Development of Stop Consonants in Children with Repaired Cleft Palate

腭裂修复儿童塞音的发展

• 批准号: 10115527
• 负责人: DAVID J ZAJAC
• 金额: $ 65.35万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-04-04 至 2024-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10115527
• 关键词: 2 year old; 5 year old; 7 year old; 8 year old; Age; Age-Months; Air; Air Pressure; Alveolar; Analysis of Variance; Anterior; Area; Articulation; Back; Behavior Therapy; Child; Child Development; Cleft Palate; Clinical; Clinical assessments; Conductive hearing loss; Congenital Abnormality; Data; Development; Diagnostic; Enrollment; Face; Fistula; Frequencies; Functional disorder; Growth; Hearing; Hearing Tests; Language; Life; Maxilla; Measures; Modeling; Nose; Operative Surgical Procedures; Oral; Otitis Media; Otitis Media with Effusion; Outcome; Patient Recruitments; Pattern; Procedures; Production; Quality of life; Recording of previous events; Research; Retrospective Studies; Sample Size; School-Age Population; Sensitivity and Specificity; Speech; Speech Delay; Speech Development; Speech Sound; Speech Therapy; Structural defect; Surgical Management; Symptoms; Testing; Time; United States; Width; Work; age effect; age related; base; bone; cleft lip and palate; cohort; evidence base; experience; improved; indexing; novel; oral communication; palatal surgery; palate repair; pressure; repaired; sound; theories; tongue apex

Cleft palate is the most frequently occurring facial birth defect in the United States. Even following palate repair, many children will experience delayed speech and language well into the second year of life. Findings from our current R01 project show that greater than 40% of children with repaired cleft palate do not achieve emergence of stop consonants by 16 months of age (4 to 6 months following palate repair) and approximately 20% do not by 20 months of age (8 to 10 months following palate repair). By school age, 20% to 30% of children with repaired cleft palate will require secondary palatal surgery for obligatory symptoms of velopharyngeal dysfunction and 60% to 70% will require speech therapy for articulation. One of the most common errors is backed (palatalized) production of alveolar targets. The specific aims of this proposed renewal are to determine: 1) if a novel aerodynamic measure of velopharyngeal closure for stop consonants at 24 months of age predicts velopharyngeal function at 3, 4, and 5 years of age in children with repaired cleft palate, 2) age-related changes in obligatory symptoms of velopharyngeal dysfunction – hypernasality and audible nasal air escape – of children with repaired cleft palate from 5 to 8 years of age, and 3) the effects of cleft type and hearing status on the development and intelligibility of alveolar stop and fricative targets in children with repaired cleft palate from 5 to 8 years of age. We will continue to follow three currently enrolled cohorts of children: 1) with repaired cleft palate (approximately 60), 2) without cleft palate but with history of early otitis media with effusion (approximately 30), and 3) typically-developing without cleft palate or history of otitis media with effusion (approximately 30). We will also enroll additional 2 and 5 year-old children to offset attrition and maintain adequate sample sizes. We will use nasal ram pressure, standard pressure-flow procedures, perceptual ratings, single-word intelligibility testing, and spectral moment analyses to accomplish the specific aims. We will evaluate the first specific aim using binomial regression and sensitivity/specificity analyses. We will evaluate the second and third specific aims using one-way analysis of variance and linear mixed models with and without cleft type and hearing status as covariates. It is anticipated that the results will a) further validate a novel and relatively simple procedure to evaluate velopharyngeal function in young children with repaired cleft palate, b) provide longitudinal data on obligatory symptoms and articulation of older children with repaired cleft palate, and c) contribute to theories of early speech development of children with structural anomalies. Such information will be instrumental to optimize the timing of secondary surgeries and provide evidence-based strategies for behavioral interventions that will improve oral communication and quality of life.

left裂是美国最常见的面部先天缺陷。甚至跟随口感 维修，许多孩子会在生命的第二年经历延迟的语音和语言。发现 从我们目前的R01项目中显示，超过40％的修复裂口儿童无法实现 停止辅音在16个月大（口感修复后4至6个月）的出现，大约 到20个月大的20％（味觉修复后8至10个月）不会。到学龄前，有20％至30％ 修复裂口的儿童将需要次要的pa氏手术，以应对强制性症状 尾咽功能障碍和60％至70％的功能障碍将需要言语治疗才能表达。最大的 常见错误是肺泡靶标的（a型）产生的。该提议的具体目的 续订要确定：1）如果尾咽闭合的新型空气动力学测量，以进行停止辅音 24个月大预测在3、4和5岁的儿童中静脉咽咽功能 pa，2）与年龄相关的速度症症状症状的变化 可听见的鼻腔空气逃生 - 5岁至8岁的修复裂口的儿童以及3） 关于肺泡停止的发展和智能的裂口类型和听力状态 5至8岁的裂口修复的儿童。我们将继续遵循目前注册的三个 儿童队列：1）维修裂口（约60），2）没有left裂，但有历史 早期的中耳炎具有积液（约30个），3）通常在没有left裂或病史的情况下开发 中耳炎有积液（约30个）。我们还将注册2个和5岁的孩子以抵消 磨损和维持足够的样本量。我们将使用鼻腔压力，标准压力流 程序，感知评级，单字可理解性测试和光谱时刻分析以完成 具体目标。我们将使用二项式回归和灵敏度/特异性评估第一个特定目标 分析。我们将使用单向方差和线性分析评估第二和第三特定目标 具有和不具有裂缝类型和听力状态的协变量的混合模型。预计结果将 a）进一步验证一种新颖且相对简单的程序来评估年轻的咽咽功能 修复裂缝的儿童，b）提供有关强制性症状和表达较老的纵向数据 修复裂口的儿童，c）有助于儿童早期言语发展的理论 结构异常。此类信息将有助于优化辅助手术的时间和 为行为干预提供基于证据的策略，以改善口头交流和质量 生活。