specialty programs

Velopharyngeal Insufficiency Treatment

Why are children with VPI often misdiagnosed with apraxia?
Some children with VPI compensate for the loss of air through the nose by articulating sounds lower in the vocal tract, so that the sounds can be produced before the air pressure escapes through the nose. The most common of these compensatory articulation errors, a glottal stop, is produced by sharp contact of the vocal folds to stop the air instead of contact of the lips (for /b,p), tongue-tip (for /t, d/), or back of the tongue (for /k,g/). To an untrained ear, the speaker sounds like he or she is omitting consonants: kitty cat sounds like ih-ee-a and big boy sounds like ih-oy. This error is called a glottal stop because the opening between the vocal folds is the glottis. Because the child has already produced the sound (although at the vocal folds instead of in the mouth), he or she does not use the lips or tongue. In other words, the child does not move the articulators. Speech pathologists inexperienced with VPI and compensatory articulation misinterpret this lack of movement as an inability to control the lips and tongue, and conclude that the child has apraxia. In reality, this is simply an error in the place of articulation. The lips and tongue are not weak and do not need strengthening or stimulation; they are simply not being used because the child has articulated the sounds using the vocal folds instead. Therefore, oral exercises and stimulation are inappropriate. Speech therapy is needed.

Our speech therapists are specialized in working with children with VPI.  The speech pathologist is the professional who is most qualified to diagnose VPI and develop recommendations for treatment. VPI can be diagnosed at an early age (possibly by age 2-3) as soon as a child starts talking in phrases and short sentences. The treatment requires a coordinated effort between the speech pathologist and cleft palate/craniofacial surgeon.



“Juli's assertive approach to challenge Ty, born with Spina Bifida L5/S1, puts him on a path to mobility and independence, giving us hope for Ty's future.  She is an integral component to Team Titus.  I love medical professionals like Juli who truly care and love the work they do.” 

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