Exploration Of Methods Of Correction Of Speech With Repaired Cleft Palate And Investigation Of The Factors On Accomplishment Of Speech Therapy

Cleft lip and palate is a common congenital defect of the maxillofacial diseases with incidence ranging from1in750to1in1000live births.In recent years,the incidence has increased gradually.With the popularity of cleft lip and palate Team Approach,the recovery of speech function has increasingly gained the attention of scholars at home and abroad,and cleft palate speech therapy has gradually become a hot topic.Cleft palate speech has a serious impact on patient’s social and psychological development such as low self-esteem,conflict,bored mood,which gradually sprouted in the patient’s psychological,and social viability decreased.This study aims to disscuss the appropriate correction method of speech therapy in different age groups,to provide a theoretical basis for speech therapy with repaired cleft palate patients,and by the follow-up investigation of the factors that affect the accomplishment of speech thera-py,we investigate and analyze the cause of pathogenic deficiencies and the high rate of attrition and interruption,and make recommendations. 1.Exploration of Methods of Correction of Speech with Repaired Cleft PalateObjectiveTo discuss the approach of speech therapy and put forward systematic treatment according to the acoustic features, articulation characteristics and psychological characteristics between the different groups,.And compare the differences in efficacy, also to provide clinical guidance for establishing a set of standardized speech therapy program.Methods77patients with incomplete repaired cleft palate were selected for this study during July2010to December2012because of speech obstacle coming to speech therapeutic room,the First Affiliated Hospital of Zhengzhou University., male41cases, female36cases, aging from4years old to24years old, median age is8years old, after cleft palate surgery from1to20years, According to different age77patients were divided into two groups,4≤age≤6years old and6years old older.Based on the young and old group of patients with abnormal articulation characteristics and psychological development characteristics, systematic and targeted treatment method was used in different groups, we compared the degree of clarity of pronunciation, treatment cycle between the two groups after treatment of speech therapy, and extracted formant of vowels and the frequency of blank space,strike and fills of consonants with CSL for data acquisition, image and acoustics analysis,.The data was analyzed with SPSS17.0.Results1.After training,the degree of clarity of pronunciation of the young group has increased from(40.90±14.17)%to(93.07±5.61)%, the degree of clarity of pronunciation of the elder group has increased from(37.39±14.49)%to (84.36±6.30)%,.The results of t test (P<0.05)suggested that according to sysmetic and targeted speech training, the degree of clarity of pronunciation of the two groups have obviously improved.2. Through the analysis of CSL, the second vowel formant of/i/the two groups of patients has increased (1974.71±128.36) Hz to (2441.59±201.48) Hz, of/i/has increased from (2441.59±201.48) Hz to (3187.33±105.38) Hz. The results of t test (P<0.05)explained that tongue retraction and VPI had been improved with speech therapy. The frenquency of gap and strike of plosive and affricate,fill of fricative has the remarkable difference before and after training with the square test(P<0.05), and the pronunciation of consonants are significantly improved.3. According to the distribution of training times between different groups, using the Wilcoxon rank test for two independent samples(P<0.05), the average speech training times of old group was long and speech intelligibility has improved less than younger age group. The average number of younger age group showed short speech training times and speech intelligibility has improved than younger age group.Conclusion1. The degree of clarity of pronunciation has improved obviously with the systematic and targeted speech therapy program,but for the speech treatment organization on the comprehensive training stage, how to improve the patient’s verbal expressive coherencen will need futher study.2. The speech correction of the younger group should be combined with the psychological characteristics and induced by imitation, goal reward. Diverse training forms can often improve patient’s enthusiasm and compliance, and improve speech training effect.3. The speech correction of the elder group correction requires repeated intensive training, focuses on the correct pronunciation, learns to use the airflow and control tongue correctly,so as to improve the training effect.4. Early operation of cleft palate provides the objective conditions for speech correction, which not only reduces the difficulty of speech therapy with repaired cleft palate, but also reduces the treatment cycle and improves the speech intelligibility significantly.5. Computer speech lab has provided the objective evaluation standard for speech therapy of cleft palate.2. Investigation of the Factors on Accomplishment of Speech TherapyObjectiveBy follow-up investigation through the recent years of cleft palate patients admitted in The First Affiliated Hospital of ZhengZhou University with telephone and questionnaires, aiming at the situation of high turnover rate, high interrupt rate, high loss rate of patients, this study has analyzed relevant reasons,and put forward related recommendation.MethodsThrough the retrospective study of the hospital registration information of cleft palate patients admitted in The First Affiliated Hospital of Zhengzhou University from January2008to October2012by the form of telephone and questionnaire, the study aims at the distribution of the operation age of the patients, discussing the cause of patients without speech therapy and patients with speech therapy who have interrupted, treatment of intention, communication language,etc and do statistical analysis.Results1. During January2008to October2012in our hospital,the early operation for patients with cleft palate has rised gradually.2. During January2008to October2012, distance as the main influence factor with the constituent ratio of37.19%,for the reason of patients without speech therapy, followed by the subjective factors, time, age, the constituent ratio was32.23%,24.79%and5.79%.3. During January2008to October2012, distance, economic factors as the first reason with the constituent ratio of33.33%for the interruption of patients with speech therapy, followed by the subjective factors, time, giving up, age and living environment, the constituent ratio was29.41%,19.61%,5.88%,3.92%and7.84%.4. During January2008to October2012patients accepted speech training in more than5times who interrupted accounted for88.33%.This survey demonstrated that the times of most patients received speech therapy could be limited within5times, completion rate was greatly reduced with more than5times.5. The survey showed that97.52%of the patients communicated using dialects, and most of them lived in rural areas.6. The survey showed that95.88%of the patients knew that speech training was essential after operation of cleft palate but did not understand the necessity of the treatment and the best time of therapy.7. The majority of patients who had completed training in our investigation can not be applied to the daily communication using the correct pronunciation method, and Long-term quality of life is not high.Conclusion1. Perfect follow-up system should be established in order to save patient data, make regular follow-up and maintain records.2. To strengthen the necessity of review after training,and the frequency of a proposed review is every once in a month originally, then can extend the review interval. The treatment guidelines should be given and timely correct problems.When necessary, we can use Internet video, telephone communication for review.3. To strengthen the popularization of knowledge of cleft palate speech therapy, organize related lectures, print brochures, establish professional stuff responsible for cleft palate speech therapy, raise the attention and enthusiasm of patients and their parents for speech therapy.4. Medical personnel and speech therapists should make well preoperative communication and coordination, preserve and analyze preoperative recording data,and adopt the proper operation procedures in order to improve the degree of clarity of pronunciation.5. Increase investment in medical resources and carry out speech therapy in subordinate prefecture-level cities and counties. 6. If there are any conditions, try to use mandarin to communicate, and reduce frequency use of dialect.7. Speech therapy should be combined with the psychological characteristics of patients, adjust treatment plan at time, avoid the conflict, fear, tired mood, construct harmonious doctor-patient relationship.