Sue E Roulstone

Speech and Language Therapy Interventions for Children With Cleft Palate: A Systematic Review

Objective (1) To examine the evidence for the effectiveness of differences in timing and type of speech and language therapy for children with cleft palate with or without a cleft lip and (2) to identify types of interventions assessed. Design Nine databases, including MEDLINE and EMBASE, were searched between inception and March 2011 to identify published articles relating to speech and language therapy for children with cleft palate with or without cleft lip. Studies that included at least 10 participants and reported outcome measures for speech and/or language measures were included. Studies where the experimental group had less than 90% of children with cleft palate with or without cleft lip were excluded. Two reviewers independently completed inclusion assessment, data extraction, and risk of bias assessment for all studies identified. Results A total of 17 papers were evaluated: six randomized control trials and 11 observational studies. Studies varied widely on risk of bias, intervention used, and outcome measures reported. None of the studies had a low risk of bias. In terms of intervention approaches, seven studies evaluated linguistic approaches and 10 evaluated motor approaches. Outcomes measures did not support either approach over the other, and based on data reported it was difficult to ascertain which approach is more effective for children with cleft palate with or without cleft lip. Conclusions The review found little evidence to support any specific intervention. Key uncertainties need to be identified and adequately powered, methodologically rigorous studies conducted to provide a secure evidence base for speech-language therapy practice in children with cleft palate with or without cleft lip.

Predictors and outcomes of speech and language therapists' treatment decisions

This study investigated predictors of decisions made by speech and language therapists (SLTs) to offer intervention for pre-school children and the childrens outcomes relative to that decision. The study uses data from 347 children who were first assessed aged under 3 years 6 months by community speech and language therapists in the UK. Of these, 158 were offered therapy, 189 were either discharged or offered only monitoring appointments. After adjusting for the childs age and gender, six variables were significantly associated with the therapists original decision: being a quiet baby, not using two word utterances or making comments on their play, being unintelligible to strangers and the childs score on auditory comprehension and expressive language scales of the Preschool Language Scales (PLS-3). These show a focus on communication variables rather than broader demographic and medical variables. At follow-up, aged 7 – 9 years, 56% of the children were available for re-assessment. Therapists decisions at initial assessment show a sensitivity of .85 and a specificity of .61 relative to childrens outcomes. Of the 191 children seen at follow-up, 21 were deemed to have ongoing difficulties.