Occurrence of consonant production errors in liquid phonemes in children with operated cleft lip and palate

Abstract

Information about the prevalence of consonant production errors, including compensatory articulations (CA), in individuals with cleft lip and palate (CLP) who speak Brazilian Portuguese is limited, particularly regarding liquid sounds. The literature primarily reports the occurrence of CA for plosive and fricative sounds, since occurrence of CAs in sounds that require higher amounts of oral air pressure is expected. While the use of CA during liquid sound production is not expected, clinical experience suggests that individuals with CLP present with inadequate backing, elevation, and anteriorization of the tongue as well as tongue clicks during production of /r/ and /l/.ObjectivesDescribe the occurrence of consonant error productions during liquid sounds for children with CLP; compare the occurrence between children operated with the Furlow and von Langenbeck techniques for palatoplasty; and compare the occurrence between children operated between 9-12 months and 15-18 months of age at primary palatoplasty. Material and MethodsA sample of 397 children (237 males and 160 females) with operated unilateral CLP was studied. In this group, 163 underwent palatoplasty with the Furlow procedure and 234 with the modified von Langenbeck procedure. Age at palatoplasty was between 9 and 12 months for 189 children and between 15 and 18 months for 208 children. Data about production of /l/, /r/, /R/, /λ/ and consonant clusters /l/ and /r/ were obtained from speech pathology records. Speech pathologists registered the speech findings after an auditory-perceptual evaluation of the participants at the sixth year of age. ResultsThe use of middorsum palatal place (MDP) of production was identified for 2% of the sample. Tongue anteriorization of the /l/ production was observed for 55% of the children. No significant difference was found related to surgical technique, but children operated earlier developed the use of the consonant cluster /r/ sooner than children operated later (p=0.040). ConclusionWe found a low occurrence of use of cleft related CA during attempts of production of liquid phonemes, and the variable age at primary palatoplasty significantly interfered with the acquisition of consonant cluster /r/.

Original article. Articulation disorders and patterns in children with a cleft

“…Both articulation patterns, that were posterior and beyond the uvular place: pharyngeal or glottal and abnormal backing of oral targets, but oral: mid-dorsal palatal, velar or uvular were the most frequent substitution for oral sounds since occurrence of CAD requires higher levels of oral air pressure, therefore, abnormal backing is the common substitution for oral sounds. These CAD abnormalities are under patients' control and can be corrected with speech therapy [14,33]. Thirty-two children (76%) with CP ± L presented with functional articulation disorders and 6 children (14%) with CP ± L had phonological errors.…”

“…CAD are generally developed from inadequate oral pressure for oral consonants caused by velopharyngeal insufficiency. Production of sounds further back in the mouth (or throat) are substituted to compensate for the inadequate oral pressure therapy, such as glottal stop for oral plosive, pharyngeal or nasal fricative for oral fricative, and, use of mid dorsum palatal place of production [14]. CAD severely affects intelligibility and usually requires a prolonged period of speech therapy.…”

Perfil da fala de pacientes submetidos à palatoplastia primária

“…According to Perry and Kuehn (9) , the occurrence of CADs justifies speech-language therapy, and the cases without velopharyngeal insufficiency (VFI) justify periodic speech-language pathology monitoring in order to avoid speech and articulation alterations. The CADs, along with hypernasality, are the most common changes in the speech of patients with palate cleft (14,18) . Speech understandability inadequacy is another commonly present alteration in cleft patients (5,6,11) .…”

“…Perceptual clinical evaluation of speech is considered the main indicator of velopharyngeal dysfunction, and it is an essential part of clinical diagnostics (18) . Although subjectively, this assessment allows identification of changes, measurement of severity, and evaluation of effectiveness of the treatments performed (18,19) .…”

“…Although subjectively, this assessment allows identification of changes, measurement of severity, and evaluation of effectiveness of the treatments performed (18,19) . Over time, studies (19) have been concerned with improving auditory-perceptual assessment in order to make it less susceptible to errors arising from its subjectivity.…”