Facial/cleft

Question 1

true or false: do not worry about therapy until after the surgical repair of the palate

Answer 1

false

Question 2

true or false: treatment does not need to begin until palatal surgery

Answer 2

false

Question 3

true or false: stops cannot be produced before palatal surgery

Answer 3

false

Question 4

true or false: glottal stops always persist because of VPI

Answer 4

false, can be a learned compensatory error

Question 5

true or false: post surgery nasal substitutions always indicate VPI

Answer 5

false

Question 6

true or false: a child with cleft palate cannot be expected to have perfectly normal speech

Answer 6

false

Question 7

approximately what percentage of children with cleft will need speech therapy?

Answer 7

25-50%

Question 8

according to Golding-Kushner (2001), when should children with cleft palate be evaluated for speech + language?

Answer 8

by at least 8 months if not sooner

Question 9

what are general early intervention principles that we should consider for the cleft population?

Answer 9

1. increase frequency + diversity of vocal development
2. increase communicative opportunities

Question 10

in terms of cleft, how can we increase frequency and diversity of vocal development

Answer 10

imitate
reinforce oral stops
encourage CV syllables that babies can easily produce

Question 11

in terms of cleft, how can we increase communicative opportunities

Answer 11

EMT
Modeling
Recasting
parent coaching

Question 12

what are two speech behaviors of particular concern that we want to address if observed (cleft)?

Answer 12

glottal stops
-address early or ASAP

phonemic specific nasal emission

Question 13

why do we want to address glottal stopping in clients with cleft ASAP?

Answer 13

it’s easier to eliminate if treated earlier

Question 14

what are the three types of VPI?

Answer 14

velopharyngeal mislearning

velopharnygeal insufficiency

velopharyngeal incompetency

Question 15

what is VP mislearning

Answer 15

learned
compensatory errors
can treat with speech therapy

Question 16

what is VP insufficiency

Answer 16

structural/anatomy
surgery

Question 17

what is VP incompetency

Answer 17

function/neurological

Question 18

if both VPD and learned/compensatory errors are present what should we consider to determine if speech therapy to address articulation or surgery to address VPI/S should come first?

Answer 18

VP surgery may be more conservative if compensatory errors are eliminated first

VPD diagnosis is more unclear when compensatory errors are present so speech therapy may help with a differential diagnosis

Question 19

cleft: what are the goals for therapy?

Answer 19

intelligible speech
age appropriate speech skills
age appropriate language skills
socially acceptable skills

Question 20

cleft: what are examples of what we can treat with speech therapy?

Answer 20

placement, pressure, manner, and voicing errors (+ language if needed)

articulation and phonological errors
(compensatory errors)

Question 21

what are two general intervention approaches that have been recommended for cleft

Answer 21

motor learning
-teach identity, location, and action or oral movement

phonological intervention approaches
- MO, minimal pairs

Question 22

what are three techniques that are often useful in speech therapy for cleft

Answer 22

cul-de-sac
shaping
whispered speech
-sustained /h/, over aspiration

Question 23

define cul de sac technique

Answer 23

nose pinching to teach airflow

redirects nasal airflow and teach oral airflow direction

Question 24

define the shaping technique

Answer 24

produce /m/ and /n/ and plug your nose to teach new phoneme sound

use something they have to get something they don’t

Question 25

define whispered speech technique

Answer 25

can't produce glottal stops with whispers so whisper helps with bilabial stops whisper can help facilitate voiceless sounds

Question 26

what are some general recommendations for techniques for cleft palate

Answer 26

may work on eliciting and stabilizing 1 sound in hierarchical progression aim for higher accuracy (90+) to solidify new sounds -teach more visible first -voiceless before voiced

Question 27

how does the need for orthodontics impact plans for speech therapy

Answer 27

myth: therapy shouldn't start until after fixed if tongue placement is limited by teeth then may need orthodontic work first

Question 28

is non speech oral motor therapy effective for addressing speech errors in this population (cleft)

Answer 28

no

Question 29

hypernasality may be...

Answer 29

structural, functional, or learned

Question 30

hyponasality is usually

Answer 30

structural

Question 31

what is the most common syndrome associated with cleft palate

Answer 31

velocardiofacial syndrome

Question 32

what are the 6 common charactieristics of VCFS

Answer 32

cleft palate communication disorder VPD neurological abnormalities facial abnormalities early feeding problems

Question 33

hypernasality VCFS may be present. what should the clinician and team be aware of and consider before recommending surgery to address VPI

Answer 33

what is the cause of the hypernasality bc if it's apraxia surgery may not totally correct hypernasality is it due to VPI or apraxia

Question 34

define apert

Answer 34

abnormal growth of the skull and face due to premature fusion of certain skull bones facial features: perturbing wide set eyes dental misalignment

Question 35

define charge

Answer 35

cause: unknown heart disease atresia of choanae coloboma- hole in eye

Question 36

define teacher collins

Answer 36

cause by altered chromosome 5 some bones are not formed typically underdeveloped jaw and cheek bone usually normal IQ

Question 37

define couzon syndrome

Answer 37

two associated genes FGFR 2 + 3 premature fusion of certain skull bones abnormal growth of skull and face abnormal growth of mid face (bulging eyes, protruding jaw) normal IQ

Question 38

define goldenhar syndrome

Answer 38

cause is unknown wide range of bone abnormalities affecting the face and sometimes the neck lower half of one side of the face does not grow normally partially formed or total absence of ear

Question 39

define Pierre robin sequence

Answer 39

may be attributed to DNA small lower jaw, tongue falling backward into throat (insufficient tongue space), may have cleft

Question 40

define stickler syndrome

Answer 40

due to a change in one of 3 genes related to connective tissue breathing and feeding difficulties flat face, epicanthal fold, small nose, hearing loss, may have cleft