Speech Therapy or a Prosthetic? What is Appropriate for Hypernasal Speech?

When dealing with hypernasal speech, the cause is typically with the velum (i.e., the soft tissue on the top of the mouth located in the back of the oral cavity). The velum may be WEAK or it may be INSUFFICIENT. Knowing the difference between these two scenarios may indicate whether a trial speech therapy period is warranted or if a prosthetic device may be more appropriate.

Treatment for a weak velum:

For a WEAK velum, trial speech therapy is suggested. There are several techniques and feedback tools that a speech therapist can use to encourage oral resonance by increasing the strength and coordination of the velopharyngeal area (i.e., the soft tissue velum and the muscles in the back of the throat) to close appropriately for speech. Specific sound misarticulations can also be coached into correct production.

Treatment for an insufficient velum:

For an INSUFFICIENT velum, however, speech therapy will most likely not aid in increasing the intelligibility of speech as the muscle and/or structure of that velopharyngeal area is not a sufficient size to maintain closure. In this scenario, surgery or a prosthetic device is the most likely course of action. The major prostheses available are speech bulbs and palatal lifts. A speech bulb is a piece that fits to partially close off the space between the velum and the pharyngeal wall to assist an insufficient closing. A palatal lift is a device that fits along the roof of the mouth to close off fistulas (i.e., very small holes in the roof of the mouth) and lift the soft palate up to decrease the effort necessary to close off the nasal cavity. A craniofacial specialist can assist you with determining appropriate options.

Process Reduction Therapy:

Process Reduction Therapy is a combination of the above situations. There is research indicating that using a prosthetic and gradually reducing the size may encourage an increased ability for the nasal cavity to close off.

Speech therapy is an excellent option for many children with hypernasal speech. Determining the cause of the hypernasal speech will provide the appropriate path for the child and help guide treatment. Contact a licensed speech pathologist with questions or concerns.

5 Things You Didn’t Know a Speech-Language Pathologist Can Help Your Child With:

The title “speech-language pathologist” can be a difficult one to discern. In addition, the shortened “speech therapist” can also be slp reading with a childmisleading. Speech-Language Pathologists work with children and adults on a wide variety of skills that may surprise you. Speech sounds are not the only skill that SLPs work on! The following list is, by no means, exhaustive of the broad scope of practice SLPs are qualified to provide service in, but rather a list of lesser-known areas of expertise for SLPs. It should be noted that, although all SLPs are trained to treat each of these areas, individual therapists do have areas of expertise, therefore, it behooves you, as a parent or educator, to seek out a therapist with training in the specific areas you seek assistance with.

5 Things You Did Not Know A SLP Works On:

  1. Reading
    1. Reading is a cornerstone skill on which academics become progressively more demanding as a child moves on from elementary through high school. Reading is a Read more

Speech-Language Screening vs. Evaluation

When there are concerns regarding your child’s speech and language skills, we have a few options available that will help to assess your  speech screenchild’s needs: a screening or a full evaluation. A screening is a brief meeting with your child that will determine your child’s strengths and weaknesses through informal measures. An evaluation is a formal, more comprehensive approach that provides more information. Below are more contrasts of these two assessments:

Speech-Language Screening:

• Completed at a school or in one of our clinics
• 15 minutes when completed a school; 15-minute screen with 10-15 minutes parent follow-up when completed in clinic
• No formal testing completed- screening protocols may be used depending upon concerns, but no standard scores comparing your child to same-age peers will be obtained
• Speech therapist informally obtains child’s articulation, language and social skills through conversation or play-based activities
• No formal written report
• School screenings- a written summary of the screening’s findings with recommendations that may include a full evaluation, referral to another discipline or monitoring of skills with a follow-up in 3 months. In clinic screenings- a wrap-up at the end of the screening with similar recommendations to the school screening

Speech-Language Evaluation:

• Approval from insurance and information of benefits required
• Physician referral or prescription required
• One 1-hour diagnostic session- if additional time is needed, this can take place during the first scheduled therapy session
• Parents complete history intake form prior to evaluation
• Parent interview will be completed at the beginning of the evaluation to learn more information and clarify any information on parent intake form
• Formal testing completed to obtain standard scores that are compared to same-age peers
• Full report composed, including background information, results of testing, impressions, additional recommendations and therapy goals
• A separate follow-up meeting will be scheduled with parents to discuss the evaluation, report and recommendations

 To find out more on how your child may benefit from a screen or evaluation, contact us here


What is Articulation Therapy

A child may have an articulation disorder if they are deleting sounds (e.g., saying “do” for “dog”), substituting sounds (e.g., “dat” for “cat”), adding girl in speech therapysounds (e.g., “balue” for “blue”) or distorting sounds (e.g., “thpoon” for “spoon”). In general, there is a range of typical speech-sound development. Most children are 90% intelligible to a wider range of communication partners by the age of four. If you are concerned about your child’s speech intelligibility or articulation, it is best to seek the advice of a licensed speech-language pathologist who will conduct a formal assessment. This formal assessment will involve looking at both speech and sound production and sound error patterns or distortions.

What Qualifies As An Articulation Disorder?

There are many factors that may contribute a child’s diagnosis of having an articulation disorder such as a medical diagnosis or illness (i.e., including neurological disorders, genetic syndromes and developmental disorders), the development and structure of the oral mechanism, exposure to adult language models and/or hearing loss. Some common articulation errors include substituting /w/ for /l/ or /r/, distortion of /s/ as /th/ with the tongue
protruding on the sides or out the front of the mouth and de-voicing, using a /k/ for /g/.  Once your child has been formally diagnosed with an articulation disorder, you may be wondering as to what articulation therapy will consist of?

What Is Articulation Therapy?

Initially, a speech-language pathologist will determine which sounds will be most beneficial to target in terms of generalizing to other sounds and overall speech intelligibility. The process of therapy will begin by teaching the sound or sounds in isolation. This isolation process will be able to teach the accurate production in terms of placement in the mouth and movement of the articulators. Once production of the sound is mastered, the speech pathologist will follow a hierarchy of more complex language targets to generalize the sound to words, phrases, sentences, and, eventually, conversational speech.  A hierarchy of speech levels includes mastering the production of the sound in that context at 80% accuracy or higher across a number of sessions.

A traditional speech therapy hierarchy may resemble the following:

  • Sounds in isolation
  • Sounds in words (i.e., all word positions: initial, medial and final)
  • Sounds in phrases
  • Sounds in sentences
  • Sounds in reading/writing
  • Sounds in spontaneous conversational speech

Articulation therapy involves significant repetition and targeting of the sounds in error. Although drills are often targeted, a speech pathologist will use a variety of methods to target sounds and keep your child motivated. Once the sound has been mastered at all levels of the hierarchy, it is likely to be remedied with minimal maintenance needed in order to support the best production.