The IO group (n = 10) obtained a statistically significant higher rating, compared with the non-IO group (n = 10). The effect size was large, indicating that the improvement may be considered a clinically important change. The cost for treatment by the orthodontist was higher in the IO group. For both groups, the mean cost was related to the mean rating for "total impression of speech quality." The resulting cost-effectiveness for IO, compared to non-IO was 1041 for 1.34 point speech quality improvement. The financial investment that is necessary to obtain this improvement seems limited. Thus, from the perspective of speech development, the cost-effectiveness of IO over non-IO seems acceptable at this point in time.

A randomized, prospective, clinical study was performed investigating the effects of presurgical infant orthopedic treatment (PIO) in children with unilateral cleft lip and palate (UCLP). The influence of PIO on speech intelligibility was evaluated with two groups, each consisting of 10 children with UCLP. One group used PIO during the first year of life, whereas the other group did not use the device. Eight children without cleft served as a second control group. Intelligibility was assessed by lay listeners using two methods: transcription and listener rating. The ratings proved to be reliable and to have sufficient validity, but they did not completely reflect intelligibility defined as the proportion of words understood by the listener. Children in the treatment group were rated as exhibiting greater intelligibility than those in the nontreatment group. However, data obtained by means of transcriptions indicated that, in fact, there were no group differences in actual intelligibility. Only in comparison with their noncleft peers were the children with cleft lip and palate significantly less well understood. © 2000 by Elsevier Science Inc.Educational Objectives: Readers will learn about (1) the reliability and validity of a rating paradigm used for assessing intelligibility of children with UCLP and (2) the relationship between the use of PIO and intelligibility in toddlers with UCLP.

To investigate the effects of infant orthopedics (IO) administered in the first year of life on the speech characteristics of 2.5-year-old children with complete unilateral cleft lip and palate (UCLP) using a perceptual evaluation instrument with equal-appearing interval (EAI) scales. Design: In a prospective randomized clinical trial (Dutchcleft), two groups of children with complete UCLP were followed longitudinally. One group received IO based on a modified Zurich approach (IO group), and the other group did not (non-IO group). The appliance was used until soft palate closure at age 12 months. Hard palate closure is delayed until 9 years of age. Participants: Three groups of 2.5-year-old toddlers participated in this investigation: 10 IO, 10 non-IO, and 8 noncleft controls matched for age and socioeconomic status. Method: Five trained listeners assessed the children's speech in a blinded perceptual rating procedure. They judged 13 specific speech characteristics and indicated their total impression of speech on EAI scales. Results: The reliability and consistency of 11 of the rating scales was good. The intelligibility rating scale was the single speech characteristic that distinguished the IO group from the non-IO group; the IO group was judged to be superior. The cleft groups differed from the noncleft group on 9 of the 11 scales. Conclusions: Evaluation of speech by means of the present newly developed perceptual rating instrument showed that the IO group obtained significantly higher ratings for intelligibility than the non-IO group. The groups did not differ regarding any of the other speech aspects. KEY WORDS: cleft lip and palate, infant orthopedics, perceptual rating scale, randomized prospective clinical trial In many cleft palate centers, especially in Europe, babies with cleft lip and palate are treated with infant orthopedics (IO). There is considerable controversy regarding this treatment. Proponents claim that IO provides correct alignment of the alveolar segments and narrowing of the cleft (McNeil, 1956), facilitation of surgical closure of the cleft and thus improved aesthetic outcome (

Children treated with IO during their first year of life followed a more normal path of phonological development between 2 and 3 years of age.

Children treated with IO during their first year of life produced longer sentences than non-IO children at the ages of 2(1/2) and 3 years. At 6 years of age, both groups presented similar expressive language skills. Hence, IO treatment did not have long-lasting effects on language development.