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  • 1.
    Billaud Feragen, Kristin
    et al.
    Oslo University Hospital, Norway; Statped Sorost, Norway.
    Semb, Gunvor
    University of Manchester, England; National Hospital Norway, Norway.
    Heliovaara, Arja
    University of Helsinki, Finland.
    Lohmander, Anette
    Karolinska Institute, Sweden.
    Johannessen, Emma Christine
    Statped Sorost, Norway.
    Boysen, Betty Marie
    University of Copenhagen Hospital, Denmark.
    Havstam, Christina
    Sahlgrens University Hospital, Sweden.
    Lundeborg, Inger
    Linköping University, Department of Clinical and Experimental Medicine, Division of Speech language pathology, Audiology and Otorhinolaryngology. Linköping University, Faculty of Medicine and Health Sciences.
    Nyberg, Jill
    Karolinska University Hospital, Sweden.
    Pedersen, Nina-Helen
    Statped Vest, Norway.
    Bogh-Nielsen, Joan
    Cleft Palate Centre, Denmark.
    Eyres, Philip
    University of Manchester, England.
    Bradbury, Eileen
    Private Practice, Manchester, UK.
    Rumsey, Nichola
    University of West England, England.
    Scandcleft randomised trials of primary surgery for unilateral cleft lip and palate: 10. Parental perceptions of appearance and treatment outcomes in their 5-year-old child2017In: Journal of Plastic Surgery and Hand Surgery, ISSN 2000-656X, E-ISSN 2000-6764, Vol. 51, no 1, p. 81-87Article in journal (Refereed)
    Abstract [en]

    Background and aim: Few studies have explored childrens emotional and behavioural reactions to cleft surgery and treatment-related stress. The objective was to investigate parents evaluations of appearance and treatment outcomes in their 5-year-old child with unilateral cleft lip and palate (UCLP), and their perceptions of how their child was coping with treatment, comparing this information with recorded postsurgical complications.Design: Three parallel group randomised clinical trials were undertaken as an international multicentre study by 10 cleft teams in five countries: Denmark, Finland, Sweden, Norway, and the UK.Methods: Three different surgical procedures for primary palatal repair were tested against a common procedure in the total cohort of 448 children born with a non-syndromic UCLP. A total of 356 parents completed the Scandcleft Parent Questionnaire, and 346 parents completed the Cleft Evaluation Profile.Results: The results indicated that the majority of parents were satisfied with cleft-related features of their childs appearance. Further, most children coped well with treatment according to their parents. Nevertheless, 17.5% of the children showed minor or short-term reactions after treatment experiences, and 2% had major or lasting difficulties. There were no significant relationships between parent perceptions of treatment-related problems and the occurrence of post-surgical medical complications.Conclusions: Most parents reported satisfaction with their childs appearance. However, treatment-related problems were described in some children, urging cleft centres to be aware of potential negative emotional and behavioural reactions to treatment in some young children, with a view to preventing the development of more severe treatment-related anxiety.

  • 2.
    Blumenthal, Cecilia
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuroscience. Linköping University, Faculty of Health Sciences.
    Lundeborg Hammarström, Inger
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuroscience. Linköping University, Faculty of Health Sciences.
    LINUS. LINköpingsUnderSökningen: Ett fonologiskt testmaterial från 3 år2014Report (Other academic)
    Abstract [sv]

    När ett barn med misstänkta tal‐ och språkavvikelser kommer till logoped för bedömning är det viktigt att samtliga aspekter av tal och språk beaktas. Under de år som svensk logopedi har vuxit fram, har ett flertal instrument för bedömning av barn tal‐ och språk tagits fram. Ett av dessa, Stora fonemtestet, som skapades i mitten av 1980‐talet, har länge varit det enda vitt spridda testet av barns fonologi i landet. Testet fanns under flera år inte att beställa på förlag, vilket var ett av motiven till arbetet med att ta fram ett nytt fonologiskt bedömningsmaterial. Ett annat var att Enheten för logopedi vid Linköpings universitet sedan 2010 ingår i en större multicenterstudie av avvikande fonologi i olika språk. Inom ramen för detta projekt och genom några magisterarbeten i logopedi har ett nytt fonologiskt bedömningsmaterial, LINUS, skapats. Vår förhoppning är att materialet skall vara ett användbart verktyg för att samla in data vid utredning av tal‐ och språkförmåga hos barn.

  • 3.
    Ericsson, Elisabeth
    et al.
    Örebro University, Sweden .
    Graf, Jonas
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuroscience. Linköping University, Faculty of Health Sciences.
    Lundeborg Hammarström, Inger
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuroscience. Linköping University, Faculty of Health Sciences.
    Hultcrantz, Elisabeth
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuroscience. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology in Linköping.
    Tonsillotomy versus tonsillectomy on young children: 2 year post surgery follow-up2014In: Journal of Otolaryngology - Head & Neck Surgery, ISSN 1916-0216, Vol. 43, article id 26Article in journal (Refereed)
    Abstract [en]

    Objectives: To study the long-term effect of tonsillotomy and tonsillectomy in young children after two years in comparison to the results after six months. Method: Children, age 4-5 with Sleep Disordered Breathing (SDB) and tonsil hyperplasia, were randomized to TE (32) or TT (35). TT was performed ad modum Hultcrantz with radiofrequency technique (Ellman). An adenoidectomy with cold steel was performed in the same session for 80% of cases. The patients were assessed prior to surgery, at six and 24 months postoperatively. Effects of surgery were evaluated clinically, through questionnaire (general health/snoring/ENT-infections), Quality of Life (QoL), survey of pediatric obstructive sleep apnea with OSA-18, and childrens behavior with the Child Behavior Checklist. Results: After two years there was still no difference between the groups with respect to snoring and frequency or severity of upper airway infections. Both TT and TE had resulted in large improvement in short and long term QoL and behavior. Three TT-children and one TE child had been re-operated due to recurrence of obstructive problems, the TE-child and one of the TT-children with adenoidectomy and two of the TT-children with tonsillectomy. Three of the TT-children had tonsil tissue protruding slightly out of the tonsil pouch and twelve TE-children had small tonsil remnants within the tonsil pouches, but with no need for surgery. Conclusion: Younger children have a small risk of symptom-recurrence requiring re-surgery within two years after TT. For the majority, the positive effect on snoring, infections, behavior and quality of life remain and is similar to TE.

  • 4.
    Ericsson, Elisabeth
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Reconstruction Centre, Department of ENT - Head and Neck Surgery UHL.
    Lundeborg, Inger
    Linköping University, Department of Clinical and Experimental Medicine, Speech and Language Pathology . Linköping University, Faculty of Health Sciences.
    Hultcrantz, Elisabeth
    Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Reconstruction Centre, Department of ENT - Head and Neck Surgery UHL.
    Child behavior and quality of life before and after tonsillotomy versus tonsillectomy2009In: International Journal of Pediatric Otorhinolaryngology, ISSN 0165-5876, E-ISSN 1872-8464, Vol. 73, no 9, p. 1254-1262Article in journal (Refereed)
    Abstract [en]

    Objectives: Compare two techniques for pediatric tonsil surgery with respect to postoperative pain and morbidity and changes in sleep behavior, health related quality of life (HRQL) and benefits due to surgery. Methods: 67 children (4.5-5.5 years) with tonsillar hypertrophy and obstructive sleep-disordered breathing with or without recurrent tonsillitis were randomized to either regular tonsillectomy (TE) (n = 32) or intracapsular tonsillectomy/tonsillotomy (TT) (n = 35) with Radiofrequency surgical technique (ellman Int.). Before TT/TE, the parents completed a validated Quality of Life survey of pediatric obstructive sleep apnea, the OSA-18 (Obstructive Sleep Apnea-18) and a standardized assessment of their childrens behavior with the Child Behavior Checklist (CBCL). Six months after surgery, the parents repeated these measurements, and assessed the health related benefits of the surgery using the Glasgow Childrens Benefit Inventory (GCBI). Results: In the TT group, the children recorded less pain from the first day after surgery onwards, used fewer doses of painkillers and were pain-free 3 days earlier than the children in the TE group. Six months after surgery, there were no significant difference between TT and TE with regard to snoring and ENT-infections. The differences in the total scores and in all the individual domains between the initial OSA-18 and post-surgery scores were all significant (P andlt; 0.0001). The improvement in the total problem score measured with CBCL was also significant (P andlt; 0.01) and there was no difference between the TT and TE children. The improvements in all subscores of the GCBI indicated a significant health benefit of both TT and TE. Conclusions: TT with RF-surgery causes less pain and postoperative morbidity than regular TE and has an equal effect on snoring and recurrent infections. Pre-school children with tonsillar hypertrophy and obstructive sleep-disordered breathing all show an impact on HRQL and behavior before surgery and improve dramatically just as much after TT as after TE. Therefore TT would be considered for treatment of small children.

  • 5.
    Ericsson, Elisabeth
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery . Östergötlands Läns Landsting, Reconstruction Centre, Department of ENT - Head and Neck Surgery UHL.
    LundeborgHammarström, Inger
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Speech and Language Pathology .
    Graf, Jonas
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery .
    McAllister, Anita
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Speech and Language Pathology . Östergötlands Läns Landsting, Reconstruction Centre, Department of ENT - Head and Neck Surgery UHL.
    Hultcrantz, Elisabeth
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery . Östergötlands Läns Landsting, Reconstruction Centre, Department of ENT - Head and Neck Surgery UHL.
    Child behavior and quality of life before and after tonsillotomy versus tonsillectomy2008In: International conference in pediatric otorhinolaryngology,2008, 2008, p. 40-40Conference paper (Other academic)
    Abstract [en]

    Introduction: The objective of the present investigation was to compare two techniques for pediatric tonsil surgery with respect to postoperative pain and morbidity and changes in sleep behavior, health related quality of life (HRQL) and benefit due to surgery. Methods: 67 children (4,5-5,5 years) with tonsillar hypertrophy and obstructive sleep related distress with or without recurrent tonsillitis were randomized to either regular tonsillectomy (TE)(n=32) or intracapsular tonsillectomy/tonsillotomy (TT) (n=35) with Radiofrequency surgical technique (Ellman Int) Before TT/TE, the parents completed a validated Quality of Life survey of pediatric obstructive sleep apnea, the OSA18 (Obstructive Sleep Apnea-18) and a standardized assessment of their children-s behavior with the Child Behavior Checklist (CBCL). Six months after surgery, the parents repeated these measurements, and assessed the health related benefits of the surgery using the Glasgow Children´s Benefit Inventory (GCBI). Results: In the TT group, the children recorded less pain from the first day after surgery onwards, used fewer doses of painkillers and were pain-free 3 days earlier than the children in the TE group. Six months after surgery, there was no significant difference between TT and TE with regard to snoring and ENT-infections. The differences were all significant in the total scores and in all the individual domains between the initial OSA-18 and post-surgery scores (p<0.0001). The improvement in the total problem score measured with CBCL was also significant (p<0.01) and there were no differences between the TT and TE children. The improvements in all sub scores of the GCBI indicated a significant health benefit of both TT and TE. Conclusions: TT with RF-surgery is a safe method, which causes less pain and postoperative morbidity than regular TE and has a similar effect on snoring and recurrent infections. Young children with tonsillar hypertrophy and different degrees of obstructive sleep related distress all show an impact on HRQL and behavior. All improve dramatically after a tonsillar operation-improving just as much after TT as after TE. Based on these results, TT should be the first choice for treatment of these small children. Support: Financial support from the Research Council of South East Sweden (FORSS).

  • 6.
    Ericsson, Elisabeth
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Oto-Rhiono-Laryngology and Head & Neck Surgery. Östergötlands Läns Landsting, Reconstruction Centre, Department of ENT - Head and Neck Surgery UHL.
    LundeborgHammarström, Inger
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Speech and Language Pathology.
    Marcusson, Agneta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Dental Clinic. Östergötlands Läns Landsting, Reconstruction Centre, Department of Oral Surgery UHL.
    Mc Allister, Anita
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Speech and Language Pathology. Östergötlands Läns Landsting, Reconstruction Centre, Department of ENT - Head and Neck Surgery UHL.
    Graf, Jonas
    Hultcrantz, Elisabeth
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Oto-Rhiono-Laryngology and Head & Neck Surgery. Östergötlands Läns Landsting, Reconstruction Centre, Department of ENT - Head and Neck Surgery UHL.
    Oralmotorik, artikulation och livskvalitet. Sexmånadersuppföljning efter tonsillotomi respektive tonsillektomi2007In: Rikstämman 2007,2007, 2007, p. 53-53Conference paper (Other academic)
  • 7.
    Graf, Jonas
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery .
    Ericsson, Elisabeth
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery . Östergötlands Läns Landsting, Reconstruction Centre, Department of ENT - Head and Neck Surgery UHL.
    LundeborgHammarström, Inger
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Speech and Language Pathology .
    Hultcrantz, Elisabeth
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery . Östergötlands Läns Landsting, Reconstruction Centre, Department of ENT - Head and Neck Surgery UHL.
    Tonsillotomi på förskolebarn-räcker det?2008In: The Annual General Meeting for the Swedish Society for Medicine,2008, 2008Conference paper (Refereed)
    Abstract [sv]

     Under förskoleålder sker en fysiologisk ökning av den sk Waldeyerska ringen med tillväxt av tonsiller och adenoid som del i utvecklingen av barnets immunförsvar Många barn kan under denna tid debutera med obstruktionsbesvär(snarkning och sömnapné). Traditionellt har tonsillerna och adenoiden genom tonsillektomi och abrasio helt avlägsnats för att komma till rätta med dessa symptom, kirurgi förenad med hög postoperativ smärtnivå. På senare tid har tonsillotomi, dvs partiellt borttagande av tonsillerna, återinförts som en något mer skonsam operationsmetod. Immunsystemetpåverkas möjligtvis inte heller i lika stor omfattning. Frågan är om detta ingrepp är tillfyllest på barn som är i den ålder då tonsillerna fortfarande växer? Syftet med föreliggande studie var att jämföra tonsillotomi med radiofrekvenskirurgi med fullständig tonsillektomi på förskolebarn vad beträffar postoperativ morbiditet och långtidseffekt på snarkning och infektionsnbenägenhet upp till två år efter operation med tonsillektomi. 67 förskolebarn(4-5 år)med symtomgivade tonsillhypertrofi randomiserades till reguljär tonsillektomi(TE) eller tonsillotomi(TT) med radiofrekvensteknik. I de flesta fall utfördes samtidigt abrasio. 6 månader efter operationen svarade alla på frågeformulär och 2 år efter operationen bedömdes de åter av ÖNH-läkare. Snarkningen före, direkt efter operationen och vid tiden för läkarbesöket utvärderades då med VAS TT barnen registrerade lägre smärta från första dagen efter operation och var helt smärtfria 3 dagar tidigare än TE-barnen. Sex månader efter operationen förelåg ingen skillnad på grupperna vad gäller snarkning och infektionsbenägehet. Efter två år hade två av de 34 TT-barnen och ett av de 33 TE-barnen blivit re-opererade pga recidiv av obstruktionsbesvär, TE-barnet med reabrasio. Övriga barn i båda grupperna var i stort sett besvärsfria vad gäller snarkning och ingen ökad infektionsbenägehet noterades hos något barn. VAS före/ två år efter operationen var 8,4/1,3 för TE och 8,5/1,6 för TT. Tre av TT barnen hade tonsillvävnad något utanför tonsillogen och hälften av TE barnen hade små tonsillrester i logerna. Cirka 6 % risk föreligger att ett yngre barn som opereras med tonsillotomi för obstruktionsbesvär behöver göra om operationen inom 2 år. Denna risk bör vägas mot den betydligt lägre postoperativa morbiditeten för tonsillotomi jämfört med tonsillektomi.

  • 8.
    Hengen, Johanna
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Speech language pathology, Audiology and Otorhinolaryngology. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, The Swedish Institute for Disability Research.
    Lundeborg Hammarström, Inger
    Linköping University, Department of Clinical and Experimental Medicine, Division of Speech language pathology, Audiology and Otorhinolaryngology. Linköping University, Faculty of Medicine and Health Sciences.
    Stenfelt, Stefan
    Linköping University, Department of Clinical and Experimental Medicine, Division of Speech language pathology, Audiology and Otorhinolaryngology. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, The Swedish Institute for Disability Research.
    Perceived Voice Quality and Voice-Related Problems Among Older Adults With Hearing Impairments2018In: Journal of Speech, Language and Hearing Research, ISSN 1092-4388, E-ISSN 1558-9102, Vol. 61, no 9, p. 2168-2178Article in journal (Refereed)
    Abstract [en]

    The auditory system helps regulate phonation. A speakers perception of their own voice is likely to be of both emotional and functional significance. Although many investigations have observed deviating voice qualities in individuals who are prelingually deaf or profoundly hearing impaired, less is known regarding how older adults with acquired hearing impairments perceive their own voice and potential voice problems. Purpose: The purpose of this study was to investigate problems relating to phonation and self-perceived voice sound quality in older adults based on hearing ability and the use of hearing aids. Method: This was a cross-sectional study, with 290 participants divided into 3 groups (matched by age and gender): (a) individuals with hearing impairments who did not use hearing aids (n = 110), (b) individuals with hearing impairments who did use hearing aids (n = 110), and (c) individuals with no hearing impairments (n = 70). All participants underwent a pure-tone audiometry exam; completed standardized questionnaires regarding their hearing, voice, and general health; and were recorded speaking in a soundproof room. Results: The hearing aid users surpassed the benchmarks for having a voice disorder on the Voice Handicap Index (VHI; Jacobson et al., 1997) at almost double the rate predicted by the Swedish normative values for their age range, although there was no significant difference in acoustical measures between any of the groups. Both groups with hearing impairments scored significantly higher on the VHI than the control group, indicating more impairment. It remains inconclusive how much hearing loss versus hearing aids separately contribute to the difference in voice problems. The total scores on the Hearing Handicap Inventory for the Elderly (Ventry amp; Weinstein, 1982), in combination with the variables gender and age, explained 21.9% of the variance on the VHI. Perceiving ones own voice as being distorted, dull, or hollow had a strong negative association with a general satisfaction about the sound quality of ones own voice. In addition, groupwise differences in own-voice descriptions suggest that a negative perception of ones voice could be influenced by alterations caused by hearing aid processing. Conclusions: The results indicate that hearing impairments and hearing aids affect several aspects of vocal satisfaction in older adults. A greater understanding of how hearing impairments and hearing aids relate to voice problems may contribute to better voice and hearing care.

  • 9.
    Hultcrantz, Elisabeth
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of ENT - Head and Neck Surgery UHL.
    Ericsson, Elisabeth
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of ENT - Head and Neck Surgery UHL. Östergötlands Läns Landsting, Sinnescentrum, Department of Anaesthesiology and Surgery UHL.
    Hemlin, Claes
    Aleris specialistvård Sabbatsberg, Stockholm.
    Eggertsen, Robert
    Avd. för Samhällsmedicin och folkhälsa/allmänmedicin, Göteborgs Universitet.
    Lundeborg-Hammarström, Inger
    Linköping University, Department of Clinical and Experimental Medicine, Speech and Language Pathology. Linköping University, Faculty of Health Sciences.
    Marcusson, Agneta
    Östergötlands Läns Landsting, Sinnescentrum, Department of Oral Surgery UHL.
    Proczkowska-Björklund, Marie
    Barn- och ungdomspsykiatri, Psykiatriska kliniken, Höglandet Eksjö/Nässjö.
    Stjernquist-Desatnik, Anna
    Öron-näsa-hals-kliniken, Universitetssjukhuset Lund.
    Zettergren-Wijk, Lena
    Avdelningen för tandreglering, Folktandvården Gävleborg AB, Gävle.
    Moa, Gunnar
    Projektledare Nationella medicinska indikationer.
    Törnqvist, Helene
    Projektledare Nationella medicinska indikationer.
    Indikation för tonsillotomi på barn och ungdomar2011Report (Other academic)
  • 10.
    Lohmander, Anette
    et al.
    Karolinska Institute, Sweden; Karolinska University Hospital, Sweden.
    Hagberg, Emilie
    Karolinska Institute, Sweden; Karolinska University Hospital, Sweden; Karolinska University Hospital, Sweden.
    Persson, Christina
    University of Gothenburg, Sweden; Sahlgrens University Hospital, Sweden.
    Willadsen, Elisabeth
    University of Copenhagen, Denmark.
    Lundeborg Hammarström, Inger
    Linköping University, Department of Clinical and Experimental Medicine, Division of Speech language pathology, Audiology and Otorhinolaryngology. Linköping University, Faculty of Medicine and Health Sciences.
    Davies, Julie
    Royal Manchester Childrens Hospital, England.
    Havstam, Christina
    Sahlgrens University Hospital, Sweden.
    Boers, Maria
    University Hospital Copenhagen, Denmark.
    Kisling-Moller, Mia
    Cleft Palate Centre, Denmark.
    Alaluusua, Suvi
    University of Helsinki, Finland.
    Aukner, Ragnhild
    Statped Sorost, Norway.
    Helen Pedersen, Nina
    Statped Vest, Norway.
    Turunen, Leena
    University of Helsinki, Finland.
    Nyberg, Jill
    Karolinska Institute, Sweden; Karolinska University Hospital, Sweden; Karolinska University Hospital, Sweden.
    Validity of auditory perceptual assessment of velopharyngeal function and dysfunction - the VPC-Sum and the VPC-Rate2017In: Clinical Linguistics & Phonetics, ISSN 0269-9206, E-ISSN 1464-5076, Vol. 31, no 7-9, p. 589-597Article in journal (Refereed)
    Abstract [en]

    Overall weighted or composite variables for perceptual auditory estimation of velopharyngeal closure or competence have been used in several studies for evaluation of velopharyngeal function during speech. The aim of the present study was to investigate the validity of a composite score (VPC-Sum) and of auditory perceptual ratings of velopharyngeal competence (VPC-Rate). Available VPC-Sum scores and judgments of associated variables (hypernasality, audible nasal air leakage, weak pressure consonants, and non-oral articulation) from 391 5-year olds with repaired cleft palate (the Scandcleft project) were used to investigate content validity, and 339 of these were compared with an overall judgment of velopharyngeal competence (VPC-Rate) on the same patients by the same listeners. Significant positive correlations were found between the VPC-Sum and each of the associated variables (Cronbachs alpha 0.55-0.87, P amp;lt; 0.001), and a moderately significant positive correlation between VPC-Sum and VPC-Rate (Rho 0.698, P amp;lt; 0.01). The latter classified cases well when VPC-Sum was dichotomized with 67% predicted velopharyngeal competence and 90% velopharyngeal incompetence. The validity of the VPC-Sum was good and the VPC-Rate a good predictor, suggesting possible use of both measures depending on the objective.

  • 11.
    Lohmander, Anette
    et al.
    Karolinska Institute, Sweden; Karolinska University Hospital, Sweden.
    Lundeborg, Inger
    Linköping University, Department of Clinical and Experimental Medicine, Division of Speech language pathology, Audiology and Otorhinolaryngology. Linköping University, Faculty of Medicine and Health Sciences.
    Persson, Christina
    University of Gothenburg, Sweden.
    SVANTE - The Swedish Articulation and Nasality Test - Normative data and a minimum standard set for cross-linguistic comparison2017In: Clinical Linguistics & Phonetics, ISSN 0269-9206, E-ISSN 1464-5076, Vol. 31, no 2, p. 137-154Article in journal (Refereed)
    Abstract [en]

    Normative language-based data are important for comparing speech performances of clinical groups. The Swedish Articulation and Nasality Test (SVANTE) was developed to enable a detailed speech assessment. This studys aim was to present normative data on articulation and nasality in Swedish speakers. Single word production, sentence repetition and connected speech were collected using SVANTE in 443 individuals. Mean (SD) and prevalences in the groups of 3-, 5-, 7-, 10-, 16- and 19-year-olds were calculated from phonetic transcriptions or ordinal rating. For the 3- and 5-year-olds, a consonant inventory was also determined. The mean percent of oral consonants correct ranged from 77% at age 3 to 99% at age 19. At age 5, a mean of 96% was already reached, and the consonant inventory was established except for /s/, /r/, /?/. The norms on the SVANTE, also including a short version, will be useful in the interpretation of speech outcomes.

  • 12.
    Lohmander, Anette
    et al.
    Karolinska Institute, Sweden; Karolinska University Hospital, Sweden.
    Persson, Christina
    University of Gothenburg, Sweden.
    Willadsen, Elisabeth
    University of Copenhagen, Denmark.
    Lundeborg, Inger
    Linköping University, Department of Clinical and Experimental Medicine, Division of Speech language pathology, Audiology and Otorhinolaryngology. Linköping University, Faculty of Medicine and Health Sciences.
    Alaluusua, Suvi
    University of Helsinki, Finland.
    Aukner, Ragnhild
    Statped Sorost, Norway.
    Bau, Anja
    University of Copenhagen Hospital, Denmark.
    Boers, Maria
    University of Copenhagen Hospital, Denmark.
    Bowden, Melanie
    Royal Manchester Childrens Hospital, England.
    Davies, Julie
    Royal Manchester Childrens Hospital, England.
    Emborg, Berit
    Cleft Palate Centre, Denmark.
    Havstam, Christina
    Sahlgrens University Hospital, Sweden.
    Hayden, Christine
    Royal Hospital Sick Children, North Ireland.
    Henningsson, Gunilla
    Karolinska University Hospital, Sweden.
    Holmefjord, Anders
    Statped Vest, Norway.
    Hölttä, Elina
    University of Helsinki, Finland.
    Kisling-Moller, Mia
    Cleft Palate Centre, Denmark.
    Kjoll, Lillian
    Statped Sorost, Norway.
    Lundberg, Maria
    Karolinska University Hospital, Sweden.
    McAleer, Eilish
    Royal Hospital Sick Children, North Ireland.
    Nyberg, Jill
    Karolinska University Hospital, Sweden.
    Paaso, Marjukka
    University of Helsinki, Finland.
    Pedersen, Nina Helen
    Statped Vest, Norway.
    Rasmussen, Therese
    Statped Vest, Norway.
    Reisaeter, Sigvor
    Statped Vest, Norway.
    Sogaard Andersen, Helene
    University of Copenhagen Hospital, Denmark.
    Schoeps, Antje
    University of Copenhagen Hospital, Denmark.
    Tordal, Inger-Beate
    Statped Sorost, Norway.
    Semb, Gunvor
    Statped Sorost, Norway; University of Manchester, England; National Hospital Norway, Norway.
    Scandcleft randomised trials of primary surgery for unilateral cleft lip and palate: 4. Speech outcomes in 5-year-olds - velopharyngeal competency and hypernasality2017In: Journal of Plastic Surgery and Hand Surgery, ISSN 2000-656X, E-ISSN 2000-6764, Vol. 51, no 1, p. 27-37Article in journal (Refereed)
    Abstract [en]

    Background and aim: Adequate velopharyngeal function and speech are main goals in the treatment of cleft palate. The objective was to investigate if there were differences in velopharyngeal competency (VPC) and hypernasality at age 5 years in children with unilateral cleft lip and palate (UCLP) operated on with different surgical methods for primary palatal repair. A secondary aim was to estimate burden of care in terms of received additional secondary surgeries and speech therapy. Design: Three parallel group, randomised clinical trials were undertaken as an international multicentre study by 10 cleft teams in five countries: Denmark, Finland, Sweden, Norway, and the UK. Methods: Three different surgical protocols for primary palatal repair were tested against a common procedure in the total cohort of 448 children born with a non-syndromic UCLP. Speech audio and video recordings of 391 children (136 girls, 255 boys) were available and perceptually analysed. The main outcome measures were VPC and hypernasality from blinded assessments. Results: There were no statistically significant differences between the prevalences in the arms in any of the trials. VPC: Trial 1, A: 58%, B: 61%; Trial 2, A: 57%, C: 54%; Trial 3, A: 35%, D: 51%. No hypernasality: Trial 1, A: 54%, B: 44%; Trial 2, A: 47%, C: 51%; Trial 3, A: 34%, D: 49%. Conclusions: No differences were found regarding VPC and hypernasality at age 5 years after different methods for primary palatal repair. The burden of care in terms of secondary pharyngeal surgeries, number of fistulae, and speech therapy visits differed.

  • 13.
    Lundeborg Hammarström, Inger
    Linköping University, Department of Clinical and Experimental Medicine, Division of Speech language pathology, Audiology and Otorhinolaryngology. Linköping University, Faculty of Medicine and Health Sciences.
    Manual till LINUS 2.0: LINköpingsUnderSökningen 2.0: Ett fonologiskt bedömningsmaterial för barn från 3 år2019Report (Other academic)
    Abstract [sv]

    När ett barn med misstänkta tal- och språkavvikelser kommer till logoped för bedömning är det viktigt att samtliga aspekter av tal och språk beaktas. Under de år som svensk logopedi har vuxit fram, har ett flertal instrument för bedömning av barns tal- och språk tagits fram. Ett av dessa, Stora fonemtestet, som skapades i mitten av 1980-talet, har länge varit det enda vitt spridda testet av barns fonologi i landet. Testet fanns under flera år inte att beställa på förlag, vilket var ett av motiven till arbetet med att ta fram ett nytt fonologiskt bedömningsmaterial. Ett annat var att Enheten för logopedi vid Linköpings universitet sedan 2010 ingår i en större multicenterstudie med syftet att jämföra fonologiska avvikelser hos barn i olika länder. Inom ramen för detta projekt och genom några magisterarbeten i logopedi färdigställdes LINUS 2014. Som en direkt följd av det fortsatta internationella forskningssamarbetet och av feed-back från kollegor som använt materialet i sin kliniska vardag, kommer nu en ny version av materialet, LINUS 2.0. och finns för gratis nedladdning på http://phonodevelopment.sites.olt.ubc.ca/practice-units/swedish/. Vi hoppas att det även fortsatt skall komma till användning vid utredning av tal- och språkförmåga hos barn.

    Linköpings universitet, 2019

    Inger Lundeborg Hammarström

  • 14.
    Lundeborg Hammarström, Inger
    Linköping University, Department of Clinical and Experimental Medicine, Speech and Language Pathology. Linköping University, Faculty of Health Sciences.
    Oral Motor Function, Voice, Speech and Language in Children with Tonsillar Hypertrophy in Relation to Surgical Outcome2010Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The aim of this thesis was two-fold: first, to evaluate four different functional aspects of the speech and language spectrum; oral-motor function, voice, /s/-articulation and phonology in preschool children with tonsillar hypertrophy before and after surgical treatment. The second aim was to investigate weather the outcome of surgery was equal for two surgical techniques; tonsillectomy or tonsillotomy combined with adenoidectomy when necessary. In all included publications (I-IV), 67 children on waiting list for tonsil surgery and randomized to either tonsillectomy (33) or tonsillotomy (34) participated. The children were assessed and audio-recorded within a month before surgery and six months postoperatively. Results were compared to age-matched control groups.

    In the first study, oral motor function was assessed using the Nordic Orofacial Test-Screening, NOT-S, consisting of a structured interview and a clinical examination. Before surgery, the children in the study group differed in all domains of the structured interview in comparison to age-matched controls and in the clinical examination regarding the parameters deviant lip position and trouble nose-breathing. Postoperatively oral motor functions were normalized in both surgical groups and no differences to age matched controls were observed. In study two, recordings of three sustained vowels (/α , u, i/) and 14 words elicited by picture naming were analysed both perceptually and acoustically. Compared to the controls, significant differences were found in the study group preoperatively with higher ratings on Visual Analogue Scales (VAS) for the voice quality parameters “hyponasality” and “compressed/throaty” and also lower for pitch. Significantly higher values on all studied perturbation measures (jitter, shimmer and Noise to Harmonics Ratio) were found. Regarding center frequencies of formants, the study groups had lower F3 values for /u / and also lower F2 and F3 for / i / compared to age-matched controls. After surgery there were no significant differences between the perceptual ratings of voice quality of the two surgical groups and there were no significant differences between the children in the surgical groups and the corresponding controls. The acoustic analyses showed a decrease in all the measures of perturbation for the study group after surgery with a slight difference between the two surgical groups. The children in the tonsillotomy group had higher shimmer value for /u/ and higher NHR for /α/. In comparison to the older controls significantly higher values were found an all perturbation measures and the difference seen regarding formant frequencies for the /i/-sound in comparison to controls still remained. The significantly lower third formant (F3) of the /u/-sound also remained. When comparing pre- versus postoperative results for the surgical group as a whole, a decrease was found on all perturbation measures postoperatively, however the differences were not statistically significant. A significant increase was found in formant 3 for /α/ and /u/ was found.

    The material used in the third study were speech samples containing the /s/-sound and elicited by picture naming and sentence repetition. Before surgery the study group was rated to have more indistinct /s/-sounds than agematched controls. The acoustic analyses showed that the study group had lower spectral peak values for the /s/-sound than controls. After surgery the operated children’s /s/-production did not differ perceptually from the older controls, neither as a whole group nor when divided according to surgical methods. Regarding the acoustic analyses however, the study groups differed from the age-matched control group showing that noise duration was longer and the peak location higher in the study groups.

    In study four, a Swedish phonology test was performed and transcribed phonetically. The transcription of each child was analyzed in terms of phonological processes and categorized into one of six developmental stages according to the model developed by Nettelbladt (1983) and adapted by Sahlén, Reuterskiold-Wagner, Nettelbladt & Radeborg (1999). A majority of the children in the study group (62.7 %) showed a slowed phonological development preoperatively (developmental stages 0-4), compared to the age-matched control group. Postoperatively the children in both surgical groups had improved their phonological skills. However, they were still behind in comparison to age-matched controls and the difference was even larger than before surgery.

    The results of this thesis project have clinical relevance for both speech and language pathologists (SLP’s) and ear-nose and throat-surgeons (ENT-surgeons). SLP’s must be aware of the potential impact of tonsillar hypertrophy on oral-motor function and the speech and language spectrum to be able to help affected children adequately and ENT- surgeons should include oral motor and speech and language problems as additional indications for tonsillar surgery.

    List of papers
    1. Oral motor dysfunction in children with adenotonsillar hypertrophy-effects of surgery
    Open this publication in new window or tab >>Oral motor dysfunction in children with adenotonsillar hypertrophy-effects of surgery
    Show others...
    2009 (English)In: Logopedics, Phoniatrics, Vocology, ISSN 1401-5439, E-ISSN 1651-2022, Vol. 34, no 3, p. 111-116Article in journal (Refereed) Published
    Abstract [en]

    Adenotonsillar hypertrophy is associated with a wide range of problems. The enlargement causes obstructive symptoms and affects different functions such as chewing, swallowing, articulation, and voice. The objective of this study was to assess oral motor function in children with adenotonsillar hypertrophy using Nordic Orofacial Test-Screening (NOT-S) before and 6 months after surgery consisting of adenoidectomy combined with total or partial tonsil removal. A total of 67 children were assigned to either tonsillectomy (n=33) or partial tonsillectomy, 'tonsillotomy' (n=34); 76 controls were assessed with NOT-S and divided into a younger and older age group to match pre- and post-operated children. Most children in the study groups had oral motor problems prior to surgery including snoring, open mouth position, drooling, masticatory, and swallowing problems. Post-surgery oral motor function was equal to controls. Improvement was independent of surgery method.

    Keywords
    Adenotonsillar hypertrophy; children; NOT-S; oral motor function; tonsil surgery
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-51583 (URN)10.1080/14015430903066937 (DOI)19565403 (PubMedID)
    Available from: 2009-11-09 Created: 2009-11-09 Last updated: 2017-12-12
    2. Acoustic and perceptual aspects of vocal function in children with adenotonsillar hypertrophy —effects of surgery
    Open this publication in new window or tab >>Acoustic and perceptual aspects of vocal function in children with adenotonsillar hypertrophy —effects of surgery
    2012 (English)In: Journal of Voice, ISSN 0892-1997, E-ISSN 1873-4588, Vol. 26, no 4, p. 480-487Article in journal (Refereed) Published
    Abstract [en]

    Objective: To evaluate outcome of two types of tonsil surgery (tonsillectomy+adenoidectomy or tonsillotomy +adenoidectomy) on vocal function perceptually and acoustically.

    Study Design: Sixty-seven children, aged 50-65 months, on waiting list for tonsil surgery were randomized to tonsillectomy (n=33) or tonsillotomy (n=34). Fifty-seven age and gender matched healthy pre-school children were controls. Twenty-eight of them, aged 48-59 months, served as control group before surgery, and 29, aged 60-71 months, after surgery

    Methods: Before surgery and six months postoperatively, the children were recorded producing three sustained vowels (/A, u, i/) and 14 words. The control groups were recorded only once.

    Three trained speech and language pathologists performed the perceptual analysis using Visual Analogue Scales (VAS) for eight voice quality parameters. Acoustic analysis from sustained vowels included average fundamental frequency, jitter percent, shimmer percent, noise-to-harmonic ratio and the centre frequencies of formants 1-3

    Results: Before surgery the children were rated to have more hyponasality and compressed/throaty voice (p<0,05) and  lower mean pitch (p<0,01) in comparison to the control group. They also had higher perturbation measures and lower frequencies of the second and third formant. After surgery there were no differences perceptually. Perturbation measures decreased but were still higher compared to the control group’s, p<0, 05. Differences in formant frequencies for /i/ and /u/ remained. No differences were found between the two surgical methods.

    Conclusion: Voice quality is affected perceptually and acoustically by adenotonsillar hypertrophy. After surgery the voice is perceptually normalized but acoustic differences remain. Outcome was equal for both surgical methods.

    Place, publisher, year, edition, pages
    Elsevier, 2012
    Keywords
    Voice quality; children; perceptual and acoustic analyses; tonsil surgery
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-61240 (URN)10.1016/j.jvoice.2010.11.003 (DOI)000305961500018 ()978-91-7393-333-9 (ISBN)
    Available from: 2010-11-08 Created: 2010-11-08 Last updated: 2018-07-03Bibliographically approved
    3. Influence of adenotonsillar hypertrophy on /s/-articulation in children-effects of surgery
    Open this publication in new window or tab >>Influence of adenotonsillar hypertrophy on /s/-articulation in children-effects of surgery
    2011 (English)In: Logopedics, Phoniatrics, Vocology, ISSN 1401-5439, E-ISSN 1651-2022, Vol. 36, no 3, p. 100-108Article in journal (Refereed) Published
    Abstract [en]

    Tonsillar hypertrophy is common in young children and affects several aspects of the speech such as distortions of the dento-alveolar consonants. The study objective was to assess s-articulation, perceptually and acoustically in children with tonsillar hypertrophy and compare effects of two types of surgery, total tonsillectomy and tonsillotomy. Sixty-seven children, 50-65 months, on waiting list for surgery, were randomized to tonsillectomy or tonsillotomy. The speech material was collected pre-operatively and six months post-operatively.  Two groups of age-matched children were controls. /S/-articulation was affected acoustically with lower spectral peak locations and perceptually with less distinct /s/-production before surgery, in comparison to controls.  After surgery /s/-articulation was normalized perceptually, but acoustic differences remained. No significant differences between surgical methods were found.

    Place, publisher, year, edition, pages
    Informa Healthcare, 2011
    Keywords
    child, s-articulation, adeno-tonsillar hypertrophy, perceptual and acoustic evaluations
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-61244 (URN)10.3109/14015439.2010.531047 (DOI)000295479900002 ()
    Available from: 2010-11-08 Created: 2010-11-08 Last updated: 2017-12-12Bibliographically approved
    4. Phonological development in children with obstructive sleep-disordered breathing
    Open this publication in new window or tab >>Phonological development in children with obstructive sleep-disordered breathing
    Show others...
    2009 (English)In: Clinical Linguistics & Phonetics, ISSN 0269-9206, E-ISSN 1464-5076, Vol. 23, no 10, p. 751-61Article in journal (Refereed) Published
    Abstract [en]

    Adeno-tonsillar hypertrophy with obstructive sleep disordered breathing (OSDB) is known to affect oral-motor function, behaviour, and academic performance. Adeno-tonsillectomy is the most frequently performed operation in children, with total tonsillectomy (TE) being more common than partial resection, 'tonsillotomy' (TT). In the present study 67 children, aged 50-65 months, with OSBD were randomized to TE or TT. The children's phonology was assessed pre-operatively and 6 months post-operatively. Two groups of children served as controls. Phonology was affected in 62.7% of OSBD children before surgery, compared to 34% in the control group (p < .001). Also, OSBD children had more severe phonological deficits than the controls (p < .001). Phonology improved 6 months equally after both surgeries. Despite improvement post-operatively, the gap to the controls increased. Other functional aspects, such as oral motor function, were normalized regardless of surgical method--TE or TT. The impact of OSBD should be considered as one contributing factor in phonological impairment.

    Keywords
    Child, phonological disorders, obstructive sleep-disordered breathing, tonsil surgery
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-51582 (URN)10.3109/02699200903144770 (DOI)19883185 (PubMedID)
    Available from: 2009-11-09 Created: 2009-11-09 Last updated: 2017-12-12
  • 15.
    Lundeborg Hammarström, Inger
    Linköping University, Department of Clinical and Experimental Medicine, Division of Speech language pathology, Audiology and Otorhinolaryngology. Linköping University, Faculty of Medicine and Health Sciences.
    Word-initial /r/-clusters in Swedish speaking children with typical versus protracted phonological development2018In: Clinical Linguistics & Phonetics, ISSN 0269-9206, E-ISSN 1464-5076, Vol. 32, no 5-6, p. 446-458Article in journal (Refereed)
    Abstract [en]

    The present study investigated word-initial (WI) /r/-clusters in Central Swedish-speaking children with and without protracted phonological development (PPD). Data for WI singleton /r/ and singleton and cluster /l/ served as comparisons. Participants were twelve 4-year-olds with PPD and twelve age- and gender-matched typically developing (TD) controls. Native speakers audio-recorded and transcribed 109 target single words using a Swedish phonology test with 12 WI C+/r/-clusters and three WI CC+/r/-clusters. The results showed significantly higher match scores for the TD children, a lower match proportion for the /r/ targets and for singletons compared with clusters, and differences in mismatch patterns between the groups. There were no matches for /r/-cluster targets in the PPD group, with all children except two in that group showing deletions for both /r/-cluster types. The differences in mismatch proportions and types between the PPD group and controls suggests new directions for future clinical practice.

  • 16.
    Lundeborg Hammarström, Inger
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Speech and Language Pathology.
    Ericsson, Elisabeth
    Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of ENT - Head and Neck Surgery UHL.
    Hultcrantz, Elisabeth
    Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of ENT - Head and Neck Surgery UHL.
    McAllister, Anita
    Linköping University, Department of Clinical and Experimental Medicine, Speech and Language Pathology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Reconstruction Centre. Östergötlands Läns Landsting, Sinnescentrum, Department of ENT - Head and Neck Surgery UHL.
    Influence of adenotonsillar hypertrophy on /s/-articulation in children-effects of surgery2011In: Logopedics, Phoniatrics, Vocology, ISSN 1401-5439, E-ISSN 1651-2022, Vol. 36, no 3, p. 100-108Article in journal (Refereed)
    Abstract [en]

    Tonsillar hypertrophy is common in young children and affects several aspects of the speech such as distortions of the dento-alveolar consonants. The study objective was to assess s-articulation, perceptually and acoustically in children with tonsillar hypertrophy and compare effects of two types of surgery, total tonsillectomy and tonsillotomy. Sixty-seven children, 50-65 months, on waiting list for surgery, were randomized to tonsillectomy or tonsillotomy. The speech material was collected pre-operatively and six months post-operatively.  Two groups of age-matched children were controls. /S/-articulation was affected acoustically with lower spectral peak locations and perceptually with less distinct /s/-production before surgery, in comparison to controls.  After surgery /s/-articulation was normalized perceptually, but acoustic differences remained. No significant differences between surgical methods were found.

  • 17.
    Lundeborg Hammarström, Inger
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Hultcrantz, Elisabeth
    Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of ENT - Head and Neck Surgery UHL.
    Ericsson, Elisabeth
    Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of ENT - Head and Neck Surgery UHL.
    McAllister, Anita
    Linköping University, Department of Clinical and Experimental Medicine, Speech and Language Pathology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of ENT - Head and Neck Surgery UHL.
    Acoustic and perceptual aspects of vocal function in children with adenotonsillar hypertrophy —effects of surgery2012In: Journal of Voice, ISSN 0892-1997, E-ISSN 1873-4588, Vol. 26, no 4, p. 480-487Article in journal (Refereed)
    Abstract [en]

    Objective: To evaluate outcome of two types of tonsil surgery (tonsillectomy+adenoidectomy or tonsillotomy +adenoidectomy) on vocal function perceptually and acoustically.

    Study Design: Sixty-seven children, aged 50-65 months, on waiting list for tonsil surgery were randomized to tonsillectomy (n=33) or tonsillotomy (n=34). Fifty-seven age and gender matched healthy pre-school children were controls. Twenty-eight of them, aged 48-59 months, served as control group before surgery, and 29, aged 60-71 months, after surgery

    Methods: Before surgery and six months postoperatively, the children were recorded producing three sustained vowels (/A, u, i/) and 14 words. The control groups were recorded only once.

    Three trained speech and language pathologists performed the perceptual analysis using Visual Analogue Scales (VAS) for eight voice quality parameters. Acoustic analysis from sustained vowels included average fundamental frequency, jitter percent, shimmer percent, noise-to-harmonic ratio and the centre frequencies of formants 1-3

    Results: Before surgery the children were rated to have more hyponasality and compressed/throaty voice (p<0,05) and  lower mean pitch (p<0,01) in comparison to the control group. They also had higher perturbation measures and lower frequencies of the second and third formant. After surgery there were no differences perceptually. Perturbation measures decreased but were still higher compared to the control group’s, p<0, 05. Differences in formant frequencies for /i/ and /u/ remained. No differences were found between the two surgical methods.

    Conclusion: Voice quality is affected perceptually and acoustically by adenotonsillar hypertrophy. After surgery the voice is perceptually normalized but acoustic differences remain. Outcome was equal for both surgical methods.

  • 18.
    Lundeborg Hammarström, Inger
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Speech and Language Pathology. Linköping University, Faculty of Health Sciences.
    Larsson, Maria
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Wiman, Sara
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    McAllister, Anita
    Linköping University, Department of Clinical and Experimental Medicine, Speech and Language Pathology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology in Linköping.
    Voice onset time in Swedish children and adults2012In: Logopedics, Phoniatrics, Vocology, ISSN 1401-5439, E-ISSN 1651-2022, Vol. 37, no 3, p. 117-122Article in journal (Refereed)
    Abstract [en]

    Voice onset time (VOT) is a temporal acoustic parameter, which reflects the timing of speech motor control. The objective of the work was to obtain normative VOT data in Swedish children. Thus, 150 children aged 8-11 years old and 36 adults were audio-recorded when producing the plosives in minimal pairs. Measures were made using waveforms and spectro-grams. Results show that Swedish children developed adult-like VOT values between 9 and 10 years. By the age of 10 years prevoicing was also found to be completely adultlike in length. The results indicate that all Swedish adults do not produce voiced plosives with prevoicing. No evident gender differences were found. The obtained VOT values can be used as normative data when assessing children with speech and language disorders.

  • 19.
    Lundeborg Hammarström, Inger
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    McAllister, Anita
    Division of Speech and Language Pathology, Karolinska institutet, Stockholm.
    Oral sensorimotor function in typically developing children 3 to 8 years old as assessed by the Nordic orofacial test, NOT-S2014In: Journal of medical speech-language pathology, ISSN 1065-1438, Vol. 21, no 1, p. 51-59Article in journal (Refereed)
    Abstract [en]

    Background: Oral senorimotor development is the basis for several vital functions for the child, hence orofacial dysfunction may be severely disabling. Recently, a comprehensive screening instrument assessing different aspects of orofacial function in adults and children age three and up was developed, the Nordic Orofacial Test-Screening (NOT-S). The aim of the present study was to establish developmental profiles of orofacial function for children 3 to 7:11 years old using NOT-S methods: A total of 231  typically developing children 3:0 to 7:11 years old were included. Data were compiled from previous investigations. Comparisons across ages and gender were made.

    Results: The total NOT-S score was below two for 58% (133) of all children in the study.There was a clear trend of lower total NOT-S score with  increased age according to a best linear fit regression, R2= .81, p = .014. The number of children without any score on NOT-S increases dramatically for the seven-year-old children, 44% compared to 20% or lower for the other age groups. Boys had statistically significant higher scores than girls on the total NOT-S score and also for the clinical examination according to a Mann-Whitney U-test, p<.000 for both cases.

  • 20.
    Lundeborg Hammarström, Inger
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Nordin, Elin
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Zeipel-Stjerna, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Mcallister, Anita
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Karolinska Institute, Sweden.
    Voice onset time in Swedish children with phonological impairment2015In: Logopedics, Phoniatrics, Vocology, ISSN 1401-5439, E-ISSN 1651-2022, Vol. 40, no 4, p. 149-155Article in journal (Refereed)
    Abstract [en]

    Mastering spatial and temporal co-ordination in speech production is a challenge for children. Voice onset time (VOT) reflects timing in speech. The objective was to study VOT in Swedish children with a diagnosed phonological impairment and compare results with normative data. Thus 38 children, aged 4-11 years, in three age-groups were audio-recorded when producing minimal pairs with the plosives /p b t d k g/. Waveforms and spectrograms were analysed. Results show that children with phonological impairment produced plosives with deviant VOT values and greater variability compared to normative data. No developmental trend was seen with increasing age. Also, no relationship was found between VOT values and degree of impairment measured by percentage phonemes correct. Furthermore no relation was found between number of errors on auditory discrimination of nine minimal pairs with the different plosives and number of deviant VOT. Findings were interpreted as displaying motor co-ordination difficulties.

  • 21.
    Lundeborg Hammarström, Inger
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Speech language pathology, Audiology and Otorhinolaryngology. Linköping University, Faculty of Medicine and Health Sciences.
    Svensson, Rose-Marie
    Uppsala Univ, Sweden.
    Myrberg, Karin
    Linköping University, Department of Clinical and Experimental Medicine, Division of Speech language pathology, Audiology and Otorhinolaryngology. Linköping University, Faculty of Medicine and Health Sciences. Uppsala Univ, Sweden.
    A shift of treatment approach in speech language pathology services for children with speech sound disorders - a single case study of an intense intervention based on non-linear phonology and motor-learning principles2019In: Clinical Linguistics & Phonetics, ISSN 0269-9206, E-ISSN 1464-5076, Vol. 33, no 6, p. 518-531Article in journal (Refereed)
    Abstract [en]

    Even though there are documented benefits of direct intensive intervention for children with speech sound disorders (SSDs), the intensity given at Swedish Speech Language Pathology services rarely exceeds once a week. Also, indirect therapy approaches are commonly employed. The purpose of the present case study was to investigate the effects of an intensive specialist therapy, based on non-linear phonological analysis and motor learning principles. The participant was a boy aged 4:10 years with severe SSD, who previously had received indirect therapy from age 3 with, very limited results. A single subject ABA design was used. At baseline, whole word match was 0%, Word shape CV match was 39% and PCC was 22, 7%. He had no multisyllabic words, no consonant clusters and no established coronals. Intervention was given 4 days weekly for 3 weeks in two periods with a 7-week intervening break and a post therapy assessments. Therapy was focused on establishing multisyllabic words, iambic stress pattern, clusters and coronals with the principle of using already established elements for targeting new elements. At post therapy assessment, whole word match was 39%, word shape CV match was 71% and PCC 69.1%. Multisyllabic words (86%), coronals (82%) and word initial clusters (80%) were established. Without being targeted, back vowels were also present and segment timing improved. The strong treatment effects of this study demonstrate that at least severe cases of SSD require the clinical knowledge and skills that only a SLP can provide and that frequent direct therapy is both beneficial and needed.

  • 22.
    Lundeborg, Inger
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Speech and Language Pathology. Linköping University, Faculty of Health Sciences.
    Ericsson, Elisabeth
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of ENT - Head and Neck Surgery UHL. Östergötlands Läns Landsting, Sinnescentrum, Department of Anaesthesiology and Surgery UHL.
    Different techniques of pediatric tonsil surgery - Effects on oral motor function, speech and language behavior and quality of life2011Conference paper (Refereed)
  • 23.
    Lundeborg, Inger
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Speech and Language Pathology . Linköping University, Faculty of Health Sciences.
    McAllister, Anita
    Linköping University, Department of Clinical and Experimental Medicine, Speech and Language Pathology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Reconstruction Centre, Department of ENT - Head and Neck Surgery UHL.
    Treatment with a combination of intra-oral sensory stimulation and electropalatography in a child with severe developmental dyspraxia2007In: Logopedics, Phoniatrics, Vocology, ISSN 1401-5439, E-ISSN 1651-2022, Vol. 32, no 2, p. 71-9Article in journal (Refereed)
    Abstract [en]

    This paper describes the use of a combination of intra-oral sensory stimulation and electropalatography (EPG) in the treatment of a case with severe developmental verbal dyspraxia. A multiple-baseline design was used. The treatment duration was 11 months and started when the subject was 5 years old. The efficacy of the treatment was assessed by calculations of percentage of correctly articulated words, percentage of consonants correct, percentage of phonemes correct and percentage of words correct. Intelligibility assessments were conducted by both naïve and expert listeners. The experts also assessed visual deviances in articulatory gestures from video recordings. Qualitative analysis of EPG data was made. The subject's speech was significantly improved by the treatment in all aspects. The results and their generalization to other cases of developmental verbal dyspraxia are discussed.

  • 24.
    Lundeborg, Inger
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Speech and Language Pathology . Linköping University, Faculty of Health Sciences.
    McAllister, Anita
    Linköping University, Department of Clinical and Experimental Medicine, Speech and Language Pathology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Reconstruction Centre, Department of ENT - Head and Neck Surgery UHL.
    Graf, Jonas
    Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery . Linköping University, Faculty of Health Sciences.
    Ericsson, Elisabeth
    Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Reconstruction Centre, Department of ENT - Head and Neck Surgery UHL.
    Hultcrantz, Elisabeth
    Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Reconstruction Centre, Department of ENT - Head and Neck Surgery UHL.
    Oral motor dysfunction in children with adenotonsillar hypertrophy-effects of surgery2009In: Logopedics, Phoniatrics, Vocology, ISSN 1401-5439, E-ISSN 1651-2022, Vol. 34, no 3, p. 111-116Article in journal (Refereed)
    Abstract [en]

    Adenotonsillar hypertrophy is associated with a wide range of problems. The enlargement causes obstructive symptoms and affects different functions such as chewing, swallowing, articulation, and voice. The objective of this study was to assess oral motor function in children with adenotonsillar hypertrophy using Nordic Orofacial Test-Screening (NOT-S) before and 6 months after surgery consisting of adenoidectomy combined with total or partial tonsil removal. A total of 67 children were assigned to either tonsillectomy (n=33) or partial tonsillectomy, 'tonsillotomy' (n=34); 76 controls were assessed with NOT-S and divided into a younger and older age group to match pre- and post-operated children. Most children in the study groups had oral motor problems prior to surgery including snoring, open mouth position, drooling, masticatory, and swallowing problems. Post-surgery oral motor function was equal to controls. Improvement was independent of surgery method.

  • 25.
    Lundeborg, Inger
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Speech and Language Pathology . Linköping University, Faculty of Health Sciences.
    McAllister, Anita
    Linköping University, Department of Clinical and Experimental Medicine, Speech and Language Pathology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Reconstruction Centre, Department of ENT - Head and Neck Surgery UHL.
    Samuelsson, Christina
    Linköping University, Department of Clinical and Experimental Medicine, Speech and Language Pathology . Linköping University, Faculty of Health Sciences.
    Ericsson, Elisabeth
    Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Reconstruction Centre, Department of ENT - Head and Neck Surgery UHL.
    Hultcrantz, Elisabeth
    Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Reconstruction Centre, Department of ENT - Head and Neck Surgery UHL.
    Phonological development in children with obstructive sleep-disordered breathing2009In: Clinical Linguistics & Phonetics, ISSN 0269-9206, E-ISSN 1464-5076, Vol. 23, no 10, p. 751-61Article in journal (Refereed)
    Abstract [en]

    Adeno-tonsillar hypertrophy with obstructive sleep disordered breathing (OSDB) is known to affect oral-motor function, behaviour, and academic performance. Adeno-tonsillectomy is the most frequently performed operation in children, with total tonsillectomy (TE) being more common than partial resection, 'tonsillotomy' (TT). In the present study 67 children, aged 50-65 months, with OSBD were randomized to TE or TT. The children's phonology was assessed pre-operatively and 6 months post-operatively. Two groups of children served as controls. Phonology was affected in 62.7% of OSBD children before surgery, compared to 34% in the control group (p < .001). Also, OSBD children had more severe phonological deficits than the controls (p < .001). Phonology improved 6 months equally after both surgeries. Despite improvement post-operatively, the gap to the controls increased. Other functional aspects, such as oral motor function, were normalized regardless of surgical method--TE or TT. The impact of OSBD should be considered as one contributing factor in phonological impairment.

  • 26.
    LundeborgHammarström, Inger
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Speech and Language Pathology .
    Ericsson, Elisabeth
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery . Östergötlands Läns Landsting, Reconstruction Centre, Department of ENT - Head and Neck Surgery UHL.
    McAllister, Anita
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Speech and Language Pathology . Östergötlands Läns Landsting, Reconstruction Centre, Department of ENT - Head and Neck Surgery UHL.
    Hultcrantz, Elisabeth
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery . Östergötlands Läns Landsting, Reconstruction Centre, Department of ENT - Head and Neck Surgery UHL.
    Effects of tonsil surgery on speech and oral motor function2008In: The 12th Congress of the International Clinical Phonetics and Linguistics association,2008, 2008, p. 119-119Conference paper (Refereed)
    Abstract [en]

     Large tonsils decrease the upper airways and cause oral breathing in children. If oral breathing persists, it leads to muscular and postural alterations, which, in turn cause dentoskeletal changes. In Sweden 6% of all children, have tonsil surgery performed. The indications are usually recurrent tonsillitis or severe snoring and/or sleep apneoa. Oral motor dysfunction including swallowing problems , disordered speech and aberrant dentofacial growth are less recognized problems as indications for treatment. We report results from a project aiming at comparing oral motor function and speech in children trated with two different surgical methods, tonsillectomy (TE) and partial tonsil resection, tonsillotomy (TT). 67 children aged 4-5 years old on ordinary waiting list for tonsil surgery were randomized to either TE or TT. They were assessed with the Swedish version of Nordic Orofacial Test (NOT-S) and a Swedish phonological test. A voice recording was also made. The assessment was repeated 6 months after surgery. The results were compared to a control group without tonsil problems. No significant differences were found between the children operated with TE or TT. Both groups performed significantly better on the oral motor test at the postoperative assessment, and voice quality had improved. However, compared to the control group, the children with enlarged tonsils had a delay in phonological development, preoperatively that remained at the 6-month postoperative control   

  • 27.
    McAllister, Anita
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuroscience. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology in Linköping.
    Aanstoot, Janna
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuroscience. Linköping University, Faculty of Health Sciences.
    Lundeborg Hammarström, Inger
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuroscience. Linköping University, Faculty of Health Sciences.
    Samuelsson, Christina
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuroscience. Linköping University, Faculty of Health Sciences.
    Johannesson, Eva
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Sandström, Karin
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Berglind, Ulrika
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Learning in the tutorial group: A balance between individual freedom and institutional control2014In: Clinical Linguistics & Phonetics, ISSN 0269-9206, E-ISSN 1464-5076, Vol. 28, no 1-2, p. 47-59Article in journal (Refereed)
    Abstract [en]

    The study investigates factors in problem-based learning tutorial groups which promote or inhibit learning. The informants were tutors and students from speech-language pathology and physiotherapy programmes. Semi-structured focus-group interviews and individual interviews were used. Results revealed three themes: Responsibility, Time and Support. Under responsibility, the delicate balance between individual and institutional responsibility and control was shown. Time included short and long-term perspectives on learning. Under support, supporting documents, activities and personnel resources were mentioned. In summary, an increased control by the program and tutors decreases students motivation to assume responsibility for learning. Support in tutorial groups needs to adapt to student progression and to be well aligned to tutorial work to have the intended effect. A lifelong learning perspective may help students develop a meta-awareness regarding learning that could make tutorial work more meaningful.

  • 28.
    McAllister, Anita
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Speech and Language Pathology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of ENT - Head and Neck Surgery UHL.
    Ferreira, Janna
    Linköping University, Department of Clinical and Experimental Medicine, Speech and Language Pathology. Linköping University, Faculty of Health Sciences.
    LundeborgHammarström, Inger
    Linköping University, Department of Clinical and Experimental Medicine, Speech and Language Pathology. Linköping University, Faculty of Health Sciences.
    Samuelsson, Christina
    Linköping University, Department of Clinical and Experimental Medicine, Speech and Language Pathology. Linköping University, Faculty of Health Sciences.
    Johannesson, Eva
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Sandström, Karin
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Rehabilitation Medicine.
    Berglind, Ulrika
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Learning in the tutorial group – a challenge between freedom and control2011In: The Third International Conference on Problem Based Learning in Speech Language Pathology and Audiology / [ed] Tara Whitehill & Susan Bridges, Hong Kong: University of Hong Kong , 2011Conference paper (Refereed)
    Abstract [en]

    Introduction: In order to improve and clarify the demands within tutorial groups in the speech and language pathology (SLP) and physiotherapy (PT) programs a joint study was conducted exploring problem areas in the tutorial groups.

    The aim was to investigate and further develop the requirements for a passing grade in the tutorial group. A long term goal was that the results could form a base for future changes regarding instructions and requirements in tutorial groups.

    Methodology:  Focus-group interviews were used to collect data. Three different groups were interviewed, two consisting of tutors from the SLP and PT programs and one consisting of last year student tutors from the SLP-program.  This data was also augmented by individual interviews of four SLP-students and five PT-students on different levels in the education.  A semi structured interview guide was used.  The interviews were analyzed using content analyses.

    Results: The analyses revealed three important themes for work in tutorial groups: Responsibility, Time and Support. Within these themes, several categories were also identified. Responsibility: Within this theme the main category was the importance of balance between individual and institutional responsibility. The students, the tutorial group, the tutor and the program all need to assume their part of the responsibility in order to clarify requirements. Time: Here different aspects of time management and work in the tutorial group were identified. These categories also related to aspects of support and continuous or lifelong learning. Support: Within this theme different support functions were identified such as documents, activities and personnel resources in the tutorial groups.  No suggestions were made in the interviews regarding the requirements for a passing grade in the tutorial groups. 

    Discussion/Conclusion: The main finding was the delicate balance between institutional control and the students own responsibility for the work within the tutorial groups.  An increased control decreases the students’ motivation to assume responsibility for their own learning. Also, study programs should adapt requirements in tutorial groups depending on years in the education.  Different support functions need to be closely coupled to tutorial work in order to have the intended effect.   

  • 29.
    Samuelsson, Christina
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Lundeborg Hammarström, Inger
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Plejert, Charlotta
    Linköping University, Department of Culture and Communication, Language and Culture. Linköping University, Faculty of Arts and Sciences.
    Video Recording as a Tool for Assessing Children’s Everyday Use of Features Targeted in Phonological Intervention2016In: Journal of Interactional Research in Communication Disorders/Equinox, ISSN 2040-5111, E-ISSN 2040-512X, Vol. 7, no 1, p. 27-48Article in journal (Refereed)
    Abstract [en]

    The last decades, speech and language pathology services have been subject to changes, and there has been a growing demand for intervention activities to be effective and evidence-based. The aim of the present study was to investigate if and how video recording can be used to assess the use of features targeted in phonological intervention, in everyday talk by children with LI. Three five-year-old girls with phonological problems participated in the study, and data consist of video recordings of intervention sessions and of interaction at home. Three different paths of development were identified: Some targeted speech sounds are displayed in everyday interaction; Targeted speech sound is present in intervention-like activity; No displays of targeted sounds. The results of the present study clearly demonstrate that the use of video recordings, transcriptions and analysis of interaction outside of the clinical setting contribute important information that may guide planning, goal-setting and evaluation of intervention.

  • 30.
    Samuelsson, Christina
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Speech and Language Pathology. Linköping University, Faculty of Health Sciences.
    Lundeborg, Inger
    Linköping University, Department of Clinical and Experimental Medicine, Speech and Language Pathology. Linköping University, Faculty of Health Sciences.
    McAllister, Anita
    Linköping University, Department of Clinical and Experimental Medicine, Speech and Language Pathology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology in Linköping.
    Experiences from Two Swedish Speech and Language Pathology Education Programmes Using Different Approaches to Problem-Based Learning2012In: Problem-Based Learning in Clinical Education: The Next Generation / [ed] Susan Bridges, Colman McGrath and Tara L. Whitehill, Dordrecht: Springer Netherlands, 2012, p. 47-58Chapter in book (Other academic)
    Abstract [en]

    In many programmes within higher education, including speech language pathology (SLP) education, students are expected to develop collaborative skills alongside acquisition of theoretical knowledge. The focus of the present chapter is to evaluate SLP graduates’ opinions on how well prepared for the professional life they feel after their education. A questionnaire, focusing on perceived professional skills in relation to education, was distributed to former SLP students from two programmes with different applications of problem-based learning (PBL). A total of 55 students (69%) completed the questionnaire. PBL has been identified as one efficient way to facilitate the development of speech and language pathology students’ abilities to meet the demands of self-directed learning in everyday worklife. Moreover, it has been shown that the use of PBL throughout the programme is beneficial to the perception of attaining general competencies. It is also demonstrated that the students from both the PBL throughout and the semi-PBL curricula rated themselves high on many specific competencies.

  • 31.
    Samuelsson, Christina
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Speech and Language Pathology .
    LundeborgHammarström, Inger
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Speech and Language Pathology .
    McAllister, Anita
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Speech and Language Pathology . Östergötlands Läns Landsting, Reconstruction Centre, Department of ENT - Head and Neck Surgery UHL.
    Specific and general competencies of graduates from Swedish speech and language pathology education2008In: The Second International Conference on PBL in Speech-Language Pathology,2008, 2008Conference paper (Refereed)
    Abstract [en]

      The topic of the present study is the relationship between the pedagogical philosophy of education and the professional outcome, mainly regarding general competencies. The overall purpose of the study is to evaluate postgraduates- opinions on how well prepared for the professional life they feel after their speech and language pathology education. Previous research have shown differences in professional skills between problem-based learning (PBL) and non-PBL graduates (Prince, van Eijs, Boshuzien, van der Vleuten & Scherpbier, 2005). Those differences mainly concern general competencies such as organizational skills and teamwork. These findings get further support from the evaluation of the Swedish medical education programmes, where PBL-graduates report better communicational, co-operational and leadership skills than non-PBL graduates (Grundutbildningsenkäten, 2006). PBL is a student centred pedagogical philosophy where students are encouraged to be very active. In PBL real-life problems become the context in which students learn academic content as well as professional skills (Biggs, 2003). The first Swedish speech language pathology program using PBL throughout the program was completed in 2007, and the graduate students have participated in an evaluation of the program. A comprehensive questionnaire, focusing on perceived professional skills in relation to education, was distributed to the students of this program, to students from a partial PBL curriculum who graduated the same year and to students from a partial PBL curriculum who finished in 2002. Preliminary results indicate that the PBL graduates feel well prepared for meeting the demands of the professional life. The results also suggest that the students who finished their education six years ago feels more able to evaluate their education. These students also seem more satisfied. The present study adds further knowledge concerning outcomes of higher medical education. It also points to differences between PBL graduates and non-PBL graduates regarding professional experiences. The study also provides information on how the opinions of the educational experience changes over time.

  • 32.
    Semb, Gunvor
    et al.
    Division of Dentistry, University of Manchester , Manchester , UK; Department of Plastic and Reconstructive Surgery , Oslo University Hospital Rikshospitalet , Oslo , Norway; Department of Speech and Language Disorders , Statped sørøst , Oslo , Norway..
    Enemark, Hans
    Cleft Palate Center , Aarhus , Denmark.
    Friede, Hans
    Department of Orthodontics , Sahlgrenska Academy, University of Gothenburg , Sweden.
    Paulin, Gunnar
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Maxillofacial Unit.
    Lilja, Jan
    Department of Plastic Surgery , Sahlgrenska Academy, University of Gothenburg , Sweden.
    Rautio, Jorma
    Cleft Palate and Craniofacial Center, Helsinki University Central Hospital , Helsinki , Finland.
    Andersen, Mikael
    Copenhagen Cleft Palate Center, University Hospital of Copenhagen , Denmark.
    Åbyholm, Frank
    Department of Plastic and Reconstructive Surgery , Oslo University Hospital Rikshospitalet , Oslo , Norway.
    Lohmander, Anette
    Division of Speech and Language Pathology , Karolinska Institute, and Karolinska University Hospital , Stockholm , Sweden.
    Shaw, William
    Division of Dentistry, University of Manchester , Manchester , UK.
    Mølsted, Kirsten
    Copenhagen Cleft Palate Center, University Hospital of Copenhagen , Denmark.
    Heliövaara, Arja
    Cleft Palate and Craniofacial Center, Helsinki University Central Hospital , Helsinki , Finland.
    Bolund, Stig
    Copenhagen Cleft Palate Center, University Hospital of Copenhagen , Denmark.
    Hukki, Jyri
    Cleft Palate and Craniofacial Center, Helsinki University Central Hospital , Helsinki , Finland.
    Vindenes, Hallvard
    Centre for Cleft Lip and Palate, Bergen University Hospital Haukeland , Bergen , Norway.
    Davenport, Peter
    Greater Manchester Cleft Lip and Palate Unit , Royal Manchester Childrens' Hospital , Manchester , UK.
    Arctander, Kjartan
    Department of Plastic and Reconstructive Surgery , Oslo University Hospital Rikshospitalet , Oslo , Norway.
    Larson, Ola
    Stockholm Craniofacial Team , Karolinska University Hospital , Stockholm , Sweden.
    Berggren, Anders
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Whitby, David
    Greater Manchester Cleft Lip and Palate Unit , Royal Manchester Childrens' Hospital , Manchester , UK.
    Leonard, Alan
    The Royal Hospital for Sick Children , Belfast , N. Ireland.
    Neovius, Erik
    Stockholm Craniofacial Team , Karolinska University Hospital , Stockholm , Sweden.
    Elander, Anna
    Department of Plastic Surgery , Sahlgrenska Academy, University of Gothenburg , Sweden.
    Willadsen, Elisabeth
    Department of Nordic Studies and Linguistics , University of Copenhagen , Denmark.
    Bannister, R. Patricia
    Greater Manchester Cleft Lip and Palate Unit , Royal Manchester Childrens' Hospital , Manchester , UK.
    Bradbury, Eileen
    Private Practitioner , Manchester , UK.
    Henningsson, Gunilla
    Stockholm Craniofacial Team , Karolinska University Hospital , Stockholm , Sweden.
    Persson, Christina
    Institute of Neuroscience and Physiology, Speech and Language; Division for Speech and Language Pathology , Sahlgrenska University Hospital , Gothenburg , Sweden Pathology Unit , Sahlgrenska Academy, University of Gothenburg , Sweden; .
    Eyres, Philip
    Division of Dentistry, University of Manchester , Manchester , UK.
    Emborg, Berit
    Cleft Palate Center , Aarhus , Denmark.
    Kisling-Møller, Mia
    Division of Dentistry, University of Manchester , Manchester , UK.
    Küseler, Annelise
    Division of Dentistry, University of Manchester , Manchester , UK.
    Granhof Black, Birthe
    Division of Dentistry, University of Manchester , Manchester , UK.
    Schöps, Antje
    Copenhagen Cleft Palate Center, University Hospital of Copenhagen , Denmark.
    Bau, Anja
    Copenhagen Cleft Palate Center, University Hospital of Copenhagen , Denmark.
    Boers, Maria
    Copenhagen Cleft Palate Center, University Hospital of Copenhagen , Denmark.
    Søgaard Andersen, Helene
    Copenhagen Cleft Palate Center, University Hospital of Copenhagen , Denmark.
    Jeppesen, Karin
    Copenhagen Cleft Palate Center, University Hospital of Copenhagen , Denmark.
    Marxen, Dorte
    Copenhagen Cleft Palate Center, University Hospital of Copenhagen , Denmark.
    Paaso, Marjukka
    Cleft Palate and Craniofacial Center, Helsinki University Central Hospital , Helsinki , Finland.
    Hölttä, Elina
    Cleft Palate and Craniofacial Center, Helsinki University Central Hospital , Helsinki , Finland.
    Alaluusua, Suvi
    Cleft Palate and Craniofacial Center, Helsinki University Central Hospital , Helsinki , Finland.
    Turunen, Leena
    Cleft Palate and Craniofacial Center, Helsinki University Central Hospital , Helsinki , Finland.
    Humerinta, Kirsti
    Cleft Palate and Craniofacial Center, Helsinki University Central Hospital , Helsinki , Finland.
    Elfving-Little, Ulla
    Cleft Palate and Craniofacial Center, Helsinki University Central Hospital , Helsinki , Finland.
    Tørdal, Inger Beate
    Department of Speech and Language Disorders , Statped sørøst , Oslo , Norway.
    Kjøll, Lillian
    Department of Speech and Language Disorders , Statped sørøst , Oslo , Norway.
    Aukner, Ragnhild
    Department of Speech and Language Disorders , Statped sørøst , Oslo , Norway.
    Hide, Øydis
    Department of Speech and Language Disorders , Statped sørøst , Oslo , Norway.
    Feragen, Kristin Billaud
    Department of Speech and Language Disorders , Statped sørøst , Oslo , Norway.
    Rønning, Elisabeth
    Department of Plastic and Reconstructive Surgery , Oslo University Hospital Rikshospitalet , Oslo , Norway.
    Skaare, Pål
    Department of Plastic and Reconstructive Surgery , Oslo University Hospital Rikshospitalet , Oslo , Norway.
    Brinck, Eli
    Department of Plastic and Reconstructive Surgery , Oslo University Hospital Rikshospitalet , Oslo , Norway.
    Semmingsen, Ann-Magritt
    Department of Plastic and Reconstructive Surgery , Oslo University Hospital Rikshospitalet , Oslo , Norway.
    Lindberg, Nina
    Department of Plastic and Reconstructive Surgery , Oslo University Hospital Rikshospitalet , Oslo , Norway.
    Bowden, Melanie
    Greater Manchester Cleft Lip and Palate Unit , Royal Manchester Childrens' Hospital , Manchester , UK.
    Davies, Julie
    Greater Manchester Cleft Lip and Palate Unit , Royal Manchester Childrens' Hospital , Manchester , UK.
    Mooney, Jeanette
    Greater Manchester Cleft Lip and Palate Unit , Royal Manchester Childrens' Hospital , Manchester , UK.
    Bellardie, Haydn
    Greater Manchester Cleft Lip and Palate Unit , Royal Manchester Childrens' Hospital , Manchester , UK.
    Schofield, Nina
    Greater Manchester Cleft Lip and Palate Unit , Royal Manchester Childrens' Hospital , Manchester , UK.
    Nyberg, Jill
    Stockholm Craniofacial Team , Karolinska University Hospital , Stockholm , Sweden.
    Lundberg, Maria
    Stockholm Craniofacial Team , Karolinska University Hospital , Stockholm , Sweden.
    Linder-Aronson Karsten, Agneta
    Stockholm Craniofacial Team, Department of Dental Medicine , Karolinska Institute , Stockholm , Sweden.
    Larson, Margareta
    Eastman Institute, Stockholms Läns Landsting , Stockholm , Sweden.
    Holmefjord, Anders
    Statped vest , Bergen , Norway.
    Reisæter, Sigvor
    Statped vest , Bergen , Norway.
    Pedersen, Nina-Helen
    Statped vest , Bergen , Norway.
    Rasmussen, Therese
    Statped vest , Bergen , Norway.
    Tindlund, Rolf
    Dental School, University of Bergen , Bergen , Norway.
    Sæle, Paul
    Oral Health Center of Expertise/Western Norway , Bergen , Norway.
    Blomhoff, Reidunn
    Centre for Cleft Lip and Palate, Bergen University Hospital Haukeland , Bergen , Norway.
    Jacobsen, Gry
    Centre for Cleft Lip and Palate, Bergen University Hospital Haukeland , Bergen , Norway.
    Havstam, Christina
    Division for Speech and Language Pathology , Sahlgrenska University Hospital , Gothenburg , Sweden.
    Rizell, Sara
    Department of Orthodontics , Sahlgrenska Academy, University of Gothenburg , Sweden.
    Enocson, Lars
    Department of Orthodontics , Sahlgrenska Academy, University of Gothenburg , Sweden.
    Hagberg, Catharina
    Department of Orthodontics , Sahlgrenska Academy, University of Gothenburg , Sweden.
    Najar Chalien, Midia
    Department of Orthodontics , Sahlgrenska Academy, University of Gothenburg , Sweden.
    Paganini, Anna
    Department of Plastic Surgery , Sahlgrenska Academy, University of Gothenburg , Sweden.
    Lundeborg, Inger
    Linköping University, Department of Clinical and Experimental Medicine, Division of Speech language pathology, Audiology and Otorhinolaryngology. Linköping University, Faculty of Medicine and Health Sciences.
    Marcusson, Agneta
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Maxillofacial Unit.
    Mjönes, Anna-Britta
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology in Linköping.
    Gustavsson, Annica
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Maxillofacial Unit.
    Hayden, Christine
    The Royal Hospital for Sick Children , Belfast , N. Ireland.
    McAleer, Eilish
    The Royal Hospital for Sick Children , Belfast , N. Ireland.
    Slevan, Emma
    The Royal Hospital for Sick Children , Belfast , N. Ireland.
    Gregg, Terry
    The Royal Hospital for Sick Children , Belfast , N. Ireland.
    Worthington, Helen
    Division of Dentistry, University of Manchester , Manchester , UK.
    A Scandcleft randomised trials of primary surgery for unilateral cleft lip and palate: 1. Planning and management.2017In: Journal of Plastic Surgery and Hand Surgery, ISSN 2000-656X, E-ISSN 2000-6764, Vol. 51, no 1, p. 2-13Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND AIMS: Longstanding uncertainty surrounds the selection of surgical protocols for the closure of unilateral cleft lip and palate, and randomised trials have only rarely been performed. This paper is an introduction to three randomised trials of primary surgery for children born with complete unilateral cleft lip and palate (UCLP). It presents the protocol developed for the trials in CONSORT format, and describes the management structure that was developed to achieve the long-term engagement and commitment required to complete the project.

    METHOD: Ten established national or regional cleft centres participated. Lip and soft palate closure at 3-4 months, and hard palate closure at 12 months served as a common method in each trial. Trial 1 compared this with hard palate closure at 36 months. Trial 2 compared it with lip closure at 3-4 months and hard and soft palate closure at 12 months. Trial 3 compared it with lip and hard palate closure at 3-4 months and soft palate closure at 12 months. The primary outcomes were speech and dentofacial development, with a series of perioperative and longer-term secondary outcomes.

    RESULTS: Recruitment of 448 infants took place over a 9-year period, with 99.8% subsequent retention at 5 years.

    CONCLUSION: The series of reports that follow this introductory paper include comparisons at age 5 of surgical outcomes, speech outcomes, measures of dentofacial development and appearance, and parental satisfaction. The outcomes recorded and the numbers analysed for each outcome and time point are described in the series.

    TRIAL REGISTRATION: ISRCTN29932826.

  • 33.
    Willadsen, Elisabeth
    et al.
    University of Copenhagen, Denmark.
    Lohmander, Anette
    Karolinska University Hospital, Sweden.
    Persson, Christina
    Sahlgrens University Hospital, Sweden; University of Gothenburg, Sweden.
    Lundeborg, Inger
    Linköping University, Department of Clinical and Experimental Medicine, Division of Speech language pathology, Audiology and Otorhinolaryngology. Linköping University, Faculty of Medicine and Health Sciences.
    Alaluusua, Suvi
    University of Helsinki, Finland.
    Aukner, Ragnhild
    Statped Sorost, Norway.
    Bau, Anja
    University of Copenhagen Hospital, Denmark.
    Boers, Maria
    University of Copenhagen Hospital, Denmark.
    Bowden, Melanie
    Royal Manchester Childrens Hospital, England.
    Davies, Julie
    Royal Manchester Childrens Hospital, England.
    Emborg, Berit
    Cleft Palate Centre, Denmark.
    Havstam, Christina
    Sahlgrens University Hospital, Sweden.
    Hayden, Christine
    Royal Hospital Sick Children, North Ireland.
    Henningsson, Gunilla
    Karolinska University Hospital, Sweden.
    Holmefjord, Anders
    Statped Vest, Norway.
    Hölttä, Elina
    Linköping University, Department of Clinical and Experimental Medicine, Division of Speech language pathology, Audiology and Otorhinolaryngology. Linköping University, Faculty of Medicine and Health Sciences.
    Kisling-Moller, Mia
    Cleft Palate Centre, Denmark.
    Kjoll, Lillian
    Statped Sorost, Norway.
    Lundberg, Maria
    Karolinska University Hospital, Sweden.
    McAleer, Eilish
    Royal Hospital Sick Children, North Ireland.
    Nyberg, Jill
    Karolinska University Hospital, Sweden.
    Paaso, Marjukka
    University of Helsinki, Finland.
    Helen Pedersen, Nina
    Statped Vest, Norway.
    Rasmussen, Therese
    Statped Vest, Norway.
    Reisaeter, Sigvor
    Statped Vest, Norway.
    Sogaard Andersen, Helene
    University of Copenhagen Hospital, Denmark.
    Schops, Antje
    University of Copenhagen Hospital, Denmark.
    Tordal, Inger-Beate
    Statped Sorost, Norway.
    Semb, Gunvor
    Statped Sorost, Norway; University of Manchester, England; National Hospital Norway, Norway.
    Scandcleft randomised trials of primary surgery for unilateral cleft lip and palate: 5. Speech outcomes in 5-year-olds - consonant proficiency and errors2017In: Journal of Plastic Surgery and Hand Surgery, ISSN 2000-656X, E-ISSN 2000-6764, Vol. 51, no 1, p. 38-51Article in journal (Refereed)
    Abstract [en]

    Background and aim: Normal articulation before school start is a main objective in cleft palate treatment. The aim was to investigate if differences exist in consonant proficiency at age 5 years between children with unilateral cleft lip and palate (UCLP) randomised to different surgical protocols for primary palatal repair. A secondary aim was to estimate burden of care in terms of received additional secondary surgeries and speech therapy. Design: Three parallel group, randomised clinical trials were undertaken as an international multicentre study by 10 cleft teams in five countries: Denmark, Finland, Norway, Sweden, and the UK. Methods: Three different surgical protocols for primary palatal repair were tested against a common procedure in the total cohort of 448 children born with non-syndromic UCLP. Speech audio- and video-recordings of 391 children (136 girls and 255 boys) were available and transcribed phonetically. The main outcome measure was Percent Consonants Correct (PCC) from blinded assessments. Results: In Trial 1, arm A showed statistically significant higher PCC scores (82%) than arm B (78%) (p=.045). No significant differences were found between prevalences in Trial 2, A: 79%, C: 82%; or Trial 3, A: 80%, D: 85%. Across all trials, girls achieved better PCC scores, excluding s-errors, than boys (91.0% and 87.5%, respectively) (p=.01). Conclusions: PCC scores were higher in arm A than B in Trial 1, whereas no differences were found between arms in Trials 2 or 3. The burden of care in terms of secondary pharyngeal surgeries, number of fistulae, and speech therapy visits differed.

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