, Morris

, eds. Multidisciplinary Management of Cleft Lip and Palate. Philadelphia: WB Saunders; 1990: 787–792.

15.

Henningsson

, Kuehn

D.P.

, Sell

, Sweeney

, Trost-Cardamone

, Whitehill

. (Speech Parameters Group). Universal parameters for reporting speech outcomes in individuals with cleft palate. Cleft Palate Craniofac J. 2008; 45: 1–17.

16.

Howard

S.J.

, Heselwood

B.C.

. Learning and teaching phonetic transcription for clinical purposes. Clin Linguist Phon. 2002; 16: 371–401.

17.

Hutters

, BrRoSndsted

. Strategies in cleft palate speech—with special reference to Danish. Cleft Palate J. 1987; 24: 126–136.

18.

Hutters

, Henningsson

. Speech outcome following treatment in cross-linguistic cleft palate studies: methodological implications. Cleft Palate Craniofac J. 2004; 41: 544–549.

19.

International Phonetic Association. Handbook of IPA. Cambridge, U.K.: Cambridge University Press; 1999.

20.

John

, Sell

, Sweeney

, Haring-Bell

, Williams

. The cleft audit protocol for speech – augmented: a validated and reliable measure for auditing cleft speech. Cleft Palate Craniofac J. 2006; 43: 272–288.

21.

Kent

R.D.

. Hearing and believing: some limits to the auditory-perceptual assessment of speech and voice disorders. Am J Speech Lang Pathol. 1996; 5: 7–23.

22.

Keuning

K.H.D.

, Wieneke

G.H.

, Dejonckere

P.H.

. The intrajudge reliability of the perceptual rating of cleft palate speech before and after pharyngeal flap surgery: the effect of judges and speech samples. Cleft Palate Craniofac J. 1999; 36: 328–333.

23.

Kreiman

, Gerratt

B.R.

, Kempster

G.B.

, Erman

, Berke

G.S.

. Perceptual evaluation of voice quality: review, tutorial, and a framework for future research. J Speech Hear Res. 1993; 36: 21–40.

24.

Kuehn

, Moller

. Speech and language issues in the cleft palate population: the state of the art. Cleft Palate Craniofac J. 2000; 37: 1–35.

25.

Kuehn

D.P.

, Moon

J.B.

. Velopharyngeal closure force and levator veli activation levels in varying phonetic contexts. J Speech Lang Hear Res. 1998; 41: 51–62.

26.

Lewis

K.E.

, Watterson

T.L.

, Houghton

S.M.

. The influence of observer experience and academic training on ratings of nasality. J Commun Disord. 2003; 36: 49–58.

27.

Lintz

L.B.

, Sherman

. Phonetic elements and perception of nasality. J Speech Hear Res. 1961; 4: 381–396.

28.

Lohmander

, Borell

, Henningsson

, Havstam

, Lundeborg

, Persson

. SVANTE - Svenskt Artikulations- och Nasalitets Test (Swedish Articulation and Nasality Test) [in Swedish]. Skivarp, Sweden: Pedagogisk Design; 2005.

29.

Lohmander

, Friede

, Elander

, Persson

, Lilja

. Speech development in patients with unilateral cleft lip and palate treated with different delays of hard palate closure after early velar repair: a longitudinal perspective. Scand J Plast Reconstr Surg Hand Surg. 2006; 46: 267–274.

30.

Lohmander

, Olsson

. Perceptual assessment of speech in patients with cleft palate: a critical review. Cleft Palate Craniofac J. 2004; 41: 64–70.

31.

McWilliams

B.J.

, Morris

L.M.

, Shelton

R.L.

. Cleft Palate Speech. Philadelphia: BC Decker; 1990.

32.

Renfrew

. The Renfrew Language Scales: Bus Story Test—A Test of Narrative Speech. Bicester, Oxon: Winslow Press Limited; 1997.

33.

Scandcleft Trials Operational Manual. University of Manchester; 1997.

34.

Sell

. Issues in perceptual speech analysis in cleft palate and related disorders: a review. Int J Lang Commun Disord. 2005; 40: 103–121.

35.

Sell

, Harding

, Grunwell

P.A.

. GOS.SP.ASS'98: an assessment for speech disorders associated with cleft palate and/or velopharyngeal dysfunction (revised). Int J Lang Commun Disord. 1999; 34: 17–33.

36.

Shaw

W.C.

, Semb

, Nelson

, Brattström

, Mølsted

, Prahl-Andersen

. The Eurocleft Project 1996–2000. Standards of Care for Cleft Lip and Palate in Europe. European Commission Biochemical and Health Research. Amsterdam: IOS Press; 2000.

37.

Shriberg

L.D.

, Lof

G.L.

. Reliability studies in broad and narrow phonetic transcription. Clin Linguist Phon. 1991; 1: 171–189.

38.

Sommerlad

B.C.

, Mehendale

F.V.

, Birch

M.J.

, Sell

D.A.

, Hattee

, Harland

. Palate repair revisited. Cleft Palate Craniofac J. 2002; 39: 295–307.

39.

Spriestersbach

D.C.

, Powers

G.R.

. Nasality in isolated vowels and connected speech of children with cleft palate. J Speech Hear Res. 1959; 2: 40–45.

40.

Trost

J.E.

. Articulatory additions to the classical description of the speech of persons with cleft palate. Cleft Palate J. 1981; 18: 193–203.

41.

Williams

W.N.

, Seagle

M.B.

, Nackashi

A.J.

, Marks

, Boggs

S.R.

, Kemker

, Wharton

, Bzoch

K.R.

, Dixon-Wood

, Pegoraro-Krook

M.I.

. A methodology report of a randomized prospective clinical trial to assess velopharyngeal function for speech following palatal surgery. Control Clin Trials. 1998; 19: 297–312.

42.

World Health Organization. International Classification of Function, Disability and Health. Geneva: WHO; 2001.