Management strategies for developmental apraxia of speech: a review of literature.

In recent years, interest in and controversy about developmental apraxia of speech has been abundant. This paper is designed to provide a series of management strategies for developmental apraxia of speech. There are numerous unanswered questions about the effects of therapy; pertinent research issues are identified.

Prevention of communication problems associated with cleft palate.

The purpose of this paper is to review principles of preventative intervention and their application to communication problems associated with cleft palate. Ten specific suggestions and activities are described.

Oral language characteristics of adult cleft-palate speakers compared on the basis of cleft type and sex.

Several language measures were administered to 103 cleft-palate adults and analyses were carried out with the subjects classified according to type of cleft (cleft palate only, unilateral cleft lip and palate, bilateral cleft lip and palate) and sex. Between-group differences according to cleft type and sex indicate that patients with cleft lip and palate have better speech and language skills than the cleft-palate-only groups. The results of this study also suggest that females have more complete sentence structure than male cleft-lip and palate subjects. Appropriate habilitative measures should continue through later ages until the cleft-palate individuals gain acceptable levels of communication.

Speech and language screening for audiologists.

Speech and language screening by audiologists is not new, although few audiologists screen speech and language, which should be an integral component of the audiological evaluation. This article considers ASHA's views about speech and language screening by audiologists, screening tests available to audiologists, and the training of audiologists to screen speech and language.

Integrating perceptual and instrumental procedures in the assessment of velopharyngeal insufficiency.

Although technology for the instrumental assessment of velopharyngeal function has advanced, management decisions still too often depend only on subjective perceptual analyses. Both perceptual and instrumental appraisal are necessary for adequate assessment. Instrumental assessment is essential prior to surgical or other long-term management. The assessment is only as valid as the instruments used. If such instruments are not readily available, clinicians should refer patients to centers where they are available and these examinations are routinely performed.

Diagnostic report writing.

This article reviews purposes and types of diagnostic reports and provides guidelines for report writing. Report writing varies greatly depending upon the examination itself and the clinician's style of reporting. Such variation is acceptable as long as professional standards are maintained. The basic guidelines of report writing are: (1) the organization should provide for easy retrieval of specific information; (2) the terms and categories should be free of ambiguity; and (3) only terms in common use by professional should be used. Lack of uniformity, bad writing, inappropriate terminology, and overstatements are the basic problems of report writing that may be overcome through practice, study of sample reports, and courses in report writing.

Oral language skills of adult cleft palate speakers.

This study investigated selected oral language skills and their relationship to speech intelligibility in forty cleft palate and normal adult speakers. Connected speech samples were analyzed to determine spoken language status which included response length, grammar or syntax, and vocabulary size. The subjects were judged for intelligibility by two groups of listeners: sophisticated and unsophisticated. It was concluded: (a) cleft palate speakers used shorter responses and were more consistent in their language usage; (b) there were no significant differnences in syntax and vocabulary; (c) for cleft palate speakers there was a relationship between intelligibility and language measures; (d) unsophisticated listiners were more consisitent in intelligibility judgements, and (e) sophisticated listeners rated cleft palate speakers poorer than unsophisticated listeners.

Survey of publications for parents of cleft palate children: a preliminary report.

In summary, these findings indicate that the general quality of the publications for parents of cleft palate children is probably mediocre and that both parents and speech pathologists tend to agree on assessments to this effect. The publications which appear to be most widely used are not necessarily those which appear to be the best available. Attention needs to be given to the design and content of future parent publications which should probably be written with knowledge of the parents' changing concerns over time. Since parent publications are used by many professionals involved in clef palate habilitation and there is no information about their opinions of the quality of these publications, additional work on this problem is planned for the future.

Responses to telephone inquiries made to craniofacial treatment teams.

This report is a follow-up to an earlier research project concerning composition and function of self-identified teams listed in the ACP-CFA 1990 Membership-Team Directory. We address the types of responses provided by personnel answering telephones for teams listed in a recent Directory. Sixty of the 228 teams listed in the continental United States were randomly selected and divided into 2 groups of 30 each. One group was telephoned by an ACP-CFA member who is the parent of a patient with cleft palate; the other group was telephoned by a graduate student in speech-language pathology. Data indicate that Directory listing does not assure access to information pertinent to cleft lip, palate, and craniofacial anomalies; different type and manner of responses were made to the 2 callers; and inadequate information was often provided by the personnel who answer the telephones. Implications include the need for more training of personnel in responding to telephone inquiry and cautious use of the directory listings as a resource for referral.

Parents' attitudes toward family involvement in cleft palate treatment.

Families exert a powerful influence upon their members and can be a significant resource in cleft palate treatment. The purposes of this study were to gather information about (1) the characteristics and attitudes of families whose children are treated for cleft palate; (2) the extent to which parents participate in decisions about treatment; and (3) parents' ideas about their participation. A 32-item survey questionnaire was distributed to 75 parents in Florida, Louisiana, Minnesota, and Pennsylvania. Forty-two survey forms (56%) were completed and returned for analysis. The majority of parents (57%) were satisfied with their present involvement in team treatment services; however, 36% wished for more involvement, and 7% wished for less involvement.

Perceptions about cleft palate held by school personnel: suggestions for in-service training development.

Public school personnel were surveyed regarding their perceptions about the effect of a cleft palate on students' behavior and achievement and their needs for in-service training on that topic. Results of the survey suggest that school personnel differ in their view of cleft palate children and their needs for in-service training.

Speech-language pathologists' opinions on the management of velopharyngeal insufficiency.

A 16-item questionnaire designed to survey opinions on the management of velopharyngeal insufficiency (VPI) was distributed to all members (N = 296) of the American Cleft Palate Association who were speech-language pathologists. Questionnaires were completed by 173 respondents (58.4 percent). There were differences of opinion among speech-language pathologists on various management issues related to VPI, including the value of instrumental assessment of VPI, the importance of oral examination of velopharyngeal function, and the effectiveness of speech therapy in the treatment of VPI. The implications of these findings for clinical training in VPI are discussed.

Information and experience with cleft palate: students, parents, professionals.

More than 1,200 students, parents, and professionals completed a questionnaire designed to assess knowledge and experience with cleft palate. Professionals knew more about cleft palate and had had more experience with it than either parents or students. Parents, however, knew more about cleft palate and had had more experience with it than had students. There was also an apparent relationship between knowledge and experience because those who knew more about cleft palate had also had more experience and training. The results reemphasize the need for pre-professional and continuing-education programs.

Survey of public awareness and knowledge of cleft palate.

The purpose of this survey was to determine the general public's awareness and knowledge of cleft palate. Telephone questionnaires were completed by a random sample of 1,200 persons, 200 in each of six cities within four states. The results indicated only limited information and awareness of cleft palate. Suggestions for improving general public awareness and educational programs are discussed.

Dental students' knowledge of an exposure to cleft palate.

A questionnaire was administered to 108 dental students from West Virginia University to assess their knowledge of cleft palate. Results revealed areas of deficiency in basic knowledge and exposure to clefting. When these data were compared to those from an earlier study (Lass et al., 1973) differences were found of varying type. A comparison between dental and medical students revealed that the basic knowledge of cleft palate and associated problems were not different between the two groups. However, the dental students had done more reading than the medical students and had the topic of cleft palate included in their coursework.

Medical students' knowledge of and exposure to cleft palate.

To compare the knowledge and experience of medical students in 1989 with that of those surveyed in 1973, a questionnaire about the various aspects of cleft palate was completed by 209 medical students from West Virginia University and the Louisiana State University Medical Center at Shreveport and New Orleans. Results revealed that 1989 students were more familiar with the embryology of cleft palate, racial and gender differences, and intellectual and psychologic issues (p less than .05). In contrast, the 1973 students were more able to define cleft palate, submucous cleft palate, and pharyngeal flap. There was no difference between the two groups of students in the amount of clinical exposure to cleft palate. These findings support the need for greater emphasis on cleft palate at the pre- and postdoctoral levels, as well as within continuing education programs. As part of current programs, the standard of practice of multidisciplinary team management for an individual with cleft palate should be underscored.