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Articulation disorders related to cleft lip or palate and craniofacial disorders

What are the goals of speech therapy for children with cleft lip or palate, or resonance disorders?

The primary goals should be to:

  • Establish correct articulatory placements. 
  • Maximize oral pressure for the pressure consonant sounds (plosives, fricatives and affricates).
  • Maximize oral-pharyngeal articulatory function. 

What are therapy techniques for treating hypernasality?

  • Small degrees of hypernasality can sometimes be managed by increasing articulatory effort. 
  • Since the soft palate is an articulator, nasality improves with improved articulation. 
  • Oral pressure is directly related to muscular activity of the levator (Moon and Kuehn, 1992).
  • Nasal occlusion can be helpful to prevent nasal pressure loss and direct the airstream orally.
  • Whispering can be helpful in preventing vocal fold adduction when glottal stops are present.

Which therapy techniques are ineffective for treating hypernasality?

Therapy tasks using sucking and blowing exercises or palatal stimulation are inappropriate and ineffective. In short, they do not work. Blowing may be diagnostic of velopharyngeal closure in a young child who may be more willing to blow a whistle than say specific words.

How long should speech therapy for hypernasality continue?

If hypernasality does not resolve with several weeks of therapy, formal evaluation or physical management such as surgery or prosthetic devices may be warranted.