Speech characteristics after articulation therapy in children with cleft palate and velopharyngeal dysfunction - A single case experimental design.
OBJECTIVE
The aim of this study was to investigate the impact of an intensive 10-week course of articulation therapy on articulation errors in cleft lip and palate patients who have Velopharyngeal Insufficiency (VPI), non-oral and passive cleft speech characteristics.


METHODS
Five children with cleft palate (+/-cleft lip) with VPI and non-oral and passive cleft speech characteristics underwent 40 intensive articulation therapies over 10 weeks in a single case experimental design. The percentage of non-oral CSCs (NCSCs), passive CSCs (PCSCs), stimulable consonants (SC), correct consonants in word imitation (CCI), and correct consonants in picture naming (CCN) were captured at baseline, during intervention and in follow up phases. Visual analysis and two effect size indexes of Percentage of Nonoverlapping Data and Percentage of Improvement Rate Difference were analyzed.


RESULTS
Articulation therapy resulted in visible decrease in NCSCs for all 5 participants across the intervention phases. Intervention was effective in changing percentage of passive CSCs in two different ways; it reduced the PCSCs in three cases and resulted in an increase in PCSCs in the other two cases. This was interpreted as intervention having changed the non-oral CSCs to consonants produced within the oral cavity but with passive characteristics affecting manner of production including weakness, nasalized plosives and nasal realizations of plosives and fricatives. Percent SC increased throughout the intervention period in all five patients. All participants demonstrated an increase in percentage of CCI and CCN suggesting an increase in the consonant inventory. Follow-up data showed that all the subjects were able to maintain their ability to articulate learned phonemes correctly even after a 4-week break from intervention.


CONCLUSIONS
This single case experimental study supports the hypothesis that speech intervention in patients with VPI can result in an improvement in oral placements and passive CSCs.
Department of Speech Therapy, School of Rehabilitation, Iran University of Medical Sciences, Tehran, Iran; Craniofacial Anomalies and Cleft Palate Research Center, Isfahan university of Medical Sciences, Isfahan, Iran.
Fatemeh
F
Derakhshandeh
Department of Physiology, School of Rehabilitation, Iran University of Medical Sciences, Tehran, Iran.
Mohammadreza
M
Nikmaram
Department of Communication Sciences and Disorders, College of Allied Health Sciences, University of Cincinnati, Cincinnati, USA.
Hedieh Hashemi
HH
Hosseinabad
Department of Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
Mehrdad
M
Memarzadeh
C.T Scan Fellowship, Social Security Organization, Isfahan, Iran.
Masoud
M
Taheri
IBCFPRS, Department of Otorhinolaryngolog, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.
Mohammadreza
M
Omrani
Department of physiotherapy, Biostatistics, School of rehabilitation, Tehran University of Medical sciences, Tehran, Iran.
Shohreh
S
Jalaie
Laboratory of Linguistics Department, University of Tehran, Tehran, Iran.
Mahmood
M
Bijankhan
North Thames Regional Cleft Centre, Speech and Language Therapy Department, Great Ormond Street Hospital Trust for Children, London, UK. Electronic address: Debbie.Sell@gosh.nhs.uk.
Debbie
D
Sell
D000293:Adolescent; D001184:Articulation Disorders / Q000209:etiology / Q000534:rehabilitation*; D002648:Child; D002675:Child, Preschool; D002971:Cleft Lip / Q000150:complications / Q000534:rehabilitation*; D002972:Cleft Palate / Q000150:complications / Q000534:rehabilitation*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D013070:Speech Therapy; D016896:Treatment Outcome; D014681:Velopharyngeal Insufficiency / Q000209:etiology / Q000534:rehabilitation*
Articulation therapy; Cleft palate; Non-oral CSCs; Passive CSCs; Single case experimental design; Speech; VPI