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STUDENT RESEARCH AT A.I.I.S.H. MYSORE

(ARTICLES BASED ON DISSERTATION DONE AT AIISH)

VOLUME VII: 2008-2009

PART - B

SPEECH LANGUAGE PATHOLOGY

Compiled by

Dr. Vijayalakshmi Basavaraj

Director

Dr. G. Malar

Reader in Special Education

All India Institute of Speech and Hearing

Manasagangothri, Mysore – 570 006

© 2010

A Publication of the All India Institute of Speech and Hearing

Under the title: “Student Research at A.I.I.S.H Mysore”

Articles based on dissertations done at AIISH: Vol. VII 2008-09

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Published by Dr. Vijayalakshmi Basavaraj

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Foreword

AIISH presents with great satisfaction, the seventh volume of full length articles based on the

dissertation work done by our post graduate students in part fulfillment of their PG degrees in

Audiology, Speech Language Pathologist and Special Education (HI) for your reading.

This volume includes articles based on dissertations done by the post graduate students during

the year 2008-09. There are 44 articles in total . Part A comprises of 20 papers related to Audiology.

Several students have shown interest in the areas of developing diagnostic/screening tests, issues

related to understanding, evaluating and comparing the benefits of hearing aids/FM system. The

interest in the hot topics of Cochlear dead region, Auditory dys-synchrony, Vestibular Evoked

Myogenic Potential (VEMP), Post Auricular Muscle Response (PAMR) has continued.

Multifrequency, Multicomponent Tympanometry is a „fresh‟ topic in the list. Evoked potential testing

continues to attract our students. Part B comprises of 20 papers in the area of Speech-Language

Pathology. Our faculty have generated interest in the areas of swallowing disorders, sign language,

dementia and relevance of Yoga in Speech Language Pathology which is encouraging. Topics in the

area of voice assessment, analysis, issues related to language development and bilingualism, dyslexia

and aphasia continue to interest our students. Part C contains 4 papers of students of M.S Ed (HI).

These papers cover the area of teaching methods, curricular adaptation and attitudes of teachers. The

M.S.Ed (HI) program is not attracting more students. However, those who have enrolled are trained

and groomed well as master trainers. Even though there are only four papers in this section, it is

published as a separate section as the readership for each section may be different. To the best of our

knowledge, this is the first effort to publish articles based on M.S. Ed (HI) dissertations. Since AIISH

library is digitized, these articles will be available for review to all the researchers, in India and

abroad, in the area of Special education.

The titles of the articles are the titles of the dissertations. The first authors are the II M.Sc

(Aud), M.Sc (SLP) & M.S.Ed (HI) students of 2008-09 and the second authors are their respective

guides who have supervised and guided the research work. The AIISH faculty members who have

guided the dissertations have modified and edited the papers to bring it to the present shape to the best

of their abilities in spite of their busy academic schedules. Dr. G.Malar, Reader, Special Education

has put in great efforts to procure and compile the edited articles and has herself corrected english in

many of the articles. This is the highly appreciated. The neat formatting by Ms. N. Parimala in a very

short time is acknowledged. The unattended mistakes in print and references, if any, in spite of best

efforts put in is regretted.

You may please e-mail your valuable feedback about this volume to [email protected]

with the subject “Student research, Volume VII A/B/C, 2008-09”.

Dr. Vijayalakshmi Basavaraj

Director

Table of Contents

Sl.

No. Title

Page

No.

1. Effect of Pranayama in the Management of Stuttering – Aiswarya

Anand & Y. V. Geetha

1

2. Reliabilty of Perceptual Evaluation of Voice Using Cape-V Rating

Scale in Indian Context – Gupta Akansha & M. Pushpavathi

17

3. A preliminary investigation in to the cognitive abilities of persons

with stuttering using Simon and Stroop tasks – Amit K. & Y. V.

Geetha

34

4. Norms for Forced & Slow Vital Capacity in adult Dravidian

Population – Annapurna S. B. & N. Sreedevi

47

5. Manual for Adult Fluent Aphasia Therapy – in Kannada (MAFAT-K)

– Chaitra S. & S. P. Goswami

61

6. Normative Nasalance Value in Malayalam Language – Devi T.R. &

Pushpavathi M.

67

7. Symbolic Play and Language: Its Relationship in Late Talkers –

Devika M. R. & N. Swapna

83

8. Subtyping of Children with Developmental Dyslexia: Implications

through Dual Route Cascaded (DRC) Model in the Indian Context –

Gnanavel K. & Jayashree C. Shanbal

99

9. Dyslexia Assessment Profile for Indian Children (DAPIC) – Kuppuraj

S. & Jayashree C. Shanbal

115

10. Clinical Protocol for Assessment of Swallowing in Adults - (CP-

ASA) – Meera Priya C. S. & R. Manjula

130

11. Comprehensive Language Assessment Tool for Children (3-6 years) –

Navitha U. & K. C. Shyamala

140

12. The Order of S, O, V Structures in Sign Language Users With

Hearing Impairment: Influence of Verbal Native Language? – Pallavi

Malik & R. Manjula

156

13. Articulatory Acquisition in Kannada Speaking Urban Children: 3-4

Years – Prathima S. & N. Sreedevi

172

14. Normative Nasalance Value in Hindi Language – Pravesh Arya & M.

Pushpavathi

188

15. Metalinguistic Abilities in Children with Developmental Dyslexia:

Implications for Reading and Writing – Priya M. B. & R. Manjula

200

16. Language Proficiency Questionnaire: An Adaptation of LEAP-Q in

Indian Context – Ramya Maitreyee & S. P. Goswami

214

17. Paraphasias in Bilingual Aphasia - Ridhima Batra & K. C. Shyamala 233

18. Meta-Phonological Abilities in Monolingual and Bilingual Children:

A Comparative Study – Samasthitha S. & S. P. Goswami

249

19. Dementia Assessment Battery – Kannada – Sunil Kumar Ravi & K. C.

Shyamala

262

20. Vocal registers in Classical Carnatic Singers: An inquiry using

Electroglottography – Sweety Joy & K. Yeshoda

276

Effect of Pranayama on Stuttering

1

Effect of Pranayama in the Management of Stuttering

Aiswarya Anand. & Y.V. Geetha*

Abstract

The present study was mainly aimed at investigating whether traditional prolongation

technique when used in combination with Pranayama would be more effective in the management of

stuttering than the prolongation technique when used alone and if it has a long term effect on the

maintenance of fluency. PWS considered in the study were randomly distributed to the treatment

programs of prolongation technique and prolongation technique with Pranayama. The experimental

group involving Pranayama with prolongation therapy consisted of five subjects and the control group

provided only Pranayama consisted of four subjects. The study focused on finding the outcomes in the

various evaluations using Stuttering Severity instrument (SSI), Treatment efficacy scale for fluency

disorders, Situational assessment checklist for PWS, aerodynamic measures for both the treatment

groups of PWS, during the pre therapy, post therapy and one month post therapy follow up conditions.

The results reveal that within both the groups the parameters such as avoidance, anxiety, attitudinal

changes, listener’s reaction, satisfaction, and total scores of treatment efficacy scale showed

significance within both experimental and control groups. The situational assessment checklist showed

significant difference within the control group alone. In the aerodynamic measurement MVV was

better for the control group and SVC did not show much significance between the groups.

Introduction

Theories that have attempted to explain the causes of stuttering have often echoed the

prevailing beliefs of the time. There have been frequent shifts in the view points about the

etiological factors for the onset and development of stuttering from physiogenic to

psychogenic and back and forth, ultimately to the combination of both. For example, in the

mid 20th century there was a trend to believe that many diseases were psychosomatic in

origin, that is, they were caused by psychological factors such as anxiety. Similar shifts in the

focus of management issues in stuttering have been noticed over the decades. The

contemporary treatment for stuttering can take widely differing forms, both in the emphases

and the procedures used to bring about the alleviation of the problem. Most of the fluency

management therapies involve a cluster of different components and is difficult to determine

which are crucial to effective treatment.

Prolongation is one of the oldest and most commonly adopted procedures in the

management of stuttering with fairly good treatment outcome. Gifford (1940) made extensive

use of prolongation in her therapy programs. There have been contemporary practitioners

since then. Both in therapy and in research in related fields there was resurgence of interest in

relaxation (Slorach, 1971). Dalton & Hardcastle (1977) expressed the opinion that relaxation,

per se, was not effective. However, they recommended its inclusion as part of an overall

remediation program.

________________________________ * Professor of Speech Language Sciences, All India Institute of Speech and Hearing, Mysore, Indi

email: [email protected]

Dissertation Vol. VII, 2008-09, Part – B, SLP, AIISH, Mysore

2

Perkins (1979) focuses on speech act in his definition of stuttering as a “disco-

ordination of phonation with articulation and respiration” and in his treatment program he

worked directly on achieving fluency through management of breath stream in order to initiate

voice with a gentle onset and maintain airflow throughout the phase.

Although the use of relaxation with the techniques for stuttering treatment is widely

implemented, the use of Yoga, one of the ancient Indian methods concerning regulation of

breathing and management of anxiety, has not been explored. Yoga aims to improve people's

inner tranquility and free them from fears and anxieties. Since it is known that stuttering

includes an element of anxiety and fear, Yoga can help reduce this. Yoga, a science not less

than 5000 years old, has addressed a normal man to move towards higher states of harmony

and peace both as an individual and also as a social being. Extensive research on yoga therapy

over the last few decades have brought out the usefulness of yoga in dealing with these

ailments as an effective adjunct to medical management and also for long term rehabilitation.

Pranayama, one of the Yoga techniques, focuses on regulating breathing. Pranayama is

derived from two Sanskrit words - Prana (life force) and Ayama (control). Therefore, in its

broadest description, Prananyama would mean the control of the flow of life force. During

breathing for Pranayama, inhalation (Puraka) stimulates the system and fills the lungs with

fresh air; retention (Kumbhaka) raises the internal temperature and plays an important part in

increasing the absorption of oxygen; exhalation (Rechak) causes the diaphragm to return to

the original position and air full of toxins and impurities is forced out by the contraction of

inter-costal muscles. These are the main components leading to Pranayama which massage the

abdominal muscles and tone up the working of various organs of the body. There are no

studies in either the Indian or the Western literature showing the effectiveness of Pranayama

in stuttering therapy. A lot of people have benefited from the practice of Pranayama for

various psychogenic and or physiogenic disorders and this preliminary attempt might throw

some light on its efficacy in the management of ever alluding disorder of fluency – stuttering.

Need for the study

The classical means for determining the value of a component of therapy is to include

it in experimental treatment and compare the outcome with that produced by treatment

without the component. Thus, a treatment encompassing the traditional practice of Pranayama

is to be determined to find its effectiveness as a treatment component in the management of

stuttering. Also, considering the various benefits of Pranayama as mentioned below, it is

important that its effect be studied.

1. Release of acute and chronic muscular tensions around the heart and digestive organs

2. Role in helping sufferers of respiratory illnesses such as asthma and emphysema to

overcome the fear of shortness of breath

3. Role in increasing lung capacity, proper nervous stimulus to the cardio-vascular

system, dramatic reduction in emotional and nervous anxiety

4. Improvement in detoxification with increased exchange of carbon dioxide and oxygen

5. Amplification of the auto immune system by increased distribution of energy to the

endocrine system


3

6. Calming the mind and integration of the mental/physical balance, its contribution to both

vitality and relaxation through this single practice

Aim of the study

The present study aims at studying the role of Pranayama in the treatment of stuttering

and also its long term effect in comparison with a group which does not practice Pranayama.

Yoga has been practiced in India for thousands of years for better control of mind and body.

Pranayama being one of the yogic practices which is very effective in breath regulation and

also control of anxiety and tension could be effective in the management of stuttering. The

current experiment aims to investigate how it applies to stuttering.

Objectives of the study

1. To investigate whether Pranayama is more effective in the management of stuttering than

the traditional prolongation technique when used in combination with it.

2. To study if the effect of Pranayama practices with prolongation when compared to

prolongation alone as a treatment technique is maintained during the period after the

termination of therapy.

3. To see if the severity of stuttering has any effect in the treatment out come with

Pranayama.

Method

The present study aimed at evaluating the changes seen in stuttering in a group of

PWS while completing a comprehensive but brief and simple Pranayama program along with

prolongation (experimental group) as against a group which follow the traditional

prolongation technique (control group).

A. Subject selection criteria

The subjects were divided into two groups and the summary is given in Table 1

Table 1: Subjects distributed in the two groups

Particulars Group A Group B

Number 5 4

Age (in years) 18 - 30 18 - 30

Gender Male Male

Severity Moderate - Severe Moderate - Severe

Group A (Experimental Group) - Pranayama as treatment program along with the

prolongation treatment program.

Group B (Control Group) - Prolongation treatment


4

Inclusion criteria

The subjects should not have undergone speech therapy in the past or should have had a

relapse after treatment, exhibiting more than moderate degree stuttering at the time of

enrollment

They should not be practitioners of Yoga

All the participants of the study have to be diagnosed by qualified speech language

pathologist as having moderate to severe stuttering, based on SSI

B. Instrumentation/Materials

The following materials were used for the study:

1. Stuttering Severity Instrument (SSI) developed by Glydon D. Riley (1994).

2. MP3 player (INVION-QBP38-IUS)

3. Treatment efficacy scale for fluency disorders (self rating) by Geetha, Sangeetha &

Anjana (2007)– see appendix A

4. Situational assessment checklist for PWS (self rating) – see appendix B

5. RMS Helios 501(Recorders and Medicare Systems)

6. 300 word passage for reading in Kannada (Jayaram & Savithri, 1985). It incorporates all

the phonemes in Kannada, with their respective frequency of occurrence

7. Set of questions for conversation

8. Specific topics given for obtaining narrative samples.

C. Procedure

All the subjects were evaluated individually using the above tests during pre therapy,

immediately after therapy and during one month post therapy follow-up. Subject’s written

consent was taken before starting the program, after briefing about the technique adopted.

1. Perceptual assessment

Subject’s reading, spontaneous speech and conversation were recorded using an MP3

player. The recordings were subjected to offline perceptual analyses to rate the severity of

dysfluency. The reading sample of 300 word passage, monologue and conversation sample

was recorded. Treatment efficacy scale for fluency disorders was used to find the efficacy of

treatment. This is an unpublished project titled “Treatment efficacy and variables for

stuttering management” (Geetha, Sangeetha & Anjana, 2007). This is a self report assessment

procedure which included separate measures of frequency of stuttering, duration, secondary

behaviors, confidence, avoidance behaviors, anxiety features, attitudinal changes, naturalness

of speaking, listeners reaction, satisfaction with treatment, self monitoring skills, feeling about

generalization and maintenance of fluency. A 5- point descriptive scale is used to allow the

subject to show how often or how much each of the aspects applies to them. Situational

assessment checklist for PWS was also employed which again the subjects had to rate on a


5

five point scale (given in appendix B). Subjects were assessed at the beginning (day 1), at the

end (day 12) of the intervention and one month follow up after the 12 day treatment period.

The recorded speech samples of the subjects were subjected to perceptual rating by 5

qualified SLPs on a 3- point scale (3- good, 2- average and 1- poor). This rating was done for

the parameters rate of speech, continuity, effort, stress and articulation. The post therapy

speech samples of experimental and control group were randomized and given to five judges

for perceptual evaluation and rating. This was to check the inter judge reliability in terms of

therapy outcomes using the two techniques.

2. Aerodynamic measurements

Respiratory measurements included the measurement using RMS Helios 501

(Recorders and Medicare Systems) - a window based program. The parameters recorded

included, slow vital capacity (SVC) and maximum voluntary ventilation (MVV). SVC is the

maximum volume of air that can be exhaled slowly after slow maximum inhalation, measured

in liters. MVV is a measure of the maximum amount of air that can be inhaled and exhaled in

one minute and it is measured in liters/minute.

D. Therapy Program

a. Experimental Group

The treatment program consisted of an integrated package comprising teaching

sessions and practice sessions using prolongation technique with Pranayama. It was

administered in the form of a 12-day outpatient course, 45 minutes each day, spread over a

period of four weeks, being interrupted by a 2-day weekend break. The course was given to a

group of 5 patients individually who were randomly assigned to the experimental group.

The Pranayamas taught included Vibhagiya Pranayama and Nadisuddi (Nagendra &

Nagaratna, 2007).

1. Vibhagiya svasana (sectional breathing): This is a preparatory breathing practice for

Pranayama. It corrects the wrong breathing pattern and increases the vital capacity of the

lungs. It has four sections and 4 steps; each practiced 5 times in each session.

Abdominal (diaphragmatic) breathing

Thoracic breathing

Clavicular breathing

Full yogic breathing.

2. Nadisuddi Pranayama: Practice involves six steps of Nadisuddi Pranayama which is

repeated 9 times: (i). Closing the right nostril with the right thumb and exhaling

completely through the (left) nostril (ii). Inhaling deeply through the same left nostril. (iii).

Closing the left nostril with ring and little finger and releasing the right nostril (iv).

Exhaling slowly and completely through the right nostril (v). Inhaling deeply through the

same (right) nostril (vi). Closing the right nostril and exhaling through the left nostril.


6

The session involved practice for each of reading, conversation and monologue for the

control group using the prolongation technique and for the experimental group, the session

was divided to encompass Pranayamas before each of the activity. The session concluded with

nadanusandana, which can be attributed to a vocal exercise. Nadanusandana encompassed the

phonation of /a/, /u/ and /m/.

b. Control group

The treatment program comprised of teaching sessions and practice sessions using

prolongation technique. It was administered in the form of a 12-day outpatient course, 45

minutes each day, spread over a period of four weeks, being interrupted by a 2-day weekend

break. The course was given to a group of 4 patients individually who were randomly

assigned to the control group.

Results and Discussion

The present study was aimed at finding difference if any was present in the therapy

programs using prolonged speech for the control group when compared to prolonged speech

in combination with Pranayama for the experimental group in the treatment of stuttering. The

study also aimed at answering the research question related to the long term effect of the

treatment program. The two groups of PWS who underwent treatment were assessed based on

Stuttering Severity Instrument (SSI), Treatment efficacy scale for fluency disorders,

Situational assessment checklist for stuttering, perceptual evaluation by judges and

aerodynamic evaluations before therapy (PT), post therapy (PoT) & FU (1 month post therapy

follow up). Results of these assessments are discussed under different headings below.

Friedman’s test was done to find if there existed any significant difference between the two

groups and further Wilcoxon's test was done to find if there existed any differences within the

two groups

I. Perceptual assessment

a. Stuttering severity instrument (SSI)

Table 2: The severity of disfluencies

Groups Pre therapy Post therapy FU

SSI Score Severity SSI Score Severity SSI Score Severity

E - 1 24.00 Moderate 16.00 Very mild 13.00 Very mild

E - 2 22.00 Moderate 14.00 Very mild 18.00 Mild

E - 3 22.00 Moderate 10.00 Very mild 12.00 Very Mild

E - 4 37.00 Very Severe 21.00 Mild 21.00 Mild

E - 5 27.00 Moderate 19.00 Mild 13.00 Very Mild

C - 1 23.00 Moderate 6.00 Very mild 8.00 Very Mild

C - 2 26.00 Moderate 13.00 Very mild 17.00 Mild

C - 3 33.00 Severe 26.00 Moderate 23.00 Moderate

C - 4 30.00 Moderate 22.00 Moderate 15.00 Mild

Subject’s reading, spontaneous speech and conversation were recorded using an MP3

player. The recordings were subjected to offline perceptual analyses to rate the severity of


7

dysfluency on SSI. Table 2 gives the summary of the severity of disfluencies in the three

conditions of pre therapy, post therapy and one month post therapy.

1) Frequency scores of SSI: There is no much difference in the SSI Frequency scores in the

three conditions of pre therapy, post therapy and follow up.

2) Duration scores of SSI: There is no much difference in the scores between the two

groups for the duration scores in SSI.

Figure 1: Mean ratings on various parameters of the treatment efficacy scale for the experimental

group

Parameters

Mai

ntai

n.

Selfm

onL.

Rea

c

Nat

u.

Atti.

Anxi

.

Avoi

d.

Con

f.

S.be

h

Dur

.

Freq

.

Mea

n R

atin

gs -

Con

trols

5.0

4.5

4.0

3.5

3.0

2.5

2.0

1.5

1.0

.5

0.0

Conditions

Pre

Post

After a month

Figure 2: Mean ratings on various parameters of the treatment efficacy scale for the control group

[Freq = Frequency of stuttering; Dur = Duration of stuttering; S.beh = Secondary Behaviors; Conf = Confidence

in Speaking; Avoid = Avoidance Features; Anxi = Anxiety Features; Atti = Attitudinal Changes; Natu =

Naturalness of Speaking; L.Reac = Listeners Reaction to speech ; Selfmon = Self monitoring Skills ; Maintain =

Feeling about generalization and maintenance about fluency; Pre = Pre therapy; Post = Post therapy; After a

month = A month after post therapy]

3) Physical concomitant scores in SSI: There is no much difference in the scores between

the two groups for the physical concomitant in SSI.

4) Total scores of SSI: It is clear that there is no significant difference in total scores on SSI.

b. Treatment efficacy scale for fluency disorders was used to find the efficacy of

treatment.

Treatment efficacy scale for fluency disorders was used to find the efficacy of treatment.

The scores are from 1 to 5, where 1 is for more severe condition and five for the less

severe condition.


8

1) Frequency of stuttering: From the mean and standard deviation obtained it is clear that

there is no significant difference in the frequency of stuttering in the treatment efficacy

scale between the experimental and control groups.

2) Duration of stuttering: There exists a significant difference in the conditions within the

control group. The pairs of conditions are pre therapy – post therapy and pre therapy – 1

month post therapy follow up conditions (Figures 8 and 9) but not within the control

group.

3) Secondary Behavior: Figures 8 and 9 shows that there exists no significant difference

between the two groups in the three conditions.

4) Confidence in speaking: From the mean and standard deviation obtained (Figures 8 and

9), it is clear that there is no significant difference in confidence in speaking in the

treatment efficacy scale.

5) Avoidance behaviors: The results show that pre therapy - 1 month post therapy follow up

is the pair for which significant difference is there in the experimental group. In the

control group, the pairs of conditions for which there exists difference is there are pre

therapy - post therapy and pre therapy - 1 month post therapy follow up conditions

respectively.

6) Anxiety features: From Figures 8 and 9, it can be seen that there exists no significant

difference in the scores.

7) Attitudinal changes: From figure 8 and 9 it can be noted that there exists no significant

difference between the two groups in the three conditions. Pre therapy - post therapy

conditions and the pre therapy - 1 month post therapy follow up conditions are the pairs of

conditions for which significant difference is present in both the experimental and control

groups.

8) Naturalness of speaking: There exists no significant difference between the two groups in

the three conditions (Figure 8 and 9). The study by Ingham and Onslow (1985) describes

two studies that illustrate the utility of listener ratings of speech naturalness for measuring

and modifying speech naturalness during a stuttering therapy program.

The program

involved 5 adolescent PWS who were receiving an intensive treatment incorporating a

prolonged speech procedure. The

results showed that each subject's speech naturalness

ratings could be modified toward a target level of speech naturalness. In the present study,

the naturalness scores are better for the experimental group than the control group. The

higher scores of the experimental group could be attributed to the therapy program which

is used which takes into account the breathing coordination and the relaxation aspect.

9) Listeners reaction: Figures 8 and 9 reveal that in the pre therapy condition, the scores are

lower for the experimental group, in post therapy condition, the scores are lower for

experimental group and in 1 month post therapy follow up condition, scores are higher for

experimental group. This suggests that in the long term the listeners’ reaction has

improved better for PWS who was in the experimental group. However, the difference is

very slight.


9

10) Satisfaction with treatment: The results revealed that pre therapy - post therapy and pre

therapy - 1 month post therapy follow up are the pairs of conditions for which significant

difference is there in the experimental group. In the control group, the pairs of conditions

for which there exists difference are pre therapy - 1 month post therapy follow up

condition.

11) Self Monitoring skills: The results revealed that no significant difference existed in the

experimental and the control groups.

12) Feeling about generalization and maintenance of fluency: From figures 8 and 9 it can

be seen that there exists no significant difference within in the experimental group. A

significant difference in the conditions within the control group was obtained. In the

control group, the pairs of conditions for which there exists difference were pre therapy -

post therapy and pre therapy - 1 month post therapy follow up conditions respectively.

13) Total scores of the treatment efficacy scale for stuttering: Pre therapy - post therapy ;

pre therapy - 1 month post therapy follow up were the pairs of conditions for which

significant difference existed in the experimental group and pre therapy - post therapy and

pre therapy - 1 month post therapy conditions in the control group.

c. Inter judge reliability for the perceptual evaluation by judges

The recorded speech samples of the subjects were subjected to perceptual rating by 5

qualified SLPs on a 3- point scale (3- good, 2- average and 1- poor). The post therapy speech

samples of experimental and control group were randomized and given to five judges for

perceptual evaluation and rating. There was good reliability obtained for all the parameters.

d. Situational assessment

Situational assessment checklist for PWS was also employed which again the subjects

had to rate on a five point scale. In the experimental group pre therapy - post therapy and pre

therapy - 1 month post therapy conditions were the conditions having significant difference.

In the control group, the pairs of conditions for which there existed a significant difference

were pre therapy - post therapy and pre therapy - one month post therapy conditions.

2. Aerodynamic measurements

Aerodynamic measurements were done during pre therapy; post therapy and 1 month

post therapy follow up condition to see if there were any differences in the experimental and

control groups. Respiratory measurements included the measurement using RMS Helios 501 -

a window based program. The parameters recorded included, slow vital capacity (SVC) and

maximum voluntary ventilation (MVV).

Slow Vital Capacity (SVC): There is no significant difference in the mean SVC scores for

either the experimental or the control group for the three conditions of pre therapy, post

therapy and one month post therapy follow up.

Expiratory Reserve Volume (ERV): There exists no significant difference between the

two groups in the three conditions. The mean scores of the experimental group are slightly

higher for all the three conditions than the control group.


10

Inspiratory Reserve Volume (IRV): The results revealed no significant difference within

the experimental condition and a significant difference in the conditions within the control

group. The IRV scores are better for the experimental group than the control group for the

three conditions of pre therapy, post therapy and 1 month post therapy follow up

conditions.

Tidal Volume (VT): There is no much difference in the mean scores of the tidal volume

for the two groups for the three conditions. The results of Friedman test shows no

significant difference between the groups in the experimental condition and in the control

condition there was a significant difference. The pairs of conditions found to have

significant difference were between pre therapy - post therapy and pre therapy - 1 month

post therapy follow up.

The study by Story & Alphonso (1996) compared the pre and post treatment

measurements of kinematics of fluent speech of PWS. The study reports changes in acoustic,

respiratory, laryngeal

and articulatory kinematics of 3 males who stutter, following

participation in a version of the Hollins Precision Fluency Shaping Program. These results

show that behavioral treatment can produce significant changes in the fluent speech of persons

who stutter with respect to respiration, laryngeal valving and articulation.

5. Maximum Voluntary Ventilation (MVV)

The results show that pre therapy - post therapy and pre therapy - one month post

therapy were the pairs of conditions for which significant difference was there. There was

difference in the scores on the parameters of MVV between the two groups where MVV is

better for the control group in the post therapy condition. MRF in the pre therapy condition is

higher for the experimental group. There is no difference in scores for the other parameters

between the two groups. There is no significant difference between the two groups in the three

conditions. The pairs of conditions for which significant difference existed were post therapy -

1 month post therapy follow up and pre therapy - 1 month post therapy follow up.

Tables 3 and 4 shows the experimental and control groups respectively and the

conditions within those groups for which significant difference existed.

Table 3: The results of the different parameters significant (from Friedman’s test) and the

pairs of conditions significant (from Wilcoxon’s test) in the experimental group.

Parameters Experimental

group

Conditions for which significant

difference is there

Avoidance 6.61* PT & 1 month PoT

Anxiety 7.53* PT & PoT ; PT & 1 month PoT

Attitude 6.53* PT & PoT ; PT & 1 month PoT

Naturalness 7.60* PT & PoT ; PT & 1 month PoT

Listeners reaction 7.60* PT & PoT ; PT & 1 month PoT

Satisfaction 8.31* PT & PoT ; PT & 1 month PoT #

Total 8.40* PT & PoT ; PT & 1 month PoT #


11

SSI Frequency 8.40* PT & PoT ; PT & 1 month PoT #

SSI Duration 9.33* PT & PoT ; PoT & 1 month PoT #

SSI Physical concomitant 9.33* PT & PoT ; PT & 1 month PoT #

SSI Total 7.89* PT & PoT ; PT &1 month PoT #

Situational assessment 8.40* PT & PoT ; PT &1 month PoT #

[SSI = Stuttering Severity Instrument Scores; * = significance at p< 0.05 (Friedman’s test); PT = Pretherapy ;

PoT = Post Therapy ; 1 month PoT = 1 month post therapy; # = significance at p< 0.05 (Wilcoxon’s test)]

Table 4: The results for the different parameters for the three conditions that are significant

(from Wilcoxon’s test) in the control group.

Parameters Control

group

Conditions for which significant

difference is there

Duration 6.53* PT & PoT ; PT & 1 month PoT

Avoidance 7.53* PT & PoT ; PT & 1 month PoT

Anxiety 7.53* PT & PoT ; PT & 1 month PoT

Attitude 6.50* PT & PoT ; PT & 1 month PoT

Listeners reaction 6.50* PT & PoT

Satisfaction 7.00* PT & 1month PoT

Maintenance 8.00* PT & PoT ; PT & 1 month PoT

Total 6.50* PT & PoT ; PT & 1 month PoT

SSI Physical concomitant 6.61* PT & 1 month PoT

SVT 6.50* PT & PoT ; PT & 1 month PoT

MVV 7.60* PT & PoT ; PT & 1 month PoT

MVT 6.50* PoT&1 month PoT; PT & 1 month PoT

Situational assessment 6.50* PT & PoT ; PT & 1month PoT

[; SSI = Stuttering Severity Instrument Scores; SVC = slow vital capacity; ERV = expiratory reserve volume;

IRV = Inspiratory Reserve Volume; SVT = Tidal Volume; MVV = Maximum Voluntary Ventilation; MVT =

MVV maneuver tidal volume; * = significance at p< 0.05 (Friedman’s test); PT = Pretherapy ; PoT = Post

Therapy ; 1month PoT = 1 month post therapy; # = significance at p< 0.05 (Wilcoxon’s test)]

It can be seen that there was no significant difference between the two groups for the

perceptual evaluations done. However, within the experimental and control groups there was

significant difference in the parameters of SSI. The results of the Treatment efficacy scale for

Fluency Disorders showed parameters to have significant difference within the experimental

and control groups. The inter judge reliability was however good. The situational assessment

checklist also showed significant difference within the various conditions. The aerodynamic

evaluations showed that for the parameters; MVT = MVV maneuver tidal volume, significant

difference was present. MRF scores in the pre therapy condition were higher for the

experimental group. MVV scores were lower in the experimental group in 1 month post

therapy follow up and higher in the pre therapy and post therapy conditions.


12

Summary and Conclusions

The current study was aimed at investigating whether prolongation technique when

used in combination with Pranayama (experimental condition) would prove to be more

effective in the management of stuttering than the prolongation technique (control condition)

when used alone. It was also aimed to study if the effect of Pranayama practiced with

prolongation when compared to prolongation alone as a treatment technique has a long term

effect on the maintenance of fluency. The study focused on finding the outcomes in the

various evaluations using Stuttering Severity instrument (SSI) developed by Glydon D. Riley

(1980), Treatment efficacy scale for fluency disorders (self rating) by Geetha, Sangeetha and

Anjana (2007), Situational assessment checklist for PWS (self rating), aerodynamic measures

using RMS Helios 501 for both the treatment groups of PWS, during the pre therapy, post

therapy and one month post therapy follow up condition. Appropriate statistical analysis was

done and the results of the study can be concluded as follows:

It can be concluded from the study that there was no significant difference between the

two groups for the perceptual measures. However, within the experimental group significant

difference was obtained for the parameters of frequency, duration and total scores of SSI for

the experimental group and for physical concomitant scores significance was obtained within

both the groups. The parameters avoidance, anxiety, attitudinal changes, listener’s reaction,

satisfaction, and total scores of treatment efficacy scale showed significance within both

experimental and control groups. The inter judge reliability was good for all the fluency

parameters rated. The situational assessment checklist showed significant difference within

the control group and not in the experimental group. In the aerodynamic measurement, MVV

was better for the control group and SVC did not show much significance between the groups.

The objective of finding the role of treatment program in maintenance of fluency reveals that

in all parameters for which significant difference was obtained, the significance was also

found in the one month post therapy when compared with pre therapy in the experimental and

control groups.

The attempt to find if the severity of stuttering has any effect in the treatment outcome

with Pranayama revels that in post therapy condition, 60% of PWS in experimental group had

very mild stuttering and 40% had mild stuttering which was maintained in the one month

follow up evaluation. In the control group, 50% of the PWS had very mild stuttering and 50%

of PWS had moderate stuttering. In the one month post therapy condition in the control group,

25% had very mild stuttering, 25% had moderate stuttering and 50% had mild stuttering. This

reveals that the severity of stuttering had an effect which could be attributable to the treatment

delivered.

Implications

The present study throws light on the fact that Pranayama, a widely practiced exercise

could be encompassed in the speech therapy program for individuals with stuttering.


13

Limitations of the study

Limitation of subject availability was the major drawback of the study because of time

constraints. There were drop outs in the subjects selected for the experimental and control

groups which limited the total number of subjects. Due to ethical issues, Pranayama alone was

not tried in the experimental group subjects. Follow up maintenance was assessed after only

one month post therapy due to time constraints.

References

Dalton & Hardcastle (1977). Relaxation and desensitization. In R. Ham (Eds.), Techniques of

Stuttering Therapy. Prentice-Hall, Inc., Englewood Cliffs, New Jersey 07632.

Geetha, Y. V., Sangeetha, M. & Anjana, R. (2007). Treatment efficacy in stuttering.

Unpublished ARF Project.

Gifford, M. (1940). Correcting Nervous Speech Disorders. Englewood Cliffs, N.J.: Prentice-

Hall.

Ingham, R.J. & Onslow, M. (1985). Measurement and Modification of Speech Naturalness

during Stuttering Therapy. Journal of Speech and Hearing Disorders, 50, 261-281.

Nagendra, H.R. & Nagarathna, R. (2007). Yoga (Practices - Breathing Practices &

Pranayama, Sithilikarana & Asanaa, Kriyas, Mudras, Bandhas, Om & Cyclic

meditations & Yoga counseling. India: Swamivivekananda Yoga Prakashana.

Perkins, W.H. (1979). Respiration and Phonation. In R. Ham (Eds.), Techniques of Stuttering

Therapy. Prentice-Hall, Inc., Englewood Cliffs, New Jersey 07632.

Riley, G. (1994). Stuttering Serverity Instrument for Children and Adults (3rd ed.). Austin,

TX: PRO-ED.

Slorach, N. (1971). Twenty years of stuttering therapy. Journal of Australian College of

Speech Therapists, 21: 19-23.

Story, R.S. & Alfonso, P.J. (1996). Pre- and Post treatment Comparison of Kinematics of

Fluent Speech of Persons Who Stutter, Journal of Speech and Hearing Research, 39,

991-1005.


14

Appendix A

Treatment Efficacy Scale for Fluency Disorders

Name: No: Age/Sex: Date:

Ph. No: e-mail id: Address:

Clinician: Supervisor:

General information

1. How many therapy sessions did you take at AIISH? 1: <5; 2: 5-10; 3:10-20; 4: 20-30; 5: >30

2. What was the therapy technique taught to you?

3. Which technique did you find most effective?

4. Has therapy helped you control your stuttering? 1: No; 2: Yes

5. After therapy how is your stuttering? 1: increased; 2: Same; 3: Decreased

6. How much do you stutter now? (1: 0%; 2: 5-10%; 3: 10-25%; 4: 25-50%; 5: 50-75%; 6: > 75%)

7. How do you rate your stuttering severity when you first visited us?

1: Severe; 2: Moderately Severe; 3: Moderate; 4: Mild; 5: Very Mild

8. Have you taken any other treatment for your stuttering? 1: Yes; 2: No. If Yes, specify

9. Do you think you can improve some more by taking our help again? 1: No; 2. Yes

10. Has your attitude toward stuttering changed since you attended therapy at AIISH? 1: No; 2: Yes

I. Frequency of stuttering

1. I have problems in speaking very often, more than three times a day

2. I face the problem at least two or three times a day

3. I face the problem more than five times per week on an average

4. I face the problem two to three times a week

5. I face the problem occasionally once or twice in a week or two

II. Duration of stuttering

1. Often I get stuck during my speech for a long time

2. I get stuck on particular sounds or words for more than five to ten seconds

3. I get stuck for long duration occasionally during speech

4. I get stuck occasionally for very short durations

5. I do not ever get stuck in my speech for any perceptible duration now

III. Secondary behaviours

1. My secondary behaviours are severe and painful to look at

2. My secondary behaviours are very distracting

3. My secondary behaviours are distracting

4. My secondary behaviours are not noticeable unless looking for

5. I do not have any secondary behaviours now

IV. Confidence in speaking

1. I’m not at all confident while speaking

2. Most of the time I’m not confidant while speaking

3. There are some situations where I am not confidant while speaking

4. I am confidant to speak in most situations

5. I am confidant to face any situation

V. Avoidance behaviours

1. I avoid speaking situation every time I possibly can

2. I try to avoid a speaking situation most of the time

3. I try not to avoid a situation, but sometimes avoid it

4. I don’t try to avoid any speaking situation, but sometimes I feel like doing so

5. I never try to avoid any speaking situation


15

VI. Anxiety features

1. I feel extremely tensed/ scared and anxious whenever I have to speak

2. I feel tensed/scared and anxious in most of the situations when I have to speak

3. I get tensed/scared in some situations and in others I am able to speak easily

4. I get anxious only on few words, but can keep myself calm in most of the situations

5. I remain calm and relaxed in all speaking situations

VII. Attitudinal changes

1. I feel very inferior to others because of my speech

2. I have come to terms with my problem but still feel low most of the time

3. I tell myself that I am not inferior but sometimes cannot help feeling so

4. I have begun to realize I’m not inferior to anybody

5. I have understood my problem well and I know I’m not inferior to anybody

VIII. Naturalness of speaking

1. My speech is very unnatural/monotonous most of the time

2. My speech is unnatural in most situations

3. My speech is unnatural in some situations

4. My speech sounds natural in most situations

5. My speech sounds natural in almost all situations

IX. Listeners’ reaction to your speech

1. I feel all listeners are very impatient toward my speech

2. Most listeners laugh at me and tease/comment on my speech

3. I feel most listeners are sympathetic and complete the sentences for me

4. I perceive subtle reactions from the listeners to my speech sometimes

5. I do not notice any negative reactions to my speech from the listeners now

X. Satisfaction with treatment

1. I am dissatisfied; therapy offered did not satisfy me at all

2. Treatment was not satisfactory and not of much help

3. Treatment has helped reduced my problem to a small extent

4. Treatment was good, has helped me reduce my problem to a large extent

5. Treatment was excellent, has helped me completely overcome my problem

XI. Self monitoring skills

1. I am not able to monitor my speech fluency at all

2. I am not able to control my stuttering in most situations

3. I can monitor my speech fluency in most situations

4. I am able to monitor my speech except in occasional situations

5. I am able to monitor and control my speech always

XII. Feeling about maintenance and generalization of fluency

1. I do not feel adequate to maintain my fluency and I am worried about relapse

2. I feel I can maintain my fluency with regular guidance from the therapist

3. I feel I can maintain my fluency with periodic guidance from therapist

4. I feel I can maintain my fluency with occasional guidance from the therapist

5. I feel confidant that I can always maintain my fluency without further guidance.


16

Appendix B

Situational Assessment Checklist for PWS

Please answer the following questions by putting a mark among the options

[0 – Nil; 1 – Very Less; 3 – More; 4 – Too much] 0 1 2 3 4

1. While speaking to friends

2. While speaking to parents

3. While speaking to siblings

4. While speaking to young children

5. While speaking to class mates/ colleagues

6. While speaking to teachers/ officers/boss

7. While speaking to strangers

8. While speaking to people of opposite sex

9. While speaking alone

10. While speaking simultaneously in a group

11. While speaking or discussing in a group

12. While addressing a small group

13. While addressing a large group

14. While singing or reciting songs or poems

15. While speaking to people in the market/railway station/bus

16. While reading loudly alone

17. While reading loudly in front of others

18. While answering questions in the classroom or work spot

19. While speaking your mother tongue

20. While speaking a language which you are not competent

21. While initiating a sentence

22. In the middle of a sentence

23. While enacting a role in a play or drama

24. While facing an interview

25. While speaking over a telephone

26. Teaching/demonstrating in a group

27. Arguing a point in a group

28. Asking/giving directions

29. When excited or happy

30. When anxious, scared, nervous or tensed

Reliability of Voice Evaluation using Cape-V Rating Scale

17

Reliability of Perceptual Evaluation of Voice using CAPE-V

Rating Scale in Indian Context

Akanksha Gupta & M. Pushpavathi*

Abstract

Human ears have the ability to identify and recognize the speaker’s voice. A trained voice

clinician is often able to determine the causative pathologies on the basis of psychoacoustic

impression of voice. Perceptual voice evaluation is an integrated process of listening to and

describing a particular voice. The Consensus Auditory-Perceptual Evaluation of Voice (ASHA, 2002)

is one of the most widely used scales in Western countries which has both categorical rating system

and visual analog scale (VAS). However no published reports are available in Indian context on

consistency of the scale as a reliable tool for perceptual analysis of voice. The aim of the study was to

evaluate the reliability across judges on different speech tasks on categorical ratings and on 100 mm

VAS and to evaluate the correlation between categorical descriptors and numerical value (on VAS)

assigned across three tasks and also to determine the most suitable voice sample (phonation/

sentences/ spontaneous speech) for perceptual evaluation of voice using CAPE-V. Twenty one adult

males who were diagnosed to have hoarse voice were taken in the study and were asked to phonate

vowels, read the sentences and spontaneously speak about their voice problem. The sample was audio

recorded and randomized and then was given to six judges for evaluation on CAPE- V scale. The

obtained value was tabulated on SPSS software for statistical analysis. Cronbach’s alpha reliability

coefficients were computed for reliability across judges on VA and ordinal scales. In general, high

reliability was observed across judges on different speech tasks. High reliability is seen in all the

parameters except for loudness, which demonstrates moderate reliability in most of the tasks. Good

correlation was observed between the two scales. That is, the judges selected VA scale value and

ordinal descriptor (degree) in such a way that it shows a relationship with each of the two. Given the

strong reliability of both, it may be noted that the higher resolution of the VA system positively

impacts the reliability of the ordinal scale. Also, it was observed that connected speech serves as the

best sample for perceptual analysis of voice. The findings of the study are helpful in evaluation of

voice disorders using perceptual scale and can be used in combination with objective analysis for

diagnosis as well as for evaluation of efficacy of voice therapy. Perceptual evaluation of voice is a

quick and reliable method of voice evaluation. Hence, its use is warranted for all the persons having

dysphonia.

Introduction

“Every human Society, no matter how primitive has developed the ability to

communicate through speech and our ability to communicate through spoken and written

language has been cited as one single most important characteristic that sets the human apart

from other animals” (Curtis, 1978). The underlying basis of speech is voice. According to

Green 2 (1964) “voice plays the musical accompaniment to speech rendering it tuneful,

pleasing, audible and coherent and is an essential feature of efficient communication by

spoken word”.

______________________________________ Reader in Speech Pathology, All India Institute of Speech and Hearing, Mysore, India



18

A good voice is a clear, resonant, stable, well supported by adequate breath control. It

is at a pitch level that is appropriate to the speaker and the message. Rate of speech is such

that the messages are clearly understood. An effective speaking voice should have the

following characteristics (Anderson, 1961).

Adequate loudness

Ease and flexibility

A vibrant, sympathetic quality

Pleasing and effective pitch level

Ease of diction

Clearness and purity of tone

Voice disorders arise when an individual‟s quality, pitch or loudness differs from

voice characteristics typical of speakers of similar age, gender, cultural background and

geographical location. The range of etiologies of voice disorders is large and these

differences may result from a variety of factors. Structural, medical or neurologic alterations

of the respiratory, laryngeal, and vocal tract mechanisms may create a voice disorder. Voice

quality is a term that subsumes a wide range of possible meanings covering both laryngeal

and supra-laryngeal aspects. It is perception of the physical complexity of laryngeal tone

modified by cavity resonation.

Voice can be evaluated objectively as well as subjectively in many ways. Objective

measurements include acoustic, aerodynamic and physiologic parameters using instruments.

Similarly, subjective evaluation includes perceptual ratings of voice on various parameters

like roughness, breathiness, resonance, loudness etc. But when objective acoustic measures

alone are used to analyze vocal quality there appear to represent only a friction of the set of

all the measures used by the human listener.

Perceptual Evaluation

Perceptual voice evaluation is an integrated process of listening to and describing a

particular voice. The clinician needs intensive training in voice dimensions that identify

pathology most effectively. Rating voice quality perceptually is universally acknowledged as

difficult task and one requires considerable experience in perceptual judgments. The

perceptual importance of different aspects of voice depends on context, attention, a listener‟s

background and the listening task (Kreiman, Garratt, Kempster, Erman & Berke, 1993).

Advantages of Perceptual Evaluation

The importance of perceptual measures is also demonstrated by their frequent use as a

standard against which acoustic measures are validated or compared (Kreiman et al, 1993).

Perceptual voice evaluation using any standardized scale is an inexpensive, readily available

and practical tool for evaluation purposes.

It has been found to be reliable in its findings in both inter-judge and intra-judge reliability.


19

Limitations of Perceptual Evaluation of Voice

The subjective evaluation of voice quality are not highly regarded as either clinical or

research tools because of the following reasons, like they are considered to lack objectivity

and do not require great technical sophistication (Weismer & Liss, 1981). Also, there is no

accepted set of perceptual scales used by the clinicians (Yumoto, Gould & Baer, 1982).

The factors like reliability and uncertainty regarding the use and meaning of various

rating scales have led some to abandon perceptual measures in favor of instrumental

approaches to voice assessment and because of inherent problems with inter-judge and intra-

judge reliability (Ludlow, 1981).

Because of these views the subjective assessment of voice has received back seat in

evaluation of voice pathology with objective evaluation as a primary means of assessment. In

literature, there are many types of perceptual scales available for the judgment of the voice

disorders. They may be a Categorical rating scale, Equal Appearing Interval (EAI) scales,

Visual Analog (VA), Direct Magnitude Estimation (DME) or Paired Comparison. Various

scales have been developed by several authors like The Voice Profile (Wilson, 1987), The

GRABS Scale (Hirano, 1981), Buffalo III Voice Profile (Wilson, 1987), The Consensus

Auditory-Perceptual Evaluation of Voice (ASHA, 2002).

The Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) was developed as

a tool for clinical auditory-perceptual assessment of voice from a consensus meeting

sponsored by ASHA held in Pittsburg (2002). Its primary purpose is to describe the severity

of auditory perceptual attributes of a voice problem, in a way that can be communicated

among clinicians. Its secondary purpose is to contribute to hypotheses regarding the anatomic

and physiological bases of voice problems and to evaluate the need for additional testing.

CAPE-V is not intended for use as the only means of determining the nature of the voice

disorder. It is not to be used to the exclusion of other tests of vocal function. Finally, it is not

expected to demonstrate a 1:1 relation to results from other tests of vocal function.

Reliability and Validity in Perceptual Evaluation of Voice

Reliability refers to the degree to which test scores are free from errors of

measurement (American Psychological Association, 1985) and the construct of reliability

then has to be defined as relatively free of random errors of measurement (Crocker and

Algina, 1986). Random errors of measurement affect the score of a person because of purely

chance happenings. They are not consistent and will smooth down over time if a test is

repeated several times. Sources of such random errors may include “guessing, distraction in

the testing situation, administration errors, content sampling, scoring errors, and fluctuations

in the individual examinee‟s state” (Crocker and Algina, 1986).


20

By contrast, systematic measurement errors are those that consistently affect the score

of a person because of particular characteristic of the person or the test that has nothing to do

with the construct being measured (e.g., a rater who always uses the scale in the same

manner). Such tendencies are supposed to persist across repeated ratings with the same

instrument and affect the score of the rater in a consistent manner. Even if both error types

are of concern in score interpretation, systematic measurement errors do not result in

inconsistent measurement. Still, they may lead to low validity in the ratings and thereby

reduce the utility. Random error, however, may reduce both the reliability and the validity

and thereby the utility of the ratings (Crocker et al, 1986).

Although reliability is an important attribute, the most critical property of any test is

its validity. Validity refers to what the measurement actually measures and how useful the

measurement is to researchers. Reliability is a condition for validity and it places an upper

limit on the validity of a test. Unreliable measures will allow tests to show little, if any,

validity. Reliability is a necessary, but not a sufficient, prerequisite for the test to have

validity (Crocker et al, 1986). These factors change slowly over time and thus hypothetically

affect inter-judge reliability more than intra-judge reliability. Additional factors related to

listeners include fatigue, attention lapses and mistakes. These error factors should affect both

interrater and intra-rater reliability (Kreiman et al 1993). Systematic interactions among

listener and task factors may also occur. Listener sensitivity may interact with scale

resolution, which adds noise to the data or results in information loss.

Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V)

It was developed by Consensus meeting sponsored by ASHA held at Pittsburgh

(2002). It has additional feature of visual analog scale (100 mm scale) where the judge is

required to mark the voice quality on the scale with left end of scale indicating no

abnormality and the right end indicating severe voice problem.

Description of the Tool

The CAPE-V (Appendix I) indicates six salient perceptual vocal attributes namely

roughness, pitch, loudness, breathiness, overall severity and strain. The preferred attributes

were regarded as most identifiable and important attributes for the analysis of voice disorders.

Also they reported them to be most commonly used and easily comprehendible ones.

Each attribute is displayed and represented by a 100- millimeter line forming a visual

analog scale (VAS). The clinician indicates the degree of perceived deviance from normal

voice for each parameter on this scale, using a tick mark. Judgments may be assisted by

referring to general regions indicated below each scale on the CAPE-V: “MI” refers to

"mildly deviant," “MO” refers to “moderately deviant,” and “SE” refers to "severely

deviant." A key issue is that the regions indicate gradations in severity, rather than


21

discrete points. The clinician may place tick marks at any location along the line.”

Ratings are based on the clinician‟s direct observations of the patient‟s performance

during the evaluation, rather than patient report or other sources.

Scale

A 100 mm line scale with unlabelled anchors, commonly known as a visual analog

scale, is used to assess each of the six quality features. The left most portion of the scale

reflects normal voice (in the case of judging Severity, Pitch, or Loudness) or none of the

quality being judged (in the case of Roughness, Breathiness, and Strain). The right end of the

scale is to reflect the listener‟s judgment of the most extreme example of deviance.

Measurement from the left end of the scale to each tick mark, in millimeters, is denoted on

the blank to the far right of the scale (___/100).

Additional CAPE-V Elements

A nominal rating judgment allows the clinician to classify the consistency or

intermittent presence of the voice quality feature within and across evaluation tasks. Sections

devoted to resonance or other features supplement the CAPE-V protocol by allowing other

salient descriptors to document a patient‟s voice quality. This flexibility is needed to capture

the spectrum of voice disorders and associated conditions or features. The list of terms

provided on the form is not inclusive, meant only as examples of specific features that may

help describe auditory-perceptual attributes.

Concurrent Validity and the CAPE-V

Karnell, Melton, Childes, Coleman, Dailey, & Hoffman, (2006) published a

preliminary report comparing the reliability of clinician based auditory-perceptual judgments

using the CAPE-V to those made with the GRABS voice rating scheme (Hirano, 1981).

These protocols were compared after use in voice assessment of forty males and sixty one

females by certified speech language pathologists. They found comparable estimates of inter-

judge reliability for the two scales, both at high levels but suggested that the CAPE-V may

offer “more sensitivity to small differences within and among patients than the GRABS

scale”.

Study done by Wuyts, De Bodt, Van de Heyning (1999) aimed at finding and

comparing the reliability of visual analog scale and an ordinal scale by perceptual voice

evaluation of fourteen pathological voices by twenty nine listeners using GRABS scale.

Agreement was found to be higher with original 4 point scale than with the visual analog

scale version for the scale items G, R, A, B and S. A tendency was noted to rate the voice on

the middle of the visual analog scale and with increased freedom of judgment the inter judge

agreement decreases considerably but it also seemed that finer judgment of voice quality is

possible with VA scale. But, the authors reported that, it is logical to assume that the listener

perceives the vocal characteristics along a continuum, rather than quantifying perception by


22

intervals. The VAS appears to be advantageous for comparison with absolute acoustic

measurements as it offers more detailed information.

Effect of Speaking Task/Sample on Reliability of Perceptual Assessment

De Krom (1994) conducted a perceptual experiment in which six listeners used the

GRABS scale to rate voice fragments from seventy eight dysphonic speakers. Four different

types of stimuli were presented to each listener: one based on connected speech fragments

and the other three on segments of a sustained vowel. Analyses focused on the consistency

and reliability of ratings and results indicated that stimulus type had virtually no effect on

either intra-rater or inter-rater reliability. When determined as a function of the overall degree

of severity of a voice, the reliability of ratings for the breathiness and roughness parameters

was slightly higher for vowel stimuli than for connected speech.

Munoz, Mendoza, Fresneda, Carballo and Ramirez, (2002) examined the agreement

and reliability of ratings made by thirty four expert listeners using the Buffalo Voice Profile

System. A sustained vowel and a short utterance of connected speech were presented to each

listener. Results revealed that for the evaluation of the sustained vowel, interrater agreement

was moderate for judgments of breathiness, hyponasal resonance, and overall severity of

dysphonia and for connected speech agreement was moderate for most voice qualities.

Need for the study

Perception of a patient‟s voice is at the heart of evaluating and treating patients with

voice disorders. Patients and their families decide whether treatment has been successful

based largely on whether the patient sounds better. Similarly clinicians make many decisions

about managing the speech and voice disorder based upon perceptual judgment. Thus, there

is always a need of a reliable perceptual voice rating scale, which has good inter-judge and

intra-judge reliability. Since CAPE–V is relatively new in its coming, not many studies have

been reported in literature on the reliability of the scale. Thus, a need was felt to assess the

reliability of the perceptual evaluation of voice using the CAPE–V scale.

Aims of the study

The present study is aimed at investigating the reliability of perceptual evaluations of

voice disorders using CAPE-V scale (Consensus Auditory Perceptual Evaluation of Voice,

2002) for different tasks like phonation, sentences and spontaneous speech, in Indian context.

The aims of the study were to evaluate the


23

Reliability across judges on different speech tasks (phonation, sentences and spontaneous

speech) on categorical ratings (mild, moderate, severe) and on 100 mm visual analog

scale.

Correlation between categorical naming (mild, moderate, and severe) and numerical value

(on VAS) assigned across three tasks.

Determination of the most suitable voice sample (phonation/ sentences/ spontaneous

speech) for perceptual evaluation of voice using CAPE-V.

Method

Twenty one male adult participants were included in the study (in the age range of 25-

45 yrs) who were diagnosed as having hoarse voice by a qualified speech language

pathologist using acoustic analysis and perceptual assessment (without any use of

standardized scale). Total fifteen native Kannada speakers and six English speakers were

considered as subjects. The audio recordings of the speech samples were done in a sound

treated room, free from all distractions and minimum ambient noise. The room was well

ventilated and well lighted. Recordings were done using Cool Edit (Version II) software in a

Compaq Lap top with an „HP Microphone‟. The microphone was placed at a distance of 6 cm

and slightly to the side of the subject‟s mouth to minimize breathing noise. Gain was adjusted

to avoid saturation and ensure optimal use of recording dynamics. Subjects were instructed to

for three different tasks at a comfortable pitch and volumes as naturally as possible. The

complete sample was audio recorded using the Cool Edit software.

Procedure

The subjects were enrolled for the study after the completion of assessment. Informed

consent was obtained from each subject.

Data Collection/ Sample Recording - The data (voice sample) was collected by asking the

subjects to carry the following three tasks-

Task I - Maximum Phonation Duration: The subjects were asked to phonate vowels /a/, /i/

and /u/ after a deep inhalation, as long as they could in their comfortable pitch.

Task II - Reading Sentences (Repetition task if the subject was illiterate).

Three oral and three nasal, Kannada or English sentences were given to the participants who

were native speakers of respective languages. Kannada sentences were taken from stimuli

developed for nasometer assessment by Jaya Kumar, 2004 (Appendix III). English oral

sentences were taken directly from the original CAPE-V rating scale given by ASHA, 2002.

English nasal sentences were taken from the stimuli developed by Kummer, 2008 (Appendix

IV).

Task III - Spontaneous Speech – The subjects were asked to describe about their voice

problem at a comfortable loudness level. The participants were instructed to speak in

response to questions like, “Describe your voice problem”? or “What problems are you

facing because of the voice problem”?


24

The three tasks were recorded with an interval of twenty seconds between each task.

The samples were recorded on Cool Edit (version II). After the speech recordings the samples

from different subjects were randomized. As, there were twenty one participants, twenty one

sets were made which had different speech tasks recording of different participants. This was

done to avoid biasing by judges while rating the voice. These randomized sets were then

copied to compact discs, which were given to the six judges of the study. These samples

along with the rating sheets (Appendix II) were given to the judges for rating the voice

quality based on CAPE- V (2002).

Six speech and language pathologists, who have an experience of 3-4 years in

assessment and management of voice disorders, were selected as judges for the study. The

randomized samples were played through the compact disc (CD) and they were asked to rate

the samples based on CAPE-V rating scale. The analysis sheets (Appendix II) were given to

the judges for perceptual judgment.

The complete perceptual analysis of all the twenty one samples by each judge was

done in two sessions. Six samples were played in the first session, then followed by a week

other fifteen samples were given to the judges for perceptual ratings on CAPE-V. The rating

sheets from judges (Appendix V) were then rearranged based on randomization which was

previously done. Each subject‟s speech samples were then grouped together. The obtained

data was tabulated on to SPSS software (version -16). Appropriate statistical measures were

applied to the get the reliability co-efficient between the parameters and judges.


I. Reliability of perceptual evaluation of voice on different tasks -

To evaluate the reliability of judges in rating the voice samples Cronbach‟s alpha (α)

coefficient was computed. Inter judge reliability was evaluated for each parameter of each

task. Table 1 depicts degree of reliability on phonation task, sentences (reading sample) and

spontaneous speech. In general high reliability was found across judges and across all the

tasks (except for loudness parameter on ordinal scale in spontaneous speech). The reliability

range was within acceptable limits of 0.05. This indicates that the judges were reliable in

giving ratings on VA scale and on ordinal scale. The results of the present study indicate that

high reliability for perceptual evaluation of voice across tasks and judges was obtained by

using CAPE- V.


25

Table 1 depicts the reliability coefficients obtained on different tasks.

Table 1: Overall inter rater reliability across tasks on both the scales of CAPE-V

* indicates reliability between 3rd & 4th judge

The results obtained from the present study support the findings of Karnell et al

(2006), Zraick et al. (2007) and Kelchner et al. (2009) who have reported significant

reliability for the perceptual evaluation using CAPE-V. Kreiman et al (1992) have suggested

that all the listeners have similar, relatively stable internal standards for “normal” voice

quality because of the everyday experience they have with normal voices. Hence, consistency

is observed when they rate normal or near normal voices. The internal standard for

pathological voice may vary from a listener to listener depending upon their experience or

exposure to it. The study does not support the findings of Wuyts et al (1999) who opined that

though VA offers finer judgment of voice quality but with increased degree of freedom the

inter rater agreement decreases considerably. They also reported that on VA scale a general

trend was exhibited i.e. the raters tend to score the voice more to the middle of the 100 mm

line. They suggested that VA scale has more variability in rating the voices than the ordinal

scale.

II. Correlation between Ordinal and VA Scale

The dimensions on which both the scales of CAPE-V evaluate a voice sample are

different. The ordinal scale has the classification as mild, mild- moderate, moderate,

moderate- severe, severe where as VA scale has values assigned from 1-100. The perceptual

scores provided by the judges were compared to find agreement between the two scales. In

order to estimate the correlation between VA and ordinal scale, Spearman's rank correlation

coefficient was computed. Table 2 illustrates the correlation coefficients between the two

scales across the three tasks, for which Spearman’s correlation coefficient was computed

and compared.

Table 2: Correlation between ordinal and VA scale on phonation, reading sentences and

spontaneous speech task. Here, “*” indicates P < 0.05; “**” indicates P < 0.01; “***”

indicates P < 0.001.


26

The present is aimed to evaluate the correlation between the two scales (VA and

ordinal) and also to examine the pattern of ratings given by the judges. Since the two scales

are fundamentally different the statistical analysis is also different. After converting the VA

to mVA scale cross tabulations were acquired for both the scales. It was observed that, very

few judges rate the voice quality as mild- moderate and moderate- severe i.e. ratings of 2 and

4 are being given much lesser than that of 1, 3 and 5 (degrees) on ordinal scale. Similar trend

was observed on all the three types of voice samples being rated. Hence during cross

tabulation the “2” and “4” (mild- mod and mod- severe degrees) have not been taken.

Table 3 shows the cross tabulation obtained for the task of phonation, sentences and

spontaneous speech. Rating patterns for mild, moderate and severe degree are been depicted

in the table.

Table 3: Cross tabulation for across all samples.


27

It can be clearly noticed similar rating patterns of judges was observed in phonation,

sentences samples and spontaneous speech task. Hence the degree assigned to particular

voice sample and the VA value given by judges, correlated well with each other. This

signifies good correlation between the VA and ordinal scale. Thus the above cross tabulations

for phonation, sentences and spontaneous speech indicates that there is a predictable pattern

in rating the voice quality on both the scales. On an average if a judge assigns VA value from

10 to 39 then he/she refers voice sample to have “mild” degree. If he/she assigns VA value

from 40 to 69 he refers the voice sample to be of “moderate” degree. Finally, if he/she gives a

VA value > 70 then it points to “severe” degree.

The findings from the present study support the results of Yu et al (2002) who

reported that the correlation between perceptual and objective voice judgment is better using

modified visual analog scale (r = 0.88) than a conventional ordinal scale (r = 0.64). This can

be attributed to the fact that distinguishing between normal and severely dysphonic voice is

easy and independent of listener’s experience or level of skill (Yu et al, 2002) but the real

challenge in perceptual analysis is recognition of intermediated grade of dysphonia (G1 and

G2 and variations in degree of dysphonia). Hence when rating on ordinal scale, judgments

even by skilled judges are subject to great variability probably because of lack of precise

internal standard to distinguish intermediate grades of dysphonia (Yu et al, 2002). This also

leads to a disadvantage that ordinal scale becomes too insensitive for small variations in voice

quality (Wuyts et al, 1999) and an advantage that it limits inter and intra rater variability by

providing a broad band for each level of severity (Yu et al, 2002). While, on the other hand it

was observed that VA scale offers increased of freedom of judgment and thus finer judgment.

But this may contribute to decreased inter rater agreement (Wuyts et al, 1999). Hence from

the present study the correlation between VA and ordinal scale can be drawn as follows,

Figure 1: Visual representation of relationship between VA and ordinal scales

III. Comparison of perceptual task across voice samples

The voice parameters were combined within phonation, sentences and spontaneous

speech. Since the study was aimed to determine the suitable task for better perceptual

evaluation of voice. In view of this, the perceptual attribute on all the dimensions were

compared across the three tasks, spearman‟s correlation coefficient was computed in order to

determine the task which shows highest correlation between the two scales of CAPE-V.

Table 4 shows the correlation coefficients obtained for each of the tasks of the study.


28

Table 4: Overall correlation between the two scales on all the three tasks.

Here „***‟ indicates P < 0.001

High degree of correlation was obtained for all the tasks. Since spontaneous speech

task demonstrates highest correlation coefficient (r = 0.82) compared to sentences (r = 0.76)

and phonation (r = 0.73), consequently this parameter can be considered to be most

appropriate for perceptual evaluation of voice. The following graphs represent the patterns of

ratings by judges on the two scales of CAPE- V. X axis represents the ordinal scale where 1

refers to mild, 2 refers to mild moderate, 3 refers to moderate, 4 refers to moderate to severe

and 5 refers to severe. Y axis refers to VA scale values from 0 to 100 on 100 mm VA scale.

Figure 2: Graph representing the rating patterns on the phonation task

The above scatter plot was obtained for the phonation sample. From the figure it can

be derived that as ratings or severity on ordinal scale enhances i.e. from mild to severe along

the X axis the scatter plots show a clear rise in the VA scale on Y axis as well. A rise in the

height of plots towards severe degree represents good correlation between the two scales in

the phonation task. The following figure was obtained for sentence task.

Figure 3: Graph representing the rating patterns on the sentence reading task.

Similarly the following figure was obtained for sentence task.


29

Figure 4: Graph representing the rating patterns on the spontaneous speech task.

Analysis of sustained vowels has always been given major importance in the

perceptual (Aronson, 1980) as well as the acoustic evaluation (Greene, 1992) of voice

disorders. However, many investigators have concluded that sustained vowels do not

adequately represent continuous speech. According to Askenfelt and Hammarberg (1986), a

sustained vowel tends to be representative of voice function status only in those cases where

the dysphonia is due to severe laryngeal pathology, like laryngeal cancer or unilateral

paralysis. Thus, for the majority of the subjects it is necessary to analyze running speech in

order to obtain an adequate estimation of the voice status. Furthermore, according to

Takahashi and Koiki (1975), the initial and the terminal parts of the voice may carry

abundant information not contained in the steady-state vowel. Similarly, Hammarberg,

Fritzell, Gauffin, Sundberg and Wedin (1980) stated "Changes in running speech such as

vocal onset and termination, voice breaks, etc., are crucial to voice quality, and are not likely

to appear in a single vowel sound."


Perceptual voice rating scales can be of different types, like - Categorical ratings,

Equal Appearing Interval scales, Visual Analog (VA), Direct Magnitude Estimation (DME)

and Paired Comparison. In literature, many types of perceptual scales are available for the

judgment of the voice disorders. But the reliability of the perceptual data varies from study to

study. CAPE-V is relatively a new scale for voice evaluation; hence only limited studies are

available on its reliability and validity as a perceptual scale. The scale was developed as a

tool for perceptual analysis of voice from a consensus meeting by speech language

pathologists and invited experts in human perception held in Pittsburg (2002). The present

study was aimed to study the reliability of perceptual evaluation of voice using CAPE- V

rating scale.

The study was an initial attempt to explore the reliability of CAPE-V on various

parameters in Indian context. The study aimed at investigating the reliability of perceptual

evaluations of voice disorders using CAPE-V scale for different tasks like phonation,

sentences and spontaneous speech, in Indian context.

Reliability across judges on different speech tasks (phonation, sentences and

spontaneous speech) on categorical ratings (mild, moderate, severe) and on 100 mm Visual

analog scale.


30

Correlation between categorical naming (mild, moderate, and severe) and numerical

value (on VAS) assigned across three tasks.

Determination of the most suitable task or voice sample (phonation/ sentences/

spontaneous speech) for perceptual evaluation of voice using CAPE-V.

The participants considered for the present study were twenty one males (in age range

of 25-45 years) diagnosed as having hoarse voice quality by a qualified speech language

pathologist. The participants were native speaker of Kannada or English. The voice samples

was collected by asking the participants to carry out three tasks i.e. Phonating /a/, /i/ and /u/;

repetition/ reading of sentences (of respective language), and spontaneously speaking about

their voice problem at their comfortable loudness level and in their native language. The tasks

were recorded with an interval of 20 seconds between each of tasks. The samples were

recorded on Cool Edit (Version II) software in a Compaq laptop using “hp” microphone. To

avoid biasing the samples were randomized. Six speech and language pathologists, who have

an experience of 3-4 years in diagnosis and management of voice disorders, were selected as

judges. The analysis sheets along with the randomized voice samples were given to the

judges for perceptual evaluation of voice. The complete evaluation of voice samples of

twenty one participants was done in two sessions by each of the judge.

Obtained data was reorganized and was tabulated on to SPSS software for statistical

analysis. Cronbach‟s alpha coefficient was computed to assess the reliability across judges.

Spearman‟s correlation coefficient was computed to determine the correlation between the

two scales i.e., VA and ordinal scale. Also, in order to determine the most suitable task for

perceptual evaluation of voice spearman‟s rank correlation coefficient was computed.

The first aim of the study was to evaluate the reliability across judges on different

speech tasks. Cronbach‟s alpha reliability coefficients were computed for both the scales of

CAPE-V i.e., VA and ordinal scales across the tasks. High reliability is seen in all the

parameters except for loudness, which demonstrates moderate reliability in most of the tasks.

The reliability range was within acceptable limits of 0.05 (among a particular voice parameter

in the two scales). This shows that the judges were reliable in giving ratings on VA and on

ordinal scale. The results of the present study indicate that high reliability for perceptual

evaluation of voice across tasks and judges was obtained using CAPE- V.

The second aim of the study was to investigate the correlation between ordinal and

VA scale across task. Spearman‟s rank correlation coefficient was computed for each of the

parameter between both the scales. The results of the computation revealed that there is high

correlation between the two scales amongst all the voice attributes of CAPE-V. However,

some of the parameters like loudness consistently demonstrate lower correlation in

comparison to parameters like roughness, breathiness, overall quality etc.

The third aim of the study was to determine the most appropriate task for perceptual

analysis of voice using CAPE-V. Spearman‟s rank correlation coefficient was computed in

order to determine overall correlation in all the three types of voice samples. It was observed


31

that overall correlation for spontaneous speech (r = 0.81) is better than that for oral- nasal

sentences (r = 0.73) and phonation (r = 0.70) tasks. Hence, following conclusions can be

drawn from the present study.

CAPE-V scale which incorporates a Visual analog and an ordinal scale has good

reliability. The use of the two scales together (VA and ordinal) facilitates reliability and

correlation across parameters and judges. It can be concluded that, spontaneous speech

sample (or connected speech sample) elicits more reliable perceptual evaluation of voice than

sustained phonation of vowel and reading sample (sentence).

Implications of the study

The findings of the study are very helpful in evaluation of voice disorders using

perceptual scale and can be used in combination with objective analysis for diagnosis as well

as for evaluation of success rates after voice therapy.

Perceptual evaluation of voice is a quick and reliable method of voice evaluation.

Hence, its use is warranted for all the patients who have dysphonia.


Sample size taken for the study was small.

Number of judges taken for study was less.

Patients only with hoarseness were included in the study.

Only inter judge reliability has been gauged in the study. No evaluation for intra judge

reliability has been done.

Directions for future research

The present study considered only trained judges who have an experience of 3-4 years

in diagnosis and management of voice disorders. The same method can be employed to

determine the effect of experience or less experience on perceptual evaluation of voice.

It may be interesting to examine the reliability of ratings of other groups of

professionals also, such as general medical practitioners or otolaryngologists, who are often

the first person called to make judgment about dysphonia and its significance in the

presentation of signs and symptoms in the patients.

Intra rater reliability can be assessed by giving the judges the same voice sample 2-3

times with an interval of some days/ week. This would be helpful in determining the internal

standard of judges as stable or unstable.


32

References

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procedures from http://www.asha.org/about/membership- certification/

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Askenfelt, A. G., & Hammarberg, B. (1986). Speech waveform perturbations analysis: A

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dissertation submitted to Mysore University, Mysore.

Karnell, M. P., Melton, S. D., Childes, J. M., Coleman, T. C., Dailey, S. A., & Hoffman, H.

T. (2007). Reliability of Clinician-Based (GRBAS and CAPE-V) and Patient-Based

(V-RQOL and IPVI) Documentation of Voice Disorders, Journal of Voice, Vol. 21

(5), 576–590.

Kelcner, L. N., Brehm, S. B., Weinrich, B., Middendorf, J., Dealarcon, A., Levin, L., Elluru,

R. (2009) Perceptual evaluation of severe pediatric voice disorders: Rater reliability

using the Consensus Auditory Perceptual Evaluation of Voice. Journal of Voice,

Article in Press.

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11, 3 – 8. Rockville, MD: American Speech Language Hearing Association.


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Munoz, J., Mendoza, E., Fresneda, M. D., Carballo, G., Ramirez, I. (2002). Perceptual

analysis in different voice samples: agreement and reliability. Percept Motor Skills,

94, 1187-1195.

Takahashi, H., & Koike, Y. (1975). Some perceptual dimensions and acoustic correlates of

pathological voices. Acta Otolaryngologica (Suppl. 338), 2-24.

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on a New Direction. Cited in C. Moore, K. Yorkston & D. Beukelman (Eds.),

Dysarthia and Apraxia of Speech: Perspective on Management (15-27) Baltimore:

Brookes.

Wilson, F. B. (1987). Voice Disorders. Texas, Austin.

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Judgement of the Severity of Dysphonic Voice. Journal of Voice, Vol. 19 (4), 574-

581. 21.

Dissertation Vol.VII, 2008-09, Part – B, SLP, AIISH, Mysore

34

A preliminary Investigation into the Cognitive Abilities of Persons with

Stuttering using Simon and Stroop Tasks

Amit K & Y.V. Geetha*

Abstract

The study was planned to investigate the cognitive abilities of persons with stuttering using

Simon and Stroop tasks. The main objectives of the study were to compare the performance of PWS

and PWNS 1) to see if there is spatial interference using Simon effect, 2) to see if there is interference

of automaticity on speed of processing in PWS compared to PWNS, 3) To see if there is semantic

interference using Stroop effect in PWS and 4) To see if there is any effect on cognitive loading

(combined Simon and Stroop effect) in PWS compared to PWNS. 15 normal individuals (Control

Group) and 15 individuals with stuttering (Experimental group) in the age range of 18-30 years who

met the specified criteria were taken for study. Both groups of subjects were administered the Simon

and Stroop tasks using the standard protocol. The data was analyzed using Mixed ANOVA which was

computed for within subject factors tasks (3), color conditions (2) and other conditions (3) and

between subject factors. The results showed that there was interaction effects for task * condition,

condition * group, color*condition and task*color. No interaction effects were found for task * group

and color * group. These results indicate that overall RT for the three tasks is different between

groups. Also RT for three conditions, that is control, incongruent and congruent, differed significantly

between groups. Present study showed longer RT in incongruent conditions than congruent

conditions in Stroop task. This indicates some processing delay in incongruent condition. Simon effect

was greater for PWS group only in sb2 condition and all the other color conditions produced either

negative effect or PWS group had lesser Simon effect compared to PWNS group. But Stroop effect

showed no statistically significant difference between groups. The results of the present experiment do

not completely prove or agree with the notion that PWS group might have some deficit in their

cognitive processing with respect to information processing. At the same time the results of this

experiment should be considered with some caution due to its simple method and materials involved.

Introduction

Speech production is a very complex process which requires great amount of

cognitive processes. In the early stage of human development through cognitive ability a

child acquires his/her basic skills for survival. Cognition also helps a child to acquire his

speech and language ability without any delay or deviancy. A child with a cognitive deficit

due to congenital or acquired problems in early stages shows delay or deviant language

development. Speech language processing has been investigated in many communication

disorders. Speech language processing is nothing but a information processing which requires

cognitive components like attention, memory, decision making, etc,.

Stuttering has been viewed as a puzzling disorder by the speech language pathologists

and by many other professionals investigating it due to its unknown cause or complex nature.

_____________________________ * Professor of Speech Language Sciences, All India Institute of Speech and Hearing, Mysore, India


Cognitive Abilities of Persons with Stuttering

35

Over the past six to seven decades stuttering has been investigated for its cause, nature,

therapeutic management by professionals from various disciplines which deal with cognition,

speech-language, behavior, information processing, etc. However, so far none of them could

explain the underlying nature of stuttering.

The findings and theory on cognition and stuttering give us an indication that the

cause does not necessarily lie at the level of peripheral neural level but might lie at a more

central level. Cognition is central for any processing and planning (motor or speech). In order

to understand the language processing, it will be useful to understand some basic processes of

cognition that is information processing. Simon Effect and Stroop Effect are a couple of tasks

evolved to study the cognitive processes involved in language processing.

The Simon Effect refers to the finding that reaction times are usually faster and more

accurate when the stimulus occurs in the same relative location as the response, even if the

stimulus location is irrelevant to the task (Simon 1960). Simon's original explanation for the

effect was that there is an innate tendency to respond towards the source of stimulation.

“Stroop Effect” is named after J. Ridley Stroop who discovered this strange

phenomenon in the 1930‟s. The Stroop Task is a psychological test of mental (attention)

vitality and flexibility. The task takes advantage of our ability to read words more quickly

and automatically than we can name colors. If a word is printed or displayed in a color

different from the color it actually names; for example, if the word "green" is written in blue

ink, we will say the word "green" more readily than we can name the color in which it is

displayed, which in this case is "blue”. The cognitive component involved in this task is

attention that inhibits or stops one‟s response in order to say or do something else.

Only few studies used Stroop task to investigate cognitive ability of PWS

(Subramanian & Yairi 2006; Caruso, Chodzko-Zajko, Bidinger & Sommers, 1994). But

none of the studies used Simon task to investigate the cognitive ability of PWS. The present

study therefore aimed at investigating information processing in PWS using both Simon and

Stroop tasks.

Aims of the study

The aim of the present study is to investigate the information processing ability in

PWS compared to Persons with No Stuttering (PWNS) using Simon and Stroop tasks by

comparing the reaction time under the following conditions: 1) Simon task in both 2 color

and 4 color conditions, 2) Stroop task, 3) RT for combined tasks (Stroop & Simon) and 4) To

compare the performance of both groups (PWS & PWNS).

Method

Subjects

Two groups of subjects were taken in the age range of 18-30 years. The control group

consisted of 15 normal individuals. Participants in the experimental group were taken from

those who registered at AIISH clinic for fluency evaluation and those who were recently

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Chodzko-Zajko%20WJ%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlus

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Bidinger%20DA%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlus

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Sommers%20RK%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlus


36

enrolled for therapy at the clinic. All the participants were native Kannada speakers. The

experimental group consisted of 15 PWS. All the participants were males. A trained speech

language pathologist administered Stuttering Severity Index (SSI) to assess the severity of the

problem.

Selection criteria for experimental group: The subjects fulfilled the following criteria to

be included in the study:

Normal hearing sensitivity

No cognitive deficit

No neurological deficits

No orofacial anomalies

Normal vision or corrected vision

No participation in any of the fluency shaping/modification therapy at least for

one year prior to the experiment

Should be literate (high school) and be able to read English

Control group

15 age matched male PWNS were considered for control group. Selection criteria

were same as for the experimental group except that the control group participants had no

fluency disorder.

Instrumentation

The experiment was carried on a computer with 15” color monitor. The sequence of

events and collection of data was randomized and controlled by using software DMDX (3.0).

Materials

5 cm squared color blocks in red, black, brown, green, blue, yellow and colored words

in Aerial font, font size 14, bold and capital words in the same color as of the blocks were

also used.

Procedure

The standard procedure recommended for testing Simon and Stroop task was

employed as follows (Simon, 1960 & Stroop 1935):

The present experiment consisted of three tasks. Task I was a Simple task which used

colored blocks. Task II was also same as task I but used color words instead of blocks. Task

III involved both Simon task and Stroop task. Participants were made to sit in front of the

monitor on a comfortable arm chair. Care was taken to provide adequate ventilation and light.

Task I: The Task I consisted of four conditions, A) Control 2 condition, B) Experimental 2

condition, C) Control 4 Condition and D) Experimental 4 Condition.

Task II: The Task II was similar to Task I with four conditions but in task II colored written

words were used instead of blocks. This would give us some information on whether word

form makes any difference in RT when compared to blocks


37

Task III: In this task in all the conditions the colors of the words were different from what the

actual written word mean (Stroop task); for example, the word “red” appeared in black color

and the word „black‟ appeared in „red‟ color. The participants were instructed to respond to

the color of the word than the meaning of the actual written word, i.e. if the word „red‟

appears in „black‟ color participants were instructed to press „z‟ key and when they saw a

written „black‟ word which appeared in „red‟ color they were supposed to press „m‟ key. This

experiment is color naming rather than reading the actual word.


Present experiment had total of 23040 (64*12*30) trials. 1518 Trials were deleted

from the analysis because they were error responses or no responses. Remaining data was

considered for further analysis. Mixed ANOVA was computed for within subject factors

tasks (3), color conditions (2) and other conditions (3) and between subject factors. The

following Table 1 shows the mean and SD for both the groups across the three tasks for all

the conditions.

Table 1: Mean and SD for all the conditions of both groups

Tasks Conditions

Group

PWNS PWS

Mean SD Mean SD

Task I

sbcon 2 399.18 25.8 517.35 82.4

sbcong 2 433.21 41.9 516.27 50.6

sbincong 2 439.26 47.1 545.87 61.0

sbcon 4 531.60 74.2 632.52 79.9

sbcong 4 480.98 39.6 640.69 104.6

sbincong 4 490.36 39.5 651.33 107.0

Task II

swcon 2 356.78 27.9 476.30 59.6

swcong 2 390.51 24.2 508.83 61.3

swincong 2 413.91 19.3 534.62 62.1

swcon 4 452.81 34.6 551.04 85.8

swcong 4 456.39 28.3 639.47 73.4

swincong 4 474.85 28.2 617.71 90.0

Task III

smstcon 2 403.96 25.3 506.33 89.1

smstcong 2 400.63 34.3 526.36 74.1

smstincog 2 426.46 27.2 549.22 68.2

smstcon 4 569.71 48.8 662.64 140.9

smstcong 4 570.20 65.6 720.60 111.7

smstincog 4 547.94 51.3 703.52 122.9 (sbcon2- Simon task 2 color condition with bocks; sb2cong- Simon task 2 color condition with bocks congruent

condition; sbincong2 - Simon task 2 color condition with bocks incongruent condition; sbcon4 -Simon task 4

color condition with blocks; sbcong4 -Simon task 4 color condition with bocks congruent condition; sbincong4-

Simon task 4 color condition with bocks incongruent condition; swcon2- Simon task 2 color condition with

written color words; swcong2- Simon task 2 color condition with written color words congruent condition;

swincong2- Simon task 2 color condition with written color words incongruent condition; swcon4- Simon task 4

color condition with written color words; swcong4- Simon task 4 color condition with written color words

congruent condition; swincong4- Simon task 4 color condition with written color words incongruent condition;

smstcon2-Simon and Stroop task 2 color condition; smstcong2-Simon and Stroop task 2 color congruent

condition ; smstincon2-Simon and Stroop task 2 color incongruent condition; smstcon4-Simon and Stroop task 4

color condition; smstcong4-Simon and Stroop task 4 color congruent condition; smstincong4-Simon and Stroop

task 4 color incongruent condition)


38

Mixed model ANOVA was computed for tasks (3), color conditions (2), and different

conditions (3) as within subject factors and group as between subject factor. The Table 2

shows the df, F, sig values for main effects and interaction effects.

Table 2: df, F, and Sig values of tasks, color condition and different conditions (control,

congruent, incongruent) between both groups.

Source df F Sig.

Task 2 34.715 .000*

Task * Group 2 .196 .823

Color 1 189.845 .000*

Color * Group 1 2.338 .137

Cond 2 42.452 .000*

Cond * Group 2 16.290 .000*

Task * Color 2 20.951 .000*

Task * Color * Group 2 .409 .666

Task * Cond 4 9.942 .000*

Task * Cond * Group 4 1.780 .138

Color * Cond 2 6.805 .002*

Color * Cond * Group 2 9.774 .000*

(* p < .00)

Results of mixed model of ANOVA showed main effect for tasks, color and for

conditions (control, congruent and incongruent). Interaction effects for task *condition,

condition*group, color*condition and task*color were found. No interaction effect were

found for task *group and color*group. Also between subject factor showed significant

difference. Boneferroni test was computed to see the pair-wise difference across tasks and

conditions. Results showed a significant difference across all the tasks and conditions (p

<.05). These results indicate that overall RT for the three tasks were different between

groups. Also RT for three conditions, that is control, incongruent and congruent, differed

significantly between groups.

Between group analyses (Task I)

The Figure 1 shows mean and SD for both the groups for task I across control,

congruent, and incongruent conditions of both color conditions between PWS and PWNS.

normal

stg

group

sbcon2 sbcon4 sbcong2 sbcong4 sbincong2 sbincong4

Condition

200.00

300.00

400.00

500.00

600.00

700.00

RT

Figure 1: Mean and SD for different conditions in task I.


39

Independent t test was computed to see the significance of difference between both

the groups across color conditions and different conditions.

The results clearly indicate that PWS group significantly differs from PWNS group in

color naming in task I. That is, the interference effect and RT for different conditions indicate

longer processing time for PWS group.

Considerably more research has been done on manual reaction times, generally by

having the subject press a button with a finger. The results have been conflicting. Borden,

(1983) reported that PWS were slower in the execution of finger counting tasks but not in

their initiation. Cross and Luper, (1983) found that voice and finger reaction times of PWS

were highly correlated but Starkweather, Franklin and Smigo (1984) did not. Wilkins,

Webster and Morgan (1984) and Hurford and Webster (1985) reported that manual reaction

times for PWS were faster after speech therapy than before. Such results shed some light on

the inability of PWS in the execution of movements on demand in complex environments.

Before execution of any movement it has to be programmed and sequenced. Using tasks

which probe planning of movements would reveal the reason for delayed responses.

Working memory cost for task I

The relative effects of increasing the number of possible stimuli from two to four -

referred to here as working memory costs - are assessed by subtracting RTs for two-color

from four-color conditions for the groups (Bialystok, Craik, Klein & Viswanathan, 2004).

That is, RT of control, congruent and incongruent 4-color condition is subtracted from

control, congruent and incongruent 2- color conditions within each task. PWS group showed

more memory cost in congruent and incongruent conditions but failed to show any significant

difference (p > .05). In control condition PWS group showed lesser memory cost than PWNS

group.

Between group analysis ( Task II)

normal

stg

group

swcon2 swcon4 swcong2 swcong4 swincong2 swincong4

Condition

0.00

200.00

400.00

600.00

RT

Figure 2: Mean and SD of different conditions in task II of PWS and PWNS

The Figure 2 shows mean and SD for both the groups for task II across different

conditions. From Figure 2 it is clear that PWS showed longer RT in all the conditions

compared to PWNS. 4-color conditions showed longer RT compared to 2-color condition.

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40

This indicates that as the complexity increased RT also increased for both groups.

Independent t test was computed to see the significance of the difference between both the

groups across color conditions and different conditions (control, congruent and incongruent).

Table 3: t, df, sig value of between group comparison

Conditions t df Sig

swcon2 -7.025 28 .000

swcong2 -6.943 28 .000

swincong2 -7.176 28 .000

swcon4 -4.108 28 .000

swcong4 -9.004 28 .000

swincong4 -5.863 28 .000

From the Table 3, showing the t values, df and p values for different conditions of

task II and Figure 2, it is clear that PWS group showed significantly longer RT (p <.05) when

compared to PWNS group across all the conditions in task II. Though the task II used

linguistic stimuli instead of blocks, the results showed a similar trend as in task I. Providing a

linguistic stimuli would involve linguistic processing as well with the spatial interference.

Both the groups performed similarly where the incongruent condition showed longer RT

compared to congruent and control condition. It was expected that involvement of linguistic

component would slower the processing ability of PWS compared to PWNS but such an

effect was not found in task II. It was hypothesized by many researchers that PWS group is

slower in their language processing than their normal peers (Kent, 1984; Postma & Kolk

1993; Conture 2001).

Memory cost for task II

normal

stg

group

smstcon2 smstcon4 smstcong2 smstcong4 smstincog2 smstincog4

Conditions

200.00

300.00

400.00

500.00

600.00

700.00

800.00

RT

Figure 3: Mean & SD of different conditions in task III

PWS group showed more memory cost for congruent and incongruent conditions than

control condition, wherein PWS group showed lesser memory cost than PWNS group. Only

congruent condition showed statistically significant difference between group (p <.05).


41

Between group analysis (Task III)

The Figure 3 indicates that PWS group showed longer RT in all the conditions

compared to PWNS, 4- color conditions showed longer RT compared to 2- color condition.

This indicates that as the complexity increased RT also increased for both groups. The results

showed some interesting findings. 2-Color condition showed shorter RT compared to 4 color

condition in both the groups as expected. But as far as the control, congruent and incongruent

conditions are concerned it failed to show a significant difference between groups. Also in 4-

color condition, incongruent condition showed shorter RT compared to congruent condition

in both the groups. It could be due to learning effect. Results showed a significant difference

across all the conditions between groups. As the complexity increased RT also increased in

both the groups. PWS and PWNS group showed longer RT in task III compared to task I and

II.

Memory cost for task III

PWS group showed more memory cost in congruent and incongruent conditions than

PWNS group. This indicates memory requirement is more in PWS group than PWNS group.

But the difference between both groups failed to show significance in all the conditions.

Simon Effect

Simon effect shows the difference between incongruent and incongruent conditions.

The difference between RTs to congruent and incongruent stimuli (the Simon effect) reflects

the efficiency of inhibitory processes. That is, the participants‟ task is to press the key

associated with the stimulus color regardless of spatial position; therefore, smaller Simon

effects reflect less inhibition cost and more efficient inhibitory processes. More Simon effect

indicates that the participant showed longer RT in incongruent than congruent condition. The

Table 4 shows mean and SD for Simon effects across three tasks.

Table 4: Mean and SD of Simon effect between both groups.

Simon effect PWNS PWS

Mean SD Mean SD

sb2eff 6.04 21.05 29.60 30.48

sb4eff 9.37 20.37 10.64 33.74

sw2eff 23.40 24.18 25.79 33.03

sw4eff 18.45 10.25 -21.76 36.91

com2eff 25.83 31.828 22.86 32.78

comb4eff -22.26 36.82 -17.08 37.91


42

normal

stg

group

sb2eff sb4eff sw2eff sw4eff com2eff comb4eff

Effects

-50.00

-25.00

0.00

25.00

50.00

Sim

on

Eff

ect

(ms

)

Figure 4: Mean and SD for Simon effects

(Sb2eff- S Simon block 2 color condition effect; sb4eff Simon block 4 color condition effect; sw2eff- Simon

word 2 color condition effect; sw4eff- Simon word 4 color condition effect; com2eff- combined 2 color

condition effect (SMST); comb4eff- combined 4 color condition effect)

Figure 4 shows mean and SD of Simon effect for all the three tasks across color

conditions for both the groups. A negative Simon effect was found for combined Simon and

Stroop 4 color condition (comb 4 eff) in both the groups. Independent „t‟ test was computed

to see the significant difference between groups for Simon effects. It revealed equivocal

results. Simon effect was greater for PWS group only in sb2 condition and all the other color

conditions produced either negative effect or PWS group had lesser Simon effect compared

to PWNS group.

The Table 5 shows the t values, df, and p values for Simon effect between groups.

Results in the table shows that there is significant difference in the Simon effect in block 2-

color condition that is task I and Simon effect in word 4-color condition that is task II and

other conditions failed to show statistically significant difference. This indicates that PWS

group had longer RT (M=29.60) than PWNS (M= 6.0493). But in sw4 condition PWNS

showed negative effect (M = -21.76) than PWNS group (M= 18.45). Also, in task III

combined effect was negative for both the groups.

Table 5: t, df, sig values for Simon effects across task and color condition between groups.

Effect t df Sig

Sb2eff -2.462 28 .020

Sb4eff -.124 28 .902

Sw2eff -.226 28 .823

Sw4eff 4.066 28 .000

comb2eff .252 28 .803

Comb44eff -.379 28 .707

In the experiment task I was presented first followed by task II and finally task III was

presented. This could have led to the learning process in both the groups. Results clearly

indicate that in task I Simon effect for both color conditions were significantly different

between groups. And as the tasks progressed the effects started to diminish.


43

Increased RT shows some deficit in information processing at the level of response

selection stage. Since no other studies have been carried out with respect to Simon task and

stuttering, the results of this investigation could not be compared. Though the PWS group

showed increased RT across all the tasks, the Simon effect failed to show such a significant

difference across tasks and color condition. Results revealed significant difference in Simon

effect only in sb2 t(28) = -2.462, P = .020) and sw4 t(28) = 4.066, P = .000) condition. Sb2

Simon effect clearly shows a greater Simon effect in PWS (M = 29 ms) compared to PWNS

(M = 6 ms). This indicates that PWS group showed reduced ability to inhibit the spatial

interference effect in selecting the target response. In sb4 and sw2 Simon effect PWS (m = 9,

23 respectively) group showed slightly higher Simon effect but not statistically significant

difference compared to PWNS (M = 10, 25). Interestingly, in task III which probed combined

effect of Simon and Stroop task showed negative effects in both the groups in 4 color

condition. It was expected that combining both Simon and Stroop tasks would maximize the

cognitive loading thus producing greater effect and increased RT. RT of combined task

seemed to be higher when compared to task I and task II in PWS and PWNS, indicating

increased processing time. But Simon effect failed to produce any significant difference

between groups, also showed a negative effect. This can be attributed to learning effect.

In within group comparison, PWNS group showed increased Simon effect across

tasks. That is task I showed lesser Simon effect compared to task II, and task III showed

increased Simon effect than task I and task II. Such a trend was not found in PWS. This could

be an indication that PWS group somehow differ from PWNS group in processing of

information. Another important factor could be that individual variability. Inter subject

variability could have masked the results.

Stroop Effect

The Figure 5 shows mean and SD of Stroop effect for different color conditions of

both the groups. The Figure 5 shows that there is increased RTs for PWS in both Stroop 2-

color condition and as well as Stroop 4-color condition than PWNS.

normal

stg

group

stroo2 stroo4

Category

0.00

100.00

200.00

Stro

op E

ffect

(ms)

Figure 5: Mean and SD for Stroop effect for both color condition.

Independent „t‟ test was computed to see the significant difference between groups for

Stroop effects. Results indicate that there is no statistically significant difference for both

Stroop 2 and Stroop 4 between groups. But PWNS group showed more Stroop effect than

PWS group in both color conditions.


44

As far as the Stroop effect is concerned there was no statistically significant

difference were found between both the groups. Results also indicated that PWS showed

lesser Stroop effect compared to PWNS group. However, Stroop effect was more in 4 color

condition compared to 2 color condition in PWNS ( M = 47, 116 ms respectively) and PWS

(M = 30, 111 ms respectively). Increased Stroop effect shows increased processing time for

both groups. This result should be noted with some caution due to simplicity of method and

color combinations. Also, variability between subjects would have masked the results. SD in

Stroop-2 color condition in PWNS was 50ms and in PWS group it was 61 ms and in Stroop

4-color condition, PWNS showed SD of 43 ms and PWS group showed 78 ms.

Subramaniyan and Yairi (2006) reported better performance by PWS group compared

to normal and high risk group. Results of their study (Subramanian & Yairi, 2006) indicated

that reaction time was greater for conflict condition, that is, when the „blue‟ word is seen in

„green‟ color. Unexpectedly, the PWS group had shorter RTs when compared to its control

group and the high risk group. Specifically, in the conflict condition, the PWS group

exhibited shortest RTs. When the ratios of the conflict-to-congruent reaction time were

calculated, the PWS group yielded a ratio of 1.16; it was 1.14 for the high risk group. The

ratios for the control groups were 1.22 and 1.26 respectively. Thus, the conflict condition did

not affect the reaction time for the experimental groups to the extent it did for the control

group. Accuracy values were 100% for all groups in the congruent condition. In fact accuracy

was high for all groups in all other conditions although still lowest for the conflict condition.

Based on these results investigators speculated that when placed under external interferences,

people who stutter may use different speech motor control (including stages of processing,

planning and production) strategies that result in lower reaction time for this group.

Present study showed longer RT in incongruent conditions than congruent conditions

in Stroop task. This indicates some processing delay in incongruent condition. But Stroop

effect showed no statistically significant difference between groups. But the procedure,

method, stimuli were entirely different between these two studies. It is not clear whether to

accept or reject the notion that cognitive ability may be deficient in PWS group. Further

studies are warranted in the same line which utilizes more complex Stroop tasks like semantic

variation, priming on a larger population for this.


In summary, findings from task which used blocks to probe Simon effect showed

increased RT for PWS compared to PWNS in 2 and 4 color conditions across control,

congruent and incongruent conditions. However Simon effect showed a significant difference

in 2-color condition where PWS group showed more Simon effect. This indicates some

deficits in inhibitory processes in PWS. But 4-coor condition failed to show such a difference

between groups, also the effect was reduced in PWS. Memory cost indicated that PWS

showed more memory cost compared to PWNS in congruent and incongruent conditions.

This indicates more processing time required by PWS group compared to PWNS. In task II

which used colored words instead of color blocks, PWS showed longer RT compared to

PWNS in 2 and 4-coor conditions across control, congruent and incongruent conditions.

Simon effect showed a scattered result, that is, in 2-color condition PWS showed slightly


45

more Simon effect but a negative effect in 4-color condition. Memory cost in task II also

showed a similar result as task I. PWS showed more memory cost in congruent and

incongruent conditions compared to PWNS. The results of the present study converge to

indicate an inconclusive evidence to prove any inadequacy of cognitive processes in PWS

group or failed to show any difference in terms of their inhibitory processes.

Stroop effect

Task III probed Stroop effect using colored words. Though there was a difference

between the two groups in Stroop effect, that is, PWS group showed more Stroop effect

compared to PWNS in 2 and 4-color conditions, it was non-significant. This indicates some

deficit in inhibiting interference caused by automaticity that is word reading in PWS

compared to PWNS.

Task III which probed the combined effect of Simon and Stroop showed longer RT in

PWS compared to PWNS in 2 and 4-color condition across control, congruent and

incongruent conditions. In 2-color condition PWS showed marginally less effect than PWNS

and in 4-four color condition both groups showed a negative effect. This negative effect may

be due to learning effect. In task III memory cost effect failed to show any significant

difference between both groups in all conditions. But PWS showed more memory cost effect

in congruent and incongruent conditions than PWNS.

To conclude, the results of the present experiment do not completely prove or agree

with the notion that PWS group might have some deficit in their cognitive processing with

respect to information processing. At the same time the results of this experiment should be

considered with some caution due to its simple method and materials involved. With the

current knowledge and experimental methodology it is not possible to say that PWS group

does not exhibit any cognitive deficits.

References

Bialystok, E., Craik, F.I., Klein, R. & Viswanathan, M. (2004). Bilingualism, aging,

cognitive control: Evidence from the Simon task. Psychol. Aging. 2004 June; 19(2):

290-303.

Borden, G. J. (1983). Initiation versus execution time during manual and oral counting by

stutterers. Journal of Speech and Hearing Research, 26, 289-296.

Caruso, A. J,, Chodzko-Zajko, W.J., Bidinger, D.A. & Sommers, R.K. (1994). Adults who

stutter: responses to cognitive stress. Journal of Speech and Hearing Research. 37(4),

746-54.

Cross, D. E. & Luper, H. L. (1983). Relation between finger reaction time and voice reaction

time in stuttering and nonstuttering children and adults. Journal of Speech and

Hearing Research, 26, 356-361.

Hurford, D. P. & Webster, H. I. (1985). Decrease in simple reaction time as a function of

stutterers‟ participation in a behavioral therapy. Journal of Fluency Disorders, 10,

301-310.


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46

Postma, A. & Kolk, H. H. J. (1993). The covert repair Hypothesis: Pre-articulatory repair

processes in normal and stuttered disfluencies. Journal of Speech and Hearing

Research, 36, 472-87.

Subramanian, A. & Yairi, E. (2006). Identification of traits associated with stuttering. Journal

of Communication Disorders. 39 (3), 200-16.

Starkweather, C., Franklin, S. & Smigo, T. (1984). Vocal and finger reaction time stutterers

and nonstutterers: Differences and correlations. Journal of Speech and Hearing

Research, 27, 193-196.

Simon, J. R. (1969). Reaction toward the source of stimulation. Journal of Experimental

Psychology, 81, 174-176.

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Norms for Vital Capacity in Adults

47

Norms for Forced & Slow Vital Capacity in Adult Dravidian Population

Annapurna S B & N Sreedevi*

Abstract

The present study established norms for some of the air volume measurements using a dry

Spirometer in the Dravidian population. 120 healthy adults in the age range of 20-40years who were

natives of south India (Dravidians) participated in the study. Subjects were sub divided into two

groups’ i.e 20-30 years and 30-40 years. Each group comprised of 30 males and females. Spirometer

Helios 501 (RMS) was used for the study. The results indicated that there is no significant difference

between the two age groups for all the parameters considered in both males and females. When

compared across postures, the results indicated that respiratory measures are significantly higher in

standing posture than in sitting posture. It was also found that FVC and FEV1 are more sensitive

parameters in indicating the significant differences across gender and posture. The obtained norms

can be used as reference standard for estimation of lung volume among subjects with voice disorders,

chronic obstructive pulmonary disease like asthma etc.

Key words: Air volume, Dravidian, FVC, FEV1, Respiratory measures.

Introduction

The act of inhaling and exhaling air in order to exchange oxygen for carbon-dioxide is

called respiration. Apart from the primary aim of sustain life, it is the source for the speech

production. Pulmonary measures like lung volumes and lung capacities are useful to

understand the working of respiratory system. Both lung volumes and lung capacities are

responsible for breathing for life and breathing for speech. Hence respiration serves both a

life sustaining function and a speech production function. Any abnormality in respiration

involves in coordination of breathing patterns for speech production.

The respiratory features important for speech production are pressure, volume, flow

and chest wall shape. Pressure refers to the forces generated by the respiratory process.

Volume refers to the amount of air in the lungs and airways. Flow refers to the measure of

volume of air moving in a certain direction over a period of time. Chest wall shape refers to

the positioning of the chest wall (ribcage, diaphragm and abdominal muscles) for speech

breathing act.

The steady outflow of air causes vibration in the vocal folds to produce voice by the

modification of the vocal tract. It has been found that during speech the abdomen is smaller

and the rib cage is larger than in their respective relaxation positions. This positioning is

efficient for speech, because when the abdominal wall moves inward it pushes the diaphragm

upward and expands the lower rib cage. This allows the diaphragm to make quick, strong

_______________________________ * Lecturer in Speech Sciences, All India Institute of Speech and Hearing, Mysore, India



48

contractions, which facilitates the quick inspirations and the constantly changing pressures

needed for speech (Hixon et al., 1973). Basically, there are four changes that occur when we

switch from breathing for life to breathing for speech: the location of air intake, the ratio of

time for inhalation versus exhalation, the volume of air inhaled per cycle and the muscle

activity for exhalation.

CHANGE LIFE SPEECH

Location of air intake

Ratio of time for

inhalation versus

exhalation

Volume of air

Muscle activity for

exhalation.

Nose

Inhale: 40%

Exhale: 60%

500 cc

10%VC

Passive: Muscles of

thorax and diaphragm

relax

Mouth

Inhale: 10%

Exhale: 90%

Variable, depending on length and

loudness of utterance, 20 to 25% VC

Active: thoracic and abdominal

muscles contract to control recoil of

ribcage and diaphragm.

The Speech Language Pathologist needs to focus on respiration as it relates to speech

production and also there is a need to evaluate the respiratory system as a part of voice

evaluation. Studies in the physiopathology of the lungs are aimed primarily at the

investigation of so called functional weakness of the respiratory organ. In the assessment of

pulmonary functions spirometry is commonly used. Spirometers are useful in determining

volumes such as vital capacity and tidal volume. Vital capacity is used as an index of lung

capacity for speech and voice functions. A person does not use the entire vital capacity in

functional, quite respiration or for speech. Thus a small percentage of total vital capacity is

used in quite breathing. In normal healthy persons, the volume of air in the lungs primarily

depend on body size and build however the body position also influences the pulmonary

measures. It has been found that most of the volumes and capacities decrease when a person

is lying down rather than standing.

Kent (1994) compiled norms for many aspects of respiration including standards of

measurement, appropriate instrumentation, capacities and respiration rates by age and gender,

physiological requirements for speech production, body size factors related to respiration,

flow volume relationships and effects of smoking on the respiratory tract. He reported that

between 25% and 40% of vital capacity is used in speech by typical adults.

The pulmonary measures are influenced by a number of factors particularly height,

age, usual habitat, geographical condition and ethnic and racial origin. In different parts of

the world several investigators have investigated the different lung function measurements

and established the normal standards (Cotes and Ward, 1966; Da Costa, 1971, Sider and

Peters 1973). In a comparative study of lung function among the American, European,

Jordanian, Negro and the Pakistani subjects, it was found that the former three groups were

superior to the remaining groups. The vital capacity varies with age, sex, height, weight, body


49

surface area, body build and other factors (Zemlin, 1981). Hutchinson (1979) had explained

the relationship between lung capacity and body size and weight.

In the Indian context, such studies were carried out for the north-west region (Jain &

Ramaiah, 1969; Mathew, 1984; Verma, 1983) and southern geographical region (Kamat et

al., 1982; Reddy and Shastry, 1944). These studies observed that the Spirometric functions

varied between these two populations. Chatterjee (1988) reported that the Spirometric

functions of Eastern region Indians are comparable to north-west Indians and superior to

southern Indians. Vital capacity can be predicted on height and weight and there is no

significant difference between the vital capacities and mean flow rates for both males and

females (Krishna Murthy, 1986). Sudhir Banu (1987) found significant differences in mean

airflow rates in dysphonics. It has been found that mean vital capacity values in Indians were

significantly lower than the western subjects (Battacharya, 1963).

It is a well established fact that respiratory measures vary across geographical

locations. There are no established norms for the respiratory measures in the Dravidian

population. Hence the present study is taken up to establish norms for some of the air volume

measurements using a dry Spirometer in the Dravidian population.

Method

120 healthy adults in the age range of 20-40years who were natives of south India

(Dravidians) were selected for the study. Subjects were sub divided into two groups i.e 20-

30years and 30-40years. Each group comprised of 30 males and females.

The subjects were selected based on the following criteria

1. Should be of Dravidian origin

2. Should be free from any history of respiratory, circulatory and neuromuscular

diseases

3. Should be non-smokers and non- alcoholics (heavy)

4. There should be no history of any serious illness and syndromatic conditions

5. Should be free from any obesity related problems

The instrument used in the study was Spirometer Helios 501 (RMS). Helios 501 is a

portable handheld monitoring spirometer.

The following measures were deduced from the study:

FVC (Forced Vital Capacity): This is the total amount of air that can forcibly be blown

out after full inspiration, measured in liters.

FEV1 (Forced Expiratory Volume in 1 Second): This is the amount of air that can be

forcibly blow out in one second, measured in liters.

FEV1 / FVC (FEV %): This is the ratio of FEV 1 to FVC. In healthy adults this should

be approximately 75 - 80%. FEV1/FVC is the FEV1 expressed as a percentage of the

FVC.


50

Slow Vital Capacity (SVC): Is the maximum volume of air which can be exhaled or

inspired in a slow/steady maneuver in liters.

TV (Tidal Volume): During each respiratory cycle, a specific volume of air is drawn into

and then expired out of the lungs. This volume is tidal volume.

Subject’s height and weight were recorded before the testing. Body Mass Index needs

to be calculated for ruling out obesity. For calculating body mass index the individual's body

weight is divided by the square of their height using the following formula (WHO, ’95,

2004).

BMI= Weight (Kg)/Height ² (m²)

The subjects were considered for the study only when the BMI score was within the

normal range. Each subject is tested individually at a time and was instructed about the test

procedures. The test begins with a model given by the researcher. Before starting the test,

mouth tubes were cleaned and sterilized properly.

Procedure for obtaining FVC (Forced Vital Capacity)

The subject is instructed to begin with a relaxed breathing, then to take a deep breath

in and to immediately blow air out as hard and fast as possible into the mouth piece until no

more air can be exhaled and then the subject should take another deep breath back in, with

the mouthpiece still in the mouth, until the lungs are full. Ask the subject to do this activity

when on the start button is clicked. The same task is repeated thrice each in both sitting and

standing postures for every subject. The best maneuver out of the 3 trials is selected by the

instrument as well as through visual examination and was considered for further analysis.

Procedure for obtaining SVC (Slow Vital Capacity)

The subject is instructed to begin with relaxed breathing through the mouth piece for

two to three cycles and then to take a deep breath followed by a deep exhalation. Both

inhalation and exhalation should be performed to the maximum extent but slowly and

following this the subject should take a few gentle and normal breaths. The subject is asked

to do this activity when the start button is clicked. From the results displayed on the screen,

values for SVC and tidal volume were noted for further analysis.


The purpose of the present study was to develop normative values for the respiratory

measures using a Spirometer. The parameters considered were forced vital capacity, slow

vital capacity and some of their related parameters in sitting and standing postures. A total

number of 120 healthy adult subjects in the age range of 20-40 years were studied. They were

divided into 2 age groups i.e. 20-30 years and 30-40 years with 30 males and females in each

group. Data obtained were analyzed using descriptive and inferential statistical procedures.

SPSS (Ver 16 & Ver 10) were used for the statistical analysis. Using Descriptive statistics

group means and standard deviations for each measure was obtained and are depicted in

Tables 1 and 2.


51

Table 1: Shows the Mean & SD of the respiratory measures for males. M

easu

res

Males

20-30 years 30-40 years

Sitting Standing Sitting Standing

Mean(SD) Range Mean

(SD)

Range Mean(SD) Range Mean

(SD)

Range

FVC 3.71(.27) 2.85-

4.07

3.78

(.33)

2.50-

4.18

3.81(.27) 1.12-

4.17

3.89(.28) 2.85-4.32

FEV1 3.39 (.38) 2.67-

3.98

3.48

(.39)

2.69-

4.05

3.78(.25) 2.85-

4.04

3.85(.21) 3.20-4.12

FEV1/

FVC

(%)

98.69

(1.98)

94.20-

100

99.32

(1.27)

94.65-

100

98.69

(2.10)

92.45-

100

99.22

(1.35)

95.60-100

SVC 3.5(0.39) 2.68-

4.37

3.61(.41) 2.77-

4.55

3.75(.14) 3.46-

3.98

3.82

(0.15)

3.50-4.11

TV 1.43(.61) 0.38-

2.38

0.57(.56) 0.40-

2.40

2.56(.63) 0.16-

2.57

1.71(0.56) 0.65-2.70

On observation of Table 1, it is evident that all the respiratory measures considered in

this study were higher in the older age group of 30-40 years compared to the younger group

of 20-30 years in men in both sitting and standing postures. The standard deviation was not

much different in the two groups. The distribution of tidal volume was scattered compared to

the other parameters in both the postures.

Table 2: Shows the Mean & SD of the respiratory measures for females.

Mea

sure

s

Females

20-30 years 30-40 years

Sitting Standing Sitting Standing

Mean(SD) Range Mean(SD) Range Mean(SD) Range Mean(SD) Range

FVC 2.38(.37) 1.76-

3.37

2.47(.35) 1.98-

3.20

2.29(.16) 2.05-

2.61

2.43(.21) 2.14-

2.90

FEV1 2.26(.37) 1.76-

3.22

2.41(.34) 1.98-

3.31

2.67(.35) 1.86-

3.22

2.76(.35) 1.98-

3.31

FEV1/

FVC

(%)

99.63

(1.02)

94.57-

100

99.93

(.66)

96.35-

100

99.69

(1.71)

94.57-

100

99.87

(.66)

96.35-

100

SVC 2.51(.41) 1.76-

3.80

2.50(.59) 0.65-

3.33

2.45(.24) 2.10-

2.90

2.52(.23) 2.18-

2.99

TV 0.99(.33) 0.70-

1.85

1.12(.38) 0.12-

2.00

0.64(.34) 0.70-

1.27

0.77(.41) 0.12-

2.00

In female subjects, considering the mean values, all the parameters had higher values

in the younger group of subjects of 20-30years compared to the older group of 30-40 years in

the sitting posture. However, in the standing posture, FEV1 and SVC were higher in the older

group of women compared to the younger group. In general, the standard deviation of the

respiratory measures was higher in females compared to their male counterparts. The

normative values obtained in the two age groups of males and females are presented in

Appendix 1.


52

Initially two way MANOVA was carried out to ensure the main effect of age, gender

and interaction between age and gender within each measure in sitting and standing postures.

Gender effect was significant in all the measures at 0.05 level of significance. Age was also

significant in FEV1 in both postures at 0.05 level of significance. There was significant

interaction between age and gender in SVC & TV in both postures. Since there is interaction

between age and gender further analysis was carried out separately for age groups and

gender.

Comparison across age

For comparison across age, Independent t test was used. Comparing males across the

two age groups, it was found that FEV1 and SVC are significantly higher in the 30-40 years

group compared to the 20-30 years group in both sitting and standing postures at 0.01 level of

significance (Graphs 1 & 3). Comparing females across the two age groups, it was found that

FEV1 and TV are significantly higher in the 20-30 years group compared to the 30-40 years

group in both the postures at 0.01 level of significance (Graphs 2 & 4).

As evident from the statistical analysis, there is no major difference between the two

age groups for all the parameters considered in both males and females as there may not be

significant changes in the chest volume over a span of just 10 years as considered in this

study. Another possible reason is that FVC and FEV1 are relatively less sensitive than

maximal mid expiratory flow (MMF) which is found to be a more sensitive test of subtle,

asymptomatic changes in pulmonary function (Williams, Miller and Taylor , 1978). This

finding is also in accordance to Ayub, Zaidi and Burki (1987), who reported that in Pakistani

men and women, effects of age on FVC and FEV1 were found to be minimal and they state

that only after the 4th

decade significant changes are expected. In the present study all the

subjects were with in 40 years of age.

Comparison across gender

Using independent t test, it was found that all the measures were significantly higher

in males compared to females in both the age groups of 20-30 years and 30-40 years at 0.01

level of significance. This finding is supported by Ali Baig and Qureshi (2007) who reported

that mean FVC and FEV1 were found to be higher in males than in the females at all ages.

Comparison across postures (standing vs sitting)

Using paired t test, in males it was found that all the measures were significantly

different across sitting and standing postures in both the age groups at 0.01 level of

significance (Table 3). Only tidal volume was found to be significantly higher in the sitting

posture all the other measures were higher in the standing posture.

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Table 3: Shows the comparison of measures in sitting Vs standing posture in males.

Measures

Males

20-30 years (N=30) 30-40 years (N=30)

Sitting Vs Standing Sitting Vs Standing

“t” value “t” value

FVC 3.56 * 9.14 *

FEV1 4.31 * 6.04 *

(%) 2.89 * 3.18 *

SVC 4.16 * 9.08 *

TV 3.49 * 5.79 *

* indicates significant difference p<0.01

On the same lines, using paired t test, it was found that all the measures except

FEV1/FVC were significantly higher in standing than in sitting posture among females in the

30-40 years group at 0.01 level of significance. Similarly it was found that all the measures

except FEV1/FVC and SVC were significantly higher in the standing posture than in sitting

posture for females in the 20-30 years group at 0.01 level of significance (Graphs 2 & 4).

The t values obtained are shown in Table 4.

Table 4: Shows the comparison of measures in sitting Vs standing posture in females.

* indicates significantly higher in standing posture (p<0.01).

Measures Females

20-30 years

(N=30)

30-40 years

(N=30)

Sitting Vs Standing Sitting Vs Standing

“t” value “t” value

FVC 2.64 * 5.67 *

FEV1 4.70 * 9.42 *

FEV1/FVC(%) - -

SVC - 8.00 *

TV 2.83 * 2.59 *

Hence, in both males and females most of the respiratory measures were significantly

higher in standing posture than in sitting posture. This can be explained on the basis that the

subjects take slightly larger inspirations in this posture than in the sitting position (Townsend,

1984). This finding is supported by Hixon, Goldman and Mead (1973) who investigated the

effects of various body positions on respiratory behavior during oral reading. They found

lung capacities are maximum in the upright position compared to other postures. In the

upright position, gravity acts in an expiratory direction on the ribcage and in an inspiratory

direction on the abdomen. The effect is mainly on the abdomen, being greater at low than at

high lung volumes because the height of the abdomen is greater and its walls less stiff in the

standing posture (Agostoni and Mead, 1964).


54

Respiratory Parameters

TVSVCFEVFVC

Mea

n V

alu

es (

litr

es)

- S

itti

ng

- M

ale

s

4.0

3.5

3.0

2.5

2.0

1.5

1.0

.5

0.0

Age Groups

20-30 yrs.

30-40 yrs.

Figure 1: Shows mean values for males across age group in sitting position.


TVSVCFEVFVC

Mea

n V

alu

es (

litr

es)

- S

itti

ng

- F

emal

es

4.0

3.5

3.0

2.5

2.0

1.5

1.0

.5

0.0

Age Groups

20-30 yrs.

30-40 yrs.

Figure 2: Shows mean values for females across age group in sitting position.


TVSVCFEVFVC

Mea

n V

alue

s (lit

res)

- St

andi

ng -

Mal

es

4.0

3.5

3.0

2.5

2.0

1.5

1.0

.5

0.0

Age Groups

20-30 yrs.

30-40 yrs.

Figure 3: Shows mean values for males across age group in standing position.


55


TVSVCFEVFVC

Mea

n V

alu

es (

litr

es)

- S

tan

din

g -

Fem

ale

s

4.0

3.5

3.0

2.5

2.0

1.5

1.0

.5

0.0

Age Groups

20-30 yrs.

30-40 yrs.

Figure 4: Shows mean values for females across age group in standing position.

As observed in the present study, Lalloo, Becklake and Goldsmith (1991) found that

on average all the Spirometric indices examined, except the peak expiratory flow rate

(PEFR), were higher in the standing position compared to the sitting position although the

change was only significant at the 5% level for FEV1 in women. Also, Townsend (1984)

reported that the forced expiratory volumes in one and in six seconds and forced vital

capacity were significantly larger in the standing than in the sitting posture.

Some of the literature reports on respiratory measures are predicted on height and

weight. Hence, looking at the data obtained in the present study, it was felt that normative

values could be determined for the respiratory measures considered in this study based on

height, weight and body mass index measures. And as the results indicated that most of the

respiratory measures obtained in the standing posture are significantly higher than in the

sitting posture, for comparisons based on height, weight and BMI, sitting posture

measurements are not considered and only standing posture measures were considered.

Height: Based on height, 120 subjects in the study were grouped into 3 groups, i.e. 150-

160cms (Group 1), 160-170 cms (Group 2) and 170-180 cms (Group 3). Groups 1, 2 and 3

consisted of 24, 32 and 64 subjects respectively including both males and females. Among

the 3 groups, the range of height varied between 153 to 182 cms. The mean and standard

deviation for the parameters with respect to height are presented in Table 5. As the 3 groups

based on height did not have equal representation or rather unequal distribution of males and

females, post hoc test was used to determine the significant difference in the respiratory

measures across groups as a whole. And therefore gender difference was not considered

based on height.

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Table 5: Shows the Mean and SD of the respiratory measures based on height.

Measures 150-160cms

(N=24)

160-170cms

(N=32)

170-180cms

(N=64)

Mean (SD) Mean (SD) Mean (SD)

FVC 2.43 (0.27) 2.49 (0.31) 3.74* (0.48)

FEV1 2.47 (0.39) 2.67 (0.38) 3.60* (0.44)

FEV1/FVC(%) 99.98* (0.09) 99.95 (0.27) 99.26 (1.32)

SVC 2.44 (0.51) 2.53 (0.40) 3.66* (0.39)

TV 1.04 (0.44) 0.88 (0.41) 1.60* (0.59)

* Indicates that measures are significantly higher compared to the other groups (p<0.01)

Post Hoc analysis was used to determine the significant difference for the respiratory

measures across the 3 groups. It was found that all the measures except FEV1/FVC were

significantly higher in the 170-180 cms group (Group 3) compared to the other two groups.

And FEV1/FVC was found to be significantly higher in 150-160 cms group (Group 1)

compared to the other two groups. Groups 1 and 2 were combined as a single group (150-170

cms) as there was no significant difference for most of the parameters across these groups.

So, two groups were made based on height. In general, the tallest group had significantly

higher respiratory measures. Similarly Virani, Shah & Celly (2001) have reported that in both

men and women height showed significant correlations in all the measures except FEV1.

Weight: Based on weight, the subjects were grouped into 5 groups i.e. <50kgs (Group 1), 50-

60kgs (Group 2), 60-70kgs (Group 3), 70-80kgs (Group 4), 80-90kgs (Group 5). The Mean

and Standard deviation are shown in Table 6. Groups 1, 2, 3, 4 and 5 consisted of 8, 37, 21,

49 and 5 subjects respectively. Among the 5 Groups, the weight range varied between 45kgs-

83kgs.

Table 6: Shows the Mean and SD of the respiratory measures based on weight.

Using Mann-Whitney test, comparisons were made across the groups based on weight

for obtaining the significant difference (Table 7). It was found that almost all the measures

were significantly higher in Groups 4 and 5 compared to the other three groups. Therefore the

first three groups were combined as a single group i.e. <50 – 70 Kg and Groups 3 and 4 are

combined as a single group i.e. 70-90 Kg. Hence there are two groups based on weight for

determining the normative values.

Measures < 50kgs

(N=8)

50-60kgs

(N=37)

60-70kgs

(N=21)

70-80kgs

(N=49)

80-90kgs

(N=5)

Mean

(SD)

Mean

(SD)

Mean

(SD)

Mean

(SD)

Mean

(SD)

FVC 2.37 (0.25) 2.52 (0.43) 2.79 (0.61) 3.81 (0.37) 3.91 (0.15)

FEV1 2.37 (0.35) 2.71 (0.46) 2.70 (0.45) 3.67 (0.38) 3.80 (0.23)

FEV1/FVC(%) 1.00 (.00) 99.94 (0.26) 99.97 (0.10) 99.13 (1.44) 99.30 (1.06)

SVC 2.49 (0.79) 2.59 (0.48) 2.82 (0.66) 3.67 (0.38) 3.84 (0.21)

TV 1.11 (0.55) 0.92 (0.46) 1.14 (0.48) 1.67 (0.59) 1.33 (0.50)

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Table 7: Shows the measures which are significantly different between the groups

Weight < 50kgs 50-60kgs 60-70kgs 70-

80kgs

80-

90kgs

< 50kgs -- -- -- -- --

50-60kgs NS -- -- -- --

60-70kgs NS NS -- -- --

70-80kgs FVC,

FEV1

FVC,FEV1,

FEV1/FVC,SVC,TV

FVC,FEV1,

FEV1/FVC,SVC,TV

-- --

80-90kgs FVC,

FEV1,

SVC

FVC,FEV1,

FEV1/FVC,SVC

FVC, FEV1, SVC NS --

(p<0.01) NS: Not significant.

As seen in height, subjects with more weight showed higher respiratory capacities.

However, this observation needs to be viewed cautiously as all the subjects in the present

study were with in normal limits of BMI. So it is erroneous to state that people with greater

height and weight will always have higher respiratory capacities.

Body Mass Index: Based on body mass index, the subjects were grouped into 3 groups i.e.

18-20 (Group 1), 21-23 (Group 2) and 24-25 (Group 3). Groups 1, 2 and 3 consisted of 29, 61

and 30 subjects respectively. The normal range of body mass index varied between 18-25

(WHO,’95, 2004) and therefore only those subjects within this range were considered for the

study. Mean and standard deviation of BMI obtained are presented for each group in Table 8.

Table 8: Shows the Mean and SD of the respiratory measures based on BMI.

Measures 18-20

(N=29)

21-23

(N=61)

24-25

(N=30)

Mean Mean Mean

FVC 2.52 (0.43) 3.23 (0.76) 3.57 (0.60)

FEV1 2.69* (0.47) 3.20 (0.66) 3.38 (0.62)

FEV1/FVC (%) 99.93 (0.29) 99.46 (1.16) 99.50 (1.16)

SVC 2.63* (0.58) 3.19 (0.70) 3.43 (0.64)

TV 0.9* (0.5) 1.32 ( 0.61) 1.54 (0.60)

* Indicates that measures are significantly lower compared to the other two groups (p<0.01).

Using Post Hoc analysis, it was found that all the measures except FVC and

FEV1/FVC were significantly lower in 18-20 BMI (Group 1) compared to the other two

groups (Table 9). Therefore Groups 2 and 3 are combined as a single group (BMI = 21-25)

for determining the normative values.

Hence in the present study, an attempt was made to establish normative values for

some of the respiratory measures based on height, weight and body mass index. The

normative values obtained are listed in Tables 9 and 10.


58

Table 9: Shows the Normative values based on height and weight for standing posture

Measures Males Females

150-170cms 170-180cms 150-170cms 170-180cms

<50

-

70k

gs

70-

90kgs

<50-

70kgs

(N=7)

70-

90kgs

(N=53)

<50-

70kgs

(N=56)

70-

90kgs

<50-

70kgs

(N=3)

70-

90kgs

(1)

FVC

*

3.77 3.84 2.46

*

**

** FEV1 3.36 3.71 2.57

FEV1/FVC (%) 99.94 99.23 99.97

SVC 3.78 3.71 2.49

TV 1.67 1.65 0.93

* Indicates no subjects were present in the group.

** Indicates less number of subjects in the group.

Table 10: Shows the normative values based on body mass index in standing posture.

Measures

Males Females

18-20

(N=2)

21-25

(N=58)

18-20

(N=27)

21-25

(N=33)

Mean Mean Mean Mean

FVC

**

3.84 2.43 2.47

FEV1 3.67 2.60 2.55

FEV1/FVC (%) 99.29 99.94 99.88

SVC 3.71 2.54 2.49

TV 1.66 0.91 0.95

** Indicates less number of subjects in the group

When the subjects were combined, the overall results have indicated that subjects

with greater height and weight and BMI in the upper limit of the normative range (21-25) had

higher respiratory capacities.

The norms obtained based on categorizing subjects according to height, weight and

BMI are also provided in the result section. However, these values cannot be recommended

for clinical utility at present as there are less number of subjects with in those groups. Hence

this only serves as a preliminary attempt to classify the subjects for their respiratory

capacities based on these variables.

To conclude, out of the respiratory measures FVC, FEV1, FEV1/FVC (%), SVC and

TV considered in the present study, it was found that FVC and FEV1 are more sensitive in

indicating the significant differences across gender and posture. The normative values


59

obtained in the present study can be used clinically for obtaining of respiratory measures in

voice disorders and other pulmonary conditions.

References

Agostoni, E, Mead, J. (1964). Statics of the respiratory system. In: Fenn WO, Rahn H,

(Editors) Handbook of Physiology. Respiration. Vol. I. Washington, DC: American

Physiological Society; p.387-409, 82 (1), 89-95.

Ali Baig, M.I, Qureshi, R.H. (2007). Pulmonary function tests: normal values in non-smoking

students and staff at the Aga Khan University, Karachi. Journal of College of

Physicians and Surgeons Pakistan, 17 (5), 265-8.

Ayub, M, Zaidi, S.H, Burki, N.K. (1987). Spirometry and flow-volume curves in healthy,

normal Pakistanis. British Journal of Diseases of the Chest, 81 (1), 35-44.

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http://www.ncbi.nlm.nih.gov/pubmed/

Appendix - 1

Measures Males Females

Mean (SD) Range Mean (SD) Range

FVC 3.83 (0.31) 2.50 - 4.32 2.45 (0.28) 1.98 - 2.90

FEV1 3.66 (0.36) 2.69 - 4.12 2.57 (0.39) 1.98 - 3.31

FEV1/FVC(%) 99.31 (1.28) 94.65 - 100 99.91 (0.50) 96.35 - 100

SVC 3.71 (0.32) 2.77 - 4.11 2.51 (0.45) 0.65 - 2.99

TV 1.65 (0.57) 0.40 - 2.70 0.93 (0.45) 0.12 - 2.00

Norms for respiratory measures in Dravidian adults (20 – 40 years) for standing posture

Note: As the respiratory measures were not significantly different between the two age groups

(20-30 Vs 30-40 years) the above norms are for Dravidian adults in the age range of 20-40 years.

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Lalloo%20UG%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlus

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Becklake%20MR%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlus

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Goldsmith%20CM%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlus

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Townsend%20MC%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlus

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Virani%20N%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlus

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Shah%20B%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlus

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Celly%20A%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlus

MAFAT - K

61

Manual for Adult Fluent Aphasia Therapy in Kannada (MAFAT-K)

Chaitra. S & S. P. Goswami*

Abstract

The language deficits seen in persons with aphasia are vast and heterogeneous in nature.

Thus it is essential that treatment should focus on all the communication deficits faced by an

individual with aphasia. The purpose of the present study was to develop a treatment manual for adult

fluent aphasia therapy in Kannada. The present manual was designed based on the documented

principles and guidelines prescribed in the literature for persons with fluent aphasia. The treatment

parameters are formulated under six main domains i.e., functional communication, auditory

comprehension, repetition, naming, expression, reading and writing. Each of these domains was

further divided into several subsections. Line drawing (coloured) pictures have been used under

various categories as stimulus. Stimulus has been judged by SLPs speaking Kannada for its relevancy

and familiarity. Stimulus has been arranged in hierarchical order of simple to complex.

Introduction

The management of persons with aphasia is a complicated task that involves the

coordinated efforts of a rehabilitation team representing several disciplines. The speech

language pathologist (SLP) being one of the key member of the team, do face number of

challenges while treating persons with aphasia. The reason is mainly due to the varied nature

of the disorder manifesting impairment in all aspects of language. Thus, the speech language

pathologists must use language treatment programs that have been described in detail and

proved to be effective (Shewan & Bandur, 1986).

Aphasia is classified into various types, one of the classifications being the basic

taxonomy of the aphasia syndrome (Kertez, 1979). According to this classification, aphasia is

broadly divided into non-fluent and fluent aphasia types.

Based on the site of lesion, the symptoms will vary accordingly. However, no two

aphasic individuals with similar subtype of aphasia will exhibit an identical symptom profile.

Thus, it is of utmost importance that the rehabilitation process is modified to suit the needs of

a particular patient.

Hence, it is imperative to have materials which are language specific and are readily

available with specific activities, based on the therapeutic approaches documented in the

literature.

Authors have proposed a number of therapy techniques and manuals for the

treatment of aphasia but, majority of them refers to the western population (English language)

for example, the Manual for Aphasia Therapy developed by Longerich (1968), An Auditory

and Verbal Task Hierarchy by Ross and Spencer (1980). In the Indian context, Manual for

Adult Non-Fluent Aphasia Therapy-in Hindi (MANAT-H, Deshpande, 2004), Manual for

Adult Non-Fluent Aphasia Therapy-in Kannada (MANAT-K,Venugopal, 2005), have been

_________________________

* Reader in Speech Pathology, All India Institute of Speech and Hearing, Mysore, India



62

developed which mainly focuses on the non-fluent type of aphasia and Word Retrieval

Manual:Hindi Aphasics (WORM- H,Praful, 2006) focuses on anomic type of aphasia. Till

date fewer attempts have been made to develop a manual for the fluent type of aphasia (for

adults) in the Indian context.

Hence, due to the vast ethno cultural and language variances, it is imperative to have

language-based manuals in Indian clinical situation. Thus, the present manual in Kannada is

proposed for the treatment of adults with fluent type of aphasia.

The aim of this study is to develop a manual for the treatment of fluent aphasia in

Kannada for adults.

Method

The present manual is designed based on the documented principles and guidelines

prescribed in the literature for persons with fluent aphasia. The illustrations of various

activities are based on the principles of aphasia management. Literature regarding fluent

aphasia and intervention strategies was reviewed from books, journals and internet sources.

The collected information from these resources are compiled and organized.

The treatment parameters are formulated under the following headings:

Functional communication (FC)

Auditory comprehension (AC)

Repetition (R)

Expression (E)

Naming (N)

Reading and writing (R&W)

Vocabulary and sentences used in everyday situation were chosen as training material.

Pictures for the manual were drawn by professional artists. The training material was tested

for familiarity by five speech language pathologists (SLPs), who were native speaker of

Kannada. The pictures were also being tested for ambiguity. The SLPs were asked to

comment on the appropriateness and hierarchy of the items used in the training material.

Development of the manual

The present manual comprises of six domains, which are taken based on the deficits

seen in various skills in persons with fluent aphasia. The various domains are as listed below:

Functional communication (FC)

Auditory comprehension (AC)

Repetition (R)

Expression (E)

Naming (N)

Reading and writing(R&W)

Each of these domains is further sub-divided into several sub-sections:

MAFAT - K

63

Functional Communication (FC)

In this domain, aspects related to daily living like nouns, common verbs which are basic and

applicable in daily life is considered. The various aspects covered under functional skills are:

A. Responding to own name

B. Recognition of family members

C. Recognition of familiar objects

D. Comprehension of simple verbal commands

E. Comprehension of action verbs

F. Functional verbal language

G. Activities of daily living

H. Activities of independence

Auditory Comprehension (AC)

The focus of this section is to improve the auditory comprehension aspect at various

linguistic levels. These levels are

I. Semantic level

II. Syntax level

III. Discourse level

I. Semantic level

A. Gross phonemic level:

Level 1: Widely variant phonemes in a word.

Level 2: Lesser variant phonemes in a word

B. Finer phonemic level

Level 1: Finer phonemic difference in bisyllabic words.

Level 2: Finer phonemic difference in trisyllabic/polysyllabic words.

C. Word level

i. Vocabulary

ii. Antonyms

iii. Synonyms

iv. Syntagmatic and paradigmatic relations

II. Syntax level

A. Person Number Gender markers (PNG)

B. Tenses

C. Plurals

D. Answering yes-no (polar) questions

E. Following body part command

F. Following commands with visual stimuli

G. Identification of objects described by function

H. Identification of objects named serially

I. Sentence types


64

III. Discourse level

A. Listening comprehension

B. Reading comprehension

Repetition (R)

This domain is again sub-divided into the following sub-sections:

A. Automatic speech

B. Vocabulary

C. Phrases and Sentences

The person with aphasia is expected to repeat using auditory and graphic cues.

Naming (N)

This domain is again sub-divided into the following sub-sections:

A. Confrontation naming

B. Responsive naming

C. Lexical generative naming: Phoneme fluency, word fluency, category specific

Cueing hierarchies are provided for each sub-section.

Expression (E)

Main aim of this domain is to reduce paraphasias, perseverations, neologisms, and

jargon utterances.

The material and strategies designed to improve the expression skills have been

chosen keeping the therapy techniques as base.

Reading and Writing (R&W)

This domain aims at improving the reading and writing skills of persons with aphasia

at both functional and advanced levels. A subsection on arithmetic skills has also

been included through which the concept of money and its usage can be worked upon.

This domain is sub-divided into four sub-sections as listed below:

A. Functional reading and writing

B. Advanced reading

C. Advanced writing

D. Arithmetic skills

The activities of each sub-section have been arranged in hierarchical order along with

its stimulus and response mode hierarchy. Scoring pattern and progress criteria have been

provided in the beginning of each sub-section. Overall progress criterion is also provided for

each domain and its sub-sections.

Treatment recording sheet

The treatment recording sheets (Adopted from Treatment protocols for language

disorders in children, Hegde, M.N., 2003) have been included for each domain and sub-

MAFAT - K

65

section. It is expected that the clinician follows these sheets to record the target activity,

mode of presentation of the stimuli, mode of responses, target skills, number of trials and

percentage of the correct responses.

Scoring

0 = No response/ incorrect response/ unintelligible response

1/2= Partially correct and intelligible response

1 = Fully correct and intelligible response

Progression criterion list

Begin with Functional Communication (FC) and Auditory Comprehension (AC)

domains simultaneously. Only when the total score in each of these domains reaches

50%, move to the next level.

Next, begin with the activities of functional reading and writing domain. When a score

of 25% is achieved in functional reading and writing and 75% in FC, AC each, proceed

to the next level.

Now, introduce the activities of repetition. When the person with aphasia scores 25% on

repetition, 50% in functional reading and writing and 100% on FC, AC, advance to the

next level.

Now, introduce the activities of expression. When 25% score is reached in expression

domain and 50% in repetition and 75% in functional reading and writing move to the

next level.

The activities in expression should be continued till a score of 75% is achieved.

Next, proceed to the naming domain and work on it till at least 75% score is achieved.

The advanced reading, writing and arithmetic skills should be introduced now and

worked upon till 75% of the score is achieved.

At the end of the manual it is expected that in each domain the performance of person

with aphasia is 75% or above and in overall 90% and above.


The manual is quite flexible and can be used by speech language pathologists,

student clinician and caregivers of persons with fluent aphasia. Further, the training

material in this manual can be easily modified by the clinicians to suit the individual

needs of persons with aphasia.

References

Ball, M.J., & Damacio, J.S. (2007). Clinical Aphasiology: Future Directions. New York:

Psychology Press, Taylor and Francis Group.


66

Bandur, D.L., & Shewan, C.M. (1986). Treatment of Aphasia: A Language-Oriented

Approach. London: Taylor & Francis Ltd., Benson, D.F., & Ardilla, A. (1996).

Aphasia. New York: Oxford University Press.

Code, C., & Muller, J. (1989). Aphasia Therapy. London: Whurr Publishers.

Despande, R. (2004). Manual for Adult Non-Fluent Aphasia Therapy - In Hindi. Unpublished

master’s dissertation submitted to University of Mysore, Mysore, India.

Duchan, J.F., & Byng, S. (2004). Challenging Aphasia Therapies: Broadening the Discourse

and Extending the Boundaries. New York: Psychology Press, Taylor and Francis

Group.

Goodglass, H., & Kaplan, E. (1983). The Assessment of Aphasia and Related Disorders. (2nd

Ed). Philadelphia: Lea and Febiger.

Goswami, S.P., & George, A. (2006). ISHA Monograph, Adult Aphasia: Language

Intervention. A publication of the Indian Speech and Hearing Association.

Hegde, M.N. (2003). Treatment protocols for language disorders in children. Vol. 2. Social

Communication. San Diego: Plural Publishing Inc.

Helm-Estabrooks, N., Fitzpatrick, P.M., & Baressi, B.N. (1982). Visual Action Therapy for

Global Aphasia. Journal of Speech and Hearing Disorders, 47, 385-389.

Helm-Estabrooks, N., & Holland, A.L. (1998). Approaches to the Treatment of Aphasia. San

Diego: Singular Publishing Group Inc.

Kertesz, A. (1979). Aphasia and Associated Disorders. New York: Grune & Stratton, Inc.

LaPointe, L.L. (1990). Aphasia and Related Neurogenic Language Disorders. New York:

Thieme Publishers, Inc.

Martin, B.R. (1962). Communicative Aids for the Adult Aphasic. Illinois: Charles.C.Thomas

Publishers.

Prema, K.S. (1997). Reading Acquisition Profile in Kannada. Unpublished Doctoral Thesis,

submitted to University of Mysore, Mysore, India

Ross, D., & Spencer, S. (1980). Aphasia Rehabilitation- An Auditory and Verbal Task

Hierarchy. Illinois: Charles.C.Thomas.

Shinde, P. (2006). Word Retrieval Manual: Hindi Aphasics. Unpublished master’s

dissertation submitted to University of Mysore, Mysore, India.

Venugopal. (2005). Manual for Adult Non-Fluent Aphasia Therapy - In Kannada.

Unpublished master’s dissertation submitted to University of Mysore, Mysore, India.

MAFAT - K

67

Normative Nasalance Value in Malayalam

67

Normative Nasalance Value in Malayalam Language

Devi T.R. & M. Pushpavathi*

Abstract

Assessment of nasality disorders in speech is traditionally proved to be a difficult perceptual

task for speech pathologists. Clients with velopharyngeal inadequacy are suggested for surgery or

speech therapy as a treatment option. Hence an accurate assessment of the nasality is critical, as this

provides valuable information for the suitable treatment. The use of instrumentation has become an

important part of the assessment and treatment of individuals with velopharyngeal dysfunction. Awan

(1996) developed a computer hardware/ software system called Nasal View (the Nasal Acquisition

System). NasalView is a cost-effective, software/hardware system designed for the data acquisition,

clinical analysis and treatment of nasal resonance disorders. Several studies have shown that

nasalance of normal speech is sensitivity to the phonetic composition of the speech stimuli, native

language, regional dialect, age, and gender. As there are very few established normalized nasalance

score, there is a strong need for establishment of regional norms. Hence ,the present study aimed at

developing the normative nasalance scores for Malayalam language across gender and stimuli in

adults. The study consisted of two groups with 50 normal adult males and females in the age range of

18 years to 35 years in each group who were native speakers of Malayalam. Stimulus set- I consisted

of five oral and five nasal sentences and stimulus set- II consisted of one nasal and one oral

paragraph. The subjects were instructed to read the sentences and paragraphs and NasalView system

was used to acquire the nasalance value for all the stimuli. The results indicated higher nasalance

values for females than males across nasal and oral stimuli. In males, the nasalance value for oral

sentence was 51.19%, nasal paragraph value was 51.43%, oral sentences value was 21.64% and oral

paragraph value was 21.36%. In females, nasalance value for nasal sentences was 57.55%, for nasal

paragraph was 56.93%, for oral sentences was 24.78% and for oral paragraph was 23.16%. The

presence of gender differences could possibly be attributed to the underlying structural and functional

differences across gender.

Key words: Nasal View, Normative nasalance value, Malayalam speaker.

Introduction

To assess and study nasalization and disorders of nasalization, speech language

pathologists and otorhinolaryngologists relay on a combination of direct and indirect

assessment procedures (Shprintzen & Bardach, 1995). Direct methods of visualization of the

velopharyngeal valve include multi view Video fluoroscopy and Nasopharyngoscopy, where

as indirect or non-visualizing procedures are illustrated by the mirror test and aerodynamic

and acoustic investigations (Van Lierde et al., 2001).

Speech language pathologist prefers the indirect methods, since it is noninvasive and

does not require additionally the medical professional support. Therefore, there is a need, in

the field of speech pathology for convenient and reliable systems to monitor velar action

___________________________




68

during speech, both to give the clinician a measure of such action and to provide a means of

feedback for the person trying to improve velar control.

The speech stimuli typically used to measure nasality have considered the nasal

passage, the Zoo passage and the Rainbow passage (Fletcher et al., 1989). These passages

differ in that the Zoo passage contains no nasal phonemes, the Rainbow passage contains

about 11% nasal phonemes and the Nasal sentences are 35% nasal phonemes. Apart from this

the oral syllable, nasal syllable and sentences loaded with high pressure consonants, oral

consonants and nasal consonants are also used for the assessment.

Development of Normative Data across languages

Since the NasalView was introduced in 1996, many articles have appeared in the

literature on developing the normative data across stimuli in various languages. But there are

only few articles which focused on development of normative data on nasalance value and

comparing nasalance value across stimuli and across gender. The following review

summarizes the articles which aimed at developing normative data on nasalance, comparing

nasalance across gender and stimuli.

Awan, S. (I998) gave preliminary normative data collected from groups of 161 male

and female children between the age range of 5 and 14 years and 20 male and female adults

between the age range of 18 and 30 years. To assess varying degrees of normal nasal

resonance, NasalView system was used and subjects were asked to read the Zoo passage, the

Rainbow passage and the Nasal sentences. Results revealed a mean nasalance value of

48.44% for nasal passage, 34.19% for Rainbow passage and 24.67% for Zoo passage.

Tim Bressmann et al. (2000) did a study to evaluate two new measures derived from

mean nasalance data: the nasalance distance (range between maximum and minimum

nasalance) and the nasalance ratio (minimum nasalance divided by maximum nasalance) and

proposed that implementing these two measure would help to overcome the problems of

differences in magnitudes of mean nasalance in speakers with perceptually normal nasal

resonance and the problems in disagreement between categorizations of speech based on

nasalance scores and perceptual judgments. Subjects were 133 cleft lip and palate patients in

the age range of 10 to 66 years with a mean age of 17 years with normal nasal resonance or

varying degrees of hypernasality. Results for the sentence stimuli ranged from 64.4% to

89.6% sensitivity and from 91.2% to 94.1% specificity. The cutoff scores for the nasalance

distance, nasal sentences–oral sentences, were 23.16 and cutoff scores for the nasalance ratio

oral/nasal sentences were 0.539. When the analysis was limited to only one nonnasal and one

nasal sentence, results ranged from 79.7% to 87.5% sensitivity and from 88.2% to 97.1%

specificity. The cutoff scores for the nasalance distance nasal sentence– oral sentence were

26.1 and cutoff scores for the nasalance ratio oral/nasal sentence were 0.502. The authors

concluded that nasalance distance and nasalance ratio measures derived from sentence stimuli

are two useful measures that are easy to apply.

Awan, S (2001) conducted a study to investigate the age and gender effects on

measures of RMS nasalance. The NasalView system was used in the collection of normative

data from groups of male and female children between the ages of 5 to14 years with an


69

addition of 20 adult males and 20 adult females in the age range of 18- 30 years. Subjects

were asked to read the Zoo passage, the Rainbow passage and the Nasal sentences while

wearing the NasalView headgear. Subjects were divided into 6 groups based on the age

groups. The nasalance values were 46.68% for Nasal Passage, 32.95% for Rainbow passage

and 23.39% for Zoo passage. Results indicated no significant differences between males and

females in terms of RMS nasalance in any age group. Though no significant differences in

RMS nasalance were observed across gender, the female subjects were observed to produce

adult levels of RMS nasalance at a younger age than the male subjects (11to12 years vs.

13to14 years). The author interpreted that this observation may be due to earlier facial

skeletal and nasopharyngeal maturation in females as compared to males.

Awan. S et al, (2001) provided normative data in English language from 255 normal

subjects who included both 203 children in the age range of 5 to 12 years and 52 adults who

were 13 years and above and all the subjects were native speakers of English language. The

author used NasalView system to collect normative nasalance data for Zoo passage, Rainbow

passage and Nasal sentences. The results revealed approximately equal nasalance score for

both males and females across age and gender. Mean nasalance values for adult females were

26.71% for Zoo passage, 37.11% for Rainbow passage and 51.18% for nasal passage. Mean

nasalance score for adult males were 26.02% for Zoo passage, 35.58% for Rainbow passage

and 51.18% for nasal passage. There was a slight increase in nasality in females compared to

males in all the three passages. The results also revealed a significant difference across the

three stimuli in both males and females.

Keuttner, C et al., (2003) obtained normal nasalance values in German language using

NasalView system. A total of 50 individuals with normal speech development were examined

with NasalView. The median age was 14 years (range 11-20 years). The test material used

comprised the vowels /a:/, /e:/, /i:/, /o:/, /u:/, the sentences S(1): "Die Schokolade ist sehr

lecker."("This chocolate is very tasty.") and S(2): "Nenne meine Mamma Mimmi."("Call my

mummy Mimmi."), and three mixed oral-nasal text passages, long text LT (1): "Nordwind

und Sonne"("Northwind and sun"), long text LT(2): "Kindergeburtstag"("A child's birthday

party") and long text LT(3): "Der grosse Gesang"("A famous song"). Results revealed that

the mean nasalance for the vowels were 35.9%, for S (1) (containing no nasal consonants)

24.9%, and for S (2) 69.6% (with many nasal sounds). The results for the mixed oral-nasal

text passages were 42.1% for LT (1), 36.9% for LT (2) and 38.2% for LT (3). The above

results revealed significant differences across the nasalance values for all the three stimuli.

The nasalance value for the nasal sentence was significantly greater than the oral sentence.

The nasalance values also varied significantly across the three oral-nasal text passages.

Tim Bressmann (2005) did a comparison of nasalance values obtained with the

Nasometer, the NasalView, and the Oronasal system. Objective of the study was to compare

nasalance values obtained with the Nasometer, the NasalView, and the OroNasal system;

evaluate test-retest reliability of the three systems; and explore whether three common text

passages used for nasalance analysis could be shortened to a sentence each. Subjects were

seventy-six adults with normal speech and hearing (mean age 26.5 years). Subjects read the

complete Zoo passage, Rainbow passage, and Nasal sentences. The subjects also read the first


70

sentence from the three passages for the purpose of comparing the nasalance values for the

long passages with their corresponding sentences. The combined mean nasalance for adult

males and females obtained from NasalView system were 21.1% for Zoo passage, 35.2% for

Rainbow passage and 55.74% for Nasal sentences. The mean nasalance for the first sentence

from Zoo passage was 21.2%, for the first sentence from Rainbow passage was 34.72% and

for the first sentence from Nasal sentences was 56.9%. Results revealed that the Nasometer

had the lowest nasalance values for the Zoo passage (13.45%). The NasalView had the

highest nasalance values for the Rainbow passage (35.2%). The OroNasal system had the

lowest nasalance values for the Nasal sentences (49.72%).

André Eckardt et al., (2007) conducted a study to compare the nasalance using

NasalView system in patients with maxillary defects who had undergone reconstruction

versus obturation. Further, these groups of patients were compared with normal controls. This

study included 28 subjects. Ten patients had obturators (group l) and in 18 patients the

maxilla was biologically reconstructed with different techniques (group 2). Sound pressure of

nasal and oral airways was assessed separately using NasalView system and standardized

German texts and the results were compared with an uncompromised sample of patients.

Results revealed no significant differences across both the groups. Furthermore, the achieved

values of nasalance were similar to healthy individuals.

Tim Bressmann, Paula Klaiman and Simone Fischbach (2006) compared the data

from normal subjects and cleft palate speakers between three systems for nasalance analysis.

The purpose of this study was to collect and compare the data with all three systems from a

group of normal speakers and a group of cleft palate patients with hypernasality. In particular,

the authors were interested in the diagnostic efficacy of the three systems, as indicated by

sensitivity and specificity. They considered fifty subjects with the mean age of 26.0 years.

Thirty-one participants were female and nineteen were male. Nineteen hypernasal patients

with cleft palate were also included in the experimental group with the age range of 11-19

years. Eight participants were female and eleven were male. The Zoo passage and the Nasal

sentences were used to assess the nasalance value. The results showed that the nasometer had

the lowest nasalance values for the non-nasal Zoo passage (13.45%) for the normal

participants but the highest values for the moderately hypernasal cleft palate patients

(34.06%). The lowest values for the Nasal sentences were recorded with the oronasal system

for the normal participants (49.72%) as well as the patients with cleft palate with moderate

hypernasality (45.93%). The lowest nasalance values for the mildly hypernasal group was

collected with the nasometer. The authors attributed these differences between the nasalance

magnitudes of the same speakers when measured with the three different systems to the

differences of the signal processing routines of the three instruments.

Arya Pravesh (2009) conducted a study to establish the normative nasalance values in

Hindi language, using NasalView system, and to investigate differences in nasalance values

across gender and across stimuli. Subjects were fifty adult males and females in the age range

of 18- 35 years. The stimulus materials included Nasal sentences, oral sentences, nasal

paragraph and oral paragraph in Hindi language. Mean nasalance values in males were

47.04% for nasal sentence, 22.48% for oral sentence, 46.85% for nasal paragraph and 21.59%


71

for oral paragraph. Mean nasalance values in females were 50.42% for nasal sentence,

22.59% for oral sentence, 49.74% for nasal paragraph and 22.23% for oral paragraph. The

results revealed significant differences across gender for nasal stimuli but not for the oral

stimuli. The significant differences were not seen across oral stimuli and across nasal stimuli

within gender groups. There was significant difference across nasal and oral stimuli at a

0.001 level of significance.

The above review of literature indicates the need of establishing normative data in

different languages, which is useful for assessing resonance disorders. One of the main aims

of the current study was to establish normative nasalance values for adults in Malayalam

language across gender and stimuli.

Aims of the study

To develop normative data on nasalance value across gender and nasalance deviation

in Malayalam language for oral and nasal sentences and paragraphs for adults.

To study the effect of stimuli on nasalance value across gender.

To study the effect of gender on nasalance value across stimuli

Method

Subjects

One hundred subjects were included in the study. The subjects were selected based on the

inclusionary and exclusionary criteria by experienced speech language pathologist.

Inclusion criteria

The subjects should be native speakers of the Malayalam language in the age range of

18-35 years.

The minimum educational qualification should be higher secondary education.

Should possess sufficient auditory and visual acuity.

Exclusion criteria

No neurologic, sensory, motor, cognitive or communicative impairments.

Subjects were divided into two groups. First group consisted of fifty females in the

age range of 18-35 years and second group consisted of fifty males in the age range of 18-35

years. Table 1 depicts the subject details.

Table 1: The subject details.

Gender Age range Sample size

Male 18-35 years 50

Female 18-35 years 50

Total 100


72

Stimuli

Two sets of stimulus material were prepared by an experienced speech language

pathologist whose mother tongue is Malayalam.

Set-1 consisted of 5 nasal and 5 oral sentences of equal length (5-6 syllables)

Set-2 consisted of nasal and oral paragraph containing 6 sentences each.

Procedure

Initially to find the content validity of the stimulus materials, 10 nasal and 10 oral

sentences were prepared using common nasal and oral words selected from Malayalam

phonetic reader (B S Kumari, 1972). The words selected satisfied the criteria of above 90%

nasal sounds for nasal words and below 10% nasal sounds for oral words. These ten

sentences, each for oral and nasal sentences, were audio recorded by a speech language

pathologist who was a native Malayalam speaker and were given for perceptual judgment of

degree of nasality to 10 speech language pathologists who had at least one year experience in

the field. A five point perceptual rating scale was used. Rating of „0‟ indicated fully oral or

no nasality; „4‟ indicated highly nasal stimuli. After perceptual evaluation 5 nasal sentences

with a perceptual nasality judgment of greater than or equal to 3, and 5 oral sentences with

perceptual nasality judgment of less than or equal to 1 were selected as the final stimulus

material set 1. Similarly the nasal and oral paragraph was prepared for the stimulus material

set 2.

Instrumentation

The Nasal View system was designed to run on a 486 or Pentium PC- compatible

system (also requires VGA graphics capability and 4 Mbytes RAM) the system includes the

following components: Headgear, Preamplification and calibration hardware, Computer

hardware, and Computer software

Data collection

The subjects were assessed and recorded individually. After selecting the subjects,

they were seated comfortably and the NasalView head gear was placed on the subject‟s head.

The position of the NasalView head gear was adjusted and secured firmly in accordance with

the manufacturer‟s instructions. The subjects were instructed to read the speech stimuli. The

nasalance trace was continuously monitored throughout each recording to ensure that the data

were being captured. After the completion of each speech sample, the nasalance trace was

stored in a computer file for further analysis.

Data analysis

Data was obtained for the two groups of stimuli. The files for all speech samples were

subjected to calculation of the mean, maximum and minimum nasalance for each stimulus

category. All computations were performed using the SPSS statistical package (SPSS 16.0 for

Windows). The data was analyzed for adult males and adult females separately using various

programs like,

Independent t test to compare nasalance values across gender.


73

Paired t test to find the effect of type and the effect of nasality on nasalance values

within gender, and

Mixed ANOVA to perform multiple pair wise comparisons between the mean

nasalance values for; the two within subject variables i.e. type and nasality with gender

as between subject factor, and, the between subject variable, i.e. gender.

Results

I. Normative value for nasalance

Table 2: indicates the normative nasalance value for adults across gender. The mean

nasalance values for sentence and paragraph are depicted along with standard deviation for

oral and nasal stimuli. The upper and lower limit for oral sentences, nasal sentences, oral

paragraph and nasal paragraph is also showed in the table.

Table 2: Normative nasalance value (in %) for adult males and adult females.

In mixed ANOVA, significant interaction was observed between the variables under

study. Hence the variables were separately analyzed as explained below. Independent t test

was done for comparison of nasalance value across gender within each type and nasality. The

following table: 3 shows the results.

Table 3: Comparison of stimulus type and nasality across gender.

Type/ nasality t (1, 98)

Oral sentence 3.168**

Oral paragraph 1.504*

Nasal sentence 6.087***

Nasal paragraph 5.608***

* Significance at 0.05 level.

** Significance at 0.01 level.

*** Significance at 0.001 level.

Gender N Category Mean (S.D) Max (SD) Min (SD)

Adult

Male

50 Oral

sentences

21.64 (4.22) 57.56 (9.16) 7.95 (1.90)

Nasal

sentences

51.19 (5.32) 85.89 (4.59) 18.61 (5.39)

Oral

Paragraph

21.36 (4.73) 71.26 (10.31) 5.92 (1.33)

Nasal

paragraph

51.43 (5.29) 87.38 (4.19) 7.93 (2.11)

Adult

Female

50 Oral

sentences

24.78 (5.61) 63.93 (7.74) 8.36 (2.92)

Nasal

sentences

57.55 (5.10) 90.22 (2.71) 22.98 (6.48)

Oral

paragraph

23.058 (6.46) 73.25 (8.74) 6.40 (2.63)

Nasal

paragraph

56.93 (4.47) 91.10 (2.13) 9.19 (3.89)


74

Results revealed significant differences for nasal sentences (p< 0.001), nasal

paragraphs (p< 0.001), oral sentence (p< 0.01) and oral paragraphs (p< 0.05) across gender.

Within gender differences between nasal stimuli and oral stimuli and within gender

differences between sentences and paragraphs were investigated using paired t test. Table 4:

shows the results.

Table 4: within gender comparison across stimuli.



The results revealed that there was significant difference across oral and nasal stimuli

in males and females (p< 0.001). There were no significant differences found across nasal

sentence and nasal paragraph neither in males (p> 0.05) nor in females (p> 0.05). There was

no significant difference across oral sentence and oral paragraph in males (p>0.05) but

significant difference was found across oral sentence and oral paragraph in females (p> 0.01).

II. Effect of Gender on Nasalance Values

Females exhibited higher nasalance value for nasal sentences which was 57.54% and

nasal paragraph which was 56.92% compared to males whose values were 51.19% for nasal

sentence and 51.43% for nasal paragraph. Independent t test revealed significant difference

across gender for nasal stimuli. Female subjects also exhibited higher nasalance value for

oral sentences which was 24.78% and for oral paragraphs which was 23.05% compared to

males for whom nasalance value for oral sentence was (21.64%) and for oral paragraph

which was 21.35%. Independent t test revealed significant difference across gender for oral

stimuli.

Interaction of stimulus type, nasality and gender

Mixed ANOVA was carried out to find out the significant differences across the two

within subject variables, i.e. type and nasality with gender as between subject factor, and the

between subject variable, i.e. gender. Table 5: depicts the F value as well as the level of

significance for these variables and their interaction effect.

Gender Source compared T (1,49)

Male Nasal sentence vs. oral sentence 38.70**

Nasal paragraph vs. oral paragraph 32.62**

Nasal sentence vs. nasal paragraph 0.54

Oral sentence vs. oral paragraph 0.66

Female

Nasal sentence vs. oral sentence 44.01**

Nasal paragraph vs. oral paragraph 45.29**

Nasal sentence vs. nasal paragraph 1.23

Oral sentence vs. oral paragraph 3.69*


75

Table 5: interaction between stimulus type nasality and gender.



*** Significance at 0.001 level.

Table 5: reveals the interaction effect of the within and between subject variables. The

table also shows the level of significance for each interaction. The significant difference was

seen for within type (p< 0.05), within nasality (p< 0.001), and within gender (p < 0.001),

interaction between type and gender (p < 0.05), interaction between nasality and gender (p<

0.01) and interaction between type and nasality (p< 0.05). There was no main effect seen in

the interaction between type, nasality and gender (p> 0.05).

Discussion

Effect of gender on nasalance values

The presence of differences in nasalance value across gender could possibly be

attributed to the underlying structural and functional differences across gender. There are

several studies reported in the literature which supports the findings of the present study.

Jayakumar (2005) in his study on developing normative data of nasalance values for

Kannada language in 50 children and 50 adults reported significant differences across gender

in adults. The author attributed this difference to the basic structural and functional

differences across gender.

Mahesh and Pushpavathi (2008) compared the nasalance values for Rainbow passage

across gender and reported significant differences across gender. Females (31.39%) had

higher nasalance values compared to males (27.93%). Also the standard deviations were

higher in females compared to males indicating higher variability among females. The

authors attributed the gender differences in nasalance to basic structural and functional

differences. They also opined that the resonance of voice is influenced by the size, shape and

surface of infraglottal and supraglottal resonating structures and cavities.

Arya P (2009) conducted a study to establish the normative nasalance values in Hindi

language, using NasalView system, and to investigate differences in nasalance values across

gender and across stimuli. Subjects were fifty adult males and females in the age range of 18-

35 years. The stimulus included nasal sentences, oral sentences, nasal paragraph and oral

paragraph in Hindi language. The results revealed significant gender differences for nasal

stimuli but not for the oral stimuli.

Source F (1, 98)

Main effect of Type 5.023*

Main effect of Nasality 3505.312***

Main effect of Gender 25.258***

Interaction between Type* Gender 4.587**

Interaction between Nasality* Gender 10.777*

Interaction between Type* Nasality 4.829*

Interaction between Type*nasality*Gender 0.625


76

In an attempt to determine the physiology behind higher nasalance values observed in

females, several authors have investigated the anatomical and/or physiological

velopharyngeal parameters. (Kuehn & Moon, 1998; McKerns & Bzoch, 1970; Zajac &

Mayo, 1996).

McKerns and Bzoch (1970) used cinefluoroscopy to observe velopharyngeal valving

and found that two basic configurations of VP closure existed in relation to gender during

connected speech production. Females were observed to have a shorter velum, use less velar

elevation and a greater amount of velar contact against the pharyngeal wall to achieve

closure. The authors attributed these differences to the sites of muscle insertion involved in

velopharyngeal closure (i.e., levator palatini, palatoglossus, and palatopharyngeus muscles),

and oral and pharyngeal dimensions (McKerns & Bzoch, 1970).

Zajac and Mayo (1996) studied the aerodynamic and temporal aspects of

velopharyngeal function in 42 normal young Caucasian adult (21 male and 21 female; mean

age 24, 23) speakers during production of the nasal-plosive sequence /mp/ in the strong-weak

stressed word, “hamper.” Significant differences across gender was demonstrated where

females exhibited significantly lower levels of peak intraoral air pressure and longer

durations in the rise of pressure during the production of the /p/ segment, indicating less

occlusion of the velopharyngeal port. It was speculated that differences in preferred intensity

levels and respiratory and velar physiology between genders might have accounted for some

of the findings (Zajac & Mayo, 1996).

Kuehn and Moon (1998) investigated velopharyngeal closure force in varying

phonetic contexts using 14 normal college-aged participants (seven male, seven female).

Statistically significant differences across gender was not found in velopharyngeal closure

force using different vowel and consonant productions, voicing, place, manner, or sequencing

conditions. It has been shown that in regard to gender, there are several possible factors

causing variation within nasalance values. There is no accepted explanation of these

differences.

Many studies have reported that a significant difference was not evident in nasalance

values across gender (Trindade et al., 1997; Whitehil (2001); Christina E et al, 2000; Daniel,

Z. H, 2001; Awan,S, 1999; Awan,S, 2001; Keuttner C et al, 2003). The results of the present

study does not support the findings.

Trindade et al., (1997) compared the nasalance values across gender. Based on the

results, they opined that a statistically significant differences was not found in the nasalance

values across gender.

Awan,S (1999, 2001) discussed the comparison of nasalance across age groups and

gender. The study included age groups from 5-14 years with an addition of 20 adult males

and 20 adult females in the age range of 18- 30 years. Results indicated no significant

differences between males and females in terms of RMS nasalance at any age group.

Keuttner, C et al.,(2003) obtained normal nasalance values in German language using

NasalView system. A total of 50 individuals with normal speech development were examined


77

with NasalView. The median age was 14 years (range 11-20 years). This study also reported

of no differences in nasalance s across gender.

I. Effect of Stimuli on Nasalance Values

The nasalance values were compared across stimuli. Results revealed a significant

difference across nasal and oral stimuli at 0.001 level of significance. The reason for this

difference could be attributed to the characteristic phonetic structure of the nasal and oral

stimuli. Production of nasal stimuli induces transfer of acoustic energy into the nasal cavity

through the open velopharyngeal port which is picked up by the nasal microphone of

NasalView. During the production of oral sounds, the velopharyngeal port is closed which

accounts for the reduction in transfer of acoustic energy into the nose and an increase in oral

acoustic energy which is picked up by the oral microphone of the NasalView headgear. The

observed variation in nasalance across oral and nasal stimuli could also be attributed to the

influence of phonetic nasal content of individual stimuli on the nasalance values, an effect

demonstrated by Fletcher, Adams and Mc Cutcheon (1989). On the whole, transpalatal

transfer of energy accounts for nasalance of speech stimuli (Emily et al, 2006). Mean

nasalance scores may be influenced by the phonemic characteristics of a language.

Consequently, the number of nasal sounds in that language as well as frequency of

occurrence of nasal sounds may be an important factor. Among the Indian languages

Malayalam has got more nasal resonance than any other languages. Malayalam has six nasal

consonants, all of which are prevalently used (bilabial, alveolar, palatal, retroflex and velar).

In addition to these nasal sounds, nasalization of vowels is also highly prevalent, which may

account for increased nasal resonance (Ramakrishna B.S, 1962).

When sentences and paragraph were compared within gender using pair t-test, there

were no significant differences across the stimuli (p>0.05) except within oral stimulus group

in females which showed significant difference at 0.001 level. The results from the present

study is supported by past studies done by Tim Bressmann, 2005; Watterson et al, 1996;

Watterson et al. 1999; Jan Van Doom, 2006.

Watterson et al, (1996) compared the nasalance values obtained from Turtle passage

and Mouse passage with the nasalance values obtained from Zoo passage and Rainbow

passage respectively. The results of the study revealed that there were no significant

differences between the passages compared. The authors concluded that nasalance measures

although sensitive to the degree of nasal phonemes in a stimulus, are not sensitive to the

remaining phonetic content.

Watterson et al. (1999) compared the nasalance measures for speech stimuli of four

different lengths. The standard for comparison was a 44- syllable passage. The 44- syllable

passage was compared to a 17- syllable passage, a 6- syllable passage and a 2- syllable word.

All stimuli were devoid of nasal consonants and were composed of only low pressure

consonants and vowels. The results showed that comparable measures of nasalance can be

obtained using stimuli as short as 6 syllable sentence, which, along with the 17- syllable

stimuli achieved high criterion validity, indicating that stimuli of that length could be

substituted for the longer 44- syllable passage.


78

Bressmann et al. (2000) compared the nasalance for individual sentences from the

Heidelberg Rhinophonia Assessment to the complete nonnasal and nasal passages and

concluded that individual sentences could substitute the complete passages as the mean

values and mean differences for the two stimuli were similar.

Jan Van Doorn et al. (2008) conducted a study with the aim of establishing whether

nasalance values from shorter sections of three Swedish speech stimuli were equivalent to

those from their corresponding whole stimulus. Nasalance recordings for three Swedish

speech stimuli (oral, nasal and oronasal) were obtained from 29 typically developing Swedish

children (7–11 years). Results showed that shorter sequences of sentences could be

considered equivalent to the whole passage for the oral and nasal stimuli, provided that the

sentences were sequenced in order of increasing difference from the whole stimulus and that

those sentences with values significantly different from the whole passage were not included.

Tim Bressmann (2005) in his study on comparison between short and long stimuli

across instruments gave results for the Nasometer and the Oronasal system that were

contradictory to the present study. The author did not find equivalence of nasalance for a

single sentence compared with full length sentence for a group of normal adult speakers for

the standard English passages, the Zoo passage and the Rainbow passage when evaluated

using the Nasometer and Oronasal systems. The discrepancies in the findings from these

studies could be due to the differences in defining “equivalence” of scores, different types of

speech stimulus or different speaker groups (Jan Van Doorn et al. 2008).

Conclusions

The present study established normative nasalance score for adults and also

investigated the effect of gender and stimuli on nasalance value. Significant difference was

evident across gender. In males, the nasalance value for oral sentence was 51.19% (5.3),

nasal paragraph value was 51.43% (5.3), oral sentences value was 21.64% (4.2) and oral

paragraph value was 21.36% (4.7). In females, nasalance value for nasal sentences was

57.55% (5.7), for nasal paragraph was 56.93% (4.5), for oral sentences was 24.78% (5.6) and

for oral paragraph was 23.16% (6.4).

The presence of gender differences could possibly be attributed to the underlying

structural and functional differences across gender. As McKerns and Bzoch (1970) suggested

that velar length and elevation is greater for men compared to women. Differences in

preferred intensity levels and respiratory and velar physiology between genders may be

accounted for the differences in nasality (Zajac & Mayo, 1996). Additionally research has

demonstrated gender differences in vocal fold vibration pattern (Oates and Dacakis, 1997).

The present study also investigated the effect of stimuli on nasalance values. The

results revealed that the differences were evidence across gender for nasal stimuli and oral

stimuli. Significant difference was not observed across sentences and paragraphs within each

oral and nasal stimulus groups except within oral stimulus group in females. Over all the

present study adds to the body of evidence that there are gender and stimulus dependent

differences in nasalance scores. Clinically the normative data reported in the present study

may help identify and treating individuals with resonance disorders.


79

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http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Dempf%20R%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlus

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Lisson%20J%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlus

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Ptok%20M%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlus


81

Appendix PPENDIX- I

MALAYALAM STIMULI

Nasal Sentences

1. id¡ CË¡I i¡µy.

2. iz© iYêy« pzY¡.

3. id¡ i»y« pzY¡.

4. i» ixµ pzY¡.

5. ixdp© CË¡I pË¡.

Oral Sentences

1. Bq PeðxÀy ekÀy.

2. Pyeðy sxky DU¡À¡.

3. Ap¬ e¼y¤j ¥eUy¶¡.

4. e¼y Fmø§ KUy¶¡.

5. e¡Zyj pzU§ pyl÷¡.

Nasal Paragraph

pyixdI iYêy« pË§ dyË¡. DYêy¥ixd§ pyixdI pxµx© ¤ZxËy. DYêy¥ix¤©÷ pxdyd¡ i¡Ëy« iydy

px© pË¡ dyË¡. ey¤Ë DYêy pyixdI KxYx© dyËymø. DYêy i¡Ëy« dyË¡ dzµy.

Oral Paragraph

qqy PyöZ¥jxU§ Pxj ¤Pxby¶¡. Ap¬ Pxjjy« Alyjx¤Z Deð§ ¥PªÀ¡. qqy PyöZ¤j qxsy¶¡.

PyöZ AZ§ ¤K¼¡ Pyky¶¡. A¥eðx¬ qqy K¢U¡Z« ¥Kxey¶¡. C¦ Ka ¥K¼§ Apª Pyky¶¡.


82

APPENDIX- II

MALAYALAM IN IPA FORMAT

Symbolic Play and Language in Late Talkers

83

Symbolic Play and Language: Its Relationship in Late Talkers

Devika M. R. & N. Swapna*

Abstract

Symbolic play involves the representational use of objects and pretending or acting out a

concept. It has been reported that symbolic play corresponds to language development in typically

developing children and in children with developmental language disorders although there have been

some mixed views. Such studies investigating the relationship between symbolic play and language

are limited in the Indian context especially in the subgroup of children who are termed ‘late talkers’.

Hence the present study was undertaken to investigate the symbolic play behaviours and its

relationship with language in late talkers particularly those with an expressive language delay. In

addition, an attempt was made to determine the effect of manipulation of physical and social context

on symbolic play. The sample included 10 typically developing Kannada speaking children and 10

late talkers in two different age groups 24 to 30 months and 30-36 months. The symbolic play

behaviors and their play and language age were assessed. The results indicated that the late talkers

exhibited lesser presymbolic and symbolic play behaviours compared to the typically developing

group. A developmental trend in the play behaviours which was observed in the typically developing

group was not seen in the late talking group. Further the manipulation of the physical and social

context increased the overall frequency of the targeted response in both the groups. While the

typically developing group exhibited more number of play behaviours with instructions alone, the late

talking group required modeling along with instructions to elicit the majority of play behaviours. It

was also found that in both the groups play age correlated with receptive and expressive language.

The developmental differences between various play behaviors and implications for clinical

assessment and management are discussed.

Introduction

Play is defined as any voluntary activity engaged for the enjoyment it gives without

consideration of the end result (Piaget, 1962). Symbolic play is a type of play which involves

simultaneous representation of objects in two ways (real and pretend) and acting out a

concept as perceived by the performer (Venkatesan, 2004). This type of play develops

between 12-36 months in an orderly and predictable manner (Piaget, 1962; Mc.Cune-

Nicolich, 1977; Watson & Fischer, 1977; Bretherton, 1984).

Symbolic play reflects both symbolizing ability and conceptual knowledge and

therefore is considered to have closer links to language (Lewis, Boucher, Lupton & Watson,

2000). Human language whether written, spoken or signed, is unique in being a symbolic

communication system. The first few years of life are the crucial time in which a child

acquires their native language. One of the powerful tool or a prime medium for developing,

learning language and practicing their new acquisition is play. The infants‟ early knowledge

about the world of objects is reflected in their symbolic play behavior which contributes to

__________________________________

* Lecturer in Speech Pathology, All India Institute of Speech and Hearing, Mysore, India




84

later language development. Symbolic play skills are highly representational and abstract and

an assessment of the same would provide us with an insight about the child‟s communicative

abilities.

Several investigators have examined the relationship between play and language.

Although, many studies carried out in the West reveal a parallel relationship between play

and language (Piaget, 1962; Bates, 1976; Westby 1980; McCune-Nicolich, 1981; Baron-

Cohen, 1987; Casby & Della Corte, 1987; Beeghly, Weiss-Perry, & Cicchetti, 1990; Ogura,

1991; Doswell, Lewis, Boucher, & Sylva, 1994; McCune, 1995; Lyytenin & Laakso, 1997;

Lifter & Bloom, 1998; Tomasello, Striano & Rochat, 1999; Kitty, 2000), some studies have

evidenced paradoxical results. Some studies have also revealed that the interdependencies

between language and symbolic skills change over time. The symbolic play abilities of

children with language impairment (developmental/specific language impairment/expressive

language delay) also have been studied by many investigators (Lovell, Hoyle, & Siddall,

1968; Udwin & Yule, 1982; Terrell, Schwartz, Prelock, & Messick, 1984; Roth & Clark,

1987; Terrell & Schwartz, 1988; Rescorla & Goosens, 1992) who found that these children

do not appear to develop complex imaginative symbolic play or, if they do, it happens very

slowly. Moreover some of these studies have reported that symbolic play is delayed relative

to play of age mates but may be more advanced than the play of younger children matched on

expressive language at least in some respect. Thus the exact nature of play and language

relationship remains unclear. There is a dearth of such studies in the Indian context carried

out on late talking children especially those with only expressive language delay in the age

group of 2-3 years.

It is also a known fact that the quality and quantity of symbolic play can be enhanced

or dampened by manipulations of physical materials or social context. For example, McCune-

Nicolich and Fenson (1984) demonstrated that the presentation of organized toy sets appears

to facilitate the production of symbolic play sequences. Using Feuerstein‟s (1980)

terminology, modeling might be considered a form of social mediation by which the child

attains a higher level of performance than he/she can attain independently. Therefore an

attempt was also made to investigate the effect of the social mediation strategies namely,

instruction and modeling on the symbolic play abilities.

Aims of the study

1) To investigate the symbolic play behaviors in typically developing and late talking

children.

2) To study the effect of social mediation strategies in the form of instruction and

modeling on symbolic play behaviours.

3) To examine the relationship between the symbolic play development and language

development in both the receptive and expressive domains.

In addition, the age related changes in the symbolic behavior and the toy and play

preference between genders in both the groups of children were examined.


85

Method

Subjects

A total of twenty children between the ages of 24 to 36 months served as subjects for

the study. The clinical group consisted of ten children in two age groups (24-30 months and

30-36 months) diagnosed as Expressive Language Delay (late talkers). The control group

consisted of ten children matched for gender, age range, socio economic status and child care

history. The criterion for inclusion of children in both the groups was on the basis of their

receptive and expressive language age revealed through the results of Three-Dimensional

Language Acquisition Test (3D-LAT, Geetha Harlekhar, 1986). The receptive and expressive

language age of the children in the control group was within 3 months of their chronological

age. On the other hand, the children in the clinical group had a receptive age which was well

within 3 months of their chronological age while their expressive age was 6 months or more

below their chronological age i.e. the gap between the chronological age and the expressive

age was greater than 6 months. (expressive language delay). The children included in both the

groups had no history of medical problems, emotional, behavioral, cognitive or sensory

disturbances. In addition the WHO Ten-question disability screening checklist (Singhi,

Kumar, Malhi, & Kumar, 2007) was used to rule out any disability for the children in the

control group. Ethical procedures were used to select the participants. The parents were

explained the purpose and the procedures of the study and an informed verbal and /or written

consent were taken.

Procedure

The procedure consisted of two phases; Phase I included the investigation of symbolic

play behaviours and the phase II included the investigation of the relationship between play

and language.

Phase I

Investigation of symbolic play behaviours

To study the symbolic play behavior, two sessions of play were organized in which all

the children participated in two types of play situations namely structured play and free play.

In the free play format a specific set of toys and/or objects was provided to play with in a

natural setting i.e., within their homes. In the first session of the structured play format

thematically related toy sets were given to each child to elicit symbolic play behaviours and

in the second session the same was elicited through social mediation strategies namely

instruction and/or modeling.

First session

a) Structured play: Each child was presented with four sets of thematically related toys, one

set at a time, and they were allowed to interact with them for approximately 5 minutes each.

The sets included several standard toys which would facilitate symbolic play and either a

stick or a block as an item to be transformed.

Set 1: Doll, baby bottle, blanket, stick.


86

Set 2: Stuffed bear, comb, blanket, stick.

Set 3: Two small human figures, horse, soap, block.

Set 4: Truck, human figure, toy screwdriver, two blocks, stick.

b) Free play: Each child was presented toys such as kitchen set, furniture set, doll, blanket,

truck, two small human figures, a comb, small plastic animals etc. which were spread in the

vicinity of the child. The child was invited to play with the toys. The mother was seated in the

room but was asked not to intervene in the child‟s play. This session lasted for approximately

10 minutes. The experimenter did not engage in the ongoing activities, but only redirected the

child‟s focus to the toys if his/her attention wandered before the end of 10 minute period.

Second session: The second session was taken a week after the first session.

a) Free play: The child was presented with the same toys as mentioned above. The same

procedure as in first session was carried out. The play behaviours were assessed for a second

time to examine test to retest reliability of play behaviors.

b) Structured play: Instruction and modeling conditions:

The child was presented with the same four sets of toys as listed in first session. The

codable pretend behaviors at different levels were elicited by the experimenter by giving the

children specific instructions. If these behaviors did not occur on instructions alone, then the

toys were presented once again and the remaining desired actions were demonstrated

accompanied by verbal instructions. For e.g., on presenting the child with a doll and a bottle,

the experimenter said, “Can you give the dolly a bottle?” If the child did not perform the

action requested, a second instruction was given in the form of a command, “Give her some

juice”. In case the child did not perform the behavior with instruction, the experimenter

elicited them by demonstration. For e.g., the experimenter picked up the necessary toys,

pretended to feed the doll with the bottle and handed over both items to the child with the

instruction that, “Can you give the dolly a bottle like that? Now do it”.

All these sessions mentioned above were videotaped. These toys have been selected

on the basis of literature support (Rescorla & Goosens, 1992) with suitable modifications for

Indian context.

Phase II: Investigation of the relationship between play and language

In addition to the free and structured play session, the Assessment Checklist for Play

Skills (Swapna, Jayaram, Prema, & Geetha, 2006) was administered to get their age-

equivalent play scores. This is a checklist standardized on Kannada speaking Indian children

to assess the overall development of play between birth to three years of age. The play

behaviors observed during the free and structured play were used to rate the child‟s play skill

on the assessment checklist. This was done in addition to the information obtained about their

play behavior though parental interviews.


87

Analysis

The symbolic play behaviors such as two basic categories of presymbolic play

(functional play including functional conventional, functional to self and functional to other

and sequential play sub classified into four types A, B, C & D), two types of symbolic play

(symbolism sub classified into three types - A, B & C and verbal symbolism) as well as a

variety of other nonsymbolic behaviors such as grouping, manipulation, wandering and social

interaction were studied.

Data coding for free play: Various types of play behaviors exhibited during free play during

both the sessions were coded from the videotape for frequency of the specified play

behaviors. For e.g., if the child puts a cup on the saucer, it was coded under „functional

conventional‟. Thus each time a play behavior occurred (details provided in the appendix), it

was marked in the response sheet and documented descriptively if required. The qualitative

differences in frequency of symbolic play in the two different age groups were also analyzed.

Data coding for structured play: The following scoring pattern was used. The spontaneous

occurrence of a desired behavior (details provided in the appendix) in the first session was

scored as „3‟, the occurrence of a desired behavior in response to instruction in the second

session was scored as „2‟ and the occurrence of a desired behavior following modeling in the

second session was scored as „1‟. The non occurrence of a desired behavior in the first or

second session was scored as „0‟. The maximum score that can be obtained by a child is „5‟

for each target behaviour with toy sets (3 for spontaneous performance in the first session

plus „2‟ for performance with instruction in the second session).

The raw data from phase I and Phase II was tabulated and further subjected to

appropriate statistical analysis.


Two qualified speech-language pathologists scored the play behaviours seen during

free and structured play. Their ratings were compared to check for the inter-rater agreement.

It was found that there was a high reliability between the two raters i.e., Cronbach‟s alpha

value being (> 0.7 to 1) for both free and structured play. The results obtained on the play

behaviours in typically developing children and late talkers from different statistical analyses

have been presented and discussed under phase I and II:

Phase I: Investigation of symbolic play behaviours

a) Free play analysis:

i) Comparison between control and clinical group: The total frequency of each type of

play was aggregated across the two sessions and the mean, standard deviation and t-values

were calculated which has been depicted in table 1.


88

Table 1: Mean and standard deviation along with t-values for free play behaviours across

both baskets for typically developing children and late talkers

Play behaviour Typically

developing group

Late talking

group t-values

( 18 ) Mean SD Mean SD

Non

symbolic

play

Grouping 5.00 3.16 4.50 4.06 0..31

Manipulation 8.60 4.59 15.60 8.34 *2.32

Social 2.30 1.56 1.10 1.66 1.66

Unoccupied 2.00 1.76 0.40 0.69 *2.66

Pre-

symbolic

play

Functional

conventional 10.30 6.53 5.40 3.37 *2.10

Functional to

self 3.90 4.35 2.90 2.92 0.60

Functional to

other 8.50 6.11 5.80 5.18 1.06

Sequence A 0.90 1.37 0.20 0.42 1.54

Sequence B 2.70 3.71 0.30 0.67 2.01

Sequence C 1.10 1.91 0 0 1.81

Sequence D 0.40 1.26 0 0 1.00

Symbolic

play

Symbolism A 3.10 2.46 1.40 1.64 1.81

Symbolism B 0.70 .823 .30 .483 1.32

Symbolism C 0 0 0 0 -

Verbal

symbolism 1.10 1.85 0 0 0.30

„-‟ indicates both are equal. [*p<0.05]

It can be seen from the table that the mean frequency of different types of play

behaviour observed in late talkers was relatively lesser than that observed in the typically

developing group. However the late talkers exhibited higher frequency of manipulation

behaviour i.e. (mouthing, squeezing etc.) when compared to the typically developing

children. It is a known fact that proper development of symbolic play requires the perceptual

and memory process and the ability to sustain and regulate attention (Tamis-Le Monda and

Bornstein, 1996). In object based symbolic play a child has to divide his or her attention

between toys, transformation, scheme sequencing and the signifier and signified relationship

(Casby, 1997). Thus it would be possible that the late talkers had mild deficits in the higher

level functions of the brain which could have resulted in their poor performance in symbolic

play.

The results of the independent t-test indicated that there was a significant difference

for manipulation (t(18)=2.32), unoccupied (t(18)=2.66) and functional conventional play

behaviours (t(18)=2.10) between the groups at 0.05 level. However, the other play behaviours

failed to show any significant difference. This can be attributed to the scatter in the age of the

subjects considered.

A closer examination of the non symbolic play across all the subjects revealed that the

mean scores were less for unoccupied behaviors. Further, there was a difference in the

unoccupied behaviours seen in both the groups. The unoccupied behaviours in the control


89

group consisted of children moving around the room, checking on with their mothers and

later coming back to the toys for playing. The late talkers, on the other hand, tended to have

fewer occurrences of off-play behaviour, but these appeared to be interludes during which the

child would sit but not be engaged with the toys. The results obtained in the current study for

the manipulation and unoccupied behaviours are in consonance with the results reported by

Rescorla and Goosens (1992). However, the results obtained for grouping and social

behaviours are not in agreement with their study.

The examination of the presymbolic play behaviours revealed maximum number of

functional conventional play behaviors in both the groups of children. This was followed by

functional to other type of play The least score was obtained for functional to self type of

play behavior. But these results appear to diverge from the findings of Watson & Fischer,

(1977); Bretherton, (1984); McCune-Nicolich (1977) and Patterson & Westby (1998) who

reported that the functional to self play behavior occurs before the functional to other kind of

play behavior in the developmental hierarchy of play. This could be because of the fact that

when the child sees many objects, he/she tries to relate these objects to the objects seen in

real life and depict its use in some manner or the other rather than doing any action on self.

Thus the wide variety of toys they are exposed to at a time could have restricted them from

performing the action on self. The functional sequential play behaviours occurred the least.

These results are consistent with Rescorla and Goosens (1992).

With respect to the symbolic play, children in both groups displayed greater number

of symbolism in their play (play behaviors in sequential order and using blocks and sticks as

a substitute for some other object) when compared to the verbal symbolism which involved

verbally creating any action, absent person or verbally substituting one object for another.

These results are also in agreement with Rescorla and Goosens (1992).

In totality, it was found that both the groups of children displayed greater number of

presymbolic play behaviours followed by nonsymbolic and relatively lesser number of

symbolic play behaviours which revealed that the play behaviours are slowly progressing into

the more advanced form. In addition, it was observed that the quality and type of play of the

late talkers was different compared to that displayed by the control group. The late talkers

involved less number of toys in free play, i.e., they continued to play with one or two toys

throughout the session and repeated the same behaviours over time but were able to

appropriately use the toys whereas, the typically developing group exhibited a wide variety of

play behaviours incorporated more number of toys. Thus the late talkers appeared to be less

responsive to the social, thematic, or representational qualities of the toys than the typically

developing children. This has also been reported by Rescorla and Goosens (1992) in their

study.

ii) Comparison of performance between groups within age group: The mean of the free

play behaviours obtained for both the groups of children was analyzed age group wise using

Mann Whitney U test. It was found that there was no statistically significant difference

among the groups within both the younger and the older age group. This could have occurred

because of the smaller sample size considered for the study.


90

iii) Comparison of performance in both groups of children across age groups: The mean

of the free play behaviours in two different age groups considered namely 2- 2.6 years and

2.6-3 years, was subjected to independent t-test to examine if any statistically significant

differences existed between the two age groups. The results indicated that there was no

statistically significant difference across both the age groups in both the control and the

clinical group. However, a developmental trend was observed in the typically developing

group in which the younger group showed more number of nonsymbolic play behaviours

(grouping and manipulation) compared to the older group who exhibited more of presymbolic

(except for functional to self) and symbolic behaviours. These findings can be supported with

the studies of Mc Cune-Nicolich, (1977); Patterson and Westby, (1998); Lyytinen, Laakso,

Poikkeus, and Rita (1999): Katz, (2001); and Casby, (2003) who reported that the play

typically follows a developmental progression in a sequential pattern: simple to complex, self

to others, concrete to abstract. When new types of play develop, „older‟ types of play do not

disappear, although they decrease in frequency.

However, such a developmental trend was not observed in the late talking group

across their age. Some of the play behaviours are scored higher by the younger group

whereas some are scored higher by the older group. This lack of a developmental trend which

was seen in the late talking group indicated that there was a variable performance among this

group and they had delayed/deviant play patterns.

b) Structured play analysis

i) Comparison between both the groups w.r.t different toy sets: The group difference in

play behaviour with respect to different toy sets were analyzed using paired t-test. The

weighted play score, mean and SD values obtained along with the F values obtained for both

the groups are depicted in table 2.

Table 2: Maximum weighted scores, Mean, SD and t-values during structured play with toy

sets, for typically developing and late talking group.

Toy

sets

Maximum

weighted

score

Typically

developing group

Late talking group t-value

(18)

Mean SD Mean SD

Set 1 60 25.00 7.55 17.20 4.91 *2.73

Set 2 60 28.00 6.74 22.10 7.75 1.81

Set 3 55 25.70 10.18 16.80 6.46 *2.33

Set 4 40 22.00 4.54 17.30 4.13 *2.41

[*p<0.05]

It is seen from the table 2 that the typically developing group performed better when

compared to the late talking group with respect to all the four sets and this difference was

statistically significant for three sets i.e., set 1, (t(18)=2.73, p<0.05), set 3 (t(18)= 2.33,

p<0.05) and set 4 (t(18)=2.41, p<0.05). However with respect to set 2 the difference was not

significant. This could be attributed to the familiarity factor of the items included in set 2


91

(comb, brush, quilt, bear). These objects are commonly found in every household and are

used on a daily basis. This resulted in late talking group performing better on this set when

compared to the other sets. This finding is not in consonance with the study done by Rescorla

and Goosens, (1992). They found a significant difference in performance between the two

groups only on sets 2, 3, & 4.

ii) Performance of the groups under social mediation strategies such as modeling and

instruction (Comparison across session I and II of structured play): The performance of

the groups between the structured play session I- spontaneous occurrence and II- elicitation

using social mediation strategies were compared using independent t-test. The maximum play

behaviour in each toy set, mean, SD and the results of the test set wise has been represented

in the table 3 below.

Table 3: Mean, SD and t-values number of targeted responses in structured play (session I)

vs. structured play (session II) by groups.

Toy

sets

Structured

play session

Max. play

behaviour

Typically developing group Late talking group

Mean

scores

SD t-value

(9)

Mean

scores

SD t-value

(9)

Set 1

Session I 12 3.30 1.40

*9.78

2.30 1.15

*10.47 Session II 12 9.10 2.20 8.10 1.59

Set 2

Session I 12 3.30 1.63

*8.61

3.80 2.20

*5.82 Session II 12 9.60 2.31 8.90 1.59

Set 3

Session I 11 3.40 1.57

*9.26

2.40 1.50

*11.00 Session II 11 9.10 1.91 7.90 2.28

Set 4

Session I 8 2.40 1.73

*14.45

2.70 1.05

*8.66 Session II 8 7.70 0.67 7.50 1.08

[*p<0.01]

The data depicted in the table 3 revealed there was a significant difference between

structured play (session I and II) in both the groups. This difference was significant for all the

four sets of toys used (p<0.01). Therefore it can be inferred that the frequency of the targeted

responses increased with social mediation (structured play session II) provided by the

experimenter. Although the late talkers did know and understand the conventional use of the

objects, they did not initiate to come up with related symbolic activities but when they were

prompted to do so by verbal or gestural instructions and modeling they were readily able to

carry out activities meaningfully.

Support can be drawn from the studies done by Watson and Fischer, (1977) and Largo

and Howard, (1979) who reported that the social mediation brings about a positive change in

the play behaviours and it helps to trigger matured forms of play. These results are also in

consonance with the study by Rescorla and Goosens (1992).


92

iii) Comparison between both groups using social mediation strategies: Independent t-test

was carried out to find if any significant difference existed between the late talkers and

typically developing group in each of the social mediation strategy namely instruction and

modeling. The mean, SD and the t-values are depicted in the table 4 given below.

Table 4: Mean, SD and t-values across both the groups under conditions of instruction and

modeling during structured play (session II)

Toy

sets

Max. Instruction t-

value

(18)

Modeling t-

value

(18) Typically

developing

group

Late talking

group

Typically

developing

group

Late talking

group

Mean SD Mean SD Mean SD Mean SD

Set 1 12 4.50 2.22 2.30 1.25 *2.72 2.50 1.43 4.90 1.28 *3.94

Set2 12 7.00 2.35 2.60 1.57 *4.90 1.00 0.94 5.70 1.33 *9.08

Set3 12 6.10 2.55 3.00 2.16 *2.92 1.40 0.69 4.10 2.13 *3.80

Set4 12 5.50 1.58 1.90 1.19 *5.74 0.90 1.10 4.60 1.64 *5.9

[*p <0.01]

The results revealed that both the groups performed better with instructions and

modeling. It was also seen that the typically developing group exhibited more number of play

behaviours in each set of toys with instructions alone and required modeling to elicit only a

few play behaviours, the late talking group exhibited lesser number of play behaviours with

instructions alone and required modeling to elicit the majority of play behaviours. There was

a significant difference between the performance of both the groups with respect to

instruction and modeling on all the four sets at p<0.01 level.

During the data coding a general difference in toy and play preference across gender

was also observed. It was seen that certain sets of toys elicit different symbolic play

behaviours in male and female children. Toys such as doll, bottle, quilt and a stick, bear,

brush, and comb elicited more symbolic play behaviours in girls whereas toys such as truck,

tools, little men, stick and blocks elicited more symbolic play behaviours in boys.

Phase II: Investigation of the relationship between play and language

The Spearman‟s rank correlation coefficient was applied to examine the correlation

between play age and the receptive and expressive language between the age group of 2-2.6

yrs and 2.6-3 years in both the groups of children the results of which have been depictd in

table 5.


93

Table 5: Correlation values between play age, receptive and expressive age across the age

groups in typically developing group and late talkers.

3D-LAT

Typically developing group Late talking group

2-2.6 yrs 2.6 – 3yrs 2-2.6 yrs 2.6 – 3yrs

Play assessment

checklist

RLA ELA RLA ELA RLA ELA RLA ELA

PLA a a 0.60 0.54 0.83 1.00** 0.73 1.00**

[**p< 0.01], RLA- Receptive Language Age, ELA - Expressive Language Age,

PLA - Play Age. a- represents constant value and therefore could not be computed.

The data in table 5 indicates that the play age remained constant in the age group of 2

– 2.6 years in the typically developing children, therefore the correlation among the play age

and other domains could not be computed. However, in the higher age group, that is, 2.6-3

years, the data revealed that there was a correlation between play age and receptive and

expressive language age, but this was not statistically significant. A closer look at the data

revealed that the correlation was high between receptive language age and play age (r=.60)

when compared to the correlation between expressive language age and play age (r=0.54).

In the late talking group, play age correlated with receptive and expressive language

age in both the age groups. The correlation between play age and expressive language age

was significant (p<0.01) in both the age groups considered, while the correlation between

play and receptive language age in the lower and higher age group was not significant. It was

also seen that the correlation between play and the receptive language age was higher in the

younger age group (r=0.83) than the older age group (r= 0.73). It can be inferred that across

the early age of 2-3 years the play age correlated with expressive rather than receptive

language in late talkers. However in late talkers it was observed that play age correlated more

with receptive language in both the age groups (r=0.83, 0.73) than in the typically developing

group (r=0.60). This could be attributed to the fact that that there was not much variation in

the play age and the receptive language age across subjects.

Thus it can be inferred that play is associated with language and that play parallels

expressive language in late talkers which in turn reflects slower maturation of a complex

developmental system of symbol use. Hence it could be argued that play and language are

mediated by a general developmental factor. The results of the present study are in agreement

with several studies carried out on typically developing children (McCune-Nicolich, 1981;

Baron-Cohen, 1987; Casby & Della Corte, 1987; Beeghly et al., 1990; Ogura, 1991; Doswell

et al., 1994; McCune, 1995; Lyytenin & Laakso, 1997; Lifter & Bloom, 1998; Tomasello et

al., 1999; Kitty, 2000; Lewis et al., 2000).


94

Conclusions

To conclude the late talkers in general have poorer symbolic play abilities compared

to the typically developing children. They exhibited lesser presymbolic and symbolic play

behaviours compared to the typically developing group. While a developmental trend was

observed in the typically developing group in which the younger group showed more number

of nonsymbolic play behaviours (grouping and manipulation) compared to the older group

who exhibited more of presymbolic (except for functional to self) and symbolic behaviours,

such a trend was not seen in the late talkers. Moreover, the social mediation (instructions and

modeling) had a definite positive effect on the symbolic play performance in both the groups.

The typically developing group exhibited more number of play behaviours with instructions

alone, however, the late talking group required modeling along with instructions to elicit the

majority of play behaviours. With regard to the play-language relationship, it was found that

in both the groups play age correlated with receptive and expressive language. In the

typically developing children, play age correlated more with receptive language, however in

the late talking group play age correlated more with expressive language age. This indicated

that the lower expressive language ability in late talkers was associated with poorly

developed symbolic play skills.

Cautions must be taken while drawing inferences from this study given the small

numbers of participants and reliance on correlation analysis, which does not clarify causal

relations. Nevertheless, the study has important implication for early childhood assessment

and intervention. This study suggests that it is crucial to examine several domains of

functioning within the same child, only then can the relationships between various skills be

revealed. Furthermore, focusing on skills common to symbolic play, cognition and language

during intervention should also be an important aspect of intervention as they have been

found to impinge on language capacities as the child matures. The findings of such research

might contribute to theories of language development as well as assist clinicians in designing

accurate screening procedures.

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Appendix

I List of play behaviors observed during free play

Nonsymbolic play

Wandering/unoccupied – Behaviours not involving any active interaction with objects or

individuals in the room.

Manipulation/handling- Involves child‟s visual and kinesthetic exploration and

manipulation of toys.

Grouping: Placing two or more like objects together in a group, line or stack.

Presymbolic play

Functional conventional (Presymbolic scheme): Behaviours indicating that child knows the

functionally appropriate use of an object

Functional to self (Auto symbolic scheme): Functionally appropriate use of an object on

oneself.

Functional to other (De-centered symbolic games): Involves performance of a pretend

action upon a recipient other than self.

Sequence Type A: Two or more consecutive but different actions, one or more which is

functional conventional.

Sequence Type B: Same recipients (two or more consecutive and) but different actions.

Sequence type C: Two or more recipients/ (two or more consecutive and) same actions.

Sequence Type D: Two or more recipients/ (two or more consecutive but) different actions.

Symbolic play

Symbolism Type A: Substitution of one object for another. Using objects in a manner

different from its intended functional use.

Symbolism type B: Pretending to use an absent object, creating an absent person, or

referring to an absent substance.

Symbolism Type C: Animating the doll or animal as an independent and active agent.

Verbal symbolism:

Verbal Transformation: Verbal substitution of one object for another

Verbal creation of object: Verbally creating an absent person or object by referring to it.

Verbal animation: Verbally creating action, animating an object or toy with no

accompanying action.

Social interaction

Child initiated social games: Play behaviour involving an adult in the room without

functional or symbolic use of an object.

Child-initiated social interaction: Active or verbal non- play behaviour initiated by the child

and directed by an adult

II Targeted behavior for structured play:

I Set 1(doll, baby bottle, blanket, stick):

Functional conventional – Spreading the Blanket

Functional to self 1- Drinking from bottle

Functional to self 2- covering self with blanket

Functional to other 1- Feeding the doll with baby bottle

Functional to other 2- Covering doll with blanket

Sequence A- Spread the blanket and put the doll in the blanket

Sequence B- Feeding doll and then putting it to sleep


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Sequence C-Feeding doll, make it drink water and then put to sleep

Sequence D- Feeding doll, make it drink water, cover self with blanket and then both go to sleep

Symbolism A- Feeding doll with stick as bottle

Symbolism B- Feeding doll with pretend bottle

Symbolism C- Having doll to spread the blanket

II Set 2 (stuffed bear, comb, blanket, stick)

Functional conventional – Spreading the blanket

Functional to self 1- Combing own hair

Functional to self 2- Covering self with blanket

Functional to other 1- Combing bear with comb

Functional to other 2- Covering bear with blanket

Sequence A- Spread the blanket and put animal to sleep

Sequence B- Combing bear‟s hair and putting it to sleep

Sequence C- Combing bear‟s hair and own hair

Sequence D- Combing bear‟s hair, covering self with blanket, and both go to sleep

Symbolism A - Combing bear with stick as brush

Symbolism B- Combing bear with pretend brush

Symbolism C- Making bear to spread blanket

III Set 3 (two small human figures, horse, soap, block)

Functional conventional- Moving the truck

Functional to self 1- Soaping own body

Functional to self 2- Self riding on the horse

Functional to other - Washing horse with soap

Functional to other 2- Giving the little man a ride on horse

Sequence B- Washing horse with soap and giving the little man a ride

Sequence C- Soaping horse and then own body

Sequence D- Making the little man pat horse and giving the little lady a ride

Symbolism A- Washing horse with block as soap

Symbolism B- Washing horse with pretend soap

Symbolism C- Making the little man wash the horse

IV Set 4 (truck, human figure, toy screwdriver, two blocks, stick)

Functional conventional – Loading truck with block

Functional to other 1- Fixing truck with toy screwdriver

Functional to other 2- Giving the little man a ride on truck

Sequence A- Loading truck with blocks and making the little man ride on truck

Sequence B- Fixing truck with screwdriver and giving the little man a ride in truck

Symbolism A- Fixing truck with stick as a tool

Symbolism B- Fixing truck with pretend tool

Symbolism C- Making the little man drive the truck

Subtyping of Children with Developmental Dyslexia

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Subtyping of Children with Developmental Dyslexia: Implications through

Dual Route Cascaded (DRC) Model in the Indian Context

Gnanavel. K & Jayashree. C. Shanbal*

Abstract

Reading is a complex cognitive process. It involves the co-ordination of a series of functions

which include visual functions such as configurational (feature) and orthographic (word form)

analyses and verbal or language functions such as phonological, semantic and syntactic coding and

decoding and other cognitive functions like memory and attention. The complexity of reading task is

clearly illustrated in recent computational models of reading (Coltheart, Rastle, Perry, Langdon, &

Ziegler, 2001; Perry, Ziegler, & Zorzi, 2007). Dual Route Cascaded Model (DRC) by Coltheart, Rastle,

Perry, Langdon and Ziegler (2001) is considered to be the most successful one in explaining visual

word recognition and reading aloud. The purpose of the present study was to explore the subtypes of

children with developmental dyslexia based on the dual route cascaded model and to assess each

representational level of the DRC model (Coltheart et.al 2001). Two groups i.e., age matched normal

children (40) and children with dyslexia (16) from grades III to VI were considered for the study.

Subjects were tested on tasks for each representational level of the model. The accuracy and reaction

time of their responses were measured and recorded using DMDX software. Overall, children with

dyslexia performed significantly poorer in all the tasks than normal children. .The results revealed that

on Subtyping in children with dyslexia there was no single isolation deficits observed and multiple

deficits were observed based on DRC model. However, cluster analysis and qualitative analysis of the

data could group the clinical data into two subtypes- phonological and mixed type of dyslexia. Subtyping

has further implication in selecting the appropriate strategy for these children in the management

program.

Introduction

Reading is a complex cognitive process. It involves the co-ordination of a series of

functions which include visual functions such as configurational (feature) and orthographic

(word form) analyses and verbal or language functions such as phonological, semantic and

syntactic coding and decoding and other cognitive functions like memory and attention and

motor skills. The complexity of reading task is clearly illustrated in recent computational

models of reading (Coltheart, Rastle, Perry, Langdon, & Ziegler, 2001; Perry, Ziegler, & Zorzi,

2007). Dual Route Cascaded Model (DRC) by Coltheart, Rastle, Perry, Langdon and Ziegler

(2001) is considered the most successful one in explaining visual word recognition and

reading aloud. As the name suggests, the DRC model has two core assumptions. First,

processing throughout the model is cascaded. That is, any activation in earlier modules starts

flowing to later modules immediately. Second, there are two routes for translating print into

sound: a lexical route, which utilizes word-specific knowledge, and a non-lexical Grapheme-

to-Phoneme Conversion (GPC) route, which utilizes a sub-lexical spelling-sound

correspondence rule system.

________________________________

* Lecturer in Language Pathology, All India Institute of Speech and Hearing, Mysore, India


Dissertation Vol. VII, Part – B, SLP, AIISH, Mysore

100

Figure1: Architecture of DRC model by Coltheart et al. (2001)

The lexical route translates the pronunciation of a word based on word specific

knowledge. The route consists of components: the orthographic lexicon, semantic and the

phonological lexicon, as seen in the left part of Figure1.The semantic system computes the

meaning of a word, whereas the lexicons compute the words‟ orthographic and phonological

form. Representations of a word in the orthographic lexicon and the phonological lexicon are

linked so that activation in one leads to activation of the other. For instance, the letters “c,”

“a” and “t” will activate the orthographic representation of “cat,” which will then activate its

phonological representation of /kæt/. Frequency scaling is also applied to each orthographic

and phonological lexicon. Thus, a high frequency word such as “the” will be named faster

than a low frequency word such as “quench.”

The non-lexical route differs from the lexical route in both the knowledge base and

the type of processing it employs. The non-lexical route generates the pronunciation of letter

string (be it a word or a non-word) via a set of sub-lexical spelling-sound correspondence

rules. The set of rules is encapsulated in the GPC module. One important feature of the GPC

module is that its processing is serial. The GPC module applies rules serially left to right to a

letter. That is, letters activate phonemes in a serial, left to right fashion. Activation of the

second phoneme does not start until a constant number of cycles after the start of activation

of the first letter. For example, given a non-word like „bant‟, the corresponding translation

would be: B -> /b/, A -> /æ/, N ->/n/, and T -> /t/. Coltheart et al. (2001) argue that the non-

word letter length effect produced by DRC model is a direct consequence of serial processing

in the GPC module. That is, because GPC processes letters serially, the time to name a non-

word increases as the length of non-word increases.

According to the DRC model, successful reading depends on the interaction of

sublexical and lexical procedures. Only when both of these procedures are functioning

adequately, is then an individual able to read all forms of text. The sublexical procedure

decodes novel letter strings via grapheme/ phoneme correspondence rules that exist in

alphabetic writing systems. A break within the lexical or the sublexical routes can affect

reading ability in a few children often referred to as children with dyslexia. Although several

different subtypes of acquired dyslexia have been proposed to equate to developmental

dyslexia counterparts (Rayner, Murphy, Henderson & Pollatsek, 1989), the most influential

corresponds to the auditory versus visual dichotomy. Castles and Coltheart (1993) proposed


101

that these phonological and surface subtypes of acquired dyslexia also existed within the

developmental dyslexic population. A break within the sublexical route results in the subtype

of acquired dyslexia referred to as phonological dyslexia. Individuals who have acquired

phonological dyslexia experience difficulties decoding unfamiliar words since the only way

to read a novel letter string that is not represented in sight vocabulary is to implement some

process of decoding (Funnell, 1983). The symptom most often associated with phonological

dyslexia is, therefore, a difficulty with the reading of non-words.

A break within the lexical procedure results in a subtype of acquired dyslexia referred

to as surface dyslexia (Behrmann & Bub, 1992). The defining characteristic of surface

dyslexia is, therefore, a difficulty with reading irregular words. The aim of the present study

is to investigating the subtypes of children with developmental dyslexia based on the dual

route cascaded model and to assess each of representational level of the DRC model.

Method

Participants

Two groups of subjects were considered for the present study, an experimental group

and a control group. The experimental group consisted of 16 dyslexic children (8-12yrs). And

the control group consisted of 40 age matched normal children and they were 10 children in

each grade from III, IV, V and VI with equal number of males and females. And none of the

children in both the groups had any known or reported hearing, neurological, developmental

or emotional problems.

Subject selection criteria

Age range of both Experimental and Control group was 8-12yrs.

Native language of both Experimental and Control group was Kannada and studied

English as the medium of instruction.

A WHO Ten –Question Disability Screening Checklist (cited in Singhi, Kumar,

Prabhjot & Kumar, 2007 ) and Developmental Screening Test (Bharath Raj, 1972),

was used to screen both the groups in terms of hearing, intelligence, motor and other

factors like school performance, emotional or behavioral factors.

Early reading skills (Loomba, 1995) was used in the selection of dyslexic children.

Computerized Linguistic Protocol for Screening (CLIPS; Anitha, 2004) was used for

screening children for language abilities.

All the children with dyslexia were assessed by a clinical psychologist for their

intelligence quotient (IQ), and were reported to be average or above average.

Test materials

Stimuli included 50 regular words and 50 irregular words taken from the class books of

grade III to VI. Pictures included 100 common line drawings taken from UNICEF picture cards

and from hundred picture naming test. For the familiarity check, from these groups of pictures and

words, 10 most familiar regular and irregular words which were matched in length were taken for


102

the present study. Twenty pronounceable pseudo words were also taken for the present study and

these selected words were presented through DMDX software 3.13.0 (Forster & Forster, 2003)

for about 250 ms.

Procedure

The participants were seated in a comfortable position facing the 15-inch screen of the

laptop in a quiet room.

The responses were recorded through a high quality microphone placed at a distance of 10

cm from the participant‟s mouth.

The following tasks were carried out in the present study

1. Reading task

The participants were instructed to read the stimuli aloud. The stimuli included 20 non

words, 10 regular words, and 10 irregular words .Regular and irregular words were matched in

terms of length and word familiarity. Non-words were created by changing the onset, the vowel or

the coda of an existing word that was matched in terms of frequency and length to the regular and

irregular words. The items were presented at the centre of the computer screen. DMDX

experimental software version 3.1.3.0 (Forster & Forster, 2003) was used for the experiment.

Participants‟ responses were recorded with a voice key and saved as separate wave files. Reaction

time was measured from the appearance of the stimulus on the screen until the participant

begins to utter the response and for accuracy the number of correct responses were assessed

2. Letter search task

The task was to search for a target letter embedded in a letter string. Following an initial

fixation point, a target letter (e.g., „„A‟‟) which will appear on the computer screen for 500 ms

(milliseconds) followed by the stimulus (word or unpronounceable letter string), which stays

on the screen until the participant presses one of the two response buttons to indicate whether

the target letter was present or not in the stimulus. The stimuli include 20 five-letter words and

20 five-letter nonwords (i.e., unpronounceable letter strings). Identity and position of the

target letter were matched across words and nonwords (e.g., „„R‟‟ in „„boire‟‟ versus

„„ghyrc‟‟). To avoid visual matching strategies, target letters were presented in upper case and

letter strings were presented in lower case. The accuracy and reaction time were assessed.

3. Picture naming task

Two sets of five line drawings of familiar objects were selected from UNICEF picture

cards a database for picture naming. All pictures names had a consonant-vowel-consonant

(CVC) structure. There was no phonological overlap between them. The pictures were checked

for familiarity and name agreement.

The objects were displayed in the centre of the computer screen one per trial.

The participant‟s task was to name the object as quickly as possible. The two lists

of five objects were repeated in pseudo-random order 10 times each (i.e., a total


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of 50 naming responses per list). During training, participants were, first presented

with a sheet that contained the five objects in an unspeeded naming task. Following

training, participants were asked to perform the picture naming task twice, once using the

items of list 1 and once using the items of list 2 (counterbalanced across participants). During

the test, participants‟ responses were recorded with a voice key. Each response was saved as a

sound file. The accuracy and reaction time were assessed.

4. Phoneme matching

Participants were asked to assess the phonological similarity of spoken words either

for the initial or the final phoneme. On each trial, three spoken CVC words were presented.

Two of them shared either the initial or the final phoneme. The participants‟ task was to indicate

which item did not share the initial or the final phoneme. To facilitate the task, phoneme

position was blocked (first position block versus final position block). The order of blocks

was counterbalanced across participants. The accuracy and reaction time were assessed

Results

Broadly the results were analyzed for accuracy and reaction time (RT) measurements

for performance of normal children and children with dyslexia on all the tasks. The results are

described below in the following sections,

I. Comparison of performance of normal children and children with dyslexia

(CWD) on reading tasks

Accuracy measurements on reading tasks

Mixed ANOVA was carried out for accuracy measures across grades in normal children

and the results showed an overall significant main effect on reading tasks across grades i.e.,

F (2, 72) = 93.22, p<0.001.

Reading Tasks

RNWIWRW

Mea

n Ac

cura

cy (i

n %

)

110

100

90

80

70

60

50

Grades

III

IV

V

VI

Figure 2: Comparison of mean accuracy of reading tasks across grades in normal children.

One- way ANOVA was carried out for accuracy measures for reading tasks (RW, IW

and NW) across grades. The results revealed that there was a significant difference in reading

RW, F (3, 36) = 2.874, p< 0.05, reading NW, F (3, 36) = 3.06, p< 0.05 in normal children and

overall reading performance F (3, 36) = 3.021, p< 0.05.


104

Reading Task

RNWIWRW

Mea

n A

ccur

acy

( in

% )

110

100

90

80

70

60

50

40

30

20

10

0

Grades

III

IV

V

VI

Figure 3: Comparison of mean accuracy for reading tasks across grades in CWD

Mann- Whitney test revealed that this was statistically significant across groups and

across tasks (RW, IW & NW).The results showed that there was a significant difference

between CWD and normal children.

Repeated measures ANOVA was computed for within subject effects on each grade

separately for accuracy measures of reading tasks in normal children. In grade III, there was

an overall significant main effect on reading tasks i.e., F (2, 18) = 22.22, p< 0.001. In grade

IV, results showed that there was an overall significant main effect on reading tasks i.e., F (2,

18) = 17.96, p<0.001. In grade V, there was an overall significant main effect on reading

tasks i.e., F (2, 18) = 10.07, p<0.05. In grade VI, results showed there was an overall

significant main effect on reading tasks i.e., F (2, 18) = 15.7, p<0.001.

Wilcoxon singed rank test results revealed that there was a significant difference found

for reading RW and NW and for reading IW and NW at 0.05 levels. Mann- Whitney test

revealed that there was any significant difference on accuracy measures of reading tasks

within each grade for normal children and children with dyslexia

Reaction Time measurements on reading tasks

Mixed ANOVA was carried out across grades in normal children. The statistical

results showed an overall significant main effect in the reading tasks across grades i.e.,

F (2, 72) = 56.61, p<0.001. The results of one-way ANOVA for RT on reading tasks across

grades revealed that there was a significant difference in reading RW, F (3, 36) = 2.87,

p<0.05 and reading IW, F (3, 36) = 2.77, p<0.05 in normal children.


105

Reading Tasks

RNWIWRW

Mea

n R

eact

ion

Tim

e (R

T) (

in m

s)

2400

2200

2000

1800

1600

1400

1200

1000

800

600

Grades

III

IV

V

VI

Figure 4: Comparison of mean reaction time for reading tasks across grades in normal

children.

Mann- Whitney test results showed that there was a significant difference for reading

RW, IW and for the overall reading performance between CWD and normal children. But

there was no significant difference for reading NW between the groups.

Reading Tasks

RNWIWRW

Mea

n R

eact

ion

Tim

e (R

T) (

in m

s)

2400

2200

2000

1800

1600

1400

1200

1000

800

600

Grades

III

IV

V

VI

Figure 5: Comparison of mean reaction time for reading tasks across grades in CWD


separately for reaction time measures of reading Tasks. In grade III, there was an overall

significant main effect on reading tasks i.e., F (2, 18) = 22.22, p<0.001. In grade IV,

Repeated measures ANOVA results showed there was an overall significant main effect on

reading tasks i.e., F (2, 18) = 17.96, p<0.001. In grade V, Repeated measures ANOVA results

showed there was an overall significant main effect on reading tasks i.e., F (2, 18) = 10.07,

p<0.05. In grade VI, Repeated measures ANOVA results showed there was an overall

significant main effect on reading tasks i.e., F (2, 18) = 15.7, p< 0.001.

II. Comparison of performance of normal children and children with dyslexia on

different components of the DRC model.

Accuracy measurements for DRC component tasks

Mixed ANOVA was carried out across grades in normal children and the results

showed an overall significant main effect in the DRC component tasks across grades i.e., F


106

(3, 108) =52.43, p<0.001. One- way ANOVA was carried find out is there any significant

difference in the performance of normal children in terms of accuracy measures of reading

tasks across grades. The results revealed that there was a significant difference in PN, F (3,

36) = 4.93, p<0.05

Tasks

PMPNLSLSNWLSW

Mea

n Ac

cura

cy (i

n %

)

110

100

90

80

70

60

50

Grades

III

IV

V

VI

Figure 6: Comparison of mean accuracy of DRC component tasks across grades in normals.

Mann- Whitney test was done for analyzing the accuracy measures across groups. The

results showed that there was a significant difference at 0.05 levels all the tasks which check

the components of the model between dyslexic and normal children.

Tasks

PMPNLSLSNWLSW

Mea

n Ac

cura

cy (

in %

)

110

100

90

80

70

60

50

40

30

20

10

Grades

III

IV

V

VI

Figure 7: Comparison of mean accuracy of DRC component tasks across grades in CWD

Repeated measures ANOVA showed that performance in terms of accuracy measures

revealed that in grade III, there was an overall significant main effect on reading tasks i.e., F

(3, 27) = 13.102, p<0.001. In grade IV, results showed there was an overall significant main

effect on reading tasks i.e., F (3, 27) = 14.766 p<0.001. In grade V, results showed there was

an overall significant main effect on reading tasks i.e., F (3, 27) = 19.439 p<0.05. In grade VI

normal children, results showed there was an overall significant main effect on reading tasks

i.e., F (3, 27) = 8.486, p< 0.001.

Wilcoxon singed rank test results revealed that there was a significant difference

found for the PM and PN and for PM and LSW, PM and LSNW. Mann- Whitney test was

done for each grade across both the groups. The results showed that in grade III, PN, LSNW

and over all letter search showed a significant difference across groups (CWD and Normal

children) at 0.05 levels. In grade VI, LSNW and over all LS showed a significant difference

across groups at 0.05 levels. In grade V all the component tasks showed a significant

difference across groups at 0.05 levels. In grade VI, PN, LSNW and PM tasks showed a

significant difference across groups at 0.05 levels.


107

Reaction Time measurements of DRC component tasks

Mixed ANOVA was carried out across grades in normal children, the results showed

an overall significant main effect in the reading tasks across grades i.e.,

F (3, 108) = 10.71, p<0.001. One- way ANOVA was carried out in normal children to find

out is there any significant difference in the RT measures of component tasks across grades.

The results revealed that there was a significant difference in letter search words, F (3, 36) =

5.1, p< 0.05, letter search nonwords words, F (3, 36) = 4.36, p<0.05 in normal children and

overall letter search performance F (3, 36) = 5.07, p<0.05

Tasks

PMPNLSLSNWLSW

Mea

n R

eact

ion

Tim

e ( R

T)( i

n m

s)

2400

2200

2000

1800

1600

1400

1200

1000

800

600

Grades

III

IV

V

VI

Figure 8: Comparison of mean reaction time (RT) of DRC component tasks across grades in

normal children.


separately for RT measures in normal children on component Tasks. In grade III, there was

an overall significant main effect on component tasks i.e., F (3, 27) = 3.58, p< 0.05. In grade

V normal children, there was an overall significant main effect on reading tasks i.e., F (3, 27)

= 5.02, p< 0.05.

Wilcoxon singed rank results revealed that there was a significant difference in

performance for the pairs PN and PM, for PN and LSW, PN and LSNW at 0.05 levels.

Mann- Whitney test was done for each grade across both the groups. In grade IV there was a

significant difference for LSNW and overall performance on LS at 0.05 levels. For grader V,

there was a significant difference for PN task at 0.05 levels and not for LSNW, LSW and PM

tasks.

Tasks

PMPNLSLSNWLSW

Mea

n R

eact

ion

Tim

e ( R

T) (

in m

s)

2400

2200

2000

1800

1600

1400

1200

1000

800

600

Grades

III

IV

V

VI

Figure 9: Comparison of mean reaction time (RT) of DRC component tasks across grades in

children with dyslexia.


108

To summarize, the performance in terms of accuracy and RT measures in CWD was

significantly poor in comparison with normal children on all the component tasks. CWD

performed poorly on PM tasks compared to LSW and LSNW, PN tasks.

III. Subtypes of dyslexia derived from the DRC model

Hierarchical cluster analysis was done for the purpose of Subtyping children with

developmental dyslexia. In this method the clusters were represented in dendrograms for the

tasks which tests the component in the nonlexical route/sublexical route (phonological tasks)

and also for the lexical route (non phonological tasks) in the dual route cascaded model

(Coltheart et al., 2001)

Phonological Tasks

Hierarchical Cluster analysis for phonological tasks on children with dyslexia

revealed that cluster I {4, 15, 10} performed poorly on phoneme matching and reading

nonwords, cluster II {8, 16, and 12} also showed poor performance in phoneme matching and

nonword reading and cluster III{6, 11}and IV {5, 14} also showed poor performance on the

above same tasks. Cluster V {2, 3} and cluster VI {7} showed poor performance only on

nonword reading and these cluster was later joined by subjects 1 and 9. And this cluster V

was less severe when compared to the above four clusters (I, II, III, IV) on phonological

tasks.

Non-Phonological Tasks

Hierarchical cluster analysis non-phonological tasks in CWD revealed that the Cluster

I {1, 12} and cluster IV {3} which had poor performance in reading irregular words and V

{6, 13} had poor performance in reading irregular words only. Cluster II {14, 15} had poor

performance in letter search words and reading regular words. Cluster III {4, 16} both had

the poor performance in letter search words and reading irregular words. Here clusters (I, IV,

V) are very less severe than cluster II and III because they had poor performance in only one

task (reading irregular words). Clusters VII {2} and VIII {9, 10} had poor performance in all

of the non-phonological tasks and so they are more severe in type than the other clusters.

Table 1. Subtyping of children with dyslexia based on phonological and non-phonological

tasks.

subjects

(CWD)

Phonological tasks

accuracy (%)

Non-phonological tasks

accuracy (%)

subtypes of

dyslexia

1 RNW (20%) RIW (40%) Mixed

2 RNW (10%) RRW (30%), RIW (30%), PN (13%) Mixed

3 RNW (0%) RIW (0%) Mixed

4 PM (20%), RNW (0%) LSW (45%), RIW (30%) Mixed

5 PM (40 %), RNW (25%) RIW (30%) Mixed

6 PM (30 %), RNW (20%) RRW (40%) Mixed

7 RNW (15%) - Phonological

8 PM (20 %), RNW 10%) RIW (20%) Mixed

9 RNW (0%) RRW (0%), RIW (0%) Mixed

10 PM (30 %), RNW (0%) LSW (45%), RRW (0%), RIW (0%), Mixed


109

11 PM (30 %), RNW (15%) - Phonological

12 PM (20 %), RNW (10%) RIW (30%) Mixed

13 PM (30 %), RNW (5%) RRW (40%) Mixed

14 PM (30 %), RNW (20%) RRW (50%) Mixed

15 PM (40 %), RNW (25%) LSW (30%), RRW (30%), Mixed

16 PM (10 %), RNW (10%) - Phonological

Table 1 summarizes the Subtypes of children with developmental dyslexia based on

the lexical and nonlexical route; this table revealed that subjects {7, 11, and 16} are purely

phonological dyslexics because they performed poorly on phonological tasks and better on

non-phonological tasks. And all other subjects performed poorly on both the phonological

and non-phonological tasks so they are grouped into mixed dyslexics {1, 2, 3, 4, 5, 6, 8, 9,

10, 12, 13, 14, 15}. There were no pure surface dyslexics found in the present study.

Discussion

The results and the findings of the present study are discussed below in the following

sections,

Performance of normal children and CWD on reading tasks

The performance of normal children on accuracy measures improved from lower

grades to higher grades thus indicating a developmental trend on irregular word reading tasks

and on reaction time measures this trend was found on reading irregular words and nonwords

but not for regular words. This developmental trend could be explained using dual route

cascaded (DRC) model (Coltheart, Rastle, Perry, Langdon, & Ziegler, 2001). In the present

study there was a significant difference across the tasks [regular words (RW), irregular words

(IRW) and non-words (NW)]. Among the reading tasks, accuracy and reaction time measures

was poorer on nonword reading task compared to irregular and regular words in normal

children. These results are in consonance with the study by Burani et al., (2002) who derived

reaction times (RTs) for naming non-words in third- to fifth-grade children. They attributed

the difference in performance effect of younger graders to the older one due to

morphological structure ,that nonwords made up of roots and derivational suffixes which

looks similar to words are read quickly than the nonwords no morphological constituency.

And the reaction time for naming reduced as the grade levels increased.

In the present study, children with dyslexia (CWD) performed poorly on all reading

tasks compared to normal children on both accuracy and reaction time measures. On nonword

reading task CWD performed poorly compared to irregular and regular word reading. This

poorer performance on nonword reading in CWD could be explained using the DRC model

(Coltheart et.al, 2001). When there is a problem in the GPC module and proper phoneme to

grapheme correspondence doesn‟t take place this leads to the impaired sublexical route, so

more errors were seen in the nonword reading. These results are in consonance with the study

by Landerl, Wimmer and Firth (1997) who studied nonword reading in 12 year old CWD and


110

reading level matched normals. Their results revealed that CWD performed poorer on

nonword reading compared to reading level matched controls.

Results also revealed that poorer performance on irregular word reading in CWD

compared to normals and this could be explained using DRC model (Coltheart et.al 2001).

For reading irregular words, there should be an intact lexical nonsemantic route which

doesn‟t involve the semantic lexicon and there is a direct connection between the

orthographic lexicon and phonological lexicon (see fig1). These results were in consonance

with the study by Coltheart and Leahy (1996) who reported that learning to read in English is

characterized by a slow increase in accuracy, although this is quite apparent for irregular

words, many errors in reading regular words can still be expected even after several years of

schooling.

Performance of normal children and CWD on different components of the DRC model.

In the present study, poor performance on letter search task for nonwords were seen in

normal children for both latency and accuracy measures. This could be explained through

DRC model (Coltheart et.al, 2001) (see Figure 1). According to this model, the letter search

task involves letter processing i.e. the letter unit component of the model (Ziegler, Van

Orden, &Jacobs, 1997), where each letter in the word is processed visually and sent to the

orthographic lexicon. If there is a problem in the letter unit processing it can lead to delay in

the letter search task or can indicate reduced accuracy and latency measures. The results also

revealed that accuracy and reaction time measures on letter search words and nonwords were

poorer compared to normal children. This poorer performance could be explained through the

DRC model (Coltheart et.al, 2001). There may be impaired connection between the letter unit

and the orthographic lexicon or problem at the level of letter unit processing. And problem at

the level of letter units causes visual processing errors. Such errors were reported in a number

of recent studies as well (Bosse, Tainturier, & Valdois, 2007)

On picture naming tasks (PN), the results of the present study showed that in normal

children the performance was better in terms of both accuracy and reaction time measures.

This could be explained taking support from the DRC model (Coltheart et al, 2001). Picture

naming tasks are supposed to involve access to the phonological lexicon in the lexical route

(Wolf & Bowers, 1999). Here there is no involvement of the letter units and orthographic

lexicon because of no written form. So it directly accesses the phonological lexicon for

naming the picture (see Figure 1).

The results also revealed that there was no significant difference in accuracy measures

on rapid picture naming tasks for both normal and CWD group. However, there was a

significant difference in the reaction time measures for phoneme matching tasks for both the

groups. Longer reaction time in CWD may be due to the delayed processing that takes place

in the phonological lexicon which results in the longer processing time. Wolf and Bowers

(1999) opined that deficits in rapid naming are most strongly associated with deficits in the

development of orthographic representations for words.


111

On phoneme matching tasks, the results of the present study revealed that both

normal children and CWD performed poorer on phoneme matching (PM) tasks. When

compared to normal children, CWD performed poorer on this task. The reason for this

trend in n could be explained by DRC model (Coltheart et al, 2001). Phoneme matching

task measures the capacity to detect and manipulate phonemes while not requiring

orthographic or visual-attentional processes. Although phoneme matching does not directly

measure the GPC procedure, the claim is that meta-linguistic awareness of individual

phonemes is necessary to create grapheme–phoneme mappings (Hulme, Caravolas, Malkova,

& Brigstocke, 2005).

Subtypes of dyslexia derived from the DRC model.

Hierarchical cluster analysis results showed that the performance of the children with

dyslexia on reading tasks and tasks related to the components of the model did not find a

convincing interpretation of the subtypes in terms of single dissociated deficits. Rather than

having a single deficit on either the lexical or nonlexical route, surface and phonological

dyslexics seem to have multiple deficits in both the lexical and sublexical route. The findings

are in consonance with the study by Pennington (2006) who has discussed the existence of

heterogeneity in developmental dyslexia. From the cluster analysis and the qualitative

analysis two major subtypes of dyslexia were derived which included phonological and

mixed subtypes. Literature review suggests broadly three subtypes of developmental dyslexia-

phonological, surface and mixed type or unclassified (Castles & Coltheart, 1993; Ziegler,

Castel, George, & Perry, 2008).

The existence of phonological and mixed subtypes of dyslexia in the present study

can be explained taking support from the DRC model (Coltheart, Rastle & Perry, 2001). In

the present study, three out of sixteen children were found to be phonological subtype {7, 11,

and 16} of dyslexia (see Table). And these children have been found to perform poorly on

phonological related tasks like nonword reading (NW), phoneme matching (PM) and letter

search nonwords (LSNW). These results were in consonance with the study by Castles and

Coltheart (1993) identified pure developmental phonological dyslexics among CWD and

their nonword reading was found to be poor compared to chronological age- matched

controls, but their exception word reading was within normal range. Castles and Coltheart

(1993) concluded that these results were best interpreted in terms of a dual route model, with

the subtype profiles representing different levels of development of the lexical and nonlexical

procedures.

Thirteen out of sixteen were found to be of mixed subtype

{1,2,3,4,5,6,8,9,10,12,13,14,15} of dyslexia(see Table 5). And these children have been

found to perform poorly on phonological tasks like nonword reading (NW), phoneme

matching (PM) and letter search nonwords. (LSNW) and non-phonological related tasks like

picture naming (PN), letter search words, reading regular (RW) and irregular words (IRW).

These results could be explained using the DRC model (Coltheart et.al 2001). When both the

lexical route and sublexical route are affected, it may show up errors in both phonological


112

tasks and non phonological tasks. Most of the errors that were seen when both the routes are

affected are of irregular word and nonword reading tasks.

These results of the present study are in consonance with the study by Castles and

Coltheart (1993) who also observed that many poor readers are impaired on both irregular

word and nonword reading tasks. They hypothesized that the reason why a correlation

between irregular and nonword reading performance might also be expected on a dual-route

account is related to the structure of the model itself, as the computational Dual Route

Cascaded (DRC) model of Coltheart and colleagues (Coltheart, Rastle, Perry, Langdon, &

Ziegler, 2001).

Conclusions

Thus, the present study explained development of various component processes of

reading in normal children where these processes develop from lower grades to higher grades

for different components of reading. Also, the study supports the existence of subtypes of

dyslexia even in Indian children learning to read and write the alphabetic language, English.


The present study has investigated individually the components of the DRC model.

This gives us an idea at which representation level the individual is having problem or

whether a single component is affected or multiple components are affected. This will

further help the clinician to plan intervention on those levels or components which

have deficits in children with dyslexia.

Studying the subtypes of developmental dyslexia (surface or phonological or mixed)

based on DRC model has made way for us to explore whether only lexical route is

affected or only the non-lexical route is affected or both. This would aid us in

understanding that subtypes could exist in developmental dyslexia and thus emphasize

on the need to design an Individualized education program (IEP) for intervention

depending on the subtypes of dyslexia.

The present study is only an initial attempt to investigate the reading performance and

subtypes of children with developmental dyslexia using DRC model. Future studies

are warranted in Indian population to study processing in semisyllabic Indian

languages (like Kannada, Hindi, etc.). Also, studies related to cross language

influences is also warranted to see whether there is facilitation or interference of an

alphabetic language with a non-alphabetic language can also be explored.


The number of subjects considered for each grade in the study is very limited and

hence difficult to generalize to normal population or children with developmental

dyslexia.


113

The present study is only an initial attempt to investigate the reading performance and

subtypes of children with developmental dyslexia using DRC model. Other factors

like the influence of native language or mother tongue or socio –economic factors,

literacy level of parents, etc. have not been explored and explained in the present

study.

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Master‟s dissertation submitted to University of Mysore.

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lexicon. Cognitive Neuropsychology, 9, 209-258.

Bosse, M.L., Tainturier, M.J., & Valdois, S. (2007). Developmental dyslexia: The visual

attention span deficit hypothesis. Cognition, 104 (2), 198-230.

Burani, C., Marcolini, S., & Stella, G. (2002). How early does morpholexical reading develop

in readers of a shallow orthography? Brain and Language, 81, 568-586.

Castles, A., & Coltheart, M. (1993). Varieties of developmental dyslexia. Cognition, 47, 149-

180.Coltheart, M., & Leahy, J. (1996). Assessment of lexical and nonlexical reading

abilities in children: Some normative data. Australian Journal of Psychology, 48, 136-

140.

Coltheart, M., Rastle, K., Perry, C., Langdon, R., & Ziegler, J. C. (2001). DRC: A dual route

cascaded model of visual word recognition and reading aloud. Psychological Review, 108,

204-256.

Forster, K. I., & Forster, J. C. (2003). DMDX: A windows display program with millisecond

accuracy. Behavior, Research Methods, Instruments & Computers, 35, 116-124.

Funnell, E. (1983). Phonological processes in reading: New evidence from acquired dyslexia.

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Hulme, C., Caravolas, M., Malkova, G., & Brigstocke, S. (2005). Phoneme isolation ability is

not simply a consequence of letter-sound knowledge. Cognition, 97, B1-B11.

Landerl, K., Wimmer, H., & Firth,U. (1997). The impact of orthographic consistency on

dyslexia: a German –English comparison. Cognition, 63,315-334.

Loomba, M. (1995). Descriptive analysis of the sequential progression of early reading skills

among Indian children. Unpublished Master‟s dissertation submitted to University of

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Perry, C., Ziegler, J. C., & Zorzi, M. (2007). Nested incremental modeling in the

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Rayner, K., Murphy, L.A., Henderson, J.M., & Pollatsek, A. (1989). Selective attentional

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Wolf, M., & Bowers, P. (1999). The question of naming-speed deficits in developmental

reading abilities: An introduction to the double deficit hypothesis. Journal of

Educational Psychology, 91, 1-24.

Ziegler, J. C., Castel, C., George, C., & Perry, C. (2008). Developmental dyslexia and the

dual route model of reading: Simulating individual differences and subtypes.

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Performance, 23, 845-860.

Dyslexia Assessment Profile for Indian Children

115

Dyslexia Assessment Profile for Indian Children (DAPIC)

Kuppuraj. S & Jayashree. C. Shanbal*

Abstract

Reading is a complex process which includes several underlying cognitive processes. The

successful assessment of reading has been challenged by factors like heterogeneity of the dyslexic

population. There is a need to assess children with dyslexia considering the high prevalence of

dyslexic population even in the Indian context. The present study aimed to develop an assessment tool

that can be used to study the development of reading and writing skills in Indian children. The

present study also focused on profiling reading and writing characteristics of children with dyslexia.

Comparisons were made between normal and dyslexic group and findings revealed that tasks like

rapid naming (RN), alliteration, sound discrimination (SDis) and spelling were found to be good

predictors for reading ability. Further, analysis revealed three major subtypes of dyslexia-

phonological, surface and mixed types of dyslexia.

Introduction

Reading is a complex cognitive process that involves multiple skills. Components of

reading ability include phonological awareness, phonological decoding, reading

comprehension, spelling, orthographic knowledge and rapid automatized naming (Gayan &

Olsen, 2003). Before one becomes completely literate, he or she must develop early reading

skills which comprised of steps like literacy awareness, syntactic awareness, word

recognition, phonological awareness, orthographic awareness (Strommen & Mates,

1997).Reading process is the conversion of print into auditory equivalents and the subsequent

interpretation of those equivalents into meanings based on previously learned language.

Comprehension is the next step which is the ability to interpret and understand the decoded

words. The next component of literacy is writing. Written language is characterized by rules

of phoneme grapheme correspondence (Nagy, Berninger, Abbott, Vaughan & Vermaulen,

2003). The rules of orthographic knowledge (processing written language letters and letter

patterns), phonological knowledge (processing or manipulating oral language sounds), and

morphological awareness in spelling performance have been well documented. As a result

spelling is related to reading and written expression. There are several stages through which a

child travels before master spelling skill. Gentry (1982) proposes stages like

precommunicative (where the child uses symbols from the alphabet but shows no knowledge

of letter-sound correspondences), semi phonetic (sounds are assigned to letters), phonetic

(The child uses a letter or group of letters to represent every speech sound that they hear in a

word), transitional (the speller begins to assimilate the conventional alternative for

representing sounds),and correct stage (the speller knows the English orthographic system

and its basic rules).

____________________________________ * Lecturer in Speech Pathology, All India Institute of Speech and Hearing, Mysore, India



116

Fletcher, Lyon, Fuchs and Barnes (2006) have quoted that reading is not natural, and

everyone is taught to read. Those children who lack the ability to learn literacy skills are

considered „dyslexic‟. Smythe and Everatt (2000) define dyslexia is a difficulty in the

acquisition of literacy skills that may be caused by combination of phonological processing,

visual and auditory system deficits. Lexical confusions and speed of processing difficulties

may also be present. The manifestation of dyslexia in any individual will depend upon not

only individual cognitive differences, but also the language used.

There are several causes proposed in the literature for dyslexia. They are heredity

(Pennington, 1989), brain differences (Galaburda, 1991), defects in rapid temporal

information processing (Tallal, Miller & Fitch 1993), selective attention and attention deficit

disorder (Zentall, 1993), middle ear problems (Roberts & Medley, 1995), cognitive rigidity

and learned helplessness (Clay, 1984). Similar to numerosity in causes of dyslexia, there exist

numerous types of learning difficulty (dyslexia). Theoretically, there are as many types of

dyslexics making the dyslexic group a heterogeneous one.

Several models have been proposed in order to hypothesize at what level the difficulty

could exist in children with dyslexia. Newcombe and Marshall (1984) proposed a reading

model which explains normal visual word reading. This model composed of two routes

namely lexical (direct route) through which words and irregular words are read. Another route

of the model is the sublexical route (indirect route) through which non words are read. Several

researchers have attempted to understand dyslexia based on the processing along these two

routes.

Castles and Coltheart (1993) broadly classified dyslexia in to two main types called

phonological and surface dyslexics. He opined that with difficulties in sub lexical skills shall

come under phonological dyslexics and if the children with dyslexia have difficulties in

lexical skills, he/she may fall under surface dyslexia. Edwards and Hogben (1999) included

another type of dyslexia called mixed dyslexia. Dyslexia of this subtype tends to find

difficulties in both lexical and sublexical route of reading, along with already proposed two

types.

There are several standardized western assessment tools available to assess children

with dyslexia. However, developing tools for children with dyslexia in Indian multilingual

context has been challenging. Moreover, assessment tools for dyslexia in India is the need for

the hour as the estimated prevalence rate of learning disability has been found to range from

3% to 10 % (Ramaa, 1985) in India. The high prevalence rate of learning disability indicates

the need for early identification and tailoring individualized intervention programs for such

children once they have been identified using the tools. Reviewing the available literature, it

has been found that dyslexic population is vastly heterogeneous and this heterogeneous nature

in the dyslexic group poses the requirement to profile the learning disabilities on individual

based performances of these children. It is important that the children with dyslexia are sub

grouped under existing subtypes based on their individual performances after profiling so that

an appropriate treatment program can be developed for these children.


117

Objectives of the study

The objectives of the study were-

I. To study the development of reading and writing skills in Indian children.

II. To identify subtypes of dyslexia based on the profiles established on children

with dyslexia.

Method

The participants of the present study included two groups. One group consisted of 60

school going normal children from grades I, II, III, IV and V. Each grade consisted of twelve

children. The other group consisted of 16 children with dyslexia (CWD) who were identified

as dyslexia at the All India Institute of Speech and Hearing, Mysore, using Test for Early

Reading Skills (ERS) (Loomba, 1995) in the clinical set up. All the participants were native

Kannada speakers with English as the medium of instruction.

A WHO Ten –Question Disability Screening Checklist (cited in Singhi, Kumar,

Prabhjot and Kumar, 2007 ) and Developmental Screening Test (Bharathraj, 1972) was used

to screen for normal children in terms of hearing, intelligence, motor and other factors like

school performance, emotional or behavioral factors.

The study was conducted in two phases.

Phase I: Test Development

The test was adopted from International Dyslexia Test (IDT) developed by Ian

Smythe (2000). This test was further modified so that it was culturally relevant to our

population. The final test that was derived out of the IDT after revisions was called the

Dyslexia assessment profile in Indian children (DAPIC).The subtests adopted from the IDT

(Smythe, 2000) included, Alphabet ,Shape copying, Spelling, Reading words and non words,

Phonological awareness skills, Word and non word repetition, Rapid naming and Sound

discrimination.

The tasks of the material have been divided under phonological and non phonological

tasks. The tasks those are considered as phonological are Alphabet, sound

discrimination(SDis), non word reading (NWreading), non word repetition(NWrep),

alliteration and rhyming. And the tasks those are considered as non phonological are Word

repetition(Wrep), word reading(Wreading), handwriting quality(HQ),shape copying(

SC),rapid naming(RN) and spelling. The following Table shows illustrations of tasks and

scoring.

Phase II: Test administration

Testing environment.

The test was administered in a quiet, noise free set up using a paper and pencil only.


118

Table 1: Details of tasks and scoring for each of the subtests

Sl.No. Subtest Task Scoring 1. Alphabet To write the alphabet that is named. Alphabets

those are visually similar are considered.

Which includes b,d,n,u,m,w,p,9,q

1- Correct

0- Incorrect

Total score: 9

2. Shape copying(SC) Copy the shapes that are given.

There are totally four shapes

(The shape that is displayed supposedly the

most complicated)

7- Most approximating

shape

1- Least clear shape.

Score:7

1 for correct and 0 for

incorrect shapes for

another three simple

shapes.

Score:3

Maximum score:10

3. Written Language

a)Spelling

Has to write down the spelling for words and

non words that are dictated. There are 30

words, 10 non words. However, the non words

are also following the phonotactics of English

1- Correct

0- Incorrect

Total score:40

b)Handwriting

quality(HQ)

Scored from Spelling performances 5- Very good

handwriting

1- Bad handwriting.

Total score: 5

4. Reading

word(Wreading)

Has to read the words that are given(list

consists of few irregular words)

1- Correct

0- Incorrect

Total score: 70

5. Reading non

word(NWreading)

Has to read the non words that are given 1- Correct

0- Incorrect

Total score: 10

6. Repetition of word

(Wrep)

Has to repeat the word after examiner. 1- Correct

0- Incorrect

Total score: 7

7. Repetition of non

word(NWrep)

Has to repeat the nonword after examiner 1- Correct

0- Incorrect

Total score: 8

8. Rhyming and

Alliteration

Has to find out the word which are in rhyme

E.g. Bat, Mat, Wall- Here “Bat” and “Mat” are

in rhyme with each other where as the „Wall”

is not

He has to find out the words which are in

alliteration with other words.

E.g. Shine, Shoe, Shop, Monsoon. Here all the

words but Monsoon begin with different letter,

or not in alliteration with other words.

1- Correct

0- Incorrect

Total score: 30

Rhyming:20

Alliteration:10

9. Rapid naming(RN) Has to name the pictures those are given. Time taken to

completely name all the

pictures.

10. Sound discrimination Has to say whether presented two words are

same or different.

E.g.

Cat, Rat- Different

Pin, Pin- Same

1- Correct

0- Incorrect

Total score: 20


119

The scoring was done as given in the Table 1. The data was subjected to quantitative

(details of statistical procedure are mentioned in the results section) analysis and qualitative

analysis. The results of this study have been discussed in the following sections.

Results

The aims of the study were

I. To study the development of reading and writing skills in Indian children.

II. To identify subtypes of dyslexia based on the profiles established on children with

dyslexia

Performance of normal children and children with dyslexia (CWD) across various tasks

Table 2 shows mean and standard deviation (SD) for normal children from Grades I to

V on all the tasks.

Table 2 shows that the performance of normal children improved from lower grades

to higher grades on tasks like HQ, SC, spelling and Wreading. The results revealed a

developmental trend on these tasks. It is evident from Table 2, that , on the alphabet subset,

all children in Grade I itself were able to score the maximum. A ceiling effect was seen for

alphabet task in Grade I itself. This indicates that the development of alphabet writing has

already taken place by Grade I itself.

Table 2: Mean and Standard Deviation (SD) of scores of Grades I to V.

Tasks

Grades

I II III IV V

Mean SD Mean SD Mean SD Mean SD Mean SD

Alphabet 9 0 9 0 9 0 9 0 9 0

HQ 3.83 0.94 4.00 0.74 4.17 0.72 4.67 0.89 4.83 0.39

RN 37.67 4.12 40.92 7.66 39.50 5.27 31.50 4.96 25.75 4.00

SC 8.08 2.07 8.75 1.22 8.92 1.24 9.42 .90 9.92 0.29

NW reading 5.17 1.75 5.08 2.78 7.00 2.26 7.33 1.83 7.58 1.97

Alliteration 2.92 2.27 3.50 2.71 6.42 2.15 6.17 2.40 9.08 1.24

Rhyming 3.92 3.39 0.42 0.99 7.33 2.35 10.33 4.70 14.50 3.00

Wrep 4.17 1.11 3.75 1.06 4.92 0.90 5.58 0.99 5.25 0.96

NWrep 4.33 0.89 4.17 1.53 5.17 1.11 6.17 0.72 6.50 0.67

SDis 17.42 1.88 17.08 1.56 18.67 1.15 19.58 1.44 20.00 0

Spelling 8.67 3.85 8.75 2.14 16.00 3.36 18.42 7.09 29.25 3.16

Wreading 15.58 7.23 20.08 4.17 26.67 4.03 31.25 10.97 54.67 6.36

Note: Handwriting Quality (HQ), Rapid Naming (RN), Shape Copying (SC), Non Word Reading (NW reading),

Word Repetition (Wrep), Non Word repetition (NWrep), Sound Discrimination (SDis),Word Reading (W

reading).

On handwriting quality (HQ), results showed that children in the higher grades

showed better performance than the lower grades (see Table 2).On shape copying (SC) task,

results revealed that children in the higher grades showed better performance than the lower

grades (see Table 2). On both spelling and reading tasks, results revealed that children in the


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higher grades showed better performance than the lower grades (see table 2). Overall, there

was a developmental pattern observed on handwriting quality (HQ), shape copying (SC),

spelling and reading words (Wreading) (see Figure 1). Results in Table 2 further showed that

for NWreading, rhyming, Wrep, NWrep and SDis tasks, showed that the performance of

children was significantly better only in the higher grades (III to V). Performance of children

on alliteration task was found to be significant in the lower grades (I to III). On rapid naming

(RN) task, no significant difference was found among Grades I through III, however grade V

participants performed significantly better than Grade IV.

To summarize, a developmental trned was found for performance of normal children

across the tasks- HQ, SC, alphabet, spelling,Wreading, NWreading, alliteration,

rhyming,Wrep, NWrep, RN, SDis. A multiple regression analysis revealed that rapid naming,

alliteration, sound discrimination and spelling were the four significant predictors for the

reading score (r2=0.89; Rapid Naming β =-.469; p<0.05; Alliteration β =1.016; p<0.05;

Sound Discrimination β =-1.54; p<0.05; Spelling: β=1.3 03; p<0.001.

Comparison of performance of normal children and children with dyslexia (CWD)

The CWD group consisted of sixteen children with dyslexia (CWD) ranging from

grade I to V who participated in the study. An individual profile of each child with dyslexia

was derived after a detailed qualitative analysis of all the samples. There was no significant

difference found in the performance of normal children and CWD on tasks of alphabet, SC,

NWreading, and Wrep were not significantly different.

Table 3 displays the mean and standard deviation values for normal children and

CWD. Results showed that normal group were significantly better than CWD group on most

of the tasks but CWD performed as good as normal children on phonological awareness tasks

like alliteration, rhyming and Dis. Figure 4 compares the performances of normal and CWD

groups across all the tasks across Grades I to V.

Table 3: Mean and SD for overall performance of normal children and CWD.

Subtests

Groups

Normal CWD

N Mean SD N Mean SD

HQ 60 4.30 .83 16 2.44 1.26

RN 60 35.07 7.71 16 50.63 20.30

Alphabet 60 9.00 .00 16 7.94 1.91

SC 60 9.017 1.38 16 6.56 2.37

NWreading 60 6.43 2.35 16 2.75 1.39

Alliteration 60 5.62 3.10 16 3.94 3.13

Rhyme 60 7.30 5.79 16 4.12 4.21

Wrep 60 4.73 1.19 16 4.00 1.09

NWrep 60 5.267 1.38 16 4.12 1.26

SD 60 18.55 1.76 16 16.94 5.94

Spelling 60 16.22 8.68 16 6.50 5.39

WReading 60 29.65 15.31 16 12.38 8.71


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Note: Handwriting Quality (HQ), Rapid Naming (RN), Shape Copying (SC), Non Word Reading (NWreading),

Word Repetition (Wrep), Non Word repetition (NWrep), Sound Discrimination (SDis), Word Reading (W

reading).

From the Figure 4, it is evident that CWD were found to perform poorly than the

normal children on all the tasks.

[HQ-Handwriting Quality, RN-Rapid Naming, SC-Shape Copying, NW reading-Non Word reading, Wrep-

Word repetition, NWrep-Non Word repetition, SDis -Sound Discrimination, WReading-Word reading]

Figure 1: Mean scores for performance of normal children and CWD across tasks.

The performance of CWD was compared with normal children qualitatively, the

CWD showed,

Regularization error, inappropriate spacing between letters, unfinished or omitted

words. mirror images of the alphabet

CWD who performed better on shape copying performed better on handwriting

quality.

Working memory deficits were masking the real performance on alliteration and

rhyming tasks.

Implementing lesser lexical cue on the Wreading task.

Inappropriate phonological working memory was evident on the repetition (words and

nonwords) tasks.

Sub typing of dyslexia based on profiling and cluster analysis

Cluster analysis was carried out as part of quantitative analysis for the CWD

group in order to classify them in to different clusters based on homogeneity among subjects

on various tasks. The tasks those were considered to arrive at overall Dendrogram were SDis,

Wrep, NWrep, Wreading, NWreading, alliteration, rhyming, RN and spelling. Analysis

revealed that Subjects 3, 2, 5, 6 performed similarly thereby forming a cluster (Cluster I)


122

themselves, Subject 1 (Ia) also performed similar to this cluster but it fell slightly apart, since

this subject couldn‟t manage any score on Spelling task, Subject 4(Ib) Having taken

maximum time for performing the Rapid Naming task falls slightly apart from Cluster the

cluster I and Ia ,Subjects 7 and 9 formed the cluster II. Cluster III was formed by the subjects

8, 12 &13, Subject 11 (IIIa) was slightly different from the cluster III, since its performance

on spelling was better compared to subjects in cluster III. Subjects 14, 15 and 16 fall in same

region of the Dendrogram forming its own cluster (Cluster IV).Ultimately, lonely subject that

didn‟t seem to fall near any of the cluster was the subject 10. This was the only subject who

read half of the words correctly in reading task (i.e.35 words), and scored maximum in this

task compared to all the other tasks.

In order to classify the CWD into phonological and non phonological group the data

was further analyzed considering phonological and non phonological tasks separately. The

phonological tasks considered were SDis, NWrep, NWreading, alliteration and rhyming. The

non phonological tasks considered were Wreading, NWreading, RN and spelling.

Phonological clusters

Subjects 2, 3, 5 and 6 formed cluster a, Subjects 1 and 4 formed the cluster (b),

Cluster(c) was formed by subjects 7 and 9, Cluster d was formed by the subjects 8, 11 &13.

Subject 12 formed the Cluster (d1), since this subject performed fair in rhyming task, Cluster

e was formed by the subject 14 since this subject had salient feature of very poor performance

on rhyming and good performance on alliteration task, Cluster (f) was formed by the subject

15, the salient phonological feature it had from other clusters was that it had very good

performance on alliteration and fair performance on rhyming task, Cluster (g) is formed by

subjects 10 and 16 and the common features these subjects shared were that all the

phonological tasks were performed fair to good. Even very good performance noticed in

alliteration tasks of subject 10

Non-phonological clusters

Subjects 8, 12 and 13 forms the cluster (a), the common non phonological features of

this group were, that all the subjects performed poorly on Spelling, WReading and Wrep.

Subject 7 and 9 forms the cluster (b), the common non phonological features they shared

were that they had good performance on Wrep and the correct responses in Wreading task

was over ten in both the subjects (poor). Subjects 11 formed cluster (b1) performed fairly on

spelling, fairly on Wreading ad very poor on Wrep thus forming a different cluster .Cluster

(c) formed by 15 and 16, the features of this cluster were their fair performance on Wrep and

Spelling tasks and Very poor to poor performance in Wreading task. Subject 10 formed the

cluster (d) performed good on Wreading and spelling and poor on Wrep. Subject 14 formed

the cluster (d1), since they had very poor performance in Wreading and spelling. These

clusters also had fair performance in RN and Wrep. Subjects 2, 3, 5 and 6 forms the Cluster

(e) the common non phonological features were, They performed poorly on spelling and

Wreading but fair performance on Wrep task. Subject 1(e1) Spelled none of the words and

read none of the words. The subject repeated repeat only the first series of stimulus which


123

had only two words in it. Subject 4 formed the cluster (f) since they showed Very poor

performance on spelling and Wreading and fair performance on Wrep task. Table 4 displays

the classification of subgroups of dyslexics based on phonological and non phonological

tasks.

Table 4: Sub grouping of CWD under phonological, non phonological and mixed type.

Phonological Surface Mixed

Subjects 1,4,16,14 & 10 Subject 15 Subjects 2,3,5,6,7,8,9,11, 12 and 13

Subjects were classified as phonological dyslexics {1, 4, 16, 14, 10} if they showed

difficulties on tasks of NWreading, NWrep, alliteration and rhyming. Subjects were classified

as surface dyslexics {15} if they find difficulties in tasks of Wreading, Wrep, RN and

Spelling. Subjects were classified as Mixed {2, 3, 5, 6, 8, 9, 11, 12, 13} if they show

difficulty in both phonological and non phonological tasks.

Discussion

The results of the study are discussed in terms of,

Development of reading and writing skills based on the adopted IDT (Smythe, 2000)

in normal children from grade I through grade V. This section will also include

discussion over the performance of children with dyslexia in comparison to the

normal grade level children.

Subtypes of dyslexia based on the profile

Development of reading and writing skills in normal children and performance of CWD

On the alphabet task all the normal children performed excellently. The mirror

writing errors shown by lower grades of CWD disappeared as grades increased. Study by

Terepocki, Kruk, and Willows (2002) who compared 10-year-old average readers and

children with reading disability concluded that the difficulties of reading disabled group in

discriminating similar looking items could be due to poorly specified representations of

letters.

It is evident from the results of the present study performance of normal children

improved from grade I to grade V on both the visuo-motor tasks such as handwriting quality

and shape copying. This may be attributed to better fine motor control over this skill with

development. These findings of the present study evidenced that these skills are acquired

much earlier that they were ought to be as mentioned in the Gessel and Amatruda (1947)

study. With respect to children with dyslexia, the results of the present study showed that

CWD children were found to have poorer hand writing quality and shape copying in

comparison to normal children. Literature suggests that children with developmental dyslexia


124

have been found to have poor fine motor abilities and often poor writing skills (Denckla,

1985). Motor problems are frequently observed in dyslexic children (Snowling, 2000), thus

reflecting on their poor writing skills.

Results of the present study also showed that the performance on spelling task

increased from lower to higher grades. It was found that children in the earlier grades used

symbols from the alphabet but showed no knowledge of letter-sound correspondences

(indicating the precommunicative stage of spelling development according to Gentry (1982).

In the later grades children were found to make better letter-sound correspondences and

further higher grades (grade IV and grade V), children were able to understand the basic

spelling rules of English and use them appropriately for reading purpose. On spelling tasks,

CWD were found to perform poorer than the normal children in the present study. Qualitative

analysis revealed that CWD even in the higher grades showed more errors in comparison to

young normal children. The errors revealed that CWD in higher grades who were supposed to

have reached the orthographic stage of spelling (Frith, 1985) are still in logographic or

alphabetic or in a transition from logographic stage to alphabetic stage.

The present study showed improved performance on word reading and non word

reading tasks from lower to higher grades in normal children. It can be hypothesized that

these lower grades normal children are still in logographic to alphabetic stage of Frith‟s

model. Typically, according to Frith this alphabetical stage is followed by orthographic stage.

This refers to the mastery of the alphabetic principle of phonography according to which

written words may be segregated into left to right series of letters, each of which can be

decoded as standing for as segment of speech. Poor performance of normal children lower

grades on non word reading task can be explained using the developmental stage models of

reading like the dual route models suggested in literature (Castles & Coltheart, 1993) .To read

a non word, it is the sub lexical processing which is important. Results of the present study

are indicative that probably in the lower grades, children have still not developed the

component process (GPC buffer in case reading a non word) that requires sub lexical

processing to read a non word correctly. The performance of CWD was significantly poorer

than normal in both word reading and non word reading tasks. The poor performance of

CWD on Wreading can be explained through Frith‟s model (1985) of reading development.

According to this model, in order to read a word, it is significant to have an orthographic

stage of reading development. In the present study we can hypothesize that, this stage of

development is deficient in CWD, thus this population find difficulties reading word. CWD

even in the higher grades were found to perform poorly in the present study. It could be that

CWD have still not developed the component process (GPC buffer in case reading a non

word) that requires sub lexical processing to read a non word correctly (Castles & Coltheart,

1993).

On the word repetition task, normal children in the present study, showed no

significant improvement in the lower grades (grade I and II), whereas showed significant

improvement in the higher grades (grades III, IV and V) only. Gathercole & Baddeley

(1989); Hoff, Cotre and Bridges (2008) have reported that word repetition in very young


125

children is related to their vocabulary size of the child. This means that children in the higher

grades have better and greater vocabulary size than the lower grades and hence the former

perform better than the latter on word repetition task indicative of an obvious developmental

trend. This vocabulary delays might have caused poor vocabulary repertoire available for the

CWD. Similar to word repetition task, on non word repetition task, the performance found to

have improved significantly in the higher grades (III, IV and V) only. It has been found to be

indicative of phonological working memory capacity (Coady & Evans, 2008) which means

developmentally older children have a better capacity of phonological working memory

which in turn help them repeat or read non words appropriately compared to younger children

who are still building up their phonological repertoire and/or knowledge. The CWD of the

present study performed poorly compared to normal children on NWrep task suggesting poor

phonological working memory capacity, lexical (the degree of accuracy correspondence to

lexical intactness)and phonological knowledge. Study by Snowling (1981) showed that

children with dyslexia experienced a greater degree of difficulty with non-words repetition,

especially at longer lengths. They hypothesized that speech-motor programs would be used

for familiar words, while such programs would be unavailable for non-words. Successful

repetition of non-words would require „subjects to process the auditory stimulus, to decode

the sound segments, and to recode these as instructions in the form of a speech-motor

program .This decoding and recoding deficits reported by Snowling could be given as a

reason for poor performance of CWD on NWrep task.

On rapid naming task, children in the present study showed increasing performance

from lower to higher grades suggesting a developmental pattern. This could be because the

time taken to access a lexicon from their repertoire is faster with the development of children.

Study by Wagner, Torgesen, Roshotte, Hecht, Baker and Burgess (1997) investigated the

relative contribution of RN to later reading ability in three developmental periods from

kindergarten to grade II, from grade I to grade III and from grade II to grade IV. They

concluded that RN was a significant variation for word reading till kindergarten to grade III

only. Findings of present study contradict Wagner et al., (1997) study as in the present study

RN was found to be improving significantly in higher grades (grade IV and V) only. In other

words RN was also found to be influencing reading in children of higher grades.

On RN task, the performance of CWD was significantly poorer than normal children

suggesting poor phonological accessing speed in CWD. Our findings are in consonance with

study by study by Bowers and Wolf (1993) who also admitted the same findings in CWD.

On rhyming task, the results revealed that the performance improved significantly

from grade III till V. On the alliteration task the significant improvement in performance was

noticed only for higher grades (grade III, IV and V). This supports findings of Wagner et al.,

(1997) concludes after his study that phoneme awareness tasks are significant contributors to

reading in higher grades only (grade III and IV). Further, results of the present study showed

that on rhyming and alliteration task, CWD performed poorly than the normal children and

performance are varying across grades. Studies by Moats and Foorman (1997) and Adams


126

(1990) also suggests that children who learn to read alphabetic language system such as

English have been found to have poor phonemic awareness tasks like rhyming and letter

identification.

On SDis the performance on normal children were improving from lower through

higher grades. It was not found to be significant in lower and higher ends whereas only grade

III found to be significantly better than grade II. In other words there was no improvement in

sound discrimination skill as the child grows older. The insignificant improvement in scores

of auditory discrimination findings are in consonance with study by Neff (2006) who

concluded that both spectral and temporal cues attain adult like by the age of six. In the

present study the CWD showed poor performance compared to normal children, though it

was not statistically significant. Tallal (1980) proposed that children with specific reading

difficulties are deficient in processing brief and rapidly changing acoustic information like

brief acoustic events in stop consonants

Subtypes of dyslexia based on the profile

One of the major aims of the present study was to subtype children with dyslexia

based on the individual profiles obtained after administering the IDT (Smythe, 2000) and

cluster analysis done on the data obtained. It was evident from cluster analysis in the present

study that dyslexia is not a homogenous group but a heterogeneous group with existence of

three major subtypes of dyslexia including phonological, surface and mixed types. Children

with dyslexia (CWD) who fell under the phonological subtype in the study included {1, 4, 14,

16, 10}.The cluster that fell under the surface subtype of dyslexia included {13}. The cluster

under the mixed subtype included CWD {2, 3, 5, 6, 7, 8, 9, 11, 12, 15} (See Table 5).

The phonological subgroup

CWD of phonological subtype could have performed poorly on phonological related

tasks in comparison to the others due to deficit in the sub lexical processing of phonemes

(Castles & Coltheart, 1993). In this group it was found that CWD performed poor mostly on

nonword reading tasks. By theory, to read a non word, it is crucial to have phoneme

grapheme conversion system intact. However, children with phonological dyslexia are unable

to read non words as it is hypothesized that the sub lexical route which is composed of

grapheme to phoneme conversion system is grossly affected.

The surface subgroup

The reason for the performance of the surface dyslexic profile could be due to a

nonphonological deficit in the lexical route as suggested also by Castles and Coltheart,

(1993). In surface dyslexics the disconnection is in between the semantics and phonological

functions leaving only the sub lexical route in operation .So, the reading of non words is

relatively intact in this population.

The mixed subgroup

The performance of mixed group in the present study could be due to the deficits in

both the routes of reading. i.e., sublexical and lexical route as suggested by Edwards &


127

Hogben, 1999) It can be hypothesized that the combined deficits in orthographic lexicon and

in Grapheme Phoneme (GPC) rules could have resulted in mixed dyslexia .In other words

they have difficulty in reading stimuli that requires both lexical and sub lexical processing

(Edwards & Hogben, 1999).

Conclusions

The results of the present study revealed that DAPIC can be used as a tool to profile

those children who show difficulties in phonological and non phonological tasks of literacy.

The results of the present study reveal that differentiating among dyslexia subtypes with

specific impairments allows a more fine grained understanding of disorder than simply

comparing dyslexics with normal. The profiling and sub typing of the present study also lead

us to understand and plan for individualized education program (IEP) for children with

developmental dyslexia .The predictors those are mentioned as predictors of reading can be

used to make a screening tool. The tool needs to be further administered on a larger sample to

generalize the findings and use regularly for the assessment of children with reading

problems. This study included a small sample of children for each grade. Administering it on

larger sample would help in standardization of the tool for assessing children with dyslexia.

Other domain specific tasks of phoneme awareness skills like phoneme stripping, word attack

tasks could have been included in the test to give a complete profile of individual‟s phonemic

awareness skills.

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Clinical Protocol for Assessment of Swallowing in Adults - (CP-ASA)

Meera Priya. C. S. & R. Manjula*

Abstract

The objective of the study was to develop a clinical protocol for the assessment of swallowing

disorders in adults, check for item and content validity and test the sensitivity of protocol developed,

by administering the same on clients with swallowing disorders. The protocol was compiled,

developed and tested for its sensitivity in 3 stages: Stage 1: Compilation and development of the

protocol and test kit. Stage 2: Checking for item & content validity of the protocol. Stage 3: Testing

the sensitivity of protocol developed by administering the same on clients with swallowing disorders.

Stage 4: Finalizing the protocol after incorporating modifications based on the feedback obtained

from stage 2 and 3. The sensitivity of the protocol was tested by administering it on three subjects

with swallowing disorders due to various impairments. Video recording of the assessment session of

the subject were randomly presented to 3 judges who were speech-language pathologists by

profession. The results of the swallowing assessment revealed that S1 presented difficulty in oral

preparatory phase, oral phase with an accompanying delay in pharyngeal phase; S2 presented

difficulty in oral preparatory phase & oral phases of swallow; S3 presented difficulty in oral

preparatory, oral and pharyngeal phases of swallowing. The outcome of these with the clients helped

to improvise some of the items in the protocol by rephrasing, substituting some of the items and

deleting some of the items. The protocol requires to be standardized after administration on many

more clients with swallowing difficulties.

Introduction

Breathing and eating are most basic physiologic functions that define life’s beginning

outside the mother’s womb for newborn infant. Breathing is reflexive and life sustaining but

provides no other intrinsic pleasure. Eating on the other hand is partly instinct and partly a

learned response. It requires ingestion of foods, which in newborn must be provided by an

outward source. Sucking and swallowing requires a complex series of events and

coordination of the neurological, respiratory and gastrointestinal systems. Normal GI function

must occur in digestion of foods to provide nutrients. All of this function occurs within the

framework of developing physical and emotional maturity. The pleasure of eating extends

beyond the feeling of satiety to the pleasure, gained through food ingested. Feeding requires a

well functioning sensorimotor swallowing mechanism, overall adequate health (including

respiratory, gastrointestinal and neurology), appropriate nutrition, central nervous integration

and adequate musculoskeletal tone. The successful emergence of communication depends

heavily on feeding and swallowing.

According to American gastroenterological association, (1999), Dysphagia, or

difficulty in swallowing, is not a disease in itself but a condition that can be brought on by

_____________________________

* Professor of Speech Pathology, All India Institute of Speech and Hearing, Mysore, India


Clinical Protocol for Assessment of Swallowing in Adults

131

many different causes because swallowing is a delicate process, easily disturbed. Dysphagia

is defined as a dysfunction or impairment of the stages of swallowing. It is defined by its

clinical features because it is symptom, or collection of symptoms of one or a number of

possible underlying disorders. In patients with dysphagia, various aspects of the anatomy and

neurophysiology in any or all of the stages in swallowing may be impaired, resulting in the

diagnosis of swallowing disorder.

Dysphagia could be caused due to multiple etiological factors Table 1 shows some of

the common causes of dysphagia in its various stages.

Table 1: Common causes of dysphagia

Types Causes

Oro

pharyngeal

dysphagia

Obstructive/

Mechanical

Neuro-

genic

Neuro-

muscular

Junction

Muscular

Upper

Esophageal

Sphincter (UES)

Esophageal Obstructive

Lesion within

the Esophagus

Obstructive

Lesion

Outside the

Esophagus

Neurogenic

Neuro-

muscular

The reported high incidence of dysphagia following stroke and consequent risk

associated emphasizes the need for early identification and evaluation of dysphagia in adult

population. American stroke association (ASA) management guidelines, (2001)

recommended the completion of a comprehensive clinical assessment for any patient

suspected with dysphagia. Identifying patients at risk for developing dysphagia remains a

difficult task. Evaluation of swallowing difficulties / dysphagia in adults is hence a preferred

practice for the professional speech - language pathologists. An extremely wide range of

assessment techniques and procedures are employed by individual therapists and institutions

for most of adult dysphasic clients, more so in India.

Several methods have been proposed for the evaluation of dysphagia. No consensus

currently exists on a standard method of assessment. Regardless of method, an appropriate

and valid assessment tool should be readily accessible for the assessment of adult dysphagic

population and should demonstrate both inter and intra subject reliability. Majority of the

specialized clinics which cater to the assessment and management of clients with dysphagia

across the world base their clinical intervention on the data available through instrumental

analysis, especially for the assessment of pharyngeal and esophageal stages of swallow. The

advantages of instrumental analysis are many, including the fact that specific information

such as site of dysfunction during swallow, data related to duration in bolus transition and the

response to different types of food consistencies are available to the clinician as first hand

information, based on which a management program specific to the client’s needs can be

developed. Many clinics, especially so in India cannot afford to procure instruments which

are often costly and also require professionals such as radiologists and gastroenterologists to

help in interpretation of the data. Hence, most of the clinics adopt the subjective and


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behavioral analysis procedures for clients with dysphagia. This is very relevant to most of the

speech clinics in India where adoption of instrumental procedures for assessment of

swallowing is a far fetched goal at present due to lack of qualified manpower, financial

constraints and cost effectiveness.

Even in those centers which adopt instrumental procedures, the common practice in

assessment is that the oral phase of swallowing is most often assessed through direct

observation as the structures are visible and accessible to the examiner. The abnormalities in

the pharyngeal and esophageal phases of swallowing are often based on instrumental

evaluation. However, the abnormalities in the pharyngeal and esophageal phases of

swallowing can also be assessed based on the inferred observations made through

information available from history and documenting the behavioral correlates of the process

of swallowing as related to the function of pharynx and esophagus.

Matrino, Pron and Diamant, (2003) reported survey data which indicated that 71% of

the respondent dysphagia clinicians (speech language pathologists) performed a complete

evaluation of dysphagia. Conversely only 36% of these clinicians completed an instrumental

swallowing examination. Moreover instrumental swallowing examinations were never

completed in the absence of full clinical examination. Thus these results strongly suggest that

clinical examination is the primary method of swallowing examination among the practicing

clinicians.

The clinical examination of swallowing is designed to provide the clinician with the

following data for use in diagnosis and treatment planning:

Information on the current medical diagnosis and medical history of the patients

swallowing disorder, including the patients awareness of his/her swallowing disorder

and indications of the localizations and nature of the disorder

Patients medical status, including nutritional and respiratory status (presence of

nasogastric feeding tube or gastrostomy and placement of a cuffed or uncuffed

tracheotomy tube)

Patients oral anatomy

Patients respiratory function and its relationship to swallow

Patients labial control, as this may affect keeping food in his/her mouth

Patients lingual control, as it may affect oral manipulation of food and posterior

transit of food through the oral cavity

Patients palatal function. As it may affect entrance of food into his or her nose during

the swallow.

Patients pharyngeal wall contraction as it may affect movement of food through the

pharynx and may cause aspiration after the swallow

Patients laryngeal control, as it may affect airway protection and aspiration during

swallow

Patients general ability to follow directions and monitor and control his or her

behavior


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Patients reaction to oral sensory stimulation including taste, temperature and texture

and

Patient’s reactions and symptoms during attempts to swallow (Griffin, 1974).

Protocols available for swallowing evaluation: Many protocols which are available and

reported are ones which are developed in the western countries. Assessment of swallowing in

children and adults assumes different dimensions. This study aims to develop a protocol for

the assessment of swallowing disorders in adult population in India.

Any protocol / test / scale developed for the assessment of swallowing difficulties is

required to meet certain features to account for its credibility as a clinical tool to aid in the

evaluation of swallowing difficulties as well as its further application in the management of

the client. These factors as listed by Murry (2001) include the following:

Appropriate definition of the anatomical structure that is involved in swallowing

dysfunction

Ability to detect and quantify aspiration

Ability to detect etiology for the swallowing dysfunction

Comprehensively assess all the phases of swallowing

Ability to test for oral reflexes

Type of test (screening and diagnostic)

Critical evaluation of the western protocols / scales:

Table 2 shows the critical evaluation of the western protocols / tests / scales.

Defines

anatomy

Detects

aspiration

Quantifies

aspiration

Detects

etiology in

swallowing

dysfunction

Comprehen-

sive assess-

ment of all

phases of

swallowing

Quantifies

reflexes

Screening/

Diagnostic

BDST - + - - - - Screening

MASA - + - + - partial Diagnostic

SAFE - - - + - partial Diagnostic

TORBSST - + - - - - Screening

EDAT - - - Screening

SWAL-

QOL

- - - - - - Patients

self

assessment

SWAL-

CARE - - - - - - Patients

self

assessment

MDADI - - - - - - Diagnostic

RSI - - - - - - Self

assessment

Critical evaluation of the western protocols / scales used for assessment of

swallowing in adults as listed in Table 2 reveals the following:


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All the scales do not assess all the phases of swallowing at a time.

Majority of the parameters addressed in these scales advocate use of stimuli, eg food

articles and their consistencies which are not culture friendly to Indian context

The scales do not promote a cause – effect relationship in terms of associating the

dysfunction with the structural deficit.

Although the BDST and MASA scales allow for detection of aspiration, there is no

scope for quantifying the extent of aspiration. The SAFE scale does not allow for

detection or quantification of aspiration.

There is no scope for inferring the specific etiology in the different phases of swallow in

BDST.

Oro pharyngeal reflexes which play a major role in the swallowing function is not

accounted for in BDST, whereas it is only partially accounted for in MASA and SAFE.

BDST is only a screening tool unlike MASA and SAFE which are diagnostic tools.

In comparison to the assessment tools available in the western countries, there are no

comprehensive protocols available to suit the Indian population and hence this is attempted in

the study.

Need for a assessment protocol in India

There are no formal protocols / tests / scales developed in the Indian context. Most

of the centers which cater to the clientele with swallowing disorders have developed their

own indigenous questionnaires and proformae to assess the swallowing disorders in

children as well as adults. However, it is known that the anatomical and physiological

differences in the swallowing mechanism call for the use of different scales in children as

compared to adults. Most of the clinical tools developed in India are not comprehensive,

specifically in terms of testing with direct stimuli (different consistencies of solid, semi

solid and liquid items and the quantity of the same) and indirect stimuli (assessment of

posture, oral sensory testing, assessment of motor functions etc). Given the multicultural

issues in India, selection of direct stimuli requires to be done with care if one attempts to

develop a test kit for the assessment of swallowing.

Keeping these in mind, the present study aims to develop a clinical protocol for

comprehensive assessment of all the three phases of swallowing, that is, oral, pharyngeal

and esophageal phase, based on behavioral paradigm. Assessment of oral and pharyngeal

stages will be aimed at using direct observation procedures, but the esophageal stage will be

assessed based on history and indirect observation procedures.

Aims of the study

To develop a clinical protocol for the assessment of swallowing disorders in adults.

To check for item and content validity of the protocol developed

To test the sensitivity of protocol developed, by administering the same on clients with

swallowing disorders.


135

Method

The protocol was compiled, developed and tested for its sensitivity in 3 stages:

Stage 1: Compilation and development of the protocol and test kit

Stage 2: Checking for item & content validity of the protocol

Stage 3: Testing the sensitivity of protocol developed by administering the same on clients

with swallowing disorders

Stage 4: Finalizing the protocol after incorporating modifications based on the feedback

obtained from stage 2 and 3.

Stage 1: Compilation and development of the protocol and test kit

A comprehensive review of different assessment scales/tools/literature and web based

search was employed. Items that contributed to the assessment of a gamut of swallowing

disorders in adults were pooled in order to develop a comprehensive protocol addressing

various aspects of the disorder. The items were then verified one by one to look for its

relevance to the adult population as well as its application in Indian context. The items which

were not relevant to the Indian context were modified and / or replaced as per the need; the

material was further classified under different domains, sections and subsections. This

exercise led to the development of a protocol comprising of four main domains, with sections

and subsections within them.

The structure of the protocol included the following:

Part A

A) Demographic details of the client

B) Client history

C) Family and medical history

Part B

Section Title of the Section & Subsections Number

of items

Scoring

Section A Assessment of Posture 14 4 point rating scale

3 = Within functional

limits

2 = Mild impairment

1 = Moderate impairment

0 = Severe impairment

Section B

Assessment of respiratory abilities

At rest

During speech

Coordination of

Respiration and swallowing

Assessment of sensory abilities

Taste

Temperature

Oral sensation

1

1

3

5

2

10

4 point rating scale


limits

2 = Mild impairment




136

Assessment of cognitive status

General status

Specific dysfunction

11

9

Section C

Assessment of Cranial nerve

functions and Oral reflexes

Assessment of cranial nerve

functions

Assessment of oral reflexes

4

4



limits

2 = Mild impairment




1 = Normal reflex for the

age

0 = Primitive/immature/ no

response/exaggerated

response to the stimulus

Section D

Physical Examination of the oral

mechanism

Lips

Tongue

Velum

Teeth

Jaw

5

7

9

2

4



limits

2 = Mild impairment



Section E

Assessment of swallow in different

stages

Oral preparatory stage

of swallow

Oral stage of swallow

Pharyngeal stage of

swallow

Esophageal stage of

swallow

25

14

18

10



limits

2 = Mild impairment



The protocol is supplemented with 2 Appendices to aid the clinician in preparation

of material required for the administration of food as well as a ready reckoner. They

include:

Scoring

A 4 point rating scale was used in all the sections except for the subsection on oral

reflexes which utilized a 2 point rating scale. The scales depict the descending order of

normal behavior of swallow in various sections. Under each section and subsection, the

specific behavior for which the rating scales need to be given is described.


137

Apart from the quantitative assessment using the rating scales, scope for qualitative

description, noting the behaviors, comments and other remarks is made available under the

column of remarks in every section and subsection.

Stage 2: Checking for item and content validity of the protocol

Once the protocol was developed, it was verified by four speech language

pathologists who had working and clinical knowledge in dysphagia management. The items

in the protocol was verified by these specialists individually and independent of each other.

They were asked to rate each item within the sections and subsections of Part A and B on a

4 point rating scale to identify whether the items were worthy of inclusion (or not) in a

clinical assessment of dysphagia. The rating scale was as follows:

1 = is poor and needs to be deleted or substituted

2 = needs major alteration

3 = needs minor alteration

4 = is adequate

Those items which were rated as 1, 2 and 3 were subject to omission or modification

as per the suggestion and the same was incorporated in the protocol.

Stage 3: Testing the sensitivity of protocol developed by administering the same on

clients with swallowing disorders

The sensitivity of the test protocol was tested by administering it on three subjects

with swallowing disorders due to various impairments. During the physical testing, it was

ensured that the client is kept in most comfortable position possible in a well-lit room with

no distracters. The session was video recorded after desensitizing the clients, in order to

facilitate observation and verification of the responses at a later time to ensure that the

behavior was rated appropriately.

The testing session was spread over 2-3 sittings depending on the clients cooperation

and fatigue level. Written consent was obtained from the clients and the purpose of the test

was also explained. Suitable instructions appropriate for each of the section and subsection

was given. The responses of the clients were recorded on the score sheets of the CP-ASA.

Whenever possible, family members were allowed to be present during the assessment and

they were also informed of the process, results and recommendations. The investigator noted

in detail the performance of each of the client on the protocol during the live testing of the

clients. This was further verified with the video recordings in order to confirm, observe in

depth, reflect and verify whether the assessment proceeded in the right way.

The results of the swallowing assessment revealed that S1 presented difficulty in oral

preparatory phase, oral phase with an accompanying delay in pharyngeal phase; S2 presented

difficulty in oral preparatory phase & oral phases of swallow; S3 presented difficulty in oral

preparatory, oral and pharyngeal phases of swallowing. Based on the observation and noting

made, suitable modifications were made in the instructions, scoring, definition of a behavior

during rating and others as was indicated during the observations. The outcome of these with


138

the clients helped to improvise some of the items the protocol by rephrasing, substituting

some of the items and deleting some of the items.

Stage 4: Finalizing the protocol after incorporating modifications based on the

feedback obtained from stage 2 and 3.

The protocol was subjected to modification based on the suggestions/outcome

obtained from stages 2 and 3.


This was a preliminary attempt made to aid in the diagnosis and therapeutic

intervention for adults with dysphagia. The protocol provides a qualitative as well

quantitative (by the use of rating scales) understanding of the elements of dysphagia in the

client. The protocol partially fulfills the need for a clinical tool required by clinicians which

can be administered based on subjective assessment of the client in the absence of

sophisticated objective tools.

The administration of the protocol takes approximately 30-45 minutes. The protocol

includes 4 main domains as follows:

Domain I: Demographic details of the client

Domain II: Client history

Domain III: Family and Medical history

Domain IV: Assessment section.

The protocol requires to be standardized after administration on many more clients

with swallowing difficulties in order to:

Establish the cut off criteria (for quantitative scoring of errors) for the diagnosis of

dysphagia.

Elaborate on specific distinguishing characteristics of different stages of swallow

dysphagia and identify clearly based on the behavioral cues, the dysfunction in different

phases of swallowing disorder.

References

American Speech-Language-Hearing Association. (1999). Definition of Swallowing

Disorder. 35. (Suppl. 10), 40-41.

American stroke Association (ASA). (2001). Comprehensive clinical assessment for any

patient suspected with dysphagia. Ad hoc committee on dysphagia report, 32 (2), 53-

57.


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Breumelhof, R., & Smout, A. J. (1991). The symptom sensitivity index: A valuable additional

parameter in 24-hour esophageal pH recording. American Journal of

Gastroenterology, 86, 160-4.

Chen, A. Y. (1996). MD Anderson Dysphagia Inventory. In Adaptation and validation of the

Italian MD Anderson dysphagia inventory (MDADI). Revue de laryngologie -

otologie - rhinologie .(2008). 129, 2, 97-100.

Depippo, K. L., Holas, M. A., & Reding, M. J. (1994). The Bruke dysphagia screening test:

validation of its use in patients with stroke. Archives of psychiatric medical

rehabilitation. 75, 1284-1286.

Griffin, K. (1974). Clinical examination of swallowing. Archives of Physical Medicine and

Rehabilitation. 55 (3), 467-570.

Kipping, P., & Ross, D. (2003). Swallowing ability and functional evaluation (SAFE), Pro-

Ed. Austin.

Martino, R., Pron, G. & Diamant, N. (2000). Screening for oropharyngeal dysphagia in

stroke: Insufficient evidence for guidelines. Dysphagia, 15, 19-3

Mann, G. D. (2002). The Mann’s assessment of swallowing ability, Austin, TX: Pro-ed.

Matrino, R., Damant, N. (2007). Toronto bed side screening test. Austin, TX: Pro-ed.

Mc Horney., Colleen, A., Harris, M. (2006). Validity and sensitivity of SWAL-QOL and AL-

CARE for patients with swallowing disorder. Dysphagia, Volume 21, No. 3, pp. 141-

148(8)).

http://www.ingentaconnect.com/content/klu/455


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Comprehensive Language Assessment Tool for Children (3-6 years)

Navitha U. & K. C. Shyamala*

Abstract

Normative approaches to assessment have historically evolved in the context of the need to

screen, identify, isolate and diagnose low achieving children from others. The valid assessment of

language is somewhat of an enigma for clinicians. Eventhough there are multitude of resources

available still assessment of language continues to be one of the most challenging. The present study

was designed to construct a tool for assessment of language and cognitive abilities in typically

developing preschool children in the age range of 3 to 6 years. The study was carried out in three

phases. The phase I incorporated the test construction, phase II consisted of pilot study where initial

filed try out of all the selected items was administered to 25 parents of typically developing preschool

children in the age range of 3- 6 years. Thus, the test device developed based on the performance of

the typically developing preschool children in the pilot study had three main sections, i.e., reception,

expression and cognition. The Phase III included the standardization procedure where the test

developed based on pilot study was administered on 150 typically developing preschool children for

obtaining the normative data. Hence, there were 5 groups ( 3 to 3.6 years, 3.6 to 4 years, 4 to 4.6

years, 4.6 to 5 years and 5 to 6 years ) consisting of 30 children in each group. The data was obtained

by an interview approach. Both boys and girls were considered for the study. The data for each group

was statistically analysed. Mean and standard deviation were obtained for each group. A general

significant correlation was obtained between the development of language and cognition. The

performances of males and females was compared which showed mixed results. After the

administration of the test, the child’s score had to be compared with the normatives.

Introduction

Communication is an essential aspect of human beings. Language is unique to man

especially in the form of speech. Language starts developing from birth through several years

of life. The speech of the child changes with different stages of language acquisition. Child‟s

expression through speech serves as one of the important avenue for language testing. The

development of speech and language in particular is a dynamic constructive process (Thelen

2005).

Cognition in simple words can be described as understanding of our experiences

through mental processes such as perception, recall, and reasoning, and it provides an

important element for the development of language. Piagetion theory has emphasized the

importance of the developing cognitive abilities of the child (Piaget, 1962). In Piaget‟s view

language is dependent on and shaped by underlying cognitive structures, and it reflects the

thought processes made possible by those structures at different stages of development.

Vygotsky (1978) claimed that linguistic growths are facilitated by cognitive development. A

child‟s development of language is dependent upon his knowledge of concepts, which in turn

is dependent upon his level of cognitive development. As a result, there is a positive

__________________________________________ Professor of Language Pathology, All India Institute of Speech and Hearing, Mysore, India

e-mail: [email protected]

Comprehensive Language Assessment Tools for Children

141

correlation between the degree of retardation and the level of language development in the

retarded child (Karlin & Strazzula, 1952). Chomsky (1957) described language on the

psychological perspective of a language user‟s ability to produce and comprehends language.

By the nature of cognitive hypothesis, language development is rooted in early cognitive

development, prior to the appearance of the first word. A particular level of cognitive

achievement is necessary before language can be used expressively.

Perception and the subsequent development of an understanding of semantic

relationships are the result of human cognitive functioning (Spelke & Tsivkin, 2001).

Language development is the product of strategies and process of general cognitive

development, although not a direct manifestation of it. Parents could identify their preschool

children‟s language skills. The literature has reported of high correlation between the

language ages obtained from a parental interview and those obtained from the tests

administered directly on the preschool children. An interview method of obtaining

information could be used by speech-language pathologists with confidence when

information could not be obtained by directly testing the child due to physical, emotional, or

intellectual disabilities. Obtaining information from an informant could be an easier, quicker

way of screening large numbers of children.

Need for the study

A number of tests have been developed to assess the language skills of preschool and

school going children in Indian context but it is very detailed and more time consuming.

Many studies available in India have focused on language acquisition (Roopa, 1981; Sudha,

1981; Vijayalakshmi, 1981) etc.

There are few assessments tools available for children with higher age in Indian

context, but they are very restricted and more time consuming. So there is a need for quick

and comprehensive standardized test for different age group of school going children. There

is a lack of tests available for assessing the acquisition of language and cognitive abilities of

the growing children especially as screening tools in the Indian context to predict the age of

their performance particularly in for difficult to test population.

Aim of the study

The main aim of the study is to develop assessment tool for children in the age range

of 3- 12years for testing their language and cognitive ability to standardize the assessment

tool on Indian population and to obtain normative data for the same.

Method

Participants

The participants in the present study were the parents or the caretakers of typically

developing preschool going children in the age range of 3-6 years. The study was carried out

in three different phases. Phase I consisted of test construction, Phase II included the pilot

study and Phase III consisted of the standardization procedure. Two groups of participants


142

were involved in the present study. The first group included a total of 25 participants who

served as subjects for the pilot study. The second group included a total of 150 participants,

who served as subjects for the standardization of the test material with 30 subjects per age

group. Hence, a total of 175 parents whose children were in the age range of 3-6 years were

considered. Language was not considered as criteria for the selection of the subjects. Based

on the report obtained from the school teachers, the children with an average or above

average performance were considered. The inclusion criteria for the selection of the

participants also included children with no history of any known organic and sensory deficits.

Both males and females were considered.

Phase I: Construction of the test material

Selection of test items

The assessment tool was designed to elicit systematic information based on the skills

present in typically developing preschool children. The construction started with the

formation of a comprehensive item pool of activities related to children below the age of

seven years. An indulgent list of approximately ten to fifteen items in each section for each

age group was selected from various sources used for the assessment of children. Majority of

the items selected were obtained from the checklist developed by Venkatesan (2004) entitled

“Activity Checklist for Preschool Children with Developmental Disability”. During initial

formation of the item pool, care was taken to see that the test items were placed in a

hierarchical order of increasing performance difficulty according to the chronological ages of

the children. The easier and lower chronologically aged test items were placed at the

beginning of the checklist, and the more difficult and higher- aged items were placed towards

the end of the checklist.

The specific domains included under Comprehensive Language Assessment Tool for

children were reception, expression and cognition. It was seen that the domains included in

the test were both exhaustive and mutually exclusive. In order to check for the content

validity of the question selection, the selected questions were given to five speech language

pathologists who had a clinical experience of more than five years. They were asked to rate

as R – if the question comes under reception, E – if under expression, and C – if under

cognition section. This was to eliminate the repetition of test items within a domain as well as

between domains. Thus, the modified questions consisted of fifty items in reception, fifty in

expression and fifty five in cognition section.

Phase II: Pilot study

The initial filed trial of selected items was carried out with 25 parents of the typically

developing preschool children based on interview session and direct observation. A minimum

of five subjects were considered in each age group which consisted of both males and

females. The entire item from each section such as reception, expression and cognition were

administered for the 25 parents of the children. An appropriate example was provided for

each age item and was explained in a simpler form in their native language to further clarify

the question for the parent. Therefore, based on the information obtained from the parents

regarding the performance of the children, the questions in which the respective age group


143

children performed well were considered for the development of the test in tune with the

suggestions of a psychologist and speech language pathologists. Thus, after addition, deletion

and modification of the test item appropriate for each age group, the test finally contained six

items in each section of Reception, Expression and Cognition. The ambiguous words and

phrases were simplified and thus a final modified test material was made with a total of 90

items, six items in each section under each age group.

Phase III: Standardization for normative data

It is essential to obtain normative data on the test constructed. Standardization can be

explained with respect to the following:

a) The population for standardization: The subject population included 150 parents of

normal children between 3 years – 6 years. The native language of the child was not

considered in grouping as the test was meant for all language groups. Only those

parents whose children had no history of any complications, either pre-natal or peri-

natal and free from any known functional or organic disabilities were taken for the

study.

b) Age groups: Totally five age groups were considered. The first four age groups

covered a time span of six months each, since this is considered as the most crucial

period of language and cognitive development ( 3-3.6, 3.6-4, 4-4.6 & 4.6-5 years ).

The last group covered an age range of one year (5-6 years).

c) Procedure: The parents of the children or a care taker (familiar with the child‟s

behavior) were interviewed to obtain the data. Parental meetings were carried out for

the same by arranging parental meetings in the school. The interview was carried out in

a closed and noise free environment free from distractors. They were told about the

purpose of the study in brief and about the kind of information that was required

regarding their children. The parents were distributed the scoring sheet and were

initially asked to fill the details of their child. The chronological age of the child in

terms of both years and months was noted along with the date of birth. All the ethical

considerations were met.

The instruction for each task was given differently based upon the type of ability

tested such as reception, expression and cognition. Items from the corresponding age groups

was asked first and their performance on other items above their age group and below was

also evaluated under each section. The parents were provided with appropriate examples

when they did not understand the purpose of the question. Responses of the child were

checked for two consecutive age groups above and below that of the child‟s chronological

age. It was continued in the lower age groups till 3 „+‟ was recorded and in the higher ones

till 3 „_‟ was obtained within the age group.

Scoring and Reliability: The responses were recorded in the response sheet. The

informants were instructed to mark the response on each item as a „plus‟ (+) when they feel

that the behavior of the child was established, a „minus‟ (-) when it had not yet emerged and a


144

„plus-minus (+/-) whenever the given language behaviors were only partially exhibited or

inconsistently noted (Remarks were also noted).

The Reliability of test scores was examined, in part, using test – retest reliability. In

this case, the consistency of performance as a function of test administration was

investigated. The test – retest reliability was conducted for 10% of the subjects in the age

range of 3-6 years selected randomly from each age group and tested using the same tool

within a span of 3 days.

Analysis of data: The data obtained from the above procedures was subjected to quantitative

analysis using Statistical Package for the Social Sciences (SPSS) (16.0 version) software for

both the pilot study and standardization population.


The raw scores were obtained by scoring the performance of every child on the test

items. A credit of one point for a response (+) and zero for no response (-) was given and the

total scores for each child on the test within each dimension (Reception, Expression and

Cognition) were obtained. The data, subjected to statistical analysis, are discussed for both

phase II (pilot study) and phase III (standardization process).

Mean scores and standard deviations

The raw scores obtained were used to determine the mean and standard deviations.

The scores achieved by each child through the above scoring method were cumulated to

calculate a total for each age group along each dimension. The total score for the boys and

girls of different groups were also found separately. Thus, the mean and standard deviation

scores for both Phase II and III in each group were calculated from the total score.

Phase I: Pilot study

Table 1: Mean and Standard deviation for the pilot group in each section of Reception,

Expression and Cognition for different age groups.

Age

Reception Expression Cognition

Mean Std.

Deviation Mean

Std.

Deviation Mean

Std.

Deviation

3-3.6 yrs

3.6-4 yrs

4-4.6 yrs

4.6-5 yrs

5 - 6 yrs

8.00 0.71 8.40 0.89 10.20 0.84

16.40 1.14 16.00 1.22 15.80 0.84

25.00 0.71 23.20 0.84 27.80 4.44

30.20 1.30 29.20 1.30 34.40 0.55

41.60 1.14 41.20 1.64 45.80 0.84

The above data represented in table 1, gives the overall mean and the standard

deviation scores. It indicated that there was not much difference present between reception,

expression and cognition within each group, but cognition was found to be better when

compared with reception and expression. The mean and standard deviation was greater for

the higher age group when compared with the lower age group. The difference in the skills


145

increased as the age progressed which could be interpreted from the increase in mean score

and standard deviation with increase in age group.

Kruskal Wallis test was carried out to compare the responses across the five groups

for the items in the three sections (reception, expression and cognition). It revealed that there

was a significant difference present between age groups in reception, expression and

cognition, reception at (2(4) = 23.175, p<0.001), expression at (

2(4) = 23.166, p<0.001) and

cognition at (2(4) = 23.166, p<0.001). From Mann Whitney U test, significant differences

were found to exist across all the age groups for all the three sections at 0.001 level of

significance. Friedman test was done to compare the scores of reception, expression and

cognition within age groups in the pilot study and the following results were achieved. If

significance was found to exist, then Wilcoxon signed rank test was done to compare items in

each section of each age group.

a) Within age group 1 (3-3.6 years)

It was ascertained that significant difference existed between reception, expression

and cognition at (2

(2) =6.000, p<0.05). Wilcoxon test revealed that there was no significant

difference found between reception and expression, expression and cognition but there was a

significant difference present between cognition and reception at 5% level of significance.

The present research is in agreement with the study done by Ogura (1991) who found a

significant relationship between young normal children‟s play and language comprehension,

but not expressive language.

b) Within age group 2 (3.6-4 years)

Friedman test showed a significant difference in three section such as reception,

expression and cognition within age group 2 at (2

(2) =7.600, p<0.05) and thus Wilcoxon

signed rank test was carried out. This also showed that there was a significant difference

present between cognition and expression (z=2.03, p<.0.05) and cognition and reception

(z=2.02, p<.0.05) but no significant difference were found between reception and expression.

Mc Cathren, Warren and Yoder (1996) reported that symbolic play competences are seen as

being among the most influential predictors of early language development during the

preschool year. Therefore parallel developments in play and language could be explained as

deriving from a common underlying capacity for cognitive representation.

c) Within age group 3 (4-4.6 years)

For the group of children who participated in the age range of 4-4.6 years, Friedman

test revealed no significant difference across the three sections such as reception, expression

and cognition at 5 % level of significance. Cognitive skills and language abilities are

associated; they develop in parallel fashion. New and increased cognitive ability may enable

a child to function differently, but it does not cause language change. Rather, cognition and

language are strongly related with underlying factors. Attainment of a skill in either area is

reflected in the other although no direct overall relationship exists, specific relationships are

evident during development (Gopnik & Meltzoff, 1986).


146

d) Within age group 4 (4.6-5 years)

It was determined from the Friedman test that there was significant difference

prevailing between all the section at (2

(2) =7.111, p<0.05). Hence pair wise analysis using

Wilcoxon signed ranks test was used to find the significant pairs between items. Results

demonstrated that there was significance differences existing for cognition and expression

and for reception and expression at 5% level of significance but no such significant difference

were found for reception and cognition. The present study is in accordance with the research

done by Chapman (2000) where the authors studied the comprehension and production of

reversible active sentences in children. He reported that the children performed better in the

production task than in the comprehension task, leading to conclusion that production

precedes comprehension.

e) Within age group 5 (5-6) years

The statistical analysis using Friedman test showed that there was no significant

difference found between all the three sections at (2 (2)=0.73, p>0.05). Thus the present

study supports one such research where it was found that language-play correlations were

strongest in early language development, and that the domains did not develop in parallel as

the child matured (Kennedy, Sheridan Radlinski & Beeghly, 1991; Ogura 1991). Ogura

(1991) also highlight that cognitive domains become increasingly modular with development

and may not be strictly „innate‟ from birth, which is in line with the neuroconstructivist

approach to development. Thus, by 5-6 years the children develop most skills when

compared to younger children.

Figure 1: Graphical representation shows the mean percentage scores of Reception,

Expression and Cognition across different level of age groups (3-6 years).

From the graph, it‟s observed that there is an increasing pattern in all the sections

(Reception, Expression and Cognition). Thus, it can be clearly interpreted that with an

increase in age, the performance on language and cognitive abilities are also found to be

increased. The results for the pilot study across the age groups and their performance

revealed that the differences in performances were observed across the groups with increase

in age of the children. There was a clear pattern of hierarchy noticed. The items with more

difficulty were found to be performed better by higher age group children when compared

with lower age group children. Result based on the statistical analysis highlights that there

was a well defined difference found on the performance of cognitive items when compared

with reception and expression.


147

According to the above results, receptive as well as expressive language skills and

cognitive skills found to be improved across the years; seemingly there are highly significant

differences in the skills acquired between 3-6 years of age. This could be attributed to the fact

that language acts as another form of behavior which is acquired as a response to the stimuli

in the environment and then it is learnt. Parental stimulation and environment exposure are

seemingly the important factors for the increased linguistic development for the present

generation. Vijayalakshmi (1981), Sudha (1981) and Santhi (2008) reported “significantly

better performance in the older age group compared to the younger age group particularly for

the expression of children in the age range of 1 to 5 years and 2 to 5 years, which supports the

present study. This could be attributed to the fact that with increase in age there was

advancement in neuromuscular maturity and motor skills as well as the linguistic and

cognitive abilities. Many researchers have also found a correlation between various aspects of

language with play. Ogura (1991) found a significant relationship between young normal

children‟s play and language comprehension, but not expressive language. Thus indirectly

supports the fact that plays acts as the basis for cognitive and linguistic development

especially in preschool children. Thus, the above mentioned studies are in accordance with

the present findings thereby highlighting the importance of play on cognition and language

acquisition during the preoperational stage in the preschoolers.

Phase III: Standardization

a) Age group 1(3-3.6 years)

Table 2: Mean and Standard deviation for the age group 3-3.6 years according to gender for

three sections (Reception, Expression and Cognition).

Subject

Number of

subjects Mean Std. Deviation

Reception

Males 13 5.00 0.913

Females 17 4.88 1.27

Expression

Males 13 4.31 1.25

Females 17 5.00 1.37

Cognition

Males 13 4.69 1.32

Females 17 5.29 1.16

The above table 2 gives the mean and standard deviation for children in the age range

of 3- 3.6 years, which included 13 males and 17 females, obtained by quantitative analysis of

the raw scores. On comparison of the performance of the male and female children across the

items, it was found that there was a wide difference between males and females children

within the age group and across the items too. The present findings contrasted with the study

done by Griffin & Norris (1967) which showed no significant differences in speech of boys

and girls. `The independent t- test was carried out to find differences between males and

females on three sections such as reception, expression and cognition. Results revealed that

there was no significant difference between the male and female groups. Further, Pearson‟s

Product Moment correlation was applied on the data to study the relationship between

reception, expression and cognition scores. It showed was a positive correlation between


148

expression and cognition (r=0.810, p<0.01), but reception was not significantly correlated

with cognition and expression. Repeated measure ANOVA was done to compare the

performance of children in the age range of 3-3.6 years across the three different sections

such as reception, expression and cognition. However, the result obtained in the present study

contrasts with the result obtained by Vijayalakshmi (1981) which revealed performance of

females to be better than the males.

Figure 2: Graphical representation of the mean scores for the age range 3-3.6 years for

Reception, Expression and Cognition between males and females.

From the graph i.e. figure: 2, it can be construed that the performance of males and

females is almost same for reception whereas expression and cognition illustrates difference,

thought not statistically significant. Researchers have found that children demonstrate certain

cognitive abilities at the approximate time as corresponding language behavior emerges

(Clark, 1980). However, Clark (1980) opines that correlation is not the same as causation;

because if two events occur at about the same time does not necessarily mean that one caused

the other. The present study concurs with the same.

b) Age group 2 (3.6- 4) years

The computation of the scores resulted in the below table 3 depicts the mean and

standard deviation for children in the age range of 3.6-4 years for both males and females (15

males and 15 females). The result revealed that there was no significant difference found

between male and female children within the age group as observed from the mean and

standard deviation scores.

Table 3: Mean and Standard deviation for the age group 3.6- 4 years according to gender for

three sections (Reception, Expression and Cognition).

Subject Number of


Reception

Males 15 4.53 1.46

Females 15 4.87 1.36

Expression

Males 15 5.07 1.16

Females 15 5.27 0.96

Cognition

Males 15 4.93 1.44

Females 15 4.67 1.18

The Independent t- test which was done to compare the performance of male and female

children also showed no significant difference between them. Further, Pearson‟s product

moment correlation exemplified that there was a significant correlation existing between


149

reception, expression and cognition leading to language development in a preschooler.

Repeated measure ANOVA was done to compare the performance of children in the age

range of 3.6-4 years across the three different sections such as reception, expression and

cognition. No significant difference was present across the sections. The present findings are

in support with the study done by Gopnik and Meltzoff (1997), where the author reported a

relationship between cognitive mechanisms and language through analysis of linguistic

components.

Figure3: Graphical representation of the mean scores for 3.6-4 years for reception, expression

and cognition between males and females.

From the above graph it can be interpreted that the performance of males is better

when compared to females though not statistically significant. Additionally, the performance

expression was considerably better followed by cognition and then reception. Recent

advances in cognitive psychology, neuroscience and linguistics support an embodied view of

cognition, i.e. the fact that cognitive functions (perception, categorization, reasoning and

language) are strictly interwined with sensorimotor and emotional processes (Ogura,1991).

This is particularly evident in recent studies on the grounding of language in action and

perception (Casby, 2003). This indirectly supports the relationship between cognition and

language, as observed in the present study.

A) Age group 3 (4-4.6 years)

The below table indicates the mean and standard deviation for children in the age

range of 4-4.6 years which included 12 males and 18 females for all the three sections i.e.

reception, expression and cognition. The score obtained by descriptive statistical procedure

reveals that there were no evident differences noticed between from the scores.

Table 4: Mean and Standard deviation scores for the age group 4-4.6 years for both male and

female children.

Subject

Number of


Reception

Males 12 4.50 1.09

Females 18 4.72 1.02

Expression

Males 12 4.92 1.08

Females 18 5.00 1.14

Cognition

Males 12 5.00 1.04

Females 18 4.78 1.22


150

There was no significant difference between the performance of male and female

children in the age range of 4-4.6 years as indicated by Independent t- test. Pearson‟s Product

Moment correlation was applied on the data to study the relationship between comprehension

and production and cognition scores. It showed no correlation between reception, expression

and cognitive. Repeated measure ANOVA was done to compare the performance of children

in the age range of 4-4.6 years across the three different sections such as reception,

expression and cognition. No significant difference was demonstrated across the sections in

the age range of 4-4.6 years.

Figure 4: Graphical representation of the mean scores for Reception, Expression and

Cognition between males and females in the age range of 4-4.6 years.

It can be inferred from the above graph that there was no significant difference

observed between the performance of males and females. Reception , Expression and

Cognition also do not demostrate a wide variation across them.The present study concurs

with the study done by Sudha (1981) where it was reported that the comprehension and

expression of children in the age range of 2 to 5 years showed no significant difference

between males and females in their performance. Slobin (1973) recognized the important

roles that the language being learned may play both in at the time of development of the

linguistic structures in that language and in the development of cognitive concepts that run

parallel to those structures, which support the present study where reception, expression and

cognition are found to be acquired paralelly.

B) Age group 4 (4.6-5 years)

Table 5: Mean and Standard deviation scores for Reception, Expression and Cognition of

males and females in the age group of 4.6-5 years.

Subject

Number of


Reception Males 17 4.82 1.24

Females 13 4.77 0.93

Expression Males 17 4.88 1.27

Females 13 5.31 1.03

Cognition Males 17 4.82 1.55

Females 13 4.54 0.78


151

The mean and standard deviation scores obtained by the male and female preschool

children in the age range of 4.6- 5 years for the three different sections of reception,

expression and cognition are represented in table 5. It can be understood from the table that

there are not much variation in the performance between the two genders in the same section

neither even across the sections such as reception, expression and cognition. Independent„t‟

test showed no significant difference between males and females. Pearson‟s product moment

correlation which was applied showed revealed that reception correlates more with cognition

and expression than, expression with cognition. Repeated measure ANOVA showed that

there was no significant difference found in the age range of 3-3.6 years across the three

different sections of reception, expression and cognition.

Figure 5: Graphical representation of the mean scores for Reception, Expression and

Cognition between males and females for 4.6-5 years.

It can be observed from the graph that reception, expression and cognition do not show

obvious differences and there was no evident variation found in the performance of males

and females except for expression. Thus, the present study finds support from the study done

by Jerperon (1922) who reported that girls talk earlier than boys; they articulate better and

acquire a more extensive vocabulary than boys of comparable age.

E) Age group 5 (5-6 years)

The mean and standard deviation for children in the age range of 5-6 years which

included 12 males and 18 females are shown in the table 6 below. There were not much

difference between males and females across the three sections.

Table 6: Mean and Standard deviation scores of males and females for Reception, Expression

and Cognition (5-6 years).

Subject N Mean Std. Deviation

Reception Males 12 4.67 1.37

Females 18 5.06 1.06

Expression Males 12 4.83 1.11

Females 18 5.00 1.03

Cognition Males 12 4.58 1.08

Females 18 5.00 1.19


152

Mc. Neil (1970) and Brown (1973) has indicated that the period from 18 months to 4

years is the most active period of language acquisition and distinct level in language

development can be made out. After the age of five years the rate of acquisition decreases

markedly and differences between adult and child specially are not so obvious. The

immaturity of a child‟s language after the age of five years is revealed only if a depth analysis

of the language structure is done (Chomsky, 1969). This can be correlated with the above

fact, demonstrated by the present study. However, it would be premature to draw any

conclusion since the age range considered was wide.

Independent„t‟ test which was carried out to compare the male and female

performances in the age range of 5- 6 years showed no significant difference between males

and females. Pearson‟s product moment correlation which was performed revealed that there

exists a close association between reception, expression and cognition. Repeated measure

ANOVA illustrates that there was no significant difference found in the age range of 5-6

years across the three different tasks such as reception, expression and cognition. The results

of the present study are in agreement with the research done by Piaget ,1962; Ogura, 1991;

McCune, 1995; Lyytenin, Laakso, 1997 & Tomasello et al., 1999). These studies also

demonstrated a strong relationship between play, cognitive development, and early

communication and language which tells the importance of cognition and language

development in preschoolers.

Figure 6: Graphical Representation of the mean scores for 5-6 years for Reception,

Expression and Cognition between males and females.

Bliss, Allen & Wrasse (1977) in their study found that males and females performed

alike, holding age constant, but the males require more prompting and structuring before they

produced the correct response. However, in the present study from the above graph, it is

understood that reception, expression and cognition the 5- 6 years old group of children. In

other words, the rate of emergence of various linguistic expressions in child language more or

less directly indexes the degree of their conceptual complexity (Huttenlocher, Smiley, &

Charney, 1983). According to some researchers, linguistic effects on cognition are more

likely to be found in domains removed from perception, involving higher-level cognitive

representations where human cognition appears to differ from other species (Spelke &

Tsivkin, 2001) thus supporting the importance of relationship between cognition and

language as discussed in the present study. Comprehension prior to production was

previously considered a universal stage of language acquisition. Data from young Thai

children suggests, however, that they may employ a distributional (Location & frequency)


153

strategy for production of certain language forms before they comprehend these forms

(Carpenter, 1991).

In general however, the current study discovered mixed results where few groups

demonstrated correlation between cognition, reception and expression and few only between

reception or expression and cognition which could be due to factors such as linguistic, social

and environmental influences experienced by the child in their day to day life. Therefore,

during the preschool years, the relationship between comprehension, production, and

cognition changes frequently and inconsistently as the child develops. In general, linguistic

developments parallel much of the cognition growth of the preschool child, although there is

no one- to- one relationship. Such heterogeneity suggests that development is very complex.

Similarly, the present study also found inconsistent female superiority in the age range

studied.

Conclusions

The present study was mainly designed to construct a tool for assessment of language

and cognitive abilities in typically developing preschool children in the age range of 3 to 6

years where language was not considered as a hurdle for testing especially in multilingual and

multicultural Indian context. A general significant correlation was obtained between the

development of language and cognition. The performances of males and females was

compared which showed mixed results. After the administration of the test, the child‟s score

had to be compared with the normatives. This would indicate whether the child is deficient in

speech, language and cognitive aspects. It can be concluded that the present assessment tool

tests the development of language and cognitive abilities in typically developing preschool

children appropriately. The normative data obtained reveals that the performance of the

children increases as a function of age.

Implications and further research

The current study would help to assess and identify the language delayed/deviant

children between 3-6 years based on their receptive, expressive and cognitive abilities. The

age range of the present test can be extended further considering the cognitive development.

Further, the test tools can be standardized for different language speakers keeping in

consideration the social and environmental needs.

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156

The Order of S, O, V Structures in Sign Language Users with Hearing

Impairment: Influence of Verbal Native Language?

Pallavi Malik & Dr. R. Manjula*

Abstract

Many investigators have expressed that structure of sign languages is essentially different

from that of the spoken languages. Very few studies have addressed the influence of verbal language

on the word order of ISL. The study aimed at investigating the sequence in which the Subject, Object,

Verb (SOV) signs occur in the sign language produced by individuals with hearing impairment

belonging to five verbal native languages (Kannada, Malayalam, Telugu, Tamil and Hindi). It also

aimed to investigate the influence of mode of communication by the signers and others in the family

on the use of SOV sequence of signs as tapped through a questionnaire. Ninety hearing impaired sign

language users belonging to five language backgrounds of Kannada, Malayalam, Telugu, Tamil and

Hindi participated in the study. They were asked to produce signs for a three picture story sequence

cards which was video recorded. The signs used were analyzed by three judges for the order of the

‘base units’ which was operationally defined for the study. Results indicated that SV was the most

commonly occurring structure in all the language groups suggesting the occurrence of an overly

simple structure which is not similar to the verbal language word order i.e. SOV. Signed expressions

beginning with S or O or V as a whole were taken into consideration for analysis. Results revealed

that signed expressions beginning with ‘S’ occurred maximally followed by ‘V’ and lastly ‘O’ for all

the language groups. The results of the questionnaire indicated that ‘only signs’ was the primary

mode of communication used by the sign language users with Hearing Impairment. A combination of

‘sign and speech’ was the primary mode of communication used by the family members except for the

Malayalam language group.

Introduction

Sign language is a language which uses manual communication, body language and

lip patterns instead of sounds to convey meaning—simultaneously combining hand shapes,

orientation and movement of the hands, arms or body, and facial expressions to express

fluidly a speaker's thoughts. In linguistic terms, sign languages are as rich and complex as

any oral language, despite the common misconception that they are not "real languages".

They have complex grammars of their own. Signs are conventional in nature, often arbitrary

and do not necessarily have a visual relationship to their referent, as in most of the spoken

languages. Sign languages are used most commonly by those individuals who have hearing

impairment. Woodward (1977) identified several language families based on hypothesized

relationship between known sign languages. According to Woodward (1977), American Sign

Language (ASL) belongs to the French sign language family and British Sign language

(BSL) belongs to the British sign language family. Other families identified include Asian,

South American, Egyptian, Indian, and Malaysian.

__________________________________

* Professor of Speech Pathology, All India Institute of Speech and Hearing, Mysore, India


Influence of Verbal Native Language on Grammatical Structure in SL users

157

The structure of sign languages as used in different countries varies. Sign languages

are natural languages that arise spontaneously wherever there is a community of

communicators; they effectively fulfill all the social and mental functions of spoken

languages; and they are acquired without instruction by children, given normal exposure and

interaction. These characteristics have led many linguists to postulate that sign languages

could be similar to spoken languages in significant ways. But sign languages are also

reported different from spoken languages. Sign languages exploit a completely different

physical medium as compared to the vocal-auditory system of spoken languages. Thus, sign

languages have their own unique phonology, morphology and syntax; which is essentially not

similar to the spoken languages.

Syntax, whether in verbal language or in sign language, begins with phrase structure.

It includes a set of properties which determine the construction of sentences in that language

(Hawkins, 2001). In spoken languages, there are conventional markings in the beginning and

end of the sentences. The order of words in a language is as important as is the meaning. If

the words or signs are not combined to the syntactic rules of that language, then the meaning

is either changed, lost or becomes unclear. The same holds good for sign languages as well.

Sign language syntax

For a long time, sign languages have been regarded as somewhat disreputable related

of spoken language. Sapir (1921) described it as a derivative of spoken language The major

breakthrough in the area of sign language syntax research began with studies in American

Sign Language (ASL). Amongst the 121 existing sign languages in the world (Gordon Jr.,

2005), American Sign Language (ASL) has been studied most extensively.

American Sign Language (ASL) is the dominant sign language used by the Deaf

community in the United States, Canada, and in some parts of Mexico. The proposal that

basic word order in ASL is Subject-Verb-Object (SVO) was supported by Fischer (1975)

who stated that (SVO) order is found in signed expressions with reversible subject and object.

Fischer (1975) also suggested the possibility of other word orders as well which generally

accompanied intonation breaks. Friedman (1976) argued against Fischer‘s (1975) analysis

claiming that several word orders occur in ASL and that the word order is of no grammatical

significance. Friedman (1976) claimed that word order is relatively free, with the exception

of the tendency for the verb to occur at last. Liddell (1980) critically evaluated both Fischer‘s

(1975) and Friedman‘s (1976) accounts and argued that Friedman‘s (1976) proposals were

not convincing. Although there was some variability in word order for declaratives, the only

grammatical word order corresponding to the yes/no question was SVO.

British Sign Language (BSL) is the sign language used in United Kingdom (UK).A

terminology known as ―Proform‖ is identified in BSL. Proforms are similar to pronouns. It is

anything that refers to, and stands in the place of something that is previously identified

(Sutton-Spence & Woll, 1999). In case of sign language, the term pronoun is used to mean I,

you, he, she, it, we, them etc., and proform is more specific only to BSL. The sign order of

BSL has its own rules which are very different from the rules of English. To use the proform,

it is necessary to sign the full sign and then the proform. BSL usually puts adjective second

whereas English puts adjective first. The time frame in BSL is marked at the beginning of the


158

signer‘s first sentence. The question and verb sign may be placed at the beginning as well as

at the end of the sentence. In BSL, the topic is established first followed by the comment on

the topic. Thus, the topic is the subject of the sentence. It does not have fixed role. It can also

be the focus, some old information, theme of the discourse till the next theme is established,

or the person or thing upon which the conversation is centered. On the other hand, comment

is the predicate. It is the new information about the topic. In BSL, the topic is marked in

several ways:

a) Topic comes first and is followed by a pause.

b) Eyes are widened during the topic and can be accompanied by a head nod.

c) The topic may be signed and held with one hand while producing the comment with

the other hand.

Major contribution in the area of word order of BSL was made by Deuchar (1983)

who supported the analysis of Friedman (1976) and stated that topic- prominence is the

characteristic of both BSL and ASL. Deuchar (1983) explained topic-prominence in BSL. On

the basis of these evidences, Deuchar (1983) questioned the variation reported in studies.

Some studies as that of Fischer (1975) and Liddell (1980) identified SVO as the basic word

order whereas others (McIntire, 1980) identified topic-comment as the basic structure of sign

language sentences. In fact, the studies which reported a topic-comment structure have

generally used recordings of spontaneous signing, while other studies reporting SVO

structure have used elicited sentences. Thus, Deuchar (1983) suggested that communication

situation may have an important effect on sentence type and thus analysis of the data in terms

of the topic-comment nature may give a useful insight into the syntactic structure of a Sign

language.

In contrast to ASL and BSL, Indian Sign Language (ISL) or Indo-Pakistani Sign

Language (IPSL) is the sign language variety that is predominantly used in the Indian sub-

continent. One of the earliest attempts to study IPSL was made by Vasishta, Woodward and

Wilson (1978). They studied the sign languages from the four major geographical divisions

of India which are expected to have some variations in the pattern of signing within the

country, namely, Delhi, Bombay, Bangalore and Calcutta. The results that they obtained were

as follows:

1. In simple sentences, predominant word order is SV.

2. Sentences comprising of Subject, Object, Verb relation were expressed using sign

order as well as various grammatical operations. Subject always preceded the object

and verb occupied the final position in 95% of the sentences

3. The expression of Subject, Verb, Object and Indirect Object relations gave different

results for different cities.


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Table 1: Expression of Subject (S), Verb (V), Object (O) and Indirect Object (IO).

4. Pronominal forms are used when a context has been established earlier. But no specific

classifiers were observed to designate Pronouns in ISL unlike The American Sign

Language. Instead, effective use of space was seen which eliminated the need for

classifiers.

5. It was noticed that adjectives were always placed after nouns that they modified, but

with one exception. Color adjectives were always placed before the noun, particularly,

when modifying object nouns.

6. Negation was always placed at the end of the sentence.

7. The single past marker occurred in the sentence final position. Like the ASL, even in

Indian Sign Language, a time frame is generally set and no mention of it is made till

shift is made.

8. Non-manual markers are seen in case of Interrogative sentences. In an attempt to

produce the interrogative equivalent of a declarative sentence, forward and sideward

tilting of the head, raised eyebrows or holding the hands in the position of the last sign

is found.

Zeshan (2003) reported that sentences are always predicate final and generally has a

verb ending. She also reported that one-word sentences are common in IPSL and that there is

a strong preference for sentences with only one lexical argument. Further, she commented

that constituent order does not play any role in the marking of grammatical relations.

Topicalization of constituents was reported as a common strategy in IPSL (Zeshan 2003;

Aboh, Pfau & Zeshan 2005).

Verbal language syntax

English is the most widely spoken verbal language. English has an unmistakable word

order of Subject – Verb – Object (SVO) (Tomlin, 1986a). It is observed that English

maintains a rigid SVO word order mainly used to signal grammatical roles.

Kannada is one of the major Dravidian languages of India. Hiremath (1961) reported

that there is freedom of occurrence in the expression of various words in the sentence in

Kannada language, implying that the SOV usage is flexible. Schiffman (1979) also stated that

the basic word order in a Kannada sentence is SOV, but other orders can be found in the

language, due to stylistic variations. Malayalam is a Dravidian language used predominantly

in the state of Kerala. Peet (1980) stated that noun precedes its governing particle and the

finite verb always closes the sentence in Malayalam language. Adverbs are placed before the

verbs and adjectives or sometimes in any part of the sentence. Telugu is a Dravidian language

used predominantly in the state of Andhra Pradesh. Subhramanyam (1974) reported that verb

Cities Word order

Delhi S – O – IO – V (Incorporation of O and IO in V)

Bangalore S – IO – O – V (Incorporation of O in V)

Calcutta S – IO – O –V

IO – S – O – V (Incorporation of O and IO in V)

Bombay S – IO – O – V

IO – S – O – V (Incorporation of O and IO in V)


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occupies the final position in the sentence, and there is an object in the sentence that usually

precedes the verb in Telugu language and the subject occupies the first position in the

sentence. Krishnamurti and Cwynn (1985) stated that when there is a transitive verb in the

sentence, then the natural word order of words is noun (subject) - noun (object) – verb. Tamil

is a Dravidian language used predominantly in the state of Tamil Nadu. Kerslake and Aiyar

(1953) reported that verb always comes in the last and the object always precedes the verb in

Tamil sentences. So the unmarked word order of Tamil language is Subject – Object – Verb

(SOV). In general, the unmarked word order of constituents in a sentence is subject-object-

verb (SOV) in the Dravidian languages (Krishnamurti, 2003).

Hindi belongs to Indo-Aryan Language family. Sharma, Chatterji, Satyanarayana,

Saksena and Nene (1994) suggested that the word order in Hindi is normally as follows:

1. When a sentence has an Intransitive Verb, then the word order found is SV.

2. When a sentence has a Transitive Verb, then the word order found is SOV.

3. When a sentence consists of a Transitive verb with two objects then the word order

followed is Subject – Secondary Object – Primary Object – Verb ( S 20O 1

0O V).

4. Adjectives are placed immediately before the noun that they qualify.

5. Adverbs are usually placed before the verb.

6. Negation denoting words are placed before the verb.

It is noteworthy that all these varied cultures have individuals with hearing

impairment who would use Sign Language. Thus, it seems natural that there would be an

influence of these spoken languages on the sign language used by these individuals as a result

of their interaction with the hearing individuals.

Need for the study

A major issue in the area of research that is less addressed is the influence of word

order of the verbal language to which the individual with Hearing Impairment who uses sign

language belongs, on the order expressed in the sign language of that individual. There are no

studies which have addressed this topic and it is quite understandable because most of the

well studied sign languages such as ASL and BSL originate from countries which are

essentially monolingual. The implication of this is that it does not facilitate cross language

comparisons in terms of the influence of native verbal language on sign language or the

influence of one or more verbal language over the sign language usage. India is a multilingual

country with 114 languages belonging to four distinct linguistic families. Thus, the scope to

address the issue of influence of verbal language word order on the order of emergence of

structure in the sign language is abundant in India.

This study attempts to look into the influence of the word order in the verbal language

on that of the order of emergence of structure in the sign language in all the four Dravidian

Languages (Kannada, Malayalam, Telugu and Tamil) and Indo-Aryan Language (Hindi). All

these languages have been found to have SOV as their predominant word order. Thus, it is

interesting to address the issue of the influence of word order of verbal language on the


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signed expressions in individuals with Hearing Impairment using sign language belonging to

various native language backgrounds. The outcome of the study will facilitate comparison of

the emerging word order in the sign language expressed by persons with Hearing Impairment

and will throw light on the influence of the verbal language if any, on the signed order by

individuals with hearing impairment. It can indirectly contribute towards an understanding of

the factors which have led to the finding of different types of signs used by persons with

Hearing Impairment residing in different states in India, even different regions/ districts

within a state of India. It will help in understanding the linguistic constraints if any in the

variations from region to region seen in the sign languages of individuals with hearing

impairment in India.

Aims of the study

To compare the sequence in which the Subject, Object, Verb (SOV) signs occur in the

sign language produced by individuals with hearing impairment belonging to five verbal

native languages (Kannada, Malayalam, Telugu, Tamil and Hindi) and investigate if there

is any similarity between the sequences of SOV in signs used and

To understand the influence of mode of communication by the signers and others in the

family on the use of SOV sequence of signs as tapped through a questionnaire.

Method

Subjects

90 sign language users with hearing impairment participated in the study. The

subjects were selected randomly for the study. The demographic details of the subjects and

the mean ages across groups are provided in Table 2.

Table 2: Demographic details of the subjects

Subject selection criteria

They belonged to the verbal native language background, of Kannada, Malayalam,

Telugu, Tamil and Hindi languages (not necessarily spoken by the subjects, but the

subjects could be exposed to these languages through parents / caregivers / teachers or

medium of instruction through writing or reading).

They were in the age range of 15 - 25 years.

The minimum educational qualification of the subjects was secondary education in a

special school for the individuals with hearing impairment.

Age Range Verbal Native Language

Kannada Malayalam Telugu Tamil Hindi

M F M F M F M F M F

15 to 25 yrs 12 8 17 3 18 2 14 1 15 -

Total 20 20 20 15 15

Mean Age 18.75 20.47 19.4 20.06 21

M = Males

F = Females


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The subjects were not exposed to any other verbal language other than their native

verbal language under which they were grouped.

Procedure

The subjects were grouped according to their verbal native language into five separate

groups. Each subject participated in the task individually. All the subjects were kept blind to

the purpose of the study. They were not allowed to discuss the task mutually before the

completion of the task.

Material

Two types of material were used in the experiment:

a) Questionnaire: A questionnaire was prepared to collect the following information from

each subject:

Family history of hearing loss

Type of school attended

Predominant mode of communication of the subject – sign / speech / sign and speech.

Predominant mode of communication used by subject‘s parents, teachers and other

communication partners, with the subject – sign / speech / sign and speech.

b) Picture stimulus cards: The subjects were provided with three sequence picture cards

which consisted of a story sequence. The three-picture story sequence cards depicted a

theme and it was such selected, that it provided a chance for the occurrence of a subject,

object and a verb in each card.

Setting and instruction: Initially, each subject was asked to fill the questionnaire. Then, each

subject was made to sit on a comfortable chair in a well-lit room with no external distracters.

Each subject was asked to express through signs, the content that was seen in the three

picture sequence story cards, as slowly and as clearly as possible.

Recording and storing

Before the commencement of the task, the three sequence cards were presented to the

subject for about 2 minutes to facilitate familiarization of the theme, the picture cards and

formulation of thoughts to express the contents through signs. Then, the cards were placed in

a row in front of the subject and the subject was asked to narrate the content using signs.

Recording of each individual‘s performance was done using a video camera and the data was

saved in compact disks for later analysis.

Analysis

Analysis of the data was done by three judges (sign language interpreters by

profession). The judges carried out the coding task independently without mutual

consultation / discussion. A ‘base unit’ was identified in the signs produced by the subjects

for the ease of analysis and to identify the word order. The ‗base unit‘ was operationally

defined in this study as one identified by each judge on the basis of following criteria:


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The unit selected should include a meaningful (semantic) unit.

The selected base unit should be related semantically to the preceding and following base

units.

The video recordings were shown to each judge separately. Each video was paused at

appropriate ‗base unit‘ locations identified by the judge. Then the judge was asked to write

down the order of occurrence of Subject (S), Object (O) and Verb (V) produced in the video

in that particular ‗base unit‘. In this manner, all the videos were coded by all the three judges.

The various word orders, in which S, V and O occurred in these five languages was then

coded according to the ‗Base units‘ identified by the judges and tabulated separately. The

order identified by the judges was then grouped as the signs beginning with ‗S‘ as the initial

structure, or ‗V‘ as the initial structure, or ‗O‘ as the initial structure. As the number of ‗base

units‘ identified in each video by the three judges was varied; the data obtained was

converted into percentages for later statistical analysis.

Inter-judge reliability: Item-by-item comparison (agreement- disagreement) of the judges

was carried out. To treat the coding as valid, a reliability coefficient of 0.8-0.9 between the

judges per subject was considered.


I) Subject, Object, Verb (SOV) order occurrence in signs

A. Various SOV patterns

With the identification of the base units, it was observed that different patterns of

SOV orders emerged in the signs used by individuals with hearing impairment belonging to

different native verbal language groups. In depth analysis of the various sentence structures

revealed that there were many structures that were exhibited less frequently than others. A

score of ‗>/= 25%‘ of occurrence was considered to include a sentence structure for further

statistical analysis. Thus, ‗V(+O)‘ was considered for statistical analysis only for Malayalam

language group, ‗O‘ for Tamil language group and ‗V (+S, O)‘ for Telugu, Tamil and Hindi

language groups. The structure ‗SOV‘, which is the reported predominant word order pattern

of all the verbal native languages of the selected languages by many investigators [Kerslake

and Aiyar (1953); Hiremath (1961); Subhramanyam (1974); Schiffman (1979); Peet (1980);

Mohanan (1982); Krishnamurti and Cwynn (1985); Sharma, Chatterji, Satyanarayana,

Saksena and Nene (1994); Asher and Kumari (1997); and Krishnamurti (2003)], was also

exhibited by all the language groups in their signed expressions. But this structure was still

considered for statistical analysis to find out if it was significantly present in these languages

or not, as it is significantly present in all the verbal native languages of the subjects of the

study.

Thus, a total of seven Subject, Object, Verb (SOV) order patterns in the signed

expressions were considered for further analysis which included SV, SOV, SV (+O), O, V

(+S), V (+O) and V (+S, O). The exclusion criteria followed for this selection was based on


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Reliability coefficient α for these word order patterns across all the language groups as coded

by all the three judges. High reliability values were obtained (α < 0.8). Further, the means and

standard deviations of these structures were computed and are tabulated in Table 3.

Table 3: Mean and Standard Deviation (SD) of the various SOV order patterns in all the

language groups.

Language groups Mean & SD SV SOV SV(+O) O V(+S) V(+O) V(+S,O)

Kannada Mean 35.34 4.45 15.72 1.30 29.84 7.93 .66

SD 21.11 8.21 15.05 3.67 30.67 17.56 2.05

Malayalam Mean 39.95 4.60 23.70 2.32 13.81 15.40 4.12

SD 15.02 7.42 13.39 4.82 16.89 28.41 7.34

Telugu Mean 45.20 3.44 19.33 3.10 17.26 .00 5.48

SD 20.47 6.61 15.57 5.61 23.36 .00 9.95

Tamil Mean 36.49 3.17 10.79 5.25 24.78 .00 13.38

SD 25.44 7.90 14.10 7.17 27.30 .00 20.26

Hindi Mean 36.17 5.33 20.65 1.48 19.12 3.57 13.66

SD 25.76 11.93 19.15 4.43 15.46 13.83 19.10

Total Mean 38.89 4.19 18.29 2.61 20.85 5.78 6.79

SD 21.29 8.26 15.69 5.26 23.84 17.49 13.46

It is observed that the ‗SV‘ structure emerged as the most predominant SOV order

pattern in all the language groups. This finding suggests that an overly simple sentence

structure was used by the subjects belonging to all the language groups predominantly which

was not similar to the one observed in verbal languages i.e. SV was found to be the most

predominant structure in all the language groups whereas SOV was identified as the principal

word order in verbal languages Kannada, Malayalam, Tamil, Telugu and Hindi languages

[Kerslake and Aiyar (1953); Hiremath (1961); Subhramanyam (1974); Schiffman (1979);

Peet (1980); Mohanan (1982); Krishnamurti and Cwynn (1985); Sharma, Chatterji,

Satyanarayana, Saksena and Nene (1994); Asher and Kumari (1997); and Krishnamurti

(2003)]. Thus, the order pattern of occurrence of Subject, Object, Verb (SOV) in sign

language expression is not similar to the verbal language word order pattern. This finding is

in line with the findings of Zeshan (2003) and Aboh, Pfau and Zeshan (2005), who stated that

ISL is a verb - final language. Vasishta, Woodward and Wilson (1978) also observed that in

simple sign expressions, subject always precedes the verb.

Multivariate measure ANOVA was carried out to compare all the five language

groups for the occurrence of predominant order patterns namely SV, SOV, SV (+O) and V

(+S) in the signed expression; which were present in all the language groups. Results of the

test revealed no significant difference for all the SOV order patterns across all the language

groups at p<0.05. This finding signifies that there exists identical pattern of occurrence of

these structures for all the language groups. Thus, it can be deduced that there is no difference


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in sign expressions among these groups further suggesting the yet to be proved possibility

that there are no dialects in ISL as observed by Gordon Jr. (2005).

One way ANOVA was also carried out to compare the occurrence of the structure ‗V

(+S, O)‘ in Telugu, Tamil and Hindi Language groups and no significant difference was

revealed at p<0.05 which indicates that the structure ‗V (+S, O)‘ occurs in the same manner

in these language groups on a statistical basis despite percentage variations. This variation in

the percentage of occurrence might be because of the sample size wherein Telugu language

group had a sample size of 20 subjects and both Tamil and Hindi language groups had a

sample size of 15 subjects only. One way ANOVA was also carried out to compare the

occurrence of the order structure ‗V (+O)‘ in Malayalam, Kannada and Hindi language

groups, ‗O‘ across Tamil language group and ‗SOV‘ across all the language groups and the

results revealed no significant difference at p<0.05.

Repeated measure ANOVA was carried out to compare the occurrence of

predominant structures i.e., SV, SV (+O) and V (+S); within all the language groups.

Repeated measure ANOVA for the Kannada language group revealed significant difference

for SV and SV (+O) structure at p<0.1 but no significant difference was observed for V (+S)

structure. This finding suggests that SV is the most predominantly occurring structure

followed by V (+S) and SV (+O) which have equal probability of occurrence in the signed

expressions of the Kannada language group. Repeated Measure ANOVA for the Tamil

language group revealed significant difference for SV and SV (+O) at p<0.05 but no

significant difference was observed for V (+S) structure These results are in agreement with

the results obtained for the Kannada language group but the results for the Tamil language

group were highly significant at p < 0.05. This pattern [i.e. SV followed by SV (+O) and V

(+S)] was more well-defined in Tamil language group than Kannada language group is

evident from the higher significance obtained. The similarity between these two language

groups might be because these languages are reported to have similar features in their

linguistic structure including the phonetic and the syntactic structure (Krishnamurti, 2003).

Repeated Measure ANOVA for the Malayalam language group revealed significant

difference for SV & SV (+O) and SV & V (+S) at p<0.001 but no significant difference was

observed for SV (+O) and V (+S). Thus, SV was the most predominantly occurring structure

followed by SV (+O) and V (+S) in the Malayalam language group. Repeated Measure

ANOVA for the Telugu language group also revealed similar results as the Malayalam

language group at p<0.01. This implies that SV is the most predominantly occurring structure

followed by SV (+O) and V (+S) in descending order. But this pattern (i.e. SV followed by

SV (+O) and V (+S) in descending order) was more well-defined in Malayalam language

group than Telugu language group as evident from the statistical analysis. This similarity can

be attributed to the fact that Kannada, Malayalam and Telugu verbal languages are reported

to be similar in their grammar, syntax and vocabulary (Varma, 1999; Kunjamma, 1993). But

here, only Malayalam and Telugu were found to share a similar hierarchy and Kannada

shared a similar hierarchy with Tamil language group.


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Repeated Measure ANOVA for the Hindi language group revealed different results as

compared to the other language groups. The results showed no significant difference for any

of the word order patterns at p < 0.05. Thus, this finding shows that there exists equal

probability of occurrence of all the three structures under comparison namely, SV, SV (+O)

and V (+S) in the Hindi language group. This unique pattern obtained might be because of

the fact that Hindi language belongs to Indo – Aryan language family which has a different

origin than other language groups which belong to the Dravidian language family.

From the above findings, it is deduced that sign language used by the signers

belonging to all the language groups showed a predominant SV word order. In the literature,

it has been reported that the SOV structure is the most predominant word order in Kannada,

Malayalam, Telugu, Tamil and Hindi languages [Kerslake and Aiyar (1953); Hiremath

(1961); Subhramanyam (1974); Schiffman (1979); Peet (1980); Mohanan (1982);

Krishnamurti and Cwynn (1985); Sharma, Chatterji, Satyanarayana, Saksena and Nene

(1994); Asher and Kumari (1997); and Krishnamurti (2003)]. However, it is apparent that the

order that emerged in signed expressions of all the verbal native language groups (i.e. SV)

was not the same as reported for the word order in verbal language expressions of these

languages (i.e. SOV). These findings support the fact that even though these language groups

do not replicate the predominant word order pattern of the respective verbal native languages,

they show some similarity in terms of depicting similar hierarchy of predominant word order

pattern occurrence for Kannada & Telugu language groups and Malayalam & Tamil language

groups; and Hindi language group follows a totally different hierarchy which is not similar to

any of the other groups.

B. Sentence initial structures

After the analysis of the various word order patterns, signed expressions beginning

with S or O or V as a whole were taken into consideration for further analysis. Reliability

coefficient α for the signed expressions beginning with S, O or V; across all the language

groups was computed for all expressions as coded by the three judges. The results revealed a

high reliability value of α > 0.8. The means and standard deviations (SD) for the occurrence

of the signed expressions beginning with S, O and V were calculated and are represented in

Table 4.

Table 4: Means and SD for the structures beginning with S, O and V

Language Mean and SD Subject (S) Object (O) Verb (V)

Kannada Mean 62.41 4.90 37.66

SD 29.13 8.24 30.76

Malayalam Mean 76.29 3.32 20.38

SD 21.25 7.16 21.45

Telugu Mean 69.66 5.11 25.22

SD 25.92 8.49 26.79

Tamil Mean 52.92 6.92 40.21

SD 34.13 8.62 32.34

Hindi Mean 62.54 3.48 33.97

SD 23.30 6.43 24.74

Total Mean 65.55 4.69 30.86

SD 27.38 7.78 27.80


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It was observed that the standard deviation for the structures beginning with O was

greater than the mean percentage of occurrence suggesting a scatter. From Table 4, it is

evident that structures beginning with S occurred more frequently in the signed expressions

of all the verbal native language groups (65.55%), followed by structures beginning with V

(30.86%) and structures beginning with O (4.69%) in the descending order. This finding is in

accordance with previous finding that ‗SV‘ is the predominant sign pattern in all the five

language groups which has contributed to the high percentage of occurrence of structures

beginning with ‗S‘ as well. Other structures found to be most predominantly occurring is ‗SV

(+O)‘ which is also a structure beginning with ‗S‘. Structures beginning with ‗V‘ follow next

as structures like V (+S), V (+O) and V (+S, O) were predominantly occurring in various

language groups. The pattern of occurrence of these structures has been discussed earlier. Out

of these structures, V (+S) was found to occur predominantly in all the language groups

whereas, other structures i.e. V (+O) and V (+S, O) were found to occur predominantly only

in Malayalam language group and Telugu, Tamil & Hindi language group respectively.

Consequently, these factors have contributed to similar hierarchy in all the language groups.

Mixed ANOVA was carried out to investigate for interaction effect, if any among all

the sentence initial structures namely S, O or V for all the language groups namely Kannada,

Malayalam, Telugu, Tamil and Hindi. The results revealed no significant difference for the

occurrence of the sentence initial structure (S or O or V) among the five language groups at p

< 0.05 i.e. there was no interaction between the sentence initial structures and the language

groups. However, a significant difference was observed for the sentence initial structures

alone at p < 0.001]. Further, Bonferroni‘s test for pair-wise comparison revealed significant

difference for all the three combinations. On the other hand, comparison of the languages

alone revealed no significant difference at p < 0.05. This finding reflects that the pattern of

occurrence of these structures are similar across all the language groups.

Further, one-way ANOVA was carried out to find out the difference, if any, across the

sentence initial structure categories between the language groups. The results of the test

suggested no significant difference for the structures beginning with S, V and O at p<0.05.

This indicates that individuals with hearing impairment in all the verbal language groups

showed a similar pattern of word order in signing when only sentence initial structure was

taken into consideration.

These findings thus suggest that though there were some differences found in the

pattern of occurrence of various signed order patterns, there was no evident difference

obtained when sentence initial structures i.e. all the structures beginning with S, O and V,

were taken up for investigation as a whole. This observation indicates that all the language

groups follow a similar trend and there are no significant variations between signing patterns

of hearing impaired individuals. This finding is in line with the findings of Vashista,

Woodward and Wilson (1978) who also stated similar findings. But their investigation

reported similarity of the signs for a list of words and not in terms of the emergence of signed

order for S, O or V. Thus, the findings of this study may be viewed as an extension to the

findings of Vashista, Woodward and Wilson (1978) with respect to emergence of S, V, O

order in signs. Although substantial support is required from other similar studies, it may be


168

stated that at a preliminary level, the results probably point towards the existence of a single

sign language in India. Further, it may also imply that ISL as a sign language may have less

likelihood of presenting with different dialects. In other words, it may be inferred that at least

in term of emergence of the order of signs for Subject, Verb and Object as syntactic

constituents of ISL, there may not be much variation across deaf communities spread across

Indian subcontinent. This observation falls in line with that of Vashista, Woodward and

Wilson (1978); Woodward (1993); Zeshan (2000) and Jepson (1991).

Furthermore, Repeated measure ANOVA was carried out to compare the occurrence

of order patterns beginning with S, O or V within the various language groups. Repeated

measure ANOVA for Kannada group revealed no significant difference between S and V as

initial structure at p<0.05. But there was a significant difference between S & O and O & V

as the initial structure. Repeated measure ANOVA for Tamil and Hindi groups revealed

similar results as the Kannada group. Hence, for Tamil and Hindi language group, there was

no significant difference between S and V as initial structure. But there was a significant

difference between S & O and O & V as the initial structure at p=0.05. Thus, the results of

the present study show that Kannada, Hindi and Tamil language groups follow a similar trend

i.e. for these language groups, there exists similar probability of occurrence for sentences

beginning with S and sentences beginning with V in spite of the huge variation of the mean

percentage occurrence of S as initial structure and V as a initial structure. The percentage of

occurrence of structures beginning with S were significantly more than the structures

beginning with O; and the structures beginning with V were significantly more than the

structures beginning with O. The similarity of the trend in Hindi language group with

Kannada and Tamil language group is not understandable as Hindi (Indo – Aryan language

family) has different origin from Kannada and Tamil languages (Dravidian language family).

Repeated measure ANOVA for Malayalam language group revealed significant

difference for all the combinations i.e. between S & V, O & V and S & O at p<0.05. Thus,

Malayalam and Telugu language groups seem to follow a similar trend of presenting

significant difference for all the sentence initial structures. Thus, sentences beginning with S

occurred more frequently followed by sentences beginning with V and O in the descending

order. This can be accredited to the piece of information that Malayalam and Telugu verbal

languages have similar syntax structure (Varma, 1999; Kunjamma, 1993) which has resulted

in this similarity in signed expression as well.

II) Response to the questionnaire to understand the mode of communication

The responses to the questionnaire obtained from the subjects were tabulated for

presence or absence of the factor sought for. The percentage of positive responses across the

subjects in the group is represented in Table 5.


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Table 5: Percentage responses of the subjects to the questionnaire

It was also observed that all the signers belonging to different language groups used

‗only signs‘ followed by ‗both signs and speech‘ as their predominant mode of

communication. However, individuals with hearing impairment using ‗both signs and speech‘

as the predominant mode of communication were more in Kannada and Malayalam language

group followed by Hindi, Telugu and Tamil language group in the descending order. This

shows that the subjects fulfilled the criterion of being a signer more predominantly than being

a user who used a ‗combination of speech and signs‘ to communicate.

Regarding the mode of communication used predominantly by the family members

with the individuals with hearing impairment, it is evident that a combination of ‗sign and

speech‘ was used in all the language groups except the Malayalam language group.

Conclusions

The study provides an insight into the SOV order pattern used by sign language users

with hearing impairment belonging to various native verbal language background and this

study supports the findings of the previous studies by Vashishta, Woodward and Wilson

(1978), Zeshan (2003) and Aboh, Pfau and Zeshan (2005); that word order pattern of the

various sign language groups is not same as the verbal native languages of those groups.

Signers with hearing impairment tend to use an overly simplified sentence structure of SV

pattern most of the time whereas verbal native languages have a predominant structure of

SOV. Presence of embedded structures reflects upon the simultaneity feature of the sign

languages. The similarities obtained between some of the sign language groups are

suggestive of the fact that they have similar origin and similar syntactical structure. Thus,

these results reveal that the various sign language groups, at least in India may not be using

different sign languages but probably various dialects of the Indian Sign language attributing

to the fact that all sign languages show same structure with subtle variations when examined

at a gross level.

Parameters Kannada Malayalam Telugu Tamil Hindi

1. Positive family history of

hearing loss

20% 10% 5% 26.6% 20%

2. Predominant mode of communication

i) Speech - - - - -

ii) Signs 55% 55% 75% 80% 66.66%

iii) Signs and Speech 45% 45% 25% 20% 33.33%

3. Mode used by the family members

i) Speech 35% 50% 30% 33.33% 13.33%

ii) Signs 10% 15% 15% - 26.66%

iii) Signs and Speech 55% 35% 55% 66.66% 53.33%


170

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172

Articulatory Acquisition in Kannada Speaking Urban Children: 3-4 years

Prathima. S & N. Sreedevi

*

Abstract

The purpose of the present study was to re-examine the articulatory norms for the

Diagnostic Kannada Articulation test (Babu, Rathna, and Bettagiri, 1972). This test was

administered to 120 typically developing children in the age range of 3-4 years. They were

divided into 2 age groups (3-3.6 years and 3.6-4 years) with six months age interval. 62

target words were picturized and were used to elicit the target response from the subjects.

The responses were audio recorded and the data obtained were transcribed using IPA

transcription. The test was scored individually and the data was statistically treated by

obtaining the mean and standard deviation. In this study, articulatory development for a

particular speech sound was assumed to be complete/mastered, if 90% of the subjects

articulated them correctly in the initial and medial positions of the target word. Two-way

ANOVA was carried out to determine the significant difference in articulatory scores between

the 2 age groups as well as across gender. In general it was found that there was no

significant difference in articulatory acquisition scores between the 2 age groups considered

as well as across gender. Results indicated that all the speech sounds in Kannada were

mastered by the age of 3-3.6 years except /r/ in the initial position and /h/ in both initial and

medial positions. However among the clusters, only /ski/ was mastered by the age of 4 years

and rest of the clusters probably continues beyond the age of 4 years.

Key Words: Articulatory acquisition, Kannada, initial/medial positions.

Introduction

Over the years, many investigators have tried to determine approximate ages of

individual sound “mastery” in specific groups of children. (Wellman‟31, Poole‟34,

Templin‟57 and Prather‟76). The results of all these studies (shown in Table 1) suggest that

the articulation scores, which is a measure of the sounds, produced correctly, increases with

age until maturity is reached by 8 years. They have also found sex and socio-economic status

differences in the age of acquisition of articulation. These guidelines regarding the speech

sound development is important when trying to separate normal from abnormal phonological

development and when determining therapy goals.

Irwin and Wong (1983) conducted a study on 100 children in the age range of 18-72

months. 10 boys and 10 girls in each of the following groups were considered for the study:

18 months, 2 years, 3 years, 4 years and 6 years. Results indicated that- At 18 months of age

only /a/, /u/, /i/ and /Λ/ were produced with atleast 70% accuracy. At 2 years of age all the

vowels and diphthongs were produced with atleast 80% accuracy with the exception of /ɚ/

_________________________________________

* Lecturer in Speech Sciences, All India Institute of Speech and Hearing, Mysore, India


Articulatory Acquisition in Kannada Speaking Children

173

and /ɝ/. At 3 years of age all the subjects produced all the vowels and diphthongs with 99-

100% accuracy.

Table 1: Age levels for the speech sound development according to different authors. Empty

space indicates sound not tested. * Criteria for the sound to be considered as acquired.

Speech

sounds

Wellman‟

31 75%*

Poole‟34

100%*

Templin‟57

75%*

Sander‟72

75%*

Prather‟75

75%*

Arlt‟76

75%*

Fudala‟86

90%*

IP FP

m 3 3 ½ 3 Below 2 2 3 2 2

n 3 4 ½ 3 Below 2 2 3 2 2

h 3 3 ½ 3 Below 2 2 3 1 ½

p 4 3 ½ 3 Below 2 2 3 2 3

f 3 5 ½ 3 3 2-4 3 2 ½ 3

w 3 3 ½ 3 Below 2 2-8 3 1 ½

b 3 3 ½ 4 Below 2 2-8 3 2 3

4 ½ 3 2 2 3 3

j 4 4 ½ 3 ½ 3 2-4 3

k 4 4 ½ 4 2 2-4 3 2 ½ 3

g 4 4 ½ 4 2 2-4 3 2 ½ 3

l 4 6 ½ 6 3 3-4 4 5 5

d 5 4 ½ 4 2 2-4 3 2 ½ 2 ½

t 5 4 ½ 6 2 2-8 3 3 4

s 5 7 ½ 4 ½ 3 3 4 11 11

r 5 7 ½ 4 3 3-4 5 5 ½

t 5 4 ½ 4 3-8 4 5 ½ 5 ½

v 5 6 ½ 6 4 4 3 ½ 5 ½ 5 ½

z 5 7 ½ 7 4 4 4 11 11

Ʒ 6 6 ½ 7 6 4 4

θ 7 ½ 6 5 4 5 6 6

ʃ 6 ½ 4 ½ 4 3-8 4 ½ 5 ½ 5 ½

Stoel-Gammon (1985), in her longitudinal study using spontaneous speech sample on

34 children, 19 boys and 15 girls in the age range of 15 to 24 months. The samples were

collected every 3 months, from 9 months to 24 months. Only the meaningful speech

production of at least 10 identifiable words during a 1- hour recording session was analyzed

and the results indicated that- By 15 months of age- voiced stops, nasals and glides were

produced in the word initial position. By 24 months of age- voiceless stops, velars, and few

fricatives were produced in the initial position. Voiceless stops and alveolar consonants were

produced in the word final position. Voiced stops appeared first in the initial position. /t/ and

/r/ appeared first in the word final position.

Fudala and Reynolds (1986) studied the acquisition of single phonemes and the

results indicated that, the age of acquisition of /s/ and /z/ appears to be quite late compared to

earlier studies i.e. from 6 to 6.5 years. As the group got older the percentage of children who

produced correctly got decreased to less than 90% (as low as 62% for the 7 to 7.11 years)

then the percentage began to gradually increase again at 8 to 8.11 years and by the age of 11


174

to 11.11 years 98.4% of children produced it correctly. Similar results were obtained for final

/-z/ and /-s/.

Extensive normative data on the articulatory acquisition in Indian languages are

limited. However, a number of attempts have been made in some of the Indian languages also

which are summarized in Tables 2 & 3 below. In Kannada, the articulation test was

developed by Babu, Rathna and Bettagiri in 1972, but the norms for the same was established

by Tasneem Banu in 1977.

Table 2: Speech sound development according to different Indian studies.

Thirumalai ‟72- Tamil Kumudavalli‟73- Kannada Sreedevi ‟76- Kannada

No. of subjects

considered: one

Age: 4.4 years old.

Results-

All the stop consonants

were produced and

Substituted alveolars

for retroflex sounds

No. of subjects considered:

105 school going children

Age range: 4 to 8 years.

Results-

Alveolar and retroflex

sounds were acquired last.

No. of subjects considered:4

children

Age range: 2 to 2.6 years.

Results-

All the stop consonants

were acquired by the age

of 2.6 years.

The laterals, sibilants and

trills were not fully

established.

Table 3: Age levels for the speech sound development according to different Indian studies.

Speech

sounds

Tasneem Banu

‟77 (Kannada)

75%*

Usha‟86

(Tamil)

75%*

Padmaja‟88

(Telugu)

75%*

Arun Banik‟88

(Bengali)

90%*

Maya‟90

(Malayalam)

75%*

m 3 3 2.6 2.5 3-3.6

n 3 3 2.6 2.5 3-3.6

ŋ + + + 2.5 3-3.6

p 3 3 2.6 2.5 3-3.6

f + + 2.9 + 3-3.6

h + + 2.6 3 3-3.6

w + + + + +

y 3 3 2.6 2.5 3-3.6

k 3 3 2.6 2.7 3-3.6

b 3 3 2.6 2.5 3-3.6

d + 3 2.6 3 3-3.6

g 3 3 2.6 3 3-3.6

r 4.6 + 3.9 4 3.7-4

s 3 3 3.3 + 3.6-4

ʃ 5.1 6 3.6 3 5-5.6

tʃ 3.7 3 2.6 3 3-3.6

t + 3 2.6 3 3-3.6


175

t 3 + + 3 3-3.6

v + 3 2.6 + 3-3.6

l 3 3 2.6 3 3-3.6

t + + + 3 +

z + + + + +

z + + + 4 +

j 3 3 2.6 3 3-3.6

hw + + + + +

’+’ indicates sound not tested. * Criteria for the sound to be considered as acquired

More recently, researchers have been concerned with the validity of the „classical‟

data with respect to modern day living with its earlier and more extensive educational

programs and the expanding effects of television on children. In view of the fact that the

study on articulatory acquisition in Kannada was conducted 30 years back (Tasneem Banu,

1977) and that recent studies focusing on phonological processes have revealed suppression

of most of the processes by the age of 3- 4 years, there is an immediate need to study the

articulatory acquisition in the present day children to verify this observation and apply it in

the clinical set up.

Method

The objectives of the study were:

1. To revise the norms for the Kannada Articulation Test (1972) and to establish the ages

at which 75% and 90% of the children produce the phonemes of Kannada correctly.

2. To compare the articulatory skills across age and gender.

3. To compare the difference in the articulatory acquisition of phonemes in the initial

and medial positions of the words.

4. To compare the data obtained with that of the earlier reported studies in both English

and Kannada.

Subjects

Kannada speaking typically developing urban children in the age range of 3-4 years

were selected randomly from different localities in Mysore city as subjects. They were sub

divided into two groups with an inter age interval of six months (3-3.6 and 3.6-4 years). Each

group comprised a total of 60 subjects including 30 boys and 30 girls. So a total of 120

subjects were considered for the present study. The subjects were selected based on the

following criteria:

1. Native speakers of Kannada, being reared in an urban ambient environment of Kannada

and belonging to middle socio economic status. The subjects were exposed to some

amount of English language also in the kindergarten set up.

2. Parents/teachers report and informal chronological age-level performance on selected

speech, language, hearing and developmental tests were used to establish typical

development. The Assessment Checklist for Speech and Language skills (Geetha,


176

Rajkumar and Divya, 2006) and Developmental Screening Test (Bharathraj, 1981) were

utilized for this purpose.

Test material

The Diagnostic Kannada Articulation Test by Babu, Ratna and Bettagiri (1972) was

used as the test material. (The recording sheet of the test is given in Appendix I). This test

comprises of four parts; Part I includes items to test 10 vowels, 2 diphthongs and 22

consonants in Kannada. Part II is similar to Part I but has different words with the same

sounds being tested for test-retest reliability. Part III tests 10 clusters and Part IV includes a

paragraph for older children. In the present study Part I and Part III were utilized. Vowels and

diphthongs were tested only in the initial position. All the consonants were tested in both

initial and medial positions except the phoneme /ʃ/ which was tested only in initial position

and phonemes // and // which were tested only in the medial position. Four clusters were

tested in the initial position and six in the medial position. The target words were picturized

on white cards of 4 x 6” size in color. The picture cards were arranged in order as per the

sequence of Kannada alphabets. One target phoneme in one position i.e. either in the initial or

medial position was tested with each picture card.

Data Collection Procedure

Each individual subject was brought into a noise free room and seated opposite to the

examiner. Once the rapport was established, the examiner presented the target pictures one

after another. The subjects were encouraged to name the item in the picture card. The

response obtained was audio recorded using Olympus digital recorder WS-100. If any of the

subjects failed to identify a target word, additional cues were presented by the examiner. In

spite of the additional cues, if the child failed to name the target picture, the child was asked

to repeat the target word after the examiner.

Data Scoring

The data obtained from all the 120 subjects were transcribed using broad and narrow

IPA transcription. All the responses of each subject were analyzed sound-by-sound on a

response sheet. Correct responses (CR), substitutions (S), indicating the substituted

phoneme, omissions (O), distortions (D), additions (A) or any other type of articulatory

deviation (Ao) was recorded on the response sheet.

Test –Retest-Reliability

Reliability of the responses was tested by “test retest” method. 10% of the subjects

from each age group were selected randomly and tested using the same material on the same

day or with in a span of three days.

Data Analysis

The detailed analysis for obtaining the articulatory norms was carried out in the

following manner:


177

1. Identification of the phonemes uttered correctly by each subject in both the positions

and a score of “one‟ was assigned to each correct item

2. From the scores obtained for the correct articulatory production, mean, standard

deviation and range of scores were calculated for each age group and independently

for boys and girls in initial and medial positions

3. Identification of phonemes which are produced correctly by 75% and 90% of the

subjects in each age group in the initial and medial positions separately. An analysis

of the phonemes substituted or distorted in production is discussed in detail.


The present study aimed at re-establishing the norms for „The Diagnostic Kannada

Articulation Test‟ by Babu, Ratna and Bettagiri (1972). Two-way ANOVA was carried out to

find the significance difference in articulatory scores between the 2 age groups as well as

across gender. In general it was found that there was no significant difference in articulatory

acquisition scores between the 2 age groups considered as well as across gender.

The results are discussed under the following 5 main headings:

1. Age vs. acquisition.

2. Gender vs. acquisition.

3. Order of acquisition of the sounds.

4. Speech sound acquisition vs. word position.

5. Test-retest reliability.

1. Age vs. Articulatory acquisition

Two-way ANOVA was carried out to find the significant difference in articulatory scores

between different age groups (3-3.6 years and 3.6-4 years). The results revealed that there

was no significant difference (p>0.05) in articulation scores across the two age groups tested.

This can be attributed to the acquisition of most of the consonants by the age of 3-3.6 years

itself, and the inter group interval considered was broad (6 months). Table 4 and Graph 1

show the mean articulation scores in the two age groups considered in the study.

Table 4: Mean articulation scores & SD in different age groups.

Gender Age Mean Std. Deviation N

Boys

3 - 3.6 yrs. 56.3917 4.38340 30

3.6 - 4 yrs 57.8000 3.36974 30

Total 57.0958 3.94079 60

Girls

3 - 3.6 yrs. 56.9167 2.96992 30

3.6 - 4 yrs 57.9500 3.37358 30

Total 57.4333 3.19390 60

Combined

Scores

3 - 3.6 yrs. 56.6542 3.72153 60

3.6 - 4 yrs 57.8750 3.34382 60


178

The findings of Wellman (1931) Poole (1934) and Templin (1957) indicated that the

“phoneme” development correlated with age, that is some sounds are mastered earlier than

others. The results of the present study are also in consonance with the above reports. It is

evident that with neuromuscular maturity all motor skills increased as the age advanced and

so also the articulation skills.

2. Gender vs. Articulatory articulation

Two-way ANOVA revealed no significant difference (p>0.05) between boys and girls

in terms of articulatory acquisition in both the age groups (shown in Table 4 & Graph 1).

Tables 5 and 6 show the development of vowels, diphthongs and consonants in 3-3.6 and 3.6-

4 year old Kannada speaking children in boys and girls respectively. Articulatory acquisition

in terms of 75% and 90% of acquisition by the children was considered as carried out in the

Western studies. In the present study, articulatory development for a particular speech sound

was assumed to be completed, if 90% of the children articulated them correctly in the initial

and medial positions of the target word.

In accordance with the present study, Roe and Milisen (1942) reported no significant

difference between articulatory skills of males and females. Perkins (1977) states that, the sex

of a child does not appear to be a significantly major factor. In the present study, the

difference between boys and girls was not significant and this may be accounted to the equal

opportunity in the speech environment for both boys and girls in the present day scenario

especially in the urban population.

3. Order of acquisition of sounds

It was generally observed that all the vowels and most of the consonants except /r/, /h/

// /d/ and // were acquired by the age of 3-3.6 years. The results of the present study

were compared with the studies of (Templin‟57 and Wellman ‟31 in English) to observe

whether the order of acquisition was similar. At the outset it appears that the age of

acquisition of different speech sounds in Indian languages are relatively faster compared to

Western studies. However this observation needs to be interpreted with much caution because

all the reported studies in the western context that are available are carried out from early

thirties to the seventies or so.


179

Comparing the present study with that of study by Tasneem Banu (1977) in Kannada

language, there are certain discrepancies noticed. She reports that the fricative /ʃ/ was

acquired by 75% of children at the age of 5.1 years and in the present study, considering 90%

criteria it is acquired by 3.6-4 years among boys and by 3-3.6 years in girls. Another salient

observation is that the semivowel /v/ is not acquired by 75% of children even at the age of 6.6

years in the earlier report, where as in the present study it is acquired by 90% of girls and

boys by the age of 3-3.6 years.

Table 5: Age of articulatory acquisition by 75%, 90% and obtained % of the boys. ‘+’ indicates

Sound acquired, ‘-‘indicates sound is not acquired. Empty space indicates sound not tested.

Boys

Speech

sound

3-3.6 years 3.6-4 years

Initial position Medial position Initial position Medial position

75% 90% obtained 75% 90% obtained 75% 90% obtained 75% 90% obtained

a + + 100% + + 100%

a + + 100% + + 100%

i + + 100% + + 100%

i + + 100% + + 100%

u + + 100% + + 100%

u + + 100% + + 100%

e + + 100% + + 100%

e + + 100% + + 100%

ai + + 100% + + 100%

o + + 100% + + 100%

o + + 100% + + 100%

ou + - 86.6% + + 90%

k + + 93.3% + + 93.3% + + 100% + + 100%

g + + 93.3% + + 93.3% + + 100% + + 100%

t + + 86.6% + + 83.3% + + 96.6% + + 100%

d + + 83.3% + + 90% + + 93.3% + + 100%

t + + 90% + + 96.6% + + 93.3% + + 96.6%

d + + 93.3% + + 93.3% + + 90% + + 90%

n + + 93.3% + + 93.3%

t + + 100% + + 100% + + 100% + + 100%

d + + 100% + + 100% + + 96.6% + + 100%

n + + 100% + + 100% + + 100% + + 100%

p + + 100% + + 100% + + 100% + + 100%

b + + 100% + + 100% + + 100% + + 100%

m + + 100% + + 100% + + 100% + + 100%

j + + 100% + + 100% + + 100% + + 100%

r - - 46.6% + - 76.6% + - 83.3% + + 90%

l + + 96.6% + + 100% + + 100% + + 100%

v + + 73.3% + + 100% + + 83.3% + + 86.6%

+ + 96.6% + - 86.6% + + 100% + + 93.3%

s + + 93.3% + + 93.3% + + 100% + + 100%

h - - 36.6% - - 43.3% - - 66.6% - - 70%

+ + 100% + + 93.3%

sta + - 83.3% - - 70% + - 80% - - 73.3%

sku + - 80% + - 76.6%

ski + - 86.6% + + 96.6%

dra - - 60% - - 60%

rti - - 66.6% + - 83.3%

kra - - 70% + + 90%

ksa + - 70% - - 73.3%

ble + - 76.6% - - 73.3%

skru - - 43.3% - - 26.6%


180

Table 6: Age of articulatory acquisition by 75%, 90% and obtained % of the girls. ‘+’ indicates

sound acquired, ‘-‘indicates sound is not acquired. Empty space indicates sound not tested.

Girls

Speech

sound


Initial position Medial position Initial position Medial position

75% 90% obtained 75% 90% obtained 75% 90% obtained 75% 90% obtained

a + + 100% + + 100%

a + + 100% + + 100%

i + + 100% + + 100%

i + + 100% + + 100%

u + + 100% + + 100%

u + + 100% + + 100%

e + + 100% + + 100%

e + + 100% + + 100%

ai + + 100% + + 100%

o + + 100% + + 100%

o + + 100% + + 100%

ou + + 96.6% + + 90%

k + + 100% + + 100% + + 100% + + 100%

g + + 100% + + 100% + + 100% + + 96.6%

t + + 96.6% + + 96.6% + + 100% + + 100%

d + + 96.6% + + 96.6% + + 96.6% + + 96.6%

t + + 96.6% + + 96.6% + + 96.6% + + 93.3%

d + - 83.3% + - 86.6% + + 90% + + 86.6%

n + + 93.3% + + 96.6%

t + + 96.6% + + 100% + + 96.6% + + 100%

d + + 100% + + 100% + + 100% + + 96.6%

n + + 100% + + 100% + + 100% + + 100%

p + + 100% + + 100% + + 100% + + 100%

b + + 100% + + 100% + + 100% + + 100%

m + + 100% + + 100% + + 100% + + 100%

j + + 100% + + 100% + + 100% + + 100%

r - - 53.3% + - 80% - - 70% + - 80%

l + + 100% + + 100% + + 100% + + 100%

v + + 90% + + 100% + + 93.3% + + 100%

+ + 96.6% + + 100% + + 100% + + 100%

s + + 96.6% + + 100% + + 100% + + 100%

h - - 53.3% - - 30% - - 66.6% - - 43.3%

+ - 86.6% + + 93.3%

sta - - 70% - - 63.3% + - 80% - - 66.6%

sku + - 86.6% - - 70%

ski + + 100% + + 96.6%

dra - - 46.6% - - 60%

rti - - 60% - - 56.6%

kra - - 63.3% + - 76.6%

ksa + - 80% - - 73.3%

ble + - 83.3% + - 80%

skru - - 43.3% - - 46.6%

When comparing the present study with that of other Indian studies, there is no much

discrepancy observed. In Tamil // is acquired by the age of 6 years and this late acquisition

is attributed to the phonetic system of the language itself as /s/ is a borrowed phoneme (Usha,

1986). Most of the speech sounds of Malayalam language are acquired by the age of 3 years

itself (Maya, 1990). In Malayalam, /s/ is acquired by 75% of children by the age of 3.6-4

years and // by the age of 5-5.6 years which is comparatively late compared to the present

study (3- 3.6 years). Padmaja‟s study (1988) in Telugu reveals that most of the speech sounds


181

are acquired by 75% of children by the age of 2.6 years and in Bengali (Arun Banik, 1988)

90% of children had acquired most of the speech sounds by 2.5-3 years of age.

The speech sounds acquired are also discussed separately in terms of Place, Voicing

and Manner features.

Place feature: According to place of articulation, un aspirated speech sounds of Kannada

language can be classified as bilabials (/p/, /b/, /m/), labiodentals (/v/), dentals (/t/, /d/,

/n/,), retroflex (//, //, //, //), palatals (/t/, /d/), velars (/k/, /g/) and glottal (/h/)

sounds. In the present study, all the bilabials, labiodentals, dentals, palatals, velars and

retroflex except //and // were acquired by the age 3-3.6 years; glottal /h/ was not

acquired even by the age of 4 years.

Voicing feature: In the present study, voiced sounds such as // and // were acquired

late i.e by the age of 3.6- 4 years considering the 90% criteria. Sounds such as /h/ and /r/ were

not acquired by 90% of the children even by the age of 4 years. /r/ was achieved in the medial

position by 90% of the boys. Where in /r/ remained not acquired even by 75% of children in

the initial position in the older group (3.6-4 years)

Manner of articulation

Vowels and Diphthong: All the vowels and diphthong /ai/ were mastered by 90% of the

children by the age of 3-3.6 years. Here there is a great possibility that all the vowels were

achieved by 3 years or soon after 3 years itself. But because of the relatively large age

interval (6 months) considered in this study, it is only possible to say vowels were mastered

by 3-3.6 years. Diphthong /ou/ was acquired by the age of 3.6-4 years. This is similar to the

reports in Western studies.

Plosives: In general, all the stops in this study were acquired by the age of 3-3.6 years.

Similar results are reported in Templin‟s (1957) and Wellman‟s (1931) studies. However,

among the stops, the voiceless retroflex // was acquired at an earlier age of 3-3.6 years in

the present study when compared to the studies of Templin (1957; 4.6 years) and Wellman

(1931; 5 years).

Fricatives: Dental /s/ (initial and medial positions) and palatal /ʃ/ (initial position) was

acquired by 90% of the children by the age of 3-3.6 years. Retroflex // (medial position)

was acquired by the age of 3.6-4 years by 90% of the girls and 87% of the boys. It is

observed that the acquisition of fricatives is much earlier compared to the studies of Templin

(1957) at 4.5 years

However, another salient observation was that the glottal fricative /h/ was not

mastered by even 75% of the children by 4 years also. This is because in colloquial Kannada,

usage of /h/ is minimal. For example, the word /hasu/ (meaning cow), is generally uttered as

/asu/ and it is considered as normal production. Earlier also in Kannada, Tasneen Banu

(1977) reports that /h/ is not acquired by 75% of children even by the age of 6.6 years owing

to the same reason.


182

Affricates: There are two affricates in Kannada language /t/ and /d/. It is observed that

both the sounds are acquired by 90% of the children by the age of 3-3.6 years, which is much

earlier compared to the western studies, as per Sander‟72, 4 years, Prather‟75, by 3-3.8 years

and Fudala‟86 , by the age of 5.6 years.

Nasals: In general it was noted that all the nasals were acquired by 3-3.6 years, which is

similar to the Western studies.

Laterals: There are two laterals in Kannada language, voiced alveolar lateral /l/ and voiced

retroflex lateral /l/. /l/ occurs in initial and medial positions and // occurs only in medial

position in Kannada language. /l/ was found to be acquired earlier (3-3.6 years) when

compared to English speaking children. In the present investigation, retroflex // was

mastered in girls earlier (3- 3.6 years) than boys (3.6- 4 years).

Trills: Voiced alveolar trill /r/ was not mastered till 4 years of age which is relatively late

compared to the other phonemes in Kannada. Also the observation was that the percent

acquisition of trills was higher in the medial position than in the initial position for both boys

and girls. The late mastery is due to the difficulty in production of /r/.

Semivowels: In the present study, /v/ and /j/ were acquired by 3-3.6 years which was much

earlier compared to that of Templin‟s (1957), by 6 years, Wellman‟s (1931) by 5 years and

in Tasneem Banu‟s (1977) data, it was not acquired till the age of 6.6 years.

Clusters: In the present study, 4 clusters (/sta/, /sku/, /ble/ and /skru/) were tested in the

initial position and other six (/sta/, /ski/, /dra/, /rti/, /kra/ and /ksa/) were tested in the

word medial position. In girls, /ski/ had 90% acquisition, /ksa/ and /ble/ had 75% acquisition

by 3-3.6 years. There were also few unusual observations in this group, i.e. clusters /sku/ and

/ksa/ was found to be acquired by 75% of children in the younger age group (3-3.6 years)

and the percentage reduced in the older age group (3.6-4 years), /sku/ (70%), /ksa/

(73.33%).

Similarly among boys, the clusters /ksa/ and /ble/ were acquired by the age of 3-3.6

years by 75% of the children and reduced in percentage by 3.6-4 years, /ksa/ (73.33%) and

/ble/ (73.33%). Clusters like /ski/ and /kra/ was acquired by 90% of the boys. The finding that

/kra/ and /ski/ are mastered by 90% of the children is in accordance with the study by Curtis

& Hardy, 1957 where in /r/ is produced correctly more often in stop blends than in fricative

blends. So stops facilitate correct production of /r/ /s/ and /z/ but only when they precede /r/

and follow /z/ and /s/.

Based on the scoring obtained from the present study, typically developing Kannada

speaking urban children should get a score of 56.39 + 4.3 (boys) and 56.91 + 2.9 (girls) in

the age range of 3-3.6 years. 57.80 + 3.36 (boys) and 57.95 + 3.37 (girls) in the age range of

3.6-4 years. Maximum score is 62. Articulation scores expected for typically developing

children in the age range of 3-4 years in boys and girls are depicted in the Table 7.


183

Table 7: Articulation scores expected for typically developing children in the age range of 3-

4 years

Age Gender Scores expected for typically

developing children

3-3.6 years Boys 56.39 + 4.3

3-3.6 years Girls 56.91 + 2.9

3.6-4 years Boys 57.80 + 3.36

3.6-4 years Girls 57.95 + 3.37

Speech sound acquisition vs. word position

In the present study, boys acquired voiced affricate /d/ earlier in the medial position

by the age of 3-3.6 years and later in the initial position. Trill sound /r/ was first acquired in

the medial position by 90% of the boys by the age of 4 years and was not acquired by 90% in

the initial position even by the age of 4 years. Among girls, there was no such variation

present in terms of position however only /r/ was acquired by 75% of girls in word medial

position first (3-3.6 years) and less than 75% of children produced it in the initial position.

Such positional variations are reported in other studies also.

Studies have suggested that fricatives (Farwell, 1977) and velars (Ingram, 1974) may

appear first in final position. Stoel-Gammon‟s (1985) study reveals one consistent difference

between initial and final position: the phoneme /r/ appeared word finally well before it

occurred word initially. This finding is similar to the present study, where in /r/ appeared

earlier in medial position than in the initial position of words.

In the present study, medial clusters (/ski/ and /kra/) were acquired earlier compared

to initial clusters. This finding is in accordance with the study by Vani Rupela and Manjula

(2006) where in medial clusters were first to be acquired and appeared by the age of 18-24

months and, more frequent and predominant at the age of 30-36 months.

5. Test-retest reliability

There was 98% reliability found between the scores of the first and the second test

administration. Table 8 shows the mean articulation scores between first and second

administration scores.

Table 8: Shows the mean articulation scores in the first and second

administration of Diagnostic Kannada Articulation Test.


First

administration

Second

administration

First

administration

Second

administration

54.50 54.00 60.00 59.50

56.00 56.00 59.50 59.50

56.00 56.00 57.00 55.50

57.50 56.00 60.00 60.00

60.50 61.00 59.50 59.00

60.00 60.00 57.00 56.50


184

Conclusions

It can be concluded that, all the vowels and diphthong /ai/ are acquired by the age of

3-3.6 years, diphthong /ou/ is acquired by the age of 3.6-4 years and most of the consonants

are acquired by the age of 3.6- 4 years except /r/ and /h/. /r/ was acquired by 90% of the

children in medial position but not in the initial position and /h/ was not acquired in both the

positions even by the age of 4 years. Among clusters, medial clusters (/ski/ and /dra/) are

acquired by the age of 3.6-4 years. Another feature observed was that, the children in the

present study acquire most of the sounds at a younger age compared to the earlier reports in

English and Kannada.

References

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based on a study of 240 normals, aged three to six. Language, Speech, and Hearing

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in part fulfillment for the master‟s degree in Speech and Hearing. University of

Mysore.

Babu, R. M., Bettagiri, R, & Rathna, N. (1972). Test of articulation in Kannada, Journal of

AIISH, 3, 64-79.

Bharathraj, (1981). Developmental Screening Test, Swayam Sidha Prakashana, Mysore

Curtis, M. E. & Hardey, W. M. (1957). Cited in Padmaja, B. (1989). Telugu articulation test.

Unpublished master‟s dissertation submitted in part-fulfillment for the master‟s

degree in Speech and Hearing. University of Mysore.

Farwell, C. B. (1976). Some strategies in the early production of fricatives. Papers and

Reports on Child Language Development, 12, 97-104.

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Los Angeles: Western psychological Press.

Geetha, Y. V., & Rajkumar (2006). The Assessment Checklist for Speech and Language

Skills. Unpublished ARF project, AIISH, Mysore.

Ingram, D. (1974). Phonological rules in young children. Journal of Child Language, 1, 49-

64.

Irwin, J. W., & Wong, S. P. (Eds.). (1983). Phonological development in children 18 to 72

months. Journal of Speech and Hearing Disorders, 12, 402-404.

Kumudavalli. (1973). The relationship between articulation and discrimination of Kannada

speech sounds in terms of distinctive features. Unpublished master‟s dissertation

submitted in part-fulfillment for the master‟s degree in Speech and Hearing.

University of Mysore.


185

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Padmaja, B. (1988). Telugu articulation test. Unpublished master‟s dissertation submitted in

part-fulfillment for the master‟s degree in Speech and Hearing. University of Mysore.

Perkins. (1977). Cited in Padmaja, B. (1989). Telugu articulation test. Unpublished master‟s

dissertation submitted in part-fulfillment for the master‟s degree in Speech and

Hearing. University of Mysore.

Prather, E., Hedrick, D., & Kern, C. (1975). Articulation development in children aged two to

four years. Journal of Speech and Hearing Research, 40, 55-63.

Poole, E. (1934). Genetic development of articulation of consonant sounds in speech.

Elementary English Review, 11, 159-161.

Roe & Milisen. (1942). Cited in Padmaja, B. (1989). Telugu articulation test. Unpublished

master‟s dissertation submitted in part-fulfillment for the master‟s degree in Speech

and Hearing. University of Mysore.

Sander, E. (1972). When are speech sounds learned? Journal of Speech and Hearing


Sreedevi. (1976). The acquisition aspects of Kannada language in 2+ year old children.

Unpublished master‟s dissertation submitted in part-fulfillment for the master‟s


Stoel-Gammon, C. (1985). Phonetic inventories, 15-24 months: A longitudinal study. Journal

of Speech and Hearing Research, 28, 505-512.

Tasneem, B. (1977). Articulatory acquisition in Kannada A study of normal children 3-6.6

years. Unpublished master‟s dissertation submitted in part-fulfillment for the master‟s


Templin, M. C. (1957). Spontaneous versus imitated verbalization in testing articulation in

preschool children. Journal of Speech and Hearing Disorders, 12, 293-300.

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part-fulfillment for the master‟s degree in Speech and Hearing. University of Mysore.

Vani, R., & Manjula, R. (2006). The Phonotactic Development in Kannada speaking children

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University of Iowa Studies in Child Welfare, 5 (2).


186

APPENDIX-I (Sample of the scoring sheet)

Name: XXX Age/Gender: 3.4 years/Male

Name of the School: The Play House, Kuvempunagar, Mysore.

Sl.

No

Ph

on

eme

Check word

Initial position

S

core

Check word

Medial position

S

core

C

R

S O D A A

o

C

R

S O D A A

o

1 a alilu √ 1

2 a ane √ 1

3 i ili √ 1

4 i iligeman

e

√ 1

5 u ugura √ 1

6 u uta √ 1

7 e ele √ 1

8 e elu √ 1

9 ai aidu √ 1

10 o ondu √ 1

11 o ole √ 1

12 ou ouada √ 1

13 k kannadaka √ 1

14 k pustaka √ 1

15 g gadijara √ 1

16 g mugu √ 1

17 t tamata √ 1

18 t batanige √ 1

19 d dade √ 1

20 d sudi √ 1

21 t topi √ 1

22 t kitaki √ 1

23 d dabbi √ 1

24 d bledu √ 1

25 n 1 gini √ 1

26 t takkadi √ 1

27 t koti √ 1

28 d dalimbe √ 1

29 d kudure √ 1

30 n naji √ 1

31 n kannadi √ 1

32 p pennu √ 1

33 p tappali √ 1

34 b bagilu √ 1

35 b ombattu √ 1

36 m muru √ 1


187

37 m emme √ 1

38 j jama √ 1

39 j rupaji √ 1

40 r redijo le ½

41 r karu lu ½

42 l lari √ 1

43 l kalu √ 1

44 v vimana √ 0

45 v bavuta √ 1

46 artu √ 1

47 bra √ 1

48 s surja √ 1

49 s bassu √ 1

50 h hattu √ 0

51 h simha √ 0

52 l 1 koli √ 1

53 sta stampu √ 1

54 sta postabaksu √ 0

55 sku skutar √ 1

56 ski biskittu √ 1

57 dra tandra √ 1

58 rti kurti √ 1

59 kra takra √ 1

60 ks

a

atoriksa √ 1

61 ble bledu √ 1

62 skr skru √ 0

Correct responses (CR-score 1), substitutions (S-score 1/2) indicating the substituted

phoneme in the respective block, omissions (O- score 0), distortions (D-score 3/4), additions (A-

score 0) any other type of articulatory deviation (Ao).

This subject obtained a Total score of 56/62.


188

Normative Nasalance Value in Hindi Language

Pravesh Arya & Dr. M. Pushpavathi*

Abstract

Nasalance is a commonly used measure that allows the speech-language pathologist to

validate and quantify a perceptual assessment. The nasalance score is calculated as a ratio of the

nasal sound pressure level to the combined nasal and oral sound pressure level (Fletcher, 1978). The

present study was aimed to develop normative data on nasalance value across gender and nasalance

deviation in Hindi language for oral and nasal sentences and paragraphs for adults and to study the

effect of stimuli and gender on nasalance value. One hundred normal Hindi speaking adults including

fifty males and fifty females with age range 18 to 35 years were taken as subjects for the study. The

Nasal View (version 4) was used for the data collection. The subjects were instructed to read or

repeat 5 oral and 5 nasal sentences & 1 oral and 1 nasal paragraphs prepared by an experienced

speech and language pathologist whose native language is Hindi. Results showed that there is a

significant difference across stimuli and gender. Females exhibited higher nasalance value than

males across gender and nasalance value for nasal stimuli was higher than oral stimuli. Clinically the

normative data reported in the present study may help to identify and treating individuals with

resonance disorders. However, normative nasalance value across dialect variation in Hindi language

and other Indian languages needs to be investigated.

Introduction

Speech refers to the processes associated with the production and perception of

sounds used in spoken language. “Speech is the form of communication in which the

transmission of information takes place by means of speech waves which are in the form of

acoustic energy. The speech waveforms are a result of interaction of one or more source with

the vocal tract filter system” (Fant, 1960).

Nasalization may be defined as the existence of significant communication between

the nasal cavity and the rest of vocal tract. Two of the most characteristic clinical components

of resonance disorders are hypernasality and nasal emission. Hypernasality may be defined as

the presence of excessive nasal resonance during the production of vowels or vowel-like

consonants. Nasal emission deals with the presence of turbulent noise production during the

production of high pressure consonants. This turbulent noise is often detected as an audible

“puff” of air emitted via nostrils. Nasality is a perceptual attribute whose detection requires

the judgment of a listener (Moll, 1964; McWilliams et al. 1981; Haapanen, 1991a).

Perceptual judgments have been and will be continued to be used in the clinical

setting because of the apparent face validity of these judgments (Dalston, 1997). However,

perceptual judgment scale has a number of significant drawbacks.

___________________________



Normative Nasalance Value in Hindi

189

In an effort to address the limitations of perceptual judgments by themselves,

numerous methods of objectively measuring various aspects of speech disorder have been

developed. In the area of resonance disorders, a number of methods have been developed to

objectively evaluate the characteristics of hypernasality and nasal emission. One of the

stronger objective assessment methods of the nasal speech signal is through the measurement

of nasalance. Nasalance has been defined as the ratio of nasal (n) to oral (o)

sound pressure level and is commonly derived via the following formula:

Nasalance is a commonly used measure that allows the speech-language pathologist

to validate and quantify a perceptual assessment. The nasalance score is calculated as a ratio

of the nasal sound pressure level to the combined nasal and oral sound pressure level

(Fletcher, 1978). There are some instruments like Nasometer, NasalView and Oronasal

system which are being use to obtain nasalance value for normal as well as disordered

individuals in all population.

NasalView (Awan, 1997) is a new PC-based system for the computerized

measurement of nasalance (Tiger Electronics, Seattle, WA). NasalView provides mean,

minimum and maximum nasalance values (in percentage) for different stimuli like syllable,

sentences and paragraphs i.e. oral, nasal and oro-nasal. The sampled sound signal or signal

selections can be played back and edited with the NasalView program. Oscillograms of the

nasal and oral signal and a nasalance curve are displayed together with nasalance statistics so

that speech segments can be identified accurately and the envelope of the nasalance curve

over time can be related to particular sounds.

Very few studies have been conducted to establish normative data across gender and

across stimuli using NasalView system and there is no published study done in Indian

language to establish normative nasalance value and to measure the effect of nasalance across

gender and across stimuli using NasalView system.

Awan, S. (1998) conducted a study to find the nasalance across two instruments i.e.

Nasometer and NasalView and to measure the effect of mean nasalance across stimuli Total

181 subjects were considered for the study, among which 161 were children and 20 were

male and female adults (age range 18-30 years). Three common passages i.e. Zoo passage

(oral paragraph), Rainbow passage (oro-nasal paragraph) and Nasal Sentence (nasal

paragraph) were used as stimuli. Results revealed that mean nasalance values (in percentage)

obtained by NasalView system were as; nasal paragraph (48.44%), Rainbow passage (34.19

%), Zoo passage (24.67 %) for normal adult subjects. Author reported that, nasalance values

obtained with the NasalView tend to be higher for oral stimuli and lower for nasal stimuli,

compare with the mean nasalance values obtained using Nasometer. Author concluded that

NasalView system appears effectively to separate varying degrees of nasal speech and

although actual nasalance values differ from those of the Nasometer, NasalView provides

high levels of both validity and reliability in its ability to measure RMS nasalance.

Nasalance = {Nasal(n) / Nasal(n) + Oral(o)} X 100

mmmmf==========+=++Oral(o)


190

Awan, S. Daniel, Z. H., Jordan, R. G. (2001) established a preliminary normative data

for both children and adults. Data was collected from total 255 subject among them 203 were

children and 52 were adult subjects (29 females and 23 males) using NasalView instrument.

Authors considered 29 normal subjects without any communication impairment and had no

history of clefting or velopharyngeal incompetence/insufficiency and no complaint of upper

respiratory infection and/or nasal congestion. To assess varying degrees of normal nasal

resonance, subjects were asked to read the following three passages while wearing the Nasal

View headgear. The Zoo Passage (Fletcher, 1972), Rainbow Passage (Fairbanks, 1960) and

Nasal Sentences (Fletcher, 1972). For those very young subjects (ages 5 to 6 years) who had

difficulty reading the three passages, subjects asked to repeat the following: The first two

sentences of the Zoo Passage; the 2nd

sentence of the Rainbow Passage and the first sentence

of the Nasal Sentence. The authors reported that mean nasalance exhibited by female subjects

was 26.71 % and mean nasalance exhibited by male subjects is 26.02 % for oral paragraph

(Zoo Passage). Similarly, mean nasalance exhibited by female subjects was 51.18 % and

mean nasalance exhibited by male subjects was 50.81% for nasal paragraph (Nasal

Sentences). Although authors have not mentioned about nasalance difference across gender

but the results revealed that significant difference was not evident across gender.

Bressmann, T. et al. (2006) conducted a study to compare the nasalance values

obtained by fifty normal subjects (Thirty-one female and nineteen male) with age range 23 to

44 years and nineteen hypernasal patients with cleft palate (Eight female and 11 male) with

age range 11 to 19 years. There mean nasalance were measured across three instruments i.e.

the Nasometer, the NasalView and the OroNasal system. Two passages were taken as

material i.e. Zoo passage (oral paragraph) and Nasal Sentence (nasal paragraph). Authors

reported that mean nasalance exhibited by fifty normal subjects (male and female combined

group) on NasalView instrument was 21.09 % for oral passage and 55.74 % for the nasal

paragraph. On the other hand, mean nasalance exhibited by eight subjects with cleft palate

with hypernasality was 25.72 % for oral paragraph and 47.55 % for nasal paragraph. Subjects

with cleft palate with moderate hypernasality exhibited mean nasalance of 27.71 % for oral

paragraph and 50.21 % for nasal paragraph using NasalView instrument. Authors concluded

that mean nasalance value exhibited by cleft palate patient with hypernasality (mild or

moderate) is higher than mean nasalance exhibited by normal subjects for both oral as well as

nasal paragraph. Their results revealed the significant difference in mean nasalance across

stimuli. They conclude that the nasalance scores from the Nasometer, the NasalView and the

Oronasal system are not interchangeable and that nasalance magnitudes from the three

systems cannot be compared directly.

A need for a reliable, objective measure of speech nasality with high level of content

validity was largely met with the NasalView system to address the limitations of perceptual

judgment in the area of assessment of resonance disorders. Studies have shown that nasalance

of normal speech is sensitive to the phonetic composition of the speech stimuli, native

language, regional dialect, age and gender. There are limited data concerning nasalance

values in Indian languages. This makes the strong need for the establishment of regional

norms as there are very few standardized normal nasalance values for normal speakers in

Indian languages.


191

Aims of the study

To develop normative data on nasalance value across gender and nasalance deviation in

Hindi language for oral and nasal sentences and paragraphs for adults.

To study the effect of stimuli on nasalance value across gender.

To study the effect of gender on nasalance value across stimuli.

Method

Subjects

One hundred normal Hindi speaking adults participated in the present study. All the

participants were native speakers of Hindi language. Each subject was evaluated by an

experienced speech and language pathologist to assess oral structure and function. Subjects

were divided into two groups. First group consist of 50 females in the age range of 18-35

years and second group was consisted of 50 males in the age range of 18-35 years. Table 1

depicts the subjects‟ details.

Table 1: Subjects details

Gender Age range (Mean age) No. of subjects

Male 18-35 years (26.5years) 50

Female 18-35 years (26.5years) 50

Total 100

Stimuli

Two sets of stimuli were prepared by an experienced speech language pathologist

whose mother tongue is Hindi. One set consisted of oral sentences, which had predominantly

oral consonants and the other set was nasal sentences which consisted of predominantly nasal

sentences. Each category consisted of ten sentences. Sentences were made simple, short, easy

to remember and meaningful. The sentences selected were ranged in length from three to four

words (five to six syllables). The paragraphs were ranged in length from six to seven

sentences.

Procedure

To find the content validity of the stimulus materials, sentences were given for

content judgment to ten speech language pathologists who had at least one year experience in

the field. Judges were asked to read the given instructions carefully before rating. A five

point perceptual rating scale was used. Rating of „0‟ indicates fully oral or no nasality and „4‟

indicated highly nasalized for both the categories. Ten sentences and two paragraphs were

given to them in each category and were provided with a scoring sheet to rate for each

sentence and paragraphs i.e. oral and nasal (scoring sheet: Appendix- I). Most appropriate

five sentences in each category out of ten were selected on the basis of rating given by

judges. The material and scoring sheet is provided in the Appendix-I (A).


192

Instrumentation

The Nasal View system is a PC/Windows-based system which provides for the

recording of high resolution speech signals using windows-compatible sound cards (sampling

at up to 4410 Hz at 8 or 16 bits of resolution). The hardware components found in the Nasal

View system include headgear and a portable custom dual-channel pre-amplification unit.

The key component of the headgear is a rigid plate constructed of 5mm thick styrene straps.

The sound separator plate is suspended from a Jackson Model 170 headgear (Jackson

Products, Belmont, MI) by styrene straps. The sound separation characteristics of this plate

are augmented by the addition of a light weight acoustic barrier material. (Fig 1.)

Figure 1: PC based NasalView system with headgear

Data Collection

The NasalView was setup in a suitable quite recording room. The instrument was

calibrated prior to the experiment based on the instructions provided in the manual. The

speech sample was recorded individually. After selecting the subjects they were seated

comfortably, and the nasal view head set was placed on subjects head (Fig 1 (c)). The

position of the nasal view head set was adjusted and secured firmly in accordance with the

manufacturer‟s instructions. Once the nasal view headset correctly positioned, subjects were

asked to read the stimuli if he/she is a literate. In case of non literate, they were asked to

repeat the speech stimuli after the speech pathologist for a reliable output. This was repeated

after 30 minutes on the same subjects for the purpose of test re -test reliability. This reliability

measures was followed for both the oral and nasal category (sentences and paragraph).

Figure 2: Subject undergoing NasalView assessment.


193

Statistical Analysis

Four types of tests i.e. descriptive analysis, mixed ANOVA (Analysis Of Variance),

independent t-test, paired t-test were administered to perform the statistic analysis. Mixed

ANOVA was used to study the effect of type, nasality and gender on nasalance value,

independent t-test was used to measure the effect of gender on nasalance value, paired t-test

was used to find the effect of stimuli on nasalance value and to compare the nasalance value

within and across stimuli.

Results

I. Effect of Stimuli on Nasalance Value in Females

The nasalance mean for oral sentences was 22.58 % with the range from 6.56 % of

minimum to 65.55 % of maximum. Similarly, nasalance mean obtained for oral paragraph

was 22.23 % with the range from 4.0 % of minimum to 85.22 % of maximum. The nasalance

mean for nasal sentences were 50.41 % with the range from of 11.31% of minimum to

87.80% of maximum. Similarly, nasalance mean for nasal paragraph was 49.74 % with the

range from 6.29% of minimum to 90.02% of maximum.

Table 2: Mean Nasalance Value (in percentage) of Oral Stimuli

Stimuli Mean (S.D) Min. (S.D) Max. (S.D)

Oral sentences 22.58 (4.61) 6.56 (1.65) 65.55 (8.42)

Oral paragraph 22.23 (4.33) 4.00 (2.13) 85.22 (6.71)

Nasal sentences 50.41 (3.94) 11.31 (2.56) 87.80 (4.62)

Nasal paragraph 49.74 (4.55) 6.29 (2.90) 90.02 (4.38)

II. Effect of Stimuli on Nasalance Value in Males

The nasalance value obtained for oral sentences was 22.48 % with the range from

6.51% of minimum to 62.83% of maximum. Similarly, nasalance values obtained for oral

paragraph was 21.59% with the range from 3.46 % of minimum to 83.22 % of maximum. It

shows that mean nasalance value obtained for Nasal sentences was 47.03 % with the range

from 9.75% of minimum to 85.74 % of maximum. Similarly, mean nasalance value obtained

for Nasal Paragraph was 46.84% with the range from 5.59% of minimum to 88.30 % of

maximum.

Table 3: Mean Nasalance Value (in percentage) of oral stimuli

Stimuli Mean (S.D) Min. (S.D) Max. (S.D)

Oral sentences 22.48 (4.79) 6.51 (1.78) 62.83 (11.40)

Oral paragraph 21.59 (4.85) 3.46 (1.23) 83.22 (8.45)

Nasal sentences 47.03 (4.86) 9.75 (2.52 ) 85.74 (6.37)

Nasal paragraph 46.84 (5.23) 5.59 (2.14) 88.30 (5.58)

The following figure depicts that the mean nasalance value obtained for oral sentences

and oral paragraphs.


194

Figure 3: Nasalance Value for Oral sentence and oral paragraph across gender.

III. Effect of Gender on Nasalance Value: Oral Stimuli

Results shows that both female and male subjects exhibited approximately same mean

nasalance value i.e.22.58 % for females and 22.48 % for males. Independent t-test was done

to find the significant difference and the results indicated that significant difference was not

evident across gender.

Table 4: Nasalance Value (in percentage) for oral sentences

Gender Mean (S.D) Min (S.D) Max (S.D)

Male 22.48 (4.79) 6.51 (1.78) 62.83 (11.40)

Female 22.58 (4.61) 6.56 (1.65) 65.55 (8.42)

IV. Effect of Gender on Nasalance Value: Nasal Stimuli

Results show that female subjects exhibited higher mean nasalance value i.e. 50.41 %

compared to mean nasalance value obtained by male subjects i.e. 47.03 % for nasal

sentences. Similarly, female subjects exhibited higher minimum nasalance value i.e. 11.31 %

as compared to minimum nasalance value obtained by male subjects i.e. 9.75 %. Maximum

nasalance value obtained by female subjects was 87.80 % which is higher than maximum

nasalance value obtained by male subjects i.e.85.74 % for nasal sentences. Independent t-test

was done to find the significant difference across gender and the results revealed significant

difference was evident. Female subjects exhibited higher mean nasalance Value for nasal

paragraph i.e. 49.74% as compared to mean nasalance values obtained by male subjects i.e.

46.84 %. Female subjects exhibited higher minimum as well as maximum nasalance values

i.e. 6.29 % and 90.02 % respectively as compared to minimum and maximum nasalance

values obtained by male subjects i.e. 5.59 % and 88.30 % respectively. Independent t-test was

used to find the significant difference across the two groups. The results revealed a

significant difference for the nasal paragraph across gender.


195

Table 5: Nasalance values for Nasal Sentences across Gender

Gender Mean (S.D) Min(S.D) Max(S.D)

Male 47.03 (4.86) 9.75 (2.52) 85.74 (6.37)

Female 50.41 (3.94) 11.31 (2.56) 87.80 (4.62)

Male 46.84 (5.23) 5.59 (2.14) 88.30 (5.58)

Female 49.74 (4.55) 6.29 (2.90) 90.02 (4.38)

The following figures depict the mean nasalance value obtained for nasal sentences and nasal

paragraphs.

Figure 3: Nasalance Value for Nasal sentence and Nasal paragraph across gender.

Results of the present study are supports the finding of Bressmann et.al, (2000), who

conducted a study to find the relationship between nasalance ratio for nasal and nonnasal

sentences using NasalView instrument. Results from their study reveal that there is a

significant difference present across stimuli. Mean nasalance obtained from nasal sentences

showed higher values than oral sentences which supports the results obtained from the

present study.

Daniel Zaoming Huang (2001) conducted a study to develop preliminary normative

data for NasalView instrument using three passages i.e. Zoo passage, Rainbow passage and

Nasal sentences. Authors reported that mean nasalance exhibited by female subjects and male

subjects are approximately same for oral paragraph (Zoo Passage), oro-nasal paragraph

(Rainbow Passage) as well as for nasal paragraph (Nasal Sentences) which reveals a

significant difference across stimuli. This could be attributed to the reason that these reports

were made on the basis of English or languages with similar phonological characteristics to

English.

Similar results were obtained from study done by Tim Bressman (2005), which

revealed that there is a significant difference present across three passages i.e. Zoo Passage,

Rainbow Passage, and Nasal Sentences i.e. mean nasalance obtained from oral and nasal

sentences, whereas there is no significant difference present within stimuli i.e. mean

nasalance obtained from oral sentences and oral paragraph and mean nasalance obtained from

nasal sentences and nasal paragraph.


196

III. Clinical Interpretation of Normative Data

Establishing the nasalance values for clinically significant abnormalities is important

in many areas of medical epidemiology. It can be approached from a clinical or statistical

perspective (Baker and Rose, 1984). Initially clinical perspective had been widely used

Dalston et al. (1991a, 1993) who used clinical rather than statistical approach. Perceptual

ratings on a numerical scale were predetermined to be clinically significant at a particular

value. Then, nasalance scores for nasalance were set as those that give the best overall correct

prediction of the presence or absence of abnormal nasality. Regardless of the methodology

differences that have led to the development of cut off scores, it is quite clear that cut off

values determines that there are some speakers whose resonance is judged to be normal and

who have abnormal resonance. Table (6) shows cut off values for normal adult male and

female.

Table 6: Cut off values for across gender and stimuli

Stimuli Female Male

Oral sentence 13.36-30.18 12.90-32.06

Oral paragraph 13.57-30.89 11.89-31.29

Nasal sentence 42.53-58.29 37.31-56.75

Nasal paragraph 40.64-58.84 36.38-57.30

A significant difference was evident across gender in adults. This difference may be

attributed to basic structural and functional differences across gender. An adult female has

difference in size, shape and resonating cavity of vocal system than an adult male. This

difference might lead to show significantly high mean nasalance value exhibited by female

subjects as compare to male subjects.

The possible reason could be the underlying anatomical and physiological differences

related to velopharyngeal closure across gender. But the present study does not support the

findings of Trindade et al., 1997; Van Doorn & Purcell, 1998; Sweeney et al., 2004, who

reported no significant difference across gender.


The present study primarily aimed to establish normative data for Hindi speaking

male and female adults. The subjects for the study considered were one hundred normal

subjects with normal oral structure and functions. All the participants were native speakers of

Hindi language. Subjects were divided into two groups. First group consisted of fifty females

and the second group consisted of fifty male adults. Both group had equal number of males

and females. For the purpose of the stimuli, experienced speech language pathologists whose

mother tongue was Hindi prepared two sets of Hindi sentences. Ten sentences and two

paragraphs were given to them in each category and were provided with a scoring sheet to

rate for each sentence and paragraphs i.e. oral and nasal (scoring sheet provided in Appendix-

I). Most appropriate five sentences in each category out of ten were selected on the basis of


197

rating given by judges. The material and scoring sheet is provided in the Appendix-II. The

Nasal View (version 4) was used to for the data collection. The instrument was calibrated

prior to the data collection. Nasal View head gear was placed on the subjects head. Once the

head set is positioned properly, the subjects were instructed to read or repeat sentences. After

the completion of each speech sample, the nasalance trace was stored on computer file for

latest analysis. The data was analyzed for adults (male and female separately) using

descriptive statistics, independent t-test, mixed ANOVA and paired t-test using SPSS

software version 16.0 package.

Following Table (12) shows the mean normative nasalance values with the range of

minimum nasalance value to the maximum nasalance value for adults across gender and

across stimuli.

Table 7: Normative mean nasalance value across gender and across stimuli

Stimuli Gender Mean (S.D) Min (S.D) Max (S.D)

Oral Sentences Male 22.48 (4.79) 6.51 (1.78) 62.83 (11.40)

Female 22.58 (4.61) 6.56 (1.65) 65.55 (8.42)

Oral paragraph Male 21.59 (4.85) 3.46 (1.23) 83.22 (8.45)

Female 22.23 (4.33) 4.00 (2.13) 85.22 (6.71)

Nasal sentences Male 47.03 (4.86) 9.75 (2.52) 85.74 (6.37)

Female 50.41 (3.94) 11.31 (2.56) 87.80 (4.62)

Nasal paragraph Male 46.84 (5.23) 5.59 (2.14) 88.30 (5.58)

Female 49.74 (4.55) 6.29 (2.90) 90.02 (4.38)

The mean nasalance value exhibited by normal adult male and female subjects for

oral sentences was 22.48 % (4.79) and 22.58 % (4.61) respectively. The mean nasalance

value exhibited by male and female subjects for oral paragraph was 21.59 % (4.85) and

22.23% (4.33) respectively. The mean nasalance values exhibited by adult male and female

subjects for nasal sentences were 47.03% (4.86) and 50.41% (3.94) respectively. The mean

nasalance value exhibited by male and female subject for nasal paragraph was 46.84% (5.23)

and 49.74 (4.55) respectively. A significant difference was evident across gender and across

stimuli.

This difference may be attributed to the basic structural and functional differences

across genders. The resonance of voice is influenced by the size, shape, and surface of the

intraglottal and supraglottal resonating structures and cavities (Shprintzen and Bardach,

1995). The mechanism for velopharyngeal valving has been found to be different for men and

women. Mckerns and Bzoch (1970) suggested that velar length is greater in men, the height

of elevation is greater and the inferior point or contact is most usually above palatal plane. In

the female similar results are not found. The other finding that supports the present result is

the acoustic transmission of palate. As the age increases, the sympathetic transfer of acoustic

energy from oral cavity to the nasal cavity also increases in females (Hoit et al., 1994). It has

been found that females had higher nasalance value in both categories of stimuli. The result


198

can also be attributed to increased respiratory effort and increased nasal cross-sectional area

in female (Seaver et al.,1991; Van Lierde et al., Fletcher,1978; Hutchinson,1978).

Overall the present study adds to the body of evidence that there are gender

differences in nasalance values. Clinically the normative data reported in the present study

may help to identify and treating individuals with resonance disorders.

References

Awan, S. N., Daniel, Z. H. & Jordan, R.G. (2001). Dr.Speech User‟s Guide, Version 4.Tiger

DRS, Inc.

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In: Ziegler W, Deger K, eds. Clinical Phonetics and Linguistics, (London: Whurr-

Publishers), pp. 522-531.

Awan, S.N. (1998). Analysis of nasalance: NasalView. In: Ziegler W, Deger K, eds. Clinical

Phonetics and Linguistics. London: Whurr-Publishers. 1997; 518-525.

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nasalview and the oronasal system. Cleft Palate Craniofacial Journal 42, 423-433.

Bressmann, T., Klaiman, P., Fischbach, S. (2006). Same noses, different nasalance scores:

Data from normal subjects and cleft palate speakers for three systems for nasalance

analysis. Clinical Linguistics & Phonetics, 20, 163-17.

Dalston, R. M., Neiman, G. S., & Gonzalez-Landa, G. (1993). Nasometric sensitivity and

specificity: a cross- Dialect and cross-culture study. Cleft Palate Craniofacial

Journal, 30, 285-291.

Dalston, R. M., Warren, D., & Dalston, E. (1991a). A primary investigation concerning use

of Nasometery in identifying patients with hypanasality and/or nasal airway

impairment. Journal of Speech and Hearing Research, 34, 11-18.

Fairbanks, G., 1960, Voice and Articulation Drillbook, 2nd Edition (New York: Harper and

Bros.).

Fant, G. (1960). “Acoustic theory of speech production”. Mournton and Co., S. Gravehage.

Fletcher, S. G., & frost, S. D. (1974). Qualitative and graphical analysis of prosthetic

treatment for “nasalance” in speech. Journal of Prosthet. Dent. 32, 284-249.

Fletcher, S.G. (1978). Diagnosing speech disorder from the cleft palate. New York : Grune &

Stratton.

Haapanen, M.L. (1991a), “A simple clinical method of evaluating perceived nasality", Folia

Phoniatr. 43 (3), 122-132.


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Hoit, J. D., Watson, P. J., Hoxon, K. E., McMahon, P., & Johnson, C. L. (1994). Age and

velopharyngeal function during speech production. Journal of Speech and Hearing

Research, 37, 295-302.

Hutchinson, J. M. , Robinson, K.L., & Nerbonne, M.A. (1978). Pattern of nasalnace in a

sample of normal gerontologic subjects. Journal of Communication Disorders, 11,

469-481.

McWilliams, B.J., Glaser, E.R., Philips, B. J., Lawrence, C., Lavorato, A. S., Eery, B. C., &

Skolnick, M. L. (1981). A comparative study of four methods of evaluating

velopharyngeal adequacy. Plastic and Reconstructive Surgery, 68, 1-9.

Moll, K. L. (1964). „Objective‟ measure of Nasality. Cleft Palate Journal, 1, 371-374.

Nasometer Manual, Kay Elemetrics, Pine Brook, New Jersy, 2003 edition.

Seaver, E.J., Dalston, R.M., & Leeper, H.A. (1991). A study of nasometric value for normal

nasal resonance. Journal of Speech and Hearing Research, 34, 715-721.

Shprintzen, R., & Bardach, J., (1995). Cleft palate speech management: A multidisciplinary

Approach. Missouri: Mosby.

Sweeney, T., Sell, D., & O‟ Regan, M (2004). Nasalance scores for normal speaking Irish

children. Cleft Palate Craniofacial Journal, 41 (2), 168-174.

Trindade, I. E. K., Genero, K. F., & Dalston, R. M.(1997). Nasalance score for normal

Brazilizn Portuguese Speakers. Brazil Journal of Dysmorphollogy Speech & Hearing


Van Doorn, J., & Parcell, A., (1998). Nasalance levels in the speech of normal Australian.

Van Lierde, K. M., Wuyts, F. L., De Bodt, M., & Van Cauwenberge, P. (2001). Normative

value for normal nasal resonance in the speech of young Flemish adults. Cleft Palate



200

Metalinguistic Abilities in Children with Developmental Dyslexia:

Implications for Reading and Writing

Priya M. B. & R. Manjula*

Abstract

The contribution of metalinguistic abilities to reading and writing is well established. These

skills are reported to be poor in children with developmental disabilities, particularly children with

developmental dyslexia. The study aimed to investigate the metalinguistic abilities and its contribution

to reading and writing in bilingual-biliterate (Kannada-English) typically developing children and

children with developmental dyslexia. 20 children with developmental dyslexia in the age range of 8-

13 years and equal number of typically developing children matched to the language age and gender

of those in the experimental group participated in the study. Subsections from Linguistic Profile Test

in Kannada (Karanth, 1980) and Reading Acquisition Profile in Kannada (Prema, 1997) were used to

assess metaphonology, metasemantics, metasyntax, reading and writing abilities in the two groups of

subjects. Results revealed poor performance of children with developmental dyslexia on all the

metalinguistic, reading and writing tasks. The metalinguistic skill that significantly contributed to

reading and writing skills in typically developing children was metaphonology whereas

metasemantics was identified as the skill that contributed significantly to reading and writing in

children with developmental dyslexia. The pattern of errors on all tasks was similar in the two groups

of children. However, the performance of children with DD was found to be similar to the younger TD

children on most of the tasks.

Introduction

Metalinguistic ability is the ability to reflect upon and manipulate the structural

features of spoken language, treating language itself as an object of thought (Tunmer, Pratt &

Herriman, 1984). Tunmer and Bowey (1984) identified four levels of metalinguistic

awareness: word awareness, phonological awareness, form awareness and pragmatic

awareness. They hypothesized that these levels play a vital role at different stages of reading

acquisition. Gombert (1992) categorized metalinguistic awareness into six groups:

metaphonological, metasyntactic, metalexical, metasemantic, metapragmatic, and

metatextual.

The development of metalinguistic ability in children is a metacognitive skill that

emerges towards the end of preschool period and is characterized by a cognitive shift in

intellectual functioning when a child can begin to treat language as an object of thought. This

ability to reflect on language has been attributed to emergence of the Piagetian stage of

concrete operations that begins to develop between 5 and 7 years of age (Van Kleeck, 1984).

Middle elementary school seems to be a pivotal period in both learning to read and

developing metalinguistic skill. Jarmulowicz, Hay, Taran and Ethington (2008) proposed a

developmental sequence beginning with receptive language followed by phonological

_________________________________ * Professor of Speech Pathology, All India Institute of Speech and Hearing, Mysore, India



Metalinguistic Abilities in Children with Developmental Dyslexia

201

awareness, morphological awareness, and a new metalinguistic task measuring oral

morphophonological accuracy, followed by decoding and culminating in reading

comprehension.

Research has shown that phonemic awareness, a crucial part of phonological

awareness is both a prerequisite and a consequence of learning to read. Grammatical

awareness has also been reported to influence reading comprehension (Bentin, Deutsch, &

Liberman, 1990). There have been several studies documenting the metalinguistic abilities in

children with various language impairments (Kamhi, Lee & Nelson, 1985; Boudreau &

Hedberg, 1999 and others). Mattingly (1972), Hodgson (1992) and others emphasize that the

metalinguistic processes, especially the metaphonological skills need to be paid more

attention to in the identification and management of reading disabled children. Children with

language disorders have shown a lack of syntactic awareness (Nation & Snowling, 2000) and

morphological awareness (Carlisle, 1987).

It has been reported that children with dyslexia appeared to be primarily impaired in

phonological and orthographic processing, rapid automatized naming, and executive

functions but to have intact oral language skills for morphology and syntax, that is, good

metalinguistic awareness at those levels of language (Berninger, 2006). However, children

with language learning disability appeared to be impaired in oral language skills,

phonological skills and reading comprehension than the dyslexics (Butler & Silliman, 2002).

Their impaired metalinguistic awareness of morphology and syntax was accounted for the

lower verbal IQs. Siegel and Ryan (1988) reported that reading disabled children scored

lower on measures of syntactic awareness than age-matched normal readers.

Bilingualism, which has been shown to affect metalinguistic abilities, influences

reading performance. The consensus in the field is that learning a second language permits

children to view their language as one system among others, thereby enhancing their

linguistic awareness. Bilingual children also outperform monolingual children on some

metalinguistic and emergent literacy tasks (Bialystok, Shenfield, & Codd, 2000).

Metalinguistic and reading abilities are language and script specific in nature and

hence investigations in the respective language and scripts are called for. Indian scripts

developed from Brahmi that are semi-syllabic in nature, is said to have highly transparent

orthographies. Studies in Kannada language on metaphonology and reading abilities

contradicted the hitherto accepted notion that metaphonological abilities are prerequisites for

the acquisition of reading (Rekha, 1996; Prakash, Rekha, Nigam & Karanth, 1993; Prakash,

Chandana & Suma, 2001). Prema (1997) has profiled the reading acquisition of children from

grade III to grade VII and reported that the hierarchy of predictors of reading disability in

Kannada are metasemantic, metasyntactic and metaphonological skills. Sharma (2000),

Cutinho (2000) and George (2001) studied children with learning disability in Hindi, English

(native language being Kannada) and Malayalam respectively and reported poor

metalinguistic abilities in these children.

Schwartz, Geva, Share and Leikin (2007) studied the cross linguistic transfer of

phonological processing skills in learning to read English as a third language (L1 and L2


202

being Russian and Hebrew respectively). The results revealed that cross-linguistic transfer of

early literacy skills can be found even in the context of different alphabetic orthographies.

The authors further reported that the outcomes of the study suggest that the actual mechanism

of transfer of early literacy skills across alphabetic orthographies is the interaction between

the generalized insight into the alphabetic principle and the specific benefits of knowledge of

an orthography characterized by fully-fledged alphabet with letters representing consonants

and vowels (i.e. Russian) in the acquisition of the another alphabet such as English.

Need for the study

It has been well documented that children with developmental dyslexia have reading

as one of their core deficits and various components that are necessary for the acquisition of

reading are affected. Studies in the area of metalinguistic abilities in bilingual-biliterate

(Kannada-English) children with developmental dyslexia are limited. Further, the relationship

between different metalinguistic skills (metasemantics, metasyntax, metaphonology) and

literacy have not been addressed in this population.

Thus, it is of interest to study the hierarchy of skills that contribute to the acquisition

of reading and writing in Kannada-English bilingual-biliterate typically developing children

and children with developmental dyslexia, which will have implications in the management

of these children.

Aims of the study

The study was undertaken with the following aims:

To compare the performance of bilingual-biliterate (Kannada-English) typically

developing children and children with developmental dyslexia across the major

domains of Metalinguistics, Reading and Writing.

To compare the performance of bilingual-biliterate typically developing children and

children with developmental dyslexia across the sub-domains of Metalinguistic

components, Reading and Writing.

To study the correlation of Reading and Writing with the Components of

Metalinguistic Skills.

To determine the Metalinguistic Skills that contributes significantly to the acquisition

of Reading and Writing Abilities in bilingual-biliterate typically developing children

and children with developmental dyslexia.

To compare the pattern of errors on Metalinguistic, Reading and Writing tasks based

on Qualitative Analysis in the two groups of children.

Method

Participants

The participants were classified into experimental and control groups.


203

Experimental group: A total of twenty children (18 males & 2 females) with developmental

dyslexia in the age range of 8-13 years (mean age: 10 years 6 months) constituted the

experimental group.

Control group: Equal number of typically developing children (mean age: 9 years 2 months),

matched for gender and language age of the subjects in the experimental group constituted

the control group.

Subject Selection Criteria

All the participants spoke Kannada as their native language and were studying in

schools with English as the medium of instruction. There was no change in the medium of

instruction at any time for any of the participants. Participants and/or parents were explained

about the purpose of the study and an informed written consent was taken.

Experimental group

Children in the age range of 8-13 years diagnosed as having developmental dyslexia.

The diagnosis of developmental dyslexia was based on the performance in the test of

Early Reading Skills (norms developed by Prema & Jayaram, 2002) as assessed by a

qualified Speech Language Pathologist and assessment by a Clinical Psychologist.

Children with developmental dyslexia who have attended therapy for not more than 6

months.

Children with additional disabilities like ADHD, stuttering, misarticulation or any

other neurological deficits were excluded from the study.

Control group

Participants in this group were screened using the WHO Ten Question Disability

Screening Checklist (cited in Singhi, Kumar, Prabhjot & Kumar, 2007 - Refer Appendix 1) to

rule out:

Learning disability

Language deficits

Delayed speech and language milestones,

Hearing impairment

Mental retardation

Behavioural and emotional disorders

Neurological deficits.

Procedure

The following tests were carried out individually for all the participants (experimental

and control subjects) in a quiet environment (Refer to Table 1).

Table 1: Tests administered on the participants of the study


204

Tests Purpose

WHO Ten Question Disability

Screening checklist

(cited in Singhi, Kumar, Prabhjot &

Kumar, 2007)

Linguistic Profile Test in Kannada

(Karanth, 1980)

Reading Acquisition Profile in

Kannada (RAP-K) (Prema, 1997)

Test for Metaphonological skills

Reading Tests

Writing Tests

To rule out any disability in control

group

To rule out disabilities in areas other

than language in experimental group

To assess the language age,

metasemantics and metasyntactic

abilities.

To assess the metaphonological, reading

and writing skills.

The tests were administered on all the participants by the investigator. The

participants in the control group were tested individually in a quiet environment in the school

setting and the participants in the experimental group were tested in a quiet environment in

the clinical setting. The testing was carried out in 2-3 sittings (on consecutive days)

depending on the comfort level of the participants. The total time taken for testing each

participant ranged between 2 ½ to 3 hours. The order of the tasks was randomised across

subjects and across groups to rule out order effect.

Data Analysis

The scores obtained in each of the domains were computed and tabulated. The data

was then subjected to suitable statistical measures and analyzed quantitatively. Qualitative

analysis of the data was also carried out to determine the pattern of errors in both the groups

of subjects. The results of the analysis are presented and discussed in the sections that follow.


The performance of children with DD and the language age matched TD children will

be presented under the following sections:

I. Performance of children across the major domains of Metalinguistics, Reading and

Writing.

II. Performance of children across the sub-domains of Metalinguistic components,

Reading and Writing.

III. Correlation of Reading and Writing with the Components of Metalinguistic Skills.

IV. Metalinguistic Skills that contribute to the acquisition of Reading and Writing

Abilities.

V. Qualitative Analysis


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I. Performance of children across the major domains of Metalinguistics, Reading and

Writing

The mean percent and standard deviation (SD) values for tasks assessing

metaphonology, metasemantics, metasyntax, reading and writing skills for the two groups of

subjects are shown in Table 2 and figure 1. The results from Table 2 and figure 1 reveal that

the TD group performed better than DD on all the tasks under study.

Figure 1: Performance of the two groups of subjects on metalinguistic, reading and writing

tasks.

Table 2: Percent Mean and Standard Deviation (SD) for the two groups of subjects on

metalinguistic, reading and writing tasks

Groups Percent Mean SD

Metaphonology TD 79.16 7.89

DD 49.65 13.70

Metasemantics TD 89.52 6.04

DD 70.67 8.33

Metasyntax TD 88.60 5.82

DD 56.90 11.89

Reading TD 85.38 8.62

DD 40.25 20.25

Writing TD 82.13 9.26

DD 24.33 14.64

Statistical analysis using mixed ANOVA revealed a significant effect of test [F (4,

152) = 82.034, p < 0.001] and groups [F (1, 38) = 147.369, p < 0.001] in the performance of

the two groups of subjects. Pair-wise comparisons using Bonferroni‘s multiple comparison

showed a significant difference between all the domains (p < 0.001) except for

metaphonology and reading (p > 0.05). The results of independent ‗t‘ test carried out to

compare the performance across the two groups of subjects revealed significant differences

between TD and DD groups for all the five domains (p < 0.001). This suggests that the

performances of the two groups of subjects on the metalinguistic, reading and writing tasks

are different.


206

The finding that children with DD perform poorly than the TD children on

metalinguistic tasks are in consonance with literature reported on metalinguistic abilities in

children with language disorders (Kamhi at al., 1985; Carlisle, 1987; Cutinho, 2000). Cutinho

(2000) reported poor metalinguistic skills in English in children with Learning Disability

whose native language was Kannada whereas the present study revealed poor metalinguistic

skills in Kannada language in Kannada-English bilingual-biliterates. Thus, children with DD

may be thought to have metalinguistic deficits in both the languages. However, the nature of

the tasks used in both the studies was different.

The findings of the present study are also in consonance with that of Prakash et al.

(1993), and Karanth and Suchitra (1993), whose findings indicate that acquisition of reading

(literacy) itself facilitates metaphonological and metasyntactic abilities, rather metalinguistic

abilities. The finding of significantly poor performance of children with DD on reading and

writing tasks are in agreement with Prakash et al. (2001) who reported that the dyslexic

children in Kannada were very poor on their orthographic awareness. This could be attributed

to the poor mental representation in these children of how phonology and orthography are

interrelated and expressed in the script.

II. Performance across the sub-domains of Metalinguistic components, Reading and

Writing.

The performance across the sub-domains for the two groups of subjects will be

presented under the following headings:

1. Metaphonology

2. Metasemantics

3. Metasyntax

4. Reading

5. Writing

For each of the domains, statistical analyses were carried out using mixed ANOVA

for the sub-domains with groups as the independent variable. This was followed by

independent ‗t‘ test to compare the performance across the two groups of subjects and

repeated measures ANOVA was carried out across the tests within each subject group. The

results of the statistical analysis reveal that the TD group performed better than DD on all the

subdomains of metaphonology, metasemantics, metasyntax, reading and writing. These are

shown in figures 2, 3, 4, 5 and 6 respectively.


207

Figure 2: Performance of the two groups of subjects on the sub-domains of metaphonology.

Figure 3: Performance of the two groups of subjects on the sub-domains of metasemantics.

Figure 4: Performance of the two groups of subjects on the sub-domains of metasyntax.


208

Figure 5: Performance of the two groups of subjects on the sub-domains of reading.

Figure 6: Performance of the two groups of subjects on the sub-domains of writing.

The metaphonological deficits observed in children with DD are supported by a vast

majority of studies in the literature which document poor phonological awareness in children

with reading disability (Tunmer & Bowey, 1984; Kamhi et al., 1985 and others).

Metaphonological deficits in these children have also been documented in the syllabic scripts

(Padakannaya, Rekha, Vaid & Joshi, 2002). Of the metaphonological tasks, poor performance

was found on phoneme deletion in both the groups of children. This supports the notion that

phoneme awareness develops at a later age when compared to the other metaphonological

tasks. Exposure to English facilitated better performance on phoneme awareness tasks

(phoneme deletion and phoneme oddity) in TD children which is in consonance to that

reported by Prakash and Rekha (1992). However, the same was not observed in children with

DD which might suggest that these children were unable to integrate the principles of

alphabetic script and the knowledge of orthographic principles of semi-syllabic script, which

is considered to be essential for cross linguistic transfer of metaphonological tasks (Schwartz

et. al, 2007).

The performance of both groups of children on tasks assessing metasemantic and

metasyntactic skills draws support from the results of investigations on these abilities in


209

alphabetic scripts (Bentin et al., 1990) as well as semi-syllabic scripts (Sharma, 2000;

George, 2001). While the reported literature is for monolingual-monoliterates, the present

study revealed similar findings in bilingual-biliterate children for the native language. The

performance on the sub-domains of metasemantics and metasyntax of the two groups of

children in Kannada is similar to that reported by Sharma (2000) and George (2001) in Hindi

and Malayalam languages respectively.

The results also support the view that judgment tasks are easier than revision tasks

and is the first of the metasyntactic skills to develop since the younger typically developing

children were able to judge the grammaticality of the sentence but unable to revise them.

III. Correlation of Reading and Writing with the Components of Metalinguistic Skills

Pearson‘s correlation was done to determine the correlation of combined reading and

writing abilities with that of metaphonology, metasemantics and metasyntax independently in

TD and DD groups. In the TD group, the correlation of reading and writing was found to be

significant with metaphonology and metasemantics but not for metasyntax. The correlation

co-efficients for the combined reading and writing abilities with that of the metalinguistic

components for the TD group is shown in Table 3.

Table 3: Correlation co-efficients for TD group

Total

Reading &

Writing

Meta-

phonology

Meta-

semantics

Meta-

syntax

Total

Reading

& Writing

Pearson Correlation 1.000 0.591** 0.489* 0.440

Sig. (2-tailed) - 0.006 0.029 0.052

N 20 20 20 20

Note: **- p<0 .01 (2-tailed), *- p<0 .05 (2-tailed).

Table 4: Correlation co-efficients for DD group

Note: **- p<0 .01 (2-tailed), *- p<0 .05 (2-tailed).

The trend of correlation in the DD group was found to be different from that of the

TD group. In the DD group, the correlation of the combined reading and writing skills was

found to be significant with metasemantics, metaphonology and metasyntax in that order. The

correlation co-efficients for the combined reading and writing abilities with that of the

metalinguistic components for the DD group is shown in Table 4.

Total

Reading &

Writing

Meta-

phonology

Meta-

semantics

Meta-

syntax

Total

Reading &

Writing

Pearson Correlation 1.000 0.660** 0.704** 0.558*

Sig. (2-tailed) - 0.002 0.001 0.011

N 20 20 20 20


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IV. Metalinguistic Skills that contribute to the acquisition of Reading and Writing

Abilities.

A step-wise multiple regression analysis was performed separately for each subject

group to determine the potential variables which contribute to the acquisition of reading and

writing skills. The results of step-wise multiple regression for the TD group revealed a

regression equation for the combined reading and writing abilities which was significant with

F (1, 18) = 9.641, p < 0.01. The regression equation included only metaphonology whereas

metasemantics and metasyntax were excluded. Of the metalinguistic skills, metaphonology

was identified as the potential contributor to the acquisition of reading and writing in the TD

group (r2=0.349; Metaphonology: β =3.111; p < 0.01) and constant was significant with value

124.237 (p < 0.05).

Step-wise multiple regression for the DD group resulted in a regression equation for

the combined reading and writing abilities which was significant with F (1, 18) = 17.736, p <

0.001. The regression equation included only metasemantics whereas metaphonology and

metasyntax were excluded. The results revealed that metasemantics was the potential

contributor to the acquisition of reading in the DD group (r2=0.496; Metasemantics: β

=6.119; p < 0.001) and constant was significant with value -251.337 (p < 0.05).

Prema (1997) reported that the hierarchy of predictors of reading abilities in Kannada

monolingual–monoliterates was found to be metasemantics, metasyntactic and

metaphonology. In the present study, the contribution of metaphonology to reading and

writing abilities in bilingual-biliterate (Kannada- English) TD children was significant.

Metasemantic and metasyntactic abilities may not have a significant contribution to reading

and writing in this population. Thus, the skills contributing to reading and writing in the

native language are different in monolingual-monoliterate and bilingual-biliterate children.

The exposure to an alphabetic script can be attributed to this finding in children who can

speak as well as read and write in two languages.

Alternatively, the metalinguistic skill which contributed significantly to reading and

writing Kannada in children with DD was found to be metasemantics, rather than

metaphonology as was the case in TD children. This finding in children with DD is similar to

that reported by Prema (1997) on TD children for monolingual-monoliterate children. This

might suggest that bilingual-biliterate children with DD perform similar to monolingual-

monoliterate children and there may be no significant cross linguistic transfer of

metalinguistic skills in this population. Thus, the metalinguistic abilities that contribute

significantly to reading and writing may be different in TD and DD groups.

V. Qualitative Analysis

The performance on the metasyntactic tasks was found to be highly influenced by the

spoken form of the language. The differences in the colloquial and pedantic forms of

Kannada, particularly with the minute morphosyntactic violations being acceptable in the

colloquial form, could be attributed to the inability of the subjects to identify certain

grammatical violations in the pedantic form.


211

It could thus be speculated that the DD group exhibited a persisting logographic type

of whole word reading, relying on semantic cues when non-word stimuli are presented.

However, they also tended to ignore the semantic cues while reading words resulting in

erroneous reading of words. The errors on writing were similar to those observed for reading

including substitution of unaspirated sounds for aspirated sounds and auditorily similar

sounds.

Thus, on the whole, no significant qualitative differences were observed on these

tasks between TD children and children with DD. However, the performance of children with

DD was found to be similar to the younger TD children on most of the tasks. These findings

are in agreement with that of Ramaa (1985), Karanth (1990) and Share (1996) who reported

that the error patterns of older poor readers suggest that they use the same strategies as

younger, normally achieving children. Children with DD were found to have greater

problems on non words and also a general delay along the developmental sequence of reading

and writing. Their errors ranged from inability to identify syllables and words to misreading,

slow reading, substitution of visually and/or auditorily similar syllables and words.

Conclusions

Thus, the present study revealed significant differences between bilingual-biliterate

typically developing children and children with developmental dyslexia on metalinguistic and

literacy skills. The significant contribution of metaphonology to the acquisition of reading

and writing and also a higher correlation between the two in a semi-syllabic script in typically

developing children exposed to an alphabetic script simultaneously, implies the cross

linguistic transfer of these skills across different orthographic systems (alphabetic and semi-

syllabic in the present study). In contrast, the contribution of metasemantics was higher in

children with developmental dyslexia leading to the speculation of persistent logographic

type of reading in this population. Thus, the metalinguistic skills were found to have a

significant role in the acquisition of reading and writing in both the groups of children.

Overall, the performance of children with developmental dyslexia resembled that of younger

typically developing children on all tasks of metalinguistics, reading and writing.

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Language Proficiency Questionnaire:

An Adaptation of LEAP-Q in Indian Context

Ramya Maitreyee & S.P.Goswami*

Abstract

The prime focus of the study was to modify and adapt the LEAP-Q to the Indian scenario. The

modified version of the questionnaire was made and given to five SLPs working in the area of

bilingualism for their suggestions. It was piloted on a group of 10 Kannada- English bilinguals.

Based on their difficulty level to respond to the questions, further modifications were incorporated

and the final questionnaire were administered on 60 Kannada/Hindi- English bi/multilinguals. The

responses were tabulated and subjected to statistical analysis using the SPSS software. The results

indicated that L1 was the primary language of communication during childhood. All the participants

had acquired L1 prior to L2 and then followed by L3. The understanding and speaking skills were

acquired earlier than the literacy skills in L1. However, all the four skills developed in a simultaneous

manner for L2 and L3. The attainment of proficiency levels in all the language followed a similar

pattern as in the acquisition. The proficiency ratings for understanding, speaking, reading and

writing obtained did not indicate a one to one correlation between the competence and performance

levels for L1. However, it was seen that if the participants rated themselves to be proficient like in

using the language then there actual performance was either native-like or good proficiency, but not

below that. Hence, this finding indicates that a correction factor needs to be employed while judging

the actual performance. Conversely, not much discrepancy was obtained between the competence and

performance ratings for L2. The findings of the various sub-sections indicate that this tool will help us

in assessing the proficiency level of a bi/multilingual participant in any of the languages in four skills,

i.e., understanding, speaking, reading and writing. It would serve as a quick measure to assess the

competence levels of an individual.

Introduction

India is a multilingual country and houses a number of languages, culture, religion

and society. Bi/multilingualism is widely spread in India making it the tower of babbles. In

India, bilingualism is one of the least understood phenomenons and there lies a dearth of

studies in this area. It has been viewed as an area too complex to investigate, considering the

multilingual mosaic of India. At times it becomes difficult on part of the researchers to

adequately assess the proficiency level of an individual in the skills of understanding,

speaking, reading and writing especially in a language they do not speak and thus, have to

rely on self-assessed information. A number of factors have been found to be responsible for

attaining proficiency in a language. The age of acquisition, the environment where it is learnt,

the culture and socioeconomic status of an individual plays a vital role in the proficiency of

languages. The complex nature of bilingualism in India has led us to adapt easily to the

western models blindly and as a result have failed to appreciate the multiplicity of Indian

languages as a beautiful aspect of this country.

______________________________________

* Reader in Speech Pathology, All India Institute of Speech and Hearing, Mysore, India email: [email protected]


Language Proficiency Questionnaire in Indian Context

215

Thus, the tests developed in western context may not be viable to be used in the Indian

context. Hence, there is a need to modify the tests according to our diversified multilingual

situation which would further prove to be a more valuable tool.

Aim of the study

The aim of the present study was to modify and adapt the LEAP-Questionnaire to the

Indian multilingual situation.

Review of Literature

Bilingualism has been extensively viewed as the equal mastery of two languages.

Different researchers have defined it in different ways. However, the core aspect remains the

same. Bloomfield (1933) defined it as the native-like control of two languages, Haugen

(1953) as the ability to produce complete meaningful utterances in the other language.

Innumerable definitions have led to the emergence of a number of typologies or classification

systems to describe various types of bilingualism.

Types of bilingualism

The different classificatory system as cited in Thirumalai and Shyamala (1986) are

listed below:

Compound and Coordinate Bilingualism

Simultaneous versus Sequential/Successive acquisition of two or more languages

Second language acquisition and Second language learning

Dominant versus Balanced bilingualism

Additive and Subtractive Bilingualism

All these classifications mentioned above which are either based on developmental or

contextual parameters of bilingualism indicate the necessity of emphasizing the process by

which bilingual proficiency is acquired in order to fully understand the nature of individual

bilingualism.

Bilingual proficiency

Bilingual proficiency refers to an individual’s ability in their two languages. The

following four skills form a core for attainment of bilingual proficiency:

Understanding ● Reading

Speaking ● Writing

Thus, a bilingual person needs to have proficiency in all the four dimensions of each

of the languages (L1 & L2). The four language abilities form an approximate ladder of

complexity. Listening would be the easiest to acquire, followed by speaking, reading and

writing. However, these four aspects are neither independent nor different skills. The

development of proficiency in one of the skills has an effect on the other.

Any individual might have an adequate knowledge of the language but while

performing might not be able to use this language to the fullest extent. Chomsky (1965) made


216

a fundamental distinction between these two concepts, which he referred to as competence

and performance. According to him, competence refers to the speakers-hearer’s knowledge of

language and performance to the actual usage of language in concrete situations.

Factors affecting language acquisition and proficiency

Extensive research has been carried out by the researchers on the influence of several

factors which affect the language proficiency of a person. These include:

a. Developmental Factors: Lenneberg (1967); Johnson and Newport (1989); Flege,

Mackay and Piske (2002); Marian, Blumenfeld and Kaushanskaya (2007); Li, 2009.

b. Educational and Environmental factors

Educational context: Collier (1995); Durgonuglu and Oney (2000); Flege and Liu

(2001).

Web-based learning: Sanaoui and Lapkin (1992); Chiswick and Miller (n.d.).

Exposure to language in the family/society: Chomsky (1957); Rosenberg (1996);

Delgado, Guerroro, Goggin and Ellis (1999), Cummins (2000) Hasson (2006),

Harniess (2008); Schmitt (2008); Tahta, Wood & Loewenthal (1981); Piske,

Mackay & Flege (2002).

Length of Residence (LOR)

Media-based learning: Johannessen and Lopez (2002)

Formal Methods for Assessing Language Proficiency

Many tests have been used to measure bilingualism. Macnamara (1969) grouped these

tests as:

I. Rating scales include:

● Self-rating scales ● Language background questionnaires

● Language usage rating scales ● Experimenter interviews

In self-rating, the bilingual is asked to rate his/her proficiency in each of the basic

skills in each language. A balance score is then calculated by subtracting the ratings of one

language from those of the other. If the difference is zero or close to zero, the bilingual is

considered to be equally fluent in both the languages.

The Language Efficiency and Proficiency Questionnaire (LEAP-Q) developed by Marian,

Blumenfeld and Kaushanskaya (2007), is a self-assessment tool that includes relevant

proficiency and experience variables in a single instrument. The internal validity of the

Language Experience and Proficiency Questionnaire (LEAP-Q) was examined in study 1

which was based on the self-report data. In Study 2 they established that self-reports were

reliable indicators of language performance. L1 proficiency was reported to be better than L2

proficiency. Family based experiences, years spent in a L1 country contributed to L1

competence and proficiency. Although, this was one of the first questionnaires which

evaluated proficiency in both the languages, yet it also has some limitations. It does not

include a detailed language history during the childhood and all the possible factors that


217

would contribute to language acquisition and proficiency directly or indirectly. It uses a wide

rating scale which can give us varied data. Keeping these shortcomings in mind the present

questionnaire is being modified and adapted to be used in the Indian scenario for adult

bi/multilinguals.

Method

Participants: A total of 60 participants were included in the present study.30 Hindi-English

bi/multilinguals (14 males & 16 females) and 30 Kannada-English bi/multilinguals (15 males

& 15 females)

Ethical procedure

Participants were selected by ethical procedures. They were explained the purpose and

procedures of the study, and an informed verbal consent was obtained from them.

Inclusion criteria

The educational qualification level of all the participants ranged from a minimum of 12 years

of education or higher in at least one of the languages. All the participants were native

speakers of Northern/Southern India and had acquired the first/second language (L1-

Hindi/English and Kannada/English in the present study) both for academic and

communicative purposes and had the knowledge of third language (L3- either Kannada or

Hindi). No obvious deficits of any neurological, psychological and or sensory were either

present or reported.

Age groups

Adult bilinguals in the age range of 18-25 years were included in the present study.

Procedure

The study was carried out in three stages. The three stages are as follows.

Stage I

A modified version of the already existing Language Efficiency and Proficiency

Questionnaire (LEAP-Q) was made. The questionnaire (Appendix I) contained a total of 18

questions. The first question was intended to collect details about the number of languages

known by each of the participants. The rest 17 questions with their sub-sections were more

relevant to assess proficiency in a language. The following domains were included in the

questionnaire:

Language history during childhood (3 questions)

Acquisition of language (3 questions)

Proficiency of language (4 questions)

Usage of language in different context (2 question)

Exposure to different languages (4 questions)

Native/non-native speaker (1 question)

The participants were asked to encircle the required language used with specific

people and situations. In obtaining information about the language acquisition age for each of


218

the languages (L1, L2 & L3), the participants were asked to give the approximate age of

acquisition and proficiency level reached for each of the languages.

Stage II

For the appropriateness of the questionnaire, it was distributed to five speech

language pathologists experienced in working with issues concerned with bilingualism for

their suggestions and the questionnaire was altered accordingly. A pilot study was also

carried out with ten adult bilinguals in the age range of 18-25 years recruited from All India

Institute of Speech and Hearing campus and based on their difficulty of answering the

questions the questionnaire was modified accordingly.

Stage III

At this stage the participants were given to fill in the final questionnaire. Along with

filling in the questionnaire the participants performed similar tasks in both the languages for

the four skills of understanding, speaking, reading and writing.

The following samples were collected:

1. Speaking

a. Picture description: The picture stimulus from the Western Aphasia Battery (Kertesz,

1982) was used in the present study. The participants were asked to describe the picture for

duration of 1 minute in both the languages, i.e., L1 and L2.

b. A spontaneous speech sample of 1 minute was also recorded from each participant.

2. Reading: Three standardized passages were used in the following study. The

standardized Kannada passage containing both voiced and unvoiced sounds was selected for

the study. The Hindi passage was selected from the AIISH Research Fund project entitled

“Speech Rhythm in Indo-Aryan and Dravidian languages”. The “Rainbow passage

(Fairbanks, 1960)” was used in order to study their proficiency in reading in L2 (English).

The samples were recorded on Wavesurfer 6.0 using a microphone, placed six inches

from the mouth of the participant, which was connected to a laptop.

3. Comprehension: A passage from the XII Standard English textbook of Karnataka

state board was chosen for the study. The original passage was retained and then it was

translated to both Kannada and Hindi. 5 questions were framed in order to assess the

comprehension abilities. The participants were asked to read the passage and answer the

questions. The same procedure was followed for both the languages, i.e., L1 and L2

4. Writing: The participants of the study were asked to write on “India- My country” in

both the languages (L1 and L2) and their performance was evaluated by three competent

speech language pathologists.

The samples collected were given to three competent speech language pathologists to

assess their proficiency levels in each of the four skills. The judges were asked to rate on 4-

point rating scale (1- Zero proficiency, 2- Low proficiency, 3- Good proficiency, 4- perfect

proficiency). This was carried out to find a co-relation between the competence and the actual

performance levels of each of the participants in the various language abilities.


219

Task

The participants were seated comfortably and they were instructed to read the

questions thoroughly and select the most appropriate option that best suits the question. The

instructions were also given in written form in the questionnaire.

The samples were collected in a quiet environment after taking consent from the

individual participants in the study.

Analysis of data

The data collected from 60 participants was subjected to quantitative analysis using

SPSS (16.0 version) software.


The results of the study are being presented under the following domains:

I. Language history during childhood

The overall statistical analysis revealed that in both the groups, i.e., Hindi and

Kannada participants used L1 to communicate with family members and neighbors in

childhood. A small percentage also accounted of using a combination of L1 and L2. These

findings could be due to the proficient and frequent usage of L1 by the family members. This

suggests that the nurture influences the acquisition of a language. Thus, this study advocates

that the stimulation provided by the environment has an impact during the childhood. Similar

views have been reported by the empiricists Delgado, Guerroro, Goggin and Ellis (1999) and

Li (2009).

The use of a combination of language was more prevalent in the Hindi group which

could be due to the environmental demands that vary from region to region in India. The

usage of English by the mothers of Hindi speaking participants may be due to the need of

adapting to the common language for globalization or higher educational achievements.

II. Acquisition of language

Learning of language

It was seen that L1 was the first language learnt for understanding and speaking. L2

was the first language used for reading and writing in Hindi group. L1 alone or a combination

of L1 and L2 was used by the Kannada-English bilinguals for reading and writing.

These findings could be attributed to the fact that the exposure of the participants

from the surrounding environment was maximum for L1. Thus, the usage of L1 in the early

stages of life for fulfilling the basic needs of an individual or for functional communication,

i.e. for understanding and speaking is widely used and accepted. Similar findings were

reported by Delgado, Guerroro, Goggin and Ellis (1999) and Li (2009).

However, the role of the second language comes into effect when an individual starts

acquiring literacy skills (reading and writing) during childhood. The findings of the present


220

investigation are in agreement with the study by Marian, Blumenfeld and Kaushanskaya

(2007).

Age of acquisition of the above skills in L1, L2 and L3

The acquisition of L1 for understanding and speaking is learnt first followed by

reading and writing for all the participants. It is obvious from the results that the basic skills

(understanding and speaking) to communicate are acquired at an earlier age (1 year),

however, the skills which require more precise integration of language and cognition for

literacy skills (reading and writing) are acquired at the age of 4 in both the groups.

All the skills develop in a parallel fashion in the acquisition of L2 and L3. L1 is

acquired first followed by L2 and L3. A significant difference was obtained in Hindi {2

(2) =

120, p<0.05}, and Kannada group {2

(2) = 202.31, p<0.05}, the data was further subjected

to Wilcoxon signed rank test. Results of this test indicated a significant difference between

L1 and L2 (z= 7.88, p<0.05); L2 and L3 (z= 9.14, p<0.05) and L1 and L3 (z= 9.53,

p<0.05) in the Kannada group. Similar findings were observed in Hindi group.

A significant difference was obtained on Mann-Whitney U test between Hindi and

Kannada groups for L1 writing (z= 2.876, p<0.05), L3 understanding (z= 5.873, p<0.05)

and L3 speaking (z= 5.875, p<0.05). The Hindi group attained understanding and speaking

L3 at a later age than the Kannada group.

The results are in accord with Durgonuglu and Oney (2000) who considered listening

skills to be developed prior to the acquisition of reading and writing in English speaking

beginning readers. Similar reports have been put forth by Li (2009). In the present study L1

was acquired within the age range of 1-6 years and L2 within 3-15 years. These findings are

in consonance with the report of Lenneberg (1967) who stated the acquisition of L2 by 12

years or puberty, while Johnson and Newport (1989) considered the time of closure to be 15

years of age.

The participants in the Hindi group also reported of never acquiring L3 for reading

and writing purposes. They had learnt Kannada in order to understand and communicate for

routine activities and for communicating to the general public.

Age of attainment of proficiency of the above skills in L1, L2 and L3

A self-reported age for attainment of proficiency in each of the four skills

(understanding, speaking, reading and writing) for L1, L2 and L3 was obtained and subjected

to descriptive statistical analysis.

(i) For L1: It can be noted that understanding and speaking which were mostly used

for functional communication reached a level of native like proficiency earlier than reading

and writing skills. However, the minimum age for acquiring proficiency in all the skills in the

Kannada group was lesser than that of the Hindi group.

(ii) For L2 and L3: It was seen that the proficiency in L2 and L3 was achieved

later than L1 and proficiency in all the skills were achieved at around the similar ages.


221

Comparison across the Languages: The overall mean and standard deviation was calculated

using descriptive statistical analysis and it was seen that the attainment of proficiency

followed the same pattern as the age of acquisition; L1 was mastered first followed by L2 and

L3. Friedman test revealed a significant difference across languages in both the groups [{2

(2) = 32.00, p<0.05}-Hindi and {2

(2) = 174.20, p<0.05}-Kannada]. Pair wise comparison

was done using the Wilcoxon signed rank test and significant difference was obtained across

all the languages in both the groups.

ProficiencyAcquisition

Me

an

Ag

e (

yrs

.)

20

18

16

14

12

10

8

6

4

2

0

Lang. & Group

L1 KAN

L1 HIN

L2 KAN

L2 HIN

L3 KAN

L3 HIN

Figure 2: Mean age of acquisition and proficiency across languages and groups.

Evidences from the literature have shown that interactions with family members

posed to be one of the major contributors for attaining proficiency in L1 (Hasson, 2006;

Marian, Blumenfeld & Kaushanskaya, 2007). Apart from the innate ability to learn a

language, the current results shed a light of importance on the variables that facilitates

language proficiency.

The upshots of the current investigation corroborated the earlier findings of Marian,

Blumenfeld and Kaushanskaya (2007). Hence, it can be concluded that all bi/multilinguals

have the same pattern of language acquisition and mastery in spite of regional, social,

cultural, environmental and attitudinal differences among varied regions of the world. This

supports the role of the nature or the innate language device as stated by Chomsky (1957).

III. Proficiency of language

a. Competence across languages: The mean values indicated that the proficiency in L1

was considered to be the best in both Hindi-English and Kannada-English bilinguals.

The participants rated themselves to be better competent in L2 [{Hindi group: 3.11,

SD=0.37} & {Kannada group: 3.12, SD=0.47}] than in L3. The Friedman test was

further carried out which revealed a significant difference across languages for both

the groups [Hindi: {2

(2) = 193.47, p<0.05}, Kannada: {2

(2) = 154.64, p<0.05}].

Additionally, the Wilcoxon signed rank test was done to analyze pair-wise difference

and a statistically significant difference was obtained across all the languages (L1, L2

and L3) in both the groups.

b. Comparison between the competence and performance ratings: A comparison of the

self-ratings and the ratings by the professional was carried out. The reliability

coefficient (Cronbach’s alpha) indicated a good reliability among the judges.


222

The self reports indicated a better L1 competence than L2 and L3. The ratings of

participants and the judges were in concordance for L2. However, it was seen that on an

average the Hindi-English bilinguals rated themselves to be more competent in L1 than their

actual performance. In contrast, Kannada-English bilinguals felt that they were less

competent than they actually were. The same has been illustrated in figure 4 & 5 (Hindi

group) and figure 6 & 7 (Kannada group). As L1 was the native language of all the

participants, they considered themselves to be native like competent in using the language.

With reference to L1, participants received either little or no feedback about their skills.

Hence, leading to either an over- or underestimation of their skills in L1. Review of earlier

findings by Shameem (1998) suggests similar results as of the present study.

Figure 4: Comparison of competence and Figure 5: Comparison of competence and

performance in L1 for Hindi group performance in L2 for Hindi group

Figure 6: Comparison of competence and Figure 7: Comparison of competence and

performance in L1 for Kannada group performance in L2 for Kannada group

There was accordance among the judges and the self-ratings for L2. The results

replicate and extend previous research on self ratings for L2, where researchers have reported

a correlation between competence and performance levels, thus validating the use of self

reports as a quick tool to measure proficiency. The present outcomes are consistent with the


223

results of MacIntyre, Noels and Clement (1997). One possible explanation for this result is

that participants receive more practice and feedback in English (L2) compared to L1. One

may contemplate that bilingual students in schools, where English is the lingua franca,

engage in more use of English either for literary activities or communication than L1.

However, it refuted the findings of Delegado, Guerrero, Goggin and Ellis (1999).

The overall ratings revealed that the competence ratings for L2 almost coincided with

the performance ratings. In contrast, this was not the case for L1 in both the groups. They

either under or over-estimated themselves by one level of their actual performing abilities.

Hence, the ratings need to be inferred with caution in order to assess the degree of bilingual

proficiency in an individual. Thus, a correction factor of level-1 below the reported rating is

advocated.

IV. Usage of language in different contexts

School environment: Descriptive statistical analysis was done and frequencies were

calculated through cross-tabulations. L2 was found to be the medium of instruction in schools

and was the language used maximally when interacting with teachers. However, L1 formed

the language of communication between peers. Some of the participants even reported of

using both the languages. The mean years of education were 17.26 (SD=1.74) years [Hindi-

17.36 (SD=1.99); Kannada-17.16 (SD=1.48)] and all the participants had a range of 15-21

years of education.

The results indicated that L2 was the most widely used language during formal

teaching situations. This would further help to contribute to the development of L2 in an

individual. This finding is supported by the study of Collier (1995); Johannessen and Lopez

(2002) and Li (2009). However, the use of L1 or a combination of languages while

interacting with friends could be attributed to the fact of language choice or proficiency of

language use of the listener/ communication partner.

The longer duration of education also contributes to the attainment of language

proficiency. This finding is in harmony with the view of Flege and Liu (2001).

Interaction with family, friends, market places, media and web based learning

situations:

L1 was the preferred language while interacting with family members and neighbors

L2 was most preferred in the educational set-up and in listening to language

instruction tapes, reading books, using internet sources.

A combination of languages (L1, L2 and L3) was preferred for media based learning,

talking to friends and in market places.

Results of the present study contribute to the existing body of literature which also

emphasizes the usage of L1 while interacting with family members (Hasson, 2006; Marian,

Blumenfeld & Kaushanskaya, 2007). The reasons of language choice could be due to the

interlocutor’s proficiency or choice of language. Cultural and ethnic factors also play a role in

the choice of language according to situations.


224

The usage of L2 especially for internet sources has also been reported by Chiswick

and Miller (n.d.) and Sanaoui and Lapkin (1992). A combination of languages was most

preferred for media-based learning and while interacting with friends. Similar evidences were

given by Hasson (2006).

Exposure to different languages

For L1: The participants in both the groups reported of being exposed to L1 for all

the 7 (SD=0.00) days in a week. The overall average hours of exposure to L1 ranged from 8-

18 hours with a mean of 14.69 (SD=1.94) hours.

For L2: The total average number of days and hours of exposure to L2 ranged from

5-7 {mean=6.79 (SD=0.58)} and 4-16 {mean=9.52 (SD=3.01)} respectively for all the

participants.

For L3: On the whole, the average number of days and hours all the participants were

exposed to L3 was 6.16 (SD=1.46, range: 0-7) days and 3.64 (SD=2.21, range: 0-10) hours.

The data for duration of exposure of each of the languages in different settings

(family, school and state) was collected and subjected to statistical analysis and the mean,

standard deviation and the range were obtained. The total mean hours of exposure to L1 for

both the groups by the family was 21.15 (SD=2.02, range: 18-25) years; school was 16.76

(SD=1.62, range: 13-20) years and state was 19.62 (SD=1.97, range: 17-23) years. However,

it was seen that participant’s family was never exposed to L2 (English) and L3

(Kannada/Hindi). Similarly the participants did not visit an English speaking country.

The Mann Whitney U-test was carried out and a significant difference among both the

groups was noted for the number of years of exposure to schooling in L3 (z=6.98, p<0.05)

and the duration of stay in a L1 (z=5.16, p<0.05) and L3 (z=6.54, p<0.05) state. The years

of exposure has been represented graphically in figure 8 (Hindi group) and figure 9 (Kannada

group). The participants showed maximum exposure for L1 with respect to the number of

days, hours, interaction with family members and residing in the L1 native-state. These

factors were same for both the groups. This shows that the exposure has played a significant

role in acquiring and making the participants native-like speakers. Similar reports have been

documented in the literature (Marian, Blumenfeld and Kaushanskaya, 2007).

Language

L3L2L1

Me

an

Nu

mb

er

of

Ye

ars

- H

ind

i G

rou

p

25

20

15

10

5

0

Exposure

Education

Family

State

3

18

21

1717

Language

L3L2L1

Me

an

Nu

mb

er

of

Ye

ars

- K

an

na

da

Gro

up

25

20

15

10

5

0

Exposure

Education

Family

State

2121

8

1617

Mean years of exposure to education, family and state for L1, L2 and L3

Figure 8: Hindi group Figure 9: Kannada group


225

Acquiring of proficiency in L2 for both the groups could be attributed to the medium

of instruction in schooling. In the Indian scenario the schools affiliated to state or central

board mostly have English as medium of instruction. As most of the participants studied in

private institutions where the medium of instruction was English, it is evident from the results

that these participants were exposed to L2 for 5-7 days with an average mean of 10 hours per

day. Thus, the duration of schooling was an important factor in learning L2. Further, all the

participants belonged to literate families where parents used L2 also for communication.

(Collier, 1995; Marian, Blumenfeld & Kaushanskaya, 2007).

The Kannada group participants had an exposure to L3 at the school level, whereas

the Hindi participants began learning L3 only when they moved from their own states to

Karnataka for higher education. This again shows that classroom teaching at school did play

an active role in learning L3. This was evident from the performance of Kannada group who

learnt L3 (Hindi) during initial stages and continued till 12th

standard of education. Thus,

most of the participants had an exposure for academic purposes for L3 for more than 7-8

years. However, such exposure was not seen for Hindi group. This further strengthens that

classroom exposure is an important contributing factor for acquiring L3. Thus, the results of

the study get support from Marian, Blumenfeld and Kaushanskaya (2007).

As a result, it can be stated from the findings that it is not the only the factors but the

duration of exposure which acts as a significant variable to learn a language/s.

Duration of exposure

a. For L1: Interaction with family, neighbors, market places, radio, watching television and

interacting with friends were the different settings where the participants were maximally

exposed for most of the time to L1. The next major important factors that contributed to

L1 learning were education writing newspapers story books and textbooks.

Exposure

Mkt

Radio TVNbFrn

dWrt

NetHBNPSBDicTBLTEd

n.Fly.

Mean

Rating

- L 1

4.0

3.0

2.0

1.0

Groups

Hindi

Kannada

Figure 10: Mean ratings of duration of exposure to the factors contributing to L1


226

Exposure

Mkt

Radio TVNbFrn

d

Wrt

Net

HBNPSBDicTBLTEdn.Fly.

Mean

Ratin

g - L

2

4.0

3.0

2.0

1.0

Groups

Hindi

Kannada


b. For L2: The results revealed two categories of contributors, i.e. most important and the

moderately important contributors to the learning of L2. The most important contributors,

i.e., the factors to which all the participants were exposed for most of the time or always were

internet, textbooks, dictionary, writing, newspapers, story & historical books, instructional

tapes and educational set-up.

c. For L3: The mean scores indicate that the participants were exposed to L3 maximally

when watching television (1.96, SD=0.88), followed by educational/workplaces (1.95,

SD=0.72), interaction with friends (1.73, SD=0.66), listening to radio (1.60, SD=0.69) and

market areas. These factors serve as catalyst to improve either the learning and/or proficiency

of language. Thus, all the above variables are unique and contribute in a unique manner to

learn the language. This study receives support from the findings of Harniess (2008).

Exposure

Mkt

Radio TVNb

FrndWrt

Net

HBNPSBDicTBLT

Edn.

Fly.

Mea

n Ra

ting

- L 3

4.0

3.0

2.0

1.0

Groups

Hindi

Kannada


V. Native/non-native speaker

The participants were asked to rate themselves on a four point rating scale about their

identification as a native speaker of the language based on their accent and pronunciation.

95% (Hindi-96.7% and Kannada- 93.3%) of the total participants reported of being identified

as a native speaker of L1 the entire time. However, majority of the participants though

competent in using L2 were rarely identified as the native speakers of that language.

The participants of the present study identified themselves as native speakers of L1

(Hindi/Kannada) as they had acquired the language since childhood and were maximally

exposed to it in all kind of situations and contexts. This finding is supported by Piske,

Mackay & Flege (2002).


227

Though they had attained good proficiency in the usage of L2 yet the degree of

foreign accent was not achieved as the participants were never exposed to the native speakers

of English. The review of literature also suggests that if a child acquires L2 before puberty,

then they acquire little or no foreign accent (Tahta, Wood & Lowenthal, 1981). All the

participants in the present study had acquired L2 before puberty and had not stayed in any of

the English speaking countries, hence this could have attributed to the development of no

foreign accent. However, few of the participants self-reported of being identified sometimes

as the native speaker of L3. This finding could be due to a longer and intensive exposure to

the language by native speakers compared to L2.


From the findings of the present study it can be concluded that this is a viable tool in

assessing the language proficiency of an individual and the factors contributing to it. This

questionnaire does not replace the earlier assessment batteries but can serve as an adjunct and

quick measure for assessing a bi/multilingual for his proficiency level. It would assist a

Speech Language Pathologist to assess the language levels of an individual in the language

that s/he does not know. Hence, it can be stated that the present questionnaire is not

supplementing rather complementing the existing tools.


This questionnaire will help the professionals to find out the level of proficiency of an

individual in a language on four basic skills, i.e., understanding, speaking, reading and

writing.

The present study further corroborates the evidences to research in language

proficiency and the factors contributing to it and opines to carry out extensive

research in this area.

Evaluation of first and second language factors will give an insight into the transfer

skills between L1 and L2 and should be considered during routine speech and

language assessments in bilinguals.

In therapeutic intervention, for individuals with aphasia, factors related to second

language exposure become crucial while deciding on the selection of language for

intervention. Hence, an evaluation of the proficiency level in the pre- and post-morbid

condition will help to choose the appropriate language for speech and language

remediation program.

References

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Chiswick, B. R., & Miller, P.W. (n.d.). Computer usage, destination language proficiency and

the earnings of natives and immigrants. KMI Working Paper Series, 9, 1-41

Chomsky, N. (1957). Syntactic Structures. The Hague:Mouton.


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Chomsky, N. (1965). Aspects of the theory of syntax. Cambridge, MA: MIT Press.

Collier, V. P. (1995). Acquiring a second language for school. Directions in Language and

Education, 1(4), 1-10.

Cummins, J. (2000). Language, power, and pedagogy: Bilingual children in the crossfire.

Clevedon, England: Multilingual Matters.

Delgado, P., Guerrero, G., Goggin, J. P., & Ellis, B. B. (1999). Self-assessment of linguistic

skills by bilingual Hispanics. Hispanic Journal of Behavioral Sciences, 21, 31-46.

Durgunoglu, A. Y. & Oney, B. (2000). Literacy Development in Two Languages: Cognitive

and Sociocultural Dimensions of Cross-Language Transfer. Paper presented at a

research symposium on High standards in reading for students from diverse language

groups: Research, practice & policy, Washington D.C.: U.S.

Flege, J. E., & Liu, S. (2001). The effect of experience on adults’ acquisition of a second

language. Studies in Second Language Acquisition, 23, 527-552.

Flege, J. E., MacKay, I. A., & Piske, T. (2002). Assessing bilingual dominance. Applied

Psycholinguistics, 23, 567-598.

Harniess, J. (2008). Approaches to second language English proficiency: Parents’

perspective. Retrieved March 23, 2009 from

http://www.hkugac.edu.hk/news/EnglishAcquisition- A Parents Perspective-

November 2008.pdf

Hasson, D. J. (2006). Bilingual language use in Hispanic young adults: Did elementary

bilingual programs help? Bilingual Research Journal, 30, 45-64.

Haugen, E. (1953). The Norwegian Language in America. Cambridge: Cambridge University

Press.

Johnson, J. S., & Newport, E. L. (1989). Critical periods effect in second language learning:

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language. Cognitive Psychology, 21, 60-99.

Johannessen, B. G. G., & Bustamante-López, I. (2002). Bilingual Academic Spanish

Proficiency Tests: Assessment of bilingual cross-cultural and language and academic

development teacher candidates. Bilingual Research Journal, 26, 563-574.

Kertesz, A. (1982). The Western Aphasia Battery. Philadelphia, PA: Grune & Stratton.

Lenneberg, E. (1967). Biological foundations of language. New York: John Wiley.

Li, Z. (2009). A probe into classroom teaching and second language acquisition.

International Education Studies. 2(1), 124-128.

MacIntyre, P. D., Noels, K. A., & Clement, R. (1997). Biases in self-ratings of second

language proficiency: The role of language anxiety. Language Learning, 47, 265–287.

Marian, V., Blumenfeld, H. K., & Kaushanskaya, M. (2007). The Language Experience and

Proficiency Questionnaire (LEAP-Q): Assessing language profiles in bilinguals and

multilinguals. Journal of Speech, Language, and Hearing Research, 50, 940–967.


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Piske, T., MacKay, I. R. A., & Flege, J. E. (2001). Factors affecting degree of foreign accent

in an L2: A review. Journal of Phonetics, 29(2), 191-215.

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Retrieved March 12, 2009 from http://iteslj.org/Articles/Rosenberg-Bilingual.html

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overview. Central Institute of Indian Languages, Mysore.


230

APPENDIX I

LANGUAGE PROFICIENCY QUESTIONNAIRE

Name: Age: Gender: Male / Female

Instructions:

Please read the questions carefully and choose the most appropriate choice wherever applicable.

1. Name all the languages you know beginning with the language that you learnt first.

Using the below mentioned scale, answer the questions below.

(1- L1, 2-L2, 3-L3, 4- Combination of any of the languages)

L1- First language that you learnt, L2- Second language that you learnt in your life,

L3- Third language.

2. When you were a child, which language did you speak

At Home 1 2 3 4

With your father 1 2 3 4

With your mother 1 2 3 4

With siblings 1 2 3 4

With guardians 1 2 3 4

With neighbors 1 2 3 4

3. Native Language of

Father 1 2 3 4

Mother 1 2 3 4

Sibling’s 1 2 3 4

Guardians 1 2 3 4

4. Language spoken with you by your

Father 1 2 3 4

Mother 1 2 3 4

Sibling’s 1 2 3 4

Guardians 1 2 3 4

Neighbors 1 2 3 4

5. Which language did you learn first for

Understanding 1 2 3 4

Speaking 1 2 3 4

Reading 1 2 3 4

Writing 1 2 3 4

6. Mention the age when you first started using each of the languages for each of the following

parameters:

Understanding Speaking Reading Writing

L1

L2

L3

7. Mention the age when you became proficient for each of the following parameters:

Understanding Speaking Reading Writing

L1

L2

L3


231

8. How many years of formal education do you have? (please specify your qualification)

What was the medium of instruction? 1 2 3 4

Which language was used maximally? 1 2 3 4

Which language did you speak with teachers 1 2 3 4

Which language did you speak with classmates 1 2 3 4

Which language was spoken by your teachers with you 1 2 3 4

Which language was spoken by your classmates with you 1 2 3 4

Did you change your medium of instruction? Yes No

If yes, specify the changed medium of instruction. At what age

did you change your medium of instruction?

1 2 3 4

9. Have you changed your state? If yes, which language do you

use to communicate?

1 2 3 4

10. On a scale from one to five, mark your level of proficiency in each of the skill

(1-Zero proficiency, 2- Low, 3- Good, 4- Native like/perfect)

Language Understanding Speaking Reading Writing

L1

L2

L3

11. How many dialects can you speak in each of the languages?

L1: L2: L3:

12. On a scale from one to five, mark your level of proficiency in each of the skill for each of the dialects

in L1, L2, L3.(1-Zero proficiency, 2- Low, 3- Good, 4- Native like/perfect)

L1 L2 L3

Dialect D1 D2 D3 D1 D2 D3 D1 D2 D3

Understanding

Speaking

13. On a scale from one to five, mark your level of proficiency in shifting from one language to the other

1-Zero proficiency 2- Low

3- Good 4- Perfect

14. Use the rating scale mentioned below, indicate which language you used maximum for the following:

(1- L1 , 2- L2, 3- L3, 4- Combination of any of the languages)

Interaction with family 1 2 3 4

Education/ work 1 2 3 4

Listening to instruction tapes at school 1 2 3 4

Text books 1 2 3 4

Dictionary 1 2 3 4


232

Story books 1 2 3 4

Newspapers 1 2 3 4

Historical books 1 2 3 4

Internet source 1 2 3 4

Writing 1 2 3 4

Interacting with friends 1 2 3 4

Interacting with neighbors 1 2 3 4

Watching TV 1 2 3 4

Listening to the radio 1 2 3 4

Market places 1 2 3 4

15. On an average, mention below the time you are exposed to each of the languages.

Languages Number of days per week Number of hours per day

L1

L2

L3

16. Mention the number of years you spent in each language environment:

Family School State Work place

L1

L2

L3

17. Using the rating scale mentioned below, indicate the extent to which you are currently exposed to

each of the languages in the following contexts in a day.

(1- never, 2- sometimes, 3- most of the time, 4- always)

L1 L2 L3

Interaction with family

Schooling/ work

Listening to instruction tapes at school

Text books

Dictionary

Story books

Newspapers

Historical books

Internet source

Writing

Interacting with friends

Interacting with neighbors

Watching television

Listening to the radio

Market places

18. Rate how frequently others identify you as a native speaker based on your accent or pronunciation in

the language (1- Never, 2- Sometimes, 3- Most of the time, 4- Always).

1. L1 2. L2 3. L3

Paraphasias in Bilingual Aphasia

233


Ridhima Batra & Dr. K.C. Shyamala*

Abstract

The language abilities of aphasia yields deficit in phonological, semantic, syntactic and

pragmatic systems. During their attempt to produce a word, aphasics tend to substitute an incorrect

word for the intended or the target word which are termed as paraphasias. Bilingual aphasics do not

necessarily show the same language disorders with the same degree of severity in both languages, so

it becomes ethically important to do a detailed evaluation of all the languages known by an aphasic

patient. The present study aimed at investigating the paraphasias in monolingual and bilingual

aphasics and highlights the variation/correlation of paraphasias across languages in bilingual

aphasics. Twenty four individuals with aphasia (twelve monolinguals and twelve bilinguals) with a

mean age of 55 years participated in the study. Naming, repetition and picture description sections of

the WAB test were audio recorded, transcribed and analyzed for the six categories of paraphasias

namely, semantic, formal, mixed, unrelated, phonemic and neologism. The results of the study

revealed a better performance of the bilingual individuals with aphasia on all the three tasks.

Amongst the aphasic subgroups, anomic aphasics showed more semantic paraphasias; conduction

aphasics produced abundant phonemic paraphasias; Wernicke’s aphasia presented with more

number of semantic and unrelated paraphasias and Broca’s and global aphasics exhibited a high

incidence of phonemic and neologistic paraphasias. The bilingual individuals with aphasia performed

better in L2 than in their mother tongue. Different types of paraphasias were observed in the two

languages in the bilingual aphasics.

Introduction

Bilingualism is a phenomenon which refers to use of two or more languages by

individuals in their everyday lives. With increasing globalization, the number of people using

two or more languages i.e., bilingual individuals are also increasing. There have been

different views of the phenomenon of bilingualism in the literature. Some researchers point

out that bilingual individuals are not two monolinguals in one person, but rather speakers

using different languages in different domains or situations, for different purposes, and with

different interlocutors. Statistics reveal an increase in bilingual population in the world. India

being a multilingual country has abundant bilingual/multilingual population with various

permutations and combinations of the languages paired.

Since most people in India know more than one language, bi/multilingualism is a very

prominent phenomenon in India. On the basis of these considerations, a large population of

individuals with aphasia in India would therefore show “bilingual aphasia”. Bilingual

aphasics do not necessarily show the same language disorders with the same degree of

severity in both languages, so it becomes ethically important to do a detailed evaluation of all

the languages known by an aphasic patient.

____________________________________________

Professor of Language Pathology, All India Institute of Speech and Hearing, Mysore, India



234

The characteristic features of the language abilities of aphasia yields deficit in

phonological, semantic, syntactic and pragmatic systems. During their attempt to produce a

word, aphasics tend to substitute an incorrect word for the intended or the target word which

are termed as paraphasias. Paraphasias can appear in naming, repetition, spontaneous speech,

reading or writing tasks. Paraphasias are common in aphasia and can help differentiate fluent

from non-fluent subgroups of aphasia.

Paraphasias can be of different kinds and have a good localization value. Different

kinds of paraphasias described by Goodglass (1993) are as follows:

Verbal paraphasia: It refers to the unintended use of another word in lieu of the target.

Phonemic paraphasia: These are also called as “literal paraphasia”. It is the production

of unintended sounds or syllables in the utterance of a partially recognizable word

(e.g., “paker” for “paper”, “sisperos” for “rhinoceros”).

Phonosemantic blends: it is often the case that a phonemic sound substitution results in

another real word, related in sound but not the meaning. E.g. „table‟ becomes „cable‟;

„telephone‟ becomes „television‟.

Neologistic paraphasia: it is the production of a non-sense word or words, usually

without recognition of error. E.g. „table‟ becomes „tilto‟.

Paraphasias have been classified differently by various authors. Lesser (1978) classified

based on the word forms, if they belonged to the language used or not. She also identified

whether the spoken word is sufficiently similar to the actual word form phonologically,

morphologically, or semantically. Li and Williams (1990) gave a checklist to examine the

repetition errors made across various aphasic syndromes and divided the errors into seven

categories (word substitution errors, addition errors, omission errors, revision errors, jargon,

paraphrase error and inadequate response). Paraphasic errors were also divided into lexical

where a real word is substituted for another, or sub-lexical when a non-word is produced

(Dell, Schwartz, Martin, Saffran & Gagnon, 1997).

Paraphasias in individuals with aphasia has been researched upon extensively, using

different tasks like naming (e.g., Goodglass, Kaplan et al., 1976; Goodglass, 1981; Kohn &

Goodglass, 1985; Martin & Saffran 1992; Gagnon et. al, 1997), repetition (e.g., Gardner &

Winner, 1978; Goodglass & Kaplan, 1983; Li & Williams, 1990) and picture description

(Williams & Canter, 1982, 1987). The naming task helps to find paraphasias in single object

confrontation naming; the repetition task taps the deficits in the transfer of information

between the input and output pathways and the picture description task is used to find the

paraphasias in a narrative context.

Studies on naming task have revealed high frequency of semantic paraphasias in

anomics as an index of word-finding difficulty (Kohn & Goodglass, 1985). Li and Williams

(1990) reported that aphasics tend to exhibit significantly more indefinite terms, extended

circumlocutions and perseverations in the naming conditions. Gagnon et. al (1997) reported

of presence of formal paraphasias in aphasics in a naming task. Using the repetition task,


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Gardner and Winner (1978) reported that conduction aphasics make more meaning errors or

verbal paraphasias, whereas, Li and Williams (1990) found phonemic attempts and revisions

to be more prominent in the repetition of conduction aphasics. Studies on picture description

task found that Broca‟s aphasics performed significantly better when naming objects on

confrontation naming task than on picture description task, whereas, a reverse trend was seen

in Wernicke‟s aphasics (Williams & Canter, 1982). Williams and Canter (1987) found that

anomics produced more of delayed responses and extended circumlocutions; Wernicke‟s

produced more neologisms and the Broca‟s produced significantly more phonemic errors and

semantic-phonemic errors on picture description task.

However, in the Indian scenario, there have been just a handful of studies to examine

the type of paraphasias produced in various subgroups of aphasia. Shantala (1997) studied

naming deficits in confrontation naming, responsive naming and generative naming tasks and

reported of neologisms and phonemic errors in Broca‟s aphasics; semantic and phonemic

errors in the anomics and conduction aphasics exhibited neologisms and gestural responses.

Similar tasks were used by Arpita (1997) to tap the naming deficits in Kannada-English

bilingual aphasics. Results revealed parallel deficits in L1 and L2 on responsive naming and

generative naming task, however, in confrontation naming task, performance was better in

L1. Error analysis revealed a difference in the performance of the bilingual aphasics in the

two languages.

Chengappa, Bhat and Damle (2003) investigated paraphasias on repetition tasks in a

multilingual Wernicke‟s aphasic patient and highlighted the variation of these across the four

languages known by the patient. Hegde and Bhat (2007) also highlighted the variation of

paraphasias across four languages known by a multilingual conduction aphasic on a repetition

section.

However, there has been limited research done to find out the type of paraphasias

produced by various bilingual aphasic syndromes and explore as to whether it differs from

monolingual aphasics. Also, there is a scarcity of research where a comparison has been

made for the types of paraphasias produced by the bilingual aphasics in the different

languages known to them.

Aims of the study

The present study aimed at investigating:

1. The paraphasias in monolingual and bilingual aphasics.

2. Highlight the variation/correlation of paraphasias across languages in bilingual

aphasics.

3. Describe the type of paraphasias in different subgroups of aphasia.


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Method

Participants

Twenty four individuals with aphasia in the age range of 30-80 years (mean age of 55 years),

identified through various sources like institutes, hospital records were taken for the study.

These participants were divided into two groups: twelve monolinguals and twelve bilinguals.

The following criteria were considered in the selection of the participants in the study.

All participants were diagnosed as having aphasia by a Speech Language Pathologist

and/or neurologist.

All monolingual individuals with aphasia were native Kannada speakers. The bilingual

individuals with aphasia had Kannada as their mother tongue and had learnt English as

second language before the age of 15 years. The bilingual individuals were identified

using Australian Second Language Proficiency Rating (ASLPR, Ingram, 1985). On the

basis of self report and information from significant others, the individuals who passed

fourth level (Vocational Proficiency) in the ASLPR (Appendix) in the second language

i.e English in at least speaking and listening domains of the rating scale premorbidly

were considered as bilinguals.

Different aphasic syndromes were considered. This was determined on the basis of

clinical observation and Western Aphasia Battery (WAB, Kertesz & Poole, 1974)

findings. The participants were grouped into fluent and non-fluent aphasia types as per

the classification system of Goodglass and Kaplan (1972). The various types of aphasic

syndromes identified were anomia (5), conduction (3), Wernicke‟s (2), trans-cortical

motor (TCM) (1), Broca‟s (8) and global (5).

Both male and female aphasics were considered for the study. Participants included five

females and nineteen males.

The participants suffered a left hemisphere stroke revealed by MRI/CT scan reports. The

time from the onset of stroke varied from two to twenty four months.

All participants were right handed. This was determined using self-report and

information from significant others.

None of the participants had any auditory or visual deficit as assessed informally.

Ethical considerations were met.

Procedure

Subjects were seated comfortably. Before starting the evaluation and recording, the subjects

were informed about the entire procedure and an informed consent was taken. The

environment was made as distraction free as possible by carrying out the procedure in a quiet

room and by removal of any potential visual distracters.


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Tests administered

Western Aphasia Battery (WAB, Kertesz & Poole, 1974) was administered for all the

participants for diagnosing and identification of the type of aphasia.

The following three sections of the WAB test were audio recorded, transcribed and

analyzed for the presence of paraphasias:

Repetition- It comprises of 20 stimulus items consisting of words, phrases and

sentences. The subjects were instructed to repeat after the examiner.

Naming- This section consists of 20 common objects. The objects were presented to

the subjects in their visual field one after the other and they were instructed to name

the objects in a single word as soon as possible. If the subjects were unable to name

the object in 30 sec, it was considered as a no response.

Picture description: The “picnic” picture served as the test stimuli to look for

paraphasias in narrative context. The subjects were instructed to describe the picture

in their own words. No time limit or word limit was given for this task.

All the three sections of the WAB were administered in Kannada for the monolingual

individuals with aphasia and both in Kannada (L1) and English (L2) for the bilingual

individuals with aphasia for comparing the type of paraphasias between monolinguals and

bilinguals and also between the two languages (L1 & L2) for bilingual individuals with

aphasia.

Scoring

The subjects‟ first response was evaluated in terms of absolute correctness for all the

three sections; repetition, naming and picture description. Any deviation from the target was

analyzed for the presence of paraphasias.

Analysis

The repetition, naming and picture description sections of the WAB test were audio

recorded, transcribed and the responses which were not appropriate to the target word

were analyzed for the presence of paraphasias and comparison was made across:

Monolinguals and bilinguals

Kannada (L1) and English (L2) in bilingual individuals with aphasia

Qualitative analysis of the different kinds of paraphasias

A list was prepared to classify the type of paraphasias shown by the participants based on

Li and Williams (1990) checklist and Dell‟s classification system of errors (1997).

The paraphasias were divided into two broad categories, lexical and sublexical. A

lexical paraphasia is a real word substituted for another whereas; a non-word produced falls

into sublexical category.


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a) At lexical level, paraphasias can be:

(i) Semantic- word related to target in meaning.

(ii) Formal- word related to target in sound.

(iii) Mixed- word with sound and meaning relationship.

(iv) Unrelated- word with no apparent relation to target.

b) At sublexical level, paraphasias can be:

i) Phonemic- non-word related in sound.

ii) Neologistic- non-word with a remote relationship to target.

Statistical Analysis

Following statistical measures were used for the analysis of the data using SPSS software

(Version-16).

a) Mann Whitney U test was done to observe whether there exists a difference between

monolingual and bilingual individuals with aphasia on the various kinds of responses

(paraphasias and other responses) given on the three tasks namely naming, repetition

and picture description.

b) Wilcoxon Signed Rank test was done for the bilingual group to see variation of the

kinds of paraphasias and other responses across the two languages, Kannada and

English on all the three tasks.

Results

The primary aim of the study was to observe the type of paraphasias in monolingual

and bilingual individuals with aphasia. A total of 24 individuals with aphasia were evaluated

on naming, repetition and picture description task. The results of the study have been

presented with reference to the performance of the participants on:

4.1 Naming task

4.2 Repetition task

4.3 Picture description task

The results of all the three tasks i.e., naming, repetition, and picture description in this

section are presented under following headings:

Comparison of monolingual group and bilingual group

Across language comparison for the bilinguals participants

Qualitative analysis of all the paraphasias


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4.1 Naming task

4.1.1 Monolinguals and bilinguals

The naming task consisted of 20 stimuli which were scored by the investigator as

either correct or incorrect response. The total mean percentages for the correct and incorrect

responses for both the fluent and non-fluent groups in monolinguals and bilinguals were

calculated. It was seen that, in the overall scores, both fluent and non-fluent bilinguals

performed better (14.58%) than the fluent and non-fluent monolinguals (9.16%). The

incorrect responses of all the participants were subjected to further analysis. Based on the

results of the analysis, the responses of the participants were classified under six categories of

paraphasias namely, semantic, formal, mixed, unrelated, phonemic and neologism.

The means and standard deviations (SD) of all the types of responses for all the groups

were measured. Figures 4.1 and 4.2 graphically represent the percentage occurrence of the six

types of paraphasias in both monolingual and bilingual group of aphasics.

Figure 4.1 Figure 4.2

Paraphasia in Naming (Kannada)

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Sem- semantic paraphasia, Form- formal paraphasia, Mixed- mixed paraphasia, Unrel-

unrelated paraphasia, Phon- phonological paraphasia, Neo- neologisms

As seen from the above results, in the naming task, the bilinguals performed better

than the monolinguals in both fluent and non-fluent groups. The most prominent paraphasias

seen were semantic paraphasias followed by phonemic paraphasias in the fluent group

whereas neologisms and phonemic paraphasias were more common in the non-fluent group

in both monolingual and bilingual aphasics. Further, Mann Whitney U test was carried out to

check the difference in the performance of fluent and non-fluent monolinguals and bilinguals

on the six types of paraphasias. The result of the Mann Whitney U test revealed no significant

difference between fluent and non-fluent monolinguals and bilinguals on any of the

paraphasias.


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4.1.2 Across language comparison

The bilingual individuals with aphasia were compared for their performance in

naming task across both Kannada and English language. The total mean percentage for the

correct and incorrect responses for both the fluent and non-fluent groups of bilinguals in both

the languages was done. Results show that the performance of both fluent and non-fluent

bilinguals is much superior in English (L2) than in Kannada (L1). Wilcoxon signed rank test

was carried to find out if there was any significant difference in the performance of fluent and

non-fluent bilinguals. The results of the test also revealed that L2 is significantly better than

L1 (z=2.371 at p<0.05).

Figure-4.3 depicts graphical representation of the percentage occurrence of the

various paraphasias for the bilingual group in English language.

Figure 4.3: Percentage occurrence of the six kinds of paraphasias in the bilingual group in the

naming task: English

Paraphasia in Naming (English)


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The results in across language comparison state that the performance of the

participants in L2 was better than in the mother tongue (L1). The fluent aphasic group

showed more semantic paraphasias in L1 and the non-fluent group showed more of

neologisms and phonemic paraphasias in both L1 and L2. Wilcoxon Signed Rank test was

conducted to find out if the performance of the aphasics in the two languages differed in

various types of paraphasias. The semantic paraphasias were found to be significantly more

in L1 than in L2 (z=2.032, p<0.05) in the fluent group of aphasia. In contrast, it was noted

that no significant difference was obtained for the non-fluent bilingual group across the two

languages in the six types of paraphasias.

4.1.3 Qualitative analysis

With reference to the paraphasias present in the various types of aphasias, semantic

paraphasias were maximally present in anomics followed by conduction aphasia. The non-

fluent individuals with aphasia in both monolingual and bilingual group exhibited phonemic


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and neologistic paraphasias predominantly. Formal paraphasias (real word related to target in

sound) were also commonly seen in Broca‟s aphasia.

4.2 Repetition task

The repetition task consisted of 50 target words presented in isolated words, phrases

and sentence forms to monolingual and bilingual aphasics.


By calculating the total mean percentage of correct and incorrect responses obtained

in repetition task for both the fluent and non-fluent monolingual and bilingual aphasics, it

was seen that the overall scores of both fluent and non-fluent bilinguals (34%) were better

than the fluent and non-fluent monolinguals (13.66 %). The error responses were divided

into six paraphasias. Figures 4.4 and 4.5 show the graphical representation of the percentage

occurrence of the six types of paraphasias in monolingual and bilingual participants in the

repetition task.


Paraphasia in Repitition (Kannada)


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As depicted in the above results, the bilinguals performed better than the

monolinguals in the repetition task. It was also noted that less number of paraphasias and

more number of no responses were obtained from all the individuals with aphasia who

participated in the study. Amongst the type of paraphasias present, formal paraphasias were

most prominent in the fluent group whereas neologisms and phonemic paraphasias were more

often seen in the non-fluent group. Mann Whitney U test was done to check whether there

exists a difference between fluent and non-fluent monolinguals and bilinguals on the six

types of paraphasias in the repetition task. As per the result of the Mann Whitney U test,

monolinguals showed significantly more mixed paraphasias in the fluent group (z=2.372 at

p<0.05) and, unrelated paraphasias in the non-fluent group (z=2.318 at p<0.05) than the

bilinguals.


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The bilingual individuals with aphasia were also examined whether their performance

on repetition task differed across languages. Results showed that the performance of fluent

bilinguals is much superior in English (L2) than in Kannada (L1). Wilcoxon signed rank test

also revealed L2 to be significantly better than L1 (z=1.992 at p<0.05) in the fluent group.

However, in the non-fluent group, the performance of the participants was not significantly

different in the two languages which was also confirmed by Wilcoxon signed rank test (z=

1.069 at p>0.05).The incorrect responses for the aphasics were again classified into six

paraphasias (graphically shown in figure-4.6).

Figure 4.6: Percentage occurrence of the six kinds of paraphasias in the bilingual

group in the repetition task: English

Paraphasia in Repitition (English)


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To sum up, the repetition ability of the bilingual individuals with aphasia was better in

L2 than in L1. The fluent group produced significantly more phonemic paraphasias in L1 and

more formal paraphasias in L2. On the other hand, the non-fluent group produced more

neologisms in both L1 and L2. Wilcoxon Signed Rank test was done for the fluent and non-

fluent bilingual aphasics to see variation across the two languages, Kannada and English and

the results of the Wilcoxon Signed Rank revealed significantly more phonemic paraphasias in

L1 in the fluent group (z=2.220 at p<0.05) while, significantly more neologisms in L2 in the

non-fluent group (z=2.023 at p<0.05).


Results of the study revealed that in the repetition task, conduction aphasics exhibited

a greater number of phonemic paraphasias; Broca‟s aphasics demonstrated more phonemic

errors and neologisms; and Wernicke‟s aphasics exhibited more unrelated paraphasias and

jargon.

Across language comparison revealed a significant difference in the performance of

the fluent group. The fluent bilingual group produced more number of formal paraphasias in

L2. Contrastively, phonemic paraphasias (non words related to the target in sound) were


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prominent in L1. Extensive number of neologisms was also seen in the repetition task by the

non-fluent group in both monolingual and bilingual group. It was also noted that the semantic

and mixed paraphasias were scantily present in the repetition task.

4.3 Picture description task

The „picnic‟ picture from the Western Aphasia Battery (WAB) was used to elicit

spontaneous speech sample of the 24 aphasics who participated in the study. This task was

chosen to examine paraphasias in the narrative context.


In the picture description task, the total number of words uttered and the number of

correct words in that were calculated from the speech sample. Results showed that, both the

fluent and non-fluent bilinguals uttered more words (32% & 21% respectively); and their

mean percentage of the correct responses was also slightly higher than the monolinguals. This

finding was confirmed by Mann Whitney U test which also revealed that the bilinguals at

large uttered significantly more number of words than the monolinguals (z=2.170 at p<0.05).

However, the total number of correct words was not significantly different in the two groups

as per the results of the test (z=0.322 at p>0.05).

Figures 4.7 and 4.8 graphically represent the percentage occurrence of the six types of

paraphasias in both monolingual and bilingual group of aphasics in the picture description

task.


Paraphasia in Picture Description (Kannada)


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As depicted in the results of monolingual and bilingual comparison for the picture

description task, bilinguals elicited more number of words than the monolinguals. Also, the

total number of correct responses were more in the bilingual group. With reference to the

type of paraphasias present, in the fluent aphasic group, both monolinguals and bilinguals

illustrated more number of formal and phonemic paraphasias. However, semantic paraphasias

were more commonly seen only in the fluent bilingual group. The non-fluent aphasics on the

other hand produced neologisms and phonemic paraphasias maximally. Mann Whitney U test


244

was done to support the above findings. The test results showed that in the non-fluent group,

monolinguals showed significantly more neologistic paraphasias (z=2.588 at p<0.05) and the

bilinguals showed significantly more semantic paraphasias (z=2.156 at p<0.05).


The bilingual individuals with aphasia were studied further to see if their performance

in picture description task differed across Kannada (L1) and English (L2) language. Figure-

4.9 illustrates the graphical representation of the percentage of occurrence of the various

paraphasias for the bilingual group in English language in the picture description task.

It was seen that the mean percentage of total words for both fluent and non-fluent

bilinguals is almost equivalent in both L1 and L2. However, the mean percentage of total

correct responses was slightly greater for L2 than L1 in both fluent and non-fluent groups.

This difference of performance of bilinguals in L1 and L2 was not significantly different as

shown by Wilcoxon signed rank test (z=1.735 at p<0.05).

Figure 4.9: Percentage occurrence of the six kinds of paraphasias in the bilingual group in the

picture description task: English

Paraphasia in Picture Description (English)


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The results of across language comparison show that the performance of the

bilinguals did not differ much across the two languages. The type of paraphasias seen in the

two languages were also not very different. The fluent group exhibited more of semantic,

formal and phonemic paraphasias whereas, the non-fluent group showed more evidence of

neologisms and phonemic paraphasias. Wilcoxon Signed Rank test was conducted to know if

the two languages were significantly different in the type of paraphasias exhibited. Results

revealed no significant difference between the languages in the fluent group for all kinds of

responses. In the non-fluent group, no significant difference was seen for six types of

paraphasias.


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Amongst the type of paraphasias present, the semantic paraphasias were most

commonly seen in the fluent aphasic group. The monolingual and bilingual aphasic group

differed slightly in their performance. Individuals with Wernicke‟s aphasia presented with

most number of semantic and unrelated paraphasias in a narrative context. Anomics also

exhibited a high number of semantic paraphasias in the bilingual group.

In the non-fluent group, the Broca‟s and global aphasics produced more of non words

with either sound relation to the target word (phonemic paraphasias) or with no apparent

relation to the target word (neologism) in the picture description task.

Thus, the results of the present study establish the fact that paraphasias exist in all the

types of aphasia and across all the languages. The paraphasias can be similar or may vary in

the different languages of a bilingual individual with aphasia. The types of paraphasias also

varies across different language tasks namely, naming, repetition and picture description task

among the various subtypes of aphasia. However, the generalization of the results would be

difficult unless variables like severity of language impairment, large and equal sample size of

all the subtypes of aphasia, the literacy level and the pre-morbid language proficiency of the

different languages known by the bilingual aphasics etc are controlled and studied.

Discussion

Comparison of monolingual and bilingual group

The results of the study revealed a better performance of the bilingual individuals

with aphasia on all the three tasks studied namely, naming, repetition and picture description.

Higher scores obtained by the bilingual participants throw light on the fact that the word

retrieval ability required for naming and picture description task, and repetition abilities for

the repetition task after stroke are better retained in individuals knowing two languages rather

than one. This can be explained by the presence of two lexicons, one for each language i.e.,

dual representation of language in bilinguals which results in a better vocabulary.

With reference to the paraphasias present in the various types of aphasias, semantic

paraphasias were produced frequently by the anomics followed by conduction aphasics. The

high frequency of semantic paraphasias in anomics is an index of word-finding difficulty

(Kohn & Goodglass, 1985). This can be due to a breakdown in the semantic boundaries

between meaning-related words that were pre-morbidly undoubtedly well-known by the

anomics.

Comparison across tasks

Across tasks, it was observed that the semantic paraphasias were more common in the

naming and picture description task while being meagerly present in the repetition task. The

current study supports the views of Li and Williams (1990) who explain that aphasics tend to

exhibit significantly more indefinite terms, extended circumlocutions and perseverations in

the naming conditions. These behaviors are verbal strategies to compensate for inability to


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produce the specific target word. These strategies are less employed during the repetition task

which is more target bound.

The results of the current study supports the findings of Li and Williams (1990) who

found phonemic attempts and revisions to be the most prominent in the repetition of

conduction aphasics.

Predominance of phonemic paraphasias in conduction aphasia was also seen in the

picture description task which is in accordance with the results of Kohn and Goodglass

(1985).

The results of the picture description task for the anomics is in accordance with

Williams and Canter (1987) who reported delayed responses and extended circumlocutions in

anomics. Williams and Canter (1987) also reported more neologisms in Wernicke‟s aphasia

which supports the finding of the current study with reference to the monolingual individual

with Wernicke‟s aphasia. However, the paraphasias seen in the bilingual individual with

Wernicke‟s aphasia disputes the results of William and Canter (1985).

Earlier findings by Gardner and Winner (1978) reported more meaning errors

whereas, Li and Williams (1990) reported of more linguistic errors (unrelated words and

jargon) in Wernicke‟s aphasics. However, in the current study, monolingual individuals with

Wernicke‟s aphasia produced unrelated, formal and phonemic paraphasias in the repetition

task. In contrast, the bilingual person with Wernicke‟s aphasia did show a reasonable

percentage of semantic and mixed paraphasias along with unrelated, formal and phonemic

paraphasias. These findings draw support from the interpretation of Goodglass and Kaplan

(1983) who explained the deficient repetition skills of Wernicke‟s aphasics on the basis of

their poor comprehension ability, resulting in a partial or complete distortion of auditory

image. The disparity in the results of Wernicke‟s aphasics can be attributed to the small

sample size in the present study and thus, the results of the present study cannot be

generalized to the entire Wernicke‟s aphasic population.

In comparing the present study with Gardner and Winner‟s 1978 study, similarities

appear in the Broca‟s aphasic group. Gardner and Winner (1978) found a majority of sound

errors, consisting of literal paraphasias, elaborations, simplifications and articulation errors,

in their Broca‟s and mixed anterior aphasics. Li and Williams (1990) also reported of

phonemic errors and omissions in Broca‟s aphasic group. The current study is in accordance

with the findings of Gardner and Winner (1978) and Li and Williams (1990). Results of the

current study revealed fewer phonemic errors in anomic aphasia which is in accordance with

the findings of Williams and Canter (1982).

Across language comparison

Across language comparison revealed a significant difference in the performance of

the fluent group. Hegde and Bhat (2007) studied paraphasias in a multilingual conduction

aphasia person. They reported phonemic errors in Kannada language which was more

familiar to the conduction aphasic subject and neologisms and real word jargon in the less


247

familiar languages (i.e., Hindi and English). In the current study, since the second language

(i.e., English) was more familiar to the participants than their mother tongue, the findings of

Hegde and Bhat (2007) get supported.

Overall, the results of the current study draw support from literature in the type of

paraphasias produced predominantly by the different subgroups of aphasia in both

monolingual and bilingual population. The generalization of the results is however guarded

as the number of subjects under each subgroup of aphasia was limited.

Conclusions

The present study was undertaken to investigate and compare the type of paraphasias

in monolingual and bilingual individuals with aphasia. Within the bilingual aphasia group, a

comparison of the type of paraphasias present across the two languages i.e., the mother

tongue (L1) and the second language (L2) was also studied.

To conclude, the influence of bilingualism was observed in the better performance of

individuals with aphasia knowing two languages over monolingual individuals with aphasia.

The type of paraphasias did not differ significantly between the monolingual and bilingual

individuals with aphasia in naming and repetition tasks. However, in the picture description

task, monolinguals produced more formal and phonemic paraphasias and the bilinguals

produced more of semantic paraphasias. Amongst the aphasic subgroups, anomic aphasics

were found to produce more semantic paraphasias; conduction aphasics produced abundant

phonemic paraphasias; Wernicke‟s aphasia presented with more number of semantic and

unrelated paraphasias and Broca‟s and global aphasics exhibited a high incidence of

phonemic and neologistic paraphasias. The bilingual individuals with aphasia performed

better in L2 than in their mother tongue. Different types of paraphasias were observed in the

two languages in the bilingual aphasics.

Thus, the results of the study show a lot of variation indicating that there could be

several parameters interacting differently in each case. Specific pattern of paraphasias is

precluded from emerging. The small number of sample may be accounting for this wide

variation. Considering the Indian scenario where the majority of the urban population is

either bi/multilingual, future research on the language aspects of bilingual individuals with

aphasia would add to both theoretical and clinical implications.

References

Arpita, B. (1997). Naming deficits in bilingual aphasics. Unpublished master‟s dissertation,

University of Mysore, India.

Chengappa, S. K., Bhat, S., & Damle, M. (2003). Paraphasias in multilingual Aphasia- A

single case study of Wernicke‟s Aphasia. Journal of the Indian Speech and Hearing

Association, 17, 66-70.

Dell, G.S., Schwartz, M.F., Martin, N., Saffran, E.M., & Gagnon, D.A. (1997). Lexical

access in aphasic and non-aphasic speakers. Psychological Review, 104, 801-838.


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Gagnon, D.A., Schwartz, M.F., Martin, N., Dell, G.S., & Saffran, E.M., (1997). The Origins

of Formal Paraphasias in Aphasics‟ Picture Naming. Brain and Language, 59, 450-

472.

Gardner, H., & Winner, E. (1978). A Study of Repetition in Aphasic Patients. Brain and

Language, 6, 168-178.

Goodglass, H. (1981). The syndromes of aphasia: Similarities and differences in

neurolinguistic features. Topics in Language Disorders, 1, 1-14.

Goodglass, H., & Kaplan, E. (1983). Boston Diagnostic Aphasia Examination. Philadelphia:

Lea & Febiger.

Goodglass, H., Kaplan, E., Weintraub, S., & Ackerman, N. (1976). The “tip of the tongue”

Phenomenon in Aphasia. Cortex, 12, 145-153.

Goodglass, H. (1993). Understanding Aphasia. Academic Press, Inc.

Hegde, M., & Bhat, S. (2007). Paraphasias in Multilingual Conduction Aphasia: A single

case study. Indian Journal of Applied Linguistics, 33 (2), 45-52.

Kohn, S. E., & Goodglass, H. (1985). Picture-Naming in Aphasia. Brain and Language, 24,

266-283.

Lesser, R. (1978). Linguistic investigation of aphasia. London: Edward.

Li, C.E., & Williams, S.E. (1990). Repetition deficits in three aphasic syndromes. Journal of

communication Disorders, 23, 77-88.

Martin, N., & Saffran, E. M. (1992). A computational account of deep dyslexia: Evidence

from a single case study. Brain and Language, 43, 240-274.

Shantala, M.S. (1997). Naming deficits in aphasics. Unpublished master‟s dissertation,

University of Mysore, India.

Williams, S. & Canter, G. (1982). The influence of situational context on naming

performance in aphasic syndromes. Brain and Language, 17, 92-106.

Williams, S. & Canter, G. (1987). Action-naming performance in four syndromes of aphasia.

Brain and Language, 32, 124-136.

Meta-Phonological Abilities in Monolingual & Bilingual Children

249

Meta-Phonological Abilities in Monolingual and Bilingual Children: A

Comparative Study

Samasthitha. S & S.P. Goswami1*

Abstract

Meta-linguistic ability is the ability to reflect upon and manipulate the structural features of

spoken language, treating language itself as an object of thought (Tunmer & Harriman, 1984). Meta-

linguistic abilities play vital roles in different stages of reading acquisition in which meta-

phonological skills are one of the facets of meta-linguistic ability. Meta-phonological abilities refer to

an individual’s explicit awareness and the ability to process and manipulate the speech sound

segments of words. This study was taken up to compare the meta-phonological and reading abilities

in monolingual and bilingual children. A total of 60 participants participated in the study (30 in

monolingual and 30 in bilingual group) in the age range of 8-9 years. All the participants were

screened to rule out signs and symptoms of learning disability, language deficits and academic

failures. RAP-K (Meta-phonological and reading sub-tests) was administered and the responses were

scored according to the instructions in the test manual. Results of the study revealed better

performances on meta-phonological and reading tasks by the bilingual group in comparison to their

monolingual counterparts. This study supports the view that the bilingual children appear to have an

advantage over the monolingual children in regard to phonological awareness and reading skills.

Introduction

“Meta-linguistic ability is the ability to reflect upon and manipulate the structural

features of spoken language, treating language itself as an object of thought” (Tunmer &

Harriman, 1984). This term was first used by Cazden (1974) to describe and explain the

transfer of linguistic knowledge and skills across languages. The nature of meta-linguistic

awareness is not defined clearly. Over the last few decades the studies in the area of meta-

linguistic skills have been attempted due to its relationship with reading acquisition.

The three main theoretical perspectives that are held in reference to reading acquisition

and meta-linguistic skills are:

1. Meta-linguistic skills are required for reading acquisition.

2. Meta-linguistic and reading skills are interactive.

3. Meta-linguistic skills are as a consequence of literacy acquisition.

Meta-linguistic abilities play vital roles in different stages of reading acquisition in which

meta-phonological skills are one of the facets of meta-linguistic ability. Meta-phonological

abilities refer to an individual‟s explicit awareness and the ability to process and manipulate

the speech sound segments of words. This requires non-lexical processing which has to look

beyond the meaning of a word to focus on the sound structure of the word. In the recent

years, predominantly the meta-phonological skills have been crucially linked to reading and

*Reader in Speech Pathology, All India Institute of Speech and Hearing, Mysore, India

Email:[email protected]


250

acquisition of reading. The relationship between meta-phonological skills, reading and

spelling ability has been well documented (Torgeson, Wagner & Rashotte 1994; Macdonald

& Cornwall, 1995; Troia, 2004). Meta-phonological ability or phonological awareness

encompasses many different skills, but all of these skills develop from the same underlying

ability (Anthony & Lonigan, 2004; Schatschneider, Francis, Foorman, Fletcher & Mehta,

1999).

Morphological awareness on the other hand reflects on the ability to understand and

correctly use small words, letters, and letter combinations that change the meaning of a word.

Strong correlations between phonological and morphological awareness are apparent

throughout the elementary years (Deacon & Kirby, 2004).

Hence, research in this field shows that both phonological and morphological

awareness are important for the acquisition of reading and spelling skills during the early

years of education.

The development of phonological awareness skills across children are learnt in the

same order. Awareness of rhyme and breaking words into syllables are two of the early meta-

phonological skills to emerge. There appears to be several influential factors affecting the

development of these skills in children. These factors include the environmental and

experiential factors. They also have a „protective influence‟ in the development of meta-

phonological and reading skills. Protective influences such as social factors and print

exposure may have an effect in the child‟s early literacy development (Scarbrough &

Dobrich, 1994). Linguistic aspects such syntax, semantics, learning to read does play key

roles in the development of meta-phonological skills. Tunmer (1989) reports that the

syntactic awareness, seems to be an important independent contributor to early reading skills.

Cognitive (verbal IQ such as abstract concepts, verbal factual knowledge, vocabulary and

verbal reasoning and inference, attention and verbal memory skills etc...) and non-cognitive

(home environment, social and family factors) predictors influence development of oral and

written language skills.

Apart from these factors print exposure i.e. in the form of alphabet books, storybooks

comics or magazines etc. influence early literacy experiences. An added relevant factor,

clearly strongly related to print exposure is how often parents read to their children.

(Scarbrough & Dobrich, 1994; Senechal et.al, 1998).

There are many documented empirical research reports on metaphonological and

reading skills and its relationship with bilingualism.

Meta-phonological abilities and reading achievement

Meta-phonological abilities begin to emerge before children start to learn to read, and

is a powerful and consistent predictor in beginning readers. Though phonological awareness

is a powerful predictor of reading achievement, both in the short and long term, acquisition of

alphabetic principles forms the foundation for children‟s rapid expansion of literacy skills.

Over the decades researchers have investigated the meta-phonological awareness and its


251

association with reading skills. The findings have been equivocal. Few reports suggest that it

is a requirement for reading (Elkonin, 1973; Liberman et.al 1977; Bradley & Bryant, 1983).

Other researchers like Morais et.al (1979), Liberman and Mattingly (1985), Read et.al (1986)

report that these skills are as a consequence of learning to read. Few other researchers report

that meta-phonological skills and reading are interactive i.e. they are reciprocal. (Ehri, 1979;

Bryant & Goswami, 1987; Prefetti, Beck, Bell & Hughes, 1987). Studies have also been

documented keeping in mind the nature of othrography like alphabetic and non-alphabetic

scripts (Morais 1991; Prakash, 1993; Prakash, Rekha, Nigam & Karanth, 1993)

Bilingualism and meta-linguistic abilities

Meta-linguistic awareness is the primary variable mediating the positive effects of

bilingualism on academic achievement. There are reports suggesting that fluent bilingualism

results in increased meta-cognitive/meta-linguistic abilities which in turn facilitate reading

acquisition. Thus, resulting in higher levels of academic achievement. It seems reasonable to

assume that not all thought processes are enhanced through a bilingual experience and that

those cognitive tasks, which rely more on language, will benefit most from that experience

(Hamers & Blanc, 1983). The most commonly studied phenomenon in bi-literacy learning

that transfers across languages and enhances literacy learning among bilingual learners is

“meta-linguistic awareness” (Koda, 2008).

Meta-phonological abilities in bilinguals have been researched and there are several

reports suggesting that bilinguals have enhanced skills compared to the monolingual

counterparts. (Bruck & Genesee, 1995; Loizou, Stuart,2003; Surabhi Bharati,2004; Vanasse,

Begin-Bertrand, Courc, Lassonde & Beland,2005; Ibrahim, Eviatar, Judith ,2007; Dodd, So

& Lam,2008)

Various studies have been documented in the area of meta-phonological abilities and

reading skills. These studies have focused on the development and factors influencing the

acquisition of the meta-phonological abilities and reading in monolingual and bilingual

children. The literature basically refers to Western studies. Hence, in the Indian context, this

domain provides the motivational grounds for this study. Thus, the present study was

undertaken with the need to compare the meta-phonological abilities and reading skills on

various meta-phonological and reading tasks in Kannada speaking monolingual and

Kannada-English speaking bilingual children in the age range of 8-9 years.

Aim of the study

The current study primarily intended to investigate the meta-phonological abilities in

monolingual and bilingual children between the age ranges of 8-9 years.


252

The objectives of the study were to:

Quantitatively study the gender differences across the two groups on the meta-

phonological and reading tasks.

Quantitatively study the performances of the two groups on the meta-phonological

and reading tasks.

Qualitatively analyze the performances of the meta-phonological and reading tasks.

Method

Participants

A total of 60 participants were included in the study. These participants were divided

in two groups:

Group- I:

30 (15 females and 15 males) school going children, with mother-tongue and exposure to

Kannada (L1) only. (Monolingual).

Group- II:

30 (15 females and 15 males) school going children with mother-tongue and exposure to

Kannada (L1) and exposure to English as L2. (Bilingual).

Age range

8.0 - 9.0 years

Ethical Standards used in the study for the selection of participants

Participants were selected by adhering to the appropriate ethical procedures.

Participants and/or parents were explained the purpose and procedures of the study, and an

informed verbal and/or written consent were taken. They were randomly selected based on

the inclusionary criteria/s.

Inclusionary Criteria

Participants were screened to rule out:

Signs and symptoms of learning disability.

Academic failures (based on teacher‟s report).

Language deficits, delayed speech and language milestones, history of any ear

pathology, emotional, behavioral and/or neurological deficits.

Participants were from middle socio-economic status.

Tools

Reading Acquisition Profile -Kannada (RAP-K) test, (Prema, 1997).

Purpose:

- To assess the meta-phonological and reading skills.


253

The following sub-sections of the test were used in the current study:

a. Meta-phonological Test

i. Rhyme recognition.

ii. Syllable stripping.

iii. Syllable oddity (words).

iv. Syllable oddity (non-words).

v. Phoneme stripping.

vi. Phoneme oddity.

b. Reading Test

i. Syllable inventory [consonant-vowel (CV), consonant-consonant-

vowel (CCV), and consonant-consonant-consonant-vowel (CCCV)].

ii. Words and non-words.

iii. Geminates – words and non-words.

iv. Polysyllabic – words and non-words.

v. Arka – words and non-words.

vi. Anuswara– words and non-words.

Data collection (Measures and Materials)

Testing was conducted in a quite surrounding (room set up). The test was

administered individually with minimal distractors around. Table-1 shows the tests

administered on the two groups with their purposes.

Table 1: Tests administered and the purpose of the tests for the two groups.

Scoring: The scores were allotted based on the performance of the participants in the two

groups.

In the meta-phonological test

All the sub-sections‟ maximum score is 12 and participants received a score of 1 for every

correct response.

In the reading test

The scoring for sub-tests were done according to the instructions given in the test

manual for the reading tasks, each correctly read word was marked with a tick mark. Each

correctly read word was given a score of 1.

Groups Tests Purpose

Group-I

(Monolinguals)

Meta-phonological and reading

tests (sub-sections of Reading

Acquisition Profile Kannada

(RAP-K) test.

To assess the meta-

phonological and reading

skills.

Group-II

(Bilinguals)

Meta-phonological and reading

tests (sub-sections of Reading

Acquisition Profile Kannada

(RAP-K) test.

To assess the meta-

phonological and reading

skills.


254

The obtained data were appropriately tabulated and subjected to statistical measures.

SPSS software (version 16.0.) package was used for statistical analysis. The tabulated scores

were used for obtaining the mean (M) and standard deviation (SD). Parametric tests were

utilized to obtain the significant difference measures. MANOVA was used to compare the

performance of female and male participants across the various meta-phonological and

reading tasks for both the groups. Repeated measures ANOVA were used to obtain the

significant difference scores between the two groups across the various meta-phonological

and reading tasks. The data was further subjected to Bonferroni test to find out significant

difference within each group, if any.


The results of the present study are summarized in the following tables,

Table 2: Mean and SD values for female and male participants of the two groups across the

meta-phonological tasks

Females Males Total

Tasks Groups Mean

SD

Mean

SD

Mean

SD

RR Monolingual

Bilingual

11.73

12.00

0.79

0.00

11.80

11.93

0.56

0.25

11.76

11.96

0.67

0.18

SS Monolingual

Bilingual

11.13

11.86

0.99

0.35

11.73

11.60

0.79

0.82

11. 43

11.73

0.93

0.63

SOW Monolingual

Bilingual

7.73

9.46

1.22

1.18

8.46

10.00

1.68

1.46

8.10

9.73

1.49

1.33

SONW Monolingual

Bilingual

7.46

9.33

1.30

1.23

7.80

9.33

1.93

1.39

7.63

9.33

1.62

1.29

PS Monolingual

Bilingual

7.80

9.13

1.42

1.50

7.73

8.53

1.38

1.18

7.76

8.83

1.38

1.36

PO Monolingual

Bilingual

5.46

7.33

1.06

1.23

6.13

7.93

1.64

1.53

5.80

7.63

1.39

1.40

Total Monolingual

Bilingual

51.33

59.13

5.21

3.94

53.66

59.33

6.56

5.39

52.50

59.23

5.94

4.64

Table 2 shows the mean and SD values for female and male participants of the two

groups across the meta-phonological tasks. The mean scores put forth clearly show that both

female and male participants of the two groups performed equally well on the meta-

phonological tasks. The scores obtained were not statistically significant at p < 0.05.


255

Table 3: Mean and SD values of female and male participants of the two groups across the

reading tasks

Females Males Total

Tasks Groups Mean SD Mean SD Mean SD

CV Monolingual

Bilingual 36.60

36.33

2.58

2.19

35.66

36.73

3.57

2.65

36.13

36.53

3.10

2.40

CCV Monolingual

Bilingual 7.53

7.80

1.30

1.14

6.93

8.20

1.43

1.08

7.23

8.00

1.38

1.11

CCCV Monolingual

Bilingual 6.13

6.66

1.68

0.81

6.20

7.06

1.74

1.22

6.16

6.86

1.68

1.04

W Monolingual

Bilingual 18.66

19.06

1.23

1.03

18.53

18.80

1.59

1.47

18.60

18.93

1.40

1.25

NW Monolingual

Bilingual 17.60

18.66

1.54

0.97

17.73

18.53

1.66

1.40

17.66

18.60

1.58

1.19

GW Monolingual

Bilingual 9.20

9.33

1.01

0.72

8.73

9.13

1.53

1.06

8.96

9.23

1.29

0.89

GNW Monolingual

Bilingual 8.40

8.66

1.12

1.11

8.20

8.53

1.65

1.35

8.30

8.60

1.39

1.22

PW Monolingual

Bilingual 17.33

17.46

1.95

1.59

16.80

17.33

1.97

2.79

17.06

17.40

1.94

2.23

PNW Monolingual

Bilingual 16.93

17.46

2.25

1.76

16.53

17.06

3.41

2.60

16.73

17.26

2.85

2.19

ARW Monolingual

Bilingual 7.66

7.46

1.79

1.18

6.73

8.13

2.37

1.45

7.20

7.80

2.12

1.34

ARNW Monolingual

Bilingual 5.86

6.40

1.95

1.63

5.60

7.13

3.08

1.68

5.73

6.76

2.54

1.67

AW Monolingual

Bilingual 7.00

8.00

1.85

1.46

6.40

8.20

2.97

1.61

6.70

8.10

2.45

1.51

ANW Monolingual

Bilingual 8.00

9.20

2.59

1.20

7.20

8.66

3.12

1.87

7.60

8.93

2.84

1.57

Total Monolingual

Bilingual 166.93

172.53

18.11

14.33

161.26

173.53

25.99

19.73

164.10

173.03

22.20

16.95

Table 3 shows the mean and SD values of female and male participants of the two

groups across the reading tasks. It is apparent that both female and male participants of the

two groups performed equally well on the reading tasks. The scores were not statistically

significant at p < 0.05 between the performance of the female and male participants in both

groups on reading tasks.

This leads to the contemplation that both female and male participants were equally

competent in learning the meta-phonological skills and reading skills in the age range of 8-9

years. This could be attributable to fact that the variables like language learning environment,


256

literacy instruction, socio-economic status, age, nurturing, parent scaffolding, may not be an

influential factor across females and males. Thus, these factors do enhance learning skills

equally across gender.

In support with the literature, there seems to be no gender-differences across the two

tasks and the two groups. This is in accord with the research work done by Burt, Holm and

Dodd (1999) who reported that females and males performed equally well on the meta-

phonological tasks. However, the socio-economic status (SES) affected the performances on

majority of the tasks. Further the older children exhibited better phonological awareness in

contrast to younger peers.

The present study also showed similar findings where female and male participants

performed like-wise on the meta-phonological tasks. This result is supported by the findings

of Dodd and Carr (2003). Evidence also comes from the research work by McDowell,

Lonigan, Goldstein (2007) who reported that age, speech sound accuracy, and vocabulary

each contributed unique variance to the prediction of phonological awareness in both females

and males.

However, the results of the current study contraindicated the results by Moura,

Mezzomo and Cielo (2009) in which they reported that on the phonemic segmentation of

words with six phonemes and phoneme reversion of words with two or three phonemes,

female participants performed better than male participants. However, this suggests that the

phonological awareness stimulation program might have lead to better learning of specific

skills like segmentation, reversion. Yet such a learning experience might not be generalized

to other skills like stripping, oddity.

Table 4: Mean and SD for the total scores obtained by the groups on meta- phonological

tasks

Tasks

Monolinguals Bilinguals Total

Mean SD Mean SD Mean SD

RR 98.05 5.65 99.72 1.52 98.88 4.19

SS 95.27 7.79 97.77 5.33 96.52 6.73

SOW 67.50 12.44 81.11 11.14 74.30 13.57

SONW 63.61 13.57 77.77 10.79 70.69 14.10

PS 64.72 11.51 73.61 11.38 69.16 12.20

PO 48.33 11.66 63.61 11.67 55.97 13.90

Total 72.91 8.25 82.26 6.44 77.59 8.72

Table 4 shows the mean and standard deviation obtained by the monolingual and

bilingual groups on meta-phonological tasks. The table-4 clearly exemplifies that the

bilingual group performed better than the monolingual group. They demonstrated better

scores particularly on the SOW, SONW, PS and PO tasks. The results also showed a

statistically significant difference at {Mono= [F= (5,145) = 197.668, p < 0.05], Bi= [F=

(5,145) = 103.093, p < 0.05]} on meta-phonological tasks in both the groups.


257

The research findings in equivalence and in disparity with that of the current study are

discussed in conjunction to the Western literature and also bearing in mind the Indian

perspective. The results of the study indicated that bilingual children performed better on

meta-phonological compared to their monolingual peers. This finding is supported by

research reports by Karanth and Prakash (1996) and Rekha (1997) reported that beginning

readers of a non-alphabetic script (Kannada) revealed that phonological awareness is greatly

influenced by alphabet like features present in the orthography and not by rhymes. Also,

Read, Zhang, Nie, and Ding (1986) reported that some aspects of phonological awareness

may not be because of maturational factors but may be a consequence of learning an

alphabetic orthography. The current study also throws insight into findings suggesting that

bilingual children perform better on the meta-phonological tasks which in turn promotes

learning to read alphabetic script which is further supported by a study reported by Prakash

et.al (1993). There also seems to be a bilingual enhancement effect. Analogous research has

been supported by researchers like Loizou, Stuart 2003; Shwartz, Geva, Share and Leikin,

2005, Ching-ning Chien, Kao and Li Wei, 2008; Dodd, So and Lam, 2008.

Table 5: Mean and SD for the total scores obtained by the groups on reading tasks

Tasks

Monolinguals Bilinguals Total


CV 90.33 7.76 91.33 6.00 90.83 6.89

CCV 72.33 13.81 80.00 11.14 76.16 13.03

CCCV 61.66 16.83 68.66 10.41 65.16 14.31

W 93.00 7.02 94.66 6.28 93.83 6.66

NW 88.33 7.91 93.00 5.95 90.66 7.33

GW 89.66 12.99 92.33 8.97 91.00 11.15

GNW 83.00 13.93 86.00 12.20 84.50 13.07

PW 85.33 9.73 87.00 11.18 86.16 10.43

PNW 83.66 14.25 86.33 10.98 85.00 12.68

ARW 72.00 21.23 78.00 13.49 75.00 17.89

ARNW 57.33 25.45 67.66 16.75 62.50 21.98

AW 67.00 24.51 81.00 15.16 74.00 21.40

ANW 76.00 28.47 89.33 15.74 82.66 23.78

Total 82.05 11.10 86.51 8.476 84.28 10.04

Table 5 shows the mean and standard deviation obtained by the monolingual and

bilingual groups on reading tasks. The overall total mean percentage scores across the tasks

for the monolingual group was 82.05 (SD=11.10); bilingual group got a total of 86.51

(SD=8.47). It is also apparent from table-5 that the mean performances of the participants in

CV, W, NW, GW, GNW, PW and PNW were almost same with not much difference in their

mean values. Alternatively the mean values for CCV, CCCV, ARW, ARNW, AW and ANW

showed higher differences. The scores also were statistically significant at {Mono= [F=

(12,348) =31.605, p < 0.05], Bi= [F= (12,348) =50.041, p < 0.05]}.


258

Figure 1: Mean total scores of the monolingual and bilingual group across the meta-

phonological and reading tasks

Figure 1 depicts the performances of the two groups across the meta-phonological and

reading tasks.

With respect to reading abilities, it is evident from the mean scores that across the

reading tasks, the bilingual children performed better than monolingual children. This finding

has been supported by Morais et.al (1979, 1986) and Read (1986) reported that individuals

who did not have direct experience with alphabetic orthography were unable to carry out

phonological segmentation tasks. Also, research reports on Indian children by Prakash and

Mohanty (1989), Malini (1996), Rekha (1996) indicate that alphabetic script may facilitate

phonological awareness. Bilingual children revealed slightly better scores when compared to

monolingual children on the non-word reading tasks, this finding is supported by the research

report Prema (!997) where she reported that children might show the absence of logographic

reading in Kannada. Investigations by Vasanta, (2004); Hamilton and Gillon (2006) and the

result of the present study suggests that phonological awareness knowledge interacts during

the reading words and non-words in such a way that children exposed to more than one

language and formal literacy instruction are more affluent in accessing phonological

knowledge as compared to children with less able-bodied orthographies.

However, there are contrastive research findings. Mann (1986). He documented that

Japanese children who were not exposed to alphabetic script were able to successfully

complete the phonological segmentation tasks by the time they reached IV grades. Similarly

Morais (1991) claims the fact that entire writing system need not be alphabetic for

development of phonological awareness. A non-alphabetic script would allow development

of phonological awareness skills to certain degree depending on specific orthographic

features of the script.

Apart from these quantitative measures, qualitative analysis was carried out to study

the nature of performances exhibited by both the groups across the two tests. Qualitative

analysis gives an insight about the performances and errors which were observed in both the

groups. The errors which were not tapped out by the quantitative analysis.

For the meta-phonological tasks, it was observed that on the oddity tasks, children in

both the groups used strategies like reading the articulatory movements, counting the number

of syllables in the word, in order to retrieve the memorized syllables to pick the odd one out.


259

A consistent finding in both the groups was that they had difficulty in deleting the middle

syllable on the syllable stripping tasks. This is further supported by Goswami (1994). She

attributed to the inability to perceive the intrasyllabic difference.

On the reading tasks, it was observed that as the complexity of the stimuli increased

there was deterioration in the performances was observed. They simplified the articulation of

the target words. It was also observed that the children (in the monolingual group) did not

exhibit realization for „arka‟ where, it is uttered first, but written following the syllable across

the words and non-words, but managed to read the frequently occurring words. For the

„anuswara‟ word and non-word reading tasks, participants of the monolingual group read the

„anuswara‟ (O) as zero when it preceded the syllable instead of reading it as /m/ or /n/or /ŋ/

depending on the word context. This could be attributed to the fact that the frequency of

occurrence and exposure to „anuswara words‟ between 8-9 years is comparatively less. It as

noticed that some participants read non-words with ease. This can be supported by the results

reported by Prema (1997) where she stated that children might show the absence of

logographic reading in Kannada.

Conclusions

The female and male participants performed equally on the meta-phonological and

reading tasks however there were subtle differences in the mean percentage scores. This

shows that SES, literacy instruction, language learning environment etc. are all independent

of the gender variable between 8-9 years. There appears to be developmental trend in the

acquisition of meta-phonological skills. The findings of the current study also suggest that the

cognitive load entailed by the children is equal amongst female and male participants in the

acquisition of meta-phonological skills. Reading skills on the other hand, should be viewed

holistically, taking into consideration other aspects like communicative abilities,

environmental factors, mental status of the child, literacy level of parents, media, apart from

the meta-phonological skills which does play a vital role in reading acquisition.

Bilingual group performed better than the monolingual group on the meta-

phonological and reading tasks suggesting that they have an advantage in fine-tuning and

growth of meta-phonological and reading skills.

On a concluding remark, it is apparent from the findings that though there are

differences in the performances of the monolingual and bilingual children on meta-

phonological tasks, these differences no where hamper but promote literacy skills.

Implications

The results of the present study are of clinical significance as it has been observed that

rhyme recognition and syllable awareness are the earliest indicators of reading abilities in

both the groups. This trend has to be kept in mind while assessing and planning treatment

program for children with developmental disorders such as in children with learning

disability, specific language disorders, and phonological disorders.


260

This study also gives scope for professionals assessing and planning intervention

programs for children with developmental disorders who are exposed to more than one

language such as Kannada, a semi-syllabic script (L1), and English, alphabetic script (L2).

Thus, it is imperative in the Indian context where bilingualism is a common phenomenon,

assessment of children in L1 and L2 becomes crucial. Hence, it is proposed that separate

assessment protocols should be made in L1 and L2 in order to arrive at clear consensus about

the assets of bilingual children.

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262

Dementia Assessment Battery – Kannada

Sunil Kumar Ravi & K.C. Shyamala*

Abstract

Dementia is a common clinical syndrome characterized by a decline in cognitive function and

memory from previously attained intellectual levels, which is sustained over a period of months or

years. The core symptoms of cognitive dysfunction in dementia include memory, language, praxis,

gnosis, executive functioning, and personality and behavioral changes. Deficits in cognitive

functioning result in various speech and language impairments in these individuals. Very limited

number of test batteries is available for speech – language pathologists to assess the speech and

language skills in individuals with dementia. Therefore, there is a great need to develop a test battery

to assess this population especially in Indian context. The present study was taken with the aim of

developing a test battery in Kannada to assess individuals with dementia. The test battery includes

four domains such as memory, linguistic expression, linguistic comprehension, and visuospatial

construction skills. This test battery was administered on 30 normal subjects in each of the age ranges

of 20 – 40 years, 40 – 60 years and above 60 years, and also administered on 10 dementics in the each

severity category of mild, moderate and severe. The normative data of all subtests included the mean

and standard deviation (S.D) scores was calculated. Results of the present study also revealed

significant deficits in individuals with dementia on all domains. Performance of mild dementics was

near normal in most of the subtests like spontaneous speech, reading comprehension, following

commands, etc. Moderate dementics had more difficulty in tasks like working memory, episodic

memory, picture naming, generative naming, and generative drawing, etc. Severe dementics’

performance was poor in all the subtests especially due to poor spontaneous speech skills, and poor

intelligibility of speech and these subjects had more difficulty in all the memory tasks and language

expression tasks like naming. These results showed that there is a significant difference in the mean

and S.D of normal groups and dementia groups and the performance of dementia group deteriorated

as the severity increased.

Keywords: dementia, Alzheimer’s disease, memory assessment, language assessment, visuospatial

construction.

Introduction

Dementia is a common clinical syndrome characterized by a decline in cognitive

function and memory from previously attained intellectual levels, which is sustained over a

period of months or years. The deterioration is of such severity that it impairs the affected

individual’s ability to work and to perform activities of daily living, including

communication. Cummings and Benson (1992) state that at least three of the following five

areas of mental activity must be involved: 1. Language; 2. Memory; 3.Visuospatial skills; 4.

Emotion or personality; and 5. Cognition (ex: abstraction, calculation, and judgment).

The Diagnostic and Statistical Manual of Mental Disorders—Fourth Edition (DSM –

IV); American Psychiatric Association, 1994 states that the essential feature in dementia is

impairment in short term and long term memory. This deficit in memory may also be

____________________________________________

Professor of Language Pathology, All India Institute of Speech and Hearing, Mysore, India


Dementia Assessment Battery - Kannada

263

associated with one or more features like, aphasia, apraxia, agnosia, impairment in abstract

thinking, impaired judgment, and personality changes.

The nature and course of dementia will vary depending upon the etiology. Most

dementias are progressive, but some are static. Dementia can be caused by a variety of

conditions like diseases, infections and infarcts. The most commonly occurring cause is

Alzheimer’s disease accounting for 50 to 60% of all the patients with dementia. Vascular

dementias (dementias caused by multiple infarcts) are seen in 20% of the dementia patients.

Alzheimer’s dementia and vascular dementia co-occur in approximately 15% of this sample,

and other conditions such as Pick’s disease, Parkinson’s disease (PD), Progressive

Supranuclear Palsy (PSP), and Creutzfeldt-Jacob disease (CJD), account for the reminder of

the irreversible dementias.

Although the core features are the same for all dementias, the onset and course may

vary. Alzheimer’s disease is usually insidious in onset. The time from the onset of clinical

features to presentation for evaluation varies considerably and depends on the etiology of the

dementia, as well as personal and social factors, including individual and cultural attitudes

and beliefs about aging, premorbid personality, and intelligence. The core symptoms of

cognitive dysfunction in dementia, as defined in the DSM-IV-TR (2004) include memory,

language, praxis, gnosis, executive functioning, and personality and behavioral changes.

The progression of dementia maybe complicated by the associated medical illness

such as stroke, TBI, etc. complicating the course of Alzheimer’s disease. In general,

degenerative dementias have an insidious onset and are gradually progressive. The pattern

may initially include periods of more gradual decline, followed by a more rapid progression.

Vascular dementia tends to have an abrupt onset and a more stepwise pattern, associated with

further vascular insults, but may have a gradual and progressive course. Radiation induced

dementia may present months after radiation exposure and may have a progressive course.

Considering the incidence of dementia related communication disorders is increasing

in India, there is a need to develop test batteries for identification and diagnose dementia by

speech language pathologists (SLPs). SLPs need to have a test battery which will be used for

differential diagnosis between normal aging and several types of dementia. Currently, there

are no specific treatment programs available for individuals with dementia as there is a lack

of information on language deficits in individuals with various types of dementia. Therefore,

there is a need to develop a test battery on which we can plan individual treatment

programmes depending upon the type of dementia and severity of dementia in early stages

itself. There are some assessment tools available in western countries but no suitable tests are

available for dementia in Indian context.

Changes in communicative function with advancing age may signal the beginning of

serious neurological conditions (e.g., dementia) that significantly impact functional

independence (Bayles & Kaszniak, 1987). The ultimate purpose of the research studies are to

develop sensitive and reliable measures of cognitive linguistic change that can be used to

periodically assess speech, language, and cognitive abilities as part of a comprehensive adult

illness prevention and health maintenance protocol. Early detection of cognitive-linguistic


264

disorders with sensitive, reliable assessment tools may be expected to result in timely

intervention thereby reducing disability and enhancing rehabilitation.

Numerous studies have investigated diagnostic markers for early identification of

dementia and mild cognitive decline with advancing age, (Albert, Blacker, Moss, Tanzi, &

McArdle, 2007; Cunje, Molloy, Standish, & Lewis, 2007). Mainly, these protocols focus on

dementia rating scales and neuropsychological test batteries to assess normally functioning

older adults and individuals with cognitive deficits. The long-term goal of these studies was

to identify measures sensitive to cognitive decline.

Language measures such as verbal fluency may be sensitive to cognitive decline

(Ostberg, Fernaeus, Hellstrom, Bogdanovic, & Wahlund, 2005), and studies have explored

language as well as cognitive variables for signs of pathological aging. For example, the

Barnes Language Assessment (Bryan, Binder, Dann, Funnell, Ramsey, & Stevens, 2001) was

developed to assess language and associated cognitive abilities in older individuals. It

includes tasks that examine language expression, comprehension, reading, writing, executive

function, and memory that were adapted from existing measures.

Confrontation naming deficits may or may not be evident early in the course of DAT,

but are invariably present by the later stages. When asked to name real items or items that

are pictured in outline drawings, DAT patients often are completely unable to name them, or

they commit semantic errors, such as producing the name of the super ordinate category to

which the item belongs (e.g. animal for horse) or an incorrect name from the same semantic

category (e.g. cow for horse). This impairment in naming ability becomes more severe as

dementia progresses. In contrast to DAT, confrontation naming remains relatively unaffected

in some other dementing disorders. Bayles and Tomoeda (1983) reported that both mildly

and moderately demented HD (Huntington’s disease) patients were unimpaired on the Boston

naming Test. Difficulty in naming or word retrieval has been observed to be the most obvious

early symptom of dementia, regardless of cause, and has been found to occur before other

language changes associated with the syndrome are measurable (Bayles, Tomoeda, Kaszniak

& Troset, 1990).

In the early stages of probable Alzheimer’s disease (PAD), semantic difficulties are

thought to be more influential on naming responses than perceptual responses and have

attracted more investigation. Semantically-related errors predominate in naming, suggesting

that there is an underlying semantic disorder (Bayles and Tomoeda 1983). Explanations for

this have followed those proposed by Warrington and Shallice (1979) of either impaired

access to semantic information or a degraded semantic store. Both the impaired access and

impaired storage accounts have been applied to naming behavior in PAD.

Nicholas, Obler, Au, & Albert, (1996) compared DAT patients performance on the

Boston naming test (BNT) with elements of empty speech in narrative description of the

cookie theft picture in an attempt to evaluate the claim that discourse incoherence could be

attributed to anomia. The authors reported a significant negative correlation between the

score of DAT patients on the Boston Naming test and the use of indefinite terms (e.g. thing

and stuff) and significant positive correlation between the BNT and the production of content


265

elements (i.e. references to characters and actives in cookie theft stories). They concluded

that the naming deficit did not underlie the emptiness of discourse presumably because many

other measures of discourse emptiness (e.g. paraphasias pronouns with accidents and deictic

terms) did not correlate with the BNT scores.

Freedman and Berman (1986) have reported that the impaired performance of the

DAT patients on these tasks presumably results from deficiency in cognitive flexibility that is

required to alternate responses and shift mental set.

An overview of the appropriate case history, medical laboratory studies and

neuropsychological tests and behavioral ratings as well as language and communication

measures will be presented based on this collaborative perspective. As specialists in

communication disorders, SLPS are often asked to provide consultation regarding

communication competence of dementia patients. Although the results of the communication

assessment may be used for differential diagnosis, it is more likely that results will be used to

evaluate the patient’s progression in the course of the dementia.

Neuropsychological performance tests provide objective and precise measurement of

cognitive function; however, a major problem with their use is that they do not relate directly

to functioning in practical situations, i.e., they lack ecological validity. For this reason,

behavioral ranting scales that illustrates/actual behavioral features are an important addition

to the assessment protocol. A multimodal assessment provides various perspectives of the

patient’s behavioral abilities necessary for a comprehensive description of functional

behavior.

The Brief Cognitive Rating Scale (BCRS) (Reisberg, 1983) is a rapid, structured

instrument for assessing cognitive decline, regardless of etiology. Items are organized into

five categories or axes. These include concentration and calculating ability, recent memory,

remote memory, orientation and Functioning and self care. Within each axis behaviors are

scored from one to seven, with one being the least impaired and seven being the most

impaired. Each score is related to distinguishable levels of functioning within the category.

The Functional Assessment Stages (FAST) distinguishes 15 distinct progressive

characteristics of the disease (Reisberg, et al, 1984). These characteristics can be related to

the seven stages within Axis V, functioning and self care, of the brief cognitive rating scale.

It is proposed that patients with uncomplicated DAT typically proceed on a linear course

through the characteristics of decline. Recognition of these distinct stages of DAT is clearly

an advance in enabling clinicians to identify the precise magnitude of the impairment as well

as help in the differential diagnosis of DAT. FAST is particularly useful in the later stages of

the disease when other measures may not carefully identify the magnitude of the breakdown.

The Working Party on Dementia Report (College of Speech and Language Therapists,

1993) reported that therapists working with people who have dementia use assessments

designed for other client groups, such as people with aphasia. Therefore, the working party

suggested that there exists a ‘clinical need for the development of conceptually strong and

clinically appropriate evaluations of a diagnostic and/or descriptive nature’.


266

Such an assessment has already been developed and standardized in the USA and UK

– Arizona Battery for Communication Disorders of Dementia (ABCD) (Bayles & Tomoeda,

1993) which can be used by SLPs to diagnose and assess the severity of dementia. This

fulfills the criteria of working party in its conceptual strength and clinical appropriateness and

in its primary aim to quantify the linguistic communication deficits associated with AD.

Furthermore, the ABCD was designed to allow a differential diagnosis between normal aging

and mild AD and between mild AD and moderate AD.

The ABCD comprises 14 subtests which comprehensively assess linguistic

comprehension and expression, verbal episodic memory, visuospatial construction and

mental status. It also contains four tasks for identifying individuals with problems that might

invalidate the test results, such as a hearing problem, illiteracy, a visual field defect, and

visual agnosia. Tests of memory, mental status and visual perceptual and construction skills

were included in the battery because by definition, dementing diseases produce deficits in

memory, mental status and perception (Reisberg, Ferris, DeLeon & Crook, 1982; Cummings

& Benson, 1992). Integrity of these processes and types of knowledge are essential for

normal communicative function to occur.

Need for the study

There are some assessment tools available in western countries but no suitable tests

are available for dementia in Indian context. So, we need to have appropriate tests to identify

the persons with dementia in Indian context. As the review of literature suggests, individuals

with dementia have language deficits along with other cognitive deficits. Therefore, there is a

need to develop a test battery to assess the language deficits and other cognitive deficits such

as memory, etc… in these subjects. Considering that the incidence of dementia related

disorders is increasing in India, there is a need to develop specific test batteries for

identification and diagnosis of dementia. We need to have a test battery which will be used

for differential diagnosis between normal aging and the several types of dementia. Currently,

there are no specific treatment programs available for individuals with dementia as there is a

lack of information on language deficits in individuals with various types of dementia.

Therefore, there is a need to develop a test battery on which we can plan initiation of

individual treatment programmes depending upon the type of dementia and severity of

dementia in early stages itself.

Aim of the study

1. To develop an assessment test battery for Kannada speaking individuals with

dementia.

2. To standardize the test material on normal population and in individuals with various

types of dementia.

3. To profile the language deficits of individuals with various types of dementia.


267

Method

The present study was undertaken to develop and standardize a test battery on normal

population and also on dementia population. Four groups of subjects were considered in

which three groups of subjects were normal individuals (young adults, adults and geriatric

groups) and another group included individuals with dementia.

Normal subjects were tested to form a baseline which will be considered as normative

for this test. Normal 30 young adult subjects in the age range of 20 – 40 years, normal 30

adults in the age range of 40 – 60 years and normal 30 old subjects aged above 60 years were

selected based on the following inclusion criteria: native Kannada speakers, no history of

major neurological or psychiatric illness or of alcoholism or drug abuse, all the subjects were

evaluated for their mental status on Mini Mental Status Examination (Folstein, Folstein &

McHugh, 1975) and all passed with a score of above 23. Finally, individuals who received

rating of 1 or 2 on Brief Cognitive Rating Scale (Riesberg, 1983) and rating of 1 (normal/ no

cognitive decline) on Functional Assessment Stages (Reisberg, Ferris, Anand, 1984) were

included in this group.

30 subjects with various types of dementia, 10 subjects in each group, mild, moderate

and severe dementia based on Functional Assessment Stages (Reisberg, Ferris, Anand, 1984)

and Brief Cognitive Rating Scale (Riesberg, 1983) were taken for the present study. The

subjects with dementia were identified through local hospitals, dementia associations and

dementia clinics in Mysore and Bangalore cities. The selection criteria for this group were:

age over 50 years, diagnosed as having dementia by a neurologist/ psychiatrist according to

NINCDS – ADRDA, native Kannada speaker, adequate hearing and vision, reported history

of gradual deterioration in cognitive abilities. All the subjects were evaluated for their mental

status on Mini Mental Status Examination (Folstein, Folstein & McHugh, 1975) and all failed

with a score of below 23. Finally, individuals who received rating above 2 on Brief Cognitive

Rating Scale (Riesberg, 1983) and rating above 1 (normal/ no cognitive decline) on

Functional Assessment Stages (Reisberg, Ferris, Anand, 1984) were included in this group.

Tests/ tools

1. Mini Mental Status Examination (MMSE) (Folstein, Folstein & McHugh, 1975)

2. Brief Cognitive Rating Scale (BCRS) (Reisberg, 1983)

3. Functional Assessment Stages (FAST) (Reisberg, Ferris & Anand, 1984)

4. Dementia Assessment Battery – Kannada.

Dementia Assessment Battery was developed in Kannada. The DAB – K (Dementia

Assessment Battery – Kannada) comprised of 17 subtests which comprehensively assessed

memory, linguistic expression, linguistic comprehension, and visuospatial construction. The

subtests were selected from different language tests, mainly from Arizona Battery of

Communication Disorders of Dementia, which was standardized on USA and UK population.

The overview of DAB – K (various domains, subtests under each domain) is given in Table

1.


268

Table 1: Domains and subtests of DAB – K.

Memory Linguistic

Expression

Linguistic

Comprehension

Visuospatial

construction

Episodic Memory Picture Naming Comparative

Questions

Generative

Drawing

Working Memory Generative

Naming

Following

Commands

Figure Copying

Semantic

Memory

Sentence

completion

Reading

Comprehension

of Sentences

Delayed Story

Telling

Responsive

Speech

Reading

Commands

Spontaneous

Speech

Repetition


The main objective of the study was to develop and standardize the Dementia

Assessment Battery – Kannada test on normal population and also on individuals with

dementia. For this, the test material was administered on different groups of subjects and the

results of the each group on each subtest are given in this section.

The Dementia Assessment Battery – Kannada consists of four domains, memory,

linguistic expression, linguistic comprehension, and visuospatial skills with several subtests

in each domain. The mean and standard deviation (S.D) of each subtest and also for each

domain are calculated and they are given in this section.

Overall Results of each domain

Domain – 1: Memory

This domain consists of four subtests namely episodic memory, working memory,

semantic memory and delayed story recall subtests. The maximum total score of this domain

is 100. The mean and standard deviation scores of each group of subjects are given in Table

2.

Table 2: Mean and S.D of each group on memory domain.

Group

Young

adults

(20 – 40

years)

Adults

(40 – 60

years)

Normal

Geriatrics

(above 60

years)

Mild

dementia

Moderate

dementia

Severe

dementia

N 30 30 30 10 10 10

Mean 93.9 92 82.3 50.7 32.6 14.8

S. D. 2.49 3.04 5.13 5.83 2.98 4.02

As it can be seen from the above table the mean and S. D of young adults; adults and

geriatrics are 93.9, 2.49; 92, 3.04 and 82.3, 5.13 respectively. The mean scores of normal


269

groups ranged from 93.9 to 82.3. This shows that there is not much difference between the

three normal groups ranging in age from 20 – 60 years on memory domain. The mean and

S.D of mild dementia, moderate dementia and severe dementia groups are 50.7, 5.83; 32.6,

2.98 and 14.8, 4.02 respectively. The scores of dementia population ranged from 50.7 to 14.8.

This shows that there is a significant difference in the mean and S.D of normal groups and

dementia groups and the performance of dementia group deteriorated as the severity

increased.

All the dementia groups performed similarly on all the tasks of memory domain, i.e.,

on episodic, working and semantic memory tasks. As mentioned above, mild dementics

performed better compared to moderate and severe dementic groups. These results are in

concurrence with the results of studies by Holm et al (2005), Lamar, et al (2007), Baddeley,

et al (1991), which reported several memory deficits in individuals with dementia.

Domain – 2: Linguistic Expression

The second domain in DAB – K is linguistic expression. This domain consists of six

subtests namely picture naming, generative naming, Sentence completion, responsive speech,

spontaneous speech and repetition subtests. The maximum total score of this domain is 250.

The mean and standard deviation scores of each group of subjects are given in Table – 3.

Table 3: Mean and S.D of each group on linguistic expression domain.

Group

Young

adults

(20 – 40

years)

Adults

(40 – 60

years)

Normal

Geriatrics

(above 60

years)

Mild

dementia

Moderate

dementia

Severe

dementia

N 30 30 30 10 10 10

Mean 242.26 233.1 217.6 149.3 110.4 55.8

S. D. 4.21 6.05 10.25 9.91 6.44 7.68


geriatrics are 242.26, 4.21; 233.1, 6.05 and 217.6, 10.25 respectively. The mean scores of

normal groups ranged from 242.26 to 217.6. This shows that there is not much difference

between the three normal groups on linguistic expression domain. The mean and S.D of mild

dementia, moderate dementia and severe dementia groups are 149.3, 9.91; 110.4, 6.44 and

55.8, 7.68 respectively. The scores of dementia population ranged from 149.3 to 55.8. This

shows that there is a significant difference in the mean and S.D of normal groups and

dementia groups and the performance of dementia group was deteriorating as the severity

increased.

All the dementia groups performed well on the tasks like spontaneous speech,

repetition etc. and performed poorly on tasks like picture naming and generative naming

tasks. As mentioned above, mild dementics performed well compared to moderate and severe

dementic groups. These results are in correlation with the results of studies by Small et al

(2008), Thomas, et al (2005), Rosselli, et al (2000) which reported linguistic expression

deficits in individuals with dementia.


270

Domain - 3: Linguistic Comprehension

This domain consists of four subtests within it. They are comparative questions,

following commands, reading comprehension of sentences and reading commands. The

maximum total score of this domain is 150. The mean and standard deviation scores of each

group of subjects are given in Table – 4.

Table 4: Mean and S.D of each group on linguistic comprehension domain.

Group

Young

adults

(20 – 40

years)

Adults (40

– 60 years)

Normal

Geriatrics

(above 60

years)

Mild

dementia

Moderate

dementia

Severe

dementia

N 30 30 30 10 10 10

Mean 150 149.6 146.43 101.5 68.0 44.5

S. D. 0 1.30 5.32 13.25 2.9 5.9


geriatrics are 150, 0.0; 149.6, 1.30 and 146.43, 5.32 respectively. The mean scores of normal

groups ranged from 150 to 146.43. This shows that there is not much difference between the

three normal groups on linguistic comprehension domain. The mean and S.D of mild

dementia, moderate dementia and severe dementia groups are 101.5, 13.25; 68.0, 2.9 and

44.5, 5.9 respectively. The scores of dementia population ranged from 101.5 to 44.5. This

shows that there is a significant difference in the mean and S.D of normal groups and

dementia groups and the performance of dementia group deteriorated as the severity

increased.

Visuospatial Construction Domain

This domain consists of two subtests, namely, generative drawing and figure copying.

The maximum possible score is 50. The mean and standard deviation scores of each group of

subjects are given in Table – 5.

Table 5: Mean and S.D of each group on visuospatial construction domain.

Group

Young

adults

(20 – 40

years)

Adults

(40 – 60

years)

Normal

Geriatrics

(above 60

years)

Mild

dementia

Moderate

dementia

Severe

dementia

N 30 30 30 10 10 10

Mean 49.86 49 47.06 30.4 19.5 11.6

S. D. 0.73 2.19 4.47 5.03 2.95 1.83


geriatrics are 49.86, 0.73; 49, 2.19 and 47.06, 4.47 respectively. The mean scores of normal

groups ranged from 49.86 to 47.06. This shows that there is not much difference between the

three normal groups on visuospatial construction domain. The mean and S.D of mild

dementia, moderate dementia and severe dementia groups are 30.4, 5.03; 19.5, 2.95 and 11.6,


271

1.83 respectively. The scores of dementia population ranged from 30.4 to 11.6. This shows

that there is a significant difference in the mean and S.D of normal groups and dementia

groups and the performance of dementia group were found deteriorating as the severity

increased.

All the dementia groups performed well on the figure copying task than generative

drawing task. As mentioned above, mild dementics performed well compared to moderate

and severe dementic groups.

Total DAB – K Scores

The Dementia Assessment Battery – Kannada consists of four domains, memory,

linguistic expression, linguistic comprehension, and visuospatial construction with several

subtests in each domain. The mean and standard deviation (S.D) of each subtest and also for

each domain are calculated and they are given in Table 6 and as well as in Figure 1.

Table 6: Mean and S.D of the subtasks and domains of DAB – K.

Group Young

adults (20

– 40 years)

Adults (40

– 60 years)

Normal

Geriatrics

(above 60

years)

Mild

dementia

Moderate

dementia

Severe

dementia

Task M S.D M S.D M S.D M S.D M S.D M S.D

Episodic

Memory

30 .00 29.8 .50 28.5 2.2 15.7 2.0 9.8 1.9 5 1.9

Working

Memory

24.6 1.9 23.6 2.0 19.4 2.9 16.2 1.6 9.4 1.6 4.4 1.5

Semantic

Memory

29.4 .89 29.0 1.4 27.2 2.5 14.0 2.8 9.4 1.5 4.8 1.8

Delayed Story

Recall

9.8 .61 9.46 1.0 7.0 1.6 4.8 2.3 4.0 1.3 1.6 .96

Memory

Domain

93.9 2.4 92 3.0 82.3 5.1 50.7 5.8 32.6 2.9 14.8 4.0

Picture Naming 89.8 .76 89.4 1.4 81.5 5.1 53.7 6.7 36.0 5.1 13.8 3.8

Generative

naming

18.1 1.7 16.5 2.2 15.1 2.2 7.5 1.9 5.8 1.1 2.5 1.4

Sentence

completion

9.7 0.5 9.0 1.3 8.4 1.7 5.3 1.0 3.9 0.7 2.3 0.6

Responsive

Speech

9.8 0.5 9.7 0.6 9.4 1.0 6 0.6 3.1 1.2 2.1 0.9

Spontaneous

Speech

20 0.0 19.9 .40 19.5 1.0 13.9 1.2 10.1 0.7 5.0 0.8

Repetition 94.7 4.0 88.5 5.6 83.7 6.8 62.9 5.8 51.5 4.0 30.1 3.7

Linguistic

Expression

Domain

242 4

233 6.0

217

10.2 149 9.91 110 6.44 55

7.68

Comparative

questions

20 0.0 19.9 .36 19.2 1.3 11.8 1.4 7.6 1.2 4.0 1.6

Following

commands

80

0.0

79.3 2.1

76.7 5.1

48.8 9.4

28.6 2.7

21.9 2.72


272

Reading

Comprehension

of Sentences

40

0.0

40

0.0

40

0.0

34.5 3.7

27

2.6

16

3.94

Reading

Commands

10

0.0

10

0.0

9.6

0.75 6.4

1.5

4.8

1.03 2.6

0.96

Linguistic

Comprehension

Domain

150 0 149

1.3

146 5.32 101

13.2 68.0 2.9

44.5 5.9

Generative

Drawing

30

0.0

29.5 1.4

28.6 2.9

16.6 2.9

12.1 2.0

7.1

1.2

Figure Copying 19.8 0.7 19.4 1.3 18.2 2.7 13.8 2.5 7.4 1.1 4.5 0.8

Visuospatial

construction

domain

49.8 0.7

49

2.1

47.0 4.4

30.4 5.0

19.5 2.9

11.6 1.8

Total Scores of

DAB –K

536 5.0 523 7.3 493 15 328 54.5 205 30.7 122 19.3


geriatrics are 536, 5.0; 523, 7.3 and 493, 15 respectively. The mean scores of normal groups

ranged from 536 to 493. This shows that there is not much difference between the three

normal groups on DAB – K. The mean and S.D of mild dementia, moderate dementia and

severe dementia groups are 328, 54.5; 205, 30.7 and 122, 19.3 respectively. The scores of

dementia population ranged from 328 to 122. This shows that there is a significant difference

in the mean and S.D of normal groups and dementia groups and the performance of dementia

group was inferior throughout and was found deteriorating as the severity increased.

Figure 1: Bar graph showing mean of all the groups on DAB – K.

The results of this study revealed that there is a significant deterioration in the

performance of dementia groups in all the tasks assessed as the severity increased. No

significant difference was found between the three normal age groups on many tasks like

episodic memory, semantic memory, responsive speech, and spontaneous speech, linguistic

comprehension, generative drawing and figure copying parameters. Thereby, indicating that

these parameters are not affected in geriatrics and are suitable to differentiate normal aging

and pathological aging. Significant difference was found on tasks of picture naming,

generative naming, working memory, repetition, etc. and indicating that these cannot be used

to differentiate normal aging and pathological aging. Results also indicate that the test can be

effectively used to differentiate between normal aging and dementics and also to assess the

severity of dementia.


273


Results of the present study revealed significant deficits in individuals with dementia

in memory, linguistic expression and linguistic comprehension. Performance of mild

dementics was near normal in most of the subtests like spontaneous speech, reading

comprehension, following commands, etc. Moderate dementics had more difficulty in tasks

like working memory, episodic memory, picture naming, generative naming, and generative

drawing, etc. Severe dementics’ performance was poor in all the subtests especially due to

poor spontaneous speech skills, and poor intelligibility of speech and these subjects had more

difficulty in all the memory tasks and expression tasks like naming, etc. These results showed

that there is a significant difference in the mean and S.D of normal groups and dementia

groups and the performance of dementia group deteriorated as the severity increased.

Results also revealed significant deterioration in the performance of normal

individuals as the age increased. Performance of geriatric group was poor compared to young

adults and adults. No significant difference was found between the three normal age groups

on many tasks like episodic memory, semantic memory, responsive speech, and spontaneous

speech, linguistic comprehension, generative drawing and figure copying parameters.

Thereby, indicating that these parameters are not affected in geriatrics and are suitable to

differentiate normal aging and pathological aging. Significant difference was found on tasks

of picture naming, generative naming, working memory, repetition, etc. and indicating that

these cannot be used to differentiate normal aging and pathological aging.


This test battery can be used by Speech language Pathologists to assess and diagnose

the individuals with dementia of mild, moderate and sever stages. This test battery can be

used to differentiate between normal aging and pathological aging. This test battery can also

be used to plan therapy programs for individuals with dementia and related disorders.

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276

Vocal Registers in Classical Carnatic Singers: An Inquiry using

Electroglottography

Sweety Joy & K. Yeshoda*

Abstract

The present study investigated glottal behaviour using some of the EGG parameters in

different vocal registers in singers. Purpose of the study was to analyze EGG waveforms and

parameters and compare the within and across registers for both Carnatic vocal singers and non

singers. The subjects participated in the study consisted of 20 female professional Carnatic singers

with 3 years of formal training in Carnatic classical musical form. Control group consisted of 20

female non singers in the age range of 18-50 years with a mean age of 34 years. Subjects were

instructed to sing vowel /a/ in ascending scale in a single breath reaching the three sthayis (registers).

And the non singers were instructed to sing vowel /a/ in the lowest pitch, habitual pitch and the highest

pitch simultaneously in continuous manner and sustain the pitch for at least three seconds. The

following EGG parameters were extracted CQ, OQ, SQ, and F0. Summary of results a) F0: The mean

F0 and CQ were higher for Carnatic singers when compared to the non singers in falsetto register. B)

CQ: CQ mean values were less in head or modal register compared to falsetto register in singers. C)

OQ: mean values were higher in head register for singers when compared to the other two registers.

And for non singers mean OQ were higher in falsetto register D)SQ: mean SQ values were

significantly different for falsetto register in singers and mean SQ values were higher in non singers in

head and falsetto register. These results revealed that except for F0, the OQ, SQ, CQ were not

significantly different though they varied across registers.

Key words: Carnatic classical music, Chest register, Head register, Falsetto register, EGG

Introduction

Singing is a sensory motor phenomenon that requires particular balanced physical

skill. A sensitive performer achieves singing as an art when these skills are developed.

„Singing‟ is such a human and moving act, both for those who sing and for those who listen.

Hence singers are considered artists in the truest sense, as they combine concepts, melody,

text and stage movement, making it all seem effortless and yet capable of winning audience

appreciation (Bunch, 1982).

It has been reported in literature that there are different registers for singing and

speech. In speech, registers are recognized in ascending scale of pitch and they are: pulse

(vocal fry), chest/modal, falsetto and whistle. In singing: they are denoted as the chest, head

and falsetto for males; and chest, middle and head for females, (Thurman, Welch, Theimer, &

Klitzke, 2004). Typical speaking registers are pulse, modal and falsetto; typical singing

registers are chest, head and falsetto (Hollien, 1974).

_____________________________ * Lecturer in Speech Sciences, All India Institute of Speech and Hearing, Mysore, India

email:[email protected]

Vocal Registers in Classical Carnatic Singers

277

The concept of register is understood to be a series of consecutive similar vocal tones

which the musically trained can differentiate at specific places from another adjoining series

of likewise internally similar tones. Its homogenous sounds depend on a definite, invariable

behaviour of the harmonics. These rows of tones correspond to definite objectively and

subjectively perceptible vibratory regions in the head, neck and chest. The position of the

larynx changes more in natural singer during the transition from one series of tones to

another than in a well trained singer. The registers are caused by a definite mechanism

(belonging to that register) of tone production (vocal fold vibration, glottal shape, air

consumption), which allows for a gradual transition however from one to an adjoining

register. A number of these tones can actually be produced in two overlapping registers but

not always with the same intensity, (Nair, 1999).

The registers have been named by singers according to the subjective sensations they

produce. The low register is referred to as “chest”, because singing in that register produces a

feeling of vibration in the upper chest and lower neck. The upper register is called “head”

(female) or “falsetto”(male) because vibration are sensed high in head. The middle register is

often called “mixed”/modal because it has the high and low qualities in it.

Different registers sound different, but variant acoustic impression derived from

changes in the way the vocal source signal is moulded by the vocal tract as well as from

differences in the vocal source signal itself. A laryngeal register reflects a specific and distinct

mode of the laryngeal action. Vocal tract contributions are irrelevant. A laryngeal register is

produced across a contiguous range of fundamental frequencies. The F0 range of any given

laryngeal register has little overlap with the F0 range of any other register.

Nair (1999) opined that production of voice registers could be described from

acoustical or physiological point of view. In particular there are three main factors influencing

the voice register production: (a) Configuration of larynx – phonatory settings (mechanism of

oscillation of the vocal folds), (b) Vocal tract resonance (formants setting influence resultant

spectrum) and (c) Interaction of the sub glottal and supra glottal resonances with the vocal

fold oscillations.

Changes in vocal register may lead to differences in control of frequency. The

description of laryngeal control of frequency relate most closely to modal register, in which a

rise in vocal pitch is principally achieved by contractions of both the cricothroid and

vocalis/thyroarytenoid. The most noticeable difference in muscle control between the modal

and falsetto register is in the activity of the vocalis/ thyroarytenoid, Aikin (1902). Closed

quotient varies in falsetto as well as in chest register (Nair, 1999).

Aronson (1973) explained the physiological mechanism of falsetto in term of both

intrinsic and extrinsic muscles of larynx as follows: a) through the action of the thyrohyoid

and the supra hyoid musculature the larynx would be elevated high in to the neck, b) through

action of the stlyohyoid muscles the larynx would be tilted downwards, maintaining the vocal

folds in a state of laxity, c) although the vocal folds would be in a flabby state, the contraction

of the crico thyroid muscles will causes the vocal folds to be stretched, d) as a result the

vocal fold mass reduces owing to loss resistance to sub glottal air pressure, e) and hence only

the medical edges of the folds vibrate will vibrate because of reduced sub glottal air pressure.


278

Measurement of Vocal registers

Vilkman, Alku, Laukkanen (1995) studied the shifts from chest to falsetto registers in

trained and untrained male and female subjects. The shift from breathy to “falsetto” phonation

to normal chest voice phonation was studied in normal female (pitch range 170–180 Hz) and

male (pitch range 94–110 Hz) subjects. The phonations gliding from falsetto to chest register

were analyzed using adaptive inverse filtering and electroglottography. The results revealed

that differences noticed in the trained and untrained subjects during the register shift were not

significant and register shift were interpreted in terms of critical mass concept.

Chen, Robb & Gilbert (2002) studied the vocal fry register in men and women using

EGG. EGG parameters noted were vocal F0, duration of opening and closing phase and SQ.

Results revealed significantly higher F0, further; it also revealed that female speakers

demonstrated greater increase in SQ in fry register, indicating longer opening-phase duration

per glottal cycle. The results confirmed that the general notion the gender difference exist

even in vocal fry register.

Henrich, (2003) measured EGG open quotient in 18 classically trained male and female

singers in different registers and results revealed that open quotient values were usually lowest

in modal and chest when compared to falsetto and head. It was concluded that OQ depended

on the functioning of laryngeal mechanism and the laryngeal mechanize were similar for

males and females.

Henrich, N., d‟Alessandro, C., Castellengo, M., & Doval, B. (2004) explored the

relationship between

open quotient and laryngeal mechanisms: vocal intensity and

fundamental frequency using EGG in 18 classically trained male and female singers in

different vocal registers. It was found that open quotient (OQ) ranged from 0.3 to 0.8 in chest

voice and from 0.5 to 0.95 in head and falsetto voices. The OQ was

strongly related to vocal

intensity in chest voice and to fundamental frequency in head and falsetto voices. Henrich,

d'Alessandro, Doval and Castellengo (2005) conducted a study and measured open quotient

using EGG during speech and singing in three singers. EGG signals were analyzed, under

various speech and singing conditions: sustained vowels, spoken and sung sentences,

crescendos and decrescendos, glissandos. They reported that open quotient was different in

male and female voices and depended on underlying laryngeal mechanism. The dynamic

variations produced were much pronounced during speaking when compared to singing. And

they also observed correlation between OQ and vocal intensity in chest register.

Howard (1995) studied the upper registers in trained singers using EGG. The results

revealed increased open phase duration and increased open quotient. It was reported that

EGG wave morphology revealed sharp peaks during upper register production reflecting; the

fact that only the superior area of the VF mucosa was in contact. Archana (1987) in her study

on five trained female singers investigated the efficacy of EGG parameters and LTAS to

differentiate the musical notes within and across the registers in carnatic vocal music:

Mandhra (low) sthayi, Madhya sthayi (mid), tara sthayi (high). And the results revealed that

all EGG parameters: the open time, closed time, opening time, closing time, open phase,

closed phase, open quotient, speed quotient, speed index and total period were significantly

different across notes and registers.

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279

The present study was planned to understand the vocal fold closure or laryngeal

behaviour in singers during different register production. The aims of the study were as

follows:

1. To compare the EGG parameters across vocal registers in classical Carnatic singers.

2. To compare the EGG parameters between Carnatic singers and non singers across

registers.

Method

Subjects

40 females in the age range of 18-50 years with a mean age of 34 years participated in

the study. Subjects had no complaints of vocal, speech or hearing problems at the time of

recording. The subjects were divided into control group and experimental group.

Experimental group consisted of 20 professional Carnatic singers with a minimum of 3 years

of formal training in Carnatic classical musical form. Control group consisted of 20 female

non-singers who had no formal training in any form of singing.

Instrumentation

Kay Pentax Electroglottograph Model 6103 was used for acquisition of the EGG data.

The acquired data was represented as (a) selected parameter, (b) F0 in Hz and (c) a glottal

wave. The glottal wave was represented as time (in seconds) on X axis and amplitude of the

signal (in volts) on Y axis. One glottal cycle at any given point could be measured by moving

the cursor horizontally.

Instruction

All the subjects were explained about the purpose of the study. Familiarization was

done for all subjects.

Singers: Singers were asked to sing song or a particular „Raaga‟ wherein, transitions across

the three registers occurred for the familiarization. Then they were asked to sing vowel /a/ in

ascending scale in a single breath reaching the three sthayis (registers).

Non singers: were familiarized with suitable examples wherein the investigator provided pre

recorded audio sung samples sung the required task. They were asked to model the task and

practice. Then they were instructed to sing vowel /a/ in the lowest pitch, habitual pitch and

the highest pitch possible simultaneously in continuous manner and sustain the pitch for at

least three seconds. They were asked to maintain a comfortable loudness level while singing.

Recording

The recordings were done individually. Subjects were seated comfortably in front of

the instrument neckbands with the electrodes were tied to the neck and securely positioned on

either sides of the thyroid prominence. They were asked to sit quiet without moving head and

the positions of the electrodes were adjusted until clear EGG sine waveforms appeared on the

screen when the subjects phonated. The gain of the instrument was also manually adjusted


280

and the task was captured directly on to the instrument. Subjects were asked to sustain the

pitch for at least 3 seconds. Each subject was asked to sing the vowel /a/ thrice and all the

data were saved on to the computer memory. The recording that yielded best EGG waveform

morphology was retained for extraction of the parameters. The cursor was positioned at the

steady state of F0 and the following EGG parameters were extracted CQ, OQ, SQ, and F0.

The measured EGG parameters were tabulated for further statistical analysis. The data

was then subjected to suitable statistical analysis using SPSS software (version 15). Mean

and standard deviation were extracted. Repeated measures ANOVA was done to analyze the

variation of glottal parameters across registers within singers and independent t test was done

for pair wise comparison of Carnatic singers and non singers for each parameter.


The study aimed to investigate the vocal fold closure during singing at different

registers in Carnatic singers and non singers. The EGG parameters used in the current study

were fundamental frequency (F0), contact quotient (CQ), open quotient (OQ), and speed

quotient (SQ). Results are discussed under the following headings. A) Mean and standard

deviations for the Carnatic singers and non singers across registers B) Comparison of Carnatic

singers across registers. C) Comparison of non singers across registers. D) Comparison of

Carnatic singers and non singers across registers

A) Mean and standard deviations for the Carnatic singers and non singers across

registers

Mean and standard deviations for all the EGG parameters in the Carnatic singers in

three different register (Chest, head and falsetto) are tabulated in Table 1. EGG values across

registers showed no much difference except in fundamental frequency. Mean CQ and SQ

values were higher in falsetto register and mean OQ scores were higher for head register.

Table 1: Mean and SD of EGG parameters across registers for Carnatic singers

Parameter Chest Head Falsetto


F0 169 31.40 223 31.72 351 39.58

CQ 46 4.29 45 5.16 47 3.54

OQ 53 4.29 54 5.15 52 3.54

SQ 116 91.20 102 81.19 127 95.40

Similarly, Mean and standard deviations were tabulated for non singers in three

different registers in Table 2. The mean values EGG parameters for the non singers across

registers do not show much difference except in fundamental frequency. Mean CQ and SQ

values were higher in head register and mean OQ values were lower for head register.


281

Table 2: Mean and SD of EGG parameters across registers for non singers

Parameter Chest Head Falsetto


F0 193 12.43 210 21.74 341 47.14

CQ 41 7.55 43 3.45 41.21 6.71

OQ 58 7.56 56 3.44 58.78 6.71

SQ 233 115.96 258 84.50 210.91 122.51

Comparison of tables 1 and 2 gives an impression that non singers were not able to

match the F0 of Carnatic singers across the registers. Especially in chest register, non singer

obtained higher mean F0 values. Also the standard deviations of non singers were more

compared to Carnatic singers in chest and falsetto registers. This indicates that non singers

could not control their F0 production in chest and falsetto registers.

B) Comparison of Carnatic singers across registers

For the comparison of EGG parameters across three register, repeated measures

ANOVA were used as shown in Table 3. It shows there is no significant difference across

registers in any of the EGG parameters, except fundamental frequency which increased with

the registers and was highest for falsetto and lowest for chest registers. Pair wise comparison

for F0 showed significant difference across the three conditions.

Table 3: f value across registers in Carnatic singers.

Parameter Number of Subjects f Significance

F0 20 227.36 0.000**

CQ 20 0.721 0.493

OQ 20 0.737 0.485

SQ 20 0.490 0.616

**p<0.001

The findings of the current study results are in contrast with Archana (1987) and

Henrich, et. Al., (2005). Archana (1987) reported significane difference in EGG parameters

across registers. Henrich et al (2005) found that OQ was higher in falsetto register. The glottal

closure decreases as the rate of vocal fold vibration increases. This could explain the

significant increase in F0 as register changes. The Graph 1 shows comparison for F0, OQ, SQ

and SQ in singers across three registers. Although from the graph it is clear that only F0 had

greater difference between the registers, even SQ was different between the registers but was

not statistically significant.


282

Graph 1: Comparison of Carnatic singers across 3 registers

C) Comparison of EGG parameters across three registers in non singers

For the comparison of EGG parameters across three register in non singer (chest, head

and falsetto) repeated measures ANOVA was used. Table 4 shows the results of repeated

measure ANOVA across registers. It shows there is no significant difference across registers

in any of the EGG parameters, except fundamental frequency which shows statistically high

significant difference across register. Pair wise comparison for F0 showed significant

difference across the three conditions.

Table 4: f value across registers in non singers.

Parameter Number of subjects f Significance

F0 20 184.07 0.000**

CQ 20 1.114 0.389

OQ 20 1.087 0.348

SQ 20 1.038 0.364

**p<0.001

Graph 2 shows the comparison F0, CQ, OQ and SQ for all the three register. It can be

noticed that only F0 had greater difference between the registers, SQ was different across the

registers but not statistically significant.

Graph 2: Comparison of non singers across 3 registers

D) Comparison of Carnatic singers & non singers across registers.

The results are pooled for the two groups in Table 5 and it reveals that singers had a wider

pitch range compared to the non singers.


283

Table 5: Mean, SD, t values for Carnatic singers and non singers.

Parameter Groups Mean SD t

F0

Falsetto Singers 351 39.58 0.488

Non-singers 341 47.14

Chest Singers 169 31.40 0.003**


Head

Singers 223 31.72 0.148


CQ

Falsetto

Singers 47 3.54 0.001**

Non-singers 41 6.71

Chest

Singers 46 4.29 0.012*

Non-singers 41 7.55

Head

Singers 45 5.15 0.117

Non-singers 43 3.45

OQ

Falsetto

Singers 52 3.54 0.001**

Non-singers 58 6.71

Chest Singers 53 4.29 0.012*

Non-singers 58 7.56

Head

Singers 54 5.15 0.117

Non-singers 56 3.44

SQ

Falsetto

Singers 127 146.40 0.058*


Chest

Singers 116 91.20 0.001**


Head

Singers 102 81.19 0.000**


* p< 0.05, **p<0.01

The mean F0 and CQ values were higher for Carnatic singers when compared to the

non singers in falsetto register. These verdicts are in consonance with the findings of Howard

(1995) and Nair (1999). Trained singers are able to produce upper register with a CQ that is

slightly above 50% (Howard, et. al., 1995), presumably because they have the ability to

strongly adduct their vocal folds. Mc Coy & Scott, (2007) opined that CQ values are higher in

heavy mechanism like chest voice; it‟s more than 50%. And CQ is less in light mechanism

like head and falsetto. In this present study CQ values are less in head or modal register

compared to falsetto register. Increased CQ values shows increased glottal adduction and

stronger contraction of inter arytenoids and lateral cricoarytenoid (LCA) increased medial

compression from activity of the thyroaryteniod muscles. Graph 3 shows comparison of EGG

parameters between the Carnatic singers and non singers. Results also shows that mean OQ

values are higher in head register for singers when compared to the other two registers. And

for non singers OQ scores are higher in falsetto register which is in consonance with Henrich

(2005). But according to Henrich (2005) the open quotient depends on the laryngeal

mechanisms in singers. The open quotient is strongly related to vocal intensity in chest,

modal,

and male head register. And OQ related to fundamental frequency in falsetto for male and

head register for female singers. SQ values were significantly different for falsetto register in

singers and mean SQ values were higher in non singers in falsetto register. SQ reflects the

asymmetry of the glottal pulse; since the F0 is higher in falsetto, it suggests more

asymmetrical vibrations in falsetto register both in Carnatic singers and non singers and

especially in non singers as they have not mastered production of those registers.


284

Registers

PulseModalLoft

Ave

rag

e P

itch

(H

z.)

400

300

200

100

Groups

Singers

Non-singers

a) F0: Carnatic singers vs

non-singers.

Registers

PulseModalLoft

Me

an

CQ

(%

)

100

80

60

40

20

0

Groups

Singers

Non-singers

c) CQ: Carnatic singers vs

non-singers.

Registers

PulseModalLoft

Me

an

OQ

(%

)

100

80

60

40

20

0

Groups

Singers

Non-singers

b) OQ: Carnatic singers vs

non-singers.

Registers

PulseModalLoft

Me

an

SQ

(H

z)

300

200

100

0

Groups

Singers

Non-singers

d) SQ: Carnatic singers vs.

non-singers

Fal Head Chest Fal Head Chest

Fal Head Chest Fal Head Chest

Graph 3: Comparison of EGG parameters between the Carnatic singers and non singers.


285

Conclusions

In general the results revealed that except for F0, the OQ, SQ, CQ were not

significantly different though they varied across registers. On comparison, singers win though

they had minimum of 3 years of experience, EGG parameters were significant by different

especially in chest and falsetto registers. This would be attributed to the training in voice use.

Limitations

Most of the singers had a minimum of 3 years of formal practice they were

still under the formal training.

Numbers of subjects were limited.

Future direction

Comparison of classical Carnatic singers and Hindustani classical singers to

know more about their laryngeal mechanism. Comparison between male and

female classical singers.

References

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