Communication attitude and speech in 10-year-old children with cleft (lip and) palate: an ICF perspective

Many children born with cleft palate have impaired speech during their pre-school years, but usually the speech difficulties are transient and resolved by later childhood. This study investigated communication attitude with the Swedish version of the Communication Attitude Test (CAT-S) in 54 10-year-olds with cleft (lip and) palate. In addition, environmental factors were assessed via parent questionnaire. These data were compared to speech assessments by experienced listeners, who rated the children's velopharyngeal function, articulation, intelligibility, and general impression of speech at ages 5, 7, and 10 years. The children with clefts scored significantly higher on the CAT-S compared to reference data, indicating a more negative communication attitude on group level but with large individual variation. All speech variables, except velopharyngeal function at earlier ages, as well as the parent questionnaire scores, correlated significantly with the CAT-S scores. Although there was a relationship between speech and communication attitude, not all children with impaired speech developed negative communication attitudes. The assessment of communication attitude can make an important contribution to our understanding of the communicative situation for children with cleft (lip and) palate and give important indications for intervention.     

唇腭裂患者心理状态及社会心理环境调查

目的了解唇腭裂患者的心理状态及其社会心理环境。方法对700例O～24岁唇腭裂患者术后随访，调查其与父母的关系、与社会的关系，并对其进行症状自评量表(SCL-90)测定。结果6岁以上患者SCL-90部分症状评分高于正常对照组；几乎所有家长均对患者有不同程度的排斥；患者的人际关系紧张，社会压力大。结论学龄以上年龄的唇腭裂患者存在较多心理障碍，而他们得到的社会支持较少，难以融入社会。     

Pre-linguistic children with cleft palate: Growth of gesture,vocalization, and word use

Abstract

Children with cleft lip and/or palate show early delays in speech and vocabulary development that may have an impact on later communication and social development. While delays in the complexity of babbling may put children at risk for later delays in speech and language development, there is considerable variability in development. This study focused on the rate of children's communication acts, canonical vocalizations, and word use as they made the transition from the pre-linguistic to linguistic development. The study included 15 children with non-syndromic cleft lip and/or palate who were seen at three time points between 17–34 months age. Communication rates were calculated from parent–child language samples collected during play activities. Assignment to linguistic stages was based on the children's expressive vocabulary, as reported on the MacArthur Communicative Development Inventory: Words and Sentences. From the pre-linguistic to linguistic level, the children's average rate per minute of: communicative acts overall increased significantly from 1.49 to 3.07 per minute; canonical vocalizations from 0.21 to 0.90 per minute; and word use from 0.16 to 3.61 per minute. Rates of communicative acts were associated with later word use. It appears that children with clefts rely on non-verbal communicative acts when verbal development is delayed.     

Sommerlad提肌重建术修复不完全性腭裂

目的探讨Sommerlad提肌重建术修复不完全性腭裂的临床效果。方法对31例不完全性腭裂患儿采用Sommerlad提肌重建术修复。结果所有患儿术后均获6个月～3年随访。所有患儿语音清晰度及腭咽闭合的水平均得到了不同程度的改善。咽腔造影显示14例（45.2%）获得了完全的腭咽闭合。结论 Sommerlad提肌重建术是目前较理想的不完全性腭裂修复方法,具有良好的临床应用前景。     

腭裂儿童早期术后语音治疗与分析

目的对唇腭裂患儿的早期语言发育进行研究,了解其语言获得情况。方法对105 例无智力与听力障碍腭裂术后患儿采用一对一治疗模式,进行语言的康复治疗,每周1~2 次,每次30~45 min。结果所有患儿训练后语音清晰度显著改善(P<0.001)。结论早期手术可尽早地恢复腭咽闭合功能,且术后语音康复效果较好。     

唇腭裂患儿术后并发症发生的影响因素分析

目的分析唇腭裂患儿术后并发症发生的影响因素分析。方法对386例唇腭裂患儿进行回顾性资料分析,其中术后出现创口裂开出血或并发感染共49例,对患儿的年龄、性别、体质量、喂养方式、手术时间、唇腭裂类型、血红蛋白、母亲年龄、母亲受教育程度等相关因素进行单因素Logistic回归分析,选择有统计学意义的因素进行多因素Logistic回归分析。结果单因素回归分析提示,患儿的年龄、性别、体质量、血红蛋白对唇腭裂患儿术后并发症无显著性影响(P>0.05),而喂养方式、手术时间、唇腭裂类型、母亲年龄、母亲受教育程度会影响唇腭裂患儿术后并发症的发生(P<0.05)。多因素Logistic回归分析发现,喂养方式(OR=5.322,95%CI为1.356~21.321)、手术时间(OR=1.167,95%CI为1.029~1.531)、母亲受教育程度(OR=1.568,95%CI为1.353~2.589)均能影响唇腭裂患儿术后并发症的发生。结论采用汤匙或注射器喂养方式、手术时间短、母亲受教育程度高能减少唇腭裂患儿术后并发症的发生。     

唇腭裂患儿全身麻醉术后舒适度的探讨

目的对唇腭裂患儿全身麻醉术后的传统护理方法加以改进并实施,为探寻能够提高唇腭裂患儿全身麻醉术后舒适度的有效护理措施提供依据。方法 2007年10月至2009年6月,选取唇腭裂患儿120例,按随机数字表法将其分为对照组60例和改良组60例,对照组患儿全身麻醉术后采取传统护理方法对其进行护理,改良组患儿采取改良后的护理方法对其进行护理。采用FLACC（The face,legs,activity,cry,consolability）量表分别于患儿术后6 h、术后24 h及术后72 h对两组患儿的舒适度进行评估并比较。结果术后6 h2、4 h以及72 h,改良组患儿的舒适度评分均优于对照组,差异有统计学意义（P〈0.01）。结论采用改良后的护理方法能提高唇腭裂患儿全身麻醉术后的舒适度,值得推广。     

腭裂术后患儿言语治疗的效果观察

目的观察言语治疗对腭裂术后患儿构音障碍恢复的效果。方法对28例腭裂术后患儿于术后4周开始进行言语训练,3个月为1个疗程,共训练1～3个疗程。训练前后分别进行腭咽闭合功能和语音清晰度测评。结果治疗后,鼻漏气率由（50.64±13.10）%降低到（23.36±13.14）%,8例语音达到正常水平,总有效率100%。结论言语治疗能使腭裂术后患儿构音障碍明显改善。     

全程健康教育对唇腭裂患儿家长健康知识知晓率的影响

目的 探讨唇腭裂患儿实施全程健康教育的效果.方法 将374例接受序列治疗的唇腭裂患儿家长分为试验组184例和对照组190例.试验组实施全程健康教育方式,对照组实施普通健康教育方式,比较2组健康教育教育知识知晓情况.结果 试验组家长正确喂养、体重达标、复诊率、疾病知识知晓率、序列治疗接受率、满意度均优于对照组,差异有统计学意义（P〈0.05）.结论 对唇腭裂序列治疗患儿实施全程健康教育满足了患儿及家长是健康需求,保证复诊率及序列治疗有效开展,减少并发症的发生,提高患儿的生存质量.     

Implementation of standardized medical photography for cleft lip and palate audit

Much has been published relating to the treatment and surgical outcome of cleft lip and palate disorders. Clinical audit is one of the most important tools for assessing the quality of care provided, with medical photography an invaluable component of this process. The Clinical Standards Advisory Group Report 1998 recommended that cleft lip and palate patients should be audited when 0 (under 1 year of age), and then at the ages of 5, 10, 15 and 20 years. For both audit and research purposes, medical photographs need to be accurate and of a consistently high standard. This paper describes the development of a standardized photographic protocol for cleft patients of audit age, to the benefit of both the multidisciplinary team and the patients.     

Tissue engineering strategies combining molecular targets against inflammation and fibrosis,and umbilical cord blood stem cells to improve hampered muscle and skin regeneration following cleft repair

Cleft lip with or without cleft palate is a congenital deformity that occurs in about 1 of 700 newborns, affecting the dentition, bone, skin, muscles and mucosa in the orofacial region. A cleft can give rise to problems with maxillofacial growth, dental development, speech, and eating, and can also cause hearing impairment. Surgical repair of the lip may lead to impaired regeneration of muscle and skin, fibrosis, and scar formation. This may result in hampered facial growth and dental development affecting oral function and lip and nose esthetics. Therefore, secondary surgery to correct the scar is often indicated. We will discuss the molecular and cellular pathways involved in facial and lip myogenesis, muscle anatomy in the normal and cleft lip, and complications following surgery. The aim of this review is to outline a novel molecular and cellular strategy to improve musculature and skin regeneration and to reduce scar formation following cleft repair. Orofacial clefting can be diagnosed in the fetus through prenatal ultrasound screening and allows planning for the harvesting of umbilical cord blood stem cells upon birth. Tissue engineering techniques using these cord blood stem cells and molecular targeting of inflammation and fibrosis during surgery may promote tissue regeneration. We expect that this novel strategy improves both muscle and skin regeneration, resulting in better function and esthetics after cleft repair.     

Cleft lip and palate: developmental effects.

Children with cleft lip and/or palate are at risk for societal disapproval and/or discrimination and emotional adjustment problems due to facial disfigurement, speech impairment, and learning difficulties. This article reviews the potential psychosocial problems from a developmental perspective and offers suggestions as to the role of nurses at each developmental stage. Nurses may be prone to the same negative attitudes and biases as the general population and may engage in subtle discrimination against children with cleft lip and/or palate.     

唇腭裂的超声筛查及诊断价值

目的：研究常规鼻唇冠状切面加特殊切面在胎儿唇腭裂畸形筛查中的应用价值.材料与方法：对11688例,孕24 ～ 30周胎儿唇腭部采用常规鼻唇冠状切面加特殊切面（经唇部冠状面、经双眼标准横断面、经鼻腔标准横断面、经上牙槽突标准横断面、经舌标准横断面、经下牙槽突标准横断面和经鼻正中矢状面）行产前超声筛查,并与出生儿颜面部检查结果进行对照分析,总结鼻唇冠状切面加特殊切面超声扫查法的诊断符合率.结果：11688例胎儿共查出59例阳性患者,阳性率0.50％（59/11688）,单纯唇裂13例,占阳性病例的22.03％ （13/59）,唇裂合并腭裂的46例,占阳性病例的77.97％（46/59）,左侧唇腭裂38例,占64.4％ （38/59）,右侧唇腭裂10例,占16.9％（10/59）,正中唇裂2例占3.39％（2/59）,双侧唇腭裂9例,占12.25％（9/59）.结论：超声诊断胎儿唇腭裂畸形通过观察鼻唇部冠状切面加特殊切面（上牙槽突标准横断面、下牙槽突标准横断面、鼻腔横断面、双眼标准横断面、舌标准横断面、胎儿头颅矢状面）及配合一定手法,可明显提高其诊断率.     

唇腭裂胎儿产前超声检查诊断分析

目的探讨胎儿唇腭裂超声表现及显示切面,提高唇腭裂的产前超声诊断率。方法选取我院经引产或产后证实的唇腭裂胎儿28例,对比产前超声检查与引产后或产后唇腭裂的类型。结果 28例经引产或产后证实的唇腭裂胎儿中,单纯唇裂5例,唇腭裂22例,单纯腭裂1例;产前检出23例,其中误诊裂口类型2例,漏诊5例。结论胎儿唇裂、原发腭裂、正中腭裂经连续性颜面部三正交切面诊断准确性较高;胎儿完全腭裂及唇裂伴继发腭裂需补充特殊切面;单纯性继发腭裂产前超声诊断仍有较大困难。     

Premaxillary protrusion: a sonographic clue to bilateral cleft lip and palate

Sonograms from 49 fetuses with cleft lip, with or without cleft palate, were reviewed. Among 37 fetuses with adequate pathologic or clinical correlation, 10 (27%) demonstrated premaxillary protrusion, seen as a paranasal echogenic mass. Nine of ten fetuses with a paranasal echogenic mass proved to have bilateral cleft lip and cleft palate. Conversely, only two of 27 fetuses who did not show a paranasal echogenic mass proved to have bilateral cleft lip and cleft palate, and neither of these fetuses showed premaxillary protrusion at birth. Sonographic evaluation of the cleft alone erroneously misclassified eight fetuses with bilateral cleft lip and cleft palate as having unilateral clefts. Premaxillary protrusion is an important clue to the presence of cleft lip and cleft palate and may be more conspicuous than the cleft itself. Furthermore, the presence of a paranasal echogenic mass favors the presence of bilateral cleft lip and cleft palate, even when sonographic evaluation of the cleft itself suggests a unilateral cleft. This information should be useful in the detection and management of fetuses with suspected facial clefts.     

50例成年唇腭裂患者及其父母心理状况调查

【目的】研究50例唇腭裂患者及其父母的心理健康状况,为改善患者及其父母的心理健康状况提供依据。【方法】采用SCL-90症状自评量表对50名成年患者及30名正常青少年的心理健康状况进行评价。同时采用生活事件量表（life event scale,LES）对唇腭裂患者组父母和正常青少年组父母,以及唇腭裂患者组父亲与母亲间心理状态进行定性和定量分析。【结果】唇腭裂患者SCL-90总分、阳性项目数及抑郁、焦虑和人际关系诸因子分高于对照组,差异有显著性。并且患者父母生活事件总刺激量、负性事件刺激量均高于对照组（P〈0．05）。其中唇裂（CL）、腭裂（CP）、唇腭裂（CLP）三亚组患者及其父母之间的心理健康状况差异均无显著性。【结论】唇腭裂患者及其父母的心理健康状况较差,对唇腭裂患者临床治疗的同时,也要重视患者家庭成员的社会、心理等因素。     

唇腭裂患儿母亲早期心理干预模式应用的效果研究

目的:探讨适合唇腭裂患儿母亲的早期心理干预模式并评价其临床效果,为有效地开展护理干预提供依据。方法:采用主观抽样法,选取符合标准的研究对象100例,按照时间顺序进行分组,实验组50例在常规护理基础上实施早期心理干预,对照组50例给予常规护理。干预前、后用症状自评量表(SCL-90)分别对两组研究对象进行心理测评。结果:干预后实验组唇腭裂患儿母亲在强迫、人际关系、焦虑、抑郁、敌对维度得分与干预前相比显著降低,与对照组相比差异有统计学意义(P<0.05)。结论:早期心理干预模式有利于改善唇腭裂患儿母亲心理健康状况,经研究证明此模式具有较好的可行性和有效性。     

先天性小儿唇腭裂的围手术期护理

目的探讨小儿先天性唇腭裂有效的围手术期护理措施。方法对我院2010年1月至2011年12月收治的43例先天性唇腭裂患儿给予围手术期护理。结果患儿伤12I愈合时间为6,7d,平均6．6d,术后对患儿家长进行护理满意度调查发现,患儿家长总满意度为100％。结论护理干预对先天性小儿唇腭裂手术的疗效具有重要意义,围手术期综合护理措施能够取得较好的临床效果,提高患儿家长的满意度。     

国内外唇腭裂专科护理发展现状的文献研究及分析

目的了解和分析国内唇腭裂专科护理工作发展的现状。方法检索并分析万方医学网、中国知网、Springer Link及PubMed英文数据库近6年有关唇腭裂手术的围术期护理、患儿的喂养、手术安全管理、围术期疼痛研究以及心理护理的相关文献。结果共检索出国内文献89篇(核心期刊20篇)、国外文献22篇,其中围术期护理38篇、患儿的喂养16篇、手术安全管理10篇、围术期疼痛研究10篇、心理护理15篇。结论与国外文献相比,国内论文总结和回顾性居多,应增加研究探讨性论文,从而促进唇腭裂临床护理工作专科化的发展。