Karlind T. Moller

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 bet...

The Presurgical Status of the Alveolar Cleft and Success of Secondary Bone Grafting

OBJECTIVE The primary purpose of this study was to evaluate presurgical status of the alveolar cleft site and success of secondary alveolar bone grafting. DESIGN Thirty patient records were retrospectively reviewed. Patients selected for inclusion had isolated cleft of at least the primary palate. Patients with additional anomalies were not selected. The study population consisted of 15 female sites and 16 male cleft sites. There were two bilateral cleft lip and palate (CLP) patients and 28 unilateral CLP patients. The age at the time of the secondary alveolar bone grafting ranged from 7 years to 14 years, 4 months. SETTING The study was conducted at the Cleft Palate Clinic at the University of Minnesota, School of Dentistry. METHOD Presurgical radiographs taken at least 1 month prior to the secondary bone grafting and postsurgical radiographs taken at least 6 months after bone surgery were measured. Measurements included size of the cleft defect and bone support for distal and mesial teeth adjacent to the cleft. Evaluation of success was determined on the basis of postsurgical measurements of satisfactory, intermediate, and unsatisfactory outcomes. RESULTS AND CONCLUSION The size of the cleft defect was not correlated with the success rate of the secondary alveolar bone grafting. If the amount of distal bone support for the mesial tooth was the same as those in a periodontally healthy individual, a satisfactory outcome was 5.8 times more likely. If the amount of mesial bone support for the distal tooth was the same as those in a periodontally healthy individual, the satisfactory outcome was 3.8 times more likely. Although not a primary purpose of the study, it was found that in this study population, if the patient was female, a satisfactory outcome was 3.8 times more likely.

Perceptions of audible nasal emission in speakers with cleft palate: a comparative study of listener judgments.

Objective Audible nasal emission is a common speech distortion observed in persons with cleft palate. This study examined the validity and reliability of perceptual judgments of audible nasal emission using interval scaling and magnitude estimation techniques. Participants Speech samples were collected from six adolescents with repaired cleft palate, all of whom demonstrated audible nasal emission. A total of 31 adults performed rating tasks in which they judged the severity of audible nasal emission in speech samples. Measures Occurrences of audible nasal emission in speech samples were identified using visual and auditory inspection. Using an acoustic modification technique, samples were digitally modified to amplify perceived occurrences of audible nasal emission to create three stimulus conditions. The original recording of the speech samples served as a control condition. The severity of audible nasal emission in the samples was judged by multiple listeners using interval scaling and magnitude estimation without a modulus. Statistical analysis included analysis of variance, regression, and curve-fitting methods. Results Magnitude-estimation ratings demonstrated stronger evidence of validity and reliability than interval scaling. A curvilinear relationship was found between the sets of ratings. Conclusions The results of this study suggest that audible nasal emission may be a prothetic or ratio-level perceptual continua. Listeners should consider using magnitude estimation or other ratio-based methods for perceptual judgments of audible nasal emission.

Quantitative assessment of dysphagia in patients with primary and secondary Sjögren's syndrome

Dysphagia is a common complaint from patients with salivary gland dysfunction. The purpose of this study was to assess and compare dysphagia in two patient groups with salivary gland dysfunction (primary Sjörgens syndrome and secondary Sjögrens syndrome with systemic lupus erythematosus, and a matched control group. Subjects diagnosed with primary Sjögrens syndrome (n = 13) and secondary Sjögrens syndrome with systemic lupus erythematosus (n = 15) were selected for the study. An age- and sex-matched group of control subjects (n = 14) was selected for comparison. Dysphagia assessments, including videofluoroscopy were performed. Dysphagia was quantified clinically and videofluoroscopically by measurement of 10 seconds of basal or dry swallows as compared with 10-second 10-ml water bolus swallows in all subjects. Subjective evaluations were recorded on a calibrated 10-cm visual analog scale. The results indicated a significant difference in the dry swallows as compared with the water bolus swallows for both salivary gland dysfunction groups and for both dry swallows and water bolus swallows as compared to controls. Videofluoroscopy yielded significantly prolonged pharyngeal transit times in both salivary gland dysfunction groups as compared with control. Subjective results indicated a greater degree of dysphagia symptoms in both the salivary gland dysfunction groups (p < 0.001). Conclusions from this study indicate clinically significant dysphagia in patients with salivary gland dysfunction associated with Sjögrens syndrome compared with a control population.

Factors affecting articulation skills in children with velocardiofacial syndrome and children with cleft palate or velopharyngeal dysfunction: A preliminary report

Objective: To examine the influence of speech perception, cognition, and implicit phonological learning on articulation skills of children with velocardiofacial syndrome (VCFS) and children with cleft palate or velopharyngeal dysfunction (VPD). Design: Cross-sectional group experimental design. Participants: Eight children with VCFS and five children with nonsyndromic cleft palate or VPD. Methods and Measures: All children participated in a phonetic inventory task, speech perception task, implicit priming nonword repetition task, conversational sample, nonverbal intelligence test, and hearing screening. Speech tasks were scored for percentage of phonemes correctly produced. Group differences and relations among measures were examined using nonparametric statistics. Results: Children in the VCFS group demonstrated significantly poorer articulation skills and lower standard scores of nonverbal intelligence compared with the children with cleft palate or VPD. There were no significant group differences in speech perception skills. For the implicit priming task, both groups of children were more accurate in producing primed nonwords than unprimed nonwords. Nonverbal intelligence and severity of velopharyngeal inadequacy for speech were correlated with articulation skills. Conclusions: In this study, children with VCFS had poorer articulation skills compared with children with cleft palate or VPD. Articulation difficulties seen in the children with VCFS did not appear to be associated with speech perception skills or the ability to learn new phonological representations. Future research should continue to examine relationships between articulation, cognition, and velopharyngeal dysfunction in a larger sample of children with cleft palate and VCFS.

Effects of immediate dentures on certain structural and perceptual parameters of speech

1 he consonant /s/ is classified as an unvoiced linguoalveolar fricative and is one of the most frequently misarticulated sounds of speech. According to a study conducted by Fairbanks’ approximately 90% of all speakers with defective articulation have difficulty with the /s/ sound. Previous dental research and clinical reports have been concerned with the effects of denture construction on speech performance. Silverman* suggested that incorrect determination of the vertical dimension of occlusion and improper placement of anterior teeth frequently results in a lisp or substitution of the /th/ sound for the /s/ sound. Tanaka” found that in edentulous patients the placement of a denture resulted in overall improvement of speech with time. He noted that the sounds most frequently in error were the sibilant sounds and that palatal contour can affect certain speech sounds. Boucher’ and Allen’ reported that edentulous patients tend to return to normal speech patterns relatively soon after insertion of dentures, whereas Troffer and Beder” found that normal speech patterns were not observed”

Structural and Functional Causes of Hypernasality in Velocardiofacial Syndrome

Objective: Hypernasality in velocardiofacial syndrome (VCFS) is more severe, persistent, and difficult to manage compared to other populations with cleft palate or velopharyngeal (VP) dysfunction. This pilot study investigated why children with VCFS have more severe hypernasality. Methods: Pressure-flow methodology indirectly measured VP orifice size and VP closure timing during speech in a group of 5 children with VCFS, 5 children with cleft palate, and 6 normal children. Results: Children with VCFS demonstrated significant differences in VP closure timing and hypernasality. There were no significant group differences in VP orifice size. Duration of nasal airflow was the strongest predictor of judgments of hypernasality. Conclusion: This study provides preliminary evidence that VP closure timing may account for the more severe hypernasality in children with VCFS, compared to structural factors alone.

Effects of Extended Speaking on Resonance of Patients with Cleft Palate

Groups of listeners and rating scales were used to study the effects of extended speaking on resonance and voice quality in eight adults with cleft palate and mild to moderate hypernasality and a matched group of noncleft adults, with normal resonance and voice quality. Authors interpret their findings as indicating that resonance changes were greater and vocal quality changes less, for the cleft group, but that changes were not extensive nor always in the direction of increased hypernasality or decreased vocal quality.

Effects of Pubertal Changes on the Speech of Persons with Cleft Palate

The effects of puberty on the speech of persons with cleft palate and normal to moderate degrees of resonance distortion were investigated. Listeners were rated for resonance, articulation, and speech acceptability from recordings made prepuberty and postpuberty for 18 males who received no surgery during the time they went through puberty. Results suggest that changes were minimal and did not always result in speech improvement or deterioration.