A telefluoroscopic study of lingual contacts made by persons with palatal defects

Telefluoroscopic tapes were viewed to obtain evaluations of lingual contacts during the production of six consonant sounds by 69 subjects who had a history of cleft palate or velopharyngeal inadequacy. Using phonetic textbook descriptions of normal lingual contacts as standards, these observed contacts were judged to be either normal or deviant in placement, and direction of deviation was noted. Clinical records of subjects afforded medical and surgical histories as well as evaluations of the subjects' intelligibility, nasal resonance and nasal emission at the time of the taping. Evaluations of velopharyngeal adequacy made from these tapes were also available. Based on the results of this study it was concluded that some but not all speakers who have a history of palatal problems use deviant lingual contacts to produce consonant sounds. The use of deviant lingual contacts does not appear to be related to the type of palatal problem, but is significantly related to the adequacy of the velopharyngeal mechanism for speech. Those with adequate mechanisms show the least use of deviant lingual contacts, subjects with borderline adequacy show a greater use, and those with inadequate closure show the greatest use of deviant contacts. There is a significant relationship between the use of deviant lingual contacts and the presence of abnormal intelligibility and abnormal nasal resonance. The tendency toward the use of deviant lingual contacts by those with velopharyngeal insufficiency suggests that these are compensations for the inadequate valving. These compensations may increase both the intelligibility and nasal resonance problems caused by the inadequate valving. Subjects who achieved adequacy of velopharyngeal mechanism for speech before the age of mastery of consonant sounds showed significantly less tendency to use deviant contacts than those who never attained adequacy. This was reflected in intelligible speech and less tendency toward abnormal nasal resonance. It is suggested that when velopharyngeal adequacy cannot be achieved through early surgical intervention, speech therapy may be indicated to promote the development of potentially adequate articulatory patterns and to discourage the development of compensatory mechanisms.