Question
My student is 7 years old with a unilateral repaired lip cleft. According to his grandmother, his lip was repaired before school age. Where do I begin therapy? Do I need to work on air pressure? Please suggest therapy techniques and strategies. Where
Answer
In cases of isolated cleft lip, intraoral air pressure and structural dysfunction are rarely concerns. In the St. Louis Children's Hospital database, approximately 25% of children with isolated cleft lip ever required therapy, and the disorders most often seen were actually language and phonological disorder.
If the child actually has cleft lip with a cleft palate, the issues are quite different. Data suggests that approximately 70% of these children will require therapy, and the most frequent disorder seen in this population is articulation disorder. Most centers report 20-25% of children with clefts of the palate, with or without cleft lip, needing prosthetic or surgical management to correct velopharyngeal dysfunction, which is characterized by excessively nasal resonance and/or reduced intraoral pressure for consonants.
First, find out if the diagnosis is cleft lip only, or cleft lip and palate. Next, do a careful evaluation of language and articulation. If you are uncertain about the articulations that you hear, or if you suspect that a dysfunctional velopharynx is confounding what you hear, repeat the articulation test with the child plugging the nose for each response. If there is noticeable improvement with the nose plugged, velopharyngeal dysfunction is a concern and the child should be evaluated by the treating cleft palate team. If you notice no change, but articulation still sounds impaired, articulation therapy is appropriate.
Get a release from the family to contact the team taking care of the child, and communicate with them about your concerns and the child's care. They may be able to give the best advice concerning this particular child's therapy and care.
A good reference book is ''Therapy Techniques for Cleft Palate and Related Disorders'' by Karen Golding-Kushner, PhD, and published by Singular. In searching for articles, good authors to look for are Judith Trost-Cardamone, PhD.; Ann W. Kummer, PhD; Sally Peterson-Falzone, PhD; and Mary Ann Witzel, PhD, to name just a few.
Lynn Marty Grames, MA, CCC-SLP, has been a team member of the Cleft Palate and Craniofacial Deformities Institute at St. Louis Children's Hospital since 1982. Her practice with the Institute focuses on cleft palate/craniofacial diagnostics, therapy, and clinical research.
