In the El Paso Cleft Lip and Palate Clinic, students from The University of Texas at El Paso’s Speech-Language Pathology (SLP) program gain a deeper understanding of the evaluation, treatment and care of individuals born with clefts, or holes, in their lip or palate, the roof of the mouth.
Since November 2017, eight graduate students have participated in the SLP program’s new specialty rotation at the monthly clinic. It offers students an opportunity to increase their knowledge of speech disorders and other medical conditions that affect individuals born with a cleft lip, cleft palate, or both.
“This was a completely unique educational opportunity,” said Marylu Vazquez, one of the first students to participate in the rotation, who graduated from UTEP in May 2018. Today she is a bilingual speech-language pathologist at a local pediatric clinic. “It exposed me to an area that we often don’t have time to cover in depth in class but is vastly in need of our services.”
Cleft lips and cleft palates are the second most common birth defects in the United States.
Children with these facial anomalies may have difficulty with speaking, eating and hearing. They also typically have dental issues. Furthermore, the condition could lead to psychological and social concerns that families may need to address.
SLP students gain real-world experience working with the clinic’s multidisciplinary team of health professionals. Each clinic draws approximately 25 patients from El Paso and Juárez who have clefts that range from mild to severe. The students screen individuals with a cleft for speech problems and consult with parents about their children’s language and eating issues.
Magda Alvarado Mena is one of four SLP students who started the rotation in June. The free clinic is offered once a month at Southwest Ear, Nose & Throat Consultants, 1600 Medical Center Street, Room 101.
The 22-week rotation, which ends in November, will count toward the 400 clinical education hours Alvarado must complete to graduate from the program. Students work in pairs under the watchful eye of two clinical supervisors who ensure they competently evaluate each patient.
At the June clinic, Alvarado and her partner consulted with parents and played word games with children to determine if they had problems with certain consonant sounds, such as “p” in “puppy.” They also listened for hypernasality, a disorder that affects individuals with a cleft palate because there is a separation between their oral and nasal cavities.
“This is hands-on learning for us,” said Alvarado, who expects to graduate in May 2019. “I think this experience will help me in the future to better provide services.”
The clinic combines the expertise of different medical providers who develop a specialized treatment plan to address each of the patient’s needs. The team includes dentists, orthodontists, pediatricians, nurse practitioners, speech pathologists, audiologists, otolaryngologists (ear, nose and throat doctors) and oral maxillofacial surgeons, specialists who treat diseases, injuries and defects to the hard and soft tissues around the head, neck, face and jaws.
During the rotations, specialists such as maxillofacial surgeons and otolaryngologists introduce students to different procedures and treatment options that they may not have learned about in class, said Gloria Macias-DeFrance, SLP lecturer and clinical supervisor.
“The development of specialties is so important because when someone brings you their child with special needs, they not only require a lot more attention than a typical developing child, but they require specific intervention strategies,” Macias-DeFrance said.
The UTEP lecturer said she plans to collaborate with community resources to create specialty rotations in aural rehabilitation for children with hearing loss, and in augmentative and alternative communication (AAC) for children who are nonverbal, The rotations will start in the 2019 spring semester.
“As a clinician, you need to be prepared to answer all parents’ questions,” Macias-DeFrance said. “This helps develop trust and paves a pathway to a sense of normalcy that families seek.”
She developed the specialty rotation with Karin De La Fuente, a speech-language pathologist who has supervised SLP graduate students in clinical settings for 25 years.
De La Fuente, owner of El Paso Speech & Language Service Excellence Inc., has volunteered with the clinic since 2015. She has traveled to Bolivia and Mexico to volunteer with Operation Smile, an international medical charity that provides free surgeries for children and young adults in developing countries who are born with cleft lips, cleft palates or other dental or facial conditions.
As part of their clinical preparation, students read journal articles about the subject and receive a list of cleft terminology. De La Fuente also briefs them about their clinical roles and responsibilities.
Before making their assessment, students review the patient’s chart that has reports from different medical providers such as the audiologist. They identify the patient’s structural abnormalities that may affect his or her ability to speak, eat or swallow.
Once with the patient, students screen for voice, resonance or articulation disorders. They ask parents about their speech therapy goals for their child and the services their child receives at home or at school.
“The students are super excited about how much learning is going on,” De La Fuente said. “Not just from me but from all the other disciplines.”
Vazquez, who completed her rotation in January 2018, returned to the clinic in June to help ease the transition of the new student teams. Alvarado said watching Vazquez evaluate patients helped her to better understand the process.
At the end of the clinic, students meet with the team to discuss their findings. They talk about each patient’s progress and make recommendations to continue therapy or suggest different treatment options.
Vazquez said that learning from the team’s health professionals has made her a better practitioner.
“What I have loved about the rotation, more than the opportunity to develop my skill set as a speech-language pathologist, is learning from other health care professionals who are just as committed as me to serving the border region,” Vazquez said.
Author: Laura L. Acosta – UTEP Communications