Jamie Perry - Academia.edu (original) (raw)

Papers by Jamie Perry

Research paper thumbnail of Investigating Velopharyngeal Closure Force with Linear Regression

Cleft palate is a common birth defect worldwide. Children diagnosed with this abnormality face di... more Cleft palate is a common birth defect worldwide. Children diagnosed with this abnormality face difficulties during feeding, hearing, and especially speech. Although surgical methods exist to repair cleft palate, subsequent corrective surgeries are often necessary since children are unable to gain full speech capabilities due to velopharyngeal inadequacy. Investigating the velopharyngeal system in normal patients can help speech pathologists, surgeons, and other medical professionals understand the effects of velopharyngeal anatomy on velopharyngeal function and improve patient diagnosis and treatment. Earlier studies visualized the velum using two-and-three dimensional modeling, but these studies did not adequately investigate the variability in velopharyngeal muscle measures nor their impact on normal and abnormal velopharyngeal function. To remedy these shortcomings, this paper investigates the effects of muscles in the velopharyngeal system on closure force with a novel application of the multiple linear regression machine learning technique. Incorporating multiple anatomical features, multiple linear regression was used to predict closure force values and their direction. The results of this study reveal that multiple linear regression was found to be an effective tool for accurately predicting velopharyngeal closure force for any set of anatomical parameters. Furthermore, these results demonstrated that the velum had a major influence on closure force challenging previous claims that the levator veli palatini muscle was responsible for generating closure force.

Research paper thumbnail of Utilization of 3D MRI for the Evaluation of Sphincter Pharyngoplasty Insertion Site in Patients With Velopharyngeal Dysfunction

The Cleft Palate-Craniofacial Journal, Sep 27, 2021

Sphincter pharyngoplasty is a surgical method to treat velopharyngeal dysfunction. However, surgi... more Sphincter pharyngoplasty is a surgical method to treat velopharyngeal dysfunction. However, surgical failure is often noted and postoperative assessment frequently reveals low-set pharyngoplasties. Past studies have not quantified pharyngoplasty tissue changes that occur postoperatively and gaps remain related to the patient-specific variables that influence postoperative change. The purpose of this study was to utilize advanced three-dimensional imaging and volumetric magnetic resonance imaging (MRI) data to visualize and quantify pharyngoplasty insertion site and postsurgical tissue changes over time. A prospective, repeated measures design was used for the assessment of craniometric and velopharyngeal variables postsurgically. Imaging was completed across two postoperative time points. Tissue migration, pharyngoplasty dimensions, and predictors of change were analyzed across imaging time points. Significant differences were present between the initial location of pharyngoplasty tissue and the pharyngoplasty location 2 to 4 months postoperatively. The average postoperative inferior movement of pharyngoplasty tissue was 6.82 mm, although notable variability was present across participants. The pharyngoplasty volume decreased by 30%, on average. Inferior migration of the pharyngoplasty tissue was present in all patients. Gravity, scar contracture, and patient-specific variables likely interact, impacting final postoperative pharyngoplasty location. The use of advanced imaging modalities, such as 3D MRI, allows for the quantification and visualization of tissue change. There is a need for continued identification of patient-specific factors that may impact the amount of inferior tissue migration and scar contracture postoperatively.

Research paper thumbnail of Effect of motor-based speech intervention on articulatory placement in the treatment of a posterior nasal fricative: a preliminary MRI study on a single subject

International Journal of Language & Communication Disorders, May 21, 2018

Background: Posterior nasal fricatives are a learned compensatory articulation error and commonly... more Background: Posterior nasal fricatives are a learned compensatory articulation error and commonly substituted for oral fricatives. Treatment of such articulation errors requires the modification or teaching of skilled movements. A motor-based approach is designed to teach the complex motor skill movement sequences required in the production of sounds. Although motor learning research is well established, little has been done to determine how the approach changes the underlying physiology of articulatory movements. While the underlying anatomical configuration of the posterior nasal fricative has been described, no studies have quantified anatomic and physiological changes pre-and post-treatment. Aims: To use magnetic resonance imaging (MRI) to visualize and quantify the results of motor-based speechintervention approach on articulatory placement for the treatment of the posterior nasal fricative. Methods & Procedures: A 6-year-old male with a history of ear infections and posterior nasal fricative substitution for /s/ underwent six 1-h sessions of a motor-based treatment approach over the course of 2 weeks. Pre-and post-treatment evaluation included perceptual and instrumental assessment of speech and resonance. Perceptual resonance was rated by two speech-language therapists and articulation was assessed at the single-word level. Instrumental assessment included the See-Scape, Nasometer II and MRI during the sustained phonation of /s/. Amira v5.6 Visualization and Volume modelling software used the midsagittal and oblique coronal plane to measure dimensions of the articulatory anatomy. Outcomes & Results: Interrater reliability was assessed using a Pearson product moment correlation (α = .05) and ranged from r = .91 to .95. Intra-rater reliability was assessed using the intra-class correlation coefficient (.976) demonstrating a high degree of reliability with a 95% confidence interval. Articulation improved from 0% accuracy for /s/ in isolation at baseline to 100% for /s/ at the word level and 95% accuracy during conversational speech by session 6. Post-treatment results from this study revealed a greater shortening of the levator veli palatini (levator) muscle length during articulatory movements, more pronounced velar knee and dimple, decreased velar thickness, increased velar length and altered tongue position. Conclusions & Implications: This study demonstrated the use of pre-and post-treatment imaging methodology to quantify articulatory changes following an intensive motor-based treatment approach. MRI demonstrated quantifiable changes in articulatory placement. Individuals who exhibit non-developmental and phoneme-specific articulation errors, such as the posterior nasal fricative, may be excellent candidates for short-term, intensive and frequent speech therapy sessions to remediate the production of the posterior nasal fricative.

Research paper thumbnail of Evaluating the Accuracy of Using at Rest Images to Determine the Height of Velopharyngeal Closure

Journal of Craniofacial Surgery, Jul 1, 2018

Prior to performing secondary surgeries, lateral cephalograms have been used during phonation to ... more Prior to performing secondary surgeries, lateral cephalograms have been used during phonation to evaluate the point of attempted velopharyngeal contact along the posterior pharyngeal wall relative to the palatal plane and the first cervical vertebra. The ability to quantify the height of velopharyngeal closure is an important aspect of planning corrective surgeries for velopharyngeal dysfunction. However, issues with patient compliance during the imaging process can present difficulties for obtaining adequate preoperative imaging data. The purpose of this study was to assess if the height of velopharyngeal closure can be accurately estimated and quantified from at rest images. Results demonstrate that the height of velopharyngeal closure above C1 can be accurately quantified using at rest images in children with cleft palate. No statistically significant difference was found between the measures obtained at rest or during sustained phonation images (P ¼ 0.573). Thus, quantitative measures from at rest images can aid in the preoperative planning process by providing surgeons with a numeric distance for tissue insertion along the posterior pharyngeal wall above C1. This distance is correlated to the height of velopharyngeal closure and successfully placing tissue at this height is likely tied to improved postoperative speech outcomes.

Research paper thumbnail of Age-Related Changes Between the Level of Velopharyngeal Closure and the Cervical Spine

Journal of Craniofacial Surgery, Mar 1, 2016

The primary focus of this study was to assess age related changes in the vertical distance of the... more The primary focus of this study was to assess age related changes in the vertical distance of the estimated level of velopharyngeal closure in relation to a prominent landmark of the cervical spine: the anterior tubercle of cervical vertebrae one (C1). Midsagittal anatomical magnetic resonance images (MRI) were examined across 51 participants with normal head and neck anatomy between 4 and 17 years of age. Results indicate that age is a strong predictor (p = 0.002) of the vertical distance between the level of velopharyngeal closure relative to C1. Specifically, as age increases, the vertical distance between the palatal plane and C1 becomes greater resulting in the level of velopharyngeal closure being located higher above C1 (range 4.88mm to 10.55mm). Results of this study provide insights into the clinical usefulness of using C1 as a surgical landmark for placement of pharyngoplasties in children with repaired cleft palate and persistent hypernasal speech. Clinical implications and future directions are discussed.

Research paper thumbnail of A Review of Image Segmentation Techniques for Tracking the Velum

Several studies have used 2D and 3D modeling to visualize the velum. Very few attempts have been ... more Several studies have used 2D and 3D modeling to visualize the velum. Very few attempts have been made to track the velum and plot its movement against time. Image segmentation has been used widely for various purposes. However, its proficiency in tracking the velum is questionable at the moment. Two image segmentation methods, EdgeTrak and the Hidden Markov Model, are reviewed in this report. EdgeTrak, a software developed at VIMS Lab, has been proven to track the surface of a human tongue during speech production. An attempt was made to similarly track the velum during speech production using EdgeTrak but the results were disappointing. Also, synchronized audio mapping using the Hidden Markov Model was only partially successful. This paper describes the challenges image segmentation faces with regards to tracking the velum.

Research paper thumbnail of Relationship Between Age and Diagnosis on Volumetric and Linear Velopharyngeal Measures in the Cleft and Noncleft Populations

Journal of Craniofacial Surgery, Jul 1, 2016

The purpose of this study was to create a 3D volumetric segmentation from magnetic resonance imag... more The purpose of this study was to create a 3D volumetric segmentation from magnetic resonance imaging (MRI) of the nasopharyngeal space and adenoid tissue and to examine the relationship between nasopharyngeal volume (NPV), adenoid volume, and linear measures of the velopharyngeal structures, pharynx, and vocal tract in children with and without cleft palate. A total of 24 participants including 18 typically developing children (4-8 years of age) and 6 children (4-8 years of age) with varying degrees of cleft palate were imaged using MRI. Linear and volumetric variables varied significantly based on age. Overall, NPV demonstrates a modest increase with age. Nasopharyngeal volume was positively correlated with age (P ¼ 0.000), oronasopharyngeal volume (P ¼ 0.000), velar length (P ¼ 0.018), and velar thickness (P ¼ 0.046). These variables tend to increase together. Differences in NPV between groups (bilateral cleft lip and palate, submucous cleft lip and palate, unilateral cleft lip and palate [UCLP], and noncleft) were statistically significant (P ¼ 0.007). Participants with bilateral cleft lip and palate demonstrated greater NPVs than those with UCLP and submucous cleft palate.

Research paper thumbnail of Simulation of Velopharyngeal Biomechanics Identifies Differences in Sphincter Pharyngoplasty Outcomes: A Matched Case–Control Study

The Cleft Palate-Craniofacial Journal, Aug 22, 2022

The purpose of this study was to develop a framework for 3D subject-specific computational models... more The purpose of this study was to develop a framework for 3D subject-specific computational models capable of simulating velopharyngeal biomechanics for anatomic changes that occur following pharyngoplasty and to gain insight into biomechanical factors that may lead to different speech/surgical outcomes. Patient-specific models for two, matched participants with differing speech/surgical outcomes were developed: one with a successful pharyngoplasty outcome and one with a failed pharyngoplasty outcome. Surgical scenarios were simulated to model pharyngoplasty location, identify LVP muscle biomechanics, and identify an optimal pharyngoplasty location for each participant. These simulations illustrate the potential for optimizing pharyngoplasties based on patient-specific geometry.

Research paper thumbnail of Academic Education of the Speech-Language Pathologist: A Comparative Analysis on Graduate Education in Two Low-Incidence Disorder Areas

Perspectives of the ASHA Special Interest Groups, Feb 21, 2020

Background/Purpose When working with a specialized population, it is necessary to have the approp... more Background/Purpose When working with a specialized population, it is necessary to have the appropriate clinical and academic training. However, many speech-language pathologists report being ill-prepared regarding best practice when evaluating and treating patients with low-incidence disorders, particularly cleft palate/craniofacial anomalies and fluency disorders. The purpose of this study was to compare differences in graduate speech-language pathology coursework in the United States across two low-incidence disorder areas: cleft/craniofacial anomalies and fluency disorders. Method A review of the accredited graduate curricula offerings within these domains was completed. Information whether coursework in these areas was offered, if the course was taught as a full course or embedded within a related course, or whether the content was required or an elective, and if the course was taught by an expert was obtained. Results Significant differences were present in the amount, quality, and type of course content offered for cleft/craniofacial anomalies compared to fluency disorders. Only 72.83% of graduate speech-language pathologist programs offered content in cleft/craniofacial anomalies. Approximately one out of every four programs (27.17%) did not provide this content within the graduate curriculum. In contrast, content in fluency disorders was taught in 99.28% of graduate programs. Conclusion Results demonstrate that graduate training in topics related to cleft/craniofacial anomalies is significantly limited, particularly in comparison to another low-incidence communication disorder.

Research paper thumbnail of Changes in the Height of Velopharyngeal Closure Relative to the Cervical Spine From Infancy Through Adolescence in Patients With Cleft Palate

The Cleft Palate-Craniofacial Journal, Dec 14, 2017

Objective: Palpation is often used to identify C1, an intraoperative landmark, for placement of t... more Objective: Palpation is often used to identify C1, an intraoperative landmark, for placement of the pharyngoplasty. However, little is known about the relationship between the palatal plane (PP) and this cervical spine landmark across select variables. This study seeks to analyze variations in the height of velopharyngeal closure relative to C1 across differing cleft types and age groups. Design: Retrospective, cross-sectional analysis. Setting: Large, multidisciplinary center for craniofacial disorders. Methods: Clinical lateral cephalograms were analyzed in nonsyndromic patients who underwent primary palatoplasty. Regression analysis and analysis of covariance were completed to determine how age and cleft type impact underlying cervical and velopharyngeal measures. Results: Age (P < .001) and cleft type (P ¼ .036) were significant predictors of the distance between the height of velopharyngeal closure and C1. Those with greater severity of clefting demonstrated larger distances between the height of velopharyngeal closure and C1. Compared to normative data, children with cleft palate have significantly larger distances between the PP and C1. The height of velopharyngeal closure above C1 was observed to range from 3.6 to 12.6 mm across cleft populations. Conclusions: This study demonstrates the variability in C1 as a landmark across variables including cleft type and age. Because of differences in the height of velopharyngeal closure across cleft types relative to C1, it is necessary to preoperatively quantify the vertical distance between the PP and palpable intraoperative landmark, C1, to determine the appropriate height of pharyngoplasty insertion.

Research paper thumbnail of A Midsagittal-View Magnetic Resonance Imaging Study of the Growth and Involution of the Adenoid Mass and Related Changes in Selected Velopharyngeal Structures

Journal of Speech, Language, and Hearing Research

Purpose: The adenoids, or pharyngeal tonsils, consist of a pad of lymphoid tissue, located on the... more Purpose: The adenoids, or pharyngeal tonsils, consist of a pad of lymphoid tissue, located on the posterior pharyngeal wall of the nasopharynx. During childhood, the adenoid pad serves as a contact site for the soft palate to assist with velopharyngeal closure during oral speech. During adenoidal involution, most children are able to maintain appropriate velopharyngeal closure necessary for normal speech resonance. The purpose of this study is to determine age-related trends of normal adenoid growth and involution from infancy through adulthood. Method/Description: Lateral view magnetic resonance imaging was used to analyze velopharyngeal variables among 270 participants, between 3 months and 34 years of age. The velopharyngeal measures of interest included velar length, effective velar length, pharyngeal depth, adenoid height, adenoid thickness, adenoid depth, and adenoid area. Participants were divided into four age groups for statistical comparison. Results: There was a statistic...

Research paper thumbnail of Effective Velopharyngeal Ratio: A More Clinically Relevant Measure of Velopharyngeal Function

Journal of Speech, Language, and Hearing Research

Purpose Velopharyngeal (VP) ratios are commonly used to study normal VP anatomy and normal VP fun... more Purpose Velopharyngeal (VP) ratios are commonly used to study normal VP anatomy and normal VP function. An effective VP (EVP) ratio may be a more appropriate indicator of normal parameters for speech. The aims of this study are to examine if the VP ratio is preserved across the age span or if it varies with changes in the VP portal and to analyze if the EVP ratio is more stable across the age span. Method Magnetic resonance imaging was used to analyze VP variables of 270 participants. For statistical analysis, the participants were divided into the following groups based on age: infants, children, adolescents, and adults. Analyses of variance and a Games–Howell post hoc test were used to compare variables between groups. Results There was a statistically significant difference ( p < .05) in all measurements between the age groups. Pairwise comparisons reported statistically significant adjacent group differences ( p < .05) for velar length, VP ratio, effective velar length, ad...

Research paper thumbnail of Does the Type of MRI Sequence Influence Perceived Quality and Measurement Consistency in Investigations of the Anatomy of the Velopharynx?

The Cleft Palate-Craniofacial Journal, 2021

Purpose: The purpose of this study was to evaluate perceived image quality, confidence in identif... more Purpose: The purpose of this study was to evaluate perceived image quality, confidence in identifying key velopharyngeal landmarks, and reliability of making velopharyngeal measures between 3-dimensional (3-D) and 2-D magnetic resonance imaging (MRI) methods and between T1-, T2-, and proton density (PD)-weighted sequences. Methods: Twelve healthy participants completed an MRI study. Three raters assessed overall image quality and their ability to identify key anatomic features within the images. A single rater evaluated the reliability of making measures between imaging methods and sequence types to determine if image type (2-D and 3-D) or image sequence (T1, T2, PD weighted) resulted in different values for key velopharyngeal landmarks. Results: An analysis of variance test revealed image quality was rated significantly different based on the scan type ( P < .001) and the sequence used ( P = .015). Image quality was rated higher among 2-D MR images compared to 3-D, and higher am...

Research paper thumbnail of English-Only Treatment of Compensatory Speech Errors in a Bilingual Adoptee With Repaired Cleft Palate: A Descriptive Case Study

American Journal of Speech-Language Pathology, 2021

PurposeThe purpose of this clinical focus article is to provide a descriptive case study of a lat... more PurposeThe purpose of this clinical focus article is to provide a descriptive case study of a late-adopted, bilingual adolescent with cleft palate speech errors. Specifically, we examined the cross-linguistic generalization of remediated compensatory cleft errors, following treatment in English (second language) only. The overarching goal of this study is to gain insights into the complexity of speech intervention for the adopted population with delayed cleft palate repair.MethodA 14-year-old female adopted from China with a repaired unilateral cleft lip and palate and maladaptive articulation errors underwent 55 one-hour sessions of a motor-based, speech therapy approach over a 15-month span, targeting English phonemes only. Pre-, mid-, and posttreatment evaluation included perceptual and instrumental assessment of speech and resonance. Outcome measures at each time point included perceptual speech and resonance ratings, nasometry scores, and percent consonants correct (PCC) in bot...

Research paper thumbnail of Identifying Predictors of Levator Veli Palatini Muscle Contraction During Speech Using Dynamic Magnetic Resonance Imaging

Journal of Speech, Language, and Hearing Research, 2020

Purpose The purpose of this study was to identify predictors of levator veli palatini (LVP) muscl... more Purpose The purpose of this study was to identify predictors of levator veli palatini (LVP) muscle shortening and maximum contraction velocity in adults with normal anatomy. Method Twenty-two Caucasian English-speaking adults with normal speech and resonance were recruited. Participants included 11 men and 11 women ( M = 22.8 years, SD = 4.1) with normal anatomy. Static magnetic resonance images were obtained using a three-dimensional static imaging protocol. Midsagittal and oblique coronal planes were established for visualization of the velum and LVP muscle at rest. Dynamic magnetic resonance images were obtained in the oblique coronal plane during production of “ansa.” Amira 6.0.1 Visualization and Volume Modeling Software and MATLAB were used to analyze images and calculate LVP shortening and maximum contraction velocity. Results Significant predictors ( p < .05) of maximum LVP shortening during velopharyngeal closure included mean extravelar length, LVP origin-to-origin dist...

Research paper thumbnail of Evaluating Nasalance Values Among Bilingual Mandarin–English Speakers

The Cleft Palate-Craniofacial Journal, 2018

Research paper thumbnail of Growth Effects on Velopharyngeal Anatomy From Childhood to Adulthood

Journal of Speech, Language, and Hearing Research, 2019

PurposeThe observed sexual dimorphism of velopharyngeal structures among adult populations has no... more PurposeThe observed sexual dimorphism of velopharyngeal structures among adult populations has not been observed in the young child (4- to 9-year-old) population. The purpose of this study was to examine the age at which sexual dimorphism of velopharyngeal structures become apparent and to examine how growth trends vary between boys and girls.MethodStatic 3-dimensional magnetic resonance imaging velopharyngeal data were collected among 202 participants ranging from 4 to 21 years of age. Participants were divided into 3 groups based on age, including Group 1: 4–10 years of age, Group 2: 11–17 years of age, and Group 3: 18–21 years of age. Nine velopharyngeal measures were obtained and compared between groups.ResultsSignificant sex effects were evident for levator length (p= .011), origin to origin (p= .018), and velopharyngeal ratio (p= .036) for those in Group 2 (11–17 years of age). Sex effects became increasingly apparent with age, with 7 of 9 variables becoming significantly diff...

Research paper thumbnail of Examining Age, Sex, and Race Characteristics of Velopharyngeal Structures in 4- to 9-Year-Old Children Using Magnetic Resonance Imaging

The Cleft Palate-Craniofacial Journal, 2017

Objective:The purpose of this study was to quantify the growth of the various craniofacial and ve... more Objective:The purpose of this study was to quantify the growth of the various craniofacial and velopharyngeal structures and examine sex and race effects.Methods:Eight-five healthy children (53 white and 32 black) with normal velopharyngeal anatomy between 4 and 9 years of age who met the inclusion criteria and successfully completed the magnetic resonance imaging (MRI) scans were included in the study.Results:Developmental normative mean values for selected craniofacial and velopharyngeal variables by race and sex are reported. Facial skeleton variables (face height, nasion to sella, sella to basion, palate height, palate width) and velopharyngeal variables (levator muscle length, angle of origin, sagittal angle, velar length, velar thickness, velar knee to posterior pharyngeal wall, and posterior nasal spine to levator muscle) demonstrated a trend toward a decrease in angle measures and increase in linear measures as age increased (with the exception of posterior nasal spine to le...

Research paper thumbnail of Variations in Velopharyngeal Structure in Adults With Repaired Cleft Palate

The Cleft Palate-Craniofacial Journal, 2018

Objective: The purpose of this study was to examine differences in velopharyngeal structures betw... more Objective: The purpose of this study was to examine differences in velopharyngeal structures between adults with repaired cleft palate and normal resonance and adults without cleft palate. Design: Thirty-six English-speaking adults, including 6 adults (2 males and 4 females) with repaired cleft palate (M = 32.5 years of age, SD = 17.4 years) and 30 adults (15 males and 15 females) without cleft palate (M = 23.3 years of age, SD = 4.1 years), participated in the study. Fourteen velopharyngeal measures were obtained on magnetic resonance images and compared between groups (cleft and noncleft). Results: After adjusting for body size and sex effects, there was a statistically significant difference between groups for 10 out of the 14 velopharyngeal measures. Compared to those without cleft palate, participants with repaired cleft palate had a significantly shorter hard palate height and length, shorter levator muscle length, shorter intravelar segment, more acute levator angles of origi...

Research paper thumbnail of Morphology of the Levator Veli Palatini Muscle in Adults With Repaired Cleft Palate

Journal of Craniofacial Surgery, 2017

The purpose of this study was to examine differences in levator veli palatini (levator) morpholog... more The purpose of this study was to examine differences in levator veli palatini (levator) morphology between adults with repaired cleft palate and adults with non-cleft anatomy. Fifteen adult participants (10 with non-cleft anatomy, 5 with repaired cleft palate) completed a 3D static MRI. Image analyses included measures of total muscle volume and the circumference and diameter at 6 points along the length of the muscle. Differences between groups were analyzed using independent sample Mann-Whitney U-Tests (α < 0.05). Significant differences between groups were noted for measures of muscle volume, circumference at the origin and insertion, anteriorposterior diameter at the origin and midline, and superior-inferior diameter at the point of insertion into the velum and midline. Differences in measures at other points along the levator muscle belly were not statistically significant. Limited sample size and gender differences may have impacted statistical findings. Overall, the levator muscle in adults with repaired cleft palate is significantly different than that of adults with non-cleft anatomy. This study demonstrates the successful implementation of a method for 3D analysis of velopharyngeal (VP) musculature with potential clinical utility given continued technological advancements in MRI. Continued evaluation of preand post-surgical anatomy and short-and long-term outcomes may contribute to a better understanding of the effects of various types of palatoplasties on levator structure, which is important to VP function for speech.

Research paper thumbnail of Investigating Velopharyngeal Closure Force with Linear Regression

Cleft palate is a common birth defect worldwide. Children diagnosed with this abnormality face di... more Cleft palate is a common birth defect worldwide. Children diagnosed with this abnormality face difficulties during feeding, hearing, and especially speech. Although surgical methods exist to repair cleft palate, subsequent corrective surgeries are often necessary since children are unable to gain full speech capabilities due to velopharyngeal inadequacy. Investigating the velopharyngeal system in normal patients can help speech pathologists, surgeons, and other medical professionals understand the effects of velopharyngeal anatomy on velopharyngeal function and improve patient diagnosis and treatment. Earlier studies visualized the velum using two-and-three dimensional modeling, but these studies did not adequately investigate the variability in velopharyngeal muscle measures nor their impact on normal and abnormal velopharyngeal function. To remedy these shortcomings, this paper investigates the effects of muscles in the velopharyngeal system on closure force with a novel application of the multiple linear regression machine learning technique. Incorporating multiple anatomical features, multiple linear regression was used to predict closure force values and their direction. The results of this study reveal that multiple linear regression was found to be an effective tool for accurately predicting velopharyngeal closure force for any set of anatomical parameters. Furthermore, these results demonstrated that the velum had a major influence on closure force challenging previous claims that the levator veli palatini muscle was responsible for generating closure force.

Research paper thumbnail of Utilization of 3D MRI for the Evaluation of Sphincter Pharyngoplasty Insertion Site in Patients With Velopharyngeal Dysfunction

The Cleft Palate-Craniofacial Journal, Sep 27, 2021

Sphincter pharyngoplasty is a surgical method to treat velopharyngeal dysfunction. However, surgi... more Sphincter pharyngoplasty is a surgical method to treat velopharyngeal dysfunction. However, surgical failure is often noted and postoperative assessment frequently reveals low-set pharyngoplasties. Past studies have not quantified pharyngoplasty tissue changes that occur postoperatively and gaps remain related to the patient-specific variables that influence postoperative change. The purpose of this study was to utilize advanced three-dimensional imaging and volumetric magnetic resonance imaging (MRI) data to visualize and quantify pharyngoplasty insertion site and postsurgical tissue changes over time. A prospective, repeated measures design was used for the assessment of craniometric and velopharyngeal variables postsurgically. Imaging was completed across two postoperative time points. Tissue migration, pharyngoplasty dimensions, and predictors of change were analyzed across imaging time points. Significant differences were present between the initial location of pharyngoplasty tissue and the pharyngoplasty location 2 to 4 months postoperatively. The average postoperative inferior movement of pharyngoplasty tissue was 6.82 mm, although notable variability was present across participants. The pharyngoplasty volume decreased by 30%, on average. Inferior migration of the pharyngoplasty tissue was present in all patients. Gravity, scar contracture, and patient-specific variables likely interact, impacting final postoperative pharyngoplasty location. The use of advanced imaging modalities, such as 3D MRI, allows for the quantification and visualization of tissue change. There is a need for continued identification of patient-specific factors that may impact the amount of inferior tissue migration and scar contracture postoperatively.

Research paper thumbnail of Effect of motor-based speech intervention on articulatory placement in the treatment of a posterior nasal fricative: a preliminary MRI study on a single subject

International Journal of Language & Communication Disorders, May 21, 2018

Background: Posterior nasal fricatives are a learned compensatory articulation error and commonly... more Background: Posterior nasal fricatives are a learned compensatory articulation error and commonly substituted for oral fricatives. Treatment of such articulation errors requires the modification or teaching of skilled movements. A motor-based approach is designed to teach the complex motor skill movement sequences required in the production of sounds. Although motor learning research is well established, little has been done to determine how the approach changes the underlying physiology of articulatory movements. While the underlying anatomical configuration of the posterior nasal fricative has been described, no studies have quantified anatomic and physiological changes pre-and post-treatment. Aims: To use magnetic resonance imaging (MRI) to visualize and quantify the results of motor-based speechintervention approach on articulatory placement for the treatment of the posterior nasal fricative. Methods & Procedures: A 6-year-old male with a history of ear infections and posterior nasal fricative substitution for /s/ underwent six 1-h sessions of a motor-based treatment approach over the course of 2 weeks. Pre-and post-treatment evaluation included perceptual and instrumental assessment of speech and resonance. Perceptual resonance was rated by two speech-language therapists and articulation was assessed at the single-word level. Instrumental assessment included the See-Scape, Nasometer II and MRI during the sustained phonation of /s/. Amira v5.6 Visualization and Volume modelling software used the midsagittal and oblique coronal plane to measure dimensions of the articulatory anatomy. Outcomes & Results: Interrater reliability was assessed using a Pearson product moment correlation (α = .05) and ranged from r = .91 to .95. Intra-rater reliability was assessed using the intra-class correlation coefficient (.976) demonstrating a high degree of reliability with a 95% confidence interval. Articulation improved from 0% accuracy for /s/ in isolation at baseline to 100% for /s/ at the word level and 95% accuracy during conversational speech by session 6. Post-treatment results from this study revealed a greater shortening of the levator veli palatini (levator) muscle length during articulatory movements, more pronounced velar knee and dimple, decreased velar thickness, increased velar length and altered tongue position. Conclusions & Implications: This study demonstrated the use of pre-and post-treatment imaging methodology to quantify articulatory changes following an intensive motor-based treatment approach. MRI demonstrated quantifiable changes in articulatory placement. Individuals who exhibit non-developmental and phoneme-specific articulation errors, such as the posterior nasal fricative, may be excellent candidates for short-term, intensive and frequent speech therapy sessions to remediate the production of the posterior nasal fricative.

Research paper thumbnail of Evaluating the Accuracy of Using at Rest Images to Determine the Height of Velopharyngeal Closure

Journal of Craniofacial Surgery, Jul 1, 2018

Prior to performing secondary surgeries, lateral cephalograms have been used during phonation to ... more Prior to performing secondary surgeries, lateral cephalograms have been used during phonation to evaluate the point of attempted velopharyngeal contact along the posterior pharyngeal wall relative to the palatal plane and the first cervical vertebra. The ability to quantify the height of velopharyngeal closure is an important aspect of planning corrective surgeries for velopharyngeal dysfunction. However, issues with patient compliance during the imaging process can present difficulties for obtaining adequate preoperative imaging data. The purpose of this study was to assess if the height of velopharyngeal closure can be accurately estimated and quantified from at rest images. Results demonstrate that the height of velopharyngeal closure above C1 can be accurately quantified using at rest images in children with cleft palate. No statistically significant difference was found between the measures obtained at rest or during sustained phonation images (P ¼ 0.573). Thus, quantitative measures from at rest images can aid in the preoperative planning process by providing surgeons with a numeric distance for tissue insertion along the posterior pharyngeal wall above C1. This distance is correlated to the height of velopharyngeal closure and successfully placing tissue at this height is likely tied to improved postoperative speech outcomes.

Research paper thumbnail of Age-Related Changes Between the Level of Velopharyngeal Closure and the Cervical Spine

Journal of Craniofacial Surgery, Mar 1, 2016

The primary focus of this study was to assess age related changes in the vertical distance of the... more The primary focus of this study was to assess age related changes in the vertical distance of the estimated level of velopharyngeal closure in relation to a prominent landmark of the cervical spine: the anterior tubercle of cervical vertebrae one (C1). Midsagittal anatomical magnetic resonance images (MRI) were examined across 51 participants with normal head and neck anatomy between 4 and 17 years of age. Results indicate that age is a strong predictor (p = 0.002) of the vertical distance between the level of velopharyngeal closure relative to C1. Specifically, as age increases, the vertical distance between the palatal plane and C1 becomes greater resulting in the level of velopharyngeal closure being located higher above C1 (range 4.88mm to 10.55mm). Results of this study provide insights into the clinical usefulness of using C1 as a surgical landmark for placement of pharyngoplasties in children with repaired cleft palate and persistent hypernasal speech. Clinical implications and future directions are discussed.

Research paper thumbnail of A Review of Image Segmentation Techniques for Tracking the Velum

Several studies have used 2D and 3D modeling to visualize the velum. Very few attempts have been ... more Several studies have used 2D and 3D modeling to visualize the velum. Very few attempts have been made to track the velum and plot its movement against time. Image segmentation has been used widely for various purposes. However, its proficiency in tracking the velum is questionable at the moment. Two image segmentation methods, EdgeTrak and the Hidden Markov Model, are reviewed in this report. EdgeTrak, a software developed at VIMS Lab, has been proven to track the surface of a human tongue during speech production. An attempt was made to similarly track the velum during speech production using EdgeTrak but the results were disappointing. Also, synchronized audio mapping using the Hidden Markov Model was only partially successful. This paper describes the challenges image segmentation faces with regards to tracking the velum.

Research paper thumbnail of Relationship Between Age and Diagnosis on Volumetric and Linear Velopharyngeal Measures in the Cleft and Noncleft Populations

Journal of Craniofacial Surgery, Jul 1, 2016

The purpose of this study was to create a 3D volumetric segmentation from magnetic resonance imag... more The purpose of this study was to create a 3D volumetric segmentation from magnetic resonance imaging (MRI) of the nasopharyngeal space and adenoid tissue and to examine the relationship between nasopharyngeal volume (NPV), adenoid volume, and linear measures of the velopharyngeal structures, pharynx, and vocal tract in children with and without cleft palate. A total of 24 participants including 18 typically developing children (4-8 years of age) and 6 children (4-8 years of age) with varying degrees of cleft palate were imaged using MRI. Linear and volumetric variables varied significantly based on age. Overall, NPV demonstrates a modest increase with age. Nasopharyngeal volume was positively correlated with age (P ¼ 0.000), oronasopharyngeal volume (P ¼ 0.000), velar length (P ¼ 0.018), and velar thickness (P ¼ 0.046). These variables tend to increase together. Differences in NPV between groups (bilateral cleft lip and palate, submucous cleft lip and palate, unilateral cleft lip and palate [UCLP], and noncleft) were statistically significant (P ¼ 0.007). Participants with bilateral cleft lip and palate demonstrated greater NPVs than those with UCLP and submucous cleft palate.

Research paper thumbnail of Simulation of Velopharyngeal Biomechanics Identifies Differences in Sphincter Pharyngoplasty Outcomes: A Matched Case–Control Study

The Cleft Palate-Craniofacial Journal, Aug 22, 2022

The purpose of this study was to develop a framework for 3D subject-specific computational models... more The purpose of this study was to develop a framework for 3D subject-specific computational models capable of simulating velopharyngeal biomechanics for anatomic changes that occur following pharyngoplasty and to gain insight into biomechanical factors that may lead to different speech/surgical outcomes. Patient-specific models for two, matched participants with differing speech/surgical outcomes were developed: one with a successful pharyngoplasty outcome and one with a failed pharyngoplasty outcome. Surgical scenarios were simulated to model pharyngoplasty location, identify LVP muscle biomechanics, and identify an optimal pharyngoplasty location for each participant. These simulations illustrate the potential for optimizing pharyngoplasties based on patient-specific geometry.

Research paper thumbnail of Academic Education of the Speech-Language Pathologist: A Comparative Analysis on Graduate Education in Two Low-Incidence Disorder Areas

Perspectives of the ASHA Special Interest Groups, Feb 21, 2020

Background/Purpose When working with a specialized population, it is necessary to have the approp... more Background/Purpose When working with a specialized population, it is necessary to have the appropriate clinical and academic training. However, many speech-language pathologists report being ill-prepared regarding best practice when evaluating and treating patients with low-incidence disorders, particularly cleft palate/craniofacial anomalies and fluency disorders. The purpose of this study was to compare differences in graduate speech-language pathology coursework in the United States across two low-incidence disorder areas: cleft/craniofacial anomalies and fluency disorders. Method A review of the accredited graduate curricula offerings within these domains was completed. Information whether coursework in these areas was offered, if the course was taught as a full course or embedded within a related course, or whether the content was required or an elective, and if the course was taught by an expert was obtained. Results Significant differences were present in the amount, quality, and type of course content offered for cleft/craniofacial anomalies compared to fluency disorders. Only 72.83% of graduate speech-language pathologist programs offered content in cleft/craniofacial anomalies. Approximately one out of every four programs (27.17%) did not provide this content within the graduate curriculum. In contrast, content in fluency disorders was taught in 99.28% of graduate programs. Conclusion Results demonstrate that graduate training in topics related to cleft/craniofacial anomalies is significantly limited, particularly in comparison to another low-incidence communication disorder.

Research paper thumbnail of Changes in the Height of Velopharyngeal Closure Relative to the Cervical Spine From Infancy Through Adolescence in Patients With Cleft Palate

The Cleft Palate-Craniofacial Journal, Dec 14, 2017

Objective: Palpation is often used to identify C1, an intraoperative landmark, for placement of t... more Objective: Palpation is often used to identify C1, an intraoperative landmark, for placement of the pharyngoplasty. However, little is known about the relationship between the palatal plane (PP) and this cervical spine landmark across select variables. This study seeks to analyze variations in the height of velopharyngeal closure relative to C1 across differing cleft types and age groups. Design: Retrospective, cross-sectional analysis. Setting: Large, multidisciplinary center for craniofacial disorders. Methods: Clinical lateral cephalograms were analyzed in nonsyndromic patients who underwent primary palatoplasty. Regression analysis and analysis of covariance were completed to determine how age and cleft type impact underlying cervical and velopharyngeal measures. Results: Age (P < .001) and cleft type (P ¼ .036) were significant predictors of the distance between the height of velopharyngeal closure and C1. Those with greater severity of clefting demonstrated larger distances between the height of velopharyngeal closure and C1. Compared to normative data, children with cleft palate have significantly larger distances between the PP and C1. The height of velopharyngeal closure above C1 was observed to range from 3.6 to 12.6 mm across cleft populations. Conclusions: This study demonstrates the variability in C1 as a landmark across variables including cleft type and age. Because of differences in the height of velopharyngeal closure across cleft types relative to C1, it is necessary to preoperatively quantify the vertical distance between the PP and palpable intraoperative landmark, C1, to determine the appropriate height of pharyngoplasty insertion.

Research paper thumbnail of A Midsagittal-View Magnetic Resonance Imaging Study of the Growth and Involution of the Adenoid Mass and Related Changes in Selected Velopharyngeal Structures

Journal of Speech, Language, and Hearing Research

Purpose: The adenoids, or pharyngeal tonsils, consist of a pad of lymphoid tissue, located on the... more Purpose: The adenoids, or pharyngeal tonsils, consist of a pad of lymphoid tissue, located on the posterior pharyngeal wall of the nasopharynx. During childhood, the adenoid pad serves as a contact site for the soft palate to assist with velopharyngeal closure during oral speech. During adenoidal involution, most children are able to maintain appropriate velopharyngeal closure necessary for normal speech resonance. The purpose of this study is to determine age-related trends of normal adenoid growth and involution from infancy through adulthood. Method/Description: Lateral view magnetic resonance imaging was used to analyze velopharyngeal variables among 270 participants, between 3 months and 34 years of age. The velopharyngeal measures of interest included velar length, effective velar length, pharyngeal depth, adenoid height, adenoid thickness, adenoid depth, and adenoid area. Participants were divided into four age groups for statistical comparison. Results: There was a statistic...

Research paper thumbnail of Effective Velopharyngeal Ratio: A More Clinically Relevant Measure of Velopharyngeal Function

Journal of Speech, Language, and Hearing Research

Purpose Velopharyngeal (VP) ratios are commonly used to study normal VP anatomy and normal VP fun... more Purpose Velopharyngeal (VP) ratios are commonly used to study normal VP anatomy and normal VP function. An effective VP (EVP) ratio may be a more appropriate indicator of normal parameters for speech. The aims of this study are to examine if the VP ratio is preserved across the age span or if it varies with changes in the VP portal and to analyze if the EVP ratio is more stable across the age span. Method Magnetic resonance imaging was used to analyze VP variables of 270 participants. For statistical analysis, the participants were divided into the following groups based on age: infants, children, adolescents, and adults. Analyses of variance and a Games–Howell post hoc test were used to compare variables between groups. Results There was a statistically significant difference ( p < .05) in all measurements between the age groups. Pairwise comparisons reported statistically significant adjacent group differences ( p < .05) for velar length, VP ratio, effective velar length, ad...

Research paper thumbnail of Does the Type of MRI Sequence Influence Perceived Quality and Measurement Consistency in Investigations of the Anatomy of the Velopharynx?

The Cleft Palate-Craniofacial Journal, 2021

Purpose: The purpose of this study was to evaluate perceived image quality, confidence in identif... more Purpose: The purpose of this study was to evaluate perceived image quality, confidence in identifying key velopharyngeal landmarks, and reliability of making velopharyngeal measures between 3-dimensional (3-D) and 2-D magnetic resonance imaging (MRI) methods and between T1-, T2-, and proton density (PD)-weighted sequences. Methods: Twelve healthy participants completed an MRI study. Three raters assessed overall image quality and their ability to identify key anatomic features within the images. A single rater evaluated the reliability of making measures between imaging methods and sequence types to determine if image type (2-D and 3-D) or image sequence (T1, T2, PD weighted) resulted in different values for key velopharyngeal landmarks. Results: An analysis of variance test revealed image quality was rated significantly different based on the scan type ( P < .001) and the sequence used ( P = .015). Image quality was rated higher among 2-D MR images compared to 3-D, and higher am...

Research paper thumbnail of English-Only Treatment of Compensatory Speech Errors in a Bilingual Adoptee With Repaired Cleft Palate: A Descriptive Case Study

American Journal of Speech-Language Pathology, 2021

PurposeThe purpose of this clinical focus article is to provide a descriptive case study of a lat... more PurposeThe purpose of this clinical focus article is to provide a descriptive case study of a late-adopted, bilingual adolescent with cleft palate speech errors. Specifically, we examined the cross-linguistic generalization of remediated compensatory cleft errors, following treatment in English (second language) only. The overarching goal of this study is to gain insights into the complexity of speech intervention for the adopted population with delayed cleft palate repair.MethodA 14-year-old female adopted from China with a repaired unilateral cleft lip and palate and maladaptive articulation errors underwent 55 one-hour sessions of a motor-based, speech therapy approach over a 15-month span, targeting English phonemes only. Pre-, mid-, and posttreatment evaluation included perceptual and instrumental assessment of speech and resonance. Outcome measures at each time point included perceptual speech and resonance ratings, nasometry scores, and percent consonants correct (PCC) in bot...

Research paper thumbnail of Identifying Predictors of Levator Veli Palatini Muscle Contraction During Speech Using Dynamic Magnetic Resonance Imaging

Journal of Speech, Language, and Hearing Research, 2020

Purpose The purpose of this study was to identify predictors of levator veli palatini (LVP) muscl... more Purpose The purpose of this study was to identify predictors of levator veli palatini (LVP) muscle shortening and maximum contraction velocity in adults with normal anatomy. Method Twenty-two Caucasian English-speaking adults with normal speech and resonance were recruited. Participants included 11 men and 11 women ( M = 22.8 years, SD = 4.1) with normal anatomy. Static magnetic resonance images were obtained using a three-dimensional static imaging protocol. Midsagittal and oblique coronal planes were established for visualization of the velum and LVP muscle at rest. Dynamic magnetic resonance images were obtained in the oblique coronal plane during production of “ansa.” Amira 6.0.1 Visualization and Volume Modeling Software and MATLAB were used to analyze images and calculate LVP shortening and maximum contraction velocity. Results Significant predictors ( p < .05) of maximum LVP shortening during velopharyngeal closure included mean extravelar length, LVP origin-to-origin dist...

Research paper thumbnail of Evaluating Nasalance Values Among Bilingual Mandarin–English Speakers

The Cleft Palate-Craniofacial Journal, 2018

Research paper thumbnail of Growth Effects on Velopharyngeal Anatomy From Childhood to Adulthood

Journal of Speech, Language, and Hearing Research, 2019

PurposeThe observed sexual dimorphism of velopharyngeal structures among adult populations has no... more PurposeThe observed sexual dimorphism of velopharyngeal structures among adult populations has not been observed in the young child (4- to 9-year-old) population. The purpose of this study was to examine the age at which sexual dimorphism of velopharyngeal structures become apparent and to examine how growth trends vary between boys and girls.MethodStatic 3-dimensional magnetic resonance imaging velopharyngeal data were collected among 202 participants ranging from 4 to 21 years of age. Participants were divided into 3 groups based on age, including Group 1: 4–10 years of age, Group 2: 11–17 years of age, and Group 3: 18–21 years of age. Nine velopharyngeal measures were obtained and compared between groups.ResultsSignificant sex effects were evident for levator length (p= .011), origin to origin (p= .018), and velopharyngeal ratio (p= .036) for those in Group 2 (11–17 years of age). Sex effects became increasingly apparent with age, with 7 of 9 variables becoming significantly diff...

Research paper thumbnail of Examining Age, Sex, and Race Characteristics of Velopharyngeal Structures in 4- to 9-Year-Old Children Using Magnetic Resonance Imaging

The Cleft Palate-Craniofacial Journal, 2017

Objective:The purpose of this study was to quantify the growth of the various craniofacial and ve... more Objective:The purpose of this study was to quantify the growth of the various craniofacial and velopharyngeal structures and examine sex and race effects.Methods:Eight-five healthy children (53 white and 32 black) with normal velopharyngeal anatomy between 4 and 9 years of age who met the inclusion criteria and successfully completed the magnetic resonance imaging (MRI) scans were included in the study.Results:Developmental normative mean values for selected craniofacial and velopharyngeal variables by race and sex are reported. Facial skeleton variables (face height, nasion to sella, sella to basion, palate height, palate width) and velopharyngeal variables (levator muscle length, angle of origin, sagittal angle, velar length, velar thickness, velar knee to posterior pharyngeal wall, and posterior nasal spine to levator muscle) demonstrated a trend toward a decrease in angle measures and increase in linear measures as age increased (with the exception of posterior nasal spine to le...

Research paper thumbnail of Variations in Velopharyngeal Structure in Adults With Repaired Cleft Palate

The Cleft Palate-Craniofacial Journal, 2018

Objective: The purpose of this study was to examine differences in velopharyngeal structures betw... more Objective: The purpose of this study was to examine differences in velopharyngeal structures between adults with repaired cleft palate and normal resonance and adults without cleft palate. Design: Thirty-six English-speaking adults, including 6 adults (2 males and 4 females) with repaired cleft palate (M = 32.5 years of age, SD = 17.4 years) and 30 adults (15 males and 15 females) without cleft palate (M = 23.3 years of age, SD = 4.1 years), participated in the study. Fourteen velopharyngeal measures were obtained on magnetic resonance images and compared between groups (cleft and noncleft). Results: After adjusting for body size and sex effects, there was a statistically significant difference between groups for 10 out of the 14 velopharyngeal measures. Compared to those without cleft palate, participants with repaired cleft palate had a significantly shorter hard palate height and length, shorter levator muscle length, shorter intravelar segment, more acute levator angles of origi...

Research paper thumbnail of Morphology of the Levator Veli Palatini Muscle in Adults With Repaired Cleft Palate

Journal of Craniofacial Surgery, 2017

The purpose of this study was to examine differences in levator veli palatini (levator) morpholog... more The purpose of this study was to examine differences in levator veli palatini (levator) morphology between adults with repaired cleft palate and adults with non-cleft anatomy. Fifteen adult participants (10 with non-cleft anatomy, 5 with repaired cleft palate) completed a 3D static MRI. Image analyses included measures of total muscle volume and the circumference and diameter at 6 points along the length of the muscle. Differences between groups were analyzed using independent sample Mann-Whitney U-Tests (α < 0.05). Significant differences between groups were noted for measures of muscle volume, circumference at the origin and insertion, anteriorposterior diameter at the origin and midline, and superior-inferior diameter at the point of insertion into the velum and midline. Differences in measures at other points along the levator muscle belly were not statistically significant. Limited sample size and gender differences may have impacted statistical findings. Overall, the levator muscle in adults with repaired cleft palate is significantly different than that of adults with non-cleft anatomy. This study demonstrates the successful implementation of a method for 3D analysis of velopharyngeal (VP) musculature with potential clinical utility given continued technological advancements in MRI. Continued evaluation of preand post-surgical anatomy and short-and long-term outcomes may contribute to a better understanding of the effects of various types of palatoplasties on levator structure, which is important to VP function for speech.