English-Only Treatment of Compensatory Speech Errors in a Bilingual Adoptee With Repaired Cleft Palate: A Descriptive Case Study.

Purpose The purpose of this clinical focus article is to provide a descriptive case study of a late-adopted, bilingual adolescent with cleft palate speech errors. Specifically, we examined the cross-linguistic generalization of remediated compensatory cleft errors, following treatment in English (second language) only. The overarching goal of this study is to gain insights into the complexity of speech intervention for the adopted population with delayed cleft palate repair. Method A 14-year-old female adopted from China with a repaired unilateral cleft lip and palate and maladaptive articulation errors underwent 55 one-hour sessions of a motor-based, speech therapy approach over a 15-month span, targeting English phonemes only. Pre-, mid-, and posttreatment evaluation included perceptual and instrumental assessment of speech and resonance. Outcome measures at each time point included perceptual speech and resonance ratings, nasometry scores, and percent consonants correct (PCC) in both English and Mandarin. Results PCC in English improved from 60% in single words and 35% in sentences pretreatment to 100% in single words and sentences during posttreatment assessment. Without direct treatment in Mandarin, PCC in Mandarin improved from 56% in single words and 50% in sentences pretreatment to 100% in single words and 99% in sentences during posttreatment assessment. Posttreatment nasometry scores decreased by 20% for the nasal sample and 17% for the oral sample compared to pretreatment. Conclusions This descriptive case study demonstrated successful remediation of cleft palate speech errors, following 15 months of treatment in a late-adopted bilingual adolescent using a motor-based therapy approach. Treatment of errors in English (second language) led to generalization of correct productions in Mandarin (first language). This study presents the potential for bilingual late adoptees to achieve intelligible speech in both languages when motor-based therapy principles are applied to intervention.

Holistic Communication Assessment for Young Children With Cleft Palate Using the International Classification of Functioning, Disability and Health:Children and Youth.

Purpose Children with a cleft palate (± cleft lip; CP±L) can have difficulties communicating and participating in daily life, yet speech-language pathologists typically focus on speech production during routine assessments. The International Classification of Functioning, Disability and Health: Children and Youth Version (ICF-CY; World Health Organization, 2007) provides a framework for holistic assessment. This tutorial describes holistic assessment of children with CP±L illustrated by data collected from a nonclinical sample of seven 2- to 3-year-old children, 13 parents, and 12 significant others (e.g., educators and grandparents). Method Data were collected during visits to participants' homes and early childhood education and care centers. Assessment tools applicable to domains of the ICF-CY were used to collect and analyze data. Child participants' Body Functions including speech, language, and cognitive development were assessed using screening and standardized assessments. Participants' Body Structures were assessed via oral motor examination, case history questionnaires, and observation. Participants' Activities and Participation as well as Environmental and Personal Factors were examined through case history questionnaires, interviews with significant others, parent report measures, and observations. Results Valuable insights can be gained from undertaking holistic speech-language pathology assessments with children with CP±L. Using multiple tools allowed for triangulation of data and privileging different viewpoints, to better understand the children and their contexts. Several children demonstrated speech error patterns outside of what are considered cleft speech characteristics, which underscores the importance of a broader assessment. Conclusion Speech-language pathologists can consider incorporating evaluation of all components and contextual factors of the ICF-CY when assessing and working with young children with CP±L to inform intervention and management practices.

Effect on Facial Growth of the Management of Cleft Lip and Palate.

Treatment of cleft lip and palate ordinarily requires multiple interventions spanning the time of birth to adulthood. Restriction of facial growth, a common occurrence in affected children, is due to multiple factors. There are multiple surgical and therapeutic options, which may have influence on facial growth in these patients. As restriction to facial development can have significant implications to form, function, and psychological well-being, practitioners should have an appreciation for the effects of the different cleft therapies to facial growth. We have outlined and thoroughly reviewed in chronological order all of the interventions from birth to adulthood necessary in the comprehensive care of the patient with cleft lip and palate, along with the effects they may or may not have on facial growth.

Folic acid fortification and prevalences of neural tube defects, orofacial clefts, and gastroschisis in California, 1989 to 2010.

BACKGROUND: We examined whether prevalences of neural tube defects (NTDs), orofacial clefts, and gastroschisis changed more rapidly after than before folic acid fortification in California. METHODS: This population-based study used vital statistics and birth defects registry data. The study population included all live births and stillbirths delivered in central California counties from 1989 to 2010. Cases included deliveries with NTDs, orofacial clefts, and gastroschisis. Weighted least squares regression was used to estimate slopes during prefortification (before 1997) and postfortification (after 1998), respectively. The difference of the two slopes with the 95% confidence interval (CI) was calculated. RESULTS: For all NTDs combined, slopes indicated that NTD prevalence was decreasing by 8.7 (slope: -8.7; 95% CI, -13.5--3.9) cases per 100,000 deliveries per year before fortification and by 1.7 (slope: -1.7; 95% CI, -3.7-0.3) after fortification; thus the decline had slowed by 7.0 (95% CI, 2.7-11.3) cases per 100,000 deliveries per year. For orofacial clefts, slopes for cleft lip with/without palate as well as for cleft palate alone indicated that the postfortification slope was lower than the prefortification slope suggesting a more accelerated decrease in the postfortification time period. For gastroschisis, the slope after fortification was lower compared with prefortification, indicating a less accelerated prevalence increase in the postfortification time period. Stratification by race/ethnicity did not substantially alter results. CONCLUSION: We observed a slower decline in prevalence of NTDs, an emergence of a decline in orofacial clefts, and a slower increase in gastroschisis, during the postfortification period in central California, relative to the prefortification period. Birth Defects Research (Part A), 2016. © 2016 Wiley Periodicals, Inc. Birth Defects Research (Part A) 106:1032-1041, 2016. © 2016 Wiley Periodicals, Inc.

Association of Parental Environmental Exposures and Supplementation Intake with Risk of Nonsyndromic Orofacial Clefts: A Case-Control Study in Heilongjiang Province, China.

The aim of present study was to check the possible association of potential parental environmental exposures and maternal supplementation intake with the risk of nonsyndromic orofacial clefting (NSOC). A retrospective study comprised 499 cases and 480 controls was conducted in Heilongjiang Province. Chi-square analysis and unconditional multiple logistic regression were used in the study. The results showed that maternal history of fever and the common cold without fever (ORCL/P = 3.11 and 5.56, 95%CI: 1.67-5.82 and 2.96-10.47, ORCPO = 3.31 and 8.23, 95%CI: 1.58-6.94 and 4.08-16.95), paternal smoking and alcohol consumption (ORCL/P = 2.15 and 5.04, 95%CI: 1.37-3.38 and 3.00-8.46, ORCPO = 1.82 and 4.40, 95%CI: 1.06-3.13 and 2.50-7.74), maternal exposure to organic solvents, heavy metals, or pesticides (ORCL/P = 6.07, 5.67 and 5.97, 95%CI: 1.49-24.76, 1.34-24.09 and 2.10-16.98, ORCPO = 10.65, 7.28 and 3.48, 95%CI: 2.54-44.67, 1.41-37.63 and 1.06-11.46) and multivitamin use during the preconception period (ORCL/P = 0.06, 95%CI: 0.02-0.23, ORCPO = 0.06, 95%CI: 0.01-0.30) were associated with cleft lip or without cleft palate (CL/P) and cleft palate only (CPO). Maternal history of skin disease and negative life events (ORCL/P = 12.07 and 1.67, 95%CI: 1.81-80.05 and 1.95-2.67) were associated with CL/P. Some potential parental hazardous exposures during the periconception period and maternal use of multivitamins during the preconception period were associated with risk of NSOC.

Fissuras orofaciais: aspectos relacionados ao diagnóstico / Orofacial clefts: aspects related to the diagnosis

Objetivo: analisar aspectos relacionados ao diagnóstico das fissuras orofaciais, enfocando o período em que ocorreu, o que foi abordado; o profissional responsável por transmitir a informação e as reações e os sentimentos gerados. Métodos: pesquisa de campo exploratória quantitativa e qualitativa realizada no Centro de Atendimento Integral ao Fissurado Labiopalatal – CAIF/AFISSUR. Foram realizadas entrevistas semi-estruturadas com 28 mães de crianças com fissuras orofaciais (FO). Os dados quantitativos foram analisados a partir do método descritivo e os qualitativos por meio da análise de conteúdo. Resultados: a maioria das entrevistadas recebeu a notícia pelo médico no momento do nascimento da criança, ou após o mesmo. A notícia privilegiou informações acerca de sintomatologia, prognóstico positivo, tratamento cirúrgico, etiologia e comparação com outros problemas. As reações diante do diagnóstico foram de choque/susto, preconceito/rejeição, desespero, contato com o desconhecido, angústia/tristeza, culpa. Conclusão: Os resultados deste estudo condizem com os achados na literatura, a qual aponta o momento tardio em que malformações congênitas são detectadas e informadas à mãe. Pode-se apreender que o desconhecimento ou o conhecimento limitado acerca das FO estão implicados com experiências de sofrimento vivenciadas pelas mães após a notícia do diagnóstico. Este estudo reitera a necessidade de ampliar dispositivos tecnológicos e recursos humanos envolvidos em programas de assistência integral a gestantes, especialmente, no contexto da saúde coletiva.

Purpose: to examine aspects related to the diagnosis of oral clefts, focusing on the period in which it occurred, what was discussed, the professional responsible for transmitting information and the reactions and feelings generated. Methods: an exploratory study, both quantitative and qualitative, held at a Center for Integral Assistance on Orofacial Cleft . Semi-structured interviews were conducted with 28 mothers of children presenting the problem. Quantitative data were analyzed by the descriptive method and the qualitative by content analysis. Results: most of the mothers received the information from a doctor at the moment of birth or soon after. The main content of the information was about symptoms, positive prognosis, surgical treatment, etiology and comparison with other problems. The reactions to the diagnosis were shock/fright, prejudice/rejection, despair, contact with the unknown, grief /sadness, guilt. Conclusion: the results of this study are consistent with findings in the literature, which points to the late time at which congenital defects are detected and reported to the mother. One can understand that ignorance or limited knowledge about the orofacial clefts are concerned with experiences of suffering experienced by mothers after the news of the diagnosis. This study reiterates the need to expand technological devices and human resources involved in programs of comprehensive care to pregnant women, especially in the context of public health.

Objetivo: Analizar los aspectos relacionados con el diagnóstico de las fi suras orofaciales con foco en el período en que ocurrió; lo que se discutió; el profesional responsable por la transmisión de información y las reacciones y los sentimientos generados. Métodos: Investigación de campo, exploratória, cuantitativa y cualitativa realizada en el Centro de Atención Integral as Fisurado Labiopalatal - CAIF / AFISSUR. Hemos llevado a cabo entrevistas semi-estructuradas con 28 madres de niños con hendiduras orofaciales (HO). Los datos cuantitativos se analizaron a partir del método descriptivo y los cualitativo por médio del analisis de contenido. Resultados: La mayoría de las entrevistadas recibió la notícia del médico en el momento del nacimiento del niño, o después de ello. La noticia privilegió informaciones sobre los síntomas, el pronóstico positivo, el tratamiento quirúrgico, la etiología y la comparación con otros problemas. Las reacciones al diagnóstico fueron: choque / susto, prejuicio / rechazo, desesperación, contacto con lo desconocido, ansiedad / tristeza, culpa. Conclusión: Los resultados de este estudio son consistentes con los hallazgos en la literatura, los cuales muestran el momento tardío en que las malformaciones congenitas son detectadas y notifi cadas a la madre. Se puede aprender que el desconocimiento o el conocimiento limitado acerca de la HO están implicados con las experiencias de sufrimiento experimentado por las madres después de la noticia del diagnóstico. Este estudio reitera la necesidad de ampliar dispositivos tecnológicos y recursos humanos involucrados en programas de atención integral a las mujeres embarazadas, especialmente en el contexto de la salud colectiva.

Fissuras orofaciais: aspectos relacionados ao diagnóstico / Orofacial clefts: aspects related to the diagnosis

Objetivo: analisar aspectos relacionados ao diagnóstico das fissuras orofaciais, enfocando o período em que ocorreu, o que foi abordado; o profissional responsável por transmitir a informação e as reações e os sentimentos gerados. Métodos: pesquisa de campo exploratória quantitativa e qualitativa realizada no Centro de Atendimento Integral ao Fissurado Labiopalatal – CAIF/AFISSUR. Foram realizadas entrevistas semi-estruturadas com 28 mães de crianças com fissuras orofaciais (FO). Os dados quantitativos foram analisados a partir do método descritivo e os qualitativos por meio da análise de conteúdo. Resultados: a maioria das entrevistadas recebeu a notícia pelo médico no momento do nascimento da criança, ou após o mesmo. A notícia privilegiou informações acerca de sintomatologia, prognóstico positivo, tratamento cirúrgico, etiologia e comparação com outros problemas. As reações diante do diagnóstico foram de choque/susto, preconceito/rejeição, desespero, contato com o desconhecido, angústia/tristeza, culpa. Conclusão: Os resultados deste estudo condizem com os achados na literatura, a qual aponta o momento tardio em que malformações congênitas são detectadas e informadas à mãe. Pode-se apreender que o desconhecimento ou o conhecimento limitado acerca das FO estão implicados com experiências de sofrimento vivenciadas pelas mães após a notícia do diagnóstico. Este estudo reitera a necessidade de ampliar dispositivos tecnológicos e recursos humanos envolvidos em programas de assistência integral a gestantes, especialmente, no contexto da saúde coletiva.(AU)

Purpose: to examine aspects related to the diagnosis of oral clefts, focusing on the period in which it occurred, what was discussed, the professional responsible for transmitting information and the reactions and feelings generated. Methods: an exploratory study, both quantitative and qualitative, held at a Center for Integral Assistance on Orofacial Cleft . Semi-structured interviews were conducted with 28 mothers of children presenting the problem. Quantitative data were analyzed by the descriptive method and the qualitative by content analysis. Results: most of the mothers received the information from a doctor at the moment of birth or soon after. The main content of the information was about symptoms, positive prognosis, surgical treatment, etiology and comparison with other problems. The reactions to the diagnosis were shock/fright, prejudice/rejection, despair, contact with the unknown, grief /sadness, guilt. Conclusion: the results of this study are consistent with findings in the literature, which points to the late time at which congenital defects are detected and reported to the mother. One can understand that ignorance or limited knowledge about the orofacial clefts are concerned with experiences of suffering experienced by mothers after the news of the diagnosis. This study reiterates the need to expand technological devices and human resources involved in programs of comprehensive care to pregnant women, especially in the context of public health.(AU)

Objetivo: Analizar los aspectos relacionados con el diagnóstico de las fi suras orofaciales con foco en el período en que ocurrió; lo que se discutió; el profesional responsable por la transmisión de información y las reacciones y los sentimientos generados. Métodos: Investigación de campo, exploratória, cuantitativa y cualitativa realizada en el Centro de Atención Integral as Fisurado Labiopalatal - CAIF / AFISSUR. Hemos llevado a cabo entrevistas semi-estructuradas con 28 madres de niños con hendiduras orofaciales (HO). Los datos cuantitativos se analizaron a partir del método descriptivo y los cualitativo por médio del analisis de contenido. Resultados: La mayoría de las entrevistadas recibió la notícia del médico en el momento del nacimiento del niño, o después de ello. La noticia privilegió informaciones sobre los síntomas, el pronóstico positivo, el tratamiento quirúrgico, la etiología y la comparación con otros problemas. Las reacciones al diagnóstico fueron: choque / susto, prejuicio / rechazo, desesperación, contacto con lo desconocido, ansiedad / tristeza, culpa. Conclusión: Los resultados de este estudio son consistentes con los hallazgos en la literatura, los cuales muestran el momento tardío en que las malformaciones congenitas son detectadas y notifi cadas a la madre. Se puede aprender que el desconocimiento o el conocimiento limitado acerca de la HO están implicados con las experiencias de sufrimiento experimentado por las madres después de la noticia del diagnóstico. Este estudio reitera la necesidad de ampliar dispositivos tecnológicos y recursos humanos involucrados en programas de atención integral a las mujeres embarazadas, especialmente en el contexto de la salud colectiva.(AU)

Tratamiento de la fisura labio palatina / Treatment of patients with cleft lip and palate

La fisura labiopalatina es una de las malformaciones congénitas más frecuentes. La incidencia en Chile es de 1.7 por mil recién nacidos, lo que significa que nacen alrededor de 400 casos cada año. Las causas determinantes son: hereditarias en 20-25 por ciento, ambientales en 10 por ciento y desconocidas hasta ahora en 70 por ciento de los casos. Con respecto a la prevención, pareciera que la suplementación con Ácido Fólico en dosis altas antes y durante los primeros meses del embarazo puede reducir el riesgo. El tratamiento es multidisciplinario y se inicia en el periodo de recién nacido. Las cirugías primarias comprenden cierre de labio (3 meses) y paladar (12 meses). La participación de diferentes especialistas odontólogos, otorrino, genetista, fonoaudiólogas, psicólogo y enfermeras coordinadoras es fundamental para lograr resultados óptimos.

Cleft lip and palate are frequent congenital malformations, in Chile 1.7 per one thousand babies are born with clefts, that is, 400 cases each year. The main causes are: hereditary 20-25 percent, environmental 10 percent and unknown reasons 70 percent up to now. In relation with prevention it seems a high dose of folic acid before and during the first months of pregnancy might reduce the risk. The interdisciplinary treatment begins at early age. Primary surgeries consist of lip closure (at 3 month of age) and palate closure (at 12 months old). To achieve the best results is essential an interdisciplinary team such as a dentist, ENT, genetist, speech therapists, psychologist and coordinator nurses.