Extension and validation of the protocol of orofacial myofunctional assessment for individuals with cleft lip and palate.

Andréia Fernandes Graziani,Katia Flores Genaro,Giédre Berretin-Félix,Irene Queiroz Marchesan,Ana Paula Fukushiro

doi:10.1590/2317-1782/20182018109

Abstract

To perform the expansion, validation of the content, criterion and construct of an orofacial myofunctional assessment protocol for individuals with cleft lip and palate; and to define evaluation parameters for the instrument use. The expansion of the instrument was performed based on the MBGR protocol; the items, sub items and possibilities of answers of the amplified instrument were analyzed for their clarity by seven examiners for the content validation.. Assessment parameters were developed for the use of the instrument in order to minimize the subjectivity. Four examiners compared the aspects of the protocol to those of another instrument for the criterion validation, and the construct validation was performed comparing the results of pre and post orthognathic surgery treatment. The Content Validation Index and the Kappa, Spearman and Wilcoxon Correlation tests were applied for the validations. The mobility, tonicity and sensitivity aspects of the evaluation were added to the protocol and at content validation, 72% of the items were classified as very clear and 28% as clear. A manual with assessment parameters for all items and sub items of the protocol was constructed. The inter-examiner agreement was moderate. In the comparison of the protocols, for the validation of the criterion, a good relation among them was observed. For the validation of the construct the protocol was able to identify outcome after the treatment. The protocol was expanded and considered validated in its entirety: content, criterion and construct, and evaluation parameters for its use were established.

Highlights

METHODSCleft lip and palate is one of the most common malformations, which needs interdisciplinary treatment, among them Speech, Language and Hearing Sciences, due to the impairments that this condition causes: esthetic, anatomic and functional alterations[1].The speech language and hearing evaluation in these cases should be performed along the different life phases, until the end of the craniofacial development, mainly by surgical procedures to which the individuals are submitted[2]
The extension of the items of the protocol was based on MBGR protocol, with the addition of the items: mobility, tonicity and sensibility, that are of general nature in other populations
At Content Validation, the items, sub items and answer possibilities for the extended protocol were analyzed regarding their clarity and, after this analysis, three sub items were excluded relating to the morphological aspects of the items

Summary

Introduction

The speech language and hearing evaluation in these cases should be performed along the different life phases, until the end of the craniofacial development, mainly by surgical procedures to which the individuals are submitted[2] Among these procedures, there are: primary and secondary surgeries for the correction of the lips and palate, pharyngeal flap surgery for the correction of the velopharyngeal insufficiency, nasal surgeries, alveolar bone grafting, orthognathic surgery for the correction of dentofacial deformity, among others. One of them is orofacial myofunctional, characterized by the alteration of the normal position at rest of the lips and tongue; of the sensibility, tonicity and mobility of the structures; of the respiratory mode, of the chewing function and the normal physiological standards of the deglutition oral phase; speech production implication, involving velopharyngeal function and its impact on speech This way, standard evaluation protocols are essential due to the scientific evidence that they present and the possibility of following up the cases. The literature suggests that, besides standardized and validated protocols, it is necessary previous and systematic training for the examiners regarding their application, in order to minimize the differences among the examiners with and without experience[5]

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Conclusion