The purpose of the present study was to examine practice patterns and opinions that speech-language pathologists (SLPs) have about speech-language intervention for children with cleft lip and palate.
Methods:
One hundred seven speech-language pathology members of the American Speech-Language-Hearing Association Special Interest Group 5: Craniofacial and Velopharyngeal Disorders Special Interest Group completed a 37-item online survey that examined common practices in early intervention as well as opinions about speech characteristics, assessment, and management strategies for children with cleft lip and palate.
Results:
The overwhelming majority of respondents (96%) agreed that speech-language pathologists (SLPs) should meet with parents before palatal surgery to discuss speech-language issues. Although 90% of the SLPs identified increasing consonant inventory as an early intervention goal, lack of consensus was evident regarding the type of consonant to stimulate. Respondents agreed that while blowing activities are not useful in strengthening labial, lingual, or velopharyngeal movements, they are useful in heightening awareness of oral airflow for children with cleft palate. A large degree of variability was evident in opinions regarding prevalence and treatment of compensatory articulations as well as the effectiveness of treatment strategies designed to reduce perceived hypernasality and audible nasal emission.
Conclusions:
The findings of this study indicate a large degree of variability in opinions of SLP respondents regarding assessment and treatment of children with cleft lip and palate.
American Cleft Palate-Craniofacial Association. Parameters for evaluation and treatment of patients with cleft lip/palate or other craniofacial differences. Cleft Palate-Craniofacial J. 2018a;55(1):137–157.
ASHA Special Interest Group 5. Therapy techniques for speech sound disorders associated with repaired cleft palate. Poster presentation at: Annual conference for American Speech-Language-Hearing Association; 2015; Denver, CO.
BrumbaughKMSmitAB. Treating children ages 3-6 who have speech sound disorder: a survey. Lang Speech Hear Serv Sch. 2013;44(3):306–319.
6.
ChapmanKLHardin-JonesMA. Compensatory articulation production in preschoolers with cleft palate. Presented at: American Cleft Palate-Craniofacial Annual Conference, San Juan, Puerto Rico; 2011.
7.
D’AntonioLL. An investigation of speech timing in individuals with cleft palate[dissertation]. San Francisco, CA; 1982.
8.
D’AntonioLL. Evaluation and management of velopharyngeal dysfunction: A speech pathologist's viewpoint. In: LehmanJA, ed. Cleft Palate Surgery. Prob Plastic Reconstruc Surg. 1992;2(1):86–111.
Golding-KushnerKJ. Commentary: A cineradiographic study of velopharyngeal movements for deviant versus nondeviant articulation. Cleft Palate-Craniofacial J. 1991;28(1):117–118.
11.
Golding-KushnerKJ. The effect of articulation therapy on velopharyngeal closure. Oral presentation at: Fourth International Congress on Cleft Palate and Related Craniofacial Anmalies; 1981; Acapulco, Mexico.
12.
Golding-KushnerKJ. Treatment of articulation and resonance disorders associated with cleft palate and VPI. In: ShprintzenRJBardachJ, eds. Cleft Palate Speech Management: A Multidisciplinary Approach. St Louis, MO: Mosby-Year Book; 1990.
13.
Golding-KushnerKJ. Therapy Techniques for Cleft Palate Speech & Related Disorders. San Diego, CA: Singular; 2001.
14.
GramesLM.Cleft Palate Speech: managing misconceptions, alternative facts, fake news. Oral presentation at: American Speech-language-Hearing Association Annual Conference, Pittsburgh, PA; April 2017.
Hardin-JonesMAChapmanKL. The implications of nasal substitutions in the early phonology of toddlers with repaired cleft palate. Cleft Palate-Craniofacial J. 2018;55(9):1258–1266.
17.
Hardin-JonesMAChapmanKSchererNJ. Early intervention for children with cleft palate. ASHA Leader. 2006;11(8):8–10.
18.
Hardin-JonesMAChapmanKLSchererNJ. Children with Cleft Lip and Palate: A Parent’s Guide to Early Speech-Language Development and Treatment. Bethesda, MD: Woodbine House; 2015.
19.
Hardin-JonesMAJonesDL. Speech production patterns of preschoolers with cleft palate. Cleft-Palate-Craniofacial J. 2005;42(1):7–13.
20.
Harding-BellAHowardS. Phonological approaches to speech difficulties associated with cleft palate. In: HowardSLohmanderA, eds. Cleft Palate Speech: Assessment and Intervention. John Wiley & Sons; 2011:275–291.
21.
HenningssonGIsbergA. A cineradiographic study of velopharyngeal movements for deviant versus nondeviant articulation. Cleft Palate-Craniofacial J. 1991;28(1):115–117
22.
HochLGolding-KushnerKSiegel-SadewitzVLShprintzenRJ. Speech therapy. In: McWilliamsBJ, ed. Seminars in Speech and Language: Current Methods of Assessing and Treating Children with Cleft Palates. New York, NY: Thieme; 1986:313–326.
23.
HodgeMMSalonkaRKolliasS. Use of nonspeech oral-motor exercises in children’s speech therapy. Poster session presented at: American Speech-Language-Hearing Association Annual Meeting, San Diego, CA; November, 2005.
24.
JoffeVPringT. Children with phonological problems: a survey of clinical practice. Int J Lang Comm Disord. 2008;43(2):154–164.
25.
JonesDLFolkinsJW. Effect of speaking rate on judgments of disordered speech in children with cleft palate. Cleft Palate J. 1985;22(4):246–252.
26.
JonesDLFolkinsJWMorrisHL. Speech production time and judgments of disordered nasalization in speakers with cleft palate. J Speech Hear Res. 1990;33(3):458–466.
27.
KanterCE. The rationale for blowing exercises for patients with repaired cleft palates. J Speech Hear Disord. 1947;12(3):281–286.
28.
KanterCE. Diagnosis and prognosis in cleft palate speech. J Speech Hear Disord. 1948;13(3):211–222.
29.
KummerAW. Cleft Palate and Craniofacial Anomalies: Effects on Speech and Resonance. Clifton Park, NJ: Thompson Delmar Thompson; 2008.
30.
KummerAW. Speech evaluation for patients with cleft palate. Clin Plast Surg. 2014;41(2):241–251.
31.
KummerAW. Cleft Palate and Craniofacial Conditions: A comprehensive guide to clinical management. 4th ed. Burlington, NJ: Jones & Bartlett Learning; Copyright 2020.
32.
KummerAWClarkSLRedleEETomsenLLBillmireDA. Current practices in assessing and reporting speech outcomes of cleft palate and velopharyngeal surgery: a survey of cleft palate/craniofacial professionals. Cleft Palate Craniofac J. 2012;49(2):146–152.
33.
LofGLWatsonMM. A nationwide survey of nonspeech oral motor exercise use: implications for evidence-based practice. Lang Speech Hear Serv Sch. 2008;39(3):392–407.
34.
MassengillRQuinnGWPickrellKLLevinsonC. Therapeutic exercise and velopharyngeal gap. Cleft Palate J. 1968;5:44–47.
35.
McCauleyRJStrandELofGLSchoolingTFrymarkT. Evidence-based systematic review: effects of non-speech oral motor exercises on speech. Am J Speech Lang Path. 2009;18(4):343–360.
36.
McWilliamsBJMorrisHLSheltonRL. Cleft Palate Speech. St. Louis, MO: Mosby; 1990.
37.
MillsBHardin-JonesMA. Update on academic and clinical training in craniofacial anomalies. Poster presented at the American Cleft Palate-Craniofacial Association Annual Conference, Boston, MA; 2018.
38.
MorleyME. Cleft Palate and Speech. Baltimore, MD: Williams and Wilkins Co; 1967.
39.
O’GaraMMLogemannJA. Phonetic analysis of the speech development of babies with cleft palate. Cleft Palate J. 1988;25(2):122–134.
40.
PamplonaMCYsunzaAEspinosaJ. A comparative trial of two modalities of speech intervention for compensatory articulation in cleft palate children, phonologic approach versus articulatory approach. Int J Ped Otorhinolaryngol. 1999;49(1):21–26.
41.
PamplonaMYsunzaAGuerreroMMeyerIGarcia-VelascoM. Surgical correction of velopharyngeal insufficiency with and without compensatory articulation. Int J Ped Otorhinolaryngol. 1996;34(1-2):53–59.
42.
PetMADodgeRSieboldBKinterSPerkinsJTseRW. Speech and surgical outcomes in children with Veau types III and IV cleft palate: a comparison of internationally adopted and nonadopted children. Cleft Palate Craniofac J. 2018;55(3):396–404.
43.
Peterson-FalzoneSJ. A cross-sectional analysis of speech results following palatal closure. In BardachJMorrisHL, eds. Multidisciplinary Management of Cleft Lip and Palate. Philadelphia, PA: W.B. Saunders; 1990:750–757.
Peterson-FalzoneSJTrost-CardamoneJEKarnellMPHardin-JonesMA. The Clinician’s Guide to Treating Cleft Palate Speech. 2nd ed. St. Louis, MO: Elsevier; 2017.
46.
PhilipsBJ. Selected case studies. Clin Commun Disord. 1991;1(3):35–41.
47.
PowersGLStarrCD. The effects of muscle exercises on velopharyngeal gap and nasality. Cleft Palate J. 1974;11(1):28–35.
48.
RuscelloDM. School-based intervention. In: ZajacDJVallinoLD, eds. Evaluation and Management of Cleft Lip and Palate: A Developmental Perspective. San Diego, CA: Plural; 2017:281–318.
49.
SalehABistaK. Examining factors that impact online survey response rates in educational research: perceptions of graduate students. J Multidisciplinary Evaluation. 2017;13(29):63–74.
50.
SchererNJWilliamsALWilliamsK. Early and later vocalization skills in children with and without cleft palate. Int J Ped Otorhinolaryngol. 2008;72(6):827–840.
51.
SchneiderEShprintzenRJ. A survey of speech pathologists: current trends in the diagnosis and management of velopharyngeal insufficiency. Cleft Palate J. 1980;17(3):249–253.
52.
SheltonRLHahnEMorrisHL. Diagnosis and therapy. In: SpriestersbachDCShermanD, eds. Cleft Palate and Communication. New York, NY: Academic Press; 1968:225–268.
53.
ShprintzenRJGolding-KushnerK. Evaluation of velopharyngeal insufficiency. Otolaryngol Clin North Am. 1989;22(3):519–536.
54.
ShprintzenRJ. Surgery for speech: The planning of operations for velopharyngeal insufficiency with emphasis on the preoperative assessment of both pharyngeal physiology and articulation. Proceedings of the British Craniofacial Society. Manchester, England: Manchester University Press; 1986.
55.
ShprintzenRJ. Treatment of articulation and resonance disorders associated with cleft palate and VPI. In: ShprintzenRJBardachJ, eds. Cleft Palate Speech Management: A Multidisciplinary Approach. St Louis, MO: Mosby-Year Book; 1990.
56.
SmithJ. Contraindications for speech therapy for cleft palate speakers. Cleft Palate J. 1969;6:202–204.
57.
TrostJE. Articulatory additions to the classical description of the speech of persons with cleft palate. Cleft Palate J. 1981;18(3):193–203.
58.
Trost-CardamoneJE.Cleft palate speech: a comprehensive two-part set. American Speech-Language-Hearing Association; 2013.
59.
Trost-CardamoneJEBernthalJE. Articulation assessment procedures and treatment decisions. In: MollerMTStarrCD, eds. Cleft Palate: Interdisciplinary Issues and Treatment. Austin, TX: Pro-Ed; 1993.
60.
WilladsenEAlbrechtsenH. Phonetic description of babbling in Danish toddlers born with and without unilateral cleft lip and palate. Cleft Palate Craniofac J. 2006;43(2):189–200.
61.
YsunzaAPamplonaCToledoE. Change in velopharyngeal valving after speech therapy in cleft palate patients. a videonasopharyngoscopic and multi-view videofluoroscopic study. Int J Ped Otorhinolaryngol. 1992;24(1):45–54.
62.
ZajacDJVallinoLD. Evaluation and Management of Cleft Lip and Palate: A Developmental Perspective. San Diego, CA: Plural; 2017.
