Holistic Communication Assessment for Young Children With Cleft Palate Using the International Classification of Functioning, Disability and Health:Children and Youth

Exploring the relationship between cleft type and speech outcome in 4-to-6-year-olds with non-syndromic cleft palate using different measures: A preliminary report

Cleft type affects speech outcomes, but exact relationships remain unclear as outcome measures vary. The primary aim was to investigate the relationship between cleft type and speech outcome using different measures in 4-to-6-year-olds with non-syndromic clefts. Secondary aims were to explore the relationships between (i) speech measures used; and (ii) parent perception of speech intelligibility and listener familiarity. Twenty-two pre-schoolers with clefts, plus one parent for each child, were recruited through a hospital outpatient clinic. Children with cleft lip and palate (CLP; n = 11) and those with cleft palate only (CP; n  = 11), matched on age and time of palate repair, were compared on Percentage Consonants Correct (PCC), clinician-reported speech intelligibility, and parent rating on the Intelligibility-in-Context Scale (ICS). Children with CLP had significantly lower PCC scores than children with CP (p = .020), but had no significant differences in their clinician- or parent-reported speech intelligibility. Clinician-reported speech intelligibility correlated significantly with both PCC (τ = .594, p < 0.01) and ICS (τ = .424, p  = 0.009). No significant correlation was found between PCC and ICS (τ =.197, p = 0.113). Overall, parents rated their child's intelligibility higher for familiar compared to unfamiliar communication partners (τ  = 2.325, p = 0.001, r  = .76). Cleft type is crucial for intervention planning when objective measures are employed. Speech outcomes should be evaluated at impairment, activity, and participation levels, and by different communication partners, to comprehensively evaluate communicative effectiveness.

Checklist of relevant ICF categories for speech and language development

PURPOSE

Create a checklist of the International Classification of Functioning, Disability and Health (ICF) based on relevant categories for the development of speech and language, according to the perception of parents and speech therapists.

METHODS

Pilot application and research were carried out. 100 parents of preschool children with typical language/cognition development and 57 language specialist speech therapists participated in the survey. A questionnaire was created with 199 ICF categories of body function components, activities and participation, and environmental factors. Each category was scored as: indispensable (2); important (1) or unimportant (0). Statistical analysis was performed (descriptive, sum, cluster/K-means and Mann-Whitney method).

RESULTS

With the sum of the points (essential, important and unimportant) and the number of responses essential, the most relevant categories were identified for each group of respondents, as well as the set of categories in common (72 considered to have the greatest influence). The common list to the groups included the three components: body functions (30 categories/40% of the total), activities and participation (35/49.29%) and environmental factors (seven/13.20%). From the selected categories, 58.33% presented statistically significant results between the groups, regarding the relevance given.

CONCLUSIONS

The categories were considered with different scores between the groups: those of body functions were more scored by speech therapists, while those of environmental factors by parents. Thus, it was possible to create a checklist from the identification of the most relevant categories for the development of speech and language, in preschool age, contemplating the components of body functions, activities and participation and environmental factors.

Intelligibility in Context Scale: Growth Curves for Typically Developing English-Speaking Children Between Ages 2;6 and 9;11

PURPOSE

The aim of this study was to quantify the clinical utility of the Intelligibility in Context Scale (ICS) English version by characterizing the growth patterns of the ICS composite scores and seven ICS individual item scores of typically developing American English-speaking children.

METHOD

Parents of 545 typically developing children aged 2;6-9;11 (years;months) completed the ICS. Using a proportional odds model, we regressed ICS composite scores on age and computed for model-estimated mean and lower quantile ICS composite scores. Logistic regression and proportional odds modeling were utilized to quantify the relationship of individual ICS items and age.

RESULTS

ICS composite scores of typically developing children changed with age, but change was small and incremental, with scores compressed between 3 and 5 across the range of ages. An average child (i.e., on the 50th percentile) is expected to have an ICS composite score of 4 beginning at 3;0 and an ICS composite score of 5 by 6;6. On average, parents gave different intelligibility ratings based on communicative partners, and the rating differences between communicative partners decreased with age.

CONCLUSIONS

Given that ICS scores increase with age, the expected score for average children also increases. A child's age is a main factor for interpreting ICS scores.

Measuring oral health-How can the International Classification of Functioning help?

There is a need for a theoretically informed, contextualized approach to measuring oral health from a multidisciplinary perspective that goes beyond the commonly used clinical indices and sociodental measures. This commentary aims to discuss the potential for the WHO's International Classification of Functioning, Disability and Health (ICF) to provide a model for the development of indicators for oral health. It is suggested that the ICF might provide both a theoretical model and an operational classification for indicators of oral health. The ICF model states that human experience of physical, cognitive and social functioning is universal and, thus, can be described and qualified. Human function is given social and environmental context within the model at both an individual and population level. The ICF can not only capture data regarding oral health and function at the physiological level (e.g. chewing) but also at the social level (e.g. sharing meals). It is able not only to capture aspects of preventive behaviour (e.g. caring for teeth) but also aspects of social facilitation (e.g. economic self-sufficiency) or ability to fulfil a social role (e.g. remunerative employment). It also includes aspects of social environment, such as healthcare services or political, economic and legal systems. Case studies are given as examples of the potential use of the ICF in the oral health domain. Examples are also given of the first steps that have been made towards operationalization of the ICF in data collection and oral health research. The challenges of encompassing such a comprehensive model into a practical oral health measure are discussed.

Fijian school students' Fiji English speech sound acquisition

Purpose: The aim of this study was to investigate Fijian students' acquisition of Fiji English speech sounds.Method: Participants were 72 multilingual students (5-10 years) living in Fiji who spoke the Fijian or Fiji Hindi dialects of Fiji English. The students' productions of single words from the Diagnostic Evaluation of Articulation and Phonology (DEAP) were analysed according to dialect using the Children's Independent and Relational Phonological Analysis (CHIRPA).Result: Most English consonants were acquired by 6;0. English consonants that were not in the inventories of Fijian or Fiji Hindi were the last acquired, while those that were common between English and the two languages were some of the earlier acquired consonants. Percentage of consonants correct (PCC) for Fiji English was significantly lower for Grade 1 students (M = 93.01, SD = 0.07) in comparison to Grade 4 students (M = 99.03, SD = 0.01). Plosive and nasal sounds were acquired by 90% of the students earlier than fricative, approximant and affricate sounds, though acquisition of some plosive and fricative sounds varied between Fiji English dialects. All word-initial consonant clusters were acquired by 90% of the students by 9;6, with r-clusters tending to be the latest acquired. The acquisition of word-final consonant clusters was highly variable as students often produced appropriate dialectal variants.Conclusion: Multilingual Fijian children may acquire English specific sounds later than their monolingual English-speaking peers. Consideration of the language environment and analysis of the speech sample with reference to the child's dominant English dialect is imperative for valid identification of speech sound disorder (SSD) in children who speak different dialects of English.

Drawing Talking: Listening to Children With Speech Sound Disorders

PURPOSE

Listening to children using age-appropriate techniques supports evidence-based clinical decision-making. In this article, we test the Sound Effects Study Drawing Protocol, an arts-based technique, to support children with speech sound disorder (SSD) to express their views about talking.

METHOD

Participants were 124 Australian children aged 4-5 years in the Sound Effects Study. Their parents and teachers were concerned about their talking, and they were assessed as having SSD on the Diagnostic Evaluation of Articulation and Phonology. Drawings and children's interpretations were elicited then analyzed using the (a) Who Am I? Draw-a-Person Scale and (b) Sound Effects Study Focal Points.

RESULTS

Drawings were developmentally typical for 4- to 5-year-olds. The six Sound Effects Study Focal Points were identified across the 124 drawings: body parts and facial expressions, talking and listening, relationships and connection, positivity, negativity, and no talking. Participants portrayed talking and listening as an action requiring mouths and ears represented by symbols (letters, speech bubbles) or as an activity with a variety of people. Children typically portrayed themselves as happy when talking; however, some portrayed negativity and some chose not to draw talking.

CONCLUSIONS

In keeping with Articles 12 and 13 of the Convention on the Rights of the Child, this research demonstrated that 4- to 5-year-old children with SSD can express their views about talking via drawing. Professionals may use the Sound Effects Study Drawing Protocol as a child-friendly technique to support children to express views to guide holistic, evidence-based, child-centered speech-language pathology practice.

The Impact of Maxillary Osteotomy on Fricatives in Cleft Lip and Palate: A Perceptual Speech and Acoustic Study

INTRODUCTION

Abnormal facial growth is a recognized outcome in cleft lip and palate (CLP), resulting in a concave profile and a class III occlusal status. Maxillary osteotomy (MO) is undertaken to correct this facial deformity, and the surgery can impact speech articulation, although the evidence remains limited and ill-defined for the CLP population.

AIMS

The aim of the study was to investigate the impact of MO on the production of the fricatives /f/ and /s/, using perceptual and acoustic analyses, and to explore the nature of speech changes.

METHODS

Twenty participants with CLP were seen 0-3 months pre-operatively (T1) and 3 months (T2) and 12 months (T3) after MO. A normal group (N = 20) was similarly recruited. Perceptual speech data was collected according to a validated framework and ratings made on audio and audio-video recordings (VIDRat). Spectral moments were centre of gravity (CG), standard deviation (SD), skewness (SK) and kurtosis (KU). Reliability studies were carried out for all speech analyses.

RESULTS

For the CLP group, VIDRat identified dentalization/interdentalization as the main type of pre-operative error for /s/ with a statistically significant improvement over time, χ2(2) = 6.889, p = 0.032. Effect sizes were medium between T1 and T3 (d = 0.631) and small between T2 and T3 (d = 0.194). For the acoustic data, effect sizes were similarly medium between T1 and T2 (e.g., SK, /f/ d = 0.579, /s/ d = 0.642) and small between T1 and T3 across all acoustic parameters. Independent t tests showed mainly statistically significant differences between both groups at all time points with large effect sizes (e.g., T2 CG, t = -4.571, p < 0.001, d =1.581), indicating that /s/ was not normalized post-operatively. For /f/, differences tended to be at T1 with large effect sizes (e.g., CG, t = -2.307, p = 0.028, d = 0.797), reflecting normalization.

CONCLUSIONS AND IMPLICATIONS

This is the first speech acoustic study on /f/ for individuals with CLP undergoing MO. The surgery has a positive impact on /f/ and /s/, which appear to stabilize 3 months post-operatively. Speech changes are an automatic and a direct consequence of the physical changes brought about by MO, effecting articulatory re-organization. The results of the study have direct clinical implications for the clinical care pathway for patients with CLP undergoing MO.

Persistence, strength, isolation, and trauma: An ethnographic exploration of raising children with cleft palate

BACKGROUND

The lives of families of young children with cleft palate (±lip) are complex. Multiple interventions are required as part of the long-term multidisciplinary treatment for children with CP±L, with an impairment-focused approach prevailing. Research with young children with CP±L has focused on treatment and intervention, and previous qualitative research has been collected predominantly via interviews, so little is understood about the day-to-day lives of families of young children with CP±L.

AIMS

(1) To increase understanding of the lives of children with CP±L and their families by applying an ethnographic lens to improve clinical practice (2) to identify key interactions and encounters that shape the experiences of children with CP±L and their families (3) to examine how family-centered practice can enhance practitioner-family relationships in providing effective and evidence-based care for children with CP±L.

METHOD

Ethnographic observations of seven families of children with CP±L and their families and educators including parents, siblings, aunts, grandparents, and teachers involved multiple site visits. Rich data were collected to gather information about different aspects of their lives (such as their strengths, routines, preferences, challenges and experiences). There were 84 artefacts collected: 18 interviews, 29 videos, one extended audio recording of a mealtime, seven photos contributed by families, seven case history questionnaires, and 22 field notes. These data were analyzed inductively using thematic analysis.

RESULTS

Three overarching themes and 11 subthemes were identified: (1) the whole child (persistence, communication, activities, mealtimes), (2) family strength and support (strong families, external support, attitudes, advocacy, positive medical experiences) and (3) family isolation and trauma (negative medical experiences, traumatic and challenging experiences).

CONCLUSION

This is the first study to use ethnographic methodology to facilitate the collection of unique insights into the lives of young children with CP±L and their families to improve clinical practice for SLPs. The unique application of family-centered practice with these families promoted trust and highlighted their challenges and strengths which could be considered by SLPs to provide holistic intervention.