Kristina Klintö

The impact of speech material on speech judgement in children with and without cleft palate

BACKGROUND The chosen method of speech assessment, including type of speech material, may affect speech judgement in children with cleft palate. AIM To assess the effect of different speech materials on speech judgement in 5-year-old children born with or without cleft palate, as well as the reliability of materials by means of intra- and inter-transcriber agreement of consonant transcriptions. METHODS & PROCEDURES Altogether 40 children were studied, 20 born with cleft palate, 20 without. The children were audio recorded at 5 years of age. Speech materials used were: single-word naming, sentence repetition (both developed for cleft palate speech assessment), retelling of a narrative and conversational speech. The samples were phonetically transcribed and inter- and intra-transcriber agreement was calculated. Percentage correct consonants (PCC), percentage correct places (PCP), percentage correct manners (PCM), and percentage active cleft speech characteristics (CSC) were assessed. In addition, an analysis of phonological simplification processes (PSP) was performed. OUTCOME & RESULTS The PCC and CSC results were significantly more accurate in word naming than in all other speech materials in the children with cleft palate, who also achieved more accurate PCP results in word naming than in sentence repetition and conversational speech. Regarding PCM and PSP, performance was significantly more accurate in word naming than in conversational speech. Children without cleft palate did better, irrespective of the speech material. The medians of intra- and inter-transcriber agreement were good in both groups and all speech materials. The closest agreement in the cleft palate group was seen in word naming and the weakest in the retelling task. CONCLUSION & IMPLICATIONS The results indicate that word naming is the most reliable speech material when the purpose is to assess the best speech performance of a child with cleft palate. If the purpose is to assess connected speech, sentence repetition is a reliable and also valid speech material, with good transcriber agreement and equally good articulation accuracy as in retelling and conversational speech. For typically developing children without a cleft palate, the chosen speech material appears not to affect speech judgement.

Phonology in Swedish-speaking 3-year-olds born with cleft lip and palate and the relationship with consonant production at 18 months.

BACKGROUND Approximately 50% of children born with cleft palate present speech difficulties around 3 years of age, and several studies report on persisting phonological problems after palatal closure. However, studies on early phonology related to cleft palate are few and have so far mainly been carried out on English-speaking children. Studies on phonology related to cleft palate in languages other than English are also warranted. AIMS To assess phonology in Swedish-speaking children born with and without unilateral cleft lip and palate (UCLP) at 3 years of age, and to identify variables at 18 months that are associated with restricted phonology at age 3 years. METHODS & PROCEDURES Eighteen consecutive children born with UCLP and 20 children without cleft lip and palate were included. Transcriptions of audio recordings at 18 months and 3 years were used. Per cent correct consonants adjusted for age (PCC-A), the number of established phonemes, and phonological simplification processes at 3 years were assessed and compared with different aspects of consonant inventory at 18 months. OUTCOMES & RESULTS PCC-A, the number of established phonemes, and the total number of phonological processes differed significantly at 3 years between the two groups. Total number of oral consonants, oral stops, dental/alveolar oral stops and number of different oral stops at 18 months correlated significantly with PCC-A at 3 years in the UCLP group. CONCLUSIONS & IMPLICATIONS As a group, children born with UCLP displayed deviant phonology at 3 years compared with peers without cleft lip and palate. Measures of oral consonant and stop production at 18 months might be possible predictors for phonology at 3 years in children born with cleft palate.

Speech and Phonology in Swedish-Speaking 3-Year-Olds with Unilateral Complete Cleft Lip and Palate Following Different Methods for Primary Palatal Surgery

Objective To describe and compare speech and phonology at age 3 years in children born with unilateral complete cleft lip and palate treated with three different methods for primary palatal surgery. Design Prospective study. Setting Primary care university hospitals. Participants Twenty-eight Swedish-speaking children born with nonsyndromic unilateral complete cleft lip and palate. Interventions Three methods for primary palatal surgery: two-stage closure with soft palate closure between 3.4 and 6.4 months and hard palate closure at mean age 12.3 months (n = 9) or 36.2 months (n = 9) or one-stage closure at mean age 13.6 months (n = 10). Main Outcome Measures Based on independent judgments performed by two speech-language pathologists from standardized video recordings: percent correct consonants adjusted for age, percent active cleft speech characteristics, total number of phonological processes, number of different phonological processes, hypernasality, and audible nasal air leakage. The hard palate was unrepaired in nine of the children treated with two-stage closure. Results The group treated with one-stage closure showed significantly better results than the group with an unoperated hard palate regarding percent active cleft speech characteristics and total number of phonological processes. Conclusions Early primary palatal surgery in one or two stages did not result in any significant differences in speech production at age 3 years. However, children with an unoperated hard palate had significantly poorer speech and phonology than peers who had been treated with one-stage palatal closure at about 13 months of age.

Phonology in Swedish-speaking 5-year-olds born with unilateral cleft lip and palate and the relationship with consonant production at 3 years of age

Abstract Purpose: At ∼3 years of age ∼50% of the children born with cleft palate present with phonological/articulatory difficulties. Differences between children with and without cleft palate have been reported to decline with age; however, the phonology in children with cleft palate at pre-school age/early school age has rarely been explored. The purpose of this study was to assess phonology in children with unilateral cleft lip and palate (UCLP) at age 5 and its relationship with performances at 3 years of age. Method: The study included 29 children with UCLP and 20 without UCLP. Percentage correct consonants adjusted for age (PCC-A) and number of consistent phonological simplification processes were assessed from phonetic transcriptions. In addition, a descriptive analysis of phonological/articulatory processes was performed. Result: The children with UCLP displayed significantly lower PCC-A and more phonological processes at age 5 years than peers without UCLP. The correlations between the outcomes at 3 and 5 years of age were significant. Conclusion: Still at 5 years of age many children with cleft palate have phonological problems and it is possible to identify children at risk for impaired phonology at earlier age.

Verbal Competence in Narrative Retelling in 5-Year-Olds with Unilateral Cleft Lip and Palate.

BACKGROUND Research regarding expressive language performance in children born with cleft palate is sparse. The relationship between articulation/phonology and expressive language skills also needs to be further explored. AIMS To investigate verbal competence in narrative retelling in 5-year-old children born with unilateral cleft lip and palate (UCLP) and its possible relationship with articulation/phonology at 3 and 5 years of age. METHODS & PROCEDURES A total of 49 children, 29 with UCLP treated according to three different procedures for primary palatal surgery and a comparison group of 20 children (COMP), were included. Longitudinally recorded audio files were used for analysis. At ages 3 and 5, the children were presented with a single-word test of word naming and at age 5 also the Bus Story Test (BST). The BST was assessed according to a test manual. The single-word test was phonetically transcribed and the percentage of consonants correct adjusted for age (PCC-A) was calculated. Differences regarding the BST results within the UCLP group were analysed. The results were compared with the results of the COMP group, and also with norm values. In addition, the relationship between the results of the BST and the PCC-A scores at ages 3 and 5 years was analysed. OUTCOMES & RESULTS No significant group differences or correlations were found. However, 65.5% of the children in the UCLP group had an information score below 1 standard deviation from the norm value compared with 30% in the COMP group. CONCLUSIONS A larger proportion of children in the UCLP group than in the COMP group displayed problems with retelling but the differences between the two groups were not significant. There was no association between the BST results in the children with UCLP and previous or present articulatory/phonological competence. Since group size was small in both groups, the findings need to be verified in a larger study.

Phonology in Swedish-speaking 3-year-olds born with unilateral cleft lip and palate treated with palatal closure in one or two stages

Abstract Background: Phonological disorders are common in 3-year-olds born with cleft palate compared to non-cleft peers. However, published results have been based on small samples. The purpose was to expand the knowledge on phonology of Swedish-speaking 3-year-olds with unilateral cleft lip and palate (UCLP), treated with primary palatal closure in one or two stages. Methods: The phonology of 26 children with UCLP was assessed with percentage consonants correct adjusted for age (PCC-A) and number of consistent phonological simplification processes (NCP) at age 3. Fifteen of the children were treated with minimal incision technique in one stage (OS) at 13 months and 11 with a two-stage closure (TS) with soft palate repair at 4 months and hard palate repair at 12 months. Their results were compared and then merged with previously obtained data from 10 children treated with OS and nine children treated with TS. Finally, the merged results were compared with those of 20 peers without UCLP. Results: No significant differences between the first two groups were found. In the merged results, NCP in the OS group was significantly lower than in the TS group. The UCLP group displayed significantly poorer results on PCC-A and NCP than peers without UCLP. Conclusion: Surgical procedure did not have a clear impact on phonology at age 3 years. Since children with UCLP are at risk of having impaired phonology at age 3, the results confirm the necessity of having both a phonological and articulatory approach when assessing and treating children born with cleft palate.

Speech in 5-Year-Olds With Cleft Palate With or Without Cleft Lip Treated With Primary Palatal Surgery With Muscle Reconstruction According to Sommerlad

Objective: To evaluate speech in 5-year-olds with cleft palate with or without cleft lip (CP±L) treated with primary palatal surgery in 1 stage with muscle reconstruction according to Sommerlad at about 12 months of age. Design: Retrospective study. Setting: Primary care university hospital. Participants: Eight 5-year-olds with cleft soft palate (SP), 22 with cleft soft/hard palate (SHP), 33 with unilateral cleft lip and palate, and 17 with bilateral CLP (BCLP). Main Outcome Measures: Percent oral consonants correct (POCC), percent consonants correct adjusted for age (PCC-A), percent oral errors, percent nonoral errors, and variables related to velopharyngeal function were analyzed from assessments of audio recordings by 3 independent speech-language pathologists. Results: The median POCC was 75.4% (range: 22.7%-98.9%), median PCC-A 96.9% (range: 36.9%-100%), median percent oral errors 3.4% (range: 0%-40.7%), and median percent nonoral errors 0% (range: 0%-20%), with significantly poorer results in children with more extensive clefts. The SP group had significantly less occurrence of audible nasal air leakage than the SHP and the BCLP groups. Before age 5 years, 1.3% of the children underwent fistula surgery and 6.3% secondary speech improving surgery. At age 5 years, 15% of the total group was perceived as having incompetent velopharyngeal function. Conclusions: Speech was poorer in many children with more extensive clefts. Children with CP±L had poorer speech compared to normative data of peers without CP±L, but the results indicated relatively good speech compared to speech of children with CP±L in previous studies.

Problems With Reliability of Speech Variables for Use in Quality Registries for Cleft Lip and Palate—Experiences From the Swedish Cleft Lip and Palate Registry

Objective: To test the reliability of the speech data in the Swedish quality registry for cleft lip and palate. Design: Retrospective study. Setting: Primary care university hospital. Participants: Ninety-four children born with cleft palate with or without cleft lip between 2005 and 2009 who had been assessed and registered in the quality registry at the age of 5 years. Main Outcome Measures: Data in the registry on percent oral consonants correct, percent oral errors, percent nonoral errors, perceived velopharyngeal function (PVPF), and intelligibility were compared with results based on reassessments by 3 independent raters from audio recordings. Agreement was calculated by the intraclass correlation coefficient (ICC), quadratic weighted kappa, and percentage agreement. Results: Absolute agreement calculated by average measures ICC for percent oral consonants correct, percent oral errors, and percent nonoral errors was above >0.90. Single measures ICC for percent oral consonants correct was 0.82, for percent oral errors 0.69, and for percent nonoral errors 0.83. The kappa coefficient for PVPF was 0.5 to 0.59 and for intelligibility 0.65 to 0.77. Exact percentage agreement for PVPF was 33% and for intelligibility 47.8%. Conclusions: The data on oral consonants correct and nonoral errors in the quality registry seem to be reliable. The data on oral errors, PVPF, and intelligibility should be interpreted with caution. If differences among treatment centers are detected, one should go back and examine the collected raw data before drawing any definitive conclusions about treatment outcome.

Does the recording medium influence phonetic transcription of cleft palate speech

BACKGROUND In recent years, analyses of cleft palate speech based on phonetic transcriptions have become common. However, the results vary considerably among different studies. It cannot be excluded that differences in assessment methodology, including the recording medium, influence the results. AIMS To compare phonetic transcriptions from audio and audio/video recordings of cleft palate speech by means of outcomes of per cent correct consonants (PCC) and differences in consonant transcriptions. METHODS & PROCEDURES Thirty-two 3-year-olds born with cleft palate were audio and audio/video recorded while performing a single-word test by picture naming. The recordings were transcribed according to the International Phonetic Alphabet. The transcriptions from the audio and the audio/video recordings were analysed with regard to PCC, differences in the use of phonetic consonant symbols and the use of diacritics. OUTCOMES & RESULTS PCC was higher when the calculation was based on transcriptions from audio recordings than when based on audio/video recordings. No such differences were seen when age-appropriate consonant processes were scored as correct. Consonants were not excluded as often in the transcriptions from audio/video recordings as they were in the transcriptions from audio recordings, and more target consonants were transcribed as dental/alveolar in the transcriptions from audio/video recordings and palatal/velar/uvular in the transcriptions from audio recordings than vice versa. Further, interdental articulation, linguolabial articulation and audible nasal air leakage were more common in the transcriptions from audio/video recordings than in those from audio recordings. All these differences were statistically significant. CONCLUSIONS & IMPLICATIONS Phonetic transcription is influenced to some extent by visual cues. However, as long as age-appropriate articulatory and phonological simplification processes are scored as correct when evaluating consonant production in the speech of young children born with cleft palate using phonetic transcription, the recording medium does not seem to affect the results.

Subjective outcomes after treatment for velopharyngeal dysfunction

Abstract Background: Velopharyngeal dysfunction (VPD) can have various causes and may be a significant disability for the affected patient. Treatment options include surgery and speech therapy, but the success rates are often inconsistent. Methods: In this study, self-assessment questionnaires were sent out to 222 Swedish patients with VPD. The questionnaire included questions about satisfaction with speech, perceived speech quality, perceived improvement from VPD-surgery, and/or speech therapy. Out of 117 (52.7%) respondents, 114 (51.4%) patients were included in the study. The participants were 7–71 years of age (median = 14 years), diagnosed with cleft palate, neurological/developmental delay, congenital hypernasality, or acquired VPD. All patients had previously undergone videofluoroscopy, and 61.4% had undergone VPD-surgery. Results: Seventy-one per cent of the patients perceived their speech to be normal or slightly deviant, but only 55% were satisfied with their speech. Sixty per cent of the operated on patients felt that the treatment had improved their speech much or very much, 10% thought that they had moderate improvement, and 30% stated that they had no or little improvement. Out of the patients that had received speech therapy, 41% felt that the treatment had improved their speech much or very much, 21% thought that they had moderate improvement, and 33% stated that they had no or little improvement. Conclusion: In conclusion, most patients with VPD in this study who underwent evaluation and treatment felt that surgery and speech therapy had improved their speech, but only about half of them were in the end satisfied with the quality of their speech.