COMD 472 Chapter 11: Clinical and Instrumental Assessment of Cleft Palate Speech Therapy Techniques

What is included in a general assessment?

Resonance, nasal air emission, compensatory articulation patterns, voice

____% of CL/CP children will have speech difficulties after repair

25

goals of assessment

determine if abnormality exists, need for instrumental testing, plan of care

determine if abnormality exists refers to identifying the:

type, severity, and cause of disorder

what are potential causes of disorders?

abnormal structure, apraxia, oral motor dysfunction, phonological disorder, developmental delay, normal developmental error

first year of assessment includes:

counseling, diagnosis, effect of anomalies on function, prognosis, verbal communication stimulation

primary concern of SLP during first year of assessment

feeding, prereqs for speech, monitoring of development

CL children continue annual screenings until age

4

When do CL children get a comprehensive speech/language assessment?

age 3

comprehensive s/l assessment evaluates what?

resonance and VP function

When are perceptual assessments needed?

prior to any surgery designed to improve speech, document baselines, postoperative assessment

components of a clinical assessment

-diagnostic interview

-oral motor examination

-language screening

Informal language screenings

observation of play behaviors, spontaneous vocalizations, repetition of sentences

formal language screenings

REEL: Receptive-Expressive Emergent Language Scale (Bzoch & League, 1991)

ELM: Early Language Milestone Scale (Coplan, 1987)

Iowa Pressure Articulation Test (IPAT) tests what?

sounds in initial, medial, and final position

high pressure consonants

hierarchy of tasks

syllable repetition then repetition of words, sentence repetition, counting and automatic speech, spontaneous connected speech, evaluate stimulability

How can you evaluate stimulability

by identifying sounds that can be modified with auditory and visual cues

Strategies that can facilitate correct production of target sounds

speech rate, phonetic context, vocal intesnity, length of utterance

gold standard of auditory perceptual judgment

absence of perception in presence of instrumental indicators is not a reason for therapy

what is a the problem with auditory perceptual judgement?

experience and reliability

interrater reliability

with other therapists

intrarater reliability

within their own patient base

what is used to measure nasal air emission visually?

mirror: hold under each nostril (look for fogging)

what are the advantages and disadvantages of the mirror technique ofr nasal air emission testing?

A: simple and inexpensive

D: some airflow may be normal

How is a see-scape used to measure nasal air emission

A styrofoam float inside a clear vertical tube, nasal airflow reflected in rising float

What are the advantages and disadvantages of the see-scape?

A: inexpensive and provides visual feedback

D: not realiable enough to quanitfy severity or progress

auditory measures of nasal air emission

nose pinch, stethoscope, listening tube

VP insufficiency compensatory articulations

hypernasality, nasal emissions

Oral nasal fistual compensatory articulations

nasal emission, hypernasality, middorsal palatal stop

abnormal dentition compensatory articulations

hyper/hyponasality, voicing errors, placement errors

Recommendations for VP insufficiency (anatomy)

surgery, speech bulb, ST for articulation and compensatory productions

Recommendations for VP Incompetence (Physiology)

surgery, prosthesis, ST

Recommendations for Velopharyngeal mislearning

Speech therapy only

Recommendations for Symptomatic Fistula

Surgery, palatal obturator, ST

nasometry

measures nasal acoustic energy in speech and calculates ratio of nasal to total

A nasolance score is a

ratio of nasal energy over total acoustic energy

aerodynamic measures of VP function

pressure-flow methods: small catheters in the oral cavity and in nostril

Nasendoscopy/nasopharyngoscopy

invasive fiberoptic scope inserted through nostril that gives superior view of VP port

Nasoendoscopy permits visualization of which VP structures?

Velum, posterior pharyngeal wall, lateral pharyngeal walls

Multi-view videofluoroscopy frontal

Visualize lateral pharyngeal walls

Multi-view videofluoroscopy lateral

velum and posterior pharyngeal wall

Multi-view videofluoroscopy base

Visualize the vp sphincter

Multi-view videofluoroscopy towne's view

Visualize the vp sphincter

Better to use than base when adenoids are enlarged

Target behaviors with CL/CP

correcting place of articulation, decreasing phoneme specific nasal emission, decreasing perceived hypernasality

Visual feedback approaches

diagrams, modeling, see-scpe, mirror, nasometric endoscopic feedback

Auditory feedback approaches

plastic tube from nostil to ear, stethoscope, amplification

Tactile Feedback Approaches

Toothette, tongue blade, chewing gum