A task-shifted speech therapy program for cleft palate patients in rural Nepal: Evaluating impact and associated healthcare barriers

Lindeborg, Michael M.; Shakya, Pramila; Pradhan, Bhawani; Kala, Shiba; Gurung, Kabita Bhattarai; Niroula, Suman; Rayamajhi, Badri; Chaudhary, Hema; Gaire, Bhagwati; Mahato, Naina; Rana, Lila; Rokaya, Phana; Shrestha, Nilam; Shrestha, Renuka; Tamang, Januka; Joshi, Hemanta Dhoj; Gaha, Pushpa; Khorja, Dhana Kumari; Nakarmi, Kiran; Mitnick, Carole D.; Man, Shankar; Shaye, David A.

doi:10.1016/j.ijporl.2020.110026

Cited by 13 publications

(29 citation statements)

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“…Findings from this study indicated that task-shifted speech therapy resulted in significant speech improvements, hence contributing to improved postsurgery care. 26 …”

Section: Discussionmentioning

confidence: 99%

Barriers and Resources to Cleft Lip and Palate Speech Services Globally: A Descriptive Study

Baigorri

Crowley

Sommer

et al. 2021

Journal of Craniofacial Surgery

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Background: Although a number of international cleft organizations and cleft professionals in low- and middle-income countries (LMICs) have built and supported comprehensive cleft care and speech therapy models to address the shortage of speech services in LMICs, the specific speech needs of individuals with cleft lip and palate (CLP) in such countries remain unknown. The objective of this study was to evaluate the barriers to accessing speech services for patients with CLP as well as the resources and models of speech services that are currently available for individuals with CLP in LMICs, with the goal of better understanding the needs of this population. Methods: Qualitative and quantitative methods consisted of Smile Train partner surveys that were distributed June 25th to July 31st, 2018 worldwide. Surveys were distributed through Smile Train's online medical database, Smile Train Express, which every Smile Train partner uses to report their Smile Train sponsored treatment outcomes. A total of 658 Smile Train partners responded to the surveys. Respondents included surgeons, speech therapists, orthodontists, administrators and nurses who represented non-governmental organizations, hospitals (private or public), hospital groups, and private clinics. Results: Results indicated that lack of resources, including access to local speech providers and language materials, as well as financial constraints such as patient travel and speech treatment costs, are the most commonly reported barriers to accessing speech services across all geographic regions surveyed. Conclusions: Improving access to CLP speech services in LMICs may require strategies that address lack of speech providers, language materials, and financial constraints.

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“…Findings from this study indicated that task-shifted speech therapy resulted in significant speech improvements, hence contributing to improved postsurgery care. 26 …”

Section: Discussionmentioning

confidence: 99%

Barriers and Resources to Cleft Lip and Palate Speech Services Globally: A Descriptive Study

Baigorri

Crowley

Sommer

et al. 2021

Journal of Craniofacial Surgery

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“…Nineteen studies contributed with IPD on speech production. As a rough overview of these studies, the therapy was implemented in the form of intensive summer camps in three studies (Pamplona et al, 2014(Pamplona et al, , 2017Van Demark & Hardin, 1986), the SLT was implemented in the form of conventional clinical care in four studies (Derakhshandeh et al, 2016;Pamplona & Ysunza, 2018;Roxburgh et al, 2016;Sweeney et al, 2020), the therapy was implemented through an initial short workshop led by SLTs and then carried out by parents or speech assistants over a long duration in nine studies (Dobbelsteyn et al, 2014;Hanchanlert et al, 2015;Makarabhirom et al, 2015;Prathanee, 2011;Prathanee et al, 2014Prathanee et al, , 2020Pumnum et al, 2015;Scherer et al, 2008;Sritacha et al, 2016), and the therapy was very brief in three studies (Alighieri et al, 2019;Lindeborg et al, 2020;Luyten et al, 2016). See Table 1 for a general overview of these studies, and see Table 2 for risk of bias assessment of these studies.…”

Section: Overview Of the Included Studiesmentioning

confidence: 99%

“…In summary, individuals with cleft palate only seem to have a greater chance of achieving this. This model was based on 303 individuals from 18 studies; Lindeborg et al (2020) did not include information on type of cleft and could thus not be included in this analysis. The intercept in this model (in log odds) was −1.59 (95% CI [−2.65, −0.78]), and the regression coefficients (in log odds) were −0.06 (95% CI [−1.18, 0.99]) and 1.01 (95% CI [0.03, 2.03]) for having a bilateral CLP or cleft palate, as compared to unilateral CLP.…”

Section: Overview Of the Included Studiesmentioning

confidence: 99%

“…We do not, however, want to devalue the great impact that many of the interventions in the reviewed studies have had on the quality of life of many participants, especially in areas where SLT or cleft-related interventions are otherwise rare (e.g., Lindeborg et al, 2020;Luyten et al, 2016;Prathanee, 2011). We only would prefer a scenario where we have more systematized data on these effects.…”

Section: Other Outcomesmentioning

confidence: 99%

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On the Benefits of Speech-Language Therapy for Individuals Born With Cleft Palate: A Systematic Review and Meta-Analysis of Individual Participant Data

Sand

Hagberg

Lohmander

2022

J Speech Lang Hear Res

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Purpose: Cleft lip and/or palate (CLP) is a common birth defect, and after reconstructive surgery, about 50% of children at 5 years of age have speech deviations and are referred to speech-language therapy (SLT). The peer-reviewed evidence for the benefit of SLT has been uncertain. Our objective was to systematically review and meta-analytically summarize the benefit of SLT for individuals born with CLP. Method: A systematic search was conducted (last search on February 19, 2021) on studies evaluating SLT with pre and post measures on speech production, language ability, intelligibility, and/or patient-reported outcomes. We sought individual participant data (IPD) and evaluated on an individual level if the outcome measure had improved to a clinically relevant degree during SLT and if the outcome measure was on a level with peers or not after SLT. Meta-analyses and meta-regressions were applied to synthesize IPD across studies. Results: Thirty-four eligible studies were found. Nineteen studies provided IPD ( n = 343) for the main analysis on speech production. The synthesized information suggests that, during SLT, speech production improved to a clinically relevant degree for many individuals (95% CI [61%, 87%]) and that speech production was on a level with peers for some individuals after SLT (95% CI [10%, 34%]). Conclusions: The main strength of this meta-analysis is that we evaluated on an individual level pre- and post-intervention data based on considerations of clinical relevance. This approach allowed us to conclude that many individuals benefit from SLT and that further work on evaluating SLT in this patient group is meaningful. Supplemental Material https://doi.org/10.23641/asha.17700992

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“…Task-shifting of CLP care is an innovative way to increase access in LMICs. Cleft speech therapy, for example, has been effectively task-shifted in Nepal, 12 yet there remain little data on the utility of task-shifting the surgical screening process. 13 Lay people may offer unique opportunities to expand surgical access in LMICs.…”

Section: Discussionmentioning

confidence: 99%

Mobile Surgical Scouts Increase Surgical Access for Patients with Cleft Lip and Palate in Nepal

Shaye

Nakarmi²,

Shakya³

et al. 2022

Facial Plastic Surgery & Aesthetic Medicine

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Background: In Nepal's remote regions, challenging topography prevents patients with cleft lip and palate (CLP) from seeking care. Objective: To measure the effect of a mobile surgical scout program on CLP surgical care in remote regions of Nepal. Methods: Forty-four lay people were trained as mobile surgical scouts and over 5 months traversed remote districts of Nepal on foot to detect and refer CLP patients for surgical care. Surgical patients from remote districts were compared with matched time periods in the year before intervention. Diagnostic accuracy of the surgical scouts was assessed. Findings: Mobile surgical scouts accurately diagnosed (90%) and referred (82%) patients for cleft surgery. Before the intervention, CLP surgeries from remote districts represented 3.5% of cleft surgeries performed. With mobile surgical scouting, patients from remote districts comprised 8.2% of all cleft surgeries ( p = 0.007). When transportation and accompaniment was provided in addition to mobile surgical scouts, patients from remote districts represented 13.5% ( p ≤ 0.001) of all cleft surgeries. Conclusion: Task-shifting the surgical screening process to trained scouts resulted in accurate diagnoses, referrals, and increased access to cleft surgery in remote districts of Nepal.

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A task-shifted speech therapy program for cleft palate patients in rural Nepal: Evaluating impact and associated healthcare barriers

Cited by 13 publications

References 28 publications

Barriers and Resources to Cleft Lip and Palate Speech Services Globally: A Descriptive Study

Barriers and Resources to Cleft Lip and Palate Speech Services Globally: A Descriptive Study

On the Benefits of Speech-Language Therapy for Individuals Born With Cleft Palate: A Systematic Review and Meta-Analysis of Individual Participant Data

Mobile Surgical Scouts Increase Surgical Access for Patients with Cleft Lip and Palate in Nepal

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