Speech therapy for cleft palate:
Children with a history cleft are at risk for resonance and speech problems due to velopharyngeal dysfunction (VPD). These problems include hypernasality (too much sound in the nasal cavity), nasal air emission (leakage of air during consonant production) and misarticulations.
Speech therapy cannot change hypernasality or nasal emission if it is due to abnormal structure.
Therapy is effective for an individual who demonstrates the following:
Therapy Techniques
Auditory Feedback
- This technique helps the child become aware of the difference between nasality and normal speech and resonance.
Use a tape recorder to record the child’s speech that demonstrates abnormal
productions and then attempts at normal production and then have the child do a self evaluation.
Use a straw or listening tube. Put one end at the entrance of child’s ear and other
end at entrance of child’s nostril. When nasality occurs it is very loud and audible making it easier for child to hear. Then the child is asked to try to reduce or eliminate nasality on oral sounds.
Use of listening tube – One side is placed in front of child’s mouth and the other is placed at the end of the child’s ear. The child can now hear the air pressure during the production of oral sounds. Now have the child try to increase the oral pressure.
The above mentioned methods does not allow the clinician or parents to hear and
provide appropriate feedback and instructions therefore the Oral and Nasal Listener is far more preferable over using a simple tube.
Oral and Nasal Listener – It can be used to provide feedback about oral resonance and oral airflow. The funnel is placed in front of the mouth instead of in front of the nostrils. This allows the child to easily hear the difference between weak consonants or hypernasal vowels and those that are oral. The child can now compare his/her own productions with the models provided by the clinician or the parent.
Visual Feedback
Nasometer - visual feedback of velopharyngeal function
Have child use air paddle during the production pressure sensitive phonemes and see if child can produce the sounds with enough pressure to force the air paddle to move.
Use of See – Scape. Instruct child to put the nasal olive in one nostril and is then
asked to try to produce pressure consonants without allowing the foam stopper to
rise in the tube.
Tactile Kinesthetic Feedback
Have child say /ah/ and use a tongue blade to raise velum up and down to produce an oral nasal contrasts. (This technique won’t work if the child has a very active gag reflex). Eventually have the child try to raise velum independently during the production of vowel sounds to produce oral-nasal contrasts.
Tactile Feedback
Have the child feel the vibration on side of nose/face during the production of nasal
phonemes vs. oral phonemes.
Have child put his/her hand in front of mouth during production of plosives to feel
the air pressure.
Lower the Back of the tongue
Have the child yawn to cause the back of tongue to go down and velum to go up. Then ask child to yawn while producing vowels and anterior sounds.
Increase Volume
Have child increase volume, which will increase respiratory support, velopharyngeal closure, oral air pressure and the force of articulation.
Increase Oral Activity
- Increasing mouth opening can reduce oral resistance and increase oral resonance.
Nose Pinch Technique
Have child pinch his/her nose while producing the nasal cognate of the oral target.
The child should become aware of the increase in oral airflow and pressure.
Misarticulations will follow protocol used for standard articulation therapy. Articulation therapy is easier to remediate than nasality.
Speech therapy cannot change hypernasality or nasal emission if it is due to abnormal structure.
Therapy is effective for an individual who demonstrates the following:
- Hypernasality or nasal emission following a surgical correction
- Misarticulations that cause nasal air emission or hypernasality that is phoneme specific
- Hypernasality secondary to dysarthria or apraxia
- Compensatory articulation productions that cause nasal emissions
Therapy Techniques
Auditory Feedback
- This technique helps the child become aware of the difference between nasality and normal speech and resonance.
Use a tape recorder to record the child’s speech that demonstrates abnormal
productions and then attempts at normal production and then have the child do a self evaluation.
Use a straw or listening tube. Put one end at the entrance of child’s ear and other
end at entrance of child’s nostril. When nasality occurs it is very loud and audible making it easier for child to hear. Then the child is asked to try to reduce or eliminate nasality on oral sounds.
Use of listening tube – One side is placed in front of child’s mouth and the other is placed at the end of the child’s ear. The child can now hear the air pressure during the production of oral sounds. Now have the child try to increase the oral pressure.
The above mentioned methods does not allow the clinician or parents to hear and
provide appropriate feedback and instructions therefore the Oral and Nasal Listener is far more preferable over using a simple tube.
Oral and Nasal Listener – It can be used to provide feedback about oral resonance and oral airflow. The funnel is placed in front of the mouth instead of in front of the nostrils. This allows the child to easily hear the difference between weak consonants or hypernasal vowels and those that are oral. The child can now compare his/her own productions with the models provided by the clinician or the parent.
Visual Feedback
Nasometer - visual feedback of velopharyngeal function
Have child use air paddle during the production pressure sensitive phonemes and see if child can produce the sounds with enough pressure to force the air paddle to move.
Use of See – Scape. Instruct child to put the nasal olive in one nostril and is then
asked to try to produce pressure consonants without allowing the foam stopper to
rise in the tube.
Tactile Kinesthetic Feedback
Have child say /ah/ and use a tongue blade to raise velum up and down to produce an oral nasal contrasts. (This technique won’t work if the child has a very active gag reflex). Eventually have the child try to raise velum independently during the production of vowel sounds to produce oral-nasal contrasts.
Tactile Feedback
Have the child feel the vibration on side of nose/face during the production of nasal
phonemes vs. oral phonemes.
Have child put his/her hand in front of mouth during production of plosives to feel
the air pressure.
Lower the Back of the tongue
Have the child yawn to cause the back of tongue to go down and velum to go up. Then ask child to yawn while producing vowels and anterior sounds.
Increase Volume
Have child increase volume, which will increase respiratory support, velopharyngeal closure, oral air pressure and the force of articulation.
Increase Oral Activity
- Increasing mouth opening can reduce oral resistance and increase oral resonance.
Nose Pinch Technique
Have child pinch his/her nose while producing the nasal cognate of the oral target.
The child should become aware of the increase in oral airflow and pressure.
Misarticulations will follow protocol used for standard articulation therapy. Articulation therapy is easier to remediate than nasality.