Cleft Assessment & Intervention

Question 0

What are INDIRECT methods of evaluation?

Answer 0

• Nasometer -measure nasalence ratio (gives oral % and nasal % of emissions emitted.
• mirror test/air paddle/see scape
• tactile assessment
• auditory assessment: perception, nose pinch, stethoscope, straw, listening tube

Question 1

What are the 2 DIRECT tools of evaluation?

Answer 1

1. Video fluoroscopy -infants, premi’s, neonatal

2. Nasopharyngoscopy- *most used -2 yrs+, goes through nasal floor, through VP & looks at laryngeal fxn.

Question 2

What are the 2 types of evaluations?

Answer 2

Direct & indirect

Question 3

Describe the assessment time table in the 1st year.

Answer 3

Feeding, language dev., counseling parents
General rule: QUANTITY of speech is much more important than QUALITY. Let them ramble because we’d rather have them talk than not talk.

Question 4

Describe annual and periodic evals.

Answer 4

• Yearly team eval until age 4
• comprehensive SLP eval at age 3
  - 1st: expressive lang dev.
  - 2nd: resonance/VP fxn unless interfering with feeding and swallowing.

Question 5

Why is it important to have a baseline assessment?

Answer 5

An instrumental and perceptual assessment should be performed prior to surgery that is designed to improve speech. We need something to compare before and after surgery.

Question 6

What should we evaluate?

Answer 6

Artic
Stimulability
Nasal air emission
Consonants
Utterance length
Oral motor
Resonance 
Phonation
Swallowing/feeding

Question 7

What are the 6 major components of and evaluation?

Answer 7

1. Diagnostic interview
2. Language screening
3. Speech samples
4. Resonance /VP Function-direct/perceptual
5. Orofacial exam
6. Recommendations/POC -help or refer out?

Question 8

What should the diagnostic interview include?

Answer 8

Medical history

Developmental history

Question 9

What should the language screening include?

Answer 9

Parent questionnaire
Informal (observe play, repetition, elicit speech)
Formal (REEL, ELM, Rosetti, Fluharty)

Question 10

What should the speech sample include?

Answer 10

Formal artic test
Syllable repetition
Sentence repetition 
Counting and rote speech 
Spontaneous connected speech

Question 11

How can nasal air emission and hypernasality be caused?

Answer 11

By an artic disorder, VPI, a fistula, or any combo

Question 12

Why is it important to know the etiology well?

Answer 12

It will impact treatment

Question 13

If a fistula is present, what can we do to determine if VPI is present?

Answer 13

Close it with gum or a fruit roll up. If fistula is closed up with fruit roll up, and there is still emission, then the problem is VPI.

Question 14

If nasal emission or hypernasality is phoneme specific (particularly in sibilants or high vowels) then what type of disorder is it?

Answer 14

Artic disorder

Question 15

If someone has VPI , do they produce emissions when saying all sounds or certain types of sounds?

Answer 15

If you have VPI, then ALL sounds are effected. So if only SOME sounds aren’t correct then It’s phoneme specific which requires artic therapy.

Question 16

How do you treat based on etiology?

Answer 16

1. VPInsuffieciency (structural abnormaility)- surgery, prosthesis(speech bulb), ST.
2. VPIncompetence (physiological Abnormality)- surgery, prosthesis(palatial lift),ST.
3. VP Mislearning- ST only
4. Symptomatic Fistula- surgery(close up and graph bone), (obturator-helps close fistula), ST