Part 1, Cleft Palate Speech: Causes, Identification, and Assessment TABLE OF CONTENTS Introduction and Learning Outcomes
i
Speaker Bio and Disclosures
ii
CHAPTER 1: Understanding the Speech Problems Introduction
1
Anatomic Underpinnings
11
How Does a Cleft Palate Impact Speech Production?
21
A Close-up Look at (and Listen to) Cleft Type Speech Characteristics
34
Compensatory Articulations
46
CHAPTER 2: Clinical Assessment of Cleft Type Speech Disorders Chapter Overview
85
Orofacial Findings Related to Cleft Palate Speech Characteristics
90
The Perceptual Assessment – Assessing for Cleft Type Speech Disorders
129
Some Comments on Instrumental Studies of VP Function
170
CHAPTER 3: Case Presentations
175
ASHA 1384
Cleft Palate Speech: Causes, Identification, and Assessment
INTRODUCTION From glottal stops to learned nasal emission, you’ll hone your knowledge and clinical practice skills in assessing speech disorders associated with cleft palate/VPI. We’ll discuss procedures and techniques, and we’ll share audio and video clips of that demonstrate how to assess the variety and uniqueness of speech deviations seen in cleft palate cases. You’ll also learn how to distinguish learned from obligatory/physicallybased problems. LEARNING OUTCOMES After completing this program, you will be able to: • identify, analyze, and summarize speech errors associated with cleft palate/VPI • perform a speech-screening assessment with someone suspected of a cleft palate/VPI • describe the difference between obligatory and learned errors • describe the pattern of phoneme-specific nasal emission PROGRAM HISTORY Program start date: June 30, 2013 Peer reviewed: May 27, 2013 Available through: May 27, 2016 IMPORTANT INFORMATION To earn continuing education credit, you must complete the test with a passing score on or before May 27, 2016. To see if this program has been renewed after this date, please search by title in ASHA’s online store at www.asha.org/shop. This course is offered for 0.5 ASHA CEUs (Intermediate level, Professional area). EVIDENCE-BASED PRACTICE It is the position of the American Speech-Language-Hearing Association that audiologists and speech-language pathologists incorporate the principles of evidence-based practice in clinical decision making to provide high quality clinical care. The term evidence-based practice refers to an approach in which current, high-quality research evidence is integrated with practitioner expertise and client preferences and values into the process of making clinical decisions. Participants are encouraged to actively seek and critically evaluate the evidence basis for clinical procedures presented in this and other educational programs. Adopted by the Scientific and Professional Education Board, April 2006
i ASHA 1384
Cleft Palate Speech: Causes, Identification, and Assessment
FACULTY Judith Trost-Cardamone, PhD, CCC-SLP is Professor of Communication Disorders and Sciences at California State University at Northridge and Speech Consultant for Ventura County Medical Center Cleft Palate Team. She received her BS, MA and PhD degrees from Northwestern University in Evanston, Illinois. Throughout her career of university teaching and hospital based speech-language pathology, Dr. TrostCardamone has served as a resource specialist to school-based clinicians and other medical and non-medical settings locally, nationally and internationally. She brings over 40 years of experience to assessment and treatment of congenital and acquired (structural and neurogenic) speech resonance, voice, articulation and disorders in children and adults. She has given numerous seminars and workshops on these topics and is nationally and internationally recognized for her clinical expertise and educational contributions. Dr. Trost-Cardamone's research and publications have focused on the description, assessment and treatment of craniofacial speech disorders. She is co-author of The Clinician’s Guide to Treating Cleft Palate Speech. Dr. Trost-Cardamone is a Fellow of ASHA. She is Member, archives Chair and past-Secretary of the American Cleft PalateCraniofacial Association past-Editor of the ACPA Newsletter. She has volunteered with Re-Surge International (formerly Interplast) as a Visiting Educator and to provide and develop speech services for children with clefts in underserved regions of the world. FINANCIAL DISCLOSURES Judith Trost-Cardamone received financial consideration from ASHA for this presentation, and receives royalties from Mosby-Elsevier.
NONFINANCIAL DISCLOSURES Judith Trost-Cardamone is a member of and advisor for the American Cleft-Palate-Craniofacial Association; and a volunteer for Americleft Speech Outcomes Project.
ASHA 1384
ii
Part 2, Cleft Palate Speech: Treatment and Team Interaction TABLE OF CONTENTS Introduction and Learning Outcomes
i
Speaker Bio and Disclosures
ii
CHAPTER 1: Therapy Principles and Techniques Early Speech Intervention for the Infant and Toddler with Cleft Palate
5
The Impact of Age at Palate Repair
9
Objectives of Early Speech Intervention
11
CHAPER 2: Direct Speech Therapy for Cleft Type Speech Error What We Can Treat and What We Can’t
19
Therapy Objectives
22
Therapy Principles
24
Techniques and Strategies for Treating Cleft Type Speech Errors
35
CHAPTER 3: Case Presentations Therapy for Compensatory Articulations
57
Therapy for PSNE and Nasal Fricatives
82
CHAPTER 4: Therapy: Review of Key Points
91
CHAPTER 5: Interacting with the Cleft Palate/Craniofacial Team Aspects of Team Care
94
Making Referrals for Team Care
99
Connecting and Collaborating
ASHA 1390
104
Cleft Palate Speech: Treatment and Team Interaction
INTRODUCTION With this program, you will gain a comfort level in treating cleft palate/VPI and in working collaboratively with the cleft palate/craniofacial team. You’ll hone your knowledge and clinical practice skills in treating speech disorders, from glottal stops to learned nasal emission. We’ll provide treatment rationales, procedures, and techniques that are supplemented with video clips. You’ll also learn how to distinguish “learned” from “obligatory”/physically-based problems. LEARNING OUTCOMES After completing this program, you will be able to: • develop and deliver early speech intervention activities for toddlers with repaired cleft palate • apply speech therapy techniques developed specifically for treating cleft palate articulation problems • provide speech therapy for learned/phoneme-specific nasal emission • make appropriate referrals to the cleft palate/craniofacial team and establish interaction with the team SLP PROGRAM HISTORY Program start date: June 30, 2013 Peer reviewed: May 27, 2013 Available through: May 27, 2016 IMPORTANT INFORMATION To earn continuing education credit, you must complete the test with a passing score on or before May 27, 2016. To see if this program has been renewed after this date, please search by title in ASHA’s online store at www.asha.org/shop. This course is offered for 0.25 ASHA CEUs (Intermediate level, Professional area). EVIDENCE-BASED PRACTICE It is the position of the American Speech-Language-Hearing Association that audiologists and speech-language pathologists incorporate the principles of evidence-based practice in clinical decision making to provide high quality clinical care. The term evidence-based practice refers to an approach in which current, high-quality research evidence is integrated with practitioner expertise and client preferences and values into the process of making clinical decisions. Participants are encouraged to actively seek and critically evaluate the evidence basis for clinical procedures presented in this and other educational programs. Adopted by the Scientific and Professional Education Board, April 2006
i ASHA 1390
Cleft Palate Speech: Treatment and Team Interaction
FACULTY Judith Trost-Cardamone, PhD, CCC-SLP is Professor of Communication Disorders and Sciences at California State University at Northridge and Speech Consultant for Ventura County Medical Center Cleft Palate Team. She received her BS, MA and PhD degrees from Northwestern University in Evanston, Illinois. Throughout her career of university teaching and hospital based speech-language pathology, Dr. TrostCardamone has served as a resource specialist to school-based clinicians and other medical and non-medical settings locally, nationally and internationally. She brings over 40 years of experience to assessment and treatment of congenital and acquired (structural and neurogenic) speech resonance, voice, articulation and disorders in children and adults. She has given numerous seminars and workshops on these topics and is nationally and internationally recognized for her clinical expertise and educational contributions. Dr. Trost-Cardamone's research and publications have focused on the description, assessment and treatment of craniofacial speech disorders. She is co-author of The Clinician’s Guide to Treating Cleft Palate Speech. Dr. Trost-Cardamone is a Fellow of ASHA. She is Member, archives Chair and past-Secretary of the American Cleft PalateCraniofacial Association past-Editor of the ACPA Newsletter. She has volunteered with Re-Surge International (formerly Interplast) as a Visiting Educator and to provide and develop speech services for children with clefts in underserved regions of the world. FINANCIAL DISCLOSURES Judith Trost-Cardamone received financial consideration from ASHA for this presentation, and receives royalties from Mosby-Elsevier.
NONFINANCIAL DISCLOSURES Judith Trost-Cardamone is a member of and advisor for the American Cleft-PalateCraniofacial Association; and a volunteer for Americleft Speech Outcomes Project.
ASHA 1390
ii
