Early intervention for speech impairment in children with cleft palate.

OBJECTIVE: This study explored the effectiveness of a parent-implemented, focused stimulation program on the speech characteristics of children younger than 3 years with cleft lip and palate. The research questions included the following: (1) Can parents be trained to deliver an early intervention (EI) program for children with cleft palate? (2) Does a parent-implemented EI program result in positive changes in speech characteristics? PARTICIPANTS: Ten mother-child pairs in which the child had cleft lip and palate (CLP) and 10 mother-child pairs in which the child did not have a cleft (NCLP). The children ranged in age from 14 to 36 months of age and were matched between the CLP and the NCLP groups for vocabulary size, age, and socioeconomic status. MAIN OUTCOME MEASURES: Group differences (CLP and the NCLP) for preintervention and postintervention language and speech measures were compared. RESULTS: The results of this study showed that the mothers could be trained to deliver the intervention reliably. Furthermore, the results indicated that the intervention resulted in increased sound inventories, increased speech accuracy, and reduced use of glottal stops for the children with clefts. CONCLUSIONS: While the intervention resulted in speech gains for the children with clefts, speech measures did not exceed those made by the children without clefts. The results of the study have implications for service delivery models where the services of speech-language pathologists are limited.

Velopharyngeal dysfunction: evolving developments in evaluation.

PURPOSE OF REVIEW: Otolaryngologists are increasingly being called upon to assist in the differential diagnosis of velopharyngeal valving disorders for speech, assisting in treatment planning and the assessment of treatment outcomes. RECENT FINDINGS: The most commonly used methods for direct visualization of velopharyngeal function remain nasendoscopy and videofluoroscopy. Literature supporting the use of either nasendoscopy followed by videofluoroscopy or the reverse can be found. Several studies also suggest that magnetic resonance imaging can make important contributions to the evaluation of velopharyngeal anatomy and function. The routine use of magnetic resonance imaging for evaluating the velopharynx is neither practical nor probable at the present time. Although magnetic resonance imaging may be as effective as videofluoroscopy or nasendoscopy, the cost of magnetic resonance imaging and the radiation exposure of videofluoroscopy will likely dictate that nasendoscopy continues to be the most common technique for evaluating velopharyngeal function during speech. Several recent studies have documented the use of instrumental assessment of velopharyngeal function for assigning patients to a given surgical procedure, predicting surgical success or complications, and evaluating treatment outcomes. SUMMARY: There are still discussions and conflicting results regarding the best method for evaluating velopharyngeal function. Opinions conflict regarding the various methods, which suggests that no single method is best. The decision regarding the most appropriate evaluation protocol should be guided by the information that the clinician is attempting to obtain and the relative benefits and risks of each method. Increasingly, these evaluation methods are used by the otolaryngologist to assist in the differential diagnosis of velopharyngeal valving disorders, the assignment of patients to various treatment options, and the evaluation of treatment outcomes.

Pharyngeal flap and sphincterplasty for velopharyngeal insufficiency have equal outcome at 1 year postoperatively: results of a randomized trial.

OBJECTIVE: The aim of this trial was to compare the relative effectiveness (efficacy and morbidity) of two surgical procedures for correcting velopharyngeal insufficiency (VPI). DESIGN: This was an international multicenter randomized trial to study the outcome of two surgical procedures (flap and sphincter pharyngoplasty) for speech, incidence of sleep apnea, and surgical complications. METHOD: Ninety-seven patients 3 to 25 years old with repaired cleft palate and previously identified VPI were enrolled from five centers in the United States, Norway, and the U.K. Data were collected at presurgery, 3 months postsurgery, and 12 months postsurgery for subsequent analysis blind to the procedure. Main outcome measures included perceptual speech parameters, sleep apnea, nasalance measures, endoscopic features, and surgical complications. RESULTS: Groups for both surgical procedures achieved a high level of clinical improvement. At 3 months postsurgery, elimination of hypernasal resonance was achieved in twice as many patients after the flap procedure. This reached significance. However, at 12 months postsurgery, no statistically significant difference in outcomes remained between the two procedures for resonance, nasalance, endoscopic outcomes, or surgical complications. Flap and sphincter pharyngoplasty rarely resulted in clinically significant sleep apnea, and no difference was detected between the two procedures in the long-term incidence of sleep apnea. CONCLUSIONS: Despite strongly held views in the literature concerning the relative effectiveness and safety of flap and sphincter pharyngoplasty, no significant differences were detected 1 year postoperatively.

Use of a consensus building approach to plan speech services for children with cleft palate in India.

Cleft lip and palate (CLP) is a common birth defect worldwide. While surgical repair can normalize appearance, debilitating speech disorders frequently persist. Speech-language pathology (SLP) services are needed to address these disorders. However in many regions of the world, there is no discipline of SLP or inadequate numbers of trained clinicians. New models for service delivery must be explored to address the needs of children with CLP. Community-based rehabilitation (CBR) programs represent one model that has been successful in the delivery of other rehabilitation services. This paper presents the outcome of a consensus workshop held in India that explored the application of the CBR model to address the need for SLP services for children with CLP when traditional SLP services are limited or not available.