The use of instrumental phonetics in the assessment and remediation of three cleft palate children with late repair of the hard palate

Abstract

Cleft palate children with relatively late repairs of the hard palate often manifest abnormal speech patterns which can severely disrupt intelligibility. However, the precise nature of these abnormal patients is often difficult to determine by impressionistic judgments, and their problems are frequently ongoing and resistant to conventional therapy. In this study we investigated the speech of three such children whose anterior fistulas were successfully closed at 7,5.5 and 5 years respectively. The instrumental techniques of pneumotachography (for measuring air pressure/flow) and electropalatography (for recording spatial and temporal details of tongue contact on the hard palate) were used to assess the children’s speech. Hearing was normal and resonance was within normal perceptual limits, but the pressure/flow measurements did reveal some slightly abnormal closure patterns of the velopharyngeal port. Electropalatographic (EPG) results confirmed that tongue contacts were frequently abnormal, particularly on those sounds involving anterior placement of the tongue in the alveolar region. EPG patterns showed generally more extensive contact than normal for alveolar stops and retracted contact patterns particularly for fricative CT). Abnormal velar contact was present for bilabial stops in one child. It was hypothesised that alveolar fricatives are most likely to be impaired because they are generally more complex and involve greater precision in muscular control and kinaesthetic feedback. Articulatory problems could be related to possible early hearing loss, the relatively late repair, presence of scar tissue interfering with tactile feedback, and shape of the palate. Therapy using EPG as a visual feedback device was successful in improving articulatory placements in all three children.