Academic journal article Journal of Medical Speech - Language Pathology

Facial Kinematics of a Speaker with a Palatal Lift Following Brainstem Impairment

Academic journal article Journal of Medical Speech - Language Pathology

Facial Kinematics of a Speaker with a Palatal Lift Following Brainstem Impairment

Article excerpt

This study examined the impact of palatal lift intervention on articulatory kinematics for a speaker with acquired velopharyngeal incompetence (VPI) following brainstem tumor excision. Articulatory adaptations to VPI management may be expected in response to sudden changes in vocal tract aerodynamics and acoustics. This investigation was designed to address the following research questions: (1) Does articulatory performance change in response to palatal lift intervention? and (2) If so, are the observed performance changes in the direction of normal speakers? Changes were observed in response to the palatal lift in kinematic measures of cumulative distance, peak speed of movement, and consistency of movement patterns. Changes were most notable in upper lip performance, which appeared to be the result of compensatory adjustments. Although the experimental participant's performance with palatal lift intervention became more similar to that of the nondisabled controls, his performance was markedly different on many kinematic parameters.

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Palatal lift intervention for velopharyngeal incompetence (VPI) improves speech performance and overall intelligibility (Esposito, Mitsumoto, & Shanks, 2000; Koidis & Topouzelis, 2003; Yorkston et al., 2001). The articulatory basis for speech improvement with the VPI intervention is poorly defined, because the primary focus of prior investigations has been on resonance and airflow management as well as overall speech intelligibility. Modifications in articulatory movements might be expected with VPI management, as patients need to accommodate sudden changes in vocal tract aerodynamics and acoustics. Immediate changes in articulatory movements may also be expected as effective VPI management can eliminate the need for compensatory gestures that were previously used to minimize nasal air emissions, optimize oral airflow and pressure, and increase acoustic contrast in hypernasal speech. The kinematic level of analysis is particularly well suited to identify subtle changes in articulatory performance with VPI that impact speech performance. Studies of orofacial kinematics (primarily of repaired lips) have been conducted on individuals with cleft lip and palate to measure articulatory movement changes after surgery (Gross, Trotman, & Moffatt, 1996; Trotman & Faraway, 1998; Trotman, Faraway, Silvester, Greenlee, & Johnston, 1998; Trot-man, Phillips, Faraway, & Ritter, 2003; van Lieshout, Rutjens, & Spauwen, 2002). The purpose of this study was to examine the impact of a palatal lift prosthesis on articulatory kinematics for a teenager with VPI due to a brainstem tumor. This investigation was designed to address the following research questions: (1) Does articulatory performance change in response to palatal lift intervention? and (2) If so, are the observed performance changes in the direction of normal speakers? Presumably, palatal lift intervention will reduce the articulatory compensation and therefore normalize articulatory performance.

METHOD

Experimental Participant

The experimental participant was a 17-year-old male with a history of surgical excision of a brainstem glioma at 12 years of age. He sustained neurological damage, which initially resulted in severely reduced speech intelligibility (5%). He demonstrated flaccid dysarthria as characterized by severe hypernasality and imprecise articulation. He was fitted for a palatal lift prosthesis approximately 12 months postsurgical excision. He participated in extensive rehabilitation targeting increasing articulatory precision for several years. At the time of the study, his speech was 97% intelligible with the palatal lift and 85% without the lift as measured by the Sentence Intelligibility Test (Yorkston, Beukelman, & Tice, 1996).

Control Participants

Data were collected from seven (4 female and 3 male) neurologically intact 16-year-old speakers. …

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