Effect of perceptive-auditory training on the classification of speech hypernasality

Manicardi, Flora Taube; Dutka, Jeniffer de Cássia Rillo; Guerra, Thais Alves; Pegoraro-Krook, Maria Inês; Chagas, Eduardo Federighi Baisi; Marino, Viviane Cristina de Castro

doi:10.1590/2317-1782/20232022069en

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Original Article • CoDAS 35 (6) • 2023 • https://doi.org/10.1590/2317-1782/20232022069en copy

Effect of perceptive-auditory training on the classification of speech hypernasality

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Purpose

To analyze the effect of auditory-perceptual training by inexperienced speech-language pathologists in the classification of hypernasality in individuals with cleft lip and palate and compare their classification of hypernasality individually, with the gold standard evaluation, before and after this training.

Methods

Three inexperienced speech-language pathologists used a four-point scale to assess 24 high-pressure speech samples from individuals with cleft lip and palate, before and after auditory-perceptual training. The speech samples corresponded to six samples of each degree of hypernasality. The speech-language pathologists received auditory-perceptual training during the assessments. They had access to anchor samples and immediate feedback of correct answers regarding the degree of hypernasality in training.

Results

There was no significant difference in the overall percentage of correct answers when comparing before and after the auditory-perceptual training. There was a significant association and agreement of the three evaluators with a gold standard evaluation after training, with an increase in agreement for a single evaluator for absent and mild degrees of hypernasality. The dichotomous analysis of the data showed an increase in the Kappa Index of Agreement of this evaluator. Although there was an increase in the Index of Agreement between evaluators for absent, mild, and severe hypernasality, this increase did not reach statistical significance.

Conclusion

The auditory-perceptual training provided did not result in a significant improvement in the hypernasality classification for the inexperienced speech-language pathologists, even though the individual data analysis showed that the training favored one of the evaluators. Further studies involving gradual and more extensive auditory-perceptual training may favor the classification of hypernasality by inexperienced SLPs.

Keywords:
Cleft Palate; Velopharyngeal Insufficiency; Speech Disorders; Speech Perception; Speech

Before training		Gold standard rating				X²	Kappa
Before training		Absent	Mild	Moderate	Severe	p-value	Kappa
EV 1	Absent	6	2	0	0	<0.001*	0.556^‡ ‡ Significant kappa coefficient for p-value ≤0.05. Findings in bold signify results that agree with the gold standard rating
	Mild	0	4	3	0
	Moderate	0	0	3	3
	Severe	0	0	0	3
EV 2	Absent	6	2	0	0	<0.001*	0.667^‡ ‡ Significant kappa coefficient for p-value ≤0.05. Findings in bold signify results that agree with the gold standard rating
	Mild	0	3	1	1
	Moderate	0	0	5	1
	Severe	0	1	0	4
EV 3	Absent	3	2	0	0	<0.001^* * significant association by the Chi-square test for p-value ≤0.05;	0.389
	Mild	3	2	1	1
	Moderate	0	2	5	2
	Severe	0	0	0	3

Before training		Gold standard evaluation				X²	Kappa
Before training		Absent	Mild	Moderate	Severe	p-value	K
EV 1	Absent	6	1	0	1	<0.001*	0.500^‡ ‡ Significant kappa coefficient for p-value ≤0.05. Findings in bold signify results that agree with the gold standard evaluation
	Mild	0	5	2	0
	Moderate	0	0	2	3
	Severe	0	0	2	2
EV 2	Absent	6	2	0	0	<0.001*	0.333^‡ ‡ Significant kappa coefficient for p-value ≤0.05. Findings in bold signify results that agree with the gold standard evaluation
	Mild	0	3	3	2
	Moderate	0	1	1	2
	Severe	0	0	2	2
EV 3	Absent	6	1	0	0	<0.001^* * significant association by the Chi-square test for p-value ≤0.05;	0.667^‡ ‡ Significant kappa coefficient for p-value ≤0.05. Findings in bold signify results that agree with the gold standard evaluation
	Mild	0	5	1	1
	Moderate	0	0	4	2
	Severe	0	0	1	3

		Gold standard rating		X² p value	Kappa
		Present	Absent	X² p value	Kappa
Before training
EV 1	Present	16	0	<0.001*	0.800^‡ ‡ Significant kappa coefficient for p-value ≤0.05
EV 1	Absent	2	6	<0.001*	0.800^‡ ‡ Significant kappa coefficient for p-value ≤0.05
EV 2	Present	16	0	<0.001*	0.800^‡ ‡ Significant kappa coefficient for p-value ≤0.05
EV 2	Absent	2	6	<0.001*	0.800^‡ ‡ Significant kappa coefficient for p-value ≤0.05
EV 3	Present	16	3	0.047*	0.412^‡ ‡ Significant kappa coefficient for p-value ≤0.05
EV 3	Absent	2	3	0.047*	0.412^‡ ‡ Significant kappa coefficient for p-value ≤0.05
After training
EV1	Present	16	0	<0.001*	0.800^‡ ‡ Significant kappa coefficient for p-value ≤0.05
EV1	Absent	2	6	<0.001*	0.800^‡ ‡ Significant kappa coefficient for p-value ≤0.05
EV 2	Present	16	0	<0.001^* * significant association by the Chi-square test for p-value ≤0.05;	0.800^‡ ‡ Significant kappa coefficient for p-value ≤0.05
EV 2	Absent	2	6		0.800^‡ ‡ Significant kappa coefficient for p-value ≤0.05
EV 3	Present	17	0	<0.001*	0.895^‡ ‡ Significant kappa coefficient for p-value ≤0.05
EV 3	Absent	1	6	<0.001*	0.895^‡ ‡ Significant kappa coefficient for p-value ≤0.05

Training	Categories	Kappa	IC 95%		p-value
Training	Categories	Kappa	LI	LS	p-value
Before	absent hypernasality	0.597	0.366	0.828	<0.001*
	mild hypernasality	-0.072	-0.303	0.158	0.538
	moderate hypernasality	0.261	0.030	0.491	0.027*
	severe hypernasality	0.356	0.125	0.587	0.003*
	Total	0.284	0.147	0.420	<0.001*
After	absent hypernasality	0.681	0.450	0.912	<0.001*
	mild hypernasality	0.280	0.049	0.511	0.0018*
	moderate hypernasality	0.074	-0.157	0.305	0.532
	severe hypernasality	0.600	0.369	0.831	<0.001*
	Total	0.413	0.276	0.550	<0.001*

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[1] Conflict of interests: nothing to declare.