A study of strategies for treating compensatory articulation in patients with cleft palate.

INTRODUCTION: Patients with cleft palate (PCP) frequently show compensatory articulation disorder (CAD). Compensatory errors require a prolonged period of speech intervention. Scaffolding strategies are used for correcting placement and manner of articulation. OBJECTIVE: To study whether some strategies commonly used in speech therapy for correcting compensatory articulation errors, can be more effective depending on severity of CAD in PCP. MATERIALS AND METHODS: Fifty PCP were studied. All patients showed velopharyngeal insufficiency (VPI) and CAD. Transcriptions of speech therapy sessions were revised in order to quantify positive changes in articulation. Correlation between effectiveness of each strategy and degree of severity of CAD was assessed. Also, different strategies were compared in order to determine whether some strategies were more appropriate for specific levels of severity of CAD. RESULTS: There was a significant relationship between the success of some strategies, as measured by the number of positive changes in articulation, and the degree of severity of CAD in PCP. CONCLUSION: There seems to be a relationship between effectiveness of some speech therapy strategies for correcting compensatory articulation errors and severity of CAD. Assessment of severity of CAD appears to be useful for planning speech intervention in PCP. Selected speech therapy strategies could be used according to severity of CAD.

The role of laryngeal electromyography in the diagnosis of vocal fold immobility in children.

INTRODUCTION: Pathology may affect the muscles that control vocal function directly by affecting peripheral function or indirectly by affecting the central nervous system. Clinically, muscle function can be assessed by observing the movements of the structures themselves or by recording the electrical activity of the muscles (electromyography, EMG). Since EMG is an invasive technique, it has enjoyed limited use in the diagnosis and management of voice disorders, especially in children. Laryngeal EMG may be helpful in those patients with voice problems of suspected neurological or neuromuscular etiology. OBJECTIVE: The purpose of this paper is to study the role of laryngeal EMG in the clinical evaluation of unilateral vocal fold immobility in children. MATERIALS AND METHODS: Twenty-five children with unilateral vocal fold paralysis were studied. Twenty-five patients with vocal pathologies secondary to vocal abuse and misuse were studied as controls. The sensitivity and specificity of the EMG as a diagnostic marker for vocal fold paralysis were obtained. Additionally, nine patients with traumatic arytenoid dislocation were also studied. All patients were subjected to laryngeal EMG. EMG showed a sensitivity of 100%, and specificity of 92%. Only two patients, present with a functional voice disorder, showed abnormalities in the EMG recordings. In the nine patients with arytenoid dislocation, EMG showed normal parameters. CONCLUSION: EMG seems a safe and reliable test for evaluating patients with vocal fold immobility. Moreover, the EMG recordings were helpful in differentiating vocal fold paralysis from arytenoid dislocation. EMG can provide useful data concerning muscle denervation, and more importantly, reinnervation. Besides its utility for the diagnosis, serial EMG can be useful for monitoring recovery and for establishing a reliable prognosis, and hence, an adequate treatment plan.

Velopharyngeal function after two different types of pharyngoplasty.

OBJECTIVE: To evaluate velopharyngeal function after two different types of pharyngoplasty: pharyngeal flap (PF) and sphincter pharyngoplasty (SP). DESIGN: Two groups of patients operated on with pharyngeal flaps or sphincter pharyngoplasty were studied prospectively. SETTING: The study was carried out at the cleft palate clinic of the Hospital Gea Gonzalez in Mexico City. PATIENTS: Fifty-eight cleft palate patients were studied. All patients had undergone palatal repair and showed residual velopharyngeal insufficiency. Twenty-five patients were operated on using a pharyngeal flap. Twenty-three patients were operated on using a sphincter pharyngoplasty. MAIN OUTCOME MEASURES: Pharyngeal muscle function was evaluated using selective electromyography (EMG) and simultaneous videonasopharyngoscopy (VNP). The superior constrictor muscle was approached directly. The levator veli palatini was included in the central pharyngeal flap. The palatopharyngeus were included in the lateral and superiorly-based surgical flaps inserted on the posterior pharyngeal wall. All patients showed a complete velopharyngeal closure after surgery. RESULTS: None of the patients showed muscle activity on the central pharyngeal flaps. None of the patients showed muscle activity on the lateral flaps of the sphincter pharyngoplasties. All the patients showed strong muscle activity of the superior constrictor. CONCLUSIONS: It is concluded that lateral pharyngeal flaps in cases of sphincter pharyngoplasty and the central pharyngeal flap in cases of pharyngeal flap, show absence of intrinsic activity during speech. The participation of these structures when velopharyngeal closure occurs during speech is rather passive. These flaps, central or lateral, increase tissue volume on specific areas; their movements are produced by the underlying superior constrictor.

Naturalistic intervention in cleft palate children.

AIM: To compare two modalities of speech intervention (SI) in cleft palate children with compensatory articulation disorder (CAD). The first modality was a phonologic based intervention, the second modality was a naturalistic intervention. The main purpose was to study whether a naturalistic intervention may reduce the total time of speech therapy necessary for correcting CAD in cleft palate children as compared to a phonologic intervention. MATERIALS AND METHODS: A prospective, comparative, and randomized trial was carried out. Cleft palate children with velopharyngeal insufficiency and CAD were included in the study group. Only patients with an age ranging from 3 to 7 years were included. A total of 30 patients were selected and were divided randomly into two groups. Fifteen patients were included in the first group (control) and received phonologic SI. The other 15 patients were included in the second group (active) and received naturalistic SI. The speech pathologist in charge of the SI was the same in all cases. A blind procedure was utilized whereby each patient was evaluated independently by two speech pathologists every 3 months until both examiners were convinced that CAD had been completely corrected. The mean total time of SI required for the normalization of speech in the two groups of patients was compared. RESULTS: Median age in the control group was 54.5 months, and 57.5 months in the active group. A Mann-Whitney rank sum test demonstrated a non-significant difference (P=0.803). The mean total time of SI in the control group was 14.53, and 16.27 in the active group. A student's t-test demonstrated that the total time of SI was not significantly reduced (P=0.331) when a naturalistic intervention was utilized. CONCLUSIONS: Naturalistic based SI did not reduce the time necessary for correcting CAD in cleft palate children.