Methods: After searching through PubMed and PsycINFO and screening each article to see if the studies matched our inclusion and exclusion criteria, 7 studies qualified for this meta-analysis. Across all studies, 274 children with NSCL/P were compared to 267 of their typically developing peers. The mean age for children with NSCL/P was 118.8 months (SD = 49.19) and 119.8 months (SD = 49.81) for typically developing children. Effect sizes and demographic information (i.e. study location, sample size, assessments used, etc.) were pulled from each study.
Results: The average effect size for this systematic review is -0.41, demonstrating that children with NSCL/P performed 0.41 standard deviations less than their typically developing peers on measures of word decoding. This was calculated using the RVE-model. Both the older and younger age range showed deficits in their word decoding abilities compared to their typically developing peers. Hearing status, language abilities, and speech abilities were reported minimally with many inconsistencies between studies.
Conclusions: These findings suggest that children with NSCL/P perform poorer on word decoding tasks than their noncleft peers. These differences are found in both the younger and older populations of our sample. More evidence and fewer inconsistencies in the research are needed to determine whether hearing, language, and speech abilities have an effect on the word decoding skills of children with NSCL/P.
Method: Three parent-child dyads participated in the study. All child participants had nonsyndromic CL/P and ranged in age from 21 to 27months. Participants received three weekly telepractice intervention sessions, along with a total of three in-person parent training sessions. Intervention and training were conducted by an SLP and trained graduate student.
Results: All speech measures indicated a gain in essential speech skills for all three children when comparing pre-intervention to post-intervention assessment results. Positive improvement was seen across multiple language measures for all participants.
Conclusion: A parent implemented EMT+PE intervention program using telepractice is an effective way to increase child speech and language outcomes for children with CL/P. Speech and language targets should be combined and delivered simultaneously in intervention.
Sheldon Clark Reed helped establish the profession of genetic counseling in the US during the twentieth century. In 1947 Reed coined the term genetic counseling to describe the interaction of a doctor explaining to a patient the likelihood of passing a certain trait to their offspring. With physicians being able to test for genetic abnormalities like cystic fibrosis, Reed helped trained individuals give patients the tools to make informed decisions. In 1955 Reed published the book Counseling in Medical Genetics. Reed educated patients about how certain genetically transmitted traits could adversely affect their offspring and provided options for remedying those effects.
Truman William Brophy developed a cleft palate surgical repair, later called the Brophy Operation, in the late nineteenth century US. The procedure improved facial aesthetics and speech in cleft palate patients. A cleft palate occurs during development when the palatal bones in the roof of the mouth don't completely fuse, leaving an opening, or cleft, in the upper lip and mouth. Brophy's cleft repair used compression inside and outside of the mouth to push the palatal bones into normal alignment shortly after birth. Brophy advocated surgery on newborns with cleft palates as soon as possible after birth, which met with opposition in the late nineteenth and early twentieth centuries when medical professionals did not operate on infants for non-life threatening conditions. However, Brophy's successful operations convinced many doctors to adopt his technique.
Noninvasive fetal aneuploidy detection technology allows for the detection of fetal genetic conditions, specifically having three chromosomes, a condition called aneuploidy, by analyzing a simple blood sample from the pregnant woman. Dennis Lo and Rossa Chiu researched methods of detection of aneuploidies in the early twenty-first century. Their research has been specifically applied to three trisomies, trisomy twenty-one known as Down syndrome, trisomy eighteen known as Edwards Syndrome, and trisomy thirteen known as Patau Syndrome. Prior to the ability to detect fetal DNA in a pregnant woman’s blood, physicians performed amniocentesis or chorionic villus sampling, two techniques that increase the risk of spontaneous abortion. Noninvasive detection of trisomy twenty-one, eighteen, and thirteen technology allows for a more accurate and safer detection of those conditions than methods available before.
Jeffrey Weinzweig and his team, in the US at the turn of the twenty-first century, performed a series of experiments on fetal goats to study the feasibility of repairing cleft palates on organisms still in the womb. Weinzweig , a plastic surgeon who specialized in cleft palate repair, and his team developed a method to cause cleft palates in fetal goats that are similar to clefts that occur in human fetuses. Using their goat congenital model, the team developed a method to repair a congenital cleft palate in utero, or in the womb. The resultant goat newborns had fully developed palates without scarring and with minimal functional impairment. The researchers recommended that surgeons use their repair methods in humans to decrease the incidence of speech impairment commonly associated with cleft palate patients.
Neurocristopathies are a class of pathologies in vertebrates,
including humans, that result from abnormal expression, migration,
differentiation, or death of neural crest cells (NCCs) during embryonic development. NCCs are cells
derived from the embryonic cellular structure called the neural crest.
Abnormal NCCs can cause a neurocristopathy by chemically affecting the
development of the non-NCC tissues around them. They can also affect the
development of NCC tissues, causing defective migration or
proliferation of the NCCs. There are many neurocristopathies
that affect many different types of systems. Some neurocristopathies
result in albinism (piebaldism) and cleft palate in humans. Various
pigment, skin, thyroid, and hearing disorders, craniofacial and heart
abnormalities, malfunctions of the digestive tract, and tumors can be
classified as neurocristopathies. This classification ties a variety of
disorders to one embryonic origin.
Children with cleft lip and/or palate undergo an extensive series of surgical, orthodontic, speech, audiologic, genetic and medical assessments and treatments during their childhood. The purpose of this study was to examine the Velopharyngeal Insufficiency Effects on Life Outcomes – Parent (VELO-P) comparison of children who had surgery and those who did not in children 5 to 7 years old. The VELO is a quality-of-life questionnaire instrument consisting of 6 subscales, speech limitation, swallowing, situational difficulty, emotional impact, perception by others, and caregiver impact. We compared two groups of children with cleft lip and palate, those who had a secondary surgery for speech hypernasality and those who did not have secondary speech for hypernasality. It is predicted that those who had secondary surgery to repair speech hypernasality will be the group that will show a higher quality of life due to the effect the repair would have on improving their speech. The participants included 30 children between the ages of 5 to 7-years-old with cleft lip and/or palate. Ten of which were male and 20 were female. As for the cleft types, 14 had a unilateral cleft lip and palate, 3 had a bilateral cleft lip and palate, and 13 had a cleft palate only. Nineteen of the children did not have surgery for speech hypernasality and eleven did have surgery. The results of study indicated that the two groups differed significantly on total VELO scores (t=.773, p=0.046) indicating that children who did not have surgery had better quality of life than those who experienced speech hypernasality and had secondary surgery. While individual subscales did not show statistical significance, two subscales showed a moderate effect size difference; caregiver impact (d= .46) and emotional impact (d=.54), indicating that having a speech impairment that requires a secondary surgery may not repair the speech impairment to provide the child intelligible speech and therefore a higher quality of life.
Children with CP+/-L presented with speech accuracy that differed according to manner of production. Speech accuracy for fricative phonemes was influenced by severity of hypernasality, although age and status of secondary surgery did not influence speech accuracy for fricatives. For place of articulation, children with CP+/-L demonstrated strongest accuracy of production for bilabial and velar phonemes, while alveolar and palatal phonemes were produced with lower accuracy. Children with clefting that involved the lip and alveolus demonstrated reduced speech accuracy for alveolar phonemes compared to children with clefts involving the hard and soft palate only.
Participants used a variety of speech error types, with developmental/phonological errors, anterior oral cleft speech characteristics, and compensatory errors occurring most frequently across the sample. Several factors impacted the type of speech errors used, including cleft type, severity of hypernasality, and age.
The results from this dissertation project support previous research findings and provide additional information regarding the severity of speech articulation deficits according to manner and place of consonant production and according to different speech error categories. This study adds information on individual and treatment characteristics that influenced speech accuracy and speech error usage.