Cleft lip and/or palate have many implications on speech, so an integral part of repair is speech therapy provided by a speech-language pathologist. Due to cleft lip and/or palate’s effect on speech and language development, speech therapy is an important part of the treatment process. Speech therapy can help children learn how to properly use their articulators after the anatomy has been structurally repaired. Speech therapy helps with the articulation and language development early on for children which also gives them a chance for better academic success.
Velopharyngeal function is an important part to achieve normal speech. The separation of the nasopharynx and the oropharynx needs to be achieved to obtain normal sounding speech. While the velopharyngeal function needs to be surgically repaired before therapy will work there are treatments to help strengthen the muscles so that it acts as the velopharyngeal function should during the production of speech. Velopharyngeal dysfunction and treatment cannot be determined by a speech-language pathologist alone.
Instead, it takes a team effort to determine repair eligibility and achieve the best possible outcomes for the child. There are two different types of video studies that can be done to help show the velopharyngeal function of a child. Videonasopharyngoscopy gives images of the entire vocal tract in motion during articulation and muliplanar videofluoroscopy provides x-ray images of the vocal tract. Both of these techniques are used because it is important to see the velopharyngeal closure on all sides of the velopharyngeal valve (Marsh, 2009; Ysunza et al. , 2015).
Nasal emissions can be a result of velopharyngeal dysfunction. When too much or not enough air comes through the nasal cavity and oral cavity during speech it can make your speech sound breathy or hoarse. This can also affect intelligibility. Thus making the child more difficult to understand. There are many tools that can help measure the amount of hypernasality or hyponasality. One such tool was designed by Cler, Lien, Braden, Mittleman, Downing, and Stepp (2016), and helps measure the amount of nasality found in speech. Nasal Accelerometry measures the amount of nasality on sounds that are plosive such as /p/.
It is measured on these sounds to help the nasal accelerometry tool differentiate between normal air emittance which you need to produce certain sounds such as /m/. During therapy, it is extremely difficult to teach someone to use less or more nasal emittance when speaking so the use of nasopharyngoscopic biofeedback is a great way to allow clients to visualize the air that they are utilizing. Getting a visual of the nasal emittance that is taking place during speech allows clients to try new ways to produce a sound and visually see how the change is helping the nasality.
Visual feedback can be a great tool to help children learn how to control the amount of nasality used during speech (Neumann & Romonath, 2012). Jaw-orthopaedics are sometimes used to help therapists correct cleft palate speech characteristics when a necessary surgery is not planned. Jaw-orthopedics is a prosthetic that is worn by the child that helps form the correct necessary articulator movement for speech before surgery takes place. This can help so that compensatory strategies are not used during the time period before surgery can be scheduled (Lohmander, Lillvik, Friede, 2004).
Articulation is difficult for many children with cleft lip and/or palate. It is important to help these kids with the correct articulation to better develop their language and reading abilities. Since many children with cleft lip and/or palate develop compensatory strategies that affect the placements for articulation, it can be difficult to know where they are placing their tongue during sound production. In cases like this, it would be beneficial to use electropalatography (EPG). EPG can help therapists and children see exactly the spot that the tongue is during articulation of different sounds.
This can better help the therapist teach the child to reposition the tongue for a more accurate production of the sound. Keep in mind that even though this is a great resource to use when available, they are unfortunately not found in many clinics, schools, and other therapy centers. However, they can greatly help in the development of articulation goals for children with articulation disorders related to cleft lip and/or palate (Gibbon, Ellis, & Crampin, 2004). The phonological approach and the articulation approach are two of the approaches used to treat speech sound disorder.
There is some debate on the best approach to use when treating the errors that are found in cleft palate speech. Some research shows that using an articulation approach where the focus is on controlling the articulators and placing them in the correct position is the best treatment method (Ysunza, Repetto, Pamplona, Calderon, Shaheen, Chaiyasate,& Rontal, 2015). However, there is also a great amount of research that shows that a phonological approach may be more beneficial for children with cleft lip and/or palate.
In the phonological approach, the child is not learning only how to control the articulators but also an entire rule system when producing the sounds necessary for speech. (Ysunza, et. al. 2015). The phonological approach was researched during a whole-word process. Ingram & Ingram (2001) found that whole-words can be used to develop sounds not already developed based on the idea that we develop and learn words and not individual sounds when we talk in everyday life.
Under this approach, treatment would involve words that increase in complexity as the child can make the correct production of the less complex words. This approach can help therapists develop goals for each child. While there are not many ways in which to measure phonological abilities within young children, one method was used in a study that determined that phonological abilities are a great predictor of academic success (Scherer, Williams, Stoel-Gammon, & Kaiser, 2012).
Being able to measure the phonological abilities of a child with cleft lip and/or palate is important in the development of goals as well as the treatment process. It was found that children with cleft palate have a very significant delay in phonetic inventory and phonetic accuracy when compared to children with no cleft lip and/or palate. This suggests that phonological approaches to treatment may help them in later years of academics as well (Scherer, Williams, Stoel-Gammon, & Kaiser, 2012).
Parental involvement plays an important role in the speech process for children with cleft lip and/or palate (L, Joan, & Kumar, 2007). Evidence has shown that the more involved parents are in the therapy for their children the more intelligible children become. Continuing therapy at home is a great benefit that continues the practice children get during therapy. It helps generalize the skills needed to have intelligible, fluent speech. The more communication between child and caregiver the better off the child will be regarding practicing their speech sounds and communication (L, Joan, & Kumar, 2007).