One Size Doesn't Fit All: A Pilot Study Toward Performance-Specific Speech Intervention in Children With a Cleft (Lip and) Palate

Purpose: Speech-language pathologists usually apply a “one size fits all” approach to eliminate compensatory cleft speech characteristics (CSCs). It is necessary to investigate what intervention works best for a particular patient. This pilot study compared the effectiveness of two therapy approaches (a motor-phonetic approach and a linguistic-phonological approach) on different subtypes of compensatory CSCs in Dutch-speaking children with a cleft (lip and) palate (CP ± L). Method: Fourteen children with a CP ± L ( M age = 7.71 years) were divided into two groups using block randomization stratified by age, gender, and type of compensatory CSC. Six children received intervention to eliminate anterior oral CSCs ( n = 3 motor-phonetic intervention, n = 3 linguistic-phonological intervention). Eight children received intervention to eliminate non-oral CSCs ( n = 4 motor-phonetic intervention, n = 4 linguistic-phonological intervention). Each child received 10 hr of speech intervention divided over 2 weeks. Perceptual and psychosocial outcome measures were used to determine intervention effects. Results: Children who received linguistic-phonological intervention to eliminate anterior oral CSCs had significantly higher correctly produced consonant scores and health-related quality of life (HRQoL) scores compared to children who received motor-phonetic intervention to eliminate anterior oral CSCs. In the group of children who received intervention to eliminate non-oral CSCs, no significant differences were found in the correctly produced consonant scores nor in the HRQoL scores between the two intervention approaches. Conclusions: Linguistic-phonological intervention seems to be more appropriate to eliminate anterior oral CSCs. The beneficial effects of linguistic-phonological intervention were less pronounced in children with non-oral CSCs. Perhaps, children with non-oral CSCs benefit more from a hybrid phonetic-phonological approach. This study is a step forward in the provision of performance-specific intervention in children with a CP ± L. Replication in larger samples is needed and will aid to tailor treatment plans to the needs of our patients.

INTERVENÇÕES FONOLÓGICAS EM CRIANÇAS COM DESVIO FONOLÓGICO: UMA REVISÃO SISTEMÁTICA

Introdução: Dentre os distúrbios dos sons da fala, tem-se o desvio fonológico, sendo este caracterizado por erros na produção de fala. A partir dos achados da avaliação fonológica, o terapeuta deverá selecionar a proposta de intervenção mais adequada para cada caso dentre os diversos modelos elaborados a partir de teorias linguísticas que buscam alcançar a reorganização fonológica. Objetivo: Avaliar a intervenção fonológica para os casos de desvios fonológicos no Português Brasileiro Método: a revisão sistemática foi conduzida conforme as recomendações do Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A busca por artigos científicos foi conduzida por dois pesquisadores independentes nas bases de dados Medline (Pubmed), LILACS, SciELO, Cochrane Library e Scopus. A pesquisa foi realizada com os descritores [(Phonological disorders) or (Phonological impairment) or (Speech sound disorders) or (Articulation Disorders) or (Language and Hearing Sciences) and (Speech Therapy) or (Speech Intervention) or (Phonological treatment) or (Phonological Intervention)] e compreendeu o período de janeiro de 2015 a maio de 2020. Resultados: Todas as crianças apresentaram evolução e ampliação no sistemas fonológicos, independente da intervenção fonológica escolhida para o caso. Entretanto, os estudos que aliaram a terapia tradicional com outros recursos alternativos (exemplo, softwares) obtiveram resultados promissores. Conclusão: Apesar dos resultados terem sido eficazes nos estudos analisados, não foi possível sistematizar a escolha da intervenção com o quadro clínico dos sujeitos em decorrência da falta de uniformização dos sujeitos e ao delineamento metodológico. Não é possível realizar conclusões sistemáticas com relação à intervenção fonológica de crianças brasileiras.

Is High-Intensity Speech Intervention Better? A Comparison of High-Intensity Intervention Versus Low-Intensity Intervention in Children With a Cleft Palate

Purpose The purpose of this study was to compare the effect of speech intervention provided with a low intensity with speech intervention provided with a high intensity on the speech and health-related quality of life (HRQoL) in Dutch-speaking children with a cleft palate with or without a cleft lip (CP ± L) between 4 and 12 years. Method A longitudinal, prospective, randomized controlled trial with a multiple baseline design was used. Twelve children with a CP ± L ( M age = 8.0 years, SD = 1.54) were divided into two groups using block randomization stratified by age and gender: One group received low-intensity speech intervention (LISI; n = 6) and one group received high-intensity speech intervention (HISI; n = 6). Children in the LISI group received intervention with a session duration of 1 hr, a dose frequency of 1 session per week, and a total intervention duration of 10 weeks. Children in the HISI group received intervention with a session duration of 1 hr, a dose frequency of 5 sessions per week, and a total intervention duration of 2 weeks. The cumulative intervention intensity was kept constant. Both groups received identical therapy programs provided by the same experienced speech therapist. Perceptual speech assessments were performed on baseline and posttreatment data points. Changes in HRQoL were assessed using the Velopharyngeal Insufficiency Effects on Life Outcomes (VELO) questionnaire. Both groups were compared over time using (generalized) linear mixed models. Results No significant Time × Group interactions were observed for the percentage of correctly produced consonants at the word and sentence levels, indicating no differences in evolution over time among the two groups. The variables speech understandability, speech acceptability, and the total VELO scores significantly improved following HISI, but not following LISI. Conclusions Children in the HISI group made equal and, for some variables, even superior progress in only 2 weeks of therapy compared to children in the LISI group who received 10 weeks of therapy. HISI is a promising strategy to improve speech outcomes and HRQoL in a shorter time period.

Reliability of Outcome Measures to Assess Consonant Proficiency Following Cleft Palate Speech Intervention: The Percentage of Consonants Correct Metric and the Probe Scoring System

Purpose This study compared the inter- and intrarater reliability of the percentage of consonants correct (PCC) metrics and the probe scoring system between an experienced and a less experienced rater and between two experienced raters. In addition, these outcome measures' ability to reflect changes following speech intervention was measured. Method During Phase 1, two raters (Rater 1 with 5 years of experience in cleft-related speech disorders and Rater 2 with limited experience in cleft-related speech disorders) independently assessed 134 speech samples at the word and sentence levels, which were collected on different data points before, during, and following a cleft palate speech intervention. During Phase 2, a third rater (with 8 years of experience) analyzed 34 speech samples. The percentage of consonants correct–revised, the percentage of correct places and manners, and probe scores at the word and sentence levels were measured. Results Poor-to-moderate interreliability between Raters 1 and 2 was found due to differences in error classification. Interrater reliability between Raters 1 and 3 was very good for both the PCC metrics and the probe scores. The interrater reliability for the amount of targets elicited was lower compared to the interrater reliability for the amount of targets correct. The probe scoring system demonstrated a greater ability to detect changes toward the correct production of the target consonant compared to the PCC metrics. Conclusions Having an experience with the assessment of cleft-related speech disorders is a crucial factor to gain reliable results. The interrater reliability for the PCC metrics and the probe scoring system between two experienced raters did not differ, suggesting that both outcome measures can be used in cleft palate speech intervention studies. Despite the ability of the probe scoring system to detect changes, further research should provide insight in the benefits of this system both for research and clinical purposes.

Intervention dose frequency: Phonological generalization is similar regardless of schedule

This study examined how intervention dose frequency affects phonological acquisition and generalization in preschool children with speech sound disorders (SSD). Using a multiple-baseline, single-participants experimental design, eight English-speaking children with SSD (4;0 to 5;6) were split into two dose frequency conditions (4 children/condition) targeting word-initial complex singleton phonemes: /ɹ l ʧ/. All children received twenty 50-minute sessions that were either provided twice a week (2×/week) for ten weeks or four times a week (4×/week) for five weeks. Tau- U effect sizes for two generalization measures, treated phoneme and percent consonants correct (PCC), were calculated for each participant. Group d-scores were calculated to measure generalization of the treated phoneme in untreated words for each condition. All eight children demonstrated gains in their phonological measures. Two children in 2×/week condition demonstrated significant changes in generalization of treated phonemes in untreated words. One child in each condition demonstrated significant changes in PCC scores. Group d-scores were similar suggesting children in both conditions generalized their treated phoneme in untreated words to a similar level. Regardless of whether speech intervention occurred 2×/week or 4×/week, children demonstrated similar phonological gains. This suggests that both dose frequencies are viable intervention schedules for preschoolers with SSD. Children in the 4×/week condition made their phonological gains in approximately half the time of children in the 2×/week condition. Thus, more frequent weekly speech intervention sessions could be more efficient in teaching phonological information than less frequent sessions.

Supporting Children With Speech Sound Disorders During COVID-19 Restrictions: Technological Solutions

Purpose “Children are the hidden victims of the COVID-19 pandemic” (United Nations Children's Fund, 2020). Timely and effective speech intervention is important to reduce the impact on children's school achievement, ability to make friends, mental health, future life opportunities, and government resources. Prior to the coronavirus disease (COVID-19) pandemic, many Australian children did not receive sufficient speech-language pathology (SLP) services due to long waiting lists in the public health system. COVID-19 restrictions exacerbated this issue, as even children who were at the top of lengthy SLP waiting lists often received limited services, particularly in rural areas. To facilitate children receiving speech intervention remotely during the COVID-19 pandemic, evidence from randomized controlled trials regarding three technological solutions are examined: (a) Phoneme Factory Sound Sorter (Sound Start Study), (b) Waiting for Speech Pathology website, and (c) Apraxia World. Conclusions For the first two technological solutions, there were similar gains in speech production between the intervention and control groups, whereas, for the third solution, the average magnitude of treatment effect was comparable to face-to-face SLP therapy. Automated therapy management systems may be able to accelerate speech development and support communication resilience to counteract the effects of the COVID-19 restrictions on children with speech sound disorders. Technology-based strategies may also provide a potential solution to the chronic shortage of SLP services in rural areas into the future.

Effectiveness of Speech Intervention in Patients With a Cleft Palate: Comparison of Motor-Phonetic Versus Linguistic-Phonological Speech Approaches

Purpose The purpose of this study was to compare the effect of two different speech therapy approaches, a traditional motor-phonetic approach and a linguistic-phonological approach, on the speech and health-related quality of life in Dutch-speaking children with a cleft palate with or without a cleft lip (CP ± L) between 4 and 12 years old. Method A block-randomized, sham-controlled design was used. Fourteen children with a CP ± L ( M age = 7.71 years) were divided into two groups using block randomization stratified by age and gender: one receiving motor-phonetic intervention ( n = 7) and one receiving linguistic-phonological intervention ( n = 7). Each group received 10 hr of speech therapy divided over 2 weeks. Perceptual speech assessments were performed on several baseline and posttreatment data points. The psychosocial effects of the intervention were assessed using the patient-reported Velopharyngeal Insufficiency Effects on Life Outcomes questionnaire. Both groups were compared over time using (generalized) linear mixed models. Within-group effects of time were determined using pairwise comparisons with post hoc Bonferroni correction. Results Significant Time × Group interactions with large effect sizes were revealed in terms of consonant proficiency, indicating significant differences in evolution over time among the two groups. Only in the group receiving linguistic-phonological intervention, percentage of correctly produced consonants and places significantly improved after the treatment. Total Velopharyngeal Insufficiency Effects on Life Outcomes scores of the parents significantly improved in both groups after the intervention. Conclusions Both motor-phonetic and linguistic-phonological speech interventions can have a positive impact on the occurrence of cleft speech characteristics and consonant proficiency in children with a CP ± L. A linguistic-phonological approach, however, was observed to be more effective in terms of improving these speech outcomes compared with a motor-phonetic approach. Speech intervention, irrespective of the used approach, significantly improved the participant's health-related quality of life.