Applying the ICF-CY Framework to Children With Cleft Palate: Narrative Review of a Fresh Approach

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The International Classification of Function, Disability and Health-Children and Youth Version (ICY-CY), (WHO, 2007) provides an important framework for the holistic consideration of children with communication disorders such as cleft lip and palate. It allows for understanding the effects of a cleft lip and palate on a child’s ability to communicate in structured and natural contexts, going beyond a focus on body structures and functions in order to examine the ways that environmental and personal factors influence the child. Over the years, a number of researchers have applied the ICF-CY framework to children with communication impairments such as speech sound disorders, language impairments, and stuttering. While there is an emerging body of research and literature on this topic, the ICF-CY does not yet appear to be widely applied clinically to children with cleft lip and palate. The aim of the study was to conduct a comprehensive narrative review of the application of the ICF-CY to children with cleft lip and palate, in order to illustrate its use in this population, to identify research needs, and to make recommendations for clinical application to assessment and intervention and integrating the ICF-CY in cleft palate curricula. A systematic search of the literature was conducted by following a specific search strategy and a systematized selection of publications for review to limit researcher bias. Computer searches of electronic data bases, as well as hand searches, were conducted to identify publications and sources that addressed the ICF-CY or ICF in children with cleft lip and palate. Publications and sources that met the inclusion criteria were selected for review. Each source was summarized according to the author(s) and publication year, and a qualitative description of each was made according to structured review procedures and templates. Applications of the specific ICF-CY components to children with cleft lip and palate were mapped, and recommendations for clinical application and future research were described. It is suggested that the ICF-CY framework should be included in cleft palate curricula to provide future speech-language pathologists with a holistic perspective on children with cleft lip and palate and to extend their thinking about the impact of speech impairment associated with cleft lip and palate. Training to adopt the ICF-CY framework will also facilitate collaborative interdisciplinary care of children with cleft lip and palate. Using the ICF-CY framework in the assessment of children in this population will focus intervention on the ultimate goal of improvement of the child's ability to communicate in natural settings. This narrative review will also serve as the theoretical underpinning for a planned survey of the clinical assessment practices of speech-language pathologists treating children with cleft lip and palate.


Johnson City, TN

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