Articulation In Patients Research Articles

Outcomes of Patients Receiving Proximal Row Carpectomy and Meniscus Interposition Allografts for the Treatment of End-Stage Wrist Arthritis: A Comparative Study.

Proximal row carpectomy (PRC) is a mainstay of wrist arthritis treatment; however, it is traditionally contraindicated in patients with an affected capitate. The use of soft tissue interposition grafts to resurface the radiocapitate articulation has been previously described to allow for PRC in these patients. In the current study, we reviewed our outcomes using knee meniscus allograft interposition to resurface the radiocapitate articulation in patients who would have otherwise been contraindicated for PRC. A retrospective study of patients who underwent PRC with or without meniscus interposition arthroplasty was performed from 2011 to 2022. Patient demographics (age, sex, occupation, hand dominance, etc) were collected. Improvement in pain was the primary outcome. Wrist range of motion and reconstructive failure requiring fusion were the secondary outcomes. We identified a total of 83 patients and 43 met the inclusion criteria. Fifteen patients (35%) underwent PRC with meniscus interposition arthroplasty, and 28 patients (65%) underwent PRC alone. Patients with and without meniscus interposition arthroplasty had documented improvement in pain postoperatively (93% vs 95%, P > .05) at a median follow-up time of 11 (range, 3-38 months) and 9 months (range, 3-64 months), respectively. Postoperative wrist range of motion (flexion: +9 vs -4, P > .05, extension: +12 vs -4, P = .10) trended toward increase in patients undergoing meniscus interposition arthroplasty compared with PRC alone. Our short- to mid-term outcomes in patients with end-stage wrist arthritis affecting the capitate who undergo PRC and meniscus interposition arthroplasty are comparable with those receiving PRC alone.

Three-dimensional evaluation of orofacial movements during articulation in patients with skeletal Class III malocclusion with mandibular asymmetry

ABSTRACT Purpose This study aimed to compare the perioral soft tissue movements in patients with skeletal Class III malocclusion with and without mandibular asymmetry during sound articulation. Materials and Methods Patients with skeletal Class III facial deformity with mandibular asymmetry (asymmetric facial deformity; AFD, n = 21), without mandibular asymmetry (symmetric facial deformity; SFD, n = 27), and control skeletal Class I healthy individuals (n = 24) participated in this study. Perioral soft tissue movements were recorded during the articulation of /apa/, /ipi/, /upu/, /epe/, and /opo/ using a three-dimensional motion capture system. The asymmetry index (AI) of the range of movements of the commissure points on both sides was compared among the three groups by Kruskal–Wallis test and Dunn–Bonferroni test. Additionally, the correlation between the AI and the range of menton (Me) deviation was examined among patients in the SFD or AFD group by Spearman’s correlation test. Results AI on the vertical and sagittal dimensions during the /ipi/ sound articulation in the AFD group was significantly lower than in the other two groups (p < 0.05). In the AFD and SFD groups, AI on the vertical dimension was significantly correlated with Me deviation during /ipi/ sound articulation, as well as on the sagittal dimension during /apa/, /ipi/, /upu/, and /epe/ sound articulation (p < 0.05). Conclusion AFD patients displayed more asymmetric perioral soft tissue movements than SFD patients during bilabial sound production.

Speech Disorder in Anterior Open Bite (AOB): Systematic Review

There have been numerous researches showing that articulation disorders and malocclusion are linked. The most prevalent malocclusion in speech or articulation disorders is anterior open bite (AOB). Excessive propulsion of the tongue forward when articulating phonemes causes altered articulation in patients with open bites, as the tongue is in a more forward posture. The presence of this speech disorder can have a negative impact on a person's quality of life, although there hasn't been much research done on the impacts of AOB in cases of speech disorders in children. This study was to look at the link between speech disorders and the occurrence of anterior open bites (AOB) in a comprehensive way. Search results of research on four databases, namely ScienDirect, PubMed, Spingerlink, and Google Scholar, are displayed. The keywords used include speech disorder, articulation disorder, open bite, anterior open bite. Five articles were selected using case control and cross-sectional methods in their research. The sample with AOB in this study was analyzed to determine the presence of speech disorders. The five articles gave similar results, showing that patients with malocclusion, especially AOB, had a tendency to have speech disorders. Articulation disorders in the phoneme /s/z/d/l/t/ become the dominant problem experienced by patients with AOB. Anterior open bite (AOB) is a form of malocclusion that causes more articulation disorders than other malocclusions. The presence and position of the tongue are thought to have a substantial influence on articulation disorders.

Cover Image

COVER ILLUSTRATION Neural changes accompanying dosage intensive treatments targeting voice or articulation in patients with Parkinson's dysphonia. Voice treatment (yellow) targeted larynx and respiration while articulation treatment (blue) targeted mouth and lips. Behaviorally, voice treatment but not articulation treatment resulted in improvement in voice quality. However, treatment target specific changes in the speech motor network were observed during a reading task immediately following each treatment. Brain areas altered by voice treatment are shown in yellow and brain areas showing changes following articulation treatment are shown in blue. Left hemisphere activations are clear and right hemisphere activations are checkered. Voice treatment increased activity in left premotor and bilateral auditory cortices while articulation treatment increased activity in bilateral premotor and left insular cortices. The intensive dosage contributed to persistent changes at 7-month follow up. These results indicate that dysphonia and the speech motor network can be differentially modified by treatment targets, while intensive dosage contribute to long lasting effects of speech treatments.

Automatic boost articulation therapy in adults with dysarthria: Acceptability, usability and user interaction.

ABSTRACTBackgroundImprecise articulation has a negative impact on speech intelligibility. Therefore, treatment of articulation is clinically relevant in patients with dysarthria. In order to be effective and according to the principles of motor learning, articulation therapy needs to be intensive, well organized, with adequate feedback and requires frequent practice.AimsThe aims of this pilot study are (1) to evaluate the feasibility of a virtual articulation therapy (VAT) to guide patients with dysarthria through a boost articulation therapy (BArT) program; (2) to evaluate the acoustic models’ performance used for automatic phonological error detection; and (3) to validate the system by end‐users from their perspective.Methods & ProceduresThe VAT provides an extensive and well‐structured package of exercises with visual and auditory modelling and adequate feedback on the utterances. The tool incorporates automated methods to detect phonological errors, which are specifically designed to analyse Dutch speech production. A total of 14 subjects with dysarthria evaluated the acceptability, usability and user interaction with the VAT based on two completed therapy sessions using a self‐designed questionnaire.Outcomes & ResultsIn general, participants were positive about the new computer‐based therapy approach. The algorithm performance for phonological error detection shows it to be accurate, which contributes to adequate feedback of utterance production. The results of the study indicate that the VAT has a user‐friendly interface that can be used independently by patients with dysarthria who have sufficient cognitive, linguistic, motoric and sensory skills to benefit from speech therapy. Recommendations were given by the end‐users to further optimize the program and to ensure user engagement.Conclusions & ImplicationsThe initial implementation of an automatic BArT shows it to be feasible and well accepted by end‐users. The tool is an appropriate solution to increase the frequency and intensity of articulation training that supports traditional methods.What this paper addsWhat is already known on the subject Behavioural interventions to improve articulation in patients with dysarthria demand intensive treatments, repetitive practice and feedback. However, the current treatments are mainly limited in time to the interactive sessions in the presence of speech–language pathology. Automatic systems addressing the needs of individuals with dysarthria are scarce. This study evaluates the feasibility of a VAT program and investigates its acceptability, usability and user interaction. What this paper adds to existing knowledge The computer‐based speech therapy approach developed and applied in this study intends to support intensive articulation training of patients with dysarthria. The virtual speech therapy offers the possibility of an individualized and customized therapy programme, with an extensive database of exercises, visual and auditory models of the target utterances, and providing adequate feedback based on automatic acoustic analysis of speech. What are the potential or actual clinical implications of this work? The automatic BArT overcomes the limitation in time of face‐to‐face traditional speech therapy. It offers patients the opportunity to have access to speech therapy more intensively and frequently in their home environment.

Is medial pivot total knee arthroplasty suitable for patients with valgus knee osteoarthritis?

Medial pivot total knee arthroplasty (MP-TKA) is characterized by the ball-in-socket medial tibiofemoral articulation to achieve low wear and to reproduce the medial pivot motion similar to that in the normal knee, and there have been reports of favorable long-term postsurgical outcomes. However, most of these cases concerned varus knees, and the outcomes of MP-TKA in valgus knees are unknown. The objective of this study was to investigate the postoperative outcomes in end-stage valgus knee OA patients who underwent MP-TKA, through comparisons with those who underwent TKA using the same prosthesis for varus deformity. This retrospective, single-center, cohort study analyzed 171 knees of 121 patients who were divided into two groups (valgus knee group: 15 knees (13 patients), varus knee group: 156 knees (109 patients)). Primary outcome measures included the knee joint range of motion (evaluated preoperatively and at every year postoperatively). Secondary outcomes included operative time, laboratory data, estimated blood loss, clinical outcome measures and adverse events. There were no significant differences in age, sex and body mass index, as well as in the postoperative primary and secondary outcome measures between the two groups. The use of MP-TKA featuring ball-in-socket medial tibiofemoral articulation in patients with valgus knee OA showed equally favorable clinical outcomes more than 2 years after surgery, compared to patients with varus knees who received MP-TKA.

Use of a modular hip dual-mobility articulation in patients with high risk of dislocation: a relatively small-sized acetabulum in Asian patients may limit its use

BackgroundDual-mobility hip component is widely used in Europe and North America, because it effectively reduces hip dislocation in primary and revision total hip arthroplasties. However, reports were limited on the use of dual-mobility articulation in Asian populations.PurposeThe aim of this retrospective study was to review the use of modular dual-mobility hip articulation in Asian patients with the high risk factor for hip dislocation. We also discussed the potential concern on the use of dual-mobility articulation in Asian patients.MethodsFrom Jan 2018 to June 2019, 17 patients were included in this study. The mean age of the patients was (73.8 ± 9.5) years (range: 57–88 years). The mean size of acetabular cup and modular DM liner were (49.5 ± 3.4) mm (range, 46–58 mm) and (40.7 ± 3.4) mm (range, 38–48 mm), respectively. The mean follow-up period was (15.8 ± 3.9) months (range, 11–24 months). The primary outcome was the rate of hip dislocation. The secondary outcomes included the Harris Hip Score. Differences were considered statistically significant at p < 0.05.ResultsHip dislocation, loosening, peri-prosthetic fractures, or intra-prosthetic dislocation was not found in the series. The mean preoperative and postoperative Harris Hip Scores were 42.2 ± 17.2 (range, 15–80) and 74.7 ± 13.5 (range, 52–97), respectively, giving a mean improvement of 32.5 ± 17.2 (range, 4–72). The improvement was statistically significant (p < 0.05).ConclusionsIn Asian patients with high risk of hip dislocation, the use of modular dual-mobility hip component produces promising outcomes without hip dislocation, but the relatively small-sized acetabulum may limit it widespread application in other populations worldwide.Trial registrationHKUCTR-2913.

Effect of boost articulation therapy (BArT) on intelligibility in adults with dysarthria.

BackgroundThe articulatory accuracy of patients with dysarthria is one of the most affected speech dimensions with a high impact on speech intelligibility. Behavioural treatments of articulation can either involve direct or indirect approaches. The latter have been thoroughly investigated and are generally appreciated for their almost immediate effects on articulation and intelligibility. The number of studies on (short‐term) direct articulation therapy is limited.AimsTo investigate the effects of short‐term, boost articulation therapy (BArT) on speech intelligibility in patients with chronic or progressive dysarthria and the effect of severity of dysarthria on the outcome.Methods & ProceduresThe study consists of a two‐group pre‐/post‐test design to assess speech intelligibility at phoneme and sentence level and during spontaneous speech, automatic speech and reading a phonetically balanced text. A total of 17 subjects with mild to severe dysarthria participated in the study and were randomly assigned to either a patient‐tailored, intensive articulatory drill programme or an intensive minimal pair training. Both training programmes were based on the principles of motor learning. Each training programme consisted of five sessions of 45 min completed within one week.Outcomes & ResultsFollowing treatment, a statistically significant increase of mean group intelligibility was shown at phoneme and sentence level, and in automatic sequences. This was supported by an acoustic analysis that revealed a reduction in formant centralization ratio. Within specific groups of severity, large and moderate positive effect sizes with Cohen's d were demonstrated.Conclusions & ImplicationsBArT successfully improves speech intelligibility in patients with chronic or progressive dysarthria at different levels of the impairment. What this paper addsWhat is already known on the subject Behavioural treatment of articulation in patients with dysarthria mainly involves indirect strategies, which have shown positive effects on speech intelligibility. However, there is limited evidence on the short‐term effects of direct articulation therapy at the segmental level of speech. This study investigates the effectiveness of BArT on speech intelligibility in patients with chronic or progressive dysarthria at all severity levels. What this paper adds to existing knowledge The intensive and direct articulatory therapy programmes developed and applied in this study intend to reduce the impairment instead of compensating it. This approach results in a significant improvement of speech intelligibility at different dysarthria severity levels in a short period of time while contributing to exploit and develop all available residual motor skills in persons with dysarthria. What are the potential or actual clinical implications of this work? The improvements in intelligibility demonstrate the effectiveness of a BArT at the segmental level of speech. This makes it to be considered a suitable approach in the treatment of patients with chronic or progressive dysarthria.

The Correlation Between Consonant Articulation and Velopharyngeal Function in Patients With Unoperated Submucous Cleft Palate.

Submucous cleft palate (SMCP) is a congenital condition related to abnormal muscle attachments within the soft palate. Even though hypernasality and nasal emission, the primary symptom of SMCP, have been well-documented, research on articulation errors is currently lacking. The object of this study was to examine the consonant articulation in patients with unoperated SMCP and its possible correlation with the velopharyngeal function. This study analyzed the perceptual speech assessment and nasopharyngoscopy data of 338 patients with unoperated SMCP between years 2008 and 2016 retrospectively. The mean age of the patients was 13.27 years. About 125 patients showed velopharyngeal competence (VPC), 174 velopharyngeal incompetence (VPI), and 39 marginal VPI (MVPI). Among the 338 patients, 137 presented normal articulation, 124 consonant omission, 25 compensatory articulation, 36 consonant weakening, 51 consonant substitution, and 36 posterior placement. About 70.40% VPC patients, 17.24% VPI patients, and 48.72% MVPI patients demonstrated normal articulation. About 59.20% VPI patients showed consonant omission. The results demonstrated that consonant articulation varied among patients with unoperated SMCP and was correlated with their velopharyngeal functions, while consonant omission was the most common articulation error. Velopharyngeal closure pattern was not associated with either velopharyngeal function or consonant articulation.

Do Patients With Neurogenic Speech Sound Impairments Benefit From Auditory Priming With a Regular Metrical Pattern?

Purpose Earlier investigations based on word and sentence repetition tasks had revealed that the most prevalent metrical pattern in German (the trochee)-unlike the iambic pattern-facilitates articulation in patients with apraxia of speech (AOS; e.g., Aichert, Späth, & Ziegler, 2016), confirming that segmental and prosodic aspects of speech production interact. In this study, we investigated if articulation in apraxic speakers also benefits from auditory priming by speech with a regular rhythm. Furthermore, we asked if the advantage of regular speech rhythm, if present, is confined to impairments at the motor planning stage of speech production (i.e., AOS) or if it also applies to phonological encoding impairments. Method Twelve patients with AOS, 12 aphasic patients with postlexical phonological impairment (PI), and 36 neurologically healthy speakers were examined. A sequential synchronization paradigm based on a sentence completion task was conducted in conditions where we independently varied the metrical regularity of the prime sentence (regular vs. irregular prime sentence) and the metrical regularity of the target word (trochaic vs. iambic). Results Our data confirmed the facilitating effect of regular (trochaic) word stress on speech accuracy in patients with AOS (target effect). This effect could, for the first time, also be demonstrated in individuals with PI. Moreover, the study also revealed an influence of the metrical regularity of speech input in both patient groups (prime effect). Conclusions Patients with AOS and patients with PI exploited rhythmic cues in the speech of a model speaker for the initiation and the segmental realization of words. There seems to be a robust metrical influence on speech at both the phonological and the phonetic planning stages of speech production.

Pigmented villonodular synovitis does not influence the outcome following cementless total hip arthroplasty using ceramic-on-ceramic articulation: a case-control study with middle-term follow-up

BackgroundPigmented villonodular synovitis (PVNS) is a relatively rare, locally aggressive, and potentially recurrent synovial disease of large joints. The purpose of this study was to investigate (1) the disease recurrence rate and (2) the treatment outcomes including Harris hip scores, complications, and revision following cementless total hip arthroplasty (THA) with ceramic-on-ceramic (CoC) articulation in patients with PVNS.MethodsTwenty-two patients (14 females and 8 males) with histologically confirmed PVNS underwent cementless THA using CoC bearings between 2000 and 2013. Three patients with less than 5-year follow-up were excluded. The mean age was 35.2 years (range, 22–58 years) with a mean follow-up of 8.6 years (range, 6.9–10.8 years). A control group was matched in a 2:1 ratio with the PVNS group for age, sex, body mass index (BMI), year of surgery, and American Society of Anesthesiologists score (ASA). Postoperative outcome variables included disease recurrence, Harris Hip Scores (HHS) at the latest follow-up, complications (dislocation, squeaking, ceramic fracture), and any-cause revision. A Kaplan-Meier implant survivorship curve with 95% confidence interval (CI) of the two groups was generated.ResultsNo recurrence of PVNS was noted in the follow-up period. The HSS in the PVNS group was 92.6 ± 5.5, which was similar to the control group (93.4 ± 4.6, p = 0.584) at the last follow-up visit. No patients sustained dislocation, osteolysis, or any ceramic fracture within the study duration. One patient in the PVNS group had a complication of squeaking, but did not require revision. Another patient in the PVNS group underwent revision surgery due to aseptic loosening. There was no significant difference in revision rates between the two groups (p = 1.000). The implant survivorship free of any revision was 90.0% (95% CI, 73.2% to 100%) in the PVNS group and 92.5% (95% CI, 82.6% to 100%) in the control group at 10 years (p = 0.99).ConclusionsFor young and active patients with end-stage PVNS of the hips, cementless THA using CoC bearing has similar functional outcome scores, a low complication rate, and similar implant survivorship compared to the control group.

Characteristics of Consonant Discrimination and Articulation in Patients with Broca’s Aphasia

Purpose: Generally, Broca s aphasia, also known as motor aphasia is characterized by non-fluent speech and poor articulation. The current study...

Appraisal of Function After Rehabilitation With Tongue Prosthesis.

Prosthetic rehabilitation following total glossectomy is very complex procedure from clinical as well as laboratory point of view. The basic objective of prosthodontic rehabilitation is to deliver a comfortable as well as esthetically suitable prosthesis, which restores the impaired speech and deglutition function. Prosthetic rehabilitation of patients after total glossectomy with tongue prosthesis to evaluate improvement in speech as well as swallowing function. Tongue prostheses were fabricated with high-temperature vulcanizing silicone and heat-polymerizing acrylic to restore the functions affected after surgical resection of tongue. Patient's speech was evaluated with Dr Speech software version 4. The speech software was used to assess different speech parameters such as maximum phonation time, fundamental frequency, intensity, jitter, and shimmer. Deglutition assessment was done subjectively by using a standardized questionnaire designed by the speech pathologist. Speech was recorded for assessment before prosthetic rehabilitation and 2 weeks after delivery of the tongue prosthesis. After analysis of various speech parameters frequency range was improved with prosthesis (ie, 172.19 Hz) as compared to without prosthesis (ie, 111.47 Hz). Speech intelligibility was improved with tongue prosthesis. Deglutition assessment revealed that patient's deglutition abilities were improved. Tongue prosthesis helps to improve speech and articulation in patients with total glossectomy. Apart from that deglutition capability is also significantly improved. Total glossectomy affects speech, mastication, and swallowing to a greater proportion. It may also lead to psychological impairment of the patient. Tongue prosthesis efficiently improves speech and deglutition abilities of the patient leading to a better quality of life.

The Phonetic Characteristics in Patients of Bilateral Vocal Fold Paralysis Without Tracheotomy.

ObjectivesPatients with bilateral vocal fold paralysis (BVFP) theoretically have difficulty producing voiceless consonants. However, perceptual studies have revealed clear production of voiceless consonants with good articulation scores in nontracheostomized patients. The purpose of this study was to clarify the production of voiceless stops during articulation in patients with BVFP compared to normal speakers.MethodsThe perceptual, acoustic, and aerodynamic characteristics of patients with BVFP and those with normal speech were investigated with special reference to voiceless stop consonants. Test words were prepared to place the stop consonants in different phonological environments, and were all nonsense words.ResultsThe patients with BVFP perceptually produced the three types of stops successfully. However, they acoustically varied voice onset time to produce phonetically representative stops but decreased voice onset time of /ph/ and /p/ compared to those of normal speakers. These patients may properly control air pressure to produce the three types of stop consonants similar to normal speakers.ConclusionThe patients with BVFP realized the distinctions between the three types of stops similar to the normal speakers. Although vocal mobility was absent in the patients with BVFP, voice onset time, vowel duration, closure duration, and air pressure were similar to those of normal speakers.

The Influence of Physiotherapy on the Range of Motion and Kinesthetic Sensation of Movement in the Radiocarpal Articulation in Patients with Carpal Tunnel Syndrome

Background: Range of motion (ROM) and kinesthetic differentiation of movement (KDM) significantly influence hand functions during work and while performing everyday activities. Because to date ROM and KDM in carpal tunnel syndrome (CTS) patients and its changes following different forms of physiotherapy have not been thoroughly assessed, they became the objective of our study. The aim was to assess the influence of two physiotherapeutic programs on the ROM and KDM in patients with CTS. Methods: 140 people participated in the experiment, including 122 (87,15%) women and 18 (,85%) men. Each person who was not excluded and fulfilled the inclusion criteria to the study was randomly assigned to a group rehabilitated by means of either manual therapy including neurodynamic techniques (MT) or physical therapy including electrophysical modalities (EM). ROM and KDM were assessed. The therapy in MT group was based on manual therapy including neurodynamic techniques and in the EM group on laser therapy and ultrasounds. Results: Statistically significant improvement was observed in flexion and extension ROM in upper extremities with CTS only in the MT group (p<0.001). Similar effects were obtained in KDM. Similar results distribution occurred while comparing extremities with CTS and healthy extremities. Statistically significant improvement in assessment of ROM and KDM were observed only in the MT group (p<0.001). Conclusions: Therapeutic program using manual therapy including neurodynamic techniques improves ROM and KDM in patients with CTS. The cycle of therapy improved the status of symptomatic limbs. A decreased difference in terms of ROM and KDM in the symptomatic limb in relation to the asymptomatic limb was observed.

Perceived articulatory precision in patients with Parkinson’s disease after deep brain stimulation of subthalamic nucleus and caudal zona incerta

The effect of deep brain stimulation (DBS) of the subthalamic nucleus (STN) and caudal zona incerta (cZi) on speech articulation in patients with Parkinson’s disease (PD) was investigated. Read speech samples were collected from nine patients with STN-DBS and 10 with cZi-DBS. The recordings were made pre-operatively and 12 months post-operatively with stimulator on and off (on medication). Blinded, randomised, repeated perceptual assessments were performed on words and isolated fricatives extracted from the recordings to assess (1) overall articulatory quality ratings, (2) frequency of occurrence of misarticulation patterns and (3) fricative production. Statistically significant worsening of articulatory measures on- compared with off-stimulation occurred in the cZi-DBS group, with deteriorated articulatory precision ratings, increased presence of misarticulations (predominately altered realisations of plosives and fricatives) and a reduced accuracy in fricative production. A similar, but not significant, trend was found for the STN-DBS group.

Strategies for Treating Compensatory Articulation in Patients with Cleft Palate

Patients with cleft palate frequently show compensatory articulation (CA). CA requires a prolonged period of speech intervention. Some scaffolding strategies can be useful for correcting placement and manner of articulation in these cases. The purpose of this paper was to study whether the use of specific strategies of speech pathology can be more effective if applied according to the level of severity of CA. Ninety patients with CA were studied in two groups. One group was treated using strategies specific for their level of severity of articulation, whereas in the other group all strategies were used indistinctively. The degree of severity of CA was compared at the end of the speech intervention. After the speech therapy intervention, the group of patients in which the strategies were used selectively, showed a significantly greater decrease in the severity of CA, as compared with the patients in whom all the strategies were used indistinctively. An assessment of the severity of CA can be useful for selecting the strategies, which can be more effective for correcting the compensatory errors.

Total Hip Arthroplasty Using Large-Diameter Metal-On-Metal Articulation in Patients With Neuromuscular Weakness

The purpose of this prospective study was to evaluate the clinical and functional outcomes of THA using large-diameter metal-on-metal articulation in patients with neuromuscular weakness. Nineteen consecutive patients (19 hips) with neuromuscular weakness and displaced femoral neck fractures were enrolled. Functional improvement and recovery, radiological evaluation of THA and surgical morbidity were assessed. Mean Harris hip and WOMAC scores at final follow-up were 81.0 and 42.9, respectively. At final follow-up, no dislocation, metal hypersensitivity, or osteolysis was observed and no patient required revision of THA. The findings of this study indicate that the functional results of THA using large-diameter metal-on-metal articulation in patients with neuromuscular weakness can produce satisfactory outcomes with early functional recovery and a low dislocation rate.

Vowel Articulation in Patients with Spinocerebellar Ataxia

Objective : Abnormalities in vowel articulation have been reported to be a common feature of dysarthria in spinocerebellar ataxia (SCA); however, findings about the degree and pattern of impaired vowel production are inconsistent. Therefore, the aim of the current study was to characterize the pattern of dysfunctional vowel production in patients with SCA by the means of acoustic analysis. Methods : 31 patients SCA and 32 healthy subjects were tested. Description of vowel articulation was based upon the frequencies of the first and second formant (F1 and F2) of the German vowels /α/, /i/ and /u/ extracted severalfold from defined words within a given reading passage. The mean as well as the coefficient of variance of the respective F1 and F2 values of each single vowel were taken as measures of distinctiveness and steadiness of vowel articulation. Results : In the SCA group, F1 and F2 values showed increased variability and a specifically restricted range which was particularly seen in the vowel /i/. Furthermore, the dysfunctional pattern differed between male and female patients with SCA. Conclusions : Measurement of F1 and F2 revealed dysfunctional vowel articulation in SCA – however, with some gender-related specifities – that can be explained by imprecision and reduced range of articulatory movements in ataxic speakers. Therefore, objective measurement of vowel formant frequencies provided additional information to the overall perceptual speech score. According to these preliminary findings, acoustic analysis of speech could be a promising tool for diagnosis, monitoring and detection of therapeutic effects in ataxic dysarthria.

Resonance and Speech Articulation After Midface Advancement in Craniofacial Dysostosis

This study aimed to analyze changes in resonance and speech articulation after midface advancement in syndromic craniofacial patients and to assess the influence of craniofacial diagnosis and the presence or absence of a cleft palate. This study is a retrospective analysis of resonance and speech articulation in patients after midface advancement. This project was carried out in a multidisciplinary pediatric craniofacial service. Eighteen patients underwent midface advancement between 2002 and 2009. Three were excluded because of inadequate records or presence of tracheostomy. Midface advancement was done by Le Fort III, facial bipartition, or monobloc, either conventional surgery or distraction osteogenesis. Outcomes include perceptual assessment of articulation and resonance using GOS.SP.ASS.98 revised and recommendation for speech surgery. Hypernasality scores decreased in 7 patients (46.7%), and 5 patients were recommended for speech surgery. Hyponasality scores improved in 10 patients (66.7%), were unchanged in 3 patients (20%), and decreased in 2 patients (13%). Articulation changed (improved) in 1 patient (6.7%) only. Hypernasality scores decreased in 33.3% of Crouzon and 71.4% of Apert patients. Five patients had a cleft palate, 4 had Apert syndrome, and hypernasality scores decreased in 3 patients. Of 3 patients with Apert syndrome but no cleft palate, 2 (66.7%) also had a decrease in hypernasality scores. Our findings suggest a high incidence of deterioration in velopharyngeal function after midface advancement, particularly in Apert syndrome, regardless of the presence of a cleft, and an improvement in hyponasality, but minimal change in articulation. Larger prospective multicenter studies are required to investigate these findings further.