Speech Training for Backward and Article III
NASAL SPEECH :Author: Eileen C. Macleod
This term is popularly used to describe several different forms of defec- tive speech, from the speech of cleft palate cases to that of children with adenoid growths.
The term correctly describes the type of speech due to cleft palate, where the greater part of the air escapes through the nose, but it is usually quite as incorrect to describe ” adenoid ” speech as nasal, as it is to say that a cold in the head makes one talk through one’s nose. Both these later conditions prevent the nasal cavity being used as a resonator, and effectually obstruct the passage of air out through the nose for the sounds m, n, and ng.
Cleft palate and hare lip is a condition caused by pre-natal failure of union of various parts which make up the lip, priemaxillary bone and palate. The cleft may involve either the hard or soft palate or both, may be accompanied by uni- lateral or bi-lateral hare lip, gross irregularity of the teeth, or in some cases entire absence of teeth in the upper jaw.
The organic condition is such that air from the windpipe cannot be directed through the mouth, but passes up through the cleft into the nasal cavity and out dirough the nose; the mouth cavity cannot be shut off from the nasal cavity in the normal way by the action of the soft palate. The English language consists of about 40 speech sounds, only three of which require the air to pass out through the nose (m, n, ng); it follows, there- fore, that if air cannot be directed through the mouth, but is obliged to pass through the nose, every speech sound except the three nasals will be distorted.
Furthermore, if the cleft is in the soft palate, the articulation of ng is affected; if the front teeth are irregular and the cleft extends through the gum, the articulation of n is interfered with, whilst if there is a hare lip, particularly double hare lip, m cannot be formed properly. Thus every sound required for speech may be affected, rendering understanding difficult or even impossible. Cleft palates are frequently found in M.D. children, which is not surprising, since the condition is due to arrested physical development in foetal life, but it is not a fact that children with cleft palates are of necessity of sub-normal intelligence. There is a tendency, not unnatural under the circumstances, to underestimate the intelligence of cleft palate children, because of the difficulty with which they express themselves in speech; these children are often back- ward in many ways owing to the difficulties due to their physical condition?in infancy there was the difficulty of feeding, since they were unable to suck, and later they could not ask the thousand and one questions which gain for normal children a certain amount of pre-school knowledge, and finally the great difficulty of going to school with other children not so handicapped, and trying to hold their own there.
Treatment. There are two methods of dealing with the organic condition ?(a) surgical and (b) prosthetic. Each case must be considered individually. Hitherto, surgeons have been very inclined to leave out of consideration the question of speech when examining a cleft palate with a view to the possibility of satisfactory surgical closure, but gradually it is becoming more usual for the surgeon to consult with the speech therapist before coming to a decision. From the speech point of view the chief objection to the surgical closure of the cleft is that scar tissue, lateral tension and shortening of the soft palate may result in a restricted movement of the soft palate and a space may be left between the palate and the back wall of the pharynx, through which air passes into the nasal cavity. Thus, in such cases, the position of the leakage is merely moved from the area of the former cleft to a position further back in the mouth.
There are, however, cases in which the operation can be performed with highly satisfactory results, which, when followed by speech training, so far improve the speech that it is almost impossible to detect the previous condition. The non-surgical or prothestic method of treatment consists in fitting an obturator or artificial palate to cover the cleft. When the appliance has been made and fitted by a dentist specialising in this work, the results are usually very good, but it needs the greatest care, and often ingenuity to build a thor- oughly satisfactory obturator or artificial velum. The speech outlook is often better in obturator cases than in surgical cases, for the reasons stated above. Whilst speech exercises and articulation drill are incapable of materially improving cleft palate speech until the organic condition has been treated, they are an absolutely essential post-operative measure, and the same applies after the fitting of an obturator. Each speech sound must be practised alone and later in combination with others, but the first necessity is practice in directing the air out through the mouth.
Exercises for Cleft Palate Speech (Post-operative or with obturator) 1. Take a big breath and puff out cheeks like a balloon?hold this position and then ” pop ” the cheeks with the hands, as one would with an inflated paper bag.
2. Blow a whistle, trumpet or other such ” musical ” instrument. Blowing bubbles through a pipe is also good.
3. Work with a small apparatus called the ” Flag Breath Indicator,” obtain- able from Cox & Co., 99, New Oxford Street, pricc 2/6. This wire frame is divided horizontally by a piece of mica shaped to fit round the upper lip; there are two little ribbon ” flags,” one below and one above the dividing mica. The object is to blow the lower flag, whilst leaving the upper motionless. The distance from the mouth can be regulated by sliding the frame along the edge of the mica. Later, a small piece of cotton wool may be placed on the upper surface of the mica, and this must not be dis- lodged when the lower flag is blown; gradually this wool may be reduced until the merest wisp remains undisturbed, when the child will have gained full control of the direction of air through the mouth.
In order to vary the exercises it is advisable to teach the sound p, followed
later by a vowel?pa, pay, poo?ap, ip, op, apa, aypay, pop, pip, etc. The lower flag may be blown in a series of puffs, in reality p, p, p, and if these exercises are ” sung,” p automatically becomes b.
t and d should follow next, alone and with vowels, then f, th, u and l, followed probably by /( and g, though this varies in different cases, s is a difficult sound and should always be taught from t, i.e., ts as in cats, then place the t silently, loosen the tongue and let the air trickle over the tip?s. Later on such combinations as tn, dn, bm and pm are extremely useful (as in mutton, sudden, su?/>?it, U/;minster). Care should be taken that no air escapes through the mouth between t and n, b and m, etc., only through the n?se with a sharp puff, the tongue and lips being kept absolutely still?tntntn, b’nbmbm, etc.
When practising vowels alone it is advisable to precede each by an h. in order to avoid a glottal catch, or explosive attack, and to get good tone, z buzzed strongly is useful, either alone or followed by each vowel in turn. It is not possible here to give the final and more detailed exercises, partly owing to the difficulty of reducing sound to writing, but mainly because it needs a highly trained ear and much practice to gauge accurately the require- ments of the pupil, and to devise exactly the right exercises to correct faults which, at this stage, may vary from day to day, as he gradually learns to use muscles which have possibly never before been active. It is, however, of the greatest importance that the first part of the training should be carried out absolutely regularly, so that bad habits are eradicated and the muscles trained to function with accuracy.
Cleft palates are not infrequent among M.D. children, but it is even more usual to find that the speech is very nasal though no cleft exists. The explana- tion is that the muscles of the palate and tongue are very sluggish, the palate hanging more or less inert, whilst the air escapes behind it through the nose. Stimulation is necessary, and the speech drill outlined above, and in the previous article should be given.
Adenoid speech is often called nasal speech, and it mav be so if the adenoid growth is relatively small and so situated that it weighs down the soft palate without blocking the nasal cavity. Usually, however, the growths prevent air passing through the nose, either in or out, with the result that the child breaths entirely through his mouth and his speech sounds as if he had a cold in his head?the three nasal sounds, m, n and ng, cannot be pro- nounced properly, but b, d and g are substituted.
This condition must be treated by surgical removal of the obstruction; when this has been done, the speech sounds like a mild cleft palate case, because the muscles, having been prevented from working by the obstructing growths, have become weak and incapable of raising the palate the required distance. Stimulation is needed, and therefore again, the above exercises and those described in my previous article should be used.
This is the concluding article of this short series, which I hope has been of some slight assistance; if there are any questions which arise, or any points which are not clear, I shall be glad to receive your letters on the subject. Please address them to me, c/o C.A.M.W., 24, Buckingham Palace Road, S.W.i.
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