Ventral frontal cortex morphology in adult males with isolated orofacial clefts: relationship to abnormalities in social function.

Objective: In a previous magnetic resonance imaging (MRI) study, men with nonsyndromic clefts of the lip and/or palate (NSCLP) were found to have abnormalities in the structure of the frontal lobe of the brain. Moreover, many subjects with nonsyndromic clefts of the lip and/or palate have been described as being socially inhibited. A subregion of the frontal lobe, the ventral frontal cortex (VFC), has been shown to be related to social function.

A comparison of oral-nasal balance patterns in speakers who are categorized as "almost but not quite" and "sometimes but not always".

Objective: The purpose of this study was to determine whether amplitude or temporal patterns of oral-nasal balance differentiate speakers with cleft palate who are classified as belonging to the "almost but not quite" (ABNQ) and "sometimes but not always" (SBNA) subgroups of marginal velopharyngeal inadequacy.

Design: The nasal accelerometric vibrational index (NAVI) was used to measure amplitude and temporal aspects of oral-nasal balance during the productions of oral and nasal syllables, words, and sentences. NAVI measures obtained include mean amplitude, time integral (area under the curve), duration, rise time, and fall time.

Efficacy of continuous positive airway pressure for treatment of hypernasality.

Objective: To determine whether speech hypernasality in subjects born with cleft palate can be reduced by graded velopharyngeal resistance training against continuous positive airway pressure (CPAP).

Design: Pretreatment versus immediate posttreatment comparison study.

Setting: Eight university and hospital speech clinics.

Structural brain abnormalities in adult males with clefts of the lip and/or palate.

Purpose: To evaluate brain morphology of adult males with nonsyndromic clefts of the lip and/or palate (NSCLP) in comparison to a matched healthy control group.

Methods: Brain structure was measured using quantitative analysis of magnetic resonance images.

Results: Subjects with NSCLP had significant abnormalities in brain morphology consisting of abnormally enlarged anterior regions of the cerebrum, and decreased volumes of the posterior cerebrum and cerebellum.

Abnormal brain morphology in patients with isolated cleft lip, cleft palate, or both: a preliminary analysis.

Objective: The aim of this study was to determine whether adult men with cleft lip and palate (CLP) have aberrant cerebral morphology.

Design: Brain morphology of 14 adult men with isolated CLP were analyzed and compared with 14 healthy controls matched for sex, age, and parental socioeconomic status.

Setting: The research took place at a large, tertiary care hospital, with participation on an outpatient basis.

A proposal for standardization of speech and hearing evaluations to assess velopharyngeal function.

The article comprises the proposal made by the Cleft Palate Committee of IALP to standardize the parameters of the speech and hearing evaluation in individuals with cleft palate/velopharyngeal incompetence (CP/VPI). The suggested parameters are the following: nasal resonance, nasal escape, articulation and its disorders, facial grimacing, speech intelligibility, patient teachability, expressive language and voice. The authors recommend a five-point scale description system, which can be used also for assessment of hearing, velopharyngeal competence and other attributes of the CP/VPI individual.

Diagnostic value of articulation tests with individuals having clefts.

Articulation testing provides a structure for evaluating children with cleft or velopharyngeal incompetency in a specific manner so that they can be compared with normative data and later to themselves. Results from an articulation test should always be compared to the precept of what is heard in conversation, specifically on articulation, nasality, and velopharyngeal competency. Analysis of an articulation test provides data for the speech clinician to develop a therapy program which is realistic and structured.

Identification of children with and without cleft palate from tape-recorded samples of early vocalizations and speech.

Thirty judges (5 speech pathologists, 10 mothers of children with cleft palate, and 15 mothers of noncleft children) listened to 90 tape-recorded samples of early vocalizations/speech obtained from noncleft babies and babies with cleft palate. Each sample was classified by the judges as normal or abnormal. As a group, the speech pathologists classified only 60% of the cleft samples as abnormal and 59% of the normal samples as normal.

Long-term speech results of cleft palate patients with primary palatoplasty.

This investigation examined the influence of cleft type, type of surgery, age at surgery, and gender on speech proficiency of 204 patients with cleft palate who required only primary palatoplasty. Speech measures were obtained for each subject from at least three annual examinations between the ages of 4 and 16 years. Neither age at surgery nor type of surgery were discriminating factors.

Correspondence between nasalance scores and listener judgments of hypernasality and hyponasality.

The relationship between nasalance scores and perceptual judgments of hypernasality and hyponasality was examined for 74 subjects (51 with cleft palate and 23 noncleft controls). Twenty-nine of the 51 subjects with cleft palate had received pharyngeal flap surgery. Predictive analyses were performed to assess the sensitivity, specificity, and efficiency of the Nasometer as a screening instrument.

Communication status following laryngectomy: the Iowa experience 1984-1987.

Data regarding treatment and outcome for a consecutive series of 73 total laryngectomy patients were collected from clinical records with a follow-up period of 30 to 78 months postoperatively. Notable findings were that 27% were women; 75% reported hoarseness or a voice change as an early symptom; and 22% reported combined heavy use of both cigarettes and alcohol. Of the 73 patients, 38 (52%) died during the follow-up period; 18 of the 38 died within 1 year postoperatively.

Long-term speech results of cleft palate speakers with marginal velopharyngeal competence.

The purposes of this study were to (1) examine the long-term speech status of patients judged to exhibit marginal velopharyngeal competence at 6 years of age and (2) determine whether speech performance data obtained at age 6 could be used to discriminate patients with marginal velopharyngeal competence who eventually demonstrate velopharyngeal incompetence from those who do not. Longitudinal speech performance data were retrieved for 48 subjects and examined descriptively for the total group. Data obtained at the subjects' last evaluation (adolescence) were then used to reassign these subjects into one of three classification groups for estimating velopharyngeal status (competent, marginal, incompetent) on the basis of the clinical ratings of velopharyngeal competence assigned at the time of their last examination in adolescence.

Velar-pharyngeal status in cleft palate patients with expected adenoidal involution.

This study was designed to provide information about whether cleft palate patients with hypertrophied adenoids maintain velar-pharyngeal contact during the time of expected adenoidal atrophy. Thirty-nine subjects were selected from a large longitudinal study on the basis of availability of lateral still x-ray films taken in series from 5 to 16 years of age. Ratings of velar-pharyngeal contact and ratings of adenoid size were obtained from the films.

Speech results of the Zürich approach in the treatment of unilateral cleft lip and palate.

The purpose of this study was to describe perceptually the speech articulation, voice quality, and velopharyngeal competency of subjects with complete unilateral cleft lip and palate treated by the Zürich approach. The mean age of the 37 subjects was 10.5 years.

Assessment of velopharyngeal competence: a long-term process.

This study compared longitudinally perceptual ratings of articulation defectiveness, nasality, and velopharyngeal competency in 13 subjects who required secondary palatal management after age 10 with a second group. Perceptual data when examined longitudinally did not adequately discriminate between subjects who at one time achieved velopharyngeal closure but who ultimately required secondary management and those patients who needed no further treatment. A decrease in articulation scores and an increase in severity of nasality and articulation defectiveness over time indicate that patients are at risk for secondary management.

Experience with surgical management of velopharyngeal incompetence.

Accurate mapping of the defect of velopharyngeal closure in patients with velopharyngeal incompetence is paramount to the planning of an operative procedure that will have a successful outcome. Nasoendoscopy and videonasoendoscopy are valuable tools for examination of the abnormal pattern of velopharyngeal movement in patients with velopharyngeal incompetence. On the basis of the knowledge of the observed defect in velopharyngeal closure for the particular patient, a pharyngeal flap operation is planned.

A study of cleft palate speakers with marginal velopharyngeal competence.

This study was designed as a partial test of a previously hypothesized model for a subgroup of cleft speakers who show marginal velopharyngeal competence during speech. Specifically, speakers in the model were hypothesized to show minimal but consistent nasalization of speech by several criteria. Fifty-two subjects were selected because they met one of the criteria for the model, lateral x-ray films on /s/ that showed touch closure or a small velopharyngeal opening.

Longitudinal speech performance in patients with cleft palate: comparisons based on secondary management.

Speech performance of three groups of speakers with cleft palate was analyzed at two-year intervals from age 4 years through age 16 years. The three groups consisted of: Group A--individuals who score below 20 percent correct on the Iowa Pressure Articulation Test (IPAT) at 4 years of age and who received secondary surgery by 8 years of age; Group B--individuals who scored below 20 percent correct on the Iowa Pressure Articulation Test at 4 years of age, but did not receive secondary management by 8 years of age; and Group C--individuals who scored above 20 percent correct on the Iowa Pressure Articulation Test and who did not receive secondary surgery by 8 years of age. The results demonstrated that Group A performed better on several measures of speech performance at 16 years of age than either of the other groups.

Effectiveness of intensive articulation therapy for children with cleft palate.

The effectiveness of a 6-week summer residential speech program was evaluated for 13 children with cleft lip and palate or cleft palate only. All children received a pretherapy evaluation followed by 4 hours of articulation therapy daily, for 26 days. Speech status was assessed immediately following the intensive therapy program and again on a 9-month follow-up.

Methods of assessing speech in relation to velopharyngeal function.

Seven speech pathologists with expertise in the evaluation of the speech of individuals with cleft palate agreed that the following parameters should be assessed: case history, oral-peripheral mechanism, articulation, and voice quality. From such information and observations the clinician should be in a position to make inferences about velopharyngeal function. If velopharyngeal function is not normal, it is mandatory that additional information about the mechanism be obtained.

Longitudinal evaluation of articulation and velopharyngeal competence of patients with pharyngeal flaps.

In this study, 129 patients with cleft palate who had pharyngeal flaps were evaluated longitudinally. Articulation scores improved approximately 15 percent following surgery, and by age 16 the majority of subjects achieved velopharyngeal competence and 90 percent correct articulation. The findings also demonstrated that the risk of requiring secondary management increased with the severity of the cleft.

Reliability of the nasopharyngeal fiberscope (NPF) for assessing velopharyngeal function: analysis by judgment.

The reliability and validity of data about velopharyngeal function obtained with the nasopharyngeal fiberscope was assessed in normal subjects. The experimental design included data reduction procedures that are likely to have clinical utility (clinical ratings). The results indicated that relative velar movement and size of the velopharyngeal port may be reliably and validly estimated using the procedures.

Pre-school articulation test to assess velopharyngeal competency: normative data.

The purpose of this work was to develop an articulation test which would be discriminating in the determination of velopharyngeal incompetency in young children. From 50 words containing the /p/ and /b/ sounds, normative data for children approximately 3 1/2 years of age were collected. From the responses of these children, 25 words were selected for a base test.