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Speech and Cleft

Your child s speech

While speech difficulties are associated with cleft palate, it is important torealize that not every child with a cleft palate will experience suchdifficulties. However, because of the nature of the problem, your child is more atrisk of having a speech and/or language problem, and both you and theprofessionals will need to keep a close eye on your child s speech development. Most problems can, however, be resolved with speech and language therapy. Childrenwith cleft lip only, rarely have any speech difficulty associated with the cleft.

The nature of speech difficulties

Speech and/or language problems in children with cleft palate are usuallyassociated with;

1. Deficits in hearing.2. Wrong patterns of tongue movement.3. Problems of palate function, or4. A combination of these factors.

The resulting problems are ones of language development, articulation andnasality.

Children with a cleft palate tend to use the back of their tongue too much,resulting in many sounds being made far back in the mouth. With a cleft palate thenormal closing action of the soft palate does not take place, resulting in airescaping into the nasal passages causing nasal sounding speech.

The Speech and Language Therapist

First contact with a speech and language therapist should be as early as 6 monthsof age if your child is experiencing feeding difficulties. You may even find thatcontact with the speech and language therapist begins earlier than this, as thisseems the practice favoured by cleft teams in their overall care approach. Thetherapist can learn much at the early stages from listening to your child s babbling pattern and observing his or her interaction with you. The therapist canalso advise you on important aspects of speech and language development, and oncein the system regular reviews can occur to ensure everything is developing alongnormal lines.

Corrective action

If your child is experiencing difficulties with their speech, a detailedassessment will determine a course of action, which may consist of;

1. A course of speech therapy.2. A course in speech therapy and an appliance in the mouth (SEE

Electropalatography below)3. Corrective surgery followed by speech therapy, or4. a combination of all three.

A small percentage of children present with significant speech problems despiteongoing therapy and require specialised assessment of palatal movement duringspeech. Two special investigations are available:

1. Videofluoroscopy, involves the use of continuous x-ray during speech,

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assessing the movement of the palate while the child is producing speech samples.The study is recorded on videotape. In order to see the palate, a liquid materialcalled barium is put through the nose either with a syringe or via a small tubethat is put into the nose.

2. Nasendoscopy, involves inserting a small scope, a nasendoscope, into thechild s nose to observe palatal movement during speech.

Information from these specialised assessments can help decide on futuremanagement for speech.

The majority of children with cleft lip and palate who have initial speechproblems will grow up to have normal speech if they are attended to at theappropriate time and have all the necessary speech therapy and surgical andorthodontic treatment. Approximately 10% of children with cleft palates will havenasal sounding speech which will require surgical intercession. This procedure,called a pharyngoplasty, involves a small operation to the muscles at the back ofthe throat, and is usually carried out between the ages of 3 to 5 years.

Electropalatography

Electropalatography, or EPG, is a technique used for recording and analysing thecontact of the tongue with the hard palate during continuous speech. A centralcomponent of EPG is an artificial plate which is moulded to fit against theindividual s hard palate. The plate must be custom-made for each individual. This plate consists of electrodes, and when the tongue comes into contact with theplate, signals are conducted to a processing unit and displayed on a computerscreen. The plate is constructed from a plaster cast taken of the roof of theindividual s mouth.

EPG has been found to be useful in correcting speech disorders by identifyingspatial distortions which should not occur in normal speech. It thereforefacilitates the speech and language therapist in the assessment of speechdisorders and the individual in helping them to modify abnormal lingual gestures.

This information is available from www.cleft.ie