Active versus passive cleft-type speech characteristics

Cleft palate speech is generally described in terms of nasal resonance, nas al emission and compensatory articulations. A longitudinal study of childre n at different stages of surgical treatment revealed a distinction between passive and active cleft-type speech characteristics whereby passive charac teristics were thought to be the product of structural abnormality or dysfu nction and active characteristics were specific articulatory gestures repla cing intended consonants. Passive and active patterns of articulation are d escribed and defined in the context of three longitudinal studies of subjec ts who were at various stages of two different surgical regimes: five bilat eral cleft lip and palate (BCLP) subjects aged 1;6-4;6, 12 mixed unilateral cleft lip and palate (UCLP) and BCLP subjects aged 4;6-7;6 and nine mixed UCLP and BCLP subjects aged 9;0-11;0. Reference is also made to data from 1 2 mixed cleft-type subjects aged 13;0 who had been treated with different s urgical timing regimes. Comparison is made between the incidence of active Versus passive processes in relation to oral structure. At age 4;6 speech s amples taken from BCLP subjects who had been treated with 1-stage versus 2- stage palate repair all evidenced both active and passive processes. The la ck of differentiation in speech results irrespective of their current surgi cal status, i.e. completely repaired palates versus residual cleft of the h ard palate, was unexpected. Cleft-type processes in completely repaired sub jects might be accounted for by the inevitable anterior defect following re pair of a bilateral cleft. Older subjects with structural defects also evid enced more cleft-type processes. The relevance of distinguishing between ac tive and passive processes is underlined by consideration of the effects of structural changes following surgery. The effect of surgery on seven subje cts' speech is discussed using the active/passive distinction. Active cleft -type characteristics did not change as a direct result of surgery, whereas passive characteristics were largely eliminated following surgery. A speci fic distinction is made between active and passive nasal fricatives, with t he implication that active nasal fricatives may not be affected by surgical intervention, whereas passive nasal fricatives may be eliminated by surger y. Accurate distinction between active and passive patterns of articulation may serve to identify those cleft-type speech error patterns most likely t o respond to surgical intervention Indications from this study are that act ive cleft-type characteristics require destabilization in a course of speec h and language therapy before the potential benefits of surgery can be prop erly assessed. An analytical protocol for the interpretation of speech samp les is presented and some therapy strategies are proposed for active and pa ssive processes.