Cleft Palate Speech and Resonance: An Audio and Video Resource

For the past 12 years or more, it is been well established that limited availability of specific coursework and clinical training in speech-language pathology graduate programs involving low-incidence populations such as children born with cleft palate contributes to the challenges to disseminate clinically relevant training materials to practicing speech-language pathologists in public schools and other settings who serve children/adults with speech/resonance disorders.^1–3 This text serves as one avenue of dissemination in this area of need by providing digitally recorded audio/video samples of speech/resonance disorders paired with accompanying clinical case studies organized into five chapters: “Resonance and Speech Problems,” “Speech Assessment,” “Auditory-Visual-Perceptual Analysis of Speech Samples,” “Treatment,” and “Referring to a Cleft Palate-Craniofacial Team.” The authors describe this text as a companion to the textbook Evaluation and Management of Cleft Lip and Palate: A Developmental Perspective⁴ and as a standalone resource to facilitate learning about speech/resonance disorders associated with cleft palate and resonance disorders in individuals without a cleft condition. The authors’ goals are to present current and evidence-based contextual information with patient examples that include a range of auditory-perceptual experiences to facilitate identification of speech, resonance, and phonatory problems exhibited by speakers with cleft palate.

The sequence of information in this text begins with an overview of the velopharyngeal mechanism and communication problems associated with cleft palate across the domains of articulation, phonatory disorders, hearing, language, and coexisting communication problems. Chapter 2 focuses on speech assessment in the areas of perception, analysis, categorization of errors/compensatory speech errors, speech understandability, acceptability and stimulability, suprasegmental features, and speech/hearing mechanism variables.

Once the reader is introduced to the speech/resonance errors (Chapter 1) and assessment domains/techniques (Chapter 2), Chapter 3, entitled “Auditory-Visual-Perceptual Analysis of Speech Samples,” provides multiple audio and video samples organized into four main sections to facilitate progress from individual speech features commonly associated with cleft palate and velopharyngeal dysfunction (Section 1) to guided practice with audio case studies (Section 2); to independent practice with audio cases (Section 3); and then to Section 4, independent practice with video case studies.

In “Section 1: Speech Features Commonly Associated with Cleft Palate and Velopharyngeal Dysfunction,” the authors provide a total of 42 audio samples organized into six modules highlighting specific categories of errors with descriptions. Module 1 contains 10 audio samples of speech resonance ranging from normal nasal resonance to severe hypernasality with one sample of mixed resonance; Module 2 provides five audio samples demonstrating obligatory nasal air emission with descriptions and spectrograms for three of the audio samples highlighting severity of frication noise; Module 3 provides eight audio samples highlighting obligatory (adaptive) oral distortions; Module 4 provides eight audio samples highlighting compensatory (maladaptive) articulation errors; Module 5 provides seven audio samples demonstrating other unusual articulations with descriptions; and Module 6 provides four audio samples of phonatory disorders (mild, moderate, and strained vocal quality).

“Section 2: Audio Case Studies: Guided Practice,” provides a total of 20 audio case studies for guided practice in applying and integrating the knowledge and skills essential to evaluating and treating speech disorders associated with cleft palate and other disorders of resonance. Each case study in this section provides the speech assessment results (resonance, nasal air emission, articulation, and phonation), impression of speech, and recommendations.

“Section 3: Audio Case Studies: Independent Practice” transitions the reader to independent practice by using detailed case histories (with audio samples) that are designed to encourage a broader analysis rather than highlighting a single construct such as “resonance.” After the listener assesses the case in Section 3, they can compare their diagnostic and treatment results with those of the authors in an Appendix at the end of the book that details the speech assessment results, impressions of speech, and recommendations. Each (audio) case history is organized by some or all of the following categories of information: surgical, dental, hearing, speech therapy, videonasoendoscopic assessment, and/or pressure-flow studies.

“Section 4: Video Case Studies: Independent Practice” then provides the listener with an additional 18 complex audio/video case studies organized similarly to the audio case studies in Section 3, also with a corresponding Appendix to compare the listener’s results with those of the authors for each case.

The final two chapters of the text provide sufficient, albeit somewhat abbreviated, information on treatment (Chapter 4) and a functional chapter on referral to a cleft palate-craniofacial team (Chapter 5). Both of these are very informative and appropriate for integration into clinical practice and/or an academic course. However, the focus of the text is to provide training in a stepwise manner with auditory/perceptual experiences (102 total audio and/or video samples), each paired with essential clinical information and/or a case study.

Strengths of this text include the progression of exposing the listener to the different types of errors and their audio/perceptual characteristics and incorporating them into broader clinical contexts (cases), which are first presented as guided studies and then offered as independent practice, with the authors’ results and impressions provided in the appendices. One weakness of this text is that it is not visually engaging; however, this is by design, as the emphasis is to provide a unique teaching resource that facilitates audio/visual training with a substantial set of clinical examples and expert interpretation by seasoned clinicians (i.e., the authors).