Cases reported "Speech Disorders"

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1/18. Effects of facial paralysis and audiovisual information on stop place identification.

    This study investigated how listeners' perceptions of bilabial and lingua-alveolar voiced stops in auditory (A) and audiovisual (AV) presentation modes were influenced by articulatory function in a girl with bilateral facial paralysis (BFP) and a girl with normal facial movement (NFM). The fuzzy logic Model of perception (FLMP) was used to make predictions about listeners' identifications of stop place based on assumptions about the nature (clear, ambiguous, or conflicting) of the A or AV cues produced by each child during /b/ and /d/ CV syllables. As predicted, (a) listeners' identification scores for NFM were very high and reliable, regardless of presentation mode or stop place, (b) listeners' identification scores for BFP were high for lingua-alveolar place, regardless of presentation mode, but more variable and less reliable than for NFM; significantly lower (overall at a chance level) for bilabial place in the A mode; and lowest for bilabial place in the AV mode. Conflicting visual cues for stop place for BFP's productions of /bV/ syllables influenced listeners' perceptions, resulting in most of her bilabial syllables being misidentified in the AV mode. F2 locus equations for each child's /bV/ and /dV/ syllables showed patterns similar to those reported by previous investigators, but with less differentiation between stop place for BFP than NFM. These acoustic results corresponded to the perceptual results obtained. (That is, when presented with only auditory information, on average, listeners perceived BFP's target /b/ syllables to be near the boundary between /b/ and /d/.)
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2/18. Foreign Accent syndrome following a catastrophic second injury: MRI correlates, linguistic and voice pattern analyses.

    A case study of Foreign Accent syndrome (FAS) is presented with discussion of anatomical localization of injury and comparisons of pre- and postinjury linguistic, phonetic, and acoustic speech characteristics. Because the patient's injury and symptoms were unrelated to previously injured left frontal cortex, and in light of another case history (Moonis et al., 1996), we suggest that FAS has a primary subcortical involvement. We also show that this case is accompanied by a deficit in linguistic, but not affective, prosodic expression. We agree that the "foreign" quality of the FAS speech is a perceptual impression of the listener and not inherent in the patient's vocalization. Finally, we suggest a battery of tests for future FAS cases to further our study and understanding of the syndrome.
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3/18. Thyroplasty type I (lateral compression) for dysphonia due to vocal cord paralysis or atrophy.

    Based on the experimental results of thyroplasty, thyroplasty type I which aims at medical shifting the vocal cord was performed on 8 patients with dysphonia, 6 with vocal cord paralysis and 2 with vocal cord atrophy. The surgery was conducted on either in- or out-patient basis and local anesthesia was used. Usually, a rectangular incision was made on the thyroid cartilage at the level of the vocal cord, and the fragmemt was depressed inward. A cartilage piece taken from the opposite side was used as a wedge, if necessary, to enhance the effect of lateral compression of the vocal cord. The voice after surgery was generally satisfactory, except in one case of traumatic vocal cord paralysis. Complications such as stridor or dyspnea were nil. As surgical intervention inside the thyroid cartilage is minimal, fine and reliable adjustment of depression is possible during the surgery.
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4/18. Rhinolalia as a presenting sign of pneumomediastinum complicating post peripheral blood stem cell transplantation bronchiolitis obliterans.

    A 26-year-old male with graft vs. host disease (GVHD) presented with rhinolalia (a squeaky voice of nasal quality) as a presenting sign for pneumonasopharynx and pneumomediastinum secondary to bronchiolitis obliterans. The patient underwent HLA-identical related peripheral blood stem cells transplantation 8 months before the diagnosis. Three weeks after transplantation he began to suffer from GVHD Grade III that involved the gut, liver, and skin and later on the lungs. Due to severe obstructive bronchiolitis obliterans the patient developed intensive cough evolving into pneumomediastinum and pneumonasopharynx with rhinolalia. The patient was treated conservatively with complete resolution. Although rare, pneumomediastinum and pneumonasopharynx can be a life-threatening event, and one should be aware of the signs and symptoms on physical examination, which may be as subtle as rhinolalia alone.
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5/18. Cervical spondylodiscitis: a rare complication after phonatory prosthesis insertion.

    BACKGROUND: Tracheoesophageal puncture has excellent voice rehabilitation after total laryngectomy. However, despite its easy insertion and use, severe complications have been reported. methods: We report a case of cervical spondylodiscitis, occurring in a 67-year-old woman submitted to phonatory prosthesis insertion. After 1 month, she complained of severe cervicalgia associated with fever. Spondylodiscitis involving C6, C7, and the intervening vertebral disk with medullary compression was detected by means of imaging studies. RESULTS: A right cervicotomy with drainage of necrotic tissue was performed, and a de-epithelialized fasciocutaneous deltopectoral flap was interposed between the neopharynx-esophagus and the prevertebral fascia to protect the neurovascular axis. MR performed 1 month later showed a complete resolution of the infectious process. CONCLUSIONS: Severe neck pain after tracheoesophageal puncture should alert the physician about the possibility of a cervical spondylodiscitis. MR is the most useful imaging technique for preoperative and postoperative evaluation. When neurologic symptoms are detected, surgical exploration of the neck is mandatory.
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6/18. nasal obstruction and human communication.

    nasal obstruction may cause a variety of communication disorders, particularly in children. The effects of nasal obstruction on hearing, speech, language, and voice are examined. methods for assessing the effects of nasal obstruction are delineated, and recommendations for therapeutic interventions are described.
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7/18. Voice recognition device as a computer interface for motor and speech impaired people.

    A voice recognition device has been identified as an interface for personal computer control by patients presenting with high-level spinal cord injuries and mild dysarthria. The device enables a person to bypass the traditional keyboard and activate a computer through voice control. The user simply creates templates of a spoken vocabulary in computer memory. The computer then matches real-time spoken words to stored templates for activation. The system has been clinically tested with one 10-year-old boy who has C1-C2 quadriplegia and a 19-year-old man who sustained a C6 spinal cord injury and dysarthria secondary to head injury. Each patient created a vocabulary for computer storage to run educational software packages and games. Accuracy rates for computer speech recognition were measured in multiple practice sessions. Intelligibility of single words produced by the dysarthric speaker was measured also. Both patients activated computer programs through voice control. Recognition rates ranged from 45 to 60% for the first patient, and 79 to 96% for the second patient. A mean success rate for voice recognition across trials with both patients was approximately 80%. The device increased the dysarthric speaker's articulatory precision. Results indicate that the system might be appropriate for rehabilitation programs though further technologic refinement of the device would increase its effectiveness.
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keywords = voice
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8/18. rehabilitation of communication impairment in dystonia musculorum deformans.

    Augmentative and alternative communication (AAC) aids were used in three young, intellectually normal patients with dystonia musculorum deformans (DMD) who had severe speech and writing impediments. These aids included speech therapy, communication boards, and voice synthesizers for verbal communication and typewriters, memowriters, and computer software and printers for written communication. At times customized accessing was needed which required specific adaptive modifications. Implementation of the AAC aids system was determined effective for DMD patients in view of the intellect-sparing nature of the disorder. Improvement was hampered by the progressive nature of the disease and by the emotional stress of accepting the long-term use of AAC. Correct and early diagnosis of communication impediments are crucial for the appropriate AAC aids prescription and implementation. An AAC protocol is suggested to meet the special communication needs of DMD patients.
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9/18. On the nature of the foreign accent syndrome: a case study.

    A detailed acoustic analysis was conducted of the speech production of a single patient presenting with the foreign accent syndrome subsequent to a left-hemisphere stroke in the subcortical white matter of the pre-rolandic and post-rolandic gyri at the level of the body of the lateral ventricle. It was the object of this research to determine those changes which contribute to the perception of a "foreign accent." A number of acoustic parameters were investigated, including features of consonant production relating to voice, place, and manner of articulation, vowel production relating to vowel quality and duration, and speech melody relating to fundamental frequency. The results indicated that many attributes which might have contributed to the foreign quality of the patient's speech were similar to those of normal English speakers. However, a number of critical elements involving consonant and vowel production and intonation were impaired. It was hypothesized that the acoustically anomalous features are linked to a common underlying deficit relating to speech prosody. It is suggested that the normal listener categorizes this speech pattern as a foreign accent because the anomalous speech characteristics, while not a part of the English phonetic inventory, reflect stereotypical features which are a part of the universal phonetic properties found in natural language.
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10/18. The Dubowitz syndrome: a retrospective.

    The purpose of the article is to update information concerning Dubowitz syndrome. A review of the literature since the disorder was originally described in 1965 is presented. In addition, case reports are presented for two siblings described in 1971 describing speech and dental development and current clinical findings. Analysis of approximately 30 cases reveals prevalence of growth failure and delayed bone age, mild microcephaly, broad forehead with sparse frontal hair, telecanthus, blepharophimosis, abnormal pinnae, broad nose, and micrognathia. Overt cleft palate or submucous cleft palate is not a prevalent finding (16%). High-pitched and hoarse voice quality appears to be a constant feature. There is the suggestion of an association with leukemia, lymphoma, and neuroblastoma. Inheritance appears clearly autosomal recessive.
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