00:00:11
Hi, my name is Cate Crowley. I am a professor of practice here at Teachers College, Columbia University in New York City.
00:00:19
Welcome to the Cleft Palate Speech and Feeding Video Tutorials that I've created with my co-authors, Dr. Miriam Baigorri and Ms. Chelsea Sommer.
00:00:29
We've created these video tutorials for children who are born with cleft palates,
00:00:34
but who may not have a speech therapist or speech pathologist available to address their speech issues.
00:00:40
In addition, we've created them for those speech language therapists and speech pathologists
00:00:44
who may want to acquire an understanding of how to work with children born with cleft palate.
00:00:50
And finally, we especially want to thank the families and children who worked in our Advanced Cleft Palate Research Clinic here at Teachers College, Columbia University
00:01:00
to provide the videos that you're going to see throughout these video modules,
00:01:05
seeing how we do speech therapy with these children born with cleft palate.
00:01:10
Thank you so much. I hope you enjoy them!
00:01:14
To begin our modules, I want to share with you our very first therapy session with Peyton and her mom, both of whom are featured throughout these video modules.
00:01:24
Peyton was born with a cleft palate and recently had surgery for speech at five years old, and had just been cleared for speech therapy.
00:01:33
This short video demonstrates the important role the speech-language pathologist or therapist can have in the lives of children born with cleft palates.
00:01:42
Say: "p, p, p"
00:01:46
"p, p, p"
00:01:50
Say: "b"
00:01:53
"m"
00:01:54
"b, b, b"
00:01:56
"m, m, m"
00:01:58
"b"
00:02:01
"m"
00:02:03
Good. So mom, do you know what we know from what she just did? She can create the pah sound, and that means she can create every single sound
00:02:16
and all we need now is speech therapy.
00:02:20
Every single sound!
00:02:22
That's what we know from that little bit.
00:02:25
Welcome to Module 1 of Cleft Palate
Speech and Feeding Video Tutorials.
00:02:32
In this module, we're going to talk about anatomy and physiology, typically how it develops,
00:02:36
and then anatomy and physiology
of children with cleft.
00:02:41
Now before we start, I want to say why this is so important.
00:02:44
When babies are born with a cleft, they have a hole in their mouths and they can't create closure in the back of their mouths.
00:02:52
So, their soft palate can't lift up and close back there, which is needed for many of the speech sounds:
00:02:58
"p", "t", "k", "g", "sh", "j", "s", "t", "d"
00:03:04
So, because those sounds can't be made, the baby begins to make different sounds
00:03:09
and until the baby's palate is repaired and they can make those sounds appropriately,
00:03:13
they develop habits of making sounds in a different way.
00:03:17
So, what we're going to do now is go
through a whole series of video tutorials
00:03:21
starting with the anatomy and
physiology, so that you can see exactly what is happening internally
00:03:28
and the whole process of providing appropriate services to children whose speech is impaired due to their
cleft palate.
00:03:37
Let's begin with looking at what happens in embryological development.
00:03:42
So, the lips and the alveolus begin at about six to seven weeks of gestation.
00:03:50
While the fetus is in the womb growing, the lips and alveolus are forming very early on
00:03:55
and it starts a point called the incisive foramen,
00:03:58
which is a very important part in the anatomy of cleft lip and palate development.
00:04:03
The hard palate begins to form at eight to nine weeks of gestation,
00:04:09
and the velum, the soft palate, and the uvula - that little thing that hangs down at the back of the throat -
00:04:13
they are completely formed at about twelve weeks of gestation.
00:04:19
So, now we're going to look at what typical anatomy looks like
00:04:22
before we look at what the anatomy of cleft lip and palate looks like.
00:04:26
So, here's an illustration done by Tina Young
00:04:30
and you can see the dental arch,
00:04:33
then the premaxilla is in that little triangle at the top, just under the nose.
00:04:38
That's a very important thing, especially when children have bilateral cleft lips - you'll see that in the next module.
00:04:44
After the premaxilla, we have the
incisive foramen, that dot I told you about -
00:04:49
that spot is actually how the lips
and the palates fuse.
00:04:54
It's sort of the beginning of the fusion point for the lips and the palate. More on that.
00:05:00
Then, we have the palatine processes of the maxilla, the palatine bone, the posterior nasal spine, the palatine foramen, the hamulus,
00:05:13
and here's two muscles: the tensor veli palatini, which many of us know
00:05:17
is the muscle that opens and closes the eustachian tube, which connects the mouth to the middle ear.
00:05:25
So, if you travel and you're on a plane and you need to yawn,
00:05:29
what's happened is the tensor veli palatini has not opened up the eustachian tube
00:05:35
to actually regulate the pressure between the airplane and what's happening in your middle ear.
00:05:41
Very important with kids with cleft palate, because often that muscle is displaced.
00:05:46
So, many kids with cleft palate have lots of conductive hearing loss.
00:05:55
The levator veli palatini
00:06:00
is the muscle that really is the primary muscle in soft palate closure.
00:06:06
It lifts up and back the soft palate to
close against the posterior pharyngeal wall. More on that.
00:06:12
And the uvula, which is
that little piece that hangs down.
00:06:17
Here's how the muscles work. This is not all of the muscles, but most of the muscles.
00:06:21
So, the velum is in green and that velum has to go up and back to the posterior pharyngeal wall for closure.
00:06:28
There's also the lateral walls that are
moving in, but we can't do that with a profile picture.
00:06:33
So, the velum goes up against the posterior pharyngeal wall,
00:06:38
then we have the glossopalatini, or the palatoglossus, which pulls the velum down when it needs to move down.
00:06:46
We also have the palatopharyngeus, that's mostly used for swallowing rather than speech,
00:06:53
but has not been fully ruled out as having some use in velopharyngeal closure.
00:07:00
Then, of course, the famous levator veli palatini
00:07:06
and the constrictor pharyngeus superior or the superior pharyngeal constrictor.
00:07:12
Those muscles move the lateral pharyngeal walls in.
00:07:17
There's another muscle called the musculus uvulae. It's at the tip of velum - at the very tip of that green -
00:07:23
and when the palate is being raised for velopharyngeal closure, it bulges the tip of the velum and also makes it a little bit stiff.
00:07:32
So, what does the typical anatomy of the oral structure look like?
00:07:36
Well, we've got the hard palate, the soft palate or velum, the uvula back there, and the tongue.
00:07:44
We also look at the outside, because when a child has a cleft lip, the outside of the face can be involved.
00:07:51
So, we have the nasal aperture, the columella, which is
00:07:56
this cartilage between the tip of the nose and this part of the face.
00:08:01
The nares - the openings. The philtrum, which is this
00:08:05
kind of depression of a line - it actually is a depression that goes in between the two seams
00:08:12
that if they're open, you'd have a cleft lip.
00:08:17
And then, the cupid's bow.
00:08:19
So, how did the oral structures develop?
00:08:21
The reason we have that beautiful jacket there is because of the zipper that closes it.
00:08:27
So now, we're talking about the incisive foramen.
00:08:30
The incisive foramen is a point in the palate from which the lips fuse and from which the palate fuses.
00:08:42
Now, imagine that the yellow dot is the bottom of the zipper
00:08:46
and there's a zipper that starts at the yellow dot
00:08:49
and goes up to the nose and closes one side of the lips,
00:08:55
then another zipper starts on the other side and closes up.
00:09:00
The palate starts at that yellow dot - that's the base of the zipper for the palate also - but, that closes from front to back.
00:09:08
So, the lips close from the incisive foramen forward
00:09:14
and the palate closes from the incisive foramen back.
00:09:17
Why that is important is, when we start to look at cleft palate and cleft lip, we'll be able to see more clearly what
happened anatomically.
00:09:29
What I love to do when I teach my classes is to just look at people's palates because they're all so different.
00:09:35
So, here's a couple of pictures of palates, but you can also do this with your friends.
00:09:39
It's a way of really getting to know people in a way you never did before, usually,
00:09:43
which is to look at their palate and their uvula.
00:09:46
So, have a look! Get your lights out and have a look.
00:09:49
Here's a few beautifully functioning palates that look quite different.
00:09:52
So that's the end of Module 1.1.
00:09:56
The next Module is 1.2, where we're going to look at the anatomy and physiology of different types of clefts.
00:10:05
Again, this is from www.leadersproject.org.
00:10:10
There's many materials there, if you just came into this one module and you want to see all of the modules,
00:10:15
go to www.leadersproject.org and they will all be there.
