Search PubMed⌕ Search

Biomedical subjects

M L Haapanen

Publications and source records attributed to M L Haapanen.

At least 19 recordsLinked to original sources
PubMed2001

Association between velopharyngeal function and dental-consonant misarticulations in children with cleft lip/palate.

We studied the association between velopharyngeal function and misarticulation of the dental consonants /r/, /s/ and /l/ in children with cleft lip/palate. We assessed 278 6-year-old Finnish-speaking non-syndromic children (115 girls, 163 boys) with isolated cleft palate (n= 81), cleft lip/alveolus (n= 82) or unilateral (n= 84) or bilateral (n= 31) cleft lip and palate. Auditory analysis of speech and velopharyngeal function, the presence of fistulae, previous velopharyngoplasty and speech therapy, as well as surgical technique and timing of primary palatal surgery were obtained from the hospital records. The misarticulations of the sounds /r/, /s/ and /l/ were evaluated in spontaneous speech by two experienced speech pathologists from the cleft team. Velopharyngeal function was categorised, on the basis of the effect on speech, into competent, marginal incompetent and obvious incompetent. Nasal grimace and distortions due to palatal fistulae were registered. The results indicated that velopharyngeal function was not significantly associated with misarticulation of any of the sounds /r/, /s/ and /l/ or their combinations in any cleft groups. The technique and timing of primary palatal surgery, the presence of fistulae and previous pharyngoplasty were not associated with misarticulations. On the basis of these results we conclude that dental-consonant misarticulations occur independently of velopharyngeal function, primary palatal surgical technique and timing of palatoplasty.

Age Factors↗
PubMed2000

Dysfunction of the auditory cortex persists in infants with certain cleft types.

Language and learning disabilities occur in almost half of individuals with oral clefts. The characteristics of these cognitive dysfunctions vary according to the cleft type, and the mechanisms underlying the relation between cleft type, cognitive dysfunction, and cleft-caused middle-ear disease are unknown. This study investigates preattentive auditory discrimination, which plays a significant role in language acquisition and usage, in infants with different cleft types. A mismatch negativity (MMN) component of brain evoked potentials, which indexes preconscious sound discrimination, and brain responses to rare sine-wave tones were recorded in 12 healthy infants and 32 infants with oral clefts at the ages of 0 and 6 months. Infants with clefts were subdivided into two categories: those with cleft lip and palate (CLP) (n=11 at birth, n=6 at the age of 6 months) and those with cleft palate only (CPO) (n=17 at birth, n=8 at the age of 6 months). At both ages, brain responses to rare sounds tended to be smaller in both cleft subgroups than in healthy peers. However, in the latency range of 300 to 500 ms, the MMN was significantly smaller in infants with CPO. In infants with CLP, the MMN was comparable to that of healthy infants. Differences in auditory discrimination between infants with CLP and CPO, as reflected by MMN, were detectable at birth and persisted into later infancy. This pattern parallels known behavioural differences between children with these cleft types. Brain responses to rare sounds, in contrast, had no differentiative power with respect to the cleft type.

Auditory Cortex↗
PubMed1999

Brain dysfunction in neonates with cleft palate revealed by the mismatch negativity.

OBJECTIVES: Our recent studies have demonstrated that the brain's automatic change-detection response, the mismatch negativity (MMN) of the event-related brain potential (ERP), is significantly attenuated in school-age children with CATCH syndrome and in children of the same age with cleft palate but without the CATCH syndrome. Among other problems, various kinds of learning difficulties are commonly reported in these patient groups. The present study aimed at investigating whether the MMN is attenuated already in newborns with cleft palate compared with healthy controls. METHODS: Stimuli of 1000 Hz were presented frequently and 1100 Hz infrequently to 9 neonates with cleft palate and to 8 healthy controls. Infrequent 1100 Hz stimuli elicited a prominent MMN in all of the healthy children, but only in 3 of the 9 infants with cleft palate. RESULTS: A significant difference in the mean amplitudes of responses to deviant tones between the healthy and cleft palate neonates was found. CONCLUSIONS: MMN may indicate brain dysfunctions long before they have manifested themselves in cognitive disabilities, which would enable one to identify the infants with an elevated risk and to start their rehabilitation much earlier than before.

Acoustic Stimulation↗
PubMed1999

Cortical auditory dysfunction in children with oral clefts: relation with cleft type.

OBJECTIVE: Up to 46% of individuals with oral clefts suffer from language-learning disabilities. The degree of these disabilities varies according to cleft type. The pathogenesis of cognitive malfunctioning or its relationship with cleft type is not known. We investigated persistence of auditory short-term memory (STM) that is implicitly involved in language-specific perception in children with clefts, grouped using fine-graded cleft classification. METHODS: Cortical evoked potentials were recorded in 78 children with non-syndromic oral clefts and in 32 healthy peers. A mismatch negativity (MMN) potential that indexes preattentive detection of change in auditory input was obtained in response to tone sounds. In order to test durability of short-term memory traces, sounds were presented with three stimulation rates. RESULTS: With slowest stimulation, MMN amplitudes were reduced in cleft children as compared to the healthy peers (P < 0.00065). Only cleft-lip children did not significantly differ from controls. Among isolated palatal clefts, the more posteriorly delimited the cleft was, the smaller was the amplitude of MMN. MMNs of smallest amplitudes were obtained in the subgroup of complete unilateral cleft of lip and palate. CONCLUSIONS: Reduced MMN amplitudes, found in cleft children, imply deficiency in auditory STM trace maintenance. This dysfunction is likely to contribute to their language and learning disabilities. The MMN diminution with shorter/more posterior clefts suggests that differences in auditory cortex function are one of the underlying mechanisms of the cleft type-malcogniton association.

Acoustic Stimulation↗
PubMed1999

Associations between dental occlusion and misarticulations of Finnish dental consonants in cleft lip/palate children.

The purpose of this study was to examine whether malocclusions in terms of crossbites, large maxillary overjet, and deep bite are related to the articulatory problems with the Finnish dental consonants /r/, /s/ and /l/ in different cleft types and gender. The subjects were 260 (108 girls, 152 boys) 6-yr-old Finnish-speaking non-syndromic children with isolated cleft palate (CP, n = 79), cleft lip/alveolus (CL(A), n = 76), unilateral (UCLP, n = 78), and bilateral (BCLP, n = 27) cleft lip and palate. Occlusal anomalies were evaluated from dental plaster casts, and speech was analyzed by two speech pathologists with a high reliability. Altogether, 43% of patients misarticulated at least one of the studied sounds, and had crossbites significantly more often (73%) than subjects with correct /r/, /s/ and /l/ production (45%). Posterior crossbites were significantly associated with defective articulation, whereas anterior crossbite alone, large maxillary overjet, or deep bite were not. It was concluded that occlusal abnormalities in terms of posterior crossbites should be considered as a risk factor for correct dental consonant articulation in cleft-affected subjects.

Articulation Disorders↗
PubMed1998

Mismatch negativity (MMN) as an index of auditory sensory memory deficit in cleft-palate and CATCH syndrome children.

Our recent study demonstrated with the brain's automatic change-detection response, the mismatch negativity (MMN) of the event-related potentials (ERPs), that the duration of auditory sensory memory is significantly shorter in school-age children with CATCH syndrome than in healthy age-matched controls. One of the characteristic symptoms of this syndrome, caused by a microdelection in chromosome 22, is cleft palate. The most common problems in these children, however, are learning difficulties and, according to our results, it is likely that these problems are not due to the dysmorphology of peripheral speech mechanisms only but are also caused by CNS dysfunctions. In the present study we show with MMN that auditory sensory memory is also shortened in school-age children with cleft palate but without the CATCH syndrome. It has been shown in previous studies with neuropsychological tests that although children with cleft palate have language and learning-related problems these difficulties are usually less severe than those of CATCH children. Likewise the present study demonstrates that the auditory sensory memory trace seems to decay more rapidly in CATCH children than in children with cleft palate.

Abnormalities, Multiple↗
PubMed1998

The association between dental arch dimensions and occurrence of Finnish dental consonant misarticulations in cleft lip/palate children.

The aim of this study was to examine whether maxillary and mandibular dental arch width, length, and palatal height dimensions are associated with the occurrence of misarticulations (phonetic or phonologic errors) in the dental consonants /r/, /s/, and /1/ in different cleft types and sexes. The subjects were 263 (109 girls, 154 boys) 6-year-old Finnish-speaking non-syndromic children with isolated cleft palate (CP, n=79), deft lip/alveolus (CL(A), n=77), unilateral (UCLP, n=80), and bilateral (BCLP, n=27) cleft lip and palate. Dental plaster casts were measured by two authors using the technique of Moorrees, and auditive speech was analyzed with high reliability by two speech pathologists. The results showed that the occurrence of misarticulations increased and dental arch dimensions decreased with the severity of the cleft. Narrower and shorter maxillary arches as well as shallower palates were related to problems with the studied dental consonants. Mandibular arch dimensions were not related to the misarticulations. However, statistical analysis did not reveal significant differences in dental arch dimensions between subjects with and without misarticulations when they were compared separately for different cleft types. The etiology of clefting per se--isolated deft palate versus cleft lip with or without deft palate--did not seem to explain the associations between dental arch dimensions and the studied misarticulations.

Articulation Disorders↗
PubMed1998

Occurrence of dental consonant misarticulations in different cleft types.

To study the occurrence and type of misarticulations in dental consonants /r/, /s/ and /l/ 280 (115 girls, 165 boys) 6-year-old cleft children were examined by 1 of the 2 experienced speech pathologists of the cleft team. The patients included 82 children with isolated cleft palate (CP), 82 with cleft lip with (34) or without (48) cleft alveolus [CL(A)], 85 with unilateral cleft lip and palate (UCLP) and 31 with bilateral cleft lip and palate (BCLP). CP children were first divided into subgroups; there were 17 children with soft palate cleft, 49 with partial and 16 with complete hard palate cleft. All patients were native Finnish speakers, and had normal hearing, no known syndrome or associated anomalies possibly affecting speech or psychomotor retardation. The results showed that the occurrence and severity as well as the number of errors of all studied sounds separately or grouped increased with the severity of the cleft being constantly greatest in the BCLP group and lowest in the CL(A) group. Altogether 44% of the patients misarticulated at least one studied sound; 41% distorted and 5% substituted, and 2% both distorted and substituted. The /r/ sound was misarticulated by 36%, the /s/ sound by 23%, and the /l/ sound by 18% of the patients. Boys tend to have more problems in producing the studied sounds correctly.

Articulation Disorders↗
PubMed1997

The first neurophysiological evidence for cognitive brain dysfunctions in children with CATCH.

CATCH syndrome, caused by a microdelection in chromosome 22, is characterized by cleft palate and cardiac anomalies. The majority of these children also have learning difficulties or speech and language deficits. These problems are often due to the dysmorphology of the articulatory system. In the present study, the duration of auditory sensory memory, which is of central importance to speech perception and understanding, was investigated. As a research method we used mismatch negativity (MMN), an attention independent event-related potential, which provides an objective electrical index of auditory sensory memory. The present data suggest that the duration of this memory span is considerably shorter in 6-10-year-old children with CATCH than in healthy controls. Thus, the language-related problems encountered in children suffering from CATCH syndrome are likely to be caused also by CNS dysfunctions.

Abnormalities, Multiple↗
PubMed1997

Velopharyngeal function in cleft patients undergoing maxillary advancement.

Maxillary advancement may result in movement of the posterior border of the hard palate with its soft palate attachment, which may cause impairment of velopharyngeal (VP) function. We examined VP function before and after Le Fort I osteotomy in 15 cleft lip and palate patients. The extent of maxillary advancement was measured by means of standard cephalometric radiographs taken before and after the operation. VP function was evaluated in terms of perceptual speech assessments, pressure-flow data and nasalance scores preoperatively and 2, 6 and 12 months after the operation. The results showed that maxillary advancement resulted in impairment of VP function in 4 (27%) of the patients.

Adolescent↗
PubMed1997

Velopharyngeal function in association with artificial obstruction of the nose: a videonasendoscopic study.

Artificial obstruction of the nose can make the nasal cavity a cul-de-sac resonator, which has clearly audible consequences. The present study compares videonasendoscopic views of the velopharyngeal mechanism in test words uttered with the nose open and obstructed in 20 subjects with a Pierre Robin sequence and in 6 subjects without this sequence. A velopharyngeal flap was constructed on 12 subjects. Videonasendoscopic findings were assessed by 3 judges with acceptable agreement. The results indicated that impairment of velopharyngeal function occurred significantly more often in subjects with a velopharyngeal flap. This was attributed to aerodynamic reasons. Clinical implications of the results are discussed.

Adolescent↗
PubMed1996

Cul-de-sac hypernasality test with pattern recognition of LPC indices.

Acoustic differences between samples of [i], [u], and [a] uttered in nose-open and nose-obstructed condition were studied in 6 women with isolated cleft palate and pathological nasalance scores and 9 healthy women with normal nasalance scores. The speech samples were depicted by 14-component vocal tract area feature vectors obtained by linear prediction and the differences between the samples were studied with a self-organized feature map. Each location on the map corresponds to a certain signal pattern, neighboring locations to similar patterns. The group of healthy subjects differed from the patients for vowels [i] and [u] but not for [a]. In the patients the nose obstruction induced a significant change in the location of these vowel samples on the map. In healthy subjects no such changes were detected. The results agreed with perceived differences between the subjects.

Adolescent↗
PubMed1996

Quality of speech correlated to craniofacial characteristics of cleft palate patients with the Pierre Robin sequence.

The present study aims at examining the relationship between cephalometric craniofacial dimensions and speech performance in 30 young adult cleft palate patients with a Pierre Robin (PR) sequence. Speech was analyzed from tape-recorded speech samples and by using nasalance measurements. Veloparyngeal closure was assessed by using videonasendoscopy. Various cephalometric dimensions reflecting facial vertical height and sagittal nasopharyngeal length were measured and compared to speech data. The results indicated that the sagittal bony nasopharyngeal depth (AD1-PNS, AD2-PNS) is significantly related to speech impairment in terms of the need for velopharyngoplasty. After comparing the present results to those obtained from patients with isolated cleft palate without a PR sequence we concluded that the cleft patients with a PR sequence require more often velopharyngeal flaps to eliminate persisting signs of velopharyngeal insufficiency.

Adolescent↗
PubMed1995

The correlation between training and skill of the surgeon and reoperation rate for persistent cleft palate speech.

The correlation between the surgeons training and skill and the speech after primary repair was tested using the reoperation rate as a measure for success in 439 cleft palate/cleft lip and palate (CP/CLP) patients operated at the average age of 22 months by 4 specialists and 4 residents. The reoperation rate for residents was 11-60% (av. 36) and for specialists 13-31% (av. 19). The relative reoperation rates in CP/CLP were 20/19% for specialists but 35/38% residents. In groups consisting of the four with the best (A) and the four with the worst results (B) the reoperations rate in group A was 16% for CP and 13% for CLP, but in group B 37/44%. As the residents became specialists, the degree of their improvement varied greatly. Thus both the training and skill are important for the patients speech, but they are not necessarily synonymous terms.

Articulation Disorders↗
PubMed1995

Effect of method of cleft palate repair on the quality of speech at the age of 6 years.

Two methods of primary palatal repair were compared for the effect that they had on the speech of 6 year old children with cleft (lip and) palate. A Veau-Wardill-Kilner V to Y pushback operation was done for 43 children (group V) and the Cronin modification for 60 children (group C) between the ages of 12 and 18 months. The groups were compared with respect to the quality of speech assessed clinically by perception, by instrumental measures of nasalance, and by the number of velopharyngeal flaps required. The quality of speech was assessed in terms of perceived signs of velopharyngeal insufficiency: hypernasality, audible nasal air emissions, weakness of plosives and compensatory articulations. Hypernasality was significantly more common in group V (16/33, 48%) than in group C (11/49, 22%) (p = 0.01). The number of velopharyngeal flaps and the nasalance scores derived from most of the individual test sentences were similar in the two groups. The mean nasalance score for the whole set of test sentences was significantly higher in group V.

Articulation Disorders↗