Short-term effect of short, intensive speech therapy on articulation and resonance in Ugandan patients with cleft (lip and) palate.

OBJECTIVES: The purpose of the current study was to assess the short-term effectiveness of short and intensive speech therapy provided to patients with cleft (lip and) palate (C(L)P) in terms of articulation and resonance. METHODS: Five Ugandan patients (age: 7.3-19.6 years) with non-syndromic C(L)P received six hours of individualized speech therapy in three to four days. Speech therapy focused on correct phonetic placement and contrasts between oral and nasal airflow and resonance. Speech evaluations performed before and immediately after speech therapy, including perceptual and instrumental assessment techniques, were compared. RESULTS: Post-therapy, improvement of speech was noted for most of the patients, although to varying degrees. Clinically relevant progress of objective nasalance values and/or articulation was obtained in four patients. Overall, two patients showed normal speech intelligibility, while three patients required additional speech therapy. CONCLUSION: These preliminary short-term results demonstrate that short and intensive speech therapy can be effective for patients with C(L)P in countries with limited access to speech-language therapy. However, further research is needed on the long-term effectiveness and the advantages of applying this treatment protocol in countries with good access to speech therapy. LEARNING OUTCOMES: The reader will be able to (1) list the challenges in resource poor-countries to achieve access to speech-language therapy services, (2) describe when the application of speech therapy is appropriate in patients with C(L)P, (3) describe the speech therapy that can be applied to reduce compensatory articulation and resonance disorders in patients with C(L)P, and (4) list the (possible) advantages of short, intensive speech therapy for both resource-poor and developed countries.

Speech characteristics in a Ugandan child with a rare paramedian craniofacial cleft: a case report.

The purpose of this study is to describe the speech characteristics in an English-speaking Ugandan boy of 4.5 years who has a rare paramedian craniofacial cleft (unilateral lip, alveolar, palatal, nasal and maxillary cleft, and associated hypertelorism). Closure of the lip together with the closure of the hard and soft palate (one-stage palatal closure) was performed at the age of 5 months. Objective as well as subjective speech assessment techniques were used. The speech samples were perceptually judged for articulation, intelligibility and nasality. The Nasometer was used for the objective measurement of the nasalance values. The most striking communication problems in this child with the rare craniofacial cleft are an incomplete phonetic inventory, a severely impaired speech intelligibility with the presence of very severe hypernasality, mild nasal emission, phonetic disorders (omission of several consonants, decreased intraoral pressure in explosives, insufficient frication of fricatives and the use of a middorsum palatal stop) and phonological disorders (deletion of initial and final consonants and consonant clusters). The increased objective nasalance values are in agreement with the presence of the audible nasality disorders. The results revealed that several phonetic and phonological articulation disorders together with a decreased speech intelligibility and resonance disorders are present in the child with a rare craniofacial cleft. To what extent a secondary surgery for velopharyngeal insufficiency, combined with speech therapy, will improve speech intelligibility, articulation and resonance characteristics is a subject for further research. The results of such analyses may ultimately serve as a starting point for specific surgical and logopedic treatment that addresses the specific needs of children with rare facial clefts.

Normative nasalance data in Ugandan english-speaking children.

AIMS: The aim of this study was to obtain normative nasalance values for typically developing Ugandan English-speaking children as a reference point for clinical practice and further research. METHODS: Sixty-nine typically developing Ugandan children (35 males and 34 females, 2.7-13.5 years of age) participated in the study. Nasalance scores were obtained with the Nasometer while children repeated 4 sustained sounds, 14 repeated syllables, 15 sentences (12 oral, 3 nasal) and 2 texts ('Rainbow Passage' and 'Zoo Passage'). Data were analyzed for gender and age dependence. RESULTS: No significant effects of age or gender on nasalance values were obtained; hence, normative values for the overall group were reported. The average nasalance scores for Ugandan English-speaking children were 17 and 64% for the oral and nasal sentences and 33 and 14% for the oronasal and oral text, respectively. CONCLUSION: The normative values are important as a reference point to assess the impact of several surgical procedures and several surgical timing strategies on speech in Uganda.

Impact of tongue reduction on overall speech intelligibility, articulation and oromyofunctional behavior in 4 children with Beckwith-Wiedemann syndrome.

OBJECTIVE: The purpose of this study was to determine the impact of partial glossectomy (using the keyhole technique) on speech intelligibility, articulation, resonance and oromyofunctional behavior. PATIENTS AND METHODS: A partial glossectomy was performed in 4 children with Beckwith- Wiedemann syndrome between the ages of 0.5 and 3.1 years. An ENT assessment, a phonetic inventory, a phonemic and phonological analysis and a consensus perceptual evaluation of speech intelligibility, resonance and oromyofunctional behavior were performed. RESULTS: It was not possible in this study to separate the effects of the surgery from the typical developmental progress of speech sound mastery. Improved speech intelligibility, a more complete phonetic inventory, an increase in phonological skills, normal resonance and increased motor-oriented oral behavior were found in the postsurgical condition. The presence of phonetic distortions, lip incompetence and interdental tongue position were still present in the postsurgical condition. CONCLUSION: Speech therapy should be focused on correct phonetic placement and a motor-oriented approach to increase lip competence, and on functional tongue exercises and tongue lifting during the production of alveolars. Detailed analyses in a larger number of subjects with and without Beckwith-Wiedemann syndrome may help further illustrate the long-term impact of partial glossectomy.

Poland syndrome with dextrocardia: case report.

Poland syndrome is a rare congenital condition presentingwith typical features including an absent costosternal head of pectoralis major andipsilateral brachysyndactyly. There are many clinical variations of the syndrome including rib defects, absence of shoulder girdle muscle and breast hypoplasia or agenesis. Dextrocardia is rarely associated with Poland Syndrome with only 22 cases being previously reported in the worldwide literature. Whereas 'classical' Poland syndrome is predominantly right sided, all cases associated with dextrocardia have been left sided. We report a further case of left sided Poland syndrome with dextrocardia which might have important implications for the understanding of the pathogenesis of this unusual condition.

Free Flap Surgery at Mengo Hospital; Uganda - A Review of The First 19 Consecutive Microvascular Free Tissue Transfers

Background: Microvascular free tissue transfer is an important method for reconstructing complex surgical and traumatic defects; allowing single stage reconstruction in most instances. This study reviews the first 19 consecutive free tissue transfer (free flap) reconstructions at Mengo hospital; Department of Plastic and Reconstructive surgery. Methods: A retrospective review of the first 19 surgical reconstructions using microvascular free tissue (free flap) transfer techniques from 2005 to date was done. Results: 10 males and 8 females have had surgical reconstructions with free flaps during this period. Average age of patients was 23yrs; ranging from 7 years to 42 years. The majority of reconstructions were in the head and neck region (n=14; 74Background: Microvascular free tissue transfer is an important method for reconstructing complex surgical and traumatic defects; allowing single stage reconstruction in most instances. This study reviews the first 19 consecutive free tissue transfer (free flap) reconstructions at Mengo hospital; Department of Plastic and Reconstructive surgery. Methods: A retrospective review of the first 19 surgical reconstructions using microvascular free tissue (free flap) transfer techniques from 2005 to date was done. Results: 10 males and 8 females have had surgical reconstructions with free flaps during this period. Average age of patients was 23yrs; ranging from 7 years to 42 years. The majority of reconstructions were in the head and neck region (n=14; 74) followed by lower limb (n=3; 16) and upper limb reconstructions (n=2; 10). Indications for reconstructions using free flaps included extensive loss of scalp; extensive loss of soft tissue following open tibial fractures; bomb blast injuries to the face; Noma; Romberg's disease; ameloblastoma. Overall flap survival rate of 79. Head and neck reconstructions flap survival rate of 83.3; lower limb and upper limb free flap survival rates of 33.3and 100respectively