Speech Telepractice and Treatment Intensity in a Cantonese-Speaking Case with 22q11.2 Deletion Syndrome Following Late Diagnosis and Management of Velopharyngeal Dysfunction
Restricted accessResearch articleFirst published online November, 2023
Speech Telepractice and Treatment Intensity in a Cantonese-Speaking Case with 22q11.2 Deletion Syndrome Following Late Diagnosis and Management of Velopharyngeal Dysfunction
This case report explores clinical treatment efficacy in a Cantonese-speaking child with 22q11.2 Deletion Syndrome where diagnosis and management of velopharyngeal dysfunction can be considered late. All treatment sessions were undertaken via telepractice during the peak of the COVID-19 pandemic in Hong Kong. A hybrid of specialized cleft palate speech treatment techniques and traditional treatment approaches in Speech Sound Disorders were utilized. Treatment intensity components including dose, dose form, session duration, and total intervention duration were documented.
ShprintzenRJGoldbergRBLewinML, et al.A new syndrome involving cleft palate, cardiac anomalies, typical facies, and learning disabilities: velo-cardio-facial syndrome. Cleft Palate J. 1978;15(1):56-62. doi:10.1097/00006534-197811000-00083
2.
ShprintzenRJ. Historical overview. In: MurphyKCScamblerPJ, eds. Velo-Cardio-Facial Syndrome: A Model for Understanding Microdeletion Disorders. Cambridge University Press; 2005:1-18.
3.
ShprintzenRJ. Velo-cardio-facial syndrome: 30 years of study. Dev Disabil Res Rev. 2008;14(1):3-10. doi:10.1002/ddrr.2
4.
Golding-KushnerK. Speech and language disorders in velo-cardio-facial syndrome. In: MurphyKCScamblerPJ, eds. Velo-Cardio-Facial Syndrome: A Model for Understanding Microdeletion Disorders. Cambridge University Press; 2005:181-199.
5.
MillsLGoslingASellD. Extending the communication phenotype associated with 22q11.2 microdeletion syndrome. Adv Speech Lang Pathol. 2006;8(1):17-26. doi:10.1080/14417040500459650
6.
SeselgyteRSwanMCBirchMJKangesuL. Velopharyngeal incompetence in children with 22q11.2 deletion syndrome: velar and pharyngeal dimensions. J Craniofac Surg. 2021;32(2):578-580. doi:10.1097/SCS.0000000000007202
7.
Mehendale FVBirchMJBirkettLSellDSommerladBC. Surgical management of velopharyngeal incompetence in velocardiofacial syndrome. Cleft Palate-Craniofac J. 2004;41(2):124-135. doi:10.1597/01-110
8.
Trost-CardamoneJE. Coming to terms with VPI: a response to Loney and Bloem. Cleft Palate J. 1989;26(1):68-70.
9.
GrunwellPSellDHardingA. GOS.SP.ASS.’98: an assessment for speech disorders associated with cleft palate and/or velopharyngeal dysfunction (revised). Int J Lang Commun Disord. 1999;34(1):17-33. doi:10.1080/136828299247595
JohnASellDSweeneyTHarding-BellAWilliamsA. The cleft audit protocol for speech-augmented: a validated and reliable measure for auditing cleft speech. Cleft Palate-Craniofac J. 2006;43(3):272-288. doi:10.1597/04-141R.1
12.
HenningssonGKuehnDPSellDSweeneyTTrost-CardamoneJEWhitehillTL. Universal parameters for reporting speech outcomes in individuals with cleft palate. Cleft Palate-Craniofac J. 2008;45(1):1-17. doi:10.1597/06-086.1
SolotCBSellDMayneA, et al.Speech-language disorders in 22q11.2 deletion syndrome: best practices for diagnosis and management. Am J Speech Lang Pathol. 2019;28(3):984-999. doi:10.1044/2019_AJSLP-16-0147
15.
SchönmeyrBWendbyLSharmaMRaud-WestbergLRestrepoCCampbellA. Limited chances of speech improvement after late cleft palate repair. J Craniofac Surg. 2015;26(4):1182-1185. doi:10.1097/SCS.0000000000001599
16.
Ortiz-MonasterioFOlmedoATrigosIYudovichMVelazquezMFuente-Del-CampoA. Final results from the delayed treatment of patients with clefts of the lip and palate. Scand J Plast Reconstr Surg Hand Surg. 1974;8(1-2):109-115. doi:10.3109/02844317409084379
17.
SellD. Speech in the unoperated or late operated cleft lip and palate patient. In: MarsMSellDHabelA, eds. Management of Cleft Lip and Palate in the Developing World. John Wiley & Sons Ltd; 2008:179-192.
18.
SellD. Speech in Sri Lankan cleft palate subjects with delayed palatoplasty [PhD thesis]. Leicester, UK: De Montfort University; 1992
19.
MurphyKCScambler eds. Velo-cardio-facial Syndrome: A Model for Understanding Microdeletion Disorders. Cambridge University Press; 2005.
American Speech Language Hearing Association. Telepractice.Available at: https://www.asha.org/Practice-Portal/Professional-Issues/Telepractice/(1997-2022, accessed November 30, 2021).
22.
WeidnerKLowmanJ. Telepractice for adult speech-language pathology services: a systematic review. Perspect ASHA Spec Interest Groups. 2020;5(1):326-338. doi:10.1044/2019_persp-19-00146
23.
PamplonaMdCYsunzaPA. Speech pathology telepractice for children with cleft palate in the times of COVID-19 pandemic. Int J Pediatr Otorhinolaryngol. 2020;138:110318. doi:10.1016/j.ijporl.2020.110318. Epub August 15, 2020. PMID: 32871515; PMCID: PMC7428427.
24.
BauerRS. The Hong Kong Cantonese language: current features and future prospects. Glob Chinese. 2016;2(2):115-161. doi:10.1515/glochi-2016-0007
25.
BauerRSBenedictPK. Modern Cantonese Phonology. Mouton de Gruyter; 1997.
26.
YiuYChanSChoiCPereiraV. Cantonese-Cleft Speech Assessment Tool. Chinese Univ Hong Kong; 2019.
JohnASellDSweeneyTHarding-BellAWilliamsA. The cleft audit protocol for speech-augmented: a validated and reliable measure for auditing cleft speech. Cleft Palate Craniofac J.2006;43(3):272-288. doi:10.1597/04-141.1
29.
HenningssonGKuehnDPSellDSweeneyTTrost-CardamoneJE. Whitehill TL; speech parameters group. Universal parameters for reporting speech outcomes in individuals with cleft palate. Cleft Palate Craniofac J. 2008 Jan;45(1):1-17. doi: 10.1597/06-086.1. PMID: 18215095.30.
30.
ZeeE. Chinese (Hong Kong Cantonese). J Int Phon Assoc. 1991;21(1):46-48. doi:10.1017/S0025100300006058
31.
MokPPKZuoDWongPWY. Production and perception of a sound change in progress: tone merging in Hong Kong Cantonese. Lang Var Change. 2013;25(3):341-370. doi:10.1017/S0954394513000161
32.
Golding-KushnerKJArgamasoRVCottonRT, et al.Standardization for the reporting of nasopharyngoscopy and multiview videofluoroscopy: a report from an international working group. Cleft Palate J. 1990;27(4):337-347. discussion 347-8. doi:10.1597/1545-1569(1990)027<0337:sftron>2.3.co;2. PMID: 2253379.
33.
ParkMAhnSHJeongJHBaekR-M. Evaluation of the levator veli palatini muscle thickness in patients with velocardiofacial syndrome using magnetic resonance imaging. J Plast Reconstr Aesthet Surg.2015;68(8):1100-1105. doi.org/10.1016/j.bjps.2015.04.013
34.
LeungMTLawSPFungSY. Type and token frequencies of phonological units in Hong Kong Cantonese. Behav Res Methods Instrum Comput.2004;36(3):500-505. doi:10.3758/BF03195596CLISPI
35.
Van RiperCEricksonRL. Speech Correction: An Introduction to Speech Pathology and Audiology. 9th ed. Pearson; 1996.
36.
BessellASellDWhitingP, et al.Speech and language therapy interventions for children with cleft palate: a systematic review. Cleft Palate-Craniofacial J. 2013;50(1):e1-e17. doi:10.1597/11-202. Epub March 20, 2012. PMID: 22433039.
37.
MaasERobinDAHulaSNA, et al.Principles of motor learning in treatment of motor speech disorders. Am J Speech Lang Pathol. 2008;17(3):277-298. doi:10.1044/1058-0360(2008/025)
38.
Golding-Kushner. Treatment of articulation and resonance disorders associated with cleft palate and VPI. In: ShprintzenRJBardachJ, eds., Cleft Palate Speech Management: A Multidisciplinary Approach. Mosby; 1995:327–351.
39.
StackhouseJWellsB. Children’s Speech and Literacy Difficulties: A Psycholinguistic Framework. Whurr Publishers; 1997.
40.
CalladineSVanceMA. Psycholinguistic approach to therapy with very young children born with cleft palate. In: HardingA, ed. Case Studies in Cleft Palate Speech: Data Analysis and Principled Intervention. J&R Press Ltd; 2019:330-360.
41.
WarrenSFFeyMEYoderPJ. Differential treatment intensity research: a missing link to creating optimally effective communication interventions. Ment Retard Dev Disabil Res Rev. 2007;13(1):70-77. doi:10.1002/mrdd.20139
42.
BakerE. Optimal intervention intensity. Int J Speech Lang Pathol. 2012;14(5):401-409. doi:10.3109/17549507.2012.700323. Epub August 23, 2012. PMID: 22916999.
43.
Todd HoustonK. Telepractice in Speech-Language Pathology. Plural Publishing; 2013.
44.
Perkins WalkerJ. University of Maine, Speech therapy telepractice and technology program manual. Published online2015.
45.
WilliamsAL. Intensity in phonological intervention: is there a prescribed amount?Int J Speech Lang Pathol. 2012;14(5):456-461. doi:10.3109/17549507.2012.688866
46.
OrenLKummerABoyceS. Understanding nasal emission during speech production: a review of types, terminology, and causality. Cleft Palate Craniofac J. 2020;57(1):123-126. doi: 10.1177/1055665619858873
47.
NeumannSRomonathR. Application of the international classification of functioning, disability, and health-children and youth version (ICF-CY) to cleft lip and palate. Cleft Palate Craniofac J. 2012;49(3):10-145. doi: 10.1597/10-145
48.
HavstamCLohmanderA. Communicative participation. In: HowardSLohmanderA, eds. Cleft Palate Speech. John Wiley & Sons Ltd; 2011:305-316.
49.
CroninAMcLeodSVerdonS. Applying the ICF-CY to specialist speech-language pathologists’ practice with toddlers with cleft palate speech. Cleft Palate-Craniofac J. 2020;57(9):1105-1116. Doi: 10.1177/1055665620918799
50.
WagnerRDWolfswinkelEMBuchananEPKhechoyanDY. Surgical outcomes for speech surgery in 22q11.2 deletion syndrome: the dilemma of persistent velopharyngeal insufficiency after pharyngeal flap operation. J Craniofac Surg. 2017;28(5):1320-1324. doi:10.1097/SCS.0000000000003722