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Background: Treatment for oral or oropharyngeal squamous cell carcinoma (O&OSCC) often leads to problems with speech articulation. Articulatory-kinematic data may be especially informative in designing new therapeutic approaches for individuals treated for these tumours., Aims: To provide a systematic review of the literature assessing the articulatory-kinematic consequences of oral and oropharyngeal cancer treatment., Methods & Procedures: Five databases (PubMed, Embase, Scopus, Web of Science and PsycInfo) were used to identify studies that used kinematic methods to characterize the speech of individuals treated for O&OSCC. Risk of bias was assessed using the critical appraisal checklist from the Joanna Briggs Institute. Data were synthesized using the Synthesis Without Meta-Analysis guidelines., Outcomes & Results: In total, 29 studies with a total of 197 individuals treated for O&OSCC were included. In most studies the risk of bias was moderate to high and certainty of evidence was very low to low. Results showed both global changes (i.e., reduced movement and increased asymmetry of the tongue) as well as more local changes (i.e., reduced palatal contact and more centralized productions of consonants) following treatment for O&OSCC. Generally, reported changes were related to tumour size and location. Smaller tumours resulted in better or more typical articulatory-kinematic speech outcomes. Articulatory movements were most reduced in the affected region of the tongue as compared with neighbouring parts. Study findings were limited to small sample sizes with generally minimal descriptions of patient characteristics. No study assessed the influence of primary radiation treatment or adjuvant radiation therapy on kinematic speech outcomes., Conclusions & Implications: Based on the literature to date, surgical treatment for O&OSCC seems to reduce articulatory-kinematics of speech, and post-treatment outcomes may be partially explained by tumour size and location. The absence of studies assessing the effect of primary or adjuvant radiation therapy on articulatory-kinematics limits our knowledge of how these interventions influence post-treatment kinematic speech outcomes. Future studies should provide detailed patient descriptions and develop standardized speech assessment tools in order to further our knowledge regarding articulatory-kinematic speech changes following treatment, and to move towards the development of active rehabilitation strategies for those with O&OSCC., What This Paper Adds: What is already known on this subject Treatment for O&OSCC can result in problems with speech articulation. Speech outcomes for O&OSCC are highly variable. What this paper adds to the existing knowledge We systematically reviewed and synthesized the literature on articulatory-kinematic changes following O&OSCC treatment and identified 29 related studies. Treatment for O&OSCC resulted in global (i.e., more asymmetrical or reduced movement patterns) and local (i.e., reduced palatal contact) articulatory-kinematic changes. In general, smaller tumours resulted in better or more typical articulatory-kinematic speech outcomes as compared with larger tumours. Articulatory movements were most reduced in the affected region of the tongue as compared with neighbouring parts. What are the potential or actual clinical implications of this work? Understanding articulatory-kinematic impacts of surgical intervention for O&OSCC can guide (the development of) tailored speech rehabilitation., (© 2024 The Author(s). International Journal of Language & Communication Disorders published by John Wiley & Sons Ltd on behalf of Royal College of Speech and Language Therapists.)

Apraxia of speech is a motor disorder characterized by the impaired ability to coordinate the sequential articulatory movements necessary to produce speech. The critical cortical area(s) involved in speech apraxia remain controversial because many of the previously reported cases had additional aphasic impairments, preventing localization of the specific cortical circuit necessary for the somatomotor execution of speech. Four patients with "pure speech apraxia" (i.e., who had no aphasic and orofacial motor impairments) are reported here. The critical lesion in all four patients involved, in the left hemisphere, the precentral gyrus of the insula (gyrus brevis III) and, to a lesser extent, the nearby areas with which it is strongly connected: the adjacent subcentral opercular cortex (part of secondary somatosensory cortex) and the most inferior part of the central sulcus where the orofacial musculature is represented. There was no damage to rostrally adjacent Broca's area in the inferior frontal gyrus. The present study demonstrates the critical circuit for the coordination of complex articulatory movements prior to and during the execution of the motor speech plans. Importantly, this specific cortical circuit is different from those that relate to the cognitive aspects of language production (e.g., Broca's area on the inferior frontal gyrus)., (© The Author(s) 2021. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background/aims: Percent consonant correct (PCC) was originally described by Shriberg and Kwiatkowski [J Speech Hear Disord. 1982 Aug;47(3):256-70] as a severity metric for phonological speech disorders, and has been adapted and used in many studies on speech sound disorders. It is well-recognized that cleft speech is complex, consisting of several interacting parameters assessed simultaneously, with error sounds not in the listener's own language. In speech outcome studies, narrow phonetic transcription and the reporting of intra- and inter-rater reliability are acknowledged as the gold standard. However, cleft speech brings special challenges to this task, as complex speech disorders are known to be associated with low transcriber agreement. Recent studies informed the decision to use PCC as the primary outcome measure in a cleft speech intervention study, given its common usage and familiarity. The aim was to specifically evaluate the intra- and inter-rater reliability of PCC in an intervention study, in contrast to other types of speech outcome studies., Methods: Two trained and experienced listeners analyzed 119 recordings, randomly selected from five data points before, during, and following intervention. The PCC score was separately calculated for words and sentences/phrases., Results: Using intraclass correlations (ICCs), Phase 1 results showed poor reliability for targets elicited for words (ICC = 0.07) and sentences/phrases (ICC = 0.42). Differences in classification of errors as glottal stops and consonant deletion accounted for this. Following further training, a second reliability study was undertaken showing improvement in the number of targets elicited in words (ICC = 0.85) and sentences/phrases (ICC = 0.94). There was very good inter-rater reliability for the PCC score on the word dataset (ICC = 0.9) and the sentence dataset (ICC = 0.88). Very good intra-rater reliability (ICC = 1.0) was found for the PCC score in both words and sentences/phrases for each listener. One listener consistently gave higher modified PCC scores., Conclusions: In cleft speech intervention studies, reliability of the number of targets elicited should be reported. Listeners need to distinguish between glottal articulation and consonant deletion, in order that the PCC score is meaningful. Attention should be paid to where listeners are reliable, but their pattern of scores consistently differs but in a consistent way. More research is needed on measuring the resolution of articulation difficulties in cleft intervention studies., (© 2019 S. Karger AG, Basel.)

Background: Across the world, research has shown that intervention for children with phonological impairment can be both effective and efficient. However, it has also raised concerns about the translation of this evidence to practice, highlighting questions around clinician knowledge and the understanding of approaches, and the intensity of intervention provided within real-life clinical contexts., Aims: To investigate the clinical management of phonological impairment by speech and language therapists (SLTs) in the United Kingdom (UK)., Methods & Procedures: An anonymous, UK-wide, online survey was developed using Qualtrics. The target audience were UK-based SLTs who worked with children with phonological impairment. The following topics were explored: (1) SLTs' understanding of intervention approaches; (2) SLTs' use of intervention approaches to treat phonological impairment; and (3) SLTs' provision of intervention intensity for children with phonological impairment., Outcomes & Results: A total of 166 responses were analyzed. To remediate phonological impairment, SLTs most commonly used speech discrimination (79.5%), conventional minimal pairs (77.3%), phonological awareness therapy (75.6%) and traditional articulation therapy (48.4%). Participants least frequently used the complexity approaches targeting the empty set (82.9%) and two- to three-element clusters (75%) as well as the cycles approach (75.6%). Results also showed that some SLTs were uncertain of what the empty set and two- to three-element clusters approaches entailed. In terms of intervention intensity, participants predominantly provided intervention once per week (69%) for a total of 9-12 sessions (ranging from five to 30 sessions, 71.5%) and elicited targets 10-30 times in single words per session (59.4%) in sessions lasting 21-30 min (41.4%)., Conclusions & Implications: The most commonly used intervention approaches identified in the current survey (i.e., speech discrimination, conventional minimal pairs and phonological awareness therapy) may be used eclectically by SLTs, which could impact upon the effectiveness and efficiency of treatment for phonological impairment. The current study also highlighted that almost half the participants always/often used traditional articulation therapy to remediate phonological impairment, even though this approach has been found to be less effective for this difficulty. Additionally, it appears that the currently provided intervention intensity for phonological impairment in the UK is significantly lower than what is indicated in the literature. Therefore, a research-practice gap exists for SLTs in the UK working with children with phonological impairment., (© 2018 Royal College of Speech and Language Therapists.)

The aim of this study was to develop and content validate specific speech and language intervention picture cards: The Letter-Sound (L&S) cards. The present study was also focused on assessing the influence of these cards on letter-sound correspondences and speech sound production. An expert panel of six speech and language therapists analysed and discussed the L&S cards based on several criteria previously established. A Speech and Language Therapist carried out a 6-week therapeutic intervention with a group of seven Portuguese phonologically delayed pre-schoolers aged 5;3 to 6;5. The modified Bland-Altman method revealed good agreement among evaluators, that is the majority of the values was between the agreement limits. Additional outcome measures were collected before and after the therapeutic intervention process. Results indicate that the L&S cards facilitate the acquisition of letter-sound correspondences. Regarding speech sound production, some improvements were also observed at word level. The L&S cards are therefore likely to give phonetic cues, which are crucial for the correct production of therapeutic targets. These visual cues seemed to have helped children with phonological delay develop the above-mentioned skills.

This study aimed to explore brain activation in patients with cleft lip and palate (CLP) using a Chinese character subvocalization task, in which the stimuli were selected from a clinical articulation evaluation test. CLP is a congenital disability. Individuals with CLP usually have articulation disorder caused by abnormal lip and palate structure. Previous studies showed that primary somatosensory and motor areas had a significant difference in activation in patients with CLP. However, whether brain activation was restored to a normal level after palatoplasty and speech rehabilitation is not clear. Two groups, adults after palatoplasty with speech training and age-matched and sex-matched controls, participated in this study. Brain activation during Chinese character subvocalization task and behavioral data were recorded using functional MRI. Patients with CLP responded to the target significantly more slowly compared with the controls, whereas no significant difference in accuracy was found between the groups. Brain activation had similar patterns between groups. Broca's area, Wernicke's area, motor areas, somatosensory areas, and insula in both hemispheres, and the dorsolateral prefrontal cortex and the ventrolateral prefrontal cortex in the right hemisphere were activated in both groups, with no statistically significant difference. Furthermore, the two-sample t-test showed that the hippocampus in the left hemisphere was activated significantly in patients with CLP compared with the controls. The results suggested that the hippocampus might be involved in the language-related neural circuit in patients with CLP and play a role of pronunciation retrieval to help patients with CLP to complete the pronunciation effectively.

Purpose: This study evaluated the efficacy of an instructive feedback strategy for modeling letter names and sounds during presentation of positive feedback within a small-group phonological awareness intervention for preschoolers., Method: Two experiments were conducted using multiple-baseline designs across children and behaviors. Letter name and sound identification and performance on a phonological awareness fluency measure served as the primary outcome variables. Six children completed Experiment 1. A progressive time delay was added to instructive feedback to elicit a response from the 9 children in the second experiment., Results: In the first experiment, 6 children demonstrated gains on phonological awareness but not alphabet knowledge. With the addition of progressive time delay in the second experiment, all 9 children demonstrated gains on letter name and sound identification as well as phonological awareness skills., Conclusions: Progressive time delay to prompt children's responses appears to bolster the effects of instructive feedback as an efficient strategy for modeling alphabet skills within a broader early literacy curriculum. Modeling alphabet skills did not detract from, and may have enhanced, phonological awareness instruction for preschoolers.

Purpose: Changes in acoustic features in the perioperative phase for elucidating the mechanisms of articulation disorder and the effect of perioperative rehabilitation were studied prospectively., Materials and Methods: Sixty-two patients with 62 tongue cancer were divided into a partial glossectomy group (n = 40) and a reconstruction group (n = 22). Acoustic characteristics were analyzed during the preoperative and postoperative periods and after rehabilitation using the first and second formants of the vowels /a/, /i/, and /u/; the triangular vowel space area (tVSA); and the slopes of formant transitions., Results: In the 2 groups, decreases in the tVSA and formant slopes were found from the preoperative to the postoperative period, and the acoustic characteristics of the reconstruction group especially improved to preoperative values after rehabilitation. Analysis of the postoperative period showed that acoustic characteristics were altered at the site of surgical resection., Conclusion: Changes of acoustic variables are related to excision size and site, suggesting the distinctive tongue portion for the articulation of each speech sound. Perioperative rehabilitation could activate the articulators and increase the range of movement of the remaining tongue, especially the preserved anterior tongue., (Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Purpose: The purpose of this study was to evaluate the speech results of posterior pharyngeal wall augmentation (PPWA) with fat grafting both in the early and late postoperative period, and to clarify the impact of the procedure concomitant with speech therapy., Materials and Methods: This is a prospective case-control study. The study involved 87 cleft palate ± cleft lip patients with velopharyngeal insufficiency (VPI) who has been treated with PPWA. Patients were separated into two groups according to age; the first group consisted of 49 pediatric participants between 6 and 12 years of age and the second group consisted of 38 adolescent participants between 13 and 18 years of age. Preoperative velopharyngeal function and articulation were compared postoperatively at the following time points: the 3rd month, 12th month, 18th month and 24th month. The velopharyngeal function was evaluated with regards to the velopharyngeal closure type and velopharyngeal closure amount, by using the pediatric flexible nasoendoscopy and the nasometer methods. In the nasometer evaluation, nasalance sores were measured by using nonsense syllables and meaningful sentences. The Ankara Articulation Test (AAT) (Ege et al., 2004) was used to detect compensatory articulation products secondary to VPI. Consonant production error types and frequencies were determined according the guidelines stated in the study of Hardin-Jones et al. (2009). These were Pharyngeal Fricatives - Posterior Nasal Fricatives/Stop Production, Glottal Stop Production, Middorsum Palatal Stop Production, Nasal Frictional Production, Posterior Nasal Frictional Production/Phoneme Specific Nasal Emission, use of Nasal Consonants for Oral Consonants, and Replacement of Trills. All the participants received concurrent speech therapy four times, twice in the post-operative period between 1 and 3 months and twice between 3 and 6 months., Results: PPWA improved the speech performance from the 18th month to 24th month of the postoperative period. AAT assessment of the first group after 24 months comparing the post-PPWA with the preoperative data showed a highly significant decrease with regard to compensatory production errors and hypernasality; however, in the second group, the same comparison revealed a highly significant decrease in regard to the degree of hypernasality and a significant difference in terms of glottal articulation and pharyngealization of fricatives. A circular closure pattern was observed in 17 individuals with cleft palate at a rate of 70.6%., Conclusion: PPWA with concurrent speech therapy is an acceptable surgical method to correct VPI and to improve speech performance., (Copyright © 2017 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

This article provides an overview of phonological treatment approaches for anomia in individuals with aphasia. The role of phonology in language processing, as well as the impact of phonological impairment on communication is initially discussed. Then, traditional phonologically based treatment approaches, including phonological, orthographic, indirect, guided, and mixed cueing methods, are described. Collectively, these cueing treatment approaches aim to facilitate word retrieval by stimulating residual phonological abilities. An alternative treatment approach, phonomotor treatment, is also examined. Phonomotor treatment aims to rebuild sublexical, phonological sequence knowledge and phonological awareness as a means to strengthen lexical processing and whole-word naming. This treatment is supported by a parallel-distributed processing model of phonology and therefore promotes multimodal training of individual phonemes and phoneme sequences in an effort to enhance the neural connectivity supporting underlying phonological processing mechanisms. The article concludes with suggestions for clinical application and implementation., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

Objective: The aim of this study was to investigate the impact of an intensive 10-week course of articulation therapy on articulation errors in cleft lip and palate patients who have Velopharyngeal Insufficiency (VPI), non-oral and passive cleft speech characteristics., Methods: Five children with cleft palate (+/-cleft lip) with VPI and non-oral and passive cleft speech characteristics underwent 40 intensive articulation therapies over 10 weeks in a single case experimental design. The percentage of non-oral CSCs (NCSCs), passive CSCs (PCSCs), stimulable consonants (SC), correct consonants in word imitation (CCI), and correct consonants in picture naming (CCN) were captured at baseline, during intervention and in follow up phases. Visual analysis and two effect size indexes of Percentage of Nonoverlapping Data and Percentage of Improvement Rate Difference were analyzed., Results: Articulation therapy resulted in visible decrease in NCSCs for all 5 participants across the intervention phases. Intervention was effective in changing percentage of passive CSCs in two different ways; it reduced the PCSCs in three cases and resulted in an increase in PCSCs in the other two cases. This was interpreted as intervention having changed the non-oral CSCs to consonants produced within the oral cavity but with passive characteristics affecting manner of production including weakness, nasalized plosives and nasal realizations of plosives and fricatives. Percent SC increased throughout the intervention period in all five patients. All participants demonstrated an increase in percentage of CCI and CCN suggesting an increase in the consonant inventory. Follow-up data showed that all the subjects were able to maintain their ability to articulate learned phonemes correctly even after a 4-week break from intervention., Conclusion: This single case experimental study supports the hypothesis that speech intervention in patients with VPI can result in an improvement in oral placements and passive CSCs., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Unlabelled: Disordered speech is common following treatment for tongue cancer, however there is insufficient high quality evidence to guide clinical decision making about treatment. This study investigated use of ultrasound tongue imaging as a visual feedback tool to guide tongue placement during articulation therapy with two participants following partial glossectomy. A Phase I multiple baseline design across behaviors was used to investigate therapeutic effect of ultrasound visual feedback during speech rehabilitation. Percent consonants correct and speech intelligibility at sentence level were used to measure acquisition, generalization and maintenance of speech skills for treated and untreated related phonemes, while unrelated phonemes were tested to demonstrate experimental control. Swallowing and oromotor measures were also taken to monitor change. Sentence intelligibility was not a sensitive measure of speech change, but both participants demonstrated significant change in percent consonants correct for treated phonemes. One participant also demonstrated generalization to non-treated phonemes. Control phonemes along with swallow and oromotor measures remained stable throughout the study. This study establishes therapeutic benefit of ultrasound visual feedback in speech rehabilitation following partial glossectomy., Learning Outcomes: Readers will be able to explain why and how tongue cancer surgery impacts on articulation precision. Readers will also be able to explain the acquisition, generalization and maintenance effects in the study., (Copyright © 2016. Published by Elsevier Inc.)

This study explores the hypothesis that the existence of a short sensitive period for lower-level speech perception/articulation skills, and a long one for higher-level language skills, may partly explain the language outcomes of children with cochlear implants (CIs). The participants were fourteen children fitted with a CI before their second birthday. Data about their language skills and the environmental conditions (e.g. Family Involvement in rehabilitation) were obtained over a period of three years. Age at implantation correlated exclusively with the ratio of errors of place of articulation, a phonological feature for which CIs provide insufficient information. The degree of Family Involvement was significantly correlated with the remaining language measures. We conclude that small plasticity reductions affecting lower-level skills may partly explain the difficulties of some CI users in developing language.

Change in oral function was evaluated longitudinally in elderly persons participating in an Exercises for Healthy Oral Function program implemented as part of the Long-Term Care Prevention Project. The participants comprised high-risk and healthy persons aged 65 yr or over. A questionnaire was used to classify them into two groups ('every day or sometimes' or 'rarely') at the end of the study for a comparison of change in repetitive saliva swallowing test (RSST) scores and oral diadochokinesis between 3 time points: at before, at immediately after, and at 1 yr after completion of the program. The average RSST score showed a decrease at 1 yr after intervention, but the difference was not statistically significant. Oral diadochokinesis showed a significant increase for all syllables upon completion of the program compared with at the beginning. This was followed by a significant decrease at 1 yr later compared with at the time of completion in the 'rarely' group for all syllables, but not in the 'every day or sometimes' group. In addition, the number of repetitions was significantly lower in the 'rarely' group than in the 'every day or sometimes' group for all syllables at 1 yr after completion. The results of the present study suggest that Long-Term Care Prevention Projects are necessary to maintain and improve oral function.

Auditory deprivation experienced prior to receiving a cochlear implant could compromise neural connections that allow for modulation of vocalization using auditory feedback. In this report, pitch-shift stimuli were presented to adult cochlear implant users to test whether compensatory motor changes in vocal F0 could be elicited. In five of six participants, rapid adjustments in vocal F0 were detected following the stimuli, which resemble the cortically mediated pitch-shift responses observed in typical hearing individuals. These findings suggest that cochlear implants can convey vocal F0 shifts to the auditory pathway that might benefit audio-vocal monitoring.

Ankyloglossia is a common condition. Its prevalence is between 3.2% and 4.8% depending on the series and is largely underestimated given the fact of non-diagnosis when the symptoms are limited. It is defined as a short lingual frenulum resulting in a limitation of the lingual mobility. It is due to a defect in cellular apoptosis embryogenesis between the floor of the mouth and tongue. The result is a fibrous and short lingual frenulum. Several classifications were used to make the diagnosis. However, these are the clinical implications, particularly on food and primarily breastfeeding in the baby and phonation in older children that will motivate the management. This is surgical and different techniques are available: infants before the age of 6 months and when the lingual frenulum is still a fine cellular membrane, frenotomy is recommended. Frenectomy with or without frenoplasty is indicated for the older child. The surgery is simple, the results are good and rapidly improving grievances. Complications are rare. Finally, speech therapy is important when there are implications for phonation., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Introduction and Objectives: The facial artery musculomucosal (FAMM) flap is a good option for covering small and medium-sized defects in the oral cavity because of its similar tissue characteristics and easy implementation., Methods: We reviewed our results using this flap between 2006 and 2014. A total of 20 patients were included and 25 FAMM flaps were performed, 16 right (64%) and 9 left (36%) flaps. Five patients had simultaneous bilateral reconstructions. The indications for flap surgery were reconstruction after resection of tumours in the floor of the mouth (8 cases, 40%), tumours in other sites of the oral cavity (4 cases, 20%), mandibular osteoradionecrosis (4 cases, 20%), oroantral fistula (3 cases, 15%) and postoperative ankyloglossia (one case, 5%)., Results: Reconstruction was successful in 92% of cases (n=23). Total flap necrosis occurred in one case and dehiscence with exposure of bone in another. Oral function and ingestion were satisfactory in all patients., Conclusions: The facial artery musculomucosal flap is reliable and versatile for reconstruction of small and medium-sized intraoral defects. It allows functional reconstruction of the oral cavity with a low risk of complications., (Copyright © 2014 Elsevier España, S.L.U. y Sociedad Española de Otorrinolaringología y Patología Cérvico-Facial. All rights reserved.)

Articulation is driven by various combinations of movements of the lip, tongue, soft palate, pharynx and larynx, where the tongue plays an especially important role. In patients with cerebrovascular disorder, lingual motor function is often affected, causing dysarthria. We aimed to evaluate the effect of visual biofeedback of posterior tongue movement on articulation rehabilitation in dysarthria patients with cerebrovascular disorder. Fifteen dysarthria patients (10 men and 5 women; mean age, 70.7 ± 10.3 years) agreed to participate in this study. A device for measuring the movement of the posterior part of the tongue was used for the visual biofeedback. Subjects were instructed to produce repetitive articulation of [ka] as fast and steadily as possible between a lungful with/without visual biofeedback. For both the unaffected and affected sides, the range of ascending and descending movement of the posterior tongue with visual biofeedback was significantly larger than that without visual biofeedback. The coefficient of variation for these movements with visual biofeedback was significantly smaller than that without visual biofeedback. With visual biofeedback, the range of ascent exhibited a significant and strong correlation with that of descent for both the unaffected and affected sides. The results of this study revealed that the use of visual biofeedback leads to prompt and preferable change in the movement of the posterior part of the tongue. From the standpoint of pursuing necessary rehabilitation for patients with attention and memory disorders, visualization of tongue movement would be of marked clinical benefit., (© 2015 John Wiley & Sons Ltd.)

Background: There has been little robust evaluation of the outcome of speech and language therapy (SLT) intervention for post-stroke dysarthria. Non-speech oro-motor exercises (NSOMExs) are a common component of dysarthria intervention. A feasibility study was designed and executed, with participants randomized into two groups, in one of which NSOMExs were a component of the intervention programme., Aims: To examine (1) operational feasibility of the programme; (2) participants' views of the programme; and (3) speech intelligibility, communication effectiveness and tongue and lip movement at four points (A1 and A2 before, and A3 and A4 after intervention)., Methods & Procedures: Thirty-nine participants were randomized into Group A (n=20) and Group B (n=19). Groups were equivalent at enrolment in demographic variables and A1 measures. Intervention was behavioural, delivered in eight home-based SLT sessions, and included practise of individually appropriate words, sentences and conversation, and for Group B also NSOMExs. Between-session practice was recorded in a diary. Data on speech intelligibility, effectiveness of communication in conversation, self-rated situational communication effectiveness, and tongue and lip movement were collected at 8-week intervals, twice before and twice after intervention. Anonymous evaluation (AE) questionnaires were completed., Outcome & Results: The recruited number was 20% below the target of 50. Thirty-six participants completed the intervention and 32 were followed through to A4. The programme was delivered to protocol and fidelity was verified. Thirty-four AEs were returned. These showed high satisfaction with the programme and its outcome. According to diary records from 32 participants, 59% carried out at least the recommended practice amount. Outcome measure performance across the four assessment points did not indicate any group effect. For the whole sample both externally rated and self-rated communication effectiveness measures showed statistically significant gains across the intervention period (A2/A3), which were maintained for 2 months after intervention (A2/A4). Non-intervention period changes (A1/A2 and A3/A4) were not present. There were no intervention-related gains in tongue and lip movement or speech intelligibility, but the latter is likely to be attributable to a ceiling effect on scores., Conclusions & Implications: The results indicate positive outcomes associated with a short period of behavioural SLT intervention in the post-stroke dysarthria population. The inclusion of NSOMExs, delivered in accordance with standard clinical practice, did not appear to influence outcomes. The results must be viewed in relation to the nature of feasibility study and provide a foundation for suitably powered trials., (© 2014 Royal College of Speech and Language Therapists.)

Absence of speech rehabilitation services is one of the critical difficulties in care for clefts in Thailand and some other developing countries. The objective of this study was to determine the effectiveness of the "Khon Kaen Community-Based Speech Therapy Model" in decreasing the number of articulation defects in children with cleft palate and/or lip. Sixteen children with cleft palate and/or lip in 6 districts of Maha Sarakham Province were enrolled for study. A three-day intensive speech camp was held in Srinagarind Hospital and followed by an outreach program of six one-day follow-up speech camps in Maha Sarakham Hospital. Six paraprofessionals, speech assistants, provided home- or community- based speech correction every week for one year. Numbers of various articulation errors were compared pre- and post-treatment using the Wilcoxon signed-rank test. The number of articulation defects showed a statistically significant reduction (mean difference = 10; Z = -3.52; p < 0.001; 95% CI: 8-13). The "Khon Kaen Community-Based Speech Therapy Model" is one of the best models for solving speech therapy problems in areas of Thailand lacking speech services and can be applied to other developing countries.

Introduction: Articulation of pronounced sounds during the training and subsequent use of esophageal speech is very important because it contributes significantly to intelligibility and aesthetics of spoken words and sentences, as well as of speech and language itself. The aim of this research was to determine the quality of articulation of sounds of Serbian language by groups of sounds in patients who had learned esophageal speech successfully as well as the effect of age and tooth loss on the quality of articulation., Material and Methods: This retrospective-prospective study included 16 patients who had undergone total laryngectomy. Having completed the rehabilitation of speech, these patient used esophageal voice and speech. The quality of articulation was tested by the "Global test of articulation.", Results: Esophageal speech was rated with grade 5, 4 and 3 in 62.5%, 31.3% and one patient, respectively. Serbian was the native language of all the patients. The study included 30 sounds of Serbian language in 16 subjects (480 total sounds). Only two patients (12.5%) articulated all sounds properly, whereas 87.5% of them had incorrect articulation., Conclusion: The articulation of affricates and fricatives, especially sound /h/ from the group of the fricatives, was found to be the worst in the patients who had successfully mastered esophageal speech. The age and the tooth loss of patients who have mastered esophageal speech do not affect the articulation of sounds in Serbian language.

Speech errors associated with cleft palate are well established for English and several other Indo-European languages. Few articles describing the speech of Putonghua (standard Mandarin Chinese) speakers with cleft palate have been published in English language journals. Although methodological guidelines have been published for the perceptual speech evaluation of individuals with cleft palate, there has been no critical review of methodological issues in studies of Putonghua speakers with cleft palate. A literature search was conducted to identify relevant studies published over the past 30 years in Chinese language journals. Only studies incorporating perceptual analysis of speech were included. Thirty-seven articles which met inclusion criteria were analyzed and coded on a number of methodological variables. Reliability was established by having all variables recoded for all studies. This critical review identified many methodological issues. These design flaws make it difficult to draw reliable conclusions about characteristic speech errors in this group of speakers. Specific recommendations are made to improve the reliability and validity of future studies, as well to facilitate cross-center comparisons.

The purpose was to investigate an intervention model for treating preschool children with phonological processes. Six children, three girls and three boys, between 4y 1m and 5y 7m, with similar developmental phonological disorder (PD) received an individually adjusted intervention including articulatory, phonological, and meta-phonological approaches. A single-subject multiple-baseline design with /f/ and /s/ as target phonemes and velar plosives and /r/ as control phonemes was used. An improved production of the treated phonemes was found in five of the children, while one girl established /f/ but not /s/. The control phonemes remained unchanged for all children. Six to 18 therapy sessions were needed to reach the intervention goal. The study highlights the importance of considering heterogeneity in children with PD.

This article focuses on methodological issues related to quantitative assessments of speech quality after glossectomy. Acoustic and articulatory data were collected for 8 consonants from two patients. The acoustic analysis is based on spectral moments and the Klatt VOT. Lingual movements are recorded with ultrasound without calibration. The variations of acoustic and articulatory parameters across pre- and post-surgery conditions are analyzed in the light of perceptual evaluations of the stimuli. A parameter is considered to be relevant if its variation is congruent with perceptual ratings. The most relevant acoustic parameters are the skewness and the Center of Gravity. The Klatt VOT explains differences that could not be explained by spectral parameters. The SNTS ultrasound parameter provides information to describe impairments not accounted for by acoustical parameters. These results suggest that the combination of articulatory, perceptual and acoustic data provides comprehensive complementary information for a quantitative assessment of speech after glossectomy.

Persons with severe speech impairments frequently communicate via non-speech means, such as speech-generating devices (SGDs). In studies of people without disabilities, use of non-speech responses has activated non-phonological modalities for short-term word storage. In the current study, short-term word storage was evaluated in 23 pre-trained adult speakers without disabilities and in four individuals who use SGDs for communication. Results indicated that participants without disabilities stored lists of words phonologically when using SGDs. Individuals who used SGDs were most successful in recall of high- frequency words, with preliminary evidence of phonological encoding for short-term storage in preparation for non-speech responses. Further research is needed to describe possible concurrent storage modalities.

Purpose: This study explored relationships among perceptual, ultrasound, and acoustic measurements of children's correct and misarticulated /r/ sounds. Longitudinal data documenting changes across these parameters were collected from 2 children who acquired /r/ over a period of intervention and were compared with data from children with typical speech., Method: Participants were 3 children with typical speech, recorded once, and 2 children with /r/ misarticulation, recorded over 7-8 months. The following data from /r/ produced in nonwords were collected: perceptually rated accuracy, ultrasound measures of tongue shape, and F3 - F2 distance., Results: Regression models revealed significant associations among perceptual, ultrasound, and acoustic measures of /r/ accuracy. The inclusion of quantitative tongue-shape measurements improved the match between the ultrasound and perceptual/acoustic data. Perceptually incorrect /r/ productions were found to feature posteriorly located peaked tongue shapes. Of the children who were seen longitudinally, 1 developed a bunched /r/ and 1 demonstrated retroflexion. The children with typical speech also differed in their tongue shapes., Conclusion: Results support the validity of using qualitative and quantitative ultrasound measures to characterize the accuracy of children's /r/ sounds. Clinically, findings suggest that it is important to encourage pharyngeal constriction while allowing children to find the /r/ tongue shape that best fits their individual vocal tract.

This review evaluates issues of teacher linguistic knowledge relating to their work with children with speech, language and communication difficulties (SLCD). Information is from Ellis and McCartney [(2011a). Applied linguistics and primary school teaching. Cambridge: Cambridge University Press], a state-of-the-art text deriving from a British Association of Applied Linguistics/Cambridge University Press expert seminar series that details: linguistic research underpinning primary school curricula and pedagogy; the form of linguistic knowledge useful for teachers supporting children with SLCD in partnership with speech and language therapists; and how and when teachers acquire and learn to apply such knowledge. Critical analysis of the options presented for teacher learning indicate that policy enjoinders now include linguistic application as an expected part of teachers' professional knowledge, for all children including those with SLCD, but there is a large unmet learning need. It is concluded that there is a role for clinical linguists to disseminate useable knowledge to teachers in an accessible format. Ways of achieving this are considered.

Purpose: Clinicians do not have an evidence base they can use to recommend optimum intervention intensity for preschool children who present with speech sound disorder (SSD). This study examined the effect of dose frequency on phonological performance and the efficacy of the multiple oppositions approach., Method: Fifty-four preschool children with SSD were randomly assigned to one of three intervention conditions. Two intervention conditions received the multiple oppositions approach either 3 times per week for 8 weeks (P3) or once weekly for 24 weeks (P1). A control (C) condition received a storybook intervention. Percentage of consonants correct (PCC) was evaluated at 8 weeks and after 24 sessions. PCC gain was examined after a 6-week maintenance period., Results: The P3 condition had a significantly better phonological outcome than the P1 and C conditions at 8 weeks and than the P1 condition after 24 weeks. There were no significant differences between the P1 and C conditions. There was no significant difference between the P1 and P3 conditions in PCC gain during the maintenance period., Conclusion: Preschool children with SSD who received the multiple oppositions approach made significantly greater gains when they were provided with a more intensive dose frequency and when cumulative intervention intensity was held constant.

Purpose: The aim of this study was to investigate the influence of phonomotor treatment on the types of errors produced during a confrontation naming task for people with aphasia (PWA)., Method: Ten PWA received 60&emsp14;hr of phonomotor treatment across 6 weeks. Confrontation naming abilities were measured before and after treatment, and responses were coded as correct or incorrect. Incorrect responses were coded for error type. Paired t tests comparing pre-, post- and 3 months posttreatment naming accuracy and error type were performed., Results: Group data showed that naming accuracy on trained items improved significantly immediately post treatment, and gains were maintained 3 months later. Naming accuracy on untrained items did not show significant improvement immediately post treatment or 3 months later. Results of error type analysis were not significant. However, a decrease in omission errors and an increase in mixed errors were noted immediately post treatment for naming of untrained items., Conclusion: Results suggest that intensive phonomotor treatment improved lexical-retrieval abilities and may have triggered a shift in linguistic processing, as indicated by a decrease in omission errors on trained items and an increase in mixed errors on untrained items.

Background: In Portugal, the routine clinical practice of speech and language therapists (SLTs) in treating children with all types of speech sound disorder (SSD) continues to be articulation therapy (AT). There is limited use of phonological therapy (PT) or phonological awareness training in Portugal. Additionally, at an international level there is a focus on collecting information on and differentiating between the effectiveness of PT and AT for children with different types of phonologically based SSD, as well as on the role of phonological awareness in remediating SSD. It is important to collect more evidence for the most effective and efficient type of intervention approach for different SSDs and for these data to be collected from diverse linguistic and cultural perspectives., Aims: To evaluate the effectiveness of a PT and AT approach for treatment of 14 Portuguese children, aged 4.0-6.7 years, with a phonologically based SSD., Methods & Procedures: The children were randomly assigned to one of the two treatment approaches (seven children in each group). All children were treated by the same SLT, blind to the aims of the study, over three blocks of a total of 25 weekly sessions of intervention. Outcome measures of phonological ability (percentage of consonants correct (PCC), percentage occurrence of different phonological processes and phonetic inventory) were taken before and after intervention. A qualitative assessment of intervention effectiveness from the perspective of the parents of participants was included., Outcomes & Results: Both treatments were effective in improving the participants' speech, with the children receiving PT showing a more significant improvement in PCC score than those receiving the AT. Children in the PT group also showed greater generalization to untreated words than those receiving AT. Parents reported both intervention approaches to be as effective in improving their children's speech., Conclusions & Implications: The PT (combination of expressive phonological tasks, phonological awareness, listening and discrimination activities) proved to be an effective integrated method of improving phonological SSD in children. These findings provide some evidence for Portuguese SLTs to employ PT with children with phonologically based SSD., (© 2012 Royal College of Speech and Language Therapists.)

Aims: The purpose of this study was to describe articulation and resonance characteristics of Ugandan English-speaking children with cleft lip and palate (CLP) after synchronous lip and palatal closure (Sommerlad technique) prior to the age of 6 months in comparison with an age- and gender-matched control group., Methods: Eleven Ugandan patients with CLP (mean age 4;9 years), repaired during a synchronous lip and (soft and hard) palatal closure at a mean age of 3.4 months, were included as well as a control group (n = 22) consisting of 2 Ugandan age- and gender-matched noncleft children for each patient (mean age 4;10 years). Objective and perceptual speech assessment techniques were applied., Results: Consonant inventories were significantly smaller in the CLP group. Moreover, phonetic disorders and phonological processes occurred in 91 and 100% of the CLP group, respectively. Perceptual consensus evaluation revealed absence of hyponasality and cul-de-sac resonance in all patients. Hypernasality and nasal emission/turbulence occurred in 18 and 27% of the patients, respectively. No significant group differences were observed regarding the mean nasalance values of oral speech samples., Conclusion: Various deviations from normal speech development seem to occur in patients with CLP following synchronous lip and palatal closure before 6 months of age.

Purpose of Review: This review covers recent research findings that demonstrate the effectiveness of speech pathology intervention in enabling male-to-female transsexual individuals to portray their gender identity through speech. Research reports that extend our understanding of communication characteristics that contribute to perceptions of sex in male-to-female transsexuals are identified. Current issues related to the measurement of therapy effectiveness are also presented., Recent Findings: Earlier studies confirmed that an increase in voice pitch is achievable for many transsexuals. However, it is now accepted that pitch is not the sole contributor to perceptions of gender. Recently, modification of vocal resonance has been shown to increase perceptions of a speaker as female. There is evidence that encouraging precise articulation results in increased perceptions of the speaker as female. Evidence for the contribution of voice quality and loudness to perceptions of gender is inconclusive. Speech rate does not appear to contribute significantly to gender perceptions.Ecologically valid measures of the individual's vocal functioning and its impact on everyday life in clinical assessment of male-to-female transsexuals are needed to provide meaningful measures of therapy outcome., Summary: There continues to be a need for ongoing research into communication characteristics that contribute to perceptions of gender. It is essential to include the perspective of the individual when evaluating therapy outcome.

Objectives: The lingual dysfunctions play a considerable role in the pathogenesis of dentoskeletal dysmorphisms. The treatment of dento-maxillofacial dysgnathia implies a functional rehabilitation to re-harmonize the stomatognathic system. This study aims to demonstrate the importance of a rehabilitation protocol of functional orofacial parameters at the end of a surgical-orthodontic treatment in order to achieve long-term success., Materials and Methods: After orthognathic surgery, facial expression exercises and jaw exercises are prescribed to promote the recovery of neuromuscular function. At the end of treatment, a sample of 30 dysgnathic patients underwent a functional evaluation of the orofacial district to identify any lingual or articulatory dysfunctions. The information gathered led to an individual re-education program that consisted of an active myofunctional-logopedic approach integrated with appliances used as retention., Results: 19 patients needed myofunctional therapy to re-educate deglutition and tongue posture. Articulatory disorders were found in 7 patients originally suffering from Class III and/or open-bite skeletal disharmony; 5 of these completed rehabilitation with speech therapy. After rehabilitation the functional parameters were completely normalized in 12 patients; in 5 cases, partial improvements were obtained, while in 2 cases the therapy was ineffective., Conclusions: In a patient undergoing post-surgical reconsolidation of his/her functional equilibrium even an uncontrolled speech defect may lead to an instable result. Only through an interdisciplinary approach it is possible to intercept and re-educate all the functions that are not compliant with the structural changes and to eliminate a tendency to relapse of the dysgnathia., (Copyright © 2011 Società Italiana di Ortodonzia SIDO. Published by Elsevier Srl. All rights reserved.)

Speech production impairment is a frequent deficit observed in aphasic patients and rehabilitation programs have been extensively developed. Nevertheless, there is still no agreement on the type of rehabilitation that yields the most successful outcomes. Here, we ran a detailed meta-analysis of 39 studies of word production rehabilitation involving 124 patients. We used a model-driven approach for analyzing each rehabilitation task by identifying which levels of our model each task tapped into. We found that (1) all rehabilitation tasks are not equally efficient and the most efficient ones involved the activation of the two levels of the word production system: the phonological output lexicon and the phonological output, and (2) the activation of the speech perception system as it occurs in many tasks used in rehabilitation is not successful in rehabilitating word production. In this meta-analysis, the effect of the activation of the phonological output lexicon and the phonological output cannot be assessed separately. We further conducted a rehabilitation study with DPI, a patient who suffers from a damage of the phonological output lexicon. Our results confirm that rehabilitation is more efficient, in terms of time and performance, when specifically addressing the impaired level of word production.

Purpose: This study compared the temporal processing performance of children with phonological disorders submitted to formal and informal auditory training., Methods: Fifteen subjects with phonological disorder (pure tone thresholds ≤20 dBHL from 0.50 to 4 kHz, and age between 7 years and 10 years and 11 months) were evaluated, divided into three groups:, Control Group: five subjects (mean age 9.1 years) without auditory processing disorder, who passed through two evaluations of the auditory processing at intervals of six to eight weeks and without any intervention; Formal Training Group with five subjects (average 8.3 years) with auditory processing disorder submitted to eight sessions of formal training; and Informal Training Group, with five subjects (average 8.1 years) with auditory processing disorder submitted to eight sessions of informal training., Results: After eight sessions the formal training group showed an improvement of 8% and the informal training group of 22.5% in comparison with the pitch pattern sequence test. For the duration pattern sequence test, the average of the formal training group improved by 12.9% and the informal training group by 18.7%. There was no statistical difference between the means obtained by both groups after intervention, neither in the pitch pattern nor in the duration pattern sequence test., Conclusion: Although the results did not present significant differences, this pilot study suggests that both formal and informal trainings provide improvement in the temporal processing abilities of children with phonological and auditory processing disorders.

Purpose: To demonstrate that early childhood speech sound disorders (SSD) and later school-age reading, written expression, and spelling skills are influenced by shared endophenotypes that may be in part genetic., Method: Children with SSD and their siblings were assessed at early childhood (ages 4-6 years) and followed at school age (7-12 years). The relationship of shared endophenotypes with early childhood SSD and school-age outcomes and the shared genetic influences on these outcomes were examined., Results: Structural equation modeling demonstrated that oral motor skills, phonological awareness, phonological memory, vocabulary, and speeded naming have varying influences on reading decoding, spelling, spoken language, and written expression at school age. Genetic linkage studies demonstrated linkage for reading, spelling, and written expression measures to regions on chromosomes 1, 3, 6, and 15 that were previously linked to oral motor skills, articulation, phonological memory, and vocabulary at early childhood testing., Conclusions: Endophenotypes predict school-age literacy outcomes over and above that predicted by clinical diagnoses of SSD or language impairment. Findings suggest that these shared endophenotypes and common genetic influences affect early childhood SSD and later school-age reading, spelling, spoken language, and written expression skills.

The goal of this research programme was to evaluate the role of word lexicality in effecting phonological change in children's sound systems. Four children with functional speech sound disorders (SSDs) were enrolled in an across-subjects multiple baseline single-subject design; two were treated using high-frequency real words (RWs) and two were treated using (low-frequency) non-words (NWs). Dependent variables were learning during treatment, generalization of treated and untreated sounds post-treatment and error consistency indices. The oldest child in the NW group demonstrated slightly greater increases in learning during treatment, and both children demonstrated increases in generalization as well as large decreases in sound error variability. In comparison, one child in the RW group demonstrated untreated sound generalization, as well as decreases in sound error variability. These results suggest that NWs may be useful in helping children learn the sound structure of words containing treated sounds. These findings are interpreted within an established connectionist model accounting for phonological and lexical representations.

Purpose: Evidence-based practice (EBP) involves the incorporation of research evidence, clinical expertise, and client values in clinical decision making. One case in which these factors conflict is the use of nonspeech oral motor treatments (NSOMTs) for children with developmental speech sound disorders. Critical reviews of the research evidence suggest that NSOMTs are not valid, yet they are widely used by clinicians based on their expertise/experience. This investigation presents detailed descriptions of clinicians' and researchers' views and opinions on NSOMTs and EBP., Method: Individual interviews with 11 clinicians who use NSOMTs and 11 researchers in child phonology were conducted. The interviews were transcribed and organized into themes, following a phenomenological research design., Results: Five themes were identified: (a) NSOMTs are effective, (b) EBP is useful, (c) there is no published research supporting NSOMTs, (d) research evidence may change clinical use of NSOMTs, and (e) researchers and clinicians have separate but shared roles in clinical decision making., Conclusions: The participants' responses provided detailed and complex insights into each group's decisions regarding NSOMTs. These responses also suggested questions that should be considered when making decisions about approaches that are not fully supported by EBP.

Purpose: A systematic review was conducted to summarize and evaluate the literature on the effectiveness of speech pathology interventions in adults with neuromuscular diseases., Method: Databases searched included the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, MEDLINE, CINAHL, EMBASE, PsycINFO and PubMed. A total of 1,772 articles were independently screened on title and abstract by 2 reviewers., Results: No randomized controlled trials or clinical controlled trials were found. Four other designs were included. Only one study on oculopharyngeal muscle dystrophy (OPMD) appeared to have sufficient methodological quality. There is evidence indicating that correction of head position in patients with OPMD improves swallowing efficiency (level III evidence)., Conclusion: Despite 1,772 studies, there is only evidence of level III regarding the effectiveness of speech pathology interventions in patients with OPMD. Recommendations for future research are given., (Copyright © 2010 S. Karger AG, Basel.)

Background: Newborn hearing screening, early intervention programs, and advancements in cochlear implant and hearing aid technology have greatly increased opportunities for children with hearing loss to become intelligible talkers. Optimizing speech intelligibility requires that progress be monitored closely. Although direct assessment of intelligibility has been a cumbersome undertaking, advancements in digital recording technology and expanded strategies for recruiting listener-judges can make this tool much more practical in contemporary school and clinical settings., Purpose: The main purposes of this tutorial are to present a rationale for assessing children's connected speech intelligibility, review important uses for intelligibility scores, and describe time-efficient ways to estimate how well children's connected speech can be understood. This information is offered to encourage routine assessment of connected speech intelligibility in preschool and school-age children with hearing loss.

The aim was to evaluate the effectiveness of electropalatography (EPG) in home training of persistent articulation errors in an 11-year-old Swedish girl born with isolated cleft palate. The /t/ and /s/ sounds were trained in a single subject design across behaviours during an eight month period using a portable training unit (PTU). Both EPG analysis and perceptual analysis showed an improvement in the production of /t/ and /s/ in words and sentences after therapy. Analysis of tongue-contact patterns showed that the participant had more normal articulatory patterns of /t/ and /s/ after just 2 months (after approximately 8 hours of training) respectively. No statistically significant transfer by means of intelligibility in connected speech was found. The present results show that EPG home training can be a sufficient method for treating persistent speech disorders associated with cleft palate. Methods for transfer from function (articulation) to activity (intelligibility) need to be explored.

The main purpose of this study was to analyze the effects of computer-assisted practice on reading and spelling in children with learning disabilities (LD). We compared three practice conditions, one with reading and two with spelling, in order to test whether computer-based reading and spelling practice has an influence on the development of reading and spelling ability in children with LD. A sample was selected of 85 children with LD, with age range between 8 years and 10 years (age, M=111.02, SD=9.6), whose spelling performance was two years below grade level. The participants were randomly assigned to one of four groups: 1) Copy the target word from the computer screen (n=22), 2) Memorize the target word and write it from memory (n=21), 3) Word reading (n=21), and 4) the untrained control group (n=21). We administered measures of pseudoword reading, phonological awareness, phonological word decoding and orthographical word decoding tasks. We examined the learning effects and transfer effects on words classified as a function of length, consistency, and complexity of syllable structure. Overall, the results showed that reading training did not improve spelling; however, the children who participated in the copy training condition improved their spelling skills.

Background: auditory training program in students with learning disabilities., Aim: to verify the efficacy of an auditory training program in students with learning disabilities; to compare the results of students with and without learning disabilities, who were and were not submitted to the auditory training program, in pre and post-testing., Method: participants were 40 students who were divided according to the following: GI, subdivided in: GIe (10 students with learning disabilities who were submitted to the program), GIc (10 students with learning difficulties who were not submitted to auditory training) and GII, subdivided in: GIIe (10 students without learning difficulties submitted to the auditory training program) and GIIc (10 students without learning difficulties who were not submitted to auditory training). The auditory training program Audio Training was used., Results: the results indicate that GI presented a lower performance when compared to GII in activities related to auditory skills and phonological awareness. When comparing the pre and post-testing results, GIe and GIIe presented better performances in activities involving auditory skills and phonological awareness after the auditory training program., Conclusion: the performance of the students with learning disabilities in auditory and phonological tasks is lower when compared to the students without learning disabilities. The use of the auditory training program was effective and allowed students to develop these skills.

Aim: The aim of this study was to describe and define the rehabilitation approach: 'Facial Oral Tract Therapy' (F.O.T.T.)., Method: We defined the content and process of the rehabilitation approach (F.O.T.T.) in a decision-algorithm supported by a manual with supplementary material. The algorithm was developed by a research occupational therapist and an F.O.T.T. senior instructor. We used an inductive approach combining existing knowledge from: F.O.T.T. instructors, therapists trained in using the F.O.T.T. approach, and existing literature. A group of F.O.T.T. instructors and the originator of the treatment approach Mrs. Kay Coombes has given comments to and approved the algorithm., Result: The algorithm consist of five flowcharts: 'one assessment' chart guiding the therapist in the examination of the patient and four 'treatment charts', one for each of the four areas of F.O.T.T.: swallowing and eating; oral hygiene; breathing, voice, and speech articulation; facial expression, giving guidance on interventions. The algorithm outlines all important components in the treatment that the therapist should decide to use or not to use in the intervention. The algorithm is supported by a manual with criteria of when to use which components., Conclusion: This algorithm is designed to be a practical guideline to therapists using F.O.T.T. in clinical practice and in educational settings. The use of this algorithm may support standardization of F.O.T.T. and thereby promote and maintain the quality in the treatment. This in turn will facilitate research that addresses F.O.T.T. and outcomes.

Purpose: In this study, the authors evaluated literacy outcome in children with histories of speech sound disorder (SSD) who were characterized along 2 dimensions: broader language function and persistence of SSD. In previous studies, authors have demonstrated that each dimension relates to literacy but have not disentangled their effects. Methods Two groups of children (86 SSD and 37 controls) were recruited at ages 5-6 and were followed longitudinally. The authors report the literacy of children with SSD at ages 7-9, compared with controls and national norms, and relative to language skill and SSD persistence (both measured at age 5-6)., Results: The SSD group demonstrated elevated rates of reading disability. Language skill but not SSD persistence predicted later literacy. However, SSD persistence was associated with phonological awareness impairments. Phonological awareness alone predicted literacy outcome less well than a model that also included syntax and nonverbal IQ., Conclusions: Results support previous literature findings that SSD history predicts literacy difficulties and that the association is strongest for SSD + language impairment (LI). Magnitude of phonological impairment alone did not determine literacy outcome, as predicted by the core phonological deficit hypothesis. Instead, consistent with a multiple deficit approach, phonological deficits appeared to interact with other cognitive factors in literacy development.

Objective: To assess, in patients undergoing glossectomy, the influence of the palatal augmentation prosthesis on the speech intelligibility and acoustic spectrographic characteristics of the formants of oral vowels in Brazilian Portuguese, specifically the first 3 formants (F1 [/a,e,u/], F2 [/o,ó,u/], and F3 [/a,ó/])., Design: Speech evaluation with and without a palatal augmentation prosthesis using blinded randomized listener judgments., Setting: Tertiary referral center., Patients: Thirty-six patients (33 men and 3 women) aged 30 to 80 (mean [SD], 53.9 [10.5]) years underwent glossectomy (14, total glossectomy; 12, total glossectomy and partial mandibulectomy; 6, hemiglossectomy; and 4, subtotal glossectomy) with use of the augmentation prosthesis for at least 3 months before inclusion in the study., Main Outcome Measures: Spontaneous speech intelligibility (assessed by expert listeners using a 4-category scale) and spectrographic formants assessment., Results: We found a statistically significant improvement of spontaneous speech intelligibility and the average number of correctly identified syllables with the use of the prosthesis (P < .05). Statistically significant differences occurred for the F1 values of the vowels /a,e,u/; for F2 values, there was a significant difference of the vowels /o,ó,u/; and for F3 values, there was a significant difference of the vowels /a,ó/ (P < .001)., Conclusions: The palatal augmentation prosthesis improved the intelligibility of spontaneous speech and syllables for patients who underwent glossectomy. It also increased the F2 and F3 values for all vowels and the F1 values for the vowels /o,ó,u/. This effect brought the values of many vowel formants closer to normal.

An imaginative scheme for a children's speech and language clinic to be sited in a part of Newcastle Upon Tyne rich in history, and a design for a new oncology centre, in Breda, Holland, conceived to help "break the taboo that shrouds cancer" won the student architects the first and second prizes respectively in the 2008 Architects for Health (AfH) Student Awards. Health Estate Journal reports.