Persson C, Davies J, Havstam C, Søgaard H, Bowden M, Boers M, Nielsen J B, Alaluusua S, Lundeborg Hammarström I, Emborg B K, Sand A, Lohmander A
Institute of Neuroscience and Physiology, Department of Health and Rehabilitation, Speech and Language Pathology Unit, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Department of Otorhinolaryngology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.
Cleft Palate Craniofac J. 2025 May;62(5):772-785. doi: 10.1177/10556656231225575. Epub 2024 Feb 26.
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.
目的
调查5岁和10岁单侧唇腭裂（UCLP）修复术后儿童的言语发育情况，确定10岁时言语能力未达到“同龄人水平”时的言语特征。估计言语治疗就诊次数与10岁时言语能力的关系，以及哪些因素可预测儿童10岁时的言语能力是否达到“同龄人水平”。
设计
来自Scandcleft项目的纵向完整数据集
参与者
来自五个国家九个腭裂治疗团队的320名儿童，采用四种手术方法之一进行手术。
干预措施
二期腭咽手术（VP手术）和言语治疗就诊次数（ST就诊次数），作为言语干预的指标。
主要观察指标
辅音正确率（PCC，>91%）的“同龄人水平”和腭咽功能综合评分（VPC-Sum，0-1）。
结果
言语能力有所提高，5岁时只有23%的参与者达到“同龄人水平”，而10岁时这一比例为56%。较差的PCC评分是10岁时低于“同龄人水平”的44%儿童最敏感的指标。10岁时“同龄人水平”言语能力的最佳预测指标是5岁时的言语能力。接受大量ST就诊并不能提高达到“同龄人水平”言语的概率，而且许多儿童似乎接受了过多的ST就诊但没有实质性改善。
结论
在5岁前努力实现“同龄人水平”的言语很重要。言语治疗干预的标准和所使用的方法需要有循证依据。
