Therapy for Unrepaired Cleft Palate

by Carla
(California)

I have never had to provide therapy for a student with an unrepaired palate.

The student just turned 3 and has just now had her lip repaired but not her palate.

What are the prevailing therapy methods that one should do to best help a client such as this one.

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Sep 08, 2019
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starstarstarstarstar 		15 year old with unrepaired soft palate
by: Anonymous

I have a student who is turning 15 soon. Lips and palate have been in the process of repair for several years. He is a new comer to the US, born in the Philippines. I really don't have the skills to work with this student in the middle school setting...any suggestions? He has a triennial review in two weeks. Parents don't speak English.
May 05, 2019
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starstarstarstarstar 		Cleft Palate & Dysphagia in the schools
by: Valerie

Hi Luke B,

Please check ASHA's website regarding our "realm" of practice. We are seeing more and more children with dysphagia in the schools as well as children with repaired and unrepaired cleft palates. We can work on faulty productions that have been learned as a result of cleft palate issues, but you are correct that we can not fix errors that are the result of structure abnormalities. Now we do need to have the skills to work in these areas. Take a look at the ASHA Leader's article by Lisa Rai Mabry-Price that states "IDEA considers a disorder "educationally relevant" if the disability interferes with the student’s ability to participate in and access the educational curriculum with same-age peers. Students must be safe while eating in school, and they must maintain adequate nutrition to fully access the educational curriculum. Therefore, it is appropriate and necessary to treat dysphagia in the school setting."

Also take a look at ASHA's position about working with children with cleft palate in the schools https://pubs.asha.org/doi/10.1044/sbi7.2.13

Furthermore, If I am not mistaken, we ARE medical professionals- no matter where we are. We use medical codes to be reimbursed for speech/language services just like other healthcare professionals use medical codes whether we are in the schools or in a clinical setting. If we were not, we would not be able to use the medical codes. Does this make sense? I hope this helps.
May 19, 2018
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starstarstarstarstar 		ASHA's position: Roles & Responsibilities: Cleft Palate
by: Anonymous

Please consult with ASHA's position statement regarding where it is appropriate to work on cleft palate or any other areas in our field. You will be surprised at what ASHA says. Here's the link for "Roles and Responsibilities:" https://www.asha.org/PRPSpecificTopic.aspx?folderid=8589942918§ion=Roles_and_Responsibilities
May 19, 2018
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starstarstarstarstar 		Play Based Therapy Cleft palate
by: Anonymous

Please see interesting article from ASHA event: file:///D:/1.%20A.%20GLES%20Stuff/1.%20A.%20S-L%20%20Eval%20forms/Play-Based%20Speech%20Intervention%20for%20the%20Infant,%20Toddler,%20and%20Preschooler%20with%20Cleft%20Palate%202386-Snelling-Theresa%20(1).pdf

They give very helpful info regarding repaired and unrepaired cleft palates, etc.They indicate when it is appropriate to work on this. They do not indicate that it is not appropriate to work on in the schools. It is very interesting with great ideas.
Sep 06, 2015
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starstarstarstarstar 		Unrepaired Cleft Palate
by: Jessica Summers

the palatal opening needs to be repaired or obturated as soon as possible. Speech therapy twice a week would be appropriate after that happens. The parents should practice with the child daily. Even with this, the prognosis is guarded given the age of the child, and the cognitive level. If progress is not being made, then therapy sessions could be spread out more to allow for more practice at home between sessions.
Aug 03, 2012
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starstarstarstarstar 		unrepaired cleft theapy
by: Anonymous

Hi Carla,

What a strange position for you to be in! I agree many of Luke B's comments are sound on some level but it's obviously difficult to comment without knowing why there is such a delay in the lip and palate repair.

At age 3 it will be so important that the child is able to achieve placement of articulation even if they cannot make an oral airstream at present. I assume the plan is for a repair and that the child has a normal cognitive profile?

You can practice POA with nose holding and lots of sound inputting modelling with soft, elongated word final pressure consonants. Without this the child is going to become more and more disadvataged as their phonological processing system develops incorrectly on in input as well as output level.

There is lots of evidence in the literature for this along the same principles of pre-palate repair early intervention for our usual 6-9 month olds.

Why dont you call your local cleft service SLP for some more support. Good luck!!
Mar 20, 2012
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starstarstarstarstar 		Therapy for Unrepaired Cleft
by: Luke B

Carla,

From what I have learned about cleft palate, you should not be providing therapy for anyone with an unrepaired cleft lip or palate until it has been taken care of surgically/medically.

I could be wrong but you can't try to make something better (in this case the palate) if it doesn't work in the first place.

On another note...I also learned in college that if a school setting is not the place to work on medically related speech and language issues (cleft palate, swallowing, etc.)

So if the client you are seeing is in a school you put yourself in risk for providing therapy that is considered outside your "realm".

Anyone else have any thoughts?

Hope that helps.

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