Benjamas Prathanee

Nasalance scores for speech in normal Thai children

To assess the standard nasalance scores for normal Thai children in their native language, we organised a prospective descriptive study at the Ear, Nose, and Throat Outpatient Department, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University. Emotionally stable, healthy school children (n = 188) between Grades 1 and 6 with normal intelligence were enrolled in the study. The students were randomly selected according to their economic status. Each subject was asked to read three standard Thai passages: the first devoid of nasal consonants, the second having a mixture of oral and nasal consonants, and the third full of nasal consonants. A nasometer was used to analyse the scores. The mean (SD) percentage scores for the three groups were 14.3 (5.8), 35.6 (5.9), and 51.1 (6.4), respectively, similar to scores for the English language. Extraneous influences on the scores such as sex were considered but were not significant. The passages proved suitable for use as a baseline for the assessment of velopharyngeal insufficiency and rehabilitation planning in Thai children.

Factors Associated With Specific Language Impairment and Later Language Development During Early Life: A Literature Review

It has been reported that 50% of children with specific language impairment (SLI) have persistent SLI, which has been associated with various risk factors. To date, however, there has not been a comprehensive review of studies into different risk factors that could be used by clinicians to facilitate parental counseling and individual case-management. Several studies about the factors associated with SLI were reviewed based on study design. This article presents a review of factors associated with later language development and SLI, and reviews the risk for children who have SLI during early life. The summary provides data including specific biologic and environmental factors that are significantly associated with SLI, to ensure early intervention for children with SLI in the presence of identified risk factors.

Oral diadochokinetic rates for normal Thai children

BACKGROUND The diadochokinetic (DDK) rate represents an index for assessing motor skills. It is commonly used in routine clinical evaluation of diseases of the central nervous system, disturbances of the peripheral sensory motor formations and immaturity of the speech mechanism. Oral DDK rates are a popular guideline for the assessment, diagnosis and treatment of patients with a neurological deficit of the speech mechanism. Baseline DDK rates have been published for English-speaking children, but not for Thai-speaking children. Thailand is situated in South East Asia, and the language belongs to the monosyllabic, tonal, Sino-Tibetan group with extensive multisyllabic borrowings from the non-tonal, Pali-Sanskrit group. AIMS To assess the oral DDK rates for normal Thai children aged between 6 and 13 attending primary schools in order to establish a baseline for assessing, diagnosing and treating patients. METHODS & PROCEDURES Subjects included 197 students who repeated, in rapid succession, specified sounds representing different levels of physiologic complexity, as indicated by differences in the developmental schedule, articulatory placement and syllabic content. Twenty syllable repetitions were required for monosyllabic utterances, 15 for bisyllablics and 10 for trisyllablics. Visi Pitch Analysis was used to calculate the average time that subjects took to produce the sounds. OUTCOMES & RESULTS The time taken for the lip functions /pe,Cyrillic/, /a:-u:/, /u:-i/ and /i:-a:/ averaged 4.55, 6.67, 7.53 and 7.27 seconds, respectively. The tongue functions /te,Cyrillic/, /le,Cyrillic/, /ke,Cyrillic/ and click averaged 4.58, 4.82, 4.85 and 5.87 seconds, respectively. Tongue movement side-to-side between the corners of the mouth averaged 8.73 seconds, while the lip-tongue functions /pe,Cyrillic-te,Cyrillic/, /pe,Cyrillic-ke,Cyrillic/ and /pe,Cyrillic-te,Cyrillic-ke,Cyrillic/ were 6.97, 7.52 and 6.85 seconds, respectively. Sex and age influenced oral DDK time. The findings differ from those reported for English-speaking children. CONCLUSIONS A basis for assessment of children with neuromotor deficits or oral structure impairment is provided for both Thai and South East Asian children with similar physiological development and languages with similar sounds.

Speech camp for children with cleft lip and/or palate in Thailand

Abstract Background: There is a critical need for speech therapy services for people born with cleft lip and/or palate in developing countries. Objective: Assess the effectiveness of a speech camp and follow-up session for children with cleft lip and/or palate. Methods: A Community-Based Model for Speech therapy was implemented at Suwanaphum Hospital District, Roiet, Thailand. Thirteen children with cleft lip and/or palate (3; 6-13 years) attended a four-day speech camp and a one-day follow-up session (six months later) for remediation of their articulation disorders. Paraprofessional training was also provided. Pre- and post-tests were administered to the participants, caregivers, and paraprofessionals to determine the effectiveness of the program. A pre- and post-articulation test, as well as an audiological evaluation were administered. Five speech and language pathologists provided speech therapy, both individual and group, for a total of 18 hours during the four-day speech camp and six hours in the one-day follow-up session. The median difference of the number of articulation errors was determined by results of the Wilcoxon Signed-Rank Test. Results: There was a significant decrease in articulation errors following both the main speech camp and the follow-up session (z = 3.11, p < 0.01; z = 2.87, p<0.01, respectively). Caregivers’ and health care providers’ satisfaction ratings for participation in the speech camps ranged from good to excellent. Conclusion: A Community-Based Model of both a speech camp and follow-up session provided an effective speech therapy treatment for children with cleft lip and/or palate.

Thai Speech Parameters for Patients with Cleft Palate in a Universal Reporting System

Abstract Speech characteristics in patients with cleft palate have typical patterns that include delayed speech and language development, articulation deficits, resonance disorders, voice disorders, and poor intelligibility. There need to be a reporting system developed as a standardized routine protocol that would be a more consistent reporting system and a means to compare speech outcomes across centers, languages, and within languages in order to make valid comparisons. Aim: To establish Thai speech parameters for patients with cleft palate in a universal reporting system. Methods: To develop a Thai universal parameters for speech outcomes based on speech sampling guidelines for universal parameters for reporting speech outcomes in individuals with cleft palate, four speech/language pathologists (SLPs) who had had experience working with individuals with cleft palate had consensus and established the first draft. Then, the speech parameter group submitted comments and suggestions on their first version. The speech samples were pictures drawn and presented to determine the validity of the two groups of 20 patients with cleft palate. This population was drawn from speech camps and 10 children without a cleft palate for content and face validity as suggested by the SLP raters. The final version was based on data from 16 children who had cleft palates and were enrolled in the project from the speech camp and community-based speech therapy model for children with cleft lip and palate and from a project of 5-year outcome of children with cleft palate and the Center for Cleft/Lip and Palate and Craniofacial Deformities, and Khon Kaen University, in association with the Tawanchai Project. Results: The final set of Thai speech parameters was composed of seven typical speech characteristics of individuals with cleft palate. The percentage of agreement ranged from 43.75 to 100. Thirty percent of the proportion of positives ranged from 0.70 to 1. Thirteen percent of proportion of negatives ranged from 0.70 to 1. Conclusion: This test might be recommended as the universal standard as a methodological approach when reporting audits and research outcomes. The SLP raters further recommended that there be ongoing training programs in listening skills for specialists for judging these types of outcomes.

Five-year speech and language outcomes in children with cleft lip-palate

OBJECTIVE To investigate 5-year speech and language outcomes in children with cleft lip/palate (CLP). MATERIALS AND METHODS Thirty-eight children aged 4-7 years and 8 months were recruited for this study. Speech abilities including articulation, resonance, voice, and intelligibility were assessed based on Thai Universal Parameters of Speech Outcomes. Language ability was assessed by the Language Screening Test. RESULTS The findings revealed that children with clefts had speech and language delay, abnormal understandability, resonance abnormality, and voice disturbance; articulation defects that were 8.33 (1.75, 22.47), 50.00 (32.92, 67.08), 36.11 (20.82, 53.78), 30.56 (16.35, 48.11), and 94.44 (81.34, 99.32). CONCLUSIONS Articulation errors were the most common speech and language defects in children with clefts, followed by abnormal understandability, resonance abnormality, and voice disturbance. These results should be of critical concern. Protocol reviewing and early intervention programs are needed for improved speech outcomes.

Thai Speech and Language Test for children between 1 and 2 years of age

BACKGROUND Children with delayed speech and language development are at considerable risk for later language impairment, social and behavioural problems, and illiteracy. Early diagnosis is needed for intervention planning and prevention. However, a speech and language test for Thai children has not been available. AIMS To establish a Thai Speech and Language Test for Thai children between zero and 2 years of age. METHODS & PROCEDURES The authors reviewed both Thai and international speech and language development tests and studies related to factors associated with speech and language development. A Thai Speech and Language Test for children between zero and 2 years of age (TSLT2) was then formulated. The test was used with 419 typically developing Thai children in Khon Kaen, north-east Thailand. OUTCOME & RESULTS Language quotients were calculated to quantify/qualify Thai language development norms. Inter-rater reliability of the test ranged between 0.64 and 1, while internal consistencies ranged between 0.83 and 0.95 for tests on children between 1 and 2 years of age. CONCLUSIONS Professionals or paraprofessionals can use the Thai Speech and Language Test for children between 1 and 2 years of age, which is the first Thai tool for the assessment, diagnosis and remediation planning of children with delayed speech and language development. It should be also adapted for use in other regions in Thailand. However, the test for children aged between 3 and 9 months should be revised and continue to be developed.

Time and frequency of maximum phonation of normal Thai children in Khon Kaen

The time and frequency of maximum phonation are simple and common clinical tests for evaluating vocal function. The few standard measurements available for Western children are not so appropriate for Thai children. We therefore evaluated 201 normal students, in grades 1-6, from five schools in Khon Kaen Municipality. The maximum phonation times in normal Thai children for the vowel sounds /aː/, /uː/, /iː/ and /s/ measured by Speech Viewer II and a stopwatch were 10.17, 10.15, 10.80, n/a and 10.21, 10.21, 10.40, 7.92 seconds, respectively. The frequencies of maximum phonation time measured by Speech Viewer II for the vowel sounds /aː/, /uː/ and /iː/ were 251.89, 270.02 and 277.78 Hz. The Pearson correlations comparing the Speech Viewer II to the stopwatch were high (0.99-1). The influence factors affecting the time and frequency of maximum phonation are discussed. Our data can serve as a baseline when comparing, diagnosing and treating the maximum phonation time and frequency of patients with voice disorders.

Original article. Articulation disorders and patterns in children with a cleft

Abstract Background: Compensatory articulation disorders (CAD) are the most common speech defects in patients with a cleft. Early prevention programs are needed to avoid CAD. Objectives: To examine articulation disorders, patterns, and related speech outcomes in children with a cleft palate with or without lip defects. Methods: Articulation test record forms and clinical records of 42 children were accessed retrospectively to provide the data of speech outcomes related to cleft palate. Double data entries and incorrect completion type errors were corrected. Results: Prevalence of articulatory defects was 88% (functional articulation disorders, 12%; compensatory articulation disorders, 10%; functional articulation disorders and CAD, 67%), resonance disorder was 50%, and voice abnormalities was 19%. Abnormal backing of oral consonants, particularly glottal substitution was the most common pattern of CAD (40%), follow by velar substitution (36%), and nasal consonant for oral pressure consonant (21%). There was high incidence of functional articulation disorder in patients with a cleft (76%). Younger children (≤7 years old) had more articulation defects than older children (>7 years old) (mean difference = 3.308, P = 0.002, 95% confident interval 1.683-6.971). Levene’s test for equal variance found that resonance disorder seems unaffected by the number of articulation errors (mean difference = 0.253, P = 0.897, 95% confident interval -3.736-4.241). Conclusion: CAD, particularly abnormal backing of oral consonants and hypernasality were the most common speech defects in children with cleft. Refinement and revision of timing for referring for early speech intervention should be reconsidered.