Velopharyngeal Insufficiency

Velopharyngeal Insufficiency

Technically defined, Velopharygneal Insufficiency (VPI) is a disorder where the soft palate does not form complete closure during speech which allows air to flow through the nose instead of only the mouth.  

Essentially, when you speak (especially saying consonants like b, p, d, t, k, and g), air comes from your lungs and out of your mouth, stopped briefly by your tongue or your lips to form the consonant sound.  The reason the air comes out of your mouth is that your soft palate (the top of your mouth toward the back of your throat) moves to block air from coming up your nose.  Ever take a drink and have milk come out your nose? Your soft palate wasn't closing off your nose.  That is a case of VPI, basically, your soft palate didn't close off your nose from your mouth.

Here are some pictures from the Seattle Children's Hospital which hopefully illustrate what I just explained above:

Soft Palate during typical speech. 

Soft Palate at rest.  See how air comes up from your lungs through your mouth and nose? That is how the soft palate rests in those with VPI during speech as well.

 The main symptoms of VPI are:

• Nasal sounding speech
• Nasal emissions (essentially snorting air out of the nose especially when producing "stop" consonants like p, b, t, d, k, and g)
• Substituting glottal stops (like the sound in between "uh-oh") for consonants
• Unusual productions of sounds like using your tongue to produce "b" instead of just your lips.

Many of the people who have VPI are those with a history of cleft palate.   Additionally, those with recent adenoidectomies, recent traumatic brain injuries are susceptible.  Occasionally, there are people who have VPI with no definable cause. 

When a child (or adult) is suspected of having VPI, the speech therapist will refer them to an ENT to get a full evaluation.  In some bigger locations, there are teams who are specialists in this area (may be cleft palate teams) who are also able to evalute.  When you go to the ENT appointment, the ENT will look through your nose and down your throat, possibly with a cool fiber optic tube to see how the soft palate is working.  Additionally, you may be asked to take part in a special x-ray to monitor soft palate use during speech. Occasionally, during diagnosis, you may be asked to see a team of specialists including an ENT, surgeon, and speech language patholgoist.

Speech Therapy cannot cure VPI alone.  While speech therapy can assist in learning techniques to help speak after the main treatment which is either a speech appliance or surgical intervention.  

A speech appliance, called an obturator, is somewhat similar to a retainer, and is worn in the mouth and used to help keep the soft palate up where it needs to be. The obturator can be used before surgery, after surgery, or instead of surgery. Additionally, some patients opt to not use it at all and wait for surgery.

Surgical Interventions are either a Furlow palatoplasty, which moves muscles in the throat to be better positioned for moving the soft palate into the position it should be for speech, or a sphincter pharyngoplasty which places tissue in the back of the throat to close the gap between the back of the throat and the soft palate. Speech therapy can be provided before and after surgery to help the child learn proper positioning of consonants and to help the child correct incorrect speech patterns.


 
References:

• Pictures and Information from Seattle Children's Hospital Velopharyngeal Insufficiency 
• Cincinnati Children's Hospital has some great pictures and explanations
• Velopharyngeal Disfunction just in case you want to get your research on! 

If You Give a Mouse a Cookie

If You Give a Mouse a Cookie

If You Give a Mouse a Cookie by Laura Numeroff is one of the most fun books to read in speech!  I love the whole series (including If You Give a Pig a Pancake and If You Give a Moose a Muffin). This book is one of the best books for simple sequencing, vocabulary, and fun related activities. 

With one of my clients, I am focusing on building basic vocabulary.  On each page as you go through the book there is a picture of what the mouse wants attached with velcro.  While at first, this will just emphasize the words that I want the child to learn, as they improve, we will increase to matching the picture to the word, using the pictures to sequence the book, and mixing them up to allow the child correct me using yes/no.

With every book I like to use "thematic learning" so that my whole session revolves around the book we are reading. I enjoy using coloring activities to learn the words for the colors, give them choices (I typically have them choose between 2-3 color choices), and to give a break of focused language attention.  When we color, I sing the song "This is the way we color the _____, color the ______ color the _____. This is the way we color the _____. We're coloring it ______" I fill in the blanks with whatever we're coloring (in this case the mouse or the cookie) and the color the child chose. 

For one of my language activities, I made a cookie jar.  Each cookie in the "jar" has one of the objects from the book on it.  We will use the jar to review vocabulary and build sentences.  For each cookie we'll place it on the square and say, "There's ______ (scissors, a cookie, a napkin, etc.) on my cookie!" and then place the cookie IN the jar.  I want to work on IN and OUT and this will be one of the ways that we work on the word "in." Every time we finish with a cookie, we'll place it in the jar.  There is a sandwich bag on the back of the jar set up to catch the cookies.  This activity could be used with other vocabulary, actions, directions, etc. What you put on the cookie is up to you.

 We've been working on yes and no questions for a while, so now we'll be working on questions with cookies.  The kiddo will use the spatula to flip over the "cookie" and then we'll ask the question.  The questions currently are about the child's likes and dislikes for yes and no, but can be expanded to any wh- question or more difficult yes/no questions. Some of our questions include "Is this a plane?" and "Are you a boy?" We're using both sign language, body language (head nodding or shaking), and verbal cues to talk about yes and no.  Additionally, we've been reading the Sandra Boynton book "Are You a Cow?" for some extra practice.

We are also still working on generalizing big and little, so I have some pictures of big and little cookies and mice to keep placing in the big and little boxes that I used in Go, Dog. Go. 

References:

• Rock Chalk Speech Talk
• LCSLP blog 
• Speech Room News

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Body Parts

Body Parts

Body parts are some of the most important labels we can teach children.  Body parts help answer important questions like, "What hurts?" or "What did you hit?" Think about how many times we tell children instructions like, "Use your fingers to paint." or "Don't use your fingers to eat." If a child doesn't understand the word "fingers" they will have a very difficult time using or not using them appropriately.

Developmentally, children between one and two should be able to point to simple body parts when they are asked to, which means they receptively understand those words. By two and a half, a child should be able to expressively identify many body parts.  This means that by 2 1/2, your child should be able to both point to and say the name of a body part.  The body parts they are able to name will vary slightly depending on what you teach them.  For example, I had a speech teacher that taught all of his children to point to their throats and say, "larynx." Obviously, that isn't super common among parents.  Your child should know the basic parts of their face (eyes, ears, mouth, nose) and their limbs (arms, legs, feet, hands, head) by 2 1/2.

For me, I use two songs to talk about body parts--head, shoulders, knees, and toes, and the hokey pokey.  Head, shoulders, knees, and toes is a quick and easy way to get kids to both hear and touch 8 parts of the body.  I use a handy visual that I found while google searching one day that looks like this:

When I use this visual in therapy, I point to each picture as we go through the song the first time we sing it together.  The second time we sing it, I place the visual where my client can see it and then I do the motions for the song with them.  I sing it at least 2 times, but up to 4 or 5 times if the kid really likes the song.

The second song I love to use is the Hokey Pokey.  The Hokey Pokey is great because I can emphasize any particular body parts I want to!  If we just want to talk about eyes, feet, and knees, that is all we sing about!  Initially with kiddos I try to use body parts that are far away from each other (like nose, tummy, and feet) so that they don't get confused (like saying ear for eye, etc). Kids love to shake it all about! If you are in a big enough space with kids who really need some movement, getting to shake and turn is great for the kids!  It's a super fun song and emphasizes exactly what I need it to.  Man, I love the Hokey Pokey.

When I sing Hokey Pokey, I use easy clip art pictures to show the kid what body part we're talking about.  Like these for example:

To talk about one body part in particular, I like to sing something like, "This is the way we touch our nose" (This is the way we touch our nose, touch our nose, touch our nose. This is the way we touch our nose, early in the morning) or "[kid's name] has a little nose" to the tune of Mary had a little Lamb (Jessica has a little nose, little nose, little nose. Jessica has a little nose and this is how we [touch, tickle, poke, etc] it.)

I love the Sandra Boynton book Horns to Toes, and In Between which goes through all sorts of different monster body parts.  I also love her book Let's Dance Little Pookie which shows a pig and his mom doing things like putting shoes on their feet, hopping around, and is an easy and quick book to label body parts in.

 References

• All images from google images
• ASHA on speech development for 1-2 year olds
• Toddler Developmental Milestones