Speech Therapy
1.    Strengths & Limitations
    a.    Can’t improve structure only function
    b.    Can improve or eliminate some of the effects of velopharyngeal dysfunction
    c.    Most effective at eliminating compensatory articulation productions
    d.    Limited effectiveness combating hypernasality, nasal air emissions & weak consonants
    e.    Should first determine underlying cause of VPD since this determines the type of management indicated

2.    Review Causes of VPD
        i.    In which of this cases would we expect speech therapy to be effective?
    b.    Velopharyngeal insufficiency
    c.    Velopharyngeal incompetence
    d.    Velopharyngeal mislearning

3.    Appropriate Candidates for Speech Therapy
    a.    Mild hypernasality or nasal air emission & child is stimulable for complete closure
    b.    Inconsistent symptoms of VPD or only occur with child is tired
    c.    Due to faulty articulation & child is stimulable
    d.    Symptoms associated with oral-motor dysfunction
    e.    Individual post surgery or post prosthetic placement who need to learn to use the new structures

4.    Muscle Training Techniques
    a.    Generally not effective in improving velopharyngeal closure for speech
    b.    Included in this group of techniques are:
        i.    Nonspeech exercises
        ii.    Temporary speech prosthesis
        iii.    Direct stimulation (electrical & tactile)
        iv.    CPAP

5.    Biofeedback
    a.    May be helpful in aiding children achieve reductions in nasal air emission, hypernasality if appropriate candidates as outlined previously
    b.    Make unconscious or autonomic physiological processes perceptible to the senses
        i.    Auditory, visual, tactile-kinesthetic
        ii.    Visual most helpful with children
    c.    Examples of instrumental biofeedback
        i.    Pressure-flow instruments
        ii.    Nasometry
        iii.    Nasopharyngoscopy

6.    Review Effects of VPD on Speech
    a.    Hypernasality
        i.    Therapy rarely appropriate
        ii.    May be helpful if secondary to dysarthria to increase oral resonance
    b.    Nasal air emission (rustle, snort, grimace)
        i.    Can be targets for speech therapy
    c.    Weak consonants
        i.    Found in conjunction with nasal air emission
        ii.    As reduce above, work on increasing oral air pressure

7.    Review (cont.)
    a.    Compensatory articulation productions
        i.    Therapy is effective
        ii.    Easier to correct if done after surgery to correct VPI
        iii.    If surgery is delayed, trial therapy to decrease nasal air emission
    b.    Hyponasality/cul-de-sac resonance
        i.    If due to blockage, therapy will not be effective
        ii.    If timing problems as in AOS, work on nasal/oral contrasts perhaps with biofeedback