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Photos courtesy of Operation Smile                             Maximizing                             Treatment Effects   ...
Structural Anomalies
Learner Objectives• Describe how craniofacial differences occur and  how they negatively impact intelligibility• List unde...
Defining VPI and VPD • Velo-pharyngeal Insufficiency  ▫ The velum (velo) is not contacting the pharynx    (back wall of th...
Defining VPI and VPD • Velo-pharyngeal Dysfunction (VPD)  ▫ Increasingly VPD is being used as the umbrella term    as VPI ...
What is a Cleft?• Clefts result from incomplete  development of the lip and/or  palate in the early weeks of  pregnancy.
What types of clefts exist? • A cleft lip (CL) is a   separation in the upper lip. • A cleft palate (CP) is an   opening i...
What types of cleft palates exist?   • A cleft palate can be:     ▫ unilateral     ▫ bilateral     ▫ submucousal with bifi...
What is the prevalence?  • Clefts occur in ~ 1/750 live births  • Estimated prevalence by type:    Lip only               ...
When does a cleft occur?  4 and 5 weeks in utero
When does a cleft occur?  5 ½ and 6 weeks in utero
When does a cleft occur?  7 and 8 weeks in utero
When does a cleft occur?
What causes a cleft?1.   Gene Mutation2.   Chromosomal Aberrations3.   Teratogenic Agents4.   Multifactoral Inheritance5. ...
How is a cleft repaired?                           The repair of a                           cleft lip or palate          ...
What is the process for the family?
Influences on familyeffectivenessParent Reaction to a CleftChild Reaction to a CleftParent InvolvementMother-child Bond an...
What is the process for the family?The Cleft Palate Team•   Clinic Director                                      • Pediatr...
Socio-emotional Development―It is reasonable to assume that individuals with CLP   should have relatively normal long-term...
The effects of CLP on the parent  Effects on the parent   ▫ Blame due to improper love, nutrition, an event     during pre...
The effects of CLP on the parentIntervention:  ▫ Education!  ▫ Support!  Research shows that when a family is in a positio...
The effects of CLP on the child  Effects on the child    ▫ Speech or hearing disorders    ▫ Parents’ feeling of guilt     ...
The effects of CLP on the child  Intervention:   The child’s psychosocial state is dependent on how    well or poorly the ...
When do emotions set in?  • Periods of:    Anxiety Optimism Depression Acceptance        occur with each surgery or event....
The Kubler-Ross Grief Cycle   • Denial: Example - “She’s fine."; "This cant be happening."   • Anger: Example - "Why me? I...
Parent Involvement • Andhra Pradesh, India  ▫ Tested:     Known context (rhymes, counting 1-10)     Unknown context (fam...
Feeding and psychological development  • Children gain pleasure from oral stimulation    and feeding         Feeding is i...
Feeding and psychological development  • CL (cleft lip only) -usually no major feeding    problem (breast feeding possible...
Feeding • Children with CLP take in more air  ▫ They need to be burped more and fed more    upright • Feedings should last...
How is communication affected?Speech Development     Articulation     Voice     ResonanceLanguage DevelopmentHearing Devel...
Communication Characteristics Children with CLP: • Show deficits in the size and composition of   their early sound invent...
Communication Characteristics Children with CLP: • Often have voice problems (harshness) due to   overuse • Can have const...
Language Development • Study using the TOLD-P (63, 4-5 y.o.)   ▫ 21% manifested receptive impairments   ▫ 26% manifested e...
Hearing development    Type of loss        4-5 years          14-15  • WNL (0-26 dB)          78                88  • Mild...
Successful Diagnostics:Using the VPI Pyramid for abottom-to-top approachUnderlying Motor AbilitiesPurposeful Use of Motor ...
VPI Pyramid
Vertical Jaw MovementA child’s ability to produce the full spectrum ofsounds is dependent on jaw height.• Is a child using...
Vertical Jaw Movement
VPI Pyramid
Breath SupportAn utterance is dependent on breath support.• Can a child independently inflate the lunges and  diaphragm?• ...
Breath Support
VPI Pyramid
Anterior/Lateral Lip MovementThe sound repertoire is also dependent onmanipulation of the oral chamber.• Can the child pro...
Anterior/Lateral Lip Movement
VPI Pyramid
Tongue PlacementConsonant repertoires are dependent on tongueplacement• Can the child follow commands to: ▫ Touch the teet...
Tongue Placement
VPI Pyramid
Phonation Differentiation between minimal pairs is dependent on the ability to control phonation. • Can a child turn phona...
Phonation
VPI Pyramid
Imitation of a Movement                   Imitation                                            of a                       ...
Imitation of a Movement   Imitation                            of a                          Movement
VPI Pyramid
Imitation of a Vowel • Vowels carry the message. The presence of   vowels is something that we normally take for   granted...
Imitation of a Vowel
VPI Pyramid
Imitation of a Consonant                    Imitation                                               of a                  ...
Imitation of a Consonant    Imitation                              of a                           Consonant
VPI Pyramid
Production of Sounds andSyllables                                 Production                                           of ...
Production of Sounds and   ProductionSyllables                            of Sounds                               and     ...
Communication goals/ Outcomesfor Structural AnomaliesIncrease Vowel RepertoireIncrease Consonant InventoriesIncrease Vocab...
Increase Vowel RepertoireDate     October 10th                 10th   November 15th                                 15th  ...
Increase Vowel Repertoire
Increase Consonant Inventories  BEFORE palate repair  LOW pressure words to target  •   Hi               •   Mamá  •   Hel...
Increase Consonant Inventories  AFTER palate repair  HIGH pressure words to target  •   Baby             •   Papá  •   Boy...
Increase Consonant Inventories
Increase Vocabulary• Sounds and vocabulary develop in tandem• Do we: ▫ Focus on articulation to give her the sounds to   p...
Increase Vocabulary • Vocabulary development should be targeted with   sound development   ▫ Choose words that:      Are ...
Increase Vocabulary
Increase Oral Airflow  • A child with a cleft does not have control over    the air leaving their throat  • In typical dev...
Increase Oral Airflow • Request an easy repetition (muh,muh,muh)   ▫ After the child starts repeating, plug his nose • Inh...
Increase Oral Airflow
Decrease use of Nasal and Glottal Sounds   13% of 63, 4-5 year olds presented with some form     of voice disorder    ▫ ha...
Decrease use of Nasal and Glottal Sounds  • Acknowledge the child’s attempt but then    requests other consonants or sound...
Case StudyApplication to Academic Needs
Identification of Initial Sound    Words           Answers   09/29/2011   01/24/2012Tobillo       /t/                 0   ...
Identification of Final Sound    Words         Answers   09/29/2011   01/24/2012Entro       /o/                 1         ...
Identification of Final Sound
Union of Sounds       Words            Answers   09/29/2011   01/24/20121/t/ /e/ /ch/ /o/      Techo           0          ...
Union of Sounds
Segmentation of Sounds       Words        Answers          09/29/2011   01/24/2012Ola            /o/ /l/ /a/              ...
Segmentation of Sounds
Omission of Initial Sound  Words    Omission    Answers   09/29/2011   01/24/2012Les       /l/         (es)           1   ...
Omission of Initial Sound
Omission of Final Sound  Words    Omission    Answers   09/29/2011   01/24/2012Osa       /a/         (os)           1     ...
Omission of Final Sound
Recognizing Words            Words           09/29/2011   01/24/20121Luz                             0             1Vive  ...
Recognizing Words
VPI Pyramid
Resources • www.cleft.com • 1-800-24CLEFT • www.operationsmile.org • www.widesmiles.org • The story of Lippy the Lion • Th...
More Great Resources onCultural and Linguistic Diversity
A word from the parents  Parents in one study reported feelings of anxiety   about how the baby would be able to eat.   ▫ ...
A word from the parents  Parents DID report positive feelings from   professionals who did not ignore condition.   ▫ Do no...
A word from the parents  Many expressed desire to meet other parents of a   child with CL/CP—to exchange thoughts and   di...
A word from the parents  Negative reactions from other people were   perceived through body language, such as   keeping at...
A word from the parents  Parents often hear ―He will be fine later‖ from   staff and other professionals and interpreted t...
A word from the CLP team  What would you consider to be the most   important thing that a service provider   should know w...
A word from the CLP teamWhat should professionals educate parents on?The second surgery normally occursaround 12 months so...
A word from the CLP team  Is there anything that the parents could know    from service providers to make the team and    ...
A word from the CLP team Is there anything problematic/difficult with family   interactions that could be addressed by ser...
Thank you!
Maximizing Treatment Effects with VPI and Cleft Lip and Palate
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Maximizing Treatment Effects with VPI and Cleft Lip and Palate

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• In this presentation you will learn to describe how craniofacial differences occur and how they negatively impact intelligibility, list underlying speech components that can be affected by VPI and Cleft Lip and/or Palate, and identify intervention and evaluation strategies for working with a child with craniofacial anomalies.

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Transcript of "Maximizing Treatment Effects with VPI and Cleft Lip and Palate"

  1. 1. Photos courtesy of Operation Smile Maximizing Treatment Effects with VPI and Cleft Lip and PalateScott Prath, M.A., CCC-SLPKeith Lebel, M.A., CCC-SLP TSHA Annual Convention March 9th, 2012- San Antonio, Texas
  2. 2. Structural Anomalies
  3. 3. Learner Objectives• Describe how craniofacial differences occur and how they negatively impact intelligibility• List underlying speech components that can be affected by VPI and Cleft Lip and/or Palate• Identify intervention and evaluation strategies for working with a child with craniofacial anomalies
  4. 4. Defining VPI and VPD • Velo-pharyngeal Insufficiency ▫ The velum (velo) is not contacting the pharynx (back wall of the throat) ▫ Can be caused by:  Muscle weakness  A large opening  Insufficient muscle function  Adenoids and tonsils
  5. 5. Defining VPI and VPD • Velo-pharyngeal Dysfunction (VPD) ▫ Increasingly VPD is being used as the umbrella term as VPI can be confusing. ▫ VPD does not exclude symptoms:  Anatomic  Myoneural  Behavioral  Combinations of disorders ▫ VPD includes:  Velopharyngeal insufficiency (lack of closure)  Velopharyngeal incompetence  Velopharyngeal inadequacy  Velopharyngeal incorrect learning
  6. 6. What is a Cleft?• Clefts result from incomplete development of the lip and/or palate in the early weeks of pregnancy.
  7. 7. What types of clefts exist? • A cleft lip (CL) is a separation in the upper lip. • A cleft palate (CP) is an opening in the roof of the mouth. • A cleft lip and palate (CLP) extends through both.
  8. 8. What types of cleft palates exist? • A cleft palate can be: ▫ unilateral ▫ bilateral ▫ submucousal with bifid uvula
  9. 9. What is the prevalence? • Clefts occur in ~ 1/750 live births • Estimated prevalence by type: Lip only 14% Palate only 37% Lip and Palate 49% (77% are unilateral left) • Estimated data by race: ▫ Asian and Caucasian populations more susceptible ▫ Black populations present with ½ the rate of Asians and Caucasians ▫ Hispanic data are inconclusive
  10. 10. When does a cleft occur? 4 and 5 weeks in utero
  11. 11. When does a cleft occur? 5 ½ and 6 weeks in utero
  12. 12. When does a cleft occur? 7 and 8 weeks in utero
  13. 13. When does a cleft occur?
  14. 14. What causes a cleft?1. Gene Mutation2. Chromosomal Aberrations3. Teratogenic Agents4. Multifactoral Inheritance5. Mechanical Factors
  15. 15. How is a cleft repaired? The repair of a cleft lip or palate is the process of taking existing tissue that surrounds the opening and rotating it or moving it to close the opening.
  16. 16. What is the process for the family?
  17. 17. Influences on familyeffectivenessParent Reaction to a CleftChild Reaction to a CleftParent InvolvementMother-child Bond and Feeding
  18. 18. What is the process for the family?The Cleft Palate Team• Clinic Director • Pediatric Dentists and• Audiologist Prosthodontists• Craniofacial Surgeon • Pediatric Radiologists• Geneticist • Physical Therapists• Neurosurgeons • Plastic Surgeons• Nurses • Speech Language Pathologists• Occupational Therapists • Surgeon’s Assistant• Oral and Maxillofacial Surgeons• Orthodontists• ENTs• Pediatrician• Pediatric Anesthesiologists
  19. 19. Socio-emotional Development―It is reasonable to assume that individuals with CLP should have relatively normal long-term health, as CLP is a reparable birth defect. However, several studies have suggested that individuals with CLP have a higher than expected incidence of psychiatric and behavior diseases, an increased risk for cancer, and increased mortality…‖Southern medical journal volume 99 number 11 oct 06 p 1112, Robin, Bates, etc.
  20. 20. The effects of CLP on the parent Effects on the parent ▫ Blame due to improper love, nutrition, an event during pregnancy ▫ Parent’s personality and their feeling of control or lack of control ▫ Feelings of disappointment or resentment if they feel that this event has dashed their hopes
  21. 21. The effects of CLP on the parentIntervention: ▫ Education! ▫ Support! Research shows that when a family is in a position where they feel that personal needs or aspects of their lives are governed by external forces or in a poor state, they exhibit negative feelings toward their child or event.
  22. 22. The effects of CLP on the child Effects on the child ▫ Speech or hearing disorders ▫ Parents’ feeling of guilt  Can cause a parent to treat a child differently ▫ Anxiety  Regular or protracted doctor visits  Parents’ ever-present fear of choking ▫ Visible scars due to surgical procedures
  23. 23. The effects of CLP on the child Intervention: The child’s psychosocial state is dependent on how well or poorly the parent is dealing with everything. It is our role to support and improve the lives of the child. This means direct social intervention with the parent.
  24. 24. When do emotions set in? • Periods of: Anxiety Optimism Depression Acceptance occur with each surgery or event. Edwards and Watson, 1980, found that there is an optimistic period right after birth because the couple is happy that there are surgical options available, but soon after they can become disheartened. • Take home message: Work to identify how a family is dealing with the process in the time that we are serving them.
  25. 25. The Kubler-Ross Grief Cycle • Denial: Example - “She’s fine."; "This cant be happening." • Anger: Example - "Why me? Its not fair!" "NO! NO! How can you accept this!" • Bargaining: Example - "Just let him talk fine, I don’t mind the scar." • Depression: Example - "Im so sad, why bother with anything?"; “Everything that we had planned for her isn’t going to happen." • Acceptance: Example - "Its going to be OK."; "I cant fight it, I may as well prepare for it."
  26. 26. Parent Involvement • Andhra Pradesh, India ▫ Tested:  Known context (rhymes, counting 1-10)  Unknown context (family information) ▫ There was a greater understandability of unknown contexts after treatment
  27. 27. Feeding and psychological development • Children gain pleasure from oral stimulation and feeding  Feeding is impaired  Feeding issues are one of the first problems that families encounter so it is not an enjoyable event • The early maternal-bonding process is often more disturbed by feeding problems than by the facial defect Kalland, 1995
  28. 28. Feeding and psychological development • CL (cleft lip only) -usually no major feeding problem (breast feeding possible) • CP has difficulty feeding because of inability generating effective oral suction
  29. 29. Feeding • Children with CLP take in more air ▫ They need to be burped more and fed more upright • Feedings should last ~30 minutes. ▫ If they are needing 40 minutes, enlarge and/or cross cut the nipple opening • Weight gain, feeding frequency, and feeding amount are normally the same for a child with CLP
  30. 30. How is communication affected?Speech Development Articulation Voice ResonanceLanguage DevelopmentHearing Development
  31. 31. Communication Characteristics Children with CLP: • Show deficits in the size and composition of their early sound inventories • Reach the babbling stage later • Show less variety of speech forms produced • Have a hypo-or hyper-nasal quality
  32. 32. Communication Characteristics Children with CLP: • Often have voice problems (harshness) due to overuse • Can have constant ear infections and temporary hearing loss • Do not necessarily have cognitive issues Outcomes are influenced by severity and time of surgery
  33. 33. Language Development • Study using the TOLD-P (63, 4-5 y.o.) ▫ 21% manifested receptive impairments ▫ 26% manifested expressive impairments ▫ General Population  3.3% • Take home message ▫ Treat CLP as a comprehensive communication disorder, not just a speech disorder
  34. 34. Hearing development Type of loss 4-5 years 14-15 • WNL (0-26 dB) 78 88 • Mild (2-40 dB) 22 12 22% exhibit hearing loss (1/5) • Take home message ▫ Keep current on hearing status. Hearing loss = speech and language loss
  35. 35. Successful Diagnostics:Using the VPI Pyramid for abottom-to-top approachUnderlying Motor AbilitiesPurposeful Use of Motor AbilitiesTypical Focus of a Standard Speech Assessment
  36. 36. VPI Pyramid
  37. 37. Vertical Jaw MovementA child’s ability to produce the full spectrum ofsounds is dependent on jaw height.• Is a child using the full range of possible movement?• How expressive is she with facial movements such as smiling?
  38. 38. Vertical Jaw Movement
  39. 39. VPI Pyramid
  40. 40. Breath SupportAn utterance is dependent on breath support.• Can a child independently inflate the lunges and diaphragm?• Can he inflate both together?• How is his posture?• Are you doing therapy in a chair or on the floor?
  41. 41. Breath Support
  42. 42. VPI Pyramid
  43. 43. Anterior/Lateral Lip MovementThe sound repertoire is also dependent onmanipulation of the oral chamber.• Can the child produce: ▫ u-e ▫ a-o
  44. 44. Anterior/Lateral Lip Movement
  45. 45. VPI Pyramid
  46. 46. Tongue PlacementConsonant repertoires are dependent on tongueplacement• Can the child follow commands to: ▫ Touch the teeth ▫ Stick out her tongue• Do consonants sound like their nasal pairs? ▫ /d/, /t/. /l/ = /n/ ▫ /b/, /p/= /m/ ▫ /g/, /k/, = ―ng‖
  47. 47. Tongue Placement
  48. 48. VPI Pyramid
  49. 49. Phonation Differentiation between minimal pairs is dependent on the ability to control phonation. • Can a child turn phonation on and off? • How long can she phonate for?
  50. 50. Phonation
  51. 51. VPI Pyramid
  52. 52. Imitation of a Movement Imitation of a MovementTherapeutic success is dependent on the child’sability to imitate movements• Does the child have experience following commands? (Simon says)• Can they imitate articulator movements? 7/10
  53. 53. Imitation of a Movement Imitation of a Movement
  54. 54. VPI Pyramid
  55. 55. Imitation of a Vowel • Vowels carry the message. The presence of vowels is something that we normally take for granted. • Take a vowel inventory ▫ Target vowels in isolation (a) ▫ In strings (a,a,a,a) ▫ In opposition (u-I, u-I a-o, a-o) 7/10
  56. 56. Imitation of a Vowel
  57. 57. VPI Pyramid
  58. 58. Imitation of a Consonant Imitation of a ConsonantConsonants require: ▫ Articuator movements (possibly tongue, cheeks, and lips) ▫ Air manipulation (phonation or bursts)• Can she imitate a consonant?• If not, what part of the lower pyramid is she missing? 7/10
  59. 59. Imitation of a Consonant Imitation of a Consonant
  60. 60. VPI Pyramid
  61. 61. Production of Sounds andSyllables Production of Sounds and Syllables Syllable production is normally where therapy begins • Everything below on the pyramid needs to be in place in order for ―meaning‖ to occur • The pyramid provides us with a lot of areas to focus on that are not dependent on surgeries
  62. 62. Production of Sounds and ProductionSyllables of Sounds and Syllables
  63. 63. Communication goals/ Outcomesfor Structural AnomaliesIncrease Vowel RepertoireIncrease Consonant InventoriesIncrease VocabularyIncrease Oral AirflowDecrease use of Nasal and Glottal Sounds
  64. 64. Increase Vowel RepertoireDate October 10th 10th November 15th 15th December 7tha 10/10e 3/10 5/10 10/10i 0/10 3/10 7/10o 10/10u 4/10 8/10 10/10a-o 0/10 4/10 6/10u-e 0/10 4/10 7/10
  65. 65. Increase Vowel Repertoire
  66. 66. Increase Consonant Inventories BEFORE palate repair LOW pressure words to target • Hi • Mamá • Hello • No • Hey • Mío • Mommy • Niña • More • Niño • Me • Ojos • No • En • Whoa • Mano • Wow • Wawa – agua • Honey
  67. 67. Increase Consonant Inventories AFTER palate repair HIGH pressure words to target • Baby • Papá • Boy • Bebé • Pop • Boca • Pooh • Gato • Pie • Todo • Toy • Tú • Doll • Tío • Daddy • Qué • Cookie • Ten • Go
  68. 68. Increase Consonant Inventories
  69. 69. Increase Vocabulary• Sounds and vocabulary develop in tandem• Do we: ▫ Focus on articulation to give her the sounds to produce more language? ▫ Focus on language to give her a way to practice her sounds? Any ideas?
  70. 70. Increase Vocabulary • Vocabulary development should be targeted with sound development ▫ Choose words that:  Are common and in their environment  Are useful  Are extremely fun (read: routines-based intervention) • Syllable should be simple CV (consonant/vowel) • Start with stops and bilabial sounds
  71. 71. Increase Vocabulary
  72. 72. Increase Oral Airflow • A child with a cleft does not have control over the air leaving their throat • In typical development we stop or slowly release this air to produce speech • Regardless of what surgeries a child has undergone, we need to familiarize the child with airflow through the mouth
  73. 73. Increase Oral Airflow • Request an easy repetition (muh,muh,muh) ▫ After the child starts repeating, plug his nose • Inhale deeply, hold your breath, and explode out with a single sound ▫ BUH!, PUH!
  74. 74. Increase Oral Airflow
  75. 75. Decrease use of Nasal and Glottal Sounds 13% of 63, 4-5 year olds presented with some form of voice disorder ▫ harshness, breathiness, nodules • Growls and nasal sounds are typical for young infants but they are used less when consonants develop • Children with clefts retain these sounds • Parents, wanting communication, reinforce these sounds
  76. 76. Decrease use of Nasal and Glottal Sounds • Acknowledge the child’s attempt but then requests other consonants or sounds • Pair voiceless consonants with whispered vowels puh/tuh/ku/huh • This keeps the glottis open and prevents the glottal stop from occurring
  77. 77. Case StudyApplication to Academic Needs
  78. 78. Identification of Initial Sound Words Answers 09/29/2011 01/24/2012Tobillo /t/ 0 0Zorro /s/ 1 1Humano /u/ 0 1Diamante /d/ 0 1Planta /p/ 0 1Jamon /j/ 1 1Lluvia /y/ 0 1Restaurante /r/ 0 1 TOTAL 2 7
  79. 79. Identification of Final Sound Words Answers 09/29/2011 01/24/2012Entro /o/ 1 1Tribu /u/ 1 1Fotos /s/ 1 1Nueve /e/ 1 1Album /m/ 0 0Estrella /a/ 1 1Calidad /d/ 1 0Caminar /r/ 0 0 TOTAL 6 5
  80. 80. Identification of Final Sound
  81. 81. Union of Sounds Words Answers 09/29/2011 01/24/20121/t/ /e/ /ch/ /o/ Techo 0 0/j/ /i/ /s/ Gis 1 1/c/ /a/ /y/ /e/ Calle 1 1/y/ /e/ /m/ /a/ Yema 0 1/b/ /u/ /rr/ /o/ Burro 0 1/v/ /e/ /l/ /o/ /s/ Veloz 0 1/p/ /l/ /u/ /m/ /a/ Pluma 0 1/r/ /e/ /g/ /l/ /a/ Regla 1 0 TOTAL 3 6
  82. 82. Union of Sounds
  83. 83. Segmentation of Sounds Words Answers 09/29/2011 01/24/2012Ola /o/ /l/ /a/ 1 0Mesa /m/ /e/ /s/ /a/ 0 1Ella /e/ /y/ /a/ 1 1Bello /b/ /e/ /y/ /o/ 0 1Pina /p/ /i/ /ny/ /a/ 0 1Jabon /j/ /a/ /b/ /o/ /n/ 0 1Arbol /a/ /r/ /b/ /o/ /l/ 0 0Verde /v/ /e/ /r/ /d/ /e/ 0 0 TOTAL 2 5
  84. 84. Segmentation of Sounds
  85. 85. Omission of Initial Sound Words Omission Answers 09/29/2011 01/24/2012Les /l/ (es) 1 1Cama /k/ (ama) 0 1Rojo /r/ (ojo) 1 1Llave /y/ (ave) 1 1Marco /m/ (arco) 0 0 TOTAL 3 5
  86. 86. Omission of Initial Sound
  87. 87. Omission of Final Sound Words Omission Answers 09/29/2011 01/24/2012Osa /a/ (os) 1 1Solar /r/ (sola) 0 1Hacen /n/ (hace) 1 0Capaz /s/ (capa) 0 1Pared /d/ (pare) 1 1 TOTAL 3 4
  88. 88. Omission of Final Sound
  89. 89. Recognizing Words Words 09/29/2011 01/24/20121Luz 0 1Vive 0 1Lleva 0 0Voy 0 1Hay 0 1Tortuga 0 1Caballo 0 1Ensena 0 0Hombres 0 0Chocolate 0 0Alfombra 1 0Pequenos 1 0 TOTAL 2 6
  90. 90. Recognizing Words
  91. 91. VPI Pyramid
  92. 92. Resources • www.cleft.com • 1-800-24CLEFT • www.operationsmile.org • www.widesmiles.org • The story of Lippy the Lion • The story of Thumper, the Cleft Affected Bunny • www.bilinguistics.com
  93. 93. More Great Resources onCultural and Linguistic Diversity
  94. 94. A word from the parents Parents in one study reported feelings of anxiety about how the baby would be able to eat. ▫ Set therapy goals to address feeding ▫ Work with nutritionists and the cleft palate team
  95. 95. A word from the parents Parents DID report positive feelings from professionals who did not ignore condition. ▫ Do not ignore the condition
  96. 96. A word from the parents Many expressed desire to meet other parents of a child with CL/CP—to exchange thoughts and discuss practical problems. ▫ Seek out support groups, resources, or other families to network with
  97. 97. A word from the parents Negative reactions from other people were perceived through body language, such as keeping at a distance, looking away. ▫ Be aware of your body language as well when interacting with child and family
  98. 98. A word from the parents Parents often hear ―He will be fine later‖ from staff and other professionals and interpreted this to mean that child was not considered fine at that moment. ▫ Be supportive and concerned about the current condition ▫ Parents stated that they grew tired of hearing these phrases
  99. 99. A word from the CLP team What would you consider to be the most important thing that a service provider should know when they are working with a child with VPI or a cleft lip and palate? Kids with clefts can’t generate pressure to make sounds. Normally they just say “muh.” We need to brush up on our A&P so that we can provide good therapy.
  100. 100. A word from the CLP teamWhat should professionals educate parents on?The second surgery normally occursaround 12 months so kids withclefts won’t develop speech soundson time. Let the parents know thatthey should be looking for andpracticing low pressure sounds toget the ball rolling.
  101. 101. A word from the CLP team Is there anything that the parents could know from service providers to make the team and surgery visits easier? Keep the child’s hearing status up to date. Hearing issues like infections can delay speech even further and cause schedules to be pushed back or visits to be cancelled.
  102. 102. A word from the CLP team Is there anything problematic/difficult with family interactions that could be addressed by services outside of the team visits? You need to do a full assessment to determine whether there are cognitive delays or other delays. Parents fear that their children are delayed in every way imaginable because of the cleft. Normally communication is the only, main issue.
  103. 103. Thank you!
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