專業(yè)英語(yǔ) Unit 26教案學(xué)習(xí)資料

UnitTwentySixCleftPalateandCleftLip:aTeamApproachtoClinicalManagementandRehabilitationofthePatientDuringthe1930sand1940smostchildrenwhohadundergonesurgeryforcleftpalaterequiredspeechtherapy.Butatthattimeitwascommonpracticeforsurgeonstowaituntiltheageofthreeorfourtoclosethepalate.Naturallythechildhaddevelopedhislanguagebyagefourandfrequentlyhadacquiredcompensatoryarticulationhabitsbecauseofaconstrictedmaxillaandanonfunctionalvelopharyngealport.Hisunoperatedconditionmadeitimpossibleforhimtoimpoundairwithintheoralcavity.Nasalairemissionandhypernasalresonancecouldnotbeavoided.Whensurgerywasfinallyperformedthefamilyaswellasthesurgeonwasoftendismayedtofindthatadramaticchangeintonalqualityhadnotoccurredwiththeclosingofthecleft.Thechildfrequentlycontinuedtotalkverymuchashehadtalkedbeforetheoperation,witha"cleftpalatespeech."Inmanycasesthiswasbecausehismaladaptivespeechhabitshadbecomesoingrainedthathisvoicesounded"familiar"and"right"tohim.Ifhedidnotrecognizeitasabnormal,thismeantthatheandthespeechclinicianwereinforalongsiegeoftherapy.Severaltypesofdentalprostheseswereusedinthe1930sand1940sasprimarytreatmentforseparatingtheoralandnasalcavities;'however,thecleftproblemwasconsideredanexerciseforthesurgeon.Ifandwhentherewasabreakdowninthesurgicalrepair,thesurgeonrepeatedhisproceduresinhisefforttoclosethepalataldefect.Someoftheearlypatienthistoriesattheinstituterecord10,15,and20surgicalproceduresinattemptingtoclosetheoraldefect.Hypernasalvoicequalityandmaladaptivearticulationhabitswereassociatedwiththesemultiplesurgicalfailures.SomeSurgeonfeltthatthenextlogicalstepaftersurgicalmanagementfailedwastoreferthepatienttoaprosthodontist.Fewspeechclinicianswereavailabletothesurgeonuntiltheteamconceptofcleftpalatemanagementdeveloped.Certainlytheearlysurgeonshadtheirmeasureofsuccess,butthepercentageofgoodresultswasnottoswelluntilthelate1950sandearly1960s,whenplasticsurgeonsexpressedtheirawarenessofhumangrowthanddevelopmentofthemid-thirdoftheface.Withthisawarenesstheywereabletoimprovetheirtechniquesandtotimethesurgicalprocedurestominimizeinterferencewithcentersoffacialgrowth.Lengtheningtheoraltissueandutilizingavomerflapgreatlyreducedthetraumatomaxillarysegments.Moreimportanttospeechdevelopmentwastheimprovedtwostagepalatalclosuretechnique,implementedbeforethechildreached18monthsofage.Thesefactshadamarkedinfluenceonthedevelopmentofmorenormalspeechandvoicepatternsinchildrenwithacleftpalate.H.KCooperrealizedthatnoone-treatmentprocedurewasapanacea.Buthisteamconcept,whichhebegantoimplementinthe1930s,emphasizethevariedadvantagesofinterdisciplinaryevaluationandtreatmentofcleftpalate.Hestressedtherehabilitativemanagementofthetotalperson,andasprofessionalmembersoftheinterdisciplinaryteam,werealizedweweredealingwithanintegratedpartof.thewholeperson.Thisistheconceptthathasbeendevelopedandcontinuallystressedatthelancastercleftpalateclinic.Whyateam?ItiswellrecognizedthatindividualsbornwithcleftsoftheUpandpalateorpalateonlywillfaceanumberofinterrelatedproblems.Intheearliestdaysofteammanagementofclefts,clinicalobservationsledtotherecognitionthatchildrenwithcleftlipandpalate(includingacleftofthemaxillaryalveolararch)requiredtheservicesofareconstructivesurgeontorepairtheclefts,aspeechpathologisttoaddressissueofvelopharyngealfunctionandarticulation,andadentalspecialisttoaddressproblemsassociatedwithocclasionandcongenitallymissingteeth.Centerswereoftenbuiltaroundthesetreatmentspecialistsbecauseoftheirlong-terminvolvementwithpatientswithclefts.Manyteamsdidnothavepediatricians(eventhoughthemajorityofpatientswerechildren),orotolaryngdogists(eventhoughmostpatientshadchronicmiddleeardisease).Initsearlyadvocacyofteams,theAmericancleftpalateAssociation(ACPA)indicatedthataproperteammusthaveataminimumaplasticsurgeon,aspeechpathologist,andanorthodontist.Wouldateamthathadonlythesespecialtiesbeabletoqualifyasacomprehensivecenter?Asthemedical,dental,andbehavioralsciencesexpanded,newsubspecialtieswereborntoaddressproblemsthatcouldnotevenbedetectedfourdecadesago.Subspecialtiessuchashumangeneticsandneuroradiologyarerecentadditionstomedicine,andspecialtytestssuchasnasopharyngoscopy,multiviewvideofluoroscopy,and3-DCTscanswerenotwidelyavailablebeforethe1980s.Asaresult,organizationssuchasACPAhaverecognizedthatminimalstandardsmaynolongerbevalid,andcenterswillneedtobemorecomprehensiveinordertomeetapatient'sneeds.Howcomprehensiveshouldateambe?Tablelliststhespecialistswhowouldhaveaninterestinchildrenwithcleftingorcraniofacialanomaliesalongwiththereasonforthatinterest.Wouldpatientcarebecompromisedifanyofthesespecialistswereomitted?Correctdiagnosescouldgoundetected.Propertreatmentsknownonlybycertainspecialistscouldgounadministered.TablelSpecialistswhoshouldbeincludedonacraniofacialteamandthereasonfortheirpresence.When"pediatric"appearsinparentheses,theimplicationisthatthemajorityofpatientsarepediatriccasesandshouldrequirepediatricsubspecialization.SpecialtyreasonforinclusionMedicalspecialistsPlasticSurgeryReconstructionofcleftandstructuralmanagementofVPIPediatrics"Medicalmanager"forthechildNeurology(Pediatric)Atleast10%ofchildrenwithcleftshaveCNSanomaliesEndocrinologyApproximately20%ofchildrenwithcleftsareofshortstatureOphthalmology(Pediatric)Frequenteyeanomalies,especiallyinSticklersyndrome(5%ofcleftpalate)Cardiology(Pediatric)Frequentheartanomalies(atlast10%ofchildrenwithclefs)Otolaryngology(Pediatric)VeryfrequentassociationofmiddleeardiseaseandairwaydisorderRadiology/NeuoradiologyVideofluoroscopy,CT,MRasfrequentdiagnosticmodalitisNeurosurgery(Pediatric)FrequencyofcraniosynostosisandneedforintracranialsurgeryPulmonology(Pediatric)FrequentassociationofairwayrelatedproblemsAnesthesiology(Pediatric)DifficultintubationscommoninchildrenwithcraniofacialanomaliesGenetics/DysmorphologyVeryhighfrequencyofassociatedsyndromesandgeneticetiologiesPsychiatryNeedtoassurepsychologicalwellbeingofchildrenundergoingfrequentsurgeryDentalspecialistOralSurgeryFrequentfacialskeletalsurgeryOrthodonticsUniversalneedfororthodontictherapyinchildrenwithcleftlip/palateProstheticDentistryNeedfortoothreplacementinmanycasesofcompletecleftsPediatricDentistryNeedtomaintaingooddentalhealthandpreventagainsttoothlossbehavioralspecialistSpeechPathologyVeryfrequentspeech/languagedisordersinchildrenwithcleftsSocialServiceSocialadjustmentproblems,hospitalrelatedproblems,fundingproblemsPsychologyAssessmentandmanagementofselfimageandadjustmentathomeandinschoolNeuropsychologyPsychometricassessmentfrequentlyrequiredAudiologyVeryfrequenthearinglossassociatedwithcleftingChildlifeSpecialistFrequenthospitalizationsrequireattentionOtherSpecialtiesNursingFrequenthospitalservices(inandoutpatient)NutritionistlowweightacommonassociatedanomalyComputerProgrammerDatabasemanagementessentialtolearningabouttreatmentoutcomeVOCABULARYl.compensatory補(bǔ)償?shù)?，代償?shù)?，賠償N，報(bào)酬的2.articulation①連接、接合②發(fā)音、發(fā)音動(dòng)作③清晰度，可值度④關(guān)節(jié)3.velopharyngeal腭咽的4.resonance①回聲，反響②共振、共鳴、諧振③叩響5.maladaptive不能適應(yīng)的，錯(cuò)誤適應(yīng)的6.ingrain①使(原料)染色②使遺體滲透，使根深蒂固n．①原料染色②固有的品質(zhì)，本質(zhì)7.voice⑦說(shuō)話聲，嗓音、嗓子；②聲音；③愿望，意見(jiàn)，發(fā)言權(quán)；④語(yǔ)態(tài)，聲帶振動(dòng)濁音特點(diǎn)8.speechclinician語(yǔ)音治療師9.awareness意識(shí)，認(rèn)識(shí)，知道10.lengthen使延長(zhǎng)，延長(zhǎng)元音音長(zhǎng)，變長(zhǎng)，延伸，長(zhǎng)起來(lái)11.vomer犁骨12.panacea治百病的靈藥，萬(wàn)能藥13.implement①工具，器具②家具，服裝vt．①貫徹、完成履行⑦給……提供方法，為……供應(yīng)器具③補(bǔ)充14.pathologist病理學(xué)家15.alveolararch牙槽弓，牙頒弓16.pediatrics兒科學(xué)17.Neurology神經(jīng)病學(xué)18.Endocrinoiogy內(nèi)分泌學(xué)19.Ophthalmology眼科