Objective: This study investigated whether adding an additional modality, namely ultrasound tongue imaging, to perception-based phonetic transcription impacted on the identification of compensatory articulations and on interrater reliability. Patients and Methods: Thirty-nine English-speaking children aged 3 to 12 with cleft lip and palate (CLP) were recorded producing repetitions of /aCa/ for all places of articulation with simultaneous audio and probe-stabilised ultrasound. Three types of transcriptions were performed: 1. Descriptive observations from the live ultrasound by the clinician recording the data; 2. Ultrasound-aided transcription by two ultrasound-trained clinicians; and 3. Traditional phonetic transcription by two CLP specialists from audio recording. We compared the number of consonants identified as in error by each transcriber and then classified errors into eight different subcategories. Results: Both the ultrasound-aided and traditional transcriptions yielded similar error-detection rates, however these were significantly higher than the observations recorded live in the clinic. Interrater reliability for the ultrasound transcribers was substantial (k=0.65), compared to moderate (k=0.47) for the traditional transcribers. Ultrasound-aided transcribers were more likely to identify covert errors such as double articulations and retroflexion than the audio-only transcribers. Conclusion: Ultrasound-tongue imaging is a useful complement to traditional phonetic transcription for CLP speech.

Background: As cost and access barriers to ultrasound technology have decreased, interest in using ultrasound visual biofeedback (U-VBF) as a tool for remediating speech sound disorders (SSD) has increased. A growing body of research has investigated U-VBF in intervention for developmental SSD; however, diversity in study design, participant characteristics, clinical methods and outcomes complicate the interpretation of this literature. Thus, there is a need for a synthesis and review of the evidence base for using U-VBF in intervention for SSD. Aims: To synthesise and evaluate the research evidence for U-VBF in intervention for developmental SSD. Methods: A systematic review was conducted. Eight electronic databases were searched for peer-reviewed articles published before 2018. Details about study design, participants, intervention procedures, service delivery, intervention intensity and outcomes were extracted from each study that met the inclusion criteria. The included studies were rated using both a critical appraisal tool and for their reporting of intervention detail. Main Contributions: Twenty-eight papers, comprising 29 studies, met the inclusion criteria. The most common research design was single-case experimental design (44.8% of studies). The studies included between one and 13 participants (mean = 4.1) who had a mean age of approximately 11 years (range = 4;0-27 years). Within the research evidence, U-VBF intervention was typically provided as part of, or as an adjunct to, other articulatorybased therapy approaches. A range of lingual sounds were targeted in intervention, with 80.6% of participants across all reviewed studies receiving intervention targeting rhotics. Outcomes following therapy were generally positive with the majority of studies reporting that U-VBF facilitated acquisition of targets, with effect sizes ranging from no effect to a large effect. Difficulties with generalisation were observed for some participants. Most studies (79.3%) were categorised as efficacy rather than effectiveness studies and represented lower levels of evidence. Overall, the reviewed studies scored more highly on measures of external validity than internal validity. Conclusions: The evidence base for U-VBF is developing; however, most studies used small sample sizes and lower strength designs. Current evidence indicates that U-VBF may be an effective adjunct to intervention for some individuals whose speech errors persist despite previous intervention. The results of this systematic review underscore the need for more high-quality and large-scale research exploring the use of this intervention in both controlled and community contexts.

Normal or "near normal" voice is a possible outcome for children who have had this surgery. Where there is an ongoing complex medical condition, voice outcome may be poorer.

Reliability of the GRBAS tool for perceptual evaluation of paediatric voice disorder is measured in this study of children with a history of laryngotracheal reconstruction surgery (LTR). Additionally, the relationship between parent proxy/child self-report of voice-related quality of life with clinician perceptual rating of voice quality is analysed. Eleven children with a history of LTR provided voice recordings following the stimuli set by the CAPE-V protocol. Subjective impact of voice quality on life was measured using the paediatric voice-related quality of life questionnaire. Four trained judges rated the sound files according to both the GRBAS and CAPE-V protocol. Intra-class correlation coefficients were high for both intra-rater and inter-rater judgments across all parameters of the GRBAS protocol, and a strong correlation was found between the grade rating of the GRBAS and the overall severity rating of the CAPE-V. Some elements of parent proxy reporting of voice-related quality of life were significantly negatively correlated with clinician perceptual rating of voice quality, while there was no significant relationship between child self-report and clinician perceptual rating.