Question
I have just recently started working with a client who has been diagnosed with Velar apraxia - or inconsistent Velopharyngeal closure. He has tested negative on genetic tests and craniofacial clinic does not recommend treatment at this time. What are some
Answer
Apraxia of speech is characterized by difficulty coordinating and sequencing the motor movements required for speech. Although we typically think of apraxia as affecting the anterior articulators (lips, tongue and jaws), it can also affect the posterior articulators (velopharyngeal valve) and other subsystems of speech (respiration and phonation).
When there is apraxia of speech, inconsistent hypernasality may be noted because the individual is unable to coordinate rapid anterior articulation movement with velopharyngeal movement. As a result, the velum stays in the resting position inappropriately. (At times there may even be some hyponasality if the velopharyngeal valve closes inappropriately on nasal sounds.) As with other errors, the hypernasality will tend to increase in severity with an increase in utterance length and phonemic complexity.
The treatment of hypernasality due to apraxia is standard articulation therapy. The only exception is that you will not tell the individual how to achieve placement. Instead, you work on oral sounds, words and sentences with increasing levels of complexity, and use the child's auditory feedback skills for monitoring. One way to help the individual to monitor his/her own production is to place one end of a straw or tube in one nostril and the other end in his ear. Have him work on oral sounds, and then words and sentences that are devoid of nasal sounds. If he hears sound in his ear, he should try again. When there is nasality, the sound in the ear is usually very loud, thus it serves as negative reinforcement as well.
For more information, see Kummer, AW. Cleft Palate and Craniofacial Anomalies: The Effects on Speech and Resonance, Thomson Delmar Learning, 2001.
Dr. Kummer is Senior Director of the Speech Pathology Department at Cincinnati Children's and Professor of Clinical Pediatrics at the University of Cincinnati Medical Center. She is the current Coordinator of ASHA's Division 5: Speech Science and Orofacial Anomalies and is an active member of the American Cleft Palate-Craniofacial Association. She does many lectures and seminars on a national and international level. She is the author of many professional articles and 11 book chapters. She is also the author of the text entitled Cleft Palate and Craniofacial Anomalies: The Effects on Speech and Resonance, Thomson Delmar Learning, 2001. She is an ASHA Fellow.