A Call for New Directions in Cleft Palate Speech Research

Abstract

Research and clinical evaluation of the speech disorder associated with cleft palate have certain distinct advantages and disadvantages when compared to research and clinical evaluation of disorders stemming from other etiologies. The major advantage is, of course, the obvious presence of the cleft—even though repaired—and the potential for inadequate velo-pharyngeal closure that results. The " fact " of the cleft is overwhelming and the seemingly straightforward relationship between velopharyngeal inadequacy and faulty consonant articulation is of paramount importance and cannot be disregarded. However, the degree to which this causes us to focus our research and clinical efforts on the velopharyngeal port, to the exclusion of other variables, represents a major disadvantage. This is a subtle diadvantage because it is attitudinal, yet it is significant because it manifests itself in our choice of research questions, our selection of research and clinical procedures, and our intepretation of research and clinical evaluation data. The purpose of this paper is to suggest that variables other than the primary effects of velopharyngeal closure deserve a greater research em— phasis. It is also a thesis of this paper that multivariate research designs and procedures that involve simultaneous measurement of multiple parameters are the preferred methods in studying speech associated with cleft palate. A fair statement of what one reads most frequently in our literature about the causes of the speech problem associated with cleft palate would be something similar to the following. The disordered speech associated with cleft palate is primarily a function of velopharyngeal inadequacy with unspecified maturational factors involved to a lesser extent. Oral cavity deviations, hearing loss, psychosocial factors, etc., represent a small portion of the total variance and are only significant in individual cases. It is not the validity of this statement that is questioned in this paper; we question the complacency that results from the inference that we have meaningfully described the speech disorder. Yes, ve10pharyngeal inadequacy is the primary influence on the speech problem, but how much of what we see in the speech behavior is directly related to velopharyngeal