Speech Therapy for Cleft Flashcards
Speech therapy CANNOT correct velopharyngeal dysfunction or hypernasality due to VPI
Speech therapy CANNOT correct velopharyngeal dysfunction or hypernasality due to VPI
What are the reasons for Speech Therapy?
- To help the individual learn to use intraoral air pressure to produce sounds normally
- To eliminate any prior compensatory artic productions
- To increase language acquisition
- To eliminate nasal rustle (turbalance) due to a small or inconsistent opening, nasal emissions, or hypernasality
- To achieve the best possible outcome to meet the needs of the pt.
Treatment Decision Making
Hypernasality and/or audible nasal emissions present, age appropriate articulation- refer them to the cleft palate team, consider imaging of VP mechanism during speech.
Hypernasality and/or audible nasal emissions, and articulation errors present
- refer to the cleft palate team, consider imaging of VP mechanism during speech if at least some oral pressure consonants are accurately produced.
- AND begin speech therapy
Treatment Decision Making
Phoneme- specific nasal air emission only
- Begin speech therapy to target articulation errors; monitor resonance and refer to cleft palate team if continue concerns of lack of progress.
General goals for children with cleft palate speech/VPD
- Establish correct oral articulatory placement and/or airflow direction and pressure buildup using behavioral, articulation (motor-phonetic) therapy.
- Maximize intraoral air pressure build up during speech sound production
- Teach new motor speech patterns to replace compensatory maladaptive articulation errors.
Basic steps of correction
- Use a phonological approach
- Start with anterior sounds
- Start with voiceless sounds
- Use auditory discrimination
Basic steps of correction
- Establish correct placement in isolation
- Incorporate correct sounds in hierarchy
- HW for patient
- Carry- over to spontaneous speech
General Therapy Guidelines
- When a phoneme is established , use /h/ to combine the consonant to the vowel.
- use phonetic placement with multi-sensory cues to provide auditory, visual, and tactile feedback
- If VPD/VPI is present, use nasal occlusion to teach airflow or prevent nasal escape. Fade from nasal occlusion as oral placement for target phoneme emerges.
Speech therapy techniques/ Hypernasality & Nasal emission
- Feedback: auditory, visual, tactile-kinesthetic, tactile (mirrow, see-scape)
- Lower back of tongue
- Increase volume *
- Increase oral activity *
- nose pinch
Ng/L substitution
- Yawn + /l/
- Gradually eliminate /l/
Nasalized plosives
- Bilabial and lingual alveolar first ( first /p/ /b/ then /t/ /d/)
- Yawn + front sounds
- Graduate to Yawn + Velar plosives
- Alternate open & closed nose during productions
Nasalized vowels
- Alternate closed & open nose during vowel
- Yawn + vowel
Glottal stops
- Feel “jerk” on neck
- Produce vl plosives w/o vowel
- Produce vl plosive + /h/ + vowel
- Move to voiced plosives by whispering slowly, then low impact voice
Middorsum Palatal Stops
- Pt bites on tongue blade w/ incisors, tongue tip touching blade during production of lingual alveolars (t/d)
- ( lateral blade placement)
Pharyngeal fricatives, affricates, & posterior nasal fricatives
- loud /t/ repetitively (for compensatory /s/)
- /t/ with teeth closed
- eliminate tongue tip movement
- produce fricatives with nostrils occluded then open
