July 2nd Slides Flashcards
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?
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
These slides discuss collaborative care in what 3 contexts?
Collaborative care in:
cleft palate
velopharyngeal dysfunction
craniofacial differences
If you provide early intervention in the home what 2 things should you be familiar with?
Art and Science of the Home Visit:
Stredler Brown, A. (2005, Jan. 18).
The ASHA Leader, pp. 6- 7, 15.
List reasons why you would sign off on early intervention in the home.
– 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!!!!!
List reasons why you would not sign off on early intervention in the home.
– 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
It may be inadvisable to spend time and resources on what with early intervention in the home for a child with cleft palate?
on a skill we will want the child to lose
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.
Teaching parents to be excellent language teachers
What should you do if If maladaptive/compensatory articulations are present in early intervention age children with cleft palate? List 3 examples.
advise family on extinction techniques
- Don’t imitate the troublesome sounds!
- Model prolonged vowels
- Model easy onset
What should you teach the parent to teach in at home early intervention.
- Good language stimulation • Helping the child to listen
- Prolonging Vowels
- Anterior articulation
- Anterior blowing
How many children with cleft palate will require speech therapy in childhood?
50% to 75%
How many children with cleft palate will require secondary velopharyngeal management?
4-38%
What is the most common speech disorder in children with cleft palate?
articulation
What kind of speech should you expect in the neurologically normal child with a cleft?
normal speech
What is the only way true velopharyngeal dysfunction can be treated?
with physical management, NOT with speech therapy
What can kinds of errors can speech therapy correct?
maladaptive/compensatory errors
What is the ONLY thing that can correct maladaptive/compensatory errors?
speech therapy
What can speech therapy correct?
articulation
Name 4 articulation error types.
Developmental
Obligatory
Maladaptive
Adaptive
Developmental error.
- May not necessarily be related to the cleft
* Will respond to the same treatment as non-cleft children on your caseload
obligatory (passive)
- 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
Adaptive error
- Difference in production caused by structural difference
- Acoustically appropriate
- Examples: [p,b,m] with macroglossia – [f,v] with anterior crossbite
- No need to treat!
Maladaptive
or “Compensatory”(CMA) “ Active errors”
- 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
Examples of Maladaptive
or “Compensatory”(CMA) “ Active errors”
glottal stop pharyngeal stops and fricatives (and affricates) mid dorsum palatal stops posterior nasal fricative velar fricatives (voiced and unvoiced) ingressive fricatives
How to test? Obligatory vs. Maladaptive
Velopharyngeal:
Do articulation testing with the nose plugged and unplugged
How to test? Obligatory vs. Maladaptive
fistula
Test articulation with the fistula plugged and unplugged
How to test? Obligatory vs. Maladaptive
dental
Diagnostic therapy to see if changing tongue placement alters distortion
Form Hypotheses and Develop a Treatment Plan
Developmental: treat or not?
Same guidelines apply as with children without cleft
Form Hypotheses and Develop a Treatment Plan
Obligatory/passive:
do not treat with speech therapy
Form Hypotheses and Develop a Treatment Plan
Maladaptive/compensatory/active:
definitely treat
Form Hypotheses and Develop a Treatment Plan
adaptive
do not treat
Form Hypotheses and Develop a Treatment Plan
UNCERTAIN
begin diagnostic therapy
Phonological Cycle?
• Despite two cited studies, most craniofacial SLPs DO NOT recommend a phonological cycle approach
• Why?
– 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?
Most cleft-affected children will NOT benefit from these techniques used as techniques in and of themselves
Non-speech oral motor exercises • Icing, brushing, and massage • Blowing, sucking, and gagging exercises and programs (horns and straws) • Vibratory stimulation • Thermal stimulation
Specificity!
The best way to treat speech is to treat speech
Use a motor learning approach
Teach place of articulation
If you are uncertain as to the velopharyngeal contribution, when what?q
plug the nose
Work from what part to what part of mouth.
front of mouth to back of mouth
Defer [k,g] until when?
until late in therapy
What should you ask yourself when doing therapy.
hint: pedagogy
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
Teach from where?
similar place of articulation
for /p,b/
use /m/ and plug the nose
for /t,d/
use [n,l], plug the nose
for /s,z/
use [t,d] prolonged
for /k,g/
use “ng,” plug the nose
For [t,d]
• Teach fully protruded or interdentally
Teach from excessively anterior place of articulation

For [s,z]
Teach from “th”
Then, gradually pull the tongue back to the correct placement
Remember that you are teaching a new motor pattern..how many times is a good start?
100 times is a good start!
What is the hierarchy of goals? GO!
Isolation Syllable Imitation Word Imitation Phrase Imitation Picture Naming Question Response Simple Sentence Complex Sentence 
Describe foundational skills.
- 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
Foundational skills should always be carried to…..
100% accuracy
Failure to carry out foundational skills to
failure to do so may result in problems with carryover later
OK, but can you really do this with a two-year old?
yes
How can you make it fun?
- 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
Home
assignments are
essential! list examples
Gimme 5
Pick a vowel
Word, phrase, sentence lists
• Target [p,b] first: Why?
– Anterior
– Visible
– Likely to achieve success
– Will need for imaging
For [p,b]
use [m] for gabriella
When do I wean from nose- plugging?
After the syllable level…but …reuse as complexity advances,
to check for coarticulation, or with new consonant targets
When should you Introduce linguistic challenge?
after stability with phrase imitation. Don’t pull out the pictures or reading flash cards before then!
What about the velopharynx?
Stay in touch with the team Learn their imaging requirements Keep addressing articulation
If the articulation is correct and stable with
the nose plugged, then what?
move on
Can you fix the articulatory placement with therapy?
yes
Can you fix resonance disorder with therapy?
NO
If the articulation does not sound correct with the nose plugged, then what?
you still need to work on placement.
[t,d] provide excellent foundation for teaching what?
central /s/
When do I wean from the nose plug? How do I do it?
Wean after 100% accuracy at syllable level, but don’t feel badly about a few minutes of plugging here and there as you advance.
Careful data collection in each therapy session is the best practice. What should you use?
pica scoring
Which format to use? What is individual pull out appropriate for?
Foundational Skills • Discrimin Pedagogy – Oral/nasal – Oral/glottal – Oral/pharyngeal • Placement teaching • Nose-plugging • Basic skill-building

What is classroom push in appropriate for?
• Classroom Push-in – Advanced Levels • Question response • Question asking • Sentence generation • Conversational speech
Examples of short sessions.
Speed speech
Mini therapies
Rapid 1:1
The articulation disorder may not be the same as others on your caseload…and the treatment techniques may….
differ as well
Consider the psychosocial issues…example….
If the techniques you need to use may expose a child to ridicule in a group, you may need to treat individually
How do you schedule an authorization by visit.
– Frequency determined by family schedule and number of visits authorized
– Length: 60 minutes +
– Schedule when family schedule allows best use of benefit
How do you schedule an authorization by calendar days?
– Frequency: as often as possible
– Schedule when family schedule allows maximum # of sessions
– Length: 60 minutes +
