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INTRODUCTION: Patients with cleft palate (PCP) frequently show compensatory articulation disorder (CAD). Compensatory errors require a prolonged period of speech intervention. Scaffolding strategies are used for correcting placement and manner of articulation. OBJECTIVE: To study whether some strategies commonly used in speech therapy for correcting compensatory articulation errors, can be more effective depending on severity of CAD in PCP. MATERIALS AND METHODS: Fifty PCP were studied. All patients showed velopharyngeal insufficiency (VPI) and CAD. Transcriptions of speech therapy sessions were revised in order to quantify positive changes in articulation. Correlation between effectiveness of each strategy and degree of severity of CAD was assessed. Also, different strategies were compared in order to determine whether some strategies were more appropriate for specific levels of severity of CAD. RESULTS: There was a significant relationship between the success of some strategies, as measured by the number of positive changes in articulation, and the degree of severity of CAD in PCP. CONCLUSION: There seems to be a relationship between effectiveness of some speech therapy strategies for correcting compensatory articulation errors and severity of CAD. Assessment of severity of CAD appears to be useful for planning speech intervention in PCP. Selected speech therapy strategies could be used according to severity of CAD.

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INTRODUCTION: Compensatory articulation disorder (CAD) severely affects speech intelligibility of cleft palate children. CAD must be treated with speech therapy. Children can manage articulation better when they use language in event contexts such as every day routines. OBJECTIVE: The purpose of this paper is to study and compare two modalities of speech intervention in cleft palate children with associated CAD. The first modality is a conventional approach providing speech therapy in 1-h sessions, twice a week. The second modality is a speech summer camp in which children received therapy 4h per day, 5 days a week for a period of 3 weeks. We were aimed to determine if a speech summer camp could significantly enhance articulation in CP children with CAD. MATERIALS AND METHODS: Forty-five children with repaired cleft palates who exhibited CAD were studied. A matched control group of 45 children with repaired cleft palate who also exhibited CAD were identified. The patients included in the first group attended a speech summer camp for 3 weeks. The matched control subjects included in the second group received speech therapy aimed to correct CAD twice per-week in 1-h sessions. RESULTS: At the onset of either the summer camp or the speech therapy period, the severity of CAD was evenly distributed with non-significant differences across both groups of patients (p > 0.05). After the summer camp (3 weeks) or 12 months of speech therapy sessions at a frequency of twice per-week, both groups of patients showed a significant decrease in the severity of their CAD (p < 0.05). However, when the distribution of the severity of CAD was compared at the end of the summer camp or the speech therapy period, non-significant differences were found between both groups of patients (p > 0.05). CONCLUSIONS: A speech summer camp is a valid and efficient method for providing speech therapy in cleft palate children with compensatory articulation disorder.

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INTRODUCTION: Superiorly based pharyngeal flaps and sphincter pharyngoplasties are the two main possibilities for the surgical treatment of hypernasality in velopharyngeal dysfunction. Videonaspharyngoscopy and multi-view videofluoroscopy can provide anatomical and physiological data for planning these surgical procedures for correcting hypernasality. AIM: This study was undertaken to assess the planning and outcome of pharyngeal flaps and sphincter pharyngoplasties for correcting velopharyngeal insufficiency. The surgical techniques were customized according to the findings of videonasopharyngoscopy and multiview videofluoroscopy. MATERIALS AND METHODS: Seventy patients with repaired palate clefts and residual velopharyngeal dysfunction were studied. The patients were randomly divided into two groups. The first group received a pharyngeal flap. The second group received a sphincter pharyngoplasty. Both procedures were individually customized according to the findings of videonasopharyngoscopy and multi-view videofluoroscopy. RESULTS: There was a non-significant difference (P >0.05) between the mean size of preoperative velopharyngeal closure gap between the two groups of patients (mean=27.5%; S.D.=7.7% versus mean=28.3%; S.D.=5.9%). Postoperatively, velopharyngeal dysfunction was completely corrected in 89% of the cases from group 1, and in 85% of the cases from group 2. There was a non-significant difference (P >0.05) between the success rate for correcting VPI in both groups of patients. CONCLUSIONS: Pharyngeal flap and sphincter pharyngoplasty seem to be safe and reliable procedures for treating residual velopharyngeal dysfunction. Although not all the patients studied for this paper achieved complete closure after the surgical procedures, all of them showed a reduction of the size of the velopharyngeal closure defect. The planning of the surgical procedure, in order to match the postoperative structure to the preoperative velopharyngeal dimensions and movements visualized through Videonasopharyngoscopy and videofluoroscopy, seems to be the most important aspect of the surgery for correcting residual velopharyngeal dysfunction.

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Justificación: Frecuentemente, los pacientes con fisura palatina presentan articulación compensatoria (AC). Este trastorno no se puede modificar con cirugía, afecta la inteligibilidad del habla y, dado que requiere un período de tiempo prolongado de terapia de lenguaje, parece necesario explorar la relación entre AC y el desarrollo lingüístico. Material y Método: Se estudió el desarrollo lingüístico de niños con insuficiencia velofaríngea residual (IVF) después del cierre de paladar, con AC y sin AC. Veintinueve niños con IVF y AC fueron incluidos en el primer grupo (activo). El segundo grupo se constituyó con 29 niños con IVF sin AC, pareados en edad y sexo (control). Para evaluar el desarrollo lingüístico se utilizó el modelo situacional-discurso-semántico. Resultados: Una prueba exacta de Fischer demostró que los pacientes con AC presentaron una frecuencia significativamente mayor de retraso en el desarrollo lingüístico en comparación con los pacientes sin AC. Conclusiones: Los resultados de este estudio sugieren que debe realizarse una evaluación de la organización lingüística-cognitiva en todos los pacientes con fisura palatina, especialmente en los pacientes que presentan AC. Así mismo, la terapia de lenguaje debe incluir no sólo la corrección del proceso de articulación, sino aspectos específicos de la organización lingüística y cognitiva.

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