Speech Therapy in an Adult With Cleft Lip and Palate: A Clinical Case Study.

CLINICAL SCENARIO

Although speech therapy (ST) has been frequently studied in children, the efficacy of motor-phonetic ST in adults with repaired cleft lip and palate (CLP) is unclear.

CLINICAL QUESTION

How does articulation change over time for an adult with CLP engaged in motor-phonetic ST?

STUDY SOURCES

This study describes articulation and motor-phonetic intervention in a 33-year-old, monolingual Spanish-speaking woman presenting with CLP and associated velopharyngeal insufficiency. Case history, initial evaluation, surgical intervention, and progress during ST are described with reference to current literature.

RESULTS

Upon initial evaluation, the patient presented with speech characterized by pervasive compensatory articulation errors and moderate hypernasality. As such, the patient completed 22 sessions of ST and underwent palatal surgery (between ST Sessions 3 and 4). Follow-up data were collected 49 days following treatment. Progress in ST was tracked using percent consonants correct (PCC) on the targets /p, t, k, s/. All therapy targets were produced at baseline as glottal stops (0% PCC). Following surgery, PCC was 56% for /p/, 31% for /t/, and 0% for /s/. In Session 11, /k/ was introduced (PCC = 45%). At Session 22, PCC was 100% for /p/, 46% for /t/, 100% for /s/, and 70% for /k/. PCC values were maintained across all target phonemes at follow-up.

CONCLUSIONS

PCC improved following intervention, and gains were maintained at follow-up. Data suggest that a motor-phonetic approach may effectively address speech sound disorders in adults with CLP. Future research is needed to explore this intervention on a larger scale and compare to other approaches.