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1.
  • Billaud Feragen, Kristin, et al. (författare)
  • Scandcleft randomised trials of primary surgery for unilateral cleft lip and palate: 10. Parental perceptions of appearance and treatment outcomes in their 5-year-old child
  • 2017
  • Ingår i: Journal of Plastic Surgery and Hand Surgery. - : TAYLOR & FRANCIS LTD. - 2000-656X .- 2000-6764. ; 51:1, s. 81-87
  • Tidskriftsartikel (refereegranskat)abstract
    • Background and aim: Few studies have explored childrens emotional and behavioural reactions to cleft surgery and treatment-related stress. The objective was to investigate parents evaluations of appearance and treatment outcomes in their 5-year-old child with unilateral cleft lip and palate (UCLP), and their perceptions of how their child was coping with treatment, comparing this information with recorded postsurgical complications.Design: Three parallel group randomised clinical trials were undertaken as an international multicentre study by 10 cleft teams in five countries: Denmark, Finland, Sweden, Norway, and the UK.Methods: Three different surgical procedures for primary palatal repair were tested against a common procedure in the total cohort of 448 children born with a non-syndromic UCLP. A total of 356 parents completed the Scandcleft Parent Questionnaire, and 346 parents completed the Cleft Evaluation Profile.Results: The results indicated that the majority of parents were satisfied with cleft-related features of their childs appearance. Further, most children coped well with treatment according to their parents. Nevertheless, 17.5% of the children showed minor or short-term reactions after treatment experiences, and 2% had major or lasting difficulties. There were no significant relationships between parent perceptions of treatment-related problems and the occurrence of post-surgical medical complications.Conclusions: Most parents reported satisfaction with their childs appearance. However, treatment-related problems were described in some children, urging cleft centres to be aware of potential negative emotional and behavioural reactions to treatment in some young children, with a view to preventing the development of more severe treatment-related anxiety.
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2.
  • Brunnegård, Karin, et al. (författare)
  • A cross-sectional study of speech in 10-year-old children with cleft palate: results and issues of rater reliability.
  • 2007
  • Ingår i: The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association. - : SAGE Publications. - 1055-6656. ; 44:1, s. 33-44
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVES: To describe speech based on perceptual evaluation in a group of 10-year-old children with cleft palate. A secondary aim was to investigate the reliability of speech-language pathologists' perceptual assessment of cleft palate speech. DESIGN: Retrospective cross-sectional study in children with cleft palate. External raters made assessments from randomized speech recordings. SUBJECTS: Thirty-eight children with unilateral cleft lip and palate (UCLP) or cleft palate only (CPO) and 10 children in a comparison group. MAIN OUTCOME MEASURES: Ratings of hypernasality, hyponasality, audible nasal air leakage, weak pressure consonants, and articulation. Exact agreement and weighted kappa values were used for reliability. RESULTS: Hypernasality was found in 25% of children with a cleft of the soft palate (CSP), 33% of children with a cleft of the hard and soft palate (CHSP), and 67% of children with a UCLP. Similar results were found for audible nasal air leakage. Articulation errors were found in 6% of the CHSP group and 25% of the UCLP group, whereas no child in the CSP group had articulation errors. The reliability was moderate to good for different variables, with lowest values for hypernasality. CONCLUSIONS: Speech results in this series seem less satisfactory than those reported in other published international studies, but it is difficult to draw any certain conclusions about speech results because of large methodological differences. Further developments to ensure high reliability of perceptual ratings of speech are called for.
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3.
  • Brunnegård, Karin, et al. (författare)
  • Comparison between perceptual assessments of nasality and nasalance scores
  • 2012
  • Ingår i: International journal of language and communication disorders. - : Wiley-Blackwell. - 1368-2822 .- 1460-6984. ; 47:5, s. 556-566
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: There are different reports of the usefulness of the Nasometer™ as a complement to listening, often as correlation calculations between listening and nasalance measurements. Differences between findings have been attributed to listener experience and types of speech stimuli.Aims: To compare nasalance scores from the Nasometer with perceptual assessments, for the same and different Swedish speech stimuli, using three groups of listeners with differing levels of experience in judging speech nasality. Methods & Procedures: To compare nasalance scores and blinded listener ratings of randomized recordings using three groups of listeners and two groups of speakers. Speakers were either classified as having hypernasal speech or speech with typical speech resonance. Listeners were speech-language pathologists (SLPs) working predominantly with resonance disorders, other SLPs and untrained listeners.Outcomes & Results: Correlations (r(s) ) between hypernasality ratings and nasalance scores for each listener group and speech stimuli were calculated. For both groups of SLPs all correlations between perceptual ratings and nasalance scores were significant at p= 0.01. The correlations between the nasalance scores and ratings by listeners in the SLP groups were higher than those for the untrained listener group regardless of stimulus type. Post-hoc Mann-Whitney U-tests showed that the only difference that was significant was expert SLP group versus untrained listener group. Secondly, correlations between perceptual ratings and oral stimulus nasalance scores were higher when the perceptual ratings were based on spontaneous speech rather than on the oral stimulus. However, a Wilcoxon signed rank test showed that the difference was not significant. A third finding was that correlations between oral stimulus nasalance scores and perceptual scores were higher than those between mixed stimulus nasalance scores and perceptual scores. A Wilcoxon signed rank test showed that the difference was significant.Conclusions & Implications: The Nasometer might be useful for the SLP with limited experience in assessing resonance disorders in differentiating between hyper- and hyponasality. With listener reliability for ratings of hypernasality still being an issue, the use of a nasalance score as a complement to the perceptual evaluation will also aid the expert SLP. It will give an alternative way of quantifying speech resonance and might help in especially hard to judge cases.
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4.
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5.
  • Brunnegård, Karin, 1973- (författare)
  • Evaluation of nasal speech : a study of assessments by speech-language pathologists, untrained listeners and nasometry
  • 2008
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Excessive nasal resonance in speech (hypernasality) is a disorder which may have negative communicative and social consequences for the speaker. Excessive nasal resonance is often associated with cleft lip and palate, velopharyngeal impairment, dysarthria or hearing impairment. Evaluation of hypernasality has proved to be a challenge in the clinic and in research. There are questions regarding the accuracy and reliability of auditory perceptual evaluations of nasal speech, and whether instrumental measures can be used to improve the reliability of clinical evaluation. There is also the question of whether clinical evaluation reflects the impact of hypernasality in a speaker’s everyday life. The purpose of this thesis was to evaluate the extent of reliability problems connected with auditory perceptual assessment of nasality in speech, to explore whether they might interfere with treatment decisions or have an impact in the everyday life of patients, and whether they can be effectively diminished by the use of nasometry. Speakers with cleft lip and palate or velopharyngeal impairment formed the basis of the clinical population used in this study. Speech samples from 52 of these speakers, along with samples from a reference population of 21 speakers who did not have cleft palate, velopharyngeal impairment or speech disorders were used in perceptual evaluation tasks. Fourteen speakers from the clinical population and 11 from the reference population also underwent nasometric evaluation. A further reference population of 220 children from three Swedish cities, whose ages were consistent with those used for clinical checks of children born with cleft palate were assessed with nasometry to establish normative data for the Nasometer™. Perceptual speech assessments were conducted on hyper- and hyponasality, as well as audible nasal air emission and/or nasal turbulence, using 5-point ordinal scales. Listeners were SLPs experienced in the evaluation of cleft palate speech, non-expert SLPs and untrained listeners. Listening assessments were performed from audio recorded speech samples assembled in random order. Nasometry measures were made on three speech passages each with specific phonetic content, using the Nasometer™, model II. Perceptual evaluation Results showed that for hypernasality assessment, 15% of hypernasality assessments had disagreements between expert SLPs that were potentially important for clinical decisions, as did 6% of assessments for audible nasal air emission and/or nasal turbulence. For nasality problems, a comparison of expert and untrained listeners showed that they generally agreed on which speakers were hypernasal and on the ranking of nasal speakers. All speakers that had been rated with moderate to severe hypernasality by expert listeners were considered by the untrained listeners as having a serious enough speech disorder to call for intervention. However, in the case of audible nasal air emission and/or nasal turbulence the expert listeners were more prone to notice this feature than the untrained listeners. Instrumental evaluation The development of normative values for the three Swedish passages for the NasometerTM (comparable to normative values in other languages) has provided a basis for use of instrumental measures in Swedish clinics, oral sentences mixed sentences nasal sentences. The measures showed no significant differences due to city, gender or age within an age range of 4-10 years. When nasometry measures were compared with perceptual evaluation of speech samples from the same speakers, all correlations were moderate to good for expert SLPs and non-expert SLPs. The difference between correlations was significantly higher for expert SLPs than for untrained listeners. Reliability figures for perceptual assessments for expert SLP listeners indicated that there were some cases where lack of reliability could affect clinical decision making. However, in the main, judgements of nasality problems made by clinicians had everyday validity. They reflected the impressions of the everyday listener, especially in regard to the need for intervention. The study also indicates that now that Swedish norms are available, the Nasometer™ might be useful as a complement to auditory perceptual clinical speech assessments in Swedish cleft palate clinics in order to improve reliability of clinical assessment.
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6.
  • Brunnegård, Karin, et al. (författare)
  • Untrained listeners’ ratings of speech disorders in a group with cleft palate : a comparison with speech and language pathologists’ ratings
  • 2009
  • Ingår i: International journal of language and communication disorders. - : John Wiley & Sons. - 1368-2822 .- 1460-6984. ; 44:5, s. 656-674
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Hypernasal resonance, audible nasal air emission and/or nasal turbulence, and articulation errors are typical speech disorders associated with the speech of children with cleft lip and palate. Several studies indicate that hypernasal resonance tends to be perceived negatively by listeners. Most perceptual studies of speech disorders related to cleft palate are carried out with speech and language pathologists as listeners, whereas only a few studies have been conducted to explore how judgements by untrained listeners compare with expert assessments. These types of studies can be used to determine whether children for whom speech and language pathologists recommend intervention have a significant speech deviance that is also detected by untrained listeners.Aims: To compare ratings by untrained listeners with ratings by speech and language pathologists for cleft palate speech.Methods & Procedures: An assessment form for untrained listeners was developed using statements and a five-point scale. The assessment form was tailored to facilitate comparison with expert judgements. Twenty-eight untrained listeners assessed the speech of 26 speakers with cleft palate and ten speakers without cleft in a comparison group. This assessment was compared with the joint assessment of two expert speech and language pathologists.Outcomes & Results: Listener groups generally agreed on which speakers were nasal. The untrained listeners detected hyper- and hyponasality when it was present in speech and considered moderate to severe hypernasality to be serious enough to call for intervention. The expert listeners assessed audible nasal air emission and/or nasal turbulence to be present in twice as many speakers as the untrained listeners who were much less sensitive to audible nasal air emission and/or nasal turbulence.Conclusions & Implications: The results of untrained listeners' ratings in this study in the main confirm the ratings of speech and language pathologists and show that cleft palate speech disorders may have an impact in the everyday life of the speaker.
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7.
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8.
  • Flynn, Traci, 1973, et al. (författare)
  • A longitudinal study of hearing and middle ear status of individuals with cleft palate with and without additional malformations/syndromes.
  • 2014
  • Ingår i: The Cleft Palate-Craniofacial Journal. - : SAGE Publications. - 1055-6656 .- 1545-1569. ; 51:5
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: To describe and compare the middle ear status and hearing sensitivity in adolescence with isolated cleft palate plus additional malformations and/or syndromes with those with only an isolated cleft palate. Design: Retrospective and longitudinal. Two groups of individuals with isolated cleft palate were compared. Participants: A cohort of individuals born over 4 years in the western region of Sweden. The cohort was divided into one group with isolated cleft palate (n = 31; ICP) and one group with isolated cleft palate plus additional malformations and/or syndromes (n = 37; ICP+). Methods: Middle ear status and hearing thresholds were collected from the medical records at 7, 10, 13, and 16 years of age, examined, and compared within and between groups over time. Results: The ICP+ group demonstrated a significantly higher prevalence of abnormal middle ear status and elevated hearing thresholds as compared with the ICP group. As the individuals aged, the prevalence of abnormal middle ear status decreased. The hearing levels in both groups decreased in the low to middle frequencies as individuals aged; however, the hearing in the high frequencies did not. Conclusions: Individuals with cleft palate need to be followed routinely for middle ear status and hearing thresholds to ensure optimal audiological rehabilitation, with particular attention to those with additional malformations and/or syndromes.
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9.
  • Flynn, Traci, 1973, et al. (författare)
  • The high prevalence of otitis media with effusion in children with cleft lip and palate as compared to children without clefts
  • 2009
  • Ingår i: International Journal of Pediatric Otorhinolaryngology. - Amsterdam : Elsevier Biomedical. - 0165-5876 .- 1872-8464. ; 73:10, s. 1441-1446
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVES: Children with cleft lip and palate universally present with otitis media with effusion. This prevalence has not been systematically studied. The purpose of the present study was to examine and compare the prevalence of otitis media with effusion, hearing sensitivity, and audiometry method utilised for assessment in children with and without clefts. METHODS: Two groups of children (children with unilateral cleft lip and palate, N=22, and children without clefts, N=20) were followed prospectively and longitudinally from 1 to 5 years of age. Data were collected at four points (1, 1.5, 3, and 5 years of age). Assessments at each of the four points included: (1) otomicroscopy, (2) tympanometry, and (3) hearing assessment. RESULTS: Overall the children with unilateral cleft lip and palate demonstrated a significantly higher prevalence of otitis media with effusion (121 ears, 74.7%) than children without clefts (31 ears, 19.4%) (p<0.001). This higher prevalence was also significant at 1, 1.5, 3, and 5 years of age (p<0.001). Of those ears with otitis media with effusion, 83.1% of the ears exhibited a hearing loss (PTA >20dB), with this loss more prevalent in the cleft group (89.7% UCLP and 70.0% non-cleft). The hearing loss was significantly more pronounced in the cleft (group 35.71dB HL UCLP and 26.41dB HL non-cleft group). Children with unilateral cleft lip and palate utilised a lower age-appropriate audiometry testing method than age-matched children with no cleft at 1, 1.5, and 3 years of age. CONCLUSIONS: Children with unilateral cleft lip and palate present with a significantly higher prevalence of otitis media with effusion than children without cleft. Also, the hearing loss associated with otitis media with effusion is demonstrated in this study. Furthermore, the method of audiometry has been examined and children with unilateral cleft lip and palate had to be assessed with a lower level of method than children without cleft.
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10.
  • Friede, Hans, 1938, et al. (författare)
  • Letter to the Editor.
  • 2012
  • Ingår i: The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association. - : SAGE Publications. - 1545-1569. ; 49:4, s. 512-513
  • Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
    • Abstract N/A.
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11.
  • Friede, Hans, 1938, et al. (författare)
  • Long-Term, Longitudinal Follow-Up of Individuals with UCLP After the Gothenburg Primary Early Veloplasty and Delayed Hard Palate Closure Protocol: Maxillofacial Growth Outcome.
  • 2012
  • Ingår i: The Cleft Palate-Craniofacial Journal. - : SAGE Publications. - 1545-1569 .- 1055-6656. ; 49:6, s. 649-656
  • Tidskriftsartikel (refereegranskat)abstract
    • Abstract Objective: To study long-term maxillofacial development in a sample of patients born with unilateral cleft lip and palate (UCLP). The patients' palatal repair had been performed according to a two-stage protocol with early velar closure and delayed hard palate surgery. Design: Retrospective longitudinal cohort study. Subjects: The sample consisted of 50 consecutive patients with UCLP born from 1980 to 1989. All of them had been operated on at the Sahlgrenska University Hospital in Gothenburg, Sweden. Methods: Certain maxillary casts as well as lateral roentgencephalograms, obtained at 5; 10; 16; and 19 years of age, were analyzed. Results: Our patients' maxillofacial growth was very good even up to the final examination at early adulthood. We ascribe the advantageous midfacial morphology of our patients particularly to limited growth restriction from palatal scars due to the surgical protocol used in our cleft center. Conclusion: The two-stage protocol advocated by us for repair of the palatal cleft resulted in very satisfactory growth outcome. A palatal scar, that might impair maxillary development, was created only by the velar surgery. If this scar was located close to the posterior border of the hard palate, it might result in less maxillary growth restriction than if it was positioned further anteriorly. Key Words: Cephalometrics, cleft lip and palate, delayed hard palate repair, growth, maxilla, surgery.
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12.
  • Friede, Hans, 1938, et al. (författare)
  • Maxillary dental arch and occlusion in patients with unilateral cleft lip and palate treated with different delays in closure of the hard palate after early velar repair.
  • 2006
  • Ingår i: Scandinavian journal of plastic and reconstructive surgery and hand surgery / Nordisk plastikkirurgisk forening [and] Nordisk klubb for handkirurgi. - : Informa UK Limited. - 0284-4311. ; 40:5, s. 261-6
  • Tidskriftsartikel (refereegranskat)abstract
    • We wanted to find out if growth of the maxilla in 26 patients with unilateral cleft lip and palate (UCLP) was adversely affected by having the residual cleft of the hard palate repaired earlier than had been done previously in a 2-stage palatal closure protocol. The ages at repair of the hard palate of the present patients ranged from 38 to 89 months. Dental casts from ages about 3 years (before any repair of the hard palate), 5, 7, and 10 years of age were analysed. The results indicated that earlier repair of the cleft in the hard palate did not influence maxillary growth differently from the later repair.
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13.
  • Friede, Hans, 1938, et al. (författare)
  • Two-stage palatal surgery with early veloplasty and delayed hard palate repair: A balanced view on speech and midfacial growth outcome
  • 2013
  • Ingår i: Cleft Lip and Palate; Diagnosis and management; Third edition; (S. Berkowitz editor). - Berlin Heidelberg 2013 : Springer-Verlag. - 9783642307690 ; , s. 413-437
  • Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
    • Today, there is general consensus that, particularly, the protocol for repair of the palate is crucial for normal speech development and adequate long-term midfacial growth in individuals affected with cleft lip and palate (CLP). About 90 years ago, a new two-stage palatal repair method was introduced. It was characterized by early veloplasty and later closure of the hard palate. Recent follow-up studies of this regimen have revealed excellent long-term outcome regarding maxillary growth and also satisfactory speech development, even if the hard palate surgery was delayed to the stage of early mixed dentition. A speech deviation, coined as “retracted oral articulation of anterior pressure consonants,” seemed to be a relatively common speech error, temporarily affecting about one third of our preschool children born with unilateral CLP. The prevalence of other, more severe cleft speech characteristics, such as symptoms of and related to velopharyngeal incompetence and the occurrence of glottal misarticulations in particular, was very low.
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14.
  • Gamble, Carrol, et al. (författare)
  • Timing of Primary Surgery for Cleft Palate.
  • 2023
  • Ingår i: The New England journal of medicine. - : Massachusetts Medical Society. - 1533-4406 .- 0028-4793. ; 389:9, s. 795-807
  • Tidskriftsartikel (refereegranskat)abstract
    • Among infants with isolated cleft palate, whether primary surgery at 6 months of age is more beneficial than surgery at 12 months of age with respect to speech outcomes, hearing outcomes, dentofacial development, and safety is unknown.We randomly assigned infants with nonsyndromic isolated cleft palate, in a 1:1 ratio, to undergo standardized primary surgery at 6 months of age (6-month group) or at 12 months of age (12-month group) for closure of the cleft. Standardized assessments of quality-checked video and audio recordings at 1, 3, and 5 years of age were performed independently by speech and language therapists who were unaware of the trial-group assignments. The primary outcome was velopharyngeal insufficiency at 5 years of age, defined as a velopharyngeal composite summary score of at least 4 (scores range from 0 to 6, with higher scores indicating greater severity). Secondary outcomes included speech development, postoperative complications, hearing sensitivity, dentofacial development, and growth.We randomly assigned 558 infants at 23 centers across Europe and South America to undergo surgery at 6 months of age (281 infants) or at 12 months of age (277 infants). Speech recordings from 235 infants (83.6%) in the 6-month group and 226 (81.6%) in the 12-month group were analyzable. Insufficient velopharyngeal function at 5 years of age was observed in 21 of 235 infants (8.9%) in the 6-month group as compared with 34 of 226 (15.0%) in the 12-month group (risk ratio, 0.59; 95% confidence interval, 0.36 to 0.99; P=0.04). Postoperative complications were infrequent and similar in the 6-month and 12-month groups. Four serious adverse events were reported (three in the 6-month group and one in the 12-month group) and had resolved at follow-up.Medically fit infants who underwent primary surgery for isolated cleft palate in adequately resourced settings at 6 months of age were less likely to have velopharyngeal insufficiency at the age of 5 years than those who had surgery at 12 months of age. (Funded by the National Institute of Dental and Craniofacial Research; TOPS ClinicalTrials.gov number, NCT00993551.).
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15.
  • Hagberg, Emilie, et al. (författare)
  • The Impact of Maxillary Advancement on Consonant Proficiency in Patients With Cleft Lip and Palate, Lay Listeners' Opinion, and Patients' Satisfaction With Speech
  • 2019
  • Ingår i: The Cleft Palate-Craniofacial Journal. - : NLM (Medline). - 1055-6656 .- 1545-1569. ; 56:4, s. 454-461
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: This study investigates the impact of maxillary advancement (Le Fort Iosteotomy) on consonant proficiency in patients with cleft lip and palate (CLP) and explores how these patients and lay people perceive their speech 1 year post Le Fort I osteotomy. Design: Retrospective group study before and after treatment. Participants: All patients with CLP who had undergone Le Fort I osteotomy for maxillary retrognathia between 2007 and 2010 at Karolinska University Hospital, Sweden (n = 21). Six patients were excluded due to additional malformations and missing data. Two experienced speech and language pathologists assessed consonant proficiency, and speech accuracy was determined by lay listeners from pre- and postoperative standardized audio recordings. The patients' satisfaction with speech postoperatively was collected from medical records. Main Outcome Measures: Percentage of oral consonants correct and acoustic analysis of /s/, lay listeners' opinion, and patients' satisfaction with speech. Results: One year postoperation, 11 of the 15 patients had improved articulation, especially on the /s/-sound, without speech intervention. The mean percentage of oral consonants correct before treatment (82%) was significantly improved later (95%; P > .01). This assessment was supported by the patients' satisfaction with speech. However, lay listeners' opinion on accuracy was inconsistent. Length of maxillary advancement or change in occlusion did not correlate with change in articulation. Conclusion: Maxillary advancement performed to normalize occlusion and facial profile improved consonant proficiency in patients with CLP 1 year postoperation. Lay listeners' and patients' perceptions of speech need further exploration.
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16.
  • Hartelius, Lena, 1957, et al. (författare)
  • Talstörningar allmän del
  • 2007
  • Ingår i: Lärobok i logopedi. Hartelius L, Nettelbladt, U, Hammarberg B (red). - Lund : Studentlitteratur. - 9789144038865 ; , s. 357-75
  • Bokkapitel (övrigt vetenskapligt/konstnärligt)
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17.
  • Havstam, Christina, 1963, et al. (författare)
  • Communication attitude and speech in 10-year-old children with cleft (lip and) palate: An ICF perspective.
  • 2011
  • Ingår i: International journal of speech-language pathology. - : Informa UK Limited. - 1754-9515 .- 1754-9507. ; 13:2, s. 156-164
  • Tidskriftsartikel (refereegranskat)abstract
    • Many children born with cleft palate have impaired speech during their pre-school years, but usually the speech difficulties are transient and resolved by later childhood. This study investigated communication attitude with the Swedish version of the Communication Attitude Test (CAT-S) in 54 10-year-olds with cleft (lip and) palate. In addition, environmental factors were assessed via parent questionnaire. These data were compared to speech assessments by experienced listeners, who rated the children's velopharyngeal function, articulation, intelligibility, and general impression of speech at ages 5, 7, and 10 years. The children with clefts scored significantly higher on the CAT-S compared to reference data, indicating a more negative communication attitude on group level but with large individual variation. All speech variables, except velopharyngeal function at earlier ages, as well as the parent questionnaire scores, correlated significantly with the CAT-S scores. Although there was a relationship between speech and communication attitude, not all children with impaired speech developed negative communication attitudes. The assessment of communication attitude can make an important contribution to our understanding of the communicative situation for children with cleft (lip and) palate and give important indications for intervention.
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18.
  • Havstam, Christina, 1963, et al. (författare)
  • Evaluation of VPI-assessment with videofluoroscopy and nasoendoscopy.
  • 2005
  • Ingår i: British journal of plastic surgery. - : Elsevier BV. - 0007-1226. ; 58:7, s. 922-31
  • Tidskriftsartikel (refereegranskat)abstract
    • The purpose of this study was to investigate how different amounts of visual assessment information influence the recommended treatment for velopharyngeal insufficiency (VPI). Is a patient presented with videofluoroscopy (VF) in lateral projection recommended the same treatment as when frontal projection, nasoendoscopy, or both, are added? Retrospective material with video recorded assessment of VPI was blinded and copied in random order. Each patient was then presented in four separate combinations: VF in lateral projection; VF in lateral and frontal projection; VF in lateral projection and nasoendoscopy; and VF in lateral and frontal projection and nasoendoscopy (all of the available assessment material). The cleft palate team of Göteborg, Sweden, mutually rated velopharyngeal function and recommended action based on the presented material. SUBJECTS: Nineteen consecutive patients (median age 7:5 years, range 4:4-19:7) investigated with VF in lateral and frontal projection and nasoendoscopy during 1997-99 at the cleft palate centre in Göteborg, Sweden. Post operative assessments were excluded. Percent agreement and Kappa calculations were used to compare the different combinations of parts of information to all of the available information. RESULTS: Thirteen of the 19 patients (68%) were recommended the same action regardless of the amount of presented information. Percent agreement (Kappa) between parts and all of the available information: VF in lateral projection 84% (0.75), VF in lateral and frontal projection 79% (0.74), and VF in lateral projection and nasoendoscopy 84% (0.72). CONCLUSIONS: VF in lateral projection is recommended to be the first step in visualising velopharyngeal function, and nasoendoscopy the next when further investigation is required.
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19.
  • Havstam, Christina, 1963, et al. (författare)
  • Speech and satisfaction with outcome of treatment in young adults with unilateral or bilateral complete clefts.
  • 2008
  • Ingår i: Scandinavian journal of plastic and reconstructive surgery and hand surgery / Nordisk plastikkirurgisk forening [and] Nordisk klubb for handkirurgi. - : Informa UK Limited. - 0284-4311. ; 42:4, s. 182-9
  • Tidskriftsartikel (refereegranskat)abstract
    • Thirty-five young adults (22-32 years old, mean 25) born with complete unilateral or bilateral clefts participated in a follow-up of speech, appearance, and teeth after treatment. They completed a questionnaire about their satisfaction with their speech, nose, lip, and teeth on visual analogue scales, and indicated on two overall questions how often they thought about their cleft, and how often they were asked questions about their speech, nose, or lip. Their speech was recorded and assessed blindly and independently by two speech and language pathologists. Participants' satisfaction with their speech did not correlate significantly with the speech assessments. Satisfaction with the nose had the highest correlation with the overall questions. No participant indicated more dissatisfaction with speech than the midpoint of the scale, making conclusions about covariance between satisfaction with speech and the overall questions difficult.
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20.
  • Havstam, Christina, 1963, et al. (författare)
  • Taking Charge of Communication: Adults' Descriptions of Growing up with a Cleft-Related Speech Impairment.
  • 2011
  • Ingår i: The Cleft palate-craniofacial journal. - : SAGE Publications. - 1545-1569 .- 1055-6656. ; 48:6, s. 717-726
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: To obtain descriptions of the experience of growing up with a cleft-related speech impairment and how it was dealt with. Design: Semistructured interviews were tape-recorded, transcribed verbatim, and analyzed using a qualitative approach inspired by grounded theory methodology. Setting: Interviews took place at participants' homes or workplaces or at the university. Participants: Thirteen young adults (25 to 34 years of age) born with cleft palate with or without cleft lip. Results: The analysis resulted in the core category Taking charge of communication, which comprised three main categories: Forming an idea of one's speech, Learning about one's communication, and Taking responsibility for communication. The first main category was made up of three subcategories and the other two had two. The categories emerged as parallel processes in the understanding and active handling of communicative interaction. Conclusions: The participants described the processes that had enabled them to take charge of their communication. Seeing things from the listener's perspective and being open about the cleft and the speech disorder emerged as important parts of taking active responsibility for communication, as well as accepting their present speech and communication. Communicative participation should be assessed more thoroughly to understand the individual needs of people born with a cleft who have a speech impairment into adolescence.
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21.
  • Johannisson, Tove B, et al. (författare)
  • Assessing intelligibility by single words, sentences and spontaneous speech: a methodological study of the speech production of 10-year-olds.
  • 2014
  • Ingår i: Logopedics, phoniatrics, vocology. - : Informa UK Limited. - 1651-2022 .- 1401-5439. ; 39:4, s. 159-168
  • Tidskriftsartikel (refereegranskat)abstract
    • The aim of this study was to investigate the impact of different assessment methods on intelligibility scores and to examine the validity and reliability of those methods. Four assessment methods were used: multiple-choice and transcription of single words (read out), transcription of sentences (read out), and spontaneous speech. The results showed a statistically significant difference between outcomes for the different assessment methods. Reliability was high for all methods. Validity was low for all three reading-based methods. The method using transcription of spontaneous speech had low validity for the population included. It was concluded that reading is not a suitable elicitation technique for 10-year-olds and that the assessment procedure used for spontaneous speech needs to be further developed and investigated.
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22.
  • Johannisson, Tove B, et al. (författare)
  • The Communication Attitude Test (CAT-S): normative values for 220 Swedish children.
  • 2009
  • Ingår i: International journal of language & communication disorders / Royal College of Speech & Language Therapists. - : Wiley. - 1460-6984 .- 1368-2822. ; 44:6, s. 813-25
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: The risk of developing a negative attitude to communication as a consequence of having a speech disorder has been in focus for decades in research concerning fluency disorders in relation to both children and adults. The Communication Attitude Test (CAT), which was created to measure children's attitudes towards their own communication, has been widely used. Research has shown that children who stutter have a significantly more negative attitude to their own communication than normal-speaking children and preliminary results show a similar picture in children with other types of speech disorders. However, the setting for obtaining data on normal-speaking children often differs from that on children with speech disorders. In order to make a significant interpretation of results from children with a speech disorder, comparable data on normal-speaking children are needed. Aims: The main purpose of this study was to obtain norm values for the Swedish version of the test (CAT-S) and examine possible differences related to age, sex or small town/big city. A second aim was to investigate some aspects of reliability, such as internal consistency, and validity in terms of item analysis as well as a qualitative analysis of the answers to the different items. In addition, group setting was compared with individual setting for the test procedure. Methods & Procedures: CAT-S was completed in a group setting by 220 normal-speaking children aged 7-15 years and by an additional group of 35 normal-speaking 10-year-old children who completed the test individually. Outcomes & Results: The 220 Swedish children had a mean score of 6.05 (a slightly higher mean score have been found in other countries, i.e. Belgium = 7.05 and USA = 8.24). The 7-year-olds had a significantly higher mean score than children at the other ages, except for the 15-year-olds. No other differences were found related to age, sex or size of community. The aspects of reliability and validity investigated for the CAT-S were satisfactory. Furthermore, there was no significant difference between the groups of 10-year-olds objected to different test procedures. Conclusions & Implications: The norm values of CAT-S could be used for comparison of scores from Swedish children with speech disorders. The CAT-S is easy to administer and could be used either in a group setting for research purpose or individually at the clinic.
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23.
  • Kjellmer, Liselotte, et al. (författare)
  • Treatment of active nasal fricatives substituting /s/ in young children with normal palatal function using motor-based intervention
  • 2021
  • Ingår i: International Journal of Speech-Language Pathology. - : Informa UK Limited. - 1754-9507 .- 1754-9515. ; 23:6, s. 503-693
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose: The aim was to evaluate the effect of a motor-based, hierarchically structured intervention directed at active nasal fricatives substituting /s/ in young children with normal palatal function.Method: An experimental single-subject design was replicated across three children, aged 4–6 years, with normal palatal function, who substituted oral /s/ with active nasal fricatives. Treatment was performed weekly by a speech-language pathologist and included home training conducted by parents. Audio documented probes were registered regularly and /s/-production evaluated as oral or nasal.Result: All children achieved 98–100% oral production of /s/ in six probed linguistic contexts at treatment end and exhibited good maintenance at follow-up. The four-year-olds showed gradual or inconsistent response and slower progress, the six-year-old direct response and faster progress.Conclusion: The study provides preliminary evidence suggesting positive intervention effects for treating active nasal fricatives in children with normal palatal function. However, possible confounding effects such as maturation or repeated testing could not be ruled out; thus, results need to be replicated with increased experimental control. Nevertheless, the study adds to the currently meagre empirical evidence-base for the population. Individual treatment response and progress patterns were found and data suggests that the intervention may be beneficial from age 4.
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24.
  • Klintö, Kristina, et al. (författare)
  • Perceptual Assessment of Cleft Palate Speech—Bridging the Gap From Research to Clinical Practice—the Swedish Perspective
  • 2023
  • Ingår i: Perspectives of the ASHA Special Interest Groups. - 2381-473X. ; 8:5, s. 986-1002
  • Forskningsöversikt (refereegranskat)abstract
    • Purpose:The purpose of this tutorial is to describe an evidence-based scientifically sustainable perceptual assessment of cleft palate speech and how standardized assessment methods for research on cleft palate speech have been implemented in clinical practice in Sweden, which makes it possible to carry out research on clinical data.Method:This tutorial is based on a literature review and own research on how to perform a valid and reliable perceptual cleft palate speech assessment and the description of clinical practice in Sweden. Perceptual speech assessment of cleft palate speech is discussed in terms of speech material, documentation, perceptual speech analysis, speech outcome measures, cross-linguistic comparisons, calculation of reliability, interpretation of results, and subject selection. We also describe the conditions that have made it possible to integrate research and clinic in cleft palate speech-language pathology in Sweden.Conclusions:Knowledge acquired from national and international research has had a great impact on the development of cleft palate speech assessment procedures in Sweden and has contributed to standardized evaluation of treatment results. This has enabled open comparisons of treatment results from the different Swedish cleft lip and palate (CLP) centers to provide a basis for improved CLP care.
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25.
  • Klintö, Kristina, et al. (författare)
  • Phonology in Swedish-speaking 3-year-olds born with cleft lip and palate and the relationship with consonant production at 18 months.
  • 2014
  • Ingår i: International Journal of Language & Communication Disorders. - : Wiley. - 1368-2822 .- 1460-6984. ; 49:2, s. 240-254
  • Tidskriftsartikel (refereegranskat)abstract
    • Approximately 50% of children born with cleft palate present speech difficulties around 3 years of age, and several studies report on persisting phonological problems after palatal closure. However, studies on early phonology related to cleft palate are few and have so far mainly been carried out on English-speaking children. Studies on phonology related to cleft palate in languages other than English are also warranted.
  •  
26.
  • Klintö, Kristina, et al. (författare)
  • Phonology in Swedish-speaking 3-year-olds born with unilateral cleft lip and palate treated with palatal closure in one or two stages
  • 2017
  • Ingår i: Journal of Plastic Surgery and Hand Surgery. - 2000-656X .- 2000-6764. ; 51:2, s. 112-117
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Phonological disorders are common in 3-year-olds born with cleft palate compared to non-cleft peers. However, published results have been based on small samples. The purpose was to expand the knowledge on phonology of Swedish-speaking 3-year-olds with unilateral cleft lip and palate (UCLP), treated with primary palatal closure in one or two stages. Methods: The phonology of 26 children with UCLP was assessed with percentage consonants correct adjusted for age (PCC-A) and number of consistent phonological simplification processes (NCP) at age 3. Fifteen of the children were treated with minimal incision technique in one stage (OS) at 13 months and 11 with a two-stage closure (TS) with soft palate repair at 4 months and hard palate repair at 12 months. Their results were compared and then merged with previously obtained data from 10 children treated with OS and nine children treated with TS. Finally, the merged results were compared with those of 20 peers without UCLP. Results: No significant differences between the first two groups were found. In the merged results, NCP in the OS group was significantly lower than in the TS group. The UCLP group displayed significantly poorer results on PCC-A and NCP than peers without UCLP. Conclusion: Surgical procedure did not have a clear impact on phonology at age 3 years. Since children with UCLP are at risk of having impaired phonology at age 3, the results confirm the necessity of having both a phonological and articulatory approach when assessing and treating children born with cleft palate.
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27.
  • Klintö, Kristina, et al. (författare)
  • Speech and Phonology in Swedish-Speaking 3-Year-Olds with Unilateral Complete Cleft Lip and Palate Following Different Methods for Primary Palatal Surgery
  • 2014
  • Ingår i: The Cleft Palate - Craniofacial Journal. - : SAGE Publications. - 1545-1569 .- 1055-6656. ; 51:3, s. 274-282
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: To describe and compare speech and phonology at age 3 years in children born with unilateral complete cleft lip and palate treated with three different methods for primary palatal surgery. Design: Prospective study. Setting: Primary care university hospitals. Participants: Twenty-eight Swedish-speaking children born with nonsyndromic unilateral complete cleft lip and palate. Interventions: Three methods for primary palatal surgery: two-stage closure with soft palate closure between 3.4 and 6.4 months and hard palate closure at mean age 12.3 months (n = 9) or 36.2 months (n = 9) or one-stage closure at mean age 13.6 months (n = 10). Main Outcome Measures: Based on independent judgments performed by two speech-language pathologists from standardized video recordings: percent correct consonants adjusted for age, percent active cleft speech characteristics, total number of phonological processes, number of different phonological processes, hypernasality, and audible nasal air leakage. The hard palate was unrepaired in nine of the children treated with two-stage closure. Results: The group treated with one-stage closure showed significantly better results than the group with an unoperated hard palate regarding percent active cleft speech characteristics and total number of phonological processes. Conclusions: Early primary palatal surgery in one or two stages did not result in any significant differences in speech production at age 3 years. However, children with an unoperated hard palate had significantly poorer speech and phonology than peers who had been treated with one-stage palatal closure at about 13 months of age.
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28.
  • Klintö, Kristina, et al. (författare)
  • Speech in 5-year-olds born with unilateral cleft lip and palate : a Prospective Swedish Intercenter Study
  • 2019
  • Ingår i: Journal of Plastic Surgery and Hand Surgery. - : Taylor & Francis. - 2000-656X .- 2000-6764. ; 53:5, s. 309-315
  • Tidskriftsartikel (refereegranskat)abstract
    • Studies on the impact of cleft palate surgery on speech with stringent methodology are called for, since we still do not know the best timing or the best method for surgery. The purpose was to report on speech outcome for all Swedish-speaking 5-year-olds born with a non-syndromic unilateral cleft lip and palate (UCLP), in 2008-2010, treated at Sweden's six cleft palate centres, and to compare speech outcomes between centres. Speech was assessed in 57 children with percent consonants correct adjusted for age (PCC-A), based on phonetic transcriptions from audio recordings by five independent judges. Also, hypernasality and perceived velopharyngeal function were assessed. The median PCC-A for all children was 93.9, and medians in the different groups varied from 89.9 to 96.8. In the total group, 9 children (16%) had more than mild hypernasality. Twenty-two children (38.5%) were perceived as having competent/sufficient velopharyngeal function, 25 (44%) as having marginally incompetent/insufficient velopharyngeal function, and 10 children (17.5%) as having incompetent/insufficient velopharyngeal function. Ten children were treated with secondary speech improving surgery and/or fistula surgery. No significant differences among the six groups, with eight to ten children in each group, were found. The results were similar to those in other studies on speech of children with UCLP, but poorer than results in normative data of Swedish-speaking 5-year-olds without UCLP. Indications of differences in frequency of surgical treatment and speech treatment between centres were observed.
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29.
  • Klintö, Kristina, et al. (författare)
  • The impact of speech material on speech judgement in children with and without cleft palate.
  • 2011
  • Ingår i: International Journal of Language & Communication Disorders. - : Wiley. - 1460-6984 .- 1368-2822. ; 46:3, s. 348-360
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: The chosen method of speech assessment, including type of speech material, may affect speech judgement in children with cleft palate.AIM: To assess the effect of different speech materials on speech judgement in 5-year-old children born with or without cleft palate, as well as the reliability of materials by means of intra- and inter-transcriber agreement of consonant transcriptions.METHODS & PROCEDURES: Altogether 40 children were studied, 20 born with cleft palate, 20 without. The children were audio recorded at 5 years of age. Speech materials used were: single-word naming, sentence repetition (both developed for cleft palate speech assessment), retelling of a narrative and conversational speech. The samples were phonetically transcribed and inter- and intra-transcriber agreement was calculated. Percentage correct consonants (PCC), percentage correct places (PCP), percentage correct manners (PCM), and percentage active cleft speech characteristics (CSC) were assessed. In addition, an analysis of phonological simplification processes (PSP) was performed.OUTCOME & RESULTS: The PCC and CSC results were significantly more accurate in word naming than in all other speech materials in the children with cleft palate, who also achieved more accurate PCP results in word naming than in sentence repetition and conversational speech. Regarding PCM and PSP, performance was significantly more accurate in word naming than in conversational speech. Children without cleft palate did better, irrespective of the speech material. The medians of intra- and inter-transcriber agreement were good in both groups and all speech materials. The closest agreement in the cleft palate group was seen in word naming and the weakest in the retelling task.CONCLUSION & IMPLICATIONS: The results indicate that word naming is the most reliable speech material when the purpose is to assess the best speech performance of a child with cleft palate. If the purpose is to assess connected speech, sentence repetition is a reliable and also valid speech material, with good transcriber agreement and equally good articulation accuracy as in retelling and conversational speech. For typically developing children without a cleft palate, the chosen speech material appears not to affect speech judgement.
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30.
  • Klintö, Kristina, et al. (författare)
  • Verbal competence in narrative retelling in 5-year-olds with unilateral cleft lip and palate.
  • 2015
  • Ingår i: International Journal of Language & Communication Disorders. - : Wiley. - 1368-2822 .- 1460-6984. ; 50:1, s. 119-128
  • Tidskriftsartikel (refereegranskat)abstract
    • Research regarding expressive language performance in children born with cleft palate is sparse. The relationship between articulation/phonology and expressive language skills also needs to be further explored.
  •  
31.
  • Lieberman, Marion, et al. (författare)
  • Parents’ contingent responses in communication with 10-month-old children in a clinical group with typical or late babbling
  • 2019
  • Ingår i: Clinical Linguistics & Phonetics. - : Informa UK Limited. - 0269-9206 .- 1464-5076. ; 33:10-11, s. 1050-1062
  • Tidskriftsartikel (refereegranskat)abstract
    • Parental responsive behaviour in communication has a positive effect on child speech and language development. Absence of canonical babbling (CB) in 10–month–old infants is considered a risk factor for developmental difficulties, yet little is known about parental responsiveness in this group of children. The purpose of the current study was to examine proportion and type of parental responsive utterances after CB and vocalization utterances respectively in a clinical group of children with otitis media with effusion, with or without cleft palate. Audio-video recordings of interactions in free play situations with 22 parents and their 10-month-old infants were used, where 15 infants had reached the CB stage and 7 infants had not. Fifty consecutive child utterances were annotated and categorized as vocalization utterance or CB utterance. The parent’s following contingent response was annotated and labelled as acknowledgements, follow-in comments, imitations/expansions or directives. The Average intra-judge agreement was 90%, and the average inter-judger agreement was 84%. There was no significant difference in proportion contingent responses after vocalizations and CB, neither when considering all child utterances nor the child’s babbling stage. However, imitations/expansions tended to be more common after CB in the typical babbling group, whereas acknowledgements were more common after CB in the late babbling group. Our findings imply that responsiveness is a supportive strategy that is not fully used by parents of children with late babbling. Implications for further research as well as parent-directed intervention for children in clinical groups with late babbling are suggested.
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32.
  • Liedman-Boshko, Julia, 0, et al. (författare)
  • Perceptual analysis of speech and the activity in the lateral pharyngeal walls before and after velopharyngeal flap surgery.
  • 2005
  • Ingår i: Scandinavian journal of plastic and reconstructive surgery and hand surgery / Nordisk plastikkirurgisk forening [and] Nordisk klubb for handkirurgi. - : Informa UK Limited. - 0284-4311. ; 39:1, s. 22-32
  • Tidskriftsartikel (refereegranskat)abstract
    • The purpose of this study was to investigate the effects of velopharyngeal flap surgery on speech and its relation with the activity in the lateral pharyngeal walls. Videofluoroscopic recordings made before and after operation were used in this retrospective study, which comprised 28 patients who had pharyngeal flap surgery between 5:5 and 14:3 (mean 8:6) years:months of age at the Sahlgrenska University Hospital, Göteborg, Sweden. Twenty-four patients had different types of clefts and four had velopharyngeal impairment (VPI) without a cleft palate. Eleven had additional malformations. Speech and activity in the lateral pharyngeal walls were perceptually preoperatively and postoperatively. The study confirmed that patients with VPI can be helped by a velopharyngeal flap operation. There seemed to be a relation with the activity in the lateral pharyngeal wall and speech. The later the postoperative assessment, the better the speech, but the age at operation did not affect the result. The impact of additional anomalies and syndromes should be investigated further.
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33.
  • Lohmander, Anette, 1956, et al. (författare)
  • A longitudinal study of speech production in Swedish children with unilateral cleft lip and palate and two-stage palatal repair.
  • 2008
  • Ingår i: The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association. - : SAGE Publications. - 1055-6656. ; 45:1, s. 32-41
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE: To describe speech production longitudinally in a group of children with unilateral cleft lip and palate (UCLP). PARTICIPANTS: Twenty consecutive children with UCLP and nine age-matched children without clefts in a comparison group. INTERVENTION: A two-stage palatal repair procedure with soft palate closure at 6 months and hard palate repair at 3 to 4 years. MAIN OUTCOME MEASURES: Percent correct consonants (PCC), percent correct places (PCP), and percent correct manners (PCM) at 3, 5, and 7 years of age. Cleft speech errors at the same ages. Previously collected data on number of consonant tokens, consonant types, frequency of occurrence of places and manners of articulation at 18 months. RESULTS: PCC and PCP were significantly lower in the UCLP group than in the comparison group at all ages. Number of consonant types and frequency of occurrence of dental plosives at 18 months correlated significantly with PCC at age 3. A high frequency of velar plosives at 18 months correlated significantly with a high prevalence of retracted oral articulation (dental/alveolar to palatal or velar) at both 3 and 5 years of age. CONCLUSIONS: The UCLP group performed worse than the comparison group at all ages. A high occurrence of dental plosives as well as a high number of consonant types in babbling and first words seem to be good indicators for better consonant production in later speech. The same prevalence of retracted oral articulation as in previous studies is attributed to the surgical technique.
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34.
  • Lohmander, Anette, 1956, et al. (författare)
  • Early Consonant Production in Swedish Infants with and without Unilateral Cleft Lip and Palate and Two-stage Palatal Repair.
  • 2010
  • Ingår i: The Cleft palate-craniofacial journal. - : SAGE Publications. - 1545-1569 .- 1055-6656. ; 48:3, s. 271-285
  • Tidskriftsartikel (refereegranskat)abstract
    • Abstract OBJECTIVE: to investigate the consonant production at 12 and 18 months of age following early soft palate repair in infants with unilateral cleft lip and palate (UCLP), and compared with typically developing children without clefts. DESIGN: randomized study with comparison group. PARTICIPANTS: 20 Swedish infants born with UCLP included in a randomized trial of palatal surgery (Scandcleft project) and 21 without clefts (COMP). Soft palate closure was completed at age 5 months, hard palate closure in 11 of the infants with UCLP at 1 year of age (HPC) and left open in nine (HPO). METHOD: Audio recordings at 12 months (UCLP=9, COMP=21) and 18 months (UCLP=18, COMP=21) were phonetically transcribed. Consonant inventory, frequency of manner and place of articulation, true canonical babbling (TCB), and impact of hearing status were analyzed. RESULTS: At 12 months of age all children had reached the stage of TCB. Mild hearing impairment was significantly correlated with fewer consonant types. A lower frequency of dentals and oral stops was found in the UCLP group than in the COMP group. However, the number of oral stops was high compared to what has been previously reported. CONCLUSIONS: Early soft palate closure seems to give a relatively high number of oral stops even with the hard palate unrepaired, although with significantly fewer dentals/alveolars than peers without clefts. Differences in consonant inventory were correlated to hearing function. KEY WORDS: babbling, consonants, unilateral cleft lip and palate, two-stage palatal repair, early velar closure, hearing impairment.
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35.
  • Lohmander, Anette, 1956, et al. (författare)
  • Electropalatography in home training of retracted articulation in a Swedish child with cleft palate: Effect on articulation pattern and speech.
  • 2010
  • Ingår i: International journal of speech-language pathology. - : Informa UK Limited. - 1754-9515 .- 1754-9507. ; 12:6, s. 483-496
  • Tidskriftsartikel (refereegranskat)abstract
    • The aim was to evaluate the effectiveness of electropalatography (EPG) in home training of persistent articulation errors in an 11-year-old Swedish girl born with isolated cleft palate. The /t/ and /s/ sounds were trained in a single subject design across behaviours during an eight month period using a portable training unit (PTU). Both EPG analysis and perceptual analysis showed an improvement in the production of /t/ and /s/ in words and sentences after therapy. Analysis of tongue-contact patterns showed that the participant had more normal articulatory patterns of /t/ and /s/ after just 2 months (after approximately 8 hours of training) respectively. No statistically significant transfer by means of intelligibility in connected speech was found. The present results show that EPG home training can be a sufficient method for treating persistent speech disorders associated with cleft palate. Methods for transfer from function (articulation) to activity (intelligibility) need to be explored.
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36.
  • Lohmander, Anette, et al. (författare)
  • Kommunikations- och sväljstörningar genom hela livet : ett logopediskt ståndpunktsdokument
  • 2017
  • Rapport (övrigt vetenskapligt/konstnärligt)abstract
    • Den forskning som bedrivs inom logopedi i Sverige idag spänner över ett brett spektrum av medfödda, utvecklingsrelaterade och förvärvade kommunikationsstörningar på grund av röst-, tal- och språksvårigheter samt sväljstörningar. Precis som i andra länder pågår en snabb utveckling både mot en breddning av det urval av områden som det forskas kring och ett ökat fokus på nationellt samarbete. Även om de framsteg som görs inom respektive fält kan mätas genom de forskningsrapporter som publiceras av respektive forskargrupper, finns det ett behov av att granska vilka forskningsinsatser som bedrivs jämte det demografiska sammanhanget. I detta ståndpunktsdokument ger vi en översikt över logopediämnet och den forskning som bedrivs i Sverige. I en kubmodell illustreras hur kommunikations- och sväljstörningar kan beskrivas. Stratifierade (per åldersintervall) uppskattningar av prevalensen av kommunikations- och sväljstörningar ges baserat på 2016 års befolkningsstruktur. Genom att presentera dessa två komponenter identifieras forskningsområden och riktningar inom logopedi som behöver ges ökad uppmärksamhet i det kommande forskningsarbetet.
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37.
  • Lohmander, Anette, 1956, et al. (författare)
  • Long-term, longitudinal follow-up of individuals with UCLP after the Gothenburg primary early veloplasty and delayed hard palate closure: Speech outcome.
  • 2012
  • Ingår i: The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association. - : SAGE Publications. - 1545-1569. ; 49:6, s. 657-671
  • Tidskriftsartikel (refereegranskat)abstract
    • Abstract Abstract Objective: To investigate long-term, longitudinal speech outcome in patients born with unilateral cleft lip and palate (UCLP) treated according to a two-stage primary palatal protocol with early veloplasty and delayed hard palate closure. Design: Retrospective, longitudinal cohort study. Setting: A University Hospital in Western Sweden. Subjects: A consecutive series of 55 patients from the total cohort of 65 were included. All patients had surgical procedures at Sahlgrenska University Hospital, Gothenburg, Sweden. Methods: Standardized audio recordings were blindly analyzed at 5, 7, 16, and 19 years of age, and after at a clinical visit at 10 years of age. Typical cleft speech variables were independently rated on ordinal scales. Intelligibility and perceived velopharyngeal function were also assessed. Prevalences of speech characteristics were determined, and inter- and intra agreement were calculated. Results: Prominent hypernasality, nasal air leakage, and retracted oral articulation at 5 years were markedly reduced throughout the years with low prevalences at age 16 and 19 years. Perceived velopharyngeal competence (VPC) was noted in 82 % at age 16 and 87 % at age 19 years along with normal intelligibility. Pharyngeal flap surgery was performed in six of the 55 patients (11 %). Conclusions: Long-term speech outcome in patients with two-stage palatoplasty with early soft palate repair was considered good and improved even before hard palate repair. The typical retracted oral articulation was quite frequent during the early ages, whereas non-oral misarticulations were almost non-existing implying good VPC. Keywords: Speech outcome, unilateral cleft lip and palate, longitudinal, long-term, two-stage repair.
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38.
  • Lohmander, Anette, 1956, et al. (författare)
  • Methodology for perceptual assessment of speech in patients with cleft palate: a critical review of the literature.
  • 2004
  • Ingår i: The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association. - 1055-6656. ; 41:1, s. 64-70
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE AND DESIGN: This review of 88 articles in three international journals was undertaken for the purpose of investigating the methodology for perceptual speech assessment in patients with cleft palate. The articles were published between 1980 and 2000 in the Cleft Palate-Craniofacial Journal, the International Journal of Language and Communication Disorders, and Folia Phoniatrica et Logopaedica. RESULTS AND CONCLUSIONS: The majority of articles (76) were published in the Cleft Palate-Craniofacial Journal, with an increase in articles during the 1990s and 2000. Information about measures or variables was clearly given in all articles. However, the review raises several major concerns regarding method for collection and documentation of data and method for measurement. The most distressing findings were the use of a cross-sectional design in studies of few patients with large age ranges and different types of clefts, the use of highly variable speech samples, and the lack of information about listeners and on reliability. It is hoped that ongoing national and international collaborative efforts to standardize procedures for collection and analysis of perceptual data will help to eliminate such concerns and thus make comparison of published results possible in the future.
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39.
  • Lohmander, Anette, 1956, et al. (författare)
  • Methodology for speech assessment in the scandcleft project-an international randomized clinical trial on palatal surgery: experiences from a pilot study.
  • 2009
  • Ingår i: The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association. - : SAGE Publications. - 1055-6656. ; 46:4, s. 347-62
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: To present the methodology for speech assessment in the Scandcleft project and discuss issues from a pilot study. Design: Description of methodology and blinded test for speech assessment. Speech samples and instructions for data collection and analysis for comparisons of speech outcomes across five included languages were developed and tested. Participants and Materials: Randomly selected video recordings of 10 5-year-old children from each language (n = 50) were included in the project. Speech material consisted of test consonants in single words, connected speech, and syllable chains with nasal consonants. Five experienced speech and language pathologists participated as observers. Main Outcome Measures: Narrow phonetic transcription of test consonants translated into cleft speech characteristics, ordinal scale rating of resonance, and perceived velopharyngeal closure (VPC). A velopharyngeal composite score (VPC-sum) was extrapolated from raw data. Intra-agreement comparisons were performed. Results: Range for intra-agreement for consonant analysis was 53% to 89%, for hypernasality on high vowels in single words the range was 20% to 80%, and the agreement between the VPC-sum and the overall rating of VPC was 78%. Conclusions: Pooling data of speakers of different languages in the same trial and comparing speech outcome across trials seems possible if the assessment of speech concerns consonants and is confined to speech units that are phonetically similar across languages. Agreed conventions and rules are important. A composite variable for perceptual assessment of velopharyngeal function during speech seems usable; whereas, the method for hypernasality evaluation requires further testing.
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40.
  • Lohmander, Anette, et al. (författare)
  • Reliability of auditory perceptual assessment of hypernasality in speech using different scales
  • 2018
  • Ingår i: Fechner Day 2018. - : International Society for Psychophysics. ; , s. 43-44
  • Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
    • Auditory-perceptual assessment has been criticized because of its inherent subjectivity. However, perceptual judgments are the primary tool in the clinical assessment of voice and resonance parameters and a key task for the speech–language pathologist/therapist (SLP/T). Decision on treatment or further examination is based on the perceptual speech assessment which need to be reliable. Of all perceptual dimensions used to distinguish normal from abnormal speech the most difficult to judge reliably is hypernasality (Watterson et al., 2017). Nevertheless, the final decision regarding whether an individual has nasality or other speech problems is based on the listener’s subjective measurement (Moll, 1λ64). Nasality is present in normal voice production and refers to perceived nasal sounds arising from the coupling of the oral and nasal resonating cavities. Nasal consonants are common in the languages. Normal nasal resonance has a range of acceptability and is perceived along a continuum, while nasal resonance disorders are associated with defects or dysfunction in the palate. In the current study the reliability of perceptual assessment of hypernasality with three different methods were compared. Standardised audio recordings of 5-year-old Swedish-speaking children with repaired cleft palate consisting of 73 stimuli in three different randomised orders were perceptually assessed by four experienced speech-language pathologists using three different methods: a sort and rate procedure (VISOR) allowing comparison between and ordering stimuli along a visual analogue scale; a 2- step method beginning with determination whether the speech resonance is within normal range or not. If not, the stimulus is rated along a 3 point ordinal category scale; a combined category-ratio scale (Borg centiMax®(cM)), where verbally well-defined categories are levelanchored to a ratio scale. Each listener completed a total of 657 hypernasality ratings (73 stimuli in 3 orders by 3 methods) for the rating task. Good to excellent intra-rater reliability was found within each listener for all methods. The highest inter-rater reliability was demonstrated for VISOR and the Borg cM. High consistency within each method was found with the highest for the Borg cM. In conclusion, both the VISOR and the Borg centiMax® seem appropriate for auditory-perceptual assessment of hypernasality with similar and high reliability. However, the Borg cM showed slightly better consistency and seems easiest to use in a clinical setting. Further research should aim for valid definitions of how hypernasality corresponds to the categories along the scale.
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41.
  • Lohmander, Anette, et al. (författare)
  • Scandcleft randomised trials of primary surgery for unilateral cleft lip and palate: 4. Speech outcomes in 5-year-olds - velopharyngeal competency and hypernasality
  • 2017
  • Ingår i: Journal of Plastic Surgery and Hand Surgery. - : TAYLOR & FRANCIS LTD. - 2000-656X .- 2000-6764. ; 51:1, s. 27-37
  • Tidskriftsartikel (refereegranskat)abstract
    • Background and aim: Adequate velopharyngeal function and speech are main goals in the treatment of cleft palate. The objective was to investigate if there were differences in velopharyngeal competency (VPC) and hypernasality at age 5 years in children with unilateral cleft lip and palate (UCLP) operated on with different surgical methods for primary palatal repair. A secondary aim was to estimate burden of care in terms of received additional secondary surgeries and speech therapy. Design: Three parallel group, randomised clinical trials were undertaken as an international multicentre study by 10 cleft teams in five countries: Denmark, Finland, Sweden, Norway, and the UK. Methods: Three different surgical protocols for primary palatal repair were tested against a common procedure in the total cohort of 448 children born with a non-syndromic UCLP. Speech audio and video recordings of 391 children (136 girls, 255 boys) were available and perceptually analysed. The main outcome measures were VPC and hypernasality from blinded assessments. Results: There were no statistically significant differences between the prevalences in the arms in any of the trials. VPC: Trial 1, A: 58%, B: 61%; Trial 2, A: 57%, C: 54%; Trial 3, A: 35%, D: 51%. No hypernasality: Trial 1, A: 54%, B: 44%; Trial 2, A: 47%, C: 51%; Trial 3, A: 34%, D: 49%. Conclusions: No differences were found regarding VPC and hypernasality at age 5 years after different methods for primary palatal repair. The burden of care in terms of secondary pharyngeal surgeries, number of fistulae, and speech therapy visits differed.
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42.
  • Lohmander, Anette, 1956, et al. (författare)
  • Speech development in patients with unilateral cleft lip and palate treated with different delays in closure of the hard palate after early velar repair: a longitudinal perspective.
  • 2006
  • Ingår i: Scandinavian journal of plastic and reconstructive surgery and hand surgery / Nordisk plastikkirurgisk forening [and] Nordisk klubb for handkirurgi. - : Informa UK Limited. - 0284-4311. ; 40:5, s. 267-74
  • Tidskriftsartikel (refereegranskat)abstract
    • We wanted to find out if different timing of delayed repair of the hard palate in a two-stage procedure had an impact on the speech of 26 patients with unilateral cleft lip and palate (UCLP). The soft palate was closed at the age of 7 months and the hard palate between 38 and 89 months of age. Speech audio recordings at the age of 3 years (baseline, before any repair of the hard palate) and at the ages of 5, 7, and 10 years (the latter obtained at least one year after closure) were analysed. We used standardised speech assessments at routine follow-up and assessment by one external listener. The prevalence of speech errors caused by the cleft was similar to those described in previous reports from our centre in which hard palate repair was delayed. Unexpectedly, the results showed no difference in speech production related to timing of hard palate repair, except for nasal air leakage at the age of 7 years.
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43.
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44.
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45.
  • Lohmander, Anette, 1956, et al. (författare)
  • The impact of early infant jaw-orthopaedics on early speech production in toddlers with unilateral cleft lip and palate.
  • 2004
  • Ingår i: Clinical linguistics & phonetics. - : Informa UK Limited. - 0269-9206 .- 1464-5076. ; 18:4-5, s. 259-84
  • Tidskriftsartikel (refereegranskat)abstract
    • The purpose of study was to investigate the impact of pre-surgical Infant Orthopaedics (IO) on consonant production at 18 months of age in children with Unilateral Cleft Lip and Palate (UCLP) and to compare the consonant production to that of age-matched children without clefts. The first ten children in a consecutive series of 20 with UCLP received IO and the following ten did not. Both groups had soft palate repair at 6.3 months of age. The cleft in the hard palate was unrepaired. Ten normally developing children without clefts served as controls. Nine children in each group accomplished the study. Phonetic transcriptions of consonants were made from audiotape recordings obtained during a 45-60 minute interactive session. No significant differences in the number of consonant tokens or of consonant types were found between the UCLP children with and without IO but both groups had significantly lower numbers than the control group. There was no significant difference in frequency of different manners or places of articulation of plosives between the UCLP groups. The frequency of occurrence of bilabial and dental consonant placements of plosives were significantly higher in the control group than in both UCLP groups.
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46.
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47.
  • Lohmander, Anette, et al. (författare)
  • Validity of auditory perceptual assessment of velopharyngeal function and dysfunction - the VPC-Sum and the VPC-Rate
  • 2017
  • Ingår i: Clinical Linguistics & Phonetics. - : TAYLOR & FRANCIS INC. - 0269-9206 .- 1464-5076. ; 31:7-9, s. 589-597
  • Tidskriftsartikel (refereegranskat)abstract
    • Overall weighted or composite variables for perceptual auditory estimation of velopharyngeal closure or competence have been used in several studies for evaluation of velopharyngeal function during speech. The aim of the present study was to investigate the validity of a composite score (VPC-Sum) and of auditory perceptual ratings of velopharyngeal competence (VPC-Rate). Available VPC-Sum scores and judgments of associated variables (hypernasality, audible nasal air leakage, weak pressure consonants, and non-oral articulation) from 391 5-year olds with repaired cleft palate (the Scandcleft project) were used to investigate content validity, and 339 of these were compared with an overall judgment of velopharyngeal competence (VPC-Rate) on the same patients by the same listeners. Significant positive correlations were found between the VPC-Sum and each of the associated variables (Cronbachs alpha 0.55-0.87, P amp;lt; 0.001), and a moderately significant positive correlation between VPC-Sum and VPC-Rate (Rho 0.698, P amp;lt; 0.01). The latter classified cases well when VPC-Sum was dichotomized with 67% predicted velopharyngeal competence and 90% velopharyngeal incompetence. The validity of the VPC-Sum was good and the VPC-Rate a good predictor, suggesting possible use of both measures depending on the objective.
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48.
  • Malmenholt, Ann, et al. (författare)
  • Childhood apraxia of speech: A survey of praxis and typical speech characteristics
  • 2017
  • Ingår i: Logopedics, Phoniatrics, Vocology. - : TAYLOR & FRANCIS LTD. - 1401-5439 .- 1651-2022. ; 42:2, s. 84-92
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose: The purpose of this study was to investigate current knowledge of the diagnosis childhood apraxia of speech (CAS) in Sweden and compare speech characteristics and symptoms to those of earlier survey findings in mainly English-speakers. Method: In a web-based questionnaire 178 Swedish speech-language pathologists (SLPs) anonymously answered questions about their perception of typical speech characteristics for CAS. They graded own assessment skills and estimated clinical occurrence. Results: The seven top speech characteristics reported as typical for children with CAS were: inconsistent speech production (85%), sequencing difficulties (71%), oro-motor deficits (63%), vowel errors (62%), voicing errors (61%), consonant cluster deletions (54%), and prosodic disturbance (53%). Motor-programming deficits described as lack of automatization of speech movements were perceived by 82%. All listed characteristics were consistent with the American Speech-Language-Hearing Association (ASHA) consensus-based features, Strands 10-point checklist, and the diagnostic model proposed by Ozanne. The mode for clinical occurrence was 5%. Number of suspected cases of CAS in the clinical caseload was approximately one new patient/year and SLP. Conclusions: The results support and add to findings from studies of CAS in English-speaking children with similar speech characteristics regarded as typical. Possibly, these findings could contribute to cross-linguistic consensus on CAS characteristics.
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49.
  • Malmenholt, Ann, et al. (författare)
  • Childhood Apraxia of Speech (CAS): a survey of knowledge and experience of Swedish Speech-Language Pathologists
  • 2012
  • Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
    • Background: Children with Childhood Apraxia of Speech (CAS) are seen by many speech and language pathologists (SLPs) in Sweden. It is commonly believed that these patients are difficult to diagnose and treat due to the absence of a validated list of diagnostic features (American Speech-Language-Hearing Association, 2007) and lack of evidence for a wide range of treatment approaches reported (Morgan & Vogel, 2009). Speech-language pathologists’ perspectives on assessment of CAS have been studied by Forrest (2003). She asked SLPs about which three characteristics they thought were crucial for diagnosing CAS. The diversity of SLPs view on CAS diagnostic markers was documented. Not less than 50 different characteristics were listed, making inconsistent productions the most frequently noted feature (14.1%).  Experience and knowledge about the typical symptoms of CAS among Swedish SLPs would be a valuable first step towards a common routine for diagnosis of this group of patients in Sweden. Aim: The aim of this paper was to perform a survey among Swedish clinical SLPs regarding symptoms, praxis for clinical diagnosis and description of patients with CAS. Methods & Procedures: A web-based questionnaire was sent to Swedish SLPs working with pre- and primary school-aged children asking 25 questions about the clinicians background, years of clinical experience, skills of assessment and intervention, estimation of own competence and opinion about need for further education concerning this particular group. The SLPs were asked to estimate the prevalence for CAS based on their own clinical experience.Outcomes & Results: One hundred-seventy-five clinical SLPs with varying experience responded, which equals a response rate of 60%. About half of them usually diagnosed CAS. In the rating of typical symptoms of CAS 85% suggested inconsistent errors as the core feature of the disorder, 82% noticed difficulties with automaticity and 71% difficulties with sequence maintenance. In 88 % of answers children with CAS were considered to make slow progress in treatment and 80% estimated that these children typically had persisting difficulties and constraints even in primary school. There was a wide range of estimated prevalence figures for CAS from less than 1% to around 50%. Almost all SLPs who answered the questionnaire reported a need for further education about CAS.Conclusions: Although Swedish SLPs rated their own knowledge about CAS as insufficient, the rating of the key classification criterion for the disorder was high, as was the view that these children make slow progress in treatment. Estimation of prevalence for CAS was highly diverse, reflecting the difficulties with the broad definition and large variation within this disorder. The collected data of the Swedish clinical SLPs experience and knowledge about CAS revealed an important consensus on the core diagnostic features but also a vagueness regarding best treatment. This reflects the current knowledge in this field and will be taken into account in continuing work towards a common and evidence based practice.ReferencesAmerican Speech-Language-Hearing Association. Childhood Apraxia of Speech [Position Statement] 2007. Available from www.asha.org/policy.)Forrest, K. (2003). Diagnostic criteria of developmental apraxia of speech used by clinical speech-language pathologists. American Journal of Speech-Language Pathology, 12, 376–380.Morgan & Vogel. Cochrane review of treatment for childhood apraxia of speech. Eur J Phys Rehabil Med. 2009 Mar;45(1):103-10.)
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50.
  • Marklund, Ulrika, et al. (författare)
  • The development of a vocabulary for PEEPS – SEprofiles of early expressive phonological skills for Swedish
  • 2018
  • Ingår i: Clinical Linguistics & Phonetics. - : Informa UK Limited. - 0269-9206 .- 1464-5076. ; 32:9, s. 844-859
  • Forskningsöversikt (refereegranskat)abstract
    • This paper describes the development of a vocabulary for Profiles of Early Expressive Phonological Skills for Swedish (PEEPS-SE), a tool for assessment of expressive phonology in Swedish-learning children in the age range of 18-36months. PEEPS-SE is the Swedish version of the original PEEPS, Profiles of Early Expressive Phonological Skills, which uses two age-adequate word listsa basic word list (BWL) for the assessment of 18-24-month-old children, to which an expanded word list (EWL) is added for assessment of 24-36-month-old children, or children with more than 250 words in their expressive vocabulary.The selection of words in PEEPS-SE is based on two types of criteria: age of acquisition and phonological complexity. The words also need to be easy to elicit in a natural way in test situations. Vocabulary data previously collected with the Swedish Early Communicative Development Inventory are used for selection of age-adequate words, where the BWL contains words acquired earlier compared to the additional words in the EWL. The latter also contains words that are more phonologically complex compared to those in the BWL. Word complexity was determined by the Swedish version of word complexity measure. PEEPS-SE has made an attempt to match the original version of PEEPS in terms of both assessment method and word selection.
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