Evidence-based cleft palate speech intervention : integration of the best available research evidence with the therapists’ and the parents’ perspectives

Introduction: Almost two decades ago, the World Health Organization stressed the need for efficacy studies within the field of cleft palate (CP) speech disorders. Unfortunately, evidence for speech intervention approaches in this population is still lacking. Aims: To provide an overview of two randomized controlled trials (RCT) investigating the effectiveness of speech intervention approaches and speech intervention intensities in children with CP. Additionally, the therapists’ and parents’ perspectives on cleft palate speech intervention will be discussed. Methods: The effect of motor-phonetic intervention was compared with linguistic-phonological intervention in 14 children with CP (Mage = 7.71y) using a block-randomized, sham-controlled trial. Each group received 10 hours of intervention for 2 weeks. In addition, the effect of high intensity speech intervention (HISI, five 1-hour sessions/week for 2 weeks) was compared with low intensity speech intervention (LISI, one 1-hour session/week for 10 weeks) in 12 children with CP (Mage = 8.0y) using a longitudinal RCT. Therapists’ and parents’ perspectives on cleft palate speech intervention were investigated using semi-structured interviews. Results: Only in the group receiving linguistic-phonological intervention, percentage correctly produced consonants significantly improved following treatment. Concerning the intervention intensities, children in the HISI group made equally and for some variables even superior progress in only 2 weeks of therapy compared to children in the LISI group who needed 10 weeks of therapy. Therapists and parents had some specific concerns regarding the used approaches and intensities. Conclusions: With regard to intervention approaches, a linguistic-phonological approach was found to be more effective in terms of improving speech outcomes than a motor-phonetic approach. With regard to intervention intensities, HISI is a promising strategy to improve speech outcomes in a shorter time period. Integration of the therapists’ and parents’ perspectives with the best available research evidence is indispensable for the provision of high quality cleft speech care