About VPI

Velopharyngeal insufficiency is a speech disorder which occurs when the soft palate or “velum” fails to make contact with the back of the throat or “pharynx”, a function necessary for normal speech. There are many causes of VPI, including:

1) Cleft palate
2) Submucous cleft palate
3) Congenitally short palate or “velum”
5) Adenoidectomy
6) Motor speech disorders
7) Velo-cardio-facial syndrome

FREQUENTLY ASKED QUESTIONS

How Do You Know If Your Child Has VPI?
What Treatment Is Best For My Child?
What Is The Difference Between Perceptual And Objective Testing?
How Is a Treatment Recommendation Made For My Child?
What Should I Do If I Think My Child Has VPI?

How Do You Know If Your Child Has VPI?

Normal oral airflow for speech

Air leaks through the nose during speech

The symptoms of VPI include:

- Nasal sound substitutions
Your child may say all nasal sounds (m,n) for oral sounds (i.e. p,b,t,d). This means that instead of your child using the sounds such as “b” in “bye-bye”, he/she would substitute the sound “m” instead and say “mye-mye”. This is not something the child can control. Rather, the structure of their palate may make it impossible to say the “b” correctly because the palate is too short to close off the oral cavity (mouth) from the nasal cavity (nose). (see figure 1 and 2)

- Nasal voice quality
Your child may be able to produce all sounds correctly but there is a “nasal” quality to his/her voice (hypernasality). This is quite different from how we sound when we have a cold (hyponasality) which is often temporary.

- Nasal air emission
When your child talks, you may hear air escaping from the nose (inappropriate nasal air emission) especially during the high pressure sounds /p,b/ or continuant sounds such as /s,z/.

- Glottal sound substitutions
Sometimes children develop a different way to produce speech sounds (compensatory or glottal substitutions) which is easier for them but very difficult to understand. Since the child cannot control the air that comes out of his/her nose, he/she may try to “stop” the air at the voicebox (larynx) which creates a rough or breathy sound or may sound like the sound is being omitted. This type of speech pattern requires correction immediately through speech therapy. Surgery alone will not improve this type of speech pattern.

A child may have a combination of these symptoms or just one.
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What Treatment Is Best For My Child?

1) If your child has glottal or compensatory articulation, then speech therapy is necessary to retrain those speech patterns, regardless of his/her age.

2) If your child is young (under 3 years of age) and has nasal substitutions, hypernasality or nasal air emission a diagnostic (trial) course of speech therapy is recommended. This may last from 3-6 months depending on the child’s progress. Speech therapy may also help prepare a young child if any instrumental (objective) testing is needed. These may include a videofluoroscopy (motion picture x-ray), nasopharyngoscopy (small nasal scope), nasometry (rates nasality during speech) and/or pressure flow measurements (measures nasal and oral air flow). These tests may be done if physical management (surgery or speech appliance) is necessary to improve the child’s speech.

3) If your child is older and has acceptable articulation skills, speech therapy may not be necessary and objective testing may be the first step.
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What Is The Difference Between Perceptual And Instrumental (Objective) Testing?

1) Perceptual testing is done by a speech pathologist. The speech pathologist will have your child say different words/sentences and listen to the quality and accuracy of his/her speech.

2) Objective or instrumental testing should be done by a speech pathologist after the perceptual testing has been completed. Some testing requires the assistance of a radiologist or physician.
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How Is A Treatment Recommendation Made For My Child?

A recommendation for treatment is made by the speech pathologist based on your child’s age, speech skills, developmental history and previous speech therapy. If physical management is necessary, the speech pathologist may refer the child for more instrumental testing and to an experienced plastic/craniofacial surgeon. The surgeon reviews the medical history and perceptual and instrumental test results and does an oral exam. The recommendation for physical management is made jointly by the surgeon and speech pathologist.
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What Should I Do If I Think My Child Has VPI?

The treatment of VPI should be done by a speech pathologist and plastic/craniofacial surgeon experienced in the area of cleft palate and oro-facial speech disorders. The American Cleft Palate-Craniofacial Association has a listing of teams throughout the U.S. and many foreign countries. The University of Florida has a VPI clinic specializing in treating children/adults with oro-facial speech disorders. Contact the UF Craniofacial Clinic office at 352-334-0228. Or for more info log onto www.ufcleft.com.

Ms. Dixon-Wood is available for private speech consultations which include:

a) Assessment of articulation, resonance, nasal emission distortion and an oral exam.
b) Referral for appropriate instrumental testing if needed.
c) Coordination of speech management including recommendations and treatment plans for local speech therapy, pre- and post-operative testing and counseling (if surgery is needed).

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