Development of community-based speech therapy model: for children with cleft lip/palate in northeast Thailand.

BACKGROUND: Surgical treatment can reduce disfigurement for children born with cleft lip/palate, however, most children are left with speech and language problems. This creates a new problem as speech and language services is limited. OBJECTIVE: To combine the principles of Community-Based Rehabilitation (CBR), Primary Health Care (PHC) and institutional medical approaches for reaching and treating speech disordered children with cleft lip and/ or palate in remote area. MATERIAL AND METHOD: The authors conducted the study from participatory workshops for development of a Community-Based Model. RESULTS: Community-Based Speech Therapy Model for children with cleft lip/palate was established based on healthcare system. CONCLUSION: Model can be implemented among children with cleft lip/palate for further process in Northeast and other areas of Thailand as well as developing countries where there is a limitation of speech therapy.

The nasoendoscopy study of velopharyngeal closure patterns in normal Thai volunteers.

The purpose of this study is to assess patterns of velopharyngeal closure in normal Thai subject. Ten volunteers with normal speech and no history of cranio-maxillo-facial abnormality, injury or surgery were included in this study. Their velopharyngeal closures were reviewed b y nasopharyngoscopy. Their articulation and resonation characteristics were also evaluated. The patterns of closure and related anatomy were studied. The results showed that all subjects achieved complete closure without a gap or nasal emission. Three patterns of velopharyngeal closure were found. A circular pattern was found in the majority of the subjects. More specifically, 6 subjects demonstrated circular closure patterns and 1 had a circular closure pattern with the Passavant’s ridge. The coronal pattern was found in the last 3 subjects. There was no correlation between patterns of closure and demographic data related to anatomy and resonation characteristics. In conclusion, 3 patterns of velopharyngeal closure were found and the circular type was the common. Further study was recommended with a larger group for gathering a database of Thai people.

Verbal expression disruption of Thai aphasic persons perceived by Their Familis.

This study reports the verbal expression disruption of Thai aphasic persons as perceived by their family members as the most salient to their mutual communication and the most disruptive to their daily communication. The family members were first interviewed and then asked to complete a questionnaire. It was found that “aphasic persons” word-finding difficulties’ was the specific verbal expressive characteristics which families perceived as the most salient and disruptive. Identifying the perceptions of the families through both interview and questionnaire procedures appeared to have advantages in tapping information about communication disability and handicaps that could lend valuable insights in planning ecological valid treatment.

Management of velopharngeal insufficiency in velocardiofacial syndrome.

This report presents an analysis of the treatment of a patient with velocardiofacial syndrome. The patient had a cleft palate and an articulation disorder with hypernasal speech. The cleft palate repair was successful but the post-operative course was complicated by velopharyngeal insufficiency. Thus, further management including reassessment and treatment for better speech quality was required.

Nasoendoscopy: Clinical implications.

The purpose of this study is to discuss the clinical use of nasoendoscopy examination of the velopharyngeal closure in patients with nasal speech and to describe the clinical implications of this technique. Three difference patients with hypernasal speech, one with cleft palate, one with hearing loss and one mental retardation, were studied velopharyngeal incompetence through direct assessment of the velopharyngeal closure by nasoendoscopy. An Olympus Nasoendoscope model ENFP3 was used and the Siriraj Speech Stimuli Resonation Test (Manochiopinig & Chuangsuwanich 2001) was used as a standard speech sample. After an explanation and informed consent, 10% of xylocaine was sprayed into a nostril for tropical anaesthesia. The first author performed the nasoendoscopy, meanwhile the second author stimulate the speech sample and velopharyngeal function. The same procedure and condition was conducted to each subject in an operation room. Excursion of the soft palate and pharyngeal wall, completeness, asymmetrical, leakage, adequacy, patterns of closure were observed during speech production. Descriptive analysis was used. The results indicate that intelligible speech production depend on a normal velopharyngeal closure mechanism. Abnormal coupling of the oral and nasal cavities of these patients are characterized by hypernasality, nasal emission, imprecise speech production and decrease speech intensity. These typical signs of velopharyngeal insufficiency could be due to either structural defect (cleft palate), physiological dysfunction (hearing loss) or mental status (mental retardation). Nasoendoscopy provides a direct approach to visualize the velopharyngeal closure. This technique helps clinicians to distinguish between those patients with nasal speech who appear to have the physiological potential for satisfactory velopharyngeal closure from those who do not. This distinction is clinically important because of the marked difference in treatment. Furthermore, in patients considered for a pharyngeal flap operation, pre-operative evaluation of the closure is vital. In conclusion, hypernasal speech alone is not a sign of velopharyngeal insufficiency from structural defect. Thus, a diagnosis is suggested to be made by a cranio-maxillo-facial team after complete evaluation. In addition, nasoendoscopy has been valuable in distinguish different groups of patient as well as planning treatment.

Applicability of the Thai nasality test.

The aim of this study was to investigate the applicability of a speech stimuli, the Thai Nasality Test, to identify the presence of hypernasality and hyponasality speech. The Thai Nasality Test was evaluated by a comparison study between the perceptual assessment rated by the investigators and the acoustic assessment by using a Nasometer. The study was conducted to 69 normal speakers, 36 dysarthric speakers, and 32 clients with cleft palate. The perceptual assessment was preceded acoustic assessment. Each subject was asked to read or repeat the Thai Nasality Test. Results indicate the reliability and validity of the Thai Nasality Test by a) a positive correlation between perceptual assessment and the instrumental assessment, b) a significant correlation between age and the Tuk Tuk passage and significant correlations between gender and the Manee as well as the Sai Yok water fall passages of the normal group, and c) the discriminating power between disordered speech from normal speech. This study indicated the Thai Nasality Test as a perfect speech stimuli to elicit speech sample for acoustic assessment, particularly the TukTuk and the Sai Yok water fall passages in assessing for hypernasality problems. While an applicability of nasal sentences the Manee to detect the hyponasality could not be confirmed definitely because there was no significant difference among studied groups.

The articulation characteristics of normal Thai children aged 3 – 10 years assessing by using the Thai Articulation Test (TAT).

This study aimed to investigate the articulation characteristics of Thai children. Subjects were 560 students aged 3-10 years in Bangkok Metrolitan area. They were divided into 8 groups according to their age. Every subject was assessed his/her articulation characteristics by using the Thai Articulation Test (TAT)4, which consisted of 69 black-white drawing pictures. Each picture represents Thai phonemes: tonal features, vowels, consonants and clusters. Results of this study indicated that all subjects mastered every tonal feature and vowel within the age 3 years. At 3 years of age, the children produced all consonants correctly, except the /r/ sound. There were 15% of 10 years old children acquired accurately. There was a significant correlation between articulation abilities and ages. This study revealed that there was no different between two genders. As a result, the TAT appeared to be a valid and reliable test for clinical and research uses for the dynamic present situation.