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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_33_библиотеки_им_акад_М_И_Перельмана
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10 Physical Management of Velopharyngeal Inadequacy
Surgical Management of Velopharyngeal Inadequacy
Prosthodontic Management of Velopharyngeal Inadequacy
References
11 Early Intervention for Infants and Toddlers
Early Monitoring and Intervention
Intervention With the Prelinguistic Child
Parents' Expectations of Palatal Surgery
Lexical and Phonological Growth Following Surgery
Oral Motor “Exercises”: A Warning
Looking Ahead
Summary
References
12 Speech Therapy for Cleft-Related Misarticulations
Deciding What Is “Treatable” and What Is Not
Deciding on the Treatment Approach
Initiating Treatment
Parents, Teachers, and the Speech Notebook
Useful Therapy Materials
Therapy for Cleft-Related Speech Errors
Summary
References
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13 Four Multianomaly Craniofacial Conditions That Include Clefts
Van Der Woude Syndrome
Pierre Robin Sequence
Stickler Syndrome
Velocardiofacial Syndrome
References
Index
Oral Cavity: Place of Production Directions and Locations
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Place Map for High Pressure
Consonants
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Copyright
3251 Riverport Lane
St. Louis, Missouri 63043
THE CLINICIAN'S GUIDE TO TREATING CLEFT PALATE
SPEECH, EDITION 2 ISBN: 978-0-323-33934-6
Copyright © 2017 by Elsevier Inc. All rights reserved.
No part of this publication may be reproduced or transmied in any
form or by any means, electronic or mechanical, including
photocopying, recording, or any information storage and retrieval
system, without permission in writing from the publisher. Details on
how to seek permission, further information about the Publisher's
permissions policies and our arrangements with organizations such
as the Copyright Clearance Center and the Copyright Licensing
Agency, can be found at our website:
www.elsevier.com/permissions.
This book and the individual contributions contained in it are
protected under copyright by the Publisher (other than as may be
noted herein).
Notices
Knowledge and best practice in this field are constantly changing. As
new research and experience broaden our understanding, changes in
research methods, professional practices, or medical treatment may
become necessary.
Practitioners and researchers must always rely on their own
experience and knowledge in evaluating and using any information,
methods, compounds, or experiments described herein. In using
such information or methods they should be mindful of their own
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safety and the safety of others, including parties for whom they have
a professional responsibility.
With respect to any drug or pharmaceutical products identified,
readers are advised to check the most current information provided
(i) on procedures featured or (ii) by the manufacturer of each
product to be administered, to verify the recommended dose or
formula, the method and duration of administration, and
contraindications. It is the responsibility of practitioners, relying on
their own experience and knowledge of their patients, to make
diagnoses, to determine dosages and the best treatment for each
individual patient, and to take all appropriate safety precautions.
To the fullest extent of the law, neither the Publisher nor the authors,
contributors, or editors, assume any liability for any injury and/or
damage to persons or property as a maer of products liability,
negligence or otherwise, or from any use or operation of any
methods, products, instructions, or ideas contained in the material
herein.
Previous edition copyrighted 2016.
International Standard Book Number: 978-0-323-33934-6
Executive Content Strategist: Kellie White
Content Development Manager: Jolynn Gower
Publishing Services Manager: Julie Eddy
Design Direction: Ashley Miner
Printed in the United States of America
Last digit is the print number: 9 8 7 6 5 4 3 2 1
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Preface
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The Care of a Child With a Cleft
Speech-language pathologists who work in the public schools or
other nonmedical seings are unlikely to encounter a child or adult
with a cleft palate or other craniofacial birth defect more than a few
times in their entire career. When they do, they may feel hesitant to
devise a treatment plan for that individual if their training did not
include a course in cleft palate or if that training was so long ago that
they fear their knowledge and clinical skills may be outdated. Each
of the authors of this book has had multiple telephone calls and emails from clinicians expressing exactly that fear. The goal of this
book is to provide enough information so that clinicians can feel
comfortable in the diagnosis and treatment of speech for an
individual with a cleft palate or other form of velopharyngeal
dysfunction. In addition, we hope this book can help in the
education of the graduate students who will soon become speech
pathologists.
This second edition of The Clinician's Guide is a consolidation of
the previous edition (2006) and portions of the fourth edition of Cleft
Palate Speech (Peterson-Falzone, Hardin-Jones, and Karnell, 2010).
The laer book is no longer in print.
Although there are many hard-working, knowledgeable surgeons,
dentists, orthodontists, speech-language pathologists, and other
clinicians devoting large chunks of their professional time to caring
for individuals with clefts and other congenital craniofacial
disorders, a basic premise of this book is that care for such a patient
is likely to be fragmented and inadequate if it is not provided by an
interdisciplinary team. On-site interaction among professionals in
plastic and reconstructive surgery, speech-language pathology,
orthodontics, dentistry, pediatrics, nursing, oral surgery,
otolaryngology, and psychology or social work (preferably both) is
key to maintaining a high standard of integrated and wellcoordinated care (Dailey and Wilson, 2015). The American Cleft
Palate-Craniofacial Association (ACPA) makes this point very clearly
in its “Standards for Cleft and Craniofacial Teams” document, and
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also in its “Parameters for Evaluation and Treatment…” document
first published in 1993 and twice revised and upheld by consensus of
the Association in the past 22 years. The boom line is simply that
team care is essential.
If you are a speech-language pathologist in the public schools or
other nonmedical seing, you may well be the key professional who
first identifies the child in need of a team or you may be the first
professional who realizes that the care previously provided for the
child with a cleft has been inadequate. Never underestimate how
important your observations and evaluations are to the child, the
family, and whoever is providing the surgical and dental
management. The treating team needs your input. You are the one
who sees the child on a regular basis, while the team may see him or
her only once every few weeks or months. Dailey and Wilson (2015)
stress the importance of good communication across treatment
seings.
Just as important: If you are the one who finds a child NOT being
treated by an interdisciplinary team, do not let a “gatekeeper” in the
office of a third-party payer tell you that referral to such a team is
not necessary. Teams usually have someone on staff who knows how
to deal with third-party payer obstinacy.
Following are three scenarios: In the first, a child with nasal
emission, hypernasal resonance, and perhaps even compensatory
misarticulations turns up in your caseload and has had no previous
diagnostic work-up, although he may have had previous speech
therapy (either appropriate or inappropriate). In the second, a child
in your caseload has a repaired cleft palate or other source of
inadequate velopharyngeal closure but is clearly in need of more
physical management. In the third scenario, you have a child or
adult who is already under team care but you need to interact with
the team in order to develop a good therapy plan for his current
speech problems. All of these scenarios demand that you make and
maintain contact with the professionals on the interdisciplinary
team.
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The Long-Term Perspective on Care for the Child
With a Cleft Palate
Following is a typical schedule of the evaluations and procedures
that will constitute the long-term care for children born with clefts
(children born with cleft lip only will generally not require such
rigorous care). Please keep in mind that the “schedule” will vary
somewhat across teams.
• At birth: neonatal evaluation, including hearing assessment if
possible, and referral to an interdisciplinary team, as well as to local
pediatrician; team evaluation as soon as possible; counseling for
parents as needed
• Monitoring of weight gain
• Evaluation of baby and family by dysmorphologist/geneticist as
soon as the family is emotionally ready for it
• Age 3 months: surgical closure of cleft lip and initial reconstruction
of the nose (often preceded by lip-taping or nasoalveolar molding)
• Age 6 months: follow-up team evaluation
• Age 12 to 18 months: another team evaluation; surgical closure of
palate, preferably around 1 year of age (may take place earlier)
• Age 2 years: team evaluation
• Annual or semiannual team evaluations, scheduling dependent
upon the needs of the particular child
• Lip-nose revision if necessary before child enters school
• First-stage orthodontic care once the first molars have erupted
(approximately age 7 or 8 years)
• Alveolar bone-grafting if necessary, preferably after completion of
orthodontic preparation, specifically expansion of the maxilla so
that the occlusion is stabilized in the correct position
• Secondary velopharyngeal surgery whenever it is determined that
this system is not functioning adequately
• Phase II of orthodontic treatment, beginning after the eruption of
most of the permanent teeth (e.g., approximately 12 to 14 years of
age)
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