英语论文网

During the 1930s and 1940s most children who had undergone surgery for cleft palate required speech therapy. But at that time it was common practice for surgeons to wait until the age of three or four to close the palate. Naturally the child had developed his language by age four and frequently had acquired compensatory articulation habits because of a constricted maxilla and a nonfunctional velopharyngeal port. His unoperated condition made it impossible for him to impound air within the oral cavity. Nasal air emission and hypernasal resonance could not be avoided.
     When surgery was finally performed the family as well as the surgeon was often dismayed to find that a dramatic change in tonal quality had not occurred with the closing of the cleft. The child frequently continued to talk very much as he had talked before the operation, with a "cleft palate speech." In many cases this was because his maladaptive speech habits had become so ingrained that his voice sounded "familiar" and "right" to him. If he did not recognize it as abnormal, this meant that he and the speech clinician were in for a long siege of therapy.
     Several types of dental prostheses were used in the 1930s and 1940s as primary treatment for separating the oral and nasal cavities; 'however, the cleft problem was considered an exercise for the surgeon. If and when there was a breakdown in the surgical repair, the surgeon repeated his procedures in his effort to close the palatal defect. Some of the early patient histories at the institute record 10, 15, and 20 surgical procedures in attempting to close the oral defect. Hypernasal voice quality and maladaptive articulation habits were associated with these multiple surgical failures. Some Surgeon felt that the next logical step after surgical management failed was to refer the patient to a prosthodontist. Few speech clinicians were available to the surgeon until the team concept of cleft palate management developed.
     Certainly the early surgeons had their measure of success, but the percentage of good results was not to swell until the late 1950s and early 1960s, when plastic surgeons expressed their awareness of human growth and development of the mid-third of the face. With this awareness they were able to improve their techniques and to time the surgical procedures to minimize interference with centers of facial growth. Lengthening the oral tissue and utilizing a vomer flap greatly reduced the trauma to maxillary segments. More important to speech development was the improved two stage palatal closure technique, implemented before the child reached 18 months of age. These facts had a marked influence on the development of more normal speech and voice patterns in children with a cleft palate.
     H. K Cooper realized that no one-treatment procedure was a panacea. But his team concept, which he began to implement in the 1930s, emphasize the varied advantages of interdisciplinary evaluation and treatment of cleft palate. He stressed the rehabilitative management of the total person, and as professional members of the interdisciplinary team, we realized we were dealing with an integrated part of. the whole person. This is the concept that has been developed and continually stressed at the lancaster cleft palate clinic.
     Why a team?
     It is well recognized that i本论文由英语论文网提供整理，提供论文代写，英语论文代写，代写论文，代写英语论文，代写留学生论文，代写英文论文，留学生论文代写相关核心关键词搜索。