Thursday 1:30 PM

Presenters: Sara Kinter, MA, CCC-SLP, Kaylee Paulsgrove, MS, CCC-SLP, Randall Bly, MD

Presenter Disclosures:  Sara Kinter has disclosed the following financial relationships: I receive a salary as an employee of Seattle Children’s Hospital as part of their Craniofacial Center.  I specialize in the evaluation and management of children with speech and resonance disorders related to craniofacial conditions.  Sara Kinter has disclosed the following non-financial relationships: I am currently a member of the ASHA SIG5 Program Development Committee and serve as the continuing education content manager for SIG5 Perspectives.  My participation will be ending 12/31/17.  Kaylee Paulsgrove has disclosed the following financial relationships: I receive a salary from Seattle Children’s Hospital.  Kaylee Paulsgrove has no relevant non-financial relationships to disclose.  Randall Bly has no relevant financial relationships to disclose.  Randall Bly has no relevant non-financial relationships to disclose.

Description: Perceptual evaluation of velopharyngeal function describes what the clinician hears while instrumental evaluation describes what the clinician observes.  Integration of both perceptual and visual findings is paramount in determining an effective management plan for each patient.  It is well-understood that correctly-articulated pressure consonants are required to establish presence of velopharyngeal insufficiency (VPI) that requires physical management.  However, motor speech disorders, compensatory misarticulations and behavioral challenges can all influence the reliability and validity of both nasopharyngoscopy and video fluoroscopy in establishing presence of VPI.  In addition, a surgeon utilizes anatomic findings based upon instrumental evaluations that inform surgical recommendations.  The goals of this presentation are: 1) to describe how different etiologies of velopharyngeal dysfunction (VPD) manifest on instrumental exam and 2) to discuss how the combination of these findings influences treatment recommendations. This study session will include presentation of endoscopic and fluoroscopic examinations from patients with different types of VPD.  Key anatomic findings influencing surgical decisions will be reviewed.  Use of the VELO (‘VPI Effects on Life Outcome’) survey as an evaluation tool will be discussed.  Case examples with co-occurrence of more than one VPD etiology will also be presented.  Rationale for pursuing surgery versus speech therapy will be discussed.  Information presented is meant to be of interest to any providers that diagnose and treat patients with VPD.  Both surgeon and speech-language pathologist perspectives will be represented.

Learning Objectives: Following this presentation, learners will be able to: 1. Describe anticipated instrumental findings given perceptual characteristics. 2. Discuss anatomic findings that may influence surgical decisions. 3. Describe how use of instrumental and perceptual findings may influence patient outcomes.

Presenters: Ann Kummer, PhD

Presenter Disclosures:  Ann Kummer has disclosed the following financial relationships: Royalties for the textbook entitled: Cleft Palate and Craniofacial Anomalies: The Effects on Speech and Resonance Oral & Nasal Listener; Nasoscope, Patent Number: 6656128; Honoraria for seminars.  Ann Kummer has no relevant non-financial relationships to disclose.

Description: Nasopharyngoscopy allows direct visualization of the velopharyngeal valve during speech. Therefore, it is commonly used by craniofacial professionals to evaluate velopharyngeal function and dysfunction. Nasopharyngoscopy can show the size, shape, location, and cause of a velopharyngeal opening. This information is valuable in determining the best surgical procedure to achieve the most successful outcome for the patient. If either residual hypernasality or nasal emission is noted after secondary surgery, or if there is evidence of airway obstruction, nasopharyngoscopy is particularly useful in determining the type of treatment or revision surgery that is needed for further correction. Although nasopharyngoscopy is an excellent diagnostic procedure, it can be challenging to perform on young children.  The purpose of this session is to provide methods, tips, and tricks for obtaining a successful nasopharyngoscopy evaluation in children as young as age three, while causing minimal distress to the child (and the parent). In addition, this session will focus on interpretation and use the nasopharyngoscopy findings to determine the surgical procedure that has the best chance of success for each individual patient. In this study session, the presenter will discuss the basic techniques of nasopharyngoscopy and also describe some tips and tricks to elicit necessary cooperation from very young children. The presenter will then explain how nasopharyngoscopy can be used to determine the size, shape, location, and cause of the velopharyngeal opening. Numerous short videos of nasopharyngoscopy examinations will be presented for participants to evaluate and discuss. The presenter will describe how the nasopharyngoscopy findings can be used to determine which surgical procedure has the best chance of a successful outcome for the patient. Finally, the presenter will discuss how nasopharyngoscopy can be used to evaluate secondary surgery for velopharyngeal insufficiency in order to develop appropriate strategies for revision, when necessary.

Learning Objectives: Participants will be able to discuss methods for performing a nasopharyngoscopy (NP) exam with good cooperation from children as young as age 3. Participants will be able to identify the size, location, and cause of a velopharyngeal opening through NP. Participants will be able to describe how NP findings can be used to determine the best surgical procedure for the patient.

Presenters: Nicola Stock, Patricia Marik, Leanne Magee, Alexis Johns, Cassandra Aspinall, Laura Garcia, Canice Crerand

Presenter Disclosures:  Nicola Stock has no relevant financial relationships to disclose.  Nicola Stock has no relevant non-financial relationships to disclose.  Patricia Marik has no relevant financial relationships to disclose.  Patricia Marik has no relevant non-financial relationships to disclose.  Leanne Magee has no relevant financial relationships to disclose.  Leanne Magee has no relevant non-financial relationships to disclose.  Alexis Johns has no relevant financial relationships to disclose.  Alexis Johns has no relevant non-financial relationships to disclose.  Cassandra Aspinall has no relevant financial relationships to disclose.  Cassandra Aspinall has no relevant non-financial relationships to disclose.  Laura Garcia has no relevant financial relationships to disclose.  Laura Garcia has no relevant non-financial relationships to disclose.  Canice Crerand has no relevant financial relationships to disclose.  Canice Crerand has no relevant non-financial relationships to disclose.

Description: The treatment of congenital craniofacial conditions is complex and multifaceted, requiring long-term intervention from a wide range of medical providers.  Psychosocial issues associated with craniofacial diagnoses, as well as the ongoing burden of care, can have a considerable impact on the quality of life of patients and their families, and can affect how patients interact with and adhere to treatment. Drawing upon the psychosocial literature and team providers’ clinical expertise, the aims of this study session are to summarize the key psychosocial issues in craniofacial care for non-mental health team members, and to offer suggestions for how all members of craniofacial teams can promote positive psychological outcomes in the patients and families they see. This session will outline the nature, prevalence, and variation in psychosocial issues across developmental phases and how these issues can be addressed using a patient-centered multidisciplinary approach. Topics will include how to facilitate psychological adjustment in parents, how to promote positive outcomes in school, how to address teasing and bullying, how to support informed medical decision-making, how to handle periods of transition, and how to use available screening measures to assess and monitor patients’ wellbeing. The focus of this session will be to provide practical suggestions which all team disciplines can apply in practice.

Learning Objectives: Medical providers will acquire greater knowledge of psychosocial issues relevant to patients with craniofacial conditions across the treatment pathway, and will take away practical guidance in how to monitor and address psychosocial concerns in the patients and families they see.

Presenters: Courtney Hall, MS CNP, Lauren Madhoun, Caitlin Cummings, Katherine Eastman

Presenter Disclosures:  Courtney Hall has no relevant financial relationships to disclose.  Courtney Hall has no relevant non-financial relationships to disclose.  Lauren Madhoun has disclosed the following financial relationships: Salary from Nationwide Children’s Hospital.  Lauren Madhoun has no relevant non-financial relationships to disclose.  Caitlin Cummings has disclosed the following financial relationships: I receive a salary for employment as a speech-language pathologist at Nationwide Children’s Hospital.  Caitlin Cummings has no relevant non-financial relationships to disclose.  Katherine Eastman has no relevant financial relationships to disclose.  Katherine Eastman has no relevant non-financial relationships to disclose.

Description: Infants with cleft lip and/or palate (CLP) are at increased risk for feeding difficulties, poor weight gain, and failure to thrive. Medical, environmental, and psychosocial barriers can impede oral feeding success and healthy growth. Standard recommendations to change the infant’s feeding system or increase caloric concentration may not be sufficient to overcome these challenging obstacles. Additional collaborative interventions are often needed to assure successful feeding and growth outcomes. The purpose of this session is to describe a model of a multidisciplinary cleft feeding team developed at a large pediatric academic medical center that manages over 75 new infants with CLP per year.  This innovative session extends the traditional discussion of cleft-related feeding disorders by focusing on how cleft teams can identify and troubleshoot challenges to providing comprehensive feeding care for infants with CLP. This panel presentation will include providers from a cleft feeding team including a nurse practitioner, speech-language pathologist, and social worker. Each will discuss their specialized roles as well as offer strategies for improving the delegation of roles/responsibilities, feeding clinic flow, and team communication procedures for the cleft feeding team. Case studies will be included to illustrate the interdisciplinary collaborative roles of nursing, speech-language pathology, social work, nutrition, and lactation in implementing successful family-centered interventions.  The panel will present examples of interventions utilized to advance family understanding and motivation to participate in the child’s feeding treatment plan, ways to improve care plan adherence, approaches to partnering with community-based programs for home health services, and how to collaborate more effectively with local primary care providers. Strategies used to educate outside medical professionals on cleft feeding techniques, advocate with providers and local agencies, and create effective after-visit summaries and instructional materials tailored to the caregivers’ literacy level and learning style will also be discussed.

Learning Objectives: Describe the feeding, weight gain, and growth risks for infants with cleft lip and/or palate and the potential consequences of failure to thrive.  Identify the structure of a Multidisciplinary Craniofacial Feeding Team and specific roles of each professional.

Presenters: Sarah Vetter, MS CCC-SLP, MA, Julia Corcoran, MD MHPE

Presenter Disclosures:  Sarah Vetter has no relevant financial relationships to disclose.  Sarah Vetter has no relevant non-financial relationships to disclose.  Julia Corcoran has no relevant financial relationships to disclose.  Julia Corcoran has no relevant non-financial relationships to disclose.

Description: To support patient/family needs and overall outcomes, teams should provide educational information about craniofacial anomalies and related disorders to parents and patients (ACPA Parameters, 2009).  Purposeful consideration of learner understanding and application of new, unfamiliar knowledge is a prevailing concern in education.  Understanding is evidenced by transfer; transfer as defined by an individual’s application of learned knowledge and skills within novel situations (Wiggins & McTighe, 2006, Understanding by Design).  One of the most basic barriers to transfer is simply overlooking it in both the design and facilitation of an educational event (Foley & Kaiser, 2013, Learning transfer and its intentionality in adult and continuing education).  The purpose of this workshop is to provide participants with a definition of learner understanding, as well as identify the barriers to understanding that exist within their clinical practice.  Within interactive activities and authentic examples, participants will themselves gain understanding of adult learning theories and strategies which best facilitate successful knowledge transfer; they will reflect on and discuss application of these strategies within their broader team care.  Participants will gain a deeper appreciation for the importance and purposeful use of adult learning strategies in order to maximize caregiver education and family centered care. General Format of Workshop:  1) Introductions & Session Objectives.  2) Understanding and its relationship to transfer Lecture & Large group discussion  3) Barriers to Transfer Small group reflection & discussion:  Participants reflect on their own discipline and setting, identifying barriers to learner understanding   Barriers to transfer occur before, during, and after a learning experience, including a lack of foundational knowledge upon entering a learning situation, a lack of motivation or confidence during the learning, and a lack of support afterward.  4) Adult learning theories and strategies which support transfer  Group discussion & Meaning-making activities  Experiential Learning:  Reflective learning; problem-based learning; cooperative learning; authentic practice  Brain Based Learning:  Establish value / relevance of new material; connect new learning to personal experience; learn from analogy and association to establish meaning  Embodied Learning:  Attention to the body and its experiences as a way of knowing  5)         Summary & Conclusion Guided discussion & Individual reflection:  Participants create action plans for implementation of skills learned into their our clinical practice / team care  Session will be evidenced based, with references from the adult education literature coupled by authentic examples from the speakers’ practice(s) serving families of children both with cleft lip/palate.  Given the interactive nature of the workshop, participation is recommended as limited to 20-25 individuals.

Learning Objectives: Participants will: Define transfer of knowledge and how it relates to understanding. Identify barriers to understanding and analyze the impact of those barriers on caregiver education.   Participate in activities that demonstrate adult learning strategies which influence successful knowledge transfer. Reflect and discuss application of adult learning strategies within their clinical practice.

Presenters: David Zajac, PhD, CCC-SLP, Linda D. Vallino

Presenter Disclosures:  David Zajac, PhD, CCC-SLP has disclosed the following financial relationships: royalties for “Evaluation and Management of Cleft Lip and Palate: A Developmental Approach” – Plural Publishing.  David Zajac, PhD, CCC-SLP has no relevant non-financial relationships to disclose.  Linda Vallino has disclosed the following financial relationships: Dr. Vallino receives a salary as Head, Craniofacial Outcomes Research Laboratory/Senior Speech Scientist Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE. She is also: Clinical Professor of Pediatrics, Jefferson Medical College Adjunct Associate Professor, University of Delaware, Dr. Vallino is co-author of Evaluation and Management of Cleft Lip and Palate: A Developmental Approach. (with Dr. David Zajac). Dr. Vallino is co-author of Evaluation and Management of Cleft Lip and Palate: A Developmental Approach (with Dr. David Zajac).  Linda Vallino has disclosed the following non-financial relationships: Dr.Vallino is an internationally recognized scholar with extensive publications and  expertise in the field of Cleft Lip and Palate . She has a specific interest in young adults with CLP, Dr. Vallino is : Head, Craniofacial Outcomes Research Laboratory/Senior Speech Scientist Nemours/Alfred I. duPont Hospital for Children Clinical Professor of Pediatrics, Jefferson Medical College Adjunct Associate Professor, University of Delaware.

Description: The speech of individuals with repaired cleft lip and palate (CLP) and/or velopharyngeal (VP) dysfunction may include problems with resonance, nasal air escape, and articulation. Surprisingly, there is little consensus regarding descriptive terms, perceptual characteristics, and underlying causes of the problems. This is especially true for perceived nasal air escape and articulation errors. This lack of consensus may confuse and even bewilder the new SLP and other non-SLP craniofacial team members. The lack of consensus and confusion stems, in part, from the fact that most descriptions of speech problems rely primarily, if not solely, on auditory-perceptual assessment. Although the ear is undoubtedly the most important tool for assessing the acceptability of speech, it has limitations relative to differential diagnosis. The occurrence of obligatory nasal air emission due to VP dysfunction, for example, may sound similar, or even identical, to a nasal fricative that occurs as a learned articulation error.  The overall goal for this study session is to introduce the new SLP and/or non-SLP team member to the types of resonance, nasal air escape, and articulation problems that are commonly encountered in the clinic. We will focus on nasal air escape and articulation errors. We will present a practical and evidence-based framework for describing speech characteristics and for discriminating between obligatory and actively learned (compensatory) behaviors. This session will include descriptions of resonance problems including hypernasality, hyponasality, mixed hyper-hyponasality, and cul-de-sac resonance. Nasal air escape will be described from a framework of obligatory versus actively learned articulations. The two generally accepted types of obligatory nasal air escape – nasal air emission and nasal turbulence (rutle) – will be described both perceptually and spectrographically. We will then describe anterior and posterior nasal fricatives that occur as actively learned articulation errors. We will emphasize that these behaviors may sound similar, or even identical, to their obligatory counterparts. We will further emphasize that active nasal fricatives are identified by an oral stopping component. We will use oral-nasal audio recordings obtained with the Nasometer to illustrate the oral stopping gesture. Finally, we will present a practical and evidence-based framework for describing and categorizing other articulation errors. We will first describe errors according to place of production as either within (e.g., palatal stops) or outside (e.g., glottal stops) the oral cavity. We will then describe the errors as either obligatory due to oral cavity defects or as compensatory due to VP dysfunction.   The format of the study session will be an interactive lecture with ongoing questions from and discussion with participants. We will present numerous audio examples of the speech symptoms described along with spectrographic interpretations.

Learning Objectives: Each learner will be able to a) describe resonance, nasal air escape, and articulation characteristics that occur in speakers with cleft lip and palate, and b) discriminate between obligatory and compensatory behaviors that occur in speakers with repaired cleft lip and palate.

Presenters: Pradip R. Shetye, DDS, Alvaro Figueroa, DDS, MS

Presenter Disclosures:  Pradip Shetye has no relevant financial relationships to disclose.  Pradip Shetye has no relevant non-financial relationships to disclose.  Alvaro Figueroa has disclosed the following financial relationships: Royalties from KLS Martin, Jacksonville, FL, 3D Systems Patent Holder.  Alvaro Figueroa has no relevant non-financial relationships to disclose.

Description: Management of patients with cleft lip and palate is complex and requires a multidisciplinary team with several treatment interventions. Proper sequencing and timing of orthodontic and surgical treatment is important for successful long-term outcome and reducing the burden of care on the families. This presentation will focus on orthodontic management of patients born with cleft lip and palate from infancy to skeletal maturity. The management of patients with cleft lip and cleft palate requires extended orthodontic treatment and an interdisciplinary approach in providing these patients with optimal esthetics, function, and stability. Orthodontic or orthopedic management in infancy, primary, mixed and permanent dentition and after the completion of facial growth will be discussed with a proper interdisciplinary approach to treatment planning and treatment sequencing during each phase of orthodontic and surgical treatment. This presentation will discuss the presurgical infant orthopedic, pre and post bone graft orthodontics, Phase II comprehensive orthodontic treatment, LeFort I distraction and orthognathic surgery at skeletal maturity. Long-term outcome of treatment will be presented of patients treated from birth to adulthood.

Learning Objectives: Each leaner will write the goals of orthodontic treatment during infancy, mixed dentition, permanent dentition and at skeletal maturity Each leaner will write the proper timing and sequencing of orthodontic and surgical treatment for patients with cleft lip and palate Each learner will write different orthodontic treatment options at each phase of growth and development.

Thursday 3:30 PM

Presenters: Ruth Trivelpiece, Jennifer Rhodes, Cassandra Aspinall, Michael Nelson, Marilyn Cohen

Presenter Disclosures:  Ruth Trivelpiece has no relevant financial relationships to disclose.  Ruth Trivelpiece has no relevant non-financial relationships to disclose.  Jennifer Rhodes has no relevant financial relationships to disclose.  Jennifer Rhodes has no relevant non-financial relationships to disclose.  Cassandra Aspinall has no relevant financial relationships to disclose.  Cassandra Aspinall has no relevant non-financial relationships to disclose.  Michael Nelson has no relevant financial relationships to disclose.  Michael Nelson has no relevant non-financial relationships to disclose.  Marilyn Cohen has no relevant financial relationships to disclose.  Marilyn Cohen has no relevant non-financial relationships to disclose.

Description: Health care providers strive to promote the standard of care for patients with craniofacial diagnoses including provision of integrated case management and comprehensive interdisciplinary team management. Team members are increasingly challenged by financial and time restraints generated by their hospitals and practices, and inadequate reimbursements from third party payers with little or no reimbursement for time-consuming coordination of care. This panel presentation will examine the economic strategies and billing practices utilized by different teams as they work to deliver multidisciplinary care in the current economic environment. A 16 question survey using Survey Monkey with IRB approval was emailed to ACPA team members and will serve as the impetus for the presentation. Panel members will include representatives from plastic surgery, dental, social work, coordinators, pediatrics and genetics who will contribute differing perspectives of teams and their challenges and successes for funding and billing. Panelists will discuss trends identified in 305 responses from plastic surgeons (20%), orthodontists (19%), speech/language pathologists (16%), nurses/coordinators (16%), oral maxillofacial surgeons (10%), pediatric dentists (5%) and other disciplines. 30% of respondents are either current or previous team directors.  41% of respondents work in freestanding childrens hospitals and 37% in university based hospitals with pediatric services. 42% of teams meet weekly followed by monthly meetings (29%) and biweekly (15%) with scatter of other schedules. Almost half of respondents reported half day clinics. Over half (53%) of respondents volunteer their team time while 41% report billing of services or receiving direct funding. 20% of teams generate a single bill for the entire team visit while 60% bill separately and 20% of respondents were unsure of billing practices. Half of respondents state they bill for team visits and half do not. 27% of responses indicated that funding is received for team participation other than through billing. Sources of funding include hospital, military, medical or dental practice support, state support, grant funding and endowments/ donations.  Results show there is wide variability in funding sources and billing practices utilized by teams throughout the country. Despite this variability, there is consensus that most teams are underfunded, reimbursement for coordination of care is ignored, and families are facing increasingly high financial commitments with multiple copays to receive recommended team care. This panel will generate strategies to increase advocacy efforts to promote a team billing mechanism and increase awareness of insurance companies and hospital and practice administrations to better support interdisciplinary team care.

Learning Objectives: Attendees will be able to identify the different challenges facing teams including different billing models and varied funding sources within the framework of increasing pressure to providers for income generating revenues.

Presenters: Carolyn A. Kerins, DDS, PhD, YongJong Park, Michael Oppedisano, DMD

Presenter Disclosures:  Carolyn Kerins has no relevant financial relationships to disclose.  Carolyn Kerins has no relevant non-financial relationships to disclose.  Yong Jong Park has no relevant financial relationships to disclose.  Yong Jong Park has no relevant non-financial relationships to disclose.  Michael Oppedisano has no relevant financial relationships to disclose.  Michael Oppedisano has no relevant non-financial relationships to disclose.

Description: Background and purpose:  Each year many orthodontists and surgeons are faced with delivery of sub-optimal care because orthodontic treatment and surgery alone are not enough to achieve esthetic and functional success.  Many craniofacial patients require prosthodontic restorative treatment through multiple phases of care to idealize the final outcomes that can be attained.   Although the majority of craniofacial patients require some form of prosthodontic treatment, insurance (3rd party and government) often don’t cover any portion these treatment costs.  The purpose of this study session is to discuss the caveats of interdisciplinary treatment planning of craniofacial cases when prosthodontic care is anticipated.  Additionally, the session will introduce strategies for providing prosthodontic care. Description:  Previously it was taught in dental schools that clefts were a known contraindication for dental implants. This is part was due to failure to achieve adequate bone in the future implant site.  Now with improved bone grafting and ridge augmentation technologies and techniques, it is possible to attain adequate bone for dental implants.  Patients with atypical clefts or other congenital or acquired craniofacial anomalies may present with other prosthodontic needs and challenges.  This study session will illustrate some of the prosthodontic dental needs of craniofacial patients, will discuss some of the access to care and funding issues related to dental treatment, and will present some cases describing the interdisciplinary coordination between the orthodontist and prosthodontist. Upon completion of this course, participants will be able to list the typical prosthodontic needs of craniofacial patients and understand that when working with a prosthodontist, the orthodontic treatment plan will likely be modified.  Additionally, participants should be able propose funding sources to offset treatment expenses not covered by dental insurance and be able to formulate a strategy to provide prosthodontic services if a team prosthodontist is not available.

Learning Objectives: Each learner be able to list the typical prosthodontic needs of craniofacial patients and understand that when working with a prosthodontist, the orthodontic treatment plan will likely be modified.

Contributors: Adriane Baylis, Ann Bedwinek, Ellen Cohn, Scott Dailey, Karen Golding-Kushner, Lynn Grames, Mary Hardin-Jones, Julia Hobbs, Ann Kummer, Judy LeDuc, Brenda Louw, Kerry Mandulak, Jamie Perry, Dennis Ruscello, Nancy Scherer, Linda Vallino, David Zajac

Moderator: Sally Peterson-Falzone

Presenter Disclosures:  Adriane Baylis has disclosed the following financial relationships: Salary from Nationwide Children’s Hospital The Ohio State University College of Medicine, consultant for Educational Testing Services National Advisory Board for Speech-Language Pathology, Contracted Research for National Institutes of Health NIDCR.  Adriane Baylis has disclosed the following non-financial relationships: ACPA, Preconference Co-Chair and Education Committee ASHA, SIG 5 Coordinating Committee.   Ann Bedwinek has no relevant financial relationships to disclose.  Ann Bedwinek has no relevant non-financial relationships to disclose.  Ellen Cohn has disclosed the following financial relationships: Professor at University of Pittsburgh, Only for Telepractice book (Springer, UK) -not related to cleft palate, Prior –site visitor for University of Kentucky College of Health Sciences.  Ellen Cohn has no relevant non-financial relationships to disclose.  Scott Dailey has no relevant financial relationships to disclose.  Scott Dailey has no relevant non-financial relationships to disclose.  Karen Golding-Kushner has no relevant financial relationships to disclose.  Karen Golding-Kushner has no relevant non-financial relationships to disclose.  Lynn Grames has disclosed the following financial relationships: I  draw salary in the provision of evaluation and treatment for individuals with cleft palate, velopharyngeal dysfunction, and craniofacial anomalies.   Lynn Grames has disclosed the following non-financial relationships:  I serve on the Professional Development Committee for ASHA SIG 5: Craniofacial and Velopharyngeal Disorders; and on the program committee for ASHA.  Mary Hardin-Jones has no relevant financial relationships to disclose.  Mary Hardin-Jones has no relevant non-financial relationships to disclose.  Julia Hobbs has no relevant financial relationships to disclose.  Julia Hobbs has no relevant non-financial relationships to disclose.  Ann Kummer has disclosed the following financial relationships: Royalties for the textbook entitled: Cleft Palate and Craniofacial Anomalies: The Effects on Speech and Resonance Oral & Nasal Listener; Nasoscope, Patent Number: 6656128; Honoraria for seminars.  Ann Kummer has no relevant non-financial relationships to disclose.  Judy LeDuc has no relevant financial relationships to disclose.  Judy LeDuc has no relevant non-financial relationships to disclose.  Brenda Louw has disclosed the following financial relationships: I am a salaried employee of East Tennessee State University, Johnson City, TN.  Brenda Louw has disclosed the following non-financial relationships: I am a member of the ACPA and ASHA SIG 5 Craniofacial and Velopharyngeal Disorders. I am a well published researcher with a specific interest in CLP and young adults with CLP, Employed as a professor in the Dept. Audiology and Speech -Language Pathology, East Tennessee State University  Professor Emeritus, University of Pretoria, South Africa.  Kerry Mandulak has no relevant financial relationships to disclose.  Kerry Mandulak has no relevant non-financial relationships to disclose.  Jamie Perry has no relevant financial relationships to disclose.  Jamie Perry has no relevant non-financial relationships to disclose.  Dennis Ruscello has no relevant financial relationships to disclose.  Dennis Ruscello has no relevant non-financial relationships to disclose.  Nancy Scherer has no relevant financial relationships to disclose.  Nancy Scherer has no relevant non-financial relationships to disclose.  Linda Vallino has disclosed the following financial relationships: Dr. Vallino receives a salary as Head, Craniofacial Outcomes Research Laboratory/Senior Speech Scientist Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE. She is also: Clinical Professor of Pediatrics, Jefferson Medical College Adjunct Associate Professor, University of Delaware. Dr. Vallino is co-author of Evaluation and Management of Cleft Lip and Palate: A Developmental Approach. (with Dr. David Zajac).  Linda Vallino has disclosed the following non-financial relationships: Dr.Vallino is an internationally recognized scholar with extensive publications and  expertise in the field of Cleft Lip and Palate . She has a specific interest in young adults with CLP, Dr. Vallino is : Head, Craniofacial Outcomes Research Laboratory/Senior Speech Scientist Nemours/Alfred I. duPont Hospital for Children Clinical Professor of Pediatrics, Jefferson Medical College Adjunct Associate Professor, University of Delaware.  David Zajac, PhD, CCC-SLP has disclosed the following financial relationships: royalties for “Evaluation and Management of Cleft Lip and Palate: A Developmental Approach” – Plural Publishing.  David Zajac, PhD, CCC-SLP has no relevant non-financial relationships to disclose.  Sally Peterson-Falzone has no relevant financial relationships to disclose.  Sally Peterson-Falzone has no relevant non-financial relationships to disclose.

Description: In 2008, ASHA ceased requiring that training programs in speech-language pathology incorporate a mandatory course in cleft palate, significantly diminishing the exposure of graduate students to the scope of disorders associated with clefts and craniofacial syndromes.  In addition, practical experience with speakers who have these physical conditions is relatively hard to acquire both in university training programs and in the post-graduate years.   This situation has led to a dearth of SLPs who comprehend (1) the difference between obligatory speech errors and learned speech errors, and (2) why neither set of errors is comparable to developmental errors.   This, in turn, has reduced the number of SLPs who are competent to treat speakers with clefts. Method: Eighteen SLPs in the U.S. known for their experience and expertise in diagnosing and treating speech errors often associated with cleft palate or other dysfunctions of the velopharyngeal system participated in an online, asynchronous discussion over a period of several weeks.  They were asked to negate or validate the identified problem and to identify solutions.  Results:  Responses revealed unanimous frustration with the lack of knowledge in this topic area shown not only among public school SLPs but even among SLPs on some cleft palate teams.  Respondents additionally reported many other foundational misconceptions that reflect a lack of evidence-based knowledge, e.g., use of ‘oral motor’ therapy to improve velopharyngeal function in speech.  Their suggestions for improving the knowledge base among clinicians included webinars, programs targeted on a yearly basis for SLPs in the public schools; increased output of A-V materials in a variety of formats; videochats; virtual meetings; ASHA and ACPA sponsored short courses; posters and presentations at the Schools Connect and Private Practice Connect conferences; state association meetings, etc.         Conclusions:  In addition to presenting the results of our ‘virtual focus group,’ this program will engage audience members in participatory problem solving.  The specific aims are to heighten awareness of the problem (i.e., an SLP workforce that is not uniformly prepared to treat children with clefts), identify causation (i.e., using the Five Whys technique from the Analyze phase of the Six Sigma DMAIC (Define, Measure, Analyze, Improve, Control) methodology, and generate solutions.

Learning Objectives: Objectives of presentation:  As a result of this activity, learners will be able to  (1) Discuss why it is important for SLPs to discriminate learned speech errors from obligatory errors in speakers with repaired clefts and other forms of velopharyngeal dysfunction. (2) Discuss why it is important for SLPs to differentiate both of the above types of errors from developmental errors.

Presenters: Ann Kummer, PhD

Presenter Disclosures:  Ann Kummer has disclosed the following financial relationships: Royalties for the textbook entitled: Cleft Palate and Craniofacial Anomalies: The Effects on Speech and Resonance Oral & Nasal Listener; Nasoscope, Patent Number: 6656128; Honoraria for seminars.  Ann Kummer has no relevant non-financial relationships to disclose.

Description: It is well-known that children with cleft lip/palate often experience speech disorders due to velopharyngeal insufficiency (VPI). What is less discussed is that they also demonstrated speech difficulties due to other causes, including related oral, dental and occlusal anomalies. These speech difficulties often persist into early adulthood when the occlusal abnormalities are surgical corrected.  Because the tongue always rests in the mandible, an abnormal position of the mandible relative to the maxilla can negatively impact the position of the tongue relative to the alveolar ridge. This can affect the production of many or all lingual-alveolar sounds. In addition, abnormal jaw position can affect bilabial competence, which affects bilabial sounds. Maxillary retrusion affects the size of the oral cavity, which can cause lingual crowding, and also have a negative impact on oral resonance. Even malpositioned teeth can cause speech distortion if they interfere with the movement of the tongue or the direction of the airstream. Finally, speech production can be affected by other oral anomalies, such as macroglossia or a fistula.  Structural abnormalities of the jaws and oral cavity can cause obligatory speech errors, where the speech distortion is directly due to the abnormal structure. They can also result in compensatory speech errors, where the function is altered in response to the abnormal structure. A differential diagnosis is important because obligatory errors can only be corrected through physical management. Compensatory errors can be corrected with speech therapy, but this is best done after the abnormal structure is corrected.  The purpose of this presentation is to describe how malocclusion, dental anomalies and oral anomalies affect speech and resonance. This presentation will also cover how physical correction of these abnormalities will correct obligatory distortions (without the need for speech therapy) and how and when speech therapy is indicated for compensatory productions. This course will include a discussion of how structure, function and even the physics of airflow and sound interact during the production of normal oral speech, using a sort of ‘science experiment’ approach. The presenter will then describe how abnormalities of the jaws and oral cavity (i.e., dental abnormalities, malocclusion, and other oral anomalies) can cause obligatory distortions and/or compensatory errors. These distortions and errors will be demonstrated and many short videos will be shown to illustrate the points. The importance of differential diagnosis will be stressed because management decisions need to be based on the diagnosis.   This course is appropriate for not only speech-language pathologists, but is also very appropriate for dental professionals and surgeons.

Learning Objectives: Each learner will be able to discuss how structure, function and physics interact during the production of normal speech. Each learner will be able to describe how various oral, dental and occlusal anomalies affect both speech and resonance. Each learner will be able to determine appropriate treatment based on whether there are obligatory distortions or compensatory errors.

Presenters: Richard E. Kirschner, MD

Presenter Disclosures:  Richard Kirschner has no relevant financial relationships to disclose.  Richard Kirschner has no relevant non-financial relationships to disclose.

Description: More than 60 years after Millard performed the first rotation-advancement procedure, the technique remains the mainstay for unilateral cleft lip repair across the globe.  Much has changed since its first description, as Millard and others have introduced many technical variations, each designed to perfect the final result.  By its nature, the technique allows for considerable variation in execution, allowing the experienced surgeon to more closely recreate the normal anatomy of the lip and nasal tip.  For the novice surgeon, however, such fluidity may serve as a drawback, for the exact position of a single point or line may destine the operation to success or doom it to something less.  This course will present the technique of a modified rotation-advancement repair that may be used to achieve successful and reproducible outcomes in the repair of all unilateral clefts. Through the use of standard lecture format and video presentation, this course will offer a vividly illustrated, interactive, step-by-step guide to unilateral rotation-advancement cleft lip repair for the beginning cleft surgeon.

Learning Objectives: The learner will be able to describe and execute a technique of modified rotation-advancement cleft lip repair.

Presenters: Jennifer Woerner, Jean-Charles Doucet, Ronald Hathaway, Timothy Turvey, Stephanie Drew

Presenter Disclosures:  Jennifer Woerner has no relevant financial relationships to disclose.  Jennifer Woerner has no relevant non-financial relationships to disclose.  Jean-Charles Doucet has no relevant financial relationships to disclose.  Jean-Charles Doucet has no relevant non-financial relationships to disclose.  Ronald Hathaway has no relevant financial relationships to disclose.  Ronald Hathaway has no relevant non-financial relationships to disclose.  Timothy Turvey  has no relevant financial relationships to disclose.  Timothy Turvey  has no relevant non-financial relationships to disclose.  Stephanie Drew has no relevant financial relationships to disclose.  Stephanie Drew has no relevant non-financial relationships to disclose.

Description: Ideal rehabilitation of the alveolar cleft includes closure of the oronasal fistula, consolidation of the maxilla with return of arch form, eruption of the permanent dentition, ability to orthodontically expand or move teeth through the grafted site, and creation of a sufficient bone stock to facilitate dental implant placement or prosthetic rehabilitation.    There is still controversy as to the timing of repair and whether primary, early secondary, or late secondary repair is the best option to fulfill all the above stated goals.  Also, it is often noted the bone graft harvest site has a higher complication rate and creates more pain then the surgical site itself.  Due to this, efforts have been made to find other grafting options, such as allograft and bone morphogenic protein, as an equivalent to autogenous bone.    The purpose of this 90-minute panel discussion is to educate the audience on controversial techniques for alveolar cleft bone grafting to be focused on timing of oronasal fistula closure and types of bone grafting materials utilized.  The general goals of the panel are to provide evidence based discussion, supported by cases presentations to evaluate the use of gingivoperiosteoplasty, describe variations in orthodontic preparation for alveolar bone grafting as related to timing of repair, describe the benefits of traditional timing of alveolar cleft bone grafting with autogenous bone, discuss the benefits and drawbacks to early secondary alveolar cleft bone grafting and possible impact on growth, and 5) Assess the use of BMP and allograft in alveolar bone grafting and data surrounding their use. This course will include intermediate-level discussion utilizing 12 minute lectures followed by 5 minutes of Q & A with 5 minutes from the standpoints of pro gingivoperioplasty, orthodontic preparation for alveolar cleft bone grafting related to timing, pro traditional timing with autogenous bone, pro early secondary alveolar cleft bone grafting, and pros for the use of bone morphogenic protein and allograft.

Learning Objectives: Each learner will be able to 1)Discuss gingivoperiosteoplasty and evidence relating to its use 2)Better understand orthodontic preparation for alveolar bone grafting as related to timing of repair 3)Describe traditional alveolar cleft bone grafting with autogenous bone 4)Discuss benefits and drawbacks to early secondary alveolar cleft bone grafting 5)Assess the use of BMP in alveolar bone grafting.

Presenters: Kelly Cordero, PhD, CCC-SLP, Angela Dixon, MA, CCC-SLP, Adriane Baylis, Kristina Wilson, Anna Thurmes

Presenter Disclosures:  Kelly Cordero has disclosed the following financial relationships: I receive a full-time salary at Barrow Cleft and Craniofacial Salary. Until 6/30/17 I received funding as a rater for NIDCR funded grant ‘An inter-center comparison of speech outcomes:  The Americleft project.’  Honorarium from ASU Women in Philanthropy Grant for participation in Cleft/Craniofacial feeding certificate modu.  Kelly Cordero has disclosed the following non-financial relationships: Member of Americleft Task Force (now inactive).  Angela Dixon has no relevant financial relationships to disclose.  Angela Dixon has no relevant non-financial relationships to disclose.  Adriane Baylis has disclosed the following financial relationships: Salary from Nationwide Children’s Hospital The Ohio State University College of Medicine, consultant for Educational Testing Services National Advisory Board for Speech-Language Pathology, Contracted Research for National Institutes of Health NIDCR.  Adriane Baylis has disclosed the following non-financial relationships: ACPA, Preconference Co-Chair and Education Committee ASHA, SIG 5 Coordinating Committee.  Kristina Wilson has disclosed the following financial relationships: Salary and Contracted Research from NIH grant funding.  Kristina Wilson has disclosed the following non-financial relationships: Board Member, ACPA Coordinating Committee Member, ASHA SIG5.  Anna Thurmes has no relevant financial relationships to disclose.  Anna Thurmes has no relevant non-financial relationships to disclose.

Description: Monitoring and reporting of speech outcomes is recognized as a critical component of cleft/craniofacial team care, both to optimize patient care and to meet the growing requirements of payers, healthcare institutions and the requests of patients.  In order to provide high quality speech outcome data, standardized speech assessment procedures and a valid and reliable ratings tool must be established.  There has not yet been consensus upon one evaluation tool and therefore, it has been difficult for teams to implement this process.  This study session aims to describe a standardized speech outcomes assessment protocol, based on the Americleft speech project, for evaluation of patients seen at cleft palate clinics in the U.S.  In addition, strategies for how SLPs can rate speech samples at their center to minimize bias, determine rater reliability, and maximize efficiency will be discussed. This session will provide a description of the Americleft speech protocol including the speech sample, elicitation and recording procedure, and the CAPS-A-AM rating scale (Chapman et al., 2016).  Clinical adaptations of research-derived procedures utilized by SLP clinicians involved in this project will be shared.  Techniques to evaluate speech outcome data within an individual center will be discussed, including the development of ‘listening calibration sessions’ using speech samples collected within the clinical environment.  These sessions can be organized to obtain consensus ratings on partially blinded samples and to establish or improve reliability between raters at the same center.  Strategies for utilization of speech outcome data for quality improvement projects vs research will be shared.  HIPAA considerations and IRB requirements will also be addressed.  Presenters will share their tips and experiences for collecting, storing, analyzing, and reporting speech outcome data within a busy clinical setting.

Learning Objectives: Attendees will: -describe methods for collecting standard high quality speech outcome data, including a clinical protocol based on the Americleft speech project. -identify documentation and regulatory requirements (e.g.  IRB) that may be necessary to collect and/or report speech outcome data for research. -describe strategies for analyzing and reporting speech outcome data for quality improvement.

Presenters: James Seaward, Rami Hallac, Maleeh Effendi, Kaylee Williams, Alex Kane

Presenter Disclosures:  James Seaward has no relevant financial relationships to disclose.  James Seaward has no relevant non-financial relationships to disclose.  Rami Hallac has no relevant financial relationships to disclose.  Rami Hallac has no relevant non-financial relationships to disclose.  Maleeh Effendi has no relevant financial relationships to disclose.  Maleeh Effendi has no relevant non-financial relationships to disclose.  Kaylee Williams has no relevant financial relationships to disclose.  Kaylee Williams has no relevant non-financial relationships to disclose.  Alex Kane has no relevant financial relationships to disclose.  Alex Kane has no relevant non-financial relationships to disclose.

Description: The true incidence of neonatal auricular deformities is unclear, with reported rates from 0.1% to 45%. Ear molding has been growing in popularity over the last 20 years as a non-surgical treatment option and several techniques have been proposed. These techniques vary widely in complexity, compliance and cost, yet few published large series of ear molding outcomes are available in the literature. We have developed an inexpensive and effective technique for neonatal ear molding, with predictable and successful outcomes, and propose a practical hands-on instructional course, using flexible 3D printed models, for providers interested in developing an ear molding service. At our Tertiary Children’s Hospital Plastic Surgery Clinic, we have established a dedicated ear molding clinic. All patients referred with neonatal ear deformities are evaluated and, if appropriate treated either with the Earwell system, or more commonly with our technique combining custom molded dental clay secured to the ear using Micropore tape. Ear molding is reviewed, adjusted and reapplied every 3  weeks throughout treatment, and the treatment is undertaken by Physician Assistants. To date, 285 ears have been treated in 153 patients. Our patients’ age at treatment initiation ranged from 3 to 116 days old with median of 10 days old. We have evaluated our treatment outcomes to date by having 3 plastic surgeons rate the severity of ear deformity pre- and post-molding on review of standardized photographs of pairs of ears pre- and post-treatment. The evaluation was conducted using a 5-point Likert scale ranging from 1-Normal to 5-Severe. Incompletely treated or non-compliant patients were excluded. The mean pre-treatment deformity was 3.8 with a median of 4. There was significant improvement (p<0.01) from molding therapy with a post-treatment mean deformity of 1.9 (median 2).  Overall, success rate was excellent with improvement noted in 99.0%, and 73.3% of ears were categorized as  normal (severity rating of 1-2) following treatment. Outcomes were further stratified based on deformity subtypes and treatment age and will be presented. This practical, hands-on instructional course will review our treatment technique and algorithm, and will enable providers interested in developing an ear molding service to gain the skills necessary to undertake neonatal ear molding in a predictable and effective way. The course will include the use of flexible 3D printed models to enable participants to gain hands-on training in creating and applying the appropriate molds for a variety of ear deformities. On completion of this course, participants will be trained in and have practiced the skills necessary to undertake neonatal ear molding effectively and safely.

Learning Objectives: Each learner will be able to undertake our ear molding technique and apply this treatment modality to their cleft / craniofacial team.