Cleft Assesment and Intervention

Question 1

Evaluation

Answer 1

Direct (visualization of structures)

• Videofluoroscopy
• Nasopharyngoscopy (not very effective)

Indirect (no visualization of structures)

• Nasometer
• Mirror test/ air paddle/ See-Scape
• Tactile assessment

Question 2

Evaluation

Answer 2

Auditory Assessment

• Perception
• Nose pinch
• Stethoscope
• Straw
• Listening tube

Question 3

Assessment Timetable

Answer 3

First year
1. SLP concerns : Feeding, Lang dev’t, counseling
Quantity of speech more important than the quality

Annual & periodic evals

• Yearly team eval until age 4 (ACPCA, 1993)
• Comprehensive SLP eval age 3
  1. expressive language dev’t
  2. resonance/ vp function

Question 4

Assessment Timetable

Answer 4

** A baseline assessment (instrumental & perceptual) should be performed prior to surgery that is designed to improve speech **

Question 5

What to evaluate?

Answer 5

• ARTICULATION
• STIMULABILITY
• CONSONANTS
• NASAL EMISSION
• ORAL MOTOR (ROM)
• UTTERANCE LENGTH
• RESONANCE
• PHONATION

Question 6

COMPONENTS OF EVALUATION

Answer 6

DIAGNOSTIC INTERVIEW

• Medical hx
• Developmental hx

LANGUAGE SCREENING

• Parent questionnaire
• Informal ( observe play, repetition, elicit speech)
• Formal ( REEL ELM ROSETTI FLUHARTY)

Question 7

COMPONENTS OF EVALUATION

Answer 7

SPEECH SAMPLES

• Formal articulation test
• Syllable repetition
• Sentence repetition
• Counting & rote speech
• Spontaneous connected speech

Resonance/VP function- DIRECT instrumental & perceptual
Orofacial exam
Recommendations/ POC

Question 8

Differential Dx

Answer 8

• Nasal air emission & Hypernasality can be caused by an articulation disorder, VPI, a fistula, or any combination.
• If fistula present, close it with gum or a fruit roll up to determine if VPI is present
• If nasal emission or hypernasality is phoneme specific ( particularly sibilants or high vowels), then it is an artic disorder.

Question 9

Tx Based on Etiology

Answer 9

VP INSUFFICIENCY (STRUCTURAL ABNORMALITY)
- Surgery, prosthesis (speech bulb), ST

• VP INCOMPETENCE (PHYSIOLOGICAL ABNORMALITY)
• Surgery, prosthesis, (palatal lift), ST

Question 10

Tx Based on Etiology

Answer 10

• VP MISLEARNING
• ST only
• SYMPTOMATIC FISTULA
• Surgery, Prosthesis, (obturator), ST