American Speech-Language-Hearing Association

EBP Compendium: Summary of Clinical Practice Guideline

Royal College of Speech & Language Therapists; Department of Health (UK); National Institute for Clinical Excellence (NICE)
RCSLT Clinical Guidelines: 5.5 Cleft Palate & Velopharyngeal Abnormalities

Taylor-Goh, S., ed. (2005).
RCSLT Clinical Guidelines. Bicester, Speechmark Publishing Ltd.

AGREE Rating: Highly Recommended

Description:

This guideline provides recommendations for the assessment and treatment of cleft palate and velopharyngeal abnormalities. The target audience for this guideline is speech-language pathologists. Recommendations are based on randomized controlled trials (Level A Evidence), well-conducted clinical studies (Level B Evidence), or expert opinion (Level C Evidence).

Recommendations:

  • Assessment/Diagnosis
    • Assessment Areas
      • Hearing - Recommend that SLPs work collaboratively with audiologists if concerns with hearing are presented which may affect communication (Level B Evidence).
      • Speech
        • Systematic assessment of speech is recommended to inform clinical decision making. Areas to be assessed included: hypernasal resonance, nasal airflow, nasal/facial grimace, voice quality, articulation and contributing factors such as oral structure, hearing, dental occlusion, dentition, lip closure, nasal airway, social and emotional issues, associated conditions/syndromes (Level B Evidence).
        • Recommendation for perceptual assessment of speech in individuals with velopharyngeal dysfunction (Level C Evidence).
        • Early monitoring of pre-speech and speech is recommended after cleft palate repair (Level B Evidence).
      • Language - In-depth assessment of language is recommended when screening indicates a delay (Level B Evidence). 
    • Assessment Instruments
      • General Findings, Videofluoroscopy & Endoscopy - Recommend differential diagnosis of velopharyngeal dysfunction with direct and indirect assessment tools which can include videofluoroscopy and perceptual evaluation, nasendoscopy, and acoustic and airflow measurements when possible (Level B Evidence).
  • Treatment
    • Speech
      • General Findings
        • Recommend phonology and articulation treatment tailored to each individual child. Treatment may include articulation, phonological or combined articulation and phonological approaches. Support for individual and group intensive treatment was found (Level A Evidence).
        • Auditory discrimination, increased speaking effort, mouth opening and decreased speaking rate have not been shown to be effective. (Level C Evidence).
      • Visual Biofeedback - Recommend use of visual biofeedback as an experimental treatment for inconsistent velopharygneal closure (Level A Evidence).
      • Electropalatography  - The guideline recommends that electropalatography be considered as a treatment option for persistent articulation disorders (Level B Evidence).
      • Non-Speech Oral Motor Treatment - Non-speech oral motor treatments including palatal exercises, massage, blowing, sucking, icing, interrupted swallowing, cheek puffing and gagging are considered inappropriate interventions for velopharyngeal dysfunction (Level C Evidence).
    • Swallowing
      • General Findings - Recommend that speech-language pathologists work collaboratively with health professionals in the management of dysphagia and feeding (Level A Evidence).
  • Service Delivery
    • Dosage & Format
      • General Findings - Intensive individual and group treatment has been shown to be effective (Level A Evidence). 

Keywords: Congenital Disorders

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Added to Compendium: November 2010

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