(by K.)
Working with a speech language pathologist as early as possible is considered important because they can share information about the best feeding techniques and how parents can encourage pre-verbal skills in their baby who has cleft lip or palate. Forming a level of comfort and trust between the SLP and the child is also important to achieve the best speech outcomes from therapy. Speech therapists can also work with children who have experienced some hearing loss as a result of ear infections and improper drainage that are common in cleft lip and palate.
Children with an orofacial cleft may experience a delay in speech and a variety of articulation and resonance difficulties, but this varies on the type of cleft, timing, and type of surgeries. Many children who have had a cleft palate may have speech problems due to velopharyngeal dysfunction (VPD), where the valve in the soft palate is not operating properly. This can lead to hypernasality of speech, where there is too much sound in the nasal cavity; nasal air emissions, when air leaks out abnormally during speech production of a consonant; and compensatory articulation. VPD causes problems with proper airflow during speech, called resonance.
Children with a cleft palate may have trouble with consonants like p, b, t, and d. Blended consonants, such as bl, br, pl, and st may also be difficult for these children and those with a cleft in the alveolar ridge. Intelligibility of the consonants k, g, f, and v may come easily, unless articulation of the k and g sounds are affected by a cleft in the soft palate, or f and v sounds are affected by a cleft in the alveolar ridge. Later, most children with a cleft are able to master the s, z, sh, ch, tch, zh, l, and r sounds.
An SLP will help with proper sound placement. After gaining trust from the child, the SLP will focus on isolated sounds through drills and activities. The end goal is for the child to pronounce the sound correctly in fluent speech consistently. Parents can help their child by talking to their child as much as possible to expose them to proper pronunciation of sounds, encouraging their child to try to say new words, and listening to their child’s SLP to practice what they are learning in speech therapy at home.
If the cleft is severe, there may be a point in speech development where correct pronunciation cannot yet be produced until another surgery is performed. This is another reason why the team approach is advised for treatment. A plan of action for the next step of treatment can then be created.
Treatment to correct an orofacial cleft may take an extensive period of time, but since most clefts can be fully surgically corrected, the goal of speech therapy should be normal speech, with proper articulation and resonance, as opposed to settling for just acceptable speech.
References
Facts about cleft lip and cleft palate. (2013, July 15). Centers for Disease Control and Prevention. Retrieved April 3, 2014, from http://www.cdc.gov/ncbddd/birthdefects/cleft
Guman-Trinkner, C. T. (2001). Your cleft-affected child: The complete book of information, resources, and hope. Alameda, CA: Hunter House.
Krummer, A. W. Speech therapy for cleft palate of velopharyngeal dysfunction (VPD). Retrieved from Cincinnati Children’s Hospital Medical Center Web site: http://www.cincinnatichildrens.org/assets/0/78/759/781/65e90133-9243-4926-a065-8a97951944fb.pdf
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