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Wombacher NR, Lancaster HS, Scherer NJ, Chen DG, Kaiser A, Yamashita R. The impact of enhanced Milieu teaching with phonological emphasis (EMT + PE) on the speech and language outcomes for toddlers with cleft palate in Brazil and the United States of America. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024:1-13. [PMID: 38859760 DOI: 10.1080/17549507.2024.2342783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2024]
Abstract
PURPOSE The purpose of this study was to compare the speech and language outcomes of children with cleft palate with or without cleft lip (CP+/-L) in the USA to children with CP+/-L in Brazil who underwent intervention with enhanced Milieu teaching with phonological emphasis (EMT + PE), as there are few cross-country intervention comparisons for children with CP+/-L. METHOD This is a retrospective analysis of 29 participants from the USA and 24 participants from Brazil who were matched on age. The US participants were between the ages of 13-35 months (M = 23.76), spoke Standard American English in the home, and were recruited from East Tennessee State University and Vanderbilt University. The Brazilian participants were between the ages of 20-34 months (M = 25.04), spoke Brazilian Portuguese in the home, and were recruited from the Hospital de Reabilitação de Anomalias Craniofaciais-Universidade de São Paulo. All treatment participants received EMT + PE from trained speech-language pathologists in hospital-university clinics. RESULT The treatment groups demonstrated greater gains than comparison groups in percent consonants correct, number of different words, and expressive/receptive vocabulary. There was no main effect nor interaction by country. CONCLUSION The application of EMT + PE in a second culture and language is a viable early intervention option for participants with CP+/-L.
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Affiliation(s)
| | | | | | | | - Ann Kaiser
- Vanderbilt University, Nashville, USA, and
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Tahmasebi N, Zarifian T, Ashtari A, Biglarian A. Telepractice Parent Training of Enhanced Milieu Teaching With Phonological Emphasis (EMT+PE) For Persian-Speaking Toddlers With Nonsyndromic Cleft Palate: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2024; 13:e54426. [PMID: 38640014 PMCID: PMC11069098 DOI: 10.2196/54426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 02/14/2024] [Accepted: 02/22/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Children born with a cleft palate with or without a cleft lip (CP/L) are at increased risk for delayed language development and speech sound disorders. Enhanced Milieu Teaching with Phonological Emphasis (EMT+PE) is a recommended naturalistic intervention for toddlers with CP/L. The parents' role in providing naturalistic interventions is critical and they need training based on learning principles to implement these interventions. Telepractice is an appropriate method for training parents and children with various speech-related disorders. OBJECTIVE This study aims to determine and compare the effectiveness of telepractice and the parent-implemented EMT+PE intervention on language and speech measures in toddlers with CP/L with usual interventions and determine the effectiveness maintenance of the intervention. METHODS A randomized controlled trial (RCT) will assess the efficacy of telepractice and the parent-implemented EMT+PE intervention in enhancing speech and language measures in toddlers with CP/L. Eligible participants will be randomly assigned to one of 2 groups: the conventional intervention group and the EMT+PE intervention group. Participants' speech and language measures will be evaluated remotely by trained raters before and after the intervention and 2 months after the intervention. Parents of participants in the intervention group will receive 3 months of training in speech and language supportive strategies from trained therapists using telehealth fidelity scales. Parents of participants in the control group will receive the conventional speech and language intervention by cleft team therapists. Study outcomes will include language variables (mean length of utterance) and speech production variables (percent correct consonants). RESULTS The protocol was approved by the Research Ethics Committee of the University of Social Welfare and Rehabilitation Sciences in February 2022. The selection process of participants, as well as training therapists and raters, commenced in January 2022, the therapy and follow-up period ended in June 2023, and pre- and postintervention assessments have been conducted. Data analysis is ongoing, and we expect to publish our results by the summer of 2024. Funding is yet to be received. CONCLUSIONS The results of this study may help us develop a speech and language intervention with a different delivery model for toddlers with CP/L, and the cleft team care can use these results in service delivery. Consistent with our hypothesis, speech and language measures are expected to improve. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/54426.
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Affiliation(s)
- Neda Tahmasebi
- Department of Speech Therapy, Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Talieh Zarifian
- Department of Speech Therapy, Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Atieh Ashtari
- Department of Speech Therapy, Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Akbar Biglarian
- Department of Biostatistics and Epidemiology, Social Determinants of Health Research Center, Social Health Research Institute, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Sakran KA, Yin J, Yang R, Elayah SA, Alkebsi K, Zhang S, Wang Y, Shi B, Huang H. Early Cleft Palate Repair by a Modified Technique Without Relaxing Incisions. Cleft Palate Craniofac J 2024; 61:646-653. [PMID: 36300250 DOI: 10.1177/10556656221135288] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024] Open
Abstract
OBJECTIVE This study sought to evaluate a modified palatoplasty technique (MPT) concerning the postoperative outcomes and associated influencing factors. DESIGN A retrospective cohort study. PARTICIPANTS AND SETTING One hundred forty-three consecutive patients with non-syndromic cleft palate, who received MPT before one year of age within an oral and maxillofacial surgery department of a university-affiliated tertiary hospital between 2011-2017, were reviewed. MAIN MEASURES The postoperative wound healing and velopharyngeal function (VPF) were the primary outcome measures. The sex, age at surgery, cleft type, cleft width, palatal width, soft palate length, pharyngeal cavity depth, and operation duration were preselected as influencing factors. Univariate and multivariate analyses were conducted. RESULTS The mean age at surgery was 9 ± 1.31 months (5-11), and the average cleft width was 9.03 ± 2.41 mm (4-15). The rate of incomplete cleft palate was 84.6% while the complete cleft palate was 15.4%. Complete wound healing was reported in 96.5% while the others (3.5%) had persistent oronasal fistula. About 90.2% of cases have shown normal velopharyngeal function whereas the others (9.8%) had sustained velopharyngeal insufficiency. The wound healing appeared to be significantly impacted by cleft width and pharyngeal cavity depth (P = .015 and 0.049, respectively). However, none of the factors had a significant association with VPF. CONCLUSIONS The present modified palatoplasty technique has obtained a low fistula rate and appropriate speech outcome. Therefore, this MPT could be promoted for early repairing cleft palate of different severities.
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Affiliation(s)
- Karim Ahmed Sakran
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Ibb University, Ibb, Yemen
| | - Jiayi Yin
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Renjie Yang
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Eastern Clinic, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Sadam Ahmed Elayah
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Ibb University, Ibb, Yemen
| | - Khaled Alkebsi
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Ibb University, Ibb, Yemen
| | - Shiming Zhang
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yan Wang
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Bing Shi
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Hanyao Huang
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
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Shafaee H, Jahanbin A, Ghorbani M, Samadi A, Bardideh E. Electromyographic Evaluation of Masticatory Muscle Activity in Individuals with and without Cleft Lip/Palate: A Systematic Review and Meta-analysis. Cleft Palate Craniofac J 2023:10556656231201235. [PMID: 38037351 DOI: 10.1177/10556656231201235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023] Open
Abstract
OBJECTIVE This study aims to systematically review and meta-analyze the electromyographic activity of masticatory muscles in cleft palate and non-cleft patients, and identify influencing factors. DESIGN Systematic Review and Meta-analysis. PATIENTS AND EXPOSURES Patients with cleft lip/ palate. COMPARISON Patients without CL/P. MAIN OUTCOME MEASURES Electrical activity of masseter and temporalis muscles at rest and during peak activation. RESULTS After a comprehensive search in MEDLINE, Web of Science, EMBASE, Scopus, and Cochrane's CENTRAL up to December 2022, without language or date restrictions. Eligible trials were selected based on the PECO question and assessed for bias using Cochrane's ROBINS-E tool. Eight clinical trials with 474 participants were included in the review. Then relevant data was extracted from included studies using customized forms. A random-effects meta-analysis was performed to combine the results of the studies, meta-analyses showed that CL/P patients have elevated electrical activity in the masseter (P = .01) and temporalis (P = <.01) muscles at rest compared to non-cleft control patients. During maximum bite force, cleft patients exhibited a statistically significant decrease in electrical activity in both the masseter (P = .03) and temporalis (P = <.01) muscles. CONCLUSIONS According to our meta-analysis, cleft patients exhibited increased resting muscle activity but decreased activity during maximum bite force, indicating reduced efficiency of masticatory muscles compared to non-cleft patients. These differences can be attributed to anatomical variations, compensatory mechanisms, and previous treatments.
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Affiliation(s)
- Hooman Shafaee
- Orthodontics Department, Dental Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Arezoo Jahanbin
- Orthodontics Department, Dental Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahsa Ghorbani
- Undergraduate Student of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Asma Samadi
- Undergraduate Student of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Erfan Bardideh
- Orthodontics Department, Dental Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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De Ryck M, Van Lierde K, Alighieri C, Hens G, Bettens K. A protocol for a randomized-controlled trial to investigate the effect of infant sign training on the speech-language development in young children born with cleft palate. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2023; 58:2212-2221. [PMID: 37376898 DOI: 10.1111/1460-6984.12920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND Children born with a cleft palate with or without cleft lip (CP ± L) are known to be at risk for speech-language disorders that impact educational and social-emotional growth. It is hypothesized that speech-language intervention delivered before the age of 3 years could decrease the impact of CP ± L on speech-language development. Infant sign training in combination with verbal input expands the natural communication of young children including multimodal speech-language input (i.e., verbal and manual input) via caregivers who act as co-therapists. AIMS To determine the effectiveness of infant sign training in 1-year-old children with CP ± L by comparing different interventions. METHODS & PROCEDURES This is a two-centre, randomized, parallel-group, longitudinal, controlled trial. Children are randomized to either an infant sign training group (IST group), a verbal training group (VT group) or no intervention control group (C group). Caregivers of children who are assigned to the IST group or VT group will participate in three caregiver training meetings to practise knowledge and skills to stimulate speech-language development. Outcome measures include a combination of questionnaires, language tests and observational analyses of communicative acts. OUTCOMES & RESULTS It is hypothesized that speech-language development of children with CP ± L will benefit more from IST compared with VT and no intervention. Additionally, the number and quality of communicative acts of both children and caregivers are expected to be higher after IST. CONCLUSIONS & IMPLICATIONS This project will contribute to the development of evidence-based clinical practice guidelines regarding early speech-language intervention in children with CP ± L under the age of 3 years. WHAT THIS PAPER ADDS What is already known on the subject Children with CP ± L are known to be at risk for speech-language delays that impact educational and social emotional growth. Given the limited scientific prove of the impact of early speech-language intervention, no standardized clinical practice guidelines are available yet for children with CP ± L under the age of 3 years. Early intervention in this population mostly focuses on improving verbal input via caregivers or professionals without including a multimodal language input. A growing scientific interest has been seen in the use of infant signs to support speech-language development and caregiver-child interaction in typically developing children and children with developmental delays. What this study adds to existing knowledge No evidence is yet available for the effectiveness and feasibility of early intervention based on infant sign training in combination with verbal input to improve speech-language skills in young children with CP ± L. The current project will investigate the effect of infant sign training on the speech-language development in this population. Outcome measures are compared with those of two control groups: verbal training only and no intervention. It is hypothesized that infant signs may support the intelligibility of verbal utterances produced by children with CP ± L. Improving children's intelligibility may increase the opportunities for these children to engage in early, frequent and high-quality interactions with their caregivers resulting in a richer social and linguistic environment. As a result, infant sign training may result in better speech-language skills compared with the control interventions. What are the potential or actual clinical implications of this work? If providing early intervention based on infant sign training is effective, there is the potential for improved speech-language outcomes in early childhood, resulting in increased speech intelligibility, increased well-being of the child and family and less need for speech-language therapy on the long-term. This project will contribute to the development of evidence-based clinical practice guidelines regarding early speech-language intervention in children with CP ± L under the age of 3 years.
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Affiliation(s)
- Mira De Ryck
- Department of Rehabilitation Sciences, Center for Speech and Language Sciences (CESLAS), Ghent University, Ghent, Belgium
| | - Kristiane Van Lierde
- Department of Rehabilitation Sciences, Center for Speech and Language Sciences (CESLAS), Ghent University, Ghent, Belgium
| | - Cassandra Alighieri
- Department of Rehabilitation Sciences, Center for Speech and Language Sciences (CESLAS), Ghent University, Ghent, Belgium
| | - Greet Hens
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
- Multidisciplinary Cleft Lip and Palate Team, University Hospitals Leuven, Leuven, Belgium
| | - Kim Bettens
- Department of Rehabilitation Sciences, Center for Speech and Language Sciences (CESLAS), Ghent University, Ghent, Belgium
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Srivastav S, Tewari N, Antonarakis GS, Duggal R, Saji S, Lokade AK, Yadav R. Evidence Mapping and Quality Analysis of Systematic Reviews on Various Aspects Related to Cleft Lip and Palate. J Clin Med 2023; 12:6002. [PMID: 37762942 PMCID: PMC10532364 DOI: 10.3390/jcm12186002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 08/30/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Management of cleft lip and palate is interdisciplinary. An evidence-mapping approach was envisaged to highlight the existing gaps in this field, using only the highest level of evidence. OBJECTIVES To conduct evidence mapping and quality analysis of systematic reviews and meta-analyses related to any aspect of cleft lip and palate. SEARCH METHODS The cleft lip and palate field was divided into 9 domains and 50 subdomains and a method of categorization of systematic reviews was established. A comprehensive search strategy was carried out in seven databases along with the search of gray literature and references of included articles. SELECTION CRITERIA Systematic reviews related to any aspect of cleft lip and palate, conducted by a minimum of two reviewers, with a comprehensive search strategy and adequate quality analysis were included. DATA COLLECTION AND ANALYSIS A self-designed, pre-piloted data-extraction sheet was used to collect information that was analyzed through an expert group discussion. Quality analysis was performed using ROBIS-I, AMSTAR 2, and the PRISMA checklist. RESULTS A total of 144 systematic reviews published between 2008 and 2022 were included. The largest number of these could be categorized in the therapeutic domain (n = 58). A total of 27% of the studies were categorized as inconclusive, 40% as partially conclusive, and 33% as conclusive. As per ROBIS-I, 77% of reviews had high risk of bias while 58% were graded as critically low in quality as per AMSTAR 2. The majority of systematic reviews showed low reporting errors. CONCLUSIONS The majority of systematic reviews related to cleft lip and palate relate to therapeutic and prognostic domains and show high risk of bias and critically low quality regardless of the source journal. The results of this paper might serve as a starting point encouraging authors to carry out high-quality research where evidence is lacking. REGISTRATION A multidisciplinary expert-group formulated an a priori protocol, registered in Open Science Framework (DOI 10.17605/OSF.IO/NQDV2).
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Affiliation(s)
- Sukeshana Srivastav
- Section of Orthodontics, Department of Dentistry and Oral Health, Aarhus University, 8000 Aarhus, Denmark
- Division of Paediatric and Preventive Dentistry, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi 110029, India
- Division of Orthodontics, University Clinics of Dental Medicine, University of Geneva, 1205 Geneva, Switzerland
| | - Nitesh Tewari
- Division of Paediatric and Preventive Dentistry, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Gregory S. Antonarakis
- Division of Orthodontics, University Clinics of Dental Medicine, University of Geneva, 1205 Geneva, Switzerland
| | - Ritu Duggal
- Division of Orthodontics and Dentofacial Deformities, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Seba Saji
- Division of Paediatric and Preventive Dentistry, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Amol Kumar Lokade
- Division of Paediatric and Preventive Dentistry, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Rahul Yadav
- Division of Oral and Maxillofacial Surgery, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi 110029, India
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Phippen G. Articulating the issues: speech assessment and intervention in cleft lip and palate. Br Dent J 2023; 234:912-917. [PMID: 37349440 DOI: 10.1038/s41415-023-5954-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 04/26/2023] [Accepted: 04/27/2023] [Indexed: 06/24/2023]
Abstract
This paper describes the impact of cleft lip and palate on speech. It provides an overview for the dental clinician of the key issues affecting speech development and clarity. The paper summarises the complex speech mechanism and cleft-related factors that affect speech, including palatal, dental and occlusal anomalies. It outlines the framework for speech assessment throughout the cleft pathway and provides a description of cleft speech disorder, as well as describing treatment approaches for cleft speech and velopharyngeal dysfunction.This is followed by a spotlight on speech prosthetics for treating nasal speech, with an emphasis on joint management by the Speech and Language Therapist and Consultant in Restorative Dentistry. This includes the core multidisciplinary approach, clinician and patient-reported outcome measures, and brief discussion of national developments in this area.The importance of multidisciplinary cleft care is highlighted and, within this, the essential interaction between speech and dental clinicians in providing routine care, as well as in delivering a highly specialist speech prosthetics service.
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Affiliation(s)
- Ginette Phippen
- Lead Speech & Language Therapist, The Spires Cleft Centre, Salisbury NHS Foundation Trust/Oxford University Hospitals NHS Foundation Trust, United Kingdom.
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