Articulatory Additions to the Classical Description of the Speech of Persons with Cleft Palate

Home , Glottal stop, Palatal stop, Velar stop

JUDITH E. TROST, Ph.D. Chicago, Illinois, 60611

Three types of compensatory articulation used by speakers with cleft palate and velopharyngeal inadequacy are described: the pharyngeal stop, the mid-dorsum palatal stop, and the posterior nasal fricative. These articulatory characteristics have not been previ- ously reported in the literature. Each is defined radiographically to depict deviant place of production. Each is also described in terms of perceptually distinct speech characteristics. Production features of these articulatory compensations are contrasted and compared with those of the glottal stop and pharyngeal fricative. The use of compensatory articulation as replacements for target phonemes is distinguished from their occurrence as aberrant co-articulations with target phonemes. Additionally, phonetic symbols for use in narrow phonetic transcription are presented, and implications for speech remediation are discussed. KEY WORDS: articulation, compensatory articulation, cleft palate

Introduction snort" (Backus, et al., 1943), "hissing noise" Throughout the literature on cleft palate, (Van Riper and Irwin, 1961), "distortion-na- the deviant speech characteristics associated sal" and "substitution-nasal" (VanDemark, with impairment to the velopharyngeal valve 1964), and nasal emission as distinguished have included four chief stigmata: hyperna- from "nasal turbulence" (McWilliams and sality, nasal air emission, weak pressure con- Philips, 1979). Although this assortment of | sonants, and compensatory articulation. labels implies variable expression of nasal FHypernasality is the resonance disturbance emission with respect to articulatory contrib- which accompanies vowels and vocalic con- utors to air turbulence or audible resistance, sonants, the glides or liquids, and gives rise to specific articulatory gestures associated with deviant voice quality in speech production. nasal escape of air have been neither docu- Nasal air emission is the nasal airflow which mented nor agreed upon among clinicians. accompanies production of pressure conso- Van Riper and Irwin (1961) alluded to pos- nants-the stops, affricates, and fricative pho- teriorly generated frication in their descrip- nemes. It is most often characterized in the tion of the "nasopharyngeal snort," and Pe- literature as an audible speech sound distor- terson (1975) noted aberrant lingual 'postur- tion. Several authors have commented on the ing to be associated with nasal emission that variable auditory perceptual qualities associ- is confined to production of sibilant fricatives ated with nasal air emission with the result and affricate phonemes. McWilliams (1980) that many labels have been applied to this has commented on "posterior distortions" phenomenon. These have included "nasal stating that these occur " . .. when the sound is produced through a channel created by the blade of the tongue articulating with the hard Dr. Trost is Associate Professor and Director of Re- palate well behind the maxillary arch or with search and Speech and Language Services at the North- western University Cleft Lip and Palate Institute, and the soft palate." (p. 408). The third feature, Associate Professor in the Department of Communicative weak pressure consonants, like nasal emission, Disorders of Northwestern University. occurs secondary to the open velopharyngeal Material included in this report was presented, in port. It has its direct consequence upon man- part, at the 1978 American Cleft Palate Association annual meeting in Atlanta, Georgia, April 5-8 and also ner of production, that is, upon the stop-con- at the 1978 Convention of the American Speech and tinuant feature dimension of articulatory Hearing Association, San Francisco, November 18-21. valving. Although these two aspects of speech 193 194 Cleft Palate Journal, July 1981, Vol. 18 No. 3 impairment are derived from the same struc- has been identified by Dalston and Trost tural or valving inadequacy, each has a dif- (1979) through phonetic transcription analy- ferent impact upon speech. Nasal air emission ses of young speakers with cleft palate. _ distorts or replaces the target phoneme, Several authors have viewed both the glot- whereas reduced intraoral pressure diminishes tal stop and the pharyngeal fricative as the plosive power and often renders even a correct speaker's attempt to valve the articulators labial or lingual articulatory gesture ineffec- where the most success can be obtained. This tive. Compensatory articulations comprises the place occurs below the level of defect (Bzoch, fourth variety of speech deviation. Within this 1971a; Morris, 1971; Lawrence and Philips, group, the glottal stop and the pharyngeal 1975). Little has been stated about the com- fricative have been given substantial thera- pensatory role(s) of the velar fricative in peutic and research attention. Bzoch (1971b) speakers with cleft palate and no systematic included the velar fricative in this category. data have been reported in the literature. In As its name implies, the glottal stop is a the author's opinion, the velar fricative occurs plosive consonant produced by vocal fold sometimes as a homorganic substitution for valving. The pharyngeal fricative, as will be the back velar stops /k/ and /I/ because of illustrated later in this report, results from the loss of the stop quality resulting from the narrowing of the pharyngeal airway by lin- velopharyngeal valve leak. It can also be spec- guapharyngeal articulatory constriction. The ulated that speakers with velopharyngeal in- velar fricative is a linguavelar articulation adequacy often use the back of the tongue to made in the approximate place of /k/ and aid in velopharyngeal valving so that it be- /9/. This third variety of articulatory devia- comes obligatory for lingual articulatory ma- tion has a high rate of occurrence in dysarthric neuvers to be shifted posteriorly. Such com- speakers because of the neuromotor involve- pensatory adjustments could underlie velar ment of the posterior tongue. The resulting fricative substitutions for sibilant fricatives velar fricative for the velar stop substitution and affricates. is often aggravated by co-existing velopharyn- Clinically, there are other frequently ob- geal incompetency. served compensatory articulations which are different from the classical descriptions of the The Nature of Compensatory Articulations glottal stop, pharyngeal fricative, and velar Several studies have demonstrated that, in fricative. These are the pharyngeal stop, mid- most instances where compensatory articula- dorsum palatal stop, and posterior nasal fricative. tions are substituted for target phonemes, the The purpose of this report is to describe per- correct manner of articulation is preserved ceptual and physiological aspects of these ad- while correct place of articulation is sacrificed ditional compensatory articulations and to (Counihan, 1956, 1960; Spriestersbach, et al., comment on their implications for diagnosis 1961). The frequently observed glottal stop and remediation. ' substitutions for stop consonants and pharyn- Procedure geal fricative substitutions for sibilant fricatives and sometimes for affricates are compat- Listener judgment data on the six types of ible with the foregoing reports. Interestingly, compensatory articulation discussed in this the extreme anterior fricatives /f, v, 8, 0/ do report show that these productions are per- not show similar vulnerability. ceptually identifiable and distinct from one Findings from studies employing cineradi- another. Six speech pathologists, three expe- ographic and videofluoroscopic procedures rienced in craniofacial disorders and three have revealed a consistent tendency for lin- inexperienced in this area, served as judges. gual place targets to be shifted posteriorly in After a one-hour training session, each judge speakers with cleft palate (Powers, 1962; listened to audio-tape recordings of 24 pa- Brooks, et al., 1965, 1966; Lawrence and tients producing sentence pairs. Order of sen- Philips, 1975). A tendency toward backed tence pairs was randomized for presentation. lingual contacts in general is clinically evi- Each sentence contained one to several occur- dent, as demonstrated in the 1979 audiotape rences of the compensatory articulation to be presentations of McWilliams and Philips, and identified and some sentences contained other TI'OSt, ARTICULATORY ADDITIONS 195

types of articulatory errors as well. Listeners were asked only to identify the compensatory articulation type used by the speaker in un- derlined segments of the sentence and were not required to do narrow phonetic transcription. The percentage of correct identification of compensatory articulation types ranged from 66.7% to 96.3% correct, with a mean percentage of correct responses of 86.8. When the poorest listener was excluded, the scores ranged from 85.2% to 96.3% with a mean B | percentage correct of 90.8. Analysis of re-pre- @ | sentations of sentence pairs included in the task yielded an intrajudge reliability of 1.0 for © five of the judges and of only .33 for the sixth judge. Interestingly, this was the same judge @) who achieved only 66.7% correct identifica-

tion. Overall, these data provide objective

support for the perceptual distinctiveness of T these compensatory productions. FIGURE 1. Lateral view schematic illustration of pharyngeal stop compensatory articulation with broken Description of The Compensatory line showing lingual configuration and placement. Articulations

The Pharyngeal Stop fricative, as a substitution for /s/, reveals a concave configuration of the base of the

The pharyngeal stop is illustrated diagra- tongue.

matically in Figure 1. As can be seen, this is Figures 3a and 3b show adult patient E.B.

a linguapharyngeal stop consontant produc- wearing a pharyngeal extension appliance. In

tion. It is used as a compensatory substitution Figure 3a, the resting posture is seen, while

for /k/ or /9/. Perceptually, the pharyngeal Figure 3b shows the pharyngeal stop articu-

stop is best described as a /k/ or // produced lation. Here the linguapharyngeal contact is

with the tongue positioned posterior and in- executed at a lower point in the pharynx. As

ferior to its normal target place. Radiographic with D.O., however, the lingual base config-

data and perceptual features show that this uration is convex, with tongue tip down and

form of articulation can occur at different retraction of the mass of the tongue. This

points along the pharyngeal tube. For exam- lingual posture appears to be characteristic of

ple, "high" pharyngeal stops may be de- the pharyngeal stop.

scribed as occurring at or near the level of High versus low pharyngeal stop contacts

anticipated velopharyngeal closure. They are give rise to perceptually distinguishable pro- perceived as higher in frequency as compared ductions, and pharyngeal stops are heard as

to "low" pharyngeal stops, which occur closer clearly distinct from glottal stops. The normal

to the glottis. speaker can simulate a pharyngeal stop by

Figure 2a shows patient D.O., a four-year- first producing a /k/ and then backing and old who has a pharyngeal flap, in resting dropping the place of articulation to assume posture. Figure 2b illustrates the linguaphar- successively lower valving points within the yngeal contact of the pharyngeal stop produc- pharyngeal tube. In its least deviant place- tion. In this instance, the area of stop contact ment, the pharyngeal stop is heard as a is high in the pharynx. Of note here also are backed /k/ or the convex conﬁguratlon of the posterior Using cineradiography and spectrography, tongue (L.B.) as it backs into the pharyngeal Honjow and Isshiki (1971) noted some in- wall, the tip-down lingual posture with over- stances of pharyngeal stop articulation in one all tongue retraction, and the slightly exces- adult patient with velopharyngeal insuffi- sive mouth opening. By contrast, as seen in ciency. Their radiographic description of the

Figure 2¢, D.O.'s production of a pharyngeal linguapharyngeal contact is compatible with 196 Cleft Palate Journal, July 1981, Vol. 18 No. 3

those contained in this report. By contrast, however, Honjow and Isshiki appear to err in concluding that the pharyngeal stop is per- D.O. REST ceptually acceptable as a normal /k/ and does not, therefore, warrant speech remediation. Their comments that this deviant stop articulation has a low frequency of occurrence among the speech errors seen in association with cleft palate and that it does not occur with production of contiguous front vowels are at odds with the clinical observations reported here and require more systematic study.

The Mid-dorsum Palatal Stop The mid-dorsum palatal stop is a stop consonant made in the approximate place of the glide /j/. Figure 4 is a schematic illustration of this oral stop consonant. This substitution is used to replace /t/, /d/, /k/, or /9/. Per- ceptually, the phoneme boundaries between /t/ and /k/ or between /d/ and // are lost. Voiceless production of the mid-dorsum stop is perceived equally as like /t/ and as like /k/; voiced production sounds equally like /d/ and like Phonetic value is, therefore, determined by semantic or grammatical context or both. Patient BF., shown in Figure 5a, is a young adult with a repaired bilateral complete cleft and a pharyngeal flap. She also has a pseudo- Class III malocclusion and mild openbite. Figure 5b depicts B.F.'s production of a mid- dorsum palatal stop. The mid-palatal lingual contact with tongue tip down is seen on the radiograph. This deviant articulation may represent a place compromise as the cleft palate speaker attempts to maintain oral articulatory contacts for the tip-alveolar and back velar stops. For purposes of comparison, Fig- ure 5¢ shows B.F.'s production of a pharyngeal fricative. The point of linguapharyngeal constriction is well below the hyoid, and the lingual dorsum concavity is prominent.

pharyngeal stop substitution for /k/, demonstrating a high point of stop contact and marked convexity of lingual dorsum and base (L.B.); (c) Lateral view radiographic FIGURE 2. (a) Lateral view radiographic illustra- illustration of D.O. producing pharyngeal fricative sub- tion of four-year-old patient D.O., at rest, with repaired stituion for /s/ and showing concave configuration of secondary palate cleft and pharyngeal flap (P.FL.); (b) lingual base (LB.), as it approximates posterior pharyn- Lateral view radiographic illustration of D.O. producing geal wall (P.P.W.).

Trosl, ARTICULATORY ADDITIONS 197

EB. REST EB. |4/K)

FIGURE 3. (a) Lateral view radiographic illustration of adult patient E.B. who has a repaired complete unilateral E.B. producing cleft, wearing pharyngeal extension appliance, at rest; (b) Lateral view radiographic illustration of base (LL.B.). pharyngeal stop substitution for /k/, revealing low point of step contact and marked convexity of lingual

approximates the pharyngeal wall, but there

is no velopharyngeal seal, and the air is re-

leased nasally. The speech consequence is an

audible frication with associated nasal air

emission. This velar articulation can be seen

radiographically as a blurring of movement

or a velar flutter (VF), as indicated in Figure 6

by broken lines. The gesture might well be

termed a "velopharyngeal fricative." In some

patients, simultaneous linguavelar articula-

tion is observed as the tongue attempts to B provide /ingual assistance (see L in Figure 6) to

@ compensate for impaired velar movement. The posterior nasal fricative with simultane-

@ ous lingual assistance posturing is observed in

some persons with submucous clefts. It has a

geal disorders, including the neurogenic prob-

lems of the dysarthrias and phoneme-specific

velopharyngeal inadequacy. This last term is FIGURE 4. Lateral view schematic illustration of used by the author to define the occurrence mid-dorsum palatal stop, with broken line showing lin- of nasal air emission and audible posterior gual configuration and placement. frication on certain pressure consonants only.

That is, this abnormal pattern of airflow oc-

The Posterior Nasal Fricative curs in the absence of any hypernasal reso-

Radiographic data obtained during pa- nance, and the remainder of the pressure

tients' productions of sustained fricatives sug- consonants are produced with adequate clo-

gests that the articulatory gestures that un- sure. Posterior posturing of the tongue, lin-

derly this articulation are variable. In some gual-assistance to velopharyngeal closure, or

cases, the frication or air turbulence appears both appear common in this subgroup of

to be generated at the velopharyngeal port. velopharyngeal inadequacies.

There is an airway constriction as the velum The child patient shown in Figures 7a and

198 Cleft Palate Journal, July 1981, Vol. 18 No. 3

if BF REST

@ﬂ @ @

posterior FIGURE nasal 6. fricativeLateral withview brokenschematic lines illustrationdepicting lin- of gualfrication configuration activity (VF). and placement (L) and velar flutter/ a7b substitution has produced for a/s/. posterior Figure nasal7b illustrates fricative the as lingualblurred imageassistance of the to posteriorclosure (LA),velum anddenotes the the(VF). presence The patient and locationshown inof Figuresvelar frication 8a and 8band has also a hasneurogenic reduced velopharyngealback-tongue valving. problem In s/,her sheattempt has produced to produce /s/ the+ atargetsimultaneous fricative or/ co-articulatedpatible with the posterior reduced nasal range fricative. of posterior Com- tonguevelar-uvular movement, frication she gesture,demonstrates with noonly assist- the ance Posterior from the nasal tongue. fricatives are observed in gealsome flappatients surgery. with Inpalatal this population,clefts after pharyn-the lat- posterioreral ports frication. appear Into thesecomprise cases, thethe posteriorpoint of nasalequacy fricative or to the occurs patient's secondary attempts to flapto persist inad- in Typically,directing thesome airstream degree ofnasally. nasal emission is obligatory in production of the posterior nasal FIGURE 3. (a) Lateral view radiographic illustration of patient B.F., who has a repaired complete bilateral cleft and pharyngeal flap (P.FL.), at rest; (b) Lateral ment; (c) Lateral view radiographic illustration of patient view radiographic illustration of patient B.F. producing B.F. producing pharyngeal fricative substitution for /s/, mid-dorsum palatal stop substitution for /t/, showing showing low point of linguapharyngeal constriction and tip-down and retracted lingual configuration and place- concave configuration of posterior tongue.

Trost, ARTICULATORY ADDITIONS 199

LK. REST

FIGURE 7. (a) Lateral radiographic view of child patient J.K. who has phoneme-specific inadequacy, at rest; (b) Lateral view radiographic illustration of patient J.K. producing posterior nasal fricative substitution for /s/, demonstrating lingually assisted posturing (L.A.) and velar flutter/frication (V.F.).

$M - VP Incomp -REST

FIGURE 8. (a) Lateral resting radiograph of patient S.M., who has velopharyngeal incompetency; (b) Lateral view radiographic illustration of patient S.M. producing co-articulation of /s/ + posterior nasal fricative, /A/, and demonstrating velar flutter (V.F.) simultaneously with lingual placement for /s/.

fricative. Perceptually, this posterior fricative nants, speakers with velopharyngeal inade- is distinguishable from nasal emission alone. quacy may generate only nasal air emission,

This is because these two phenomena have or nasal air emission simultaneous with pos-

different loci of turbulence or resistance to terior nasal fricatives, or only posterior nasal airflow. With nasal emission alone, any au- fricatives. It is perhaps this variability in com-

dible resistance to airflow must be intra-nasal binations of occurrence that has led to the

as compared to the velopharyngeal port locus numerous labels applied to identify the nasal

of the posterior nasal fricative. Clearly, when airflow deviations heard in persons with ve-

there is complete blockage of the nasal pas- lopharyngeal impairments.

sages or in patients with obstructive pharyn- Clinically, the posterior nasal fricative has

geal flaps, nasal emission is minimal or absent, been observed as a substitution for the pho-

and only the posterior nasal fricative may be nemes (s, z, §, 3/. This posterior fricative also

heard. Thus, in targeting for pressure conso- exists as an abnormal co-articulation by oc-

200 Cleft Palate Journal, July 1981, Vol. 18 No. 3 _

curring simultaneous with a fricative, affri- author from IPA notation in order to simplify cate, or stop consonant. The speaker postures phonetic notation. Likewise, for the mid-dor- the articulators so as to produce simultane- sum palatal stop, the unvoiced symbol is ously an oral pressure consonant and a pos- drawn to represent the underlying compro- terior nasal fricative. In speakers with pho- mise in articulatory gestures, /t/, and /k/, neme-specific velopharyngeal inadequacy while its voiced counterpart is an ortho- where only selected oral consonants reveal graphic blending of the /d/ and // pho- nasal airflow, the posterior nasal fricative, nemes. The symbol for posterior nasal frica- with or without nasal air emission, may be tive was developed in 1978 by Dalston who the only perceptually deviant speech charac- has referred to it as a "flap fricative" because teristic. of its occurrence in post-pharyngeal flap cases. Phonetic Transcription of Compensatory The symbols characterizing the pharyngeal Articulations stop cognate pair are designed to represent the length of the pharyngeal tube with the Table 1 summarizes all six types of com- rounded portion, also seen in the pharyngeal pensatory articulations and the corresponding fricative, depicting the articulatory gesture of phonetic symbols that can be used in narrow "tongue backing into the posterior pharyngeal phonetic transcription. Symbols are provided wall." The symbols for the pharyngeal stop for voiced and unvoiced productions except versus the pharyngeal fricative are intended for the voiced glottal stop and the unvoiced to distinguish production features of stop ver- posterior nasal fricative. New symbols are pro- sus continuant, as the upper portion of the - vided for the pharyngeal stop, mid-dorsum pharyngeal fricative symbol remains open. palatal stop, and posterior nasal fricative. The symbols for glottal stop and velar fricative Compensatory Articulations As should be familiar to persons acquainted with Substitutions and Co-Articulations the International Phonetic Alphabet (IPA). For ease of discussion, Table 2 provides an Symbols denoting the cognate pair of pharyn- empirically derived listing of how compensa- geal fricatives have been modified by the tory articulations tend to be distributed as a) TABLE 1. Six types of compensatory articulation and target sound substitution/replacement only, as in corresponding phonetic symbols for unvoiced and /?/ for /p/, or b) co-articulation as in | f? As voiced productions. ‘ used here, the term co-articulation denotes

Phonetic Symbol atypical simultaneous articulatory maneu- Compensatory Articulation vers. As shown in the example above, it is Unvoiced Voiced characterized by one manner of production, Glottal Stop ' /? / stop, with simultaneous valving at two places Pharyngeal fricative /§/ [L/ of production, glottal and bilabial. It is em- Velar fricative /x/ // phasized that these are clinically observed Mid-Dorsum Palatal Stop /€/ 1g/ trends and do not, to date, have the scientific Posterior Nasal Fricative /A/ support of systematic data. That clinicians Pharyngeal Stop 4 / /4/ are aware of this aberrant type of co-articu-

TABLE 2. Empirically derived listing of target phoneme classes that are substituted for, replaced by, or co- articulated with compensatory articulation.

Target Phoneme Class Compensatory Articulation Substituted / Replaced Co-articulated /? / Stops, occasionally affricates Stops, affricates /%, T/ Fricatives, predominantly sibilants Fricatives (sibilants) /§.{/ Back velar stops None /A/ Sibilant fricatives All pressure consonants Back velar stops/sibilant fricatives None /k.4/ Tip alveolar stops/back velar stops None

Trost, ARTICULATORY ADDITIONS 201 lation is supported by the observations of deed, with the exception of the velar fricative McWilliams and Philips (1979). ' for velar stop substitution and some occur- Based on observations reported here, the rences of /A/ articulation, most of the com- pharyngeal stop, velar fricative, and mid-dor- pensatory articulations seen in this population sum stop occur more typically as phoneme involve errors in place of production. Exclu- replacements, while the glottal stop, pharyn- sive of substitution of the mid-dorsum palatal geal fricative, and posterior nasal fricative stop for the back-velars /k/ and /J/, these occur either as phoneme replacements or as place errors represent posterior or backed artic- co-articulations. These observed patterns of ulation patterns. The therapeutic goal is to bring distribution may relate simply to motor the articulatory placements more forward. speech mechanics in that with /?/, /A/, and Auditory modeling, alone, is generally un- /%, G/, the tongue is freer to make simulta- successful in shifting compensatory articula- neous, more anterior contacts or approxima- tion postures. Some form of diagramatic or tions. Clearly, systematic research data are other visual representation of desired targets needed so that more reliable and valid con- for contrast with faulty placements is a useful clusions can be drawn regarding patterns of technique. A simple, unlabeled lateral draw- compensatory articulations used by speakers ing, like that shown in Figure 9a, can be used with cleft palate and velopharyngeal inade- to visualize a patient's error postures relative quacy. to correct targets. Both errors of substitution and of co-articulation can be represented, and Implications for Treatment children as young as four years can benefit The remarks offered here are not research from this type of approach. For example, findings and are intended to serve only as Figures 9b and 9¢ are illustrative of the sub- guidelines to assist the clinician in thinking stitution of a pharyngeal stop for /k/ and of through and planning the patient's treatment the co-articulation of a glottal stop + /t/, needs, based upon the total composite of respectively. The clinician can contrast the speech diagnostic findings. At the outset, the patient's incorrect versus the correct produc- clinician must determine that velopharyngeal tions, can relate these auditory perceptual structure and functional potential are ade- models to diagramatic representations, and quate to control resonance and airflow, or can begin to work toward extablishment of must understand the treatment limitations the new target place. On the basis of this posed by varying degrees of inadequacy in the author's experience, it is best to work on mechanism. An inadequate velopharyngeal establishing correct place of production only, in valving mechanism does not preclude working the absence of other features. In this way, the on selected components of articulation, par- stop or fricative manner, so strongly associ- ticularly place deviations of the speech im- ated with the aberrant place, is temporarily pairment. Often, in fact, diagnostic therapy "left behind." In eliminating /?/ as a substi- wisely precedes decisions regarding the need tution, or as a co-articulation with a stop for further surgical or prosthetic management. consonant, it is often best at first to attach the For articulation assessment in both single fricative manner to the new place before es- words and connected speech, the clinician tablishing the stop manner. Again, this ap- should do whole word narrow phonetic tran- proach appears to be successful in dissociating scription to delineate the presence and the the strongly habituated aberrant place + stop types of compensatory articulations and to pattern. define overall error patterns, including errors Summary of substitution versus those of co-articulation. All correct phoneme productions should be Compensatory articulations used by speak- noted by context for purposes of defining pre- ers with cleft palate and velopharyngeal in- treatment phoneme production repertoire. adequacy have been described radiographi- Errors that are derived from aberrant lin- cally and with respect to perceptual charac- gual valving postures or faulty placement are teristics and articulatory gestures. These pro- probably the most common type of error ob- ductions have been discussed in relation to served in persons with palatal clefts. In- the more familiar glottal stop, and pharyngeal 202 Cleft Palate Journal, July 1981, Vol. 18 No. 3 FIGURE 9. (a) Unlabeled lateral line drawing for use in noting deviant or correct articulatory valving postures for speech; (b) Lateral line drawing contrasting correct place for /k/ articulation with its incorrect place substitution, unvoiced pharyngeal stop, 4A (c) Lateral line drawing depicting places of simultaneous articulation used in co-articulation of /t/ and glottal stop, /I / P

and velar fricative productions. In addition, symbols for phonetic notation have been in- troduced for the pharyngeal stop, mid-dorsum palatal stop, and posterior nasal fricative, and guidelines for speech remediation have been offered. In our continuing efforts to understand the articulatory adjustments mandated by palatal clefts and other disorders related to velopharyngeal incompetency, there is need for systematic study of these types of compensatory articulations. Hopefully, such research will yield objective and quantifiable defini- tions of the physiologic and acoustic characteristics of these speech patterns. Clinicians are encouraged to establish early diagnostic speech intervention programs for cleft palate babies. Early evaluation would enable devel- opment of protocols for identification of age (s) of onset of these deviant articulatory patterns. Such information might contribute to more valid determination of a communicatively op- timal age for palatopharyngeal surgery and should serve to upgrade speech management of persons with palatal clefts and related velopharyngeal impairments. Acknowledgment: The author acknowledges Penny Wheeler Davis, M.A., who preceded her at the Cleft Palate Institute and who, upon vacating her post, suggested that the author pay attention to a type of "mid-dorsum articulation" she had noticed in young- sters with clefts. Appreciation is also expressed to Maryann Culbertson for careful assistance in preparation of this manuscript. Reprints: Judith E. Trost, Ph.D. Northwestern University . Cleft Lip and Palate Institute 240 E. Huron Street Chicago, Illinois 60611

References Backus, P., Crancy, J., Henry, L., and KrempER, J., The Child with a Cleft Palate, Ann Arbor: University of Michigan Press, 1943. Brooks, A. R., Surrton, R. L., and Younastrom, K. A., Compensatory : tongue-palate-posterior pharyngeal - wall relationships in cleft palate, J. Speech Hear. Dis., 30, 166-173, 1965. TI'OSt, ARTICULATORY ADDITIONS 203

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