Abstract
Structured ObjectivesTo describe the perceptual speech outcomes from the Cleft Care UK (CCUK) study and compare them to the 1998 Clinical Standards Advisory Group (CSAG) audit.Setting and sample populationA cross-sectional study of 248 children born with complete unilateral cleft lip and palate, between 1 April 2005 and 31 March 2007 who underwent speech assessment.Materials and methodsCentre-based specialist speech and language therapists (SLT) took speech audio–video recordings according to nationally agreed guidelines. Two independent listeners undertook the perceptual analysis using the CAPS-A Audit tool. Intra- and inter-rater reliability were tested.ResultsFor each speech parameter of intelligibility/distinctiveness, hypernasality, palatal/palatalization, backed to velar/uvular, glottal, weak and nasalized consonants, and nasal realizations, there was strong evidence that speech outcomes were better in the CCUK children compared to CSAG children. The parameters which did not show improvement were nasal emission, nasal turbulence, hyponasality and lateral/lateralization.ConclusionThese results suggest that centralization of cleft care into high volume centres has resulted in improvements in UK speech outcomes in five-year-olds with unilateral cleft lip and palate. This may be associated with the development of a specialized workforce. Nevertheless, there still remains a group of children with significant difficulties at school entry.
Highlights
During the 1980s, the Eurocleft study showed that many aspects of care and some outcomes of treatment in two UK centres fell below those of European Centres such as Oslo in Norway [1]
The aim of this study was to determine the perceptual speech outcomes of children included in the Cleft Care UK (CCUK) study and to compare these with speech outcomes reported in the Clinical Standards Advisory Group (CSAG) study [5]
Centralization of cleft care in the UK over the last fifteen years appears to have resulted in improvements in speech outcomes in five-yearolds born with unilateral cleft lip and palate
Summary
During the 1980s, the Eurocleft study showed that many aspects of care and some outcomes of treatment in two UK centres fell below those of European Centres such as Oslo in Norway [1]. The Clinical Standards Advisory Group (CSAG) study determined multidisciplinary outcomes of children born with unilateral complete cleft lip and palate (UCLP) at the ages of five and twelve years [2,3,4,5]. This included speech [4]. They reported that the speech in 19% of five-year-olds and 4% of twelve-year-olds was judged to be impossible to understand or only just intelligible to strangers. Eighteen per cent of fiveyear-olds and twelve-year-olds had consistent hypernasality of mild, moderate or severe degree
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