RESUMEN
This article examines the phonetic and phonologic skills of 2-year-olds with cleft palate. Fifteen children, 10 children with cleft palate and five noncleft children, participated in the study. The children with cleft palate all received palatal surgery after 12 months of age and after the onset of meaningful speech. All subjects were video and audiotaped while interacting with their mothers during unstructured play. At least one hundred different spontaneous word productions were phonetically transcribed and analyzed for (1) percent consonants correct, (2) phonologic processes, and (3) "compensatory" articulation patterns. A comparison between the groups indicated that although the children with cleft palate exhibited more errors overall, they were similar to their noncleft peers in their phonologic process usage with two exceptions. Additionally, few "compensatory" articulation errors were noted in the speech of these children.
Asunto(s)
Trastornos de la Articulación/etiología , Fisura del Paladar/complicaciones , Fonética , Adaptación Fisiológica , Factores de Edad , Preescolar , Fisura del Paladar/fisiopatología , Fisura del Paladar/cirugía , Femenino , Humanos , Masculino , Pruebas de Articulación del Habla , Inteligibilidad del Habla , Grabación en Cinta , Grabación de Cinta de VideoRESUMEN
The relationship between nasalance scores and perceptual judgments of hypernasality and hyponasality was examined for 74 subjects (51 with cleft palate and 23 noncleft controls). Twenty-nine of the 51 subjects with cleft palate had received pharyngeal flap surgery. Predictive analyses were performed to assess the sensitivity, specificity, and efficiency of the Nasometer as a screening instrument. The overall relationship between perceptual judgments of hypernasality and nasalance scores was good for the nonflap subjects when a nasalance cutoff score of 26 was used. A sensitivity coefficient of 0.87 and a specificity coefficient of 0.93 were obtained. Ninety-one percent of the nasometry-based classifications accurately reflected listener judgments of hypernasality. The correspondence between nasalance scores and clinical judgments of hyponasality was also good for the nonflap subjects when a nasalance cutoff score of 50 was used. Ninety-one percent of these classifications were consistent with the listener judgments. Efficiency of nasometry was poorer for the flap subjects.
Asunto(s)
Labio Leporino/fisiopatología , Fisura del Paladar/fisiopatología , Trastornos del Habla/diagnóstico , Percepción del Habla/fisiología , Adolescente , Adulto , Niño , Labio Leporino/cirugía , Fisura del Paladar/cirugía , Femenino , Humanos , Masculino , Manometría , Persona de Mediana Edad , Nariz/fisiopatología , Variaciones Dependientes del Observador , Fonética , Presión , Ventilación Pulmonar/fisiología , Sensibilidad y Especificidad , Trastornos del Habla/fisiopatología , Colgajos Quirúrgicos/métodosRESUMEN
This study examined the influence of familiarity and gender of raters on judgments of facial appearance for individuals with repaired cleft lip and palate. Forty professionals familiar with cleft lip and palate and forty individuals unfamiliar with the disorder were asked to examine photographs of 24 adolescents and rate them for facial appearance. The familiar judges assigned more negative ratings of facial appearance than did the unfamiliar judges. In addition, males responded more negatively than did females. There was also a significant gender by familiarity interaction, with familiar males assigning more negative ratings of appearance than any other group.
Asunto(s)
Labio Leporino/patología , Fisura del Paladar/patología , Estética , Cara , Adolescente , Adulto , Actitud , Actitud del Personal de Salud , Labio Leporino/psicología , Fisura del Paladar/psicología , Femenino , Genética , Humanos , Juicio , Masculino , Enfermeras y Enfermeros , Variaciones Dependientes del Observador , Pediatría , Psicología , Factores Sexuales , Patología del Habla y LenguajeRESUMEN
Results of recent investigations (O'Gara and Logemann, 1990; Estrem and Broen, 1989) indicate that the presence of an unrepaired cleft will influence a toddler's early phonologic development and lexical selectivity. Although additional information is needed to characterize the early vocalizations of children with cleft palate, the available findings underscore the need for early, aggressive speech-language intervention. The education and assistance in language stimulation provided to parents during a child's first year of life can minimize the deleterious effects of an unrepaired palate. Treatment for older children and adults with borderline VPI continues to pose management problems for the SLP. Although new palatal training strategies and tools have been developed and employed with some success, efficacy studies are needed to identify those patients who are likely to benefit from behavioral intervention and those who ultimately will require surgical management.
Asunto(s)
Labio Leporino/cirugía , Fisura del Paladar/cirugía , Trastornos del Desarrollo del Lenguaje/terapia , Terapia del Lenguaje , Complicaciones Posoperatorias/terapia , Trastornos del Habla/terapia , Logopedia , Niño , Preescolar , Humanos , Lactante , Recién Nacido , Trastornos del Desarrollo del Lenguaje/etiología , Grupo de Atención al Paciente , Complicaciones Posoperatorias/etiología , Trastornos del Habla/etiología , Insuficiencia Velofaríngea/terapiaRESUMEN
Maternal language addressed to 1-, 2-, and 3-year-old children with cleft lip and palate was studied. Videotaped interactions were obtained from 23 mother-child dyads (13 mother-cleft lip and palate child dyads, and 13 mother noncleft child dyads) during free play. Results indicated more similarities than differences in maternal language characteristics for the two groups of mothers.
Asunto(s)
Labio Leporino/psicología , Fisura del Paladar/psicología , Lenguaje , Relaciones Madre-Hijo , Preescolar , Empleo , Femenino , Humanos , Lactante , Masculino , Edad Materna , Juego e Implementos de Juego , Lectura , Reproducibilidad de los Resultados , Factores Socioeconómicos , Habla , EnseñanzaRESUMEN
The purposes of this study were to (1) examine the long-term speech status of patients judged to exhibit marginal velopharyngeal competence at 6 years of age and (2) determine whether speech performance data obtained at age 6 could be used to discriminate patients with marginal velopharyngeal competence who eventually demonstrate velopharyngeal incompetence from those who do not. Longitudinal speech performance data were retrieved for 48 subjects and examined descriptively for the total group. Data obtained at the subjects' last evaluation (adolescence) were then used to reassign these subjects into one of three classification groups for estimating velopharyngeal status (competent, marginal, incompetent) on the basis of the clinical ratings of velopharyngeal competence assigned at the time of their last examination in adolescence. Differences in measures of articulation proficiency and hypernasality among the three groups were examined at age 6 using an analysis of variance. A stepwise discriminate analysis was also performed to determine whether the speech data obtained at age 6 could be used to discriminate the three adolescent classification groups. The ANOVA revealed no significant differences among the classification groups in type of articulation errors. Differences in articulation test scores and severity ratings of articulation defectiveness and nasality in connected speech were evident among the groups. The discriminate analysis revealed that the groups could be separated, in part, on the basis of two variables: the severity ratings of articulation defectiveness and nasality.
Asunto(s)
Trastornos de la Articulación/diagnóstico , Fisura del Paladar/complicaciones , Pruebas de Articulación del Habla , Insuficiencia Velofaríngea/diagnóstico , Adolescente , Trastornos de la Articulación/terapia , Niño , Fisura del Paladar/cirugía , Estudios de Seguimiento , Humanos , Estudios Longitudinales , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/terapia , Inteligibilidad del Habla , Logopedia , Insuficiencia Velofaríngea/terapiaRESUMEN
This study compared longitudinally perceptual ratings of articulation defectiveness, nasality, and velopharyngeal competency in 13 subjects who required secondary palatal management after age 10 with a second group. Perceptual data when examined longitudinally did not adequately discriminate between subjects who at one time achieved velopharyngeal closure but who ultimately required secondary management and those patients who needed no further treatment. A decrease in articulation scores and an increase in severity of nasality and articulation defectiveness over time indicate that patients are at risk for secondary management. Evaluation of lateral x-rays indicated that those in the group that required secondary operations demonstrated more variability in velopharyngeal closure than those in the comparison group, who required no secondary operations and that adenoidal involution did not appear to be a significant factor.
Asunto(s)
Paladar Blando/fisiología , Faringe/fisiología , Adolescente , Cefalometría , Niño , Labio Leporino/fisiopatología , Labio Leporino/cirugía , Fisura del Paladar/fisiopatología , Fisura del Paladar/cirugía , Femenino , Humanos , Lactante , Estudios Longitudinales , Masculino , Faringe/cirugía , Habla/fisiología , Trastornos del Habla/diagnóstico , Colgajos Quirúrgicos , Insuficiencia Velofaríngea/diagnósticoRESUMEN
This study was designed as a partial test of a previously hypothesized model for a subgroup of cleft speakers who show marginal velopharyngeal competence during speech. Specifically, speakers in the model were hypothesized to show minimal but consistent nasalization of speech by several criteria. Fifty-two subjects were selected because they met one of the criteria for the model, lateral x-ray films on /s/ that showed touch closure or a small velopharyngeal opening. The subjects were then examined by the other five criteria used for defining the hypothesized model, and were found to meet, in the majority, fewer than three. These findings indicate that lateral x-ray films are not sufficient for identifying this diagnostic subgroup, if it exists. Another possible conclusion is that the model proposed is too simplistic and that cleft palate speakers with marginal velopharyngeal competency typically show more variability in speech performance than was originally implied in the model.
Asunto(s)
Fisura del Paladar/diagnóstico , Insuficiencia Velofaríngea/diagnóstico , Niño , Preescolar , Humanos , Pruebas de Articulación del Habla , Inteligibilidad del HablaRESUMEN
The effectiveness of a 6-week summer residential speech program was evaluated for 13 children with cleft lip and palate or cleft palate only. All children received a pretherapy evaluation followed by 4 hours of articulation therapy daily, for 26 days. Speech status was assessed immediately following the intensive therapy program and again on a 9-month follow-up. The findings of this study indicated that while the subjects significantly improved their articulation performance during the program, their progress was much slower than expected. There was no significant difference between the articulation scores obtained immediately posttherapy and those obtained during the 9-month follow-up examination, even though most subjects had received speech therapy during the year through their public school system. Only 3 of the 13 subjects demonstrated better articulation skills during the follow-up examination.
Asunto(s)
Trastornos de la Articulación/terapia , Labio Leporino/complicaciones , Fisura del Paladar/complicaciones , Logopedia , Trastornos de la Articulación/etiología , Trastornos de la Articulación/fisiopatología , Niño , Femenino , Humanos , Masculino , Pruebas de Articulación del Habla , Logopedia/métodos , Insuficiencia Velofaríngea/fisiopatología , Calidad de la VozRESUMEN
The purpose of this study was to examine the relative contribution of clinical data obtained during speech examinations at age 4 years and at each subsequent age through 13 years to the prediction of judged speech proficiency at age 14 years for children with unilateral cleft of the lip and palate. Psychological scale values of speech proficiency were obtained for 50 adolescents and used as the dependent variable in each analysis. The 16 independent variables used in the analysis at age 4 years included four nonspeech variables (gender, type and age of primary surgery, and pharyngeal flap surgery) and 12 speech measures obtained from speech examination. In subsequent analyses at ages 5 through 13 years, the rate of change between adjacent age levels for each of the 12 speech measures was also included, for a total of 28 independent variables. The data were analyzed using the MAXR stepwise regression procedure, first for the total group of subjects and then separately for males and females. The results of this investigation indicated that a large percentage of the variance in judged speech proficiency at age 14 years can be accounted for, using clinical data obtained for speech examinations at ages 4 through 13 years. When the regression analyses were performed for the total group of subjects at ages 4 through 13 years, the most efficient set of predictors accounted for 50 to 75 percent of the variance in the dependent variable. The variable of gender was identified as the single most important predictor in nine of the 10 regression analyses, alone accounting for at least 40 percent of the variance in judged speech proficiency. When the regression analyses were performed separately for males and females, approximately 50 to 80 percent of the variance was accounted for in judged speech proficiency for males and 50 to 90 percent for females using one, two, or three of the independent variables. The most efficient set of predictors varied across age levels for both groups. In addition, these predictors differed between males and females.
Asunto(s)
Labio Leporino/fisiopatología , Fisura del Paladar/fisiopatología , Trastornos del Habla/fisiopatología , Inteligibilidad del Habla , Adolescente , Niño , Preescolar , Labio Leporino/cirugía , Fisura del Paladar/cirugía , Femenino , Estudios de Seguimiento , Humanos , Masculino , Modelos Biológicos , Probabilidad , Análisis de Regresión , Estudios Retrospectivos , Factores Sexuales , Habla/fisiología , Pruebas de Articulación del Habla , Factores de TiempoRESUMEN
In this study, 129 patients with cleft palate who had pharyngeal flaps were evaluated longitudinally. Articulation scores improved approximately 15 percent following surgery, and by age 16 the majority of subjects achieved velopharyngeal competence and 90 percent correct articulation. The findings also demonstrated that the risk of requiring secondary management increased with the severity of the cleft. In addition, a higher percentage of patients who had received a primary Von Langenbeck procedure required secondary management than did patients who had the Wardill primary palatoplasty. Age at time of the pharyngeal flap operation did not emerge as a critical factor in speech outcome.