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Scandcleft randomiz...
Scandcleft randomized trials of primary surgery for unilateral cleft lip and palate: Speech proficiency at 10 years of age
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- Willadsen, E. (author)
- Univ Copenhagen, Denmark
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- Jorgensen, L. D. (author)
- Univ Hosp Copenhagen, Denmark,Royal Manchester Childrens Hosp, England
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- Alaluusua, S. (author)
- Helsinki Univ Cent Hosp, Finland
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- Pedersen, N. H. (author)
- Statped Vest, Norway
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- Nielsen, J. B. (author)
- Cleft Palate Ctr, Denmark
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- Holtta, E. (author)
- Helsinki Univ Cent Hosp, Finland
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- Hide, O. (author)
- Statped Sorost, Norway
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- Hayden, C. (author)
- Royal Hosp Sick Children, North Ireland
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- Havstam, Christina, 1963 (author)
- Gothenburg University,Göteborgs universitet,Institutionen för neurovetenskap och fysiologi, sektionen för hälsa och rehabilitering,Institute of Neuroscience and Physiology, Department of Health and Rehabilitation
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- Lundeborg Hammarström, Inger, 1956- (author)
- Linköpings universitet,Avdelningen för sinnesorgan och kommunikation,Medicinska fakulteten
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- Davies, J. (author)
- Royal Manchester Childrens Hosp, England,Univ Copenhagen, Denmark
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- Boers, M. (author)
- Univ Hosp Copenhagen, Denmark
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- Andersen, H. S. (author)
- Univ Hosp Copenhagen, Denmark
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- Aukner, R. (author)
- Statped Sorost, Norway
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- Morris, D. Jackson (author)
- Univ Copenhagen, Denmark
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- Nielsen, S. F. (author)
- Copenhagen Business Sch, Denmark
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- Semb, G. (author)
- Oslo Univ Hosp Rikshosp, Norway
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- Lohmander, A. (author)
- Karolinska Institutet,Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden
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- Persson, Christina, 1959 (author)
- Gothenburg University,Göteborgs universitet,Institutionen för neurovetenskap och fysiologi, sektionen för hälsa och rehabilitering,Institute of Neuroscience and Physiology, Department of Health and Rehabilitation
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Hide, Ø (author)
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(creator_code:org_t)
- 2022-12-21
- 2023
- English.
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In: International journal of language and communication disorders. - : WILEY. - 1368-2822 .- 1460-6984. ; 58:3, s. 892-909
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https://urn.kb.se/re...
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https://doi.org/10.1...
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https://gup.ub.gu.se...
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Abstract
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- Background & AimTo assess consonant proficiency and velopharyngeal function in 10-year-old children born with unilateral cleft lip and palate (UCLP) within the Scandcleft project. Methods & ProceduresThree parallel group, randomized, clinical trials were undertaken as an international multicentre study by nine cleft teams in five countries. Three different surgical protocols for primary palate repair (Arm B-Lip and soft palate closure at 3-4 months, hard palate closure at 36 months, Arm C-Lip closure at 3-4 months, hard and soft palate closure at 12 months, and Arm D-Lip closure at 3-4 months combined with a single-layer closure of the hard palate using a vomer flap, soft palate closure at 12 months) were tested against a common procedure (Arm A-Lip and soft palate closure at 3-4 months followed by hard palate closure at 12 months) in the total cohort of 431 children born with a non-syndromic UCLP. Speech audio and video recordings of 399 children were available and perceptually analysed. Percentage of consonants correct (PCC) from a naming test, an overall rating of velopharyngeal competence (VPC) (VPC-Rate), and a composite measure (VPC-Sum) were reported. Outcomes & ResultsThe mean levels of consonant proficiency (PCC score) in the trial arms were 86-92% and between 58% and 83% of the children had VPC (VPC-Sum). Only 50-73% of the participants had a consonant proficiency level with their peers. Girls performed better throughout. Long delay of the hard palate repair (Arm B) indicated lower PCC and simultaneous hard and soft palate closure higher (Arm C). However, the proportion of participants with primary VPC (not including velopharyngeal surgeries) was highest in Arm B (68%) and lowest in Arm C (47%). Conclusions & ImplicationsThe speech outcome in terms of PCC and VPC was low across the trials. The different protocols had their pros and cons and there is no obvious evidence to recommend any of the protocols as superior. Aspects other than primary surgical method, such as time after velopharyngeal surgery, surgical experience, hearing level, language difficulties and speech therapy, need to be thoroughly reviewed for a better understanding of what has affected speech outcome at 10 years. WHAT THIS PAPER ADDSWhat is already known on the subjectSpeech outcomes at 10 years of age in children treated for UCLP are sparse and contradictory. Previous studies have examined speech outcomes and the relationship with surgical intervention in 5-year-olds. What this study adds to the existing knowledgeSpeech outcomes based on standardized assessment in a large group of 10-year-old children born with UCLP and surgically treated according to different protocols are presented. While speech therapy had been provided, a large proportion of the children across treatment protocols still needed further speech therapy. What are the potential or actual clinical implications of this work?Aspects other than surgery and speech function might add to the understanding of what affects speech outcome. Effective speech therapy should be available for children in addition to primary surgical repair of the cleft and secondary surgeries if needed.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Annan medicin och hälsovetenskap -- Övrig annan medicin och hälsovetenskap (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Other Medical and Health Sciences -- Other Medical and Health Sciences not elsewhere specified (hsv//eng)
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Oto-rhino-laryngologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Otorhinolaryngology (hsv//eng)
Keyword
- consonant proficiency; palatal surgical protocols; randomized controlled trial (RCT); unilateral cleft lip and palate (UCLP); velopharyngeal competence (VPC) velopharyngeal incompetence (VPI)
Publication and Content Type
- ref (subject category)
- art (subject category)
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- By the author/editor
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Willadsen, E.
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Jorgensen, L. D.
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Alaluusua, S.
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Pedersen, N. H.
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Nielsen, J. B.
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Holtta, E.
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show more...
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Hide, O.
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Hayden, C.
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Havstam, Christi ...
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Lundeborg Hammar ...
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Davies, J.
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Boers, M.
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Andersen, H. S.
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Aukner, R.
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Morris, D. Jacks ...
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Nielsen, S. F.
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Semb, G.
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Lohmander, A.
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Persson, Christi ...
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Hide, Ø
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MEDICAL AND HEAL ...
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and Other Medical an ...
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and Other Medical an ...
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Otorhinolaryngol ...
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International jo ...
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Linköping University
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Karolinska Institutet
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University of Gothenburg