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

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Background: Increasing attention is paid to the effectiveness of high-intensity speech intervention in children with a cleft (lip and) palate (CP±L). It is, however, unknown if high-intensity intervention is acceptable to the intervention recipients. Parents have an integral role in supporting their children with intervention highlighting the importance of intervention acceptability to parents. Aims: To compare the retrospective acceptability of high-intensity speech intervention (10 1-hr speech therapy sessions divided over 2 weeks) with the retrospective acceptability of low-intensity speech intervention (10 1-hr speech therapy sessions divided over 10 weeks) for children with a CP±L from the parents' point of view. Methods & Procedures: Twelve parents of 12 children, aged 6-0 years who received high-intensity speech intervention (n = 6) or low-intensity speech intervention (n = 6), were invited to participate in this study. Seven parents (n = 3 in the high-intensity group and n = 4 in the low-intensity group) agreed to participate (total response rate: 7/12, 58.33%). A qualitative study design using semi-structured interviews was applied. To investigate the retrospective acceptability of the two intervention intensities, deductive coding according to the Theoretical Framework of Acceptability (TFA) was used.Outcomes & Results: With regard to the TFA construct 'affective attitude', results demonstrated that parents had positive feelings about the provided speech intervention regardless of the intensity. Parents of children who received high-intensity speech intervention reported two specific benefits related to the high intervention intensity: (1) it improved their relationship with the speech-language pathologist and (2) it improved their child's ability to make selfcorrections in his/her speech. Even though both high-intensive and low-intensity speech intervention were considered burdensome (TFA construct 'burden'), parents were less likely to drop out of high-intensity intervention because the total intervention period was kept short.

Section: Methodsmentioning

confidence: 99%

The retrospective acceptability of high intensity versus low intensity speech intervention in children with a cleft palate: A qualitative study from the parents’ point of view using the Theoretical Framework of Acceptability

Alighieri

Lierde

Cammu

et al. 2022

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“…By including additional strategies to stimulate their participation (e.g., parent reflection, role play, provision of real-time feedback from the SLP to the parents), parents can be more adequately deployed in the intervention process (Sugden et al, 2016). A recently performed randomized controlled trial, which investigated the effectiveness of two different speech therapy approaches in 14 children with a CP±L, suggested that the specific content of a therapy can influence parents' willingness to practice at home (Alighieri et al, 2020a). Findings of that study suggested that parents were more likely to practice at home when straightforward, easy and child-friendly games were provided rather than asking them to apply more complex techniques.…”

Section: Discussionmentioning

confidence: 99%

From excitement to self‐doubt and insecurity: Speech–language pathologists’ perceptions and experiences when treating children with a cleft palate

Alighieri

Bettens

Verhaeghe

et al. 2021

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Background: Speech disorders in children with a cleft palate with or without a cleft lip (CP±L) are complex given the magnitude of influencing factors. Providing intervention to eliminate these speech errors is often challenging. Speechlanguage pathologists (SLPs) might have negative perceptions of the treatment of children with a CP±L. Aims:To explore how community SLPs perceive and experience the provision of speech intervention to children with a CP±L.Methods & Procedures: A total of 18 female community SLPs, aged between 23 and 62 years, were included in this study. Semi-structured interviews were conducted. The interviews were analysed using an inductive thematic approach aiming to identify themes driven by the data. Trustworthiness of the data was achieved by including researcher triangulation (involving three researchers with different research backgrounds) and deviant case analysis of two cases.Outcomes & Results: Initial responses demonstrated that the community SLPs were excited and enthusiastic to treat children with a CP±L. Expanding on these initial reports, however, they revealed that their excitement turned into professional self-doubt and insecurity when confronted with the treatment challenges inherent with this population. To cope with this self-doubt, they outlined several responsibilities for the cleft team SLPs. They expressed a strong desire to receive confirmation and approval on their treatment practices from more experienced SLPs (i.e., the cleft team SLPs). Their perceptions were dominated by a polarized thinking pattern. Treatment approaches were divided in categories as 'right' or 'wrong' and 'good' or 'bad'. Conclusions & Implications:The community SLPs are lacking professional confidence when treating children with a CP±L. They put themselves in a subordinate position towards the cleft team SLPs and expect the latter to provide ready-made answers to problems and questions. This expectation can perhaps be explained by their fear of making mistakes during therapy preventing treatment progress. If they handle in accordance with the experts' advice, they cannot blame themselves in cases where no treatment progress is seen. Educational programmes need to pay more attention to gaining professional confidence (in

“…Internationally, there have been few studies that have addressed how dosage and frequency impacts speech intervention outcomes (Baker & McLeod, 2011;Cummings et al, 2020) and even fewer focusing on the dosage of intervention for children with CP±L (Alighieri et al, 2020). Alighieri et al (2020) compared the effects of a traditional motor-phonetic approach and a linguistic-phonological approach on the speech outcomes of children with CP±L aged 4-12 years old. Intervention was provided by a speech and language therapist with follow-up practice at home.…”

Section: Length Frequency and Duration Of Interventionmentioning

confidence: 99%

A systematic review of early speech interventions for children with cleft palate

Lane

Harding

Wren

2021

Background: Children with cleft palate with or without cleft lip (CP±L) are at high risk of problems with early speech sound production, and these difficulties can persist into later childhood. Early intervention could help to reduce the number of children whose problems become persistent. However, much research in the field to date has focused on older children. There is a need to determine if providing intervention during the phase of early typical speech development leads to better outcomes. Aims: To review the evidence for the effectiveness of interventions targeting speech, delivered in the first 3 years of life for children with CP±L, and discuss factors such as intervention type, facilitator, dosage, outcome measures and the age of the child. Methods & Procedures: The systematic review was registered with PROS-PERO (CRD42019121964). Eight bibliographic databases including CINAHL and MEDLINE were searched in August 2018. Studies were included if participants received speech and language interventions before 37 months and if they reported outcomes for speech. Two reviewers independently completed inclusion reviews, quality analysis and data extraction. Outcome & Results:The review included seven papers: one pilot randomized controlled trial, one controlled trial, four cohort studies and one case series report. Interventions largely took a naturalistic approach, namely focused stimulation and milieu teaching. The findings provide preliminary support for naturalistic interventions and suggest that these interventions can be delivered by parents with suitable training. Studies included in the review provided low-strength evidence with variation in both the type of intervention, the manner of delivery and in the risk of bias in the designs used. Conclusions & Implications:The papers included in this review suggest that early naturalistic interventions can have positive impacts on the speech development of children with CP±L. However, the reported methodological quality of the publications overall was weak, and the current evidence lacks clarity and specificity in terms of therapy technique, delivery and optimum age of delivery.Future research should use more robust methodological designs to determine whether early speech interventions are beneficial for children born with CP±L.