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Objective: Evaluate the speech services using a Community-Based Speech Therapy model by trained speech assistants (SAs) on the improvement of articulation in cleft palate children., Material and Method: Seventeen children with repaired cleft palates who lived in Chiang Rai and Phayao provinces were registered to the camp. They received speech therapy with a 4-day intensive camp and five follow-up camps at Chiang Rai's The Young Men's Christian Association (YMCA). Eight speech assistants (SAs) were trained to correct articulation errors with specific modeling by the speech-language pathologists (SLPs). SAs encouraged family members to stimulate their children every day with speech exercise at home. Each camp was covered with a main speech therapy and others supported by the multidisciplinary team, as well as, discussion among SLPs, SAs and the care givers for feedback or difficulties., Results: Results showed a sufficient method for treating persistent speech disorders associated with cleft palate. Perceptual analyses presented significant improvement of misarticulation sounds both word and sentence levels after speech camp (mean difference = 1.5, 95% confidence interval = 0.5-2.5, p-value <0.01; mean difference = 2.5, 95% confidence interval = 1-3, p-value <0.001, respectively)., Conclusion: The Community-Based Speech Therapy model is a valid and efficient method for providing speech therapy in cleft palate children.

Background: Most children with cleft lip and palate have articulation problems because of compensatory articulation disorders from velopharyngeal insufficiency. Theoretically, children should receive speech therapy from a speech and language pathologist (SLP) 1-2 sessions per week. For developing countries, particularly Thailand, most of them cannot reach standard speech services because of limitation of speech services and SLP Networking of a Community-Based Speech Model might be an appropriate way to solve this problem., Objective: To study the effectiveness of a networking of Khon Kaen University (KKU) Community-Based Speech Model, Non Thong Tambon Health Promotion Hospital, Borabue, Maha Sarakham, in decreasing the number of articulation errors for children with CLP., Material and Method: Six children with cleft lip and palate (CLP) who lived in Borabue and the surrounding district, Maha Sarakham, and had medical records in Srinagarind Hospital. They were assessed for pre- and post-articulation errors and provided speech therapy by SLP via teaching on service for speech assistant (SA). Then, children with CLP received speech correction (SC) by SA based on assignment and caregivers practiced home program for a year., Results: Networking of Non Thong Tambon Health Promotion Hospital, Borabue, Maha Sarakham significantly reduce the number of post-articulation errors for 3 children with CLP. There were factors affecting the results in treatment of other children as follows: delayed speech and language development, hypernaslaity, and consistency of SC at local hospital and home., Conclusion: A networking of KKU Community-Based Speech Model, Non Thong Tambon Health Promotion Hospital, Borabue, and Maha Sarakham was a good way to enhance speech therapy in Thailand or other developing countries, where have limitation of speech services or lack of professionals.

Background: Cleft lip and palate (CLP) congenital anomalies have a high prevalence in the Northeast of Thailand. A care team's understand of treatment plan would help to guide the family of patients with CLP to achieve the treatment., Objective: To examine the impact of the empowering volunteer project, established in the northeast Thailand., Material and Method: The Empowering Volunteer project was conducted in 2008 under the Tawanchai Royal Granted project. The patients and family's general information, treatment, the group brainstorming, and satisfaction with the project were analysed., Results: Participants were 12 children with CLP their families and five volunteers with CLP; the participating patients were predominantly females and the mean age was 12.2 years. The treatment comprised of speech training, dental hygiene care, bone graft and orthodontic treatment. Four issues were addressed including: problems in taking care of breast feeding, instructions' needs for care at birth, difficulty in access information and society impact, and needs in having a network of volunteers., Conclusions: Empowering volunteer is important for holistic care of patients with CLP which provides easy access and multiple channels for patients and their families. It should be developed as part of the self-help and family support group, the development of community based team and comprehensive CLP care program.

Background: Prevalence of cleft lip and palate (CLP) is high in Northeast Thailand. Most children with CLP face many problems, particularly compensatory articulation disorders (CAD) beyond surgery while speech services and the number of speech and language pathologists (SLPs) are limited., Objective: To determine the effectiveness of networking of Khon Kaen University (KKU) Community-Based Speech Therapy Model: Kosumphisai Hospital, Kosumphisai District and Maha Sarakham Hospital, Mueang District, Maha Sarakham Province for reduction of the number of articulations errors for children with CLP., Material and Method: Eleven children with CLP were recruited in 3 1-year projects of KKU Community-Based Speech Therapy Model. Articulation tests were formally assessed by qualified language pathologists (SLPs) for baseline and post treatment outcomes. Teachings on services for speech assistants (SAs) were conducted by SLPs. Assigned speech correction (SC) was performed by SAs at home and at local hospitals. Caregivers also gave SC at home 3-4 days a week., Results: Networking of Community-Based Speech Therapy Model signficantly reduced the number of articulation errors for children with CLP in both word and sentence levels (mean difference = 6.91, 95% confidence interval = 4.15-9.67; mean difference = 5.36, 95% confidence interval = 2.99-7.73, respectively)., Conclusion: Networking by Kosumphisai and Maha Sarakham of KKU Community-Based Speech Therapy Model was a valid and efficient method for providing speech services for children with cleft palate and could be extended to any area in Thailand and other developing countries, where have similar contexts.

Background: Cleft lip and cleft palate are the most common craniofacial anomalies affecting approximately 2.49 of every 1,000 children born in North-east of Thailand. Srinagarind Hospital has 100-150 cases of cleft lip each year. Children with cleft lip and palate need surgical procedures as soon as possible. After lip repair the normal recommendation is not using bottle or breast feeding for 2 weeks to avoid tension at the sutured area during sucking and possible cause of wound dehiscence. So this is quite complicated for the parents, and patients feel frustrated, cry, and move their head around, because of hunger which cannot easily be satisfied. Previous research found that sucking does not cause wound dehiscence, but mentioned no detail about severity of cleft., Objective: Primary objective is to compare surgical wound dehiscence between breast feeding/bottle and spoon/syringe feeding after lip repair., Material and Method: This is an experimental study: non-inferiority trials study. The population is the patients with cleft lip who underwent lip repair in Inpatient Department 3C, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University. The study period is during May 2010-February 2013. The total sample size in the present study is 192 participants, 96 cases breast/bottle feeding, 96 cases spoon/syringe feeding. The wound dehiscence rate was analyzed by Z-test. Parents'satisfaction is a qualitative data and was analyzed through content analysis., Results: No statistical significant diference between breast/bottle and spoon/syringe groups (p-value = 0.320, 95% confidence interval -0.031-0.010). Parents were more satisfied to feed children by breast/bottle and patients were more relaxed with breast/bottle feeding., Conclusion: Breast/bottle feeding and syringe/spoon feeding have the same result on the surgical wound. Breast/bottle feeding are not causes of wound dehiscence.

Background: Surgical treatment and speech therapy for people with cleft lip and palate (CLP) in the Lao People's Democratic Republic (Lao PDR) are either limited or not available in some areas. There continue to be patients needing surgical correction for abnormalities but they are past the age when surgery would be appropriate. Moreover, they have not been given speech services or received integrative multidisciplinary diagnosis and treatment., Objective: To explore satisfaction on speech and treatment outcomes, as well as the further treatment needs for CLP in Lao PDR., Material and Method: A literature review was undertaken and a background conducted on the problems of services for CLP in Lao PDR. A questionnaire was then developed to explore the magnitude of effects on speech and treatment outcomes as well as further treatment needs for CLP., Results: Average scoring of children with CLP speech and configuration indicated that they have the least satisfaction with articulation and figure of lips. The majority of caregivers and patients agreed that correction of articulation defects was the aspect of their care most needing further treatment., Conclusion: Satisfaction with speech and treatment outcomes was critical issues in Lao PDR requiring development of an appropriate therapy model for children with CLP.

Background: Surgical treatment can reduces disfigurement for children with cleft lip/palate (CLP); however, most children have persistent speech and language problems especially if speech and language services are not available in underserviced and/or developing regions and countries. Children in such areas cannot reach appropriate and timely speech therapy services., Objective: To establish a speech and language therapy model in Lao People's Democratic Republic (Lao PDR), by combining the principles of Community-Based Rehabilitation (CBR), Primary Health Care (PHC) and institutional medical approaches., Material and Method: Participatory workshops during which a speech and language therapy model would be developed., Results: A speech and language therapy model for children with CLP in Lao PDR was established based upon the existing healthcare system and regional context., Conclusion: A speech and language therapy model should be implemented among children with CLP in Lao PDR as well as other developing countries where there is a paucity of speech and language therapy services.

Objective: To propose a community-based network system and interdisciplinary management for children with cleft lip/ palate, applicable to Thailand and other developing countries., Material and Method: A network was developed for the care of patients with cleft lip/palate by combining primary health care, community-based rehabilitation and institutional expertise (Tawanchai Center), Five workshops were conducted, including: 1) network development for cleft lip-palate care in the new millennium; 2) a multi-center study on the incidence and etiology of oral clefts and associated abnormalities in Northeast Thailand; 3) establishment of a Network for Children with Cleft Lip/Palate care in Northeast Thailand, including: 3.1) Skill development in cleft lip/palate care for parents and family; 3.2) a community-based model for speech disorders for children with cleft lip/palate in developing countries and for holistic nursing care for children with cleft lip/palate in developing countries; and, 4) development of interdisciplinary team system and network for holistic care for community-based quality of life, health promotion, speech and language intervention for Thai cleft lip/palate., Results: A community-based network system model with interdisciplinary care was developed., Conclusion: A community-based network system model with interdisciplinary care can be applied for children with cleft lip/ palate in Thailand and developing countries where there exists a lack of coordinated multidisciplinary services. We plan to implement such a system in the near future.

Objectives: To establish a Community-Based Model for Speech Therapy in Thailand and to implement it., Materials and Method: The development of a Community-Based Model for Speech Therapy was based on the principles of primary healthcare, community-based rehabilitation and institutional sharing. Workshops for speech and language pathologists (SLPs), including "Training for Trainers" and six "Smart Smile & Speech" workshops were held. We held 1) a workshop for training SLPs in how to manage speech and language problems in cleft lip and palate (CLP); 2) a workshop for training healthcare providers who are not speech and language pathologists (para-speech and language pathologists: para-SLPs) how to identify speech, language and hearing problems in CLP and undertake early intervention; and, 3) four speech camps for continuing education via life demonstration and practice., Results: Standard guidelines were produced for SLPs to remedy speech and language disorders in children with CLP in Thailand and para-SLP manuals for speech and language intervention for CLP were developed. Para-SLPs will be better equipped to identify and then provide early intervention for individuals with CLP, as well as to refer children with CLP and complicated speech and language disorders to speech clinics for the further management. Percentage of agreement among SLP, audiologists and para-SLPs ranged 50-93.33 while the Kappa coefficients ranged -0.07 to 0.86., Conclusion: The Community-Based Model for Speech Therapy for Children with CLP was an appropriate approach for coming up with solutions for the lack of speech services for children with CLP in Thailand.