“A
speech-language pathologist is responsible for the diagnosis, prognosis,
prescription, and remediation of speech, language, and swallowing disorders” (“Definitions
of the Professions," 2014). Speech-language pathologists (SLPs) are educated and
trained to look at a person’s behavioral issues, communication abilities, their
style of learning, academic achievements, and other organic variables to
determine a logical diagnosis of a speech, language, or swallowing disorder if
one is present. SLPs should be aware of the characteristics of Velocraniofacial Syndrome (VCFS) accompanied by the presence of cleft palate and recognize
the appropriate signs when they are present (Carneol, Marks, & Weik, 1999).
VCFS
causes numerous speech, language, hearing, and swallowing deficits. Hypernasal
speech is almost always a prominent feature of this disorder. Speech delay is
also often apparent, especially referring to expressive language (Pike &
Super, 1997). According to Morrison (n.d.), some children with VCFS may be
non-verbal until they are two or three years of age. Although expressive
language delay is usually higher, receptive language, as well as IQ scores are
also reduced. Due to incompetency of the velopharyngeal mechanism, many
articulation errors can be seen. (Fullman & Boyer, 2012). Quite often,
other phonological or articulation disorders can also be seen in clients with
VCFS, such as dyspraxia of speech, dysarthria, a high pitched voice, and
phonological disorders or delays. Hearing loss due to otitis media may also
affect clients with VCFS from time to time (Carneol et al., 1999).
Speech-language pathologists provide remediation for all of these types of
disorders by using different therapy approaches.
VCFS also causes swallowing and feeding difficulties. Carneol et al. (1999) reported that 90% of those who have VCFS also have pharyngeal hypotonia. This lack of movement in the pharyngeal mechanism makes it difficult for these clients to swallow efficiently. Clients with VCFS may also have other difficulties that may adversely affect their ability to swallow or feed effectively. Some of those may be vascular anomalies, airway compromise, irritable temperament, palatal and pharyngeal anomalies, chronic constipation, and slow gastric emptying (Fullman & Boyer, 2012). SLPs should be involved in the treatment of swallowing and feeding difficulties for these clients. Some techniques that may be recommended are using a botulinum toxin A injection in order to relax the upper esophageal sphincter, adjusting behavior, or adjusting diet, perhaps by adding more strongly flavored foods in order to compensate for hyposensitivity within the pharynx. Most importantly, an SLP should work closely with a team of professionals, as well as with the client’s family in order to provide the best care possible (Fullman & Boyer, 2012).
VCFS also causes swallowing and feeding difficulties. Carneol et al. (1999) reported that 90% of those who have VCFS also have pharyngeal hypotonia. This lack of movement in the pharyngeal mechanism makes it difficult for these clients to swallow efficiently. Clients with VCFS may also have other difficulties that may adversely affect their ability to swallow or feed effectively. Some of those may be vascular anomalies, airway compromise, irritable temperament, palatal and pharyngeal anomalies, chronic constipation, and slow gastric emptying (Fullman & Boyer, 2012). SLPs should be involved in the treatment of swallowing and feeding difficulties for these clients. Some techniques that may be recommended are using a botulinum toxin A injection in order to relax the upper esophageal sphincter, adjusting behavior, or adjusting diet, perhaps by adding more strongly flavored foods in order to compensate for hyposensitivity within the pharynx. Most importantly, an SLP should work closely with a team of professionals, as well as with the client’s family in order to provide the best care possible (Fullman & Boyer, 2012).
One
of the primary symptoms of VCFS is cleft palate. Because of malformations in
the oral cavity, hearing loss, and repeated invasive surgeries, babbling in
babies with cleft palate is typically delayed or reduced (Chapman,
Hardin-Jones, Schulte, & Halter, 2001). Any child with a cleft is likely to
have a resonance, language, voice, or articulation disorder (Sharp, Daily,
Moon, 2003). Children with cleft palate may also suffer from pragmatic or
social delays due to their other cognitive and language issues. Younger
school-aged children may show adequate ability to keep up with their studies,
but as the children get older and the academics become more difficult, these
children tend to fall behind (Hardin-Jones & Chapman, 2011).
SLPs play a role in the treatment of cleft palate related to VCFS. They provide feeding strategies or make recommendations to other professionals on their team. One treatment strategy that may be used is maximizing feeding by adjusting an infant’s position. Sitting in an upright position during feeding allows gravity to help the food go where it is supposed to. This keeps food away from the nasopharynx and Eustachian tubes. Because children with cleft palate do not have an efficient seal in their oral cavity, air is often taken into the stomach. Having an upright feeding position can help to mobilize this air, if combined with breaks for burping (Glass & Wolf, 1999). Shaw et al. (1999) reported that using modified equipment such as an orthodontic nipple combined with a compressible bottle and parental counseling has moderate to strong evidence to support its success in helping babies with cleft palate to gain weight (as cited in Reid, 2004). Brine et al. (1994) also wrote about the success of using modified equipment such as a rigid bottle with a crosscut teat and a Mead Johnson cleft palate feeder along with a nutrition intervention protocol to help infants gain weight during their first 18 months (as cited in Reid, 2004). SLPs could recommend and implement these treatment strategies for their clients.
An SLP’s main role, in regards to children with cleft palate due to VCFS, is to correctly assess and provide early intervention and therapy services. The areas of communication, feeding, gross motor exercises, and social-emotional areas should all be addressed during therapy (Boyer, Fullman, Bruns, 2012). Integrating communication into a client’s daily play or feeding activities allows intervention strategies to be both functional and generalizable. An accurate diagnosis, as well as early intervention, can allow for great improvements of social-emotional, feeding, gross oral motor, and communication abilities in a client with cleft palate due to VCFS.
SLPs play a role in the treatment of cleft palate related to VCFS. They provide feeding strategies or make recommendations to other professionals on their team. One treatment strategy that may be used is maximizing feeding by adjusting an infant’s position. Sitting in an upright position during feeding allows gravity to help the food go where it is supposed to. This keeps food away from the nasopharynx and Eustachian tubes. Because children with cleft palate do not have an efficient seal in their oral cavity, air is often taken into the stomach. Having an upright feeding position can help to mobilize this air, if combined with breaks for burping (Glass & Wolf, 1999). Shaw et al. (1999) reported that using modified equipment such as an orthodontic nipple combined with a compressible bottle and parental counseling has moderate to strong evidence to support its success in helping babies with cleft palate to gain weight (as cited in Reid, 2004). Brine et al. (1994) also wrote about the success of using modified equipment such as a rigid bottle with a crosscut teat and a Mead Johnson cleft palate feeder along with a nutrition intervention protocol to help infants gain weight during their first 18 months (as cited in Reid, 2004). SLPs could recommend and implement these treatment strategies for their clients.
An SLP’s main role, in regards to children with cleft palate due to VCFS, is to correctly assess and provide early intervention and therapy services. The areas of communication, feeding, gross motor exercises, and social-emotional areas should all be addressed during therapy (Boyer, Fullman, Bruns, 2012). Integrating communication into a client’s daily play or feeding activities allows intervention strategies to be both functional and generalizable. An accurate diagnosis, as well as early intervention, can allow for great improvements of social-emotional, feeding, gross oral motor, and communication abilities in a client with cleft palate due to VCFS.
References
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