July 9 Flashcards
What foundational skills should be established in therapy?
- 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 be carried to what accuracy?
always 100%
Failure to carry foundational skills to 100% results in
Failure to do so may result in problems with carryover later
Practice activities can explore what?
a range of content and form?
Introduce linguistic challenge after
stability with phrase imitation
Early Intervention for Children with Cleft Palate aged 0-5
What do you do first?
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
What are related issues for Children with Cleft Palate aged 0-5
- Eustacian tube dysfunction
- Middle ear disease
- Conductive Hearing loss
- Effusions can occur without acute infection
Pierre Robin Sequence • Earlyproblems:
– Neonatal respiratory distress
– Feeding
Later concerns: Pierre Robin Sequence
– MED
– Speech-language (90%)
– Resonance disorder (25%)
Pierre Robin Sequence
Micrognathia
• Glossoptosis
• Cleft secondary palate – U-shaped`
Pierre Robin Sequence, Routine…..
genetics screening needed
Pierre Robin Sequence, • Differential Diagnosis:
– Stickler Syndrome
– Velo-Cardio-Facial Syndrome
Cleft Palate and the Tongue
Babies with cleft palate, even with Pierre Robin Sequence, ……..
have tongues which are functionally and structurally normal.
Feeding the child with cleft lip, Typically addressed by
nurses
cleft lip only real feeding issue to address is….
lip seal
cleft lip, can they breast feed?
May often breast feed successfully
Feeding the Child with Cleft Palate, ususally do well with…..
feeding modifications
Feeding the Child with Cleft Palate, need good communication with…..
• Parent
• Pediatrician
Team
Feeding the Child with Cleft Palate, Transition to cup and spoon foods…..
– Learning to keep food out of the nose
– Spouted cups can be difficult before rep
T OR F: EI-SLP intervention IS ALWAYS NEEDED.
NO IT MAY NOT BE NEEDED
In regards to feeding, parents may need…
reassurance
– May be fearful of the cleft
– May need support to advance to next level
In regards to feeding SLP should…..
Collaborate with the team
– Contact them with concerns, questions, ideas – Keep them apprised of plans and progress
Are long term feeding issues common in cleft palate population.
NO
Are long term feeding issues related to other issues instead if cleft.
YES
Can cleft be a complicating factor in feeding?
yes
What should SLP do about feeding with child with cleft palate.
collaborate with team
What do we know about the development of the baby born with a cleft palate?
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
How many children with cleft palate never need speech therapy?
25 -50%
How many kids with cleft palate will require speech therapy in childhood?
50 -75%
What percentage of kids will require secondary velopharyngeal management?
20 -25%
Is it reasonable to expect normal speech in the neurologically normal child with a cleft?
yes
Most children with cleft palate and impaired intelligibility have what?
an articulation disorder
is it likely that motor speech or phonological disorders occur often in this population?
no
if present, articulation disorders
can and must be treated
Is dditional surgery needed before treating articulation disorder?
NO
Are there things we can do to prevent an artculation disroder?
yes, we can always try
Promote longer duration vowels in the infant
Cooing with the baby Long sighs
avoid modeling what when trying to prevent and articulation disorder
modeling glottal stops, think looooong vowels
How do you extinguish maladaptive errors?
• 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
What else can you do to prevent an articulation disorder.
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
What is percentage of centers with resonance disorder?
20-25% in nonsyndromic populations
Can resonance disorder be treated with speech therapy?
NO
Treatment of resonance disorder (Velopharyngeal Dysfunction), how do you treat this?
• Surgical
– Palatal re-repair
• Furlow double opposing z-plasty • Radical intravelar veloplasty
– Sphincter pharyngoplasty – Pharyngeal flap
• Prosthetic – Palatal lift
– Pharyngeal extension obturator (speech bulb)
how to treat VPD?
• 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?
Is a true language disorder common with cleft palate?
no, – but May be co-morbid condition
IsTreatment of language disorder different because of the cleft
no
Is a voice disorder the same as a resonance disorder?
NO, but it Can be a co-morbid condition of VPD – Reassessed after treatment of VPD
why might someone with cleft palate have a voice disorder?
May result from the same causes seen in the general pediatric population
Evaluation in the first year of life?
• 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
To Treat or Not to Treat? from first year of life eval?
• 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!
The Art and Science of the Home Visit
1. Reconnect and Review • 2. Address Priorities • 3. Show the Craft • 4. Assess and Evaluate reflect on the visit
1.ReconnectandReview
– 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?
2.AddressPriorities
What does the child, family need? – Lily
- Show the Craft
– 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
- Assess and Evaluate
– As implementation concludes, discuss
effectiveness • Lily
• Booksharing
• Effects of Narration
Reflect on the Visit
Does the parent feel comfortable trying the
techniques?
– Are there questions left unanswered?
– Where might these techniques lead us?
Tools of the Trade
- Information Resource
• 2. Validator
• 3. Sounding Board
• 4. News Commentator
Age 2: Evaluation
MacArthur-Bates Communicative Development Inventory
• Articulation Test or consonant inventory – Resonance assessment
– General intelligibility assessment
• Receptive Language assessment • Review of medical history
Ages 3-5: Evaluation
Review of medical history
• CELF Preschool
• Articulation Test and/or Articulation/Resonance Quick Check
Evaluation
• Oral Mechanism
• 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
How to test? Obligatory vs. Maladaptive
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
To Treat or Not to Treat: Age 2 and beyond
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
