Electropalatography (EPG) to Support Speech Pathology Assessment, Diagnosis and Intervention
Submitting InstitutionQueen Margaret University Edinburgh
Unit of AssessmentModern Languages and Linguistics
Summary Impact TypeSocietal
Research Subject Area(s)
Medical and Health Sciences: Clinical Sciences
Psychology and Cognitive Sciences: Psychology, Cognitive Sciences
Summary of the impact
The impact is primarily in Public Health. It mainly concerns the adoption
of and demand for a speech research technology, Electropalatography (EPG),
for clinical diagnosis and treatment of speech disorders. Our continuing
long-term and interdisciplinary research into EPG has increased our impact
in this census period from the previous RAE2008, during which time the UOA
had already been awarded a Queen's Anniversary Prize (2002) for working
towards the clinical application of speech science.
Financial Support from the charitable sector and the NHS for the training
of classroom assistants and SLTs in EPG therapy is highlighted, along with
user testimonials, unmet demand, and small-scale provision of the therapy.
The underpinning research overlaps the other case study. Here we focus on
the phonetic, linguistic and clinically oriented research that underpins
this case. CAPITALISED names are of individuals contributing outputs to
this UOA in this REF, and other researchers named in this section were QMU
staff (or RAs) at the time of producing the underpinning research.
QMU lecturing staff and researchers have undertaken research into EPG
over two decades, since the appointment of Hardcastle (1991-2009) and
Gibbon (1992-2009). Both led the strategic development of the therapeutic
use of EPG, usually in a medical research context. It was decided to spin
out Articulate Instruments Ltd. (in September 2003) from QMU to enable it
to obtain a CE mark certification for non-research use of EPG as a
clinical healthcare tool. CE marking of EPG for clinical (e.g. NHS) use
was achieved by Articulate Instruments Ltd. in 2004, meeting stringent
safety and quality-insurance regimes required by legislation. This was a
crucial element in promoting the impactful use of EPG in the UK and EU
that had previously been missing. This process also enabled Articulate
Instruments Ltd. to exploit the freedom and flexibility of the commercial
sector to tailor underpinning research to the needs of non-academic users.
Nevertheless, a strategic synergy has been maintained between QMU and
Articulate Instruments Ltd., and collaboration for research and impact
have continued and prospered under WOOD.
The underpinning research is mainly applied or clinically related.
Funding has been obtained through strategic internal investment and
peer-reviewed competitive external grants. The latter clearly provides
evidence of its quality, as does the selection of peer-reviewed outputs
The themes of the underpinning research highlighted in this case address
the following questions:
- How best can EPG be used in a clinical domain as a diagnostic and
therapeutic tool, with what client groups and with what models of
intervention? (Gibbon, WOOD, CLELAND);
- What articulatory patterns, analysis variables, statistical
comparisons and other phonetic characteristics of clinical speech are
characteristic of disordered speech before, during, and after treatment?
(Gibbon, WOOD, Timmins, Hardcastle);
- Does EPG therapy improve the speech of children with speech disorders
resulting from Down's Syndrome? (WOOD, CLELAND, Gibbon);
- Does EPG therapy improve the speech of children with speech disorders
resulting from Cleft Palate? (Gibbon, Roxburgh);
- What are normal speech production patterns? (SCOBBIE, S.SCHAEFFLER,
- What are the psycholinguistic processes underlying real time visual
biofeedback, and how best should the feedback be presented by software?
(CLELAND, SCOBBIE, WRENCH).
It is important to note that the underpinning research has a long time
base. It involves a broad set of QMU-based researchers and employs a
variety of research methods, from electronic and software engineering,
phonetics, laboratory phonology, psycholinguistics, speech technology,
clinical linguistics. It addresses theoretical linguistic questions as
well as clinical and methodological topics, and targets an increasing
range of caseloads.
An MRC research project showed EPG could significantly improve the speech
clarity of children and young people with Down's syndrome. The
underpinning research by WRENCH prior to his departure from QMU to set up
Articulate Instruments Ltd. in 2003 was to:
a. Develop an MS-Windows version of EPG, with a software environment
called Articulate Assistant (AA) that enables the capture, storage, and
analysis of client data with synchronised audio and articulatory patterns
(at 200Hz). The software provides side-by-side therapist/client real time
visual biofeedback and models of correct productions;
b. Develop a different, extendable, multi-channel EPG system ("AAA")
which can be augmented with modules for other articulatory instruments.
(Initially this was EMA, but later developments include video-based
Ultrasound Tongue Imaging and high-speed Ultrasound Tongue Imaging, both
of which are beginning to be applied in a clinical domain).
References to the research
We highlight here research into normative patterns, pathological patterns
and clinical protocols. Evidence of 2* quality: peer-reviewed papers are
, , , , . Bold names were QMU staff at the time. In
the case of Wrench, he was staff in 2002 and Category C in 2004 (cf.
 Hardcastle WJ and Gibbon, FE (1997)
Electropalatography and its clinical applications. In: MJ Ball and C Code
(eds.) Instrumental Clinical Phonetics. Whurr: London, pp.
 Wrench, AA, Gibbon, FE, McNeill, AM, Wood, SE
(2002) An EPG therapy protocol for remediation and assessment of
articulation disorders. Proc. ICSLP-2002, pp. 965-968.
 Scobbie, JM, Wood, SE and Wrench, AA (2004)
Advances in EPG for treatment and research: an illustrative case study. Clinical
Linguistics and Phonetics 18 pp. 373-389.
 Lee, A, Gibbon, FE, Crampin, L Yuen, I and McLennen,
G (2007) The national CLEFTNET project for individuals with speech
disorders associated with cleft palate. Advances in Speech Language
Pathology 9(1) pp. 57-64.
 Wood, S, Hardcastle, WJ and Gibbon, FE (2011) EPG patterns in
a patient with phonemic paraphasic errors. Journal of Neurolinguistics
24(2) pp. 213-221.
 Pouplier, M, Hoole, P and Scobbie, JM (2011) Investigating
the asymmetry of English sibilant assimilation: Acoustic and EPG data. Journal
of Laboratory Phonology 2(1) pp. 1-33.
Details of the impact
The impacts are in healthcare, public awareness, and quality of life. We
detail how we attracted support to undertake impactful activity with EPG,
how the media has presented our work, and the positive effect it has had
on some clients. Its use has been seen in three main clinical areas:
a. speech disorders in children with cleft palate, in cleft palate
centres in UK and Scandinavia;
b. speech disorders in children with hearing impairment, in Cornwall, as
part of a pre-RCT;
c. speech disorders in children, with no known aetiology ("phonological
1. Charitable Funding Awards to provide clinical treatment with EPG
Project #1 - Cleftnet. The support from various charities (£20k
in 2008-2012) maintained a national Cleftnet network linking EPG
therapists in the cleft palate centres in the UK and linking to QMU for
expert support for their caseloads.
Project #2 - Baily Thomas. This support (£37k in 2008-2010, for
"Enhancing Speech Intelligibility in Children and Young People with Down
syndrome") offered EPG therapy to 18 children who had volunteered for an
MRC research project but had been allocated as controls for the
research, therefore receiving either no treatment or conventional
treatment. This donation was "to aid the care and relief of those
affected by learning disability". In all, the MRC research project had
given EPG therapy to 8 children. We have generally not kept records of
parental testimony nor taken quality of life scores as outcome measures,
but we have speech analysis scores that show improved speech as evidence
of impact. Evidence of impact on public awareness and quality of life of
participants is provided by the Client D testimonial (below) from press
Project #3 - Nuffield. This award of £147k, from April 2012-May
2014, ("Improving the speech communication abilities of children with
Down's syndrome: A new model of service delivery using
electropalatography") was mainly for therapy. A component of applied
research is also included, primarily to design therapy protocols that
can be implemented by learning assistants in schools and to assess the
level of improvement in speech. Treatment of 17 children is on-going.
This award also attracted press and TV reports, quoting testimonials
(04/13). The City of Edinburgh Council's Support to Children and Young
People unit was very supportive in preparation and has provided the
liaison, resourcing and support for the classroom assistants and
2. Uptake of training in EPG by therapists
NHS Education Scotland. A CSMEN award (£5k) was made during the
census period to support WOOD to train therapists in EPG and to support
a small clinical caseload of 3 children in Edinburgh, East Lothian and
West Lothian. The actual intervention started after 31 July, so is
detailed in our impact template as future activity. The Clinical Lead
Community Services will corroborate the need for such treatment and
associated training for NHS staff.
EPG workshops (QMU). Whole day workshops (2010, 2011, 2012) have
attracted around 20 clinicians. (The 2013 workshop is a UTI workshop,
associated with Ultrafest VI.)
EPG workshops (elsewhere). Workshops for clinicians have been
run at other locations when QMU staff have been invited and funded to
attend. This shows an on-going demand from professional organisations
for training and discussion of clinicians. Notable events:
- 2008 Stockholm, Sweden, EPG workshop (WRENCH, CLELAND);
- 2009 Salzburg, Austria, EPG workshop (WRENCH);
- 2012 Osaka, Japan, EPG symposium (WRENCH);
- 2012 London, England, ASLTIP (Association of SLTs in Independent
Practice) EPG & Ultrasound workshop (WRENCH, CLELAND);
- 2013 Linköping, Sweden, EPG workshop (WRENCH).
3. NHS trials
Though EPG is not routinely available, small-scale implementations of
therapy associated with research in particular caseloads typically show
improvements to speech.
4. Cleftnet UK
Prior to her departure in 2009, Gibbon coordinated a network of all 14
NHS cleft-palate centres in the UK, offering EPG in all locations to a
small trial caseload.
5. Cornwall trial
There was a pre-RCT trial in Cornwall (2011-2013) of EPG therapy for
children with severe and profound hearing impairment. It was supported
by a Research for Patient Benefit grant (£250k) from the National
Institute of Health Research. Again, this was a mixed research/impact
activity, providing EPG therapy and evaluating the feasibility of a full
RCT leading to improvements to delivery in non-academic contexts.
Improvements in children's speech performance were observed and
reported, providing evidence of impact.
6. Testimonials and public awareness via press coverage following EPG
Client A. EPG therapy (and latterly some that was
ultrasound-based) was given to a 10-year-old girl fitted in infancy with
a cochlear implant, who had been referred by a CASL audiologist (White).
Aged 15, A was keen for her testimonial to be featured in the press and
in other publicity, because, in her words: "The EPG helped me relearn
how to speak. I didn't realise what I was doing wrong before but
seeing the shapes my tongue made on a computer screen made it easy for
me to learn how to change my words. People understand me so much
better now and I don't have to repeat what I say nearly so much. And
having better speech gave me the confidence to be a speaker at a
conference for parents of deaf babies. I wanted to show how well their
children could do when they grow up. Lots of the mums and dads were so
moved they cried - even my mum." The article concludes that Client
A: "now wants more deaf people to benefit from the same techniques
that helped her. "I'm the only one of all my deaf friends who has had
EPG and that's not fair. Everyone should have an equal chance to
improve their speech," she said." (14/05/11)
Clients B and C, Parent, Classroom Assistant. After 3 months of
the Nuffield project, a classroom assistant said: "It's been very
positive... [B, age 11] knows exactly how to produce sounds because
she's seeing them on a screen and she really enjoys using the palate."
"[C]... was also benefitting from the trial, with nine-year-old [X]
also set to get on board." Additionally, B's mother said: "I
think EPG has made her think about the sounds she's producing much
more. The screen makes it easier to imagine the sounds and picture
them, and I think the whole experience has just given her more
confidence." (09/04/13) (See also press coverage 05/02/13,
Client D. D (aged 8) was selected to meet H.M. the Queen when
she opened QMU's new campus in 2008. In April 2012, she voluntarily
contacted the BBC in response to a call for stories to illustrate
"meeting the Queen" as part of the Diamond Jubilee. In 2012, aged 12,
"The Queen watched me doing speech therapy. She was in a room next
door, looking through a window. I was using an electronic palate,
which showed different patterns on the screen when I made different
sounds. I met the Queen afterwards. I was excited, because she's a
character in one of my favourite books - The BFG by Roald Dahl. I told
my mum I would say 'Hello, your Majister', like the BFG, but my mum
said I shouldn't. So I just said, 'Hello, Your Majesty'. The Queen
asked me if I found it interesting working with the electronic palate.
I said 'Yes, I did, your Majesty'." (03/06/2012)
7. Un-met demand for EPG therapy from clinician workshops,
The local model of integrating EPG into available care pathways, devised
in collaboration with local SLT services, concentrates on clinical
activity being targeted towards specific client groups, in small,
manageable cohorts. We therefore discourage unsolicited referrals to QMU
for EPG therapy. Even so, from 2008-2012 WOOD's records confirm we
received 15 enquiries for therapy coming from word-of-mouth contacts of
research participants. Following the February 2013 press stories about
EPG, WOOD received 12 requests for therapy from clinicians and the
general public. In association with calls for participants in
therapeutic case studies, we receive many more referrals than we can
satisfy. A brief 2008 call to SLTs for 2 cases to be the basis of a book
chapter illustrating the methods and results of EPG therapy (Gibbon and
WOOD, 2010) quickly drew 6 referrals. The CSMEN award (2013) to treat 3
children attracted 24 new referrals from local SLTs. After EPG workshops
for about 6 SLTs, we predict a dozen or so referrals. As we
unfortunately lack the resources and mandate to provide a therapeutic
pathway of care and EPG is not yet available on the NHS, we have been
careful not to create unmet demand. Nevertheless, the amount of pent-up
demand revealed by spontaneous enquiries demonstrates impact in a way
that also illustrates some of the ethical difficulties in aiming for
impact in the first place.
Sources to corroborate the impact
These news coverage sources corroborate the quoted public testimonials
selected for use