title: The Cleft Care UK study. Part 4: perceptual speech outcomes.
abstract: OBJECTIVE
  To describe the perceptual speech outcomes from the Cleft Care UK (CCUK) study and compare them to the 1998 Clinical Standards Advisory Group (CSAG) audit.
  
  
  METHODS
  A cross-sectional study of 248 children born with complete unilateral cleft lip and palate, between 1 April 2005 and 31 March 2007 who underwent speech assessment.
  
  
  METHODS
  Centre-based specialist speech and language therapists (SLT) took speech audio-video recordings according to nationally agreed guidelines. Two independent listeners undertook the perceptual analysis using the CAPS-A Audit tool. Intra- and inter-rater reliability were tested.
  
  
  RESULTS
  For each speech parameter of intelligibility/distinctiveness, hypernasality, palatal/palatalization, backed to velar/uvular, glottal, weak and nasalized consonants, and nasal realizations, there was strong evidence that speech outcomes were better in the CCUK children compared to CSAG children. The parameters which did not show improvement were nasal emission, nasal turbulence, hyponasality and lateral/lateralization.
  
  
  CONCLUSIONS
  These results suggest that centralization of cleft care into high volume centres has resulted in improvements in UK speech outcomes in five-year-olds with unilateral cleft lip and palate. This may be associated with the development of a specialized workforce. Nevertheless, there still remains a group of children with significant difficulties at school entry.
authors.affiliation: Speech and Language Therapy Department and Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital NHS Foundation Trust, London, UK.
authors.forename: D
authors.initials: D
authors.lastname: Sell
authors.affiliation: Previously South Thames Cleft Service, Guys and St Thomas' NHS Foundation Trust Hospital, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Mildinhall
authors.affiliation: University Hospitals Bristol NHS Trust, Cleft Lip and Palate Team, Bristol, UK.
authors.forename: L
authors.initials: L
authors.lastname: Albery
authors.affiliation: School of Oral and Dental Sciences, University of Bristol, Bristol, UK.
authors.forename: A K
authors.initials: AK
authors.lastname: Wills
authors.affiliation: School of Oral and Dental Sciences, University of Bristol, Bristol, UK.
authors.forename: J R
authors.initials: JR
authors.lastname: Sandy
authors.affiliation: School of Oral and Dental Sciences, University of Bristol, Bristol, UK.|National Institute for Health Research (NIHR) Biomedical Research Unit in Nutrition, Diet and Lifestyle at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK.
authors.forename: A R
authors.initials: AR
authors.lastname: Ness
mesh_terms: D002675:Child, Preschool; D002971:Cleft Lip / Q000145:classification / Q000150:complications*; D002972:Cleft Palate / Q000150:complications*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D015203:Reproducibility of Results; D013060:Speech; D013064:Speech Disorders; D016896:Treatment Outcome
keywords: cleft lip; cleft palate; speech; treatment outcome