Early Assessment of Infants with Cleft Palate Following Surgical Repair

婴儿腭裂手术修复后的早期评估

• 批准号: 7501955
• 负责人: DAVID J ZAJAC
• 金额: $ 17.57万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-09-28 至 2011-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7501955
• 关键词: Address; Age; Age-Months; Age-Years; Anterior nares; Articulation Disorders; Behavioral; Cannulas; Child; Classification; Cleft Lip; Cleft Palate; Clinic; Clinical; Closure; Code; Communication; Congenital Abnormality; Crying; Data; Development; Diagnostic Procedure; Distress; Equipment and supply inventories; Feedback; Functional disorder; Goals; Gold; Infant; Intervention; Invasive; Language; Learning; Nose; Operative Surgical Procedures; Oral; Parents; Pathologist; Phonetics; Physiological; Preschool Child; Procedures; Production; Relative (related person); Reporting; Sensitivity and Specificity; Speech; Speech Delay; Speech Development; Speech Therapy; Standards of Weights and Measures; Structure; Surgeon; Techniques; Time; Toddler; United States; Week; base; blind; craniofacial; indexing; member; novel; novel diagnostics; palatal surgery; palate repair; pressure; repaired; success; tool; vocalization

DESCRIPTION (provided by applicant): Cleft palate is one of the most frequently occurring birth defects. The goal of cleft palate surgery is to provide adequate velopharyngeal (VP) function to enable normal speech development. Although most infants undergo surgery by 9 to 12 months of age, definitive assessment of VP function is not possible until the child is a) at least 3 years of age, b) uses multiple word utterances, and c) is fairly cooperative for clinical procedures. Currently, it is known that at least 25% of children will require secondary palatal surgery to correct persisting VP dysfunction. In addition, the majority of children (approximately 70%) will require behavioral speech therapy to address various communication issues related to clefting. The long term objective of this proposal is to explore the use of a novel, non-invasive assessment procedure to determine adequacy of VP function in infants soon after cleft palate surgery. 48 infants with non-syndromic cleft palate with or without cleft lip will be studied longitudinally at four time points beginning at approximately 12 months of age: pre-surgery, 2 weeks post, 4 months post, and 12 months post surgery. 12 infants without cleft palate also will be studied longitudinally at three corresponding time points: 12, 16, and 24 months of age. A double-barreled nasal cannula and microphone will be used to record nasal ram pressure and vocalizations of the infants, respectively. Vocalizations will be coded as cries, isolated vowels, single consonant-vowel syllables, and multiple syllable utterances and classified relative to VP status as closed, partially closed, or open based upon nasal pressure data. At 24 months of age, the children with cleft palate will be audio recorded and a panel of listeners who are blind to the nasal pressure assessments will perceptually evaluate VP closure of the children. Specific aims include determining 1) the time course of VP closure in both groups of children, and 2) the sensitivity and specificity of the nasal pressure classifications of VP status as compared to perceptual speech assessments of children with repaired cleft palate at 24 months of age. We anticipate that the results of the study will a) generate much needed physiologic information on the time course of VP closure during early speech development, b) provide early feedback to surgeons regarding the success of surgical techniques, and c) suggest behavioral and/or secondary surgical intervention strategies for children with VP dysfunction at earlier time periods than currently practiced.

描述（由申请人提供）：腭裂是最常见的出生缺陷之一。腭裂手术的目标是提供足够的腭咽（VP）功能以实现正常的言语发育。尽管大多数婴儿在 9 至 12 个月大时接受手术，但直到孩子 a) 至少 3 岁，b) 使用多个单词发音，以及 c) 对临床手术相当配合时，才能对 VP 功能进行明确评估。目前，已知至少 25% 的儿童需要二次腭手术来纠正持续的 VP 功能障碍。此外，大多数儿童（约 70%）需要行为言语治疗来解决与唇裂相关的各种沟通问题。该提案的长期目标是探索使用一种新颖的非侵入性评估程序来确定腭裂手术后婴儿 VP 功能的充分性。将对 48 名患有非综合征性腭裂（伴或不伴唇裂）的婴儿进行纵向研究，从大约 12 个月大开始，在四个时间点进行纵向研究：手术前、术后 2 周、术后 4 个月和术后 12 个月。还将在三个相应的时间点（12、16 和 24 个月大）对 12 名无腭裂婴儿进行纵向研究。双管鼻插管和麦克风将分别用于记录婴儿的鼻塞压力和发声。发声将被编码为哭声、孤立元音、单辅音-元音音节和多音节话语，并根据鼻压数据将相对于 VP 状态分类为闭合、部分闭合或开放。在 24 个月大时，将对腭裂儿童进行录音，一组对鼻压评估视而不见的听众将通过感知评估儿童的 VP 闭合情况。具体目标包括确定 1) 两组儿童 VP 闭合的时间过程，以及 2) 与 24 个月大腭裂修复儿童的感知言语评估相比，VP 状态的鼻压分类的敏感性和特异性。我们预计该研究的结果将a）产生关于早期语言发育期间VP闭合时间过程的急需的生理信息，b）向外科医生提供有关手术技术成功的早期反馈，以及c）建议行为和/或针对 VP 功能障碍儿童的二次手术干预策略比目前实施的时间更早。