Repaired bilateral cleft lip has hypernasal speech

This Monday I will see a 25 year-old with a repaired bilateral cleft lip and palate who has hypernasal speech.  She has very clear myo issues as well just by looking at her smile and face:  (crowded teeth, open mouth posture, etc). I thought that I would treat her case like any other myo case as far as oral habits?  She presents with asymmetric lips due to the cleft repair.  Would you recommend  the Battle Button exercise?  I am afraid that this might hurt her lips?  I feel like this is a silly question but you and Becky said there is not silly questions. … I feel nervous because I have not had a client with a cleft palate repair before.

A: Why is the person coming to see you? Who sent her or was did she find you on her own?  What are her goals in seeking therapy?  Is she coming for her voice issue only or was she sent as a myo case?  Without that info, I can’t give a more thorough response.  I would handle each of those scenarios somewhat differently, working in conjunction with any medical/dental person sending her as opposed to easing her into the information about myo and how it relates to her difficulties.  As for exercises, unless her repair was recent, she probably can follow through with usual myo exercises from the Myo Manual Treatment Program.  As I mentioned in class, we don’t do anything that hurts or aggravates any condition.  I doubt that will be the case, but your case history will be important to know how to proceed. Remember that we maximize each patient according to their abilities. I hope this helps and please do share with Myo Masters …. Sandra