Cleft Palate Speech

Sara Howard is Reader in Clinical Phonetics,?University of Sheffield, UK. Anette Lohmander is Professor and Head of Division of Speech and Language Pathology, Department of Clinical Science, Intervention and Technique, Karolinska Institutet, Sweden.

List of Contributors xi

Preface xvii

Part One Speech Production and Development 1
Sara Howard and Anette Lohmander

1 Physical Structure and Function and Speech Production Associated with Cleft Palate 5
Martin Atkinson and Sara Howard

1.1 Introduction 5

1.2 The Hard and Soft Palates and the Velopharynx 6

1.3 The Tonsils and Adenoids 9

1.4 The Larynx 11

1.5 The Jaws, Dentition and Occlusion 12

1.6 Symmetry: Structure and Function 15

1.7 The Tongue 16

1.8 The Lips 18

1.9 Summary: Compensations Across Systems 19

References 19

2 The Development of Speech in Children with Cleft Palate 23
Kathy L. Chapman and Elisabeth Willadsen

2.1 Overview 23

2.2 The Impact of Clefting on Speech Production 24

2.3 Variables Impacting Speech Development for Young Children with Cleft Palate 25

2.4 Speech Development: Birth to Age Five 26

2.5 Conclusion 35

References 36

3 The Influence of Related Conditions on Speech and Communication 41
Christina Persson and Lotta Sjögreen

3.1 Introduction 41

3.2 Conditions Related to Structural Etiologies 42

3.3 Conditions Related to Neurological Aetiology 47

3.4 Conditions Related to a Combination of Structural and Neurological Aetiology 49

3.5 Clinical Implications 50

References 50

4 Surgical Intervention and Speech Outcomes in Cleft Lip and Palate 55
Anette Lohmander

4.1 Introduction 55

4.2 Basics of Surgery on Cleft Palate 57

4.3 Basics of Outcomes 64

4.4 Speech Outcomes 65

4.5 Conclusion 69

Appendix 4.A Review of Evidence and Methodology in Studies of Speech Outcome in Individuals Born with Cleft Lip and Palate 70

References 82

5 Secondary Management and Speech Outcome 87
John E. Riski

5.1 Introduction 87

5.2 Secondary Surgical Management of Velopharyngeal Incompetence 88

5.3 Secondary Pharyngeal Flap 88

5.4 Posterior Pharyngeal Wall Augmentation by Muscle Transposition 91

5.5 Studies Comparing Treatments of VPI 94

5.6 Posterior Pharyngeal Wall Augmentation by Implants and Injections 95

5.7 Velarplasty 96

5.8 Other Considerations in Managing VPI 97

5.9 Complications Secondary to Pharyngoplasties 99

5.10 Conclusions 99

References 100

6 Cleft Palate Speech in the Majority World: Models of Intervention and Speech Outcomes in Diverse Cultural and Language Contexts 105
Debbie Sell, Roopa Nagarajan and Mary Wickenden

6.1 Introduction 105

6.2 Speech Outcomes in a Majority World Context 106

6.3 Different Models of Provision 109

6.4 Attitudes/Cultural Aspects 115

6.5 Conclusion 119

References 119

Part Two Speech Assessment and Intervention 123
Anette Lohmander and Sara Howard

7 Phonetic Transcription for Speech Related to Cleft Palate 127
Sara Howard

7.1 Introduction 127

7.2 What is Phonetic Transcription? 128

7.3 Why Transcribe? 129

7.4 What to Transcribe and How to Transcribe It 130

7.5 Features of Cleft Speech Production 131

7.6 Pitfalls of Transcription 134

7.7 Conclusion 138

Appendices 139

References 142

8 Instrumentation in the Analysis of the Structure and Function of the Velopharyngeal Mechanism 145
Debbie Sell and Valerie Pereira

8.1 Introduction 145

8.2 Visualization of the Velopharyngeal Mechanism 147

8.3 Multiview Videofluoroscopy 147

8.4 Nasendoscopy Procedure 151

8.5 Magnetic Resonance Imaging (MRI) 155

8.6 Variability in Practice 158

8.7 Future 162

References 162

9 Cross Linguistic Perspectives on Speech Assessment in Cleft Palate 167
Gunilla Henningsson and Elisabeth Willadsen

9.1 Introduction 167

9.2 Vulnerable Speech Sounds 168

9.3 Language Background of the Listener Assessing the Speech of Children with Cleft Palate 170

9.4 What Is Known about More Unfamiliar Languages? 173

9.5 Cross Linguistic Speech Samples 173

9.6 Influence on Assessment of Language Acquisition in the Young Child with Cleft Palate 176

9.7 Conclusion 177

References 177

10 Voice Assessment and Intervention 181
Lesley Cavalli

10.1 Introduction 181

10.2 Defining a Voice Disorder 181

10.3 Assessment 184

10.4 Instrumental Assessment 189

10.5 Vocal Handicap Measures 190

10.6 Treatment 191

10.7 Conclusion 195

References 196

11 Nasality – Assessment and Intervention 199
Triona Sweeney

11.1 Introduction 199

11.2 Perceptual Assessment of Nasality and Nasal Airflow Errors 205

11.3 Instrumental Assessment of Nasality and Nasal Airflow Errors 207

11.4 Interpreting Results 211

11.5 Intervention 214

11.6 Conclusion 216

Appendix 11.A Temple Street Scale of Nasality and Nasal Airflow Errors 217

References 217

12 Articulation – Instruments for Research and Clinical Practice 221
Fiona E. Gibbon and Alice Lee

12.1 Introduction 221

12.2 Electropalatography (EPG) 222

12.3 Imaging Techniques 228

12.4 Motion Tracking 233

12.5 Conclusion 235

Acknowledgement 235

References 235

13 Psycholinguistic Assessment and Intervention 239
Joy Stackhouse

13.1 Introduction 239

13.2 What is a Psycholinguistic Approach? 240

13.3 A Psycholinguistic Assessment Framework 242

13.4 Intervention from a Psycholinguistic Perspective 245

13.5 Literacy: Phonological Awareness and Spelling 250

13.6 Summary 254

References 255

14 Early Communication Assessment and Intervention 259
Nancy Scherer and Brenda Louw

14.1 Introduction 259

14.2 Assessment 260

14.3 Intervention 267

References 272

15 Phonological Approaches to Speech Difficulties Associated with Cleft Palate 275
Anne Harding-Bell and Sara Howard

15.1 Introduction 275

15.2 Variability, Variation and Compensation 277

15.3 Classification of Speech Difficulties Related to Cleft Palate 278

15.4 Phonological Assessment of Speech Data Related to Cleft Palate 278

15.5 Phonological Consequences of Speech Production Related to Cleft Palate 279

15.6 Intervention 283

15.7 Summary 287

References 288

16 Speech Intelligibility 293
Tara L. Whitehill, Carrie L. Gotzke and Megan Hodge

16.1 Introduction 293

16.2 Definition of Intelligibility and Related Concepts 294

16.3 Measurement Issues 294

16.4 Studies of Intelligibility in Speakers with Cleft Palate 296

16.5 Current and Future Developments 298

16.6 Conclusion 300

References 301

17 Communicative Participation 305
Christina Havstam and Anette Lohmander

17.1 Introduction 305

17.2 ICF 306

17.3 Communicative Participation 307

17.4 Conclusions and Clinical Implications 312

References 312

18 Evaluation and Evidence-Based Practice 317
Linda D. Vallino-Napoli

18.1 Introduction 317

18.2 Intervention for Speech Disorders 318

18.3 Evidence-Based Practice 319

18.4 The Systematic Review Process 323

18.5 Evidence Findings Establishing Therapy Effectiveness 325

18.6 Instrumentation – Visual Feedback 349

18.7 Surgery 350

18.8 Comments about Intervention Effectiveness 351

18.9 Intervention and the International Classification of Function (ICF) 352

18.10 Research Designs for Intervention Studies 352

18.11 Conclusions 352

Appendix 18.A Commonly Used Evidence Hierarchies for Intervention Studies 354

References 354

Index 359