Speech And Reso Intervention Flashcards
(84 cards)
1
Q
Who are the members of the CLAP Team?
A
- Plastic surgeon
- Oral/maxillofacial surgeon
- Craniofacial surgeon
- Nurse
- Social Worker
- Psychologist
- Audiologist
- Otolaryngologist
- Speech-Language Pathologist
- Pediatric Dentist
- Orthodontist
- Prosthodontist
- Geneticist
- Pediatrician
- Pulmonologist
2
Q
What does a plastic surgeon do?
A
- Surgical repair of the lip and palate
- Surgical reconstruction of facial and cranial anomalies
- Surgery for correction of VPI
- Plastic surgeons may also perform bone grafts, orthodontic surgery on jaws.
3
Q
What is the aim of plastic surgery in terms of CLAP management?
A
** Repair the structural defects ** so there is improvement in the patient’s overall facial aesthetics, function, and speech.
4
Q
This usually does the bone graft (to the alveolar cleft) and performs orthodontic surgeries to normalize occlusion (bet mandibular & maxillary arches)–maxillary advancement and mandibular setback. Who is this?
A
Oral/Maxillofacial surgeon
5
Q
What does a craniofacial surgeon do?
A
Craniofacial surgery is a subspecialty of both oral/maxillofacial and plastic surgery. The role of this surgeon is to correct the congenital deformities of the head, skull, face, neck, jaws, and associated structures.
6
Q
What is the role of a nurse?
A
- Assesses the child’s overall physical development. They determine whether the child is growing normally or is in good general health.
- Assists the family in developing compensatory feeding techniques
- Usually the one who counsels the family regarding surgical procedures and answers their specific questions.
7
Q
What does a social worker do?
A
- Helps families deal with the challenges they experience when trying to manage the child’s special needs.
- May be the one to coordinate appointments and assist families in dealing with insurance or other funding sources.
- May help the family manage their stress and emotional reactions.
8
Q
What does a psychologist do?
A
- Assesses the patient’s psychosocial needs
- Assists the patient and family in dealing with medical, social, emotional challenges
- Assists the physician in determining the emotional preparedness of the patient for surgical procedures.
9
Q
What does an audiologist do?
A
- Work with otolaryngologists (ENT doctor) in monitoring hearing and middle ear function.
- Patients with craniofacial anomalies → at high risk for structural anomalies, middle ear disease, and hearing loss
- Tests the patient’s hearing and middle ear function
10
Q
What does an otolaryngologist do?
A
- Aka ENT (ear, nose, throat) specialist
- Monitors middle ear function and hearing– treats middle ear disease
- Also manages upper airway obstruction (for Pierre Robin sequence)
- Assesses structural aspects of the oral cavity, oropharynx, nasal cavity, and upper airway
-Some ENTs perform nasopharyngoscopy evaluation, do surgeries for VPI, and do surgeries for nasal and oral repairs
11
Q
What is the role of an SLP in the CLAP team?
A
- Counsels parents regarding what to expect with communication development
- Evaluates feeding and swallowing, speech, language, resonance, and VP function
- Provides therapy for communication problems and disorders of feeding and swallowing
- Some SLPs perform nasopharyngoscopy evaluations
12
Q
What is the role of the dentist in the CLAP team?
A
Responsible for the general care of the child’s teeth –prevention and treatment of tooth decay
- ensures child develops good oral habits of good oral hygiene, protects and preserves even the primary teeth because they act as placeholders for permanent teeth, improves early (primary dentition stage) - - malocclusion → moving maxillary segments thru palatal expansion
- May be involved in the management of misaligned cleft segments prior to lip closure
13
Q
What is the role of an orthodontist?
A
Responsible for: aligning misplaced teeth, correcting dental and skeletal malocclusion.
Works to normalize jaw relationships–to achieve normal dental function and to improve facial and dental aesthetics
14
Q
What does a prosthodontist do?
A
Involved with the restoration of natural teeth or replacement of missing teeth
- Develops devices to replace or improve the appearance of oral and facial structures that cannot be adequately improved with surgery dental care
- Can manufacture and fit devices to assist with VP closure if surgery is not an option
15
Q
Aka dysmorphologist. Responsible for assessing patients with a history of cleft, VP dysfunction, and craniofacial anomalies for a pattern that indicates a known syndrome or cause. He/she also counsels the family regarding diagnosis, recurrence risk, prognosis (if a syndrome is identified)
A
Geneticists
16
Q
What is the role of a pediatrician in the CLAP management?
A
- Responsible for assessing the patient’s overall medical health, growth, and development
- Determines whether there are other related/unrelated conditions that must be addressed, particularly those that can affect plans for surgical intervention
17
Q
This allied health professional evaluates and monitors the patient’s airway and sleep–many children with cleft and craniofacial anomalies have airway issues and sleep problems. If obstructive sleep apnea (OSA) is suspected, this professional will order a sleep study
A
Pulmonologist
18
Q
What are the surgical managements for CLAP?
A
- Cleft lip repair (cheiloplasty)
- Cleft palate repair (palatoplasty)
- Oronasal fistula repair
- Surgery for VP insufficiency/incompetence
19
Q
What is a velum?
A
Soft palate
The velum separates the nasal cavity from the oral cavity
20
Q
What is a fistula?
A
It is an abnormal opening; hole
21
Q
Meaning of unilateral and bilateral
A
Unilateral: one side
Bilateral: two sides
22
Q
What is VP insufficiency?
A
Soft palate is too short
23
Q
What does it mean if the patient has VP incompetence?
A
The soft palate or velum is not short, but not functioning well (neurological impairment)
24
Q
What is the goal of cheiloplasty? What is minimized? Why?
A
- The goal is to bring together the skin, muscle, and mucous membrane
- Achieve symmetry: nostrils and cupid’s bow
- Minimize scarring (scarred/tight upper lip may have a detrimental effect on maxilla growth)
25
What is the goal of palatoplasty? What is its purpose?
- To close of the oral cavity from the nasal cavity
- For feeding, middle ear function, and speech
26
The timing for cheiloplasty is? What is the 10s rule?
**3-6 months old**
-10 weeks
-10 pounds
-10 grams of hemoglobin
27
What is the timing for palatoplasty?
- Early: 6-15 months
- Late: 15-24 months
28
What is intentional fistula?
- Deliberately left in the alveolus to allow anterior facial growth without restriction
29
What is an unintentional fistula? What can it cause?
- Occurs when palate fails to heal after palatoplasty
- Palatal Fistula
- A palatal fistula can be asymptomatic (does not have any effect) or it can cause NAE, hypernasality, and nasal regurgitation
30
There are times when surgical correction is not possible thus what is recommended for the patient?
Prosthesis- Obturator
31
What is VP insufficiency following a palatal repair can be due to:
- Scarring from initial palatoplasty → can shorten the velum → making it impossible to reach the posterior pharyngeal wall during speech → can cause muscular dysfunction too, resulting in poor velar movement
- Cranial base anomalies (e.g., nasopharynx is too deep relative to velum position)
32
What is pharyngoplasty?
- Procedure of the pharynx is designed to **correct VPI**
- Goal is to **normalize VP closure for speech**
33
How do we assess if the patient has a VPI?
Nasopharyngoscopy or Videofluoroscopy
34
Presurgical management. As the SLP, what do you have to check before the surgery of the patient?
- Make sure that it is not VP mislearning
- Adenoid pads, tonsils, presence of micrognathia (small mandible)
- May not be appropriate for patients with: significant airway obstruction, neurological conditions, significant cognitive disability, severe hearing loss, bleeding disorder
35
Orthognathic surgery
- Craniofacial conditions not only affect soft tissues but also bony tissues
- Skeleton = scaffolding for the soft tissues envelope the face
36
So orthodontic surgery is a type of surgery that involves the bones of the upper jaw (maxilla) and the ___________.
Lower jaw (mandible)
37
What is the goal of orthognathic surgery?
**Improve the skeletal scaffolding** and therefore, the soft tissues envelope the face, as well as underlying function
38
What are the three types of orthognathic surgery?
- Alveolar bone grafting
- Maxillary advancement
- Mandibular reconstruction
39
What is the purpose of alveolar grafting? What is its timing?
Alveolus intentionally not addressed in cheiloplasty and palatoplasty; left untreated to allow for less restricted maxilla growth
- Provide bony support for eruption of permanent teeth
Timing: 6-11 years old when the roots of the teeth are ⅔ developed and are ready to erupt
40
Cleft patients often have Class III malocclusion (underbite). Maxilla is behind the mandible arch, maxilla growth = usually inhibited because of scar tissue and disturbances to the growth centers from previous surgeries. Class III malocclusion causes oral cavity crowding, which leads to obligatory/compensatory errors (e.g., lingual sounds). What is the purpose of maxillary advancement? When is its timing?
Purpose: **normalize occlusal relationship** between maxilla and mandible arch
Timing: 7-9 years old when maxillary sinus is developed. (Maxillary sinus = storehouse for permanent teeth)
41
Patients with craniofacial conditions often have micrognathia (small mandible), which causes airway obstruction, sleep apnea, desaturation of O2 during feeding. What is the purpose of the mandibular reconstruction? What is its timing?
- Provide adequate airway for respiration and feeding
Timing: Ideally done in skeletally mature patients to avoid relapse from post-surgical growth
42
What is prosthesis?
A **fabricated substitute** for a body part that is missing or malformed
43
A prosthesis is done by
Orthodontist or prosthodontist
44
What are prosthetic devices?
- Dental appliances
- Facial prosthesis
- Feeding obturators
45
What are speech appliances?
- Palatal lift
- Palatal obturator
- Speech bulb obturator
46
What does a feeding obturator do? What does it provide? What does it eliminate?
- Used in the first months of life to **assist infant in feeding**
- Covers a portion of baby’s cleft palate
- Provides a solid surface so that the tongue can achieve compression with the nipple to express milk
- Eliminates nasal regurgitation
47
What does a palatal lift do?
Used for? Not used for?
Who may benefit?
- Used for VP incompetence
- Elevates a passive velum and holds it in place against the posterior pharyngeal wall
- Does not add length therefore not useful for short velum
- Patient with dysarthria and apraxia may benefit
48
What is a palatal obturator?
- Used cover an **open palatal defect**
- Common use: occlude a palatal fistula
49
What is a speech bulb obturator?
- Used for VP insufficiency
- For when velum is short (relative to the depth of the PPW)
- The bulb servs to fill VP space, in order to close of the nasal cavity from the oral cavity
50
How does a prosthetic device help with speech therapy?
A prosthetic device can **improve VP closure** therefore giving the patient the ability to impound intraoral pressure for the production of high pressure sounds (e.g., p, t, k)
51
Patients with a history of CLAP or craniofacial anomalies are at risk for speech and resonance disorders secondary to:
- VPD (velopharyngeal dysfunction)
- Oral anomalies
- Dental malocclusion
52
You have to know the distinctive features of the consonants. Where is the breakdown with the following:
- Placement of the articulators
- Manner of the air
- Voicing
53
For the vowels, you go back to the
Vowel quadrangle–height, frontness, roundness
54
What are the high and front sounds?
/i/
55
What are the high and back sounds?
/u/
56
What are the mid front sounds?
/e/
57
What are the mid and back sounds?
/o/
58
What are the low and central sounds?
/a/
59
Before the surgery, what should an SLP do during therapy?
- Target the placement not the manner of airflow
- If the surgery is on hold and there is concern regarding developing compensatory productions, speech therapy can still be done with certain modifications
60
After the surgery, what does an SLP do?
- Changing the structure does not automatically change the function
- Target the manner (or airflow) along with the placement and voicing
61
What does an SLP work on after the surgery?
- Hypernasality
- NAE
- Compensatory errors
- Inadequate intraoral pressure
- Short utterance length
62
What are obligatory errors? What does it require? Signs?
Speech errors caused by a structural or physiological issue (e.g., oronasal fistula, vp insufficiency)
Requires surgery for structural repair or prosthetic intervention
Often accompanied by hypernasality, NAE, Weak consonants and short utterance length
63
What are compensatory errors?
- Errors that are learned from having a faulty mechanism and persists once the mechanism is repaired
- Require speech therapy for correction
64
The SLP should be able to establish the following before intervention:
(1st Step) Establish understanding–the SLP should be sure that the patient and the parent understand the problem
(2nd Step) Establish discrimination–discriminate between correct and incorrect sounds
(3rd Step) Establish placement–correct placement of articulators in relation to each other
(4th) Establish airflow awareness–how the air flows and where the air should exit
65
How should you select target sounds?
- Most **stimulable** (more stimulable → easier to correct → early success)
- Choose the **most visible** (target the front sounds before targeting the posterior or back sounds) because it provides visual feedback for the patient
- **Developmentally appropriate** (early 8 | middle 8 | late 8)
- Effect on **intelligibility** (prioritize common speech sounds in the patient’s language)
66
When selecting stimulus words, you have to consider several aspects of the words such as:
- Phonetic context
- Meaningfulness (degree of familiarity)
- Communicative potency - how functional the words are
- Syllable shape and phonetic inventory (we consider the phonetic repertoire and syllable shapes)
67
For phonetic context (inventory and arrangement of vowels and consonants in a word) it may have significance on its production
- Length of the word → **few syllables** are easier > in comparison of many syllables
- Word/syllable position → **word initial** is easier > in comparison to word medial/ word final
- Syllable structure → **open syllable (CV)** is easier > in comparison to closed syllable (CVC)
- Stress → stressed syllable is easier > in comparison to unstressed syllable
- Coarticulation factors → we consider adjacent sounds, number of times target sounds appears in a word (e.g., target /l/ | cape > cake). (Easier if once lang nagaappear yung sound sa word)
68
What are the phases of the treatment continuum?
Establishment
Generalization
Maintenance
69
During the establishment phase, the SLP
The SLP **elicits the target** and try the **stabilize it at a voluntary level**
70
Carry over in several levels and contexts
Generalization
71
Self-monitoring
Maintenance
72
What is the cleft speech therapy hierarchy
Isolation
Syllable (initial and final)
Word (initial, medial, and final)
Phrase/sentence level
Spontaneous speech
73
Motor learning is ___________
How do you achieve better speech?
What does not carryover to speech?
What does speech require?
- Task specific
- So to achieve better speech, you have to practice speaking
- Non-speech activities alone (e.g., sucking, blowing, whistling) do not directly carryover to speech
- Speech requires motor movements that are **fast, complex, automatic, and effortless** (FACE)
74
What to prioritize in terms of infants/toddlers?
- Feeding and nutrition
- We want them to gain weight to be eligible for surgery
- Counseling
- Language stimulation (learn as much concepts)
- Quantity of words > quality of how they say it
75
What to prioritize in terms of preschool age? Goal?
- Presurgery: Target the correct placement
- Goal: Age appropriate speech
76
Normal speech sound production involves both productions of sounds at the
- At the motor level
- And their USE in accordance with the rules of language
- These two skills are intertwined
Basically, kaya nilanb iproduce (motor) correctly and kaya nilang gamitin meaningfully (linguistic) according sa rules ng language
77
Nasal sounds
/m, n, ng/
78
Low pressure sounds
/w, y, r, l/
79
High pressure sounds
/p, t, k, b, d, g, s, z, f, v, th, sh, ch, j/
This is where mostly they have difficulty with
80
AVTK cues
Auditory
Visual
Tactile
Kinesthetic
81
Give an example of auditory cues
Auditory highlighting, recorder, oral-nasal listener, listening tube, straw
82
Given an example of visual cues
Visual models, diagrams, mouth models, cotton, tissue, paper, camera recorder,
83
Give an example of tactile cues
Feeling the vibration on the throat, the sides of the nose, feeling the airflow through the mouth
84
Given an example of kinesthetic cues
Nasal occlusion, manual manipulation of articulators when teaching placement
