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60 Cards in this Set
- Front
- Back
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Surgical Management of Clefts: Primary Surgical Correction
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Palatoplasty-surgical repair of clefts. Divided in to two stages; primary surgical correction and secondary surgical correction.
-Primary surgical correction: To separate oral and nasal cavities. Aid in swallowing, feeding, reducing # of middle ear infections. First stage- lip surgery, before 3 mo. Second stage-Palate, between 9-12 mo |
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Secondary Surgical Correction
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Secondary surgical correction: additional surgery to aid in adequate velopharyngeal closure.
-pharyngeal flap: cutting flap of tissue from pharyngeal wall and attach to velum. Generally performed between 6-12 yrs old. Complications include snoring, sleep apnea, blockage of airway. |
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Dental Management of Clefts
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Dental problems can interfere with chewing, swallowing, and speech production.
-Orthodontists: alignment of teeth and dental malocclusions. *malocclusion-improper alignment of maxillary and mandibular dental arches. -prosthodontist: replacement of missing teeth/oral structures. -prosthetic obturator- dental prostheses designed to fill cleft and separate oral & nasal cavities. -speech bulb-posterior portion of obturator that fills in velopharyngeal space |
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Audiological Management of Clefts
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Clefts = higher incidence of hearing disorders and middle ear disease.
-58% have some type of HL -with a cleft palate, tensor veli palatini muscle does not function properly and will not open and drain eustachian tube. -myringotomy: surgical procedure, tube is inserted in to tympanic membrane to equalize pressure. -screen every 3-6 months |
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Communication Problems with Clefts: Voice disorders
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80% expected to develop good speech.
-may have voice disorders, resonance/articulation disorders associated with VPI. -vocal hyperfuntion-compensatory behavior -vocal nodules (related to vocal hyperfuntion) -soft-voice syndrome- reduces vocal loudness to prevent air escaping through nose ASSESSMENT: Case history, personality, phonation, modification! |
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Resonance Disorders from Clefts
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Hypernasality- most common. Too much nasal quality.
Hyponasality- lack of nasal resonance. ASSESSMENT: -nasometer: measures air coming out nose) -multiview videofluoroscopy: x-ray images of velopharyngeal function from 3 different perspectives; front, side, and beneath. Continuous Positive Airway Pressure (CPAP)- treatment. 8 week muscle training program. Strengthens muscles of soft palate. Positive air pressure through nose mask. 50 specified words and 6 sentences. |
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Articulation Disorders from Clefts
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Patients with cleft palates are unable to build up intra oral air pressure needed for stop sounds.
-Nasal emission: air escaping trough nose. -Compensatory Articulation Errors: sound substitution error used as an attempt to compensate for sound unable to produce. -Glottal stop- build up air pressure in glottis rather then behind lips TREATMENT: reduce glottal stops, increase consonant inventory, electropalatalgraph |
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Language Disorders with Clefts
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People with clefts often have language delays. May be due to lengthy hospital stays, HL, other syndromes.
ASSESSMENT: -should be routinely examined for delays -evaluations should include environmental factors, motor/mental development, hearing ability. -language samples, standardized tests TREATMENT: same as other population! -family counseling, language enrichment, treatment ot ME disease. |
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Augmentative and Alternative Communication
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AAC: A set of procedures and processes by which an individual's communication skills can be maximized for functional and effective communication. It involves supplementing or replacing natural speech and/or writing with aided and/or unaided symbols.
*Augmentative communication- supplements speech. *Alternative Communication- replaces speech. |
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Why do we use AAC?
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-used for people with severe speech and language impairments.
-assists with daily communication needs -facilitate development of speech/language -facilitate return or speech and language -12 out of 1,000 people can't communicate orally -two types: unaided and aided |
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Unaided AAC
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-do not involve any external equipment and rely only on the individuals body
-gesturing, signing, fingerspelling, CUED speech, and writing. -Amerind: American Indian gesturing system. Relatively grammar free, can be done with 1 hand. 3 types of signs: Iconic- look like what they represent Transparent- easily guessable, memorable Opaque- difficult to interpret |
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Aided AAC: Assistive Technologies
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Assistive technologies: communication boards and electronic modes of communication. Assists daily living. Includes communication aids, prosthetic devices, seating systems, transportation aids.
-"no tech"- uses readily available materials ( e.g. pencil and paper, spelling out a message) -"low tech"-simple, few moving parts (e.g. wheelchair?) -"high tech"- more sophisticated, usually computer based |
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Added AAC Systems/Graphic Means of Representation
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Aided AAC Systems differ in the type of system, the graphic means of representation, and the input and output modes.
Graphic Means of Representation: -symbols include pictures, representational systems, printed words. -may include iconic or less iconic representations -can use variety of means to represent different concepts -for young children or severely cognitively impaired individuals, can use actual objects, photographs, or drawings. (Very concrete!) -bliss symbols: 100 arbitrary symbols. Rule governed, generative. |
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Aided System INPUT
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Input- determines how client will select symbol. "Access method". Based on cognitive impairment.
-Direct selection: point with finger, object, pointer, joystick. Good for school aged children, not as good for low functioning/poor motor abilities. -Scanning: choices are presented sequentially to user, who signals when desired symbol has been presented. -can respond with pressure switches, pneumatic "sip and puff" switches, and eye blink switches. -effective but laborious and slow -can be sped up by changing # of rows, columns, and putting most used symbols first |
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Aided System OUTPUT
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OUTPUT of message. How it is communicated.
Voice Output: -recorded or digitized: most natural sounding. Can match to age and gender. Recorded by a person, but not generative. Fixed recordings. -synthesized: not pre-recorded so more flexability, but mechanical and robotic. Both user and listener require training. Comprehension for listener can increase with exposure. |
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Speech VS AAC
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-AAC slower then speech. Causes problems for user and listener. Listener may want to complete sentence for user, which takes away users control.
-Some communication less face to face then speech. -BUT learning to use an AAC often enhances other aspects of communication and can facilitate production of natural speech. -AAC can reduce physical demands, communicative demands (pressure to speak), hand over hand shaping and modeling, and increased involvement of the right hemisphere. (Facilitating language & communication) |
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Lifespan Issues of AAC
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-exposure can begin with in the first few months of life
-developmental continuum- device must change and grow with child. -can provide initial communication and motivation to learn language -as AAC users age, communication needs to change. Must alter with for changes in hearing or vision, or as disorder progresses. -progressive disease- maintain verbalization as long as possible. Then use AAC intermittently, then more permanently. |
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AAC Assessment/Selection
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-is SLP things it may be needed at some point, should be introduced as early as possible.
-assess for communication abilities, motor skills, communication preferences, WILLINGNESS. *assessment always first! -selection of AAC must consider clients motor abilities, cognitive abilities, vocabulary size, and the flexibility and intelligibility of system |
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Intervention Considerations: SLP MUST!
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The SLP must...
-Identify opportunities for communication -create a need for communication -maximize instructional benefit Must address: -linguistic and communicative competence-must be able to communicate wants/needs in conversation -operational competence-must be able to operate! -must address long and short term needs For success, must have -family support -community support |
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Modeling/teaching techniques
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-Modeling: method for teaching production of multi-symbol messages. SLP points to 2 symbols while providing a grammatically complete spoken model.
-Aided Language Modeling (ALM): method to help children with ASD. Engaging children in active play and providing models of AAC symbols on communication board. -Milieu Teaching: SLP performs an action while asking questions such as "what am I doing?". If child fails to respond, or responds incorrectly, SLP models correct response and asks again. Taught during regular activities. -Community based training: when client becomes more comfortable and efficient using AAC in public places. Leads to optimum use. |
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Optimal Use of AAC
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Optimal use is when client uses AAC willingly at every opportunity.
Real communication with meaningful outcomes. |
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Development of the Secondary Palate
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Secondary Palate: the hard and soft palate
8-12 weeks gestation: processes of hard and soft palate fuse. This separates the oral and nasal cavity -palatal shelves come down and fuse. Tongue is pushed downward and away from palatal shelves -nasal septum grows down to meet palatal shelves separating rt and lf nasal cavity *Cleft of the palate: fusion of palatal shelf is interrupted. (Can be from tongue not moving down!) |
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Classifications of Clefts: The Veau System
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The Veau System: Classification scheme developed in the 30's and still used today. Quick general reference regarding nature and extent of clefts. Classifies clefts in to four classes:
1) Cleft of the soft palate only 2) Cleft of the hard and soft palate 3) Complete unilateral cleft of the soft and hard palate and on the lip and alveolar ridge on one side 4) Complete bilateral cleft of the soft and hard palate and/or the lip and alveolar ridge on both sides |
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Classifications of Clefts: Kernahan's Striped Y
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A visual identification system based on location and developed by the American Cleft Palate Association (ACPA). Focuses on the primary and secondary palate.
***Look at diagram! On test!!!********* |
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Clinical Features of Clefts: classification of features
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Clefts vary in type and severity. Commonly classified as:
1) Unilateral or bilateral cleft of the lip 2) Unilateral cleft of the lip and palate 3) Bilateral cleft of the lip and palate 4) Submucous Cleft 5) Bifid Uvula |
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Cleft of the Lip
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-involves vermillion (reddish notch in upper lip) and can extend through tip of nostril
Incomplete Cleft: minor V-shaped notch in vermillion Complete Cleft: continues from vermillion to upper lip into the floor of the nostril -causes flattening of nose and flaring of the nostril on one side -collumella (strip of tissue connecting base and tip of nose) is short and misaligned |
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Cleft of the lip: Unilateral vs Bilateral
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-if unilateral, most commonly on left side
-if bilateral, usually accompanied by cleft palate *isolated cleft rare, less then 5% of cases. Clefts of the lip usually extend through the alveolar process |
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Unilateral Cleft of the Lip and Palate
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Unilateral Complete Cleft of the Lip and Palate
-extends from external portion of upper lip, through alveolus, through the hard and soft palate. -Clefts of secondary palate alone (with out lip) is sometimes observed. Vary in severity |
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Bilateral Cleft of the Lip and Palate
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Most severe type of cleft due to severe lack of tissue.
-lip and alveolar processes cleft under both nostrils -abnormal positioning of prolabium (central portion of lip), alveolar process, and premaxila (as protruding mass of tissue at tip of nasal septum) -columella usually absent, resulting in tup of nose attaching directly to lip -nasal septum not attached to palatal shelves |
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Submucous Cleft
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-cleft in muscular region of soft palate
-can be concealed by a thin layer of mucosal tissue -may not be detected until late childhood Physical Characteristics -bifid uvula: uvula devided in to 2 parts -zona pellucida: bluish line in middle of soft palate -notch on posterior border of hard palate (can be felt) *All above may lead to Velopharyngeal Incompetence |
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Etiologies of Clefts: What causes them?
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Genetic Disorders:
-Treacher Collins Syndrome, Pierre Robin Syndrome, Velocardiofacial Syndrome, Alpert Syndrome Chromosomal Aberrations: -Trisomy 13 Teratogenically Induced Disorders Mechanical Induced Abnormalities |
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Genetic Disorders:
Peirre Robin Syndrome |
Account for a substantial percentage of clefting,
Clefting is associated with over 400 syndromes. Pierre Robin Syndrome: *micrognathia: small mandible (chin) -retracted and elevated tongue -isolated cleft of the hard and soft palate (not usu. lip) -congenital heart problems -digital anomalies -conductive HL -delayed language *small mandible interferes with decent of tongue causing isolated palatal cleft - |
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Treacher Collins Syndrome
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*malar hypoplasia: underdeveloped cheekbones and mandible
-Conductive HL, malformation of ear and ear canal -cleft palate (not lip) -projection of scalp hair on to cheek -communication problems-from cleft and HL but **NO cognitive problems** |
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Velocardiofacial Syndrome
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-language deficits
-learning disabilities -palatal cleft -small stature with broad, flattened nose and underdeveloped cheekbones -heart problems -communication problems: difficulty with abstract language, perseveration |
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Albert Syndrome
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*craniosynostosis: premature closing of the sutures of the skull resulting in disfiguration of forehead
*syndactyly: webbing of fingers and toes -high and narrowed arched palate -30% have cleft -expressive language delay |
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Chromosomal Abberations
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Chromosomal Abberations=Multiple congenital abnormalities.
Trisomy 13- results in cleft lip with or with out palate in 60%-70% of cases. -rare condition resulting from appearance of 3rd #13 -one in 6,000 births -coloboma, clenched fists, eyes very close |
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Teratogenically Induced Disorders/ Mechanically Induced Abnormalities
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Agents that interfere with or interrupt normal development of fetus and create congenital malformations.
-recognized teratogens-dilantin (anti convulsant), thalidomide (sedative/cancer treatment), excessive asprin use, alcohol, nicotine, caffiene. -also x-rays, viruses, some natural environmental sub Mechanically Induced Abnormalities: infringe directly on embryo. -amniotic rupture, intrauterine crowding, uterine tumor |
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Incidence of Clefts/Sex and Racial Differences
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-1 in 750 births
-Cleft lip with or with out cleft palate occur more often then cleft palate alone -submucous cleft: 1 in 1,200 births Sex and Racial Differences -clefts of lip twice as common in males -cleft of palate alone more common in females -submucous cleft same frequency in males and females. Most common in Native American's. (In US) |
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Cleft Palate Team and General Management
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Cleft Palate Team: group of specialists working together. TEAM APPROACH- family can see several specialists during one appointment, all specialists can communicate with one another.
Includes surgeons, dental specialists, SLP's, Audiologists. |
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Surgical Management of Clefts: Primary Surgical Correction
|
Palatoplasty-surgical repair of clefts. Divided in to two stages; primary surgical correction and secondary surgical correction.
-Primary surgical correction: To separate oral and nasal cavities. Aid in swallowing, feeding, reducing # of middle ear infections. First stage- lip surgery, before 3 mo. Second stage-Palate, between 9-12 mo |
|
|
Secondary Surgical Correction
|
Secondary surgical correction: additional surgery to aid in adequate velopharyngeal closure.
-pharyngeal flap: cutting flap of tissue from pharyngeal wall and attach to velum. Generally performed between 6-12 yrs old. Complications include snoring, sleep apnea, blockage of airway. |
|
|
Dental Management of Clefts
|
Dental problems can interfere with chewing, swallowing, and speech production.
-Orthodontists: alignment of teeth and dental malocclusions. *malocclusion-improper alignment of maxillary and mandibular dental arches. -prosthodontist: replacement of missing teeth/oral structures. -prosthetic obturator- dental prostheses designed to fill cleft and separate oral & nasal cavities. -speech bulb-posterior portion of obturator that fills in velopharyngeal space |
|
|
Audiological Management of Clefts
|
Clefts = higher incidence of hearing disorders and middle ear disease.
-58% have some type of HL -with a cleft palate, tensor veli palatini muscle does not function properly and will not open and drain eustachian tube. -myringotomy: surgical procedure, tube is inserted in to tympanic membrane to equalize pressure. -screen every 3-6 months |
|
|
Communication Problems with Clefts: Voice disorders
|
80% expected to develop good speech.
-may have voice disorders, resonance/articulation disorders associated with VPI. -vocal hyperfuntion-compensatory behavior -vocal nodules (related to vocal hyperfuntion) -soft-voice syndrome- reduces vocal loudness to prevent air escaping through nose ASSESSMENT: Case history, personality, phonation, modification! |
|
|
Resonance Disorders from Clefts
|
Hypernasality- most common. Too much nasal quality.
Hyponasality- lack of nasal resonance. ASSESSMENT: -nasometer: measures air coming out nose) -multiview videofluoroscopy: x-ray images of velopharyngeal function from 3 different perspectives; front, side, and beneath. Continuous Positive Airway Pressure (CPAP)- treatment. 8 week muscle training program. Strengthens muscles of soft palate. Positive air pressure through nose mask. 50 specified words and 6 sentences. |
|
|
Articulation Disorders from Clefts
|
Patients with cleft palates are unable to build up intra oral air pressure needed for stop sounds.
-Nasal emission: air escaping trough nose. -Compensatory Articulation Errors: sound substitution error used as an attempt to compensate for sound unable to produce. -Glottal stop- build up air pressure in glottis rather then behind lips TREATMENT: reduce glottal stops, increase consonant inventory, electropalatalgraph |
|
|
Language Disorders with Clefts
|
People with clefts often have language delays. May be due to lengthy hospital stays, HL, other syndromes.
ASSESSMENT: -should be routinely examined for delays -evaluations should include environmental factors, motor/mental development, hearing ability. -language samples, standardized tests TREATMENT: same as other population! -family counseling, language enrichment, treatment ot ME disease. |
|
|
Augmentative and Alternative Communication
|
AAC: A set of procedures and processes by which an individual's communication skills can be maximized for functional and effective communication. It involves supplementing or replacing natural speech and/or writing with aided and/or unaided symbols.
*Augmentative communication- supplements speech. *Alternative Communication- replaces speech. |
|
|
Why do we use AAC?
|
-used for people with severe speech and language impairments.
-assists with daily communication needs -facilitate development of speech/language -facilitate return or speech and language -12 out of 1,000 people can't communicate orally -two types: unaided and aided |
|
|
Unaided AAC
|
-do not involve any external equipment and rely only on the individuals body
-gesturing, signing, fingerspelling, CUED speech, and writing. -Amerind: American Indian gesturing system. Relatively grammar free, can be done with 1 hand. 3 types of signs: Iconic- look like what they represent Transparent- easily guessable, memorable Opaque- difficult to interpret |
|
|
Aided AAC: Assistive Technologies
|
Assistive technologies: communication boards and electronic modes of communication. Assists daily living. Includes communication aids, prosthetic devices, seating systems, transportation aids.
-"no tech"- uses readily available materials ( e.g. pencil and paper, spelling out a message) -"low tech"-simple, few moving parts (e.g. wheelchair?) -"high tech"- more sophisticated, usually computer based |
|
|
Added AAC Systems/Graphic Means of Representation
|
Aided AAC Systems differ in the type of system, the graphic means of representation, and the input and output modes.
Graphic Means of Representation: -symbols include pictures, representational systems, printed words. -may include iconic or less iconic representations -can use variety of means to represent different concepts -for young children or severely cognitively impaired individuals, can use actual objects, photographs, or drawings. (Very concrete!) -bliss symbols: 100 arbitrary symbols. Rule governed, generative. |
|
|
Aided System INPUT
|
Input- determines how client will select symbol. "Access method". Based on cognitive impairment.
-Direct selection: point with finger, object, pointer, joystick. Good for school aged children, not as good for low functioning/poor motor abilities. -Scanning: choices are presented sequentially to user, who signals when desired symbol has been presented. -can respond with pressure switches, pneumatic "sip and puff" switches, and eye blink switches. -effective but laborious and slow -can be sped up by changing # of rows, columns, and putting most used symbols first |
|
|
Aided System OUTPUT
|
OUTPUT of message. How it is communicated.
Voice Output: -recorded or digitized: most natural sounding. Can match to age and gender. Recorded by a person, but not generative. Fixed recordings. -synthesized: not pre-recorded so more flexability, but mechanical and robotic. Both user and listener require training. Comprehension for listener can increase with exposure. |
|
|
Speech VS AAC
|
-AAC slower then speech. Causes problems for user and listener. Listener may want to complete sentence for user, which takes away users control.
-Some communication less face to face then speech. -BUT learning to use an AAC often enhances other aspects of communication and can facilitate production of natural speech. -AAC can reduce physical demands, communicative demands (pressure to speak), hand over hand shaping and modeling, and increased involvement of the right hemisphere. (Facilitating language & communication) |
|
|
Lifespan Issues of AAC
|
-exposure can begin with in the first few months of life
-developmental continuum- device must change and grow with child. -can provide initial communication and motivation to learn language -as AAC users age, communication needs to change. Must alter with for changes in hearing or vision, or as disorder progresses. -progressive disease- maintain verbalization as long as possible. Then use AAC intermittently, then more permanently. |
|
|
AAC Assessment/Selection
|
-is SLP things it may be needed at some point, should be introduced as early as possible.
-assess for communication abilities, motor skills, communication preferences, WILLINGNESS. *assessment always first! -selection of AAC must consider clients motor abilities, cognitive abilities, vocabulary size, and the flexibility and intelligibility of system |
|
|
Intervention Considerations: SLP MUST!
|
The SLP must...
-Identify opportunities for communication -create a need for communication -maximize instructional benefit Must address: -linguistic and communicative competence-must be able to communicate wants/needs in conversation -operational competence-must be able to operate! -must address long and short term needs For success, must have -family support -community support |
|
|
Modeling/teaching techniques
|
-Modeling: method for teaching production of multi-symbol messages. SLP points to 2 symbols while providing a grammatically complete spoken model.
-Aided Language Modeling (ALM): method to help children with ASD. Engaging children in active play and providing models of AAC symbols on communication board. -Milieu Teaching: SLP performs an action while asking questions such as "what am I doing?". If child fails to respond, or responds incorrectly, SLP models correct response and asks again. Taught during regular activities. -Community based training: when client becomes more comfortable and efficient using AAC in public places. Leads to optimum use. |
|
|
Optimal Use of AAC
|
Optimal use is when client uses AAC willingly at every opportunity.
Real communication with meaningful outcomes. |
