Timing of Palatal Surgery and Speech Outcome
01 May 2008-The Cleft Palate-Craniofacial Journal (American Cleft Palate Craniofacial Association)-Vol. 45, Iss: 3, pp 297-308
TL;DR: The findings suggested that children who were less lexically advanced and younger at the time of palatal surgery exhibited better articulation and resonance outcomes at 3 years of age.
Abstract: Objective: To examine the impact of age and lexical status at the time of primary palatal surgery on speech outcome of preschoolers with cleft palate. Participants: Forty children (33 to 42 months) with nonsyndromic cleft palate participated in the study. Twenty children (Group 1) were less lexically advanced and younger (mean age = 11 months) and 20 children (Group 2) were more lexically advanced and older (mean age = 15 months) when palatal surgery was performed. Main Outcome Measures: Samples of the children's spontaneous speech were compared on 11 speech production measures (e.g., size of consonant inventory, total consonants correct, % correct for manner of articulation categories, compensatory articulation usage, etc.). Next, listeners rated a 30-second sample of each child's connected speech for articulation proficiency and hypernasality, separately, using direct magnitude estimation (DME). Results: Group differences were noted for 4 of the 11 speech production measures. Children in Gr...
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TL;DR: The senior surgeon's 29-year palatoplasty experience with respect to incidence of fistula and VPI was assessed, and the incidence of palatal fistula was low and Velopharyngeal insufficiency was associated with increasing age at pal atoplasty and with the Veau hierarchy.
Abstract: The primary objective of cleft palate repair is velopharyngeal competence without fistula. The reported incidence of fistula and velopharyngeal insufficiency (VPI) is variable. Our purpose was to assess the senior surgeon's 29-year palatoplasty experience with respect to incidence of fistula and VPI. Our hypotheses were that VPI is related to (1) age at palatoplasty, (2) cleft palate type, and (3) VPI and palatal fistula incidence decrease with the surgeon's experience. We reviewed the records of all children with cleft palate treated by the senior author between 1976 and 2004. Cleft palate was categorized according to Veau. Palatoplasty was performed on 449 patients, using a 2-flap technique with muscular retropositioning. The mean age at palatoplasty was 11.6 +/- 4.9 months (range, 7.0-46.4 months). The incidence of palatal fistula was 2.9%, and velopharyngeal sufficiency was found in 85.1% of patients. We found a significant association between age at palatoplasty and VPI (P = 0.009, odds ratio, 1.06 [95% confidence interval, 1.02-1.10]). Velopharyngeal insufficiency was also associated with the Veau hierarchy (P = 0.001). Incidence of VPI was independent of surgeon experience (P = 0.2). In conclusion, the incidence of palatal fistula was low. Velopharyngeal insufficiency was associated with increasing age at palatoplasty and with the Veau hierarchy.
131 citations
TL;DR: Long-term speech outcome in patients with two-stage palatoplasty with early soft palate repair was considered good and improved even before hard palate repair, implying good velopharyngeal competence.
Abstract: Objective: To investigate long-term, longitudinal speech outcome in patients born with unilateral cleft lip and palate treated according to a two-stage primary palatal protocol with early veloplasty and delayed hard palate closure. Design: Retrospective, longitudinal cohort study. Setting: A university hospital in western Sweden. Subjects: A consecutive series of 55 patients from the total cohort of 65 were included. All patients had surgical procedures at Sahlgrenska University Hospital, Gothenburg, Sweden. Methods: Standardized audio recordings were blindly analyzed at 5, 7, 16, and 19 years of age and after at a clinical visit at 10 years of age. Typical cleft speech variables were rated independently on ordinal scales. Intelligibility and perceived velopharyngeal function were assessed also. Prevalences of speech characteristics were determined, and interrater and intrarater agreement were calculated. Results: Prominent hypernasality, nasal air leakage, and retracted oral articulation at 5 years were ...
73 citations
TL;DR: For children older than 4 years, primary pharyngeal flap is also highly successful but equally so as a secondary operation and can be reserved, if necessary, following double-opposing Z-palatoplasty.
Abstract: Objective: Our purpose was to compare speech outcomes among three primary procedures for symptomatic submucous cleft palate (SMCP): two-flap palatoplasty with muscular retropositioning, double-opposing Z-palatoplasty, or pharyngeal flap. Design: Retrospective review. Setting: Tertiary hospital. Patients, Participants: All children with SMCP treated by the senior author between 1984 and 2008. Interventions: One of three primary procedures: two-flap palatoplasty with muscular retropositioning, double-opposing Z-palatoplasty, or pharyngeal flap. Main Outcome Measures: Speech outcome and need for a secondary operation were analyzed among procedures. Success was defined as normal or borderline competent velopharyngeal function. Failure was defined as persistent borderline insufficiency or velopharyngeal insufficiency with recommendation for a secondary operation. Results: We identified 58 patients with SMCP who were treated for velopharyngeal insufficiency. We found significant differences in median age at ope...
68 citations
Cites background from "Timing of Palatal Surgery and Speec..."
...This has been shown to be a critical age as velopharyngeal competence is attained more often in infants with CP (Veau I–IV) when the palate is repaired before 1 year of age (Dorf and Curtin, 1982; Marrinan et al., 1998; Rohrich et al., 2000; Chapman et al., 2008; Sullivan et al., 2009)....
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TL;DR: Word naming is the most reliable speech material when the purpose is to assess the best speech performance of a child with cleft palate and 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.
Abstract: 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.
66 citations
Cites background or methods from "Timing of Palatal Surgery and Speec..."
...Percentage compensatory articulation has been used as a measure by Chapman et al. (2008)....
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...8 Recent studies on cleft palate speech based on phonetic transcriptions usually report a transcriber agreement of about 80-90 % (Chapman and Hardin 1992, Morris and Ozanne 2003, Willadsen and Albrechtsen 2006, Chapman et al. 2008, Lohmander and Persson 2008)....
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...PCC in cleft palate speech has also been calculated based on different types of articulatory manners, such as stops, fricatives, nasals, affricates, liquids and glides (Morris and Ozanne 2003, Chapman et al. 2008)....
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...…cleft palate consonant articulation Rating has been a commonly used method to assess cleft palate speech (Lohmander and Olsson 2004), but in recent years phonetic transcription has become more common (Chapman and Hardin 1992, Morris and Ozanne 2003, Chapman et al. 2008, Lohmander and Persson 2008)....
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TL;DR: The comprehensive management of cleft lip and palate has received significant attention in the surgical literature over the last half century and there is significant phenotypic variation in the specific presentation of facial clefts.
65 citations
References
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01 Dec 1969TL;DR: The concepts of power analysis are discussed in this paper, where Chi-square Tests for Goodness of Fit and Contingency Tables, t-Test for Means, and Sign Test are used.
Abstract: Contents: Prefaces. The Concepts of Power Analysis. The t-Test for Means. The Significance of a Product Moment rs (subscript s). Differences Between Correlation Coefficients. The Test That a Proportion is .50 and the Sign Test. Differences Between Proportions. Chi-Square Tests for Goodness of Fit and Contingency Tables. The Analysis of Variance and Covariance. Multiple Regression and Correlation Analysis. Set Correlation and Multivariate Methods. Some Issues in Power Analysis. Computational Procedures.
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"Timing of Palatal Surgery and Speec..." refers methods in this paper
...Effect sizes (Cohen’s d [Cohen, 1988]) were calculated following the procedures described by Dunst et al. (2004) for nonindependent sample designs....
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TL;DR: In this article, the authors present guidelines for choosing among six different forms of the intraclass correlation for reliability studies in which n target are rated by k judges, and the confidence intervals for each of the forms are reviewed.
Abstract: Reliability coefficients often take the form of intraclass correlation coefficients. In this article, guidelines are given for choosing among six different forms of the intraclass correlation for reliability studies in which n target are rated by k judges. Relevant to the choice of the coefficient are the appropriate statistical model for the reliability and the application to be made of the reliability results. Confidence intervals for each of the forms are reviewed.
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"Timing of Palatal Surgery and Speec..." refers background in this paper
...See Shrout and Fleiss (1979) for a complete description of interclass correlations....
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01 Jan 2000
TL;DR: The Emergence of the Speech Capacity as discussed by the authors is an infrastructural model of speech development in infants, focusing on the first months of life of infants and revealing how infant vocalizations mature by increasingly adhering to the rules of well-formed speech.
Abstract: Recent studies of vocal development in infants have shed new light on old questions of how the speech capacity is founded and how it may have evolved in the human species. Vocalizations in the very first months of life appear to provide previously unrecognized clues to the earliest steps in the process by which language came to exist and the processes by which communicative disorders arise. Perhaps the most interesting sounds made by infants are the uniquely human 'protophones' (loosely, 'babbling'), the precursors to speech. Kimbrough Oller argues that these are most profitably interpreted in the context of a new infrastructural model of speech. The model details the manner in which well-formed speech units are constructed, and it reveals how infant vocalizations mature through the first months of life by increasingly adhering to the rules of well-formed speech. He lays out many advantages of an infrastructural approach. Infrastructural interpretation illuminates the significance of vocal stages, and highlights clinically significant deviations, such as the previously unnoticed delays in vocal development that occur in deaf infants. An infrastructural approach also specifies potential paths of evolution for vocal communicative systems. Infrastructural properties and principles of potential communicative systems prove to be organized according to a natural logic--some properties and principles naturally presuppose others. Consequently some paths of evolution are likely while others can be ruled out. An infrastructural analysis also provides a stable basis for comparisons across species, comparisons that show how human vocal capabilities outstrip those of their primate relatives even during the first months of human infancy. The Emergence of the Speech Capacity will challenge psychologists, linguists, speech pathologists, and primatologists alike to rethink the ways they categorize and describe communication. Oller's infraphonological model permits provocative reconceptualizations of the ways infant vocalizations progress systematically toward speech, insightful comparisons between speech and the vocal systems of other species, and fruitful speculations about the origins of language.
573 citations
"Timing of Palatal Surgery and Speec..." refers background in this paper
...However, their early babbling has been found to differ from that of noncleft babies in the types of sounds that are produced and frequency of canonical syllables (well-formed syllables that resemble adult speech [Oller, 2000])....
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TL;DR: The purpose of the Iowa Articulation Norms Project and its Nebraska replication was to provide normative information about speech sound acquisition in these two states as discussed by the authors, and an assessment instrument con...
Abstract: The purpose of the Iowa Articulation Norms Project and its Nebraska replication was to provide normative information about speech sound acquisition in these two states. An assessment instrument con...
555 citations
"Timing of Palatal Surgery and Speec..." refers background or methods in this paper
...%) produced /t/ with 75% accuracy; although, Smit et al. (1990) found that /t/ was acquired by 75% of the children in her study by age 3....
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...Normative data of Smit et al. (1990) were used to determine if a child’s speech was age appropriate or delayed....
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