Speech Production in Children with Cleft Palate

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Table of Contents

Introduction
Background to the study
Methodology
Summary of articles
The process of speech production
Critique
Recommendations
Conclusion
References

Introduction

Speech production describes the process of translating thoughts into speech. This process includes the selection of relevant grammatical forms and subsequent articulation of the emerging sounds by the motor system with the aid of vocal parts. In a bid to understand spoken language, it is fundamental to establish what restricts the form of speech and the application of speech. Consequently, that will entail a study of how human’s vocal mechanisms produces sounds or of how sounds generate auditory sensations.

However, this process must incorporate the study of perception, memory, and cognition. This paper seeks to examine the process of speech production and perception among children with speech production errors related to cleft palate speech challenges. Cleft palate speech refers to conditions such as altered laryngeal voice quality, disordered nasal airflow, and atypical consonant productions. Children with cleft palate are at risk for speech difficulties most likely those caused by velopharyngeal inadequacy.

The major problem associated with cleft palate is that during speech production, the tongue touches the palate thus interfering with the normal flow of air through the oral cavity. The aim of this paper is to conduct a review of five articles in a bid to establish speech production for children with cleft palate as well as how the findings of the evaluation can help in generating intervention decisions. Instrumental procedures that issue useful information about the function of the velopharyngeal valve will be examined.

Background to the study

In spite of the changes and benefits offered by the medical sector, research indicates that a large number of children with cleft palate indicate speech production problems particularly in articulation and resonance during early childhood. Management of patients with a cleft palate has improved significantly over the past decade. Even though most of the procedures used today are improved surgical techniques that were applied in the past, the outcome is viewed to have improved immensely.

Early intervention through palatal surgery is necessary for better speech production. In an effort to enhance speech production in children with cleft palate, optimal treatment is necessary, especially the intervention measures involving primary palate repair at early stages of development. However, this section seeks to show that early intervention for children with cleft palate is necessary for speech production among the affected population.

Methodology

This study relied on secondary information obtained from various texts and articles selected from large pool materials. The databases used for search the articles include EBSCOhost, JSTOR, PubMed, and NCBI among others. The initial search targeted twenty articles, but only three were chosen based on the richness of evidence regarding the topic. The search focused on identifying articles that offered insights about speech production among children with cleft palate.

The search for relevant sources targeted to establish the different types of cleft palate among preschoolers. The inclusion criteria targeted sources that covered physical (acoustic, aerodynamic, physiological) measures of speech. This search included peer-reviewed articles mainly discussing IT advances in the oil and gas industry. Sources that manifested only phonetic transcription were not selected for this study.

Summary of articles

The first article by Gibbon, Lee, and Yuen (2010) holds that individuals with cleft palate are likely to make many errors when articulating high vowels. This problem occurs after the tongue and the palate come into contact, thus obstructing the normal passage of air through the oral cavity. The authors posit that the “complete contact suggests that the tongue is raised to the extent that it presses up against the palate, obstructing airflow through the mouth and increasing the likelihood of nasalized vowels” (Gibbon et al., 2010, p. 410).

Some of the proposed intervention measures include oral examination, therapy, and velopharyngeal port imaging. Oral examination entails observation of the hard palate and the soft palate to identify any signs of velar elevation that might provide evidence of velopharyngeal closure. However, completion of speech evaluation is necessary before oral examination is conducted. A repaired cleft lip and palate may cause an anterior cross bite that decreases articulatory space and leads to the creation of distortions. Therapy entails decisions to conduct surgery in a bid to eliminate the maladaptive compensatory errors such as pharyngeal substitutions.

If a child manifests these errors, as s/he undergoes surgical management to rectify velopharyngeal function, it is essential for the speech-language pathologist to coach the child to plug the nose during surgery and then focus on the particular lip and tongue placement for desired phonemes. Velopharyngeal port imaging during speech is essential in determining if a surgical process is inevitable and the most suitable procedure to enhance speech production. Hearing loss is also identified as a possible problem to children with cleft palate. These children have high chances of getting fluid in the middle ear as well as infections.

These infections may lead to partial hearing impairment. Since children learn to speak and comprehend speech via hearing, it is critical that ear health and hearing effects are keenly monitored. The author claims that children born with cleft palate may experience a delay in the start of speech sounds. The author suggests various intervention measures to deal with the issue of cleft palate. These measures include speech therapy, surgery and regular ear and hearing tests. This intervention measures seek to assist a child in learning the proper way of using the lips and tongue appropriately during speech. Alternatively, for those children with mild speech errors, providing language-learning opportunities can help develop good speech.

In the second article, Gibbon (2004) posits, “Individuals with cleft palate, even those with adequate velopharyngeal function, are at high risk for disordered lingual articulation” (p. 285). The widely used corrective therapy for this condition is electropalatography (EPG) to help the affected individuals overcome the problems associated with articulation. Gibbon (2004) notes that this problem can resolve itself spontaneously in small children, but as time progresses, the problem becomes almost impossible to disappear without the intervention of therapy.

Therefore, the EPG treatment becomes useful in such situations as it has a feedback mechanism that allows one to monitor the tongue-palate contact patterns during speech. These patterns are then studied and employed during therapy to prevent contact. Gibbon (2004) notes that EPG “is not just a therapy tool; however, the data can provide objective, quantifiable, and clinically relevant information about lingual articulation that adds to our knowledge about speech difficulties experienced by individuals with cleft palate” (p. 286). So far, the use of EPG has allowed researchers to identify eight different patterns of contact between the tongue and the palate in individuals with cleft palate.

The article acknowledges that more research is needed to address missing aspects associated with articulation difficulties in children with cleft palate. For instance, little information is available on the nature of problems experienced when pronouncing consonant clusters.

The third article by Gibbon, Smeaton-Ewins, and Crampin (2005) claims that even with early-cleft repair, some children manifest poor speech defined by abnormal nasal resonance and abnormal nasal airflow. This article examines the signs to determine those that can be rectified via speech therapy, the ones that occur in the course of the child’s growth, and the advanced cases where medical intervention is needed. In cases where VPD is identified, measures like nasoendoscopy should be taken to offer information regarding the capability of the velopharyngeal valve for speech generation and further management of this error.

This article shares further information on effects of cleft on voice by suggesting that patients with cleft palate may also manifest dysphonia. Some of the signs of this condition include gruffness and breathing with difficulties coupled with speaking in low tones. This complexity is caused by increased breathing effort. Besides, dysphonia may also mask nasality, and inhibit perceptual evaluation. Even with early intervention, a majority of children exhibit delays in speech development thus it is necessary to ensure continued therapy to correct speech disorder by the age of 5 years.

The process of speech production

Speech production emanates from the brain where the message and the lexico-grammatical structure build. Then a pattern of organized movements that starts with airflow from the breathing system occurs. The airflow is “regulated at the laryngeal, articulatory, and resonatory arrangement” (Gibbon, 2004, p. 290). The physical production of sounds entails four procedures that include initiation, phonation, nasal mechanisms and articulation.

The initiation mechanism entails the expulsion of the air from the lungs. The phonation process takes over at the larynx that contains the two focal folds. These folds have a gap between them referred to as glottis. In some instances, the glottis can be closed allowing no air to penetrate, it can have a narrow opening that causes the vocal folds to vibrate and make the voiced sounds. The glottis can also be wide open like in the case with normal breathing system. The articulation stage happens in the mouth enabling individuals to distinguish most speech sounds. However, since the palate affects the articulation, the speech sounds are produced depending on the influence of the cleft palate.

Different sounds are generated across the vocal tract. The sounds that come out are dependent on the location and behavior of the intonations. The vowels are generated without any major restriction made by the lip or tongue (Gibbon et al., 2010). The classification of vowels is based on the location and the length of the tongue coupled with how the lips adjust in the process. On the other hand, the consonants are grouped as glottal, velar, retroflex, palatal, dental, and bilabial depending on the location where tongue makes the constriction. Most likely, the pressure consonants are highly affected than the other sounds.

Critique

This paper has reviewed three different articles that manifest consistency in their findings. These articles cover critical areas of speech production among patients with cleft palate such as speech perception and acoustics concerning practical applications as well as theories. However, this review suggests that the claims warrant extended scientific scrutiny. Various theories reckon the presence of a linkage between speech perception and production.

For the motor theorists, the linkage mirrors biological coevolution of the generation and perception systems. However, this manifests a bias for language communities to choose articulations that possess auditory diverse acoustic consequences. However, since most readers are not used to phonetic symbols for speech phonemes, the articles make use of understandable language to communicate.

Recommendations

Speech intervention for patients with cleft palate should commence even before the palate is corrected. In young children, the focus should be on educating the people around the child, especially parents or the people who spend a lot of time with the child, on how to induce the child’s capability to learn and apply the different aspects of language. Several studies agree on the usefulness of parents in assisting children at an early stage on how to learn and use language, which averts different errors in communication.

However, it should be noted that errors resulting from structural defects cannot be restored via speech therapy. In case a structural correction has been carried out, the individual should go through several sessions of speech therapy to ensure the proper production of sounds during speech. Since patients with cleft palate have enough muscle, strength oromotor exercises should be excluded.

Conclusion

The production of speech is a complex motor task that is widely recognized as a medium of communication thus inevitable to human beings. Therefore, young children with cleft palate should be exposed to language simulation exercises to improve their speech production. This process should entail frequent sentence repetition tasks to encourage them to develop speech. Although the speech sounds of children with cleft palate will be nasally produced before correction, these sounds should be encouraged over glottal stops. Essentially, speech production among children with cleft palate is possible if appropriate intervention measures are observed.

References

Gibbon, E. (2004). Abnormal patterns of tongue-palate contact in the speech of individuals with cleft palate. Clinical Linguistics & Phonetics, 18(4), 285-311.

Gibbon, E., Lee, A., & Yuen, I. (2010). Tongue-palate contact during selected vowels in normal speech. Cleft Palate – Craniofacial Journal, 47(4), 405-411.

Gibbon, E., Smeaton-Ewins, P., & Crampin, L. (2005). Tongue-palate contact during selected vowel in children with cleft palate. Folia Phoniatr Logop, 57(4), 181-192.

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