By Karen Tessler, PhD
As the speech language pathologist at the Rush Craniofacial Center, I have the great honor of working with patients and families who are coping with birth defects that affect the head and face. These families give new and true meaning to the concept of beauty.
Cleft lip and palate is the most common birth defect, affecting about 1 in 800 births per year. In the Craniofacial Center, we see children with those as well as other less common craniofacial anomalies, such as Apert’s syndrome, which affects skull and facial growth, fingers, toes and the palate.
These congenital defects not only cause irregular appearance, they also result in speech deficits such as hypernasality and articulation disorders. These difficulties affect the ability for these patients to produce speech that others will easily understand.
By using assessment techniques and instituting resonance and articulation therapy, speech pathologists help their patients achieve normal or greatly improved speaking ability. This function, which most of us take for granted, is crucial to a child’s cognitive development, social acceptance and educational success.
A child who is able to produce a “b” sound after years of having it sound like an “m’ due to hypernasality can suddenly make himself better understood to those around him. Such improvements reduce his frustration and bring great joy to the entire family. Every sound that is mastered by a child makes me feel like I have given the child an additional tool for success in life.
‘The confidence to share her voice’
One particularly gratifying example of the impact speech therapy can make on a child’s life is a girl I’ll call Alicia (not her real name). She was born with hemifacial microsomia, a condition in which the lower portion of one side of the face fails to adequately grow in a developing fetus.
The results of this condition can include an underdeveloped cheek and jaw and an absent or incomplete ear on the affected side. The overall impression is that of an asymmetrical face.
Alicia has not had it easy. She has undergone several surgical procedures to help align her lower face. Multiple hospitalizations, foster parenting and social difficulties marked her early years. She needed a great deal of support to help her through her early years of looking very different than her peers and coping with the impact of her appearance on her sense of self.
When I started seeing Alicia six years ago for her yearly follow up at the Craniofacial Center, her speech was very difficult to understand. Her impairment furthered her already difficult social situation with friends and classmates. Not being easily understood and not having the ability to effortlessly share knowledge and feelings made an already hard situation that much worse.
Upon examining her, I noted that Alicia presented with severe ankyloglossia — known as “tongue tie.” This condition prevented her from moving the tip of her tongue because it was attached to the floor of her mouth by a tight frenulum (tissue under the tongue). A surgeon performed a procedure to release the tongue tip, finally allowing Alicia full movement of her tongue.
Since pediatric speech and language treatment services recently began for Rush craniofacial patients, Alicia and I have engaged in intensive articulation therapy to help her gain control of her tongue. With slow and steady work, Alicia has been able to increase her control over her tongue movements, which has had a great effect on her overall intelligibility.
Alicia is now 18 years old. She recently has undergone additional surgeries to help make both sides of her face look more symmetrical. She is also in the process of having an ear built from the cartilage of her ribs, a set of complex and difficult surgeries.
She is starting to blossom, wearing makeup and having her hair done in a way that flatters her face. Her braces have come off her teeth, leaving Alicia with a spectacular smile. Alicia continues to work with me on perfecting her speech and recently gave me a preview of an oral presentation she was giving to her senior class. She sounded great.
With her physical appearance greatly improved, Alicia is ready to meet the challenges of graduating high school and starting her college career. Working on clarity of speech is giving her the confidence to share her voice with the world.
Rush recently expanded the offerings in its Speech and Language Clinic to include assessment and treatment of Rush patients from the Craniofacial Center as well as general pediatric speech and language services. I am thrilled and honored to be able to offer this transformative service to Rush pediatric patients.
Karen Tessler, PhD, is a speech language pathologist and assistant professor at Rush. For information regarding the Speech and Language Clinic at Rush, please call Michele Casalor at (312) 942-5013, or for the Rush Craniofacial Center, please contact Nicole Heller, DNP, at (312) 563-2578.