Cleft Palate Exam 3
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| What percentage of cleft kids require speech therapy in childhood? | 50 - 75%
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| What percentage of cleft kids require secondary VP management? | 4-38%
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| What is the most common speech disorder? | Articulation
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| What should you expect in a neurologically normal child with a cleft? | Normal speech
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| Therapy can't fix ____- | Obligatory errors, VPI, abnormal structure
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| Therapy can fix_______ | Compensatory errors, velopharyngeal mislearning, sometimes VP incompetence
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| Oral motor exercises | Not backed by EBP, need speech to increase speech
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| When is blowing appropriate? | To initially facilitate teaching of oral airflow
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| Therapy at birth to 3 | Quantity, feeding, parent education, oral experiences via nasal pinching
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| What do you increase at birth to 3 yr? | Nonspeech sounds, speech sound inventory (imitation/vocal play), vocabulary, MLU
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| What do you do with brith to 3 yr before palatal surgery? | Oral experiences, model correct sound production, ignore hypernasality errors and provide correct model
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| What do you do with birth to 3 yr after palatal surgery? | Continue oral experiences, placement, model/counseling
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| What do you look at between 3 - 4 yrs? | Eval speech, VP function, start therapy or consider additional surgery, appropriate referrals
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| What is therapy used for? | Monitor language development, compensatory arctic., phone specific NAE, phone specific hypernasality b/c of misarticualtion, hypernasality due to oral-motor dysfunction
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| If it's developmental.... | Same guidelines as w/o cleft, plan, diagnose the source
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| if it's Obligatory | Don't treat
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| if it's Adaptive | Don't treat
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| if it's Uncertain | Begin diagnostic therapy
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| if it's Maladaptive/compensatory | Treat
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| What are the most common compensatory errors? | Glottal stops
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| Types of articulation errors | Developmental, obligatory, maladaptive, adaptive
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| Developmental errors | May not be related o cleft, respond to same treatment as non-cleft kiddos
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| Obligatory | Distortion caused by structural anomaly, won't respond to therapy, tested in eval or therapy
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| Examples of obligatory errors | Hyper/hypo, nasal air escape, cul de sac
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| Adaptive | Difference in production caused by structural difference, acoustically appropriate
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| Possible causes of adaptive | Dentition
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| Do you treat adaptive errors? | Best to wait it out
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| Examples of adaptive errors | p, b, m with macroglossia, v. f with anterior cross bite
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| Maladaptive or Compensatory Active errors (CMA) | Compensation for defect of mechanism before or after palatal repair, likely replaced to poor hearing status
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| How to treat cleft kiddos? | Start at front of mouth and go back
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| Types of Maladaptive compensatory errors | Glottal stop, pharyngeal stop, mid-dorsum palatal stop, posterior nasal fricative
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| Glottal stop | Forceful adduction of vocal folds and build up air pressure under glottis, mis identified as sound omission
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| How to eliminate glottal stop | Auditory awareness, tactile cues, continuous airflow /h/, easy onset, consonant-vowel combos
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| What is continuous airflow /h/? | Insert /h/ to create continuous airflow and softer one
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| What sounds do you start wit when treating glottal stop? | More anterior oral sounds, less nasal so they can see it, easier to treat
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| Pharyngeal stops and Fricatives | BoT moves back to articulate against the PPW
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| What are pharyngeal stops often substituted for? | Velar stops
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| What are pharyngeal fricatives often substituted for? | Fricative sounds (s, sh)
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| How do you treat pharyngeal fricatives, affricates, and posterior nasal fricatives? | Anterior placement of tongue (th, d or raspberries), for /s/, use /t/ then /t/ closed, then /ts/, then eliminate /t/
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| Mid-dorsum palatal stops | Dorsum og tongue articulates against palate, sub for lingual alveolars (t, d, n, I), velars (k, g, ng) (more anterior sound)
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| What causes mid-dosrum palatal stops? | Crowding, anterior cross bite, fistula, class III occlusion
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| How to eliminate mid-dorsum palatal stops? | Tongue blade b/e canine and moan teeth to practice /t, d, n/ in front of blade and /k, g, ng/ behind blade
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| Posterior nasal fricatives | Produced with back of tongue against the velum sin production of /ng/, sub for /s/ and other fricatives
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| Anterior nasal fricatives | Produced by constricted air in the anterior nares, nasal grimace, sub for /s/ and other fricative sounds
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| What do you do for phone specific NAE? | Awareness, provide contrast, occlude and unocclude nostrils during /s/ productions, start with /t/ and work to /ts/ and then /s/, no surgery
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