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Effect of Performance-specific Cleft Speech Intervention and Long-term Learning in Children With a Cleft Palate

ConditionsCleft Palate ChildrenSpeech Disorders in ChildrenCleft Lip and PalateSpeech Therapy
Trial statusRecruiting
Trial phaseNot applicable
Trial typeInterventional
Biological sexAll
Age4-12
SponsorUniversity Ghent

About this trial

Speech therapy in children with a palate deals with two scientific challenges that will be addressed in this project.

The first challenge is selecting the best speech approach for a child with a specific cleft speech characteristic (CSC). Many speech therapists use a 'one-size-fits-all' approach to treat compensatory CSCs resulting in poor short- and long-term speech outcomes. To increase the effectiveness and quality of cleft speech care, it is necessary to find the best match between a specific therapy and a given type of CSC. Therefore, this proposal will compare the effect of 3 different speech approaches on the speech and quality of life in Dutch speaking children with different types of CSCs.

The second challenge is selecting the best speech approach to enhance long-term learning and transfer of newly established speech skills to untrained consonants. To date, research mainly focused on immediate therapy effects. It is unknown if permanent speech changes occur. Hence, this project will also investigate the short-term and long-term learning effects (retention and transfer) of the different speech approaches from the first objective.

This proposal will improve evidence-based and patient-tailored cleft speech therapy.

Eligibility criteria

This trial does not accept healthy volunteers

Qualifiers

Belgian Dutch-speaking children with a cleft palate with or without a cleft lip

Aged between 4 and 12 years

Presence of at least one compensatory speech error in their speech based on the perceptual assessment of one experienced speech-language pathologist

Disqualifiers

Children with syndromic clefts

Oronasal fistula

Velopharyngeal insufficiency

Hearing disabilities based on pure tone audiometry (>25 dB HL)

Trial design

Design model

Parallel

Treatments tested in this trial

  • Motor-phonetic intervention

    Behavioral

    Children will receive phonetic articulation therapy treating consonants in a phoneme-by-phoneme basis, emphasizing phonetic placement and shaping techniques. Phonetic articulation therapy includes a progression of the target consonant from isolated level, syllable level, word level, sentence level, spontaneous speech level in five different steps: identification of the target consonant using visual, tactile, and auditory feedback techniques, discrimination between the used and targeted consonant, (3) variation and correction, (4) stabilize the target, and (5) maintenance of the target. A next level will be introduced when the child is able to correctly produce the sound in 90% of the time with minimal cues from the therapist.

  • Phonological intervention

    Behavioral

    The phonological approach consists of two phases. In the first phase, the child's attention is drawn to the contrastive features of the speech sound system which are relevant to the target consonants. Terms that describe the sound features will be introduced using words on the child's level, e.g. in the case of active nasal fricatives the words 'nose' and 'mouth' will be used. Child-friendly games will be played to illustrate the contrast between the concepts followed by activities that focus on the contrasts in non-speech sounds, in which child and therapist will alternate between being listener and speaker. At the end of this phase, minimal word pairs (e.g. tap/cap), only produced by the therapist, will be used to facilitate the child's awareness of sounds in words and meaningful differences based on distinctive features. In the second phase, the child will produce minimal pairs providing the opportunity to monitor his/her speech and to make self-corrections.

  • Combined phonetic-phonological intervention

    Behavioral

    Children will receive motor-phonetic articulation therapy supplemented with phonological principles. Therapy will be provided following the same five steps as the 'motor-phonetic group'. However, articulation errors will not be treated in a phoneme-by-phoneme basis. In contrast, multiple errors will be targeted simultaneously by focusing on a process. For example, if the child produces glottal stops for the /t/ and the /p/, these sounds will be treated simultaneously as sounds requiring oral front placements. Exercises will be embedded in meaningful language contexts such as minimal pairs

Treatment groups

135 Participants
are divided into 3 treatment groups
Group A: Children with anterior oral cleft speech characteristicsActive comparator 3 interventions
Group B: Children with posterior oral cleft speech characteristicsExperimental treatment 3 interventions
Group C: Children with non-oral cleft speech characteristicsExperimental treatment 3 interventions

Trial outcomes

Primary outcomes

1

Consonant proficiency

Consonant proficiency will be measured in terms of percentage correctly produced consonants (%)

Time frame
Assessment immediately pre-intervention
2

Consonant proficiency

Consonant proficiency will be measured in terms of percentage correctly produced consonants (%)

Time frame
Assessment immediately post-intervention
3

Consonant proficiency

Consonant proficiency will be measured in terms of percentage correctly produced consonants (%)

Time frame
Assessment at 1 month post-intervention
4

Consonant proficiency

Consonant proficiency will be measured in terms of percentage correctly produced consonants (%)

Time frame
Assessment at 3 months post-intervention

Secondary outcomes

1

Intelligibility in Context

To assess possible transfer of learned speech skills to contexts outside the therapy setting, the Intelligibility in Context Scale (ICS) will be administered before and after intervention. The ICS rates the degree to which children's speech is understood by different partners (caregivers, immediate and extended family, friends, acquaintances, teachers, and strangers) on a 5-point scale (1 - never intelligible to 5 - always intelligible)

Time frame
Assessment immediately pre-intervention
2

Intelligibility in Context

To assess possible transfer of learned speech skills to contexts outside the therapy setting, the Intelligibility in Context Scale (ICS) will be administered before and after intervention. The ICS rates the degree to which children's speech is understood by different partners (caregivers, immediate and extended family, friends, acquaintances, teachers, and strangers) on a 5-point scale (1 - never intelligible to 5 - always intelligible)

Time frame
Assessment immediately post-intervention
3

Intelligibility in Context

To assess possible transfer of learned speech skills to contexts outside the therapy setting, the Intelligibility in Context Scale (ICS) will be administered before and after intervention. The ICS rates the degree to which children's speech is understood by different partners (caregivers, immediate and extended family, friends, acquaintances, teachers, and strangers) on a 5-point scale (1 - never intelligible to 5 - always intelligible)

Time frame
Assessment at 1 month post-intervention
4

Intelligibility in Context

To assess possible transfer of learned speech skills to contexts outside the therapy setting, the Intelligibility in Context Scale (ICS) will be administered before and after intervention. The ICS rates the degree to which children's speech is understood by different partners (caregivers, immediate and extended family, friends, acquaintances, teachers, and strangers) on a 5-point scale (1 - never intelligible to 5 - always intelligible)

Time frame
Assessment at 3 months post-intervention

Other outcomes

Sponsors and contacts

Click on the lead sponsor to view all of their trials.

University Ghent

Lead sponsor

Research Foundation Flanders

Collaborator

Source ClinicalTrials.gov
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