1. Syllabic nasals – How do we treat them?
Caroline Hattee
Cleft Net East

2. Aims
Study results
Therapy ideas
Diagnostic implications

3. Study Retrospective case note review
N= 9 ( 6 non cleft, 2 cleft, 1 SMCP)
Assessed using the STAP and GOSSPASS
Consonant and vowel inventory tabulated and nasality and nasal airflow noted

4. Subjects

5. Outcomes Therapy eliminated syllabic nasals in 8/9 cases.
3/9 prolonged therapy
1/9 persisting syllabic nasals
1/9 secondary speech surgery during this treatment period.
Close vowels /i, Ì, u/ (and for the diphthongs containing these) tended to respond most quickly to therapy.

6. Therapy

7. Vowel Therapy to update input processing
Auditory perceptual approaches
Input modelling/vowel bombardment therapy (e.g. Hope cochlear implant ideas hope.cochlearamericas.com)
Audio and Video therapy e.g. lorry reversing iiii ; u for cow
Headphone use as playback in video therapy – optimal proximity of sound

8. Vowel Therapy to update vowel perception
Input : Extended vowel duration (Rusche et al 2004)
Increased pitch via Melodic Intonation Therapy (Helfrich-Miller 1984) –counting 1-6 contains u/i/Ì. Hope cochlear website has good resources in pitch unit section.
Output : immediate verbal feedback for each production as “incorrect” placement information or sensory feedback can hamper potential for subsequent target sound production (Ruscello 2008).

9. Video TK orl

10. Vowel Therapy Visual feedback Historical glossometry; speech viewer
EPG
The future - MRI imaging/ultrasound
Computer approaches
PC programmes –; SAILS (Rvachew et al 2004) ; Earobics (Earobics cognitive Concepts 2000); Phoneme factory (Wren &Roulstone 2006); LiPS(Lindamood & Lindamood 1998); Nessy language programme.
Apps available - vowel viz and IPA vowels; cued articulation; vowels central

11. Apps
Vowel viz
Just to demo an app.

12. Vowel Therapy Linguistic approaches:
Maximal contrast therapy : contrasting open front vowels with close back vowels.
Metaphonological – e.g. The vowel house/Metaphon – visual referent lip rounding vs lip spread
Core vocabulary (Cosbie,et al 2006).
Semantic/rhyme sets e.g. baby/mummy/dummy.

13. Vowel Therapy Motor approaches
Nuffield production and sequencing (Williams and Stephens 2010).
PROMPT
Cued vowels

14. Implications for future Practice
Assess consonants and vowels; notice weak syllables
Hearing levels and complexity of speech disorder important prognostic factors – maximise visual and auditory input

15. Implications for future practice
Diagnostic therapy may help differentiate between syllabic nasals and nasalised vowels
Syllabic nasals do respond to therapy
Detailed notes of therapy aims and methods needed to inform outcome. Ideally video pre and post therapy
SLT Training at undergraduate level
Further research opportunities

16. Conclusion
Geirut 1998 “ direct therapy for vowels can have a positive outcome”
But…..
Gibbon 2013 “one approach not advocated is non speech oral motor activities as there is no evidence to suggest that these methods are effective”.

17. Don’t be alarmed – go for it !

18. Acknowledgements Jennie Smith – Specialist SLt Cleft Net East
Anne Harding-Bell Module Co-ordinator, Human Communication Sciences, University of Sheffield

19. Additional Resources
Video data of case examples to be made available via SIG website
Forthcoming text
Purdy S, Harding-Bell , Differential diagnosis :signs of conductive hearing loss In Case Studies of Cleft Palate Speech. Ed Harding- Bell, A. J&R Press (Forthcoming)

20. References
Ball,M.J,Gibbon,F.E.(2013).Handbook of Vowels and Vowel Disorders.Psychology Press
Hope Cochlear Implant Ideas
Cosbie,S,Pine,C,Holm,A and Dodd,B.(2006).Treating Jarrod:A core vocabulary approach.Advances in Speech-Language Pathology,8(3),
Gierut,J.A(1988)Treatment efficiency:functional phonolgydisorders in children.Journal of Speech, Language Haring Research 41,85-100
Gibbon, F(2013).Therapy for abnormal vowels in children withspeech disorders in Ball,M.J,Gibbon,F.E.(2013).Handbook of Vowels and Vowel Disorders.Psychology Press
Hayden,D,A,Eigen,J,Walker,A,Olsen,L.(2010)PROMPT:A Tactually grounded model. In Williams,Smcleaod, and R Mcauley(eds)Interventions for speech sound disorders in children.Brookes:Baltimore.
Helfrich-Miller,KR.(1984).Melodic Intonation therapy with developmentally apraxic children.In Perkins WH,Northern JL.Editors:Seminars in speech and Language .New York.
Passy,J(1990)Cued Vowels.Ponteland:STASS publications. Also available as app
Ruscello,D.M. (2008).Treating Articulation and Phonological Disorders in Children.Mosby
Reid,J(2003)The Vowel House.A cognitive approach to vowels for literacy and speech.Child Language Teaching and Therapy,19,
Rusche, N., Markovitz, S., & Kwiatkowski, J. (2004, November). Treating vowel errors in speech-delay: A case study. Poster presented at the Annual Convention of the American Speech-Language-Hearing Association, Philadelphia, PA
Shriberg,LD,Friel-Path,S,Flipsen,P.(2000).Otitis media, Fluctuating hearing loss and speech – language outcomes:a preliminary structural equation model.Journal Speech Language Hearing Research 43:

21. References
Rvachew,S;Slawinski,E,B;Williams,M.(1996) Formant frequencies of vowels produced by infants with and withot early nset otitis media.Canadian Acoustics24(2),19-28
Ferdos,N;Ashayer,A;Modarresi,Y;Rovshan,B.(2014)The effectiveness of melodic intonation therapy on fundametal frequency and intensity in Persian autistic children’s speech.Audiology23(2):74-82
Williams,P&StephensH.(2010).The Nuffield Centre Dyspraxia Porgramme.