During our international trips to Peru, the days often get caught up in the details of the cleft surgeries: admitting, vitals, the surgery itself, medicines, recovery… While the surgery is an essential component in the treatment of cleft lip and palates, speech therapy is equally as important in comprehensive cleft care. After a cleft palate surgery, the normal sounds and patterns of speech must be learned which requires the help of a trained speech therapist. For truly comprehensive cleft care, surgery and speech therapy are both needed.
When a child has their palate closed at an early age, say 12 months, they often will develop normal speech without therapy because they haven’t started to talk or develop bad speech habits, like mispronunciation. If a child’s palate is closed later, say around age 3 or 4, they have already developed a number of abnormal productions of speech sounds.
“The older the child is, the more established these error patterns become,” explains FACES Speech Therapist Lance Tsugawa. “Just doing the surgery does not change the speech. You have to reestablish normal speaking patterns.”
To do the cleft lip and palate patient must begin speech therapy soon after surgery and continue, in many cases, for several years. It’s important to surgically repair the palate as early as possible in a child’s life. However, even at later ages, it’s possible to make very good progress with speech therapy.
“Any way we can help these children be understood is excellent,” says Vanderbilt Speech Pathologist Jennifer Craig, who is on her first trip with the FACES team. “Therapy helps reduce the child’s frustrations with communication, as well as the parent’s frustration.”
The problem for FACES is that their target demographic are medically isolated, indigent patients who have little or no access to even the most basic medical facilities. Additionally, explains Lance, “most developing nations have very little in the way of speech therapy resources. If they are available they are fee for service and are often performed by local therapists who do not have the specialty training needed. FACES is one of the few surgical foundations that offers speech therapy services after cleft repair and we are continuing to develop more effective systems for therapy delivery.”
For the past five years, FACES has been working on developing an easily replicable model for speech therapy post-cleft surgery utilizing Internet connectivity.
“Knowing that they are therapy candidates ahead of time is fantastic,” explains Jennifer. “With technology becoming more and more accessible, there are a lot of great opportunities for these kids to receive treatment sooner and more frequently from what they may have access to now. “
From left: Dr. Kristina Ruybalid and speech therapists Lance Tsugawa and Jennifer Craig provide a speech therapy consult in Lambayeque.
The FACES team evaluates a patient for speech therapy.