The Reliability of Visual Ratings of Velopharyngeal Physiology for Speech.

BACKGROUND: Analyze intrarater and interrater reliability for evaluating endoscopic images of velopharyngeal (VP) physiology. METHOD: Speakers produced 9 speech stimuli representing 4 stimulus types: sustained phonemes, repetitions of "puh," single words, and short phrases. The 37-speaker participants included 16 patients with VP dysfunction and 21 control participants. Five raters independently rated the video images for degree of VP opening, location of opening, and pattern of closure. Outcome measures included intrarater and interrater measures of reliability and the effects of raters and stimulus type on ratings. RESULTS: Intrarater reliability was acceptable, and ratings were logically consistent. Fixed effects regression coefficients for the patient and the control groups showed that raters were a significant source of variability for degree of opening and pattern of closing. Stimulus type was not a significant source of variation for any metric for the controls, but stimulus type was a significant determinant for degree of opening for patients. The degree of opening was larger for sustained phonemes than for the other speech stimuli. Ratings for degree of opening were most similar for repeated "puh." CONCLUSIONS: Interrater reliability needs to be improved so that the assessment procedure produces more consistent findings among clinicians, thus strengthening our evidence base for this procedure. Interrater additional research is needed to understand how the stimulus affects ratings of VP physiology, to identify stimuli that yield the most useful clinical information, and to understand how training affects the ratings of VP physiology.

Perceptual Anchors and the Dispersion of Nasality Ratings.

OBJECTIVE: This investigation studied the effects of perceptual anchors on the dispersion and reliability of listener ratings of nasality. DESIGN: Listeners (N = 129) were assigned to one of six listening groups. Each group rated nasality independently for 100 speech samples on a seven-point scale that ranged from 1 = normal nasality to 7 = severe hypernasality. The anchors used were examples of a 1, 3, 4, 5, and/or 7 on the rating scale. These anchors were played selectively to group 2 (4), group 3 (1 and 7), group 4 (3 and 5), group 5 (1, 4, 7), and group 6 (7). Group 1 had no anchor. PARTICIPANTS: Of the speakers, 95 were children followed by a craniofacial team and five were children without histories of speech disorders. MAIN OUTCOME MEASURES: The outcome measures were 12,900 ratings of nasality on a seven-point scale. RESULTS: Q values showed that group 5, which was the only group to receive three anchors, had the lowest, or best, Q value (0.78), and group 1 (no anchor) had the highest, or worst, Q value (0.99). Across groups, the most reliable ratings were those at scale values 1 (Q = 0.46) and 7 (Q = 0.56). The least reliable ratings were at scale values 3 (Q = 1.01), 4 (Q = 1.03), and 5 (Q = 1.06). CONCLUSIONS: Nasality rating reliability/dispersion was influenced by the presence and location of anchor stimuli. Consistent with absolute judgment theory, nasality ratings showed a strong end effect.

The differential influence of vowels and palatal covering on nasalance scores.

Objective : To investigate whether nasalance scores would differ when the hard palate and soft palate were covered during speech. Design : Nasalance scores were obtained during production of sentence stimuli loaded with differing vowel content across three conditions: (1) hard and soft palate uncovered (U); (2) hard palate covered by acrylic appliance (H); (3) both hard and soft palate covered by acrylic appliance (B). Sentences were loaded with high front, low front, high back, low back, or mixed vowels. Velopharyngeal closure was verified by nasoendoscopy. Participants : Six female adults with normal speech and resonance provided the speech samples. Main Outcome Measures : Nasalance scores for each of five sentences in each of three palatal conditions. Results : Mixed and high front sentences had significantly higher mean nasalance scores in the U (P < .01) and H (P < .05) conditions but not in the B condition. For all sentence stimuli combined across palatal conditions, there was a significant difference in mean nasalance scores between H and B conditions (P < .05) but not between the U condition and either the H or B conditions (P > .05). Conclusions : Data suggest that the primary place of transpalatal transfer of acoustic energy was the soft palate but only sentences with high-front vowels were affected by this phenomenon.

Reliability and validity of nasality ratings between a monolingual and bilingual listener for speech samples from English-Spanish-Speaking children.

OBJECTIVE: This study sought to determine if a monolingual English listener could rate nasality in English and in Spanish with the same proficiency as a bilingual English-Spanish listener, and to compare nasalance scores with nasality ratings. PATIENTS AND METHODS: Speakers for this study were 26 bilingual English-Spanish-speaking children. Speech samples and nasalance scores were obtained simultaneously as each speaker recited one English sentence and one Spanish sentence. A monolingual listener and a bilingual listener rated nasality. RESULTS: For the English sentences, the intrajudge correlation coefficient was r = 0.89 for the monolingual listener and r = 0.89 for the bilingual listener. For the Spanish sentences, the intrajudge correlation coefficient was r = 0.91 for the monolingual listener and r = 0.92 for the bilingual listener. Interjudge agreement was r = 0.86 for rating English sentences and r = 0.78 for rating Spanish sentences. All correlation coefficients were significant (p < 0.001). The correlation coefficients between nasality ratings and nasalance scores were essentially the same for both listeners and both languages. CONCLUSION: A monolingual and a bilingual judge had high agreement on ratings of nasality for English and Spanish speech. The relationship between nasalance and nasality was not different across languages.

Sports game play: a comparison of moderate to vigorous physical activities in adolescents.

BACKGROUND: Research suggests participation in sports is an important contributor to overall adolescent physical activity (PA). Sports play has become increasingly important in physical education (PE) classes as a means for promoting healthful and enjoyable PA. Research is needed that investigates physiological and perceptual responses to sport play. METHODS: We studied 101 (55 males; 46 females, age 11-14) students who participated in flag football (FF), basketball (BB), and flag rugby (FR). Activity counts were collected using accelerometers. Perceived competence and enjoyment were measured using the intrinsic motivation inventory. RESULTS: Each sport activity produced acceptable levels of activity and positive perceptual responses, but differences among sports were noted. Accelerometry data indicated that FR and BB were more intense than FF (p < .001). Perceptual data indicated participation in FR elicited higher perceptions of competence and greater enjoyment when compared to FF and BB (p < .001). CONCLUSIONS: Participation in sport activity within middle school PE classes provides excellent opportunities for energy expenditure and positive perceptual responses. Most importantly, FR provides an activity stimulus that has potential benefits both physiologically and psychologically.

Relationship between the perception of hypernasality and social judgments in school-aged children.

Purpose : This study investigated both the ability of children to rate nasality and the relationship of those ratings to expert ratings and social acceptance judgments. Method : A total of 10 speech samples were judged for nasality by 44 children ranging in age from 8 to 11 and by an expert judge. Listeners rated nasality on a 3-point response scale. The peer listeners also made five social acceptance ratings about each speaker. Results : Kappas for interrater reliability were moderate to substantial. There was no difference between peer ratings and expert ratings. As ratings of nasality increased, social acceptance ratings became more negative. Conclusion : Professionals who evaluate and treat children with cleft palate should consider the negative social consequences of even mild hypernasality.

The relationship between nasalance scores and nasality ratings obtained with equal appearing interval and direct magnitude estimation scaling methods.

OBJECTIVES: To assess the nasalance/nasality relationship and Nasometer test sensitivity and specificity when nasality ratings are obtained with both equal appearing interval (EAI) and direct magnitude estimation (DME) scaling procedures. To test the linearity of the relationship between nasality ratings obtained from different perceptual scales. STIMULI: Audio recordings of the Turtle Passage. DESIGN: Participants' nasalance scores and audio recordings were obtained simultaneously. A single judge rated the samples for nasality using both EAI and DME scaling procedures. PARTICIPANTS: Thirty-nine participants 3 to 17 years of age. Across participants, resonance ranged from normal to severely hypernasal. MAIN OUTCOME MEASURES: Nasalance scores and two nasality ratings. RESULTS: The magnitude of the correlation between nasalance scores and EAI ratings of nasality (r  =  .63) and between nasalance and DME ratings of nasality (r  =  .59) was not significantly different. Nasometer test sensitivity and specificity for EAI-rated nasality were .71 and .73, respectively. For DME-rated nasality, sensitivity and specificity were .62 and .70, respectively. Regression of EAI nasality ratings on DME nasality ratings did not depart significantly from linearity. CONCLUSIONS: No difference was found in the relationship between nasalance and nasality when nasality was rated using EAI as opposed to DME procedures. Nasometer test sensitivity and specificity were similar for EAI- and DME-rated nasality. A linear model accounted for the greatest proportion of explained variance in EAI and DME ratings. Consequently, clinicians should be able to obtain valid and reliable estimates of nasality using EAI or DME.

The effect of nasal decongestion on nasal patency and nasalance scores in subjects with normal speech.

OBJECTIVE: The objective of this study was to evaluate the effects of pharmacological decongestion on nasalance scores. PARTICIPANTS: The participants were 20 adults with normal speech and resonance. METHODS: Nasal patency was first determined by measuring the mean minimal cross-sectional area of the nasal passages by acoustic rhinometry. Each participant then read two passages as two predecongestion nasalance scores were obtained. A nasal decongestant was then administered to each nostril without removing the separation plate. Ten minutes later, nasalance scores were repeated. Finally, the separation plate was removed and the mean minimal cross-sectional area was obtained again. MAIN OUTCOME MEASURES: The outcome measures were the pre- and postdecongestion measurements of nasal patency and nasalance scores. RESULTS: Minimal cross-sectional area increased significantly from 0.53 cm(2) before decongestion to 0.66 cm(2) after decongestion. For the Turtle Passage, the group mean nasalance for the two predecongestion measures (10.70% versus 11.55%) were significantly different and the pre- versus postdecongestion measures (10.70% versus 12.15%) were also significantly different. For the Mouse Passage, the group mean nasalance scores for the two predecongestion measures (32.10% versus 32.00%) were not significantly different but the pre- versus postdecongestion means (32.10 versus 34.40) were significantly different. Correlation coefficients showed a negligible relationship between measures of nasal patency and nasalance scores for both stimulus passages. CONCLUSIONS: Nasalance score variability was small and not meaningful for standard clinical purposes. The correlation between nasalance scores and nasal patency was weak.

Comparison of short-term and long-term variability in nasalance scores.

OBJECTIVE: To evaluate long-term nasalance score variability while accounting for short-term variation associated with subject performance and headgear change variability. STIMULI: Turtle and Mouse Passages. DESIGN: Short-term immediate test-retest nasalance score variability was assessed with no headgear change (NCHG) and with change of headgear (CHG). Long-term variability was assessed with scores obtained in the morning and afternoon of the same day, 1 day apart, and 1 week apart. Scores from the long-term conditions necessarily reflect variability associated with headgear change plus variability, which may be attributed to time. PARTICIPANTS: Twenty-six adults (19 to 70 years of age) with normal speech and resonance. MAIN OUTCOME MEASURES: Forty-six nasalance scores per subject. RESULTS: Mean nasalance difference scores across conditions were compared. Three contrasts were significantly different, each involving comparison of nasalance difference scores in the NCHG condition to difference scores from a CHG condition. Overall, long-term variability was slightly greater than short-term variability. For the Turtle Passage, in the short-term CHG condition, 92% of repeated scores were within five points. In the long-term conditions, 83% to 89% of scores were within five points. For the Mouse Passage, 88% of repeated scores in the CHG condition were within five points. In the long-term conditions, 81% to 83% of scores were within five points. CONCLUSIONS: Nasalance scores obtained over time showed slightly greater variability than scores obtained in immediate test-retest conditions; however, variability did not increase as the length of time between measures increased.

Effect of vowel type on reliability of nasality ratings.

UNLABELLED: This study investigated the effects of high front (HF) vowels and low back (LB) vowels on inter-listener and intra-listener reliability in rating hypernasality. Audio recorded samples of two sentences, one containing only high front vowels and one containing only low back vowels, were judged by two expert listeners. Speakers were 25 children; 20 hypernasal and 5 with normal resonance. The inter-listener ratings for LB samples were more similar than the inter-listener ratings for HF samples (t=3.20, (24), p=.004). The mean difference between the two listeners' ratings for the LB samples was 46.32 (S.D. 49.66) and for the HF samples 85.39 (S.D. 85.81). For intra-listener reliability, the ratings for the LB vowels were significantly more similar for one listener but not for the other. Additionally, the HF samples were rated as significantly more nasal than the LB samples. These findings suggest that listener reliability can be influenced by the vowel content of the stimulus. LEARNING OUTCOMES: As a result of this activity, the participant will be able to (1) describe the general effects of phonemes on judgments of hypernasality; (2) describe the specific effects of vowel types on the reliability of inter-listener and intra-listener judgments of nasality; and (3) appreciate how this information might be used in clinical and research applications.

Test-retest nasalance score variability in hypernasal speakers.

OBJECTIVE: The objective of this study was to evaluate test-retest nasalance score variability in subjects with hypernasal resonance. DESIGN: Two groups of subjects with hypernasal speech recited both the Turtle Passage and the Mouse Passage two times each. For one group, the Nasometer headgear was not changed between repetitions of each stimulus (NCHG; n = 17); and for the other group, the headgear was changed between repetitions (CHG; n = 18). Three subjects in the CHG group would not recite the Mouse Passage two times. PARTICIPANTS: The subjects were 35 patients with hypernasal speech followed by a cleft palate team. MAIN OUTCOME MEASURES: The outcome measures were the four nasalance scores obtained for each subject. RESULTS: There was no significant difference between first and second repetitions for either stimulus in either the NCHG group or in the CHG group. Cumulative frequency tables showed that for the Turtle Passage-NCHG condition, 15 of the 17 (88%) repeated nasalance scores were within 5 nasalance points of each other. For the CHG condition, however, only 9 of 18 (50%) repeated nasalance scores were within 5 points. For the Mouse Passage-NCHG condition, 15 of the 17 (88%) repeated nasalance scores were within 5 points. For the CHG condition, however, only 11 of 15 (73%) repeated scores were within 5 points. CONCLUSIONS: Test-retest variability was greater in a population of hypernasal patients than that reported in other studies for normal speakers, and headgear change increased test-retest variability.

Comparison of Nasalance scores obtained with the Nasometer 6200 and the Nasometer II 6400.

OBJECTIVE: This study was designed to compare nasalance scores obtained with the old Nasometer 6200 and the new Nasometer II 6400, and to evaluate test-retest reliability of nasalance scores on each machine. DESIGN: Nasalance scores were obtained for 60 subjects reading each of two stimuli. Each subject read each stimulus two times on one machine; the headgear was removed and replaced and each stimulus was read a third time. The same procedure was then repeated with the second machine. Within machines, nasalance scores were compared for repeated stimuli with and without headgear change. The first reading of each stimulus with each machine was used to compare nasalance scores across machines. PARTICIPANTS: The subjects were 60 adults with normal speech ranging in age from 19 to 59 years. MAIN OUTCOME MEASURES: The main outcome measures were the 12 nasalance scores obtained for each of 60 subjects. RESULTS: For both passages, there was a significant difference in nasalance scores between the old Nasometer and the Nasometer II; however, the actual variability that could be attributed to a difference between machines was small. Most of the variability between machines could be explained as within-subject performance variability and variability associated with headgear change. There was no significant difference in repeated scores within machines with or without headgear change. CONCLUSIONS: For clinical purposes, care should be exercised when comparing nasalance scores between the old Nasometer and the Nasometer II.

The influence of listener experience and academic training on ratings of nasality.

This study assessed listener agreement levels for nasality ratings, and the strength of relationship between nasality ratings and nasalance scores on one hand, and listener clinical experience and formal academic training in cleft palate speech on the other. The listeners were 12 adults who represented four levels of clinical experience and academic training in cleft palate speech. Three listeners were teachers with no clinical experience and no academic training (TR), three were graduate students in speech-language pathology (GS) with academic training but no clinical experience, three were craniofacial surgeons (MD) with extensive experience listening to cleft palate speech but with no academic training in speech disorders, and three were certified speech-language pathologists (SLP) with both extensive academic training and clinical experience. The speech samples were audio recordings from 20 persons representing a range of nasality from normal to severely hypernasal. Nasalance scores were obtained simultaneously with the audio recordings. Results revealed that agreement levels for nasality ratings were highest for the SLPs, followed by the MDs. Thus, the more experienced groups tended to be more reliable. Mean nasality ratings obtained for each of the rater groups revealed an inverse relationship with experience. That is, the two groups with clinical experience (SLP and MD) tended to rate nasality lower than the two groups without experience (GS and TR). Correlation coefficients between nasalance scores and nasality judgments were low to moderate for all groups and did not follow a pattern. EDUCATIONAL OUTCOMES: As a result of this activity, the reader will be able to (1) describe the influence of listener experience and academic training in cleft palate speech on perceptual ratings of nasality. (2) describe the influence of experience and training on the nasality/nasalance relationship and, (3) compare the present findings to previous findings reported in the literature.

Comparison of nasalance scores obtained from the Nasometer and the NasalView.

OBJECTIVE: Nasalance scores obtained from the Nasometer and the NasalView were compared for five different sentences. DESIGN: Vowel content was controlled in the design of the five stimulus sentences. One sentence was loaded with high-front vowels, one with high-back vowels, one with low-front vowels, one with low-back vowels, and one contained a mixture of vowel types. SUBJECTS: The subjects were 50 elementary school children ranging from kindergarten to sixth grade. Each subject was a native speaker of English, had no history of adenoidectomy, and was not currently enrolled in speech therapy services. MAIN OUTCOME MEASURES: The main outcome measures were the nasalance scores obtained from the Nasometer and the NasalView for each of the five sentences. RESULTS: There was a significant difference in the nasalance scores between the Nasometer and the NasalView for four of the five stimuli, but not all differences were in the same direction. For two stimuli, the Nasometer scores were significantly higher, and for two stimuli the NasalView scores were higher. Bivariate correlations between nasalance scores for individual stimuli were in the good range for the Nasometer but poor for the NasalView. CONCLUSION: Speech stimuli weighted with different vowel types are differentially affected by the different acoustical filtering used in the Nasometer versus the NasalView. Nasalance scores obtained with the NasalView were qualitatively and quantitatively different from those obtained with the Nasometer. This suggests that the two machines provide different information, and the scores are not interchangeable.