Influence of timing of delayed hard palate closure on articulation skills in 3‐year‐old Danish children with unilateral cleft lip and palate

Willadsen, Elisabeth; Boers, Maria; Schöps, Antje; Kisling-Møller, Mia; Nielsen, Joan Bogh; Jørgensen, Line Dahl; Andersen, Mikael; Bolund, S.; Andersen, Helene Søgaard

doi:10.1111/1460-6984.12331

Cited by 19 publications

(12 citation statements)

References 51 publications

(150 reference statements)

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“…Despite this, they still had poorer articulation skills than children in arm A in center 1. This finding indicates that delaying hard palate closure (arm B) until 3 years of age still has a negative effect on the developing phonological system at age 5 as previously demonstrated (Willadsen et al, 2018). The importance of this finding is underlined by the present and previous findings that children with UCLP have poorer articulation skills than children without CP (Lohmander and Persson, 2008; Klintö et al, 2014a).…”

Section: Discussionsupporting

confidence: 78%

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

Willadsen

Lohmander

Persson

et al. 2019

The Cleft Palate Craniofacial Journal

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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.

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Section: Discussionsupporting

confidence: 78%

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

Willadsen

Lohmander

Persson

et al. 2019

The Cleft Palate Craniofacial Journal

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“…This is in line with the findings of Peterson-Falzone 36 and Willadsen, Boers, Schöps, Kisling-Møller, Nielsen, Jørgensen. 37 This study showed that surgery outcomes using different surgical protocols achieved similar GOSLON ratings. 38 The UPFCD clinic displayed good treatment outcomes comparable to those of the CCUK cohort and the Americleft Study Centre C. This study outcome suggests that the clinical treatment protocol at UPFCD is an effective strategy for treating patients with UCLP regarding favourable maxillary development.…”

Section: Treatment Outcome Auditmentioning

confidence: 60%

Primary surgery effect on dental arch relationships of patients born with unilateral cleft lip and palate using the GOSLON yardstick index

Ghabrial

Plessis³

2021

S. Afr. dent. j.

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To score dental arch development using the Great Ormond Street, London, and Oslo (GOSLON) yardstick index, following primary surgery in patients with a complete unilateral cleft lip and palate (UCLP), and to compare the outcome score with the GOSLON score of Cleft Care UK (CCUK) as well as with the Clinical Standards Advisory Group (CSAG), United Kingdom.Study models of patients (average age 12 years) with a non-syndromic complete UCLP, who had been surgically treated at the University of Pretoria Facial Cleft Deformity (UPFCD) clinic. They were assessed using the GOSLON yardstick index by certified raters from the Dental School in Dundee, Scotland. The mean outcome ratings were calculated from the scoring of 27 sets of plaster models. The other scoring rounds were used to calculate intraand inter-observer agreement using Cohen's weighted kappa and Fleiss's multi-rater kappa. There were strong intra- and inter-observer agreement, with a weighted kappa of 0.92. The Facial Cleft Deformity (FCD) clinic data showed a good treatment outcome with a mean GOSLON rating of 2.85 compared to a rating of 3.2 for the CSAG and 2.62 for the CCUK cohort studies. The UPFCD clinic primary surgical protocol displayed a good treatment outcome rating, in line with that of the CCUK cohort and better than the CSAG results.

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“…Several studies reported on both cleft and developmental phonological processes (Willadsen et al . , Chacon et al . , Klintö et al .…”

Section: Resultsmentioning

confidence: 99%

“…Several studies reported on both cleft and developmental phonological processes (Willadsen et al 2018, Chacon et al 2017, Klintö et al 2014a, 2014b, Willadsen 2012, Konst et al 2003, Morris and Ozanne 2003, Hutters et al 2001). This provides a broader perspective of an individual's phonological development from both a cleft and developmental perspective.…”

Section: Swedenmentioning

confidence: 99%

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

Fitzpatrick

Coad

Sell

et al. 2020

Intl J Lang & Comm Disor

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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.

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Influence of timing of delayed hard palate closure on articulation skills in 3‐year‐old Danish children with unilateral cleft lip and palate

Cited by 19 publications

References 51 publications

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

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

Primary surgery effect on dental arch relationships of patients born with unilateral cleft lip and palate using the GOSLON yardstick index

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

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