**4. Speech assessment**

**Figure 4** shows our treatment schedule for speech in cleft palate patients. Speech management by a speech therapist starts just after birth, and the patient's motor development is facilitated. A check by an ENT doctor for the presence of otitis media is performed every 6 months. Palatal repair is then performed at 1.5 years. And after palatal repair, exercise facilitating VP closure is performed by a speech therapist. When the patient reaches the age of 4 years, VP closure (VPC) function is evaluated more precisely. If VPI remains, speech therapist starts training facilitating VPC. Our goal is to achieve a normal speech before entering elementary school.

 **Figure 4.** Treatment schedule for speech in cleft palate patients in Kagoshima University Hospital.

Postoperatively, patients were followed by 2 SLTs every 3 months until around 4 years. In this study, perceptual rating of hypernasality and nasal emission was carried out for all participants using the preserved sound sources by SLTs. In perceptual rating, hypernasality and nasal emission were classified into four categories: none, slight/mild, moderate, and severe. Articulation was also evaluated using the articulation test of the Japan Society of Logopedics and Phoniatrics and then converted to IPA 2005 phonetic symbols so that all abnormalities could be diagnosed and transcribed in IPA.

Nasometry scores were obtained for all patients using the Kay 6200 Nasometer II (Kay Elemetics, Lincoln Park, NJ, USA). For speech stimuli, the low-pressure vowel /i:/ and low-pressure sentence /yooi wa ooi/ and the high-pressure consonant-vowel syllable /tsu/ and high-pressure sentence /kitsutsuki ga kiwotsutsuku/ were used [13]. The reason, why we selected /i:/ extending the verbalization of /i/ among the all low-pressured vowels, was based on our previous study on the relationship between nasalance score and the perceptual rating of resonance in Japanese cleft and noncleft subjects [14]. In the previous study, we found that nasalance score during phonation of /i:/ was correlated with perceptual rating of resonance and cleft and noncelft subjects with normal resonance demonstrated the mean nasalance score less than 20% during phonation of /i:/.

**4. Speech assessment**

66 Designing Strategies for Cleft Lip and Palate Care

**Figure 4** shows our treatment schedule for speech in cleft palate patients. Speech management by a speech therapist starts just after birth, and the patient's motor development is facilitated. A check by an ENT doctor for the presence of otitis media is performed every 6 months. Palatal repair is then performed at 1.5 years. And after palatal repair, exercise facilitating VP closure is performed by a speech therapist. When the patient reaches the age of 4 years, VP closure (VPC) function is evaluated more precisely. If VPI remains, speech therapist starts training facilitating VPC. Our goal is to achieve a normal speech before entering elementary school.

Postoperatively, patients were followed by 2 SLTs every 3 months until around 4 years. In this study, perceptual rating of hypernasality and nasal emission was carried out for all participants using the preserved sound sources by SLTs. In perceptual rating, hypernasality and nasal emission were classified into four categories: none, slight/mild, moderate, and severe. Articulation was also evaluated using the articulation test of the Japan Society of Logopedics and Phoniatrics and then converted to IPA 2005 phonetic symbols so that all abnormalities

 **Figure 4.** Treatment schedule for speech in cleft palate patients in Kagoshima University Hospital.

Nasometry scores were obtained for all patients using the Kay 6200 Nasometer II (Kay Elemetics, Lincoln Park, NJ, USA). For speech stimuli, the low-pressure vowel /i:/ and

could be diagnosed and transcribed in IPA.
