Maximizing Treatment Effects
withVPI and Cleft Lip and Palate
Scott Prath, M.A., CCC-SLP
Keith Lebel, M.S., CCC-SLP
Texas ...
Do you need Continuing Education or want 
to listen to this course live?
Click here to visit 
the online courses.
Young Children
with a Cleft of
the Lip &/or
Palate
The physical and socio-emotional
effects on the family and child
Photos...
Learner Objectives
Participants will:
• Become familiar with what causes clefts
• Understand the process that a family thr...
3 Great Reasons to Learn about CLP
1. Vocabulary
Salpingopharyngeus
3 Great Reasons to Learn about CLP
Cleft Lip and Palate BINGO!
Generating 
Suction
Maxillofacial 
Surgeons
Maternal bondin...
3 Great Reasons to Learn about CLP
2. Faith in the Medical System
From age 0 – 17 a child will:
- attend 30+ visits
- will...
3 Great Reasons to Learn about CLP
3. Emotional Satisfaction
The child born with a cleft is not the child that
the parents...
All of the documents and charts in this presentation 
can be downloaded from our Free Resource Library.
Click here to visi...
Click for Audio‐over‐Powerpoint Presentation
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 in th...
What types of cleft palates exist?
• A cleft palate can be:
▫ unilateral
▫ bilateral
▫ submucousal with bifid
uvula
What is the prevalence?
• Clefts occur in ~ 1/750 live births
• Estimated prevalence by type:
Lip only 14%
Palate only 37%...
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 Mutation
2. Chromosomal Aberrations
3. Teratogenic Agents
4. Multifactoral Inheritance
5. Mec...
How is a cleft repaired?
The repair of a cleft lip or palate is
the process of taking existing
tissue that surrounds the o...
What is the process for the family?
What is the process for the family?
The Cleft Palate Team
• Clinic Director
• Audiologist
• Craneofacial Surgeon
• Genetic...
How is development affected?
1. Communication Development
1. Speech Development
1. Articulation (mouth)
2. Voice (throat)
...
Diagnosis and Treatment
Characteristics
Treatment & Goals
Communication Characteristics
Children with CLP:
• Show deficits in the size and composition of
their early sound inventor...
Communication Characteristics
Children with CLP:
• Often have voice problems (harshness) due to
overuse
• Can have constan...
Communication goals/ outcomes
for ECI
1. Increase Consonant Inventories
2. Increase Vocabulary
3. Increase Oral Airflow
4....
1. Increase Consonant Inventories
• The sounds that a child with CLP can produce
are:
▫ Restricted by their structural abi...
1. Increase Consonant Inventories
• Hi
• Hello
• Hey
• Mommy
• More
• Me
• No
• Whoa
• Wow
• Honey
• Mamá
• No
• Mío
• Niñ...
1. Increase Consonant Inventories
• Baby
• Boy
• Pop
• Pooh
• Pie
• Toy
• Doll
• Daddy
• Cookie
• Go
• Papá
• Bebé
• Boca
...
A word on VPI
• Velo-pharyngeal Insufficiency
▫ The velum (velo) is not contacting the pharynx
(back wall of the throat)
▫...
2. Increase Vocabulary
• Sounds and vocabulary develop in tandem
• Do we:
▫ Focus on articulation to give her the sounds t...
2. Increase Vocabulary
• Vocabulary development should be targeted with
sound development
▫ Choose words that:
 Are commo...
Consonants + Vocabulary
Syllable structure
• Syllable should be simple
▫ CV (consonant/vowel)
▫ CVC
▫ CVCV
Sound Class
• S...
3. Increase Oral Airflow
• A child with a cleft does not have control over
the air leaving their throat
• In typical devel...
3. Increase Oral Airflow
• Request an easy repetition (muh,muh,muh)
▫ After the child starts repeating, plug his nose
• In...
4. Decrease use of Nasal and Glottal
Sounds
13% of 63, 4-5 year olds presented with some form
of voice disorder
▫ harshnes...
4. Decrease use of Nasal and Glottal
Sounds
• Acknowledge the child’s attempt but then
requests other consonants or sounds...
Language Development
• Study using the TOLD-P (63, 4-5 y.o.)
▫ 21% manifested receptive impairments
▫ 26% manifested expre...
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 (...
Influences on family
effectiveness
Parent Reaction to a Cleft
Child Reaction to a Cleft
Parent Involvement
Mother-child Bo...
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 pregnancy
...
The effects of CLP on the parent
Intervention:
▫ Education
▫ Support
Research shows that when a family is in a position
wh...
The effects of CLP on the child
Effects on the child
▫ Speech or hearing disorders
▫ Parents’ feeling of guilt
 Can cause...
The effects of CLP on the child
Intervention:
The child’s psychosocial state is dependent on how
well or poorly the parent...
When do emotions set in?
• Periods of:
Anxiety Optimism Depression Acceptance
occur with each surgery or event.
Edwards an...
The Kubler-Ross Grief Cycle
• Denial: Example - “She’s fine."; "This can't be happening."
• Anger: Example - "Why me? It's...
Parent Involvement
• Andhra Pradesh, India
▫ Tested:
 Known context (rhymes, counting 1-10)
 Unkknown context (family in...
Feeding and psychological development
• Children gain pleasure from oral stimulation
and feeding
 Feeding is impaired
 F...
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 ~30...
A word from the parents
Parents in one study reported feelings of anxiety
about how the baby would be able to eat.
▫ Set t...
A word from the parents
Parents DID report positive feelings from
professionals who did not ignore condition.
▫ Do not ign...
A word from the parents
Many expressed desire to meet other parents of a
child with CL/CP—to exchange thoughts and
discuss...
A word from the parents
Negative reactions from other people were
perceived through body language, such as
keeping at a di...
A word from the parents
Parents often hear “He will be fine later” from
staff and other professionals and interpreted this...
A word from the CLP team
What would you consider to be the most
important thing that a service provider
should know when t...
A word from the CLP team
What should ECI professionals educate parents
on?
The second surgery normally occurs around 12
mo...
A word from the CLP team
Is there anything that the parents could know
from the ECI agencies to make the team and
surgery ...
A word from the CLP team
Is there anything problematic/difficult with family
interactions that could be addressed by servi...
When does a cleft occur?
7 and 8 weeks in utero
5.
Structural
Anomaly
A word on VPI
• Velo-pharyngeal Insufficiency
▫ The velum (velo) is not contacting the pharynx
(back wall of the throat)
▫...
Structural Anomalies
Communication goals/ Outcomes for Structural
Anomalies
• Increase Vowel Repertoire
• Increase Consona...
Increase Vowel Repertoire
• Take a vowel inventory
▫ Target vowels in isolation (a)
▫ In strings (a,a,a,a)
▫ In opposition...
Increase Vowel Repertoire
• Take a vowel inventory
▫ Target vowels in isolation (a)
▫ In strings (a,a,a,a)
▫ In opposition...
Increase Vowel Repertoire
• Take a vowel inventory
▫ Target vowels in isolation (a)
▫ In strings (a,a,a,a)
▫ In opposition...
Increase Consonant Inventories
• Hi
• Hello
• Hey
• Mommy
• More
• Me
• No
• Whoa
• Wow
• Honey
• Mamá
• No
• Mío
• Niña
•...
Increase Consonant Inventories
• Baby
• Boy
• Pop
• Pooh
• Pie
• Toy
• Doll
• Daddy
• Cookie
• Go
• Papá
• Bebé
• Boca
• G...
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 common a...
Increase Oral Airflow
• A child with a cleft does not have control over
the air leaving their throat
• In typical developm...
Increase Oral Airflow
• A child with a cleft does not have control over
the air leaving their throat
• In typical developm...
Increase Oral Airflow
• Request an easy repetition (muh,muh,muh)
▫ After the child starts repeating, plug his nose
• Inhal...
Decrease Use of Nasal and
Glottal Sounds
• Growls and nasal sounds are typical for young infants
but children with clefts ...
VPI Pyramid
Click here to download this chart as a pdf.
Resources
• www.cleft.com
• 1-800-24CLEFT
• www.operationsmile.org
• www.widesmiles.org
• The story of Lippy the Lion
• Th...
Click to visit www.bilinguistics.com
Difference or Disorder? 
Understanding Speech and Language 
Patterns in Culturally and Linguistically 
Diverse Students
Ra...
Maximizing Treatment Effects with VPI and Cleft Lip and Palate
Upcoming SlideShare
Loading in …5
×

Maximizing Treatment Effects with VPI and Cleft Lip and Palate

2,641 views

Published on

• 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.

Published in: Health & Medicine
0 Comments
2 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
2,641
On SlideShare
0
From Embeds
0
Number of Embeds
501
Actions
Shares
0
Downloads
72
Comments
0
Likes
2
Embeds 0
No embeds

No notes for slide

Maximizing Treatment Effects with VPI and Cleft Lip and Palate

  1. 1. Maximizing Treatment Effects withVPI and Cleft Lip and Palate Scott Prath, M.A., CCC-SLP Keith Lebel, M.S., CCC-SLP Texas Speech-Language-Hearing Association 2012 Annual Convention March 8-10, San Antonio,Texas
  2. 2. Do you need Continuing Education or want  to listen to this course live? Click here to visit  the online courses.
  3. 3. Young Children with a Cleft of the Lip &/or Palate The physical and socio-emotional effects on the family and child Photos courtesy of Operation Smile
  4. 4. Learner Objectives Participants will: • Become familiar with what causes clefts • Understand the process that a family through with a child that has a cleft lip and/or palate • Identify our role as service providers in working with the family • Identify intervention and evaluation strategies for working with a child with a cleft lip and palate
  5. 5. 3 Great Reasons to Learn about CLP 1. Vocabulary Salpingopharyngeus
  6. 6. 3 Great Reasons to Learn about CLP Cleft Lip and Palate BINGO! Generating  Suction Maxillofacial  Surgeons Maternal bonding unilateral Oral Airflow Palatal obturator fistula Prosthodontists Lippy the Lion Teratogenic Bilateral Oral Hygiene salpingopharingeous High Pressure CVCV Tympanostomy  tube Anxiety VPI Andhra  Pradesh Prevalence Resonance Glottis Submucousal  7 weeks Parent  Involvement
  7. 7. 3 Great Reasons to Learn about CLP 2. Faith in the Medical System From age 0 – 17 a child will: - attend 30+ visits - will undergo 4-8 surgeries - will interact with approximately 20 professionals
  8. 8. 3 Great Reasons to Learn about CLP 3. Emotional Satisfaction The child born with a cleft is not the child that the parents expect. You may be the only outside resource that the family has in understanding that everything is going to be alright.
  9. 9. All of the documents and charts in this presentation  can be downloaded from our Free Resource Library. Click here to visit the Resource Library
  10. 10. Click for Audio‐over‐Powerpoint Presentation
  11. 11. What is a Cleft? • Clefts result from incomplete development of the lip and/or palate in the early weeks of pregnancy.
  12. 12. 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.
  13. 13. What types of cleft palates exist? • A cleft palate can be: ▫ unilateral ▫ bilateral ▫ submucousal with bifid uvula
  14. 14. 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
  15. 15. When does a cleft occur? 4 and 5 weeks in utero
  16. 16. When does a cleft occur? 5 ½ and 6 weeks in utero
  17. 17. When does a cleft occur? 7 and 8 weeks in utero
  18. 18. When does a cleft occur?
  19. 19. What causes a cleft? 1. Gene Mutation 2. Chromosomal Aberrations 3. Teratogenic Agents 4. Multifactoral Inheritance 5. Mechanical Factors
  20. 20. 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.
  21. 21. What is the process for the family?
  22. 22. What is the process for the family? The Cleft Palate Team • Clinic Director • Audiologist • Craneofacial Surgeon • Geneticist • Neurosurgeons • Nurses • Occupational Therapists • Oral and Maxilliofacial Surgeons • Orthodontists • ENTs • Pediatrician • Pediatric Anesthesiologists • Pediatric Dentists and Prosthodontists • Pediatric Radiologists • Physical Therapists • Plastic Surgeons • Speech Language Pathologists • Surgeon’s Assistant
  23. 23. How is development affected? 1. Communication Development 1. Speech Development 1. Articulation (mouth) 2. Voice (throat) 3. Resonance (nose) 2. Language Development 3. Hearing Development 2. Socio-emotional Development
  24. 24. Diagnosis and Treatment Characteristics Treatment & Goals
  25. 25. 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
  26. 26. 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 influenced by severity and time of surgery
  27. 27. Communication goals/ outcomes for ECI 1. Increase Consonant Inventories 2. Increase Vocabulary 3. Increase Oral Airflow 4. Decrease use of Nasal and Glottal Sounds
  28. 28. 1. Increase Consonant Inventories • The sounds that a child with CLP can produce are: ▫ Restricted by their structural abilities  However, there many things that can be focused on ▫ Dependent on the surgeries  Different sounds are addressed before and after the palate repair Don’t be scared! Most children with CLP are highly intelligible by age 5 because of you!
  29. 29. 1. Increase Consonant Inventories • Hi • Hello • Hey • Mommy • More • Me • No • Whoa • Wow • Honey • Mamá • No • Mío • Niña • Niño • Ojos • En • Mano • Wawa – agua BEFORE palate Repair LOW pressure words to target
  30. 30. 1. Increase Consonant Inventories • Baby • Boy • Pop • Pooh • Pie • Toy • Doll • Daddy • Cookie • Go • Papá • Bebé • Boca • Gato • Todo • Tú • Tío • Qué • Ten AFTER palate Repair HIGH pressure words to target
  31. 31. A word on VPI • 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
  32. 32. 2. 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? Anyone want to guess?
  33. 33. 2. 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)
  34. 34. Consonants + Vocabulary Syllable structure • Syllable should be simple ▫ CV (consonant/vowel) ▫ CVC ▫ CVCV Sound Class • Start with stops and bilabial sounds • Add fricatives later
  35. 35. 3. 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
  36. 36. 3. 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!
  37. 37. 4. 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
  38. 38. 4. 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
  39. 39. 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
  40. 40. 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
  41. 41. Influences on family effectiveness Parent Reaction to a Cleft Child Reaction to a Cleft Parent Involvement Mother-child Bond and Feeding
  42. 42. 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…”
  43. 43. 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
  44. 44. The effects of CLP on the parent Intervention: ▫ 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.
  45. 45. 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
  46. 46. 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.
  47. 47. 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.
  48. 48. The Kubler-Ross Grief Cycle • Denial: Example - “She’s fine."; "This can't be happening." • Anger: Example - "Why me? It's not fair!" "NO! NO! How can you accept this!" • Bargaining: Example - "Just let him talk fine, I don’t mind the scar." • Depression: Example - "I'm so sad, why bother with anything?"; “Everything that we had planned for her isn’t going to happen." • Acceptance: Example - "It's going to be OK."; "I can't fight it, I may as well prepare for it."
  49. 49. Parent Involvement • Andhra Pradesh, India ▫ Tested:  Known context (rhymes, counting 1-10)  Unkknown context (family information) ▫ There was a greater understandability of unknown contexts after treatment
  50. 50. 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
  51. 51. 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
  52. 52. 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
  53. 53. 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
  54. 54. A word from the parents Parents DID report positive feelings from professionals who did not ignore condition. ▫ Do not ignore the condition
  55. 55. 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
  56. 56. 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
  57. 57. 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
  58. 58. 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 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.
  59. 59. A word from the CLP team What should ECI professionals educate parents on? The second surgery normally occurs around 12 months so kids with clefts won’t develop speech sounds on time. Let the parents know that they should be looking for and practicing low pressure sounds to get the ball rolling.
  60. 60. A word from the CLP team Is there anything that the parents could know from the ECI agencies 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.
  61. 61. 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.
  62. 62. When does a cleft occur? 7 and 8 weeks in utero 5. Structural Anomaly
  63. 63. A word on VPI • 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. Structural Anomaly
  64. 64. Structural Anomalies Communication goals/ Outcomes for Structural Anomalies • Increase Vowel Repertoire • Increase Consonant Inventories • Increase Vocabulary • Increase Oral Airflow • Decrease use of Nasal and Glottal Sounds 5. Structural Anomaly
  65. 65. Increase Vowel Repertoire • 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) 5. Structural Anomaly
  66. 66. Increase Vowel Repertoire • 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) 5. Structural Anomaly
  67. 67. Increase Vowel Repertoire • 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) 5. Structural Anomaly
  68. 68. Increase Consonant Inventories • Hi • Hello • Hey • Mommy • More • Me • No • Whoa • Wow • Honey • Mamá • No • Mío • Niña • Niño • Ojos • En • Mano • Wawa – agua BEFORE palate repair LOW pressure words to target 5. Structural Anomaly
  69. 69. Increase Consonant Inventories • Baby • Boy • Pop • Pooh • Pie • Toy • Doll • Daddy • Cookie • Go • Papá • Bebé • Boca • Gato • Todo • Tú • Tío • Qué • Ten AFTER palate repair HIGH pressure words to target 5. Structural Anomaly
  70. 70. 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? 5. Structural Anomaly
  71. 71. 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 5. Structural Anomaly
  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 5. Structural Anomaly
  73. 73. 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 5. Structural Anomaly
  74. 74. 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! 5. Structural Anomaly
  75. 75. Decrease Use of Nasal and Glottal Sounds • Growls and nasal sounds are typical for young infants but children with clefts obtain these sounds later • Parents, wanting communication, reinforce these 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 5. Structural Anomaly
  76. 76. VPI Pyramid Click here to download this chart as a pdf.
  77. 77. 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
  78. 78. Click to visit www.bilinguistics.com
  79. 79. Difference or Disorder?  Understanding Speech and Language  Patterns in Culturally and Linguistically  Diverse Students Rapidly identify speech‐language  patterns related to second language  acquisition to  distinguish difference from disorder.

×