Pamela Grunwell

GOS.SP.ASS.'98: an assessment for speech disorders associated with cleft palate and/or velopharyngeal dysfunction (revised)

In 1994 the present authors proposed a speech assessment protocol for speech disorders associated with cleft palate and/or velopharyngeal dysfunction known as GOS.SP.ASS. (Great Ormond Street Speech Assessment). In a recent survey undertaken to review the different speech assessment protocols used in six cleft palate centres in the UK, GOS.SP.ASS. was selected from six protocols as the optimal procedure for clinical and research purposes. The process of identifying an optimal procedure involved analysis of completed forms for each assessment. Analysis of the completed GOS.SP.ASS. forms revealed significant ambiguities in the protocol which led to differences in form completion. This paper describes important revisions to the original GOS.SP.ASS. protocol in order to ensure comparable data from different clinicians. This detailed speech assessment is now complemented by the Cleft Audit Protocol for Speech (CAPS), a tool recommended for clinical audit. As a result of close collaboration in their preparation, the results are directly comparable. In addition, the speech elicitation sentences and the phonetic diagram have been modified.

Characteristics of cleft palate speech

In recent years, interest in the nature of cleft palate speech and the influences on speech quality has increased. This overview of contemporary research reveals new perspectives on cleft palate speech development and the phonological consequences of early articulatory constraints. Cleft palate speech is perceived as the result of the synthesis between physical, physiological, cognitive and linguistic development. Developmental influences on cleft palate speech are considered in the context of early vocalisations of cleft and non-cleft children, followed by an examination of the literature on the development of babble, the emergence of early words and consonant development in children born with cleft palate. Speech development is then discussed from a phonological perspective interpreting reported characteristics as cleft-type developmental processes, for example, lack of target stabilisation; compensatory articulations; active/passive strategies; and systematic sound preference. Given these influences on speech development the extent to which cleft palate speech should be regarded as an articulatory disorder has been reconsidered. Descriptions and interpretations of nasal resonance, nasal emission, and nasal turbulence are followed by discussion of articulatory errors in place and manner and patterns of change in cleft palate speech. Finally, some of the available evidence on speech in relation to structural imperfections, such as unrepaired clefts, velopharyngeal insufficiency, oro-nasal fistulae, dental and occlusal deviations, and open-mouth posture is summarised briefly. These new perspectives aim to facilitate more effective clinical management and to provide indications for future research.

Active versus passive cleft‐type speech characteristics

Cleft palate speech is generally described in terms of nasal resonance, nasal emission and compensatory articulations. A longitudinal study of children at different stages of surgical treatment revealed a distinction between passive and active cleft-type speech characteristics whereby passive characteristics were thought to be the product of structural abnormality or dysfunction and active characteristics were specific articulatory gestures replacing intended consonants. Passive and active patterns of articulation are described and defined in the context of three longitudinal studies of subjects who were at various stages of two different surgical regimes: five bilateral cleft lip and palate (BCLP) subjects aged 1;6-4;6, 12 mixed unilateral cleft lip and palate (UCLP) and BCLP subjects aged 4;6-7;6 and nine mixed UCLP and BCLP subjects aged 9;0-11;0. Reference is also made to data from 12 mixed cleft-type subjects aged 13;0 who had been treated with different surgical timing regimes. Comparison is made between the incidence of active versus passive processes in relation to oral structure. At age 4;6 speech samples taken from BCLP subjects who had been treated with 1-stage versus 2-stage palate repair all evidenced both active and passive processes. The lack of differentiation in speech results irrespective of their current surgical status, i.e. completely repaired palates versus residual cleft of the hard palate, was unexpected. Cleft-type processes in completely repaired subjects might be accounted for by the inevitable anterior defect following repair of a bilateral cleft. Older subjects with structural defects also evidenced more cleft-type processes. The relevance of distinguishing between active and passive processes is underlined by consideration of the effects of structural changes following surgery. The effect of surgery on seven subjects speech is discussed using the active/passive distinction. Active cleft-type characteristics did not change as a direct result of surgery, whereas passive characteristics were largely eliminated following surgery. A specific distinction is made between active and passive nasal fricatives, with the implication that active nasal fricatives may not be affected by surgical intervention, whereas passive nasal fricatives may be eliminated by surgery. Accurate distinction between active and passive patterns of articulation may serve to identify those cleft-type speech error patterns most likely to respond to surgical intervention. Indications from this study are that active cleft-type characteristics require destabilization in a course of speech and language therapy before the potential benefits of surgery can be properly assessed. An analytical protocol for the interpretation of speech samples is presented and some therapy strategies are proposed for active and passive processes.

A phonetic framework for the cross-linguistic analysis of cleft palate speech

The Eurocleft Speech Group was formed in 1989. The group is made up of eight speech and language therapists/logopedists from the six centres involved in the Eurocleft Orthodontic study, (Amsterdam/Rotterdam, Copenhagen, London, Manchester, Oslo, Stockholm) a clinical phonetician/speech and language therapist, (advisor on statistical analytical techniques) and a professor of clinical linguistics (director of the group). This six-centre international study of cleft palate speech presented major methodological problems, which appeared to be unprecedented in this area of speech pathology research. A research protocol had to be devised that would provide comparable information about the speech of children from five different language backgrounds. This paper describes the analytical framework developed for this purpose. This framework takes account of the common phonetic characteristics of the five target languages and the possible effects of the cleft palate condition on the realization of these phonetic targe...

A play-based methodology for assessing idiom comprehension in children with semantic-pragmatic difficulties.

In response to the lack of suitable material for assessing idiom comprehension in children with semantic-pragmatic difficulties, a new, play-based methodology is presented. The child listens to a tape-recorded story into which are embedded a range of idiomatic expressions. The child then acts out the story as it is played again, sentence by sentence. The play is video-recorded and transcribed. Actions for each idiom are categorised and are then amenable to within-child, between-child, and between-group analyses. The results of a pilot project indicate that this methodology overcomes may of the problems inherent in assessing children identified as having semantic-pragmatic difficulties.

A note on: Describing types of nasality

In the description of nasality in normal, typical speech the range of different types of nasal segments is relatively small. In the speech of individuals with atypical oronasal structure and/or function there is a much greater range of types of nasality. This note amplifies and extends the categories of atypical nasality described in Duckworth, Allen, Hardcastle and Ball (1990 Clinical Linguistics & Phonetics, 4, 273–283).

Changing phonological patterns

This paper reviews developments over the past decade in the clinical investigation and management of children with developmental phono logical disorders. It examines three aspects of this investigation: descrip tive assessment procedures, patterns of disorder, and treatment strategies. New approaches for clinical practice are described in all three areas.