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CLEFT AND CRANIOFACIAL · BIRTH THROUGH HIGH SCHOOL
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Speech therapy for cleft palate, Part Two: Treatment
We all had that one course in grad school that reviewed clefts and maybe touched on what we’re supposed to do for all the speech issues they can cause. Need a refresher? Here’s your rundown, including some of the current evidence and resources to help you get started with high-quality interventions and therapy techniques for kids with cleft palate.
July 11, 2023
Remind me, what are the cleft-related speech characteristics I should be treating?
If you read Part 1 in this series, we summarized the key speech errors you’re likely to encounter in patients with cleft palate. As a refresher, we classify cleft-related speech errors as active (anterior, posterior, nonoral sound substitutions) or passive. To get the most bang for our therapeutic bucks, we need to focus on knowing what these different errors sound like and remediate the active speech errors!
Glottal stops and nasal fricatives fall under the nonoral speech errors category and are some of the most common nonoral errors.
Where does speech therapy fit in? What therapy approaches should I use?
Children with cleft palate have articulatory deficits with phonological consequences (Grunwell and Harding,1995). Therefore, both motor-phonetic and linguistic-phonological speech interventions can be helpful, although Alighieri et al. (2020) found that…
Looking for more resources?
Don't forget to read Part 1 of this series about assessing speech and resonance in children with clefts, understanding velopharyngeal dysfunction, and making appropriate referrals to cleft teams.
But if you need more on treatment, here’s a list of all of the evidence cited in this review!
Therapy Methods, Techniques, and Tools:
- 2018 Parameters For Evaluation and Treatment of Patients With Cleft Lip/Palate or Other Craniofacial Differences. The Cleft Palate Craniofacial Journal. https://doi.org/10.1177/1055665617739564 [Free PDF Summary]
- Alighieri, C., Bettens, K., Bruneel, L., D'haeseleer, E., Van Gaever, E., & Van Lierde, K. (2020). Effectiveness of speech intervention in patients with a cleft palate: Comparison of motor-phonetic versus linguistic-phonological speech approaches. Journal of Speech, Language, and Hearing Research. https://doi.org/10.1044/2020_JSLHR-20-00129 [available to ASHA members]
- Alighieri, C., Van Lierde, K., De Caesemaeker, A. S., Demuynck, K., Bruneel, L., D'haeseleer, E., & Bettens, K. (2021). Is high-intensity speech intervention better? A comparison of high-intensity intervention versus low-intensity intervention in children with a cleft palate. Journal of Speech, Language, and Hearing Research. https://doi.org/10.1044/2021_JSLHR-21-00189 [available to ASHA members]
- Alighieri, C., Bettens, K., Bruneel, L., D'haeseleer, E., Van Gaever, E., & Van Lierde, K. (2021). Reliability of outcome measures to assess consonant proficiency following cleft palate speech intervention: The percentage of consonants correct metric and the probe scoring system. Journal of Speech, Language, and Hearing Research. https://doi.org/10.1044/2021_JSLHR-20-00628 [available to ASHA members]
- Chapman, K. L., Hardin-Jones, M., & Halter, K. A. (2003). The relationship between early speech and later speech and language performance for children with cleft lip and palate. Clinical Linguistics & Phonetics. https://doi.org/10.1080/0269920021000047864
- Gibbon, F., Hardcastle, W. J., Crampin, L., Reynolds, B., Razzell, R., & Wilson, J. (2001). Visual feedback therapy using electropalatography (EPG) for articulation disorders associated with cleft palate. Asia Pacific Journal of Speech, Language and Hearing. https://doi.org/10.1179/136132801805576798
- Harding, A., & Grunwell, P. (1998). Active versus passive cleft‐type speech characteristics. International Journal of Language & Communication Disorders. https://doi.org/10.1080/136828298247776
- Hardin-Jones, M., Chapman, K., & Scherer, N. J. (2006). Early intervention in children with cleft palate. The ASHA Leader. https://doi.org/10.1044/leader.FTR3.11082006.8 [available to ASHA members]
- Hegarty, N., Titterington, J., McLeod, S., & Taggart, L. (2018). Intervention for children with phonological impairment: Knowledge, practices and intervention intensity in the UK. International Journal of Language & Communication Disorders. https://doi.org/10.1111/1460-6984.12416
- John, A., Sell, D., Sweeney, T., Harding-Bell, A., & Williams, A. (2006). The cleft audit protocol for speech—augmented: A validated and reliable measure for auditing cleft speech. The Cleft Palate-Craniofacial Journal. https://doi.org/10.1597/04-141.1 [Free for ACPA Members]
- Kaiser, A. P., Scherer, N. J., Frey, J. R., & Roberts, M. Y. (2017). The effects of enhanced milieu teaching with phonological emphasis on the speech and language skills of young children with cleft palate: A pilot study. American journal of speech-language pathology. https://doi.org/10.1044/2016_AJSLP-16-0008 [available to ASHA members]
- Karling, J., Larson, O., & Henningsson, G. (1993). Oronasal fistulas in cleft palate patients and their influence on speech. Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery. https://doi.org/10.3109/02844319309078111
- Kjellmer, L., Raud Westberg, L., & Lohmander, A. (2021). Treatment of active nasal fricatives substituting/s/in young children with normal palatal function using motor-based intervention. International Journal of Speech-Language Pathology. https://doi.org/10.1080/17549507.2021.1891285
- Kotlarek, K. J., & Krueger, B. I. (2023). Treatment of Speech Sound Errors in Cleft Palate: A Tutorial for Speech-Language Pathology Assistants. Language, Speech, and Hearing Services in Schools. https://doi.org/10.1044/2022_LSHSS-22-00071 [open access]
- Lien, K. M., Scherer, N. J., Cordero, K. N., & Sitzman, T. J. (2023). Speech Production Errors in Children With Cleft Palate With or Without Cleft Lip. Journal of Speech, Language, and Hearing Research. https://doi.org/10.1044/2022_JSLHR-22-00264 [available to ASHA members]
- Lof, G. L., & Ruscello, D. (2013). Don't blow this therapy session!. Perspectives on Speech Science and Orofacial Disorders. https://doi.org/10.1044/ssod23.2.38 [available to ASHA SIG members]
- Mason, K. N. (2020). The effect of dental and occlusal anomalies on articulation in individuals with cleft lip and/or cleft palate. Perspectives of the ASHA Special Interest Groups. https://doi.org/10.1044/2020_PERSP-20-00056 [available to ASHA SIG members]
- McFaul, H., Mulgrew, L., Smyth, J., & Titterington, J. (2022). Applying evidence to practice by increasing intensity of intervention for children with severe speech sound disorder: a quality improvement project. BMJ Open Quality. https://doi.org/10.1136/bmjoq-2021-001761 [open access]
- McFaul, H., Mulgrew, L., Smyth, J., & Titterington, J. (2022). Applying evidence to practice by increasing intensity of intervention for children with severe speech sound disorder: a quality improvement project. BMJ Open Quality. https://bmjopenquality.bmj.com/content/bmjqir/11/2/e001761.full.pdf [open access]
- Pamplona, C., Ysunza, A., Patiño, C., Ramírez, E., Drucker, M., & Mazón, J. J. (2005). Speech summer camp for treating articulation disorders in cleft palate patients. International Journal of Pediatric Otorhinolaryngology. https://doi.org/10.1016/j.ijporl.2004.10.012
- Ruscello, D., & Vallino, L. (2014). The application of motor learning concepts to the treatment of children with compensatory speech sound errors. Perspectives on Speech Science and Orofacial Disorders. https://doi.org/10.1044/ssod24.2.39 [available to ASHA SIG members]
- Sand, A., Hagberg, E., & Lohmander, A. (2022). On the benefits of speech-language therapy for individuals born with cleft palate: A systematic review and meta-analysis of individual participant data. Journal of Speech, Language, and Hearing Research. https://doi.org/10.1044/2021_JSLHR-21-00367 [open access]
- Watterson, T. (2020). The use of the nasometer and interpretation of nasalance scores. Perspectives of the ASHA Special Interest Groups. https://doi.org/10.1044/2019_PERSP-19-00029 [available to ASHA SIG members]
- Zajac, D. J. (2015). The nature of nasal fricatives: Articulatory-perceptual characteristics and etiologic considerations. Perspectives on Speech Science and Orofacial Disorders. https://doi.org/10.1044%2Fssod25.1.17 [open access via PubMed Central and free for ASHA Members]
- Zajac, D. J. (2019). Obligatory nasal turbulence as a trigger for the development of posterior nasal fricatives in a child with repaired cleft palate. The Cleft Palate-Craniofacial Journal. https://doi.org/10.1177/1055665618805889 [free for ACPA Members]
TISLP Research Reviews to Read:
- Speech therapy for cleft palate, Part One: Assessment and referrals
- Amp up your skills
- Everything you want to know about treatment approaches for speech sound disorders
- If all the other therapies jumped off bridges for 30 minutes, twice a week, would you?
- Speech but make it snappy
- Treatment approaches for cleft speech errors
- Treatment planning for cleft
- On intelligibility: Why use it and options for measurement
Textbooks & Online Resources:
- Kummer, A. W. (2018). Cleft palate and craniofacial conditions. Jones & Bartlett Learning, LLC.
- ASHA Practice Portal
- American Cleft Palate Craniofacial Association’s Resource Center and handbook
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