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Data for Boxes lA to VI of Appendix 8-G taken and modified from
Henningsson GE, Kuehn DP, Sell D, Sweeney T, Trost-Cardamone
JE, Whitehill TL. Universal parameters for reporting speech
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outcomes in individuals with cleft palate. Cleft Palate Craniofac J 45:
1-15, 2008.
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*Persists after adequate physical management.
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APPENDIX 8-H
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Speech Assessment Information
for EC
As stated in Chapter 5, not all individuals with cleft palate develop
deviant articulation that warrants in-depth assessment for purposes of
treatment planning and recommendations. For the majority of
youngsters, the team visit with the speech-language pathologist (SLP)
involves a brief speech evaluation sufficient to make judgments
regarding resonance (hypernasality or hyponasality), airflow (audible
nasal emission and/or nasal turbulence), perceived oral pressures
(weak pressure consonants), and global parameters of
understandability and acceptability. Articulation errors are noted but
may require more in-depth assessment during a follow-up
appointment or through collaboration with the treating SLP. For all
youngsters, it is advisable to record the sessions (ideally videorecord)
until the time that speech is within normal limits or “as good as it can
be,” so that the data are available for later analysis, quality
improvement, and audit purposes. The speech data can also have
research application.
EC, the case presented here, can serve as a flexible template for the
extended speech evaluation.
NOTE: Forms used to analyze and report EC's speech findings are
included on the Evolve website. All ratings were based on the scales
and descriptors provided in Appendix 8G. You will want to download
these forms and have them handy as you watch EC's video segments.
Brief Background
• Male with cleft palate only (CPO); soft palate cleft
with partial extension into the posterior hard palate.
• Palate repair done at age 16 months (referred to the
team surgeon at age 14 months); cleft was not noted
until he began to talk.
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• Pressure equalizing (PE) tubes placed at the time of
palatoplasty; no subsequent tubes necessary.
• Hearing WNL; history unremarkable for continued
middle ear effusions or hearing loss.
• Orofacial exam was within normal limits.
Collecting the Sample (based on assessment at age 4 years, 10 months)
• Sampling contexts (Listen to Video 8-5
, which
includes the asterisked items below).
— Conversational speech sample excerpts.*
— Counting 1 to 20.*
— American English Sentence Sample (AESS) (Trost-
Cardamone, 2013).*
— Goldman-Fristoe Test of Articulation-2 (GFTA-2).
Analyzing the Sample
• Conversational speech
— Primary use is for rating Speech Understandability
and Speech Acceptability.
— Can also be used to document types, frequency, and
consistency of compensatory articulations and other
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cleft-related speech errors.
• Place-Manner-Voicing (P-M-V) Matrix
— Provides an easy-to-interpret visual display of target
sound replacements.
— In EC's case, it is easy to see his use of (1) gloal
stops for all oral stop placements (bilabial, alveolar,
velar), (2) pharyngeal affricates for the oral affricates,
and (3) pharyngeal fricatives for sibilant fricatives.
• AESS
— EC's sentence sample is the sample used in the
Americleft Speech Project, modified to be compatible
with the Cleft Audit Protocol for Speech-Augmented
(CAPS-A). It is slightly different than the original
AESS provided in Appendix D in that
○ Only initial and final positions are assessed (making
the total possible errors 42 instead of 60); this
reduces the opportunity for more cleft-related
speech errors to occur. Initial and final targets are
bolded. Medial targets are not scored in the
Americleft version, although you will hear errors on
some medial targets.
○ There is an alternate sentence for /l/.
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○ There is an “/s/ clusters” sentence and the last
sentence in Appendix D is not included.
• GFTA-2
— Published and normed inventories like the
Goldman-Fristoe (GFTA-2 or later edition)
○ Are useful with youngsters with repaired cleft palate
who present with developmental disorders with or
without cleft-related misarticulations.
○ Should not be used in place of a conversational
speech sample or sentence sample designed to
capture cleft palate speech deviations.
○ Can expand the number of opportunities to make
cleft-related misarticulations; in EC's case, this is
clearly evident in his consistent substitution of
pharyngeal fricatives and pharyngeal affricates for
the oral fricatives and affricates.
○ Often do not provide a useful or accurate age-
equivalent standard score or percentile rank, as was
the case with EC.
NOTE that the GFTA-2 does not reveal any of EC's gloal stop
substitutions and the sentence sample reveals only one instance
(sentence #10 [ʔ/d] in the word “Do”). Neither of these sampling
contexts captures the nasal fricative. This highlights the importance of
the conversational speech sample in which we hear multiple gloal
stop substitutions in EC's connected spontaneous speech.
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Reporting the Findings and Making Recommendations for EC
• Option #1: Narrative summary of findings and
recommendations, for example, for EC:
“EC, age 4-10, presents with a repaired cleft palate
only. Speech was assessed during conversation,
counting from 1 to 20, repetition of the American
English Sentence Sample, and single word naming
using the Goldman-Fristoe Test of Articulation-2.
Based on this sampling, conversational speech was
often hard to understand (rated 2 on a scale of 0 to 3
where 0 = WNL and 3 = hard to understand most/all
of the time) and characterized by mild hypernasality
(rated 1 on a scale of 0 to 3 where 0 = WNL and 3 =
severe HN) and cleft-related/compensatory
misarticulations. The sibilant fricatives
s, z, and sh
and affricates
ch and j were absent from his
consonant inventory and consistently replaced by
pharyngeal fricatives and pharyngeal affricates,
respectively. His consistent replacement of sibilant
fricatives and affricates by pharyngeal fricatives and
affricates in all phonetic contexts, although deviant,
may have benefied speech understandability. By
contrast, speech acceptability was rated 3 (on a scale
of 0 to 3 where 0 = WNL and 3 = severely
unacceptable). Pharyngeal fricatives inconsistently
and atypically replaced the fricative
f and oral stops
p, b, and k. Gloal stops frequently replaced any of
the oral stops in intervocalic and word medial
positions and inconsistently replaced word initial
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