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The International Classification of Function, Disability and Health-Children and Youth Version (ICY-CY), (WHO, 2007) provides an important framework for the holistic consideration of children with communication disorders such as cleft lip and palate. It allows for understanding the effects of a cleft lip and palate on a child’s ability to communicate in structured and natural contexts, going beyond a focus on body structures and functions in order to examine the ways that environmental and personal factors influence the child. Over the years, a number of researchers have applied the ICF-CY framework to children with communication impairments such as speech sound disorders, language impairments, and stuttering. While there is an emerging body of research and literature on this topic, the ICF-CY does not yet appear to be widely applied clinically to children with cleft lip and palate. The aim of the study was to conduct a comprehensive narrative review of the application of the ICF-CY to children with cleft lip and palate, in order to illustrate its use in this population, to identify research needs, and to make recommendations for clinical application to assessment and intervention and integrating the ICF-CY in cleft palate curricula. A systematic search of the literature was conducted by following a specific search strategy and a systematized selection of publications for review to limit researcher bias. Computer searches of electronic data bases, as well as hand searches, were conducted to identify publications and sources that addressed the ICF-CY or ICF in children with cleft lip and palate. Publications and sources that met the inclusion criteria were selected for review. Each source was summarized according to the author(s) and publication year, and a qualitative description of each was made according to structured review procedures and templates. Applications of the specific ICF-CY components to children with cleft lip and palate were mapped, and recommendations for clinical application and future research were described. It is suggested that the ICF-CY framework should be included in cleft palate curricula to provide future speech-language pathologists with a holistic perspective on children with cleft lip and palate and to extend their thinking about the impact of speech impairment associated with cleft lip and palate. Training to adopt the ICF-CY framework will also facilitate collaborative interdisciplinary care of children with cleft lip and palate. Using the ICF-CY framework in the assessment of children in this population will focus intervention on the ultimate goal of improvement of the child's ability to communicate in natural settings. This narrative review will also serve as the theoretical underpinning for a planned survey of the clinical assessment practices of speech-language pathologists treating children with cleft lip and palate.

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Background & Purpose Approximately 50β of children born with cleft lip and/or palate (CL/P) will need speech and language intervention (Lockhart, 2003). Speech difficulties are related to poorer academic performance, higher risk of retention in younger grades, and greater risk of being bullied or having a low self-esteem (Byrd, 1994; Lockhart, 2003). Since parents are the primary decision makers when it comes to treatment for their child, how closely do parents' perceptions of speech, appearance, and emotional consequences match the perception of their child? This study assessed differences in perceptions between parents and children with CL/P regarding speech, the emotional impact of having a cleft, and quality of life. Methods & Description Twenty parent-child dyads were recruited at a University based cleft palate clinic. The children were between 7 and 17 years of age, with a diagnosis of cleft palate, cleft lip and alveolus, submucous cleft only, or cleft lip and palate. During a routine clinic appointment, the child and a parent/legal guardian completed the VPI Effects of Life Outcome (VELO) Survey. Parents and children completed the VELO Survey separately to facilitate open, unbiased responses, especially regarding sensitive issues such as facial appearance and emotional health. Results Overall, parents and their affected children did not view the child's speech significantly differently. A Wilcoxon signed rank test found that the differences between parent and child responses were not significant (p=0.3979). Gender, age, and cleft type were not found to have statistically significant impact on differences between parent and child scores. The VELO Survey is divided into five main sections. This study identified the subsection relating to speaking in various situations as having a significantly greater parental concern when compared across all VELO subsections. After applying a Bonferroni multiple comparison adjustment to control the type error rate at 0.05 for all five subsections, a statistically significant relationship was found indicating higher parent ratings than their child in this subsection (p=0. 0.0184). Speech-language pathologist ratings showed a statistically significant linear relationship with the child total VELO scores (p=0.0116), and with parent total VELO scores (p=0.0009). This means that a higher score on the VELO by the parent or the child, and a lower SLP rating, both indicate lower severity of impact of the cleft disorder on the child's life. Conclusion While parents, children, and the speech-language pathologist often agreed with each other in their rating how having a cleft affected the child's life, significant differences did exist between some parent-child dyads. These differences have important clinical implications, primarily the importance of including both parents and children in discussions of the impact of the cleft condition and treatment options.

As alterações volumétricas da cavidade oral, nasal e espaço faríngeo após a cirurgia ortognática, têm sido objetivo de muitos estudos, uma vez que, essas alterações dependem da direção e magnitude da movimentação dos segmentos ósseos, porém, poucos são os trabalhos que combinam os diferentes métodos para a avaliação da nasofaringe. O objetivo deste estudo foi correlacionar o espaço aéreo faríngeo em pacientes com fissura labiopalatina, submetidos à cirurgia ortognática com avanço de maxila e/ou recuo de mandíbula, por meio da análise do volume e área seccional mínima utilizando imagens de tomografia computadorizada de feixe cônico e pela rinomanometria anterior modificada (técnica fluxo-pressão) no pré e pós-operatório de um ano da cirurgia ortognática. Desse modo, a amostra foi composta por 41 indivíduos, que foram avaliados no pré-operatório e no pós-operatório, na qual, avaliou-se a área seccional mínima pela rinomanometria anterior modificada expressos em mm2 e pelas imagens de tomografia de feixe cônico, que foram importadas em DICOM e avaliadas pelo software Dolphin Imaging 11.0, obtendo os valores numéricos de volume (V), expressos em cm3, bem como a área seccional mínima, expressa em mm2. Notou-se que, em todas as variáveis, houve aumento médio dos valores no pós-operatório em relação ao pré-operatório. Além disso, notouse uma diferença estatisticamente significante ao comparar os resultados dos volumes e da área seccional mínima da área nasofaríngea no pré e pós-operatório pelo software Dolphin Imaging 11.0 ao aplicar o Teste de Wilcoxon. Observou-se também, o aumento discreto da área nasofaríngea avaliada pela rinomanometria, no préoperatório de 105,9 mm2 para 107,1 mm2 no pós-operatório, mas sem diferença estatisticamente significante com p=0,493 pelo Teste de Wilcoxon. E ao comparar a ASM pela TCFC (ASMD) e pela rinomanometria (notou-se diferença estatística (p= 0,033) pelo Teste de Wilcoxon. Por conseguinte, concluiu-se que, existe diferença estatisticamente significante entre a área seccional mínima obtida da TCFC com a rinomanometria pela técnica de fluxo-pressão. / The volumetric changes of the oral cavity, nasal cavity and pharyngeal space after orthognathic surgery have been the objective of many studies, since these alterations depend on the direction and magnitude of the movement of the bone segments, however, there are few studies that combine the different methods for evaluating the nasopharynx. The objective of this study was to correlate the pharyngeal air space in patients with cleft lip and palate submitted to orthognathic surgery with maxillary advancement and / or mandible retreatment, by means of volume analysis and minimum sectional area using conical beam computed tomography by modified anterior rhinomanometry (flow-pressure technique) in the pre- and postoperative year of orthognathic surgery. Thus, the sample consisted in 41 individuals, which were evaluated preoperatively and postoperatively, in which the minimum sectional area was determined by modified anterior rhinomanometry expressed in mm2 and by conical beam tomography images, which were imported into DICOM and evaluated by Dolphin Imaging 11.0 software, obtaining the numerical values of volume (V), expressed in cm3, as well as the minimum sectional area, expressed in mm2. It was observed that, in all variables, there was an average increase in postoperative values in relation to the preoperative period. In addition, a statistically significant difference was observed when comparing the results of the volumes and the minimum sectional area of the nasopharyngeal area in the pre and postoperative period by the Dolphin Imaging 11.0 software when applying the Wilcoxon Test. It was also observed a discrete increase in the nasopharyngeal area evaluated by rhinomanometry, in the preoperative period from 105.9 mm2 to 107.1 mm2 postoperatively, but without a statistically significant difference with p = 0.493 by the Wilcoxon test. When comparing ASM by CBCT (ASMD) and rhinomanometry (a statistical difference (p = 0.033) was noted by the Wilcoxon test. Therefore, it was concluded that there is a statistically significant difference between the minimum sectional area obtained from the CBCT with rhinomanometry.