This study, contributes to understandings regarding Mandarin vowel performance of children with and without repaired cleft lip and palate, with an
emphasis on investigating the production of the five Mandarin cardinal vowels.
Several limitations exist in this study and suggestions for further study are provided in this section.
First of all, this present study focuses in participants in southern Taiwan whose mother tongue is Mandarin. Speech performance may be different if the same study were to be conducted with different participants. Therefore, further studies should focus on investigating children with repaired cleft lip and palate from other parts of Taiwan, such as eastern, central, or northern Taiwan. More participants from different areas would help to provide a more detailed
examination of the speech performance of children with repaired cleft lip and palate.
In addition, there were only 14 participants participating in this study. This sample is too small to reliably generalize the results to the wider population of children with the same impairment. For further study, the number of the participants should be increased in order to improve generalizability.
The final limitation concerns the language investigated in this study. Only Mandarin vowels are examined in this research. The results may vary according to different vowel sounds in other languages such as Taiwanese. Hence, the production of vowel sounds in other languages should be examined in the further studies.
REFERENCES
中⽂文⽂文獻
⿈黃國佑 (1996)。︒｡元⾳音的構⾳音、︑､聲學特徵與知覺。︒｡載於曾進興（主編）， 語⾔言病
理學基礎第⼆二卷 （1-31）。︒｡臺北：⼼心理出版社。︒｡
鄭靜宜 (2004)。︒｡不同⾔言語速度下國語各⾳音段時⾧長變化及其於連續語⾔言中可預測性
之探討。︒｡國科會專題研究計畫成果報告， NSC 92-2413-H-024-019。︒｡
鄭靜宜 (2005)。︒｡不同⾔言語速度、︑､發語單位和發語位置對國語⾳音段時⾧長的影響。︒｡南
⼤大學報，39，161-185。︒｡
鄭靜宜 (2011)。︒｡語⾳音聲學：說話聲⾳音的科學。︒｡臺北：⼼心理出版社。︒｡
English References
Ahn, J., Kim, G., Kim, Y. H., & Hong, J. (2015). Acoustic analysis of vowel sounds before and after orthognathic surgery. Journal of Cranio-Maxillofacial Surgery, 43(1), 11-16.
Akafi, E., Vali, N., Moradi, K. & Baghban, K. (2013). Assessment of hypernasality for children with cleft palate based on cepstrum analysis. Journal of Medical Signals and Sensors, 3(4), 209-216.
Baghban, K., Torabinezhad, F., Moradi, N., Asadollahpour, F., Ahmadi, N., &
Mardani, N. (2015). Temporal characteristics of nasalization in Persian speaker children with and without cleft palate. International journal of pediatric
otorhinolaryngology, 79(4), 546-552.
Bennun, R. D., Tainijoki, S. P., Ylikontiola, L. P., Sandor, G. K. B., & Casadio, V.
(2016). International multicenter protocol. In R. D. Bennun, J. F. Harfin, G. K.
B. Sandor, & D. Genecov (Eds.), Cleft lip and palate management (pp. 53-61).
New Jersey: John Wiley & Sons, Inc.
Bradlow, A. R., Torretta, G. M., & Pisoni, D. B.(1996). Intelligibility of normal speech I: global and fine-grained acoustic-phonetic talker characteristics.
Speech Communication, 20(3-4), 255-272.
https://doi.org/10.1016/S0167-6393(96)00063-5
Casadio V. (2016). Detailed Speech Therapist Work. In R. D. Bennun, J. F. Harfin, G.
K. B. Sandor, & D. Genecov (Eds.), Cleft lip and palate anagement (pp. 59-60).
New Jersey: John Wiley & Sons, Inc.
Chapman, K. L., & Willadsen, E. (2011). The development of speech in children with cleft palate. In S. Howard, & A. Lohmander (Eds.), Cleft palate speech:
assessment and intervention (pp. 23-36). Oxford: Wiley-Blackwell.
Chung, R. F. (2016). Introduction to Modern Linguistics. Taipei: Wu Nan.
Crystal, D. (2008). A Dictionary of Linguistics and Phonetics (6th ed.). Malden:
Blackwell Publishing.
Ha, S., & Kuehn, D. P. (2006). Temporal characteristics of nasalization in children and adult speakers of American English and Korean during production of three vowel contexts. The Journal of the Acoustical Society of America, 120(3), 1622-1630. https://doi.org/10.1121/1.2225382
Harding, A., & Grunwell, P. (1996). Characteristics of cleft palate speech, European Journal of Disoders of Communication, 31(4), 331—357.
Honda, Kiyoshi. (2015). Supralaryngeal articulators in the oropharyngeal region. In M. A. Redford (Ed.), The handbook of speech production (pp. 59-78). West Sussex: John Wiley & Sons Inc.
Howard, S. (2013). A phonetic investigation of single word versus connected speech production in children with persisting speech difficulties relating to cleft palate.
The Cleft Palate-Craniofacial Journal, 50(2), 207-223.
Hsiao, K. L. (2013). Interface of vowels between practiced and theories in SLA.
(Unpublished master thesis). Southern Taiwan University of Science and Technology, Taiwan.
Jeng, J. Y. (2000). The Speech Intelligibility and Acoustic Characteristics of
Mandarin Speakers with Cerebral Palsy. (Unpublished doctoral dissertation).
University of Wisconsin- Madison, USA.
Johnson, K. (2004). Massive reduction in convensational English. In K. Yoneyama, &
K. Maekawa (Eds.), Spontaneous speech: data and analysis. Proceedings of the
1st session of the10th international symposium (pp. 29-54). Tokyo: The National
International Institute for Japanese Language.
Klein, E. S., & Flint, C. B. (2006). Measurement of intelligibility in disordered speech.
Language Speech and Hearing Services in Schools, 37(3), 191-199.
Ladefoged, P. (2001). A Course in Phonetics (4th ed.). New York: Harcourt College Publishers.
Ladefoged, P. & Johnson, K. (2011). A Course in Phonetics (6th ed.). Wadsworth:
Cengage Learning.
Lai, Y. H. (2006). A phonetic and phonological study on English vowel acquisition for Taiwanese EFL learners. (Unpublished doctoral dissertation). National
Kaohsiung Normal University, Taiwan.
Liu, H. M. (2005). The effect of reduced vowel working space on speech intelligibility in Mandarin-speaking young adults with cerebral palsy. The Journal of the Acoustical Society of America,117(6),
3879-3889. https://doi.org/10.1121/1.1898623.
Maurer, D., & Suter, H. (2015). Gender and age differences in vowel-related formant patterns: what happens if men, women, and children produce vowels on
different and on similar F0? The Journal of the Acoustical Society of America, 137(4), 2416. https://doi.org/10.1121/1.4920812.
Niemi, M., Laaksonen, J. P., Peltomäki, T., Kurimo, J., Aaltonen, O., & Happonen, R.
P. (2006). Acoustic comparison of vowel sounds produced before and after
orthognathic surgery for mandibular advancement. Journal of Oral and Maxillofacial Surgery, 64(6), 910-916.
O’ Grady, W., & Archibald, J. (2016). Contemporary Linguistic Analysis: An Introduction (8th ed.). Toronto: Pearson.
Pickett, J. M. (1999). The Acoustics of Speech Communication. Boston: Allyn &
Bacon.
Trost, J.E. (1981). Articulation additions to the classical description of the speech of persons with cleft palate. Cleft Palate Journal, 18(3), 193-203.
Tung, T. H. (1994). Chinese Phonology (13th ed.). Taipei: Wen Shi Zhe.
Turner, G. S., Tjaden, K., & Weismer, G. (1995). The influence of speaking rate on vowel space and speech intelligibility for individuals with amyotrophic lateral sclerosis. Journal of Speech, Language, and Hearing Research, 38(5),
1001-1013. https://doi.org/10.1044/jshr.3805.1001.
Sandoval, S., Berisha, V., Utianski, R. L., Liss, J. M. & Spanias, A. (2013).
Automatic assessment of vowel space area. The Journal of the Acoustical Society of America, 134(5), 477-483. https://dx.doi.org/10.1121/1.4826150.
Shriberg, L. D., & Kent, R. D. (1982). Clinical Phonetics (2nd ed.). Baltimore:
University Park Press.
Zajac, D. J., Cevidanes, L., Shah, S., & Haley, K. L. (2012). Maxillary arch
dimensions and spectral characteristics of children with cleft lip and palate who produce middorsum palatal stops. Journal of Speech, Language, and Hearing Research, 55(6), 1876-1886.
Appendix A
The protocol treatment suggested by Bennun et al. (2016) Prenatal diagnosis:
• Parent’s consultation with the team coordinator.
• Family handling and understanding of diagnosis and treatment needs.
• Indication of main interventions.
Supporting delivery:
• Avoid baby separation from parents, oral tube utilization, and prolonged hospital stay.
Orofacial dysmorphology:
• Participate in the diagnosis and collection of pertinent records.
• Distinguish between syndromic and nonsyndromic.
Oral health:
• Oral examination.
• Dentist should collect an impression to build the oral plate.
• Early presurgical treatment.
Psychosocial support:
• Address barriers to medical and healthcare with family.
• Monitor parent–child issues.
• Referral to parent support groups.
Suction:
• Assess feeding and swallowing with interdisciplinary team.
Speech and language support:
• Counsel parents on early stimulation development.
• Assessment of early vocal output and communicative behavior.
General pediatric health:
• Pediatric care provider screening and presurgical evaluation.
ENT health:
• Physical assessment of oral and pharyngeal structures.
• Middle ear status diagnosis.
Surgical reconstruction:
• Lip and nose primary reconstruction from 2 to 6 months.
Anesthesiology:
• The airway skills of an experienced pediatric anesthesiologist are required to provide clinical care during operative procedures in order to maximize success and minimize risk.
• The use of local and regional anesthesia with epinephrine as a complement is useful in reducing bleeding, pain, and general anesthesia dose, and to allow ambulatory care surgeries.
Oral health:
• Nasal component removing and oral plate adaptation.
• Caries prevention anticipatory guidance.
ENT health:
• Follow-up for patients with recurrent infections, hearing loss, Eustachian tube dysfunction, miringotomy tube indication.
General pediatric health:
• Pediatric care provider screening and presurgical evaluation.
Surgical reconstruction:
• Complete cleft palate closure from 8 to14 months.
• Miringotomy tube insertion.
Complete diagnostic assessment (2 years):
• Address barriers to medicine and healthcare within family.
• Speech and language development.
• Facial growth and development.
• Scars and aesthetic evaluation.
Complete sequels detection (4–6 years):
• Annual pediatric care provider screening.
• Monitor dental development and malocclusion.
• Assess Eustachian tube dysfunction, recurrent infections, sleep apnea, airway issues.
• Monitor school achievement, screen for precursors of learning disability, and assess emotional and behavioral functioning.
• Evaluation of language comprehension and competence, and phonologic and phonetic development.
Complete sequels treatment (6–12 years):
• After permanent teeth eruption orthodontics treatment must be implemented.
• The interdisciplinary team must be ready to solve any dysfunctional condition.
Appendix B
The speech therapist suggested by Casadio (2016) Stage 1. From birth to cheiloplasty
Objective of the treatment: Promote maternal nutrition. General stimulation in the stomatognathic system.
• Early stimulation.
• Avoid tube feeding.
• Suction stimulation.
• Use of pacifier.
• Use of baby bottle, nipple selection.
• Feedingpatterns.
• Strengthening bond between mother and child.
• Hearing screening.
Stage 2. Until palatoplasty
Objective of the treatment: General stimulation in the communication area and speech.
Assistance every 1, 2, or 3 months, according to the needs of each particular case.
• Early stimulation.
• Dietary change, determined by the child maturation.
• Stimulation through vocal games. Vowel phonemes and consonant phonemes from 6 months and so on.
• Motor control.
• Hearing screening.
Stage 3. From palatoplasty until year 4
Objective of the treatment: Improve speech and comprehensive–expressive language development through systemized treatment.
• Guidelines.
• Stimulation of the velar mucous.
• Stimulation of the speech by onomatopoeia sounds.
• Comprehensive–expressive language.
• Gestural and facial mime.
• Nasal permeability.
• Hearing screening.
From 24 months and onward
• Control in the process of language development.
• Control in dietary change.
• Systematized treatment using games.
• Assist in the speech development in the different linguistic aspects:
phonological, grammatical, and semantic.
• Respiratory control.
• Body posture control.
• Velo palatine exercises.
• Articulations of the occlusal–fricative phonemes.
• Labial, lingual, velar, and mandibular praxis.
• Auditory discrimination.
Stage 4. From year 4 till year 6
Objective of the treatment: Improve articulation: manner and place. Resonance.
Audition.
• Evaluation of the velopharyngeal competence. Rinofibroscopy.
• Evaluation of articulations.
• Hearing screening through the audiological procedure: oeas, acoustic impedance, audiometry, and tone and speech testing.
• Systematized diagnosis and treatment.