Speech and Language Issues in the Cleft Palate Population: The State of the Art

Abstract

Objective State-of-the-art activity demands a look back, a look around, and, importantly, a look into the new millennium. The area of speech and language has been an integral part of cleft palate care from the very beginning. This article reviews the development and progression of our knowledge base over the last several decades in the areas of speech; language; anatomy and physiology of the velopharynx; assessment of velopharyngeal function; and treatment, both behavioral and physical, for velopharyngeal problems. Method The clear focus is on the cleft palate condition. However, much of what is reviewed applies to persons with other craniofacial disorders and with other underlying causes of velopharyngeal impairment. A major challenge in the next several years is to sort through speech disorders that have a clear anatomic underpinning, and thus are more amenable to physical management, versus those that may be treated successfully using behavioral approaches. Speech professionals must do a better job of finding and applying ways of treating individuals with less severe velopharyngeal impairment, thus avoiding the need for physical management in these persons or ignoring the speech problem altogether. Conclusion Early and aggressive management for speech and language disorders should be conducted. For most individuals born with cleft conditions, a realistic goal should be normal speech and language usage by the time the child reaches the school-age years.

Surgery for speech in cleft palate patients

“…Treating only the articulation disorders does not seem enough for these patients. It seems more appropriate to consider higher levels of language including abstract thought and reading and writing activities [10,14]. With limited time and resources, intervention that simultaneously addresses both CAD and the linguistic aspects, promises greater efficacy.…”

“…Patients with congenital anomalies including cleft palate often have hypernasal speech. Indeed, excessive nasality or hypernasality is probably the signature characteristic of persons with cleft palate [10]. Resonance distortion is for the most part, the direct effect of coupling of the nasal space with the oral pharyngeal space during articulation.…”

Expressive language skills in Chinese Singaporean preschoolers with nonsyndromic cleft lip and/or palate

“…Research examining language skills in children with CLP has been ongoing for the past five decades [1]. Infants and toddlers with CLP are frequently found to be at increased risk of impairment in speech and language development compared to their peers without CLP [17].…”

“…Commonly reported reasons for language disruption include poor early hearing history, articulation disorders, compromised velopharyngeal integrity, decreased speech and language stimulation, and central auditory processing deficits [1,[24][25][26][27][28][29]. However, there is still insufficient longitudinal research evidence to determine how each aetiology impacts on subsequent language development in children with CLP.…”

Speech summer camp for treating articulation disorders in cleft palate patients

“…These anomalous articulation patterns are usually referred as compensatory articulation disorder (CAD). This disorder severely decreases intelligibility and usually requires a very prolonged period of speech therapy [3,11,12].…”