การพัฒนาโปรแกรมปรับลดเสียงขึ้นจมูกมากเกินไป ในเด็กวัยเรียนที่มีภาวะปากแหว่งเพดานโหว่

Abstract

Cleft lip and/or palate (CLP) is a congenital malformation. Hypernasality with/without articulation disorders is the most common speech defects in patients with CLP. This study aimed to conduct 1) develop program “Hypernasality Modification Program in School Aged Children with CLP”, 2) compare pre-and post-test the severity of hypernasality, nasal air emission, and the number of articulation errors: word and sentence levels by perceptual assessment; also, nasalance scores after providing the program. Hypernasality modification program was designed after literature reviewing, from word to telling story level-based on Thai phonetic and language structure. All five experts performed content validity index (CVI) revealed that the hypernasality modification program with the item content validity index (I-CVI) = 0.8 to 1 and scale content validity index (S-CVI) = 0.98. Hypernasality modification program has tested the effectiveness in 15 school-aged children with CLP who have the severity of hypernasality mild to a moderate degree. Participants were assessed pre-and post-test the severity of hypernasality (Normal = 0, 1 = Mild, 2 = Moderate), nasal air emission (Normal = 0, 1 = Intermittent, 2 = Pervasive), the number of articulation errors by perceptual assessment, and nasalance scores by nasometer before and after providing the program. Hypernasality Modification Program in School-Aged Children with CLP was used for children with CLP 6 weeks, therapy session was 30-minutes session for each week. Parents did home exercises. Results revealed that the severity of hypernasality mild degree = 6.67% increased to the normal degree of 33.33%. Compared to the severity median of the hypernasality at the word level found statistically significant difference (Median Difference (MD) = 0.5, 95% Confident Interval (CI) = 0 to 0.5). The severity of hypernasality mild degree = 6.67% increased to the normal degree of 40%. Compared to the severity median of the hypernasality at the sentence level presented statistically significant difference (MD = 0.5, 95% CI = 0 to 1) and the severity of nasal air emission intermittent level = 26.67% increased to the normal degree of 40%. Compared to the severity median of nasal air emission at the sentence level found a statistically significant difference (MD = 0.5, 95% CI = 0 to 1). The number of articulation errors was significantly decreased at the word and sentence level (Word level; MD = 2.5, 95% CI = 1 to 4; Sentence level; MD = 2.5, 95% CI = 1 to 4 respectively). However, the nasalance scores when assessed by nasometer and nasal air emission when assessed by perceptual found no statistically significant differences. In conclusion, Hypernasality Modification Program in School Aged Children with CLP had CVI high level, can be used as a guideline for modifying hypernasality in school-aged children with CLP.