Cleft Palate andor Velopharyngeal Dysfunction: Assessment and Treatment Education Committee, ASHA Sp

1
Cleft Palate and/or Velopharyngeal Dysfunction
Assessment and TreatmentEducation Committee,
ASHA Special Interest Division 5

• Therapy Approaches-General goals
• 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
• 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
• 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.

Purpose of this Poster This poster 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.
Effects of VPD on Resonance and Articulation
(These differ from patient to patient, one or
several symptoms may be present) Hypernasality-
too much sound resonating in the nasal cavity
during oral speech, especially on vowels and
voiced oral consonants Audible nasal air
emission- audible emission of air stream through
nasal cavity during production of oral pressure
consonants Weak pressure consonants- reduced
intraoral pressure on consonants Shorter
Utterance Length- breath support for speech is
compromised due to air leaking through nose as a
result of VPD Compensatory Articulation errors-
inappropriate speech behaviors with faulty
articulatory placement in an attempt to buildup
oral pressure and airflow Voice disorders-
hoarseness, breathiness, reduced volume, glottal
fry
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 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 Causes of VPD -Anatomical/st
ructural defects known as velopharyngeal
insufficiency (Trost-Cardamone, 1989) e.g. cleft
palate, submucous cleft palate, short velum, deep
pharynx, irregular adenoid, enlarged tonsils
-Physiological /functional defects known as
velopharyngeal incompetence (Trost-Cardamone,
1989) e.g. poor muscle function, paralysis,
neuromuscular disorders -Other causes known as
velopharyngeal mislearning (Trost-Cardamone,
1989) e.g. learned behaviors, conversion
disorder, stress-induced velopharyngeal
inadequacy, hearing loss, abnormal posterior or
nasal articulation, phoneme-specific nasal air
emission
Kummer (2001)

• Assessment of Speech Disorders associated with
  VPD
• RESONANCE
• -SLP should judge resonance as normal,
  hypernasal, hyponasal or mixed.
• -SLP should assess if nasal emission and nasal
  turbulence exist.
• Use connected speech, sentences with oral sounds,
  sentences with nasal sounds, low pressure
  sentences, and high pressure phonemic contexts.
• ARTICULATION
• SLP should assess place and manner of production.
  
• SLP should assess for any compensatory
  articulation behaviors.
• Use single word productions and spontaneous
  speech
• Additional techniques for assessing VPD
• Auditory detection Using listening tubes,
  straws, stethoscope, nose plugging (Cul de Sac
  test)
• Tactile detection Feeling the sides of nose for
  nasal turbulence
• Visual detection Using a mirror to observe nasal
  air emission
• IMPORTANT SLP must also monitor hearing acuity
  and middle ear disease for potential effects on
  speech and language

Kummer (2001)
Kummer (2001)
Velum at rest
Velum during speech
Additional Resources Contact American Cleft
Palate-Craniofacial Association For SLP members
and Cleft Palate-Craniofacial Teams http//www.acp
a-cpf.org/ 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 Clinicians Guide to Treating Cleft Palate
Speech. St. Louis, MO Mosby Elsevier Trost-Carda
mone, J. (1989). Coming to terms with VPI a
response to Loney and Bloom. CPJ 26
68-70. Acknowledgment This poster presentation is
the result of a collaborative effort on the part
of the ASHA Special Interest Division 5 Education
Committee
Nasometer
Kummer (2001)
Nasoendoscopy
Kummer (2001)