ABSTRACT
Individuals with a history of cleft lip/palate or velopharyngeal dysfunction may demonstrate
any combination of speech sound errors, hypernasality, and nasal emission. Speech
sound distortion can also occur due to other structural anomalies, including malocclusion.
Whenever there are structural anomalies, speech can be affected by obligatory distortions
or compensatory errors. Obligatory distortions (including hypernasality due to velopharyngeal
insufficiency) are caused by abnormal structure and not by abnormal function. Therefore,
surgery or other forms of physical management are needed for correction. In contrast,
speech therapy is indicated for compensatory articulation productions where articulation
placement is changed in response to the abnormal structure. Speech therapy is much
more effective if it is done after normalization of the structure. When speech therapy
is appropriate, the techniques involve methods to change articulation placement using
standard articulation therapy principles. Oral-motor exercises, including the use
of blowing and sucking, are never indicated to improve velopharyngeal function. The
purpose of this article is to provide information regarding when speech therapy is
appropriate for individuals with a history of cleft palate or other structural anomalies
and when physical management is needed. In addition, some specific therapy techniques
are offered for the elimination of common compensatory articulation productions.
KEYWORDS
Cleft palate - velopharyngeal insufficiency - velopharyngeal incompetence - velopharyngeal
dysfunction - compensatory articulation - speech therapy
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Ann W KummerPh.D. CCC-SLP ASHA-F
Division of Speech Pathology, MLC 4011, Cincinnati Children's Hospital Medical Center
3333 Burnet Avenue, Cincinnati, OH 45229-3039
eMail: ann.kummer@cchmc.org