Speech Ratings of Patients with Clefts: Comparing Caregivers’ Ratings to Speech- Language Pathologist’s Emily Swain Department of Speech Pathology and Audiology

Cleft lip and/or palate is one of the most common congenital abnormalities. It is present in 1 of every 711 live births (CDC, 2012)

Background The primary area of concern for children with cleft lip and/or palate is speech outcome. During the Fall semester, I completed a literature review of research that studied the ratings of speech outcome for cleft lip and/or palate populations.

Types of Studies Caregiver vs. Patient Results: Mixed Caregiver vs. Speech Pathologist Results: No difference in nasality or articulation

Types of Studies cont. Limitations Sample size Controlling for type of cleft Method of collection Control groups

Purpose of Study To describe the relationship between caregivers’ and speech-language pathologist’s (SLP’s) ratings of speech outcome in the cleft palate clinic.

Methods The Human Subjects Institutional Review Board (HSIRB) of the University of Michigan approved the study ( ) Retrospective review of clinical data

Methods: Inclusion and Demographics Included if caregiver completed Speech Assessment Survey 29 clinical cases seen in the Oral Cleft Clinic Age: 15 months to 20 years old Gender: 14 males and 15 females Primary Language: English

Methods cont. 1. I can understand my child’s speech all the time. 2. Other adults, such as teachers, can understand my child’s speech all the time. 3. My child’s friends can understand my child’s speech all the time. 4. My child’s speech sounds the same as other children who are the same age. 5. My child’s speech sounds like it comes out of his/her nose more than it should. 6. My child’s speech sounds like s/he has a cold or “stuffy” nose. 7. I am happy with how my child’s speech sounds. 8. Overall, my child’s speech is excellent. 29 Caregivers Strongly Agree Agree Neutral Disagree Strongly Disagree

Methods cont. 1. Intelligibility 0= Normal 1= Mildly Reduced 2= Moderately Reduced 3= Moderately Severe 4= Severe 2. Articulation 0= No concerns 0a= Developmental Errors 1= Distortions 2= Substitutions/Omissions 3= Compensatory Errors 3. Resonance (Hypernasality) 0= Normal 1= Borderline 2= Mild 3= Moderate 4= Severe 4. Resonance (Hyponasality) 1= Normal 2= Mild 3= Marked 1 Certified Speech- Language Pathologist Oral Cleft Speech Screening Protocol

Methods cont. Data were entered in Excel using scaled scores +2 strongly agree 1 agree 0 neutral -1 disagree -2 strongly disagree Correlations between caregivers and the SLP’s ratings were calculated in SPSS.

Results

Results cont.  Intelligibility Normal (n=8) Mildly Reduced (n=6) Moderately Reduced (n=6) Moderately Severe (n=3) Severe (n=2) Articulation No concerns (n=8) Development error (n=5) Distortions (n=5) Substitutions/Omissions (n=1) Compensatory Errors (n=6) 3. Resonance (Hypernasality) Normal (n=11) Borderline (n=2) Mild (n=2) Moderate (n=7) Severe (n=1) 4. Resonance (Hyponasality) Normal (n=17) Mild (n=3) Marked (n=0)

Discussion Caregiver ratings of “overall, my child’s speech is excellent” were moderately correlated with SLP ratings of intelligibility (r =.68). Intelligibility

Discussion cont. Caregiver ratings of “overall, my child’s speech is excellent” were strongly correlated with SLP ratings of articulation (r =.88). Articulation

Discussion cont. Caregiver ratings of resonance (my child’s speech sounds like…) were moderately correlated with SLP ratings of hypernasality (r =.50). Note: Recent addition to questionnaire allowing for only 10 caregiver to respond. Resonance

Discussion cont. Not much can be concluded due to infrequency with which it was rated by SLP Preliminary findings: More parents noted hyponasality “my child’s speech sounds like…” (n=10) compared with only 7 from the SLP. Resonance (Hyponasality)

Discussion cont. Not the purpose of this study Compared age groups: under age 9 (n= 14) and 9 or older (n=15) Using the patients’ self-assessment ratings, it was determined that speech ratings and satisfaction increase, as children grow older. Age Related Factor

Limitations Compared different questions/statements Incomplete protocols Bias SLP ratings Rater variability Sample Size Control group Cleft type or severity

Conclusion Relationship between caregivers’ ratings of overall speech excellence and speech-language pathologists ratings of intelligibility, articulation, and hypernasality. No relationship between caregivers’ ratings of overall speech excellence and speech-language pathologists ratings of hyponasality.

Questions? The Human Subjects Institutional Review Board (HSIRB) of the University of Michigan approved the study ( ). Acknowledgements:  I would like to thank Dr. Sharp for allowing me to access and analyze the data collected at WMU School of Medicine Clinic. Thank you also for all of the time you spent editing and answering questions regarding evaluation of the results.  I would also like to thank Dr. Tasko and Professor Glista for being a part of my Honors Defense Committee.