Question
I am working with a six-year-old male with inconsistent velopharyngeal incompetency and motor speech disorder best characterized as dysarthria.
Surgical intervention or a prosthetic appliance were not recommended by a medical team. Palatal lift exercis
Answer
This is an uncommon recommendation, about which I can only speculate. It is a procedure that is not routinely used by cleft and velopharyngeal teams across the country. If a prosthetic appliance was not recommended, I can only assume that they are not actually fitting the child for a palatal lift, which is a prosthetic appliance. I am not exactly sure what is meant by "palatal lift exercise." Some older texts have speculated on the use of hand-held lifts or obturators that could be used as an exercise tool for improving velopharyngeal closure, but literature which documents the efficacy of such a therapy program is quite sparse, and the use of such tools has never been widespread in cleft palate and velopharyngeal management.
Some programs have used pharyngeal extension obturators (speech bulbs) as a means of training improved velopharyngeal closure. The child is actually fitted with an obturator, and over time the obturator is gradually reduced in size to increase velopharyngeal activity. Periodic endoscopic monitoring accompanies such a program. The child also continues therapy, and it has been somewhat unclear across patients as to whether the improved function results from improved articulation, or if it is directly due to stimulation from the obturator reduction procedures alone.
In this particular case, you will need to be a close collaborator with the medical team that made the recommendation. Have the child's parents sign a release allowing you to communicate directly with the medical team. Find out from the team the details of the program and what is expected of you in the process. If you are unable to meet their expectations, it will important for you to communicate that to the team and to the family, so that the alternate arrangements can be made or that training can be provided to you. If the medical team is unwilling to collaborate or communicate, discuss alternatives with the family. This is a difficult and unusual case, and best care can only occur if all care providers are willing to communicate and collaborate. Good luck to you!
References:
1. Cole, Richard M (1979) "Direct Muscle Training for the Improvement of Velopharyngeal Activity" in Communicative Disorders Related to Cleft Lip and Palate (2nd ed) K.R. Bzoch, ed. Boston: Little, Brown and Co. (pp. 328-340)
2. Golding-Kushner, K.J., Cisneros, G., LeBlanc, E. (1995) Speech Bulbs. In R.J. Shprintzen and J. Bardach (eds), Cleft Palate Speech Management: A Multidisciplinary Approach.(pp. 352-363.) St. Louis, MO: Mosby.
3.Grames, LM: "Implementing Treatment Recommendations: The Role of the Craniofacial Team Speech-Language Pathologist in Working With the Client's Speech-Language Pathologist" Perspectives on Speech Science and Orofacial Disorders, Vol 14, No 2, October 2004.
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.
