06 Treatment

Question 1

What is the role of the SLP before physical management (after cleft palate closure and it didn’t work) ?

Answer 1

through language and speech assessment you need to distinguish between:

• FNAE/hypernasality (focused nasal air emission)
• Developmental errors
• Phonological processes
• the whole class of sounds is disturbed, not just one phoneme
• Compensatory errors
• Obligatory

Question 2

What should we inform parents?

Answer 2

-Timeline for treatment
-Speech/Langugae development
Abnormal speech sounds, watch for them, praise place, even if manner isn’t correct.
-Enlist the parents to look out for development of compensatory strategies —> the abnormal sounds!
we need to see this kiddos asap!!

Question 3

what are some other roles?

Answer 3

1. Training the patient/client to make the best of the appliance or pharyngoplasty or appliance
2. Reduce NAE/hypernasality after appliance or surgical management.
3. Eliminate artic errors now that mechanism works
4. Assume the surgery or obturator was a good fit

Question 4

How can you reduce NAE/hypernasality after appliance or surgical management.

Answer 4

• Use the octopus and get the patient to close the velopharyngeal port
• You may need to train the kiddos to open the pharynx rather than closure because they’re not used to it and end up sounding hypo nasal

Question 5

Speech therapy goals are addressing the most _______ in the cleft palate population

Answer 5

common error

• Treatment may have different errors so kids can be successful if they have a less than optimal obturator
• The best way to conduct articulation therapy is very early to prevent these errors from occurring in the first place.

Question 6

What are the 4 goals?

Answer 6

Goal #1 – Decrease velopharyngeal patency (opening)
Goal #2 – Decrease NAE/increase oral pressure.
Goal #3 – Decrease hypernasality
Goal #4 – Decrease compensatory errors.

Question 7

Explain goal 1

Answer 7

Goal #1 – Decrease velopharyngeal patency (opening)

after the physical management you teach them to get closure

Question 8

Explain goal 2

Answer 8

Goal #2 – Decrease NAE/increase oral pressure.
-You say “let more air come out of your mouth”
-Need auditory feedback
-Use a listening tube or Octopus (best)
-See-Scape
-Produce sustained fricatives without NAE
-Tactile feedback
Fingers on the nose for feeling the vibrations
You can plug your nose and say sounds
-Light, quick articulator contacts

Question 9

Explain goal 3

Answer 9

Goal #3 – Decrease hypernasality
-Is present on vowels
-It’s all about tongue position
The high back /i/ can put air through the nose and sounds the most hypernasal if the individual is hypernasal
So bring the tongue back in the oral cavity can increase oral air pressure
-You can do a CV combination
if they can get closeure on /t/ you will try to keep the velopharyngeal closure through the vowel —> /t^/ or /ti/

Question 10

Explain goal 4

Answer 10

Goal #4 – Decrease compensatory errors.

-The best way to get the articulation errors
talk to the parents about the f/s and the glottal stops
-Treatment may have a different order
-Articulation therapy for glottal/pharyngeal stops