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Helping children who were born with cleft palate to speak clearly

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What did the project achieve?

Dr Joanne Cleland at the University of Strathclyde in Glasgow, working closely with clinicians at the Glasgow Dental Hospital, has developed and tested a new ultrasound-based assessment to help children born with a cleft lip and/or palate to overcome speech problems.

“Using our new ultrasound method in combination with traditional assessment approaches gives a more accurate and detailed diagnosis and can also identify speech errors that were not identified by listening alone,” says Dr Cleland. “This enables speech and language therapists to develop a more accurate treatment plan for each child, ultimately leading to better speech outcomes.”

In the UK, one in every 700 babies is born with a gap or split in their upper lip and/or roof of their mouth (palate).1 The child will usually have surgery to close the gap and improve the appearance of their face, but despite this, many still experience difficulties when learning how to speak. They may need support from a speech and language therapist (SLT) who will assess children by ear, writing down issues as they listen. But some problems are difficult to identify in this way, meaning important information can be missed.

Dr Cleland’s team recorded 39 children speaking while imaging their tongue movements using an ultrasound probe (similar to that used in image babies in the womb) – to find out whether this could help to detect speech errors that are hard to identify by listening alone.

“Our results showed that assessing a child using ultrasound imaging was more reliable than without,” says Dr Cleland. “We were able to identify eight different types of errors in the children’s speech – some of which were not previously identified by standard listening approaches and may affect treatment choices.”

The researchers were also able to use these ultrasound images to show some of the children how to move their tongues to produce more accurate sounds, which led to improvements in their speech.

“Our new assessment is already being used in four clinics in the UK with children who have a wider variety of speech disorders – and we hope it will be rolled out further in the future,” says Dr Cleland.

The team has also developed an assessment protocol and recording format for the ultrasound assessment and published this for SLTs to access and use.



  1. NHS website: Cleft lip and palate. https://www.nhs.uk/conditions/cleft-lip-and-palate/

This research was completed on

Around one in 700 babies in the UK is born with a cleft lip and/or palate, which means they have a gap, or a split, in the upper lip and/or the roof of the mouth.1 Babies normally have surgery to close the gap and improve the appearance of the face. Despite this, many go on to have communication problems, because of difficulties learning how to speak clearly. Dr Joanne Cleland, of the University of Strathclyde, is investigating whether ultrasound scans help when diagnosing and treating children’s speech problems. Learning how to speak clearly would be life changing for children with severe speech problems.

This grant is a jointly funded award from Action Medical Research and The Chief Scientist Office (CSO), Scotland.​​

How are children’s lives affected now?

Every day in the UK, on average three babies are born with a cleft lip and/or palate, which is the most common facial abnormality at birth.1,2

Despite having surgery, many of these children have ongoing problems with their speech. Some can find it hard to speak in a way that’s easy for other people to understand.

“Normally, when a speech therapist assesses a child to diagnose the problem, they listen to the child speaking and write down the errors they hear,” says Dr Cleland. “Unfortunately though, children with a cleft palate may have speech errors that cannot easily be distinguished by ear, which can make it difficult to choose the right treatment. With the wrong treatment, errors may become more deeply ingrained in children’s speech.”

“Speech problems can have negative effects on a child’s life, including their education and social development,” says Dr Cleland.

We need better ways to help children with their speech.

How could this research help?

“Firstly, we aim to find out whether we can use ultrasound to diagnose speech errors in around forty eight children who were born with a cleft lip and/or palate,” says Dr Cleland. “If we can, speech therapists would soon be able to incorporate this use of ultrasound into routine practice.”

The technique involves placing a small ultrasound scanner under each child’s chin so that therapists, and indeed the children themselves, can see how the tongue moves during speech in real time on a computer screen.

“We are also running a trial with eight of the children to see if we can use ultrasound in speech therapy to help children correct their speech,” says Dr Cleland. Larger trials would be needed, but if successful as a therapy, ultrasound may one day help more children who were born with a cleft lip and/or palate to experience the life-changing benefits that learning how to speak clearly can bring.


1. Bellis TH and Wohlgemuth B . The incidence of cleft lip and palate deformities in the south-east of Scotland (1971-1990). Br J Orthod. 1999; 26: 121-5.

2. Cleft Lip and Palate Association (CLAPA). Home page. https://www.clapa.com/ Website accessed 14 January 2017.






Project Leader Dr Joanne Cleland PhD BSc(Hons) MRCSLT
Project Team Ms Lisa Crampin BMedSci Hons
Project Location Psychological Sciences and Health, University of Strathclyde
Project Location Other Speech and Language Therapy Department, Glasgow Dental Hospital
Project duration 15 months
Date awarded 21 November 2016
Project start date 17 April 2017
Project end date 31 July 2018
Grant amount £42,739
Grant code GN2544


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