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Arts and Humanities
Craniofacial Chapter 8 (Speech for Clefts)
Terms in this set (36)
For infants and toddlers, the most important priority is ___ followed by ___
Feeding; language development
SLPs should focus on the ___ of a child's speech and not the ___ initally
Quantity; quality (focus on language rather than the quality or intelligibility of speech)
___ are the primary instructors of language for the child
What are some things parents and SLPs can do to aid intervention for celft kids?
Encourage production of plosives once the cleft is repaired- do this before surgery to get ahead of mislearning
Work with normal sound production in order to prevent the development of compensatory articulation production
If there is hypernasality the parents should be taught how to pinch the child's nostrils during sound imitation to allow for more normal production
What should be the focus for speech in regards to prechool chlidren?
They should be communicating with complete sentences with some errors in syntax and morphology; should be using some fricatives and affricates
This is a good time to eval speech, resonance, and VP function
Parents should be encouraged to observe tx and taught to be effective therapists at home (n/a)
For preschool children, the big goal is to ___
Get as close to age appropriate speech as possible before the child enters kindergarten
Preschool children have good success rates because of what two main factors?
They are more prone to remediation due to brain plasticity and their patterns are less ingrained, making it easier for them to learn new things as opposed to older counterparts
***For school age children, VPI errors can be caused by what things?
Compensatory errors (glottal stop for plosive)
Obligatory (nasal emission)
Speech is contraindicated for what kinds of errors?
Obligatory errors (correcting the anomaly will correct the error)
Structure should be corrected before trying to correct placement with tx
Speech therapy for compensatory errors is difficult and ineffective in the presence of an anomaly
Corrective errors need to be followed with speech therapy- summer camp or residential programs (this includes intensive speech therapy while giving the children opportunities to interact with others who have similar problems and experiences) (n/a)
What are things to focus on in adult pts?
Pt must be extremely motivated to correct errors
Uncorrected VPI requires surgery or prosthetics
Artic may be addressed but prognosis isnt great because of the long standing habit of producing sounds a certain way for so long
***Speech therapy is appropriate for the elimination of ___ developed secondary to VPI
Compensatory articulation production and phoneme specific hypernasality
***For artic tx for correction of misarticulaitons, the goal is to ___
Correct the placement of production which oftenleads to better VP closure and elimination of hypernasality
***What are some things to consider when doing artic therapy for pts with resonance problems?
Using a phonological approach results in faster progress (pt's may back so target the process)
Use sounds that the child is most stimulable as well as sounds that will have the biggest impact on intelligibility
Begin with anterior sounds because they are most visible
Start with the voiceless cognate and then add voicing
Change one feature at a time when moving from one sound in a group to the next sound
If a pt presents with hypernasality and nasal emissions with weak consonants, this may be difficult to correct due to VPI and VP mislearning (actual funciton and not just the way the person made up for the problem) (n/a)
What are some ways to provide auditory feedback during tx for resonance?
-Oral nasal listener (pictured)
-Using a straw
What are some ways to provide visual feedback during tx for resonance?
What are some ways to provide tactile-kinesthetic feedback during tx for resonance?
-While the child is producing vowel sounds preferably /e/ raise the velum up and down with a tongue blade to produce oral nasal contrast; next have the child try to raise and lower the velum independently during the production of vowel sounds to produce oral-nasal contrasts
-Touch the sides of their nose with their fingers to feel the nares vibrate (pictured)
***What are some additional methods to reduce hypernasality?
Use ONL for feedback
Lower back of tongue- get the back of the tongue down and the velum up by having the child yawn; have the child think of the yawn movements when articulating other sounds (it opens the back of the pharynx and prevents the nasality from occuring)
Increase volume- have the child increase volume which will increase respiratory support, VP effort and therefore closure, oral air pressure, and the force of articulation
Increase oral activity- increasing mouth opening can also reduce oral resistance
For misartics for compensatory production and phoneme specific nasality, it is best to ___
Wait until surgery to begin tx- correcting compensatory errors with the VP dysfunction is hard
Phoneme specific nasality occurs due to ___
Misarticulations as a result of an open VP port during production; can be corrected by correcting the placement
What is a tx technique to help with glottal stops?
Have the child place feel his/her hand on his/her neck during the production of a glottal stop to feel the "jerk" then let them feel your neck to tell the difference
Tell the child that you are going to eliminate the "jerk" during speech and have the child produce voiceless plosive slowly without the vowel
Have the child produce the voiceless plosive and then the vowel preceded by an /h/ (which keeps the vocal folds open and prevents the glottal stop)
For example: /p....hhhhe/ for /pe/, and /p....hhhho/ for /po/)- this softens the sounds at the level of the VFs to decrease the harshness of the sound
What are some tx techniques that can help with nasalized vowels?
Have the child alternately close and open the nose during production of the vowel; if they hear a difference, have them try to make it the right way
Ask the child yawn, which pushes the back of the tongue down and the velum up- have the child be aware of the "stretch" in the back of the mouth
What are some tx techniques that can help with ng/l substitutions?
Have the child produce a big yawn to get the base of the tongue down and the velum up, making sure they feel the stretch in their throat
With the yawn have the child coarticulate the /l/
Gradually eliminate the use of the yawn movement but tell the child to think of the movement during production
What are some tx techniques that can help with ng/r substitutions?
Teach them that the /r/ is produced by cupping the tongue into a boat shape and that the sides of the tongue rest on each side of the molars
For pharyngeal fricatives, one technique you can use is to ___
Place a straw on the incisors and note the airflow through the straw; make the sound until they hear the airflow through the straw
Have the child produce fricative sounds with the nostrils occluded and then open in order to get the feel for oral rather than pharyngeal airflow
For middorsum palatal stops, you can use a ___
Tongue blade- have the pt bite on it and use that to show their tongue the correct placemeent
What are some good biofeedback instruments you can use?
Nasometry- visual feedback via graphs and a small animation that dances across the screen for reinforcement
Nasopharyngoscopy- only practical method for direct visualization of the VP mechanism because it is well tolerated by most patients, doesn't impede speech and can be repeated without any risk to the patients
CPAP- provides resistance training for the velopharyngeal muscles by having them work actively against positive air pressure
Name some pros and cons for the CPAP
Pros- provides resistance so that the muscles are strengthened and can help VP closure, noninvasive, easy to use, can be done at home
Cons- need good cooperation and use (24 minutes, 6 days per week), may be scary for young kids
Using a CPAP is best for pts who ___
Have poor velar movement (like TBIs- less effective for mild-mod VPI or structure problems)
T/F Oral motor exercises are good to use to help strengthen VP muscles and function
FALSE- there are different movements of the velum in speech as opposed to non-speech exercises
What are some ways to support carryover for speech produciton with resonance/clefts?
1. New speech production must be easy to produce and therefore practice in drills can be helpful
2. The child must be able to self monitor and self-correct
3. There must be support from the family to encourage the use of the sound at home and to correct the misarticulations when necessary
The ultimate goal for clefts is to ___
Get surgical services to decrease hypernasality and nasal emissions
Why is tx not appropriate for VP insufficiency?
Because the problem is structural and not funcitonal- you cannot correct errors d/t the anatomy of the pt
What makes up the primary palate?
Incisive foramen and alveolar process
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