Jordan Differding, Patti Bailey, Kimberly T. Webster, Patrick Byrne, M.D., Ivette Icaza, M.D., Socorro Valladares, Veronica Mejia, Edwin Hernandez
Perceptual Assessment of Resonance in Spanish-Speaking Individuals With Cleft Palate via Web Conferencing
Introduction: In third world countries, access to speech pathology services is limited.
This project is a continuation of on-site and teleconferencing work with Johns Hopkins
University and Greater Baltimore Medical Center in Baltimore, Maryland and APROQUEN
in Managua, Nicaragua. Speech-Language Pathologist in Baltimore have been using teleconferencing
in lieu of travel thus requiring the crucial need to document that perceptual judgments
of resonance are reliable and accurate.
Objectives: The first objective is to determine if resonance can be accurately assessed
via the use of teleconferencing. The second objective is to determine if paraprofessionals
in Managua who have been trained as 'speech technicians' can accurately rate participant's
speech resonance as hyponasal, hypernasal or considered within normal limits. The
hypothesis of this study proposes that, when compared to objective nasometry measures,
perceptual assessment of resonance will be accurately rated by speech pathologist
via teleconferencing with inter-rater agreement of 80% for Baltimore SLP raters and
60% for Managuan 'speech technicians' raters.
Methods: Ten Spanish speaking children were selected by the APROQUEN team in Managua.
Children read or repeated sentences with nasal and high pressure oral consonants.
Perceptual ratings of Spanish speaking children were made by the team in Managua.
Video and objective measures were sent to a research assistant in Baltimore where
samples were randomized and 2 blinded Baltimore SLPs rated the nasality of the participants.
Findings were then compared for intra- and inter-rater reliability between and among
SLPs in Baltimore, paraprofessional team in Managua, and between clinicians/team and
objective nasometry measures.
Conclusion: The hypothesis of this research was supported indicating that teleconferencing
is a reliable method for assessing resonance in underserved areas. This study also
indicated briefly that training paraprofessional staff in resonance disorders related
to cleft palate could be a viable solution to the lack of post surgical speech treatment.
This pilot study demonstrated that the use of video teleconferencing to perceptually
assess for hypernasality can be used to collect additional data and improve outcomes
in this population. Future research continues to gather data on the effectiveness
of paraprofessional staff acting as primary providers of speech-language assessment
and intervention of children who are pre/post-cleft lip and palate reconstruction.
The hope of this research is to develop a curriculum based on the project completed
in Managua for future replication in additional underserved locations.