Investigation of the effectiveness of articulation therapy through tele-practice on children with cleft palate in Khuzestan Province during COVID-19 pandemic.

INTRODUCTION: A cleft palate is a common type of facial malformation. Compensatory articulation errors are one of the important causes of unclear speech in children with cleft palate. Tele-practice (TP) helps to connect therapists and clients for assessment and therapy. Our goal is to investigate the effectiveness of articulation therapy through tele-practice on cleft palate children in Khuzestan Province during the COVID-19 pandemic. MATERIALS & METHODS: Before starting the treatment, a 20-min speech sample was recorded individually from all the children. Speech intelligibility and the percentage of correct consonants were assessed for each speech sample. The control group received treatment sessions in person at the cleft palate center, and the other group received treatment via tele-practice using the ZOOM platform. Treatment sessions were provided in the form of 45-60-min group sessions, twice a week, for 5 weeks (10 sessions in total). After 10 treatment sessions, the speech sample was recorded again. The level of parental satisfaction was measured using a Likert 5-level survey. RESULTS: The mean score of intelligibility of the two groups decreased (-1.4400 and 0.7200). The two groups' mean percentage of correct consonants increased. (26.09 and 17.90). In both groups, the mean score of parents' satisfaction with the treatment was high (3.44 and 3.84). The mean of difference before and after the speech intelligibility and the percentage of correct consonants variables in both groups was statistically significant (P = 0.001 and P = 0.002, respectively). In both groups, the satisfaction variable was not associated with a statistically significant difference (P = 0.067). CONCLUSION: The effectiveness of in-person therapy over a certain period of time is higher than tele-practice. Nevertheless, the results demonstrated an increase in the intelligibility of speech and the percentage of correct consonants in both groups, thus proving the effectiveness of articulation therapy in correcting compensatory articulation errors in children with cleft palate through in-person and tele-practice.

Speech pathology telepractice for children with cleft palate in the times of COVID-19 pandemic.

OBJECTIVE: To study whether providing Speech and Language Pathology (SLP) interventions by telepractice (TP) could effectively improve speech performance in children with cleft palate (CCP). METHODS: Forty-three CCP were treated with TP intervention in 45 min sessions, 2 times per week for a period of one month. Children ages ranged 4-12 years (X = 7.04; SD = 2.59). All children presented with velopharyngeal insufficiency (VPI) and compensatory articulation (CA) after palatal repair. TP was provided in small groups (5-6 children) following the principles of the Whole Language Model (WLM). Severity of CA was evaluated by a standardized scale at the onset and at the end of the TP period. RESULTS: At the onset of the TP intervention period, 84% of the patients demonstrated severe CA. At the end of the TP period there was a significant improvement in severity of CA (p < 0.001). CONCLUSION: The results of this study suggests that TP can be a safe and reliable tool for improving CA. Considering that the COVID-19 pandemic will radically modify the delivery of Health Care services in the long term, alternate modes of service delivery should be studied and implemented.

Diagnosis and treatment of speech disorders in children with Moebius syndrome.

BACKGROUND: Moebius syndrome (MS) is characterized by congenital bilateral paralysis of the facial and abducens nerves. Clinical features include feeding problems, dysarthria, dysphagia, sialorrhea, strabismus, and lack of facial expression. Patients with MS frequently present with dysphagia during infancy. Further on during childhood a severe speech disorder is a common feature. However, articulation deficits in patients with MS are scarcely reported in the related scientific literature. OBJECTIVE: The aim of this study is to describe speech deviations, intelligibility and sialorrhea in patients with MS. MATERIAL AND METHODS: Eighty-seven patients with MS were prospectively studied. Age ranged from 4 to 18 years. A complete Speech and Language Pathology (SLP) evaluation was performed in all cases. The evaluation focused on articulation placement, sialorrhea and intelligibility of speech. RESULTS: Sialorrhea was detected in 23% of the patients. Abnormal articulation placement of bilabial phonemes was observed in 68% of the patients. Another 50% of the patients presented with articulation placement errors in other phonemes. Intelligibility was classified as adequate in 18% of the cases. Mildly affected intelligibility was found in 51% of the patients. Speech was considered moderately unintelligible in 20% of the cases. Unintelligible speech was found in 11% of the patients. CONCLUSIONS: From the results of this prospective study it can be concluded that a high percentage of patients with MS are at high risk of presenting with moderate to severe speech disorders. Thus, an early SLP intervention should be provided for this population in order to enhance speech development and reducing the risk of severe oral communication impairments.

Simulation-Based Comprehensive Cleft Care Workshops: A Reproducible Model for Sustainable Education.

OBJECTIVE: Evaluate simulation-based comprehensive cleft care workshops as a reproducible model for education with sustained impact. DESIGN: Cross-sectional survey-based evaluation. SETTING: Simulation-based comprehensive cleft care workshop. PARTICIPANTS: Total of 180 participants. INTERVENTIONS: Three-day simulation-based comprehensive cleft care workshop. MAIN OUTCOME MEASURES: Number of workshop participants stratified by specialty, satisfaction with the workshop, satisfaction with simulation-based workshops as educational tools, impact on cleft surgery procedural confidence, short-term impact on clinical practice, medium-term impact on clinical practice. RESULTS: The workshop included 180 participants from 5 continents. The response rate was 54.5%, with participants reporting high satisfaction with all aspects of the workshop and with simulation-based workshops as educational tools. Participants reported a significant improvement in cleft lip (33.3 ± 5.7 vs 25.7 ± 7.6; P < .001) and palate (32.4 ± 7.1 vs 23.7 ± 6.6; P < .001) surgery procedural confidence following the simulation sessions. Participants also reported a positive short-term and medium-term impact on their clinical practices. CONCLUSION: Simulation-based comprehensive cleft care workshops are well received by participants, lead to improved cleft surgery procedural confidence, and have a sustained positive impact on participants' clinical practices. Future efforts should focus on evaluating and quantifying this perceived positive impact, as well reproducing these efforts in other areas of need.

Deliberate Practice: Preliminary Results of a Useful Strategy for Correcting Articulation in Children With Cleft Palate.

Children with cleft palate frequently show speech and language disorders. In the related scientific literature, several reports have described the use of different strategies for treating speech disorders in children with cleft palate. However, only a few studies have addressed the use of these strategies within a meaningful linguistic context.Deliberate practice is a procedure or strategy, which proposes that the key for achieving high levels of expert performance is dedicating long time for practice. Deliberate practice has been studied mainly in the areas of sports and intellectual games. The purpose of this article is to study whether the use of a strategy originally designed for achieving expert performance in sports and intellectual games, can be useful for the speech intervention of children with cleft palate.For this project, 32 children with cleft palate were studied. The children were randomly assigned to 2 independent groups. Both groups received speech therapy based on the principles of the Whole Language Model. In addition, deliberate practice was used in the children included in the active group.After a speech intervention, although both groups of children demonstrated significant improvement in articulation placement, the active group demonstrated a significantly higher improvement as compared with the control group.In conclusion, these preliminary results seem to suggest that the use of deliberate practice can be effective for enhancing articulation in children with cleft palate.

Audiovisual materials are effective for enhancing the correction of articulation disorders in children with cleft palate.

INTRODUCTION: Children with cleft palate frequently show speech disorders known as compensatory articulation. Compensatory articulation requires a prolonged period of speech intervention that should include reinforcement at home. However, frequently relatives do not know how to work with their children at home. OBJECTIVE: To study whether the use of audiovisual materials especially designed for complementing speech pathology treatment in children with compensatory articulation can be effective for stimulating articulation practice at home and consequently enhancing speech normalization in children with cleft palate. MATERIALS AND METHODS: Eighty-two patients with compensatory articulation were studied. Patients were randomly divided into two groups. Both groups received speech pathology treatment aimed to correct articulation placement. In addition, patients from the active group received a set of audiovisual materials to be used at home. Parents were instructed about strategies and ideas about how to use the materials with their children. Severity of compensatory articulation was compared at the onset and at the end of the speech intervention. RESULTS: After the speech therapy period, the group of patients using audiovisual materials at home demonstrated significantly greater improvement in articulation, as compared with the patients receiving speech pathology treatment on - site without audiovisual supporting materials. CONCLUSION: The results of this study suggest that audiovisual materials especially designed for practicing adequate articulation placement at home can be effective for reinforcing and enhancing speech pathology treatment of patients with cleft palate and compensatory articulation.

The effectiveness of mentoring speech and language pathology students when they face patients with cleft palate.

INTRODUCTION: Mentoring programs can boost Speech & Language (SL) pathologists' satisfaction about their clinical skills, increasing their professional competence. A quality induction program provides a bridge for an efficient and comfortable transition between theoretical knowledge and clinical practice in front of clients. This transition can be especially difficult when the SL pathologist confronts patients with cleft palate. OBJECTIVE: To study whether a mentoring program can improve SL Pathology students' performance for treating patients with cleft palate. MATERIALS AND METHODS: 18 SL Pathology students coursing the third year of a SL Pathology graduate program volunteered for participating in the study. The students were divided in two groups. All SL students from both groups were equally supervised. The students were followed for two semesters during their participation in the SL Pathology intervention for patients with cleft palate. The only difference between the students from each group was that one group (active group) was mentored by an experienced SLP who had previously received specific training to become a mentor. All SL students were assessed at the onset and at the end of the study. The assessment was performed through an analysis according to a previously validated scale (Learning Continuum of Speech & Language pathologists). RESULTS: A Wilcoxon test demonstrated a significant improvement (P<0.05) in the levels of The Learning Continuum of Speech & Language Pathologists at the end of the follow-up period in both groups of students. When the levels of performance at the end were compared between groups, a Mann Whitney test demonstrated a significant difference (P<0.05). The students included in the active group who were receiving additional mentoring besides the usual clinical supervision, showed a greater improvement as compared with the students from the control group. CONCLUSIONS: Learning how to conduct an adequate and effective intervention in cleft palate patients from an integral stand point is not easy for SL students. The support and guidance of an experienced mentor seems to enhance self-confidence and improve students' performance confronting patients with cleft palate.

[Summer school speech therapy for children with cleft palate and language disorder]. / Terapia de lenguaje en la modalidad de "curso de verano" para niños con fisura palatina y trastorno de lenguaje.

INTRODUCTION: Cleft palate patients with language impairment require specific therapy. OBJECTIVE: Study two modalities of speech intervention in cleft palate children with associated linguistic impairment, a conventional approach providing speech therapy, twice a week, and a speech summer camp for a period of three weeks. MATERIALS AND METHODS: Twenty-five cleft palate patients with language impairment were studied. A matched control group was gathered. Patients included in the first group attended a three week duration speech summer camp. Control patients included in the second group received speech therapy twice a week. RESULTS: At the onset of either the summer camp or the speech intervention period, the severity of language impairment was evenly distributed with non-significant differences across groups (p > 0.05). After the summer camp or 9 months of speech therapy sessions, both groups showed a significant decrease in the severity of language impairment (p < 0.05). At the end of the summer camp, and the therapy period, non-significant differences, were found between groups (p > 0.05). CONCLUSIONS: Speech summer camp is a reliable and efficient method to provide speech therapy for left palate patients with language impairment.

Terapia de lenguaje en niños con trastorno de articulación compensatoria. Resultados preliminares / Phonologic speech intervention in children with compensatory articulation disorder. Preliminary results

Objetivo. El propósito de este estudio fue comparar dos modalidades de terapia de lenguaje en niños con fisura de paladar secundario y trastorno de articulación compensatoria. La primer modalidad fue un abordaje de terapia con base en aspectos fonológicos. La segunda modalidad fue un abordaje convencional de terapia con base en aspectos fonéticos o articulatorios. Material y métodos: Se realizó un estudio prospectivo, comparativo y aleatorio. Se estudiaron 29 niños con fisura de paladar secundario, insuficiencia velofaríngea y trastorno de articulación compensatoria de 3 a 7 años de edad. Los pacientes que se dividieron en dos grupos mediante un proceso aleatorio Quince pacientes se incluyeron en el primer grupo (control) y recibieron terapia con abordaje articulatorio, 14 pacientes se incluyeron en el segundo grupo (activo) y recibieron terapia con abordaje fonológico. Se comparó el promedio del tiempo total de terapia necesario para la normalización del habla en los dos grupos. Resultados. El promedio del tiempo total de terapia en el grupo control fue de 30.7 meses y de 14.5 meses en el grupo activo. El tiempo total de terapia se redujo significativamente (p) cuando se utilizó un abordaje de terapia con base en aspectos fonológicos. Conclusiones. La terapia de lenguaje con base en aspectos fonológicos redujo significativamente el tiempo total de terapia necesario para corregir el trastorno de articulación compensatoria en los niños con fisura de paladar secundario.

Interacción lingüística: el papel activo de los padres en la terapia de lenguaje / Linguistic interactivity: the active role of parents in speech therapy

A medida que la terapia de lenguaje adopta los principios del aprendizaje natual, se hace evidente que el desarrollo de los niños está muy influido por la calidad y cantidad de relaciones que los adultos usan con el niño. El presente trabajo compara dos grupos de niños en terapia de lenguaje: Uno donde los niños asisten solos con la terapeuta y otro donde asisten acompañados por su madre. Esto con el fin de evaluar y modificar de ser necesario, el estilo de interacción que las madres tienen con su hijo y proporcionar un estilo que facilite el desarrollo lingüístico. Ambos grupos se evaluaron antes y después del período de terapia para poder medir el grado de avance de cada uno. Los pacientes que acudieron a terapia acompañados por su madre mostraron un grado de avance lingüístico significativamente mayor en comparación con los pacientes que recibieron terapia solos. Se comprueba que los resultados apoyan el postulado de que el desarrollo del niño en diversos campos (cognitivo, sensorio-motor, social, emocional, comunicativo) está influenciado profundamente por el estilo de interacción que los adultos usan con el niño

Experiencia con cuatro sitemas de implante coclear / Experience with four different types of cochlear implants

Cuatro tipos de implante coclear fueron evaluados en sordos prelingüísticos, para determinar si los resultados ameritaban continuar su uso; estos fueron un implante extracoclear de 8 electrodos, un sistema de procesador multicanal de un solo electrodo, que podría ser colocado intra o extracoclearmente, y un sistema intracoclear de 22 electrodos. Se encontró que (1) Los implantes extracocleares tienen mayor tendencia a fallar que los intracocleares; y (2) Los implantes monoelectrodos usados, tanto en posición intra como extracoclear, no proporcionan beneficios adecuados a sujetos con sordera de aparición en la etapa prelingüal.