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Purpose: The purpose of this article is to apply the principles of evidence-based practice to clinical observation; that is, the highest level of evidence for making decisions about these observations. In addition, a format for reporting and evaluating evidence-based observations (EBOs) is described. Method: Literature relevant to EBOs was reviewed. Results: A framework for reporting and evaluating EBOs was developed, and specific evaluation criteria were identified. The steps identified were the application of EBOs to clinical training and practice, and reporting and evaluating EBOs. Forms for reporting and evaluating observations are provided. Conclusion: Speech-language pathologists should apply the highest level of evidence to make clinical decisions, although there is a gap between the use of research and clinical practice. EBOs should in part reduce this gap. This information may also be useful to other health care professionals. [ABSTRACT FROM AUTHOR]

Speech-language pathologists are often involved in the diagnosis and treatment of velopharyngeal incompetence (VPI). Some speech-language pathologists have extensive educational and clinical experience with VPI; others have limited training and experience. Thus, the quality of speech-language services for people with VPI is heterogenous, and it ranges from poor to excellent. There are, as yet, no specific guidelines for speech-language pathologists providing services to people with VPI. Optimal services require specific guidelines for training and experience. The purpose of this article was to (a) review speech-language pathology standards and qualifications, (b) provide reasons for identifying qualified speech-language pathologists, and (c) identify strategies for reduction of risks involved in the delivery of speech-language services for people with VPI. [ABSTRACT FROM AUTHOR]

Speech and language screening by audiologists is not new, although few audiologists screen speech and language, which should be an integral component of the audiological evaluation. This article considers ASHA's views about speech and language screening by audiologists, screening tests available to audiologists, and the training of audiologists to screen speech and language. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this article is to help speech-language pathologists (SLPs) apply the principles of evidence-based practice (EBP) to nonspeech oral motor treatments (NSOMTs) in order to make valid, evidence-based decisions about NSOMTs and thus determine if they are viable treatment approaches for the management of communication disorders., Method: A detailed description of EBP is provided, including levels of evidence for rating the quality of evidence. NSOMTs are described and a survey of the literature on NSOMTs is provided along with a determination of the level of evidence of each study reported. A systematic literature search was conducted using the electronic databases of MEDLINE and CINAHL (Cumulative Index to Nursing and Allied Health Literature) within an unrestricted time period. In addition, reference lists from identified articles were also reviewed. Ethical and fiscal issues related to EBP and NSOMTs, as well as clinical implications of EBP for the use of NSOMTs, are discussed., Results: A total of 45 articles/reports were published between 1981 and 2006 in peer-reviewed and non-peer-reviewed journals. Most of the sources (25) relied on weak anecdotal evidence and opinions. Moreover, studies that employed stronger designs reported negative results for NSOMTs (i.e., evidence against the use of NSOMTs for modifying speech)., Conclusion: Despite their use for many years and their popularity among some SLPs for the treatment of a wide variety of speech problems in children and adults, NSOMTs are controversial because sufficient evidence does not exist to support their effectiveness in improving speech. Moreover, limited evidence exists for the use of NSOMTs to facilitate nonspeech activities. Therefore, the available evidence does not support the continued use of NSOMTs as a standard treatment and they should be excluded from use as a mainstream treatment until there are further data. SLPs should consider the principles of EBP in making decisions about NSOMTs.

Objective: The purpose of this study was to obtain information about academic and clinical training of speech-language pathology students in cleft palate (CP)., Methods: Representatives of 232 accredited graduate programs in speech-language pathology were invited via e-mail to complete a web-based 32-item questionnaire. Questions focused on the type and nature of courses offered related to CP, availability of clinical practica, and number of hours of clinical experience by students. An item-by-item analysis was conducted and descriptive statistics obtained., Results: A total of 127 (54.7%) of the programs responded. Sixty-seven percent offered coursework exclusively devoted to CP, and for 53% of these it was a required course. For the programs that did not offer an exclusive course on CP, 35% indicated that CP was covered in other courses such as articulation, voice, or anatomy and physiology. Fifty-four percent of the programs offered clinical practica in CP. For these, a median of five students of a median graduate speech-language pathology class of 43 were enrolled in practica involving CP (range = 0-21), and students spent a median of 2 hours in practica involving CP (range = 0-100)., Conclusions: Cleft palate is a complex disorder to which many students have limited exposure and for which more graduate training is unlikely since the 1993 American Speech-Language-Hearing Association (ASHA) certification changes. As a result, there is a need to look towards alternative methods to enhance the educational and clinical experiences of students and practitioners in cleft palate.

Speech and language screening by audiologists is not new, although few audiologists screen speech and language, which should be an integral component of the audiological evaluation. This article considers ASHA's views about speech and language screening by audiologists, screening tests available to audiologists, and the training of audiologists to screen speech and language.

This report is a follow-up to an earlier research project concerning composition and function of self-identified teams listed in the ACP-CFA 1990 Membership-Team Directory. We address the types of responses provided by personnel answering telephones for teams listed in a recent Directory. Sixty of the 228 teams listed in the continental United States were randomly selected and divided into 2 groups of 30 each. One group was telephoned by an ACP-CFA member who is the parent of a patient with cleft palate; the other group was telephoned by a graduate student in speech-language pathology. Data indicate that Directory listing does not assure access to information pertinent to cleft lip, palate, and craniofacial anomalies; different type and manner of responses were made to the 2 callers; and inadequate information was often provided by the personnel who answer the telephones. Implications include the need for more training of personnel in responding to telephone inquiry and cautious use of the directory listings as a resource for referral.

A questionnaire on nasopharyngoscopy was completed by 93 speech-language pathologists randomly selected from the Directory of the American Cleft Palate-Craniofacial Association. Although the majority rated nasopharyngoscopy as important in the assessment of velopharyngeal function, and believed that it should be performed by speech-language pathologists, the majority do not perform nasopharyngoscopic examinations. Moreover, 40% had no academic preparation and 20% had no clinical experience in nasopharyngoscopy. Implications of these findings concerning exposure to nasopharyngoscopy in speech-language pathology graduate training programs and in continuing education programs for practicing speech-language pathologists are discussed.

Families exert a powerful influence upon their members and can be a significant resource in cleft palate treatment. The purposes of this study were to gather information about (1) the characteristics and attitudes of families whose children are treated for cleft palate; (2) the extent to which parents participate in decisions about treatment; and (3) parents' ideas about their participation. A 32-item survey questionnaire was distributed to 75 parents in Florida, Louisiana, Minnesota, and Pennsylvania. Forty-two survey forms (56%) were completed and returned for analysis. The majority of parents (57%) were satisfied with their present involvement in team treatment services; however, 36% wished for more involvement, and 7% wished for less involvement.

To compare the knowledge and experience of medical students in 1989 with that of those surveyed in 1973, a questionnaire about the various aspects of cleft palate was completed by 209 medical students from West Virginia University and the Louisiana State University Medical Center at Shreveport and New Orleans. Results revealed that 1989 students were more familiar with the embryology of cleft palate, racial and gender differences, and intellectual and psychologic issues (p less than .05). In contrast, the 1973 students were more able to define cleft palate, submucous cleft palate, and pharyngeal flap. There was no difference between the two groups of students in the amount of clinical exposure to cleft palate. These findings support the need for greater emphasis on cleft palate at the pre- and postdoctoral levels, as well as within continuing education programs. As part of current programs, the standard of practice of multidisciplinary team management for an individual with cleft palate should be underscored.

Questionnaire data about services and practices of cleft palate-craniofacial teams were obtained from 63 teams in 35 states. Findings indicate the following: (1) research was the least frequently conducted activity, although 73 percent of the teams indicated that they conducted research; and (2) the majority of those responding regarded cinefluoroscopy, endoscopy, perceptual assessment, oral examination, and videoendoscopy as important procedures, yet most patients (90%) seen by these teams did not receive instrumental assessment of velopharyngeal function.

A questionnaire was administered to 108 dental students from West Virginia University to assess their knowledge of cleft palate. Results revealed areas of deficiency in basic knowledge and exposure to clefting. When these data were compared to those from an earlier study (Lass et al., 1973) differences were found of varying type. A comparison between dental and medical students revealed that the basic knowledge of cleft palate and associated problems were not different between the two groups. However, the dental students had done more reading than the medical students and had the topic of cleft palate included in their coursework.

A 16-item questionnaire designed to survey opinions on the management of velopharyngeal insufficiency (VPI) was distributed to all members (N = 296) of the American Cleft Palate Association who were speech-language pathologists. Questionnaires were completed by 173 respondents (58.4 percent). There were differences of opinion among speech-language pathologists on various management issues related to VPI, including the value of instrumental assessment of VPI, the importance of oral examination of velopharyngeal function, and the effectiveness of speech therapy in the treatment of VPI. The implications of these findings for clinical training in VPI are discussed.

The purpose of this paper is to review principles of preventative intervention and their application to communication problems associated with cleft palate. Ten specific suggestions and activities are described.

Seven speech pathologists with expertise in the evaluation of the speech of individuals with cleft palate agreed that the following parameters should be assessed: case history, oral-peripheral mechanism, articulation, and voice quality. From such information and observations the clinician should be in a position to make inferences about velopharyngeal function. If velopharyngeal function is not normal, it is mandatory that additional information about the mechanism be obtained.

Public school personnel were surveyed regarding their perceptions about the effect of a cleft palate on students' behavior and achievement and their needs for in-service training on that topic. Results of the survey suggest that school personnel differ in their view of cleft palate children and their needs for in-service training.

More than 1,200 students, parents, and professionals completed a questionnaire designed to assess knowledge and experience with cleft palate. Professionals knew more about cleft palate and had had more experience with it than either parents or students. Parents, however, knew more about cleft palate and had had more experience with it than had students. There was also an apparent relationship between knowledge and experience because those who knew more about cleft palate had also had more experience and training. The results reemphasize the need for pre-professional and continuing-education programs.

This article reviews purposes and types of diagnostic reports and provides guidelines for report writing. Report writing varies greatly depending upon the examination itself and the clinician's style of reporting. Such variation is acceptable as long as professional standards are maintained. The basic guidelines of report writing are: (1) the organization should provide for easy retrieval of specific information; (2) the terms and categories should be free of ambiguity; and (3) only terms in common use by professional should be used. Lack of uniformity, bad writing, inappropriate terminology, and overstatements are the basic problems of report writing that may be overcome through practice, study of sample reports, and courses in report writing.

In summary, these findings indicate that the general quality of the publications for parents of cleft palate children is probably mediocre and that both parents and speech pathologists tend to agree on assessments to this effect. The publications which appear to be most widely used are not necessarily those which appear to be the best available. Attention needs to be given to the design and content of future parent publications which should probably be written with knowledge of the parents' changing concerns over time. Since parent publications are used by many professionals involved in clef palate habilitation and there is no information about their opinions of the quality of these publications, additional work on this problem is planned for the future.

A questionnaire designed to survey methods of assessing velopharyngeal closure and the extent of training and experience in velopharyngeal assessment was distributed to 256 randomly selected American Cleft Palate Association members. There was a 50% response rate and 94% of those responding were associated with cleft palate teams. Findings included the following: (1) the respondents rely primarily upon the use of listener judgments of spontaneous speech samples, phonological analysis, and lateral view cine/videofluoroscopy; (2) the majority spend thirty minutes or less on an average diagnostic evaluation of velopharyngeal competency; and (3) 45% feel that they are inadequately trained in assessment of velopharyngeal closure.

Several language measures were administered to 103 cleft-palate adults and analyses were carried out with the subjects classified according to type of cleft (cleft palate only, unilateral cleft lip and palate, bilateral cleft lip and palate) and sex. Between-group differences according to cleft type and sex indicate that patients with cleft lip and palate have better speech and language skills than the cleft-palate-only groups. The results of this study also suggest that females have more complete sentence structure than male cleft-lip and palate subjects. Appropriate habilitative measures should continue through later ages until the cleft-palate individuals gain acceptable levels of communication.

This study investigated selected oral language skills and their relationship to speech intelligibility in forty cleft palate and normal adult speakers. Connected speech samples were analyzed to determine spoken language status which included response length, grammar or syntax, and vocabulary size. The subjects were judged for intelligibility by two groups of listeners: sophisticated and unsophisticated. It was concluded: (a) cleft palate speakers used shorter responses and were more consistent in their language usage; (b) there were no significant differnences in syntax and vocabulary; (c) for cleft palate speakers there was a relationship between intelligibility and language measures; (d) unsophisticated listiners were more consisitent in intelligibility judgements, and (e) sophisticated listeners rated cleft palate speakers poorer than unsophisticated listeners.