Make the Referral:
When these characteristics are noted, a referral should be made to a regional craniofacial or cleft palate team (even if there is no history of cleft) for further assessment and management.
When we Can do Therapy:
- phoneme-specific nasality or nasal emission due to faulty articulation
- children who use compensatory articulation productions due to a history of velopharyngeal dysfunction
- after surgical management of velopharyngeal dysfunction to help the child to learn to make the best use of the new structures
How ‘Bout Some Blowing and Sucking Exercises?
ASHA advises against use of non-speech oral motor exercises like blowing and sucking for improving velopharyngeal function. The parts of the brain that control blowing and sucking are not the same as those that control speech production so benefits will not carry over to speech.
How DO we do therapy?
- If there is nasal emission on sibilants only, have the child produce a /t/ sound with the teeth closed. Next, have the child prolong that sound. If the child has a normal velopharyngeal valve, this should result in a normal /s/ without nasal emission. This skill can then be transferred to the other sibilant sounds.
- If the child co-articulates /ng/ for /l/ or /r/, or if the child has a high tongue position for vowels, it is often helpful to have the child co-articulate a yawn with the sounds. With a yawn, the back of the tongue goes down and the velum goes up.
What if it’s Not Working?
If the child continues to demonstrate hypernasality or nasal emission after a few months of treatment, that child should be referred to a specialist for further assessment and consideration of physical management.