[PART 4] IMPLICATION OF CLEFT AND CRANIOFACIAL ABNORMALITIES

OBLIGATORY ERRORS

→ d/t structural abnormality (dental maloclussion, velopharyngeal insufficiency, or an oronasal fistula)

→ includes hypernasality, nasal emission, weak consonants, short MLU

→ structures are deformed

COMPENSATORY ERRORS

→ d/t incorrect placement of articulators 

→ mislearning 

→ VPD 

→ where therapy comes in 

→ act of trying to do something in attempt to produce the proper sound

→ despite surgery compensatory will insist because it’s what they are used to

CONSONANT PRODUCTION

→ distorted production

→ omission of consonants

→ distortion of some of the consonant sounds 

→ not learning how the sounds sound like

IMPLICATION ON LANGUAGE

UTTERANCE LENGTH

ORONASAL FISTULA: VELOPHARYNGEAL INSUFFICIENCY

UTTERANCE LENGTH

Short MLU, immature syntactic development

ORONASAL FISTULA: VELOPHARYNGEAL INSUFFICIENCY

→ leak airflow through the nose reduces the oral airflow airflow available for connected speech

→ increased physical effort for speech and higher fatigability

IMPLICATION ON FEEDING AND SWALLOWING

CLEFT LIP

CLEFT PALATE

CLEFT LIP AND PALATE

CLEFT LIP

→ no significant problems during feeding (esp if unilateral) 

→ problem with an adequate lip seal (soft, wide-based nipple to close the area of the cleft) 

→ there are specialized bottles for cleft children 

→ FEEDING OBSTURATORS: prosthetic device used in infants with cleft lip and/or palate to aid in feeding by creating a seal between oral and nasal cavities

FEEDING OBSTURATORS:

prosthetic device used in infants with cleft lip and/or palate to aid in feeding by creating a seal between oral and nasal cavities 

CLEFT PALATE

→ unable to generate negative pressure for suction 

→ risk for nasal regurgitation 

• Use of assisted feeding techniques

  • Positioning the infant upright position

  • Allow the infant to cough or sneeze

  • Modified nipples

  • Feeding obturators

CLEFT LIP AND PALATE

→ inadequate lip closure

→ Unable to generate negative pressure for suction 

→ Risk for nasal regurgitation

IMPLICATION ON HEARING

HISTORY OF CLEFT PALATE

OTHER CRANIOFACIAL SYNDROMES

HISTORY OF CLEFT PALATE

→ high risk for chronic middle ear effusion and conductive hearing loss

→ may result in otitis media affecting speech and language dev

OTHER CRANIOFACIAL SYNDROMES

Conductive or sensorineural hearing loss as a phenotypic feature

IMPLICATION ON EDUCATION

UNDERPERFORMANCE

LESS PARTICIPATION

UNDERESTIMATED BY TEACHERS

UNDERPERFORMANCE

→ score lower on tests that require verbal skills 

→ score lower on intelligence tests

LESS PARTICIPATION

In social activities and extracurricular activities

UNDERESTIMATED BY TEACHERS

→ don’t challenge the kids with cleft to perform = underperformance

IMPLICATION ON PSYCHOSOCIAL

FAMILY

SOCIETY

SELF PERCEPTION

FAMILY

→ emotional challenge 

→ negative feelings and adjustment subside after first few weeks

SOCIETY

→ discrimination and stigma 

→ participation

SELF PERCEPTION

→ generally shy towards peers and strangers 

→ negative self concept 

→ important: support of the family and environment

RESONANCE DISORDERS

→ abnormal transmission of sound energy through oral, nasal, pharyngeal cavities 

→ hypernasality, hyponasality, cul-de-sac resonance, mixture, nasal air emission, nasal grimace 

→ open palate: sounds migrated to nasal palate

HYPERNASALITY	HYPONASALITY
→ oral sounds that do not require nasal resonance become nasal  → abnormal nasal resonance  b → m; d→ n; g → ŋ	→ nasal sounds are obstructed → reduction in normal nasal resonance during speech caused by obstruction in the nasopharynx/nasal cavity → consonant sounds cognates m → b; n → d; ŋ → g
CUL-DE-SAC RESONANCE	MIXED RESONANCE
→ sound enters a cavity but  → blocked from exiting at the cavity’s exit point → muffled speech & decreased volume d/t structural abnormality causding blockage  cannot be corrected with speech therapy	→ any combination of hypernasality, hyponasality, and cul-de-sac resonance combination of VPI and blockage in pharync → hyponasality + hypernasality

NASAL AIR EMISSIONS (NAEs)

→ inappropriate flow of airstream through the nose during speech → distortion of speech caused by velopharyngeal dysfunction 

→ air coming out of the nose during production of speech sounds

→ open palate or velopharyngeal dysfunction

INSUFFICIENCY	INADEQUACY	MISLEARNING
→ when there is not enough tissue in the palate  → throat let palate contact the back of the throat during speech	→ soft palate is complete but it does not move properly → problem with how the soft palate moves to make speech sounds	→ presence of clear palate → when a child learns the wrong way  → some develop unusual speech patterns

HYPERNASALITY

→ oral sounds that do not require nasal resonance become nasal 

→ abnormal nasal resonance 

• b → m; d→ n; g → ŋ

HYPONASALITY

→ nasal sounds are obstructed

→ reduction in normal nasal resonance during speech caused by obstruction in the nasopharynx/nasal cavity

→ consonant sounds cognates

• m → b; n → d; ŋ → g

CUL-DE-SAC RESONANCE

→ sound enters a cavity but 

→ blocked from exiting at the cavity’s exit point

→ muffled speech & decreased volume d/t structural abnormality causding blockage 

• cannot be corrected with speech therapy 

MIXED RESONANCE

→ any combination of hypernasality, hyponasality, and cul-de-sac resonance combination of VPI and blockage in pharync

→ hyponasality + hypernasality

INSUFFICIENCY

→ when there is not enough tissue in the palate 

→ throat let palate contact the back of the throat during speech 

INADEQUACY

→ soft palate is complete but it does not move properly

→ problem with how the soft palate moves to make speech sounds 

MISLEARNING

→ presence of clear palate

→ when a child learns the wrong way 

→ some develop unusual speech patterns