Speech disorders in individuals with cleft palate often occur due to velopharyngeal dysfunction (the gap between the nasal and oral cavity is not closed due to the soft palate not moving enough during speech or being short) Any disruption in the velopharyngeal valve mechanism will adversely affect the features of resonance and articulation.
Individuals with a history of cleft lip / palate or velopharyngeal dysfunction may have speech sound errors as well as resonance problems. Anatomical disorders of structures in the vocal pathways may cause compensatory or obligatory articulation disorders.
Compensatory articulation disorders seen in cleft palate appear due to deviations occurring at the movement site. The person changes the speech sound occurrence site to create the intraoral pressure required for speech. Disorders of the jaw closure patterns may also cause compensatory articulation disorders.
Mandatory articulation disorders are distortion of speech sound that occurs due to structural anomalies (dental disorders, short uvula, unrepaired cleft palate, fistula formation) It is not possible to treat without any surgical or prosthetic intervention.
Resonance disorder is a sound quality disorder that occurs when one or more of the spaces in the vocal tract is disrupted by the vibration pattern. Hypernasality, hyponasality, cul-de-sac resonance, mixed nasality, and nasal emission are the resonance disorders.
EVALUATION OF THE SPEECH
Evaluation of the speech of the individual with cleft palate is one of the most important elements of the comprehensive team approach. Because of families focus on anatomical structure disorders from birth, they can ignore the process that may be associated with speech. For this reason, it is very important for the language and speech therapist, who is in the cleft lip / palate team, to make the necessary directions and interventions on time.
For being able to interfere in the current speech disorder, evaluation must be done by appropriate methods. Speech evaluation can be done using perceptual and objective approaches.
INDICATIONS OF SPEECH THERAPY
One or more of the resonance or articulation disorders may occur together in individuals with cleft lip ± palate or velopharyngeal dysfunction. While surgical intervention is necessary for speech problems seen due to anatomical structure disorders, speech therapy should be applied primarily in functional disorders. In cases where obligatory articulation disorders are observed depending on the abnormal structure, surgical intervention is required first, whereas speech therapy is useful in situations that reveal abnormal articulation.
In the preschool period, the education of the family is essential, focusing on language development up to the first 3 years of age. In particular, increasing the use of consonant phonemes and the number of words, noticing the flow of oral air during phoning, observing early communication skills, and making recommendations are extremely important.
Children with proceed speech problems continue to the speech therapy. However, necessary interventions should be made to structural anomalies (velopharyngeal insufficiency, fistula etc.) that exist until school age. If problems with speech persist despite all interventions, it will be convenient to apply to the Cleft Lip Palate Team.
In our country, adolescents and adults are seeking of speech therapy, due to the lack of specialists or the lack of proper guidance at the right time. Speech therapy can be started in these age groups after applying the necessary surgical / prosthetic approaches. However, since the critical process in speech development is passed, it is extremely difficult to achieve success in speaking skills. In addition, the individual must be well motivated in order to gain the best possible speaking skills.
