Cleft palate and vpi
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This presentation reviews assessment and treatment approaches for children with cleft palate and/or velopharyngeal dysfunction. It describes normal velopharyngeal function and velopharyngeal dysfunction. Therapy approaches aim to improve articulatory placement, oral pressure/airflow, and oral resonance. Close collaboration with an interdisciplinary cleft palate team is important, as is monitoring progress and considering physical management if speech therapy progress stalls.
Cleft palate and vpi
- 1. Cleft Palate and/or Velopharyngeal Dysfunction: Assessment and Treatment Arooba Asmat Dev Speech Language Pathologist
- 2. Purpose of this Assignment • This presentation will review assessment and therapeutic approaches for working with children who demonstrate speech disorders related to cleft palate and/or velopharyngeal dysfunction. • Methods for collaborating with the interdisciplinary cleft palate/craniofacial team and enhancing the ability to make differential diagnoses of resonance versus articulation disorders will be included.
- 3. Normal Velopharyngeal Function • Closes off nasal cavity from oral cavity during speech • Important for pressure sensitive sounds and normal resonance • Velopharyngeal closure accomplished by action of the velum, lateral pharyngeal walls, and posterior pharyngeal walls
- 4. Velum at rest Velum during speech Kummer (2001)
- 5. Velopharyngeal Dysfunction (VPD) • Failure of the velum, the lateral pharyngeal walls, and posterior pharyngeal walls to achieve complete closure during oral speech tasks • Allows for the leakage of air and sound energy into the nasal cavity during oral speech
- 7. 1. Improve articulatory placement • -may eliminate compensatory errors, improve velopharyngeal function, and decrease the perception of hypernasality • -target voiceless sounds before voiced (w, h, p, t, etc) • -use visual cues as needed • -start with sounds in isolation, then progress to syllables, words, phrases, sentences • -use nasal occlusion to prevent development • of nasal snorting or fricatives
- 8. Improve oral pressure/airflow, reduce nasal emissions,and increase oral resonance • -auditory feedback: listening tubes, straws, stethoscope • -tactile feedback: feeling the nose during oral and nasal speech • -visual feedback: using air paddles, See Scape, Nasometer • -increase articulatory effort: wider mouth opening, • overarticulation, loudness • -increase awareness of oral and nasal airflow: negative practice, description exercises
- 9. PLEASE KEEP IN MIND!!!!! • ***SLPs work on changing articulation. • ***Blowing, sucking, gagging, and oral motor exercises do NOT improve velopharyngeal function for speech. • ***Speech therapy is appropriate for teaching proper articulatory placement prior to surgery for repair of a fistula or surgery to augment velopharyngeal function. • ***If no true progress is seen within 6-8 weeks of speech therapy—referral back to Cleft Palate team for further assessment. • ***Significant VPD may need to be managed physically.
- 10. Additional Resources • Contact: American Cleft Palate-Craniofacial Association • For SLP members and Cleft Palate-Craniofacial Teams • http://www.acpa-cpf.org/
- 11. Suggested References • Golding-Kushner, K.J. (2001). Therapy Techniques for Cleft Palate Speech and Related Disorders. San Diego,CA: Singular. • Kummer, A. (2001). Cleft Palate and Craniofacial Anomalies: Effects on Speech and Resonance. Clifton Park, NY: Thomson Delmar Learning. • Kummer, A. & Lee, L. (1996). Evaluation and Treatment of Resonance Disorders. LSHSS, 27, 271-281. • Peterson-Falzone, S.J., Hardin-Jones, M., & Karnell, M.P. (2001). Cleft Palate Speech, 3rd edition. St. Louis, MO: Mosby. • Peterson-Falzone, S.J., Trost-Cardamone, J.E., Karnell, M.P. & Hardin-Jones, M. (2006). The Clinician’s Guide to Treating Cleft Palate Speech. St. Louis, MO: Mosby Elsevier • Trost-Cardamone, J. (1989). Coming to terms with VPI: a response to Loney and Bloom. CPJ 26: 68-70.