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Cleft Palate ChildrenNCT06143254

Effect of Infant Sign Training on Speech-language Development

A study testing Infant sign training and Verbal training in people with Cleft Palate Children, run by University Hospital, Ghent at 1 site in Belgium.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

Children born with a cleft lip and palate (CLP) are known to be at risk for speech-language disorders that impact academic and social emotional growth. Even at very young ages (<3 years), speech-language disorders are already observed. Read more about this study

Who is it for?
Ages 12 to 24 months
Conditions the study is for
Cleft Palate Children
What is being tested?
Infant sign training and Verbal training
Could I receive a placebo?
No, everyone receives an active treatment
How many people
30 participants
Where
1 siteBelgium
Study dates
9 Nov 2023to 30 Oct 2027
Phase
Interventional
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 12 to 24 months
  • All sexes
  • No healthy volunteers
  • Child

Who may be able to join

  • Born with cleft palate (with or without cleft lip)
  • Having Dutch as mother tongue

Who cannot join

  • syndromic cleft
  • more than mild hearing loss (i.e. > 40dB hearing threshold bilaterally)
  • neurosensory hearing loss
  • cognitive delay
  • motor delay

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

Kim Bettens, PhD contact

+32 9 332 94 26

Kim.Bettens@UGent.be

Kristiane Van Lierde, PhD contact

+32 9 332 23 91

Kristiane.Vanlierde@UGent.be

Belgium1 site, 1 recruiting
  • Ghent University Hospital

    Ghent, East Flanders, 9000

    Kim Bettens, PhD, +32 9 332 94 26, Kim.Bettens@UGent.be

    Kristiane Van Lierde, PhD, +32 9 332 23 91, Kristiane.Vanlierde@UGent.be

    Recruiting

Other trials in Belgium

About this study

Official title: The Effect of Using Symbolic Gestures on the Speech and Language Development in Prelinguistic Children Born With Cleft Palate

Children born with a cleft lip and palate (CLP) are known to be at risk for speech-language disorders that impact academic and social emotional growth. Even at very young ages (<3 years), speech-language disorders are already observed. It is hypothesized that speech-language intervention delivered before the age of 3 years old could decrease the impact of CLP on speech-language development. This would result in a decreased need for speech-language therapy on the long-term and a reduced burden of care on children, families and health services. However, no evidence is yet available to support any specific model of early speech-language intervention in this population. Consequently, no standardized clinical practice guidelines are available yet. Symbolic gesture training in combination with verbal input expands the natural communication of young children including multimodal speech-language input (i.e., verbal and manual input) via caregivers who act as co-therapists. To contribute to the evidence-based practice in the field of cleft speech therapy, this research project aims to determine the effectiveness and feasibility of symbolic gesture training in one-year old children with CLP by comparing different intervention approaches based on perceptual, psychosocial and qualitative outcome measures.

Read the detailed description

Children with CP±L are known to be at risk for speech-language delays that impact educational and social-emotional growth. Early intervention in this population mostly focuses on improving verbal input via caregivers or professionals without including a multimodal language input. As stated above, no evidence is yet available for the effectiveness and feasibility of early intervention based on symbolic gesture training in combination with verbal input to improve speech-language skills in young children with CP±L. To contribute to the evidence-based practice in the field of early cleft palate speech intervention, this research project will focus on the effectiveness of symbolic gesture training in one-year old children with CP±L by comparing different intervention approaches based on quantitative and qualitative outcome measures. This project meets the need to evaluate the impact of early intervention on speech-language outcomes in children with CP±L as proposed by several researchers based on reviews regarding this topic.

The primary objective is to explore if children with CP±L who are enrolled in symbolic gesture training to support verbal in- and output at the age of 12 months have increased receptive and expressive language skills compared to children with CP±L who are enrolled in verbal training or not involved in any intervention at all.

The secondary objectives are:

2.1 To explore if children with CP±L who are enrolled in symbolic gesture training at the age of 12 months have improved speech skills, compared to children with CP±L who are enrolled in verbal training or not involved in any intervention at all; 2.2 To explore if children with CP±L who are enrolled in symbolic gesture training at the age of 12 months demonstrate more gesture use, compared to children with CP±L who are enrolled in verbal training or not involved in any intervention at all; 2.3 To explore if caregivers of children with CP±L who are enrolled in symbolic gesture training when their child is 12 months of age provide more frequent and more complex linguistic input to their child's utterances compared to caregivers of children with CP±L who are enrolled in verbal training or not involved in any intervention at all.

Being tested
Infant sign training, Verbal training
Keywords
cleft palate, gesture, speech and language development, therapy
Medical subject headings
Cleft Palate, Gestures, Speech

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Infant sign trainingBehavioural

    Training session 1: Information is given about what infant signs are, how they originated, how speech and (gestural) language develop in young children with CP ± L, the possible advantages of using infant signs and tips for success. Twelve signs are chosen to start with: six narrative signs (mostly object concepts) and six steering signs (mostly non-object concepts). Training session 2: Experiences with using infant signs at home are shared, repetition of the 12 infant signs and tips for success are discussed. Another 12 signs are chosen to add to the repertoire the caregivers can use, based on caregiver input. Training session 3: The same as training session 2. The content is based on the input the caregivers experience. Another 12 signs are chosen to add to the repertoire the caregivers can use, based on caregiver input. Reading aloud while using infant signs is shown and practiced.

  • Verbal trainingBehavioural

    Training session 1: Information is given about how speech and language develop in young children with CP ± L and how caregivers can support their child during this development Tips for success and suggestions on how to use these supportive verbal techniques at home are discussed. Training session 2: Experiences with using supportive verbal techniques at home are shared and supportive verbal techniques repeated. Information is provided about how children learn new words and tips for success are expanded. Training session 3: The same as training session 2. The content is based on the input the caregivers experience. Additionally, advances of reading aloud are discussed and reading aloud is practiced.

Study groups in NCT06143254
Study groupRoleWhat they receive
Symbolic Gesture Training GroupExperimentalCaregivers of children who are assigned to the SGT group will participate in three caregiver training meetings to learn how to use infant signing in combination with verbal training to promote the speech and language development of their child. These meetings will take place 1 month (meeting 1), 2 months (meeting 2) and 3 months (meeting 3) after baseline assessments are performed (T0). Each meeting will take two hours. After the first training session (meeting 1), caregivers will start using the symbolic gestures to support verbal in- and output at home with their child.
Receives: Behavioral: Infant sign training
Verbal Training GroupActive comparatorCaregivers of children who are assigned to the VT group will participate in three caregiver training meetings to learn how to use verbal training to promote the speech and language development of their child. These meetings will take place 1 month (meeting 1), 2 months (meeting 2) and 3 months (meeting 3) after baseline assessments are performed (T0). Each meeting will take two hours. After the first training session (meeting 1), caregivers will start using supporting verbal in- and output at home with their child.
Receives: Behavioral: Verbal training
No Intervention Control GroupNo interventionStandard clinical care at this moment at the Cleft Palate Teams of the University Hospitals of Ghent and Leuven includes providing information to caregivers about speech-language development and encouraging caregivers to communicate with their children. This information will be orally provided by an SLP during a standard clinical appointment at the cleft team at the age of 12 months. A brochure including this information will be provided. Caregivers of children who will be assigned to group C will have the opportunity to receive the most effective intervention (SGT or VT) after finishing the study.

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Receptive language level based on language test

    To verify the receptive language level, the Dutch Nonspeech Test will be used at T0 and T1. This standardized test observes, scores and judges communication conditions and first verbal and non-verbal communication in the age range of 12 to 21 months. At T2, the Schlichting Test of Language Comprehension and Language Production will be used. This standardized test measures receptive and expressive language development starting from 24 months of age.

    This outcome measure will be expressed in percentiles.

    Measured: 12 months

  2. Expressive language level based on language test

    To verify the expressive language level, the Dutch Nonspeech Test will be used at T0 and T1. This standardized test observes, scores and judges communication conditions and first verbal and non-verbal communication in the age range of 12 to 21 months. At T2, the Schlichting Test of Language Comprehension and Language Production will be used. This standardized test measures receptive and expressive language development starting from 24 months of age.

    This outcome measure will be expressed in percentiles.

    Measured: 12 months

  3. Total language level based on caregiver report

    Caregivers will complete the Dutch version of the MacArthur Communicative Development Inventory, 'words and signs' (T0 and T1) or 'words and sentences' (T2). These standardized questionnaires evaluate word comprehension and production, the use of signs by the child, and grammatical development.

    This outcome measure will be expressed in percentiles.

    Measured: 12 months

Secondary outcomes (3)
  1. Communicative acts produced by the child

    The communicative acts of the child will be analyzed based on a video recording of 30 minutes free play with four standardized toy sets (i.e., a farm, a house, cutlery, and vehicles) between the child and caregiver at T0, T1 and T2. Each potential communicative act of the child will be annotated by the means of communication (eye contact, gesture or vocalization; vocalization will be identified as non-canonical, canonical or word).

    This outcome measure will be expressed in the total number of communicative acts produced by the child.

    Measured: 12 months

  2. Communicative acts produced by the caregiver

    The communicative acts of the caregiver will be analyzed based on a video recording of 30 minutes free play with four standardized toy sets (i.e., a farm, a house, cutlery, and vehicles) between the child and caregiver at T0, T1 and T2. Each potential communicative act of the caregiver will be annotated by the means of communication (eye contact, gesture or vocalization).

    This outcome measure will be expressed in the total number of communicative acts produced by the caregiver.

    Measured: 12 months

  3. Articulatory precision of the child

    Based on the vocalizations of the child, the Percentage Consonants Correct will be determined. This outcome measure is expressed in percentage.

    Measured: 12 moths

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted22 Nov 2023
  2. Study start9 Nov 2023
  3. Primary completion30 Oct 2027 (estimated)
  4. Study completion30 Oct 2027 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
The trial is a two-centre, randomized, parallel-group, longitudinal, controlled trial. Treatment allocation is in a 1:1:1:ratio. Children are randomized to either an infant sign training group (IST group), a verbal training group (VT group) or no intervention control group (C group). The aim is to demonstrate superiority of the active intervention (IST group) compared with control (VT group and C group).
Masking
Double blind
Who is masked
Investigator, Outcomes assessor
Enrolment
30 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06143254
Sponsor's protocol ID
ONZ-2022-0581
Status last verified
Jan 2024
First submitted
10 Nov 2023
Last updated
30 Jan 2024
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No: Data are stored in REDCap, an electronic data capture system (Harris et al., 2019). The research is carried out in accordance with the information security policy of Ghent University. Personal data are pseudo-anonymized at the level of data collection and anonymized at the level of data analysis. A separate file is created with the key to the code assigned to each participant. This file is stored separately from the other databases and is only accessible to the first and last authors or to the appointed replacement. Only anonymized data are used for analysis and in any type of documentation, reports or publications concerning this study.

Publications

  • De Ryck M, Van Lierde K, Alighieri C, Hens G, Bettens K. A protocol for a randomized-controlled trial to investigate the effect of infant sign training on the speech-language development in young children born with cleft palate. Int J Lang Commun Disord. 2023 Nov-Dec;58(6):2212-2221. doi: 10.1111/1460-6984.12920. Epub 2023 Jun 28.

    PubMed 37376898
  • Lancaster HS, Lien KM, Chow JC, Frey JR, Scherer NJ, Kaiser AP. Early Speech and Language Development in Children With Nonsyndromic Cleft Lip and/or Palate: A Meta-Analysis. J Speech Lang Hear Res. 2019 Dec 13;63(1):14-31. doi: 10.1044/2019_JSLHR-19-00162. Print 2020 Jan 22.

    PubMed 31841365
  • Scherer NJ, Boyce S, Martin G. Pre-linguistic children with cleft palate: growth of gesture, vocalization, and word use. Int J Speech Lang Pathol. 2013 Dec;15(6):586-92. doi: 10.3109/17549507.2013.794475. Epub 2013 Sep 27.

    PubMed 24073662
  • Lane H, Harding S, Wren Y. A systematic review of early speech interventions for children with cleft palate. Int J Lang Commun Disord. 2022 Jan;57(1):226-245. doi: 10.1111/1460-6984.12683. Epub 2021 Nov 12.

    PubMed 34767284
  • Bessell A, Sell D, Whiting P, Roulstone S, Albery L, Persson M, Verhoeven A, Burke M, Ness AR. Speech and language therapy interventions for children with cleft palate: a systematic review. Cleft Palate Craniofac J. 2013 Jan;50(1):e1-e17. doi: 10.1597/11-202. Epub 2012 Mar 20.

    PubMed 22433039
  • Chapman KL, Hardin-Jones M, Halter KA. The relationship between early speech and later speech and language performance for children with cleft lip and palate. Clin Linguist Phon. 2003 Apr-May;17(3):173-97. doi: 10.1080/0269920021000047864.

    PubMed 12858838
  • Frey JR, Kaiser AP, Scherer NJ. The Influences of Child Intelligibility and Rate on Caregiver Responses to Toddlers With and Without Cleft Palate. Cleft Palate Craniofac J. 2018 Feb;55(2):276-286. doi: 10.1177/1055665617727000. Epub 2017 Dec 14.

    PubMed 29351026

Questions about this trial

What is this clinical trial studying?

A study testing Infant sign training and Verbal training in people with Cleft Palate Children, run by University Hospital, Ghent at 1 site in Belgium.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 2 inclusion and 5 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: looking for participants now, as of the sponsor's last update on 30 Jan 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Belgium. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Kim Bettens, PhD (+32 9 332 94 26, Kim.Bettens@UGent.be), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Receptive language level based on language test (time frame: 12 months). The study lists 3 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT06143254, which also lists 7 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 30 Jan 2024.

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