Abstract
The objective of this study was to describe the process of intensive speech therapy for a 6-year-old child using compensatory articulations while presenting with velopharyngeal insufficiency (VPI) and a history of cleft lip and palate. The correction of VPI was temporarily done with a pharyngeal obturator since the child presented with very little movement of the pharyngeal walls during speech, compromising the outcome of a possible pharyngeal flap procedure (pharyngoplasty). The program of intensive speech therapy involved 3 phases, each for duration of 2 weeks incorporating 2 daily sessions of 50 minutes of therapy. A total of 60 sessions of intervention were done with the initial goal of eliminating the use of compensatory articulations. Evaluation before the program indicated the use of co-productions (coarticulations) of voiceless plosive and fricative sounds with glottal stops (simultaneous production of 2 places of productions), along with weak intraoral pressure and hypernasality, all compromising speech intelligibility. To address place of articulation, strategies to increase intraoral air pressure were used along with visual, auditory and tactile feedback, emphasizing the therapy target and the air pressure and airflow during plosive and fricative sound productions. After the first two phases of the program, oral place of articulation of the targets were achieved consistently. During the third phase, velopharyngeal closure during speech was systematically addressed using a bulb reduction program with the objective of achieving velopharyngeal closure during speech consistently. After the intensive speech therapy program involving the use of a pharyngeal obturator, we observed absence of hypernasality and compensatory articulation with improved speech intelligibility.
Highlights
Among the areas of Dentistry, Odontopediatrics, Orthodontics and Maxillofacial prosthesis are closely UHODWHG ZLWK VSHHFK SDWKRORJ\ 7KH SURVWKRGRQWLVW and his partner, the prosthetic technician, are LQYROYHG ZLWK WKH VSHHFK SDWKRORJLVW SDUWLFXODUO\ during treatment of oncologic and neurologic cases, DV ZHOO DV GXULQJ PDQDJHPHQW RI FUDQLRIDFLDO anomalies like cleft palate.Cleft lip and palate (CLP) is a common congenital anomaly, occurring at a rate of 1:650 live births in Brazil11
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According to Pinto, Dalben and Pegoraro-Krook8 (2007), prosthetic treatment of VPI involves the use of pharyngeal obturators and the outcome of this approach depends on the degree of hypernasality, type of compensatory articulation used, age and dental conditions of the candidate, DORQJ ZLWK VWUXFWXUDO DQG IXQFWLRQDO FRQGLWLRQV RI WKH SDODWH DQG SKDU\QJHDO ZDOOV 7KH SDWLHQW GHVFULEHG LQ WKLV FDVH UHSRUW ¿WWHG WKH FULWHULD IRU recommendation of the combined prosthetic and behavioral treatment
Summary
Among the areas of Dentistry, Odontopediatrics, Orthodontics and Maxillofacial prosthesis are closely UHODWHG ZLWK VSHHFK SDWKRORJ\ 7KH SURVWKRGRQWLVW and his partner, the prosthetic technician, are LQYROYHG ZLWK WKH VSHHFK SDWKRORJLVW SDUWLFXODUO\ during treatment of oncologic and neurologic cases, DV ZHOO DV GXULQJ PDQDJHPHQW RI FUDQLRIDFLDO anomalies like cleft palate. Once velopharyngeal VXI¿FLHQF\ LV HVWDEOLVKHG ZLWK WKH SKDU\QJHDO EXOE the speech pathologist can use behavioral strategies DORQJ ZLWK EXOE UHGXFWLRQ WR PRGLI\ WKH SDWWHUQ RI functioning of the velopharynx improving excursion RI YHOXP DQG SKDU\QJHDO ZDOOV DIIHFWLQJ VXUJLFDO recomendation. DQG HYHQ WUDQVGLVFLSOLQDU\ ZRUN EHWZHHQ DUHDV RI dentistry and speech pathology It may be the only DOWHUQDWLYH DYDLODEOH WR SDWLHQWV ZKR KDYH D SRRU SURJQRVLV IRU VXUJLFDO FRUUHFWLRQ RI LQVXI¿FLHQF\ due to the presence of incompetency resulting from learned velopharyngeal inadequacy, such as hypodynamic velopharynx
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