Cleft Palate

Speech Therapy

Speech Therapist's Role in Cleft Care

Speech-Language Pathologists (SLP) specialize in the evaluation and treatment of communication delays and disorders. The speech-language pathologist treats children and adults with speech or language difficulties, as well as feeding and swallowing difficulties in infants. SLPs work with patients of all ages, from infants to adults, to become efficient and effective communicators. The speech-language pathologist collaborates with other members of the inter-disciplinary team, including the audiologist, psychologist, pediatrician, dentist and surgeon to provide comprehensive patient care.

Targeting Difficulties in the Areas of:

1. Speech Sound Production
2. Resonance (Hypernasality, Hyponasality)
3. Feeding 

In addition to the Following, as Needed:

1. Expressive language - communicating wants and needs
2. Receptive language - understanding others' communication 
3. Pragmatic (Social) language - how we say things to others and body language 
4. Augmentative Alternative Communication (AAC) 
5. Fluency - improve stuttering, if present 

Evaluations

At the initial visit, the speech pathologist evaluates the patient's speech and resonance skills. These non-invasive assessments provide a baseline for speech therapy, if recommended. The speech pathologist continues to monitor and assess the patient's speech skills throughout their development to determine progress and achievement of speech and language developmental milestones. Feeding evaluations may also occur for infants, especially those with cleft palate.

If a patient is scheduled to undergo oral or nasal surgery, the SLP will evaluate the patient's speech skills both before and after surgery, to determine if there are any speech changes.

A Speech Evaluation may Consist of:

• Patient History
• Speech Sound Production Assessment 
• Perceptual Resonance and Airflow Control Assessment  
• Comprehensive Oral Examination 
• Additional Speech-Language Assessment, As Needed 
• Additional Instrumental Analyses, As Needed 
• Review of Evaluation Results and Discussion of Recommendations

What to Bring to an Evaluation:

A copy of your child's school-based Individualized Education Program (IEP), if applicable.

Speech-Language Therapy:

If skilled speech therapy services are recommended, duration and frequency of services will be determined based on the individual needs of the patient.

Parent/Caregiver Education:

The SLP works closely with patients and their families to provide strategies and an individualized home-program for practice and carryover of speech therapy goals into the home setting.  It is recommended that patients participating in speech therapy practice their speech therapy targets daily for optimal progress. 

Continuity of Care:

The Speech-Language Pathologist helps patients to work towards their goal of efficient and effective communication. To accomplish this goal, there are typically multiple team members participating in a patient's care-both within and outside of the Craniofacial Center (CFC). The Speech-Language Pathologist works closely with all members of the CFC Team to achieve a collaborative patient care experience. The CFC Speech-Language Pathologist is able to work in collaboration with a patient's school-based SLP, special education team, local SLP, and healthcare providers, to achieve effective team-based care in the area of speech and language. 

Speech:

• Many children born with cleft lip and palate experience articulation difficulties (difficulties saying speech sounds). The speech-language pathologist helps children to communicate clearly and effectively.
• Children born with only a cleft lip tend to have minimal to no articulation difficulties, while children with cleft palate may experience more significant difficulties. The SLP helps children to develop and correct their speech sound skills before and after the palate repair, and through their school-age and teen years. 
• Before the cleft palate repair, children have difficulty producing speech sounds that require oral air pressure, such as 'p' or 'b'. The SLP may encourage families of children with cleft palate to model, or practice, the following speech sounds with their children, as they require less oral air pressure to be produced correctly:
  • Nasal speech sounds: 'm' (as in "mama"), 'n' (as in "no")
  • Low pressure speech sounds:  'w' (as in "woo"), 'h' (as in "hi"), 'y' (as in "yay") 
  • Vowel sounds: including  'ahh', 'ohh'
• After the cleft palate repair, the child should now be able to create oral air pressure. The SLP works with the child and their family to aid in the development of high pressure speech sounds. Children at this stage may benefit from speech therapy, in the clinic or through Early Intervention. Early developing high pressure sounds include the following:
  • 'P' (as in "papa")
  • 'B' (as in "baby")
  • 'T' (as in "two")
  • 'D' (as in "dada") 
• It is common for children with cleft palate of all ages to receive speech therapy targeting articulation, depending on their individual needs. Children with cleft palate should attend regular speech evaluations and speech therapy, as recommended, with the Cleft Team Speech-Language Pathologist.

Resonance:

Children with cleft palate may demonstrate hypernasality (excess nasal sound) and nasal emissions (air rustle during consonant production).

The SLP helps the team to determine if abnormal resonance is caused by a structural defect (i.e. when the connection between the oral cavity and nasal cavity is unable to be completely closed by the palate/pharyngeal walls), called Velopharyngeal Insufficieny (VPI); or if is caused by learned speech errors with adequate structure and function, called Velopharyngeal Mislearning. Speech therapy for abnormal resonance will only be beneficial for patients with adequate structure and function.  

Speech Therapist's Role in Cleft Care

The speech-language pathologist (SLP) specializes in the evaluation and treatment of communication delays and disorders. The Craniofacial Center SLP specializes in improving speech and resonance for children with cleft lip and palate. The Craniofacial Center SLP also helps babies with cleft lip and palate and their families to achieve effective, efficient, and safe feeding.

Many children born with cleft lip and palate experience articulation difficulties (difficulties saying speech sounds). The speech-language pathologist helps children to communicate clearly and effectively.

Children born with only a cleft lip tend to have minimal to no articulation difficulties, while children with cleft palate may experience more significant difficulties. The SLP helps children to develop and correct their speech sound skills before and after the palate repair, and through their school-age and teen years.

Before the cleft palate repair, children have difficulty producing speech sounds that require oral air pressure, such as 'p' or 'b'. This is because the cleft allows air to escape into the nose from the mouth. 

After the cleft palate repair, the child should now be able to create oral air pressure. The SLP works with the child and their family to aid in the development of high pressure speech sounds.

It is common for children with cleft palate of all ages to receive speech therapy targeting articulation, depending on their individual needs. Children with cleft palate should attend regular speech evaluations and speech therapy, as recommended, with the Cleft Team Speech-Language Pathologist.