Longitudinal Speech Outcome at 5 and 10 Years in UCLP: Influence of Speech Therapy and Secondary Velopharyngeal Surgery

Abstract

ObjectiveTo investigate speech development of children aged 5 and 10 years with repaired unilateral cleft lip and palate (UCLP) and identify speech characteristics when speech proficiency is not at 'peer level' at 10 years. Estimate how the number of speech therapy visits are related to speech proficiency at 10 years, and what factors are predictive of whether a child's speech proficiency at 10 years is at 'peer level' or not.DesignLongitudinal complete datasets from the Scandcleft projectParticipants320 children from nine cleft palate teams in five countries, operated on with one out of four surgical methods.InterventionsSecondary velopharyngeal surgery (VP-surgery) and number of speech therapy visits (ST-visits), a proxy for speech intervention.Main Outcome Measures'Peer level' of percentage of consonants correct (PCC, > 91%) and the composite score of velopharyngeal competence (VPC-Sum, 0-1).ResultsSpeech proficiency improved, with only 23% of the participants at 'peer level' at 5 years, compared to 56% at 10 years. A poorer PCC score was the most sensitive marker for the 44% below 'peer level' at 10-year-of-age. The best predictor of 'peer level' speech proficiency at 10 years was speech proficiency at 5 years. A high number of ST-visits received did not improve the probability of achieving 'peer level' speech, and many children seemed to have received excessive amounts of ST-visits without substantial improvement.ConclusionsIt is important to strive for speech at 'peer level' before age 5. Criteria for speech therapy intervention and for methods used needs to be evidence-based.

Keywords: cleft lip and palate; pharyngeal flap; speech production; speech therapy.

Figure 1.

(A) A scatterplot (“Brinley plot”) of each child's percentage consonants correct score (PCC) (marked as different symbols) at 5 years of age (x-axis) and 10 (y-axis). In all panels, dashed horizontal and vertical lines illustrate our cut offs for considering PCC to be at ‘peer level’ or not. Triangles – PCC were not at ‘peer level’ at 5 or 10 years of age, diamonds - PCC were below ‘peer level’ at 5 years of age but at ‘peer level’ at 10-years of age, circles - PCC were at ‘peer level’ at both time points, and squares - PCC were at ‘peer level’ at 5 years of age, but not at 10 years of age. (B) A scatterplot of each child's PCC score at 5 years of age and their number of ST-visits between 5 and 10 years of age. Note that the y-axis is logarithmic.

Figure 2.

Two heatmaps of the 140 children whose speech proficiency (PCC and/or VPC-Sum) were not at ‘peer level’ at 10-years of age. Each row is one child and each column one colour coded speech variable. To the left is a heatmap of the children's speech on the five variables at 5 years of age. To the right, the corresponding heatmap for the children at 10 years of age. PCC is coded as at ‘peer level’ (PL = PCC > 91%) in green or not (not PL = PCC < 91%) in red. VPC-Sum was illustrated from green (competent = 0) to red (incompetent = 6), and the speech errors (oral errors, non-oral errors and DSC); green (no errors = 0), yellow (1–2 errors) and red (3 or more errors). The outcomes were ordered according to their speech proficiency at 10-years of age. The same ordering was kept when illustrating their speech at 5-years of age (left panel). Note. VPC-Sum = Velopharyngeal Competence-Sum. DSC = Developmental Speech Characteristics.

Figure 3.

(A) A scatterplot of each child's number of ST-visits between 5 and 10 years of age and their difference in PCC-scores between those ages (calculated as PCC 10y minus PCC 5y, so that positive values indicate improvement). The dotted horizontal line indicates zero improvement. The black “curve” is the linear relationship between the x- and y-axis; note that a linear relationship looks like a curve when one of the axes are logarithmic. (B) A scatterplot of each child's number of ST-visits between 5 and 10 years of age and their PCC-scores at 10 years of age. The dotted curve is the result of the logistic regression and is plotted against the right-hand y-axis that indicates the predicted probability that a child's speech is at ‘peer level’ or not. The numbers written on the bottom are the proportion of children with ‘peer level’ speech in each, demarcated by the vertical dashed line.