Objective To summarize speech outcomes in children born with unilateral cleft lip and palate (UCLP) throughout the United Kingdom. Design Prospective descriptive study on a cross-sectional sample of children. Patients/Participants Data were collected for 238 5-year-olds (born between April 1, 1989, and March 31, 1991) and 218 12-year-olds (born between April 1, 1982, and March 31, 1984) with complete UCLP. Main Outcomes Ratings of intelligibility, nasality, “speech cleft type characteristics” and speech therapy intervention. Conclusions Nineteen percent of 5-year-olds and 4% of 12-year-olds were judged to be impossible to understand or just intelligible to strangers. Thirty-four percent of 5-year-olds and 17% of 12-year-olds had at least one serious error of consonant production. Eighteen percent of 5-year-olds and 12-year-olds had consistent hypernasality of mild, moderate, or severe degree. Approximately two-thirds of both age groups had undergone speech therapy.
S 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. Ces dernières années ont vu un accroissement de l'intérêt porté à la parole chez ceux qui sont affec‐tés d'un palais fendu – du point de vue de sa nature et de la qualité qui en résulte. Le panorama de la recherche contemporaine révèle de nouveaux points de vue sur le développement de la parole dans ce cas et sur les conséquences phonologiques des restrictions articulatoires chez le tout jeune enfant. La parole en cas de palais fendu est perçue comme le résultat d'une synthèse entre les développements physique, physiologique, cognitif et linguistique. Ces influences sont examinées dans le contexte des premières vocalisations d'enfants au palais fendu par comparaison avec celles d'enfants normaux; ensuite l'on examine la documentation sur le développement du babillage chez les premiers, la naissance des premiers mots et le développement consonantique. Puis Von discute du développement de la parole d'un point de vue phonologique selon lequel les caractéristiques rap‐portées ici sont des ‘procédés développementaux du type du palais fendu’, par exemple le manque de stabilisation des objectifs; les articulations compensators; les stratégies actives/passives; et les préférences systématiques pour certains sons. Ces influences sur le développement de la parole remettent en question la mesure dans laquelle l'on do...
SThis paper presents a comprehensive screening procedure for describing the speech characteristics commonly associated with cleft palate andlor velopharyngeal dysfunction. A uni ue method of representin the information visually is proposed. The theoretical back round an% recommendatiom for c&ical ap lication are discussed. This rocedure is designelfor use by specialist and non-specialist speecland language therapists wor&ng in this field. It has been developed primarily with a child population but can be used with all age groups. It rovides a structure for assessment, record keeping, report writing and research, thereby facilitating t A development of intercentre studies.Cette communicahn prhente une prockdure de &pistage exhaustif en vue de &crire les caractdristiques de parole associkes commudment au palais fendu etlou a des dysfonctions vklopharyngales. L'on propose une mkthode originale pour reprksenter visuellement les renseignements. La discussion traite des bases thkoriques ainsi que des recommandations pour une application clinique. La rockdure est destinke a l'usage des thkrapeutes de la parole et du langage qui travaillent dans ce &mine, qu'ik soient spkcialistes ou non. Elle a ktk mise au point au dkpart au contact dune population enfantine mais peut s'utiliser avec toutes les classes d'rige. Elle fournit une structure pour l'kvaluation, la conservation des donnkes, la rkdaction des ra ports et la recherche, ce qui devrait faciliter le dkveloppement d'kchanges scientifiques entre d d r e n t s centres. Eine wnfassende Untersuchungsmethode wird vorgestellt, die der Erfasung von den iiblicherweise mit Gaumenspalten bzw. mit velopha ngaler Dys nktion assoziierten Sprechcharakteristiken dienen. Eine neue Methode wird vorgesch%gen, wn k Information visuell hrzustellen. Der theoretische Hintergrund und Empfehlungen fur die klinische Anwendun werden diskutiert. Die Methode ist f i r den Einsatz durch Spezialisten und durch allgemeine Sprec f und Sprachtherapeuten, die in diesem Bereich arbeiten, beabsichtigt. Sie ist in Verbindung mit Kindern entwickelt worden, kann aber m't allen Altersgruppen angewandt werden. Sie bietet eine Struktur f i r Evaluierung, Datenerjassung, Berichterstamuzg und Forschung und fordert h i t die Entwicklung von inter institutionellen Studien.
Cleft palate speech is generally characterised by hypernasality 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 as described by Hutters and Brondsted (1987). Passive characteristics are the product, not of disordered articulatory patterns, but of structural abnormality or dysfunction. Active characteristics are alternative articulatory gestures which function in place of intended consonants. Passive and active patterns of articulation will be described and defined in the context of three longitudinal studies: five bilateral left 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. The effects of surgery on the speech of seven subjects will be 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. This distinction between active and passive patterns of articulation can 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 destabilisation in a course of speech and language therapy before the potential benefits of surgery can be properly assessed.
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