Impact of Timing of Surgery on the Development of Speech in Toddlers with Repaired Cleft Lip and Palate

Abstract

Introduction: Cleft lip and palate (CLP) is one of the most prevalent congenital deformities seen in Indian children. This condition hinders effective communication in early childhood due to speech and language difficulties. The development of speech and language is mainly based on the type and severity of CLP and the age at which surgical intervention followed by speech therapy was initiated. Early intervention plays an important role in enhancing the communication skills in children with CLP. Objectives: The present study endeavours to compare and profile the speech characteristics of toddlers with repaired cleft of lip and palate (RCLP) with respect to the frequency, type and pattern of speech sound inventory of those who had undergone surgical intervention at an early age versus those who had delayed surgery. Participants: Six Kannada speaking toddlers in the age range of 2–3 years, who were diagnosed to have Expressive Language Delay secondary to repaired cleft of lip and/or palate were considered for the Early Intervention Programme. The six participants were placed into two groups based on the age of surgical intervention. Thus there were three participants in the early intervention group (EIG—who underwent surgery before 1.6 years of age) and three in the delayed intervention group (DIG—who underwent surgery after 1.6 years of age). Method: The baseline was established and measures such as type and pattern of the vowels and consonant inventory were analysed for toddlers in both the groups. Speech and language therapy was given for 20 sessions. Focused stimulation technique was used to enhance speech and language parameters. Post-therapy measurement was done after 20 sessions. Main outcome measures: Descriptive statistics was used to compare the differences in speech measures for the pre-therapy and post-therapy conditions between early and delayed intervention groups. Results: The results revealed certain points of interest. Although both groups showed an improvement in the quality and quantity of phonetic inventory between pre- and post-therapy conditions, it was interesting to note that the mean values in the EI group were consistently higher across phonemes when compared to the DI group. The results clearly highlight the positive effects of early surgical and speech intervention. The speech patterns of each group and the consequent implications have been discussed in detail. Conclusions: The present study is one of the few attempts to investigate the impact of timing of surgical correction on the development of phonetic inventory in children with CLP and also highlights the clinical implications of early surgical and subsequent speech and language intervention.