51 ་ NICHD grantees also are studying the acquisition and development of normal articulatory behavior to provide a basis for diagnosing and treating articulatory problems. Articulation problems are the most common speech disorders, and seven out of every ten individuals with speech disorders have them. One NINDS-supported investigator in Seattle has developed a technique for measuring jaw displacement during the process of speech. This new technique together with the findings from the expanded research on the dysarthrias could provide assistance to the many children affected with articulation problems. Nearly 70 percent of the mentally retarded have some articulation problems. Since most retarded children also manifest other language problems, the intelligibility of their communication depends even more on clear articulation. NICHDsupported investigators at Parsons State Hospital and Training Center and the University of Kansas have developed better methods for improving the articulation of retarded children. One of their major advances applies to the carry-over of more intelligible speech from therapy to everyday use. This is done by allowing stimuli which occur in the child's natural environment to reinforce correct responses acquired in the therapy session. Laryngectomy and Cleft Palate Speech disorders resulting from laryngectomy operations for cancer of the larynx are also being investigated. Dramatic advances have been made in maintaining or restoring speech function following surgery for removal of the larynx which contains the vocal cords. Improved methods of detection are enabling doctors to make an early diagnosis, before the damage is too widespread. In these cases, conservation surgery which removes only the cancerous parts of the larynx provides the best prognosis for the restoration of speech. Following recent approval by the Food and Drug Administration of the use of teflon (suspended in glycerin) for injections to strengthen remaining tissue, restoration of speech and the ability to swallow have been made possible in a large percentage of patients. An exciting advance in larynx surgery was made recently by scientists in Massachusetts. They used a carbon dioxide laser integrated with an operating microscope to selectively evaporate predetermined amounts of abnormal vocal cord tissue. Removal is reported to be precise and rapid. Follow-up examinations indicate normal healing similar to that in clean surgical wounds. A head and neck registry is being kept at Washington University in St. Louis to maintain statistics on the long-term survival rates and quality of life of patients who have undergone larynx removal. For those whose cancer is too widespread for conservation surgery, speech prostheses are being developed by several investigators, while others are conducting animal studies to evaluate the possibility of reconstructing a normal larynx. NIDR-supported scientists at Haskins Laboratories report that the muscle patterns in nasal speech are very different from those in oral speech. In most speech sounds, the passage between the nose and throat (velopharyngeal gap) must be closed to force the airstream out through the articulators--lips and tongue. Most of this closure is controlled by one muscle in the palate. In contrast, m, n, and ng sounds require that some of the airstream be released through the nose. The investigator found that this release requires suppression of the activity of a number of muscles in the palate and side walls of the throat, and that these muscle patterns vary surprisingly from person to person. An additional NIDR-supported study used fiber optics and muscle electrodes to visualize the production of sounds called stops (a gutteral k) made deep in the throat voice box or larynx. In English only one type of stop is used, and that is made by alternately tightening and loosening the vocal folds which 52 vibrate across the voice box. However, other languages require a wider variety of stop sounds, and a comparison of those spoken by a visiting Korean showed that a number of other laryngeal muscles and their controlling nerves are involved in the production of two other types of stop. Among speech studies designed to help the victims of cleft palate, one made at the University of North Carolina shows that, next to the ability to close the velopharyngeal gap, a very important factor to be considered for good speech is the subject's ability to control the size of the mouth opening while making fricative sounds (s, z, f, and v). If the opening is too large, the air pressure in the mouth portion of the voice tract drops too much to articulate these sounds properly. Often, cleft palate victims are so busy trying to close the back of the throat that it is hard for them to close the mouth. The tongue can compensate for other muscles for either the back or front opening but not for both at once. On the other hand, a number of children with cleft palates habitually fail to open their mouths wide enough to speak properly. Speech investigators at Duke University found that simple bite blocks made from wooden tongue depressors and used for a few minutes a day in a summer camp for cleft palate teenagers is a great help in training them to develop better speech habits. A speech specialist at the University of Pittsburgh compared several tests used in various speech and hearing clinics to indicate the vocabulary, language, and mental development of young children four to five years of age. She found that no single test reliably predicts performance of any individual child, and recommends that clinicians use more than one test in connection with the StanfordBinet Intelligence Scale in order to get more reliable results. Voice Prostheses Experimental prosthetic aids include a pneumatic device called the LaBarge prosthesis developed by scientists in New York. The LaBarge prosthesis connects a fistula or hole in the neck to the esophagus so that the air used for breathing can also be used for esophageal speech by vibrating remaining tissue. This procedure, which has had limited use by human voluhteers, is still in the investigative stage. A new type of laryngeal voice prosthesis with no electronic components is undergoing development at the Northwestern University-McGraw Medical Center, Chicago, and affiliated hospitals. Unlike most other voice prostheses, the Northwestern model is designed particularly for those laryngectomy patients who have not yet learned or cannot learn esophageal speech. The artifical larynx can produce a very intelligible voice immediately. Utilizing a hypopharyngeal pseudoglottis for voice, the device has an air bypass tube that shunts expired air from the trachea into a hypo-pharyngeal fistula. The fistula is placed high in the throat so as to take advantage of each patient's natural "vibrator" which has a slightly different location in each patient. Other earlier devices featured fistulas that were lower, near the esophagus--impracticable for patients who had undergone extensive esophageal surgery. NINDS-supported scientists have provided clear insight into the dynamics of respiratory functions specific ly associated with speech and voice production. Since there is a positive correlation between variation in pulmonary expiratory pressures and loudness of sound during phonation, direct control of the expiratory muscles is of importance for the production of speech. A systematic clinical investigation by NINDS-supported scientists at the University of Florida of speaker identification and recognition utilizing eye, ear, and computer technology represents a major contribution in the communicative 53 sciences. Researchers have demonstrated that certain segments of the acoustical signal (voice print) are predictors of certain laryngeal pathologies. This noninvasive technique will permit early, accurate and painless diagnosis of certain laryngeal disorders. Animal and human hearing studies undertaken at the University of Florida compliment the speech investigation and are contributing to the development of a theory of speech production and reception. NINDS-supported researchers at the University of Cincinnati and Washington University, St. Louis, are working to reconstruct the larynx from natural tissue. Animal studies at Cincinnati, for instance, have shown that a functioning larynx in dogs can be made from their own throat tissues. Studies are now being conducted to see if this procedure can be applied to baboons, whose upright stance is similar to that of man. Construction of the new larynx has been completed, and investigators are now attempting to refine construction of the vocal cords. SHARING OUR RESEARCH FINDINGS The dissemination of research findings and their application are considered by NIH to be one of its major functions. Each of the Institutes involved in communication research has held conferences and published proceedings. The latest of a series of conferences supported by NICHD on Communicating by Language was entitled, "The Role of Speech in Language." The proceedings will be published by the M. I. T. Press. A previous conference resulted in a book entitled Language by Ear and by Eye. Highlights of this book, which is now available in a paperback edition, are summarized in a NICHD pamphlet entitled, The Relationships Between Speech and Reading. Other publications in this NICHD series include The Speech Process, The Genesis of Language, and The Reading Process. In co-sponsorship with its Mental Retardation Research Centers, the NICHD has also initiated a series of seminars which will result in state-of-the-art documents for the scientific community on aspects of mental retardation. Recognizing that language ability is a vital element in the development and performance of the mentally retarded, and that language deficiencies are the most commonly shared handicaps of mental retardation, the first seminar in this series deals with language and the mentally retarded. The proceedings resulted in a publication entitled, Language of the Mentally Retarded. To complement this effort a second conference was held bringing together basic scientists and clinicians in the field of language. This resulted in the publication of Language Perspectives--Acquisition, Retardation and Intervention. This conference and publication form a bridge between basic research and clinical application. The The NINDS-supported Information Center has had a number of workshops. proceedings of many of these have been published, including Vascular Disorders and Hearing Defects; Sensory Input in Hearing Impaired Children, and Neuroanatomy of the Auditory System and Physiology of the Auditory System. The Center has also had issued several publications including: Index-handbook of Ototoxic Agents, 1966-1971; Biblio-Profiles (including Homotransplantation, Auditory Physiology, Otitis Media, Surgical Treatment of Deafness, Viral Infection and Hearing, Neuroanatomy of Speech, and Rehabilitation of Language Disorders in Children); research bibliographies; and two directories, Information Sources in Hearing, Speech and Communication Disorders--Publications and Organizations. Available also from NINDS are the following publications: Human Communication and Its Disorders: An Overview--Monograph 10; Reading Forum--Monograph 11; Learning to Talk; and in the Hope through Research series, the following: Hearing Loss, Dizziness including Meniere's Disease, and Acoustic Neuroma. 54 GALLAUDET COLLEGE Gallaudet College: Gallaudet College, established in Washington, D.C. by an Act of Congress in 1857, has as its purpose to provide a liberal arts undergraduate education program for the deaf, a tutorial school for deaf students who need such training to qualify for college admission, a graduate school program in fields related to deafness, and a continuing education program for deaf adults. In 1975, an estimated 986 undergraduates and 212 graduate students will attend the College. In order to promote student development, the College offers a wide variety of learning experiences and instructional options, mediated instruction, significant interaction with the larger society, and experiences which encourage growth toward self-fulfillment, including participation and practice in decision making. In addition, the College offers technical assistance to outside organizations and agencies and services to deaf individuals and persons concerned with the needs of the deaf. Model Secondary School for the Deaf: Public Law 89-694 provides for the establishment of day and residential facilities for the secondary education of young persons who are deaf in order to prepare them for college, other advanced training or employment. The Public Law authorizes the Secretary, after consultation with the National Advisory Committee on Education of the Deaf, to enter into construction of such a school. The agreement was signed in May 1969. The completed school will serve residents of the District of Columbia and nearby states of Virginia, West Virginia, Maryland, Pennsylvania, and Delaware. In 1975, MSSD will have an enrollment of about 130 students. The permanent facilities for the Model Secondary School for the Deaf (MSSD) are presently being constructed on the campus of Gallaudet College. The first phase of construction, including the academic building, will be completed in FY 76. In one of the boldest experiments in the history of American education, students and staff have come together in a school with no classes, in classrooms with no walls, to seek new ways in which today's young deaf students may be educated toward more productive and meaningful lives. An open laboratory school which employs computer-assisted education, educational television, and individualized instruction, the MSSD is, hopefully, a promise of things to come for schools for the deaf throughout the country. It is expected that the MSSD will provide an exemplary secondary school program to stimulate the development of similarly excellent programs throughout the Nation. Kendall Demonstration Elementary School: Under P.L. 91-587, Gallaudet College was authorized by Congress to operate Kendall Elementary School as a national demonstration school for the deaf. In 1975 approximately 175 children will attend the school from the Washington, D.C. area. 50-132 O 75 pt. 1 22 As a demonstration school, KDES is attempting to develop an exemplary educational program for children from the onset of deafness through the age of 15. The School also provides for a diagnostic center and a parent education program. Because of its special focus, Kendall School is also becoming a source of important research on the learning problems of young deaf children. The obligations for fiscal years 1972-76 for Gallaudet College are as follows: 55 Gallaudet $ 7,955,000 $8,779,000 $10,218,000 $12,269,000 $13,985,000 |