The Velum and Speech and Swallowing

The velum or soft palate is the soft tissue constituting the back of the roof of the mouth. During non-speech tasks such as swallowing, blowing, sucking and whistling the velum elevates and retracts to separate the nasal cavity from the oral cavity. Improper closure of the velopharyngeal sphincter can lead to difficulty with bottle feeding because proper intra oral pressure is necessary to achieve an adequate suck, swallow, breathing pattern. If the nasal cavity is not properly sealed via velophayrngeal closure choking or coughing can occur due to liquids or solids entering the nasal and pharyngeal cavities causing nasal regurgitation. During speech tasks the velum also elevates and retracts to separate the oral cavity (mouth) from the nasal cavity to produce consonants including /p, b, t, d, k, g, s, z, ch, zh, sh, r, l/ and remains open for nasal sounds /m,n,ng/. If there is improper closure of the velopharyngeal port, air escapes through the nose leading to “nasal” speech sounds. Complete velopharyngeal sufficiency (velopharyngeal competency) occurs when the velum occludes the velopharyngeal port which separates the oral cavity (mouth) and nasal cavity in a proper and timely manner.

There are a variety of disorders of the velum including:

Velopharyngeal Insufficiency (VPI) is caused by anatomical defects such as a cleft palate or submucous cleft (overt or occult), short velum or deep pharynx, irregular adenoids and enlarged tonsils.

Velopharyngeal Incompetence (VPI) is caused by physiological defects such as reduced muscle function secondary to a history of a cleft lip or palate,  submucous clefts, pharyngeal hypotonia, velar paralysis or paresis due to brain stem or cranial nerve injury, neuromuscular disorders including Myasthenia Gravis, Dysarthria or Apraxia due to congenital or acquired neurological impairments.

Velopharyngeal Mislearning is abnormal nasal articulation as a result of inadequate velopharyngeal closure on certain sounds that can be phoneme specific and is a learned misarticulation.

Hypernasality occurs when there is too much sound vibrating in the nasal cavity causing speech to have a nasal quality.

Hyponasality occurs due to limited nasal airflow during the production of nasal sounds /m,n,ng/ that often results in a sound with a perceptual quality of having “a cold”. This can be the result of obstruction when there is nasal congestion, enlarged adenoids and a deviated septum.

Therapy is effective and appropriate if the individual demonstrates the following:

  • Hypernasality or variable resonance due to apraxia
  • Compensatory articulation productions secondary to VPI that cause nasal emission
  • Misarticulations that cause nasal air emission that are phoneme-specific
  • Hypernasality or nasal emission following surgical correction.
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What is Oral Motor Weakness?

Oral facial muscle weakness affects the structures of the oral mechanism and surrounding facial muscles that impacts the modalities of speech production and feeding/mastication. Speech production requires the integration of several systems one of which being neuromuscular motor output. If the muscles of the oral mechanism (mouth) and surrounding facial muscles do not have adequate strength, they are unable to perform the fine motor movements necessary for speech and feeding/mastication. Oral facial muscle weakness can influence affect, the face at rest, and the ability to make facial expressions.

The production of speech requires the articulation of sounds to be executed through the precise movements of speech structures within the musculature of the oral mechanism including the jaw, lips, cheeks, tongue and palate. When the muscles of this mechanism (such as muscles of the lips) are weakened, they are unable to make the precise contact necessary to make sounds such as bilabials /m,b,p,w/.

Oral facial muscle weakness affects feeding as the mouth and muscles of the mouth plays an integral part in the process of eating by containing the food within the mouth, chewing, and preparing the food for swallowing. Weakness to any of the muscles required for this process can result in deficits with feeding and swallowing (Dysphagia). Difficulty with straw drinking, drinking from an open cup or managing/manipulating food within the mouth is characteristic of an oral facial muscle weakness.

Oral facial muscle weakness not only affects feeding and swallowing but also can be problematic for non-speech tasks that require motor movements from the oral facial musculature such as the lips for actions such as blowing, puckering and smiling. These individuals may also have difficulty performing one or more of these movements in tandem. Individuals with oral facial muscle weakness may present with reduced muscle strength, reduced speed of movement of the muscle, reduced range of movement of the muscle, poor dissociation (independent movement) of the structures required for speech, reduced accuracy of the muscle movement, and diminished muscle tone. These deficits perceptually affect speech and can affect an individual’s ability to be understood by others when speaking.

Oral facial muscular weakness can co-occur with a variety of disorders such as dysarthria, cerebrovascular accidents (CVA), oral myofuntional disorders, multiple sclerosis, myasthenia gravis, muscular dystrophy, Bell’s palsy or they can be iatrogenic, meaning to relating to an illness cause by medical examination or treatment.

Assessment for oral facial muscle weakness can be conducted through subjective measures, instrumentation and biofeedback methods, and standardized measures administered by a trained Speech Language Pathologist. Tools and oral motor treatment protocols are used to teach dissociation, grading of the muscles of the jaw that are necessary for safe feeding and the production of speech. Treatment of oral facial muscle weakness involves several methods targeted at increasing the strength of the muscles of the oral mechanism through oral motor exercises, biofeedback methods and extinguishing behaviors that promote oral muscle facial weakness such as prolonged bottle, pacifier and sippy cup use.

Should you feel you fit the criteria of anything described or have any further questions relating to oral facial muscle weakness please contact one of our local offices to arrange an evaluation or to speak with one of our trained speech language pathologists.

Hope this was helpful!

Remy

 

 

Autism Awareness

Since it is autism awareness month, I thought I should shed some light on behaviors and difficulties associated with children who have autism. The following is a list of milestones that these children may have difficulty achieving:

3-4 months

Children should follow moving objects with their eyes, watch faces with interest, and turn toward a sound.

7 months

Children should respond to their names, respond to the emotions of others, enjoy face-to-face play, and babble in chains of sound.

12 months/1 year

Children should imitate sounds and use single words, use simple gestures like pointing, and find hidden objects.

2 years

Children should combine 2 words to communicate, have names for familiar people and favorite toys, and follow simple directions.

3 years

Children should be openly affectionate and use make believe to play.

4 years

Children should begin telling stories, use colors and count.

See autismspeaks.com for more information on developmental milestones.

Children with autism typically have difficulty with social interactions, including communication. These children are often not interested in other people and use poor eye contact. It has been described as if the child appears to be looking around you or past you as you are speaking to him. They will often grab your hand to move you toward objects they want. For example, they may grab your hand and put it on a container of Play-Doh so that you open it, or put your hand on a book to get you to read it.

Children with autism engage in what is known as echolalia. They will often repeat words and sentences rather than making their own sentences. When asked questions, they often will repeat the question rather than answering it. This is especially true if they do not know the answer to the question. Their intonation is sometimes flat and they do not change their pitch to match the mood of the sentence or for asking questions.

Another behavior seen in children with autism is self-stimulatory behaviors and hand flapping. This behavior is seen in many children before 2 years old, but when it persists, it is often a sign of autism.

Tension Reducing Exercises

Many of us carry tension in our shoulders. The stress of driving to work, being at work, kids, school, housework; everyday activities cause tension, good and bad. It is very important to spend some time every day to decompress and release that tension. This stress and tension can eventually lead to health problems, including voice disorders and the voice box is located in your throat where this tension lies.

Yoga is a great way to decompress. Realistically, however, many of us do not have the time to pull out a mat and do a full hour session of deep breathing and stretches every day. On days that you can’t take the time to really decompress, here are some quick things you can do to ensure mental and physical well-being.

Every day, or every stressful activity if need be, should begin with a warm-up and end with a cool-down. Just like if you were about to run a marathon; you wouldn’t just stand up and start running then lay down and watch TV as soon as you are done. First you must stretch or do some speed walking, and when you are done you will probably cool off by doing some walking or more stretching. So when entering a stressful situation or a situation during which you will do a lot of talking, warm- up your voice and your shoulder and neck muscles. Likewise, when you are done with you stressful situation, cool off your voice and your tension areas with a cool-down. Remember, cool-downs do not have to be as long as warm-ups.

Start with shoulder and neck stretching:

Shoulder Rolls- Bring your shoulders forward and roll them back to gather tension up then release it. Inhale for upward motion, and exhale for downward motion. Remember that you want to open the chest area by rolling back, not forward.

Head rolls- Turn your head over one shoulder, roll it down so your chin touches your chest and to the next shoulder. Never roll your head backwards when trying to reduce tension because this will add tension to your voice box. Inhale for the downward motion to the chest and exhale for the upward motion to the next shoulder.

Head tilts- While keeping your shoulders in place, tilt your head as far to the side as you can to the shoulder without moving your shoulders up. For the exhale, release and slowly move your head back to midline. Repeat this on the other side.

These exercises should take less than 5 minutes to do. Do each of these approximately 5 times. Take notice of which work best for you and do those more than the others.

Next, warm-up your voice with:

Lip trills- Take a deep, slow breath and expel it by doing raspberries. Hold this out until you finish the entire breath stream. This exercise is like a massage for your vocal cords.

Sighing- This helps you to release tension while relaxing the vocal cords. Take a deep breath. Open your mouth wide and let out a big yawn and a loud sigh. Make sure that the sigh lasts until you are out of breath. (Warning- this exercise is most likely going to make you yawn for real!)

For a cool-down, simply do an abbreviated version of these exercises. Remember, these exercises are meant to decrease tension and stress as well as promote good vocal hygiene!

That’s all for now. Hope this helps. Keep calm and breathe on!

-Melissa

Apraxia

Apraxia is a disorder that can be confusing to understand. Children with apraxia have difficulty planning the movements for speech. They often will have a few words that they say well but cannot say other words that have the same sounds. This is because words that are automatic are easier to say than new words. When counting to 10, you probably don’t have to think too much about which number is coming next. That is because numbers are automatic. The more exposure you have to a word or phrase, the more automatic it becomes. Here are some ideas to help you work with your child who has apraxia.

READ and SING- Reading repetitive nooks and songs is helpful. Read and sing the same books and songs often and the words will become more automatic for your child.

PLAY WITH VOWELS- Vowels are often overlooked when children are learning sounds. Work on saying all of the vowel sounds by themselves before doing other sounds. Then, play with sounds combining them with the vowels. Try to keep your sounds in the same category. For example, m, b, p, w are all made using the lips. Try one vowel at a time when playing (moe, bow, poe, whoa), then switch vowels after these combinations are easy to say (me, pea, bee, whee). This helps your child learn to say different consonant sounds next to vowels; therefore, making it easier to plan out new words.

Hope this helps!

-Melissa