Question
I see a 3 year old child diagnosed with a submucous cleft that reportedly does not require surgery. The child was not diagnosed until age 2. What treatment protocol would you suggest to address intelligibility?
Answer
This is a difficult one to answer without knowing more about the child's errors and concerns. Not all children with submucous cleft palate, or overt cleft palate for that matter, are alike, and not all children with clefts of the palate will require speech therapy.
First, I would recommend that you have the parents sign a release for you to communicate with the cleft palate team caring for the child. Find out who, and how it was determined that the child does not need surgery. Find out what speech testing has already been done, and what the specific recommendations were. Find out if the child has actually been seen by a cleft palate speech specialist, or if he or she was seen by a physician only.
Next, do a full diagnostic exam yourself, including articulation testing and spontaneous speech sampling. Contact the cleft team speech pathologist to discuss and compare your findings with theirs. Ask them for specific recommendations regarding this particular child, and develop an ongoing collaborative relationship with the team and its speech-language members in particular.
If the child has not been in team care and has actually not been seen by an SLP, you may wish to contact a local team SLP for advice and mentoring. If you are uncertain of cleft team resources in your area, you can contact the Cleft Palate Foundation's Cleftline at 1-800-24-CLEFT or visit their website at www.cleftline.org/. At this website, there is an easy-to-use directory for locating the team or teams nearest you.
As a general resource, I highly recommend the following book: Peterson-Falzone, S.J; Trost-Cardamone, J; Karnell, M; Hardin-Jones, M. (2006) The Clinician's Guide to Treating Cleft Palate Speech. St. Louis: Mosby/Elsevier. However, without knowing more about this particular child, it would be difficult to say how much of this book is applicable in this case. Other useful resources are these:
References for Cleft Palate and Velopharyngeal Dysfunction:
Clark, H.M. (2003). Neuromuscular treatments for speech and swallowing: a tutorial. American Journal of Speech-Language Pathology, 12, 400-415.
Golding-Kushner, K.J. (2001) Therapy techniques for cleft palate speech and related disorders. San Diego: Singular.
Kummer, A.W. (2001) Cleft palate and craniofacial anomalies: effects on speech and resonance. San Diego; Singular.
Peterson-Falzone, S.J. (1986) Speech characteristics: updating clinical decisions. Seminars in Speech and Language, 7, 269-295.
Peterson-Falzone, S.J; Trost-Cardamone, J; Karnell, M; Hardin-Jones, M. (2006) The Clinician's Guide to Treating Cleft Palate Speech. St. Louis: Mosby.
Ruscello, D.M. (1984) Motor learning as a model for articulation instruction. In J. Costello (Ed.), Speech disorders in children. San Diego: College Hill Press.
Ruscello, D.M. (1993). A motor skill learning treatment program for sound system disorders. Seminars in Speech and Language, 14, 106-118.
Trost, J.E. (1981) Articulation additions to the classical description of the speech of persons with cleft palate. Cleft Palate Journal. 18: 193-203.
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.
