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Nguyen TT, Nguyen-Phuoc TM, Lee SAS. Language-Common and Language-Specific Speech Characteristics of Vietnamese Children With Repaired Cleft Palate: A Single-Site Observational Study. Cleft Palate Craniofac J 2025:10556656251340251. [PMID: 40432399 DOI: 10.1177/10556656251340251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2025] Open
Abstract
ObjectivesSpeech characteristics of children with cleft palate (CP) have primarily been studied in Indo-European languages. Vietnamese has a unique phonological system that differs from English and other Indo-European languages. The speech characteristics of Vietnamese children with CP, however, have not been thoroughly explored. This study aimed to investigate the speech and resonance characteristics of Vietnamese children with repaired CP who attended a speech evaluation clinic in Hanoi, Vietnam.MethodSeventy-two monolingual Vietnamese children with repaired CP, aged 3 to 12 years, participated in the study. Resonance, cleft-related errors, phonological errors, and speech production accuracy were examined. In particular, cleft-related errors and phonological errors were analyzed separately for word-initial and word-final positions. A database of 63 typically developing Vietnamese children was used to compare speech production accuracy.ResultsBoth language-common and language-specific characteristics were identified. Most Vietnamese children with repaired CP in this study demonstrated persistent abnormal resonance and lower articulation skills than their typically developing peers. Nasal air emission and cleft-related speech errors primarily occurred in the word-initial position, whereas the most frequent type of errors in the word-final position were developmental errors. This language-specific characteristic was likely due to the Vietnamese phonotactic constraints.ConclusionsLanguage-common and language-specific speech characteristics in Vietnamese children with CP may improve our understanding of CP speech. These error patterns are especially beneficial for Vietnamese speech therapists worldwide when assessing and treating children with CP who speak Vietnamese.
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Affiliation(s)
- Thanh Thi Nguyen
- Vietnam National Children's Hospital, Hanoi, Vietnam
- Cleft Palate and Craniofacial Anomaly Clinic, Texas Tech University Health Sciences Center, Lubbock, USA
- PhD Program in Rehabilitation Science, Department of Speech-Language-Hearing Sciences, Texas Tech University Health Sciences Center, Lubbock, USA
| | - Tam Minh Nguyen-Phuoc
- Cleft Palate and Craniofacial Anomaly Clinic, Texas Tech University Health Sciences Center, Lubbock, USA
- PhD Program in Rehabilitation Science, Department of Speech-Language-Hearing Sciences, Texas Tech University Health Sciences Center, Lubbock, USA
- Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Sue Ann S Lee
- Cleft Palate and Craniofacial Anomaly Clinic, Texas Tech University Health Sciences Center, Lubbock, USA
- PhD Program in Rehabilitation Science, Department of Speech-Language-Hearing Sciences, Texas Tech University Health Sciences Center, Lubbock, USA
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Arora JS, Khoshab N, Kanack M, Chase L, Kadakia N, Vargas S, Zadeh T, Vyas RM. Newly Identified Developmental Delays in a Large Population of Children With Nonsyndromic Cleft Lip and Palate. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2025; 13:e6655. [PMID: 40182299 PMCID: PMC11964386 DOI: 10.1097/gox.0000000000006655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2024] [Accepted: 01/31/2025] [Indexed: 04/05/2025]
Abstract
Background Nonsyndromic cleft lip and/or palate (NSCLP) is the most common congenital craniofacial anomaly. Early recognition of developmental delays associated with NSCLP is critical for counseling and management. This study investigates developmental delays in a large population of children with NSCLP. Methods This is an institutional review board-approved, retrospective analysis of children 5-21 years of age with a diagnosis of NSCLP. Demographic and clinical variables were collected for patients and a control group without NSCLP from the 2018 National Survey of Children's Health (NSCH) database. Results A total of 617 patients with NSCLP subjects and 29,147 NSCH participants were included. Among orofacial clefts, 45.2% were unilateral cleft lip and palate, followed by isolated cleft palate (30%), bilateral cleft lip and palate (16.4%), and isolated cleft lip (8.4%). NSCLP children with isolated cleft lip (odds ratio [OR]: 3.97), unilateral cleft lip and palate (OR: 2.17) and bilateral cleft lip and palate (OR: 2.91) had significantly higher odds of being diagnosed with attention-deficit hyperactivity disorder than the NSCH cohort. Rates of autism/pervasive developmental disorder were higher in children with isolated cleft lip than cleft lip and palate (11.5% versus 4.7%, P = 0.06), but this association was not significant. Children with isolated cleft palate had higher rates of intellectual disability, speech delay, global developmental delay, cerebral palsy, and hearing loss compared with the NSCH cohort (P < 0.05). Conclusions Higher rates of attention disorders and developmental delays in children with NSCLP highlight the importance of proper risk assessment and multidisciplinary management for this population.
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Affiliation(s)
- Jagmeet S. Arora
- From School of Medicine, University of California Irvine, Irvine, CA
| | - Nima Khoshab
- Department of Plastic Surgery, University of California Irvine, Orange, CA
| | - Melissa Kanack
- Department of Plastic Surgery, University of California Irvine, Orange, CA
| | - Leah Chase
- From School of Medicine, University of California Irvine, Irvine, CA
| | - Nikita Kadakia
- School of Medicine, University of California Riverside, Riverside, CA
| | - Sharon Vargas
- CHOC Children’s Hospital of Orange County, Orange, CA
| | - Touran Zadeh
- CHOC Children’s Hospital of Orange County, Orange, CA
| | - Raj M. Vyas
- Department of Plastic Surgery, University of California Irvine, Orange, CA
- School of Medicine, University of California Riverside, Riverside, CA
- CHOC Children’s Hospital of Orange County, Orange, CA
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Davies A, Southby L, Baker S, Extence H, Brierley N, Wren Y. Impact of Pandemic-Related Social Restrictions on Language and Speech Development in Children with Cleft Lip and/or Palate at 18-24 Months. Cleft Palate Craniofac J 2025:10556656251328843. [PMID: 40152049 DOI: 10.1177/10556656251328843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2025] Open
Abstract
ObjectiveDetermine if early speech and language development in children born with cleft lip and/or palate (CL/P) was impacted by social restrictions during the COVID-19 pandemic.DesignCohort study using data from The Cleft Collective.ParticipantsChildren with CL/P whose first 18-24 months were before the pandemic compared to children whose first 18-24 months were impacted by the pandemic.MeasuresPrimary outcome: parental reported Ages and Stages Questionnaire-Third Edition (ASQ-3). Secondary outcomes: 18- to 24-month speech and language therapy (SLT) assessment location; ability to judge velopharyngeal function for speech; SLT judged-expressive language and consonant inventory size for children with a cleft palate. Analyses adjusted for confounders.ResultsWe found no statistical evidence to suggest a difference in ASQ-3 communication (n = 631; ORadjusted 0.96; 95% CIs 0.533, 1.742; P = 0.902), SLT judgements of expressive language (n = 175; ORadjusted 0.66; 95% CIs 0.224, 1.947; P = 0.452), or consonant inventory size at age 18-24 months (n = 186; IRRadjusted 0.98; 95% CIs 0.775, 1.249; P = 0.896) between pre-pandemic and pandemic impacted groups. There was weak statistical evidence of an association between virtual appointments and SLT being unable to rate features of velopharyngeal function for speech (ORadjusted 3.54; 95%CIs 0.849, 14.755; P = 0.083).ConclusionsNo statistical evidence of an association between exposure to pandemic-related social restrictions and early language development or consonant inventory size at age 18-24 months. Small sample sizes, variation in the pandemic impacted groups, and limitations of the measures should be considered when interpreting the findings. Further work is required to further examine the use of virtual appointments for speech assessment.
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Affiliation(s)
- Amy Davies
- The Cleft Collective, Bristol Dental School, University of Bristol, Bristol, UK
- Bristol Dental School, University of Bristol, Bristol, UK
| | - Lucy Southby
- The Cleft Collective, Bristol Dental School, University of Bristol, Bristol, UK
- Bristol Dental School, University of Bristol, Bristol, UK
- Bristol Speech and Language Therapy Research Unit, North Bristol NHS Trust, Bristol, UK
| | - Sharon Baker
- The Welsh Centre for Cleft Lip and Palate, Swansea Bay University Health Board, Port Talbot, UK
| | - Helen Extence
- The Welsh Centre for Cleft Lip and Palate, Swansea Bay University Health Board, Port Talbot, UK
| | - Neil Brierley
- West Midlands Cleft Service, Birmingham Children's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Yvonne Wren
- The Cleft Collective, Bristol Dental School, University of Bristol, Bristol, UK
- Bristol Dental School, University of Bristol, Bristol, UK
- Bristol Speech and Language Therapy Research Unit, North Bristol NHS Trust, Bristol, UK
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
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Alighieri C, Bettens K, Scheerens C, Allemeersch F, Mouton T, Hens G, Van Lierde K. Diagnosis and Treatment of Speech Disorders in Children With a Cleft (Lip and) Palate: A State-Of-The-Art Overview. J Craniofac Surg 2025:00001665-990000000-02545. [PMID: 40146325 DOI: 10.1097/scs.0000000000011313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2025] [Accepted: 03/05/2025] [Indexed: 03/28/2025] Open
Abstract
In children born with a cleft in the palate with or without a cleft in the lip (CP±L), velopharyngeal insufficiency may persist even after successful surgical closure of the palate. This results in speech disorders including both resonance and speech sound disorders. These speech disorders may have a severe impact on the children's speech understandability and speech acceptability which may, in turn, influence psychosocial well-being, quality of life, and inclusion into society. This article provides an overview of the most important speech characteristics per age group (ie, 0-4, 4-6, 6-12, and >12 y). In addition, a state-of-the-art overview of current practices in speech diagnosis and speech intervention is included.
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Affiliation(s)
- Cassandra Alighieri
- Department of Rehabilitation Sciences, Centre for Speech and Language Sciences, Ghent University (Hospital), Gent
| | - Kim Bettens
- Department of Rehabilitation Sciences, Centre for Speech and Language Sciences, Ghent University (Hospital), Gent
| | - Charlotte Scheerens
- Multidisciplinary Cleft Palate Team, Department of Otorhinolaryngology-Head and Neck Surgery, Leuven, Belgium
| | - Fien Allemeersch
- Department of Rehabilitation Sciences, Centre for Speech and Language Sciences, Ghent University (Hospital), Gent
| | - Tara Mouton
- Multidisciplinary Cleft Palate Team, Department of Otorhinolaryngology-Head and Neck Surgery, Leuven, Belgium
| | - Greet Hens
- Multidisciplinary Cleft Palate Team, Department of Otorhinolaryngology-Head and Neck Surgery, Leuven, Belgium
| | - Kristiane Van Lierde
- Department of Rehabilitation Sciences, Centre for Speech and Language Sciences, Ghent University (Hospital), Gent
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Weismann C, Schmidt M, Effert J, Schulz MC, Poets CF, Koos B, Aretxabaleta M. Effects of malocclusion and orthodontic treatment on quality of life among orthodontic patients with craniofacial disorder compared to healthy controls : A cross-sectional study. J Orofac Orthop 2025:10.1007/s00056-024-00571-w. [PMID: 39899037 DOI: 10.1007/s00056-024-00571-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Accepted: 11/18/2024] [Indexed: 02/04/2025]
Abstract
PURPOSE Craniofacial disorders (CD) affect the Oral Health Impact Profile (OHIP). Therefore, this study evaluates the OHIP in orthodontic patients with cleft lip and/or palate or Robin sequence compared to healthy controls (C). METHODS A prospective, cross-sectional study was conducted. Oral health-related quality of life (OHRQoL) was assessed using the OHIP-14 questionnaire, with responses categorized into functional and psychological well-being items. In addition, the study considered the influence of crossbite, orthodontic appliance type, oral hygiene, and speech therapy. A high OHIP score represents a good quality of life. The Mann-Whitney test was used for nonparametric quantitative variables; statistical significance was set at p < 0.05. RESULTS The study included 119 participants (ages 7-21 years; 61 male, 58 female), divided into a CD group consisting of patients with cleft lip and/or palate or Robin sequence (n = 42) and a control group (C; n = 77; mean age 13.5 ± 5.2 and 14.3 ± 3.3 years, respectively). Both groups showed comparable OHIP-14 scores. The CD group reported significantly higher satisfaction regarding nutritional intake (p = 0.03), while the social and psychological dimensions were reduced (p = 0.04). Factors like crossbite, orthodontic appliance and speech therapy did not have a significant impact on OHIP. CD patients with good oral hygiene showed significantly superior self-reported psychological OHIP (p = 0.04). CONCLUSION Patients with cleft lip and/or palate or with Robin sequence exhibited OHIP scores comparable to healthy individuals despite their underlying condition. Early guidance on dental care and tooth-friendly nutrition has the potential to improve OHRQoL. Additionally, providing supplemental psychological support during orthodontic treatment is advisable.
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Affiliation(s)
- C Weismann
- Department of Orthodontics, University Hospital Tuebingen, Osianderstr. 2-8, 72076, Tuebingen, Germany.
- Center for Cleft Lip, Palate and Craniofacial Malformations, University Hospital Tübingen, Osianderstr. 2-8, 72076, Tübingen, Germany.
| | - M Schmidt
- Department of Orthodontics, University Hospital Tuebingen, Osianderstr. 2-8, 72076, Tuebingen, Germany
| | - J Effert
- Department of Orthodontics, University Hospital Tuebingen, Osianderstr. 2-8, 72076, Tuebingen, Germany
| | - M C Schulz
- Department of Oral and Maxillofacial Surgery, University Hospital Tuebingen, Osianderstr. 2-8, 72076, Tuebingen, Germany
| | - C F Poets
- Department of Neonatology, University Hospital Tuebingen, Calwerstr. 7, 72076, Tuebingen, Germany
- Center for Cleft Lip, Palate and Craniofacial Malformations, University Hospital Tübingen, Osianderstr. 2-8, 72076, Tübingen, Germany
| | - B Koos
- Department of Orthodontics, University Hospital Tuebingen, Osianderstr. 2-8, 72076, Tuebingen, Germany
- Center for Cleft Lip, Palate and Craniofacial Malformations, University Hospital Tübingen, Osianderstr. 2-8, 72076, Tübingen, Germany
| | - M Aretxabaleta
- Department of Orthodontics, University Hospital Tuebingen, Osianderstr. 2-8, 72076, Tuebingen, Germany
- Center for Cleft Lip, Palate and Craniofacial Malformations, University Hospital Tübingen, Osianderstr. 2-8, 72076, Tübingen, Germany
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Andersen HS, Jørgensen LD, Wilstrup C, Willadsen E. Multiple oppositions intervention: effective phonological treatment of two children with cleft lip and palate and severe speech sound disorder. CLINICAL LINGUISTICS & PHONETICS 2025; 39:57-78. [PMID: 38770980 DOI: 10.1080/02699206.2024.2339308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 04/01/2024] [Accepted: 04/01/2024] [Indexed: 05/22/2024]
Abstract
The purpose of this study was to investigate if multiple oppositions intervention (MOI) generated widespread change in the phonological systems of two children with cleft lip and palate (CLP) and severe speech sound disorders (SSD). We treated two children (ages 5;4 and 5;6) with CLP and severe SSD using MOI for 24 and 29 sessions. We measured the percentage consonants correct (PCC) for target consonants and untreated consonants in non-treatment single words, as well as PCC for connected speech. Data points were collected in the baseline, intervention, and maintenance phase with post-tests conducted immediately after intervention and at 1, 3, 6 and 12 months. Two speech and language therapists (SLTs) unfamiliar with the children performed phonetic transcriptions, and we calculated intra- and inter-rater agreement. We graphed the data, and used permutation tests to analyse the probability that the observed increases in PCC were due to random chance. Both children experienced considerable improvements in PCC across all measures at the first post-test, supporting the impact of MOI on their entire phonological system. The PCC continued to increase during the maintenance phase. By the final post-test, the PCC in connected speech exceeded 90% for both children, reducing their SSD classification to mild. Our findings support that a phonological, contrastive intervention approach targeting multiple consonants simultaneously can create system-wide phonological change for children with CLP and severe SSD. Further research with more participants is needed to strengthen these findings.
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Affiliation(s)
- Helene Søgaard Andersen
- Copenhagen Cleft Palate Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- PPR, Rudersdal Municipality, Rudersdal, Denmark
| | - Line Dahl Jørgensen
- Department of Nordic Studies and Linguistics, University of Copenhagen, Copenhagen, Denmark
- PPR, Roskilde Municipality, Roskilde, Denmark
| | | | - Elisabeth Willadsen
- Department of Nordic Studies and Linguistics, University of Copenhagen, Copenhagen, Denmark
- PPR, Hillerød Municipality, Hillerød, Denmark
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Schmidt G, Engeli N, Matuschek C, Hunn-Stohwasser C, Bestendonk C, Heiland M, Hirschfelder A, Hofmann E. Speech Outcomes in Children with Robin Sequence Treated with a Pre-Epiglottic Baton Plate. Cleft Palate Craniofac J 2024:10556656241298430. [PMID: 39552325 DOI: 10.1177/10556656241298430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2024] Open
Abstract
OBJECTIVE To analyze speech outcomes and cleft shape changes in children diagnosed with Robin sequence (RS) treated with a customized pre-epiglottic baton plate (PEBP). DESIGN Single-surgeon retrospective analysis. SETTING Tertiary care institution. PATIENTS AND PARTICIPANTS Twenty-five patients with RS who were treated with PEBP and primary cleft palate repair between 2010 and 2019. INTERVENTIONS Postnatal use of a PEBP. MAIN OUTCOME MEASURES Speech assessment at the age of 3.5 to 4.5 years documenting hypernasality, nasal emission, nasal turbulence, voice quality, and consonant production, and analysis of digitally scanned cast models before and after the use of PEBP to quantify changes in cleft shape and width. RESULTS The study cohort (N = 25) consisted of 19 patients with hard and soft cleft palates and 6 patients with soft cleft palate only and postnatal use of PEBP. The mean reduction in cleft width following PEBP treatment prior to cleft palate repair in 19 infants with hard and soft cleft palates was 41.30% (standard deviation, 13.25). Speech assessments were conducted at a mean age of 48.5 months in all 25 children treated with PEBP. Most children presented with absent or mild hypernasality (96%), a rate of 8% of nasal emission and 4% of nasal turbulence was found. The most frequent findings were articulation errors in 14 children (56%), of whom 2 presented with cleft-type characteristics. CONCLUSIONS Children with RS and cleft palate treated with PEBP demonstrated a narrowing of the cleft palate prior to a timely surgical repair, and favorable speech outcomes already at a young age during childhood.
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Affiliation(s)
- Gül Schmidt
- Department of Oral and Maxillofacial Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Nora Engeli
- Department of Oral and Maxillofacial Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Carsten Matuschek
- Department of Oral and Maxillofacial Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Christa Hunn-Stohwasser
- Department of Oral and Maxillofacial Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Carolin Bestendonk
- Department of Oral and Maxillofacial Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Max Heiland
- Department of Oral and Maxillofacial Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Anke Hirschfelder
- Department of Phoniatrics and Pedaudiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Elena Hofmann
- Department of Oral and Maxillofacial Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- BIH Biomedical Innovation Academy, BIH Charité Junior Clinician Scientist Program, Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
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Lien KM, Ellis P, Scherer NJ, Lancaster HS. A meta-analysis of the relationship between speech and language development in children with nonsyndromic cleft palate with or without cleft lip. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024:1-13. [PMID: 39487993 DOI: 10.1080/17549507.2024.2412610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2024]
Abstract
OBJECTIVE Children with nonsyndromic cleft palate with or without cleft lip are at risk of speech production and language delays. In typical development, a strong relationship exists between speech and expressive language development. However, the understanding of this relationship in children with nonsyndromic cleft palate with or without cleft lip is incomplete. The objective of this study was to determine the average correlation between consonant inventory and two expressive language skills in children with NSCP ± L. DESIGN The study used a random effects meta-analyses design. Articles were included by searching PubMed, APA PsycINFO, and ERIC. MAIN OUTCOME MEASURES Correlations between consonant inventory and (1) expressive vocabulary and (2) mean length of utterance. RESULT Based on eight studies representing 187 children with nonsyndromic cleft palate with or without cleft lip, consonant inventory was positively correlated with expressive vocabulary size (k = 8, z = 0.74, SE = .16, p < .001, [0.424, 1.052]). Using data from four studies, representing 83 children with nonsyndromic cleft palate with or without cleft lip, consonant inventory had a positive nonsignificant correlation with mean length of utterance (k = 4, z = 0.513, SE = 0.293, p = .081, [-0.063, 1.088]). CONCLUSION Results support a connection between consonant inventory and expressive vocabulary size in children with nonsyndromic cleft palate with or without cleft lip across four languages. Small consonant inventories are often associated with expressive language delays.
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Affiliation(s)
- Kari M Lien
- Department of Communication Sciences & Disorders, College of Health, University of Utah, Salt Lake City, UT, USA
| | - Paige Ellis
- Paradise Valley Unified School District, Scottsdale, AR, USA
| | - Nancy J Scherer
- Program of Speech and Hearing Science, College of Health Solutions, Arizona State University, Phoenix, AR, USA, and
| | - Hope Sparks Lancaster
- Center for Childhood Deafness, Language & Learning, Boys Town National Research Hospital, Omaha, NE, USA
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Pereira VJ, Sell D. How differences in anatomy and physiology and other aetiology affect the way we label and describe speech in individuals with cleft lip and palate. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2024; 59:2181-2196. [PMID: 37650488 DOI: 10.1111/1460-6984.12946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 07/31/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Speech in individuals with cleft lip and/or palate (CLP) is a complex myriad of presenting symptoms. It is uniquely associated with the structural difference of velopharyngeal insufficiency (VPI), together with a wide and heterogeneous range of other aetiologies which often co-occur. The nature of the speech sound disorder (SSD) including VPI may also change over the course of an individual's care pathway. Differences in terminology and approaches to analysis are currently used, resulting in confusion internationally. Additionally, current diagnostic labels and classification systems in SSD do not capture the complexity and full nature of speech characteristics in CLP. AIMS This paper aims to explore the different aetiologies of cleft palate/VPI speech and to relate aetiology with speech characteristic(s). In so doing, it attempts to unravel the different terminology used in the field, describing commonalities and differences, and identifying overlaps with the speech summary patterns used in the United Kingdom and elsewhere. The paper also aims to explore the applicability of current diagnostic labels and classification systems in the non-cleft SSD literature and illustrate certain implications for speech intervention in CLP. METHODS AND PROCEDURES The different aetiologies were identified from the literature and mapped onto cleft palate/VPI speech characteristics. Different terminology and approaches to analysis are defined and overlaps described. The applicability of current classification systems in SSD is discussed including additional diagnostic labels proposed in the field. OUTCOMES AND RESULTS Aetiologies of cleft palate/VPI speech identified include developmental (cognitive-linguistic), middle ear disease and fluctuating hearing loss, altered oral structure, abnormal facial growth, VPI-structural (abnormal palate muscle) and VPI-iatrogenic (maxillary advancement surgery). There are four main terminologies used to describe cleft palate/VPI speech: active/passive and compensatory/obligatory, which overlap with the four categories used in the UK speech summary patterns: anterior oral cleft speech characteristics (CSCs), posterior oral CSCs, non-oral CSCs and passive CSCs, although not directly comparable. Current classification systems in non-cleft SSD do not sufficiently capture the full nature and complexity of cleft palate/VPI speech. CONCLUSIONS AND IMPLICATIONS Our attempt at identifying the heterogeneous range of aetiologies provides clinicians with a better understanding of cleft palate/VPI speech to inform the management pathway and the nature and type of speech intervention required. We hope that the unravelling of the different terminology in relation to the UK speech summary patterns, and those used elsewhere, reduces confusion and provides more clarity for clinicians in the field. Diagnostic labels and classification require international agreement. WHAT THIS PAPER ADDS What is already known on the subject Speech associated with cleft palate/velopharyngeal insufficiency (VPI) is a complex myriad of speech characteristics with a wide and heterogeneous range of aetiologies. Different terminology and speech summary patterns are used to describe the speech characteristics. The traditional classification of cleft palate/VPI speech is Articulation Disorder, although evidence is building for Phonological Disorder and contrastive approaches in cleft speech intervention. What this paper adds to existing knowledge This paper explores the range of aetiologies of cleft palate/VPI speech (e.g., altered oral structure, abnormal facial growth, abnormal palate muscle and iatrogenic aetiologies) and attempts to relate aetiology with speech characteristic(s). An attempt is made at unravelling the different terminology used in relation to a well-known and validated approach to analysis, used in the United Kingdom and elsewhere. Complexities of current diagnostic labels and classifications in Speech Sound Disorder to describe cleft palate/VPI speech are discussed. What are the potential or actual clinical implications of this work? There needs to be a common language for describing and summarising cleft palate/VPI speech. Speech summary patterns based on narrow phonetic transcription and correct identification of aetiology are essential for the accurate classification of the speech disorder and identification of speech intervention approaches. There is an urgent need for research to identify the most appropriate type of contrastive (phonological) approach in cleft lip and/or palate.
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Affiliation(s)
- Valerie J Pereira
- Division of Speech Therapy, Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Debbie Sell
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital, London, UK
- School of Health Sciences, University of Surrey, Guildford, UK
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10
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Moura LB, Antoneli MZ, Passaglia IRG, Yokoyama FJ, Sampaio ECDF, Alonso N. Speech Outcomes After Primary Palatoplasty and Presurgical Cleft Characteristics: Is There a Predictive Association? J Craniofac Surg 2024:00001665-990000000-02071. [PMID: 39633579 DOI: 10.1097/scs.0000000000010744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2024] [Accepted: 09/09/2024] [Indexed: 12/07/2024] Open
Abstract
Speech disorders related to cleft lip and palate exhibit different degrees of involvement and can occur even after primary palate repair. Hypernasality can be present as a result of velopharyngeal insufficiency, as well as nasal emission, weak pressure, articulatory errors and facial grimace, affecting speech intelligibility. Palatoplasty outcomes can be variable, and among the influencing factors are the surgical technique, the surgeon's experience, the postoperative care, and the patient/cleft characteristics. The aim of this study was to correlate speech results after primary palate repair with surgical technique and cleft characteristics, using anthropometric measurements and speech assessment in patients diagnosed with cleft lip and palate. A longitudinal, retrospective study with patients who underwent primary palatoplasty between 2015 and 2019 and still attend Craniomaxillofacial Surgery Outpatient Clinic was conducted. Patients were operated on by a single surgeon using the intravelar technique veloplasty with maximal retropositioning of the soft palate elevator muscle. Patients who underwent primary palatoplasty after 2018 had the measurements before and immediately after palatoplasty recorded: length of palate, and the distances from cleft and uvula to posterior pharyngeal wall, and uvula to adenoid. Considering the total of 39 patients, 30 (76.9%) were male, with a mean age of 20.9 months (9-53 mo). All patients had their speech recorded between ages of 60 and 120 months. Speech samples were assessed by 3 different speech pathologists experienced in cleft speech, with an intrarater and inter-rater reliability >80%. The most frequent cleft type was unilateral complete cleft lip and palate (59%). One patient had mild hyponasality, 1 isolated obligatory disorder (nasal turbulence), and 3 patients presented compensatory articulation (2 isolated and 1 also presented obligatory disorder). Only 1 patient had marginal velopharyngeal insufficiency. Postoperatively, there was a mean increase in palate length from 5.4 to 5.6 cm, and a statistically significant decrease in the distance from the uvula to the pharynx wall, with a mean of 1.7 to 1.1 cm (P<0.001). In general, patients analyzed did not have significant alterations in speech assessment, which did not allow further comparisons and correlation. Therefore, regardless of the anatomic characteristics of the palate, it is possible to achieve good results depending on the handling experience and the technique used.
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Affiliation(s)
| | - Melissa Z Antoneli
- Department of Speech and Hearing, Hospital for Rehabilitation of Craniofacial Anomalies University of São Paulo (USP)
| | | | | | | | - Nivaldo Alonso
- Faculty of Medicine of University of São Paulo Coordinator of Craniofacial Surgery HRAC-USP Bauru, São Paulo, Brazil
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11
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Fujiki RB, Lien KM, Munday J, Thibeault SL, on behalf of the Cleft Outcomes Research NETwork (CORNET) Consortium. Socioeconomic Deprivation Detrimentally Influences Language Outcomes in Toddlers With Cleft Palate. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2024; 67:3113-3132. [PMID: 39173117 PMCID: PMC11427525 DOI: 10.1044/2024_jslhr-24-00060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 04/16/2024] [Accepted: 06/27/2024] [Indexed: 08/24/2024]
Abstract
PURPOSE The purpose of this study was to examine the influence of socioeconomic deprivation on language and developmental outcomes in toddlers with cleft palate with or without cleft lip (CP ± L). Other factors known to influence language outcomes were also considered, including home language history, history of hearing problems, syndromic diagnoses, and sex. METHOD A multicenter, cross-sectional study design was conducted. Data for 566 16-month-old toddlers with CP ± L were collected from 17 outpatient cleft palate clinics located throughout the United States. Outcome measures included the MacArthur-Bates Communicative Development Inventories, LENA Developmental Snapshot, age at first word as reported by the caregiver, and the Ages and Stages Questionnaires-Third Edition (ASQ-3). Multivariable linear or logistic regression was used to determine the influence of socioeconomic deprivation, as measured by the Area Deprivation Index, on language and developmental outcomes. RESULTS Greater socioeconomic deprivation significantly predicted poorer language outcomes in toddlers with CP ± L, including receptive vocabulary words (p = .02), expressive vocabulary words (p = .02), and late-developing gestures (p = .02). Additionally, toddlers from less affluent neighborhoods produced their first words significantly later than their counterparts living in more affluent areas (p < .01). Lower maternal education levels predicted significantly increased risk for problem solving delays (p < .01), and patients with subsidized insurance were at significantly increased risk for personal-social delays on the ASQ-3 (p < .01). CONCLUSIONS Children with CP ± L are susceptible to developmental delays associated with socioeconomic deprivation. These findings have implications for identifying a child's individual risk factors for developmental language disorders when conducting speech-language assessments. Future study should examine how inequities in care can be mitigated and addressed.
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Affiliation(s)
| | - Kari M. Lien
- Department of Communication Sciences and Disorders, The University of Utah, Salt Lake City
| | - John Munday
- Department of Surgery, University of Wisconsin–Madison
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12
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Wombacher NR, Lancaster HS, Scherer NJ, Chen DG, Kaiser A, Yamashita R. The impact of enhanced Milieu teaching with phonological emphasis (EMT + PE) on the speech and language outcomes for toddlers with cleft palate in Brazil and the United States of America. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024:1-13. [PMID: 38859760 PMCID: PMC11632144 DOI: 10.1080/17549507.2024.2342783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2024]
Abstract
PURPOSE The purpose of this study was to compare the speech and language outcomes of children with cleft palate with or without cleft lip (CP+/-L) in the USA to children with CP+/-L in Brazil who underwent intervention with enhanced Milieu teaching with phonological emphasis (EMT + PE), as there are few cross-country intervention comparisons for children with CP+/-L. METHOD This is a retrospective analysis of 29 participants from the USA and 24 participants from Brazil who were matched on age. The US participants were between the ages of 13-35 months (M = 23.76), spoke Standard American English in the home, and were recruited from East Tennessee State University and Vanderbilt University. The Brazilian participants were between the ages of 20-34 months (M = 25.04), spoke Brazilian Portuguese in the home, and were recruited from the Hospital de Reabilitação de Anomalias Craniofaciais-Universidade de São Paulo. All treatment participants received EMT + PE from trained speech-language pathologists in hospital-university clinics. RESULT The treatment groups demonstrated greater gains than comparison groups in percent consonants correct, number of different words, and expressive/receptive vocabulary. There was no main effect nor interaction by country. CONCLUSION The application of EMT + PE in a second culture and language is a viable early intervention option for participants with CP+/-L.
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Affiliation(s)
| | | | | | | | - Ann Kaiser
- Vanderbilt University, Nashville, USA, and
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13
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Heron MJ, Rezwan SK, Zhu KJ, Gornitsky J, Redett RJ, Yang R. A Geospatial Analysis of Barriers to Cleft Lip and Palate Care in the United States. Cleft Palate Craniofac J 2024:10556656241259883. [PMID: 38836317 DOI: 10.1177/10556656241259883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2024] Open
Abstract
OBJECTIVE This study evaluates the geospatial distribution of cleft lip and/or cleft palate (CL/P) care in the United States, assesses disparities between families with and without one-hour proximity to CL/P care, and recommends interventions for improving access. DESIGN We identified American Cleft Palate Craniofacial Association-approved CL/P teams and calculated a one-hour driving radius around each clinic. We then used census data to compare risk factors for developing cleft (i.e., incidence risk factors) and obstacles to care (i.e., access risk factors) between counties with and without one-hour proximity. RESULTS We identified 187 CL/P teams in 45 states. Most were in the South (n = 60, 32.0%), though children in the Middle Atlantic had the greatest access to care. Alabama, Mississippi, Tennessee, and Kentucky had the least access. Children without access were 39% more likely to have gestational tobacco exposure, 8% more likely to have gestational obesity exposure, and 28% less likely to have health insurance (p < 0.01). Children without access in the South were 29% more likely to have a low birth weight and 46% more likely to be living below the poverty line (p < 0.01). Children with access were twice as likely to live in immigrant families and 7-times more likely to speak English as a second language. CONCLUSIONS Pronounced disparities affect patients with and without one-hour access to CL/P care. Interventions should address care costs for patients living furthest without access and language barriers for patients with access that speak English as a second language.
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Affiliation(s)
- Matthew J Heron
- Department of Plastic & Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Siam K Rezwan
- Department of Plastic & Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Katherine J Zhu
- Department of Plastic & Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jordan Gornitsky
- Department of Plastic & Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Richard J Redett
- Department of Plastic & Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Robin Yang
- Department of Plastic & Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Tsur N, Beer Z, Rittblat M, Yaacobi D, Elmograbi A, Reuven Y. Intelligence among ear deformities and cleft lip and/or alveolus and/or cleft palate patients during 50 years in Israel. Orthod Craniofac Res 2024; 27 Suppl 1:14-20. [PMID: 37650486 DOI: 10.1111/ocr.12709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 08/02/2023] [Accepted: 08/18/2023] [Indexed: 09/01/2023]
Abstract
PURPOSE We evaluated hearing loss and general intelligence among persons with auricle anomalies and cleft lip and/or alveolus and/or cleft palate (CLAP). METHODS A nationwide cross-sectional study of data recorded during 1966-2019, as mandatory pre-military recruitment of individuals. RESULTS Of 3 182 892 adolescents, 548 were diagnosed with auricle anomalies and 2072 with CLAP. For the latter, the adjusted odds ratios for the low, low to medium and medium general intelligence categories compared to the highest category were 1.4 [95% CI 1.5-1.2], 1.2 [95% CI 1.4-1.1] and 1.1 [95% CI 1.2-0.9] respectively. The corresponding values for the auricle anomalies were not significant. CONCLUSIONS General intelligence was impaired among individuals with CLAP, but no significant correlation was found among individuals suffering from auricle anomalies.
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Affiliation(s)
- Nir Tsur
- Israel Defense Forces, Medical Corps, Ramat Gan, Israel
- Department of Otolaryngology-Head and Neck Surgery, Schneider Children's Medical Center, Petah Tikva, Israel
| | - Zivan Beer
- Israel Defense Forces, Medical Corps, Ramat Gan, Israel
- Department of Military Medicine, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Mor Rittblat
- Israel Defense Forces, Medical Corps, Ramat Gan, Israel
- Department of Military Medicine, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dafna Yaacobi
- Department of Plastic Surgery and Burns, Rabin Medical Center-Beilinson Hospital, Petah Tikva, Israel
| | - Aiman Elmograbi
- Department of Otolaryngology-Head and Neck Surgery, Schneider Children's Medical Center, Petah Tikva, Israel
| | - Yonatan Reuven
- Department of Otolaryngology-Head and Neck Surgery, Schneider Children's Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Crowley CJ, Yanowitch D, Baigorri M, Hwang KH, Cordero KN, Gonzalez A, Goes M, Bohórquez D, Sierra N, Zavaleta SG, Levy ES. Impact of an International Training on Interventionists' Expertise in Cleft Palate Speech: Results From Oaxaca, Mexico. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 33:1456-1470. [PMID: 38557150 DOI: 10.1044/2024_ajslp-23-00397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
PURPOSE International cleft lip and palate surgical charities recognize that speech therapy is essential for successful care of individuals after palate repair. The challenge is how to ensure that cleft speech interventionists (i.e., speech-language pathologists and other speech therapy providers) provide quality care. This exploratory study investigated effects of a two-stage cleft training in Oaxaca, Mexico, aimed at preparing speech interventionists to provide research-based services to individuals born with cleft palate. Changes in the interventionists' content knowledge and clinical skills were examined. METHOD Twenty-three cleft speech interventionists from Mexico, Guatemala, and Nicaragua participated in a hybrid two-stage training, completing an online Spanish cleft speech course and a 5-day in-person training in Oaxaca. In-person training included a didactic component and supervised clinical practice with 14 individuals with repaired cleft palates. Testing of interventionists' content knowledge and clinical skills via questionnaires occurred before the online course (Test 1), immediately before in-person training (Test 2), and immediately after in-person training (Test 3). Qualitative data on experience/practice were also collected. RESULTS Significant increases in interventionists' overall content knowledge and clinical skills were found posttraining. Knowledge and clinical skills increased significantly between Tests 1 and 2. Clinical skills, but not knowledge, showed further significant increases between Tests 2 and 3. Posttraining, interventionists demonstrated greater expertise in research-based treatment, and fewer reported they would use nonspeech oral motor exercises (NSOME). CONCLUSIONS Findings provide preliminary support for such two-stage international trainings in preparing local speech interventionists to deliver high-quality speech services to individuals born with cleft palate. While content knowledge appears to be acquired primarily from the online course, the two-stage training incorporating in-person supervised practice working with individuals born with cleft palate may best enhance continued clinical skill development, including replacement of NSOME with evidence-based speech treatment. Such trainings contribute to building capacity for sustainable quality services for this population in underresourced regions.
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Affiliation(s)
- Catherine J Crowley
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| | - David Yanowitch
- Columbia Secondary School for Math, Science, and Engineering, New York, NY
| | - Miriam Baigorri
- Department of Communication Sciences and Disorders, Long Island University-Brooklyn, NY
| | - Kyung Hae Hwang
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| | | | | | | | | | | | | | - Erika S Levy
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
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16
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Hui LH, Ling EY, Rusli YA, See GB, Ibrahim HM. Language abilities and associated risk factors of school-aged children with cleft lip and palate. PLoS One 2024; 19:e0299095. [PMID: 38648208 PMCID: PMC11034652 DOI: 10.1371/journal.pone.0299095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 02/05/2024] [Indexed: 04/25/2024] Open
Abstract
Previous research on children with cleft lip and palate (CLP) reported unequivocal findings with regard to language skills, with the majority suggesting persistent difficulties in early childhood. While expressive language deficits improved with age, receptive language skills were consistently lower than peers. Further study investigating the long term and persistent impact of language deficits amongst school-aged children with CLP is warranted. This was a cross-sectional study, aimed to determine the language abilities and explore the associated risk factors in Malay speaking children with CLP in Malaysia. Fifty-two children with CLP aged 7- to 12-year-old participated in this study. Language skills were assessed using the Malay Preschool Language Assessment Tool and the adapted Subway-School-age Language & Assessment Measures. Findings revealed that 14 (26.92%) school-aged children with CLP demonstrated language deficits. Children with CLP performed significantly poorer in reading comprehension (p = 0.031) and narrative (p = 0.026) skills. It was found that the age significantly influenced total receptive language score (β = 0.421, p = 0.003) and total expressive language score (β = 0.477, p = 0.000). Findings suggested that children with CLP may continue to have persistent language deficits into their school-age years. Recommendations for regular monitoring of language performance especially for those from younger age groups is warranted to help maximize school attainment.
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Affiliation(s)
- Lim Hui Hui
- Speech Sciences Program, School of Rehabilitation Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia (UKM), Kuala Lumpur, Malaysia
| | - Eh Yee Ling
- Speech Sciences Program, School of Rehabilitation Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia (UKM), Kuala Lumpur, Malaysia
| | - Yazmin Ahmad Rusli
- Speech Sciences Program, School of Rehabilitation Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia (UKM), Kuala Lumpur, Malaysia
| | - Goh Bee See
- Department of Otorhinolaryngology, Head & Neck Surgery, Faculty of Medicine, Hospital Canselor Tuanku Muhriz, UKM, Kuala Lumpur, Malaysia
| | - Hasherah Mohd Ibrahim
- Speech Sciences Program, School of Rehabilitation Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia (UKM), Kuala Lumpur, Malaysia
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Tahmasebi N, Zarifian T, Ashtari A, Biglarian A. Telepractice Parent Training of Enhanced Milieu Teaching With Phonological Emphasis (EMT+PE) For Persian-Speaking Toddlers With Nonsyndromic Cleft Palate: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2024; 13:e54426. [PMID: 38640014 PMCID: PMC11069098 DOI: 10.2196/54426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 02/14/2024] [Accepted: 02/22/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Children born with a cleft palate with or without a cleft lip (CP/L) are at increased risk for delayed language development and speech sound disorders. Enhanced Milieu Teaching with Phonological Emphasis (EMT+PE) is a recommended naturalistic intervention for toddlers with CP/L. The parents' role in providing naturalistic interventions is critical and they need training based on learning principles to implement these interventions. Telepractice is an appropriate method for training parents and children with various speech-related disorders. OBJECTIVE This study aims to determine and compare the effectiveness of telepractice and the parent-implemented EMT+PE intervention on language and speech measures in toddlers with CP/L with usual interventions and determine the effectiveness maintenance of the intervention. METHODS A randomized controlled trial (RCT) will assess the efficacy of telepractice and the parent-implemented EMT+PE intervention in enhancing speech and language measures in toddlers with CP/L. Eligible participants will be randomly assigned to one of 2 groups: the conventional intervention group and the EMT+PE intervention group. Participants' speech and language measures will be evaluated remotely by trained raters before and after the intervention and 2 months after the intervention. Parents of participants in the intervention group will receive 3 months of training in speech and language supportive strategies from trained therapists using telehealth fidelity scales. Parents of participants in the control group will receive the conventional speech and language intervention by cleft team therapists. Study outcomes will include language variables (mean length of utterance) and speech production variables (percent correct consonants). RESULTS The protocol was approved by the Research Ethics Committee of the University of Social Welfare and Rehabilitation Sciences in February 2022. The selection process of participants, as well as training therapists and raters, commenced in January 2022, the therapy and follow-up period ended in June 2023, and pre- and postintervention assessments have been conducted. Data analysis is ongoing, and we expect to publish our results by the summer of 2024. Funding is yet to be received. CONCLUSIONS The results of this study may help us develop a speech and language intervention with a different delivery model for toddlers with CP/L, and the cleft team care can use these results in service delivery. Consistent with our hypothesis, speech and language measures are expected to improve. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/54426.
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Affiliation(s)
- Neda Tahmasebi
- Department of Speech Therapy, Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Talieh Zarifian
- Department of Speech Therapy, Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Atieh Ashtari
- Department of Speech Therapy, Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Akbar Biglarian
- Department of Biostatistics and Epidemiology, Social Determinants of Health Research Center, Social Health Research Institute, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Ellis PK, Scherer NJ, Lien KM. Enhanced milieu teaching with phonological emphasis: A pilot, telepractice study for parent training in early intervention. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 26:179-193. [PMID: 37265060 DOI: 10.1080/17549507.2023.2199176] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE This pilot study evaluated enhanced milieu teaching with phonological emphasis (EMT + PE) parent training intervention delivered through telepractice and its impact on parent implementation, child speech outcomes, and child language outcomes. METHOD A multiple baseline design across behaviours was used to assess response to parent training and child outcomes. The intervention was delivered to four parents and their young children with repaired cleft palate. Speech production, receptive language, and expressive language were assessed prior to intervention. EMT + PE strategies including matched turns, modelling and expansions, and prompting/speech recasting were taught to parents using the teach-model-coach-review model. Social validity questionnaires were administered pre- and post-intervention to assess parents' rating of competence and confidence for managing their child's early development. Reliability and procedural fidelity were conducted. RESULT All parents increased their use of modelling and expansions, and prompting and speech recasting in response to training, as evidenced by large effect sizes. Children also responded positively to these strategies by increasing percentage of consonants correct (PCC) and target vocabulary, although PCC gains were less than observed in a prior hybrid telepractice and face-to-face intervention. Social validity measures indicated parents increased their confidence to provide intervention for their children. CONCLUSION This pilot study indicated that effective parent training in EMT + PE strategies can be delivered through telepractice.
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Affiliation(s)
- Paige K Ellis
- Paradise Valley Unified School District, Scottsdale, AZ, USA
| | - Nancy J Scherer
- College of Health Solutions, Arizona State University, Tempe, AZ, USA
| | - Kari M Lien
- Communication Sciences and Disorders University of Utah, Salt Lake City, UT, USA
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Kapp-Simon KA, Crilly Bellucci C, Albert M, O'Gara M, Richards S, Morgan A. The Association of Speech/Language Risk With Phonological Awareness, Rapid Naming, and Reading Ability in Children With Cleft Lip and/or Palate. Dev Neuropsychol 2024; 49:61-85. [PMID: 38414409 DOI: 10.1080/87565641.2023.2293715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 12/02/2023] [Indexed: 02/29/2024]
Abstract
Children with cleft lip and/or palate were assessed for speech, language, phonological awareness (PA), rapid naming (RN) and reading ability using standardized instruments at baseline (T1; N = 142, Mage = 6.14 years, 51% males) and 2-year follow-up (T2; 89% retention, Mage = 8.38). Children with no speech or language risk scored higher for T1 and T2 PA, RN, and reading than children with both speech and language risk [Adjusted Mean Difference (AMD) ranged from 11.79 to 21.25]; language risk (AMD 8.37 to 13.58); and speech risk (0.51 to 6.87). No significant differences by cleft type or child sex.
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Affiliation(s)
- Kathleen A Kapp-Simon
- Pediatric Plastic Surgery, Shriners Hospitals for Children-Chicago, Chicago, IL, USA
| | | | - Meredith Albert
- Pediatric Plastic Surgery, Shriners Hospitals for Children-Chicago, Chicago, IL, USA
| | - Mary O'Gara
- Pediatric Plastic Surgery, Shriners Hospitals for Children-Chicago, Chicago, IL, USA
| | - Sarah Richards
- Pediatric Plastic Surgery, Shriners Hospitals for Children-Chicago, Chicago, IL, USA
| | - Amy Morgan
- Pediatric Plastic Surgery, Shriners Hospitals for Children-Chicago, Chicago, IL, USA
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Tio PAE, Rooijers W, de Gier HHW, Poldermans HG, Koudstaal MJ, Caron CJJM. Velopharyngeal insufficiency, speech, and language impairment in craniofacial microsomia: a scoping review. Br J Oral Maxillofac Surg 2024; 62:30-37. [PMID: 38057178 DOI: 10.1016/j.bjoms.2023.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/22/2023] [Indexed: 12/08/2023]
Abstract
This review provides a comprehensive overview of the literature on velopharyngeal insufficiency, associated anomalies, and speech/language impairment in patients with craniofacial microsomia (CFM). A systematic search of the literature was conducted to identify records on VPI and speech impairment in CFM from their inception until September 2022 within the databases Embase, PubMed, MEDLINE, Ovid, CINAHL EBSCO, Web of Science, Cochrane, and Google Scholar. Seventeen articles were included, analysing 1,253 patients. Velopharyngeal insufficiency results in hypernasality can lead to speech impairment. The reported prevalence of both velopharyngeal insufficiency and hypernasality ranged between 12.5% and 55%, while the reported prevalence of speech impairment in patients with CFM varied between 35.4% and 74%. Language problems were reported in 37% to 50% of patients. Speech therapy was documented in 45.5% to 59.6% of patients, while surgical treatment for velopharyngeal insufficiency consisted of pharyngeal flap surgery or pharyngoplasty and was reported in 31.6% to 100%. Cleft lip and/or palate was reported in 10% to 100% of patients with CFM; these patients were found to have worse speech results than those without cleft lip and/or palate. No consensus was found on patient characteristics associated with an increased risk of velopharyngeal insufficiency and speech/language impairment. Although velopharyngeal insufficiency is a less commonly reported characteristic of CFM than other malformations, it can cause speech impairment, which may contribute to delayed language development in patients with CFM. Therefore, timely recognition and treatment of speech impairment is essential.
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Affiliation(s)
- Pauline A E Tio
- The Dutch Craniofacial Centre, Department of Oral and Maxillofacial Surgery, Erasmus University Medical Centre, Sophia's Children's Hospital Rotterdam, Rotterdam, The Netherlands.
| | - Wietse Rooijers
- The Dutch Craniofacial Centre, Department of Oral and Maxillofacial Surgery, Erasmus University Medical Centre, Sophia's Children's Hospital Rotterdam, Rotterdam, The Netherlands
| | - Henriëtte H W de Gier
- Department of Otorhinolaryngology, Erasmus University Medical Centre, Sophia's Children's Hospital Rotterdam, Rotterdam, The Netherlands
| | - Henriëtte G Poldermans
- Speech and Language Centre, Erasmus University Medical Centre, Sophia's Children's Hospital Rotterdam, Rotterdam, The Netherlands
| | - Maarten J Koudstaal
- The Dutch Craniofacial Centre, Department of Oral and Maxillofacial Surgery, Erasmus University Medical Centre, Sophia's Children's Hospital Rotterdam, Rotterdam, The Netherlands
| | - Cornelia J J M Caron
- The Dutch Craniofacial Centre, Department of Oral and Maxillofacial Surgery, Erasmus University Medical Centre, Sophia's Children's Hospital Rotterdam, Rotterdam, The Netherlands
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21
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De Ryck M, Van Lierde K, Alighieri C, Hens G, Bettens K. A protocol for a randomized-controlled trial to investigate the effect of infant sign training on the speech-language development in young children born with cleft palate. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2023; 58:2212-2221. [PMID: 37376898 DOI: 10.1111/1460-6984.12920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND Children born with a cleft palate with or without cleft lip (CP ± L) are known to be at risk for speech-language disorders that impact educational and social-emotional growth. It is hypothesized that speech-language intervention delivered before the age of 3 years could decrease the impact of CP ± L on speech-language development. Infant sign training in combination with verbal input expands the natural communication of young children including multimodal speech-language input (i.e., verbal and manual input) via caregivers who act as co-therapists. AIMS To determine the effectiveness of infant sign training in 1-year-old children with CP ± L by comparing different interventions. METHODS & PROCEDURES This is a two-centre, randomized, parallel-group, longitudinal, controlled trial. Children are randomized to either an infant sign training group (IST group), a verbal training group (VT group) or no intervention control group (C group). Caregivers of children who are assigned to the IST group or VT group will participate in three caregiver training meetings to practise knowledge and skills to stimulate speech-language development. Outcome measures include a combination of questionnaires, language tests and observational analyses of communicative acts. OUTCOMES & RESULTS It is hypothesized that speech-language development of children with CP ± L will benefit more from IST compared with VT and no intervention. Additionally, the number and quality of communicative acts of both children and caregivers are expected to be higher after IST. CONCLUSIONS & IMPLICATIONS This project will contribute to the development of evidence-based clinical practice guidelines regarding early speech-language intervention in children with CP ± L under the age of 3 years. WHAT THIS PAPER ADDS What is already known on the subject Children with CP ± L are known to be at risk for speech-language delays that impact educational and social emotional growth. Given the limited scientific prove of the impact of early speech-language intervention, no standardized clinical practice guidelines are available yet for children with CP ± L under the age of 3 years. Early intervention in this population mostly focuses on improving verbal input via caregivers or professionals without including a multimodal language input. A growing scientific interest has been seen in the use of infant signs to support speech-language development and caregiver-child interaction in typically developing children and children with developmental delays. What this study adds to existing knowledge No evidence is yet available for the effectiveness and feasibility of early intervention based on infant sign training in combination with verbal input to improve speech-language skills in young children with CP ± L. The current project will investigate the effect of infant sign training on the speech-language development in this population. Outcome measures are compared with those of two control groups: verbal training only and no intervention. It is hypothesized that infant signs may support the intelligibility of verbal utterances produced by children with CP ± L. Improving children's intelligibility may increase the opportunities for these children to engage in early, frequent and high-quality interactions with their caregivers resulting in a richer social and linguistic environment. As a result, infant sign training may result in better speech-language skills compared with the control interventions. What are the potential or actual clinical implications of this work? If providing early intervention based on infant sign training is effective, there is the potential for improved speech-language outcomes in early childhood, resulting in increased speech intelligibility, increased well-being of the child and family and less need for speech-language therapy on the long-term. This project will contribute to the development of evidence-based clinical practice guidelines regarding early speech-language intervention in children with CP ± L under the age of 3 years.
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Affiliation(s)
- Mira De Ryck
- Department of Rehabilitation Sciences, Center for Speech and Language Sciences (CESLAS), Ghent University, Ghent, Belgium
| | - Kristiane Van Lierde
- Department of Rehabilitation Sciences, Center for Speech and Language Sciences (CESLAS), Ghent University, Ghent, Belgium
| | - Cassandra Alighieri
- Department of Rehabilitation Sciences, Center for Speech and Language Sciences (CESLAS), Ghent University, Ghent, Belgium
| | - Greet Hens
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
- Multidisciplinary Cleft Lip and Palate Team, University Hospitals Leuven, Leuven, Belgium
| | - Kim Bettens
- Department of Rehabilitation Sciences, Center for Speech and Language Sciences (CESLAS), Ghent University, Ghent, Belgium
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Curtis SW, Carlson JC, Beaty TH, Murray JC, Weinberg SM, Marazita ML, Cotney JL, Cutler DJ, Epstein MP, Leslie EJ. Rare variant modifier analysis identifies variants in SEC24D associated with orofacial cleft subtypes. Hum Genet 2023; 142:1531-1541. [PMID: 37676273 DOI: 10.1007/s00439-023-02596-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 08/18/2023] [Indexed: 09/08/2023]
Abstract
As one of the most common structural birth defects, orofacial clefts (OFCs) have been studied for decades, and recent studies have demonstrated that there are genetic differences between the different phenotypic presentations of OFCs. However, the contribution of rare genetic variation genome-wide to different subtypes of OFCs has been understudied, with most studies focusing on common genetic variation or rare variation within targeted regions of the genome. Therefore, we used whole-genome sequencing data from the Gabriella Miller Kids First Pediatric Research Program to conduct a gene-based burden analysis to test for genetic modifiers of cleft lip (CL) vs cleft lip and palate (CLP). We found that there was a significantly increased burden of rare variants in SEC24D in CL cases compared to CLP cases (p = 6.86 [Formula: see text] 10-7). Of the 15 variants within SEC24D, 53.3% were synonymous, but overlapped a known craniofacial enhancer. We then tested whether these variants could alter predicted transcription factor binding sites (TFBS), and found that the rare alleles destroyed binding sites for 9 transcription factors (TFs), including Pax1 (p = 0.0009), and created binding sites for 23 TFs, including Pax6 (p = 6.12 [Formula: see text] 10-5) and Pax9 (p = 0.0001), which are known to be involved in normal craniofacial development, suggesting a potential mechanism by which these synonymous variants could have a functional impact. Overall, this study indicates that rare genetic variation may contribute to the phenotypic heterogeneity of OFCs and suggests that regulatory variation may also contribute and warrant further investigation in future studies of genetic variants controlling risk to OFC.
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Affiliation(s)
- Sarah W Curtis
- Department of Human Genetics, Emory University, Atlanta, GA, 30322, USA
| | - Jenna C Carlson
- Department of Human Genetics, University of Pittsburgh, Pittsburgh, PA, 15621, USA
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, 15261, USA
| | - Terri H Beaty
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Jeffrey C Murray
- Department of Pediatrics, University of Iowa, Iowa City, IA, 52242, USA
| | - Seth M Weinberg
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, 15261, USA
- Center for Craniofacial and Dental Genetics, Department of Oral and Craniofacial Sciences, University of Pittsburgh, Pittsburgh, PA, 15261, USA
| | - Mary L Marazita
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, 15261, USA
- Center for Craniofacial and Dental Genetics, Department of Oral and Craniofacial Sciences, University of Pittsburgh, Pittsburgh, PA, 15261, USA
| | - Justin L Cotney
- Department of Genetics and Genome Sciences, University of Connecticut, Farmington, CT, 06030, USA
| | - David J Cutler
- Department of Human Genetics, Emory University, Atlanta, GA, 30322, USA
| | - Michael P Epstein
- Department of Human Genetics, Emory University, Atlanta, GA, 30322, USA
| | - Elizabeth J Leslie
- Department of Human Genetics, Emory University, Atlanta, GA, 30322, USA.
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Chow JC, Sandbank M, Hampton LH. Guidance for Increasing Primary Study Inclusion and the Usability of Data in Meta-Analysis: A Reporting Tutorial. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023:1-9. [PMID: 37263184 DOI: 10.1044/2023_jslhr-22-00318] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Meta-analyses can be used to comprehensively summarize the state of a given literature base, understand development and relations between constructs, and synthesize intervention effects to identify "what works for whom," all of which can directly inform research, practice, and policy. In this tutorial, we first argue that data reporting in primary studies can meaningfully affect the results of meta-analyses and, most importantly, the subsequent interpretations and use of the findings in research, practice, and policy in speech, language, and hearing sciences. Though reporting guidelines have been well established for the results of meta-analyses, there is limited focus on the essentials for primary study reporting that allow for inclusion in meta-analyses. To this end, we provide guidance for primary study authors to ensure their studies can maximize their contributions to research syntheses and, specifically, to meta-analyses. We discuss current and ongoing issues related to reporting, provide data-based examples of instances where lack of reporting or transparency has rendered a study ineligible from inclusion in a meta-analysis, encourage editorial teams and peer reviewers to be flexible in the inclusion of supplemental data reporting based on journal requirements and limits, and suggest being explicit and earnest about why these requests are important to advancing the field. Supplemental Material: https://doi.org/10.23641/asha.23117996.
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24
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van Eeden S. The relationship between auditory behaviours and speech and language development in children with cleft lip and palate. Curr Opin Otolaryngol Head Neck Surg 2023; 31:165-170. [PMID: 36912233 PMCID: PMC10171286 DOI: 10.1097/moo.0000000000000883] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
PURPOSE OF REVIEW Children born with a cleft lip and palate (CLP) are at risk of speech problems. There is a high prevalence of conductive hearing loss due to otitis media with effusion and recent research has highlighted broader difficulties with language and educational attainment. There has been increased interest in the impact of auditory processing on a child's development, but little study into links between auditory skills and speech and language development. RECENT FINDINGS Children with CLP consistently struggle with auditory tasks. Difficulties processing words in a noisy background, auditory attention and temporal processing are frequently reported. A recent study in the United Kingdom investigated the auditory behaviours of 95 children aged 5-8 years with nonsyndromic CLP and compared these with speech and language profiles. Auditory difficulties correlated with speech development and most auditory behaviours correlated with language outcomes. There was also a correlation of language with speech outcomes, suggesting a more complex and interdependent relationship. SUMMARY Children with CLP present with high levels of difficulties with auditory skills. The potential impact of this on broader development needs further research, but clinicians should ensure that auditory skills beyond the hearing test are monitored, and advice given to parents to minimize the impact.
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Affiliation(s)
- Stephanie van Eeden
- School of Education, Communication and Language Sciences, Newcastle University
- Newcastle upon Tyne Cleft Lip and Palate Service, Royal Victoria Infirmary, Newcastle upon Tyne, UK
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25
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Curtis SW, Carlson JC, Beaty TH, Murray JC, Weinberg SM, Marazita ML, Cotney JL, Cutler DJ, Epstein MP, Leslie EJ. Rare genetic variants in SEC24D modify orofacial cleft phenotypes. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.03.24.23287714. [PMID: 37034635 PMCID: PMC10081436 DOI: 10.1101/2023.03.24.23287714] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
As one of the most common structural birth defects, orofacial clefts (OFCs) have been studied for decades, and recent studies have demonstrated that there are genetic differences between the different phenotypic presentations of OFCs. However, the contribution of rare genetic variation genome-wide to different subtypes of OFCs has been understudied, with most studies focusing on common genetic variation or rare variation within targeted regions of the genome. Therefore, we used whole-genome sequencing data from the Gabriella Miller Kids First Pediatric Research Program to conduct a gene-based burden analysis to test for genetic modifiers of cleft lip (CL) vs cleft lip and palate (CLP). We found that there was a significantly increased burden of rare variants in SEC24D in CL cases compared to CLP cases (p=6.86×10-7). Of the 15 variants within SEC24D, 53.3% were synonymous, but overlapped a known craniofacial enhancer. We then tested whether these variants could alter predicted transcription factor binding sites (TFBS), and found that the rare alleles destroyed binding sites for 9 transcription factors (TFs), including Pax1 (p=0.0009), and created binding sites for 23 TFs, including Pax6 (p=6.12×10-5) and Pax9 (p= 0.0001), which are known to be involved in normal craniofacial development, suggesting a potential mechanism by which these synonymous variants could have a functional impact. Overall, this study demonstrates that rare genetic variation contributes to the phenotypic heterogeneity of OFCs and suggests that regulatory variation may also contribute and warrant further investigation in future studies of genetic variants controlling risk to OFC.
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Affiliation(s)
- Sarah W Curtis
- Department of Human Genetics, Emory University, Atlanta, GA, 30322, USA
| | - Jenna C Carlson
- Department of Human Genetics, University of Pittsburgh, Pittsburgh, PA, 15621, USA
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, 15261, USA
| | - Terri H Beaty
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205,USA
| | - Jeffrey C Murray
- Department of Pediatrics, University of Iowa, Iowa City, IA, 52242, USA
| | - Seth M Weinberg
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, 15261, USA
- Center for Craniofacial and Dental Genetics, Department of Oral and Craniofacial Sciences, University of Pittsburgh, Pittsburgh, PA, 15261, USA
| | - Mary L Marazita
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, 15261, USA
- Center for Craniofacial and Dental Genetics, Department of Oral and Craniofacial Sciences, University of Pittsburgh, Pittsburgh, PA, 15261, USA
| | - Justin L Cotney
- Department of Genetics and Genome Sciences, University of Connecticut, CT, 06030, USA
| | - David J Cutler
- Department of Human Genetics, Emory University, Atlanta, GA, 30322, USA
| | - Michael P Epstein
- Department of Human Genetics, Emory University, Atlanta, GA, 30322, USA
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26
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Zhang W, Zhao C, Sun L, Yang X, Yang L, Liang Y, Zhang X, Du X, Chen R, Li C. Articulation-Function-Associated Cortical Developmental Changes in Patients with Cleft Lip and Palate. Brain Sci 2023; 13:brainsci13040550. [PMID: 37190514 DOI: 10.3390/brainsci13040550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/17/2023] [Accepted: 03/22/2023] [Indexed: 03/29/2023] Open
Abstract
Cleft lip and palate (CLP) is one of the most common craniofacial malformations. Overall, 40–80% of CLP patients have varying degrees of articulation problems after palatoplasty. Previous studies revealed abnormal articulation-related brain function in CLP patients. However, the association between articulation disorders and cortical structure development in CLP patients remains unclear. Twenty-six CLP adolescents (aged 5–14 years; mean 8.88 years; female/male 8/18), twenty-three CLP adults (aged 18–35 years; mean 23.35 years; female/male 6/17), thirty-seven healthy adolescents (aged 5–16 years; mean 9.89 years; female/male 5/16), and twenty-two healthy adults (aged 19–37 years; mean 24.41 years; female/male 19/37) took part in the experiment. The current study aims to investigate developmental changes in cortical structures in CLP patients with articulation disorders using both structural and functional magnetic resonance imaging (MRI). Our results reveal the distinct distribution of abnormal cortical structures in adolescent and adult CLP patients. We also found that the developmental pattern of cortical structures in CLP patients differed from the pattern in healthy controls (delayed cortical development in the left lingual gyrus (t = 4.02, cluster-wise p < 0.05), inferior temporal cortex (z = −4.36, cluster-wise p < 0.05) and right precentral cortex (t = 4.19, cluster-wise p < 0.05)). Mediation analysis identified the cortical thickness of the left pericalcarine cortex as the mediator between age and articulation function (partial mediation effect (a*b = −0.48), 95% confident interval (−0.75, −0.26)). In conclusion, our results demonstrate an abnormal developmental pattern of cortical structures in CLP patients, which is directly related to their articulation disorders.
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27
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Nitin R, Shaw DM, Rocha DB, Walters CE, Chabris CF, Camarata SM, Gordon RL, Below JE. Association of Developmental Language Disorder With Comorbid Developmental Conditions Using Algorithmic Phenotyping. JAMA Netw Open 2022; 5:e2248060. [PMID: 36580336 PMCID: PMC9857086 DOI: 10.1001/jamanetworkopen.2022.48060] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
IMPORTANCE Developmental language disorder (DLD) is a common (with up to 7% prevalence) yet underdiagnosed childhood disorder whose underlying biological profile and comorbidities are not fully understood, especially at the population level. OBJECTIVE To identify clinically relevant conditions that co-occur with DLD at the population level. DESIGN, SETTING, AND PARTICIPANTS This case-control study used an electronic health record (EHR)-based population-level approach to compare the prevalence of comorbid health phenotypes between DLD cases and matched controls. These cases were identified using the Automated Phenotyping Tool for Identifying Developmental Language Disorder algorithm of the Vanderbilt University Medical Center EHR, and a phenome enrichment analysis was used to identify comorbidities. An independent sample was selected from the Geisinger Health System EHR to test the replication of the phenome enrichment using the same phenotyping and analysis pipeline. Data from the Vanderbilt EHR were accessed between March 2019 and October 2020, while data from the Geisinger EHR were accessed between January and March 2022. MAIN OUTCOMES AND MEASURES Common and rare comorbidities of DLD at the population level were identified using EHRs and a phecode-based enrichment analysis. RESULTS Comorbidity analysis was conducted for 5273 DLD cases (mean [SD] age, 16.8 [7.2] years; 3748 males [71.1%]) and 26 353 matched controls (mean [SD] age, 14.6 [5.5] years; 18 729 males [71.1%]). Relevant phenotypes associated with DLD were found, including learning disorder, delayed milestones, disorders of the acoustic nerve, conduct disorders, attention-deficit/hyperactivity disorder, lack of coordination, and other motor deficits. Several other health phenotypes not previously associated with DLD were identified, such as dermatitis, conjunctivitis, and weight and nutrition, representing a new window into the clinical complexity of DLD. CONCLUSIONS AND RELEVANCE This study found both rare and common comorbidities of DLD. Comorbidity profiles may be leveraged to identify risk of additional health challenges, beyond language impairment, among children with DLD.
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Affiliation(s)
- Rachana Nitin
- Vanderbilt Brain Institute, Vanderbilt University, Nashville, Tennessee
- Department of Otolaryngology–Head & Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Douglas M. Shaw
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Daniel B. Rocha
- Phenomic Analytics and Clinical Data Core, Geisinger, Danville, Pennsylvania
- NewYork-Presbyterian Hospital, New York
| | - Courtney E. Walters
- Department of Otolaryngology–Head & Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
- Vanderbilt University Neuroscience Program, Vanderbilt University, Nashville, Tennessee
- Loma Linda School of Medicine, Loma Linda University, Loma Linda, California
| | | | - Stephen M. Camarata
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Reyna L. Gordon
- Vanderbilt Brain Institute, Vanderbilt University, Nashville, Tennessee
- Department of Otolaryngology–Head & Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Psychology, Vanderbilt University, Nashville, Tennessee
- Vanderbilt Kennedy Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jennifer E. Below
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
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Winters KL, Jasso J, Pustejovsky JE, Byrd CT. Investigating Narrative Performance in Children With Developmental Language Disorder: A Systematic Review and Meta-Analysis. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:3908-3929. [PMID: 36179252 DOI: 10.1044/2022_jslhr-22-00017] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
PURPOSE Narrative assessment is one potentially underutilized and inconsistent method speech-language pathologists may use when considering a diagnosis of developmental language disorder (DLD). However, narration research encompasses many varied methodologies. This systematic review and meta-analysis aimed to (a) investigate how various narrative assessment types (e.g., macrostructure, microstructure, and internal state language) differentiate children with typical development (TD) from children with DLD, (b) identify specific narrative assessment measures that result in greater group differences, and (c) evaluate participant and sample characteristics that may influence performance differences. METHOD Electronic databases (PsycINFO, ERIC, and PubMed) and ASHAWire were searched on July 30, 2019, to locate studies that reported oral narrative language measures for both DLD and TD groups between ages 4 and 12 years; studies focusing on written narration or other developmental disorders only were excluded. We extracted data related to sample participants, narrative task(s) and assessment measures, and research design. Group differences were quantified using standardized mean differences. Analyses used mixed-effects meta-regression with robust variance estimation to account for effect size dependencies. RESULTS Searches identified 37 eligible studies published between 1987 and 2019, including 382 effect sizes. Overall meta-analysis showed that children with DLD had decreased narrative performance relative to TD peers, with an overall average effect of -0.82 SD, 95% confidence interval [-0.99, -0.66]. Effect sizes showed significant heterogeneity both between and within studies, even after accounting for effect size-, sample-, and study-level predictors. Across model specifications, grammatical accuracy (microstructure) and story grammar (macrostructure) yielded the most consistent evidence of TD-DLD group differences. CONCLUSIONS Present findings suggest some narrative assessment measures yield significantly different performance between children with and without DLD. However, researchers need to improve consistency of inclusionary criteria, descriptions of sample characteristics, and reporting of correlations between measures to determine which assessment measures reliably distinguish between groups. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.21200380.
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Affiliation(s)
| | - Javier Jasso
- The University of Texas at Austin
- Widener University, Chester, PA
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29
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Benninger KL, Richard C, Conroy S, Newton J, Taylor HG, Sayed A, Pietruszewski L, Nelin MA, Batterson N, Maitre NL. One-Year Neurodevelopmental Outcomes After Neonatal Opioid Withdrawal Syndrome: A Prospective Cohort Study. PERSPECTIVES OF THE ASHA SPECIAL INTEREST GROUPS 2022; 7:1019-1032. [PMID: 36211832 PMCID: PMC9539823 DOI: 10.1044/2022_persp-21-00270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Purpose The aims of this study were, in a cohort of children with neonatal opioid withdrawal syndrome (NOWS), (a) to report 1-year neurodevelopmental outcomes and specifically characterize speech, language, and hearing outcomes and (b) to report the prevalence of cleft lip and/or cleft palate. Method This prospective observational cohort study includes newborns with confirmed in utero opioid exposure who received pharmacological treatment for NOWS. During 1-year-old developmental visits, we administered standardized assessments (Bayley Scales of Infant and Toddler Development-Third Edition [Bayley-III] or Developmental Assessment of Young Children-Second Edition [DAYC-2]-due to COVID-19 restrictions). We compared Bayley-III scores to standardized population means using one-sample z tests. We report estimates, 95% confidence intervals, and two-sided p values. Results We enrolled 202 infants (October 2018 to March 2020). Follow-up at 1-year was 80%. Infants with NOWS had lower Bayley-III scores at 1 year compared to published norms for cognitive, language, and motor domains. One infant with NOWS was diagnosed with isolated cleft palate and Pierre Robin sequence. All infants passed the newborn hearing screen, and 7.5% had a formal hearing evaluation after neonatal intensive care unit discharge, with 40% having abnormal or inconclusive results; middle ear effusion was the leading cause of abnormal hearing (66.7%). Ten percent of children received a speech-language pathology referral prior to 2 years of age. Infants born to mothers with mental health conditions were more likely to have Bayley-III or DAYC-2 scores below 95 in language or motor domains. Conclusions Infants with pharmacologically treated NOWS have significantly lower cognitive, language, and motor scores on standardized developmental testing compared to population means at 1 year of age. Early speech-language pathology referral is frequently necessary to promote optimal development in this population. Supplemental Material https://doi.org/10.23641/asha.20044403.
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Affiliation(s)
- Kristen L. Benninger
- Department of Pediatrics, Nationwide Children’s Hospital and The Ohio State University Wexner Medical Center, Columbus
- Center for Perinatal Research, The Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, OH
| | - Celine Richard
- Department of Otolaryngology, The University of Tennessee Health Science Center College of Medicine, Memphis
- Department of Otolaryngology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Sara Conroy
- Biostatistics Core, The Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, OH
- Center for Biostatistics, The Ohio State University Wexner Medical Center, Columbus
| | - Julia Newton
- Center for Perinatal Research, The Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, OH
| | - H. Gerry Taylor
- Department of Pediatrics, Nationwide Children’s Hospital and The Ohio State University Wexner Medical Center, Columbus
- Center for Biobehavioral Health, The Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, OH
| | - Alaisha Sayed
- Department of Pediatrics, Nationwide Children’s Hospital and The Ohio State University Wexner Medical Center, Columbus
- Center for Perinatal Research, The Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, OH
| | - Lindsay Pietruszewski
- Center for Perinatal Research, The Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, OH
| | - Mary Ann Nelin
- Department of Pediatrics, Nationwide Children’s Hospital and The Ohio State University Wexner Medical Center, Columbus
| | - Nancy Batterson
- Department of Pediatrics, Nationwide Children’s Hospital and The Ohio State University Wexner Medical Center, Columbus
- Center for Perinatal Research, The Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, OH
| | - Nathalie L. Maitre
- Department of Pediatrics, Emory University and Children’s Healthcare of Atlanta, GA
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30
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Nachmani A, Biadsee A, Masalha M, Kassem F. Compensatory Articulation Errors in Patients With Velopharyngeal Dysfunction and Palatal Anomalies. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:2518-2539. [PMID: 35858260 DOI: 10.1044/2022_jslhr-21-00679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE The aim of this study was to assess the frequency and types of compensatory articulations (CAs) in nonsyndromic patients with velopharyngeal dysfunction (VPD) and various palatal anomalies and to determine the relationship between the frequency of CAs, type of palatal anomaly, and phonological errors. METHOD A total of 783 nonsyndromic, Hebrew-speaking patients with VPD and various palatal anomalies (cleft lip and palate [CLP], cleft palate [CP], submucous CP [SMCP], occult submucous CP [OSMCP], or non-CP) were studied retrospectively. Perceptual VPD tests, including articulation and phonological assessment, were conducted. CAs were described as below the level of the defect in the vocal tract (abnormal backing of oral targets to post-uvular place) or in front of it within the oral cavity (palatalization) and at the velopharyngeal port. RESULTS Among 783 patients, 213 (27.2%) had CAs. Most CAs (18.4%) occurred below the level of the defect, followed by CAs at the velopharyngeal port (12.0%) or in front of it (4.9%). No differences were found in the frequency of CAs between patients with CP (47.8%) or CLP (52.6%) and between those with non-CP (13.6%) or OSMCP (14.7%). SMCP patients had lower frequency of CAs (29.8%) than CP (p = .003) and CLP (p = .002) patients but higher frequency than OSMCP (p = .002) and non-CP (p = .002) patients did. Among the 783 patients, 247 (31.5%) had phonological errors. A higher frequency of phonological errors was found in patients with CAs (55.4%) compared to those without (22.6%) and in all palatal anomaly groups except CLP (31.4% vs. 23.9%). CONCLUSIONS CAs in nonsyndromic patients with VPD remained relatively high in all age groups, up to adulthood. CAs are influenced by inadequate velar length following palatal repair, as well as by oral structural abnormalities, whereas poor muscle function due to OSMCP and/or abnormal size and/or shape of nasopharynx has less influence. Errors produced in front of the velopharyngeal port are influenced by the structural anomaly of CLP. This information may contribute to general phonetic and phonological theories and genetic investigations about CP anomalies.
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Affiliation(s)
- Ariela Nachmani
- Faculty of Communication Disorders, Hadassah Academic College, Jerusalem, Israel
- Department of Communication Disorders, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Ameen Biadsee
- Department of Otolaryngology-Head and Neck Surgery, Meir Medical Center, Kfar Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Israel
- Department of Otolaryngology-Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Muhamed Masalha
- Department of Otolaryngology-Head and Neck Surgery, Emek Medical Center, Afula, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Firas Kassem
- Department of Otolaryngology-Head and Neck Surgery, Meir Medical Center, Kfar Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Israel
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Eshghi M, Adatorwovor R, Preisser JS, Crais ER, Zajac DJ. Lexicogrammatical skills in 2-year-old children with and without repaired cleft palate. CLINICAL LINGUISTICS & PHONETICS 2022; 36:528-546. [PMID: 34263689 PMCID: PMC8760352 DOI: 10.1080/02699206.2021.1941263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 05/11/2021] [Accepted: 05/14/2021] [Indexed: 06/05/2023]
Abstract
The purpose of the current research was to compare the lexical-grammatical skills of two-year-old children with and without repaired cleft palate (CP), accounting for the effect of variables such as vocabulary size at 18 months of age, maternal education level, and gender. Participants included 52 children with CP and 25 typically developing (TD) children. The CDI-WS was employed to measure vocabulary and grammatical skills. Significant differences were observed between the CP and TD groups with respect to the number of words, word forms (irregular nouns and verbs), word endings (overuse of plural (-s) and past tense (-ed) markers), the mean number of morphemes in their three longest utterances (M3L), and sentence complexity. In addition, compared to TD children, significantly smaller proportions of children with CP were observed to use words to talk about past and future events or use words to talk about an absent object. The difference between the CP and TD groups in terms of the size of vocabulary at 24 months of age remained statistically significant in the multivariable model. Among all predictors, the size of vocabulary at 18 months of age was identified as the most robust precursor of lexical and grammatical skills at 24 months of age. Gender was identified as a predictor of the M3L measure as an index for syntactic ability.
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Affiliation(s)
- Marziye Eshghi
- Ph.D., Postdoctoral Research Associate, Speech and Feeding Disorders Lab, MGH Institute of Health Professions
| | - Reuben Adatorwovor
- Ph.D., Assistant Professor, Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, Kentucky
| | - John S. Preisser
- Ph.D, Research Professor, Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Elizabeth R. Crais
- Ph.D, Professor, Division of Speech and Hearing Sciences, School of Medicine, University of North Carolina at Chapel Hill
| | - David J. Zajac
- Ph.D, CCC-SLP, Professor, Department of Craniofacial and Surgical Care, Associate Director, Speech-Language Pathology, Craniofacial Center, School of Dentistry, University of North Carolina at Chapel Hill
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Bettens K, Alighieri C, Bruneel L, D'haeseleer E, Luyten A, Sseremba D, Musasizib D, Ojok I, Hodges A, Galiwango G, Vermeersch H, Van Lierde K. Better speech outcomes after very early palatal repair?-A longitudinal case-control study in Ugandan children with cleft palate. JOURNAL OF COMMUNICATION DISORDERS 2022; 96:106198. [PMID: 35217335 DOI: 10.1016/j.jcomdis.2022.106198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 01/11/2022] [Accepted: 02/02/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Children born with cleft palate with or without cleft lip (CP±L) tend to use less oral pressure consonants and more glottal sounds in their babbling. The purpose of very early palatal repair (i.e., one-stage palatal closure prior to 6 months of age) is to make the palate functional before the onset of speech acquisition to reduce the anchoring of wrong patterns in the child's developing phonological system. As a result, less compensatory articulation errors are expected to be present. Currently, no detailed longitudinal speech outcomes after very early palatal closure are available. This study aimed to provide longitudinal speech outcomes in Ugandan children with CP±L who received palatal closure prior to the age of 6 months. METHODS Ten children with CP±L were assessed at a mean age of 5 and 10 years old. Speech understandability, speech acceptability, resonance, nasal airflow and articulation were perceptually rated by two experienced speech-language pathologists. Velopharyngeal function was estimated using the velopharyngeal composite score (VPC-sum). Information regarding speech therapy, fistula rate, and secondary (speech) surgery was collected. The outcomes were compared with the longitudinal outcomes of an age- and gender-matched control group of 10 Ugandan children without CP±L. RESULTS Speech understandability and acceptability improved significantly over time in the group with CP±L (all p's ≤ 0.05, all Z's > -2.43). At both test dates, significantly worse judgments were found for the group with CP±L compared to the control group for these variables and variables related to passive speech errors (all p's ≤ 0.05, all Z's > 2.49). A statistically significant difference with the control group was found for the presence of compensatory articulation errors at the age of 5 years but not at the age of 10 years, indicating a catch up by the children with CP±L. CONCLUSION Whether a one-stage palatal closure prior to the age of 6 months is more favorable for speech outcomes compared to one-stage palatal closure at 12 months is still not clear. Speech of the children with CP±L improved over time, but significantly differed from the control group at the age of 5 and 10 years old. Limited access to health care facilities and possible influence of malnutrition on wound healing need to be considered when interpreting the results. Whether palatal closure prior to the age of 6 months is transferable to other countries is subject for further research, including both longitudinal and prospective designs with larger samples.
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Affiliation(s)
- Kim Bettens
- Department of Rehabilitation Sciences, Center for Speech and Language Sciences (CESLAS), Ghent University, Ghent, Belgium.
| | - Cassandra Alighieri
- Department of Rehabilitation Sciences, Center for Speech and Language Sciences (CESLAS), Ghent University, Ghent, Belgium
| | - Laura Bruneel
- Department of Rehabilitation Sciences, Center for Speech and Language Sciences (CESLAS), Ghent University, Ghent, Belgium
| | - Evelien D'haeseleer
- Department of Rehabilitation Sciences, Center for Speech and Language Sciences (CESLAS), Ghent University, Ghent, Belgium
| | - Anke Luyten
- Speech Pathology, Fontys University of Applied Sciences, Eindhoven, the Netherlands
| | - Daniel Sseremba
- Department of Speech-Language Pathology, Comprehensive Rehabilitation Services in Uganda (CoRSU), Kisubi, Uganda
| | - Duncan Musasizib
- Department of Speech-Language Pathology, Comprehensive Rehabilitation Services in Uganda (CoRSU), Kisubi, Uganda
| | - Isaac Ojok
- Department of Speech-Language Pathology, Comprehensive Rehabilitation Services in Uganda (CoRSU), Kisubi, Uganda
| | - Andrew Hodges
- Department of Plastic and Reconstructive Surgery, Comprehensive Rehabilitation Services in Uganda (CoRSU), Kisubi, Uganda
| | - George Galiwango
- Department of Plastic and Reconstructive Surgery, Comprehensive Rehabilitation Services in Uganda (CoRSU), Kisubi, Uganda
| | - Hubert Vermeersch
- Department of Head and Skin, Ghent University, Ghent, Belgium; Department of Plastic Surgery, Ghent University Hospital, Ghent, Belgium
| | - Kristiane Van Lierde
- Department of Rehabilitation Sciences, Center for Speech and Language Sciences (CESLAS), Ghent University, Ghent, Belgium; Department of Speech-Language Therapy and Audiology, University of Pretoria, Pretoria, South-Africa
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Scherer NJ, Yamashita R, de Oliveira DN, DiLallo J, Trindade I, Fukushiro AP, Richards K. Early speech and language intervention in Brazilian-Portuguese toddlers with cleft lip and/or palate. CLINICAL LINGUISTICS & PHONETICS 2022; 36:34-53. [PMID: 33899624 PMCID: PMC8858428 DOI: 10.1080/02699206.2021.1912187] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 03/27/2021] [Accepted: 03/30/2021] [Indexed: 05/30/2023]
Abstract
Young children with cleft palate with or without cleft lip (CL/P) are at risk for early vocabulary and speech sound production delays. Early intervention studies have shown some promising findings to promote early speech and vocabulary development following palate repair; however, we know little about how these interventions can be used in other international contexts. This study adapted an early speech and language intervention developed in the US, Enhanced Milieu Teaching with Phonological Emphasis (EMT+PE), to the Brazilian context at the Hospital for Rehabilitation of Craniofacial Anomalies at the University of São Paulo-Bauru. The purpose of this study was to compare the speech and language performance of 24 toddlers with CL/P randomized into an EMT+PE intervention group and a business-as-usual (BAU) comparison group over three time points: prior to, immediately following, and three months after intervention. Results immediately following intervention indicate gains in multiple measures of language. Three months following intervention, participants showed gains in both language and speech measures.
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Affiliation(s)
- Nancy J Scherer
- Department of Speech and Hearing Science, Arizona State University, Tempe, Arizona, USA
| | - Renata Yamashita
- Laboratory of Physiology, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, Brazil
| | - Debora Natalia de Oliveira
- Laboratory of Physiology, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, Brazil
| | - Jennifer DiLallo
- Department of Speech and Hearing Science, Arizona State University, Tempe, Arizona, USA
| | - Inge Trindade
- Laboratory of Physiology, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, Brazil
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | - Ana Paula Fukushiro
- Laboratory of Physiology, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, Brazil
- Department of Speech-Language Pathology and Audiology, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | - Kacey Richards
- Department of Speech and Hearing Science, Arizona State University, Tempe, Arizona, USA
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Nachmani A, Masalha M, Kassem F. Phonological Profile of Patients With Velopharyngeal Dysfunction and Palatal Anomalies. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:4649-4663. [PMID: 34739332 DOI: 10.1044/2021_jslhr-20-00652] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE This purpose of this study was to assess the frequency and types of phonological process errors in patients with velopharyngeal dysfunction (VPD) and the different types of palatal anomalies. METHOD A total of 808 nonsyndromic patients with VPD, who underwent follow-up at the Center for Cleft Palate and Craniofacial Anomalies, from 2000 to 2016 were included. Patients were stratified into four age groups and five subphenotypes of palatal anomalies: cleft lip and palate (CLP), cleft palate (CP), submucous cleft palate (SMCP), occult submucous cleft palate (OSMCP), and non-CP. Phonological processes were compared among groups. RESULTS The 808 patients ranged in age from 3 to 29 years, and 439 (54.3%) were male. Overall, 262/808 patients (32.4%) had phonological process errors; 80 (59.7%) ages 3-4 years, 98 (40, 0%) ages 4.1-6 years, 48 (24.7%) 6.1-9 years, and 36 (15.3%) 9.1-29 years. Devoicing was the most prevalent phonological process error, found in 97 patients (12%), followed by cluster reduction in 82 (10.1%), fronting in 66 (8.2%), stopping in 45 (5.6%), final consonant deletion in 43 (5.3%), backing in 30 (3.7%), and syllable deletion and onset deletion in 13 (1.6%) patients. No differences were found in devoicing errors between palatal anomalies, even with increasing age. Phonological processes were found in 61/138 (44.20%) with CP, 46/118 (38.1%) with SMCP, 61/188 (32.4%) with non-CP, 70/268 (26.1%) with OSMCP, and 25/96 (26.2%) with CLP. Phonological process errors were most frequent with CP and least with OSMCP (p = .001). CONCLUSIONS Phonological process errors in nonsyndromic VPD patients remained relatively high in all age groups up to adulthood, regardless of the type of palatal anomaly. Our findings regarding the phonological skills of patients with palatal anomalies can help clarify the etiology of speech and sound disorders in VPD patients, and contribute to general phonetic and phonological studies.
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Affiliation(s)
- Ariela Nachmani
- Communication Disorders Faculty, Hadassah Academic College, Jerusalem, Israel
- Communication Disorders Faculty, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Muhamed Masalha
- Department of Otolaryngology, Head and Neck Surgery, Emek Medical Center, Afula, Israel
- The Ruth and Bruce Rappaport School of Medicine, Technion - Israel Institute of Technology, Haifa
| | - Firas Kassem
- Department of Otolaryngology - Head and Neck Surgery, Meir Medical Center, Sackler School of Medicine, Tel Aviv University, Israel
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Morrison MM, Mason NT, Forde BL, Stone PR, Fowler PV, Thompson JMD. Speech Outcomes of a National Cohort of Children with Orofacial Cleft at 5 and 10 Years of age. Cleft Palate Craniofac J 2021; 59:1400-1412. [PMID: 34672811 DOI: 10.1177/10556656211044939] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess speech outcomes at five and ten years of age in a nationwide study of children with orofacial cleft. DESIGN Prospective study. PARTICIPANTS Children born with orofacial cleft and having primary surgery in New Zealand. Speech samples were available for 151 five-year-old, and 163 ten-year-old children. MAIN OUTCOME MEASURES Intelligibility, Acceptability, Velopharyngeal function, Hypernasality, Hyponasality, severity of airflow evaluated by perceptual speech assessment (using the standardised Rhinocleft assessment), and overall assessment of requirement for clinical intervention. RESULTS A large proportion of five-year-old children had speech that was considered to be not completely intelligible, was not acceptable, and had inadequate velopharyngeal function. The noted deficiencies led to a clinical judgement that further speech and/or surgical intervention was required in 85% with cleft lip and palate, 65% with cleft palate and 26% with cleft lip. The proportion of children with poor speech outcomes in the ten-year-old children was lower, though of clinical importance, further intervention required for 25% with CLP, 15% with CP and 3% with CL. The number of sound production errors in both age groups followed the same pattern with fewest in those with CL and most in those with CLP. CONCLUSIONS A significant proportion of children with orofacial cleft were found to have poor speech outcomes requiring further treatment. The outcomes are poor compared to centres reported in the UK and Scandinavia. New Zealand requires a review of the current services for individuals born with cleft to improve speech outcomes and interdisciplinary care.
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Affiliation(s)
- Maeve M Morrison
- Department of Allied Health, 1400Middlemore Hospital, Counties Manukau District Health Board.,Department of Plastics, 1400Middlemore Hospital, Counties Manukau District Health Board
| | - Nicola T Mason
- Speech Language Therapy, 67587Christchurch Hospital, Canterbury District Health Board
| | - Bryony L Forde
- Speech Language Therapy, 161292Hutt Valley Hospital, Hutt Valley District Health Board
| | - Peter R Stone
- Department of Obstetrics and Gynaecology, 1415University of Auckland, Auckland, New Zealand
| | | | - John M D Thompson
- Department of Obstetrics and Gynaecology, 1415University of Auckland, Auckland, New Zealand.,Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
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Lancaster HS, Lien KM, Haas J, Ellis P, Scherer NJ. Reading Development in Children With Nonsyndromic Cleft Palate With or Without Cleft Lip: Meta-analysis and Systematic Review. Cleft Palate Craniofac J 2021; 59:1155-1166. [PMID: 34516236 DOI: 10.1177/10556656211039871] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We conducted a meta-analysis and systematic review of literature comparing pre-reading and general reading in school-age children with nonsyndromic cleft palate with or without cleft lip (NSCP/L) to their peers without NSCP/L. METHODS Our literature search identified 1238 possible records. After screening we identified 11 samples for inclusion for systematic review and eight for meta-analysis. We compared 292 children with NSCP/L to 311 peers for 23 pre-reading effect sizes and 17 general reading effect sizes (EFg). We conducted a random-effects metaregression using robust variance estimation. RESULTS On average school-age children with NSCP/L scored lower on pre-reading (EFg = -0.36) and general reading measures (EFg = -0.38) compared to their peers. We conducted post-hoc analyses on phonological awareness and word decoding effect sizes; children with NSCP/L performed lower on phonological awareness (EFg = -0.22) and word decoding (EFg = -0.39) compared to their peers. There was weak evidence that hearing status and/or speech-language functioning might moderate reading development. There was limited evidence that age or socioeconomic status moderated reading development. However, samples did not consistently report several characteristics that were coded for this project. CONCLUSIONS Our findings suggest that school-age children with NSCP/L have persistent reading problems. Further research is needed to explore reading development in children with NSCP/L, as well as the relationships among hearing, speech, language, and reading development.
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Affiliation(s)
- Hope Sparks Lancaster
- 6213Boys Town National Research Hospital, Omaha NE, USA.,Arizona State University, Tempe AZ, USA
| | - Kari M Lien
- Barrow Neurological Institute, Phoenix AZ, USA
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Saad MA, Jan JM, Wahid R. Parents' linguistic strategies in interaction with their children with history of cleft lip and/or palate. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2021; 56:940-953. [PMID: 34250713 DOI: 10.1111/1460-6984.12646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 05/22/2021] [Accepted: 05/27/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Cleft lip and/or palate (CL/P) presents a rather complex challenge that requires understanding beyond biological or clinical perspective. Even though inaccuracies in speech articulation are the common consequences of CL/P, individuals with repaired CL/P are likely to experience other language-associated issues. Studies on social interaction have generally reported the children to be passive interlocutors, despite having their surgical treatment at the early stages of life. AIMS This study aims to describe the linguistic strategies that parents employ when interacting with their repaired CL/P child. How parents allocate the next turn of speaking to their repaired CL/P child will be specifically examined. METHODS & PROCEDURES Three parent-child pairs with each child having repaired CL/P were selected to participate in the study. Guided by the principles of Conversation Analysis, their everyday interactions in their homes were video-recorded and transcribed according to the Jefferson System of Transcription Notation (2004). The transcriptions were subsequently analysed in order to highlight the linguistic strategies. OUTCOMES & RESULTS Three main linguistic strategies are identified in the parents' turns when they allocate the next turn of speaking to their repaired CL/P child. Specifically, parents' turns are constructed through interrogative sentences in addition to using emphasis words and repeated elicitation of responses from their child. CONCLUSION & IMPLICATIONS Parents' linguistic strategies are found to be restrictive as they limit children's active participation. Consequently, the interaction becomes asynchronous rather than synchronous, which could otherwise benefit children's language development. Findings provide information on how parents can be supported in order to foster a positive growth of the children's language development through everyday interactions. WHAT THIS PAPER ADDS What is already known on the subject Even after repair surgery, children with CL/P may experience poor language performance that is not limited to inaccuracies in speech articulation. Studies within the area of pragmatics have consistently shown the CL/P children to be passive interlocutors. What this paper adds to existing knowledge This study describes the linguistic strategies employed by parents when they allocate the next turn of speaking to their repaired CL/P child. Parents are found to employ three main strategies: framing the turn into an interrogative sentence, deploying emphasis words and repeatedly eliciting responses. The findings suggest that such strategies limit the interactions, making them asynchronous and potentially unconducive to the positive growth of the child's language development. What are the potential or actual clinical implications of this work? In addition to providing speech treatment to children affected with CL/P, parents, especially those belonging to collectivist groups that are sympathetic to authoritarian parenting styles, can also be informed or trained on other ways to communicate with such individuals.
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Affiliation(s)
- Mohammad Azannee Saad
- Department of Language and Literacy, International Islamic University Malaysia, Gombak, Selangor, Malaysia
| | - Jariah Mohd Jan
- Faculty of Languages and Linguistics, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Ridwan Wahid
- Faculty of Languages and Linguistics, Universiti Malaya, Kuala Lumpur, Malaysia
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Philp J, Ellis PK, Scherer NJ, Lien KM. Enhanced Milieu Teaching with Phonological Emphasis: A Pilot Telepractice Parent Training Study for Toddlers with Clefts. CHILDREN (BASEL, SWITZERLAND) 2021; 8:children8090736. [PMID: 34572168 PMCID: PMC8471217 DOI: 10.3390/children8090736] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/15/2021] [Accepted: 08/19/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE the purpose of this study was to evaluate the effects of training caregivers to use intervention strategies from the Enhanced Milieu Teaching with Phonological Emphasis (EMT + PE) program, delivered via telepractice, and to examine the effects on child speech and language outcomes for children with repaired cleft lip +/- palate (CL/P). DESIGN A multiple baseline within subject design across parent behaviors was replicated across three participating dyads. A pre-post intervention comparison was provided with a non-cleft twin. PARTICIPANTS Three mother-child dyads participated in this study. Children ranged in age from 21 to 27 months at the beginning of the study and all had a diagnosis of CL/P. A noncleft twin without CL/P was assessed pre- and post-intervention to provide a normative comparison. RESULTS Parents demonstrated a positive intervention effect by substantially increasing their use of EMT + PE intervention strategies during telepractice intervention sessions (Tau 0.675 to 1.1333). Following the conclusion of intervention, parents were able to maintain their use of strategies once direct coaching had been discontinued. Children demonstrated increased talking rate, improved speech production and expanded expressive vocabulary measures over the course of intervention. Speech and language development of a child without cleft palate was provided as a comparison. CONCLUSIONS Parents were trained through telepractice to effectively deliver EMT + PE speech and language facilitation strategies that resulted in increased language and speech outcomes for their children with CL/P.
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Affiliation(s)
- Jennifer Philp
- Barrow Cleft and Craniofacial Center, 124 W Thomas Rd 3rd Floor, Phoenix, AZ 85013, USA; (J.P.); (K.M.L.)
| | - Paige K. Ellis
- College of Health Solutions, Arizona State University, Tempe, AZ 85281, USA;
| | - Nancy J. Scherer
- College of Health Solutions, Arizona State University, Tempe, AZ 85281, USA;
- Correspondence: ; Tel.: +1-480-965-2905
| | - Kari M. Lien
- Barrow Cleft and Craniofacial Center, 124 W Thomas Rd 3rd Floor, Phoenix, AZ 85013, USA; (J.P.); (K.M.L.)
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Johns A, Wallace E, Thach J, Ola C, Gallagher E, Gutierrez Y, Collett B. Exploratory Qualitative Analysis of Early Literacy Engagement in Latinx Parents of a Child With a Cleft. J Craniofac Surg 2021; 32:1817-1821. [PMID: 34319683 DOI: 10.1097/scs.0000000000007550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Literacy interventions are needed for children born with orofacial clefts, particularly for Latinx children who may experience multiple risk factors. To collect formative data for intervention design, focus groups and interviews were completed with 18 Latinx parents of children ages 13 to 49 months with orofacial clefts. Interviews focused on literacy experiences and practices. Six themes were identified through inductive qualitative analysis: child reading skills were highly valued; parents were motivated to improve on their childhood reading experiences; bilingualism was a goal for all parents; parents noted challenges in building child reading skills; reading engagement was broadly defined; and impact of cleft diagnosis was wide-reaching. Implications for intervention include a bilingual strength-based approach incorporating cleft-specific speech concerns, play, parallel online programming, behavioral strategies, and social support options. Use of telephone and online intervention with mailed materials can also help address family resource and time limitations.
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Affiliation(s)
- Alexis Johns
- Keck School of Medicine, University of Southern California and Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA
| | - Erin Wallace
- Department of Environmental and Occupational Health Sciences, University of Washington, and Center for Child Health, Behavior and Development, Seattle Children's Research Institute
| | - Jenny Thach
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute
| | - Cindy Ola
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute
| | - Emily Gallagher
- Department of Pediatrics, Division of Craniofacial Medicine, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA
| | - Yvonne Gutierrez
- Keck School of Medicine, University of Southern California and Division of General Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA
| | - Brent Collett
- Department of Psychiatry and Behavioral Sciences, University of Washington and Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA
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Palomares-Aguilera M, Inostroza-Allende F, Solar LR. Speech pathology telepractice intervention during the COVID-19 pandemic for Spanish-speaking children with cleft palate: A systematic review. Int J Pediatr Otorhinolaryngol 2021; 144:110700. [PMID: 33862334 PMCID: PMC8016537 DOI: 10.1016/j.ijporl.2021.110700] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 01/29/2021] [Accepted: 03/28/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Due to the lockdown and quarantines caused by the COVID-19 pandemic, the need to study and use telepractice for providing speech pathology interventions for children with cleft palate has arisen. OBJECTIVE To carry out a systematic review of the use of telepractice during the COVID-19 pandemic for providing speech pathology interventions for Spanish-speaking children with cleft palate. METHODS In July and August 2020, the authors searched the electronic databases Medline, LILACS, SciELO, and the Cochrane Library using the following keywords in English (MeSH): Cleft palate combined with Early intervention, Speech therapy, Rehabilitation of speech and language disorders, Speech production measurement, Speech articulation tests and Telemedicine. Original articles were selected and analyzed, complemented by an analysis of flowcharts and recommendations by the GES Clinical Guide of Cleft Lip and Palate of Chile's Government and the authors' expert opinions. RESULTS A total of 2680 articles were retrieved, of which 23 were critically analyzed and used to adapt the early stimulation, evaluation, and treatment of children with CP to speech therapy telepractice at the Gantz Foundation, a Hospital in Santiago de Chile. LIMITATIONS Only three researchers carried out a quick review, which limited the depth of individual analysis of the studies included. Also, the suggestions and material presented should be evaluated in future investigations. CONCLUSION This systematic review provides useful guidelines for providing speech pathology interventions through telepractice for children with cleft palate. Audiovisual materials seem to be extremely useful for families receiving the interventions. The use of interactive videos for Spanish-speaking children and educational videos for parents is manifest.
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Affiliation(s)
- Mirta Palomares-Aguilera
- Speech Therapy Unit, Alfredo Gantz Mann Foundation, Santiago, Chile; Smile Train - South American Medical Advisory Council (SAMAC), Chile; Speech Pathology Career, Rehabilitation Science Faculty, Universidad Andrés Bello, Santiago, Chile
| | - Felipe Inostroza-Allende
- Speech Therapy Unit, Alfredo Gantz Mann Foundation, Santiago, Chile; Departamento de Fonoaudiología, Universidad de Chile, Santiago, Chile.
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Bodoni PSB, Leoni RF, do Vale AB, da Silva PHR, Meira Junior SG, Richieri Costa A, Tabaquim MDLM. Neuropsychological functioning and its relationship with brain anatomical measures of children and adolescents with non-syndromic cleft lip and palate. Child Neuropsychol 2021; 27:2-16. [PMID: 32546116 DOI: 10.1080/09297049.2020.1776240] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 05/23/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Children and adolescents with non-syndromic cleft lip and palate (NSCLP) show cognitive performance below expected. This difficulty can be associated with alterations in the cortical thickness and volume of brain regions. The aim of this study was to investigate anatomical brain characteristics and their relationship with the neuropsychological scores of children and adolescents with NSCLP. Methods: Twenty-four children and adolescents with ages from 10 to 16 years and 11 months (12 with a diagnosis of NSCLP; 12 with typical development) were enrolled. Neuropsychological tests were administered and high-resolution, structural magnetic resonance imaging (MRI) was performed in a 1.5 T scanner. Results: Compared to the control group, NSCLP individuals showed intellectual (p = 0.006) and cognitive (p = 0.003) impairment, as well as deficits in subdomains of executive functions (sustained attention, working memory, and cognitive planning). The morphological analysis showed reduced volumes and cortical thickness in temporal, parietal, and frontal regions, in both hemispheres, of the NSCLP group. Significant, strong associations of structural alterations and cognitive performance were observed. Conclusions: Our study provided strong evidence of the relationship between brain development in children and adolescents with NSCLP, and their neuropsychological profile. This relationship is characterized by a malfunction of associative areas of the brain, such as parieto-temporo-occipital, frontoparietal, and prefrontal regions.
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Affiliation(s)
| | | | | | | | | | | | - Maria De Lourdes Merighi Tabaquim
- Craniofacial Anomaly Rehabilitation Hospital, University of São Paulo , Bauru, Brazil
- Department of Speech Therapy, FOB, University of São Paulo , Bauru, Brazil
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Guerra MS, Franchi V, Novaes BA, Favero M, Pirana S. Cleft lip and palate: Relationship between phonological awareness and audiological characteristics in children. JOURNAL OF CLEFT LIP PALATE AND CRANIOFACIAL ANOMALIES 2021. [DOI: 10.4103/jclpca.jclpca_45_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Williams C, Harding S, Wren Y. An Exploratory Study of Speech and Language Therapy Intervention for Children Born With Cleft Palate ± Lip. Cleft Palate Craniofac J 2020; 58:455-469. [PMID: 32945191 DOI: 10.1177/1055665620954734] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Children born with a cleft palate ± lip are at risk of developing speech and language difficulties, which may require intervention from a speech and language therapist (SLT). To date, there is no strong evidence to support one approach to intervention over another, neither is it clear which approaches or methods of provision are commonly used. OBJECTIVES To describe the range of speech and language therapy interventions being used with children born with cleft palate in the United Kingdom up to 5 years of age. To explore the different ways, interventions are being delivered. DESIGN A prospective study to conduct 9 semi-structured focus groups. Iterative content analysis was completed. SETTING Regional Cleft Lip and Palate Centers in the United Kingdom. PARTICIPANTS Sixty-two speech and language therapy professionals from specialist cleft teams and community services. RESULTS Four main codes were identified: "intervention approaches," "service delivery models," "decision-making and rationale," and "patient-centered care." Participants frequently discussed how they adopt an eclectic style when delivering intervention, the importance of an individualized approach for each child and service delivery constraints, such as a lack of resources. CONCLUSION Insight into the multitude of intervention approaches used by SLTs, aspects which influence their decision-making and the variability of service delivery models were gained. Uncertainty regarding which intervention approaches and methods for delivery are most effective provides rationale for future research, to improve the effectiveness of speech and language intervention for children with cleft palate ± lip.
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Affiliation(s)
- Caroline Williams
- Bristol Speech and Language Therapy Research Unit, 1982North Bristol NHS Trust and University of Bristol, England, UK
| | - Sam Harding
- Bristol Speech and Language Therapy Research Unit, 1982North Bristol NHS Trust and University of Bristol, England, UK
| | - Yvonne Wren
- Bristol Speech and Language Therapy Research Unit, 1982North Bristol NHS Trust and University of Bristol, England, UK
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van Eeden S, Stringer H. Linguistic and auditory processing skills in non-syndromic children with cleft palate: A scoping review. JOURNAL OF COMMUNICATION DISORDERS 2020; 87:106029. [PMID: 32712335 DOI: 10.1016/j.jcomdis.2020.106029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 05/26/2020] [Accepted: 05/30/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Cleft lip and/or palate (CL/P) is the most common congenital craniofacial condition. Children born with CL/P are at increased risk of persistent speech difficulties related to velopharyngeal incompetence (VPI) and compensatory articulation problems. It has also been reported that they achieve poorer results academically than their peers. There is a further body of evidence to suggest delayed language skills. These potentially related outcomes are often reported separately. AIM To review published and unpublished research into the nature of difficulties related to spoken and written language across all non-syndromic cleft diagnoses. To review any evidence of associations between comorbidities. METHOD A scoping review was carried out in October 2016 and updated in June 2019 following published methodology (Arksey & O'Malley, 2005; Levac et al. 2010). RESULTS A search of the literature over the two time points found 38 papers in total. Three main themes were found: oral language skills, reading and auditory processing difficulties. CONCLUSIONS There is evidence of early language delay in children born with CL/P. Evidence of persistent oral language problems is less conclusive. Many studies have reported scores within the average range for language, auditory processing and reading but poorer outcomes when compared to non-cleft control groups. However, studies have used a range of outcome measures, making comparisons difficult. Moreover there is no clear evidence how these difficulties might relate to speech outcomes or educational achievement and no comparison to other populations with speech, language and communication needs (SLCN).
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Affiliation(s)
- Stephanie van Eeden
- School of Education, Communication and Language Sciences, Newcastle University, King George VIth Building, Queen Victoria Road, Newcastle upon Tyne, NE1 7RU, United Kingdom; Regional Cleft Lip and Palate Service, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, United Kingdom.
| | - Helen Stringer
- School of Education, Communication and Language Sciences, Newcastle University, King George VIth Building, Queen Victoria Road, Newcastle upon Tyne, NE1 7RU, United Kingdom.
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Cronin A, McLeod S, Verdon S. Holistic Communication Assessment for Young Children With Cleft Palate Using the International Classification of Functioning, Disability and Health:Children and Youth. Lang Speech Hear Serv Sch 2020; 51:914-938. [PMID: 32697920 DOI: 10.1044/2020_lshss-19-00122] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Purpose Children with a cleft palate (± cleft lip; CP±L) can have difficulties communicating and participating in daily life, yet speech-language pathologists typically focus on speech production during routine assessments. The International Classification of Functioning, Disability and Health: Children and Youth Version (ICF-CY; World Health Organization, 2007) provides a framework for holistic assessment. This tutorial describes holistic assessment of children with CP±L illustrated by data collected from a nonclinical sample of seven 2- to 3-year-old children, 13 parents, and 12 significant others (e.g., educators and grandparents). Method Data were collected during visits to participants' homes and early childhood education and care centers. Assessment tools applicable to domains of the ICF-CY were used to collect and analyze data. Child participants' Body Functions including speech, language, and cognitive development were assessed using screening and standardized assessments. Participants' Body Structures were assessed via oral motor examination, case history questionnaires, and observation. Participants' Activities and Participation as well as Environmental and Personal Factors were examined through case history questionnaires, interviews with significant others, parent report measures, and observations. Results Valuable insights can be gained from undertaking holistic speech-language pathology assessments with children with CP±L. Using multiple tools allowed for triangulation of data and privileging different viewpoints, to better understand the children and their contexts. Several children demonstrated speech error patterns outside of what are considered cleft speech characteristics, which underscores the importance of a broader assessment. Conclusion Speech-language pathologists can consider incorporating evaluation of all components and contextual factors of the ICF-CY when assessing and working with young children with CP±L to inform intervention and management practices.
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Affiliation(s)
- Anna Cronin
- School of Teacher Education, Charles Sturt University, Bathurst, New South Wales, Australia
| | - Sharynne McLeod
- School of Teacher Education, Charles Sturt University, Bathurst, New South Wales, Australia
| | - Sarah Verdon
- School of Community Health, Charles Sturt University, Albury, New South Wales, Australia
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