Developing a Novel Speech Intervention iPad Game for Children With Cleft Palate

Hsieh, Tsung Yen; Funamura, Jamie Lauren; Roth, Christina; Rubin, Zachary; Kurniawan, Sri; Tollefson, Travis Tate

doi:10.1001/jamafacial.2015.0164

Cited by 4 publications

(5 citation statements)

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“…This last research project extends from testing the effect of VPI surgery on QOL (as shown in this study) to include other factors in the entire care delivery process, such as compliance with follow-up, and availability of speech therapy. Currently the senior author is using the VELO instrument as a measure of the impact of augmenting speech therapy using iPad speech games for children in remote areas with obstacles to speech care …”

Section: Discussionmentioning

confidence: 99%

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Association of Velopharyngeal Insufficiency With Quality of Life and Patient-Reported Outcomes After Speech Surgery

Bhuskute

Skirko

Roth

et al. 2017

JAMA Facial Plast Surg

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IMPORTANCE Patients with cleft palate and other causes of velopharyngeal insufficiency (VPI) suffer adverse effects on social interactions and communication. Measurement of these patient-reported outcomes is needed to help guide surgical and nonsurgical care.OBJECTIVES To further validate the VPI Effects on Life Outcomes (VELO) instrument, measure the change in quality of life (QOL) after speech surgery, and test the association of change in speech with change in QOL. DESIGN, SETTING, AND PARTICIPANTSProspective descriptive cohort including children and young adults undergoing speech surgery for VPI in a tertiary academic center. Participants completed the validated VELO instrument before and after surgical treatment. MAIN OUTCOMES AND MEASURESThe main outcome measures were preoperative and postoperative VELO scores and the perceptual speech assessment of speech intelligibility. The VELO scores are divided into subscale domains. Changes in VELO after surgery were analyzed using linear regression models. VELO scores were analyzed as a function of speech intelligibility adjusting for age and cleft type. The correlation between speech intelligibility rating and VELO scores was estimated using the polyserial correlation.RESULTS Twenty-nine patients (13 males and 16 females) were included. Mean (SD) age was 7.9 (4.1) years (range, 4-20 years). Pharyngeal flap was used in 14 (48%) cases, Furlow palatoplasty in 12 (41%), and sphincter pharyngoplasty in 1 (3%). The mean (SD) preoperative speech intelligibility rating was 1.71 (1.08), which decreased postoperatively to 0.79 (0.93) in 24 patients who completed protocol (P < .01). The VELO scores improved after surgery (P<.001) as did most subscale scores. Caregiver impact did not change after surgery (P = .36). Speech Intelligibility was correlated with preoperative and postoperative total VELO score (P < .01) and to preoperative subscale domains (situational difficulty [VELO-SiD, P = .005] and perception by others [VELO-PO, P = .05]) and postoperative subscale domains (VELO-SiD [P = .03], VELO-PO [P = .003]). Neither the VELO total nor subscale score change after surgery was correlated with change in speech intelligibility.CONCLUSIONS AND RELEVANCE Speech surgery improves VPI-specific quality of life. We confirmed validation in a population of untreated patients with VPI and included pharyngeal flap surgery, which had not previously been included in validation studies. The VELO instrument provides patient-specific outcomes, which allows a broader understanding of the social, emotional, and physical effects of VPI.LEVEL OF EVIDENCE 2.

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Section: Discussionmentioning

confidence: 99%

“…Currently the senior author is using the VELO instrument as a measure of the impact of augmenting speech therapy using iPad speech games for children in remote areas with obstacles to speech care. 19…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Association of Velopharyngeal Insufficiency With Quality of Life and Patient-Reported Outcomes After Speech Surgery

Bhuskute

Skirko

Roth

et al. 2017

JAMA Facial Plast Surg

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“…Velopharyngeal insufficiency is the most common speech abnormality after cleft palate repair. Velopharyngeal Insufficiency results in poor speech intelligibility, which may further deteriorate the patient’s quality of life 8,9,30 . Patients with repaired cleft palates are evaluated for velopharyngeal function.…”

Section: Discussionmentioning

confidence: 99%

“…Velopharyngeal Insufficiency results in poor speech intelligibility, which may further deteriorate the patient’s quality of life. 8 , 9 , 30 Patients with repaired cleft palates are evaluated for velopharyngeal function. Speech evaluation should be primarily considered for VPI because it reflects the impact on social communication.…”

Section: Discussionmentioning

confidence: 99%

Deep Learning–Based Diagnostic System for Velopharyngeal Insufficiency Based on Videofluoroscopy in Patients With Repaired Cleft Palates

Ha,

Lee,

Kwon

et al. 2023

Journal of Craniofacial Surgery

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Velopharyngeal insufficiency (VPI), which is the incomplete closure of the velopharyngeal valve during speech, is a typical poor outcome that should be evaluated after cleft palate repair. The interpretation of VPI considering both imaging analysis and perceptual evaluation is essential for further management. The authors retrospectively reviewed patients with repaired cleft palates who underwent assessment for velopharyngeal function, including both videofluoroscopic imaging and perceptual speech evaluation. The final diagnosis of VPI was made by plastic surgeons based on both assessment modalities. Deep learning techniques were applied for the diagnosis of VPI and compared with the human experts’ diagnostic results of videofluoroscopic imaging. In addition, the results of the deep learning techniques were compared with a speech pathologist’s diagnosis of perceptual evaluation to assess consistency with clinical symptoms. A total of 714 cases from January 2010 to June 2019 were reviewed. Six deep learning algorithms (VGGNet, ResNet, Xception, ResNext, DenseNet, and SENet) were trained using the obtained dataset. The area under the receiver operating characteristic curve of the algorithms ranged between 0.8758 and 0.9468 in the hold-out method and between 0.7992 and 0.8574 in the 5-fold cross-validation. Our findings demonstrated the deep learning algorithms performed comparable to experienced plastic surgeons in the diagnosis of VPI based on videofluoroscopic velopharyngeal imaging.

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“…Lastly, there is an emerging role for technology in interdisciplinary, international cleft discussion forums and education. Examples of speech applications tailored to caring for CLP patients are yet another example [66]. Technology may also democratize education by breaking down language barriers across SSA.…”

Section: Cleft Care Barriers and Solutionsmentioning

confidence: 99%

Perspectives on the state of cleft lip and cleft palate patient care in Africa

Liu,

Manana,

Tollefson

et al. 2024

Current Opinion in Otolaryngology &Amp; Head &Amp; Neck Surgery

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Purpose of review As the most common congenital craniofacial defect, patients with cleft lip -palate (CLP) experience morbidity and social stigma, particularly in low-income and middle-income countries (LMICs) such as those of sub-Saharan Africa (SSA). Delays in treatment secondary either to lack of awareness, skills, equipment and consumables; poor health infrastructure, limited resources or a combination of them, has led to SSA having the highest rates of death and second highest rates of disability-adjusted life years in patients with CLP globally. Here we review current perspectives on the state of comprehensive cleft lip and palate repair in Africa. Recent findings To bridge gaps in government health services, nongovernmental organizations (NGOs) have emerged to provide care through short-term surgical interventions (STSIs). These groups can effect change through direct provision of care, whereas others strengthen internal system. However, sustainability is lacking as there continue to be barriers to achieving comprehensive and longitudinal cleft care in SSA, including a lack of awareness of CLP as a treatable condition, prohibitive costs, poor follow-up, and insufficient surgical infrastructure. With dedicated local champions, a comprehensive approach, and reliable partners, establishing sustainable CLP services is possible in countries with limited resources. Summary The replacement of CLP ‘missions’ with locally initiated, internationally supported capacity building initiatives, integrated into local healthcare systems will prove sustainable in the long-term.

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Developing a Novel Speech Intervention iPad Game for Children With Cleft Palate

Cited by 4 publications

References 8 publications

Association of Velopharyngeal Insufficiency With Quality of Life and Patient-Reported Outcomes After Speech Surgery

Association of Velopharyngeal Insufficiency With Quality of Life and Patient-Reported Outcomes After Speech Surgery

Deep Learning–Based Diagnostic System for Velopharyngeal Insufficiency Based on Videofluoroscopy in Patients With Repaired Cleft Palates

Perspectives on the state of cleft lip and cleft palate patient care in Africa

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