How to carry out postoperative voice training after cleft palate surgery

After cleft palate repair surgery, some children's physiological structure has been restored, but in our work, we found that even if the palatopharyngeal closure function is normal, but also due to the existence of bad compensatory articulation habits, so that the clarity of their voice is lower than normal; or the palatopharyngeal can be completely closed at the time of checking, but the palatopharyngeal closure incomplete in the speech, this part of the children, are the object of the cleft palate postoperative voice training. Experts point out that for children who still have significant palatopharyngeal insufficiency after cleft palate surgery, any form of speech training treatment is futile. This group of children should first consider pharyngeal formation surgery or the use of palatopharyngeal blockers to restore the physiological conditions necessary for articulation, and only in this way is voice training likely to yield good results. When a child with normal speech development is about 2 years old, we can begin a formal phonological evaluation, and in conjunction with the results of the evaluation, we can begin progressive phonological training and develop a home training program for the parents. The training includes both *** sound and sound formation. (1) Improve the perceptual and motor function of the palate muscles, using the belly of the middle finger to massage the hard palate and the front of the soft palate along the edge of the scar, or use a soft brush to gently wipe the palate. The operation should be gentle and careful not to cause any reflex nausea. (2) Pharyngeal movement: rely on the tongue root activity reflex to force the soft palate to move. (3) Sounding high and long tones: the longer, louder and higher the sound is required, the better, and gradually increase the pitch, train with a and i. At the beginning of the training, the nostrils should be blocked. (4) Blowing Exercise: This exercise can be carried out by blowing water bubbles, blowing a harmonica, blowing a whistle, blowing a balloon, etc. It requires deep inhalation and slow exhalation, and the longer the blowing time, the better. (B) Pronunciation training Before the pronunciation training, the organs of pronunciation are trained first, and then the control training of pronunciation is carried out. 1. Lip and tongue movement exercises Elementary exercises (1) Open mouth exercises: easily close the lips, open the mouth to the maximum limit, while exhaling outward, or a sound. At the end of the exhalation, gently close the lips and inhale at the same time. Repeat 4~8 times. (2) Lip spreading exercises: easy to close the lips, double teeth normal bite, the tip of the tongue against the back of the lower teeth, lips to the sides of the spread, while sending out a continuous i: sound, the air flow can not support, back to the closed lip state, while inhaling, repeated 4 to 8 times. (3) Round lips exercise: still closed lips, then lips lightly together, outward exhalation or send u sound, to the end of the exhalation, and then back to the closed lips position, at the same time, inhale. Repeat 4-8 times. (4) Lip summary exercise: lips lightly closed, then force the lips to be tight, the tip of the tongue against the back of the lower teeth, send air to do whistling or send ü sound like. Return to the lightly closed lips, while inhaling, repeated 4-8 times. (5) Bite the lip exercise: place the lower lip between the upper and lower teeth, exhale, the lower lip and upper and lower teeth relationship remains unchanged, to the end of the exhalation, inhale. Then bite the lip and exhale, repeat the exercise 4-8 times. (6) lips press each other exercise: lips squeeze each other, take a piece of paper between the lips, hold your breath, extract the piece of paper with your hand, lips forcefully clamp the piece of paper, repeat the exercise 4-8 times. (7) Lip smacking training: lips force each other, suddenly release, make a soft lip smacking sound. Repeat the exercise 4-8 times. (8) puffing and exhaling exercises: lips lightly closed, mouth full of gas, a piece of paper outside the mouth, exhale, blow the paper down. At the same time make a soundless pu sound. Inhale. Repeat the exercise 4-8 times. (9) Tongue stretching exercise: induce the patient to stretch the tongue flat to the outside of the mouth, relax the lips, shrink the lips back to the inside of the mouth. Repeat the exercise 4-8 times. (10) Tongue extension and upward curling exercise: Extend the tongue to the maximum extent outside the mouth, the tip of the tongue upward curling, to the upper lip or contact with the middle of the person. Return to the flat tongue position. Repeat the exercise 4-8 times. (11) Open mouth and roll the tongue exercise: try your best to open your mouth wide, roll the tongue upward to the outer side of the upper teeth, and then slide upward in the direction of the back of the teeth, the hard palate and the soft palate, and then go back to the closed mouth position, and repeat the exercise for 4~8 times. (12) Open mouth and flat tongue exercise: open the mouth moderately, and lift the tongue flat against the hard palate. The tip of the tongue is placed against the back of the upper teeth. Return to the resting position and repeat the exercise 4-8 times. (13) Tongue tip on the teeth exercise: open the mouth moderately, the tip of the tongue against the coronal surface of the upper teeth or the back of the upper teeth, and quickly leave, making a "smack, smack" sound. Repeat the exercise 8~12 times. (14) Tongue flicking exercises: the front of the tongue against the hard palate, the tip of the tongue against the back of the upper teeth, moderately open the mouth. Quickly flick the tongue away from the body. Repeat the exercise 8~12 times. (15) Tongue retraction exercises: open your mouth, retract your tongue, feel the pressure on the epiglottis, return to the resting position and retract again. Repeat the exercise 4~8 times. 2. Comprehensive Pronunciation Exercises (1) Spreading Lips - Rounded Lips Exercise: a→o→a Note that the sound should not be "broken", repeat the exercise until you need to inhale. Start the a sound again, repeat 8-12 times. (2) Spreading the lips - handful of lips exercise: i→ü→i, the sound is continuous, repeated 8-12 times. (3) Rounded-lip-expanded-lip exercise: u→e→u, sound continuous, repeat 8-12 times. (4) Three-vowel exercises: ba→da→ga, pa→ta→ka, as many times as possible within a certain period of time. (5) Exercises for rolled tongue: L→La, L→Le. (6) Exercises for rolled-flat tongue: sh→s→sh, repeated until the tongue moves freely. For young children's phonological training, experts recommend adopting a game + training method to avoid boring training methods and make children lose interest in training, and at the same time, we must obtain the cooperation of parents, maintain communication with them, and often understand the child's training situation, as well as the problems that arise during training. Speech training for young children usually starts 3 months after surgery, and is conducted on a one-on-one basis, with parents being instructed to conduct the training at home. According to the characteristics of young children, the training time should not last too long and should be varied according to the state of the child. The content of the training should be integrated into the life, lively and diversified, in order to maintain the interest of the children, and constantly encourage parents to participate in the training work with confidence and perseverance, so that the children can return to normal speech as soon as possible.