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5.CD1-CleftLipPalate
CommDis1
| Term | Definition |
|---|---|
| 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