Assessing speech at three years of age in the cleft palate population: a scoping review of assessment practices

Abstract

Background There is no consensus in the UK regarding the types of speech samples or parameters of speech that should be assessed at 3 years of age in children with cleft palate ± cleft lip (CP±L), despite cleft units routinely assessing speech at this age. The standardization of assessment practices would facilitate comparisons of outcomes across UK cleft units; earlier identification of speech impairments—which could support more timely treatments; and more reliable recording of therapy impacts and surgical interventions. Aims To explore assessment practices used to assess speech in 3‐year‐old children with CP±L, including speech parameters, methods of assessment and the nature of the speech sample used. Methods & Procedures A broad examination of the literature was undertaken through the use of a scoping review conducted in accordance with Joanna Briggs Institute guidelines. Search terms were generated from a preliminary search and then used in the main search (Medline, CINAHL, Embase, AMED and PsycINFO). Main Contribution A combination of approaches (medical, linguistic, developmental and functional) is required to assess CP±L speech at age 3. A developmental approach is recommended at this age, considering the complexity of speech profiles at age 3, in which typically developing speech processes may occur alongside cleft speech characteristics. A combined measure for both nasal emission and turbulence, and an overall measure for velopharyngeal function for speech, show potential for assessment at this age. Categorical ordinal scales are frequently used; the use of continuous scales has yet to be fully explored at age 3. Although single‐word assessments, including a subset of words developed for cross‐linguistic comparisons, are frequently used, more than one type of speech sample may be needed to assess speech at this age validly. The lack of consensus regarding speech samples highlights a need for further research into the types of speech samples 3‐year‐olds can complete; the impact of incomplete speech samples on outcome measures (particularly relevant at this age when children may be less able to complete a full sample); the impact of different speech samples on the validity of assessments; and the reliability of listener judgements. Conclusions & Implications Whilst a medical model and linguistic approaches are often central in assessments of age‐3 cleft speech, this review highlights the importance of developmental and functional approaches to assessment. Cross‐linguistic single‐word assessments show potential, and would facilitate the comparison of UK speech outcomes with other countries. Further research should explore the impact of different speech samples and rating scales on assessment validity and listener reliability.

“Is there a relationship between palatal asymmetry and early speech outcomes in children with isolated cleft palate after double opposing Z-plasty?”

“…Considering incomplete speech development at the preschool age, samples mainly consisting of single sounds, rather than continuous sentences, were used by a single experienced speech pathologist in our study. 25 In addition, speech was assessed in a categorical manner instead of numerical scales. Articulation error (expressed as a percentage of peer average) was also excluded from our analysis because it is associated with language development and thus needs follow-up evaluation.…”

Subjective and Objective Evaluation of Speech in Adult Patients with Unrepaired Cleft Palate

“…This is consistent with the findings of preoperatively juvenile cleft palate patients. 30 32 Rhinomanometry which is considered the best modality for objective evaluation of nasal emission in cleft patients and is widely used in otorhinolaryngology in China. In the future, we will consider this instrument in the objective evaluation of nasality and nasal emission.…”

Exploration of the Utility of the Generic ICHOM Standard Set Measures in Evaluating the Speech of Patients with Cleft Lip/Palate

“…The CAPS-A-AM subcomponents related to velopharyngeal function are “hypernasality,” which is scored on a five-point ordinal scale (0–4), and “audible nasal emission (and/or turbulence),” scored on a three-point ordinal scale (0–3). 23 Of note, audible nasal emissions can also be caused by unrepaired oronasal fistulas in addition to velopharyngeal incompetence, but the scale is agnostic to etiology.…”