Cleft Lip and Palate
Perceptual Speech Evaluation for Cleft Palate
Children with cleft palate often suffer from Velopharyngeal dysfunction (VPD), which may result from structural defects (e.g., cleft palate, short soft palate, deep pharynx, cervical spine anomalies, etc.), neurological/physiological disorders (e.g., dysarthria, apraxia), and development of atypical articulatory placements and error patterns (e.g., velopharyngeal mislearning). Cleft palate is one of the most well-known causes of VPD. Clefts are categorized based on the severity, presentation, and combination of cleft lip and/or palate.
Common issues that children with a history of cleft palate can encounter include problems related to:
Dental and occlusal deviations
Hearing and middle ear function
Speech sound acquisition and language development
The goal of the speech evaluation of a child with cleft palate or suspected velopharyngeal dysfunction is to answer two simple questions: What is the child doing now? What is the child capable of doing? The answers to these questions will help determine whether and/or when a child would benefit from speech therapy and if further physical management is warranted.
Our perceptual speech evaluation involves the following components:
1. Resonance and airflow/pressure evaluation: This is used to determine if the child presents with a resonance disorder, nasal air emission, or both. Resonance is assessed using voiced (resonating) sounds, including vowels, nasal consonants, and vocalic consonants. Airflow and pressure is assessed using high pressure consonants, including stops, fricatives, and affricates.
2) Articulation evaluation: This includes a conversational speech sample and structured informal speech tasks. An articulation assessment is used to determine if the child's speech errors are obligatory or compensatory. Obligatory errors are caused by structural or neurogenic problems, such as fistulas or velopharyngeal insufficiency. These errors will require physical management to correct.
Compensatory articulation errors are learned articulation errors that some children with cleft palate or velopharyngeal dysfunction develop in their early speech learning due to an inability to generate adequate intra-oral air pressure for typical production of pressure consonants. Compensatory errors may be referred to as "cleft type" speech errors. They can be difficult to identify, and accurate perceptual identification takes practice. Velopharyngeal mislearning includes these compensatory errors as well as (learned) phoneme-specific nasal air emission in which nasal air emission is noted only on particular speech sounds, especially /s/ and the other sibilant fricatives and sometimes affricates. All of these learned errors are corrected through speech therapy only.
3. Oral mechanism examination: This is completed to assess oral cavity structures and examine dentition, tonsils, and occlusal status.
4. Speech and Language evaluation: Standardized tests for speech and language assessment are formal assessment tools, which can be valuable in determining performance in relation to normative data.