On the Benefits of Speech-Language Therapy for Individuals Born With Cleft Palate: A Systematic Review and Meta-Analysis of Individual Participant Data

Abstract

Purpose: Cleft lip and/or palate (CLP) is a common birth defect, and after reconstructive surgery, about 50% of children at 5 years of age have speech deviations and are referred to speech-language therapy (SLT). The peer-reviewed evidence for the benefit of SLT has been uncertain. Our objective was to systematically review and meta-analytically summarize the benefit of SLT for individuals born with CLP. Method: A systematic search was conducted (last search on February 19, 2021) on studies evaluating SLT with pre and post measures on speech production, language ability, intelligibility, and/or patient-reported outcomes. We sought individual participant data (IPD) and evaluated on an individual level if the outcome measure had improved to a clinically relevant degree during SLT and if the outcome measure was on a level with peers or not after SLT. Meta-analyses and meta-regressions were applied to synthesize IPD across studies. Results: Thirty-four eligible studies were found. Nineteen studies provided IPD ( n = 343) for the main analysis on speech production. The synthesized information suggests that, during SLT, speech production improved to a clinically relevant degree for many individuals (95% CI [61%, 87%]) and that speech production was on a level with peers for some individuals after SLT (95% CI [10%, 34%]). Conclusions: The main strength of this meta-analysis is that we evaluated on an individual level pre- and post-intervention data based on considerations of clinical relevance. This approach allowed us to conclude that many individuals benefit from SLT and that further work on evaluating SLT in this patient group is meaningful. Supplemental Material https://doi.org/10.23641/asha.17700992

Exploring Reliable and Identifiable Quantitative Anatomical, Timing, and Displacement Measures in the VFS of Speech

“…Patients with noncleft VPI had longer velum and longer lift times. This matches with what we see clinically, as noncleft VPI cases have not had surgery on their palate and tend to have more typical structural and muscular anatomy as their VPI may be neurological in nature 7,11 . Sustained closure during /s/ had moderate inter-rater reliability.…”

“…It is well understood that speech therapy intervention is required to correct the articulation and phonological components of the disordered speech of individuals identified as having “CP speech,” 11–13 however, the components of speech related to VPI, including hypernasal resonance and abnormal nasal air emission, often require surgical consideration to improve the speaker’s ability to achieve VP closure.…”

Scandcleft randomized trials of primary surgery for unilateral cleft lip and palate: Speech proficiency at 10 years of age

“…However, Sand et al. (2022) concluded that many individuals benefit from speech therapy, even though less than a third of the individuals’ speech production reached the level of their peers after speech therapy. Therefore, it is important to control for the number of speech therapy visits across arms and trials.…”

How acceptable is the use of linguistic–phonological intervention in children with cleft palate? A qualitative study in speech therapists

“…This evidence should not necessarily include randomized controlled trials with large sample sizes. A recently published systematic review and meta‐analysis called for more research on the individual level with an eye on considering clinically relevant improvements rather than statistical significance (Sand et al., 2022). This call opens some interesting perspectives for SLPs who are active in clinical practice.…”