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The Source® for Cleft Palate and Craniofacial Speech Disorders
Ages: Birth-18   Grades: Birth-Adult

SLPs who see a few children with craniofacial conditions and SLPs who are new to the craniofacial team will be well-prepared to assess and treat such children with this comprehensive resource!


  • Effectively assess the speech problems exhibited by children with cleft palate and/or craniofacial anomalies
  • Eliminate compensatory articulation errors with phonetically-controlled stimuli
  • Reduce the symptoms of velopharyngeal dysfunction and improve intelligibility
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This book explains:

  • the unique speech needs of infants and children with cleft palate and/or craniofacial anomalies
  • what speech skills to address at each stage of development
  • how to prevent faulty learning of compensatory errors of speech
  • how to differentiate speech symptoms due to physical limitations from speech symptoms due to learned patterns (which require speech therapy)
  • how to treat compensatory errors of speech with a step-by-step, phonetically-controlled approach
  • how to manage and reduce the symptoms of velopharyngeal dysfunction

Ready-to-use tools are found in the book to help you assess and treat cleft palate and craniofacial speech disorders.  The book comes with a FREE CD of these printable materials in PDF format:

  • The Cleft Palate and Craniofacial Speech Assessment (CPCSA) consisting of:
    • Articulation Screening (for compensatory errors of speech)
    • Cleft Palate and Craniofacial Case History
    • Oral Peripheral Evaluation
    • Velopharyngeal Functioning Scale
    • Auditory-Perceptual Evaluation
  • 79 pages of pictures and scenes with phonetically-controlled stimuli to eliminate compensatory errors of speech
  • 19 pages of pictures and scenes with phonetically-controlled stimuli to improve intelligibility by reducing symptoms of velopharyngeal dysfunction
  • 18 pages of word, phrase, and sentence lists for the treatment of compensatory errors of speech
  • 6 pages of word, phrase, and sentence lists for the management of velopharyngeal functioning


Copyright © 2010

138-page book plus a CD of an additional 136 printable pages in PDF format (printable evaluation tools and therapy materials)
  • Management of patients with craniofacial anomalies is best provided by an interdisciplinary team of specialists (including speech-language pathologists, plastic surgeons, orthodontists, maxillofacial surgeons, audiologists, otolaryngologists, dentists, geneticists, pediatricians, nurses, nutritionists, audiologists, social workers) to comprehensively monitor the child's development through facial growth maturity (ACPA, 2007b).
  • The speech-language pathologist works within the framework of an interdisciplinary cleft palate team, extending its network into the community (Taylor-Goh, 2005).
  • Cleft palate and craniofacial disorders may adversely affect normal resonance and speech, and/or typical language development (Peterson-Falzone, Trost-Cardamone, Karnell, & Hardin-Jones, 2006).
  • Assessing characteristics of cleft palate and/or craniofacial speech involves evaluating nasality and nasal air emissions, resonance, compensatory articulations, and obligatory articulations (ACPA, 2007a).
  • The perceptual assessment of speech is the gold standard and has a central position in the assessmentof velopharyngeal dysfunction (Taylor-Goh, 2005).
  • Speech characteristics are typically evaluated through a combination of auditory-perceptual, aero-dynamic, and instrumental measures to accurately describe and quantify the child's resonance and speech (ACPA, 2007a).
  • If compensatory errors of speech are habituated and/or imbedded into the child's phonological system, the errors may persist after initial palate surgery, and intensive speech therapy is warranted (Peterson-Falzone, Trost-Cardamone, Karnell, & Hardin-Jones, 2006).
  • Dysfunction of the velopharyngeal valving mechanism can be the result of compensatory articulation errors, and improvement in the velopharyngeal valving can occur through speech therapy aimed at elimination of compensatory articulation errors (Hoch, Golding-Kushner, Siegel-Sadewitz, & Shprintzen, 1986).
  • Treatment includes remediating compensatory errors using a multi-sensory (visual, tactile, auditory) articulation approach, not an oral-motor approach (which is ineffective in treating velopharyngeal dysfunction or compensatory errors of speech) (Taylor-Goh, 2005; Lass & Pannbacker, 2008).
  • Blowing exercises and oral-motor therapy are not useful in treating velopharyngeal dysfunction. (ACPA, 2007a).  

The Source for Cleft Palate and Craniofacial Speech Disorders incorporates these principles and is also based on expert professional practice.


American Cleft Palate-Craniofacial Association (ACPA). (2007a). Core curriculum for cleft palate and other craniofacial anomalies. Retrieved September 11, 2009, from

American Cleft Palate-Craniofacial Association (ACPA). (2007b). Parameters for evaluation and treatment of patients with cleft lip/palate or other craniofacial anomalies. Retrieved September 11, 2009, from

Hoch, L., Golding-Kushner, K., Siegel-Sadewitz, V.L., & Shprintzen, R.J. (1986). Speech therapy. Seminars in Speech Language, 7, 313-325.

Lass, N.J., & Pannbacker, M. (2008). The application of evidence-based practice to nonspeech oral motor treatments. Language, Speech, and Hearing Services in Schools, 39(3), 408-421.

Peterson-Falzone, S.J., Trost-Cardamone, J., Karnell, M.P., & Hardin-Jones, M.A. (2006). The clinician's guide to treating cleft palate speech. St. Louis, MO: Mosby.

Taylor-Goh, S. (2005). Royal college of speech and language therapists: Clinical guidelines. United Kingdom: Speechmark.


Sandra L. Sulprizio


Sandra L. Sulprizio, MSPA, CCC-SLP, received her bachelor's and master's degrees from the University of Washington in Seattle and worked there as a speech-language pathologist in early infant and school district programs.  After five years, she moved to California, where she was employed by the Oakland Unified School District in their "special speech" programs.  Later she joined the staff at Children's Hospital Oakland.  With other pediatric specialists, she established one of the first craniofacial and cleft lip and palate clinics in the East Bay and started the speech and nasoendoscopy programs.  Years later, Kaiser Permanente started the Northern California Craniofacial Clinic.  Again, Sandra introduced the speech and nasoendoscopy clinics.  She is currently a speech coordinator in their craniofacial clinic.

Sandra has evaluated and provided speech therapy for craniofacially- involved children almost exclusively for over 20 years.  She has taught the Oral Facial Anomalies class at California State University-East Bay and has given many in-services and seminars on cleft palate speech therapy to school districts and universities.  She has written articles on cleft palate speech therapy and 22q11.2 (VCF-velocardiofacial syndrome) both from a surgical and clinical standpoint, and she has presented at state and national organizations.

Sandra is a member of the American Speech-Language-Hearing Association (ASHA), California Speech-Language-Hearing Association (CSHA), and American Cleft Palate-Craniofacial Association (ACPA).  She is actively involved in CSHA and ACPA committees.  She co-authored the speech pathology portion of the ACPA's Core Curriculum.

Aside from work, Sandra has two lovely, adult children, Gina and Dino, and a wonderful, supportive husband.  Her weekends are filled with road and mountain bike riding, downhill and cross country skiing, gardening, and reading.

The Source for Cleft Palate and Craniofacial Speech Disorders is Sandra's first publication with LinguiSystems.


The Source for Cleft Palate and Craniofacial Speech Disorders is intended for school- and community-based speech-language pathologists (SLPs) who might only see a few individuals with craniofacial conditions and SLPs who are new to the craniofacial team setting.

Many training programs do not offer classes on cleft palate and/or spend only a few weeks studying this area (Grames, 2009).  Most class curriculum is spent on anatomy, physiology, and diagnosis, with little time left for the application of speech therapy.

To help fill this void, I frequently write a treatment program with every clinic evaluation, including words to target in a step-by-step approach.  I have found that this information is appreciated by treating SLPs.  For this reason, I wrote this book to provide more specific information about cleft and craniofacial disorders as well as the appropriate steps and picture stimuli for therapy.

Overview of the book:

  • Chapter 1 provides a review of speech anatomy and physiology.
  • Chapter 2 describes effective auditory-perceptual assessment and includes a rating scale for velopharyngeal dysfunction (VPD) and test forms to evaluate resonance, inappropriate nasal air emission, and articulation.
  • Chapter 3 reviews proven and effective speech therapy approaches.
  • Chapter 4 describes a variety of craniofacial conditions and provides early communication strategies for families to help prevent or reduce speech problems.  Since many of the articulation problems of children with cleft palate/craniofacial disorders are the result of gross mislearning, early intervention can play a key role in preventing or at least reducing speech problems.
  • Chapter 5 outlines a program for early speech intervention for children with palatal problems.  With the help of the SLP, early intervention can be carried out by families.
  • Chapter 6 provides a step-by-step, phonetically-controlled approach to eliminating compensatory errors of speech.  It includes targeted phonemes in pictures and scenes, vocabulary with correctly produced non-target phonemes, and phrase and sentence lists for imitation and generalization.  Strategies to work with adolescents and adults along with ideas for essential home and school carryover are also provided.
  • Chapter 7 suggests techniques to reduce symptoms of VPD and to improve intelligibility.  It includes information on instrumental measurements, prosthetic management, and speech therapy.

My goal is to provide you with a useful resource to increase your competency and accuracy in treating individuals with cleft palate and craniofacial speech disorders.  I hope the information presented here demystifies the challenges and treatment of compensatory speech errors.