Development of Stop Consonants in Children with Repaired Cleft Palate

腭裂修复儿童塞音的发展

基本信息

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
项目类别：
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

项目摘要

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.

腭裂是美国最常见的面部出生缺陷，甚至仅次于腭裂。研究结果显示，许多儿童在进入第二年时都会出现言语和语言发育迟缓的情况。我们当前的 R01 项目显示，超过 40% 的腭裂修复儿童没有达到塞音辅音在 16 个月大时出现（上颚修复后 4 至 6 个月），大约 20% 的人在 20 个月大时（上颚修复后 8 至 10 个月）不会出现这种情况。到了学龄，20% 至 30% 的人会出现这种情况。患有腭裂修复的儿童将需要进行二次腭手术以治疗以下强制性症状腭咽功能障碍，60% 至 70% 需要言语治疗以进行发音治疗。常见的错误是支持（腭化）牙槽目标的产生。更新的目的是确定： 1) 是否有一种新颖的软腭咽闭合空气动力学措施，用于停止辅音 24 个月大可预测唇裂修复儿童 3、4 和 5 岁时的腭咽功能上颚，2）与年龄相关的腭咽功能障碍的必然症状的变化——鼻音过多和听到鼻腔漏气的声音 – 5 至 8 岁修复腭裂的儿童，以及 3) 裂隙类型和听力状况对齿槽塞音和摩擦音目标的发展和清晰度的影响 5 至 8 岁的腭裂修复儿童我们将继续追踪目前入组的三名儿童。儿童队列：1) 患有腭裂修复（约 60 名），2) 没有腭裂，但有腭裂病史伴有渗出液的早期中耳炎（约 30 例），以及 3) 典型发展，无腭裂或既往病史渗出性中耳炎（约 30 名）我们还将招收额外的 2 岁和 5 岁儿童来抵消。我们将使用鼻腔压力、标准压力流量。程序、感知评级、单字可懂度测试和谱矩分析来完成我们将使用二项式回归和敏感性/特异性来评估第一个具体目标。我们将使用单向方差分析和线性分析来评估第二个和第三个具体目标。预计结果将具有或不具有裂隙类型和听力状态作为协变量。 a) 进一步验证一种新颖且相对简单的方法来评估年轻人的腭咽功能腭裂修复儿童，b) 提供老年人强制性症状和发音的纵向数据腭裂儿童的早期语言发展理论此类信息将有助于优化二次手术的时机和提供基于证据的行为干预策略，以改善口语交流和质量的生活。