Use of a Perceptual Evaluation Instrument to Assess the Effects of Infant Orthopedics on the Speech of Toddlers with Cleft Lip and Palate

Abstract

Objective

To investigate the effects of infant orthopedics (IO) administered in the first year of life on the speech characteristics of 2.5-year-old children with complete unilateral cleft lip and palate (UCLP) using a perceptual evaluation instrument with equal-appearing interval (EAI) scales.

Design

In a prospective randomized clinical trial (Dutchcleft), two groups of children with complete UCLP were followed longitudinally. One group received IO based on a modified Zurich approach (IO group), and the other group did not (non-IO group). The appliance was used until soft palate closure at age 12 months. Hard palate closure is delayed until 9 years of age.

Participants

Three groups of 2.5-year-old toddlers participated in this investigation: 10 IO, 10 non-IO, and 8 noncleft controls matched for age and socioeconomic status.

Method

Five trained listeners assessed the children's speech in a blinded perceptual rating procedure. They judged 13 specific speech characteristics and indicated their total impression of speech on EAI scales.

Results

The reliability and consistency of 11 of the rating scales was good. The intelligibility rating scale was the single speech characteristic that distinguished the IO group from the non-IO group; the IO group was judged to be superior. The cleft groups differed from the noncleft group on 9 of the 11 scales.

Conclusions

Evaluation of speech by means of the present newly developed perceptual rating instrument showed that the IO group obtained significantly higher ratings for intelligibility than the non-IO group. The groups did not differ regarding any of the other speech aspects.

Keywords

cleft lip and palate infant orthopedics perceptual rating scale randomized prospective clinical trial

References

Bokhout

Hofman

FXWM

van Limbeek

Kramer

G.J.C.

Prahl-Andersen

Increased caries prevalence in 2.5-year-old children with cleft lip and/or palate.

Eur J Oral Sci. 1996; 104: 518–522.

Bzoch

K.R.

Measurement and assessment of categorical aspects of cleft palate speech. In: Bzoch

K.R.

, ed. Communicative Disorders Related to Cleft Lip and Palate. Boston: Little, Brown; 1979.

Cohen

Statistical Power Analysis for the Behavioral Sciences. New York: Academic Press; 1977.

Dalston

R.M.

Marsh

J.L.

Vig

K.W.

Witzel

M.A.

Blumsted

R.M.

Minimal standards for reporting the results of surgery on patients with cleft lip and palate, or both: a proposal.

Cleft Palate J. 1988; 25: 3–7.

Estrem

Broen

P.A.

Early speech production of children with cleft palate.

J Speech Hear Res. 1989; 32: 12–23.

Eurocleft Speech Group: Bronsted

Grunwell

Henningson

Jansonius

Karling

Meijer

Ording

Sell

Wyatt

Vermeij-Zieverink

Cleft palate speech in a European perspective: Eurocleft Speech Project. In: Grunwell

, ed. Analysing Cleft Palate Speech. London: Whurr Publishers; 1993: 142–160.

Folkins

J.W.

Moon

J.B.

Approaches to the study of speech production. In: Bardach

Morris

H.L.

, eds. Multidisciplinary Management of Cleft Lip and Palate. Philadelphia: WB Saunders; 1990: 707–716.

Gnoinski

Infant orthopedics and later orthodontic monitoring for unilateral cleft lip and palate patients in Zurich. In: Bardach

Morris

H.L.

, eds. Multidisciplinary Management of Cleft Lip and Palate. Philadelphia: WB Saunders; 1990: 578–585.

Grunwell

Russell

Vocalisations before and after cleft palate surgery: a pilot study.

Br J Disord Comm. 1987; 22: 1–17.

10.

Harding

Grunwell

Characteristics of cleft palate speech.

Eur J Disord Comm. 1996; 31: 331–357.

11.

Hirschberg

Van Demark

D.R.

A proposal for standardization of speech and hearing evaluations to assess velopharyngeal function.

Folia Phoniatr Logop. 1997; 49: 158–167.

12.

Hotz

Gnoinski

Perko

Nussbaumer

Hof

Haubensak

The Zurich approach, 1964 to 1984. In: Hotz

Gnoinski

Perko

Nussbaumer

Hof

Haubensak

, eds. Early Treatment of Cleft Lip and Palate. Toronto: Hans Huber Publishers; 1986: 42–48.

13.

Huddart

A.G.

Presurgical orthopedic treatment in unilateral cleft lip and palate. In: Bardach

Morris

H.L.

, eds. Multidisciplinary Management of Cleft Lip and Palate. Philadelphia: WB Saunders; 1990: 574–578.

14.

Kazis

L.E.

Anderson

J.J.

Meenan

R.F.

Effect sizes for interpreting changes in health status.

Med Care. 1989; 27: 178–189.

15.

Kent

R.D.

Hearing and believing: some limits to the auditory-perceptual assessment of speech and voice disorders.

Am J Speech Lang Pathol. 1996; 5: 7–23.

16.

Konst

E.M.

Rietveld

Peters

Kuijpers-Jagtman

A.M.

Language skills of young children with unilateral cleft lip and palate following infant orthopedics: a randomized clinical trial.

Cleft Palate Craniofac J. 2003a; 40: 356–362.

17.

Konst

E.M.

Rietveld

Peters

Prahl-Andersen

Phonological development of toddlers with unilateral cleft lip and palate who were treated with and without infant orthopedics: a randomized clinical trial.

Cleft Palate Craniofac J. 2003b; 40: 32–39.

18.

Konst

E.M.

Weersink-Braks

Rietveld

Peters

An intelligibility assessment of toddlers with cleft lip and palate who received and did not receive presurgical infant orthopedic treatment.

J Commun Disord. 2000; 33: 483–501.

19.

Konst

E.M.

Weersink-Braks

Rietveld

Peters

H.F.M.

Prelexical development of unilateral cleft lip and palate babies with reference to presurgical infant orthopaedics: a randomized prospective clinical trial.

Clin Linguist Phon. 1999; 13: 395–407.

20.

Kreiman

Gerratt

B.R.

Kempster

G.B.

Erman

Berke

G.S.

Perceptual evaluation of voice quality: review, tutorial, and a framework for future research.

J Speech Hear Res. 1993; 36: 21–40.

21.

Lubit

E.C.

Cleft palate orthopedics: why, when, how.

Am J Orthod. 1976; 69: 562–571.

22.

McNeil

C.K.

Congenital oral deformities.

Br Dent J. 1956; 18: 191–198.

23.

McWilliams

B.J.

Morris

H.L.

Shelton

R.L.

Cleft Palate Speech. Philadelphia: BC Decker Inc.; 1984.

24.

Morley

M.E.

Cleft Palate and Speech. Edinburgh: Livingstone; 1970.

25.

O'Gara

M.M.

Logemann

J.A.

Phonetic analyses of the speech development of babies with cleft palate.

Cleft Palate J. 1988; 25: 122–134.

26.

Oliver

H.T.

Neonatal orthodontics.

Trans Eur Orthod Soc. 1973; 562–563.

27.

Prahl

Kuijpers-Jagtman

A.M.

Van't Hof

M.A.

Prahl-Andersen

A randomised prospective clinical trial into the effects of infant orthopaedics on maxillary arch dimensions in unilateral cleft lip and palate (Dutchcleft).

Eur J Oral Sci. 2001; 109: 297–305.

28.

Preminger

J.E.

Van Tasell

D.J.

Quantifying the relation between speech quality and speech intelligibility.

J Speech Hear Res. 1995; 38: 714–725.

29.

Pruzansky

Pre-surgical orthopedics and bone grafting for infants with cleft lip and palate: A dissent.

Cleft Palate J. 1964; 1: 164–186.

30.

Rietveld

van Hout

Statistical Techniques for the Study of Language and Language Behaviour. Berlin/New York: Mouton de Gruyter; 1993.

31.

Schiavetti

Scaling procedures for the measurement of speech intelligibility. In: Kent

R.D.

, ed. Intelligibility in Speech Disorders. Amsterdam/Philadelphia: John Benjamins Publishing Co.; 1992: 11–34.

32.

Schlichting

JEPT

van Eldik

M.C.M.

Lutje Spelberg

H.C.

van der Meulen

S.J.

van der Meulen

B.F.

Schlichting test voor Taalproductie. Nijmegen: Berkhout Nijmegen BV; 1995.

33.

Sell

Grunwell

Mildinhall

Murphy

Cornish

T.A.O.

Bearn

Shaw

W.C.

Murray

J.J.

Williams

A.C.

Sandy

J.R.

Cleft lip and palate care in the United Kingdom—the clinical standards advisory group (CSGG) study. Part 3: speech outcomes.

Cleft Palate Craniofac J. 2001; 38: 30–37.

34.

Sell

Harding

Grunwell

A screening assessment of cleft palate speech (Great Ormond Street Speech Assessment).

Eur J Disord Commun. 1994; 29: 1–16.

35.

Severens

J.L.

Konst

E.M.

Prahl

Principes van kosten-effectiviteitsanalyse bij stem-, spraak-en taalstoornissen.

Stem Spraak Taalpath. 1998; 7: 158–167.

36.

Shaw

W.C.

Semb

Nelson

Brattström

Mølsted

Prahl-Andersen

The Eurocleft Project 1996-2000. Amsterdam/Berlin: IOS Press; 2000.

37.

Smith

The emergent lexicon from a phonetic perspective. In: Smith

M.D.

Locke

J.L.

, eds. The Emergent Lexicon: The Child's Development of a Linguistic Vocabulary. San Diego: Academic Press; 1988: 75–106.

38.

Smith

B.L.

Oller

D.K.

A comparative study of pre-meaningful vocalizations produced by normally developing and Down's syndrome infants.

J Speech Hear Disord. 1981; 46: 46–51.

39.

Stengelhofen

Nature and causes of communication difficulties. In: Stengelhofen

, ed. Cleft Palate: Nature and Remediation of Communication Problems. Edinburgh: Churchill Livingstone; 1989.

40.

Stevens

S.S.

Psychophysics. New York: Wiley; 1975.

41.

Stoel-Gammon

Phonetic inventories, 15–24 months: a longitudinal study.

J Speech Hear Res. 1985; 28: 505–512.

42.

Stuffins

G.M.

Speech and mental attitudes in the older presurgical child. In: Kehrer

Slingo

Graf

Bettex

, eds. Long Term Treatment in Cleft Lip and Palate. Proceedings of the First International Symposium. Bern: Hans Huber Publishers; 1981: 199–206.

43.

Van Erp

A.J.M.

The Phonetic Basis of Personality Ratings, with Special Reference to Cleft Palate Speech. Leidschendam: Royal PTT Nederland; 1991.

44.

Wyatt

Sell

Russell

Harding

Harland

Albery

Cleft palate speech dissected: a review of current knowledge and analysis.

Br J Plast Surg. 1996; 49: 143–149.

45.

Zraick

R.I.

Liss

J.M.

A comparison of equal-appearing interval scaling and direct magnitude estimation of nasal voice quality.

J Speech Lang Hear Res. 2000; 43: 979–988.