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Sue Mildinhall Lead Speech and Language Therapist South Thames Cleft Service Guys and St Thomas NHS Trust, London, England
Plan
1.To describe the work of the Speech and Language Therapist in the cleft team 2.To discuss speech difficulties associated with cleft palate 3. To describe how we manage the speech problems of the child with cleft palate
To ensure best possible speech outcome for child born with cleft palate as early in life as possible
How do we do this?
Early speech and language development advice Speech assessments at regular intervals Therapy as needed Regular joint clinics with surgeons
How do we speak ?
We speak on exhaled air Voice is produced by the larynx The soft palate lifts to close off the nasal cavity We shape the air with lips & tongue to make different sounds Sequence into words & sentences
key
Nasal consonants (m n ng) should be possible Oral consonants (pb td kg s f sh ch) are vulnerable
Soft Palate may not work effectively Fistulae Orthodontic problems Malocclusion Fluctuating Hearing Loss
What do we assess?
1. Intelligibility can we understand the child? 2. Airflow problems -balance of air resonating in oral/nasal cavities? Nasal emission of air? 3. Articulation are sounds produced correctly?
Intelligibility
How difficult is it to understand the child according to; 1. The parent/carer 2. School/Nursery 3. Unfamiliar adults 4. The SLT?
What is the reason for the poor intelligibility?
? Fistula or VPI
2. Articulation
Cleft-type speech patterns:
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Lateralisation Palatalisation Backing to velar Backing to uvular Pharyngeal Glottal Active Nasal Fricatives Weak nasalised consonants Nasal realisations Absent pressure consonants
(GOS.SPASS 1998)
Prediction of cases impossible 25 - 30% will need further surgery for speech (CSAG 1998, Mildinhall et al 2007)
Why investigate?
Perceptual speech assessment indicates characteristics of VPI Objective investigation required to inform further management Oral examination alone inadequate Videofluroscopy shows us the structure.length, stretch of the soft palate during speech Nasendoscopy shows sphincter from above Leads to treatment plan
Summary
Speech and Language Therapists role in assessment, diagnosis, therapy Speech difficulties associated with cleft / VPI Principles of speech assessment Good practice in the speech management of children with cleft palate and VPD Importance of a Team approach
Team work
Surgeons, dentists, specialist nurses, Speech and Language Therapists, psychologists, audiologists collaborate in the care of the child with cleft throughout childhood