Cleft lip and palate is the most common congenital malformation of the oral and maxillofacial region, with an average of 1 in 700 babies born with cleft lip and palate. In children with cleft palate, because of the cleft between the oral and nasal cavities, the necessary negative pressure cannot be formed in the oral cavity when suckling, so the child has difficulty suckling, resulting in malnutrition. Because the oral cavity is connected to the nasal cavity, the oral cavity is poorly cleaned and therefore prone to otitis media and respiratory tract infections. Severe dysphonia is caused by horizontal cleft palate, which not only always has excessive nasal sound but also has a significant lack of airflow pressure in the oral cavity, resulting in unclear speech.
The characteristics of speech disorders in cleft palate patients include.
● Children with cleft palate deformities are usually associated with delayed speech development.
The cleft palate is more difficult to pronounce blends than consonants, and consonants than vowels.
The most affected sounds are fricatives and blasts.
When pronouncing consonants, the airflow pressure in the mouth is low, and thus the articulation is unclear.
When pronouncing non-nasal consonants, gas is shunted through the nostrils and nasal leakage occurs.
When pronouncing non-nasal consonants, especially when pronouncing [i] or [u], nasal resonance occurs and excessive nasal sounds occur.
● When pronouncing nasal consonants, such as [m] and [n], nasal resonance is lacking and excessive hypernasality (cold speech) occurs.
● To compensate for the primary or postoperative persistence of incomplete palatopharyngeal closure, pronunciation occurs by moving the articulatory site backward and compensatory speech occurs.
Speech therapy for cleft lip and palate.
Speech training should be intervened in cleft lip and palate patients 2-3 months after surgery, the younger the better, so as to correct the speech problems that exist in cleft lip and palate patients and thus achieve the goal of having the same speech as normal people.
(1) Speech evaluation: At the age of 2 to 3 years, the first speech evaluation is required. If everything is normal, a follow-up evaluation is required every six months or year until the age of 6 years, depending on the situation, to record the speech development.
(2) Speech training: ① Early speech training before the age of 4, parents must cooperate with the speech therapist to assist the child to do suction and blowing exercises to strengthen the function of the soft palate muscles, as well as oral motor exercises using games to strengthen the flexibility and sensitivity of the tongue and to make the pronunciation clearer. ②Speech training in the hospital. At the age of about 4 years old, children with more concentration can go to the hospital once a week to receive individual or group speech training. (3) Speech camp: The purpose is to make the language of the affected children live, to make the correct pronunciation more proficient, and also to develop a natural way of speaking and habits.
(3) Special examination: If the nasal voice problem does not improve by the age of 4, the child must be examined by special instruments, such as radiography, nasopharyngeal fiberscope, speech spectrometer, etc. Depending on the situation, a decision will be made whether to undergo pharyngoplasty or to install speech aids to improve the excessive nasal voice.
The aims of speech therapy for patients with cleft palate are.
(i) teach the patient to produce the correct sounds and airflow from the mouth, i.e., learn how to control the palatopharyngeal structure to make sounds and airflow come out of the mouth; (ii) palatopharyngeal closure function training: good palatopharyngeal closure function is the basic physiological condition for normal speech. The ideal cleft palate repair can only give the patient a near-normal palatopharyngeal anatomical structure, but since this structure is reconstructed later, the function of the soft palate muscle is bound to be weaker, therefore, post-cleft palate patients mostly have palatopharyngeal closure insufficiency. The training of palatopharyngeal closure function usually starts in 3-4 weeks after surgery, and the movement of palatopharyngeal muscles is coordinated with the muscles of other articulatory structures of the oral cavity. ③ Training for correction of bad speech habits: when children with cleft palate reach the age when they should speak, the language conditioned reflex is not easily established due to the abnormal structure of articulatory organs. In such an abnormal condition to learn pronunciation and speech, the child will naturally make use of nostril closure, linguopharyngeal closure, epiglottis closure and other bad speech habits. After the normal anatomical structure is restored through surgery, these bad speech habits often persist and are difficult to correct. However, they can be improved with the correct guidance of the phonetician and the active cooperation of the parents of the child. ④ Teach the patient to correctly pronounce vowels and consonants produced in different positions; to use the newly learned sounds correctly in conversation, to correct the bad pronunciation habits, and to make the correct pronunciation a habit.
The content of language training includes: strengthening of palatopharyngeal closure function, related muscle strength training, lung capacity and intraoral airflow control, motor function training of the organ of articulation and treatment of dysarthria.
1, blast p, b, t, d, k, g training.
Blast sounds are relatively easy to learn some of the consonant sounds. In the blast sound and clear consonants p, t, k relatively cloudy consonants l, d, g easy to send. The patient should start with b and p. b and p are bilabial blast sounds, let the patient close the mouth, inflate the cheeks, then prominently release the lips, the airflow and P sound will come out of the mouth naturally. b and p are pronounced in the same way. Since b is a cloudy consonant, the vocal folds have to vibrate at the same time when the lips are released and the airflow is ejected from the mouth.
2. Training of fricatives and fricatives z, c, s, j, z, x, zh, ch, sh, r, f, h.
In the training of z, c, s, j, q, t and other sounds, first let the patient learn how to blow the airflow from the correct position in the mouth, let the patient clench the front teeth, the corners of the mouth grin open, the airflow from the tip of the tongue above, the gap between the teeth can be blown out. Keep the airflow above the tip of the tongue and between the upper front teeth in the middle of the mouth. The closer the tip of the tongue is to the lingual surface of the upper front teeth, the closer the sound is to the s-sound. The more the patient blows, the closer the sound is to the sh sound. j, q, and x are pronounced in the mid-dorsal portion of the tongue, behind the tip of the tongue. For patients with heavy compensatory bad pronunciation habits, it is sometimes very difficult to pronounce these sounds correctly. It is necessary to repeatedly emphasize the pronunciation essentials and let patients imitate and learn them repeatedly. Some patients may have side leakage when pronouncing these sounds, that is, the sound and airflow do not come from the middle of the mouth, but blow on the buccal mucosa from the sides of the tongue. The sound produced gives an auditory impression of a large tongue. This wrong pronunciation habit must be corrected.
3. Training of the nasal sounds m, n, n, g and the marginal sound l.
m is the front nasal sound, close the upper and lower lips tightly and send the sound and airflow from the nasal cavity. n and g are the back nasal sounds. The root of the tongue is lifted up to make contact with the soft palate so that the sound comes out of the nasal cavity. These two sounds are generally said to be not much of a problem. Some patients are unable to distinguish clearly between n and l. When n and l are pronounced in the same position, the edge of the tongue is in full contact with the palate and the airflow and sound come out of the nasal cavity. While when pronouncing l, the tip of the tongue is in contact with the front part of the hard palate and the palatal side of the upper front teeth, and the two edges of the tongue are separated from the palate, and the airflow and sound are completely issued from both sides of the tongue and then from the front of the tongue by the mouth.
4.Both lips and tongue movement. Including mouth opening exercises; round lip exercises; lip smacking exercises; tongue extension exercises, etc.
In short, most cleft lip and palate patients can have normal language development and habits, and can obtain the same intellectual and psychological development as normal people, but the key is to go through comprehensive treatment in order to fully recover.