Scandcleft Project, Trial 1: Comparison of Speech Outcome in Relation to Timing of Hard Palate Closure in 5-Year-Olds With UCLP

2019 ◽  
Vol 56 (10) ◽  
pp. 1276-1286 ◽  
Author(s):  
Elisabeth Willadsen ◽  
Anette Lohmander ◽  
Christina Persson ◽  
Maria Boers ◽  
Mia Kisling-Møller ◽  
...  
Keyword(s):  
Hard Palate ◽  
Cleft Lip ◽  
Speech Therapy ◽  
Cleft Lip And Palate ◽  
Reference Data ◽  
Burden Of Treatment ◽  
Speech Characteristics ◽  
Velopharyngeal Incompetence ◽  
Hearing Thresholds ◽  
Age Appropriate

Objective: To compare in-depth speech results in Scandcleft Trial 1 as well as reference data from peers without cleft palate (CP). Design: A prospective randomized clinical trial. Setting: A Danish and a Swedish CP center. Participants: 143 of 148 randomized 5-year-olds with unilateral cleft lip and palate. All received lip and velum closure at 4 months, and hard palate closure at 12 months (arm A) or 36 months (arm B). Main Outcome Measures: A composite measure based on velopharyngeal competence (VPC) or velopharyngeal incompetence (VPI), an overall assessment of VPC from connected speech (VPC-Rate), Percentage of Consonants Correct (PCC-score), and consonant errors. Speech therapy visits, average hearing thresholds, and secondary pharyngeal surgeries documented burden of treatment. Results: Across the trial, 61.5% demonstrated VPC and 38.5% VPI. Twenty-two percent of participants achieved age appropriate PCC-scores. There were no statistically significant differences between arms or centers for these measures. In the Danish center, arm B: achieved lower PCC-scores ( P = .01); obtained PCC-scores without s-errors below 79% ( P = .002); produced ≥3 active oral cleft speech characteristics ( P = .004) than arm A. In both centers, arm B attended more speech visits. Conclusions: At age 5, differences between centers and treatment arms were not statistically significant for VPC/VPI, but consonant proficiency differed between treatment arms in the Danish center. Poor speech outcomes were seen for both treatment arms. Variations between centers were observed. As the Swedish center had few participants, intercenter comparisons should be interpreted with caution.

scholarly journals Scandcleft Project Trial 2—Comparison of Speech Outcome in 1- and 2-Stage Palatal Closure in 5-Year-Olds With UCLP

2019 ◽  
Vol 57 (4) ◽  
pp. 458-469
Author(s):  
Inger Lundeborg Hammarström ◽  
Jill Nyberg ◽  
Suvi Alaluusua ◽  
Jorma Rautio ◽  
Erik Neovius ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Hard Palate ◽  
Cleft Lip ◽  
Speech Therapy ◽  
Cleft Lip And Palate ◽  
Burden Of Treatment ◽  
Hearing Thresholds ◽  
Significant Difference ◽  
Age Appropriate ◽  
Velopharyngeal Function

Objective: To investigate in-depth speech results in the Scandcleft Trial 2 with comparisons between surgical protocols and centers and with benchmarks from peers without cleft palate. Design: A prospective randomized clinical trial. Setting: Two Swedish and one Finnish Cleft Palate center. Participants: One hundred twelve participants were 5-years-old born with unilateral cleft lip and palate randomized to either lip repair and soft palate closure at 4 months and hard palate closure at 12 months or lip repair at 3 to 4 months (Arm A), or a closure of both the soft and hard palate at 12 months (Arm C). Main Outcome Measures: A composite measure dichotomized into velopharyngeal competency (VPC) or velopharyngeal incompetency (VPI), overall assessment of velopharyngeal function (VPC-Rate), percentage of consonants correct (PCC score), and consonant errors. In addition, number of speech therapy visits, average hearing thresholds, and secondary surgeries were documented to assess burden of treatment. Results: Across the trial, 53.5% demonstrated VPC and 46.5% VPI with no significant differences between arms or centers. In total, 27% reached age-appropriate PCC scores with no statistically significant difference between the arms. The Finnish center had significantly higher PCC scores, the Swedish centers had higher percentages of oral consonant errors. Number of speech therapy visits was significantly higher in the Finnish center. Conclusion: At age 5, poor speech outcomes with some differences between participating centers were seen but could not be attributed to surgical protocol. As one center had very few participants, the results from that center should be interpreted with caution.

Scandcleft Project Trial 3: Comparison of Speech Outcomes in Relation to Sequence in 2-Stage Palatal Repair Procedures in 5-Year-Olds With Unilateral Cleft Lip and Palate

2020 ◽  
Vol 57 (3) ◽  
pp. 352-363 ◽  
Author(s):  
Christina Persson ◽  
Nina-Helen Pedersen ◽  
Christine Hayden ◽  
Melanie Bowden ◽  
Ragnhild Aukner ◽  
...  
Keyword(s):  
Soft Palate ◽  
Hard Palate ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Composite Measure ◽  
Connected Speech ◽  
Prospective Randomized Clinical Trial ◽  
Speech Characteristics ◽  
Significant Difference ◽  
Age Appropriate

Objective: To compare speech outcome following different sequencing of hard and soft palate closure between arms and centers within trial 3 and compare results to peers without cleft palate. Design: A prospective randomized clinical trial. Setting: Two Norwegian and 2 British centers. Participants: One hundred thirty-six 5-year-olds with unilateral cleft lip and palate were randomized to either lip and soft palate closure at 3 to 4 months and hard palate closure at 12 months (arm A) or lip and hard palate closure at 3 to 4 months and soft palate closure at 12 months (arm D). Main Outcome Measures: A composite measure of velopharyngeal competence (VPC), overall assessment of VPC from connected speech (VPC-Rate). Percentage of consonants correct (PCC), active cleft speech characteristics (CSCs), subdivided by oral retracted and nonoral errors, and developmental speech characteristics (DSCs). Results: Across the trial, 47% had VPC, with no statistically significant difference between arms within or across centers. Thirty-eight percent achieved a PCC score of >90%, with no difference between arms or centers. In one center, significantly more children in arm A produced ≥3 active CSCs ( P < .05). Across centers, there was a statistically significant difference in active CSCs (arm D), oral retracted CSCs (arm D), and DSCs (arms A and D). Conclusions: Less than half of the 5-year-olds achieved VPC and around one-third achieved age-appropriate PCC scores. Cleft speech characteristics were more common in arm A, but outcomes varied within and across centers. Thus, outcome of the same surgical method can vary substantially across centers.

Visual Training and Correction of Articulation Disorders by Use of Dynamic Palatography

1986 ◽  
Vol 51 (3) ◽  
pp. 226-238 ◽  
Author(s):  
Ken-Ichi Michi ◽  
Noriko Suzuki ◽  
Yukari Yamashita ◽  
Satoko Imai
Keyword(s):  
Cleft Palate ◽  
Hard Palate ◽  
Cleft Lip ◽  
Speech Therapy ◽  
Cleft Lip And Palate ◽  
Treatment Plan ◽  
Visual Display ◽  
Palatal Plate ◽  
Articulation Disorders ◽  
Visual Indication

The dynamic palatograph is an electrical apparatus that generates a visual display of constantly changing palatolingual contact as a function of time, using an artificial palatal plate with affixed electrodes. This paper describes a technique of speech therapy incorporating dynamic palatography for a cleft palate patient. The patient, a 6-year-old Japanese girl with a repaired unilateral cleft lip and palate, had been judged to demonstrate articulation disorders involving contact of the tongue with the hard palate or alveolus following surgical improvement of velopharyngeal function. Prior to therapy the tongue tended to contact the hard palate more posteriorly than normal. After therapy with the dynamic palatograph, palatolingual contact was normal in comparison with average speakers. Our findings suggest that the facility of constant visual indication of tongue posture to the clinician and patient during corrective speech therapy using dynamic palatography may expedite results with cleft palate patients in the speech clinic when implemented in a carefully structured treatment plan.

The effect of speech therapy on acoustic speech characteristics of cleft lip and palate patients: a preliminary study

2013 ◽  
Vol 34 (2) ◽  
pp. 84-87
Author(s):  
Arezoo Jahanbin ◽  
Mohammad Reza Pahlavannezhad ◽  
Maryam Savadi ◽  
Nadia Hasanzadeh
Keyword(s):  
Cleft Lip ◽  
Speech Therapy ◽  
Cleft Lip And Palate ◽  
Speech Characteristics ◽  
Preliminary Study

Perceptual Speech Outcomes After Early Primary Palatal Repair in Ugandan Patients With Cleft Palate

2020 ◽  
pp. 105566562098024
Author(s):  
Kim Bettens ◽  
Laura Bruneel ◽  
Cassandra Alighieri ◽  
Daniel Sseremba ◽  
Duncan Musasizib ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Cleft Lip ◽  
Speech Therapy ◽  
Cleft Lip And Palate ◽  
Control Group ◽  
English Speaking ◽  
And Gender ◽  
Early Primary ◽  
Velopharyngeal Function ◽  
Normal Speech

Objective: To provide speech outcomes of English-speaking Ugandan patients with a cleft palate with or without cleft lip (CP±L). Design: Prospective case–control study. Setting: Referral hospital for patients with cleft lip and palate in Uganda. Participants: Twenty-four English-speaking Ugandan children with a CP±L (15 boys, 9 girls, mean 8.4 years) who received palatal closure prior to 6 months of age and an age- and gender-matched control group of Ugandan children without cleft palate. Interventions: Comparison of speech outcomes of the patient and control group. Main Outcome Measures: Perceptual speech outcomes including articulation, resonance, speech understandability and acceptability, and velopharyngeal composite score (VPC-sum). Information regarding speech therapy, fistula rate, and secondary surgery. Results: Normal speech understandability was observed in 42% of the patients, and 38% were judged with normal speech acceptability. Only 16% showed compensatory articulation. Acceptable resonance was found in 71%, and 75% of the patients were judged perceptually to present with competent velopharyngeal function based on the VPC-sum. Additional speech intervention was recommended in 25% of the patients. Statistically significant differences for all these variables were still observed with the control children ( P < .05). Conclusions: Overall, acceptable speech outcomes were found after early primary palatal closure. Comparable or even better results were found in comparison with international benchmarks, especially regarding the presence of compensatory articulation. Whether this approach is transferable to Western countries is the subject for further research.

scholarly journals Cleft Maxillary Hypoplasia

2021 ◽  
pp. 1675-1702
Author(s):  
Philip Mathew ◽  
Mustafa. K ◽  
Paul Mathai
Keyword(s):  
Treatment Planning ◽  
Hard Palate ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Clinical Problem ◽  
Congenital Defect ◽  
Individualized Treatment ◽  
Maxillary Hypoplasia ◽  
Surgical Interventions ◽  
Detailed Evaluation

AbstractCleft lip and palate patients are born with a challenging deformity that requires multiple surgical interventions in order to reach functional and esthetic harmony. Mid face deficiency in cleft patients is a challenging clinical problem very often encountered in the management of this congenital defect. Cleft maxillary hypoplasia can be attributed to the inherited traits, acquired traits and Induced traits. CLP patients usually present with symptoms varying from malocclusion, retrusion of midface, and a narrow hard palate. A detailed evaluation and individualized treatment planning is of utmost importance in dealing with these patients. Treatment involves the contribution from both the orthodontist and the craniofacial team. The goals for the treatment for cleft maxillary hypoplasia are improvement of aesthetic deficits as well as correction of malocclusion.

scholarly journals Atuação Fonoaudiológica e Fisioterápica nas Fissuras Orofaciais não Sindrômicas

UNICIÊNCIAS ◽  
2021 ◽  
Vol 24 (2) ◽  
pp. 205-210
Author(s):  
Carla Meliso Rodrigues Silvestre ◽  
Ana Clara Giraldeli ◽  
Luana Borges Estevão ◽  
Eliane Gomes Fernandes de Oliveira ◽  
Cristhiane Almeida Leite da Silva ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cleft Lip ◽  
Speech Therapy ◽  
Cleft Lip And Palate ◽  
Functional Independence ◽  
Oral Feeding ◽  
Orofacial Clefts ◽  
Long Term Treatment ◽  
Speech Therapist

A fissura de lábio e ou de palato não sindrômicas são anomalias congênitas craniofaciais mais frequentes. Elas ocasionam problemas estéticos e funcionais que requerem tratamento em longo prazo, envolvendo reabilitação multidisciplinar incluindo a fonoaudiologia e fisioterapia. Este estudo propõem apresentar alguns dos princípios de atuação do fonoaudiólogo e do fisioterapeuta nas fissuras orofaciais não sindrômicas. Realizou-se uma revisão de literatura narrativa com busca na Bireme e Scielo e nas bases Lilacs, Pedro e  PubMed em outubro de 2020, envolvendo a atuação do  fonoaudiólogo e do fisioterapeuta nas fissuras orofaciais não sindrômica, no idioma inglês e português, sem recorte temporal. Os estudos encontrados observaram que a intervenção fonoaudiológica e fisioterapêutica deve ser mais precoce e de acordo com a disfunção apresentada. De modo geral, a atuação do fonoaudiólogo favorece a alimentação oral  e o desenvolvimento global referente à linguagem, a fala, audição e neuropsicomotor, para evitar atrasos e favorecer o melhor desenvolvimento infantil. A atuação fisioterapêutica visa diminuir a hospitalização prolongada, melhorar a qualidade de vida e funcionalidade, bem como assistir as crianças que cursarem com problemas motores, posturais e respiratórios. Conclui-se que a atuação fonoaudiológica nas diferentes fases da reabilitação de indivíduos com fissuras labiopalatinas contribui para alimentação e inteligibilidade da fala, beneficiando assim a comunicação verbal e consequentemente a interação com o meio social; e a assistência fisioterapêutica ajuda e melhorar a sintomatologia e as disfunções respiratórias apresentadas, prevenindo e tratando complicações de forma a melhorar a qualidade de vida e restabelecer a independência funcional.   Palavras-chave: Fissura Palatina. Fenda Labial. Aleitamento Materno. Fala. Fisioterapia.   Abstract Non-syndromic cleft lip and or palate are the most frequent congenital craniofacial anomalies. They cause aesthetic and functional problems that require long-term treatment, involving rehabilitation including speech therapy and physiotherapy. This study proposes to present some of the principles of performance of the speech therapist and physiotherapist in non-syndromic orofacial clefts. A narrative literature review was carried out with searches in Bireme and Scielo and in the Lilacs, Pedro and PubMed databases in October 2020, involving the performance of the speech therapist and physiotherapist in non-syndromic orofacial clefts, in English and Portuguese, with no time frame. The studies observed that speech therapy and physiotherapy intervention should be as earlier and in accordance with the presented dysfunction. In general, the performance of the speech therapist favors oral feeding and the global development related to language, speech, hearing and neuropsychomotor, to avoid delays and favor best child development. Physiotherapeutic action aims to reduce the prolonged hospitalization, improve quality of life and functionality, as well as assist children who are experiencing motor, postural and respiratory problems. It is concluded that the speech therapy performance in the different phases of rehabilitation of individuals with cleft lip and palate contributes to feeding and speech intelligibility, thus benefiting verbal communication and consequently the interaction with the social environment; and physiotherapeutic assistance helps and improves the symptoms and respiratory disorders presented, preventing and treating complications in order to improve the quality of life and restore functional independence.   Keywords: Cleft Palate. Cleft Lip. Breast Feeding. Speech. Physiotherapy.

scholarly journals USE OF THE SPEECH PASSPORT IN REHABILITATION OF CHILDREN WITH CONGENITAL MAXILLOFACIAL MALFORMATIONS

2019 ◽  
Vol 15 (2) ◽  
pp. 79-83
Author(s):  
Павел Токарев ◽  
Pavel Tokarev ◽  
Алексей Шулаев ◽  
Aleksey Shulaev ◽  
Ринат Салеев ◽  
...  
Keyword(s):  
Cleft Lip ◽  
Speech Therapy ◽  
Cleft Lip And Palate ◽  
Main Group ◽  
Speech Development ◽  
Control Group ◽  
Speech Activity ◽  
Speech Therapist ◽  
Rehabilitation Measures ◽  
Definition Of

Subject. The article describes the child's speech passport, as one of the important mechanisms of the rehabilitation and speech recovery in children with congenital cleft lip and palate. Purpose of the study ― evaluation of the treatment outcome in children with cleft palate with the use of a speech passport at the stage of rehabilitation. Materials and methods. The article presents the experience of the rehabilitation of more than 2,000 patients with congenital maxillofacial defects from 1998 to 2017. Results. The features of speech development were studied in 93 patients divided into two groups. The main group consisted of 56 people, in whom the definition of the algorithm of medical and logopedic aid was carried out using a speech passport, then the rehabilitation measures complex developed by us for restoring and correcting the speech function was applied. The control group included 37 people: patients who did not receive medical and speech therapy in the postoperative period, and patients who underwent rehabilitation measures in outpatient clinic at the place of residence. The speech activity indicators in patients of the compared groups had significant differences (p = 0,026), due to a more pronounced positive dynamics of speech activity recovery in the main group - the percentage of patients increased 3,6 times ― from 17,9 to 64,3 %, while in the control group the rate increased only 1,9 times ― from 21,6 up to 40,5 %. Conclusion. The developed speech passport involves a multidisciplinary approach to the child, early detection, treatment and rehabilitation. It is also can be defined as a link between health care, speech therapy and pedagogy. The child's speech passport data can be filled by a pediatrician, neurologist, maxillofacial surgeon, orthodontist, speech therapist and speech therapist defectologist at various stages of treatment and rehabilitation.

Hard Palate Repair Timing and Facial Growth in Unilateral Cleft Lip and Palate: A Longitudinal Study

2006 ◽  
Vol 43 (5) ◽  
pp. 547-556 ◽  
Author(s):  
Yu-Fang Liao ◽  
Timothy J. Cole ◽  
Michael Mars
Keyword(s):  
Longitudinal Study ◽  
Hard Palate ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Sri Lankan ◽  
Facial Morphology ◽  
Facial Growth ◽  
Clinical Notes ◽  
Timing Effect ◽  
Palate Repair

Objective: To investigate whether timing of hard palate repair had a significant effect on facial growth in patients with unilateral cleft lip and palate (UCLP). Design: Retrospective longitudinal study. Setting: Sri Lankan Cleft Lip and Palate Project. Patients: A total of 104 patients with nonsyndromic UCLP who had hard palate repair by age 13 years, with their 290 cephalometric radiographs taken after lip and palate repair. Main Outcome Measures: Clinical notes were used to record surgical treatment histories. Cephalometry was used to determine facial morphology and growth rate. Results: Timing of hard palate repair had a significant effect on the length and protrusion of the alveolar maxilla (PMP-A and SNA, respectively) and the anteroposterior alveolar jaw relation (ANB) at age 20 years but not on their growth rates. Conclusion: Timing of hard palate repair significantly affects the growth of the maxilla in patients with UCLP. Late hard palate repair has a smaller adverse effect than does early hard palate repair on the growth of the maxilla. This timing effect primarily affects the anteroposterior development of the maxillary dentoalveolus and is attributed to the development being undisturbed before closure of the hard palate.

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