title: Overall intelligibility, articulation, resonance, voice and language in a child with Nager syndrome.
abstract: OBJECTIVE
  The purpose of this study was to provide a description of the language and speech (intelligibility, voice, resonance, articulation) in a 7-year-old Dutch speaking boy with Nager syndrome. To reveal these features comparison was made with an age and gender related child with a similar palatal or hearing problem.
  
  
  METHODS
  Language was tested with an age appropriate language test namely the Dutch version of the Clinical Evaluation of Language Fundamentals. Regarding articulation a phonetic inventory, phonetic analysis and phonological process analysis was performed. A nominal scale with four categories was used to judge the overall speech intelligibility. A voice and resonance assessment included a videolaryngostroboscopy, a perceptual evaluation, acoustic analysis and nasometry.
  
  
  RESULTS
  The most striking communication problems in this child were expressive and receptive language delay, moderately impaired speech intelligibility, the presence of phonetic and phonological disorders, resonance disorders and a high-pitched voice. The explanation for this pattern of communication is not completely straightforward. The language and the phonological impairment, only present in the child with the Nager syndrome, are not part of a more general developmental delay. The resonance disorders can be related to the cleft palate, but were not present in the child with the isolated cleft palate. One might assume that the cul-de-sac resonance and the much decreased mandibular movement and the restricted tongue lifting are caused by the restricted jaw mobility and micrognathia. To what extent the suggested mandibular distraction osteogenesis in early childhood allows increased mandibular movement and better speech outcome with increased oral resonance is subject for further research.
  
  
  CONCLUSIONS
  According to the results of this study the speech and language management must be focused on receptive and expressive language skills and linguistic conceptualization, correct phonetic placement and the modification of hypernasality and nasal emission.
authors.affiliation: Department of Otorhinolaryngology and Speech Language Pathology, University Gent, Belgium. kristiane.vanlierde@ugent.be
authors.forename: Kristiane M
authors.initials: KM
authors.lastname: Van Lierde
authors.forename: Anke
authors.initials: A
authors.lastname: Luyten
authors.forename: Geert
authors.initials: G
authors.lastname: Mortier
authors.forename: Anouk
authors.initials: A
authors.lastname: Tijskens
authors.forename: Kim
authors.initials: K
authors.lastname: Bettens
authors.forename: Hubert
authors.initials: H
authors.lastname: Vermeersch
mesh_terms: D001184:Articulation Disorders / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007805:Language Development Disorders / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D007808:Language Therapy / Q000379:methods; D008297:Male; D008342:Mandibulofacial Dysostosis / Q000150:complications / Q000175:diagnosis; D010700:Phonetics; D018570:Risk Assessment; D012494:Sampling Studies; D013064:Speech Disorders / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D013065:Speech Intelligibility; D013068:Speech Production Measurement; D013070:Speech Therapy / Q000379:methods; D014833:Voice Quality