The Role of the Speech and Language Therapist in the Cleft TeamSue Mildinhall Lead Speech and Language Therapist South Thames Cleft Service Guy’s and St Thomas’ NHS Trust, London, England South Thames Cleft Clinics Outcomes of cleft palate surgery Speech Appearance & Growth Psychological well-being To describe the work of the Speech and Language Therapist in the cleft team 2. To describe how we manage the speech problems of the child with cleft palate .To discuss speech difficulties associated with cleft palate 3.Plan 1. Aim of the Team To ensure best possible speech outcome for child born with cleft palate as early in life as possible . The work of the Speech and Language Therapist (SLT) • Monitor speech development and speech outcomes in relation to cleft • Provide differential diagnosis for cleft/non cleft speech problems • Advise surgeon when VPI suspected & about all slt issues • Participate in multi-disciplinary clinic • Speech assessments & palate investigations • Teaching • Liaise with local SLT or family about treatment strategies • Provide therapy to local or challenging cases . How do we do this? • Early speech and language development advice • Speech assessments at regular intervals • Therapy as needed • Regular joint clinics with surgeons • Regular feedback to surgeons on outcomes . 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 . Why is the soft palate important? • Romanian has 20 consonants • English 24 consonants • Only 2 are nasals – n m • All the others are oral & are produced with a raised soft palate • Closure is particularly important for the sounds requiring a build up of oral pressure . key . Types of speech problems • May sound “nasal” • Sounds may be mispronounced/omitted • Nasal consonants (m n ng) should be possible • Oral consonants (pb td kg s f sh ch) are vulnerable . What might cause the problem? • • • • Soft Palate may not work effectively Fistulae Orthodontic problems Malocclusion Fluctuating Hearing Loss . What do we assess? 1. Airflow problems -balance of air resonating in oral/nasal cavities? Nasal emission of air? 3. Intelligibility – can we understand the child? 2. Articulation – are sounds produced correctly? . The SLT? What is the reason for the poor intelligibility? . The parent/carer 2. 1. School/Nursery 3. Unfamiliar adults 4.Intelligibility How difficult is it to understand the child according to. Airflow Problems –Hypernasal resonance • Too much air resonates in the nasal cavity • Oral consonants can sound nasalised • Or become nasal eg b=m • Suspected velopharyngeal insufficiency (VPI/VPD) . . Airflow Problems . f • ? Fistula or VPI . t.Audible Nasal Emission • Audible air escape from the nose • Heard accompanying sounds eg p. k. s. . 2. 2. 5.SPASS 1998) . 6. 9. 8. 7. Articulation Cleft-type speech patterns: 1. Lateralisation Palatalisation Backing to velar Backing to uvular Pharyngeal Glottal Active Nasal Fricatives Weak nasalised consonants Nasal realisations Absent pressure consonants (GOS. 4. 3. 10. . . Mildinhall et al 2007) .30% will need further surgery for speech (CSAG 1998.Who will need speech therapy? • 50% 5 year olds more or less normal speech • 81% 12 year olds “ “ (CSAG 1998) • Prediction of cases impossible • 25 . Work with families.The skill of therapy • Recognise when children are ready/not for therapy .continue work at home .What needs therapy and what needs surgery .Provide therapy in a timely and fun way . giving them the skills to .Adapt therapy style according to child’s needs . . . length. stretch of the soft palate during speech • Nasendoscopy shows sphincter from above • Leads to treatment plan .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. . . . . Speech Surgery after investigation • Palate re repair • Pharyngoplasty • Posterior pharyngeal wall implant • John Boorman • Norma Timoney . 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 .Summary • Speech and Language Therapist’s role in assessment. diagnosis. Speech and Language Therapists. dentists. audiologists collaborate in the care of the child with cleft throughout childhood .Team work Surgeons. specialist nurses. psychologists.