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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

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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. 

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