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Posted by sdc on 1/29/2009, 4:14 pm, in reply to "Rachel"
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I am an SLP and a mom with a son with the same issue. So, I have researched a lot on this matter. Basically, if the child has an inability to produce enough air pressure, then the structure probably needs to be corrected surgically.
There are several different types of velopharyngeal dysfucntion. It can be phoneme specific (usually s/z/sh...fricatives), it can be mislearning, it can be structurally based, secondary to a syndrome, or caused from an cleft palate/submucous cleft or fistula.
If he has correct placement, but the pressure just isn't there then I would suspect a structural defect (which is what my son has). Nothing else will correct it other than surgery. Believe me we've tried. As far as blowing goes, I would not use it in an attempt to correct the structure. Yet, if the child can not blow at all, you may want to work on it simply to introduce oral air flow, and so he will be able to blow out candles on a birthday cake :)!!!!
As far as the ENT goes, it is a good place to start. However, I have learned that the ENT isn't the EXPERT in the matter. An ENT actually recommended that we get a referral to a plastic surgeon on a cleft palate team (even if there is no evidence of a cleft palate). They are the experts in velopharyngeal dysfunction. Also, there are SLPs on the team (which we have dealt with the most). The SLP can perform an observational screening/test to identify certain charateristics & conduct a palatal study (either with a videofluroscopy or nasoendoscopy).
The major "red flag" in regards to a structural defect is the lack of oral air pressure.
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