1. WHOLE LANGUAGE MODEL FOR PROVIDING SPEECH THERAPY IN VCFS PATIENTS

2. CLINICAL RESEARCH IN SPEECH PATHOLOGY  EARLY SURGERY PREVENTS COMPENSATORY ARTICULATION  THE OLDER THE PATIENT IS WHEN PALATE IS REPAIRED, THE GREATER THE RISK FOR DEVELOPING COMPENSATORY ARTICULATION  THERE IS A NEGATIVE CORRELATION BETWEEN LINGUISTIC DEVELOPMENT AND THE DEVELOPMENT OF COMPENSATORY ARTICULATION DISORDER [CAD] IVF GROUP WITHOUT CAD [ 79% ] ADEQUATE LINGUISTIC DEVELOPMENT IVF GROUP WITH CAD [ 62% ] ADEQUATE LINGUISTIC DEVELOPMENT

3. CLINICAL RESEARCH IN SPEECH PATHOLOGY  WHOLE LANGUAGE MODEL IS EFFICIENT FOR THERAPY AIMED TO CORRECT COMPENSATORY ARTICULATION.  PHONETIC GROUP = 30 MONTHS  WHOLE LANGUAGE MODEL = 14.8 MONTHS  WHEN COMPENSATORY ARTICULATION IS CORRECTED, MOTION OF VELOPHARYNGEAL SPHINCTER DURING SPEECH IS MODIFIED ( INCREASES )  WHEN COMPENSATORY ARTICULATION IS PRESENT, SPEECH THERAPY SHOULD BE INDICATED BEFORE SURGERY FOR VPI.

4. ESTRATEGIES FOR ENHANCING PHONOLOGIC DEVELOPMENT  EMPHASIZE USE OF SPEECH SOUNDS WITH COMMUNICATIVE PURPOSES MORE THAN PRODUCTION AS A GOAL ( FEY, 1992 )  MODIFICATION OF GROUPS OF SOUNDS TREATED SIMILARLY BY THE CHILD ( FEY, 1992 )  MODELING : RECONSTRUCTION OF ABNORMAL EMISSIONS

5. ESTRATEGIES FOR ENHANCING PHONOLOGIC DEVELOPMENT  USE OF STRUCTURED ACTIVITIES WITHIN APPROPRIATE LINGUISTIC CONTEXT ( HOFFMAN, 1992 )  MODIFICATION OPHONOLOGIC PERFORMANCE IS INFLUENCED BY HIGHER LEVELS OF LINGUISTIC ORGANIZATION  CLOSING : ORGANIZATION OF EMISSIONS INCLUDING PHONOLOGIC INFORMATION  EXPANSIONS : INCREASE SEMANTIC, SINTAX & PHONOLOGIC COMPLEXITY ( WARREN, 89 )

6. VERBAL COMMUNICATION MODEL (LUNCH) (HOFFMAN, 1992)  MEANING ( GOALS ) – BE PREPARED, EAT, CLEAN  PROPOSITIONAL ( ACCTIONS WITHIN THE GOAL ) – EAT, DRINK  CONCEPTUAL ( ACTORS, OBJECTS, ACTIONS ) – JUICE, DAD, MOM  LINGUISTIC MEANING ( PHRASES, RELATIONSHIPS AND CONCEPTS ) – “I DRINK JUICE”  SYLLABE  PHONEME  GESTURE : PLACEMENT & MANNER – TONGUE APEX, RAISE, DECREASE

7. SPEECH ARTICULATION  MOTOR  PERIPHERAL  PHONEME BASED  EVALUATES USE OF PHONEMES  PART TO WHOLE PHONOLOGY  COGNITIVE  CENTRAL  LINGUISTIC CODE  PHONOLOGICAL PROCESSES  WHOLE TO PART

8. VCFS PATIENTS WITH VPI SPEECH :  NASAL EMISSION  HYPERNASALITY  COMPENSATORY ARTICULATION : ABNORMAL ARTICULATION PATTERNS

9. TEACHING – LEARNING CONTEX  STORY BOOKS  USEFUL AT ANY LEVEL OF DEVELOPMENT ( WHEN APPROPRIATE )  PROVIDE STABLE AND REDUNDANT CONTEXT WHICH REMAINS THROUGH TIME  KEEP ACTIVITIES STABLE (PROVIDES STABILITY)  ENHANCE PARALELL WORK WITH ORAL & WRITTEN LANGUAGE

10. TEACHING – LEARNING CONTEX  EVENT REPRESENTATION  THE BASIC STRUCTURE OF KNOWLEDGE IS ORGANIZED AROUND EVENTS  PROVIDES A GUIDE FOR STRUCTURE AND CONTENT OF LINGUISTIC & NON – LINGUISTIC ASPECTS  REDUCE COGNITIVE WORK ENHANCING COMMUNICATIVE PERFORMANCE  THE MORE A SCRIPT IS PERFORMED, IT CAN BE PROCESSED MORE EFFICIENTLY

11. TEACHING – LEARNING CONTEX  EVENT REPRESENTATION ( CONT.)  PHONOLOGIC FORMS WILL BE INCLUDED IN GREATER UNITS  PLAY IS AN EVENT REPRESENTATION.  THE SPEECH PATHOLOGIST MUST KEEP THE ORGANIZATION AND USE ESTRATEGIES FOR ENHANCING USE OF MORE COMPLEX LINGUISTIC – PHONOLOGIC LEVELS.

12. VPI  MECHANICAL  PLAN : SURGERY WITH COMPENSATORY ARTICULATION DISORDER  FUNCTIONAL  ENTIRE VOCAL TRACT IS INVOLVED  PLAN : SPEECH THERAPY WITHOUT COMPENSATORY ARTICULATION DISORDER

13. SPEECH THERAPY APPROACH – TREAT :  PHONOLOGICAL DISORDER  COMPENSATORY ARTICULATION  LINGUISTIC ORGANIZATION

14. COMPENSATORY ARTICULATION  STARTS AS A CONSEQUENCE OF VPI ( CLEFT PALATE )  IN TIME, THE ERRORS ARE INCORPORATED INTO THE LINGUISTIC RULES SYSTEM

15. COMPENSATORY ARTICULATION GLOTTIC STOPS  ARTICULATION AT GLOTTIS LEVEL  SUSTITUTION OF : /K/, /P/, /T/ PHARYNGEAL FRICATIVE  PHARYNGEAL PLACEMENT OF ARTICULATION  SUSTITUTION OF : /S/

16. WHOLE LANGUAGE  LANGUAGE IS AN INTEGRATED SYSTEM  ALL COMPONENTS ARE SIMULTANEOUSLY PRESENT AND INTERACTING  USE OF LANGUAGE OCCURS WITHIN A CONTEXT OR SITUATION  LEARNING IS ACHIEVED FROM GENERAL TO PARTICULAR ( WHOLE TO PART )

17. TEACHING – LEARNING CONTEX  GRAPHIC ORGANIZERS  PROVIDE VISUAL TOOLS FOR EFFECTIVE TEACHING  VISUAL TOOLS ARE USEFUL FOR VISUAL AND MIXED LEARNERS ( MOST OF POPULATION )

21. FORGET, DISMISS, CANCEL “EXERCISES” !!!!!  THE ONLY USEFUL EXERCISE FOR SPEECH IS SPEECH  ELECTROMYOGRAPHY AND VIDEOFLUOROSCOPY DEMONSTRATES THAT VOCAL TRACT MOTION DURING SPEECH IS QUITE COMPLEX ( SEVERAL STRUCTURES MOVING SIMULTANEOUSLY IN A COORDINATED FASHION ). BESIDES, FREQUENCY OF MUSCLE ACTIVITY DURING SPEECH IS SIGNIFICANTLY HIGHER THAN BLOWING, SWALLOWING, ASPIRATING, ETC. THESE ACTIONS SHOW ENTIRELY AND COMPLETELY DIFFERENT PATTERNS OF ACTIVITY.

22. THERAPY MODALITIES  CONVENTIONAL ( AS FREQUENT AS POSSIBLE )  “SPEECH SUMMER CAMP”

23. THERAPY MODALITIES  “SUMER CAMP”  NATURAL ENVIRONMENT  PLAY AND STORY TELLING  MORE EFFECTIVE ( 4 HOURS PER DAY AND FOR 3 – 4 WEEKS)

24. THERAPY MODALITIES  “SUMER CAMP”  CAREFUL PLANNING OF ACTIVIES  ADEQUATE “GROUPING” CLASSIFICATION OF PATIENTS IN GROUPS  ASSEMBLE HOMOGENEOUS GROUPS

25. THERAPY MODALITIES  “SUMER CAMP”  INCLUDE MOM & DAD ( AT LEAST MOM ) :  MODIFY STYLE OF INTERACTION, RECRUIT THEM AS “ALLIES”  INCLUDE VISITING SPEECH PATHOLOGISTS