Cleft Lip and Palate

Case Presentation
2SLPB
Bullo. Libozada. Ligutom. Parcon. Tangan
Px’s Name: John
Date of Birth: January 22, 2014
Chronological Age/ Sex: 3:9/M
Medical Diagnosis: Bilateral Cleft Lip and Palate
SLP Diagnosis: Speech and Language Delay
 01.
BACKGROUND
INFORMATION
BACKGROUND INFORMATION
● Chief Complaint: “ mandalas di maintindihan”
● Brought to Craniofacial Foundation of the Philippines (CFFP)
for the operation of both lip and palate, 9 - 10 months old
● Born full term via normal delivery
○ The mother tripped and fell on a 3- step stairs during
the 2nd semester of pregnancy
● Does not attend school
○ Usually play throughout the day
● Speech Intelligibility was rated 1
● Uses gestures and actions when communicating wants and
needs
● No feeding concerns
○ Eat all types and consistencies of foods
 02.
TEST RESULTS
TEST RESULTS AND OBSERVATIONS

Behavior
PRESENT ABSENT

Stranger anxiety, Separation anxiety, Aggressive Behavior

Escape Behavior

Good - Frustration tolerance

Fair - Attention span, Concentration

span, Impulse control

Poor to Fair - Sitting Span

Language
Precursory Skills
CONTENT
● (+) object search, action on object, object-object relations, disappearance hide object
FORM
● (+) imitation, approximating adult linguistic forms
USE
● (+) gazing interpersonally
● (+) focusing using joint attention
● (+/-) taking turns
● (+) making inference → show, give, point object, and point object while vocalizing
● (+) regulating
○ (+) reach toward, reach for object and vocalize, gesture to request help, and
gesture to request action
○ (-) protesting
Inner Language
Westby Symbolic Play Scale
● Self-other relation skills → 15 - 17 months
● Decontextualization, thematic content, and
organization skills → 19- 22 months
Language
Receptive Language
Vocabulary and Concepts

Auditory Comprehension
● Able to follow one step command accompanied with gesture
○ Example: “bigay car” or “kunin mo”
● Unable to exhibit 2 or more CE and multi step commands
○ Example: “bigay mo car and doll” and “talon ka tapos clap”
Answering Questions
● Emerging skill → answering Yes/No
● Absent → WH questions
Language
Expressive Language
CONTENT
● existence and action
FORM
● Pointing with vocalizations, reaching, and word approximations
USE
● Commenting
● Regulate - focus attention
● Regulate - obtain objects and direct action
● Discourse: respond
Concept integration
● (+) association
○ “broom broom” → car; “meow” → cat
○ Object function
■ How to comb hair when giving a comb
Speech
Respiration
● Thoraco- clavicular breathing
● 20-25 bpm, normal
Voice
● Pitch, loudness, and vocal quality is WNL
Resonance
● Hypernasal
○ /p/ and /b/ to a nasal sound /m/
○ Presence of vibration along the sides of the nose as the child produce oral sounds
Articulation
● Most complex canonical form → C1V1C2V2
● Able to produce all Filipino vowels
● Present phonemes
○ /p,m,n,h,y,w/
■ Some phonemes are inconsistently produced such as /p/ in isolation
● Rating scale 0 (normal) - 6 (cannot be understood)
○ Speech intelligibility is describe to be 5, with known context
OPM
● Not all movements were assessed due to limited ability to follow directions
○ (+) elevate and depress jaw
○ (+) protrude, retract tongue; depress tongue tip
○ (+) lip retraction and pursing
● Presence of oronasal fistula in hard palate
● Scarring from palatoplasty
● No uvula

Hearing
● Good hearing
○ Able to listen and respond appropriately to the directions and questions
given verbally by the clinician
 03.
PRIORITIZED
PROBLEM LIST
PRIORITIZED PROBLEM LIST
1. Precursory Skills
a. Absent skill for protesting
b. Emerging skills for turn taking
2. Inner language skills
a. Delayed self-other relations skills (15-17 months)
b. Delayed decontextualization, thematic content, and organization skills (19-22 months)
3. Receptive language
a. Vocabulary and content
i. Absent spatial and temporal concepts
ii. Emerging action, qualitative, and quantitative concepts
b. Following directions
i. Inability to follow commands with two or more critical elements and multi- step command
c. Answering questions
i. Absent WH questions
ii. Emerging yes/no questions
4. Expressive language
a. Communicates primarily through gestures and vocalizations
5. Oral Peripheral Mechanism
a. No uvula
b. Presence of oronasal fistula in hard palate near incisive foramen
i. Presence of scarring from palatoplasty
6. Speech
a. Presence of hypernasal resonance
b. Incomplete early 8 sounds in phonetic repertoire
i. Absent /b,d/ phonemes are not stimulable
c. Limited phonotactic repertoire
i. Most complex canonical form is disyllabic: C1V1C2V2
d. Intelligibility rating scale of “5- can understand with effort if content is known”
 04.
CASE MAP
 05.
RECOMMENDATIONS
Respectfully recommending the following:
● Further assessment
○ To check other consonant inventory
● Speech and language therapy to improve the following:
○ Precursory skills
○ Inner language skills
○ Receptive and Expressive language skills
○ Speech
● Referral to Occupational therapist
○ To address behavioral concerns
● Re-evaluation after 3 months
THANK YOU!