NEWS | March 15, 2018

Spanish questionnaire expected to reduce disparities in speech treatment for cleft-palate patients


The Spanish version of a questionnaire used to assess the speech and quality-of- life of children and young adults following cleft-palate surgery has been developed by craniofacial disorder specialists at UC Davis Health and the University of Utah.

Travis Tollefson Travis Tollefson

Once tested in a clinical study, the new 25-question instrument, known as the Spanish Velopharyngeal Insufficiency Effects on Life Outcomes (VELO) questionnaire, is expected to reduce disparities in care for patients with cleft palate whose preferred language is Spanish.

The translation project is summarized in a research letter published in the current issue of JAMA Plastic Surgery.

Surgery before 14 months of age is highly successful in reducing or even eliminating speech difficulties associated with cleft palate, according senior author Travis Tollefson, director of facial plastic and reconstructive surgery in the UC Davis Department of Otolaryngology – Head and Neck Surgery.

For about 10 to 15 percent of patients, however, air will leak between the soft palate and back of the throat and cause speech difficulties later in life, Tollefson explained. The result, known as velopharyngeal insufficiency, can be overly nasal-sounding speech and problems communicating clearly.

“The English VELO is exceptional for assessing speech and guiding decisions about further treatment,” Tollefson said. “Without a valid translation, we weren’t able to use this important tool with Spanish-speaking patients and their families. The new version helps eliminate that gap.”

VELO translation
An intensive process of forward-backward translations combined with cognitive interviews led to the Spanish Velopharyngeal Insufficiency Effects on Life Outcomes questionnaire.

Developing the Spanish VELO involved an intensive linguistic validation process that began with independent translations by two native Spanish speakers. Discrepancies between the two versions were reconciled with verbal discussions. The Spanish VELO was then translated back into English and compared to the original, once again with discrepancies addressed through discussion. That version was then translated into Spanish and assessed by a panel of Spanish-speaking patients with cleft palate and their parents, whose feedback was incorporated to create the final version.

Treatment possibilities for velopharyngeal insufficiency include surgery to connect the soft palate to the back of the throat, visual feedback techniques, directed speech therapy and palate-lengthening procedures, according to Tollefson.

“We work closely with patients and their families to determine the best approach, and VELO results are key to guiding those decisions,” Tollefson said. “Together with medical evaluations, the questionnaire allows us to identify specific speech concerns along with the degree to which those concerns affect the patient’s daily interactions.”

Tollefson and colleague Jonathan Skirko of the University of Utah, the researcher who developed the VELO and a co-author of the research letter, previously published an assessment of the English VELO that validated its use in understanding the social, emotional and physical effects of velopharyngeal insufficiency. They will now conduct a similar study to evaluate the Spanish version.

Tollefson expects to use the Spanish VELO in his UC Davis clinic and multidisciplinary cleft program and during surgical outreach projects in Central and South America, where cleft palate is prevalent.

“Effective health care requires dialogue and respect, which are not possible without linguistically appropriate medical assessment tools,” Tollefson said. “The Spanish VELO gets us much closer to that ideal with children with cleft palate.”

Additional authors of the letter were UC Davis medical student Rosario Santillana and speech-language pathologist and UC Davis cleft team coordinator Christina Roth.

The translation project had no external funding.

A copy of the letter, titled “Spanish Linguistic Validation for the Velopharyngeal Insufficiency Effects on Life Outcomes,” is available online

More information about UC Davis Health and its Department of Otolaryngology is at