Utilizing Augmentative and Alternative Communication and a Mixed Therapy Approach to Address the Complex Communication Needs for a Patient With Cleft Palate, Velopharyngeal Insufficiency, Spina Bifida, and 16p11.2 Deletion Syndrome.

Purpose: This study aims to describe the use of a mixed therapy approach--including enhanced milieu teaching with phonological emphasis (EMT + PE), implementation of augmentative and alternative communication (AAC), and articulatory shaping (AS)--to support language and articulation skills for a patient with complex communication needs. Method: This case study presents the speech therapy treatment plan over a 3-year period for a patient with a history of unilateral cleft lip and palate, velopharyngeal insufficiency (VPI), spina bifida meningomyelocele, and 16p11.2 deletion syndrome. Results: At 16 months old, the patient was using one consonant phoneme and one spontaneous word. EMT + PE was utilized during the early intervention period to address language skills. At 35 months old, he was attempting three consonant phonemes and had nine spontaneous words in his expressive vocabulary. Due to limited progress with traditional language therapy alone, an AAC device was introduced to increase his participation with communication partners while continuing to work on verbal language skills using EMT + PE. At 4 years old, compensatory articulation errors became evident, and symptoms of VPI were observed. AS began to be utilized in therapy, in addition to EMT + PE and his AAC device, to expand his phonetic inventory in preparation for future VPI management. Conclusions: Patients with cleft palate and other comorbidities may present with complex communication needs. Individuals with a similar communication profile to the patient described in this case study may benefit from a mixed therapy approach that includes EMT, AAC, and AS to maximize language and articulation progress and enable participation with communication partners.