The impact of enhanced Milieu teaching with phonological emphasis (EMT + PE) on the speech and language outcomes for toddlers with cleft palate in Brazil and the United States of America

The purpose of this study was to compare the speech and language outcomes of children with cleft palate with or without cleft lip (CP+/-L) in the USA to children with CP+/-L in Brazil who underwent intervention with enhanced Milieu teaching with phonological emphasis (EMT + PE), as there are few cross-country intervention comparisons for children with CP+/-L. This is a retrospective analysis of 29 participants from the USA and 24 participants from Brazil who were matched on age. The US participants were between the ages of 13–35 months (<i>M</i> = 23.76), spoke Standard American English in the home, and were recruited from East Tennessee State University and Vanderbilt University. The Brazilian participants were between the ages of 20–34 months (<i>M</i> = 25.04), spoke Brazilian Portuguese in the home, and were recruited from the <i>Hospital de Reabilitação de Anomalias Craniofaciais–Universidade de São Paulo</i>. All treatment participants received EMT + PE from trained speech-language pathologists in hospital-university clinics. The treatment groups demonstrated greater gains than comparison groups in percent consonants correct, number of different words, and expressive/receptive vocabulary. There was no main effect nor interaction by country. The application of EMT + PE in a second culture and language is a viable early intervention option for participants with CP+/-L.

本研究旨在对比美国伴或不伴唇裂的腭裂（cleft palate with or without cleft lip, CP+/-L）儿童与巴西同类患儿的言语与语言结局，其中巴西患儿均接受以语音学为重点的强化情境教学（enhanced Milieu teaching with phonological emphasis, EMT+PE）干预。鉴于当前针对CP+/-L儿童的跨国干预对比研究较为稀缺，本研究应运而生。

本研究为回顾性分析，共纳入29名美国受试者与24名巴西受试者，两组按年龄进行匹配。美国受试者年龄介于13~35个月之间，均值（M=23.76），家庭日常使用标准美式英语，招募自东田纳西州立大学与范德堡大学；巴西受试者年龄介于20~34个月之间，均值（M=25.04），家庭日常使用巴西葡萄牙语，招募自圣保罗大学颅面异常康复医院（Hospital de Reabilitação de Anomalias Craniofaciais–Universidade de São Paulo）。

所有受试儿童均在医院-大学联合诊所接受由经过专业培训的言语语言病理学家实施的EMT+PE干预。结果显示，干预组在正确辅音百分比、不同词汇数量以及表达性/接受性词汇量三项指标上的提升幅度均显著优于对照组；未观察到显著的国家主效应及国家相关交互效应。

综上，在第二文化与语言环境中应用EMT+PE，可为CP+/-L儿童提供一种可行的早期干预方案。