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What is a Cleft? -malformation that occurs during fetal development and is present when the child is born. -one of the most commonly occurring birth defects. Lip and/or palate. Unilateral or bilateral. Hard or soft palate. Mild to severe.
Incidence 1/750 births in Caucasians. 1/500 births in Asian/Native Americans. 1/1900 births in African Americans. Males (2:1)
Surgical Timetable ~3 months/10 pounds 1. Lip closure and initial repair work to nose if needed. (anesthesia tolerance)
Surgical Timetable - 10 to 14 months Palatal closure. (by this point cartilage has ossified)
Surgical Timetable - preschool Repair to any lip or nose work prior to school entry. (social concern)
Surgical Timetable - 5 to 9 yearsold Bone grafting to the alveolar ridge for added support and risk reduction of maxillary arch collapse. (skulls and teeth are becoming more adult-like)
Surgical Timetable - adolescence Jaw replacement performed in teen years (if necessary).
Surgical Timetable Surgery to correct velopharyngeal insufficiency (VPI) or palatal fistulas (if necessary). (Problems, especially with nasal emissions - also resonance.)
Communication Considerations (2) Significant risk of speech production errors (i.e., articulation and resonance) prior to and following surgery.
Communication Diagnostic Considerations (3) Full medical history: -Surgeries, cognitive deficits, co-occurring syndromes, prenatal exposures, chromosomal defects. -Nasometry for resonance (or a well-trained ear). -Formal/informal assessment can be used for speech production.
Communication Therapeutic Considerations (3) -Minimize compensatory speech behaviors. -Focus on correct placement (especially frontal sounds). -Surgical intervention to repair structural deficits may be needed before effective therapy can take place.
Specific Speech Problems (5) -Fricatives (dental abnormalities) -Hypernasality/nasal emission (connected nasal and oral cavities add length) -Loudness (larger tube) -Weak pressure consonants (decreased air pressure in oral cavity) -Articulatory Compensations
Feeding/Swallowing probs (4) 1.Oral-motor deficits (due to incomplete structures) 2.Interactive patterns (bonding) 2.Nutrition/hydration (poor myelination). 3.Aspiration/penetration/choking (bulb syringe/machine suction) 4.Breathing disruptions/apnea
Feeding/Swallowing risks (5) 1.malnutrition 2.dehydration 3.aspiration (pneumonia) 4.penetration 5.choking
Feeding/Swallowing signs (4) 1.Irritability or refusal. 2.History of pneumonia. 3.Wet vocal quality. 4.Nasal regurgitation.
Feeding/Swallowing diagnosis Ultrasound, Modified Barium Swallow Study. (We make feeding/nutritional recommendations for attending physicians, not decisions.)
BREAST FEEDING keys (6) 1.Positioning 2.Eye/skin contact 3.Allow breast tissue to fill gap. 4.Not always successful (pumping instruction) 5.Bottle supplementation (flexibility) 6.Specialized bottles/alternatives (palatal obdurator, bulb syringe, Haberman feeder)
BOTTLE FEEDING positioning (3) 1.Hold baby semi-upright 2.Hold the head and shoulders in one hand, and the bottle in the other 3.Baby’s head, neck, and shoulders aligned with the chin tucked toward the chest
Importance of Feeding/Swallowing position Easier control/transport of bolus. Flattens tongue. Funnels food/drink to the esophagus & away from trachea.
Feeding Coaches (there is no certification) SLP, lactation consultant, nurses, doctors, surgeons, dental specialists, prosthedontists, dietitians (enteral feeds)
Created by: ashea01