Hadiya Coppedge Samantha Taft What is Velopharyngeal Inadequacy (VPI)? Velopharyngeal (cid:128) insufficiency results when the soft palate (velum), during constriction, fails to elevate and retract against the stationary posterior pharyngeal wall. Dworkin, Marunick, Krouse, 2004 Causes of VPI VPI flow chart compiled from the following sources: Johns, Rohrich & Awada, 2003  and Peterson‐Falzone, Karnell, Hardin‐Jones,& Trost‐Cardamone, 2005 Speech Characteristics of VPI Abnormal tone or resonance resulting in (cid:128) excessive nasality = hypernasality Consonant weakness (cid:128) Consonants produced further back in oral (cid:128) cavity (pharynx, glottis, nasopharynx) (Sell & Ma, 1996) Assessment for VPI Oral Mechanism (cid:128) Exam Screening (cid:128) (cid:121) Procedure ○ Request client to count from 60 to 80. ○ Multiple production of following words: puppy, house, push, jelly, peach, etc… (cid:121) Hypernasal resonance auditorily evident Dworkin, Marunick, Krouse, 2004 Deep Testing VP Anatomy and Physiology – Step 1 General Survey • Client tilts head back slightly, open mouth wide. Clinician shines flashlight on VP region and appraises VP at rest – Step 2 Velar Activity • Client opens mouth wide and says /a/ for as long as steadily as possible – Step 3 Gag Reflex • Client opens mouth, tongue depressor is used to elicit a gag reflex – Step 4 Speech Task • Client repeats stimuli while a laryngeal mirror is periodically placed beneath the most patent nostril to detect nasal airflow. Dworkin, Marunick, Krouse, 2004 Main Methods of Treatment for VPI Surgical 1. (cid:121) Pharyngoplasty Prosthetics 2. (cid:121) Appliance added to aid in velar closure Therapy Treatment ☺ 3. (cid:121) Muscle rehabilitation techniques Active Exercises: Strength & Stretching/ROM Training Strength Stretching/ROM Nonspeech Oral Phonetic-Based 1. 1. Motor Treatment Speech Production Biofeedback 2. 2. Exercises 1. Nonspeech Oral Motor Exercises: Participants (cid:128) (cid:121) 13 subjects diagnosed with VPI divided into 3 treatment groups Methodology (cid:128) (cid:121) Group 1: Practiced blowing exercises on a manometer (cid:121) Group 2: Performed sucking exercises with a straw or used a meter that measured pressure (cid:121) Group 3: Practiced swallowing exercises while monitoring thyroid excursion with their index finger. ** All groups received articulation therapy in conjunction with nonspeech oral motor exercises** Massengill, 1968, Ruscello, 2008