The state of the art: Speech and language issues in the cleft palate population

Objective: State-of-the-art activity demands a look back, a look around, an d, importantly, a look into the new millennium. The area of speech and lang uage has been an integral part of cleft palate care from the very beginning . This article reviews the development and progression of our knowledge bas e over the last several decades in the areas of speech; language; anatomy a nd physiology of the velopharynx; assessment of velopharyngeal function; an d treatment, both behavioral and physical, for velopharyngeal problems. Method: The clear focus is on the cleft palate condition. However, much of what is reviewed applies to persons with other craniofacial disorders and w ith other underlying causes of velopharyngeal impairment. A major challenge in the next several years is to sort through speech disorders that have a clear anatomic underpinning, and thus are more amenable to physical managem ent, versus those that may be treated successfully using behavioral approac hes. Speech professionals must do a better job of finding and applying ways of treating individuals with less severe velopharyngeal impairment, thus a voiding the need for physical management in these persons or ignoring the s peech problem altogether. Conclusion: Early and aggressive management for speech and language disorde rs should be conducted. For most individuals born with cleft conditions, a realistic goal should be normal speech and language usage by the time the c hild reaches the school-age years.