Right on the Nose: What You Need to Know about VPI

Cleft lip and palate is the second most common birth defect in the United States and it affects 1 in every 940 births (ASHA, n.d.). Despite this incidence, many graduate training programs in speech-language pathology do not provide specific courses to teach assessment and intervention in this population. Clinicians are left to rely on continuing education and/or mentoring to improve their skills. Limited knowledge in this area can lead to inappropriate treatment and/or unnecessary surgery. In 2010, 82% of those surveyed did not feel qualified to treat children with a speech disorder secondary to cleft palate (Baigorri 2020). Thus there is a clear need to make education in this area accessible to speech-language pathologists.

In the first section of this workshop, we’ll review a foundation of oral anatomy as it relates to cleft lip and palate. The various types of clefts and their possible etiologies will be discussed, along with the impact of dentition on speech production. Then we’ll review the typical timeline for cleft lip and palate repairs as well as discuss the most common revision surgeries.

The second section will elaborate on the functions of the oral structures reviewed earlier. We’ll discuss the function of the VP port and the difficulties presented when it does not work correctly. We’ll also discuss how to differentiate between true structural-functional issues and VP mislearning. Then we’ll examine the specific impact VPI has on speech production, and touch on feeding difficulties in this population.

With a strong foundation from the first two sections, we will dive into evaluation for the third section. We’ll look at thoroughly assessing the oral mechanism, speech production, voice and resonance. We will also discuss when to refer for instrumental evaluations such as soft palate studies and nasopharyngoscopy. During this section we’ll view a number of videos and practice diagnostics.

In the last section, we’ll cover treatment, including pre-surgery and post-surgery techniques. We will discuss the selection of appropriate targets and how to progress through additional targets, strategies for specific sound errors including compensatory errors, and why it is never appropriate to use non-speech oral motor exercises (NSOMEs). We will also touch on considerations for Spanish-speakers and those clinicians in telepractice.

Following this training, participants will be able to: 

1. Describe how anatomical structures and functions impact speech and resonance.
2. Identify nasal emission, hypernasality, and nasalized consonants in a child’s speech.
3. Contrast compensatory errors with obligatory distortions.
4. Assess whether a child’s speech disorder is caused by VPI or velopharyngeal mislearning.
5. Utilize a protocol for assessment of resonance and velopharyngeal function.
6. Explain when a referral to ENT or cleft palate team is necessary.
7. Implement 3 specific treatment techniques for articulation errors related to VPI.
8. Explain why NSOMEs are not indicated in treatment of VPI.

This course meets the requirement for Professional Development hours towards your ASHA renewal since it is approved by TSHA! You can count these hours towards ASHA renewal when you submit your Compliance Form.