Improving Speech Outcomes in Low- and Middle-Income Countries for Patients Born with Cleft Palate

Summary: This article reviews the research and current practices aimed at building cleft speech therapy capacity in low- and middle-income countries (LMICs), given the paucity of qualified speech-language pathologists with cleft palate expertise. The importance of a successful initial palate repair is emphasized, as well as the more specialized training and skills needed for speech clinicians working with patients requiring secondary procedures. Intensive short-term cleft speech clinics (ISSCs), which incorporate both didactic learning and hands-on clinical experiences, are introduced. Outcomes, advantages, and limitations of ISSCs are discussed. Resources for ongoing support of cleft speech therapy in local languages in LMICs are described, including online classes with accompanying assessments in 5 languages, cleft speech assessment screeners in 30 languages, and cleft therapy word games in almost 40 languages, covering more than 200 different sounds. Recommendations for building capacity for cleft speech therapy are provided, including (1) identifying and addressing factors leading to a greater likelihood of velopharyngeal insufficiency or fistulas after primary palate repair; (2) expanding the use of ISSCs to build capacity in cleft palate speech therapy in LMICs, where more traditional weekly or biweekly therapy sessions are challenging due to long distances between the patient homes and the speech providers; and (3) continuing to create and disseminate speech care courses, trainings, and mentorship opportunities for cleft speech therapy. These recommendations are meant to implement the current research to meet the goal of improving speech outcomes for all children born with cleft palate, especially those born in LMICs.