Journal of communication disorders | 2019
Analysis of oral-nasal balance after intensive speech therapy combined with speech bulb in speakers with cleft palate and hypernasality.
Abstract
OBJECTIVE\nTo evaluate the efficacy of the combination of a speech bulb with an intensive speech therapy program in hypernasal participants with cleft palate.\n\n\nMETHODS\nTwenty hypernasal speakers with cleft palate (12 females and 8 males, median age 28.45 years), who were wearing speech bulbs underwent an intensive speech therapy program of 45 sessions over 3 weeks. Three experienced speech-language pathologists rated the participants speech recordings before and after intensive speech therapy, with and without the speech bulb. Nasometric recordings and long-term averaged spectra were also analyzed using repeated-measures ANOVAs.\n\n\nRESULTS\nThe ANOVA of the hypernasality ratings showed significant effects of therapy [F (1,19)\u202f=\u202f15.97; p\u202f<\u202f.001], speech bulb [F(1,190\u202f=\u202f28.54, p\u202f<\u202f.001] and a therapy -speech bulb interaction effect [F(1.19)\u202f=\u202f22.30, p\u202f<\u202f0.001]. The most favorable listener ratings of hypernasality were obtained post-therapy when participants were wearing their speech bulbs. Without the speech bulb, intensive speech therapy by itself did not result in a significant improvement. With speech bulb, nasalance scores for high [F (1,19)\u202f=\u202f14.07, p\u202f<\u202f.001] and low pressure [F (1,19)\u202f=\u202f14.84, p\u202f<\u202f.001] sentences were significantly lower post-therapy, providing preliminary evidence that an intensive speech therapy program may enhance the effect of a speech bulb. Before and after comparisons of individual nasalance profiles demonstrated variable improvement in 15 participants, no progress in 2 participants and more severe hypernasality after therapy in 3 participants. Long-term averaged spectra corroborated the findings of the perceptual analysis. Based on a frequency bin from 201 to 300\u202fHz, there was a significant within-subject effect for with and without speech bulb [F(1, 18)\u202f=\u202f4.54, p\u202f=\u202f.047] as well as for before vs. after session [F (1,18)\u202f=\u202f7.14, p\u202f=\u202f.015].\n\n\nCONCLUSION\nThe speech bulb in combination with intensive speech therapy resulted in improved oral-nasal balance for the majority of participants. More research is needed to investigate long-term outcomes as well as individual factors contributing to therapy success.