Treatment of velopharyngeal closure for speech: Discussion and implications for management.

Abstract

The velopharyngeal closure mechanism acts as a valve to separate the oral and nasal cavities during speech and swallowing. Velopharyngeal closure deficits are generally identified by the speech-language pathologist and corrected through surgery or speech prosthetics. However, there is a small subset of clients who may benefit from treatments using task specific muscle rehabilitation procedures. This review article addresses the following topics: structure/function relationships of velopharyngeal closure, motor programming of velopharyngeal closure, aims and findings of various types of muscle treatment programs, discussion and rationale of successful muscle treatments, and guidelines for utilizing muscle treatment for the management of clients with velopharyngeal closure deficits.

Nasoendoscopy of velopharynx before and during diagnostic therapy

“…The therapist then guides the speaker targeting voluntary control of the movements and progressively increasing the complexity of the tasks. While improved velopharyngeal function during speech therapy with endoscopic feedback has been reported by several authors 2 , 4 , 7 , 8 , 13 manipulation of velopharyngeal functioning with diagnostic therapy in the nasoendoscopic assessment during the decision making process for management of VPD has not been described.…”

“…The use of visual biofeedback of the velopharynx with nasoendoscopy has been described as a strategy for behavioral modification of velopharyngeal functioning during speech therapy 2 , 4 , 7 , 8 , 13 . Usually, during speech therapy with endoscopic biofeedback, the subjects are initially asked to observe their VP mechanism during function with attention called on both, movements and sensations.…”

Vaikų, Gimusių Su Lūpos, Alveolinės Ataugos Ir Gomurio Nesuaugimais, Nuo Burnos Sveikatos Priklausanti Gyvenimo Kokybė

“…Visa tai gali sukelti pirmuosius psichologinius sutrikimus: susier-11 zinimą, savęs nuvertinimą ar net depresijos požymius [3]. Taip pat svarbu paminėti ir galimus žymius kalbos sutrikimus, kurie išlieka net ir po operacinių intervencijų [4]. Visus šiuos aspektus apjungia nuo burnos sveikatos priklausančios gyvenimo kokybės sąvoka.…”

An Examination of Nonspeech Oral Motor Exercises for Children with Velopharyngeal Inadequacy

“…This review is presented within a framework of muscle rehabilitation that was proposed by Clark 35,36 and used in other discussions of VPI management. 37 The purpose of muscle rehabilitation programs is to improve different aspects of velopharyngeal function, such as strength, speed, range of movement, and/or skill, so a client can achieve velopharyngeal closure without surgery or wearing a speech appliance. The different types of muscle treatment programs include active exercise, passive exercise, and sensory stimulation (Table 1).…”

“…11 However, the reader needs to be aware that the studies using NSOMEs discussed here were conducted in the 1960s through 1970s, and best practice publications since that period have consistently discussed the lack of support for treatments using NSOMEs to foster speech sound development and improve VPI. 3,4,9,10,16,17,32,[35][36][37] We must question why SLPs continue to use treatments with NSOMEs when no evidence base supports its use. 31,33,94 Survey data obtained by Schneider and Shprintzen 15 30 years ago regarding the use of NSOMEs to manage VPI are similar to data recently generated by Lof and Watson, 33 which is very distressing considering the advances in our understanding of speech and resonance variables associated with cleft palate.…”