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Occurrence of consonant production errors in 

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3.e-mail: esteprandini@usp. SP. Graduate Program at Hospital for Rehabilitation of Craniofacial Anomalies and at Communication Disorders Department. SP. Assistant Professor. Octavio Pinheiro Brizolla. Brazil. Assistant Professor.Bauru . Department of Speech-Language Pathology and Audiology.apto 42 . University of São Paulo. University of São Paulo. Brazil.UNESP.SP . Corresponding address: Estefânia Leite Prandini .Brazil .Alameda Dr.PhD. Department of Speech-Language Pathology and Audiology. Univ.17012901 .br  . lip and palate Estefânia Leite PRANDINI1.97718452 . Estadual Paulista . Bauru School of Dentistry. Maria Inês PEGORARO-KROOK2.Graduate student. Marília. Brazil. Bauru.PhD. Full Professor.Phone: 32274308 . University of São Paulo. Bauru School of Dentistry. SP. Viviane Cristina de Castro MARINO4 1.Edifício Van Gogh . Brazil. Department of Speech-Language Pathology and Audiology. Bauru. SP. 7-12 . 4. Bauru. Bauru School of Dentistry.PhD. Jeniffer de Cássia Rillo DUTKA3. 2.

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including compensatory          .   ABSTRACT I nformation about the prevalence of consonant production errors.

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since occurrence of CAs in sounds that require higher amounts of oral air pressure is expected.   Portuguese is limited. The literature primarily reports the occurrence of CA for plosive and fricative sounds. While the use of CA during      . particularly regarding liquid sounds.

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Objectives: Describe the occurrence    . as tongue clicks during production of /r/ and /l/.

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Material and Methods: A sample +'0 . '()* months and 15-18 months of age at primary palatoplasty.

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 evaluation of the participants at the sixth year of age. Results: The use of middorsum palatal .

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Conclusion: We     .  found related to surgical technique.040). but children operated earlier developed the use of the consonant cluster /r/ sooner than children operated later (p=0.

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Liquid phonemes. 579 2011. acquisition of consonant cluster /r/.19(6):579-85 . Key words: Articulation disorders. Cleft lip and palate. Speech J Appl Oral Sci.

Occurrence of consonant production errors in liquid phonemes in children with operated cleft lip and palate .

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 to their place of production. The /f/ and /v/ are  .

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/l/ and /r/). /d/ and > > .   the alveolar ridge (such as /s/. and are named linguodental (such as /t/. /z/.

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  the teeth. /g/ and /R/ involves contact or approximation of the back of the tongue to the back of the hard . Production of the velar sounds such as /k/.

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Thus. plosives sounds involve complete #   . type of constriction resulting from the articulatory contact.

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/d/ and /g/. Fricative sounds are those involving a close approximation of the articulators. leading to an audible friction  . Plosive sounds include /p/. /k/. /b/. /t/.  release that is heard as a plosion.

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and /R/4. We can also name sounds according  .>>>@> /r/.20.

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and affricate). G .   (like nasals and liquids) and high-pressure sounds (like plosive. fricative.

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as plosives.23. As described by TrostCardamone23 *337  . According to Warren24 (2004).17. called compensatory articulations (CAs). and affricates2.   " consonants that require a high amount of intraoral air pressure. the inability to generate and/or maintain adequate levels of intraoral pressure for production of plosion or friction may lead to the development of atypical places of production. fricatives.

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  production is atypically posteriorized. the use of the glottis or larynx (such as in the glottal stops or laryngeal fricatives). posterior nasal fricatives. occurring at a frequency #. or even oral but backed places of production (such as velar INTRODUCTION Cleft lip and palate (CLP) is a common congenital anomaly. or pharyngeal plosives). Atypical place of production used for CA may involve the use of the pharynx (such as in the pharyngeal fricatives.

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et al.15*337 . According to Pegoraro-Krook.  )V<33   )V033 # 17.

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 only the lip and premaxilla (CL). usually there is .

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intelligibility is affected by sound distortions resulting from dento-occlusal conditions or by lip retraction due to surgical scars. either as an isolated cleft palate (CP) or cleft lip and palate (CLP). When cleft involves the palate.  disorders are present. oral communication can be severely affected #&.

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    for nutrition and psychosocial and educational .

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(3) dentoocclusal conditions. (2) velopharyngeal dysfunction (VPD) resulting from the failure of the primary surgery to establish a functional velopharyngeal mechanism.  & be due to several factors: (1) unoperated cleft. Surgical repair of the palate aims to correct  . among other factors. and (4) hearing loss due to associated chronic otitis media.

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B".#  "      conditions for the velopharyngeal mechanism to function adequately.21 . preventing the development of VPD and associated speech disorder 12.

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Authors suggest that the technique used for primary palatoplasty and the age of the   & .   of the face and the development of speech and hearing2.15.

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 occurrence of speech and hearing disorders in  .

That is. according to the literature. The production of speech requires coordinated . some children are at higher risk of developing speech disorders due to the type of surgical correction they received for CLP.      ]=13.18.

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Production of consonants involves complete or partial obstruction of air in the oral cavity 4.20.    " 9     the airstream. the production of    . More specifically.

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/b/ and /m/.  production) has an impact on the type of sound that is generated.19(6):579-85 . 580 2011. The sounds /p/. for J Appl Oral Sci.

DUTKA JCR. PEGORARO-KROOK MI. MARINO VCC is important for the development of prevention    .PRANDINI EL.

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including CAs in  . of consonant error production.

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22. The presence of VPD. /d/. /k/ and /g/19. The use of middorsum palatal stop (MDPS) is described in literature for the plosives /t/. or a palatal 9   . fricative and middorsum palatal stop).  protocols for CLP.

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leading to compensations like the MDPS. for example17. placement during speech.234G .

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resulting in the use of the  ".     attempt to avoid air leakage during production of plosives /t/ and /d/.

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18.  (        abnormalities8.17.  .27. When a crossbite is present.12.

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  the tongue dorsum (instead of the tip) in contact   .

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a production called middorsum palatal (MDP)124 G    . alveolar region) can also be observed for liquid sounds.

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Articles describing the use of MDP place of articulation for     . both MDPS and MDP can be observed. MDP is used in substitution for liquid sound that does not involve high pressure. so plosion is absent. While MDPS is used in substitution for plosive sounds and the plosion characteristic is present. &   dento-occlusal abnormalities are the cause of the compensatory adjustment.

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Besides backing of liquid oral targets. developmental articulatory errors   "  . elevation.    CLP can make articulatory adjustments involving inadequate backing. protrusion. particularly during production of /r/ and /l/. or even clicks of the tongue.

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&  speech sound development are also reported in the .

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Information on prevalence of consonant production .14.

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9. and affricate sounds for the Portuguese speakers1. fricative.15. This study investigates consonant error production.5.2. including CAs. the occurrence of CA during production of plosive.21. during liquid sound   4  .

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OBJECTIVE G . of consonant production error during liquid sounds J Appl Oral Sci.

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 the occurrence of consonant production errors during liquid sound production. to compare the    .

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and to  .   Langenbeck techniques for palatoplasty.

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MATERIAL AND METHODS G .  operated early (9-12 months of age) to those operated late (15-18 months of age) at primary palatoplasty.

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 Ethics Committee of the Hospital for Rehabilitation of Craniofacial Anomalies at the University of São Paulo (HRAC/USP). The population of interest for this study consisted of 460 children of both genders  .

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 of the healthcare records of the referred children  .

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At the sixth year  .  conducted by the speech-language pathologist (SLP) at the sixth year of life.

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 completed phonological acquisition of speech sounds and to be compliant to speech assessment. …           .

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The SLPs’ rated both.   the healthcare records of the participants. The protocol for auditory-perceptual ratings included observations       >>>>>@>>?>  consonant clusters /r/ and /l/. et al. An adaptation of Henningsson.8 (2008) recommendations   . manner and place of production of liquid consonants produced by children speaking the Brazilian Portuguese language.

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These authors suggested categorizing consonant production errors into  .   used for this study.

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c) abnormal backing of oral 581 2011.V       limits.19(6):579-85 . b) abnormal backing of oral targets to post uvular places.

e) nasal consonant for oral pressure consonants.Occurrence of consonant production errors in liquid phonemes in children with operated cleft lip and palate targets but place remains oral. d) nasal fricatives. f) nasalized voiced oral pressure consonants. g) .

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While Henningsson. 8 (2008) reported middorsum palatal stops and middorsum palatal fricatives/affricates as “abnormal backing of oral targets but place remains oral”. i) developmental errors. et al. in this study   .    (including erros related to dentofacial and oral structure deviations).

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 #   pre-uvular backing of liquid targets (middorsum palatal liquids). this study reported delay in acquisition of liquids and simple substitutions during liquid targets. = . Furthermore. this study included observation of tongue anteriorization (beyond incisors) and sound distortions. Instead of an overall developmental error category.

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   frequency of occurrence of consonant production errors during liquid sounds calculated in percentages. E (†  .

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 difference in occurrence of sound production errors " 9 ‡343<3  .

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No secondary surgeries had been performed by the time the speech evaluations reported in this study . 208 children (52%) received late primary palatoplasty (15-18 months). While 189 children (48%) received early primary palatoplasty (9-12 months). according to palatoplasty technique and according to age at palatoplasty.

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liquid sound productions      .4 As indicated in Table 1.

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(b) tongue anteriorization (14%). delay in acquisition of liquids (4%). sound distortions (2%). children at the sixth year of age (average=71%). and simple substitutions (6%). † . Consonant production errors observed included: (a) middorsum palatal liquids (2%).

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The differences observed #. distributing the samples according to palatoplasty technique (Table 2) and according to age at primary palatoplasty (Table 3).

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RESULTS   "    . )<  18 months of age).

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only 397 (66%) had speech evaluation completed at the sixth year of life. Therefore. Out of the 460 children of interest for this study. data reported     &  .& closure) and 15-18 months (late closure).

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  evaluations obtained from 237 males (60%) and 160 females (40%). A total of 163 children  .

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 <'F4 Table 1.Distribution of percentage occurrence of consonant production errors during liquid targets     Adequate Mid dorsum palatal Tongue anteriorization Distortion Late acquisition Substitution /l/ 33% 5% 55% 1% 0% 6% /r/ 68% 3% 13% 5% 1% 10% /R/ 91% 0% 0% 1% 1% 7%  78% 1% 13% 1% 0% 7% Cluster /r/ 82% 1% 1% 2% 11% 3% Cluster /l/ 74% 1% 2% 2% 11% 10% Average 71% 2% 14% 2% 4% 6% J Appl Oral Sci. 582 2011.19(6):579-85 .

MARINO VCC Table 2. PEGORARO-KROOK MI.PRANDINI EL.Distribution of percentage occurrence of consonant production errors during liquid targets for data distributed according to surgical technique (Furlow versus von Langenbeck) for palatal repair No alteration Mid dorsum Palatal Tongue anteriorization Distortion Late acquisition Substitution Fw VL Difference Fw VL Difference Fw VL Difference Fw VL Difference Fw VL Difference Fw VL Difference /l/ 32% 34% 2% 5% 0% 5% 58% 54% 4% 0% 1% 1% 0% 1% 1% 5% 6% 1% /r/ 71% 66% 5% 3% 3% 3% 12% 14% 2% 4% 5% 1% 1% 1% 0% 9% 11% 2% /R/ 92% 91% 1% 0% 0% 0% 0% 0% 0% 0% 1% 1% 1% 1% 0% 7% 7% 0%    78% 78% 0% 1% 1% 0% 15% 11% 4% 1% 1% 0% 0% 0% 0% 6% 8% 2% Cluster /r/ 84% 81% 3% 1% 0% 1% 0% 2% 2% 2% 2% 0% 9% 12% 3% 4% 3% 1% Cluster /l/ 72% 74% 2% 1% 0% 1% 2% 2% 0% 2% 2% 0% 9% 12% 3% 8% 12% 4% Average 72% 71% 2% 2% 1% 2% 15% 14% 2% 2% 2% 1% 3% 5% 1% 7% 8% 2% Fw: Samples of patients who received palatoplasty with Furlow technique VL: Samples of patients who received palatoplasty with von Langenbeck technique Difference: difference in % between groups Fw and VL Table 3. DUTKA JCR.Distribution of percentage occurrence of consonant production errors during liquid targets for data distributed according to age at primary palatoplasty (early versus late) No alteration Mid dorsum palatal Tongue anteriorization Distortion Late acquisition Substitution 9-12 15-18 Difference 9-12 15-18 Difference 9-12 15-18 Difference 9-12 15-18 Difference 9-12 15-18 Difference 9-12 15-18 Difference /l/ 33% 35% 2% 7% 3% 4% 56% 54% 2% 0% 1% 1% 0% 0% 1% 4% 7% 3% /r/ 70% 67% 3% 4% 2% 2% 13% 13% 0% 5% 5% 0% 0% 1% 0% 8% 12% 4% /R/ 92% 91% 1% 0% 0% 0% 0% 0% 0% 1% 0% 1% 2% 1% 0% 5% 8% 3%    78% 78% 0% 1% 1% 0% 12% 13% 1% 3% 0% 3% 0% 0% 0% 6% 8% 2% 9-12: Samples of patients who received palatoplasty between 9 and 12 months 15-18: Samples of patients who received palatoplasty between 15 and 18 months Difference: difference in % between groups 9-12 and 15-18    .

      J Appl Oral Sci.19(6):579-85 Cluster /r/ * Cluster /l/ 86% 75% 79% 74% 7% 1% 1% 1% 0% 0% 1% 1% 1% 2% 1% 2% 0% 0% 3% 3% 1% 1% 2% 2% 7% 8% 14% 14% 7%* 6% 2% 8% 5% 9% 3% 1% Average 72% 71% 2% 2% 1% 1% 14% 14% 1% 3% 1% 2% 3% 5% 2% 6% 8% 3% . 583 2011.

Occurrence of consonant production errors in liquid phonemes in children with operated cleft lip and palate Ozanne14 (2003). consonant cluster reductions    9       .

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  therapy during pre-school years. distortions (2%). In our study. and sound substitution (6%) for liquids together represented & ))F   . late acquisition (4%).

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26.  . Significant differences due to timing of palatal surgery. investigations. Liquid sounds in the Brazilian Portuguese language are usually completely acquired by the end of the 6 th year of life 25.

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the greater the   . months.  '()*    )<(). Studies have suggested that the earlier the surgery establishes adequate oral structure and velopharyngeal functioning.

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While consonant clusters are one of the last phonological acquisitions14 their production depends on more complex articulatory ^ . speech16. In the present study. children operated earlier (9 and 12 months) developed the use of the consonant cluster /r/ sooner than children operated on later (15-18 months).

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and    "  . ear pathologies). variables like dental conditions. oral habits. In this retrospective study.

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  production errors during liquid sounds for children    *.F4 E "   .

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  and dentition stage of children at sixth year of age (primary and mixed dentition). As reported in the .

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Particularly.  ( occlusal abnormalities are suggested by some authors17.27 to be the reason for adjustment of the tongue to a reduced oral space. the use of MDPS has been related to .

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one can also suggest that middorsum palatal    .234%   " these authors explanation for occurrence of MDPS. ]= > 917.

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posteriorized tongue posture  #. anatomical structure.

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as place of articulation               . The use of atypical place of production. such as pharynx or larynx.  9 and VPD.

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such as glottal stops and pharyngeal fricatives. Significant difference in the occurrence of &.  that CAs. are used for sounds that require higher amounts of intraoral air pressure.

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Correct production of speech sounds depends on . studies addressing these variables. are recommended. therefore.

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  CLP are often hospitalized and commonly present hearing loss secondary to persistent middle ear _    .

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   presenting consonant production errors. HardinJones and Jones7 *33< "".

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CONCLUSION G .  sound development. According to Morris and J Appl Oral Sci.

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 of consonant production errors during liquid 584 2011.19(6):579-85 .

MARINO VCC          . PEGORARO-KROOK MI.PRANDINI EL. DUTKA JCR.

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Cleft palate and craniofacial anomalies: effects on speech and resonance. Cohen S. Cohen E . LaRossa D. Randall P. 13.  children operated early and those operated late.McWilliams BJ. 12.Kummer AW. Clifton Park: Thomson Delmar Learning. 2001. Yu J.

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4  Reconstr Surg. Ozanne A. 14.Morris H. 1996:98(4)610-9. Phonetic. and language    . phonological.

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4 .

 .

    ›4 2003.Pegoraro-Krook MI. Dutka-Souza JCR. Magalhães LCT. 15.40(5):460-70. Feniman E?46 .

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žŸ   š" 9 46 V%.

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%   "4 São Paulo: Rocca. 339-455. p. )2(. 2004.

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Hardin-Jones MA. Sussman J. Cleft Palate Craniofac J.Peterson-Falzone SJ.Peterson-Falzone SJ.Santelmann L. St. Louis: Mosby. 19. 3rd ed. Karnell MP. Cleft palate speech. HardinJones MA. Perception of mid         . Chapman K. The clinician's guide to treating cleft palate speech. 2006. 2006. Trost-Cardamone JE. Louis: Mosby. 17. 18. 2001.(43)3:295-309. St.   an isolated cleft palate: a longitudinal perspective. Karnell MP.

 .

.

    .

.

  .

1999.36:233-42. 20.    repaired cleft palate.Silva TC. Cleft Palate Craniofac J. Fonética e fonologia do português: roteiro de estudos .

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.

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“ 4.’.

4BŸ  V .

Fissuras labioplatinas: uma abordagem interdisciplinar. São Paulo: Editora Santos. Articulatory additions to the classical descriptions of .! $*33<4 21. 22. Silva Filho OG.Trost JE.Trindade IEK. 2007.

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4.

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9.

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5th ed. 24. Austin: Pro-Ed. In: Bzoch KR. Communicative disorders related to cleft lip and palate. 5th ed. In: Bzoch KR.  error patterns for planning therapy or physical management needs. ed. ed. Austin: Pro-Ed. 2004. 2004. Aerodynamic assessments and procedures to determine extent of velopharyngeal inadequacy. *<(†.Warren DW. Communicative disorders related to cleft lip and palate.

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œ%œ.

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 H.

B%49žŸ  do distúrbio fonológico por meio de duas medidas de análise:  .

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*0( †.Wertzner HF. 26. Processos fonológicos detectados em crianças de sete a oito anos.  £  dos processos (PDI).16(3):275-82. 2004. Pró-Fono. Consorti T. Pró-Fono. 2001.13(1):90-7.

 E4   .

   .

  .

org. St. Bardach J. Cleft palate speech management . p. Louis: Mosby. ACKNOWLEGMENTS G &  . In: Shprintzen RJ.a multidisciplinary approach. 137-66.   clefting. 1995.

#&"   .

REFERENCES )(    …4 % #  4 7’4 . brazilian government (CNPq) for junior investigator.

2005. *( B”.4 “#V Pró-Fono.

 %4 •.

.

.

1996. 1993. 10ª. Pró-Fono.8(1):36-46. ed. Rio de Janeiro: Jorge Zahar. Phonetics for speech pathology. In: Ball MJ. Zimmermann MC. Leite Y.Dutka JCR. Identification of  .Ball MJ. Iniciação à fonética e à fonologia. Manner of articulation. Tabith A. 4. 34-42. London: Whurr. 3. 5.  “  9 labiopalatina operada.Callou D. p. 2005.

 &     .

   .

  & ".

  .

&˜ .

.

.

Baltimore.™4<<th Annual Meeting of the American Cleft Palate-Craniofacial Association. 1998 Apr. Maryland. 20-25. 2( %.

Jones DL.“  E4 %   "       š" V motricidade oral e audiologia. Speech production of preschoolers  .Hardin-Jones MA. 1999. São Paulo: Pancast. 1ª ed. 7.

.

4.

.

(œ.  ›4*33<$7*)V0()+4 .

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=B.

=B.

.

.

&GG ( .

Withehill TL. et al. JE. Universal parameters for reporting speech  .

   .

.

4.

.

9.Jones CE. Brasil: Roca. 2009.45(1):1-17. 2008. Chapman KL.fundamentos para a prática fonoaudiológica. Di Ninno CQMS.   J. 10. Speech development  . Hardin-Jones MA.Jesus MSV. Fissura labiopalatina .

 .

.

#.

 .

 .

".

&4.

40(1):19-31. 2003. 11. Research on speech motor control and it disorders: a .Kent RD. Palate Craniofac J.

.

  .

.

585 2011.4›  = 4*333$++<V+')(7*04 J Appl Oral Sci.19(6):579-85 .