AN INSTRUMENT FOR THE MULTIPARAMETER ASSESSMENT OF SPEECH

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1 AN INSTRUMENT FOR THE MULTIPARAMETER ASSESSMENT OF SPEECH by Paul Dean Sharp A thesis submitted for the Degree of Doctor of Philosophy in Electronic Engineering at the University of Kent at Canterbury 2000

2 ABSTRACT Speech is the result of a highly complex and versatile system of co-ordinated muscular movements, and although perceptual assessments contribute valuable information to the process of diagnosing speech disorders, instrumental observation and measurement offer significant advantages. Increasingly, clinicians are beginning to appreciate the considerable benefits of instrumental analysis, which provides quantitative, objective data on a wide range of different speech parameters. In addition, such measures are becoming increasingly important as the need to prove efficacy grows. Although current instruments are extremely useful, giving excellent measures of individual articulatory function, few are able to measure the co-ordination of the main articulators. The instrumentation described in this thesis, namely SNORS+, encompasses several speech assessment techniques in a single PC based clinical system. Both hardware and software provide a user-friendly interface that allows the simultaneous measurement of five key speech parameters: respiration, larynx excitation, velopharyngeal closure, tonguepalate contact and speech outcome. In addition, audio playback provides accurate identification of the recorded multiparameter data, and a synchronised video input enables simultaneous use with established imaging techniques. The results of a small trial conducted on 40 subjects, considered by the author to exhibit normal speech, are presented. The outcome of this trial has produced a series of baseline parameters that may be used to compare normal speech with pathological speech. To allow comparison with pathological data, two case studies are presented. The first study examines the hypernasal speech production of a cleft palate subject, and second investigates the speech production of a young boy with lateral misarticulations. The development of SNORS+ has given clinicians the unique ability to assess the contributory and co-ordinated effects of the main articulators on speech production. As a result, the system has proved to be extremely valuable in the assessment and treatment of various speech disorders. ii

3 TABLE OF CONTENTS 1 Introduction Speech and Language Speech Production Disorders of Speech and Language Speech Assessment Techniques Project Overview Thesis Structure Speech Speech Production Speech Organs Articulatory Phonetics Place and Manner of Articulation Consonants Vowels Disorders of Speech and Language Developmental Disorders Cleft Lip and Palate Acquired Dysarthria Acquired Apraxia and Dyspraxia Aphasia Speech and Language Therapy Assessment of Articulatory Speech Disorders Treatment of Articulatory Speech Disorders Instrumental Assessment Techniques Aerodynamic Assessment The Super Nasal Oral Ratiometry System (SNORS) iii

4 3.2 Electrolaryngography Laryngograph Electropalatography Linguagraph Imaging Techniques Videofluoroscopy Endoscopy Acoustic Analysis Oscillographic Displays FFT Displays Spectrograms Summary Project Specification System Specification EN and EC directive 93/42/EEC Technical Specification Operating System Data Acquisition Card Sound Card Video Acquisition Card PC Specification Hardware Overview External Module Connection Enveloped Lx Signal High and Low Waveform Resolution Switching Fundamental Frequency Derivation from Laryngograph Dual Channel EPG Audio Signal Conditioning Automatic Module Detection Auxiliary Channel iv

5 4.4 Software Overview C and the Multiple Document Interface The Main Application Window Real-Time Windows Test Protocol Test Analysis Windows File Handling Printing Help SNORS Hardware Implementation Linguagraph Interface Linguagraph Overview Input Buffers Dual Channel Multiplexers The Clock Generator Signal Conditioning Lx Envelope Generator High-Pass Filter Half Wave Rectifier and Low-Pass Filter Offset and Gain Adjustment Fx Generator Voltage Level Shifter and Frequency to Voltage Converter Low-Pass Filter and Gain Adjust Waveform Resolution Switching Automatic Module Detection Audio Signal Conditioning Power Supply PCB Design v

6 6 Biofeedback Software Implementation The Multithreaded Environment Scheduling The Thread Architecture The DAS-1202 Data Acquisition Thread Initialisation Data Acquisition Data Notification Thread Termination The Real-Time Bar Window High-Level Function Low-Level Function The Real-Time Scope Window High-Level Function Low-Level Function The Real-Time EPG Window High-Level Function Low-Level Function The Wave Data Acquisition Thread Initialisation Data Acquisition Data Notification Thread Termination The Real-Time Wave Window High-Level Function Low-Level Function The Real-Time FFT Window High-Level Function Low-level Function The Real-Time Spectrogram Window High-Level Function vi

7 6.9.2 Low-Level Function The Real-Time Video Window High-Level Function Low-Level Function Analysis Software Implementation Test Protocol Word List The Word Display Period Sample Frequency Parameter Selection Display Options Setup The Test Data Acquisition Thread Initialisation Data Acquisition The Test Analysis Windows The Test Scope Window Test Analysis Child Windows Results and Analysis Qualitative Analysis of Multiparameter Data Analysis of Combined Acoustic, Airflow, Voicing and EPG Data Analysis of Combined Airflow and Videofluoroscopy Data Quantitative Analysis of Multiparameter Data The Trial Analysis Procedure Results A Single Aerodynamic Case Study Analysis of Electropalatography Data Qualitative Analysis of Electropalatography Data Electropalatography Data Reduction vii

8 8.3.3 Quantitative Analysis of Electropalatography Data A Single Electropalatography Case Study Conclusions and Further Work Clinical Evaluation Clinical Measurements Relating Speech Mechanism to Outcome Assessment of Velopharyngeal Incompetence Identification of Tongue-Palate Configurations Further Work Novel Clinical Applications Hardware and Software Enhancements Bibliography Appendices viii

9 PREFACE The research documented in this thesis was funded by the Engineering and Physical Sciences Research Council (EPSRC), and conducted within the Medical Electronics Research Group, Electronic Engineering Laboratory, University of Kent at Canterbury. During the research period, aspects of the work contained in this thesis have been published in the Journal of Medical Engineering and Physics (Sharp et al., 1999), and presented at numerous conferences, symposiums and study days. In addition, eleven SNORS+ systems are now in regular clinical use in the UK, Sweden and Iran. ix

10 ACKNOWLEDGEMENTS I wish to express my particular appreciation towards my supervisor, Mr Steve Kelly, for his constant support and encouragement throughout the course of this research. I would like to extend my thanks to all those subjects who consented to participate in the clinical trail, and to the many clinicians who s constructive comments have made a significant contribution to this research. Particular mention must be made of: Ms. Alison Main, Speech and Language Therapist, for her rigorous clinical evaluation of the user interface. Mr. John Boorman, Plastic Surgeon, and Ms. Denise Dive, Speech and Language Therapist, for their collaboration on the technique of multiparameter assessment with combined videofluoroscopy. Dr. Graham Manley, Dental Surgeon, for introducing the work on speech assessment techniques to the Medical Electronics Research Group some 13 years ago, and for his collaboration throughout the course of this project. I also acknowledge the debt I owe to all past and present members of the Medical Electronics Research Group for their help and assistance. Lastly and most importantly, I would like to thank my family and close friends for their patience and support during the last three years. x

11 CHAPTER 1 INTRODUCTION 1.1 Speech and Language The human ability to produce and understand speech is often taken for granted, and little thought is given to its nature and function. It is not surprising, therefore, that many people overlook the great influence of speech on the development and normal functioning of human society (Denes and Pinson, 1968). Speech is the conversion of a language into sound (Borden and Harris, 1984). A particular language is a rule governed communication system composed of meaningful elements, which can be combined in many ways to produce sentences. Wherever human beings cohabit they develop a spoken language with which to communicate; even people in the most primitive societies use speech as a means of communication. The most important feature of human language, that which differentiates it from every other known mode of animal communication, is its flexibility, subtlety and infinite range of meanings. To a great extent, the development of human civilisation is made possible by man s ability to share experiences, to exchange ideas and to transmit knowledge from one generation to another. Man has developed many systems with which to communicate, such as Morse code, semaphore, or the written word. Unquestionably, however, man has found speech to be the most efficient and convenient form of communication. An example of the overwhelming importance of speech in human society is a comparison of the social attitudes of the blind to those of the deaf. Generally, blind people tend to integrate well with their fellow human beings despite their handicap. But the deaf, who can still read and write, often feel cut off from society. Deaf people, deprived of their primary means of communication, tend to withdraw from the world and live within themselves (Denes and Pinson, 1968). When most people stop to consider speech, they think only in terms of lip and tongue movement. In reality, speech is the result of a highly complex and versatile system of coordinated muscular movements (Borden and Harris, 1984). 1

12 Chapter 1: Introduction 1.2 Speech Production Speech is produced by an air stream originating in the lungs, which is propelled upwards by the diaphragm through the trachea (the windpipe), oral cavity and nasal cavity. During its passage, various organs of speech (the articulators) modify this air stream to produce different speech sounds. Speech production may be divided into four separate but interrelated processes (Giegerich, 1992): The air stream generated in the lungs to power the speech process. Its phonation in the larynx through the operation of the vocal folds. Its direction by the velum into either the oral or nasal cavity. And finally its articulation, primarily by the tongue and lips in the oral cavity. The speech production process is illustrated in Figure 1.1. Velum Nasal Cavity Nasal Speech Lungs Vocal Folds Pharynx Tongue Combined Speech Oral Cavity Lips Oral Speech Passive Articulators Figure 1.1: The speech production process, taken from Sharp et al., (1999). When it is considered that the average rate of speech is up to four syllables per second, each of which may contain anything up to seven consonants and a vowel sound, the complexity of articulatory movement becomes apparent. It has been estimated that over 100 muscles are involved in the speech process (Lenneberg, 1967) and their controlled coordination requires around 140,000 neuromuscular events every second (Darley et al., 1975). If the timing and/or position of the articulators are not properly controlled, abnormal speech may occur. 2

13 Chapter 1: Introduction 1.3 Disorders of Speech and Language Disorders of speech and language refer to problems in communication and related areas such as articulatory function. These range from simple sound substitutions to the inability to understand language or control the speech production mechanism. Speech disorders can be either developmental or acquired, and may be either physical or neurological. Causes include: Mislearning where the speech mechanism is physically unaffected, but the individual is still unable to produce adequate speech. A classic example is the lisp. Sensory impairment where there is an impairment in the interaction of speech and other senses; for example in a profoundly deaf subject who cannot hear the speech they produce. Neurological disorders a common factor amongst these disorders is the lack of control over the speech production mechanism. For example, acquired dysarthria reduces muscular control of the articulators, and may result from Parkinson s disease, motor neurone disease and stroke (Darley et al., 1975). Structural defects where there is a physical defect in one or more of the speech production organs, making it physically impossible to generate the appropriate speech sounds. In cleft palate speech, for example, the ability to achieve adequate velopharyngeal closure during oral sounds is often affected. 1.4 Speech Assessment Techniques Assessment of speech defects is initially subjective, relying on the clinical judgement of the speech and language therapist. This will involve both assessment of the intelligibility and quality of the patient s speech, and observation of the visible aspects of articulation (e.g. lip and some tongue movement). However, the majority of the articulators are not visible during speech. Additionally, there is a growing need for evidence-based intervention. Therefore, objective quantitative assessment is increasingly important (Sharp et al., 1999). A number of individual instruments are available that can achieve this: Videofluoroscopy - records moving X-ray images onto videotape. This provides a view of the velum and tongue during speech, and yields useful dynamic information. 3

14 Chapter 1: Introduction Nasendoscopy - utilises an endoscope, passed through the nares and nasal cavity to image the velum during speech. The vocal folds can also be viewed in this way. Electroglottography - measures vocal fold activity. This is achieved by placing a set of electrodes on the patient s neck, either side of the thyroid cartilage. By passing a small electric current through the vocal folds and measuring impedance changes, it is possible to detect their vibration as well as simple movements of the glottis. Nasal anemometry - allows the position of the velum to be inferred by measuring nasal airflow during speech. Electropalatography - determines tongue-palate contact by using a special artificial palate containing an array of electrodes embedded on its tongue-facing surface. A small electrical signal, fed to the patient, is conducted through the tongue to any touched electrodes and thence, via the electronics unit, to a computer where the tonguepalate contact is displayed. Whilst the above techniques yield useful information about the individual articulatory function they provide little or no information relating to the synchronisation of the articulators. This is considered a major limitation when assessing speech disorders involving more than one articulator (Main, 1998). 1.5 Project Overview The instrumentation described in this thesis encompasses all of the above techniques in a single PC based clinical system. Both hardware and software provide a user-friendly interface that allows the simultaneous measurement of five key speech parameters: Respiration. Larynx excitation. Velopharyngeal closure. Tongue-palate contact. Speech outcome. These parameters may be displayed as trend waveforms over time, or as two-dimensional dynamic images. Data from the various instruments are synchronously combined within an interface unit, which facilitates a single connection to the host computer s data 4

15 Chapter 1: Introduction acquisition card. Audio playback provides accurate identification of sound elements within the featured waveforms. Synchronised video input allows simultaneous use with established and respected imaging techniques such as videofluoroscopy and nasendoscopy. In addition, the inclusion of spectral analysis software allows the rapid variations in the acoustic signal to be visualised and hence a measure of speech outcome to be obtained. A simplified block diagram of the system is illustrated Figure 1.2. Microphone Palate Electropalatography Unit Airflow Transducer Anemometry Unit Interface PC Electrodes Electroglottography Unit Video Source Figure 1.2: A block diagram of the multiparameter system. The result is a system capable of the simultaneous measurement of four major speech organs: the lungs, larynx, velum and tongue. Together with the resultant speech outcome this presents the clinician with a comprehensive view of the speech production process. 1.6 Thesis Structure The general structure of the thesis is detailed below. Chapter 1: Chapter 2: Presented a general overview of the project. Describes the physiological process of speech production, giving a detailed account of each major speech organ. Articulatory phonetics, which is the study of the individual speech sounds, is also discussed. The chapter then describes several disorders affecting speech and language, and concludes with a discussion on the role of speech and language therapy in the assessment of these disorders. 5

16 Chapter 1: Introduction Chapter 3: Chapter 4: Chapter 5: Chapter 6: Chapter 7: Chapter 8: Chapter 9: Introduces a selection of instrumental techniques commonly used in the assessment of disordered speech. Outlines the main user requirements of a multiparameter speech workstation. It then provides a full technical specification and concludes with a system overview in terms of both hardware and software. Discusses the technical aspects of the hardware, giving a detailed account of the individual elements that comprise the interface unit. Introduces the concepts of real-time data acquisition under the Windows operating system, and explains how these have been implemented in the biofeedback software. Describes the test protocol used to conduct formal speech assessment. Techniques for the synchronised acquisition of multiple source data are then discussed. Finally, the methods used to format, display and analyse the synchronised multiparameter data are described. Presents a series of test results acquired using the multiparameter system. This chapter is divided into three main sections: qualitative analysis of multiparameter data, quantitative analysis of multiparameter data (excluding lingual parameters), and the analysis of electropalatograpy data. Draws conclusions from the work presented in the thesis, and suggests areas of further research. 6

17 CHAPTER 2 SPEECH This chapter describes the physiological process of speech production, giving a detailed account of each major speech organ. Articulatory phonetics, which is the study of the individual speech sounds, is also discussed. The chapter then describes several disorders affecting speech and language, and concludes with a discussion on the role of speech and language therapy in the assessment of these disorders. 2.1 Speech Production On choosing to speak an individual must initially arrange their thoughts, decide on the message content, and then convert it into linguistic form (Denes and Pinson, 1968). The conversion is achieved by selecting the necessary words and phrases to express the meaning of the message, and by placing them in the correct order as dictated by the grammatical rules of the language. This process is associated with brain activity, and it is here that the appropriate instructions, in the form of impulses along the motor nerves, are generated and transmitted to the muscles of the vocal organs. These nerve impulses set the vocal muscles into motion, which in turn produce minute pressure changes in the surrounding air. The resultant sound waves produce similar pressure changes within the listener s ear, activating the hearing mechanism. Consequently, nerve impulses are produced which travel along the acoustic nerve to the brain where the original message is reconstructed. In addition, to ensure the resultant speech approximates to the speaker s original intention, he or she must continually listen to themselves whilst speaking and make any necessary adjustments, such as pitch level or voice intensity. In engineering terms the speech production process represents a closed loop feedback system Speech Organs The gross components of the human speech production mechanism are: the lungs (air supply) the trachea (windpipe) the larynx (vocal cords) 7

18 Chapter 2: Speech the pharyngeal cavity (throat) the oral cavity (mouth) the nasal cavity (nose) These are illustrated in Figure 2.1. Soft Palate (Velum) Hard Palate Nasal Cavity Nostril Oral Cavity Pharyngeal Cavity Larynx Lip Tongue Teeth Esophagus Jaw Trachea Lung Diaphragm Figure 2.1: Schematic view of the human speech production mechanism, taken from Rabiner (1993). Generally, the pharyngeal and oral cavities are grouped into one unit referred to as the vocal tract, which begins at the output of the larynx (or glottis), and terminates at the input to the lips. The shape of the vocal tract can be varied extensively by moving the active articulators such as the tongue, lips and jaw. The nasal cavity is often called the nasal tract, which begins at the velum and ends at the nostrils. When the velum is lowered the nasal tract is acoustically coupled to the vocal tract to produce nasal sounds. During speech, the lungs and associated muscles produce the air source required to power the vocal mechanism. The muscle force pushes air out of the lungs and through the trachea. 8

19 Chapter 2: Speech When the vocal cords are tensed, the airflow causes them to vibrate producing so-called voiced speech sounds. When the vocal cords are relaxed, in order to produce a sound, the airflow must pass through a constriction in the vocal tract and thereby become turbulent, producing so-called unvoiced sounds. Alternatively, the air can build up pressure behind a point of total closure within the vocal tract and cause a brief transient sound when the pressure is abruptly released. The sections that follow detail the individual speech organs and outline their respective role in the speech production process The Respiratory System The lungs are masses of spongy, elastic material contained within the rib cage. They supply oxygen to the blood and dispose of waste products such as carbon dioxide. The intercostal muscles, abdomen and diaphragm control the act of respiration. At rest a balance of forces exists between the lungs and thoracic cavity, and the pressure within the lungs (pulmonary pressure) is at atmospheric level. During inspiration, the diaphragm and external intercostal muscles contract which increase lung volume and hence decrease the pulmonary pressure. The reduction of pressure draws air into the lungs until atmospheric pressure is again reached. At the end of inhalation a state of equilibrium is reached thus preventing further airflow. On relaxation of the inhalation muscles, equilibrium is lost and the elastic forces of the lung and thoracic cavity contract the lungs. This increases the pulmonary pressure above atmospheric and draws air out of the lungs to produce an exhaled air stream. On completion of the exhalation phase, rest is again reached and the cycle repeats itself (refer to Figure 2.2). 9

20 Chapter 2: Speech Figure 2.2: The respiratory cycle, taken from Tortora and Grabowski (1993). Normal respiration rate is around fifteen times per minute, with the inspiration and expiration phases approximately equal in duration. However, during speech it is possible to influence the respiration rate in accordance with the length of the sentence or phrase. Since all English speech sounds are initiated by an egressive air stream (Giegerich, 1992), the duration of exhalation is increased and inhalation decreased. The respiration rate may reduce to as little as four times per minute during speech (Fry, 1994). 10

21 Chapter 2: Speech The Larynx The air from the lungs flows through the trachea towards the larynx, which is a cartilaginous tube connecting the trachea and the pharynx (refer to Figure 2.1). Its main function is to protect the airway by closing off during swallowing, and by expelling anything that enters the larynx by coughing. As illustrated in Figure 2.3, the larynx contains two horizontal folds of tissue (the vocal folds), which extend from the arytenoid cartilage to the thyroid cartilage (Adam s Apple). The gap between the vocal folds, through which the air stream passes upward into the oral cavity, is called the glottis. Arytenoid Cartilage Thyroid Cartilage (a) (b) Vocal Folds Figure 2.3: Diagram of the glottis shown from above with (a) vocal folds open and (b) vocal folds closed, taken from Plant (1999). During breathing the arytenoid cartilages are held outward, pulling the vocal folds to the side, thus keeping the glottis wide open. However, for many of the speech sounds, the vocal folds are used to interrupt the flow of air causing periodic pulses of sound or phonation (Main, 1998). This is achieved by moving the arytenoid cartilages inward to bring the vocal folds to a position of adduction. The lungs are caused to contract, generating a pressure head below the glottis. If the resulting force is sufficient, it overcomes the elastic force holding the vocal folds together, thereby causing the glottis to open and air to flow out. The vocal folds then close rapidly due to a combination of factors, including their elasticity, laryngeal muscle tension and the Bernoulli effect. Pressure below the glottis then builds up and the events repeat themselves. 11

22 Chapter 2: Speech The mass and length of the vocal folds vary; for example in men they are substantial and mm in length, whereas in women they are finer and mm in length. The differing mass and length lead to different fundamental frequencies of vibration: around 125 Hz in men, 200 Hz in women and 300 Hz in children (Borden and Harris, 1984). As mentioned, the vocal folds can be manipulated by the speaker and brought into a variety of different positions, thus altering the shape of the glottis. At least three such positions are linguistically significant: Closed glottis. The vocal folds are brought close together so that no air can pass between them. The resulting speech sound from the closure of the glottis and subsequent release is called the glottal stop and is sometimes heard in English preceding a forcefully pronounced vowel (as in Out!). Narrow glottis. When the vocal folds are brought together in such a way that makes them vibrate, the resulting sound waves characterise the voiced sounds of speech. All vowels are voiced, as are sounds like /m/, /l/, /v/, /b/ etc. Open glottis. The glottis assumes this state in normal breathing as well as in the production of voiceless sounds. The vocal folds are spread and do not vibrate; the glottis is of sufficient width as to allow the air stream to pass through without obstruction. Voiceless sounds are, for example, the /st/ sequence in stone the rest of the word is voiced. The resultant sound waves may be further modified by the configuration of the vocal tract The Pharynx The pharynx is the section of the vocal tract nearest the glottis. It is a muscular tube connecting the trachea and oesophagus to the oral and nasal cavities (refer to Figure 2.1). For speech, the pharynx serves as an acoustic filter that suppresses the passage of sound at certain frequencies while allowing its passage at other frequencies. The resonant properties of the pharynx and other cavities together modify the voice source and help characterise the individual speech sounds (phonemes). The overall shape, length and volume of the pharynx determine the transfer function of the filter. The flexibility of the human vocal tract, in which the articulators can easily adjust to form a variety of shapes, results in the potential to produce a wide range of sounds. 12

23 Chapter 2: Speech The Velum Having passed through the larynx and pharynx, the air stream may flow through the oral and nasal cavities. In normal breathing the air stream will usually pass through the nasal cavity. However, during many speech sounds the nasal cavity is blocked and the air stream is directed into the oral cavity. This is achieved with the velum, a muscular structure extending from the posterior border of the hard palate (refer to Figure 2.1). The nasal cavity is also obstructed during swallowing to prevent food or liquids from being forced through the nose. The velum, which may be adjusted, has two linguistically significant positions: Elevated. When raised and pressed against the back of the pharynx, the velum prevents the entry of air into the nasal cavity. Since the air stream emerges through the oral cavity the speech sounds produced in this manner are called oral sounds. The vast majority of consonants in the English language are produced in this manner. Lowered. When the velum is lowered the air stream has access to the nasal cavity. If at the same time the oral cavity is occluded, causing the entire air stream to pass through the nasal cavity, the result is a nasal sound. A purely nasal escape of this type occurs in the nasal consonants /m/, /n/ and //. The occlusion of the oral cavity is different for each of these sounds thus altering the dimensions of the resonating cavity. The velum has five pairs of muscles, which control its position within the pharynx. The lateral and posterior pharyngeal walls are made up of various pharyngeal muscles, and can move medially and anteriorly respectively to vary the cross sectional area of the pharynx. To achieve velopharyngeal closure the velum is elevated and moves posteriorly towards the walls of the pharynx, such that the mass of the velum blocks much of the cross section of the pharynx. In addition, the pharyngeal walls move medially. The movement of the velum and pharyngeal walls combine to form a closure of the velopharyngeal valve, required for most speech sounds. Borden and Harris (1984) suggest that, in general, a small gap in velopharyngeal closure (c. 20 mm 2 ) will not effect the resultant sound. However, larger gaps will cause audible nasal resonance The Tongue The most versatile of the articulators is the tongue, which is involved in the production of all vowels and the vast majority of consonants (Crystal, 1989). Different sounds require 13

24 Chapter 2: Speech different tongue configurations. By altering tongue position and shape, the size of the oral cavity and therefore its resonating characteristics are changed. Besides making movements required for speech, the tongue mixes food with saliva during chewing, forms the food into a bolus and initiates swallowing. The tongue covers the majority of the oral cavity floor. It consists primarily of connective tissue and muscle, covered with a mucous membrane. Both intrinsic and extrinsic skeletal muscle fibres form the tongue. The intrinsic muscles are confined to the tongue and are unattached to bone. They include bundles of fibres that run in three planes: longitudinal, transverse and vertical. These enable the fine, rapid control of tongue shape and positioning which are necessary for the articulation of speech sounds. The extrinsic muscles extend from the tongue to their points of origin on the hyoid, skull and mandible. Their purpose is to alter the gross tongue position within the mouth; they protrude, retract and elevate it. The extrinsic muscles also form the body of the floor within the mouth and hold the tongue in position. The tongue is divided by a midline connective tissue septum and each half contains identical groupings of the intrinsic and extrinsic muscles. In order to speak, the complex movements made by the tongue must be co-ordinated with the controlled movement of the other articulators. Any errors in co-ordination, speed of movement, shape, or place of tongue contact will cause articulation to be distorted and speech intelligibility to be affected (Crystal, 1989) The Lips The lips (labia) are composed mainly of the orbicuslaris oris muscle covered by skin on the outside and a mucous membrane on the inside. Many other muscles are attached to the orbicuslaris oris muscle and together they work to create the movements and power required for speech, eating and forming facial expressions. For speech production the lips have three functions: A place of closure. By closing and subsequently opening the lips, sounds such as the plosives /p/ and /b/ are produced. A resonance modifier. Variations in the size and shape of the resonating cavities can be achieved by altering lip shape. For example, lip rounding and protrusion lengthen the oral cavity, as in the articulation of the sound //. 14

25 Chapter 2: Speech A sound source. Where the lips are held sufficiently close together so that friction occurs between them. For example, during the sound /f/, the lower lip is raised against the upper incisors and air passing through the gap under pressure causes friction The Teeth and Hard Palate The speech organs that are not mobile are called passive articulators; these include the teeth (or more precisely, the incisors) and hard palate. The hard palate forms the anterior portion of the roof of the mouth and is divided into two sections: The alveolar ridge a hard ridge that can be felt behind the upper incisors. The palate a hard bony structure in the front part of the roof. Whilst not regarded as active articulators, the teeth and hard palate do contribute to the articulation of many speech sounds (Main, 1998). 2.2 Articulatory Phonetics Articulatory phonetics is the study of the individual speech sounds by identifying how and where they are articulated. To enable the various speech sounds to be accurately transcribed, the International Phonetic Association has developed the International Phonetic Alphabet (IPA). 15

26 Chapter 2: Speech Table 2.1: International Phonetic Alphabet, taken from Roach (1991). The following sections introduce the major classes into which speech sounds are divided according to the IPA system Place and Manner of Articulation The distinction between place and manner of articulation is particularly important for the classification of consonants. The manner of articulation is defined by a number of factors: Voiced vs. Voiceless: Whether there is vibration of the vocal cords. For example /v/, /d/ and /g/ are voiced, whereas /s/, /t/ and /k/ are unvoiced. Consonant vs. Vowel: Whether there is obstruction of the air stream at any point above the glottis. 16

27 Chapter 2: Speech Nasal vs. Oral: Whether the air stream passes through the nasal cavity in addition to the oral cavity. In English the only nasal consonants are /m/, /n/ and //. All other speech sounds are described as oral. Non-Lateral vs. Lateral: Whether the air stream passes through the middle of the oral cavity or along the sides. For example /s/ is non-lateral, whereas /l/ is lateral. The place of articulation is the point at which the air stream is obstructed, as illustrated in Figure 2.4. In the majority of cases it is possible to characterise the place of articulation in terms of the passive articulators involved (Giegerrich, 1992). Alveolar Palatal Velar Uvular Bilabial Labio-Dental Pharyngeal Dental Glottal Figure 2.4: Places of articulation, taken from O Connor (1991). The place of articulation can be any of the following: The lips (bilabials), examples include /p/ and /b/. The teeth (dentals), examples include // and //. The lips and teeth (labio-dentals), examples include /f/ and /v/. The alveolar ridge (alveolar articulations), examples include /t/, /d/ and /l/. The hard palate (given its large size, it is possible to distinguish between palatoalveolars and palatals), for example // and /j/ respectively. The soft palate (or velum - velar articulations), examples include /k/, /g/ and //. 17

28 Chapter 2: Speech The uvula (uvulars), for example //. The pharynx (pharyngeals), for example //. The glottis (glottals), examples include /h/ and // Consonants Consonants my be further categorised as: Stops: A stop sound is produced by completely blocking the airflow within the oral cavity. For example, in the sound /t/ air pressure builds up in the oral cavity behind the tongue and its subsequent rapid release causes an explosive sound. For this reason stops are often referred to as plosives. Fricatives: A fricative sound is produced when two articulators are placed in close proximity generating turbulent noise when air passes between them. For example, the /s/ sound is produced when a groove is present between the tongue and the hard palate creating a hissing sound as air passes between them. Other examples include /z/, /f/ and /v/. Affricates: The production of an affricate can be characterised by a stop closure followed by a fricative-like release of air. An example of this sound is // in church. The initial sound begins as a stop but ends like a fricative. Nasals: A nasal is a sound made with the velum lowered so that air flows through the nasal cavity. Examples include /m/, /n/ and //. Liquids: In the production of these sounds there is some obstruction to the airflow within the oral cavity, but it is not sufficient to cause any real constriction or friction. In English the only liquids are /l/ and /r/ (Fromkin and Rodman, 1993). Glides: These sounds lie somewhere in between a consonant and a vowel, since they provide almost no obstruction to the airflow within the oral cavity. Glides such as /w/ and /y/ are also called semivowels Vowels The main characteristic of vowels is the freedom with which the air stream, once out of the glottis, passes through the speech organs. The acoustic quality of the vowel is dependent on the size and shape of the oral cavity, which acts as a resonator. The shape of the oral 18

29 Chapter 2: Speech cavity is largely determined by the general position of the tongue within the mouth. This divides the vowels into three classes: Front vowels: Tongue body in the pre-palatal region, for example //. Central vowels: Tongue body in the medio-palatal region, for example //. Back vowels: Tongue body in the post-palatal or velar region, for example /a/. Although by no means exhaustive, the lists of terms described in this section allow the characteristics of individual speech sounds to be accurately described. 2.3 Disorders of Speech and Language Disorders of speech and language refer to problems in communication and related areas such as articulatory function. These range from simple sound substitutions to the inability to understand language or control the speech production mechanism. Disorders can be either developmental or acquired and may be either physical or neurological. Causes include hearing impairment, brain injury, mental retardation, Parkinson s or motor neurone disease, drug abuse, cleft lip or palate and vocal abuse or misuse. Frequently, however, the cause is unknown. The following section introduces the developmental speech and language disorders associated with children, placing particular emphasis on cleft lip and palate. The text then details four commonly acquired disorders of speech and language: dysarthria, apraxia, dyspraxia and aphasia Developmental Disorders There are many potential causes of speech and language disorders in children, including hearing impairment, cognitive impairment, autism, lack of stimulation and structural abnormalities such as cleft lip and palate. A child's communication is considered delayed when they are noticeably behind their peers in the acquisition of speech and/or language skills. Disorders of speech refer to difficulties in the production of speech sounds. These may be characterised as: Dysfluency - an interruption in the flow or rhythm of speech, such as stuttering. Articulatory - difficulties associated with the way sounds are formed. 19

30 Chapter 2: Speech Phonation - problems associated with pitch level, volume and voice quality. A language disorder is an impaired ability to understand and/or use words in context, both verbally and non-verbally. Children may have receptive language impairments (understanding), expressive language impairments (speaking) or both. Characteristics of language disorders include: Improper use of words and their meanings. Inability to express ideas. Inappropriate grammatical patterns. Reduced vocabulary. Inability to follow directions. A child affected by language learning disabilities or developmental language delay may exhibit one or a combination of the above characteristics. Since all communication disorders carry the potential to isolate individuals from their social and educational surroundings, it is essential to find appropriate and timely intervention Cleft Lip and Palate A cleft lip is a developmental defect that occurs in the womb in the fourth to sixth week of gestation. As can be seen in Figure 2.5 (left), the defect results in a separation of the two sides of the upper lip, often including the bones of the upper jaw and/or upper gum. A cleft lip may be unilateral (affecting one side of the mouth) or bilateral (affecting both). A cleft palate is a birth defect that occurs in the eighth to twelfth week after conception. It is an opening in the roof of the mouth where the two sides of the palate have failed to fuse, refer to Figure 2.5 (right). As described in section 2.1.1, the roof of the mouth is divided into two parts, the hard palate and the soft palate. In mild forms of cleft palate there may be only a slight notching of the soft palate. However, most defects involve both the soft and hard portions of the roof of the mouth. 20

31 Chapter 2: Speech Figure 2.5: A unilateral cleft lip (left) and a cleft palate (right), taken from the American Society of Plastic Surgeons official Web site. Because the lip and palate develop separately, it is possible for the child to have a cleft lip, cleft palate, or both. Errors in articulation are common in cleft palate patients, especially those involving affricates and fricatives (Hegde, 1996). Other errors affect stops, glides, and nasal semivowels. Nasal air emissions during the production of pressure sounds are often associated with velopharyngeal incompetence, which is an impairment of the velopharyngeal valving mechanism (Haapanen, 1992). Velopharyngeal competence is an important determinant of articulatory performance in cleft palate speech. It has been estimated that 75% of patients achieve velopharyngeal competence following primary cleft palate surgery, increasing to 90-95% with directed secondary procedures (Quinn, 1998) Acquired Dysarthria Dysarthria is the most common of the acquired disorders of speech and language (Enderby and Emerson, 1996). It is a neuromotor speech disorder resulting from lesion or lesions in the nervous system, which cause movement or postural disturbances that affect the strength, timing and/or tone of the muscle functions used for speech (Netsell and Daniel, 1979). These muscular aberrations may result in the following: Articulatory difficulties due to interference with lip, jaw, and tongue musculature. Phonation problems due to laryngeal and respiratory musculature involvement. Inappropriate resonance when the muscles of the soft palate and pharynx are affected. 21

32 Chapter 2: Speech Malfunction of the peripheral speech mechanism is often the first and perhaps the only symptom of neurological disease. Acquired dysarthria may be caused by: Vascular diseases, including intracerebral haemorrhage, thromboses and embolisms. Infectious diseases, such as meningitis. Metabolic diseases, including blood diseases such as sickle-cell anaemia and leukaemia, or disorders of amino acid or carbohydrate metabolism. Tumours, including those within the brain, the spinal cord, and the cranial and spinal nerves. Trauma, such as closed-head injuries or depressed-skull fractures, which result in concussion, contusion or laceration. Toxins, including metabolic toxins associated with diphtheria, tetanus and botulism; inorganic metals, such as lead or mercury poisoning; and organic substances, such as barbiturates and carbon monoxide. Neurological disorders, such as Parkinson s and motor neurone disease. There is a cause and effect relationship between the location of damage within the nervous system and the type of dysarthria that results. Types of dysarthria may be classified in to six specific subgroups: flaccid, spastic, ataxic, hypokinetic, hyperkinetic and mixed (Darley et al., 1975) Flaccid Dysarthria Flaccid dysarthria results from lesions of the peripheral nervous system or the lower motor neuron system. Flaccidity refers to flabbiness and implies weakness, lack of normal muscle tone and reduced or absent reflexes associated with paresis or paralysis. These conditions occur when a lesion is present anywhere along the motor unit. Depending on the affected area, the larynx, pharynx, tongue and soft palate may show flaccid impairment. Speech symptoms include breathy, harsh or weak voice, hypernasality, nasal air emission and distorted consonants (Darley et al., 1975) Spastic Dysarthria Symptoms include muscular weakness, greater than normal muscular tone, slow movements, limited range of motion, and hyperactive reflexes. Spastic dysarthria results 22

33 Chapter 2: Speech from damage to the upper motor neuron system (Love and Web, 1996). In unilateral involvement, the dysarthria is usually not severe and has significant consequences only for the lips, lower face, and tongue. Bilateral lesions cause more severe speech deviations, where all components of the speech mechanism may be involved and muscles on both sides of the body are affected Ataxic Dysarthria Damage to the cerebellum (usually bilateral) causes difficulties in regulating force, speed, range, timing, and direction of voluntary movements (Love and Web, 1996). There is also lower than normal tone in the muscular system, essentially normal reflexes and tremor during voluntary efforts. The respiratory, laryngeal and articulatory system are involved to varying degrees but the velopharyngeal mechanism is rarely affected. In severe cases there may be major respiratory problems and sudden changes in pitch and loudness. In mild cases only articulation may be affected Hypokinetic Dysarthria Hypokinesia causes slow movements, movements of limited extent, abnormal posturing, loss of automatic movements, increased muscle tone and rhythmic resting tremor in different structures. Patients often have difficulty starting and stopping movements and seem to move rigidly. Parkinsonism is the primary syndrome involving hypokinesia and speech involvement may encompass the entire speech musculature, affecting pitch, loudness and voice quality (Adams, 1997). Severity may range from mildly imprecise articulation to almost complete unintelligibility Hyperkinetic Dysarthria Hyperkinesia results mainly from lesions of the extrapyramidal system that cause abnormal involuntary movements ranging from slow to very fast, which are difficult or impossible to inhibit (Love and Web, 1996). Symptoms can be either unilateral or bilateral. The soft palate is commonly abnormal but phonation is the major speech problem, including momentary interruptions of phonation as a result of involuntary movements in the larynx or diaphragm. These interruptions are apparent on vowels but usually have no significant affect on intelligibility. 23

34 Chapter 2: Speech Mixed Dysarthria Mixed dysarthria may involve any combination of the above, and usually results from diffuse neurological damage. The greater the degree of diffusion, the greater the number of motor components involved Acquired Apraxia and Dyspraxia. Darley (1982) describes apraxia of speech as a disorder in which the patient has trouble speaking because of a cerebral lesion that prevents them executing, voluntarily and on command, the complex motor activities involved in speaking, despite the fact that muscle strength is undiminished. The disorder may be characterised by a variety of abnormalities, including: Slow speaking rate with prolonged transitions, steady states and inter-syllable pauses. Reduced movement of articulators. Uncoordinated voicing with other articulations. Initiation difficulties. Errors of selection or sequencing of segments. Where impaired muscle strength is present however, the condition is known as dyspraxia. The difficulties in speech, which result from conditions such as articulatory dyspraxia are inconsistent and often accompanied by struggle behaviour as the speaker attempts to execute the appropriate movements (Main, 1998). Each attempt at the same sound may be different. Stressed words and initial sounds have been found to give the most difficulty, with the same sounds being clearly articulated in other word positions. Articulatory dyspraxia affects only volitional speech. Automatic speech, for example counting or reciting a well-known phrase may be unaffected (Darley et al., 1975). These characteristics are used to differentiate dyspraxia from dysarthria Aphasia The term aphasia (also known as dysphasia) denotes a class of acquired language disorders caused by damage to the cerebral hemispheres of the brain. The nature and severity of aphasia is dependent on the site and extent of damage (Main, 1998). Aphasia may be classified into the following categories: 24

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