Impact of an International Training on Interventionists' Expertise in Cleft Palate Speech: Results From Oaxaca, Mexico.

PURPOSE: International cleft lip and palate surgical charities recognize that speech therapy is essential for successful care of individuals after palate repair. The challenge is how to ensure that cleft speech interventionists (i.e., speech-language pathologists and other speech therapy providers) provide quality care. This exploratory study investigated effects of a two-stage cleft training in Oaxaca, Mexico, aimed at preparing speech interventionists to provide research-based services to individuals born with cleft palate. Changes in the interventionists' content knowledge and clinical skills were examined. METHOD: Twenty-three cleft speech interventionists from Mexico, Guatemala, and Nicaragua participated in a hybrid two-stage training, completing an online Spanish cleft speech course and a 5-day in-person training in Oaxaca. In-person training included a didactic component and supervised clinical practice with 14 individuals with repaired cleft palates. Testing of interventionists' content knowledge and clinical skills via questionnaires occurred before the online course (Test 1), immediately before in-person training (Test 2), and immediately after in-person training (Test 3). Qualitative data on experience/practice were also collected. RESULTS: Significant increases in interventionists' overall content knowledge and clinical skills were found posttraining. Knowledge and clinical skills increased significantly between Tests 1 and 2. Clinical skills, but not knowledge, showed further significant increases between Tests 2 and 3. Posttraining, interventionists demonstrated greater expertise in research-based treatment, and fewer reported they would use nonspeech oral motor exercises (NSOME). CONCLUSIONS: Findings provide preliminary support for such two-stage international trainings in preparing local speech interventionists to deliver high-quality speech services to individuals born with cleft palate. While content knowledge appears to be acquired primarily from the online course, the two-stage training incorporating in-person supervised practice working with individuals born with cleft palate may best enhance continued clinical skill development, including replacement of NSOME with evidence-based speech treatment. Such trainings contribute to building capacity for sustainable quality services for this population in underresourced regions.

Speech Production Errors in Children With Cleft Palate With or Without Cleft Lip.

PURPOSE: The purpose of this study was to describe the frequency of speech production errors in children with cleft palate with or without cleft lip (CP±L) and explore characteristics related to speech production errors. METHOD: Fifty-six children with nonsyndromic CP±L between the ages of 4;0 and 7;11 (years;months) were included in this study. The children's audio-recorded production of a sentence repetition task was transcribed using narrow transcription and coded for speech error type. RESULTS: Children used, on average, 18 speech errors during the sentence repetition task that sampled 59 phoneme targets. On average, phonological errors were used most frequently, with nine errors per sample, followed by anterior oral speech errors at four errors per sample, and non-oral compensatory errors at three errors per sample. Individual-level characteristics including age and cleft type were related to frequency of phonological errors and anterior oral speech errors, respectively. One treatment-level characteristic, hypernasality, was related to use of non-oral compensatory errors and passive speech errors. CONCLUSIONS: This study identified the most frequent speech production errors as phonological errors, followed by anterior oral speech errors and non-oral compensatory errors. Individual-level and treatment-level characteristics were related to speech production errors. Future research should explore additional characteristics that may influence use of speech production errors. Clinically, this study adds information regarding speech error types that should be monitored throughout cleft care, including phonological errors that were most prevalent among this sample. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.22044095.

The Americleft Speech Project: A Training and Reliability Study.

OBJECTIVE: To describe the results of two reliability studies and to assess the effect of training on interrater reliability scores. DESIGN: The first study (1) examined interrater and intrarater reliability scores (weighted and unweighted kappas) and (2) compared interrater reliability scores before and after training on the use of the Cleft Audit Protocol for Speech-Augmented (CAPS-A) with British English-speaking children. The second study examined interrater and intrarater reliability on a modified version of the CAPS-A (CAPS-A Americleft Modification) with American and Canadian English-speaking children. Finally, comparisons were made between the interrater and intrarater reliability scores obtained for Study 1 and Study 2. PARTICIPANTS: The participants were speech-language pathologists from the Americleft Speech Project. RESULTS: In Study 1, interrater reliability scores improved for 6 of the 13 parameters following training on the CAPS-A protocol. Comparison of the reliability results for the two studies indicated lower scores for Study 2 compared with Study 1. However, this appeared to be an artifact of the kappa statistic that occurred due to insufficient variability in the reliability samples for Study 2. When percent agreement scores were also calculated, the ratings appeared similar across Study 1 and Study 2. CONCLUSION: The findings of this study suggested that improvements in interrater reliability could be obtained following a program of systematic training. However, improvements were not uniform across all parameters. Acceptable levels of reliability were achieved for those parameters most important for evaluation of velopharyngeal function.

Reliability and validity of nasality ratings between a monolingual and bilingual listener for speech samples from English-Spanish-Speaking children.

OBJECTIVE: This study sought to determine if a monolingual English listener could rate nasality in English and in Spanish with the same proficiency as a bilingual English-Spanish listener, and to compare nasalance scores with nasality ratings. PATIENTS AND METHODS: Speakers for this study were 26 bilingual English-Spanish-speaking children. Speech samples and nasalance scores were obtained simultaneously as each speaker recited one English sentence and one Spanish sentence. A monolingual listener and a bilingual listener rated nasality. RESULTS: For the English sentences, the intrajudge correlation coefficient was r = 0.89 for the monolingual listener and r = 0.89 for the bilingual listener. For the Spanish sentences, the intrajudge correlation coefficient was r = 0.91 for the monolingual listener and r = 0.92 for the bilingual listener. Interjudge agreement was r = 0.86 for rating English sentences and r = 0.78 for rating Spanish sentences. All correlation coefficients were significant (p < 0.001). The correlation coefficients between nasality ratings and nasalance scores were essentially the same for both listeners and both languages. CONCLUSION: A monolingual and a bilingual judge had high agreement on ratings of nasality for English and Spanish speech. The relationship between nasalance and nasality was not different across languages.