Cleft palate speech therapy

This post is dedicated to a little boy who I have been seeing for speech and language therapy since he was six weeks old…..I was actually part of the initial CORE evaluation….and than was asked to join his team as the early intervention speech and language pathologist.  Of course I was thrilled to be asked…because this family was and is just one of those families you fall in love with right away….because you can see that they are kind and caring people…people that will appreciate your help and want to learn from you to help their little one.  And I can easily say that because in my 19 years experience I have been treated like the help a few times…and families like that don’t really care to be empowered with the tools you have to help their little one….your often seen as less than them….yeah it is true…some people are just not nice.

However…not this family….this little one will be five in May of 2012…..and when you are with a family for such a long time….it is hard not to become part of the family…in a way…..for me…..the bond I feel with the little ones I see can be compared to how I feel for my own children.  For this little one…I will call him D to keep him anonymous…..he has always pulled on my heart strings….and his family…. both immediate and extended are probably one of the most amazing families I have met.  D had a tough early road as a little one…..he is determined though….he’s smart…and does not seem to give up on any challenges….he pushes forward….I love that about him.  And his parents and grandparents are just the same….they all work hard for him. 

D was born with a cleft of his soft palate…which is also called your velum.  He had his velum repaired soon after his first birthday.  So initially….prior to surgery I was there as the feeding specialist….and after the surgery as the feeding specialist/speech language pathologist.  I remember after his surgery the post operative recommendations were that he eat only from a big wooden spoon that had to be presented side-ways…and I am pretty sure he just used his upper lip to clear the food from the spoon.  Can you imagine the challenge for him….and most especially the mama.  She never complained though….she is an amazing mama….she works D hard….for him…so he continues to move forward.

Well after the surgery and as the years moved on, D acquired sounds, then sound combinations, then words and now sentences.  He is incredible..his vocabulary…and the sentences he comes out with….I am awed everyday working with him.  So now we are working on improving his clarity of speech.  You see…when children have their velum repaired…it does not always mean that the velum will meet the back of the pharyngeal wall in order to make closure for speech production.  In English there are only three nasal sounds: N, M, and NG (ing)…this means during production of these sounds…your velum does not make closure with the back of your pharyngeal wall…so the air now escapes out of your nasal passages (your nose).  For children that have an unrepaired soft palate…they will sound completely hyper-nasal….because all of the air will now escape out of the nose…for all the sounds in English.  Once the repair is done….a child may still need therapy due to the nasality of speech.  Usually between four and five years of age the child will have a scope done to determine how competent the velum is during speech production.  I went with D to his last one this past September of 2012….and although it does not seem to hurt..it is a little invasive…and I had tears in my eyes..that was my boy….and I felt the pain in my heart just as if he were my boy…..I was glad to be there for D and there with his parents too.

The scope gives us lots of information….and it did tell us that for D he was not always making closure with his soft palate…however, hopefully with time and growth and intensive speech therapy he would become less hyper-nasal.

So…how is this done….how do we improve clarity of speech.  It is important that we talk about the function of the articulators…that means we have to be sure that the articulators (the tongue, lips, velum, jaw) can obtain the correct position for sound production.  So if I can teach D to find the right placement for the sounds..then to me that means that his articulators are functioning how I want them too….because once I have D find the right placement….the sides of his pharyngeal wall should compensate for the closure his velum can not make!  Yea!  So that is what we have been doing….and can I tell you how hard D works…because it is hard work….and I know he will do it…because as I said he is determined..he is smart…and he pushes through the tough stuff…he may have a day here and there that are more challenging…but don’t we all.

Okay…I want to start off with….there is some research indicating that the straw kit offered by www.talktools.com is also beneficial for children that have had their soft palate repaired.  Why….because it improves lingual retraction…and strengthens the velum….ah!…this will help with closure then.  D is on the third of eight straws.

Remember again….there are only three nasal sounds in English…and of course D can produce them because he does not have to make closure with his soft palate.  So I use these sounds to help production of the non-nasal sounds:

 

To help with production of D and T :(both sounds are alveolar sounds-the little bump behind your top teeth)…I use the N sound to help shape D and T….the little boy I see can make the N sound…and he can make the N sound because N is a nasal sound…so N will help shape D and T:  so we practice sound combinations like this:

nadee

nadie

naday

nadoo

nado

 

natee

natay

natie

natoo

nato

 

 

To help with production of K and G:-both of these sound are very challenging…they both are velar sounds…soft palate sounds…they are made in the back of your throught…but his soft palate has to make closure in order to produce these sounds…so…I use the NG sound (which is a nasal sound…he can produce it…and it is a velar sound….like K and G!….so this should work!)…..

 

For K and G:

ing-go

ing-ga

ing-gay

ing-gee

ing-goo

ing-guy

 

ing-key

ing-kay

ing-ki

ing-koo

ing-ku

 

To help with production of B and P– both B and P are bilabial sounds…so I will use a bilabial sound that D has to help with B and P.  He can produce M!  This is a bilabial sound….and it is a nasal sound…so of course he can produce it….so let’s use M to shape B and P:

maybe

maybye

maybay

mayboo

maybo

maypay

maypee

maypie

maypoo

maypu

 

I think for today I will end this post…as this was a lot of information….I have more to follow regarding a therapy plan and how to target sound production.  Please post with any questions.

Finally…..in September of 2012 D will go to kindergarten….and I remember how I felt when my oldest went to kindergarten….he was my first….and the firsts of everything with your first is hard on the mama….well for me….D is my first little one I have seen from birth-basically until school-aged…..so this one is going to be hard on this speech mama…but I know we will be forever connected….me and D’s family….and I am thankful for that.

Kim

 

 

 

 

 

 

 

 

 

 

 

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About Kim

My name is Kim Marino and I have been practicing as a licensed speech and language pathologist since 1993. I work on Long Island providing diagnostic evaluations and services to children from birth to age 21. My experience is vast and am proud to say that I work with children that may present with articulation and phonological concerns, oral motor feeding concerns, Down Syndrome feeding, cognitive rehabilitation, auditory processing delays, receptive language delays, cleft palate feeding and sound development and expressive language delays. Most importantly, I am the mother of four amazing children and am happily married to my childhood sweetheart. I feel blessed to have my four children and so lucky to share this journey in life with my husband. I always had it somewhere in my head that I wanted to develop a blog or a website of some sort so that I could provide families with an additional resource....so that parents could help their little ones become a better communicator. And as I was developing this blog....I realized that I also needed to share the stories about my life and my children....and the funny things along the way that help to keep me smiling. Whether you are a working mother or not...finding balance between home, children and life can be a challenge....I hope that my blog helps to bring a smile to your face..and also some tools to help you help your little or big one. I hope you enjoy! Kim
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7 Responses to Cleft palate speech therapy

  1. pushon says:

    thanks. i will try for my 4.5 year son. recently we repair his palate for third time. first 2 time didnt repair correctly and got fistula. we wish this time he will recover properly.his everything allright accept pallate.

  2. Kim says:

    Great! Post with any questions. Best, Kim

    • Kim says:

      hi there..how many sounds does she have in her sound system. does she need another surgery on her soft palate? does her soft palate make good VPC…and is she able to communicate non-verbally?

      • Kim says:

        Hi…please give me a few days to respond..i have been busy..but will get back to you by the end of the week. Best, Kim

      • Kim says:

        Hi VPC means how competent her soft palate is in making closure. do they feel it is making closure. it sounds as if you should be increasing the number of sounds in her sound system. does she understand how to imitate sounds…if so maybe try and start off with the cues I have for the B sound. and once she is able to do so..we can expand to words. how does she do with the vowel sounds…I like to start off with the LONG E sound..she can sing Old McDonald?…can she make the T sound? You can use my strategies for T as well. keep me posted. Kim

  3. Melissa Farina says:

    BTW… ofcourse i am crying. Tears of joy 🙂

  4. Melissa Farina says:

    Kim we couldn’t have gotten through the last five years without you.
    We love you and you are family to us.
    Love The Farinas 🙂

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