Artic therapy for CLP

Desireable components of a speeh therapy program for patients with cleft lip and palate

• Parent counseling

• Home speech and language stimulation program

• Direct speech therapy

• A team management approach

Phonetic vs. Phonemic Artic tx

• Phonetic: traditional-motor approach

• Phonemic: phonology-based therapy

• Articulation therapy for cleft palate compensatory articulation tends to follow the phonetic approach

Elements of phonetic therapy

• Ear training

• Sound production in isolation

• Nonsense syllables

• World level (word level?)

• Phrases and sentences

• Speech in structured contexts

• Spontaneous speech and carryover

• Successful dismissal: 50% accuracy in spontaneous speech

  • Long-term follow-up

high vs low intensity therapy

High intensity speech therapy (2 weeks with 5 sessions) had equal or better outcomes compared to traditional low-intensity therapy (10 weeks with 1 session)

Rationale for light articulatory contacts + disadvantage

• Rationale: Light articulatory contacts result in lower oral pressure, so patients with velopharyngeal dysfunction will have less nasal air emission.

  • not as much aerodynamic pressure

  • quick and light contacts

• Disadvantage: Hypernasality may drown out consonant sounds and make speech unintelligible.

rationale for strong articulatory contacts + disadvantage

• Rationale: Strong articulatory contacts increase tactile feedback, helping the patient learn.

• Don’t increase volume, overemphasize contacts

• Increase pressure build up

• Perceptually, strongly articulated consonant sounds will be audible despite the hypernasality.

• As long as the articulatory contacts are strong, it can be acceptable if hypernasality and nasal emissions increase.

• Disadvantage: The increased audible nasal emissions may distract listeners

is one of strong or weak articulatory contacts better than the other?

no both are good

Principles for the admin of speech therapy

• Intensive therapy

• Frequent therapy

• Effective use of reinforcers

• Home assignments and carryover

therapy of cleft related artic

• Get an accurate articulatory profile and determine the therapy sequence.

  • May be variability of how speech sounds are produced

• Work from front sounds to back sounds, and from simple to more complex articulatory gestures.

  • More proprioception and awareness

• Encourage the use of strong articulatory contacts (maximum effort without increase in volume).

• Be direct and specific

• Build a repertoire of correct target words and use these for drill exercises

Different cues for artic therapy

• Auditory cues (modeling)

• Phonetic cues (using one sound to facilitate another)

• Visual cues (mirror, cotton balls etc)

• Verbal cues (specific instructions and reinforcement)

• Manual cues (manipulation of articulatory organs)

• Tactile cues (kinesthetic feedback for the patient

Techniques from the cookbook approach

• change the label’

• eliminate glottal stops and coproductions

• use aspiration to avoid glottal co productions

• use nasal occlusion to builld up intra oral pressure for /f/

How does changing the label work and when would you do this

If the child had too much previous therapy:

• Change the label

• Facilitation of speech sound learning by redefining the goal (the ‘wohobi’ /s/)

How to eliminate glottal stops and glottal co productions

• Create auditory awareness for the sound

• Use tactile feedback from the neck (glottal plosion can be felt on the sides of the thyroid)

• Use whispering to prevent glottal adduction

• Aspirate voiced and unvoiced plosives (t-hhh-a)

• Increase the transition times of voiced plosives (sustain voicing before the release and aspirate the vowel onset)

How to use nasal occlusion to build up oral air pressure for /f/

• Occlude nares and sustain /f/ for five seconds.

• Repeat sustained /f/ with occluded and opened nares (occlusion - release - occlusion)

• Repeat sustained /f/ with occluded and opened nares ( release - occlusion - release)

• Proceed to CV syllables and quickly into meaningful contexts (words).

How to treat PSNEs

• Establish oral vs. nasal airflow

• Practice the target in isolation

• Use target re-labeling, if needed

• Use adjacent places of articulation to facilitate the target (e.g., use /f/ to facilitate /s/)

• Use drill to consolidate correct productions

• Use biofeedback (low-tech or hi-tech)

What are some biofeedback techniques for linguopalatal contacts

• EPG display of typical palatal contact areas for different consonant sounds

• UofT reminder appliance

• Ultrasound biofeedback