Huang Diyan, Department of Stomatology, Jinan Military General Hospital Cleft palate voice is one of the main symptoms of cleft palate, which arises from congenital cleft palate malformation. The healing of cleft palate voice does not disappear completely with the repair of cleft palate deformity, and 5%-10% still have cleft palate voice after surgery [1]. Many factors contribute to postoperative cleft palate voice, such as late or inappropriate surgery, severity of cleft palate deformity and poor compensatory articulation, etc., and its treatment is a complex process. Because cleft palate speech is a pathological speech, it has developed a regular and fixed form of speech during its creation and developmental changes, just like normal speech. If we want to correct this wrong speech, we must objectively analyze and evaluate the type of this speech error, find out the causes of its production and the pronunciation pattern, and then we can carry out effective correction and correct speech training. If not treated properly, cleft palate speech will stay with the patient for life. The current situation of cleft palate speech therapy is described as follows.
1. Overview of cleft palate speech research
Cleft palate speech is a pathological speech, the concept of its speech pathology and its research in developed countries in Europe and the United States, has a history of more than half a century. Cleft palate speech research belongs to the scope of speech pathology research. It is a multidisciplinary fringe science that studies communication disorders due to language disorders, speech disorders, hearing disorders, and learning difficulties in children. People engaged in this discipline include speech-language pathologists, speech therapists, psychologists, and educators. The study of speech pathology in China started late, and since the 1980s, some experts and scholars have made a lot of research on the formation mechanism, characteristics, types of disorders, objective evaluation criteria and treatment methods of cleft palate speech, and basically formed a situation to study the pathological speech of cleft palate and put forward the concept of Chinese speech pathology of cleft palate [2]. The application of nasopharyngoscopy, phonogram and computer analysis techniques for the analysis of pathological speech of cleft palate have reached the international advanced level. Although the history of speech pathology research in China is relatively short, many research results show that Chinese speech pathology in China is moving towards the international advanced ranks.
2.The current situation of cleft palate speech therapy
The treatment of cleft palate speech is part of the cleft lip and palate sequence therapy. Cleft lip and palate sequence therapy originated from developed countries in Europe and America. The concept of sequential therapy was proposed as early as the 1930s by Copper in England, who believed that perfect cleft lip and palate treatment should be accomplished by a group of units composed of experts from various disciplines [3].In 1948, Norway established the world’s first TEAM for cleft lip and palate treatment, the Oslo team, which first proposed the centralization, standardization, diversification, sequential long-term and continuity, and the Oslo treatment plan was developed [4]. Subsequently, the concept and treatment plan of sequential treatment rapidly became popular in developed countries in Europe and the United States, bringing a profound impact on the treatment of cleft lip and palate worldwide. Sequential cleft lip and palate treatment means that patients are orthopedically treated as needed at each developmental period under the supervision of a physician as soon as they are born, with the involvement of relevant physicians in oral and maxillofacial surgery, plastic surgery, orthodontics, otorhinolaryngology, speech pathology, neurology, psychological disciplines, and pediatric internal medicine to provide continuous and progressive treatment until normal speech is obtained. The treatment of cleft palate speech has long formed a systematic and standardized treatment model in some advanced countries and regions abroad, and has achieved very good treatment results. For example, in the late 1980s, the clinical and phonological treatment of speech pathology in Japan has entered the international leading level.
The first cleft lip and palate treatment centers were established in China in the early 1970s, and serial cleft lip and palate treatment was started in the late 1980s. In the 1990s, research centers for cleft lip and palate treatment were established one after another in medical schools in some major cities, and interdisciplinary organizations for serial cleft lip and palate treatment, mainly in oral and maxillofacial surgery, were established. At present, in the field of cleft palate speech treatment, China has developed from simple surgical treatment to interdisciplinary comprehensive sequence treatment; in the evaluation and correction training of speech, advanced foreign medical equipment has been introduced to improve the accuracy of speech evaluation and shorten the period of speech treatment; many experts have accumulated new techniques in the treatment methods of cleft palate speech, improving the speech clarity of patients after cleft palate surgery and comprehensive sequence treatment of cleft palate. Many experts have accumulated rich clinical experience and summarized a set of suitable clinical sequence methods in the treatment methods of cleft palate speech, improving the speech clarity of post-operative patients and new techniques of comprehensive cleft palate sequence treatment. For example, in voice training, emphasis is placed on training with Mandarin speech system to enable patients to master the pronunciation method and rules of Mandarin, correct pathological speech, and establish normal speech. In voice training, starting from Mandarin Chinese phonemes, patients are taught to pronounce correctly step by step, and lip-lingual and palatopharyngeal closure training is conducted to guide and correct each individual’s bad pronunciation habits. Through syllable → phrase → phrase practice → natural communication. In order to cooperate with cleft palate speech therapy and popularize the knowledge of speech therapy, publications such as “Speech training after cleft palate surgery”, “Speech therapy for cleft palate” and “Handbook for the use of speech training after cleft palate surgery” have been published [3, 6, 7], which play an active role in improving the level of speech therapy. The concept of postoperative speech therapy for cleft palate is increasingly recognized to be deeply rooted, and it is recognized that surgical repair of cleft palate alone is not sufficient, but non-surgical treatment, i.e. speech therapy training, must also be adopted to achieve satisfactory results. The fundamental purpose of cleft palate surgery is to restore the patient’s normal voice, and when judging the postoperative outcome of cleft palate surgery, the superiority or inferiority of the voice outcome must be an important criterion for evaluating the effectiveness of cleft palate surgery [8]. From primary hospitals to large hospitals, it is being recognized that early rehabilitation after cleft palate surgery can significantly improve patients’ speech [9], and comprehensive speech therapy can significantly improve patients’ speech [10]. In order to adapt to our national situation, some hospitals have also created a trinity of home-school-hospital voice training model [11].
Despite the promising achievements in basic theoretical research on cleft palate speech and speech therapy work in China, there is a big gap compared with developed countries abroad. There is no specialization in speech pathology in China, there is a lack of speech therapists working in this field, and there are too few trained professionals to train a qualified speech therapist in 2-3 years, as the experts concerned have said that they can train a surgeon in the short term [12]. There are no unified norms in the criteria for the assessment and detection of cleft palate speech, in the methods for the evaluation of treatment effects, and in the procedures for treatment. In addition, China has a large population and the number of cleft lip and palate patients far exceeds that of developed countries, and the economic and cultural and educational development of each region is unbalanced. Quality speech therapy resources are concentrated in the famous hospitals in big cities, while the primary hospitals in many regions are lacking from equipment to specialized physicians. It was reported that 43.9% of the patients did not know about voice training; only 18.9% of the patients understood its importance [13]. All these factors affect the popularity and promotion of sequential cleft palate treatment, and do not allow each cleft lip and palate patient to obtain the ideal treatment effect at the best time.
3, Outlook
Although speech therapy has not been widely popularized in China, its medical market is large [14]. With the progress of China’s economy, science and technology, the development of the basic theory of speech pathology research; with the popularization of speech therapy knowledge and the importance of patients’ families, China’s speech therapy will rapidly move forward and enter the ranks of international advanced.
References
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