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Chapman KL, Sitzman T, Baylis A, Hardin-Jones M, Kirschner R, Temkit MH. A Comparative Effectiveness Study of Speech and Surgical Outcomes: Study Overview. Cleft Palate Craniofac J 2024:10556656241274242. [PMID: 39363863 DOI: 10.1177/10556656241274242] [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: 10/05/2024] Open
Abstract
AIMS To provide an overview of the Cleft Outcomes Research NETwork (CORNET) and the CORNET Speech and Surgery study. The study is (1) comparing speech outcomes and fistula rate between two common palate repair techniques, straight-line closure with intra-velar veloplasty (IVVP) and Furlow Double-Opposing Z-palatoplasty (Furlow Z-plasty); (2) summarizing practice variation in the utilization of early intervention speech-language (EI-SL) services; and (3) exploring the association between EI-SL services and speech outcomes. DESIGN Prospective, longitudinal, observational, comparative effectiveness, multi-center. SITES Twenty sites across the United States. PARTICIPANTS One thousand two hundred forty-seven children with cleft palate with or without cleft lip (CP ± L). Children with submucous cleft palate or bilateral sensorineural severe to profound hearing loss were excluded from participation. INTERVENTIONS Straight-line closure with IVVP or Furlow Z-plasty based on each surgeon's standard clinical protocol. MAIN OUTCOME MEASURE(S) The primary study outcome is perceptual ratings of hypernasality judged from speech samples collected at 3 years of age. Secondary outcomes are fistula rate, measures of speech production, and quality of life. The statistical analyses will include generalized estimating equations with propensity score weighting to address potential confounders. CURRENT PROGRESS Recruitment was completed in February 2023; 80% of children have been retained to date. Five hundred sixty two children have completed their final 3-year speech assessment. Final study activities will end in early 2025. CONCLUSIONS This study addresses long-standing questions related to the effectiveness of the two most common palatoplasty approaches and describes CORNET which provides an infrastructure that will streamline future studies in all areas of cleft care.
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Affiliation(s)
- Kathy L Chapman
- Department of Communication Sciences & Disorders, University of Utah, Salt Lake City, UT, USA
| | - Thomas Sitzman
- Phoenix Children's Center for Cleft and Craniofacial Care a Division of Plastic Surgery, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Adriane Baylis
- Department of Plastic and Reconstructive Surgery, Nationwide Children's Hospital and Department of Plastic Surgery, The Ohio State University Medical College, Columbus, Ohio, USA
| | - Mary Hardin-Jones
- Division of Communication Disorders, University of Wyoming, Laramie, WY, USA
| | - Richard Kirschner
- Department of Plastic and Reconstructive Surgery, Nationwide Children's Hospital and Department of Plastic Surgery, The Ohio State University Medical College, Columbus, Ohio, USA
| | - M'hamed Hamy Temkit
- Phoenix Children's Center for Cleft and Craniofacial Care a Division of Plastic Surgery, Phoenix Children's Hospital, Phoenix, AZ, USA
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Patrick K, Fricke S, Rutter B, Cleland J. Clinical application of usage-based phonology: Treatment of cleft palate speech using usage-based electropalotography. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 26:595-610. [PMID: 37652151 DOI: 10.1080/17549507.2023.2238924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
PURPOSE To investigate whether a novel electropalatography (EPG) therapy, underpinned by usage-based phonology theory, can improve the accuracy of target speech sounds for school-aged children and adults with persistent speech sound disorder (SSD) secondary to cleft palate +/- lip. METHOD Six consecutively treated participants (7-27 years) with long-standing speech disorders associated with cleft palate enrolled in a multiple baseline (ABA) within-participant case series. The usage-based EPG therapy technique involved high-volume production of words. Speech was assessed on three baselines prior to therapy, during weekly therapy, at completion of therapy, and 3 months post-therapy. Percent correct of target phonemes in untreated words and continuously connected speech were assessed through acoustic phonetic transcription. Intra- and inter-transcriber agreement was determined. RESULT Large to medium treatment effect sizes were shown for all participants following therapy (15-33 sessions). Percentage of targets correct for untreated words improved from near 0% pre-therapy, to near 100% for most target sounds post-therapy. Generalisation of target sounds to spontaneous connected speech occurred for all participants and ranged from 78.95-100% (M = 90.66; SD = 10.14) 3 months post-therapy. CONCLUSION Clinically significant speech change occurred for all participants following therapy. Response to the novel therapeutic technique is encouraging and further research is indicated.
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Affiliation(s)
- Kathryn Patrick
- Regional Cleft Unit, Royal Manchester Children's Hospital, Manchester, UK
| | - Silke Fricke
- Division of Human Communication Sciences, The University of Sheffield, Sheffield, UK
| | - Ben Rutter
- Division of Human Communication Sciences, The University of Sheffield, Sheffield, UK
| | - Joanne Cleland
- School of Psychological Sciences and Health, The University of Strathclyde, Glasgow, UK
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Sitzman TJ, Baylis AL, Perry JL, Weidler EM, Temkit M, Ishman SL, Tse RW. Protocol for a Prospective Observational Study of Revision Palatoplasty Versus Pharyngoplasty for Treatment of Velopharyngeal Insufficiency Following Cleft Palate Repair. Cleft Palate Craniofac J 2024; 61:870-881. [PMID: 36562144 PMCID: PMC10287832 DOI: 10.1177/10556656221147159] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To present the design and methodology for an actively enrolling comparative effectiveness study of revision palatoplasty versus pharyngoplasty for the treatment of velopharyngeal insufficiency (VPI). DESIGN Prospective observational multicenter study. SETTING Twelve hospitals across the United States and Canada. PARTICIPANTS Individuals who are 3-23 years of age with a history of repaired cleft palate and a diagnosis of VPI, with a total enrollment target of 528 participants. INTERVENTIONS Revision palatoplasty and pharyngoplasty (either pharyngeal flap or sphincter pharyngoplasty), as selected for each participant by their treatment team. MAIN OUTCOME MEASURE(S) The primary outcome is resolution of hypernasality, defined as the absence of consistent hypernasality as determined by blinded perceptual assessment of a standard speech sample recorded twelve months after surgery. The secondary outcome is incidence of new onset obstructive sleep apnea. Statistical analyses will use propensity score matching to control for demographics, medical history, preoperative severity of hypernasality, and preoperative imaging findings. RESULTS Study recruitment began February 2021. As of September 2022, 148 participants are enrolled, and 78 have undergone VPI surgery. Enrollment is projected to continue into 2025. Collection of postoperative evaluations should be completed by the end of 2026, with dissemination of results soon thereafter. CONCLUSIONS Patients with VPI following cleft palate repair are being actively enrolled at sites across the US and Canada into a prospective observational study evaluating surgical outcomes. This study will be the largest and most comprehensive study of VPI surgery outcomes to date.
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Affiliation(s)
- Thomas J. Sitzman
- Division of Plastic Surgery, Phoenix Children’s Hospital, Phoenix, Arizona, USA
- Division of Plastic Surgery, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Adriane L. Baylis
- Department of Plastic and Reconstructive Surgery, Nationwide Children’s Hospital, Columbus, Ohio, USA
- Department of Plastic and Reconstructive Surgery and Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
- Department of Speech Language Hearing Sciences, The Ohio State University, Columbus, Ohio, USA
| | - Jamie L. Perry
- Department of Communication Sciences and Disorders East Carolina University, Greenville, North Carolina, USA
| | - Erica M. Weidler
- Division of Plastic Surgery, Phoenix Children’s Hospital, Phoenix, Arizona, USA
| | - M’hamed Temkit
- Department of Clinical Research, Phoenix Children’s Hospital, Phoenix, Arizona, USA
| | - Stacey L. Ishman
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Raymond W. Tse
- Division of Craniofacial and Plastic Surgery, Department of Surgery, Seattle Children’s Hospital, Seattle, Washington, USA
- Division of Plastic Surgery, Department of Surgery, University of Washington, Seattle, Washington, USA
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Hattori Y, Tu JCY, Chou PY, Lo LJ. Two-flap technique with interpositional dermofat graft for anterior oronasal fistula closure in patients with cleft: A case series. J Plast Reconstr Aesthet Surg 2024; 90:51-59. [PMID: 38359499 DOI: 10.1016/j.bjps.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 11/28/2023] [Accepted: 01/29/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Oronasal fistula at the anterior hard palate is one of the common sequelae after cleft surgery, and the leakage negatively affects the patient's quality of life. Although several surgical techniques have been proposed for reconstruction, it remains challenging because of the scarred regional tissue with a high rate of fistula recurrence. In this study, we present the anterior oronasal fistula repair using a two-flap technique with an interpositional dermofat graft (DFG). METHODS A retrospective review of anterior oronasal fistula repair performed by the senior author between April 2018 and August 2022 at the Craniofacial Center was conducted. Patients who underwent a fistula repair using the technique were further identified and investigated. RESULTS Thirty-four operations were performed using the technique, and 31 fistulas were completely closed, with a success rate of 91.2%. The fistula symptom improved but persisted postoperatively in 3 patients, of whom 2 patients underwent a second fistula repair using the same procedure, resulting in successful closure. Fistula recurrence was significantly correlated with fistula size (p = 0.04). The DFG was simultaneously utilized for nasal dorsum and/or vermillion reconstruction in 28 cases. CONCLUSION The two-flap technique enabled tension-free approximation, and the interpositional DFG facilitated watertight closure of the fistula, resulting in a high success rate of anterior oronasal fistula repair. The fistula closure could be combined with other revisional procedures for cleft-related deformities, where the DFG was simultaneously utilized.
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Affiliation(s)
- Yoshitsugu Hattori
- Craniofacial Center, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Junior Chun-Yu Tu
- Craniofacial Center, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Pang-Yun Chou
- Craniofacial Center, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Lun-Jou Lo
- Craniofacial Center, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Graduate Institute of Dental and Craniofacial Science, Chang Gung University, Taoyuan, Taiwan.
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Kinter S, Susarla S, Delaney JC, Chapman K, Kapadia H, Weiss N. Does Distraction Lower Risk of VPI Compared to Conventional Maxillary Advancement? A Retrospective Cohort Study of Adolescents with Cleft Palate. Cleft Palate Craniofac J 2024; 61:422-432. [PMID: 36373608 PMCID: PMC10752384 DOI: 10.1177/10556656221138895] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023] Open
Abstract
OBJECTIVE To determine whether method of maxillary advancement in adolescents with cleft palate with or without cleft lip (CP ± L) influences post-operative velopharyngeal function. DESIGN Retrospective cohort. SETTING Pediatric Tertiary Care Hospital. PARTICIPANTS One hundred and ninety-nine patients with CP ± L after LeFort I osteotomy for maxillary advancement at our institution between January 2007 and June 2019. INTERVENTIONS LeFort I osteotomy via distraction osteogenesis (DO) or conventional osteotomy (CO). MAIN OUTCOME MEASURES Patients who underwent DO or CO were compared for the presence of new velopharyngeal insufficiency (VPI), as measured by perceptual rating by a craniofacial speech-language pathologist. Of the 199 patients who underwent maxillary advancement, 126 were available for analysis. The DO group was younger, male, and had more severe maxillary hypoplasia. Following surgery, 17/41 (41.5%) of the DO group had new VPI, compared to just 23/85 (27.1%) of the CO group. After adjusting for cleft type and predicted maxillary advancement, however, there was not sufficient evidence to reject the null hypothesis of no difference in risk of post-operative VPI between the two surgical groups (prevalence ratio [PR] 1.40, 95% CI 0.68-2.90). Increased prevalence of VPI after DO versus CO was primarily observed among patients with a pre-operative velopharyngeal need ratio < 0.8 (PR = 2.01, 95% CI 0.79-5.10) and patients with normal velopharyngeal function pre-operatively (PR = 2.86, 95% CI 0.96-8.50). Our results suggest an increased rather than decreased risk of VPI following DO relative to CO. This association is primarily seen among those with a smaller velopharyngeal ratio or perceptually normal velopharyngeal function pre-operatively.
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Affiliation(s)
- Sara Kinter
- Department of Pediatrics, Division of Craniofacial Medicine, University of Washington, Seattle, WA, USA
- Craniofacial Center, Seattle Children’s Hospital, Seattle, WA, USA
| | - Srinivas Susarla
- Craniofacial Center, Seattle Children’s Hospital, Seattle, WA, USA
- Department of Oral & Maxillofacial Surgery, University of Washington, Seattle, WA, USA
- Department of Surgery, Division of Plastic Surgery, University of Washington, Seattle, WA, USA
| | - Joseph Christopher Delaney
- College of Pharmacy, University of Manitoba, Winnipeg, Canada
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Kathy Chapman
- Department of Communication Sciences & Disorders, University of Utah, Salt Lake City, UT, USA
| | - Hitesh Kapadia
- Craniofacial Center, Seattle Children’s Hospital, Seattle, WA, USA
- Department of Surgery, Division of Plastic Surgery, University of Washington, Seattle, WA, USA
- Department of Orthodontics, University of Washington, Seattle, WA, USA
| | - Noel Weiss
- Department of Epidemiology, University of Washington, Seattle, WA, USA
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Kinter S, Delaney JA, Susarla S, McKinney C. Retrospective Cohort Studies in Craniofacial Outcomes Research: An Epidemiologist's Approach to Mitigating Bias. Cleft Palate Craniofac J 2024:10556656241233234. [PMID: 38389276 DOI: 10.1177/10556656241233234] [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: 02/24/2024] Open
Abstract
Retrospective cohort studies, defined as a follow-up study in which outcome occurred prior to study onset, are common in craniofacial outcomes research and will continue to be prevalent given the increasing availability of secondary datasets and inherent prospective study limitations. However, if available data are not adequately measured, or necessary variables are absent, retrospective cohort studies can be particularly prone to bias. This brief communication aims to highlight the primary sources of bias, including measurement error, selection bias, and confounding. Each source is clearly defined, examples pertinent to craniofacial outcomes are provided, and mitigation strategies are discussed.
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Affiliation(s)
- Sara Kinter
- Department of Pediatrics, Division of Craniofacial Medicine, University of Washington, Seattle, WA, USA
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, USA
| | - Joseph A Delaney
- General Internal Medicine, University of Washington, Seattle, WA, USA
| | - Srinivas Susarla
- Department of Oral & Maxillofacial Surgery, University of Washington, Seattle, WA, USA
- Department of Surgery, Division of Plastic Surgery, University of Washington, Seattle, WA, USA
| | - Christy McKinney
- Department of Pediatrics, Division of Craniofacial Medicine, University of Washington, Seattle, WA, USA
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, USA
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7
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Arganbright J. Surgical Management of Velopharyngeal Dysfunction. Facial Plast Surg Clin North Am 2024; 32:69-83. [PMID: 37981418 DOI: 10.1016/j.fsc.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
Velopharyngeal dysfunction (VPD) is caused by inadequate closure of the velopharyngeal port. VPD can hinder a child's ability to communicate and can impact his/her quality of life. Evaluation of children with VPD is often completed in a multidisciplinary setting and often involves studies that allow for the visualization of the velopharyngeal closure during voluntary speech (ie, nasopharyngoscopy). Multiple surgical options exist for the treatment of VPD including pharyngeal flap, sphincter pharyngoplasty, buccal myomucosal flaps, Furlow palatoplasty, palate re-repair, intravelar veloplasty, and injection pharyngoplasty. Each speech surgery has its unique benefits and drawbacks and the decision on which surgery to recommend should be tailored to each patient's specific needs and weighing the risk/benefit profile for their specific surgeries.
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Affiliation(s)
- Jill Arganbright
- Children's Mercy Hospital, University of Missouri-Kansas City, 2401 Gillham Road, Kansas City, MO 64108, USA.
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McCarty G, Wyeth EH, Sullivan T, Crengle S, Nelson V, Derrett S. Health-related quality of life measures used with Indigenous children/youth in the Pacific Rim: a scoping review. BMJ Open 2023; 13:e070156. [PMID: 36997253 PMCID: PMC10069609 DOI: 10.1136/bmjopen-2022-070156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
OBJECTIVE To identify and describe (1) which health-related quality of life (HRQoL) measures have been used with Indigenous children/youth (aged 8-17 years) within the Pacific Rim; and (2) studies that refer to Indigenous health concepts in the use of child/youth HRQoL measures. DESIGN A scoping review. DATA SOURCES Ovid (Medline), PubMed, Scopus, Web of Science and CINAHL were searched up until 25 June 2020. ELIGIBILITY CRITERIA Eligible papers were identified by two independent reviewers. Eligible papers were written in English, published between January 1990 and June 2020 and included an HRQoL measure used in research with Indigenous child/youth populations (aged between 8 and 17 years) in the Pacific Rim region. DATA EXTRACTION AND SYNTHESIS Data extracted included study characteristics (year, country, Indigenous population, Indigenous sample size, age group), HRQoL measure characteristics (generic or condition-specific measure, child or adult measure, who completed the measure(s), dimensions, items and response scale of measure) and consideration of Indigenous concepts (created for Indigenous population, modified for Indigenous population, validated for Indigenous population, reliability in Indigenous populations, Indigenous involvement, reference to Indigenous theories/models/frameworks). RESULTS After removing duplicates, 1393 paper titles and abstracts were screened, and 543 had full-text review for eligibility. Of these, 40 full-text papers were eligible, reporting on 32 unique studies. Twenty-nine HRQoL measures were used across eight countries. Thirty-three papers did not acknowledge Indigenous concepts of health, and only two measures were specifically created for use with Indigenous populations. CONCLUSIONS There is a paucity of research investigating HRQoL measures used with Indigenous children/youth and a lack of involvement of Indigenous peoples in the development and use of HRQoL measures. We strongly recommend explicit consideration of Indigenous concepts when developing, validating, assessing and using HRQoL measures with Indigenous populations.
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Affiliation(s)
- Georgia McCarty
- Ngāi Tahu Māori Health Research Unit, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Emma H Wyeth
- Ngāi Tahu Māori Health Research Unit, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Trudy Sullivan
- Preventive and Social Medicine, University of Otago Dunedin School of Medicine, Dunedin, New Zealand
| | - Sue Crengle
- Ngāi Tahu Māori Health Research Unit, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Vicky Nelson
- Ngāi Tahu Māori Health Research Unit, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Sarah Derrett
- Ngāi Tahu Māori Health Research Unit, Division of Health Sciences, University of Otago, Dunedin, New Zealand
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Alighieri C, Haeghebaert Y, Bettens K, Kissel I, D'haeseleer E, Meerschman I, Van Der Sanden R, Van Lierde K. Peer attitudes towards adolescents with speech disorders due to cleft lip and palate. Int J Pediatr Otorhinolaryngol 2023; 165:111447. [PMID: 36701818 DOI: 10.1016/j.ijporl.2023.111447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 01/09/2023] [Accepted: 01/11/2023] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND AIMS Individuals with speech disorders are often judged more negatively than peers without speech disorders. A limited number of studies examined the attitudes of adolescents toward peers with speech disorders due to a cleft lip with or without a cleft of the palate (CL ± P). Therefore, the aim of the present study was to investigate the attitudes of peers toward the speech of adolescents with CL ± P. METHOD Seventy-eight typically developing adolescents (15-18 years, 26 boys, 52 girls) judged audio and audiovisual samples of two adolescents with CL ± P based on three attitude components, i.e., cognitive, affective, and behavioral. The degree of speech intelligibility was also scored by their peers. The study investigated whether the three attitudes were determined by speech intelligibility or appearance of an individual with CL ± P. Furthermore, the influence of knowing someone with a cleft, the age, and gender of the listeners on their attitudes were explored. RESULTS A significantly positive correlation was found between the speech intelligibility percentage and the three different attitude components: more positive attitudes were observed when the speech intelligibility of the speaker was higher. A different appearance due to a cleft lip does not lead to more negative attitudes. Furthermore, boys seem to have more negative attitudes toward individuals with CL ± P compared to girls. CONCLUSION This study provided additional evidence that peers show more negative attitudes toward adolescents with less intelligible speech due to CL ± P. Intervention should focus on changing the cognitive, affective, and behavioral attitudes of peers in a more positive direction and remove the stigma of patients with a cleft. Further research is needed to verify these results.
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Affiliation(s)
- Cassandra Alighieri
- Department of Rehabilitation Sciences, Center for Speech and Language Sciences (CESLAS), Ghent University, Ghent, Belgium.
| | - Ymke Haeghebaert
- Department of Rehabilitation Sciences, Center for Speech and Language Sciences (CESLAS), Ghent University, Ghent, Belgium
| | - Kim Bettens
- Department of Rehabilitation Sciences, Center for Speech and Language Sciences (CESLAS), Ghent University, Ghent, Belgium
| | - Imke Kissel
- Department of Rehabilitation Sciences, Center for Speech and Language Sciences (CESLAS), Ghent University, Ghent, Belgium
| | - Evelien D'haeseleer
- Department of Rehabilitation Sciences, Center for Speech and Language Sciences (CESLAS), Ghent University, Ghent, Belgium; Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
| | - Iris Meerschman
- Department of Rehabilitation Sciences, Center for Speech and Language Sciences (CESLAS), Ghent University, Ghent, Belgium
| | - Rani Van Der Sanden
- 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; Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium; Department of Speech-Language Therapy and Audiology, University of Pretoria, Pretoria, South Africa
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Alighieri C, Bettens K, Perry J, Hens G, Roche N, Van Lierde K. Achieving the next level in cleft speech intervention: A protocol of a randomized sham-controlled trial to provide guidelines for a personalized approach in children with cleft palate. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2023. [PMID: 36721996 DOI: 10.1111/1460-6984.12853] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 01/10/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Compensatory cleft speech disorders can severely impact speech understandability and speech acceptability. Speech intervention is necessary to eliminate these disorders. There is, however, currently no consensus on the most effective speech therapy approach to eliminate the different subtypes of compensatory cleft speech disorders. AIMS To compare the immediate, short- and long-term effects of three well-defined speech intervention approaches (i.e., a motor-phonetic approach, a linguistic-phonological approach and a combined phonetic-phonological approach) on the speech and health-related quality of life (HRQoL) in Belgian Dutch-speaking children with cleft palate with or without cleft lip (CP±L) and different subtypes of compensatory speech disorders (i.e., anterior oral cleft speech characteristics (CSCs), posterior oral CSCs or non-oral CSCs). Besides, the perceived acceptability of these three speech intervention approaches will be investigated from the perspectives of caregivers and children with a CP±L. METHODS & PROCEDURES A two-centre longitudinal randomized sham-controlled trial was used. Children were randomly assigned to one of the three intervention programmes and received 10 h of speech intervention divided over 2 weeks. Block randomization was used, stratified by age and gender. Primary outcome measures included perceptual speech outcomes. Secondary outcome measures included patient-reported outcomes. OUTCOMES & RESULTS The results of this trial will provide speech-language pathologists evidence-based guidelines to better tailor intervention approaches to the specific needs of a child with a defined compensatory speech disorder. WHAT THIS PAPER ADDS What is already known on this subject Speech therapy approaches to address cleft palate speech disorders are broadly divided into two categories: motor-phonetic interventions and linguistic-phonological interventions. Some limited evidence demonstrated the positive effects of these approaches in eliminating compensatory cleft speech disorders. Different studies have reported inter-individual variation, suggesting that one child may benefit more from a particular intervention approach than the other child. Perhaps this variation can be attributed to the specific subtype of compensatory speech disorder (i.e., anterior oral CSC, posterior oral CSC or non-oral CSC). What this paper adds to existing knowledge This paper describes a randomized sham-controlled trial that compared the immediate, short- and long-term effects of three well-defined speech intervention approaches (i.e., a motor-phonetic approach, a linguistic-phonological approach and a combined phonetic-phonological approach) on the speech and HRQoL in Belgian Dutch-speaking children with CP±L and different subtypes of compensatory cleft speech disorders (i.e., anterior oral CSCs, posterior oral CSCs or non-oral CSCs) measured by perceptual and psychosocial outcome measures. Besides, the experienced acceptability of these three speech intervention approaches were investigated from the perspectives of caregivers and children. What are the potential or actual clinical implications of this work? This project provides evidence-based knowledge on patient-tailored cleft speech intervention considering both scientific evidence and the perspectives of caregivers and children. The results aid SLPs in better tailoring intervention approaches to the needs of a child with a specific type of compensatory cleft speech disorder.
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Affiliation(s)
- Cassandra Alighieri
- Department of Rehabilitation Sciences, Centre of Speech and Language Sciences Ghent University, Gent, Belgium
| | - Kim Bettens
- Department of Rehabilitation Sciences, Centre of Speech and Language Sciences Ghent University, Gent, Belgium
| | - Jamie Perry
- Department of Communication Sciences and Disorders, East Carolina University, Greenville, NC, USA
| | - Greet Hens
- Department Neurosciences, KU Leuven, Leuven, Belgium
| | | | - Kristiane Van Lierde
- Department of Rehabilitation Sciences, Centre of Speech and Language Sciences Ghent University, Gent, Belgium
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11
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Diallo-Hornez G, Khonsari RH, Mercier JM, Delaire J, Balandier S, Defay V, Isidor B, Rousteau G, Talmant JC, Perrin JP, Bertin H, Corre P. Could pharyngeal fat injection be a first-line treatment of velopharyngeal insufficiency? JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:e206-e211. [PMID: 34844018 DOI: 10.1016/j.jormas.2021.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 11/23/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Garance Diallo-Hornez
- Clinique de Chirurgie Maxillo-faciale et de Stomatologie, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Roman Hossein Khonsari
- Hôpital Necker Enfants - Malades, Service de Chirurgie Maxillo-faciale et Chirurgie Plastique, Assistance Publique - Hôpitaux de Paris, Université de Paris , Paris, France
| | - Jacques-Marie Mercier
- Clinique de Chirurgie Maxillo-faciale et de Stomatologie, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Jean Delaire
- Clinique de Chirurgie Maxillo-faciale et de Stomatologie, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Sophie Balandier
- Clinique de Chirurgie Maxillo-faciale et de Stomatologie, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Virginie Defay
- Clinique de Chirurgie Maxillo-faciale et de Stomatologie, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Bertrand Isidor
- Service de Génétique clinique, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Gabriel Rousteau
- Clinique de Chirurgie Maxillo-faciale et de Stomatologie, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Jean-Claude Talmant
- Chirurgie Plastique, Reconstructrice et Esthétique, Clinique Jules Verne, Nantes, France
| | - Jean-Philippe Perrin
- Clinique de Chirurgie Maxillo-faciale et de Stomatologie, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Hélios Bertin
- Clinique de Chirurgie Maxillo-faciale et de Stomatologie, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Pierre Corre
- Clinique de Chirurgie Maxillo-faciale et de Stomatologie, Centre Hospitalier Universitaire de Nantes, Nantes, France.
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12
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de Blacam C, O'Dwyer A, Oderoha KE, Gilroy TC, Duggan L, Orr DJA. The case for the pharyngeal flap pharyngoplasty in the management of velopharyngeal dysfunction. J Plast Reconstr Aesthet Surg 2022; 75:3436-3447. [PMID: 35729045 DOI: 10.1016/j.bjps.2022.04.048] [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: 10/24/2021] [Revised: 02/28/2022] [Accepted: 04/12/2022] [Indexed: 11/15/2022]
Abstract
Velopharyngeal dysfunction (VPD) occurs when there is inadequate closure of the velopharyngeal sphincter during speech. An incompetent velopharyngeal sphincter may require surgical intervention to create a functional seal between the oropharynx and the nasopharynx during speech. To date, no single pharyngoplasty procedure has emerged as superior to another, and the comparison of results between studies has been limited by variation in outcomes reporting. Here, we use the newly defined Core Outcome Set for VPD (COS-VPD) to report a consecutive series of 109 patients managed with a midline pharyngeal flap and simultaneous dissection and repositioning of the velar muscles. The overall 30-day postoperative complication rate was 3.6% (4 out of 109 patients). At 12-month follow-up, 79.3% of patients experienced a statistically significant improvement in hypernasality. Seven patients (6.4%) developed obstructive sleep apnoea (OSA) postoperatively, and this was confirmed with polysomnography, with four (3.6%) patients requiring takedown of the pharyngeal flap. Seven patients in total (7.3%) required takedown of the pharyngeal flap and sphincter pharyngoplasty because of insufficient improvement of their VPD following the initial procedure. Patient-reported outcomes were investigated using the Velopharyngeal Effects on Life Outcome (VELO) instrument, and a mean total score of 74.5 out of 100 was recorded. We conclude that cleft surgeons should not be dissuaded by historical concerns about high rates of perioperative complications and OSA and should consider including the pharyngeal flap in their armamentarium when managing patients with VPD.
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Affiliation(s)
- Catherine de Blacam
- Department of Plastic & Reconstructive Surgery, Children's Health Ireland at Crumlin, Dublin, Ireland; Royal College of Surgeons in Ireland, Ireland.
| | - Aisling O'Dwyer
- Department of Speech & Language Therapy, Children's Health Ireland at Crumlin and St James's Hospital Dublin, Ireland
| | | | - Tanya C Gilroy
- Department of Speech & Language Therapy, Children's Health Ireland at Temple Street, Ireland
| | - Laura Duggan
- Dublin Cleft Centre, Children's Health Ireland at Crumlin and St James's Hospital Dublin, Ireland
| | - David J A Orr
- Department of Plastic & Reconstructive Surgery, Children's Health Ireland at Crumlin, Dublin, Ireland; Department of Surgery and Paediatrics, Trinity College Dublin, Ireland
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Alighieri C, Bettens K, Bruneel L, Perry J, Hens G, Van Lierde K. One Size Doesn't Fit All: A Pilot Study Toward Performance-Specific Speech Intervention in Children With a Cleft (Lip and) Palate. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:469-486. [PMID: 35021015 DOI: 10.1044/2021_jslhr-21-00405] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE Speech-language pathologists usually apply a "one size fits all" approach to eliminate compensatory cleft speech characteristics (CSCs). It is necessary to investigate what intervention works best for a particular patient. This pilot study compared the effectiveness of two therapy approaches (a motor-phonetic approach and a linguistic-phonological approach) on different subtypes of compensatory CSCs in Dutch-speaking children with a cleft (lip and) palate (CP ± L). METHOD Fourteen children with a CP ± L (M age = 7.71 years) were divided into two groups using block randomization stratified by age, gender, and type of compensatory CSC. Six children received intervention to eliminate anterior oral CSCs (n = 3 motor-phonetic intervention, n = 3 linguistic-phonological intervention). Eight children received intervention to eliminate non-oral CSCs (n = 4 motor-phonetic intervention, n = 4 linguistic-phonological intervention). Each child received 10 hr of speech intervention divided over 2 weeks. Perceptual and psychosocial outcome measures were used to determine intervention effects. RESULTS Children who received linguistic-phonological intervention to eliminate anterior oral CSCs had significantly higher correctly produced consonant scores and health-related quality of life (HRQoL) scores compared to children who received motor-phonetic intervention to eliminate anterior oral CSCs. In the group of children who received intervention to eliminate non-oral CSCs, no significant differences were found in the correctly produced consonant scores nor in the HRQoL scores between the two intervention approaches. CONCLUSIONS Linguistic-phonological intervention seems to be more appropriate to eliminate anterior oral CSCs. The beneficial effects of linguistic-phonological intervention were less pronounced in children with non-oral CSCs. Perhaps, children with non-oral CSCs benefit more from a hybrid phonetic-phonological approach. This study is a step forward in the provision of performance-specific intervention in children with a CP ± L. Replication in larger samples is needed and will aid to tailor treatment plans to the needs of our patients.
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Affiliation(s)
| | - Kim Bettens
- Department of Rehabilitation Sciences, Ghent University, Belgium
| | - Laura Bruneel
- Department of Rehabilitation Sciences, Ghent University, Belgium
| | - Jamie Perry
- Department of Communication Sciences and Disorders, East Carolina University, Greenville, NC
| | - Greet Hens
- Department of Neurosciences, Katholieke Universiteit Leuven, Belgium
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14
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Sakran KA, Al‐Rokhami RK, Wu M, Chen N, Yin H, Guo C, Wang Y, Alkebsi K, Abotaleb BM, Mohamed AA, Al‐Watary MQ, Shi B, Huang H. Correlation of the Chinese velopharyngeal insufficiency-related quality of life instrument and speech in subjects with cleft palate. Laryngoscope Investig Otolaryngol 2022; 7:180-189. [PMID: 35155796 PMCID: PMC8823188 DOI: 10.1002/lio2.705] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 10/06/2021] [Accepted: 11/16/2021] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE Assessment of the hypothesized correlation between the Chinese Velopharyngeal Insufficiency (VPI) Effects on Life Outcomes (VELO) instrument and measured speech parameters. METHODS A cross-sectional study was conducted in the Oral Clefts Center of West China Hospital of Stomatology between January 2019 and December 2019. Speech parameters including speech intelligibility deficit, VPI severity, VP gap, and need for speech therapy were evaluated by speech-language pathologists. All patients and their parents completed the VELO instrument. The correlation between aforementioned speech parameters and VELO scores was examined utilizing Spearman correlation coefficients. The reliability of VELO test-retest and parent proxy assessment was estimated utilizing intraclass correlation coefficients (ICC). A receiver operating characteristic curve was used to calculate the cutoff VELO score. RESULTS One hundred and forty patients with their parents were enrolled. The mean age was 12.58 ± 3.72 years. Both parent and youth VELO total and domain scores recorded moderate to strong correlations with all speech parameters (r > -.40, P ˂ .001) except the swallowing domain. Most VELO domain items have shown significant correlations with at least one speech parameter. Moreover, the scales of all speech parameters showed different VELO scores (P ˂ .001). The ICC reported test-retest correlation >.73 in all domains, and parent proxy correlation >.63 in most domains except the emotional and perception domains. The cutoff VELO score was 79.04 in parent version and 85.77 in youth version. CONCLUSIONS The correlations between VELO scores and measured speech parameters have provided evidence for test-retest and parent proxy reliability and criterion and construct validity of the Chinese version of the VELO instrument. A VELO score ≥79.04 (in parent version) or ≥85.77 (in youth version) mostly reflects proper speech-related quality of life. Hence, this instrument could serve as a simple tool to help clinicians understand the social, emotional, and physical influences of VPI.
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Affiliation(s)
- Karim Ahmed Sakran
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of StomatologySichuan UniversityChengduChina
- Department of Oral and Maxillofacial Surgery, Faculty of DentistryIbb UniversityIbbYemen
| | | | - Min Wu
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of StomatologySichuan UniversityChengduChina
| | - Nan Chen
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth HospitalSichuan UniversityChengduChina
| | - Heng Yin
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of StomatologySichuan UniversityChengduChina
| | - Chunli Guo
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of StomatologySichuan UniversityChengduChina
| | - Yan Wang
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of StomatologySichuan UniversityChengduChina
| | - Khaled Alkebsi
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of StomatologySichuan UniversityChengduChina
- Department of Oral and Maxillofacial Surgery, Faculty of DentistryIbb UniversityIbbYemen
| | - Bassam Mutahar Abotaleb
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of StomatologySichuan UniversityChengduChina
- Department of Oral and Maxillofacial Surgery, Faculty of DentistryIbb UniversityIbbYemen
| | - Abdo Ahmed Mohamed
- Department of Oral and Maxillofacial Surgery, Faculty of DentistryIbb UniversityIbbYemen
- Department of Oral and Maxillofacial Surgery, Guanghua School of StomatologySun Yat‐sen UniversityGuangzhouChina
| | - Mohammed Qasem Al‐Watary
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of StomatologySichuan UniversityChengduChina
| | - Bing Shi
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of StomatologySichuan UniversityChengduChina
| | - Hanyao Huang
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of StomatologySichuan UniversityChengduChina
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15
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Alighieri C, Bettens K, Verhaeghe S, Van Lierde K. Speech diagnosis and intervention in children with a repaired cleft palate: A qualitative study of Flemish private community speech-language pathologists' practices. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 24:53-66. [PMID: 34229538 DOI: 10.1080/17549507.2021.1946153] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Purpose: This study investigated the practice patterns of private community speech-language pathologists (SLPs) when treating children with a repaired cleft of the palate with or without a cleft of the lip (CP ± L). Practices were explored in terms of diagnostics and treatment focus, treatment dosage and experienced difficulties when treating children with a CP ± L.Method: Eleven female private community SLPs, who lived in Flanders (i.e. the northern part of Belgium) and were aged between 23 and 62 years participated in this study. Data were collected from semi-structured face-to-face interviews. The qualitative software program NVivo 12 was used for data analysis. The interviews were analysed using an inductive thematic approach.Result: SLPs reported a lack of available information on speech-related cleft care. SLPs expressed the need to receive a referral letter from the hospital in order to make an adequate speech diagnosis. Most therapists reported that they performed an articulatory assessment combined with a language assessment. Most SLPs used a hybrid treatment model including a variety of intervention techniques. These techniques were not always in line with available scientific evidence. SLPs reported the desire to receive practical step-by-step guidelines on how to provide speech intervention to children with a CP ± L. In contrast, there was a strong consensus among the therapists that an individualised treatment plan is necessary.Conclusion: The results of this study have revealed gaps in the dissemination and implementation of scientific evidence relevant to speech services for children with a CP ± L (i.e. a research-practice gap) in Flanders. Research evidence needs to be adequately translated into clinical practice by providing concrete and practical guidelines.
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Affiliation(s)
| | - Kim Bettens
- Department of Rehabilitation Sciences, Ghent University, Gent, Belgium
| | - Sofie Verhaeghe
- Department of Public Health and Primary Care, Ghent University, Gent, Belgium
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16
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Parents' perceptions on speech therapy delivery models in children with a cleft palate: A mixed methods study. Int J Pediatr Otorhinolaryngol 2021; 151:110958. [PMID: 34736010 DOI: 10.1016/j.ijporl.2021.110958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 10/11/2021] [Accepted: 10/25/2021] [Indexed: 11/21/2022]
Abstract
PURPOSE This study investigated parents' perceptions on two different speech therapy delivery models in children with a CP ± L, namely an innovative high intensity speech intervention (i.e. HISI: 10 1-h sessions divided over 2 weeks) and a low intensity speech intervention (i.e. LISI: 10 1-h sessions divided over 10 weeks). METHOD Twelve parents of 12 children who received HISI (n = 6) or LISI (n = 6) were contacted with the request to participate to this study to review their opinion on the received therapy. Participation included the completion of a questionnaire containing items related to satisfaction, speech progress, intervention intensity and frequency, transfer, and need for further speech therapy. Additionally, semi-structured interviews were carried out. The interviews were analyzed using an inductive thematic approach. RESULTS There were no significant differences between the two groups in satisfaction with the "general speech therapy, "duration of one speech therapy session", "total intervention duration" and "degree of improvement of speech intelligibility". Following HISI, parents perceived more improvement in terms of spontaneous speech and better resolution of the speech disorders. The interviews revealed 3 themes of importance to the parents: (1) treatment-related expectations, (2) treatment-related burden, and (3) patient-therapist relationship. Parents in the HISI group reported two concerns: (1) the lack of variation when receiving daily intervention, and (2) the emotional burden when the child is confronted with his/her speech disorder on a daily basis. CONCLUSIONS Parents were equally satisfied with the provided intervention. Parents in the HISI group perceived more speech progress following the intervention compared to parents in the LISI group. The intensive contact with the speech pathologist enhanced the patient-therapist relationship. To support a cultural shift away from low intensity therapy delivery models, it will be important to counsel and inform parents of the benefits of HISI and to counterbalance concerns.
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Thouvenin B, Soupre V, Caillaud MA, Henry-Mestelan C, Chalouhi C, Houssamo B, Chapuis C, Lind K, Royer A, Vegas N, Amiel J, Couly G, Picard A, Vaivre-Douret L, Abadie V. Quality of life and phonatory and morphological outcomes in cognitively unimpaired adolescents with Pierre Robin sequence: a cross-sectional study of 72 patients. Orphanet J Rare Dis 2021; 16:442. [PMID: 34670591 PMCID: PMC8527704 DOI: 10.1186/s13023-021-02072-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 10/10/2021] [Indexed: 01/28/2023] Open
Abstract
Background Pierre Robin sequence (PRS) is a heterogeneous condition involving retro(micro)gnathia, glossoptosis and upper airway obstruction, very often with posterior cleft palate. Patients with PRS, either isolated or associated with Stickler syndrome have good intellectual prognosis. Nevertheless, the quality of life in adolescence and the phonatory and morphological outcomes are rarely analysed. We assessed the phonatory and morphological outcomes of 72 cognitively unimpaired adolescents with PRS, studied their oral (COHIP-SF19), vocal (VHI-9i) and generic quality of life (QoL; KIDSCREEN-52), and searched for determinants of these outcomes.
Results Two-thirds of our adolescents retained low or moderate phonation difficulties, but risk factors were not identified. For 14%, morphological results were considered disharmonious, with no link to neonatal retrognathia severity. Only one vs two-stage surgery seemed to affect final aesthetic results. The oral QoL of these adolescents was comparable to that of control patients and was significantly better than that of children with other craniofacial malformations (COHIP-SF19 = 17.5, 15.4 and 25.7, respectively). The oral QoL of the adolescents with non-isolated PRS was significantly worse (COHIP-SF19 = 24.2) than that of control patients and close to that of children with other craniofacial malformations. The vocal QoL of the adolescents (mean [SD] VHI-9i = 7.5 [5.4]) was better than that of patients with other voice pathologies and better when phonation was good. The generic QoL of the adolescents was satisfactory but slightly lower than that of controls, especially in dimensions concerning physical well-being, relationships and autonomy. QoL results were lower for adolescents with non-isolated than isolated PRS. Only non-isolated PRS and low oral QoL affected generic QoL. Conclusion Morphological or phonatory impairments remain non-rare in adolescents with PRS but do not seem to be directly responsible for altered QoL. These adolescents, especially those with non-isolated PRS, show self-confidence and social-relation fragility. We must focus on long-term functional and psychological results for PRS patients and improve therapy protocols and follow-up, notably those affecting the oral aspects of the disease.
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Affiliation(s)
- Béatrice Thouvenin
- General Paediatrics Unit, Necker University Hospital, APHP, 149 rue de Sèvres, 75015, Paris, France.,Referral Centre for Rare Diseases "Syndrome de Pierre Robin et troubles de succion-déglutition congénitaux», Necker University Hospital, APHP, Paris, France
| | - Véronique Soupre
- Referral Centre for Rare Diseases "Syndrome de Pierre Robin et troubles de succion-déglutition congénitaux», Necker University Hospital, APHP, Paris, France.,Paediatric Maxillofacial and Plastic Surgery Unit, Necker University Hospital, APHP, Paris, France
| | | | - Charlotte Henry-Mestelan
- General Paediatrics Unit, Necker University Hospital, APHP, 149 rue de Sèvres, 75015, Paris, France
| | - Christel Chalouhi
- General Paediatrics Unit, Necker University Hospital, APHP, 149 rue de Sèvres, 75015, Paris, France.,Referral Centre for Rare Diseases "Syndrome de Pierre Robin et troubles de succion-déglutition congénitaux», Necker University Hospital, APHP, Paris, France
| | - Bachar Houssamo
- Referral Centre for Rare Diseases "Syndrome de Pierre Robin et troubles de succion-déglutition congénitaux», Necker University Hospital, APHP, Paris, France.,Paediatric Maxillofacial and Plastic Surgery Unit, Necker University Hospital, APHP, Paris, France
| | - Cécile Chapuis
- Paediatric Maxillofacial and Plastic Surgery Unit, Necker University Hospital, APHP, Paris, France
| | - Katia Lind
- General Paediatrics Unit, Necker University Hospital, APHP, 149 rue de Sèvres, 75015, Paris, France
| | - Aurélie Royer
- General Paediatrics Unit, Necker University Hospital, APHP, 149 rue de Sèvres, 75015, Paris, France.,Referral Centre for Rare Diseases "Syndrome de Pierre Robin et troubles de succion-déglutition congénitaux», Necker University Hospital, APHP, Paris, France
| | - Nancy Vegas
- General Paediatrics Unit, Necker University Hospital, APHP, 149 rue de Sèvres, 75015, Paris, France.,Referral Centre for Rare Diseases "Syndrome de Pierre Robin et troubles de succion-déglutition congénitaux», Necker University Hospital, APHP, Paris, France.,Imagine Institute, Paris, France
| | - Jeanne Amiel
- Imagine Institute, Paris, France.,Genetics Department, Necker University Hospital, APHP, Paris, France.,Paris University, Paris, France
| | - Gérard Couly
- Paediatric Maxillofacial and Plastic Surgery Unit, Necker University Hospital, APHP, Paris, France.,Paris University, Paris, France
| | - Arnaud Picard
- Referral Centre for Rare Diseases "Syndrome de Pierre Robin et troubles de succion-déglutition congénitaux», Necker University Hospital, APHP, Paris, France.,Paediatric Maxillofacial and Plastic Surgery Unit, Necker University Hospital, APHP, Paris, France.,Paris University, Paris, France
| | - Laurence Vaivre-Douret
- Imagine Institute, Paris, France.,Paris University, Paris, France.,INSERM Unit 1178, CESP, Paris, France
| | - Véronique Abadie
- General Paediatrics Unit, Necker University Hospital, APHP, 149 rue de Sèvres, 75015, Paris, France. .,Referral Centre for Rare Diseases "Syndrome de Pierre Robin et troubles de succion-déglutition congénitaux», Necker University Hospital, APHP, Paris, France. .,Imagine Institute, Paris, France. .,Paris University, Paris, France. .,INSERM Unit 1178, CESP, Paris, France.
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18
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Lambert EM, You P, Kacmarynski DS, Rosenberg TL. Adenoidectomy and persistent velopharyngeal insufficiency: Considerations, risk factors, and treatment. Int J Pediatr Otorhinolaryngol 2021; 149:110846. [PMID: 34329831 DOI: 10.1016/j.ijporl.2021.110846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 06/05/2021] [Accepted: 07/16/2021] [Indexed: 10/20/2022]
Abstract
IMPORTANCE Persistent velopharyngeal insufficiency (VPI) is a rare but well-recognized complication of adenoidectomy. VPI can have a significant impact on the communication of a child. OBJECTIVE To describe the pathophysiology of post-adenoidectomy VPI, identify its associated risk factors, and illustrate the techniques used to treat the entity. EVIDENCE REVIEW A search of English or translated English articles concerning adenoidectomy, partial adenoidectomy, superior adenoidectomy; and velopharyngeal insufficiency, speech and voice from 1980 to 2021 was performed using Pubmed and Embase. Data from prospective and retrospective studies and their relevant references were pooled. RESULTS By objective measures, hypernasality is noted in many pediatric patients post-adenoidectomy, but this typically resolves in 3-6 months. Risk factors for the development of post-adenoidectomy VPI include low birth weight, family history of hypernasality, and history of speech problems or nasal regurgitation. The cleft palate, submucous cleft palate, poor palate mobility, and a deep pharynx may indicate susceptibility to VPI. Speech therapy is successful in up to 50% of patients, while surgical intervention may be tailored based on the diagnostic evaluation of the velopharynx with videofluoroscopy or nasoendoscopy. CONCLUSION We present a comprehensive review of the literature on the pathophysiology, risk factors, and treatment of post-adenoidectomy VPI. We hope to bring awareness to the factors that can lead to a rare but potentially devastating complication in one of the most common procedures performed by Otolaryngologists.
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Affiliation(s)
- Elton M Lambert
- Department of Otolaryngology-Head and Neck Surgery, Texas Children's Hospital, Baylor College of Medicine, 6701 Fannin Street D.640, Houston, TX, 77030, USA.
| | - Peng You
- Department of Otolaryngology-Head and Neck Surgery, Texas Children's Hospital, Baylor College of Medicine, 6701 Fannin Street D.640, Houston, TX, 77030, USA.
| | - Deborah S Kacmarynski
- Department of Otolaryngology-Head and Neck Surgery, Division of Pediatric Otolaryngology, University of Iowa Hospitals and Clinics, 200 Hawkins Dr, Iowa City, IA, 52242, USA.
| | - Tara L Rosenberg
- Department of Otolaryngology-Head and Neck Surgery, Texas Children's Hospital, Baylor College of Medicine, 6701 Fannin Street D.640, Houston, TX, 77030, USA.
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19
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Alighieri C, Van Lierde K, De Caesemaeker AS, Demuynck K, Bruneel L, D'haeseleer E, Bettens K. Is High-Intensity Speech Intervention Better? A Comparison of High-Intensity Intervention Versus Low-Intensity Intervention in Children With a Cleft Palate. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:3398-3415. [PMID: 34433000 DOI: 10.1044/2021_jslhr-21-00189] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Purpose The purpose of this study was to compare the effect of speech intervention provided with a low intensity with speech intervention provided with a high intensity on the speech and health-related quality of life (HRQoL) in Dutch-speaking children with a cleft palate with or without a cleft lip (CP ± L) between 4 and 12 years. Method A longitudinal, prospective, randomized controlled trial with a multiple baseline design was used. Twelve children with a CP ± L (M age = 8.0 years, SD = 1.54) were divided into two groups using block randomization stratified by age and gender: One group received low-intensity speech intervention (LISI; n = 6) and one group received high-intensity speech intervention (HISI; n = 6). Children in the LISI group received intervention with a session duration of 1 hr, a dose frequency of 1 session per week, and a total intervention duration of 10 weeks. Children in the HISI group received intervention with a session duration of 1 hr, a dose frequency of 5 sessions per week, and a total intervention duration of 2 weeks. The cumulative intervention intensity was kept constant. Both groups received identical therapy programs provided by the same experienced speech therapist. Perceptual speech assessments were performed on baseline and posttreatment data points. Changes in HRQoL were assessed using the Velopharyngeal Insufficiency Effects on Life Outcomes (VELO) questionnaire. Both groups were compared over time using (generalized) linear mixed models. Results No significant Time × Group interactions were observed for the percentage of correctly produced consonants at the word and sentence levels, indicating no differences in evolution over time among the two groups. The variables speech understandability, speech acceptability, and the total VELO scores significantly improved following HISI, but not following LISI. Conclusions Children in the HISI group made equal and, for some variables, even superior progress in only 2 weeks of therapy compared to children in the LISI group who received 10 weeks of therapy. HISI is a promising strategy to improve speech outcomes and HRQoL in a shorter time period.
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Affiliation(s)
| | - Kristiane Van Lierde
- Department of Rehabilitation Sciences, Ghent University, Belgium
- Faculty of Humanities, Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa
| | | | - Kris Demuynck
- Department of Electronics and information systems, Ghent University, Belgium
| | - Laura Bruneel
- Department of Rehabilitation Sciences, Ghent University, Belgium
| | | | - Kim Bettens
- Department of Rehabilitation Sciences, Ghent University, Belgium
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20
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Lu L, Yakupu A, Wu Y, Li X, Zhang P, Aihaiti G, Xu H. Quality of Life in Patients With Velopharyngeal Insufficiency in West China. Cleft Palate Craniofac J 2021; 59:1024-1029. [PMID: 34460333 DOI: 10.1177/10556656211034107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE This study aimed to investigate the quality of life (QOL) of patients with cleft lip and palate and velopharyngeal insufficiency (VPI) in relation to sex, age, age at initial cleft lip surgery, and age at initial cleft palate surgery. DESIGN This is a cross-sectional study. SETTING The study was conducted in a tertiary medical center. PARTICIPANTS The participants were caregivers of 72 patients with cleft lip and palate and VPI aged 4 to 20 years. MAIN OUTCOME MEASURE(S) Participants completed the Chinese version of the caregiver report of the VPI Effects on Life Outcomes (VELO) questionnaire. The Mann-Whitney U test was used to evaluate the patients' sex, age, age at initial cleft lip repair, and age at initial cleft palate repair in relation to VELO total score and domains. Spearman correlation analysis was completed including all study variables. Associations between the study variables and the VELO total score were tested using a generalized linear mixed model. RESULTS In the univariate analysis, patients' age and age at initial cleft palate surgery influenced the QOL of patients with VPI. There were no differences in the VELO total score or domains based on sex or age at first cleft lip surgery. In the generalized linear mixed model, patients older than 8 years had higher VELO total scores. CONCLUSIONS By caregiver report, the QOL of patients under age 8 years with VPI was lower than older patients. In addition, the caregiver impact domain was higher for parents of children who had their initial cleft palate surgery at age 2 years or younger.
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Affiliation(s)
- Lidan Lu
- Department of Oral and Maxillofacial Surgery, 159426People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China.,Postgraduate College of Xinjiang Medical University, Urumqi, China
| | - Aipiziguli Yakupu
- Department of Oral and Maxillofacial Surgery, 159426People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China.,Postgraduate College of Xinjiang Medical University, Urumqi, China
| | - Yanhui Wu
- Department of Oral and Maxillofacial Surgery, 159426People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China.,Postgraduate College of Xinjiang Medical University, Urumqi, China
| | - Xiangnan Li
- Department of Oral and Maxillofacial Surgery, 159426People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China.,Postgraduate College of Xinjiang Medical University, Urumqi, China
| | - Pengxin Zhang
- Department of Oral and Maxillofacial Surgery, 159426People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China.,Postgraduate College of Xinjiang Medical University, Urumqi, China
| | - Guliziba Aihaiti
- Department of Oral and Maxillofacial Surgery, 159426People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China.,Postgraduate College of Xinjiang Medical University, Urumqi, China
| | - Hui Xu
- Department of Oral and Maxillofacial Surgery, 159426People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China.,Stomatology School of Xinjiang Medical University, Urumqi, China
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21
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Stiernman M, Klintö K, Persson M, Becker M. Comparison of Corresponding Scores From the Cleft Hearing Appearance and Speech Questionnaire (CHASQ) and CLEFT-Q in Swedish Patients With Cleft Lip and/or Palate. Cleft Palate Craniofac J 2021; 58:736-745. [PMID: 33047614 PMCID: PMC8165751 DOI: 10.1177/1055665620964124] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The primary aim of this study was to compare corresponding scores between 2 existing cleft-specific patient-reported outcome measures (PROMs)-Cleft Hearing Appearance and Speech Questionnaire (CHASQ) and CLEFT-Q. The second aim of the study was to investigate patient opinion on the 2 PROMs. DESIGN Cross-sectional questionnaire study. SETTING Participants were recruited from a University Hospital. They answered CHASQ and CLEFT-Q either in the hospital or at home. PARTICIPANTS Thirty-three participants with cleft lip and/or palate, aged 10 to 19 years. MAIN OUTCOME MEASURE CHASQ and CLEFT-Q. RESULTS The CHASQ scores and the corresponding CLEFT-Q scores on appearance correlated significantly. Corresponding scores regarding speech did not correlate significantly. A majority, 15 (58%) participants, answered that they liked CLEFT-Q more than CHASQ, 18 participants (69%) thought CHASQ was easier to complete, and 19 (76%) thought CLEFT-Q would better inform health care professionals. CONCLUSION Both instruments showed strengths and limitations. Clinicians will have to consider each instrument's respective qualities when choosing to implement either PROM.
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Affiliation(s)
- Mia Stiernman
- Department of Plastic and Reconstructive Surgery, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences in Malmö, Lund University, Sweden
| | - Kristina Klintö
- Department of Clinical Sciences in Malmö, Lund University, Sweden
- Department of Otorhinolaryngology, Skåne University Hospital, Malmö, Sweden
| | - Martin Persson
- Department of Health and Society, Kristianstad University, Sweden
| | - Magnus Becker
- Department of Plastic and Reconstructive Surgery, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences in Malmö, Lund University, Sweden
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22
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Alighieri C, Bettens K, Bruneel L, D'haeseleer E, Van Gaever E, Van Lierde K. Effectiveness of Speech Intervention in Patients With a Cleft Palate: Comparison of Motor-Phonetic Versus Linguistic-Phonological Speech Approaches. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2020; 63:3909-3933. [PMID: 33253622 DOI: 10.1044/2020_jslhr-20-00129] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose The purpose of this study was to compare the effect of two different speech therapy approaches, a traditional motor-phonetic approach and a linguistic-phonological approach, on the speech and health-related quality of life in Dutch-speaking children with a cleft palate with or without a cleft lip (CP ± L) between 4 and 12 years old. Method A block-randomized, sham-controlled design was used. Fourteen children with a CP ± L (M age = 7.71 years) were divided into two groups using block randomization stratified by age and gender: one receiving motor-phonetic intervention (n = 7) and one receiving linguistic-phonological intervention (n = 7). Each group received 10 hr of speech therapy divided over 2 weeks. Perceptual speech assessments were performed on several baseline and posttreatment data points. The psychosocial effects of the intervention were assessed using the patient-reported Velopharyngeal Insufficiency Effects on Life Outcomes questionnaire. Both groups were compared over time using (generalized) linear mixed models. Within-group effects of time were determined using pairwise comparisons with post hoc Bonferroni correction. Results Significant Time × Group interactions with large effect sizes were revealed in terms of consonant proficiency, indicating significant differences in evolution over time among the two groups. Only in the group receiving linguistic-phonological intervention, percentage of correctly produced consonants and places significantly improved after the treatment. Total Velopharyngeal Insufficiency Effects on Life Outcomes scores of the parents significantly improved in both groups after the intervention. Conclusions Both motor-phonetic and linguistic-phonological speech interventions can have a positive impact on the occurrence of cleft speech characteristics and consonant proficiency in children with a CP ± L. A linguistic-phonological approach, however, was observed to be more effective in terms of improving these speech outcomes compared with a motor-phonetic approach. Speech intervention, irrespective of the used approach, significantly improved the participant's health-related quality of life.
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Affiliation(s)
| | - Kim Bettens
- Department of Rehabilitation Sciences, Ghent University, Belgium
| | - Laura Bruneel
- Department of Rehabilitation Sciences, Ghent University, Belgium
| | | | - Ellen Van Gaever
- Department of Rehabilitation Sciences, Ghent University, Belgium
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23
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Ecuadorian Spanish translation and validation of the VELO quality of life instrument. Int J Pediatr Otorhinolaryngol 2020; 138:110312. [PMID: 32882600 PMCID: PMC7649090 DOI: 10.1016/j.ijporl.2020.110312] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 08/08/2020] [Accepted: 08/09/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Adapt the Spanish translation of VPI Effects on Life Outcome (VELO) instrument into Ecuadorian Spanish; test the resulting instrument for reliability and validity. METHODS A cross-sectional, prospective design, set at a humanitarian mission within a community hospital. Linguistic validation: native Ecuadorian-Spanish speakers modified the Spanish VELO to Ecuadorian Spanish. Cognitive interviews were conducted with children with cleft palate (CP) and their parents (n = 50), guiding instrument modifications. An expert panel reviewed changes, resulting in the VELO-Ecuadorian dialect (VELO-Ec). INSTRUMENT ASSESSMENT 88 participants with CP (88 parents, 46 children) and 33 non-cleft controls (33 adult, 11 children) completed the VELO-Ec, Spanish-Pediatric Voice Handicap Index (pVHI), and Spanish-Intelligibility in Context Scale (ICS). Internal consistency was assessed with Cronbach's alpha; test-retest reliability was assessed by calculating the intraclass correlation coefficient (ICC); standard error of measurement (SEM) was calculated. Concurrent validity was assessed with Pearson correlations of VELO-Ec with pVHI and ICS. Discriminant validity assessment used an established ICS cutoff. Construct validity was assessed by grouping patients by parent report of hypernasality and early vs. late cleft repair (>24 months) using the Wilcoxon Rank-Sum test. RESULTS VELO-Ec showed excellent internal consistency (alpha 0.96) and test-retest reliability (ICC = 0.85, 95% CI 0.68-0.93, SEM 5.71). It had strong concurrent validity, correlating with ICS (r = 0.75, p < 0.001) and pVHI (r = -0.79, p < 0.001). Discriminant validity was strong with better VELO-Ec scores among subjects with normal vs. abnormal ICS score (median 95 & 61, p < 0.001). Strong construct validity was identified: those with parent-reported hypernasality had worse VELO-Ec scores than those without (median 59 & 75, p < 0.001). Those with repair before or after 24 months had similar VELO-Ec scores (p = 0.882). CONCLUSION The VELO-Ec is a valid and reliable measure of VPI-related quality of life, useful to clinicians and researchers treating Ecuadorian CP patients, especially in areas with limited resources such as on humanitarian missions.
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Torrecillas V, Pollard SH, McCrary H, Taylor HM, Palmer A, Meier J, Muntz H, Skirko JR. Management of Velopharyngeal Insufficiency in Cleft Patients With and Without Multidisciplinary Team Care. Cleft Palate Craniofac J 2020; 58:479-488. [PMID: 33016110 DOI: 10.1177/1055665620954063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To evaluate the effect of an American Cleft Palate-Craniofacial Association (ACPA)-approved multidisciplinary team on velopharyngeal insufficiency (VPI) diagnosis and treatment. DESIGN Retrospective cohort setting; tertiary children's hospital patients; children with cleft palate repair identified through procedure codes. MAIN OUTCOME MEASURES Velopharyngeal insufficiency diagnosis was assigned based on surgeon or team assessment. Age at diagnosis and surgery was recorded. Difference in age and rate of VPI diagnosis and surgery was analyzed with t test. Multivariate linear and logistic regression adjusted for confounding variables. RESULTS Nine hundred forty patients were included with 71.5% cared for by an ACPA-approved multidisciplinary team. More (38.8% ) team care patients were found to have a diagnosis of VPI in comparison to 10% in independent care (P < .001). Team care was associated with an almost 6-fold increase in VPI diagnosis (P < .001). Team care was associated with a higher proportion of speech surgery (21% vs 10%, P < .001). Among children receiving team care, each visit was associated with 25% increased odds of being diagnosed with VPI (P < .001) and 20% increased odds of receiving speech surgery (P < .001). Age at VPI diagnosis and speech surgery were similar between groups (P = .55 and .29). DISCUSSION Team care was associated with more accurate detection of VPI, resulting in more VPI speech therapy visits and surgical management. A higher number of team visits were similarly associated. CONCLUSION Further studies of the clinical implication of timely and accurate VPI diagnosis, including quality of life assessments, are recommended to provide stronger guidance on team visit and evaluation planning.
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Affiliation(s)
- Vanessa Torrecillas
- Division of Otolaryngology, University of Utah, 7060The University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Sarah Hatch Pollard
- Division of Otolaryngology, University of Utah, 7060The University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Hilary McCrary
- Division of Otolaryngology, University of Utah, 7060The University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Helene M Taylor
- Intermountain Primary Children's Hospital, 7060The University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Alexandra Palmer
- Division of Otolaryngology, University of Utah, 7060The University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Jeremy Meier
- Division of Otolaryngology, University of Utah, 7060The University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Harlan Muntz
- Division of Otolaryngology, University of Utah, 7060The University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Jonathan R Skirko
- Division of Otolaryngology, University of Utah, 7060The University of Utah School of Medicine, Salt Lake City, UT, USA
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25
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Pedersen HM, Goodie PA, Braden MN, Thibeault SL. Comparing Quality of Life and Perceptual Speech Ratings in Children With Cleft Palate. Cleft Palate Craniofac J 2020; 58:139-145. [PMID: 32799664 DOI: 10.1177/1055665620949435] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To delineate the relationship between patient and parent-reported quality of life (QOL) ratings and perceptual characteristics of speech assigned by a speech-language pathologist (SLP) in children with repaired cleft palate. DESIGN Prospective. SETTING Academic Children's Hospital. PARTICIPANTS This population-based sample included children, aged 3 to 18 with a history of repaired cleft palate, and their parents. INTERVENTION Participants completed the Velopharyngeal Insufficiency Effects on Life Outcomes Questionnaire (VELO). Children's speech was judged perceptually by an expert SLP using the Pittsburgh Weighted Speech Scale (PWSS). MAIN OUTCOME MEASURE(S) Velopharyngeal Insufficiency Effects on Life Outcomes questionnaire assessed participant and parent perceptions of impact of velopharyngeal function on QOL. Pittsburgh Weighted Speech Scale assessed nasal emissions, facial grimacing, nasality, quality of phonation, and articulation. RESULTS Enrollment included 48 participant parent dyads. Overall, participants reported high QOL scores within the 95% CI with children reporting slightly better yet not significantly different QOL (86.27 ± 8.96) compared to their parents (81.81 ± 15.2). Children received an average score of 1.38 ± 1.96 on the PWSS corresponding to borderline velopharyngeal competence. A significant moderate negative correlation was found between PWSS total score and parent VELO total score (r = -0.51103, P = .0002). Mild-moderate significant negative correlations were measured between PWSS total and the 5 subscales of the VELO. No significant correlations were measured between PWSS and child VELO total responses or between total scores and subscales. CONCLUSIONS Results suggest that as perceptual analysis of speech improves, overall QOL improves moderately.
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Affiliation(s)
- Hailey M Pedersen
- Division of Otolaryngology-Head and Neck Surgery, 5232University of Wisconsin, Madison, Wisconsin, WI, USA
| | - Paige A Goodie
- Department of Otolaryngology, 5718Vanderbilt University, Nashville, TN, USA
| | - Maia N Braden
- Division of Otolaryngology-Head and Neck Surgery, 5232University of Wisconsin, Madison, Wisconsin, WI, USA
| | - Susan L Thibeault
- Division of Otolaryngology-Head and Neck Surgery, 5232University of Wisconsin, Madison, Wisconsin, WI, USA
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Velopharyngeal Insufficiency Impact and Nasopharngoscopy Discomfort and Cooperation: Patient, Parent, and Provider Perspectives. J Craniofac Surg 2020; 31:1713-1716. [PMID: 32310884 DOI: 10.1097/scs.0000000000006463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Velopharyngeal insufficiency (VPI) impacts resonance and articulation and contributes to social difficulties. Nasopharngoscopies (NPs) often inform VPI treatment planning. Using a mixed-model prospective design, this study describes the impact of VPI, NP perceptions, and ratings of pain, discomfort, and cooperation during NP from multiple perspectives. Participants (N = 33) were 7 to 16 years old (mean 8.8 years) with diagnoses primarily of cleft lip and palate (52%) or cleft palate (42%). Mostly mothers (82%) completed measures in English (58%). Patients (52%) reported some teasing related to VPI, with higher parent report of their child being teased (70%). Themes of not being understood, teasing, and negative emotions were described. Coping themes included social support, distraction, and speech therapy. Patients' Beck Youth Inventories-Second Edition scores were in the average range. Over half of patients and parents reported anxiety about NPs and about a third reported understanding NPs. The Faces Pain Scale-Revised mean of 2.5 ± 3.2 and the Face, Legs, Activity, Cry, Consolability scale mean of 2.5 ± 2.2 were low. Discomfort was most often rated as "a little" by patients (55%), parents (42%), speech-language pathologists (49%), and plastic surgeons (39%). There was concordance across pain and discomfort ratings. High cooperation (61%-72%) was seen across reporters, which was negatively correlated with pain measures. Patient anxiety was related to NP pain and discomfort, suggesting integrating coping for procedural anxiety into the NP preparation might benefit patients. Additionally, negative VPI social experiences should be screened for as part of VPI management.
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McCrary H, Pollard SH, Torrecillas V, Khong L, Taylor HM, Meier J, Muntz H, Skirko J. Increased Risk of Velopharyngeal Insufficiency in Patients Undergoing Staged Palate Repair. Cleft Palate Craniofac J 2020; 57:975-983. [PMID: 32207321 DOI: 10.1177/1055665620913440] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To evaluate the association of 2-stage cleft palate (CP) surgery on velopharyngeal insufficiency (VPI) incidence, speech surgeries, and cleft-related surgical burden. DESIGN Retrospective cohort with follow-up of 4 to 19 years. SETTING Academic, tertiary children's hospital. PATIENTS Patients who underwent CP surgery between 2000 and 2017. Exclusions included submucous CP or age at last contact under 3.9. INTERVENTIONS Cleft palate surgery, completed in either a single-stage or 2-stage repair. MAIN OUTCOME MEASURE(S) Rates of VPI diagnosis and speech surgery and total cleft surgeries; t tests, tests of proportion, and linear and logistic regression were performed. Total cleft-related surgeries were examined in a subset (n = 418) of patients with chart reviews. RESULTS A total of 1047 patients were included; 59.6% had 2-stage CP repair, 40.4% had single-stage repair. Approximately 32% of children with 2-stage CP repair were diagnosed with VPI, as opposed to 22% of single-stage patients (P < .001). Children with 2-stage CP repair were 1.8 times as likely to be diagnosed with VPI (P < .001). Speech surgery rates were similar across groups. Patients who had 2-stage repair received an average of 2.3 more cleft-related procedures, when excluding prosthesis management procedures. CONCLUSION Our data show an increased risk of VPI diagnosis and increased surgical burden among patients receiving 2-stage CP repair.
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Affiliation(s)
- Hilary McCrary
- Division of Otolaryngology, University of Utah, Salt Lake City, UT, USA
| | | | | | - Leon Khong
- School of Medicine, University of Utah, Salt Lake City, UT, USA
| | | | - Jeremy Meier
- Division of Otolaryngology, University of Utah, Salt Lake City, UT, USA
| | - Harlan Muntz
- Division of Otolaryngology, University of Utah, Salt Lake City, UT, USA
| | - Jonathan Skirko
- Division of Otolaryngology, University of Utah, Salt Lake City, UT, USA
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Lindeborg MM, Shakya P, Pradhan B, Rai SK, Gurung KB, Niroula S, Rayamajhi B, Chaudhary H, Gaire B, Mahato N, Rana L, Rokaya P, Shrestha N, Shrestha R, Tamang J, Joshi HD, Gaha P, Khorja DK, Mitnick CD, Rai SM, Shaye DA. Nepali Linguistic Validation of the Velopharyngeal Insufficiency Effects on Life Outcomes Instrument: VELO-Nepali. Cleft Palate Craniofac J 2020; 57:967-974. [PMID: 32054301 DOI: 10.1177/1055665620905173] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To translate and validate the velopharyngeal insufficiency (VPI) effects on life outcomes (VELO) instrument into Nepali, and test its internal consistency and validity. DESIGN Quality-of-life instrument translation and validation. SETTING Community served by Nepal's craniofacial referral hospital. PARTICIPANTS Twenty-three postpalatoplasty children with VPI, 19 family guardians of VPI cases, and 29 non-VPI controls. INTERVENTIONS The VELO instrument was translated to Nepali by 2 independent bilingual translators, reconciled, backward-translated, compared, and modified using patient cognitive interviews. All VPI children, guardians, and controls completed the VELO-Nepali. MAIN OUTCOME MEASURE(S) The VELO internal consistency was evaluated using Cronbach α coefficient. Concurrent validity and discriminant validity were assessed using 2-sample t test: assuming unequal variances. RESULTS The VELO was translated and optimized using cognitive interviews. The VELO-Nepali demonstrated excellent internal consistency, with Cronbach α coefficients of 0.93, 0.94, and 0.90 for VPI cases, guardians of VPI cases, and non-VPI controls, respectively. The VELO-Nepali exhibited strong discriminant validity between VPI cases (x¯ = 45.4, standard deviation [SD] = 22.1) and non-VPI controls (x¯ = 84.9, SD = 12.3), (P < .001). The VELO-Nepali showed strong concurrent validity with similarities in VPI case scores (x¯ = 45.4, SD = 22.1), and guardian scores (x¯ = 52.9, s = 22.8; P = .473). CONCLUSION The translated VELO-Nepali demonstrates strong internal consistency, discriminant validity, and concurrent validity, and can assess quality of life for Nepali VPI patients. This instrument represents the first VPI quality of life assessment validated in Nepali, and supports the feasibility of its implementation in other low- and low-middle-income countries.
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Affiliation(s)
- Michael M Lindeborg
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, MA, USA.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.,Michael Lindeborg and Pramila Shakya are co-first authors
| | - Pramila Shakya
- Department of Burns, Plastic and Reconstructive Surgery, Kirtipur Hospital, Nepal.,Michael Lindeborg and Pramila Shakya are co-first authors
| | - Bhawani Pradhan
- Department of Burns, Plastic and Reconstructive Surgery, Kirtipur Hospital, Nepal
| | - Shiba Kala Rai
- Department of Burns, Plastic and Reconstructive Surgery, Kirtipur Hospital, Nepal
| | | | - Suman Niroula
- Department of Burns, Plastic and Reconstructive Surgery, Kirtipur Hospital, Nepal
| | - Badri Rayamajhi
- Department of Burns, Plastic and Reconstructive Surgery, Kirtipur Hospital, Nepal
| | - Hema Chaudhary
- Department of Burns, Plastic and Reconstructive Surgery, Kirtipur Hospital, Nepal
| | - Bhagwati Gaire
- Department of Burns, Plastic and Reconstructive Surgery, Kirtipur Hospital, Nepal
| | - Naina Mahato
- Department of Burns, Plastic and Reconstructive Surgery, Kirtipur Hospital, Nepal
| | - Lila Rana
- Department of Burns, Plastic and Reconstructive Surgery, Kirtipur Hospital, Nepal
| | - Phana Rokaya
- Department of Burns, Plastic and Reconstructive Surgery, Kirtipur Hospital, Nepal
| | - Nilam Shrestha
- Department of Burns, Plastic and Reconstructive Surgery, Kirtipur Hospital, Nepal
| | - Renuka Shrestha
- Department of Burns, Plastic and Reconstructive Surgery, Kirtipur Hospital, Nepal
| | - Januka Tamang
- Department of Burns, Plastic and Reconstructive Surgery, Kirtipur Hospital, Nepal
| | - Hemanta Dhoj Joshi
- Department of Burns, Plastic and Reconstructive Surgery, Kirtipur Hospital, Nepal
| | - Pushpa Gaha
- Department of Burns, Plastic and Reconstructive Surgery, Kirtipur Hospital, Nepal
| | - Dhana Kumari Khorja
- Department of Burns, Plastic and Reconstructive Surgery, Kirtipur Hospital, Nepal
| | - Carole D Mitnick
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Shankar Man Rai
- Department of Burns, Plastic and Reconstructive Surgery, Kirtipur Hospital, Nepal
| | - David A Shaye
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, MA, USA.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.,Department of Otolaryngology, Harvard Medical School, Boston, MA, USA
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Brazilian-Portuguese Linguistic Validation of the Velopharyngeal Insufficiency Effects on Life Outcome Instrument. J Craniofac Surg 2020; 30:2308-2312. [PMID: 31233001 DOI: 10.1097/scs.0000000000005679] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The purpose of this study was to conduct a linguistic validation of the velopharyngeal insufficiency (VPI) Effects on Life Outcome (VELO) instrument for use in Brazilian-Portuguese patients with VPI. METHODS The original English version of the VELO instrument was translated into Brazilian-Portuguese, back-translated, and adapted among the Brazilian patients (n = 21) with VPI and their parents, based on the standardized guidelines for the cross-culture adaption process. Discrepancies in the forward and backward translation steps were computed. Comprehension rates were captured for each debriefing interview. The content validity index (CVI) per item (I-CVI) and of the scale (S-CVI universal agreement [S-CVI/UA] and averaging [S-CVI/Ave]) were calculated. RESULTS Reconciliation of the 2 forward translations and the comparison between the back translation and the original VELO version resulted in some item wordings with discrepancies which were reviewed by the research team (translators, expert committee, and original developers of instrument). Three rounds of cognitive interviews also led to some revisions of wording. Comprehension rates of patients and their parents were 60% to 100%, 80% to 100%, and 100% in the first, second, and third rounds of cognitive interviews, respectively. The I-CVI, S-CVI/AU, and SCI/Ave for the Brazilian-Portuguese VELO version were 0.83 (or higher), 0.83 (or higher), and 0.97, respectively. CONCLUSIONS The linguistic validation process of the VELO instrument created a cross-culturally equivalent Brazilian-Portuguese version for use in Brazilian-Portuguese speaking patients with VPI.
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Denadai R, Sabbag A, Vieira PR, Raposo-Amaral CA, Buzzo CL, Raposo-Amaral CE. Predictors of Speech Outcome in Posterior Pharyngeal Fat Graft Surgery for Velopharyngeal Insufficiency Management. J Craniofac Surg 2020; 31:41-45. [PMID: 31369510 DOI: 10.1097/scs.0000000000005802] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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Li L, Strum D, Larson S, Preciado D. Quality of life outcomes following velopharyngeal insufficiency surgery. Int J Pediatr Otorhinolaryngol 2019; 127:109643. [PMID: 31442731 DOI: 10.1016/j.ijporl.2019.109643] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 08/09/2019] [Accepted: 08/10/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Velopharyngeal insufficiency (VPI) may be due to functional or anatomic causes, and can lead to speech deficits, communication difficulty, and emotional strain on patients and their caregivers. The VPI Effects on Life Outcomes (VELO) instrument quantifies quality of life outcomes in VPI patients both before and after VPI surgery. This study aims to identify pre-operative patient characteristics associated with better post-operative quality of life. METHODS This study is a retrospective chart review of 51 patients who underwent VPI surgery between 2009 and 2018 at a tertiary free-standing children's hospital. A 26-item parent-proxy VELO questionnaire was administered by telephone to parents to assess their child's quality of life post-VPI surgery. RESULTS Twenty-seven parents responded to the VELO questionnaire. Average post-operative VELO score was significantly higher in non-syndromic patients as compared with syndromic patients. Average post-operative VELO score was not significantly different between patients with and without submucous cleft (SMC) or those with mild to moderate versus severe pre-operative hypernasality. On multivariate analysis, absence of genetic syndrome, lack of submucous cleft, and presence of severe-pre-operative hypernasality were significantly and positively associated with increased post-operative VELO scores. CONCLUSION Children who undergo VPI surgery are more likely to have better post-operative quality of life outcomes if their VPI was not associated with a genetic syndrome or submucous cleft. Non-syndromic and non-SMC patients with severe pre-operative hypernasality may benefit significantly from VPI surgery and have improved post-operative quality of life.
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Affiliation(s)
- Lilun Li
- Department of Otolaryngology, Children's National Health System, 111 Michigan, Washington, DC, 20010, USA; Division of Otolaryngology, George Washington University, 2300 M St, Washington, DC, 20037, USA
| | - David Strum
- Department of Otolaryngology, Children's National Health System, 111 Michigan, Washington, DC, 20010, USA; Division of Otolaryngology, George Washington University, 2300 M St, Washington, DC, 20037, USA
| | - Stephen Larson
- Department of Otolaryngology, University of Tennessee Health Science Center, 910 Madison Avenue, Memphis, TN, 38163, USA
| | - Diego Preciado
- Department of Otolaryngology, Children's National Health System, 111 Michigan, Washington, DC, 20010, USA; Division of Otolaryngology, George Washington University, 2300 M St, Washington, DC, 20037, USA.
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Santillana R, Skirko J, Roth C, Tollefson TT. Spanish Linguistic Validation for the Velopharyngeal Insufficiency Effects on Life Outcomes. JAMA FACIAL PLAST SU 2019. [PMID: 29522150 DOI: 10.1001/jamafacial.2018.0005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Rosario Santillana
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento
| | - Jonathan Skirko
- Department of Otolaryngology, University of Utah, Salt Lake City
| | - Christina Roth
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento
| | - Travis T Tollefson
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento
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Bruneel L, Alighieri C, Bettens K, Musasizi D, Ojok I, D'haeseleer E, Van Lierde K. Assessing health-related quality of life in patients with cleft palate in resource-limited countries: A preliminary evaluation of the VELO questionnaire in Uganda. Int J Pediatr Otorhinolaryngol 2019; 124:39-46. [PMID: 31158570 DOI: 10.1016/j.ijporl.2019.05.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 04/15/2019] [Accepted: 05/16/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND AIMS Studies evaluating health-related quality of life (HRQoL) in patients with cleft palate living in resource-limited countries such as Uganda are scarce. The VELO questionnaire evaluates the impact of speech (and swallowing) difficulties on the patient's HRQoL. The aim was to evaluate an adapted English version of the VELO questionnaire with reduced response options in Ugandan patients with a cleft lip and palate in order to identify influencing factors and future perspectives to implement HRQoL assessement in this population. METHODS Based on the responses of 16 parents of patients with cleft palate, 6 adolescent/adult patients with cleft palate and 12 control participants without cleft palate, observations regarding linguistic and cultural difficulties were noted and the discriminant validity and internal consistency of this adapted version of the questionnaire were evaluated. Additionally, the relationship between these responses and perceptually assessed speech parameters was assessed. RESULTS Half of the participants (11/22) completed the questionnaire independently, frequently resulting in incomplete responses (8/11). Difficulties with wording and cultural aspects influencing the responses were identified. The subscales showed excellent internal consistency, with the exception of the subscale 'swallowing problems'. The score on the subscale 'perception by others' of the parent report showed no significant difference with the score of the control group. The total score on the parent report and the youth report was (borderline) significantly related to the speech variables speech understandability, speech acceptability and the VPC-SUM. DISCUSSION AND CONCLUSION Promising results regarding the validity and internal consistency of the adapted instrument were found, indicating the potential of the VELO questionnaire for HRQoL assessment at the CoRSU hospital in Uganda. However, results should be interpreted cautiously, given that all participants had a primary language other than English, the small sample size with skewed distribution of speech characteristics, and the bias induced by socially desirable responses. In future studies, adaptations based on qualitative research to account for linguistic and cultural aspects, followed by a rigorous forward-backward translation of the questionnaire to English and Luganda are needed.
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Affiliation(s)
- Laura Bruneel
- Ghent University, Department of Rehabilitation Sciences, Corneel Heymanslaan 10 2P1, 9000, Ghent, Belgium.
| | - Cassandra Alighieri
- Ghent University, Department of Rehabilitation Sciences, Corneel Heymanslaan 10 2P1, 9000, Ghent, Belgium
| | - Kim Bettens
- Ghent University, Department of Rehabilitation Sciences, Corneel Heymanslaan 10 2P1, 9000, Ghent, Belgium
| | - Duncan Musasizi
- Comprehensive Rehabilitation Services in Uganda (CoRSU), P.O. Box 46, Kisubi, Uganda
| | - Isaac Ojok
- Comprehensive Rehabilitation Services in Uganda (CoRSU), P.O. Box 46, Kisubi, Uganda
| | - Evelien D'haeseleer
- Ghent University, Department of Rehabilitation Sciences, Corneel Heymanslaan 10 2P1, 9000, Ghent, Belgium
| | - Kristiane Van Lierde
- Ghent University, Department of Rehabilitation Sciences, Corneel Heymanslaan 10 2P1, 9000, Ghent, Belgium
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Joujima T, Oda M, Sasaguri M, Habu M, Kataoka S, Miyamura Y, Wakasugi-Sato N, Matsumoto-Takeda S, Takahashi O, Kokuryo S, Sago T, Yoshiga D, Tanaka T, Morimoto Y. Evaluation of velopharyngeal function using high-speed cine-magnetic resonance imaging based on T2-weighted sequences: a preliminary study. Int J Oral Maxillofac Surg 2019; 49:432-441. [PMID: 31451304 DOI: 10.1016/j.ijom.2019.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 06/06/2019] [Accepted: 08/07/2019] [Indexed: 10/26/2022]
Abstract
The objective was to introduce a new technique for visualizing the three-dimensional (3D) movements of velopharyngeal-related muscles using high-speed cine-magnetic resonance imaging (MRI) based on T2-weighted sequences. The evaluation of phonation- and water swallowing-related events was performed in 11 healthy subjects. Specifically, whether cine-MRI could precisely visualize normal velopharyngeal function during these two events was examined. The 3D movements of the soft palate, superior pharyngeal constrictor muscles, and levator veli palatini muscles were visualized in all 11 subjects. A noteworthy finding was that the magnetic resonance signals of the superior constrictor pharyngeal muscles and the levator veli palatini muscles were significantly higher during phonation and during water swallowing than at rest. This initial study suggests that the 3D movements of velopharyngeal-related muscles can be successfully and precisely visualized without side effects. The magnetic resonance signal changes seen in the superior pharyngeal constrictor and levator veli palatini muscles using the technique described here should be useful to develop better methods of evaluation of velopharyngeal function.
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Affiliation(s)
- T Joujima
- Division of Oral and Maxillofacial Radiology, Kyushu Dental University, Kitakyushu, Japan
| | - M Oda
- Division of Oral and Maxillofacial Radiology, Kyushu Dental University, Kitakyushu, Japan
| | - M Sasaguri
- Division of Maxillofacial Surgery, Kyushu Dental University, Kitakyushu, Japan
| | - M Habu
- Division of Maxillofacial Surgery, Kyushu Dental University, Kitakyushu, Japan
| | - S Kataoka
- Division of Anatomy, Kyushu Dental University, Kitakyushu, Japan
| | - Y Miyamura
- Division of Oral and Maxillofacial Radiology, Kyushu Dental University, Kitakyushu, Japan
| | - N Wakasugi-Sato
- Division of Oral and Maxillofacial Radiology, Kyushu Dental University, Kitakyushu, Japan
| | - S Matsumoto-Takeda
- Division of Oral and Maxillofacial Radiology, Kyushu Dental University, Kitakyushu, Japan
| | - O Takahashi
- Division of Maxillofacial Surgery, Kyushu Dental University, Kitakyushu, Japan
| | - S Kokuryo
- Division of Oral Medicine, Kyushu Dental University, Kitakyushu, Japan
| | - T Sago
- Division of Dental Anaesthesiology, Kyushu Dental University, Kitakyushu, Japan
| | - D Yoshiga
- Division of Oral Medicine, Kyushu Dental University, Kitakyushu, Japan
| | - T Tanaka
- Division of Oral and Maxillofacial Radiology, Kyushu Dental University, Kitakyushu, Japan
| | - Y Morimoto
- Division of Oral and Maxillofacial Radiology, Kyushu Dental University, Kitakyushu, Japan.
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Denadai R, Raposo-Amaral CE, Sabbag A, Ribeiro RA, Buzzo CL, Raposo-Amaral CA, Hung M, Skirko JR. Measuring Patient-Reported Health-Related Quality of Life in Velopharyngeal Insufficiency: Reliability and Validity of the Brazilian Portuguese Version of the VELO Instrument. Cleft Palate Craniofac J 2019; 56:1195-1205. [PMID: 31079479 DOI: 10.1177/1055665619846763] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To test the Brazilian Portuguese velopharyngeal insufficiency (VPI) Effects on Life Outcome (VELO) instrument for reliability and validity. DESIGN Cross-sectional methodological study. SETTING Tertiary craniofacial medical center. PARTICIPANTS Participants with VPI (VPI group, n = 60), with cleft and without VPI (no VPI/cleft group, n = 60), and with no cleft nor VPI (no VPI/no cleft group, n = 60) and their parents (n = 180). INTERVENTIONS All patients with VPI 8+ years old and their parents completed the Brazilian-Portuguese VELO instrument and other questionnaires (Pediatric Quality of Life Inventory4.0, PedsQL4.0; Pediatric Voice-Related Quality of Life, PVRQOL; and Intelligibility in Context Scale, ICS) at baseline; patients with VPI and their parents completed the VELO instrument again 2 weeks later. MAIN OUTCOME MEASURES The VELO instrument was tested for internal consistency, test-retest reliability, discriminant validity (participants with VPI against participants with no VPI), concurrent validity against other questionnaires, criterion validity against hypernasality severity, and construct validity against nasal air emission and overall velopharyngeal competence (speech construct) and velopharyngeal gap (anatomic construct). RESULTS The VELO had excellent internal consistency (Cronbach α 0.99 for parents and 0.98 for participants with VPI) and test-retest reliability (all intraclass correlation coefficient > 0.87). The VELO discriminated well between VPI group and unaffected groups (all P < .05). The VELO was significantly correlated with the PedsQL4.0, PVRQOL, and ICS (-r > 0.75; P < .001). The VELO met criterion validity, speech construct validity, and anatomic construct validity (r > 0.7; P < .001). CONCLUSIONS The Brazilian-Portuguese VELO instrument demonstrated reliability (internal consistency and test-retest) and validity (discriminant, concurrent, criterion, and construct).
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Affiliation(s)
- Rafael Denadai
- 1 Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, Campinas, São Paulo, Brazil
| | | | - Anelise Sabbag
- 1 Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, Campinas, São Paulo, Brazil
| | - Rafael Andrade Ribeiro
- 1 Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, Campinas, São Paulo, Brazil
| | - Celso Luiz Buzzo
- 1 Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, Campinas, São Paulo, Brazil
| | | | - Man Hung
- 2 College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT, USA.,3 Department of Orthopaedic Surgery Operations, University of Utah, Salt Lake City, UT, USA
| | - Jonathan R Skirko
- 4 Division of Pediatric Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
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Greenberg M, Caloway C, Hersh C, Ryan D, Goldenberg P, Hartnick C. Pharyngeal flap using carotid artery mobilization in 22q11.2 deletion syndrome with velopharyngeal insufficiency. Int J Pediatr Otorhinolaryngol 2019; 120:130-133. [PMID: 30784809 DOI: 10.1016/j.ijporl.2019.02.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 02/02/2019] [Accepted: 02/02/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION 22q11.2 deletion syndrome is the most common microdeletion syndrome in children. Many patients with this disease develop craniofacial defects including cleft palate, bifid uvula, and velopharyngeal insufficiency. Our study adds to the current body of literature by describing a novel technique of carotid mobilization performed in conjunction with pharyngeal flap surgery in patients with extensive medialization of the carotid artery. METHODS Carotid artery mobilization followed by insertion of a superiorly based pharyngeal flap was performed on two patients, a 10-year-old girl and a 5-year-old boy, with 22q11.2 deletion syndrome concurrent with velopharyngeal insufficiency. RESULTS Neither patient experienced significant post-operative issues. Following the procedure, parents of both patients noted significant speech and voice improvement. Both patients had improvements in VPI Effects On Life Outcome (VELO) scores, nasometry, and production of paragraph passages following surgery. CONCLUSIONS Our study describes a novel surgical treatment for children with 22q11.2 deletion syndrome with significant velopharyngeal insufficiency (VPI). The procedure wherein is characterized by an extensive mobilization of the carotid artery followed by implantation of a pharyngeal flap. This technique resulted in no significant intra-operative bleeding, and was measured to be successful as noted by nasometry scores and changes in pre- and post-op VELO scores.
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Affiliation(s)
- Max Greenberg
- Rosalind Franklin University of Medicine and Science, Chicago Medical School, North Chicago, IL, USA; Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Christen Caloway
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Cheryl Hersh
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Daniel Ryan
- Massachusetts General Hospital for Children, Harvard Medical School, Boston, MA, USA
| | - Paula Goldenberg
- Massachusetts General Hospital for Children, Harvard Medical School, Boston, MA, USA
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Bruneel L, Bettens K, Van Lierde K. The relationship between health-related quality of life and speech in patients with cleft palate. Int J Pediatr Otorhinolaryngol 2019; 120:112-117. [PMID: 30776568 DOI: 10.1016/j.ijporl.2019.02.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 02/04/2019] [Accepted: 02/05/2019] [Indexed: 11/18/2022]
Abstract
INTRODUCTION In health-care, current efforts focus on providing patient-centered care. Specifically for patients with velopharyngeal insufficiency, and by extent patients with cleft palate, the Velopharyngeal Insufficiency (VPI) Effects on Life Outcomes (VELO) questionnaire (Skirko et al., 2012; 2013) allows the clinician to map the impact of speech and swallowing difficulties on the patient's health-related quality of life (HRQoL). The current study evaluated the hypothesized association between this speech-related HRQoL measure and perceptually and instrumentally assessed speech variables, to provide evidence for the construct validity of the Dutch version of the VELO questionnaire. MATERIALS AND METHODS Thirty participants, twenty-five patients with cleft palate and five controls, were enrolled. Perceptual speech assessment was conducted following the recently developed Belgian Dutch outcome tool for perceptual speech assessment in patients with cleft palate. In addition, nasalance values and the Nasality Severity Index (NSI) 2.0 were determined. The relationship between these speech outcomes and the scores on the VELO parent report was determined using Spearman rank-order correlation coefficients. RESULTS Moderate to strong correlations were found between the total score on the VELO parent report and five speech variables: the VPC-SUM score (rs = -0.476), speech understandability (rs = -0.657), passive CSC's (rs = -0.654), speech acceptability (rs = -0.591) and the need for C(L)P-related speech therapy (rs = -0.711). Furthermore, these variables were associated with at least one subscale of the VELO questionnaire. DISCUSSION AND CONCLUSION Correlations between speech outcomes and the Dutch version of the VELO questionnaire provide evidence for the construct validity of this version of the instrument. Furthermore, insights in these associations may lead the way to efficient therapy approaches, targeting speech features with the greatest impact on the patient's health-related quality of life.
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Affiliation(s)
- Laura Bruneel
- Ghent University, Department of Rehabilitation Sciences, Speech-language Pathology/Audiology, Research Group, Ghent, Belgium.
| | - Kim Bettens
- Ghent University, Department of Rehabilitation Sciences, Speech-language Pathology/Audiology, Research Group, Ghent, Belgium
| | - Kristiane Van Lierde
- Ghent University, Department of Rehabilitation Sciences, Speech-language Pathology/Audiology, Research Group, Ghent, Belgium; University of Pretoria, Faculty of Humanities, Department of Speech-Language Pathology and Audiology, Pretoria, South Africa
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Health-related quality of life in patients with cleft palate: Reproducibility, responsiveness and construct validity of the Dutch version of the VELO questionnaire. Int J Pediatr Otorhinolaryngol 2019; 119:141-146. [PMID: 30708181 DOI: 10.1016/j.ijporl.2019.01.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 12/13/2018] [Accepted: 01/19/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Recently, the Velopharyngeal Insufficiency (VPI) Effects on Life Outcomes (VELO) questionnaire, which evaluates the impact of speech and swallowing difficulties on health-related quality of life (HRQoL) in patients with VPI (Skirko et al., 2012), was translated to Dutch (Bruneel et al., 2017). The purpose of this study was to evaluate the reproducibility, responsiveness and construct validity of this Dutch version of the questionnaire. METHODS To evaluate the reproducibility, 50 parents and 14 children with cleft palate re-completed the questionnaire after two weeks. Thirty-five parents and 8 children with cleft palate completed the VELO questionnaire after one year for the evaluation of the responsiveness. The correlation between age and the VELO questionnaire (construct validity), and the internal consistency (Cronbach's α) were re-determined based on the responses of 73 parents and 24 children. RESULTS Based on descriptive statistics, results of the Wilcoxon signed rank-test, and the absolute (SEM) and relative (ICC) consistency, the questionnaire showed good reproducibility. VELO scores did not significantly differ after one year, neither when performing separate analyses for the intervention (speech therapy) and the non-intervention group. Correlations indicated higher HRQoL, as perceived by the parents, with increasing age. The reverse was the case for the youth report. Cronbach's α showed excellent internal consistency for both reports. CONCLUSIONS The VELO questionnaire showed good reproducibility and internal consistency. Moreover, results reconfirmed the age effect on VELO scores. To understand the implications of the results regarding the questionnaire's responsiveness, future research should focus on the identification of factors influencing the patient's evolution in HRQoL.
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Huang H, Chen N, Yin H, Skirko JR, Guo C, Ha P, Li J, Shi B. Validation of the Chinese Velopharyngeal Insufficiency Effects on Life Outcomes Instrument. Laryngoscope 2019; 129:E395-E401. [PMID: 30671957 DOI: 10.1002/lary.27792] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2018] [Indexed: 02/05/2023]
Affiliation(s)
- Hanyao Huang
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral Maxillofacial Surgery West China Hospital of Stomatology, Sichuan University, Chengdu, China;West China Second University Hospital, Sichuan University Chengdu China
| | - Nan Chen
- Key Laboratory of Birth Defects and Related Diseases of Women and Children and Office of Educational AdministrationWest China Second University Hospital, Sichuan University Chengdu China
| | - Heng Yin
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral Maxillofacial Surgery West China Hospital of Stomatology, Sichuan University, Chengdu, China;West China Second University Hospital, Sichuan University Chengdu China
| | - Jonathan R. Skirko
- Pediatric Otolaryngology (ENT) and Pediatric Facial Plastic SurgeryUniversity of Utah and Primary Children's Medical Center Salt Lake City Utah U.S.A
| | - Chunli Guo
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral Maxillofacial Surgery West China Hospital of Stomatology, Sichuan University, Chengdu, China;West China Second University Hospital, Sichuan University Chengdu China
| | - Pin Ha
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral Maxillofacial Surgery West China Hospital of Stomatology, Sichuan University, Chengdu, China;West China Second University Hospital, Sichuan University Chengdu China
| | - Jingtao Li
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral Maxillofacial Surgery West China Hospital of Stomatology, Sichuan University, Chengdu, China;West China Second University Hospital, Sichuan University Chengdu China
| | - Bing Shi
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral Maxillofacial Surgery West China Hospital of Stomatology, Sichuan University, Chengdu, China;West China Second University Hospital, Sichuan University Chengdu China
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Peterson KA, Zhou L, Watzlaf VJM. A Comprehensive Review of Quality of Life Surveys for Trauma-Affected Communities. PERSPECTIVES IN HEALTH INFORMATION MANAGEMENT 2019; 16:1e. [PMID: 30766456 PMCID: PMC6341418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Research shows that exposure to community and domestic violence leads to psychological trauma from childhood through adulthood, which can lead to poor health and early death. A team of health information management (HIM) professionals reviewed existing surveys to determine their suitability for assessing the quality of life (QoL) of people in trauma-affected communities (TACs). Keywords were used to search for papers describing validated QoL surveys. The obtained papers were screened, reviewed, and summarized to determine if they include the aspects needed for assessing QoL in TACs. Survey items from 20 surveys were identified as relevant to this study. Most of these 20 surveys cover one or two domains of QoL, and none of them were specifically designed for people in TACs. Therefore, it is necessary to develop a psychometrically sound assessment tool to quantify the levels of trauma, resilience, and well-being in TACs. HIM professionals have the required skills for this task.
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Affiliation(s)
- Kimberly A Peterson
- Department of Health Information Management at the University of Pittsburgh in Pittsburgh, PA
| | - Leming Zhou
- Department of Health Information Management at the University of Pittsburgh in Pittsburgh, PA
| | - Valerie J M Watzlaf
- Department of Health Information Management at the University of Pittsburgh in Pittsburgh, PA
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Guyton KB, Sandage MJ, Bailey D, Haak N, Molt L, Plumb A. Acquired Velopharyngeal Dysfunction: Survey, Literature Review, and Clinical Recommendations. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2018; 27:1572-1597. [PMID: 30208483 DOI: 10.1044/2018_ajslp-17-0222] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 05/10/2018] [Indexed: 06/08/2023]
Abstract
PURPOSE The aim of this study was to describe the clinical assessment recommendations for acquired velopharyngeal dysfunction (AVPD) and, through a literature review and online survey, summarize current practice patterns for evaluation and treatment pathway determination for this target population. METHOD An online survey to query current assessment procedures and treatment pathway recommendations for AVPD was developed. Following survey results, a literature review was completed to determine evidence-based recommendations for assessment procedures and intervention recommendations based on assessment findings. Literature search terms included the following: acquired velopharyngeal dysfunction, hypernasality, non-cleft velopharyngeal dysfunction, velopharyngeal dysfunction, velopharyngeal dysfunction AND iatrogenic, velopharyngeal dysfunction AND neurogenic, velopharyngeal dysfunction AND assessment OR evaluation, velopharyngeal dysfunction AND treatment OR intervention, velopharyngeal dysfunction AND practice patterns OR clinical guidelines, velopharyngeal insufficiency. Inclusion criteria were limited to practice patterns/recommendations for assessment and/or treatment recommendations for AVPD, English language articles published between 2000 and 2017, and peer-reviewed journals. Studies regarding solely congenital or cleft palate velopharyngeal dysfunction and intervention outcome studies were excluded. Forty articles met inclusionary criteria. RESULTS The online survey results indicated lack of consensus for AVPD assessment and treatment recommendation protocols, with 93% of respondents indicating the need for a clinical guide for developing treatment recommendations. The majority of recommendations were filtered into an algorithm for clinical decision making. CONCLUSIONS Clinical uncertainty among speech-language pathologists surveyed and the paucity of published clinical guidelines for assessing individuals with AVPD indicate the need for additional clinical research for this disorder, one that is heterogeneous and distinct from those with congenital velopharyngeal dysfunction. The proposed evidence-based clinical worksheet may assist in determining management for patients with AVPD and may serve as a starting place for validation of a clinical guideline.
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Affiliation(s)
- Kelsey B Guyton
- Department of Communication Disorders, Auburn University, AL
| | - Mary J Sandage
- Department of Communication Disorders, Auburn University, AL
| | - Dallin Bailey
- Department of Communication Disorders, Auburn University, AL
| | - Nancy Haak
- Department of Communication Disorders, Auburn University, AL
| | - Lawrence Molt
- Department of Communication Disorders, Auburn University, AL
| | - Allison Plumb
- Department of Communication Disorders, Auburn University, AL
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Spanish Linguistic Validation of the Velopharyngeal Insufficiency Effects on Life Outcomes: VELO-Spanish. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1986. [PMID: 30881793 PMCID: PMC6414130 DOI: 10.1097/gox.0000000000001986] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 09/05/2018] [Indexed: 11/26/2022]
Abstract
Background: Quality of life (QOL) assessments are useful tools that measure a patient’s health status and monitor patient-reported outcome measures. This study highlights the process of linguistic validation of a QOL assessment to serve Spanish-speaking families and ultimately help decrease language barriers in the treatment of velopharyngeal insufficiency (VPI). Methods: The standardized linguistic validation process included forward and backward translation, reconciliation, and cognitive interviews with patients and families. Preliminary instrument test-retest measurement was assessed. Eligibility for cognitive interviews included families with familiarity of velopharyngeal insufficiency. Exclusion criteria included illiteracy and parent and child respondents who do not speak Spanish. Reliability was tested by intraclass correlation (ICC) on VPI Effects on Life Outcomes (VELO)–Spanish instruments completion on 2 measurements from the medical record. Results: The instrument was optimized through a standardized forward and backward translation process. Further problematic language was identified during cognitive interviews with families and their children. In the second interview, only minimal changes were needed. Twenty-one patients (8 males and 13 females) were included. Mean (SD) age was 8.0 (5.3) years (range, 3–21 years). The mean (SD) Velo-Spanish score was 65 (22.1); range 32.7–100. The VELO-Spanish instrument demonstrated excellent test–retest reliability [ICC = 0.91; n = 21 and internal consistency (α = 0.96)]. Conclusions: The Spanish VELO has been developed and refined for use in Spanish-speaking populations as a VPI-specific QOL instrument. The linguistic validation process including cognitive interviews and initial reliability testing. The instrument may improve the understanding of patient-reported outcomes and potential disparities from linguistic and cultural barriers in VPI treatment
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de Blacam C, Smith S, Orr D. Surgery for Velopharyngeal Dysfunction. Cleft Palate Craniofac J 2017; 55:405-422. [DOI: 10.1177/1055665617735102] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: This systematic review sought to evaluate the consensus in the literature regarding the surgical management of VPD and to determine whether a particular procedure results in superior speech outcome or less morbidity Design: A systematic review was carried out according to PRISMA-P guidelines. Systematic review software was used to facilitate 3-stage screening and data extraction by 2 reviewers. Setting: University teaching hospital. Patients, Participants: Studies that reported perceptual speech assessment or obstructive sleep apnea (OSA) in patients who had undergone surgery for VPD were included in the review. Interventions: Four categories of surgery for VPD were examined—pharyngeal flap, sphincter pharyngoplasty, palatoplasty, and posterior pharyngeal wall augmentation. Main outcome measures: Perceptual speech assessment, need for further surgery, and occurrence of OSA were the outcomes of interest. Results: Eighty-three relevant studies were identified, comprising data on 4011 patients. Pharyngeal flap was the most common procedure (64% of patients). Overall, 70.7% of patients attained normal resonance and 65.3% attained normal nasal emission. There was no notable difference in speech outcomes, need for further surgery, or occurrence of OSA across the 4 categories of surgery examined. Heterogeneous groups of patients were reported upon and a variety of perceptual speech assessment scales were used. Conclusions: There is a lack of consensus in the literature to guide procedure selection for patients with VPD. The development of a standardized minimum data set to record postoperative speech, OSA, and patient-reported outcomes is required.
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Affiliation(s)
- Catherine de Blacam
- Department of Plastic and Reconstructive Surgery, Our Lady’s Children’s Hospital, Crumlin, Dublin, Ireland
| | - Susan Smith
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - David Orr
- Departments of Surgery and Paediatrics, Trinity College Dublin, Dublin, Ireland
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Bhuskute A, Skirko JR, Roth C, Bayoumi A, Durbin-Johnson B, Tollefson TT. Association of Velopharyngeal Insufficiency With Quality of Life and Patient-Reported Outcomes After Speech Surgery. JAMA FACIAL PLAST SU 2017; 19:406-412. [PMID: 28727858 PMCID: PMC5710625 DOI: 10.1001/jamafacial.2017.0639] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 03/29/2017] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Patients with cleft palate and other causes of velopharyngeal insufficiency (VPI) suffer adverse effects on social interactions and communication. Measurement of these patient-reported outcomes is needed to help guide surgical and nonsurgical care. OBJECTIVES To further validate the VPI Effects on Life Outcomes (VELO) instrument, measure the change in quality of life (QOL) after speech surgery, and test the association of change in speech with change in QOL. DESIGN, SETTING, AND PARTICIPANTS Prospective descriptive cohort including children and young adults undergoing speech surgery for VPI in a tertiary academic center. Participants completed the validated VELO instrument before and after surgical treatment. MAIN OUTCOMES AND MEASURES The main outcome measures were preoperative and postoperative VELO scores and the perceptual speech assessment of speech intelligibility. The VELO scores are divided into subscale domains. Changes in VELO after surgery were analyzed using linear regression models. VELO scores were analyzed as a function of speech intelligibility adjusting for age and cleft type. The correlation between speech intelligibility rating and VELO scores was estimated using the polyserial correlation. RESULTS Twenty-nine patients (13 males and 16 females) were included. Mean (SD) age was 7.9 (4.1) years (range, 4-20 years). Pharyngeal flap was used in 14 (48%) cases, Furlow palatoplasty in 12 (41%), and sphincter pharyngoplasty in 1 (3%). The mean (SD) preoperative speech intelligibility rating was 1.71 (1.08), which decreased postoperatively to 0.79 (0.93) in 24 patients who completed protocol (P < .01). The VELO scores improved after surgery (P<.001) as did most subscale scores. Caregiver impact did not change after surgery (P = .36). Speech Intelligibility was correlated with preoperative and postoperative total VELO score (P < .01) and to preoperative subscale domains (situational difficulty [VELO-SiD, P = .005] and perception by others [VELO-PO, P = .05]) and postoperative subscale domains (VELO-SiD [P = .03], VELO-PO [P = .003]). Neither the VELO total nor subscale score change after surgery was correlated with change in speech intelligibility. CONCLUSIONS AND RELEVANCE Speech surgery improves VPI-specific quality of life. We confirmed validation in a population of untreated patients with VPI and included pharyngeal flap surgery, which had not previously been included in validation studies. The VELO instrument provides patient-specific outcomes, which allows a broader understanding of the social, emotional, and physical effects of VPI. LEVEL OF EVIDENCE 2.
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Affiliation(s)
- Aditi Bhuskute
- Department of Otolaryngology–Head and Neck Surgery, University of California, Davis, Sacramento
| | - Jonathan R. Skirko
- Division of Pediatric Otolaryngology, University of Utah, Salt Lake City
| | - Christina Roth
- Department of Otolaryngology–Head and Neck Surgery, University of California, Davis, Sacramento
| | - Ahmed Bayoumi
- Department of Otolaryngology–Head and Neck Surgery, University of California, Davis, Sacramento
| | - Blythe Durbin-Johnson
- Division of Pediatric Otolaryngology, University of Utah, Salt Lake City
- Department of Otolaryngology–Head and Neck Surgery, Primary Children’s Medical Center, Salt Lake City, Utah
| | - Travis T. Tollefson
- Department of Otolaryngology–Head and Neck Surgery, University of California, Davis, Sacramento
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Impieri D, Tønseth K, Hide Ø, Feragen K, Høgevold H, Filip C. Change in quality of life after treatment of mild velopharyngeal insufficiency with autologous fat transplantation. JPRAS Open 2017. [DOI: 10.1016/j.jpra.2017.05.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Injection Pharyngoplasty With a Hyaluronic Acid and Dextranomer Copolymer to Treat Velopharyngeal Insufficiency in Adults. Mayo Clin Proc Innov Qual Outcomes 2017; 1:176-184. [PMID: 30225414 PMCID: PMC6134910 DOI: 10.1016/j.mayocpiqo.2017.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objective To describe the treatment of adult velopharyngeal insufficiency (VPI) with injection of a hyaluronic acid and dextranomer copolymer (Dx/HA). Patients and Methods This was a retrospective case series of 25 consecutively treated adults with VPI who underwent Dx/HA injection pharyngoplasty in a multidisciplinary clinic from January 1, 2011, to December 31, 2014. Data recorded included etiology of VPI, perceptual analysis of resonance, nasalance scores, and estimation of velopharyngeal gap characteristics on video nasendoscopy before and after the intervention. Statistical comparisons were made using a 2-tailed Wilcoxon signed rank test and the Kruskal-Wallis test. Results Patients had VPI due to a neurologic etiology, due to a benign anatomic etiology, or acquired after treatment for a head and neck malignancy. Injections were performed with local anesthesia, monitored anesthesia care, or general anesthesia. There were statistically significant improvements in speech resonance, nasalance, and velopharyngeal gap size after treatment. Patients with neurologic or benign anatomic etiologies of their VPI had more significant improvement than those with VPI after treatment of malignancy. Nineteen of the 25 patients required only 1 injection to achieve their final result. Conclusion Injection pharyngoplasty with a readily available Dx/HA is an effective treatment for VPI that allows for titration to complete velopharyngeal closure under local anesthesia or light sedation. It is most effective in patients with nonmalignant etiologies of VPI and in those with good lateral wall motion. Complications experienced were postoperative neck pain and occult retropharyngeal fluid collection, highlighting the importance of follow-up.
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Bruneel L, Van Lierde K, Bettens K, Corthals P, Van Poel E, De Groote E, Keppler H. Health-related quality of life in patients with cleft palate: Validity and reliability of the VPI Effects on Life Outcomes (VELO) questionnaire translated to Dutch. Int J Pediatr Otorhinolaryngol 2017; 98:91-96. [PMID: 28583513 DOI: 10.1016/j.ijporl.2017.04.049] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 04/28/2017] [Accepted: 04/30/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Disease-specific health-related quality of life (HRQOL) questionnaires provide the clinician with important information regarding the impact of the disease on functioning and well-being. For patients with velopharyngeal insufficiency (VPI), the VPI Effects on Life Outcomes (VELO) questionnaire was developed and validated in English by Skirko et al. (2012). However, a valid and reliable Dutch translation of this questionnaire is not available yet. METHODS The English questionnaire was translated to Dutch following a forward-backward translation procedure. A linguistic validation and the evaluation of the internal consistency (Cronbach's α) of this Dutch version were performed based on the responses of 39 parents of patients with cleft (lip and) palate (mean age: 6.8 years) (parent report) and the responses of 14 patients older than 8 years (mean age: 9.5 years) (child report). Additionally, the concurrent validity was assessed by comparing the scores on the parent report to those on the pediatric voice handicap index. Furthermore, the validity of the parent proxy assessment and the relationship between age and responses on the VELO questionnaire were investigated. Based on the responses of an age and gender matched control group without cleft palate, the discriminant validity was evaluated. RESULTS The parent report was easy to complete for all parents. Nine of the fourteen (64%) patients were able to complete the child report independently. The median scores on the parent report and the child report were 82.7 and 95.1 respectively. The patient group had a significantly worse perception of HRQOL compared to the control group (p < 0.001; p = 0.029). There were no significant differences between the responses of the parent and their child's (p = 0.345). A significant positive correlation was found between the score on the parent report and the age of the patients (p = 0.001). Furthermore, a significant negative correlation was found between the parent report and the P-VHI (p < 0.001). Cronbach's α was 0.955 and 0.817 for the parent report and the child report respectively. CONCLUSION The Dutch VELO questionnaire is a valid, reliable and user-friendly tool that provides important information about HRQOL in patients with cleft (lip and) palate.
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Affiliation(s)
- Laura Bruneel
- Department of Speech, Language and Hearing Sciences, Ghent University, Ghent, Belgium.
| | - Kristiane Van Lierde
- Department of Speech, Language and Hearing Sciences, Ghent University, Ghent, Belgium; Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
| | - Kim Bettens
- Department of Speech, Language and Hearing Sciences, Ghent University, Ghent, Belgium
| | - Paul Corthals
- Department of Speech, Language and Hearing Sciences, Ghent University, Ghent, Belgium; Faculty of Education, Health and Social Work, University College Ghent, Belgium
| | - Esther Van Poel
- Department of Speech, Language and Hearing Sciences, Ghent University, Ghent, Belgium
| | - Evelien De Groote
- Department of Speech, Language and Hearing Sciences, Ghent University, Ghent, Belgium
| | - Hannah Keppler
- Department of Speech, Language and Hearing Sciences, Ghent University, Ghent, Belgium
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Meier JD, Muntz HR. Velopharyngeal Dysfunction Evaluation and Treatment. Facial Plast Surg Clin North Am 2016; 24:477-485. [DOI: 10.1016/j.fsc.2016.06.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Skirko JR, Weaver EM, Perkins JA, Kinter S, Eblen L, Martina J, Sie KCY. Change in Quality of Life with Velopharyngeal Insufficiency Surgery. Otolaryngol Head Neck Surg 2015; 153:857-64. [PMID: 26124262 DOI: 10.1177/0194599815591159] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Accepted: 05/22/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVES (1) To define the minimal clinically important difference (MCID) of the Velopharyngeal Insufficiency (VPI) Effects on Life Outcomes (VELO) instrument, and (2) to test for the change in quality of life (QOL) after VPI surgery. STUDY DESIGN Prospective observational cohort. SETTING VPI clinic at a tertiary pediatric medical center. SUBJECTS AND METHODS Children with VPI and their parents completed the VELO instrument (higher score is better QOL) at enrollment and then underwent VPI surgery (Furlow palatoplasty or sphincter pharyngoplasty, n = 32), other treatments (obturator or oronasal fistula repair, n = 7), or no treatment (n = 18). They completed the VELO instrument again and an instrument of global rating of change in QOL at 1 year. The MCID was anchored to the global change instrument scores corresponding to "a little" or "somewhat" better. Within-group (paired t test) and between-group (Student t test) changes in VELO scores were tested for the VPI surgery and no treatment groups. The association between treatment group and change in VELO scores was tested with multivariate linear regression, adjusting for confounders. RESULTS Follow-up was obtained for 37 of 57 (65%) patients. The mean (±standard deviation) change in VELO scores corresponding to the MCID anchor was 15 ± 13. The VELO score improved significantly more in the VPI surgery group (change, 22 ± 15; P < .001) than in the no treatment group (change, 9 ± 12; P = .04), after adjusting for confounders (P = .007 between groups). CONCLUSION VPI surgery using the Furlow palatoplasty or sphincter pharyngoplasty improves VPI-specific QOL, and the improvement is clinically important.
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Affiliation(s)
- Jonathan R Skirko
- Department of Otolaryngology-Head & Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Edward M Weaver
- Department of Otolaryngology-Head & Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Jonathan A Perkins
- Department of Otolaryngology-Head & Neck Surgery, University of Washington, Seattle, Washington, USA Division of Pediatric Otolaryngology-Head & Neck Surgery, Seattle Children's Hospital, Seattle, Washington, USA Childhood Communication Center, Seattle Children's Hospital, Seattle, Washington, USA
| | - Sara Kinter
- Speech and Language Services, Seattle Children's Hospital, Seattle, Washington, USA
| | - Linda Eblen
- Speech and Language Services, Seattle Children's Hospital, Seattle, Washington, USA
| | - Julie Martina
- Speech and Language Services, Seattle Children's Hospital, Seattle, Washington, USA
| | - Kathleen C Y Sie
- Department of Otolaryngology-Head & Neck Surgery, University of Washington, Seattle, Washington, USA Division of Pediatric Otolaryngology-Head & Neck Surgery, Seattle Children's Hospital, Seattle, Washington, USA Childhood Communication Center, Seattle Children's Hospital, Seattle, Washington, USA
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