Pd. Witt et al., SPEECH OUTCOME FOLLOWING PALATOPLASTY IN PRIMARY-SCHOOL CHILDREN - DOLAY PEER OBSERVERS AGREE WITH SPEECH PATHOLOGISTS, Plastic and reconstructive surgery, 98(6), 1996, pp. 958-965
The aim of this study was twofold: (1) to test the ability of normal c
hildren to discriminate the speech of children with repaired cleft pal
ate from the speech of unaffected peers and (2) to compare these naive
assessments of speech acceptability with the sophisticated assessment
s of speech pathologists. The study group (subjects) was composed of 2
1 children of school age (aged 8 to 12 years) who had undergone palato
plasty at a single cleft center and 16 matched controls. The listening
team (student raters) was composed of 20 children who were matched to
the subjects for age, sex, and other variables. Randomized master aud
iotape recordings of the children who had undergone palatoplasty were
presented in blinded fashion and random order to student raters who we
re inexperienced in the evaluation of patients with speech dysfunction
. The same sound recordings were evaluated by an experienced panel of
extramural speech pathologists whose intrarater and interrater reliabi
lities were known; they were not direct care providers. Additionally,
the master tape was presented in blinded fashion and random order to t
he velopharyngeal staff at the cleft center for intramural assessment.
Comparison of these assessment methodologies forms the basis of this
report. Naive raters were insensitive to speech differences in the con
trol and cleft palate groups. Differences in the mean scores for the g
roups never approached statistical significance, and there was adequat
e power to discern a difference of 0.75 on a 7-point scale. Expert rat
ers were sensitive to differences in resonance and intelligibility in
the control and cleft palate groups but not to other aspects of speech
. The expert raters recommended further evaluation of cleft palate pat
ients more often than control patients. Speech pathologists discern di
fferences that the laity does not. Consideration should be given to th
e utilization of untrained listeners to add real-life significance to
clinical speech assessments. Peer group evaluations of speech acceptab
ility may define the morbidity of cleft palate speech in terms that ar
e most relevant to the patients themselves and may safeguard against t
he possibility of offering treatment that may be unnecessary.