| Objective:1.To investigate the clinical characteristics of consonant construction in preschool children with cleft palate.2.To explore the training methods suitable for improving the speech effect of preschool children with cleft palate.Methods:1.70 patients with cleft palate who were treated in Nanjing Stomatological Hospital,Medical School of Nanjing University from June 2020 to December 2021 were selected as the research objects,aged(4～6)years,and all of them received surgical treatment in our hospital at the age of 9 to 12 months.The computer speech lab(CSL)and the speech test form of West China Stomatological Hospital were used to subjectively evaluate the velopharyngeal function and consonant construction characteristics of children.The evaluation methods are shown below :(1)Hypernasality and nasal air emission were not found in speech evaluation;(2)The lateral cephalic X-ray film showed that the soft palate was lifted backward and upward to contact the posterior pharyngeal wall and completely closed the pharyngeal cavity.The evaluation result of patients who met both criteria was complete velopharyngeal competence(VPC).If there is a conflict between the evaluation results of condition 1 and condition 2,nasopharynx fiberscope shall be performed,and the final result shall be subject to the result of nasopharynx fiberscope.The evaluation results of other patients were velopharyngeal incompetence(VPI).The consonant construction characteristics of children with VPC and VPI were analyzed respectively.2.40 patients with cleft palate who were treated in the Nanjing Stomatological Hospital,Medical School of Nanjing University from June 2020 to December 2021 were selected as the research objects,aged(4～6)years.They received surgical treatment in our hospital at the age of 9 to 12 months.They were followed up for online or offline speech training 3～6 years after operation.Group A: Online Wechat speech training: group A1: low-intensity speech training,once a week,0.5 h each time,10 times as a course of treatment,lasting for1 course of treatment;Group A2:high-intensity speech training,three times a week,0.5 h each time,10 times as a course of treatment,lasting for 1 courses of treatment;Group B: Offline speech training: Group B1: low-intensity speech training,once a week,0.5 h each time,10 times as a course of treatment,lasting for 1 course of treatment;Group B2high-intensity speech training was treated three times a week for 0.5 h,10 times as a course of treatment,lasting for1 course of treatment.The training method of changing the position of articulation by phonological therapy is adopted to construct the correct position of articulation,that is,the position of articulation is mentioned to the mouth and combined with the treatment of articulation.Chinese speech intelligibility test table and compensatory articulation degree table(1～7)were used to record before and after speech training respectively,and the speech intelligibility(SI)value and compensatory articulation degree(CA)were calculated to analyze the speech effects of different training methods.3.Adopt Spss 22.0 statistical software for statistical processing.In Study 1,the mean,standard deviation,frequency and percentage were used for statistical description,and paired t-test was used for inter group analysis;Paired t-test was used to analyze the effect of speech training in Study 2;The values of Ci and Ca between groups were compared by two independent sample t-test α= 0.05。Result:1.Among the 70 preschool children with cleft palate after operation,there were 46 cases in VPC group,with an average age of(4.78 ± 0.92)years,including 26 males and 20 females,with a male: female ratio of 1.2:1.The consonant correct rate in VPC group was 43.6%;There were 24 cases in VPI group,with an average age of(4.82 ±0.90)years,including 13 males and 11 females.The male: female ratio was 1.2:1.The consonant correct rate in VPI group was 16.8%,and the difference was statistically significant(P < 0.05).The compensation rate of VPC group was 9.8%,and that of VPI group was 37.8%,the difference was statistically significant(P < 0.05).2.The order of abnormal frequency of VPC group articulation from high to bottom is ellipsis,weakness,CA and substitution.The order of abnormal frequency of VPI group articulation from high to bottom is ellipsis,CA,weakness and substitution.On the tip of the tongue,the accuracy of VPC group was higher than that of VPI group,the omission rate had no significant difference,and the compensation rate was lower than that of VPI group(P < 0.01).There was no significant difference in the rate of omission and weakness between the two groups(P > 0.05),and the correct rate of VPC was higher than that of VPI group(P < 0.05).In the root sound of the tongue,the VPC group was mainly ellipsis,while the VPI group was mainly CA(P < 0.05).On the double lip sound,the omission rate of VPC group was lower than that of VPI group,and the weakness was obvious.The compensation rate of VPI group was higher than that of VPC group(P < 0.01).On the labiodental sound,the data comparison of omission rate and weakening rate between the two groups was not statistically significant(P > 0.05),but the compensation rate of VPI group was higher than that of VPC group(P < 0.05).3.The speech intelligibility of the online group increased from 63.25% before training to 91.55% after training,with an average increase of 28.30%(t=-8.718,P< 0.001).The degree of compensatory articulation increased from 4.30 before training to 5.50 after training,with an average increase of 1.20 points(t=-8.718,P< 0.001).After training,the speech intelligibility of offline group increased from 63.15% before training to 93.05% after training,with an average increase of 29.90%(t=-9.131,P<0.001).The degree of compensatory articulation increased from 4.35 before training to 5.90 after training,with an average increase of 1.55 points(t=-9.131,P<0.001).The speech intelligibility of offline group after training was 93.05%,which was slightly higher than that of online group 91.55%(t=-2.111,P=0.041).The degree of compensatory articulation was 5.9,which was similar to the online group(5.5),and the datas comparison between the two groups was not statistically significant(t=-1.710,P = 0.095).The speech intelligibility after high-intensity training was 93.75%,and that after low-intensity training was 90.85%(t=-4.952,P<0.001);The degree of compensatory articulation after high-intensity training was 6.0,and the degree of compensatory articulation after low-intensity training was 5.4,the difference was statistically significant(t=-2.698,P<0.001).Conclusion:1.The forms of consonant construction in preschool children after cleft palate surgery:mainly omission,(or)weaness and compensatory articulation.The consonant construction forms of VPC children are mainly ellipsis and / or weakness,while the consonant construction forms of VPI children are mainly ellipsis and / or weakening and compensatory articulation.2.The compensatory articulation and speech intelligibility of children were significantly improved at the end of the two training methods;There was no significant difference in the degree of compensatory articulation between the online group and the offline group.The speech intelligibility of the offline group was slightly better than that of the online group.Increasing the training intensity can improve the speech effect. |
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