This document describes the appropriate hierarchy of speech therapy for a child after they have received surgery to repair their cleft palate.
Cleft Palate Speech Therapy Hierarchy
Download Link: Cleft Palate Speech Articulation Hierarchy
- Discrimination. Begin with discrimination between the correct production and the compensatory production (ex. bilabial plosive P production versus a glottal stop)
- Single Sounds. Work on the sound in isolation.
- Syllables*. Work on the sound in syllables. (Acevedo Spoke: consonant-vowel CV, VCV, VC). E.g. CV-pa, pa, pa, pa, then pa, pe, pi, po, pu, then VC ap, ap, ap, then ap, ep, ip, op, up, then, VCV-apa, epe, ipi , opo, upu.
- Words**. Target the sound in words*
- Begin with the sound in initial position (first sound in a word)
- Then the sound in final position (last sound in a word)
- Then the sound in the medial position (middle sound in a word)
- Phrases and Sentences. Target the sound in short phrases and then sentences.
- Conversation. Target the sound in conversation.
- Begin hierarchy again with the next sound on the patient’s therapy plan
* See the Acevedo Spoke video on LEADERSproject.org to learn speech therapy strategies when the child is at the syllable stage
** Use the cleft palate speech therapy books on LEADERSproject.org. These books each focus on particular high-pressure oral sounds and eliminate others that are challenging to those with cleft palate speech
NB: Voiceless cognate is generally targeted before the voiced sound of the same manner and place. E.g., target P (voiceless) before B (voiced)
NB: The client must be able to produce the sound with 100% accuracy at one stage on the hierarchy before moving to the next stage.