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Cleft Palate > July 9 > Flashcards

July 9 Flashcards

1
Q

What foundational skills should be established in therapy?

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
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2
Q

Foundational skills should be carried to what accuracy?

A

always 100%

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3
Q

Failure to carry foundational skills to 100% results in

A

Failure to do so may result in problems with carryover later

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4
Q

Practice activities can explore what?

A

a range of content and form?

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5
Q

Introduce linguistic challenge after

A

stability with phrase imitation

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6
Q

Early Intervention for Children with Cleft Palate aged 0-5

What do you do first?

A

Always have parents sign a release allowing you to communicate with the treating team
Send your results
Address your concerns
Don’t hesitate to ask questions

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7
Q

What are related issues for Children with Cleft Palate aged 0-5

A
  • Eustacian tube dysfunction
  • Middle ear disease
  • Conductive Hearing loss
  • Effusions can occur without acute infection
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8
Q

Pierre Robin Sequence • Earlyproblems:

A

– Neonatal respiratory distress

– Feeding

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9
Q

Later concerns: Pierre Robin Sequence

A

– MED
– Speech-language (90%)
– Resonance disorder (25%)

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10
Q

Pierre Robin Sequence

A

Micrognathia
• Glossoptosis
• Cleft secondary palate – U-shaped`

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11
Q

Pierre Robin Sequence, Routine…..

A

genetics screening needed

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12
Q

Pierre Robin Sequence, • Differential Diagnosis:

A

– Stickler Syndrome

– Velo-Cardio-Facial Syndrome

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13
Q

Cleft Palate and the Tongue

Babies with cleft palate, even with Pierre Robin Sequence, ……..

A

have tongues which are functionally and structurally normal.

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14
Q

Feeding the child with cleft lip, Typically addressed by

A

nurses

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15
Q

cleft lip only real feeding issue to address is….

A

lip seal

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16
Q

cleft lip, can they breast feed?

A

May often breast feed successfully

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17
Q

Feeding the Child with Cleft Palate, ususally do well with…..

A

feeding modifications

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18
Q

Feeding the Child with Cleft Palate, need good communication with…..

A

• Parent
• Pediatrician
Team

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19
Q

Feeding the Child with Cleft Palate, Transition to cup and spoon foods…..

A

– Learning to keep food out of the nose

– Spouted cups can be difficult before rep

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20
Q

T OR F: EI-SLP intervention IS ALWAYS NEEDED.

A

NO IT MAY NOT BE NEEDED

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21
Q

In regards to feeding, parents may need…

A

reassurance
– May be fearful of the cleft
– May need support to advance to next level

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22
Q

In regards to feeding SLP should…..

A

Collaborate with the team

– Contact them with concerns, questions, ideas – Keep them apprised of plans and progress

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23
Q

Are long term feeding issues common in cleft palate population.

A

NO

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24
Q

Are long term feeding issues related to other issues instead if cleft.

A

YES

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25
Q

Can cleft be a complicating factor in feeding?

A

yes

26
Q

What should SLP do about feeding with child with cleft palate.

A

collaborate with team

27
Q

What do we know about the development of the baby born with a cleft palate?

A

The Infant with Cleft Palate
• May have fluctuating, conductive hearing loss –
Auditory input may be distorted
– May be less attentive to sound
• The oral and nasal cavities are coupled
– Intraoral air pressure is significantly diminished –
The variety of consonants is diminished
Infant vocalizations may be of shorter duration
• Lingual contacts may be different – Lingua alveolar
– Linguapalatal
• Delayed onset of canonical babbling
• Slower growth in expressive vocabulary

28
Q

How many children with cleft palate never need speech therapy?

A

25 -50%

29
Q

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

A

50 -75%

30
Q

What percentage of kids will require secondary velopharyngeal management?

A

20 -25%

31
Q

Is it reasonable to expect normal speech in the neurologically normal child with a cleft?

A

yes

32
Q

Most children with cleft palate and impaired intelligibility have what?

A

an articulation disorder

33
Q

is it likely that motor speech or phonological disorders occur often in this population?

A

no

34
Q

if present, articulation disorders

A

can and must be treated

35
Q

Is dditional surgery needed before treating articulation disorder?

A

NO

36
Q

Are there things we can do to prevent an artculation disroder?

A

yes, we can always try
Promote longer duration vowels in the infant
Cooing with the baby Long sighs

37
Q

avoid modeling what when trying to prevent and articulation disorder

A

modeling glottal stops, think looooong vowels

38
Q

How do you extinguish maladaptive errors?

A

• Never imitate!
• Counsel parents to identify imitators in the environment
– Advise them to have the imitators stop
• Choose an alternate behavior
• Ignoring is a last resort, but may be needed for well-entrenched behaviors

39
Q

What else can you do to prevent an articulation disorder.

A 
Practice oral stops • Work on imitation of sounds
– Have fun!
• Set up back and forth sound making
• Model nose plugging
• Model plugging partner’s nose
– Let baby see that people have fun!
• Try plugging baby’s nose
40
Q

What is percentage of centers with resonance disorder?

A

20-25% in nonsyndromic populations

41
Q

Can resonance disorder be treated with speech therapy?

A

NO

42
Q

Treatment of resonance disorder (Velopharyngeal Dysfunction), how do you treat this?

A

• Surgical
– Palatal re-repair
• Furlow double opposing z-plasty • Radical intravelar veloplasty
– Sphincter pharyngoplasty – Pharyngeal flap
• Prosthetic – Palatal lift
– Pharyngeal extension obturator (speech bulb)

43
Q

how to treat VPD?

A 
• Most centers treat after the third birthday
• If articulation skills are adequate
• Various instrumental assessments used
– Imaging
• Videonasopharyngoscopy • Videofluoroscopy
– Non-imaging
• Pressure flow
• Nasometry
• Find out what tests are used.
• Can you assist with prep?
44
Q

Is a true language disorder common with cleft palate?

A

no, – but May be co-morbid condition

45
Q

IsTreatment of language disorder different because of the cleft

A

no

46
Q

Is a voice disorder the same as a resonance disorder?

A

NO, but it Can be a co-morbid condition of VPD – Reassessed after treatment of VPD

47
Q

why might someone with cleft palate have a voice disorder?

A

May result from the same causes seen in the general pediatric population

48
Q

Evaluation in the first year of life?

A

• Get a release signed for contact with the treating cleft palate team
• Make contact with the team after first visit – Introduce yourself
– Fax/mail report
– Discuss concerns, plan
• Obtain medical, family, and social history
– Ear health and hearing
• Remind parents to request ear check with each office
visit
– Learn about possible familial trends
– Learn about additional complicating factors
• Evaluate infant development
– Various instruments available
– MacArthur-Bates Communciative Development Inventory 8-30 months
– Assess vowel and consonant inventory
• Evaluate parental knowledge and skills for language stimulation
– Observe interaction with the baby – Observe imitative attempts
– Observe reading attempts
– Note amount of time in front of TV

49
Q

To Treat or Not to Treat? from first year of life eval?

A 
• Before and after the first birthday
– Attention
• Is a hearing test needed?
– Interaction
• Is a hearing test needed, or another exam?
– Receptive language
• Teach the parent to be the teacher
– Vowel and consonant inventory • Teaching and extinguishing
– Hearing!
50
Q

The Art and Science of the Home Visit

A 
1. Reconnect and Review
• 2. Address Priorities
• 3. Show the Craft
• 4. Assess and Evaluate
reflect on the visit
51
Q

1.ReconnectandReview

A

– What has transpired since last visit? • Any changes? Improvements?
What concerns does the family have?
• What is working, what isn’t working?
• What things interfere with follow through?

52
Q

2.AddressPriorities

A

What does the child, family need? – Lily

53
Q
  1. Show the Craft
A

– Play and interaction begin
– Demonstrate the skill you would like to teach
• Activities of daily living (food prep, diaper change, bath,
going for a walk, letting the dog in/out…) • Book sharing
• Modeling
• Home practice activities

54
Q
  1. Assess and Evaluate
A

– As implementation concludes, discuss
effectiveness • Lily
• Booksharing
• Effects of Narration

55
Q

Reflect on the Visit

A

Does the parent feel comfortable trying the
techniques?
– Are there questions left unanswered?
– Where might these techniques lead us?

56
Q

Tools of the Trade

A
  1. Information Resource
    • 2. Validator
    • 3. Sounding Board
    • 4. News Commentator
57
Q

Age 2: Evaluation

A

MacArthur-Bates Communicative Development Inventory
• Articulation Test or consonant inventory – Resonance assessment
– General intelligibility assessment
• Receptive Language assessment • Review of medical history

58
Q

Ages 3-5: Evaluation

A

Review of medical history
• CELF Preschool
• Articulation Test and/or Articulation/Resonance Quick Check

59
Q

Evaluation

• Oral Mechanism

A 
• Oral Mechanism
– Note occlusion
– Note tonsils, and adenoid if visible
– Observe palatal lift
– Observe for palatal fistula or prior velopharyngeal surgery
– Test oral volitional movement
– Diadochokinesis
60
Q

How to test? Obligatory vs. Maladaptive

A

Velopharyngeal:
Do articulation testing with the nose plugged and unplugged
Fistula:
Test articulation with the fistula plugged and unplugged
Dental:
Diagnostic therapy to see if changing tongue placement alters distortion

61
Q

To Treat or Not to Treat: Age 2 and beyond

A

Intelligibility: Treat:
– If impairment is significant
– If maladaptive errors are present
• Language:
– Treat if significant deficits are present
– Can treat in conjunction with intelligibility
• Resonance: Differentiate articulation errors from true resonance disorder
– You can treat articulation, but not resonance

Cleft Palate (5 decks)

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