Sara Howard is Reader in Clinical Phonetics,?University of Sheffield, UK. Anette Lohmander is Professor and Head of Division of Speech and Language Pathology, Department of Clinical Science, Intervention and Technique, Karolinska Institutet, Sweden.

• List of Contributors xiPreface xviiPart One Speech Production and Development 1Sara Howard and Anette Lohmander1 Physical Structure and Function and Speech Production Associated with Cleft Palate 5Martin Atkinson and Sara Howard1.1 Introduction 51.2 The Hard and Soft Palates and the Velopharynx 61.3 The Tonsils and Adenoids 91.4 The Larynx 111.5 The Jaws, Dentition and Occlusion 121.6 Symmetry: Structure and Function 151.7 The Tongue 161.8 The Lips 181.9 Summary: Compensations Across Systems 19References 192 The Development of Speech in Children with Cleft Palate 23Kathy L. Chapman and Elisabeth Willadsen2.1 Overview 232.2 The Impact of Clefting on Speech Production 242.3 Variables Impacting Speech Development for Young Children with Cleft Palate 252.4 Speech Development: Birth to Age Five 262.5 Conclusion 35References 363 The Influence of Related Conditions on Speech and Communication 41Christina Persson and Lotta Sjögreen3.1 Introduction 413.2 Conditions Related to Structural Etiologies 423.3 Conditions Related to Neurological Aetiology 473.4 Conditions Related to a Combination of Structural and Neurological Aetiology 493.5 Clinical Implications 50References 504 Surgical Intervention and Speech Outcomes in Cleft Lip and Palate 55Anette Lohmander4.1 Introduction 554.2 Basics of Surgery on Cleft Palate 574.3 Basics of Outcomes 644.4 Speech Outcomes 654.5 Conclusion 69Appendix 4.A Review of Evidence and Methodology in Studies of Speech Outcome in Individuals Born with Cleft Lip and Palate 70References 825 Secondary Management and Speech Outcome 87John E. Riski5.1 Introduction 875.2 Secondary Surgical Management of Velopharyngeal Incompetence 885.3 Secondary Pharyngeal Flap 885.4 Posterior Pharyngeal Wall Augmentation by Muscle Transposition 915.5 Studies Comparing Treatments of VPI 945.6 Posterior Pharyngeal Wall Augmentation by Implants and Injections 955.7 Velarplasty 965.8 Other Considerations in Managing VPI 975.9 Complications Secondary to Pharyngoplasties 995.10 Conclusions 99References 1006 Cleft Palate Speech in the Majority World: Models of Intervention and Speech Outcomes in Diverse Cultural and Language Contexts 105Debbie Sell, Roopa Nagarajan and Mary Wickenden6.1 Introduction 1056.2 Speech Outcomes in a Majority World Context 1066.3 Different Models of Provision 1096.4 Attitudes/Cultural Aspects 1156.5 Conclusion 119References 119Part Two Speech Assessment and Intervention 123Anette Lohmander and Sara Howard7 Phonetic Transcription for Speech Related to Cleft Palate 127Sara Howard7.1 Introduction 1277.2 What is Phonetic Transcription? 1287.3 Why Transcribe? 1297.4 What to Transcribe and How to Transcribe It 1307.5 Features of Cleft Speech Production 1317.6 Pitfalls of Transcription 1347.7 Conclusion 138Appendices 139References 1428 Instrumentation in the Analysis of the Structure and Function of the Velopharyngeal Mechanism 145Debbie Sell and Valerie Pereira8.1 Introduction 1458.2 Visualization of the Velopharyngeal Mechanism 1478.3 Multiview Videofluoroscopy 1478.4 Nasendoscopy Procedure 1518.5 Magnetic Resonance Imaging (MRI) 1558.6 Variability in Practice 1588.7 Future 162References 1629 Cross Linguistic Perspectives on Speech Assessment in Cleft Palate 167Gunilla Henningsson and Elisabeth Willadsen9.1 Introduction 1679.2 Vulnerable Speech Sounds 1689.3 Language Background of the Listener Assessing the Speech of Children with Cleft Palate 1709.4 What Is Known about More Unfamiliar Languages? 1739.5 Cross Linguistic Speech Samples 1739.6 Influence on Assessment of Language Acquisition in the Young Child with Cleft Palate 1769.7 Conclusion 177References 17710 Voice Assessment and Intervention 181Lesley Cavalli10.1 Introduction 18110.2 Defining a Voice Disorder 18110.3 Assessment 18410.4 Instrumental Assessment 18910.5 Vocal Handicap Measures 19010.6 Treatment 19110.7 Conclusion 195References 19611 Nasality – Assessment and Intervention 199Triona Sweeney11.1 Introduction 19911.2 Perceptual Assessment of Nasality and Nasal Airflow Errors 20511.3 Instrumental Assessment of Nasality and Nasal Airflow Errors 20711.4 Interpreting Results 21111.5 Intervention 21411.6 Conclusion 216Appendix 11.A Temple Street Scale of Nasality and Nasal Airflow Errors 217References 21712 Articulation – Instruments for Research and Clinical Practice 221Fiona E. Gibbon and Alice Lee12.1 Introduction 22112.2 Electropalatography (EPG) 22212.3 Imaging Techniques 22812.4 Motion Tracking 23312.5 Conclusion 235Acknowledgement 235References 23513 Psycholinguistic Assessment and Intervention 239Joy Stackhouse13.1 Introduction 23913.2 What is a Psycholinguistic Approach? 24013.3 A Psycholinguistic Assessment Framework 24213.4 Intervention from a Psycholinguistic Perspective 24513.5 Literacy: Phonological Awareness and Spelling 25013.6 Summary 254References 25514 Early Communication Assessment and Intervention 259Nancy Scherer and Brenda Louw14.1 Introduction 25914.2 Assessment 26014.3 Intervention 267References 27215 Phonological Approaches to Speech Difficulties Associated with Cleft Palate 275Anne Harding-Bell and Sara Howard15.1 Introduction 27515.2 Variability, Variation and Compensation 27715.3 Classification of Speech Difficulties Related to Cleft Palate 27815.4 Phonological Assessment of Speech Data Related to Cleft Palate 27815.5 Phonological Consequences of Speech Production Related to Cleft Palate 27915.6 Intervention 28315.7 Summary 287References 28816 Speech Intelligibility 293Tara L. Whitehill, Carrie L. Gotzke and Megan Hodge16.1 Introduction 29316.2 Definition of Intelligibility and Related Concepts 29416.3 Measurement Issues 29416.4 Studies of Intelligibility in Speakers with Cleft Palate 29616.5 Current and Future Developments 29816.6 Conclusion 300References 30117 Communicative Participation 305Christina Havstam and Anette Lohmander17.1 Introduction 30517.2 ICF 30617.3 Communicative Participation 30717.4 Conclusions and Clinical Implications 312References 31218 Evaluation and Evidence-Based Practice 317Linda D. Vallino-Napoli18.1 Introduction 31718.2 Intervention for Speech Disorders 31818.3 Evidence-Based Practice 31918.4 The Systematic Review Process 32318.5 Evidence Findings Establishing Therapy Effectiveness 32518.6 Instrumentation – Visual Feedback 34918.7 Surgery 35018.8 Comments about Intervention Effectiveness 35118.9 Intervention and the International Classification of Function (ICF) 35218.10 Research Designs for Intervention Studies 35218.11 Conclusions 352Appendix 18.A Commonly Used Evidence Hierarchies for Intervention Studies 354References 354Index 359