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Cleft Palate > July 2nd Slides > Flashcards

July 2nd Slides Flashcards

1
Q

What is STEP ONE of evaluation, Planning, and Treatment for the Child with Cleft Palate? What are 3 other things you should do within the first step?

A 
Step One: Always have parents sign a release allowing you to communicate with the treating team
Also: 
Send your results 
Address your concerns 
Don’t hesitate to ask questions
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2
Q

These slides discuss collaborative care in what 3 contexts?

A

Collaborative care in:

cleft palate
velopharyngeal dysfunction
craniofacial differences

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3
Q

If you provide early intervention in the home what 2 things should you be familiar with?

A

Art and Science of the Home Visit:
Stredler Brown, A. (2005, Jan. 18).

The ASHA Leader, pp. 6- 7, 15.

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4
Q

List reasons why you would sign off on early intervention in the home.

A

– If the parent requests it
– If the parent is willing and able to learn the new skill
– If the parent understands the reasons for using it
EDUCATE WELL!!!!!

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5
Q

List reasons why you would not sign off on early intervention in the home.

A

– If the parent is stressed or not coping well
– If the parent may have difficulty learning a new skill
– If the parent may have trouble understanding the reasons for introducing sign
– If it may cause the parent to think their baby will not talk

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6
Q

It may be inadvisable to spend time and resources on what with early intervention in the home for a child with cleft palate?

A

on a skill we will want the child to lose

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7
Q

What may be a better use of resources for the child with a cleft palate instead of spending time and resources on a skill we will want the child to lose.

A

Teaching parents to be excellent language teachers

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8
Q

What should you do if If maladaptive/compensatory articulations are present in early intervention age children with cleft palate? List 3 examples.

A

advise family on extinction techniques

  • Don’t imitate the troublesome sounds!
  • Model prolonged vowels
  • Model easy onset
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9
Q

What should you teach the parent to teach in at home early intervention.

A
  • Good language stimulation • Helping the child to listen
  • Prolonging Vowels
  • Anterior articulation
  • Anterior blowing
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10
Q

How many children with cleft palate will require speech therapy in childhood?

A

50% to 75%

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11
Q

How many children with cleft palate will require secondary velopharyngeal management?

A

4-38%

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12
Q

What is the most common speech disorder in children with cleft palate?

A

articulation

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13
Q

What kind of speech should you expect in the neurologically normal child with a cleft?

A

normal speech

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14
Q

What is the only way true velopharyngeal dysfunction can be treated?

A

with physical management, NOT with speech therapy

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15
Q

What can kinds of errors can speech therapy correct?

A

maladaptive/compensatory errors

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16
Q

What is the ONLY thing that can correct maladaptive/compensatory errors?

A

speech therapy

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17
Q

What can speech therapy correct?

A

articulation

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18
Q

Name 4 articulation error types.

A

Developmental
Obligatory
Maladaptive
Adaptive

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19
Q

Developmental error.

A
  • May not necessarily be related to the cleft

* Will respond to the same treatment as non-cleft children on your caseload

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20
Q

obligatory (passive)

A
  • Distortion caused by a structural anomaly
  • Will not respond to therapy, there is no need to treat.
  • Some can be tested in evaluation, some can be tested in therapy
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21
Q

Adaptive error

A
  • Difference in production caused by structural difference
  • Acoustically appropriate
  • Examples: [p,b,m] with macroglossia – [f,v] with anterior crossbite
  • No need to treat!
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22
Q

Maladaptive

or “Compensatory”(CMA) “ Active errors”

A
  • First described by Trost-Cardamone in 1981
  • Further delineated by Peterson-Falzone and others
  • Believed to develop as a compensation for defect of mechanism before or after palate repair
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23
Q

Examples of Maladaptive

or “Compensatory”(CMA) “ Active errors”

A 
glottal stop
pharyngeal stops and fricatives (and affricates)
mid dorsum palatal stops
posterior nasal fricative
velar fricatives (voiced and unvoiced)
ingressive fricatives
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24
Q

How to test? Obligatory vs. Maladaptive

Velopharyngeal:

A

Do articulation testing with the nose plugged and unplugged

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25
Q

How to test? Obligatory vs. Maladaptive

fistula

A

Test articulation with the fistula plugged and unplugged

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26
Q

How to test? Obligatory vs. Maladaptive

dental

A

Diagnostic therapy to see if changing tongue placement alters distortion

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27
Q

Form Hypotheses and Develop a Treatment Plan

Developmental: treat or not?

A

Same guidelines apply as with children without cleft

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28
Q

Form Hypotheses and Develop a Treatment Plan

Obligatory/passive:

A

do not treat with speech therapy

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29
Q

Form Hypotheses and Develop a Treatment Plan

Maladaptive/compensatory/active:

A

definitely treat

30
Q

Form Hypotheses and Develop a Treatment Plan

adaptive

A

do not treat

31
Q

Form Hypotheses and Develop a Treatment Plan

UNCERTAIN

A

begin diagnostic therapy

32
Q

Phonological Cycle?
• Despite two cited studies, most craniofacial SLPs DO NOT recommend a phonological cycle approach
• Why?

A

– Seen as ineffectual in children returning for subsequent evaluations
– Is this a concern for all children in phonological cycle approaches administered in school settings, or only children with cleft palate?

33
Q

Most cleft-affected children will NOT benefit from these techniques used as techniques in and of themselves

A 
Non-speech oral motor exercises
• Icing, brushing, and massage
• Blowing, sucking, and gagging exercises and programs (horns and straws)
• Vibratory stimulation
• Thermal stimulation
34
Q

Specificity!

A

The best way to treat speech is to treat speech

Use a motor learning approach

35
Q

Teach place of articulation

If you are uncertain as to the velopharyngeal contribution, when what?q

A

plug the nose

36
Q

Work from what part to what part of mouth.

A

front of mouth to back of mouth

37
Q

Defer [k,g] until when?

A

until late in therapy

38
Q

What should you ask yourself when doing therapy.

hint: pedagogy

A

Why is therapy needed?
• What needs to be changed?
• What should be known before a consonant is taught?
• Parts of the mouth and their names
– (oral awareness?)
– Difference between target and error • Give the sound a new name!
– How to imitate

39
Q

Teach from where?

A

similar place of articulation

40
Q

for /p,b/

A

use /m/ and plug the nose

41
Q

for /t,d/

A

use [n,l], plug the nose

42
Q

for /s,z/

A

use [t,d] prolonged

43
Q

for /k,g/

A

use “ng,” plug the nose

44
Q

For [t,d]

A

• Teach fully protruded or interdentally
Teach from excessively anterior place of articulation


45
Q

For [s,z]

A

Teach from “th”

Then, gradually pull the tongue back to the correct placement

46
Q

Remember that you are teaching a new motor pattern..how many times is a good start?

A

100 times is a good start!

47
Q

What is the hierarchy of goals? GO!

A 
Isolation 
Syllable Imitation 
Word Imitation 
Phrase Imitation 
Picture Naming 
Question 
Response 
Simple Sentence 
Complex Sentence

48
Q

Describe foundational skills.

A
  • Early discrim pedagogy
  • Establishment of consonant in isolation
  • Advancement to syllable segments
  • Use in word imitation and picture naming • Use in phrase imitation
  • Single-word question response
49
Q

Foundational skills should always be carried to…..

A

100% accuracy

50
Q

Failure to carry out foundational skills to

A

failure to do so may result in problems with carryover later

51
Q

OK, but can you really do this with a two-year old?

A

yes

52
Q

How can you make it fun?

A
  • iPad apps
  • Puzzles
  • Mr. Potato Head • Hide and Seek
  • Bean Bag Toss • Ring Toss
  • Bead stringing
  • Angry Birds
  • Dot-to-Dots
  • Board games
  • Card games
  • Indoor basketball • Construction Toys • Stickersheets
53
Q

Home
assignments are
essential! list examples

A

Gimme 5
Pick a vowel
Word, phrase, sentence lists

54
Q

• Target [p,b] first: Why?

A

– Anterior
– Visible
– Likely to achieve success
– Will need for imaging

55
Q

For [p,b]

A

use [m] for gabriella

56
Q

When do I wean from nose- plugging?

A

After the syllable level…but …reuse as complexity advances,
to check for coarticulation, or with new consonant targets

57
Q

When should you Introduce linguistic challenge?

A

after stability with phrase imitation. Don’t pull out the pictures or reading flash cards before then!

58
Q

What about the velopharynx?

A

Stay in touch with the team Learn their imaging requirements Keep addressing articulation

59
Q

If the articulation is correct and stable with

the nose plugged, then what?

A

move on

60
Q

Can you fix the articulatory placement with therapy?

A

yes

61
Q

Can you fix resonance disorder with therapy?

A

NO

62
Q

If the articulation does not sound correct with the nose plugged, then what?

A

you still need to work on placement.

63
Q

[t,d] provide excellent foundation for teaching what?

A

central /s/

64
Q

When do I wean from the nose plug? How do I do it?

A

Wean after 100% accuracy at syllable level, but don’t feel badly about a few minutes of plugging here and there as you advance.

65
Q

Careful data collection in each therapy session is the best practice. What should you use?

A

pica scoring

66
Q

Which format to use? What is individual pull out appropriate for?

A 
Foundational Skills
• Discrimin Pedagogy – Oral/nasal
– Oral/glottal
– Oral/pharyngeal
• Placement teaching • Nose-plugging
• Basic skill-building



67
Q

What is classroom push in appropriate for?

A 
• Classroom Push-in
– Advanced Levels
• Question response
• Question asking
• Sentence generation
• Conversational speech
68
Q

Examples of short sessions.

A

Speed speech
Mini therapies
Rapid 1:1

69
Q

The articulation disorder may not be the same as others on your caseload…and the treatment techniques may….

A

differ as well

70
Q

Consider the psychosocial issues…example….

A

If the techniques you need to use may expose a child to ridicule in a group, you may need to treat individually

71
Q

How do you schedule an authorization by visit.

A

– Frequency determined by family schedule and number of visits authorized
– Length: 60 minutes +
– Schedule when family schedule allows best use of benefit

72
Q

How do you schedule an authorization by calendar days?

A

– Frequency: as often as possible
– Schedule when family schedule allows maximum # of sessions
– Length: 60 minutes +

Cleft Palate (5 decks)

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