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Biomedical subjects

H L Morris

Publications and source records attributed to H L Morris.

At least 19 recordsLinked to original sources
PubMed1992

Communication status following laryngectomy: the Iowa experience 1984-1987.

Data regarding treatment and outcome for a consecutive series of 73 total laryngectomy patients were collected from clinical records with a follow-up period of 30 to 78 months postoperatively. Notable findings were that 27% were women; 75% reported hoarseness or a voice change as an early symptom; and 22% reported combined heavy use of both cigarettes and alcohol. Of the 73 patients, 38 (52%) died during the follow-up period; 18 of the 38 died within 1 year postoperatively. Thirty-nine (53%) of the 73 had received a surgical tracheoesophageal fistula (TEF) for voice restoration, as either a primary or a secondary procedure. Of the 39, 75% were using the TEF at last examination, with no failures attributed to sphincter spasm. Of the total group, the primary communication modality was reported to be use of a TEF by 44% and use of an electrolarynx by 50%. Limitations of the study and directions for future investigations are discussed.

Aged↗
PubMed1992

Correspondence between nasalance scores and listener judgments of hypernasality and hyponasality.

The relationship between nasalance scores and perceptual judgments of hypernasality and hyponasality was examined for 74 subjects (51 with cleft palate and 23 noncleft controls). Twenty-nine of the 51 subjects with cleft palate had received pharyngeal flap surgery. Predictive analyses were performed to assess the sensitivity, specificity, and efficiency of the Nasometer as a screening instrument. The overall relationship between perceptual judgments of hypernasality and nasalance scores was good for the nonflap subjects when a nasalance cutoff score of 26 was used. A sensitivity coefficient of 0.87 and a specificity coefficient of 0.93 were obtained. Ninety-one percent of the nasometry-based classifications accurately reflected listener judgments of hypernasality. The correspondence between nasalance scores and clinical judgments of hyponasality was also good for the nonflap subjects when a nasalance cutoff score of 50 was used. Ninety-one percent of these classifications were consistent with the listener judgments. Efficiency of nasometry was poorer for the flap subjects.

Adolescent↗
PubMed1992

Results of multidisciplinary management of bilateral cleft lip and palate at the Iowa Cleft Palate Center.

Bilateral cleft of the lip and palate is by many standards the most complex and severe form of the defect. The complexity and severity of the defect require an unusual degree of cooperation among all specialists and especially between the surgeon and the orthodontist. There are no published findings that we know about in which comprehensive data from a number of disciplines are reported for the same group of bilateral cleft patients. Fifty randomly selected patients with bilateral complete clefts were examined by the Iowa team and two orthodontists from other institutions. The evaluations revealed that a large number of patients over the age of 10 have multiple residual problems requiring further treatment. Only 23 percent of the older patients studied were judged to have had treatment completed by the surgeon, speech pathologist, and orthodontist. It is very difficult to state whether the results obtained by our team can be considered satisfactory because there are no comparable studies that have attempted to evaluate the same parameters in multidisciplinary management.

Adolescent↗
PubMed1991

Cleft palate. Diagnosis.

The necessary information for diagnosis of "cleft palate speech" is available from clinical speech pathology tests and observations for the majority of patients. Test findings about error type and stimulability often give direction to our decisions about speech therapy. Other kinds of tests are useful for confirming these findings or for other purposes. Trial speech therapy is a very useful diagnostic procedure. Problem patients (those who fail to make suitable progress) should be referred without hesitation to a cleft palate team, or to a colleague who is an SLP on that team. Referrals to other specialists should be made appropriately, using careful, clear referral language.

Child↗
PubMed1990

Long-term speech results of cleft palate speakers with marginal velopharyngeal competence.

The purposes of this study were to (1) examine the long-term speech status of patients judged to exhibit marginal velopharyngeal competence at 6 years of age and (2) determine whether speech performance data obtained at age 6 could be used to discriminate patients with marginal velopharyngeal competence who eventually demonstrate velopharyngeal incompetence from those who do not. Longitudinal speech performance data were retrieved for 48 subjects and examined descriptively for the total group. Data obtained at the subjects' last evaluation (adolescence) were then used to reassign these subjects into one of three classification groups for estimating velopharyngeal status (competent, marginal, incompetent) on the basis of the clinical ratings of velopharyngeal competence assigned at the time of their last examination in adolescence. Differences in measures of articulation proficiency and hypernasality among the three groups were examined at age 6 using an analysis of variance. A stepwise discriminate analysis was also performed to determine whether the speech data obtained at age 6 could be used to discriminate the three adolescent classification groups. The ANOVA revealed no significant differences among the classification groups in type of articulation errors. Differences in articulation test scores and severity ratings of articulation defectiveness and nasality in connected speech were evident among the groups. The discriminate analysis revealed that the groups could be separated, in part, on the basis of two variables: the severity ratings of articulation defectiveness and nasality.

Adolescent↗
PubMed1990

Speech production time and judgments of disordered nasalization in speakers with cleft palate.

The purpose of this study was to investigate the effect of production time on the perception of disordered nasalization in children with cleft palate. The subjects with cleft palate included 5 who produced acceptable speech consistently, 5 who produced disordered nasalization consistently, and 10 who were inconsistent in the production of disordered nasalization. We examined a range of production times similar to those for the production of single-word and connected speech tasks. Ten judges used direct magnitude estimation to rate severity of disordered nasalization. An accelerometric ratio technique was used to estimate the extent and timing of nasal acoustic activity. The results showed that reducing the production time did not change perceptible nasalization.

Adolescent↗
PubMed1990

Velar-pharyngeal status in cleft palate patients with expected adenoidal involution.

This study was designed to provide information about whether cleft palate patients with hypertrophied adenoids maintain velar-pharyngeal contact during the time of expected adenoidal atrophy. Thirty-nine subjects were selected from a large longitudinal study on the basis of availability of lateral still x-ray films taken in series from 5 to 16 years of age. Ratings of velar-pharyngeal contact and ratings of adenoid size were obtained from the films. The obtained data indicated the expected decrease in adenoid size but also, for the group, maintenance of velar-pharyngeal contact. However, three of the 39 subjects were judged to show loss of such contact during the period of study, and an additional four had surgery for velopharyngeal incompetence after the completion of the study. All seven appeared to show significant deterioration of velopharyngeal status in middle or late adolescence. Implications of these findings are discussed.

Adenoids↗
PubMed1989

Cleft lip and palate and related disorders: issues for future research of high priority.

On October 14 to 17, 1987, a meeting entitled "State of the Art Conference: Multidisciplinary Management of Cleft Lip and Palate" was held in Iowa City. The major purpose of the conference was to review the available knowledge concerning management of unilateral cleft lip and palate from the perspectives of surgery, speech-language pathology, and orthodontics. The closing feature of the conference was the identification of issues for future research. Participants identified issues of high priority that were then discussed by the entire conference faculty. This paper reports the summary of that discussion and the recommendations of the Conference.

Cleft Lip↗
PubMed1988

Perception of syllable stress in esophageal speech.

This study is part of a larger investigation designed to assess the ability of esophageal speakers to effect systematic changes in listener perceptions of syllable stress. Ten male functional esophageal speakers and ten normal speakers were instructed to produce 25 repetitions of the disyllable/mama/ using five different conditions of syllable stress, ranging from strong first syllable stress through strong second syllable stress. Nine normal listeners judged both relative and absolute syllable stress of the disyllables, using a nine-point scale for each syllable. The results indicated that highly reliable judgments can be made when judging relative and absolute syllable stress in disyllables produced by both normal and esophageal speakers. In response to experimenter direction, both normal and esophageal speakers are able to effect systematic changes of direction and degree in listener perceptions of relative stress.

Aged↗
PubMed1988

Assessment of velopharyngeal competence: a long-term process.

This study compared longitudinally perceptual ratings of articulation defectiveness, nasality, and velopharyngeal competency in 13 subjects who required secondary palatal management after age 10 with a second group. Perceptual data when examined longitudinally did not adequately discriminate between subjects who at one time achieved velopharyngeal closure but who ultimately required secondary management and those patients who needed no further treatment. A decrease in articulation scores and an increase in severity of nasality and articulation defectiveness over time indicate that patients are at risk for secondary management. Evaluation of lateral x-rays indicated that those in the group that required secondary operations demonstrated more variability in velopharyngeal closure than those in the comparison group, who required no secondary operations and that adenoidal involution did not appear to be a significant factor.

Adolescent↗
PubMed1986

A study of cleft palate speakers with marginal velopharyngeal competence.

This study was designed as a partial test of a previously hypothesized model for a subgroup of cleft speakers who show marginal velopharyngeal competence during speech. Specifically, speakers in the model were hypothesized to show minimal but consistent nasalization of speech by several criteria. Fifty-two subjects were selected because they met one of the criteria for the model, lateral x-ray films on /s/ that showed touch closure or a small velopharyngeal opening. The subjects were then examined by the other five criteria used for defining the hypothesized model, and were found to meet, in the majority, fewer than three. These findings indicate that lateral x-ray films are not sufficient for identifying this diagnostic subgroup, if it exists. Another possible conclusion is that the model proposed is too simplistic and that cleft palate speakers with marginal velopharyngeal competency typically show more variability in speech performance than was originally implied in the model.

Child↗
PubMed1986

Contribution of selected variables to the prediction of speech proficiency for adolescents with cleft lip and palate.

The purpose of this study was to examine the relative contribution of clinical data obtained during speech examinations at age 4 years and at each subsequent age through 13 years to the prediction of judged speech proficiency at age 14 years for children with unilateral cleft of the lip and palate. Psychological scale values of speech proficiency were obtained for 50 adolescents and used as the dependent variable in each analysis. The 16 independent variables used in the analysis at age 4 years included four nonspeech variables (gender, type and age of primary surgery, and pharyngeal flap surgery) and 12 speech measures obtained from speech examination. In subsequent analyses at ages 5 through 13 years, the rate of change between adjacent age levels for each of the 12 speech measures was also included, for a total of 28 independent variables. The data were analyzed using the MAXR stepwise regression procedure, first for the total group of subjects and then separately for males and females. The results of this investigation indicated that a large percentage of the variance in judged speech proficiency at age 14 years can be accounted for, using clinical data obtained for speech examinations at ages 4 through 13 years. When the regression analyses were performed for the total group of subjects at ages 4 through 13 years, the most efficient set of predictors accounted for 50 to 75 percent of the variance in the dependent variable. The variable of gender was identified as the single most important predictor in nine of the 10 regression analyses, alone accounting for at least 40 percent of the variance in judged speech proficiency. When the regression analyses were performed separately for males and females, approximately 50 to 80 percent of the variance was accounted for in judged speech proficiency for males and 50 to 90 percent for females using one, two, or three of the independent variables. The most efficient set of predictors varied across age levels for both groups. In addition, these predictors differed between males and females.

Adolescent↗
PubMed1985

Relationships between the perception of nasalization and speech movements in speakers with cleft palate.

The purpose of this study was to examine the relationships between several temporal measures of speech movements and perceived nasalization in speakers with cleft palate. Four adult subjects with repaired cleft palate were filmed using high-speed (100 frames/s) cinefluorography as they produced target syllables embedded in a carrier phrase. Perceived nasalization of each extracted acoustic target syllable was rated by 18 trained judges. Movements of the tongue tip, tongue dorsum, jaw, velar knee, velar tip, and posterior pharyngeal wall were plotted over time. Time of movement onsets and movement offsets was identified from the plots. Voice onset and offset times were identified from the synchronized acoustic recordings. The findings indicate that normally expected velopharyngeal movements occurred near the time of jaw-lowering onset during nasalized CVC and CVN productions in two subjects who were judged to exhibit high levels of nasalization. The other two subjects showed no velopharyngeal movements during the CVC production. It is speculated that velopharyngeal movements normally expected in CVC utterances may be avoided by some speakers with cleft palate in order to minimize perceptible nasalization.

Adult↗
PubMed1984

Late results of primary veloplasty: the Marburg Project.

Forty-five randomly selected patients with unilateral cleft lip, alveolus, and palate, all operated upon by Dr. Wolfram Schweckendiek were evaluated by three American specialists to assess the validity of primary veloplasty. Examination revealed an unusually high incidence of short palate and poor mobility of the soft palate. Facial growth was found to be highly acceptable in the majority of the patients. Unusually high incidence of velopharyngeal incompetence was found in these patients.

Adolescent↗
PubMed1983

Reliability of the nasopharyngeal fiberscope (NPF) for assessing velopharyngeal function.

Simultaneous side-view nasopharyngeal fiberscopic (NPF) and lateral cinefluoroscopic (cine) recordings were taken for two normal subjects to determine the stability of NPF placement for the study of velopharyngeal function, and the reliability and validity of NPF findings. The results indicate that the NPF was highly stable during the several velopharyngeal activities examined, the NPF tip maintaining a relatively constant relationship within the vertebral complex. Therefore, it seems likely that similar NPF views are obtained on different occasions with a subject. The findings also indicate that measurements can be made from NPF still photos for several aspects of the velopharyngeal mechanism. However, measurements of the left lateral wall movement were not reliable. Measurement of velar movement from NPF correlated well with cine measures of velar movement, indicating validity of that NPF measure.

Adult↗
PubMed1983

Reliability of the nasopharyngeal fiberscope (NPF) for assessing velopharyngeal function: analysis by judgment.

The reliability and validity of data about velopharyngeal function obtained with the nasopharyngeal fiberscope was assessed in normal subjects. The experimental design included data reduction procedures that are likely to have clinical utility (clinical ratings). The results indicated that relative velar movement and size of the velopharyngeal port may be reliably and validly estimated using the procedures. However NPF estimates of lateral pharyngeal wall movement were not reliable. Finally, the data indicated that velar movement and size of V-P port were consistent within subjects and tasks across data collection sessions. Data about consistency of lateral wall movement across sessions was inconclusive, however. Additional research involving similar procedures with subjects who have morphologic deficits is indicated.

Cineradiography↗