Stages in the Development and Validation of a Belgian Dutch Outcome Tool for the Perceptual Evaluation of Speech in Patients With Cleft Palate

Abstract

Objective: To develop and validate a Belgian Dutch outcome tool for the perceptual evaluation of speech in patients with cleft palate. Setting: Cleft palate team in a tertiary university hospital. Methods: The tool was based on the Cleft Audit Protocol for Speech–Augmented (John et al., 2006; Sell et al., 2009), with adaptations to some of the speech variables and the structured listening protocol. Following a preliminary listening experiment in phase 1, the tool was optimized. In the second phase, a listening experiment with 4 experienced listeners was set up to assess face validity, inter- and intrarater reliability and criterion validity. Results: Results of phase 1 indicated good to very good inter- and intrarater reliability for the majority of the speech variables, good discriminant validity, and varying sensitivity and specificity based on a comparison with nasalance values and the Nasality Severity Index 2.0 (criterion validity). Results of phase 2 showed good to very good interrater reliability for 5 of the 14 variables and good intrarater reliability in 3 of the 4 experienced listeners. Sensitivity and specificity were sufficient, except the specificity of the hypernasality judgments in comparison with the nasalance values of the oral text. Overall, listeners positively judged the face validity of the tool. Conclusion: The 2-phase evaluation indicated varying validity and reliability results. Future studies will aim to optimize validity and reliability of the developed tool based on adaptations to the listening protocol, the addition of speech variables, and the inclusion of a more elaborate training.

Clinical Application of a New Approach to Identify Oral–Nasal Balance Disorders Based on Nasalance Scores

“…These shortcomings should be taken into account in future research. Fortunately, a new Dutch assessment protocol for the perceptual evaluation of speech in patients with cleft palate was recently developed and introduced in our clinical and research practice (Bruneel et al, in submission). This will result in the availability of a more standardized and comprehensive data collection for future research.…”

Achieving the next level in cleft speech intervention: A protocol of a randomized sham‐controlled trial to provide guidelines for a personalized approach in children with cleft palate

“…The raters would not provide speech therapy to any of the included patients and were blinded to the treatment allocation of the children. A structured listening protocol was used for the perceptual analysis of the speech samples as extensively described by our group (Bruneel et al., 2020). First, speech understandability was assessed based on the audio recordings of the child's spontaneous speech.…”

“…The speech sample consisted of spontaneous speech, automatic rote speech, sentences and words. This sample was constructed as part of a Dutch outcome tool for cleft palate speech (Bruneel et al., 2020) as per guidelines described by Henningsson et al. (2008).…”

“…The speech sample on the sentence and word level includes 13 sentences and 31 words targeting all the Dutch pressure consonants in possible positions (i.e., /p/, /b/, /t/, /d/, /s/, /z/, /ʃ/, /ʒ/, /f/, /v/, /k/, /x/, /ɣ/). Besides these 13 target high‐pressure consonants, the speech sample on the sentence level includes three additional sentences with s‐clusters (i.e., /st‐/, /sp‐/, /‐ks/) (Bruneel et al., 2020).…”

“…The speech sample consisted of spontaneous speech, automatic rote speech, sentences and words. This sample was constructed as part of a Dutch outcome tool for cleft palate speech (Bruneel et al, 2020) as per guidelines described by Henningsson et al (2008). The spontaneous speech sample was collected by asking participants to tell something about the holidays, their interests, etc.…”