Condition: Cleft Lip and/or Palate
Task Analysis (How To):
- Ensure Proper Medical Care: Make sure child is being treated and followed by a cleft palate team
- Assessment: Identify limitations of the child’s structures (which sounds is the child physically capable of producing?)
- Establish Sounds: Correct placement and production for any sounds that the child is physically able to produce (typical articulation therapy) while making sure to teach and establish appropriate intra-oral air flow for these sounds (no air escaping through the nose)
- Find Approximations: If the child is not physically able to produce a sound, find the closest approximation for that sound that the child is able to do. Teach the child this compensatory error and work on correct air flow with that sound. Get it as close as possible to the original sound so that others will have a better chance of understanding the child.
- Anticipate Future Surgeries: If the child is about to get surgery to correct physical limitations, you can teach correct placement for sounds ahead of time to get a head start on therapy once the surgery is completed.
- Consider AAC: Use AAC as necessary to aid the child in functional communication with those around him
Note: Non-Speech Oral Motor Exercises are not advised for this population
This is definitely not a condition that we want to be treating in a bubble! Cleft lip and palate cases should be followed by a full cleft palate team. If the client that you are working with is not currently being seen by a team, please use the following link to find the one nearest to you:
The first part of our assessment will require a thorough review of the child’s medical history and files. If the child has been followed by a cleft palate team, then you should have very thorough information to go on.
It is important to review all future surgeries and interventions as well as reports of the child’s current structures and functions. The cleft palate team’s SLP should have completed a full review of this for you to look over.
In addition, do some work with the child directly to determine which sounds he or she is stimulable for. Also, perform a thorough oral mechanism exam to determine how things look right now. If it has been a while since the child’s last evaluation, things may have changed as his mouth grew.
The goal of this section is to make sure you understand exactly what’s going on inside the child’s oral mechanism and the child’s current level of functioning.
Now’s the hard part, let’s get those sounds rolling! Here is a cheat sheet with a few tips for working on placement and correct air flow:
Sometimes, a cleft palate is not fully-repaired and it may be physically impossible for a child to be able to produce certain sounds. At that point, we need to consider some alternative approaches. Here is a video that sums up what to do when you need to work toward approximations instead of fully-correct productions:
Make sure that you are kept up to date on all upcoming surgeries and prosthetics. This will help you know what you can be working toward in therapy. If you have a child who is about to undergo surgery that should help with achieving oral air-flow, then you know you can focus solely on articulator placement for the time being and hold off on air flow until after the surgery.
What do you do if these things don’t work the way they’re supposed to? Well, nothing’s ever easy, is it? Try these great troubleshooting tips that some of our other members have found helpful. Click the problem to drop down the link to the solution.