Use of Electropalatography to Improve Speech Sound Production

The Use of Electropalatography to Improve Speech Sound Production in Deaf Adults With Cochlear Implants

The purpose of this proposed study is to examine the benefits of using electropalatography (EPG) during speech therapy with adult individuals who are either congenitally deaf or adventitiously deaf and use a cochlear implant.

Study Overview

• Status: Withdrawn
• Conditions: Hearing Impairment
• Intervention / Treatment: Behavioral: Visual biofeedback, auditory feedback and models

Detailed Description

It has been established in numerous research studies that there is a definitive link between speech perception and speech production, in that what one can perceive, one can produce. Hearing loss disrupts this link and while cochlear implants make a significant difference in perception of sound, adults who are deaf and receive a cochlear implant (CI) do not gain the same perceptual benefits as children who are deaf and are implanted at a young age. Thus, the speech production of the adult CI user is reported to be less intelligible. The purpose of this proposed study is to examine the benefits of using electropalatography (EPG) during speech therapy with adult individuals who are either congenitally deaf or adventitiously deaf and use a cochlear implant. The investigators have proposed to study 10 CI users (5 in each etiological group) who will undergo speech intelligibility testing, and receive speech therapy (1x/week for 10 weeks) using EPG that provides both visual (biofeedback) and auditory feedback. It is hypothesized that the biofeedback in addition to the auditory feedback from the CI will result in an increase in articulation skills and thus the speech intelligibility in these individuals will improve significantly.

• Study Type: Interventional
• Phase: Not Applicable

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 16 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• All participants in this study will be at least 3 years post-implant and they must use the implants consistently.
• Participants who have adventitious/acquired hearing loss must have had normal hearing through their 18th year.
• Participants with congenital hearing loss will have received oral or total communication education, worn hearing aids and consider themselves to be "oral deaf" adults.

Exclusion Criteria:

• Individuals who do not meet this criteria will be excluded from the protocol.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Non-Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Congenitally deaf; Prior and post speech training, participants will read aloud a standard paragraph (Rainbow passage), complete a traditional speech test (Goldman Fristoe Test of Articulation - 3) to assess the sounds of the English language in all word positions (initial, medial, final) and read a list of consonant-vowel-consonant (CVC) combinations. Individual treatment will be provided once a week for 10 consecutive weeks. Traditional speech intervention with visual biofeedback from the EPG will be used. Auditory feedback will be provided through the participants own cochlear implant.	Behavioral: Visual biofeedback, auditory feedback and models; The EPG software program allows the speech clinician to model and comment upon the visual patterns during tongue/palate contact and to replay the participant's production for additional correction or reinforcement productions. Auditory feedback will be used to facilitate participant's perception of differences in production.
Experimental: Adventitiously deaf; Prior and post speech training, participants will read aloud a standard paragraph (Rainbow passage), complete a traditional speech test (Goldman Fristoe Test of Articulation - 3) to assess the sounds of the English language in all word positions (initial, medial, final) and read a list of CVC combinations. Individual treatment will be provided once a week for 10 consecutive weeks. Traditional speech intervention with visual biofeedback from the EPG will be used. Auditory feedback will be provided through the participants own cochlear implant.	Behavioral: Visual biofeedback, auditory feedback and models; The EPG software program allows the speech clinician to model and comment upon the visual patterns during tongue/palate contact and to replay the participant's production for additional correction or reinforcement productions. Auditory feedback will be used to facilitate participant's perception of differences in production.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Improved Speech Intelligibility	Change from baseline in speech intelligibility within a 10 week period after exposed to visual display of speech sound production.	10 weeks.

Collaborators and Investigators

• Sponsor: Molloy College
• Investigators: Principal Investigator: Diane Saulle, Ph.D, Molloy College; Principal Investigator: Nancy McGarr, Ph.D., Molloy College

Publications and helpful links

General Publications

• Bernhardt, B. H., Loyst, D., Pichora-Fuller, K., & Williams, R. (2000). Speech production outcomes before and after palotometry for a child with a cochlear implant. Journal-Academy of Rehabilitative Audiology, 33, 11-38.
• Bernhardt B, Gick B, Bacsfalvi P, Ashdown J. Speech habilitation of hard of hearing adolescents using electropalatography and ultrasound as evaluated by trained listeners. Clin Linguist Phon. 2003 Apr-May;17(3):199-216. doi: 10.1080/0269920031000071451.
• Byun TM, Hitchcock ER. Investigating the use of traditional and spectral biofeedback approaches to intervention for /r/ misarticulation. Am J Speech Lang Pathol. 2012 Aug;21(3):207-21. doi: 10.1044/1058-0360(2012/11-0083). Epub 2012 Mar 21.
• Dagenais PA. Electropalatography in the treatment of articulation/phonological disorders. J Commun Disord. 1995 Dec;28(4):303-29. doi: 10.1016/0021-9924(95)00059-1.
• Dagenais PA, Critz-Crosby P. Consonant lingual-palatal contacts produced by normal-hearing and hearing-impaired children. J Speech Hear Res. 1991 Dec;34(6):1423-35. doi: 10.1044/jshr.3406.1423.
• Fabus, R., Raphael, L., Gatzonis, S., Dondorf, K., Giardina, K., Cron, S., & Badke, B. (2015). Preliminary case studies investigating the use of electropalatography (EPG) manufactured by CompleteSpeech® as a biofeedback tool in intervention. International Journal, 3(1), 11-23.
• Fletcher SG, Hasegawa A. Speech modification by a deaf child through dynamic orometric modeling and feedback. J Speech Hear Disord. 1983 May;48(2):178-85. doi: 10.1044/jshd.4802.178.
• Fletcher SG, Dagenais PA, Critz-Crosby P. Teaching consonants to profoundly hearing-impaired speakers using palatometry. J Speech Hear Res. 1991 Aug;34(4):929-42. doi: 10.1044/jshr.3404.929.
• Fletcher, S., Hasegawa, A., McCutcheon, M., & Gilliom, J. (1980). Use of linguapalatal contact patterns to modify articulation in a deaf adult. In D. L. McPherso (Ed.), Advances in prosthetic devices for the deaf: A technical workshop (pp.127-133). Rochester, MD: NTID Press.
• Gibbon, F., Stewart, F., Hardcastle, W. J., & Crampin, L. (1999). Widening access to electropalatography for children with persistent sound system disorders. American Journal of Speech-Language Pathology, 8(4), 319-334.
• Goldman, R., & Goldman, F. M. (2000). Fristoe Test of Articulation. American Guidance Service.
• Lane H, Perkell J, Svirsky M, Webster J. Changes in speech breathing following cochlear implant in postlingually deafened adults. J Speech Hear Res. 1991 Jun;34(3):526-33. doi: 10.1044/jshr.3403.526.
• Martin, K. L., Hirson, A., Herman, R., Thomas, J., & Pring, T. (2007). The efficacy of speech intervention using electropalatography with an 18-year-old deaf client: A single case study. Advances in Speech Language Pathology, 9(1), 46- 56.
• McGarr NS. The intelligibility of deaf speech to experienced and inexperienced listeners. J Speech Hear Res. 1983 Sep;26(3):451-8. doi: 10.1044/jshr.2603.451.
• McGarr, N. S., Raphael, L. J., Kolia, B., Vorperian, H. K., & Harris, K. (2004). Sibilant production in speakers who have hearing loss: Electropalatographic and perceptual evidence. The Volta Review, 104(3), 119.
• Pantelemidou V, Herman R, Thomas J. Efficacy of speech intervention using electropalatography with a cochlear implant user. Clin Linguist Phon. 2003 Jun-Aug;17(4-5):383-92. doi: 10.1080/0269920031000079958.
• Parsloe R. Use of the speech pattern audiometer and the electropalatograph to explore the speech production/perception relationship in a profoundly deaf child. Int J Lang Commun Disord. 1998 Jan-Mar;33(1):109-21. doi: 10.1080/136828298247947.
• Pratt, S. R. (2007). Using electropalatographic feedback to treat the speech of a child with severe-to-profound hearing loss. The Journal of Speech and Language Pathology-Applied Behavior Analysis, 2(2), 213.
• Shriberg, L. D. (1980). An intervention procedure for children with persistent /r/ errors. Language, Speech, and Hearing Services in Schools, 11(2), 102-110. SmartPalate Overview. (n.d.). Retrieved from http://completespeech.com/smartpalate/smartpalate_overview/
• Subtenly, J. D., Orlando, N. A., & Whitehead, R. L. (1981). Speech and voice characteristics of the deaf. Washington, DC: The Alexander Graham Bell Association of the Deaf.
• Waldstein RS. Effects of postlingual deafness on speech production: implications for the role of auditory feedback. J Acoust Soc Am. 1990 Nov;88(5):2099-114. doi: 10.1121/1.400107.

Study record dates

Study Major Dates

• Study Start (Anticipated): September 30, 2019
• Primary Completion (Anticipated): April 30, 2020
• Study Completion (Anticipated): June 1, 2020

Study Registration Dates

• First Submitted: April 22, 2019
• First Submitted That Met QC Criteria: August 13, 2019
• First Posted (Actual): August 14, 2019

Study Record Updates

• Last Update Posted (Actual): September 30, 2019
• Last Update Submitted That Met QC Criteria: September 26, 2019
• Last Verified: September 1, 2019

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Nervous System Diseases; Neurologic Manifestations; Otorhinolaryngologic Diseases; Ear Diseases; Sensation Disorders; Hearing Disorders; Hearing Loss; Deafness
• Other Study ID Numbers: 04190121

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: No

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No