Cleft Palate and Velopharyngeal Disorders
Cleft Palate is a condition occurring before the baby is born affecting the formation of the palate. The palate forms the roof of your mouth. The soft palate is at the back of the mouth towards your throat and is made up of muscles which move when you talk. The soft palate is important in speech and separates the nose from the mouth and ensures that no air escapes inappropriately from the nose. This is necessary to make most speech sounds well.
Recognised characteristics of Cleft Palate:
- A cleft affecting the formation of the palate.
- Fluctuating conductive hearing loss.
- Problems with facial growth.
- Atypical dentition.
- Co-occurrence of other syndromes in some cases (e.g. Pierre Robin).
Communication and other problems related to Cleft Palate (or Cleft Lip and Palate):
- Speech sound difficulties. Some sounds may be difficult to make if the palate is allowing air to escape into the nose because of the malformation. Speech sounds may be weak, or be replaced by incorrect or unusual sounds.
- Disorders of nasality. Speech may sound nasal (hypernasality) - this is the opposite of how you sound when you have a cold.
- Language Delay.
- Voice Problems.
- Feeding difficulties.
Speech and language therapists are often involved with multi-professional teams working with Cleft Palate. Owing to the success and early timing of surgery many children will not develop speech and language difficulties. Speech therapists on a 'cleft team' assess children at key ages - usually around 18 months and 3 years of age - seeing children within the multi-disciplinary team appointments. The Specialist Speech and Language Therapist will review the child to assess the speech and language development, and advise parents as necessary. Depending on the severity of the cleft, speech therapy may begin as early as 18 months - 2 years, and continue until late adolescence.
The following may form part of therapy input for children with Cleft Palate:
- Assessment, advice to parents, and close liaison with the specialist team.
- Monitoring only if no direct therapy is indicated.
- Referral for specialist investigations of nasal speech.
- Direct therapy as appropriate for speech sound difficulties, disorders of nasality, and language delay, to facilitate communication development. This may be on a weekly basis or as intensive therapy for specific problems (e.g. forcing air down the nose for s/z sounds).
- Electropalatography (EPG) when a special dental plate is made with electrodes which are linked up to a computer to provide visual feedback on where speech sounds are being made in the mouth, and how this differs from the way the sounds should be made.
- Prosthetics. (A removable plastic plate is made that fits over the hard and soft palate. The back of the plate is extended to reduce the nasal tone of the voice.) This is considered when other options such as surgery have failed.
Some points you may wish to discuss with any therapist you contact:
- The therapist's specialist credentials in the area of Cleft Palate. The therapist will usually have received extra training. Work experience at a specialist centre is very important. The therapist is then likely to be familiar with electropalatography (EPG) and nasendoscopy (viewing of the critical area via the nose).
- How much experience the therapist has with Cleft Palate (particularly at specialist centres).
- Where the therapist sees people for assessment/therapy.
- How much the therapist charges for assessment and/or regular therapy.
Click here to search for Speech Therapists in your area with Cleft Palate as a specialty.