Early monitoring with group workshops: speech guidance
As part of the treatment of palatal clefts, the systematic participation of a specialised speech-language therapist in the multidisciplinary team has become an absolute must. This presence has improved the outcome for most patients on the speech/langage development level.
Our intervention starts early, with the organisation of regular so-called “parental guidance“ sessions. Their goal is to limit long-term speech therapy by promoting educational monitoring offered through these workshops.
One of the main factors of this evolution is the result of the research by psycholinguists in the eighties. They showed the importance of the pre-phonatory period (before the age of 12 months). This period appears as essential for the acquisition and development of the articulation of the sounds of speech. It is also essential for the cognitive development of the child.
On the other hand, our knowledge of disorders related to velo-pharyngeal incompetence having increased, we wanted to interact early with children and their parents. We try, among other things, to prevent or limit the development of severe articulatory disorders and compensatory phenomena. These are, in most cases, mainly due to bad habits or inappropriate solicitations from the entourage.
Our experience having led us to observe how difficult it is to correct this type of disorders once acquired, it is desirable to associate parents as soon as possible to avoid them. The timing of our orthophonic therapeutical contribution is related to the timing of the primary surgical intervention on the soft palate. The acquisition and development of speech should be possible at a normal age, when favorable anatomical conditions are made possible thanks to the early surgical repair in our center (3-4 months).
Group guidance sessions
Two sessions will be offered to children of the same age and pathology, preferably accompanied by both parents.
Parents will have been previously made aware by the surgeon of the important role of the soft palate for the acquisition of language. Explanations and recommendations will have been given as early as during the antenatal consultation and before primary surgery.
The first guidance groups 4 to 6 children aged 12 and 16 months.
Its purpose is to reassure and inform parents. Explanations of the role of the soft palate in phonation will be given clearly. Once assimilated, they will allow them to understand the importance of breathing exercises. These will be done with parents and their child and will have to be practiced daily at home.
For the same reasons we will also stress the importance of “learning to drink with a straw” early. The mobility, the activity of the soft palate being solicited thanks to these activities, it is necessary to practice them regularly and as soon as possible in order to optimize the velo-pharyngeal competence. In the same way, games involving the participation of lips, tongue and cheeks will be proposed and explained.
On the other hand, the child primarily learns to speak through his own experience. We will insist during this workshop on the importance of feedback.
We will then talk about the importance of O.R.L. monitoring, explaining the potential risk of serous otitis that children with cleft palate can present, and its consequences on the quality of hearing.
Normal hearing is a key element in learning to speak.
The role and active participation of parents is therefore essential and indispensable.
The second guidance workshop is organised at age 28 to 36 months.
It will be devoted mainly to judging the achievements of the children, to adapt new exercises to their possibilities, always seeking to mobilize the soft palate by more directional and tonic games. ENT monitoring will also be recommended.
One can frequently judge, on these occasions, the level of the child’s speech acquisition, and the quality of the articulation produced in spontaneous language. The possibility of velo-pharyngeal competence can also be assessed clinically.
In the case of reduced intelligibility, in the presence of compensatory disorders, or sometimes when we observe a significant degree of hearing loss, the child will be oriented, and only in these cases, to an early speech therapist, whenever possible close to the child’s home.
These workshops allow for the implementation of essential recommendations to develop velar competence and promote language acquisition. During these sessions time is always managed for the parents to ask questions and exchange experience with other parents.
Often the experience of some is useful to others. Sharing experience with others make parents feel less alone when facing certain difficulties with their child.
Phonation is a key element in interpersonal exchanges. A disability in oral communication is difficult to accept and tolerate.
As a result, early and systematic involvement of a specialised speech therapist in the multidisciplinary team is fully justified. The expected achievements of the guidance workshops, however, remain dependent on the surgical repair of the soft palate during the first year of life.
These benefits should then be combined with those obtained by choosing the best time to intervene orthophonically. This is made possible by the understanding and knowledge of the overall treatment plan by each member of the team.
We expect to see a reduction in the number and especially the duration of speech therapy.
One might even hope for a significant decrease in secondary surgery indications.
C. Zbinden, M. Artaz, C. Beguin: speech therapists, members of the FLMP team at CHUV