To compare in-depth speech results in Scandcleft Trial 1 as well as reference data from peers without cleft palate (CP).
Design:
A prospective randomized clinical trial.
Setting:
A Danish and a Swedish CP center.
Participants:
143 of 148 randomized 5-year-olds with unilateral cleft lip and palate. All received lip and velum closure at 4 months, and hard palate closure at 12 months (arm A) or 36 months (arm B).
Main Outcome Measures:
A composite measure based on velopharyngeal competence (VPC) or velopharyngeal incompetence (VPI), an overall assessment of VPC from connected speech (VPC-Rate), Percentage of Consonants Correct (PCC-score), and consonant errors. Speech therapy visits, average hearing thresholds, and secondary pharyngeal surgeries documented burden of treatment.
Results:
Across the trial, 61.5% demonstrated VPC and 38.5% VPI. Twenty-two percent of participants achieved age appropriate PCC-scores. There were no statistically significant differences between arms or centers for these measures. In the Danish center, arm B: achieved lower PCC-scores (P = .01); obtained PCC-scores without s-errors below 79% (P = .002); produced ≥3 active oral cleft speech characteristics (P = .004) than arm A. In both centers, arm B attended more speech visits.
Conclusions:
At age 5, differences between centers and treatment arms were not statistically significant for VPC/VPI, but consonant proficiency differed between treatment arms in the Danish center. Poor speech outcomes were seen for both treatment arms. Variations between centers were observed. As the Swedish center had few participants, intercenter comparisons should be interpreted with caution.
BrittonLAlberyLBowdenMHarding-BellAPhippenGSellD. A cross-sectional cohort study of speech in five-year-olds with cleft palate ± lip to support development of national audit standards: benchmarking speech standards in the United Kingdom. Cleft Palate Craniofac J. 2014;51(4):431–451.
2.
BzochKR. Articulation proficiency and error patterns of preschool cleft palate and normal children. Cleft Palate J. 1965;2:340–349.
3.
ClausenMCFox-BoyerA. Phonological development of Danish-speaking children: a normative cross-sectional study. Clin Linguist Phon. 2017;31(6):440–458.
4.
DoddBHolmAHuaZHUCrosbieS. Phonological development: a normative study of British English-speaking children. Clin Linguist Phon. 2003;17(8):617–643.
5.
FriedeHLiljaJLohmanderA.. Two-stage palatal surgery with early veloplasty and delayed hard palate repair: a balanced view on speech and midfacial growth outcome. In: BerkowitzS, ed. Cleft Lip and Palate. Berlin, Germany: Springer-Verlag; 2013.
6.
HardingAGrunwellP. Characteristics of cleft palate speech. Int J Lang Commun Disord. 1996;31(4):331–357.
7.
HuttersBBrøndstedK. Strategies in cleft palate speech–with special reference to Danish. Cleft Palate J. 1987;24(2):126–136.
8.
JohnASellDSweeneyTHarding-BellAWilliamsA. The Cleft Audit Protocol for Speech—augmented: a validated and reliable measure for auditing cleft speech. Cleft Palate Craniofac J. 2006;43(3):272–288.
9.
KlintöKSalamehEKOlssonMFlynnTSvenssonHLohmanderA. Phonology in Swedish-speaking 3-year-olds born with cleft lip and palate and the relationship with consonant production at 18 months. Int J Lang Commun Disord. 2014a;49(2):240–254.
10.
KlintöKSvenssonHElanderALohmanderA. Speech and phonology in Swedish-speaking 3-year-olds with unilateral complete cleft lip and palate following different methods for primary palatal surgery. Cleft Palate Craniofac J. 2014b;51(3):274–282.
11.
KuehnDPMollerKT. Speech and language issues in the cleft palate population: the state of the art. Cleft Palate Craniofac J. 2000;37(4):348–348.
12.
LohmanderA. Surgical intervention and speech outcomes in cleft lip and palate. In: LohmanderAHowardS, eds. Cleft Palate Speech: Assessment and Intervention. Hoboken, NJ: John Wiley & Sons; 2011:55–85.
13.
LohmanderAFriedeHElanderAPerssonCLiljaJ. Speech development in patients with unilateral cleft lip and palate treated with different delays in closure of the hard palate after early velar repair: a longitudinal perspective. Scand J Plast Reconstr Surg Hand Surg. 2006;40(5):267–274.
14.
LohmanderAFriedeHLiljaJ. Long-term, longitudinal follow-up of individuals with unilateral cleft lip and palate after the Gothenburg primary early veloplasty and delayed hard palate closure protocol: speech outcome. Cleft Palate Craniofac J. 2012;49(6):657–671.
15.
LohmanderAHagbergEPerssonCWilladsenELundeborgIDaviesJHavstamCBoersMKisling-MøllerMAlaluusuaSet al.Validity of auditory perceptual assessment of velopharyngeal function and dysfunction—the VPC-Sum and the VPC-Rate. Clin Linguist Phon. 2017b;31(7-9):589–597.
16.
LohmanderALundeborgIPerssonC. SVANTE—The Swedish Articulation and Nasality Test—Normative data and a minimum standard set for cross-linguistic comparison. Clin Linguist Phon. 2017c;31(2):137–154.
17.
LohmanderAPerssonC. A longitudinal study of speech production in Swedish children with unilateral cleft lip and palate and two-stage palatal repair. Cleft Palate Craniofac J. 2008;45(1):32–41.
18.
LohmanderAPerssonCWilladsenELundeborgIAlaluusuaSAuknerRBauABoersMBowdenMDaviesJEmborgBHavstamCet al.Scandcleft randomised trials of primary surgery for unilateral cleft lip and palate: 4. Speech outcomes in 5-year-olds—velopharyngeal competency and hypernasality. J Plast Surg Hand Surg. 2017a;51(1):27–37.
19.
LohmanderAWilladsenEPerssonCHenningssonGBowdenMHuttersB. Methodology for speech assessment in the Scandcleft project—an international randomized clinical trial on palatal surgery: experiences from a pilot study. Cleft Palate Craniofac J. 2009;46(4):347–362.
20.
Lohmander-AgerskovA. Speech outcome after cleft palate surgery with the Göteborg regimen including delayed hard palate closure. Scand J Plast Reconstr Surg Hand Surg. 1998;32(1):63–80.
21.
Lohmander-AgerskovASöderpalmEFriedeHLiljaJ. A comparison of babbling and speech at pre-speech level, 3, and 5 years of age in children with cleft lip and palate treated with delayed hard palate closure. Folia Phoniatr Logop. 1998;50(6):320–334.
22.
McCormackJMcLeodSMcAllisterLHarrisonLJ. My speech problem, your listening problem, and my frustration: the experience of living with childhood speech impairment. Lang Speech Hear Serv Sch. 2010;41(4):379–392.
23.
McLeodSHarrisonLJMcCormackJ. The intelligibility in context scale: validity and reliability of a subjective rating measure. J Speech Lang Hear Res. 2012;55(2):648–656.
24.
MorrisHOzanneA. Phonetic, phonological, and language skills of children with a cleft palate. Cleft Palate Craniofac J. 2003;40(5):460–470.
25.
Peterson-FalzoneSJ. Optimal age for palatoplasty to facilitate normal speech development: What is the evidence? In BerkowitzS, ed. Cleft Lip and Palate. Berlin, Heidelberg: Springer; 2013:787–802.
26.
RautioJAndersenMBolundSHukkiJVindenesHDavenportPArctanderKLarsonOBerggrenAÅbyholmFet al.Scandcleft randomised trials of primary surgery for unilateral cleft lip and palate: 2. Surgical results. J Plast Surg Hand Surg. 2017;51(1):14–20.
27.
RenfrewCE. Bus Story Test: A Test of Narrative Speech. Bicester, England: Winslow; 1997.
28.
SellDJohnAHarding-BellASweeneyTHegartyFFreemanJ. Cleft Audit Protocol for Speech (CAPS-A): a comprehensive training package for speech analysis. Int J Lang Commun Disord. 2009;44(4):529–548.
29.
SellD. Issues in perceptual speech analysis in cleft palate and related disorders: a review. Int J Lang Commun Disord. 2005;40(2):103–121.
30.
SellDMildinhallSAlberyLWillsAKSandyJRNessAR. The Cleft Care UK study. Part 4: perceptual speech outcomes. Orthod Craniofac Res. 2015;18(suppl 2):36–46.
31.
SellDSouthbyLWrenYWillsAKHallAMahmoudOWaylenASandyJRNessAR. Center-level variation in speech outcome and interventions, and factors associated with poor speech outcomes in 5-year-old children with non-syndromic unilateral cleft lip and palate: The Cleft Care UK study. Part 4. Orthod Craniofac Res. 2017;20(S2):27–39.
32.
SembGEnemarkHFriedeHPaulinGLiljaJRautioJAndersenMÅbyholmFLohmanderAShawWet al.Scandcleft randomised trials of primary surgery for unilateral cleft lip and palate: 1. Planning and management. J Plast Surg Hand Surg. 2017;51(1):2–13.
33.
ShawWCSembGLohmanderA, Clinical outcomes research and evidence based practice, Chapter 2. In: LoseeJEKirschnerRE, eds. Comprehensive Cleft Care. Vol. 1. Boca Raton, FL: CRC Press; 2016.
34.
ShribergLDAustinDMcSweenyJLWilsonDL. The Percentage of Consonants Correct (PCC) metric: extensions and reliability data. J Speech Lang Hear Res. 1997;40(4):708–722.
35.
ShribergLDKwiatkowskiJ. Phonological disorders III: a procedure for assessing severity of involvement. J Speech Hear Disord. 1982;47(3):256–270.
36.
ShribergLDLofGL. Reliability studies in broad and narrow phonetic transcription. Clin Linguist Phon. 1991;5(3):225–279.
37.
SmedbergENeoviusELohmanderA. Impact of maxillary advancement on speech and velopharyngeal function in patients with cleft lip and palate. Cleft Palate Craniofac J. 2014;51(3):334–343.
38.
TrostJE. Articulatory additions to the classical description of the speech of persons with cleft palate. Cleft Palate J. 1981;18(3):193–203.
39.
WilladsenE. Influence of timing of hard palate repair in a two-stage procedure on early speech development in Danish children with cleft palate. Cleft Palate Craniofac J. 2012;49(5):574–595.
40.
WilladsenEBoersMSchöpsAKisling-MøllerMNielsenJBJørgensenLDAndersenMBolundSAndersenHS. Influence of timing of delayed hard palate closure on articulation skills in 3-year-old Danish children with unilateral cleft lip and palate: articulation skills in Danish 3-year-olds with UCLP. Int J Lang Commun Disord. 2018
41.
WilladsenELohmanderAPerssonCLundeborgIAlaluusuaSAuknerRBauABoersMBowdenMDaviesJet al.Scandcleft randomised trials of primary surgery for unilateral cleft lip and palate: 5. Speech outcomes in 5-year-olds—consonant proficiency and errors. J Plast Surg Hand Surg. 2017;51(1):38–51.
