Instrumento de rastreio do risco para alterações de fala em crianças com fissura labiopalatina

Abstract

Screening tool to identify children with cleft lip and palate at risk for speech disorders Objectives: To develop and to evaluate screening tool to identify children with cleft lip and palate (CLP) at risk for speech disorder addressing the relationship between clinical factors and aspects of speech production and perception in the first three years of life. Methods: The study involved 3 phases: phase 1 the planning and development of the instrument was done combining a list of clinical factors and a list of speech behaviors. After an initial evaluation of the material, by one Pediatrician and one Speech-Language Pathologist (SLP) experienced with CLP, the lists were combined creating the screening tool to identify children with Cleft Lip and Palate at Risk for Speech Disorder (CLP-RSP). Phase 2 involved the content evaluation of the CLP-RSP by five Pediatricians and three SLPs from the Hospital de Reabilitação de Anomalias Craniofaciais (HRAC), establishing the Content Validity Index (CVI) followed by refinement of the CLP-RSP. Phase 3 included the preliminary assessment of the CLP-RSP effectiveness in corroborating the speech-language pathologist's referrals (follow-up of speech development or speech therapy). Results: The tool developed in this study aims to combine the clinical conditions related to CLP (such as hospitalizations, middle ear conditions, oronasal coupling, for example) with speech behaviors expected during the first three years of life. The content of the material was evaluated by 5 pediatricians and 3 SLPs and, after modifications, the CLP-RSP was created with the purpose of identify what the toddler understands, what the toddler speaks and clinical factors observed during the first three years of life. To better interpret the findings, the items in the CLP-RSP were divided into 6 age groups (0-6months, 7-12months, 13-18months, 19-24months, 25-30months, and 31-36 months) including three behaviors each for speech production and speech perception paired with possible clinical conditions expected at each age group for babies and toddlers with CLP. The content of the CLP-RSP was evaluated positively with a mean Content Validity Index indicating that 87% of the evaluators considered the content of the material very clear while 13% considered it clear. That is, there was no ratings indicating least clear or not clear content. The tool was applied with 18 caregivers establishing its efficacy in corroborating the SLPs referrals for either follow-up of speech development or intervention with speech therapy. Conclusion: In the present study the screening tool to identify children with Cleft Lip and Palate at Risk for Speech Disorder (CLP-RSP) was developed and its content was evaluated by pediatricians and SLPs experts in CLP management, which agreed in its majority, that the proposed material is "very clear". After establishing the tool preliminary efficacy, final refinement was proposed and should be implemented before its use in future studies to validate the screening tool CLP-RSP.