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.     

Facilitating communication among speech pathologists treating children with cleft palate.

An interactive web-based system was designed to facilitate communication between nonspecialist speech pathologists who provide therapy for individuals with speech disorders associated with cleft palate or craniofacial anomalies and specialist speech pathologists who provide physiologically based assessments of speech production. The web site includes instructional presentations, streaming video clips of endoscopic examinations, and exchange of information about the nature of therapy as recommended by the specialist and as provided by the nonspecialist. The approach demonstrates use of web-based computer facilities to improve the quality of communication among professionals with the goal of improving the outcomes of speech therapy. Information from the site can also be used in academic training programs as a teaching tool in courses on cleft palate speech.     

Caries prevalence and enamel defects in 5- and 10-year-old children with cleft lip and/or palate: A case-control study

Objective. To determine the prevalence of dental caries and enamel defects in 5- and 10-year-old Swedish children with cleft lip and/or palate (CL(P)) in comparison to non-cleft controls. Materials and methods. The study group consisted of 139 children with CL(P) (80 subjects aged 5 years and 59 aged 10 years) and 313 age-matched non-cleft controls. All children were examined by one of two calibrated examiners. Caries was scored according to the International Caries Detection and Assessment System (ICDAS-II) and enamel defects as presence and frequency of hypoplasia and hypomineralization. Results. The caries prevalence among the 5-year-old CL(P) children and the non-cleft controls was 36% and 18%, respectively (p < 0.05). The CL(P) children had higher caries frequency (initial and cavitated lesions) in the primary dentition than their controls (1.2 vs 0.9; p < 0.05). A significantly higher prevalence of enamel defects was found in CL(P) children of both age groups and anterior permanent teeth were most commonly affected. Conclusions. Preschool children with cleft lip and/or palate seem to have more caries in the primary dentition than age-matched non-cleft controls. Enamel defects were more common in CL(P) children in both age groups.     

A longitudinal study of speech production in Swedish children with unilateral cleft lip and palate and two-stage palatal repair.

OBJECTIVE: To describe speech production longitudinally in a group of children with unilateral cleft lip and palate (UCLP). PARTICIPANTS: Twenty consecutive children with UCLP and nine age-matched children without clefts in a comparison group. INTERVENTION: A two-stage palatal repair procedure with soft palate closure at 6 months and hard palate repair at 3 to 4 years. MAIN OUTCOME MEASURES: Percent correct consonants (PCC), percent correct places (PCP), and percent correct manners (PCM) at 3, 5, and 7 years of age. Cleft speech errors at the same ages. Previously collected data on number of consonant tokens, consonant types, frequency of occurrence of places and manners of articulation at 18 months. RESULTS: PCC and PCP were significantly lower in the UCLP group than in the comparison group at all ages. Number of consonant types and frequency of occurrence of dental plosives at 18 months correlated significantly with PCC at age 3. A high frequency of velar plosives at 18 months correlated significantly with a high prevalence of retracted oral articulation (dental/alveolar to palatal or velar) at both 3 and 5 years of age. CONCLUSIONS: The UCLP group performed worse than the comparison group at all ages. A high occurrence of dental plosives as well as a high number of consonant types in babbling and first words seem to be good indicators for better consonant production in later speech. The same prevalence of retracted oral articulation as in previous studies is attributed to the surgical technique.     

强化性语音训练在腭裂术后语音治疗中的应用

目的：采用强化性针对性语音训练以期缩短音训练治疗时间。方法：采用发音部位及发音方式异常针对性语音训练方法,声门停顿音矫治训练方法对患者进行每天１～２次训练,以能发对所有汉语辅音、音节、词组及短句为标准决定训练完成时间。结果：１６名患者经过平均２５ｄ的强化训练后,语音清晰度从平均４９．９％提高到平均８８．２％。平均提高３８．５％。统计学检查有极显著差异性（Ｐ＜０．００１）。结论：强化性针对性语音训练确能在较短时间内达到提高语音清晰度,改善语音功能的目的。     

腭裂语音的塞擦音语图模式研究

目的 初步掌握健康儿童和腭裂术前患者汉语普通话语音的塞擦音语图模式特征。方法 本研究应用VS-9700语音工作站(1．0版)分别对22名正常儿童和19例腭裂患者的汉语普通话塞擦音([ts]、[ts‘]、[ts]、[ts‘]、[tc]、[tc‘])进行声学分析，观察了塞擦音语图模式特征，分析各自的特点。结果 腭裂患者的塞擦音语图模式上无塞音特征，只有擦音特征，以不送气塞擦音表现明显，而送气塞擦音的送气段明显，从而加强了擦音特征，塞擦音的强频区位置下移。结论 腭裂患者塞擦音语图模式上只有擦音特征，送气塞擦音送气时能量加强,从而较不送气塞擦音易听辨。     

A comparison of orofacial profiles in 5- and 10-year-old Swedish children with and without cleft lip and/or palate

Clinical Oral Investigations - The objectives of this study were to assess orofacial profiles in 5- and 10-year-old children with cleft lip and/or palate (CL/P) compared to controls and to estimate...     

语音训练在腭裂术后患者语音恢复中的价值

为探讨语音训练在腭裂术后患者语音恢复中的作用，本研究应用计算机语音信号分析系统对经语音训练的26例腭裂术后患者进行单元音头三个共振峰频率测试，语音训练重点对唇的协调性，舌的灵活性及下颌运动的准确性训练、结果表明，腭咽闭合完全者经语音训练代偿性不良习惯已基本矫正，语音清晰度显著提高。本文指出腭裂术后患者必须在腭咽闭合的基础上，语音训练才能打破异常的神经─肌肉模式，矫正代偿性不良发音习惯，获得清晰准确的语音。     

Preliminary results of an intelligibility measure for English-speaking children with cleft palate.

OBJECTIVE: This study describes a preliminary evaluation of the construct and concurrent validity of the Speech Intelligibility Probe for Children With Cleft Palate. DESIGN: The study used a prospective between-groups design with convenience samples. PARTICIPANTS: Participants (ages 39 to 82 months) included 5 children with cleft palate and 10 children with typical speech development and no history of craniofacial abnormalities. All children had age-appropriate language skills. INTERVENTIONS: Each child completed the Speech Intelligibility Probe for Children With Cleft Palate by imitating single words. Each child's word productions were recorded and played back to listeners who completed open-set and closed-set response tasks. Recorded utterances that represented a contiguous 100-word sample of each child's spontaneous speech also were played back to listeners for completion of an open-set word identification task. MAIN OUTCOME MEASURES: Measures reported include group means for (1) intelligibility scores for the open-set Speech Intelligibility Probe for Children With Cleft Palate and spontaneous speech sample conditions, and (2) percentage of phonetic contrasts correct and correct-distorted from the Speech Intelligibility Probe for Children With Cleft Palate closed-set response task. RESULTS: The group of children with cleft palate had significantly lower intelligibility scores, lower percentage of correct phonetic contrasts, and higher percentage of correct distorted items (construct validity). A strong positive correlation (r = .88, p < .01) was found between intelligibility scores from the Speech Intelligibility Probe for Children With Cleft Palate and the spontaneous sample (concurrent validity). CONCLUSIONS: The results provide preliminary support for the construct and concurrent validities of the Speech Intelligibility Probe for Children With Cleft Palate as a measure of children's speech intelligibility.     

Audiological issues in children with cleft lip and palate in one area of the U.K.

OBJECTIVE: The purpose of this study was to determine the extent of multidisciplinary care and audiological services rendered to children with CL/P who underwent surgical repair of the cleft in 1998 and 1999. This followed proposals to radically reorganize cleft lip and palate services in the U.K. after unsatisfactory findings in a national review. METHOD: Information was obtained from questionnaires sent to clinicians (audiologists; ear, nose, and throat surgeons; and community pediatricians) from audiology teams, and parents were asked to retrieve information from their Personal Child Health Record. Standards chosen were based on the Clinical Standards Advisory Group, the South Thames Audiology Audit Group, and the National Deaf Children's Society. RESULTS: None of the agreed standards were achieved at an acceptable level. CONCLUSIONS: This demonstrates the need for better communication systems between teams, including better use by parents and professionals of the Personal Child Health Record. A clinical care pathway is suggested here with other recommendations.     

Increased caries prevalence in 2.5-year-old children with cleft lip and/or palate

The prevalence of dental caries was determined clinically in 2.5-year-old Dutch cleft lip and/or palate children ( n =76) and in children without congenital malformation ( n =75). The parents were given a structured questionnaire regarding the child's dietary habits, oral hygiene, fluoride exposure and social economic background. The prevalence of dental caries was higher in children with oral cleft than in children without oral cleft. Initial caries (white spots) was diagnosed in 17.1% of the subjects with oral cleft compared with 4.0% of the control subjects. Manifest caries (cavities) was found in 26.3% of the children with oral cleft compared with 5.3% of the controls. The dft score (manifest caries) was significantly higher for the oral cleft group (0.59±1.35) than for the control group (0.11±0.54). 52% of the total number of initial and manifest lesions were localized to the maxillary incisors. A multivariate analysis yielded initial caries, oral hygiene and treatment with preoperative infant orthopaedics as the variables significantly associated with manifest caries.     

Caries prevalence and bottle-feeding practices in 2-year-old children with cleft lip, cleft palate, or both in Taiwan.

OBJECTIVE: The purposes of this study were to investigate the caries prevalence in cleft lip, cleft palate, or both in children under the age of 2 years and to evaluate parental attitudes toward bottle-feeding, dental care, and their relationship to baby bottle tooth decay (BBTD) in Taiwan. DESIGN: Randomized and prospective study. SETTING: Institutional setting. PATIENTS AND METHODS: One hundred twenty-three 2-year-old children (68 boys and 55 girls) with cleft lip, cleft palate, or both were selected for this study. A questionnaire that asked questions about knowledge of oral health, knowledge and beliefs about BBTD, children's feeding habits, children's dental care, and parenting attitudes toward children with clefts was completed by the parents or caretakers. Children were divided into bottle-feeding and non-bottle-feeding groups according to the questionnaire responses of parents or caretakers. Each child was examined with a dental mirror and explorer under focused flashlight using defs index to determine the presence of BBTD. RESULTS: Thirty-nine percent (48) subjects reported a bottle-feeding habit; the overall prevalence of BBTD was 15.4%. The habit of bottle-feeding was significantly related to BBTD (p = .019). The defs score for children who were bottle-fed was significantly higher than children who were not bottle-fed (p = .045). Parents or caretakers of both bottle-feeding and non-bottle-feeding children showed no significant differences in their attitudes toward bottle-feeding and feeding habits (p > .05). However, parents of non-bottle-fed children had significantly better dental care than parents of bottle-fed children in brushing frequency (p < .001) and brushing before bed (p < .001). CONCLUSIONS: Children with clefts who took a bottle to bed showed an increased risk of developing BBTD. The parents or caretakers of bottle-fed children also showed a lack of motivation to perform regular preventive dental home care for their children. This suggests that oral health promotion programs should begin in infancy for children with clefts and their parents.     

Effect of speaking rate on judgments of disordered speech in children with cleft palate

The effect of increased speaking rate on the perception of disordered speech in children with cleft palate was studied. Six children with cleft palate (ages 7 years to 10 years of age) produced three different sentences over a continuum of speaking rates. Fifteen judges rated each sentence according to the severity of disordered speech perceived, including nasality, nasal distortions, nasal emission, glottal stops, and pharyngeal fricatives. Mean ratings for the 15 judges were determined for each sentence. The results indicated that the perception of disordered speech did not increase as a function of increased speaking rate. Possible explanations for the results include: (1) The speakers with cleft palate made adjustments in movement strategy to accommodate the reduced time in a manner similar to speakers without a cleft. (2) The speakers with cleft palate used movement strategies which, although unlike those used by speakers without a cleft, allowed them to avoid speech deterioration. (3) Increasing speaking rate did not reduce the time available to an extent that it was necessary to change movement strategy.     

Craniofacial variability in parents of children with cleft lip and cleft palate.

The purpose of this study was to determine whether there are variations in the craniofacial morphology between parents of children with non-syndromic cleft lip and palate and normal controls with no history of cleft in the families in a Saudi sample. Frontal skull radiographs were obtained from a study group consisting of 40 couples, who have a child with cleft deformity and control group of 32 males and 35 females, who have no history of clefts in the family. A total of 18 landmarks were digitized for each individual by a custom made computer program. T-test, logistic regression analysis were applied to the data. Significant findings were obtained for both males and females of the affected children. The males displayed wider nasal cavity and a narrower maxillary width with asymmetry of the face. Females showed smaller facial dimension as a whole, and asymmetry of the face.