[Adaptation of the GOS.SP.ASS Screening Assessment]

by

Acknowledgement

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Table of Contents

TABLE OF CONTENTS4

LITERATURE REVIEW5

Framework for Speech Assessment7

Nasality7

Consonant Errors7

Intelligibility8

Role of the Speech Language Pathologist8

Role of the Audiologist10

Role of the Dentist11

Role of the Orthodontist11

SUMMARY17

REFERENCES18

GOS.SP.ASS. for Children with Cleft Palate

Literature Review

In 1994 the present authors proposed a speech assessment protocol for speech disorders associated with cleft palate and/or velopharyngeal dysfunction known as GOS.SP.ASS. (Great Ormond Street Speech Assessment). This detailed speech assessment is now complemented by the Cleft Audit Protocol for Speech (CAPS), a tool recommended for clinical audit. As a result of close collaboration in their preparation, the results are directly comparable. In addition, the speech elicitation sentences and the phonetic diagram have been modified.

Treatment of children born with a cleft requires care from many disciplines. The development of normal speech is among the most important goals, and it is well recognized that patients with unoperated cleft palate have severely disordered speech (Sell, 2002). Any study, therefore, on outcomes of primary surgery for patients born with a cleft must include an assessment of speech. The principal speech disorders associated with cleft lip and palate include abnormal consonant production, abnormal nasality, nasal air emission, nasal turbulence, and speech quality (McWilliams et al., 2010). The most common disorder of resonance is hypernasality; the most frequent cause of this disorder is velopharyngeal insufficiency (VPI), for which surgical correction is usually required (Sell and Ma, 2006). The prevalence of hypernasality is viewed as an important speech outcome. The need for secondary surgery is also indicative of speech quality.

Peterson-Falzone (2006) highlighted the lack of general studies that report speech outcomes for patients born with a cleft. Investigations into speech have tended to focus on the timing or technique of palatoplasty, and several recent studies have reported speech results comparing different surgical procedures (Brothers et al., 2005; Haapanen, 2005; Lohmander-Agerskov, 2008; Williams et al., 2008; Ysunza, et al., 2008; Lin et al., 2009). Unfortunately, many investigations of speech following primary palatoplasty do not use similar methodology to assess outcomes. For example, Morley (2009) reported the speech results of one surgeon (Braithwaite) using a simple classification of speech but with no reporting of individual speech parameters by independent listeners. There are also few studies in which large numbers of patients with a single cleft type have been examined with a detailed evaluation of speech.

In a literature survey of the results of primary surgery in relation to the outcome of velopharyngeal function, Morris (2003) and Spriestersbach et al. (2003) found that approximately 25% had VPI. Enderby and Emerson (2005) presented data on the prevalence of VPI, which ...