Cleft Lip/palate Consultation

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Treatment recommendations include

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surgical management, prosthetic management, speech therapy

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Additional assessments from other professionals include

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audiologist, geneticist, neurologist, dentist, orthodontist

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other diagnostic procedures include

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sleep study X ray, videofluoroscopy swallow study

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obligatory errors

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what have to do because of a physical reason

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velopharyngeal incompetence

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physiological abnormality

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velopharyngeal insufficiency

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structural abnormality - suggest options such as speech bulb

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fistula requires

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obturartor

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Reports should include

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appropriate language - explain resonance, cause of resonance

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Direct measures for

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you see a direct view inside
videofluoroscopy, nasendoscopy

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Indirect

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nasometer pressure flow equipment

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nasometry includes

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a plate that includes a nose and mouth microphone and a computer gives a ratio/ a visual representation of resonance / 2 microphones seperated by a plate

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pros

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noninvasive method for obtaining objective data regarding resonance
provides a visual representation in real time
gives descriptive data of the relative amount of nasal resonance in speech

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nasalance score

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nasal/oral ratio ratio of nasal over total (nasal plus oral) acoustic energy

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nasalance score is then compared to

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normative data

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high scores suggest hypernasality above 30 on nasalance

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measure on high intra oral consonants - p b

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Nasalance scores should be between

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15 and 20

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Nasal sentences should be highly nasal

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Low scores suggest hyponasality

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high scores and low scores on nasalance indicate

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mixed resonance

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Perceptual passages include

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zoo passage, rainbow passage, nasal sentences

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zoo passage is unique because

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it does not contain nasals

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nasometry is useful when doing

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evaluation and treatment, measure changes in resonance following surgury, show effects of therapy and prosthetic management

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radiography includes

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lateral cephalometric images MRI videofluoroscopy

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lateral cephalometric images

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Xray of midsagittal plane

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advantages of lateral cephalometric images

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shows hard palate, velum, PPW allows examiner to evaluate the status of the cervical spine, cranial base angle and the facial skeleton

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during the lateral cephalometric having them say....

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/s/ as it allows the velum to be closed for a period of time

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dis of lateral ceph

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/s/ is not a true measure of the velum movermnt lateral pharyngeal walls can not be observed velum movement is not observed

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MRI

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uses a magnetic field and radio waves to produce detailed images of inside the human body / provides a very clear view of internal body structurs with a good detail

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disadv

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enclosed structure, cost

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nasoendoscopy

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enters through the nose going down to view the velum

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Adv

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closure pattern can be determined, PPW can be examined, degree of velar, lateral and PPW, can be moved further down the pharynx for a view of the larynx and vocal folds

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gaps, bubbles indicate

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air is leaking through

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disadv of nasometry

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it's indirect, it's not in a school setting, you don't know what is causing the velum insufficiency

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to intervene with a preschool child Rule 1 is

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teach identity location and actions of oral structures (speech helpers)

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Remember doing this helps ...

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close their nose to prevent air from leaving the nose helping them use correct articulation placement

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To show speech helpers use a

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mirror

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Practical uses of teaching

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use mirror, use popsicle stick, puff out cheeks, let out small burst of air, wide open mouth to see velum, swallow with mouth open, say ah and watch velum go up and down

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teach place...doing this consider

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start with the most visible, use mirror, multimodal combine visual, tactile, auditory cues, fricatives first because of prolonged tactile cue, RF approximations, contrast different places

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Intervention for preschoolers include

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teaching place, teach orthographic symbol, teach difference between nasal and oral airflow

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difference between oral and nasal airflow is taught by

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gentle blowing - see scape
auditory discrimination

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phonetic approach

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perceptual training usually auditory but also visual which emphasizes target sound identification and discrimination from error sounds

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Remember to teach the child how to make the sound not

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how to use it

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phonetic approach includes

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the ability to self monitor and self correct, error sounds treated one at a time, practice and stabilize in a hierarchical fashion

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Hierarchial order in the phonetic approach is

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syllable to word, pre, post intervocalic

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Make sure the child ...

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hears the error, teach the right place/airflow, hear and feel the difference, practice alot

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The presence of clefting does NOT indicate

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a lack of tongue/velar strength or function

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Do not use

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in oral motor exercises increasing muscle strength

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VPI is because the velum is

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the palate is too short not weak

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SLPS can use low resistance blowing to demonstrate forward

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air flow and orally directed A/F

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Materials for oral airflow include

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blowing bubbles, whistle, cotton balls, straw and glass of water, pinwheels, nose clips

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nasal emission is caused by

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VPI fistula articulation disorder

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cause is important to determine

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because it can influence treatment recommendations

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Recommendations of treatment based on cause: velopharyngeal insufficiency

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surgery, prosthesis speech bulb, speech therapy for articulation and compensatory problems

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nasometry is for

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evaluation measure changes in resonance
shows the effect of therapy and prosthetic management

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disadvantage of lateral cephalmetric Xray

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it is not 3 dimensional lateral walls can not been seen image must be taken with a single production of speech such as /s/ not a true measure of speech
measurement of velopharygeal structures can not be evaluated with this procedure

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disadvantage of MRI

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it is costly closure of the MRI test may scare the child cooperation is needed

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Because of disadvantages of MRI it is

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not standard procedure to use

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advantages of videofluoroscopy

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examiner can confirm size of the opening cause of velum problems can be evaluated short velum or poor movement

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videofluoroscopy you can see

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velar movement during speech
surgical and prosthetics options can be considered because of the test
can be used to determine the effects of surgury

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flexible fiberoptic nasopharyngoscopy adv

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velar closure pattern can be determined
degree of velar, lateral, and PPW movement can be observed
Can be moved further down the pharynx to the VFs

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teach ...

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teach place, orthographic letters, teach difference between oral and nasal airflow

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phonetic motor approach

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ability to self monitor, self correct, errors treated at one time practiced and stabilized in a hierachrial order