tips for articulation with cleft palate

Cleft palate and velopharyngeal dysfunction are hard! I feel like as a new therapist, they are totally intimidating to work with and make you feel insecure about your therapy skills. I have the most precious, smart friend with cleft palate on my caseload right now that has made great progress. She mastered /p, b, m, n, t, d, k, g/ in words with adequate pressure. Then I felt stuck! What do we work on and how do we work on it? Of course, we can work on medial positions and connected speech (phrases, sentences)....but I also wanted to work on airflow for some of those harder sounds f, s, sh, ch to increase her inventory. Airflow is tricky! Especially when compensatory strategies are in place. Here are 3 things I am trying to teach airflow and decrease hypernasality:

1. /t/ to /s/ production: I have her say t, t, t, t, tssssssss. She is a great sport and will do multiple repetitions.

2. tubing from the mouth to ear: I have some handy fat, bendy plastic straws. I have her hold the straw from her mouth to her ear and then produce /s/. When the air is coming out the mouth, you can hear/feel it whistling in the ear. When the air is coming out the nose, you can't. It's pretty cool to try it on yourself :)

3. pressing down with production: I have her push hard on the table while making /s/ or /sh/ or pull up hard on the table while squeezing her "speech muscles" hard. Hoping to increase closure and pressure by doing this.

That's all I have got! A recent training stressed that non-speech blowing tasks are NOT effective treatment strategies. Sometimes I get overwhelmed working with these complex artic kids sometimes....especially when I feel like maybe surgery (like in VPI) is the only thing that will help their speech. Never fear! It was encouraging to hear in training that kids that received speech therapy prior to surgery and after surgery compared to kids that only received speech after surgery made greater and faster gains. Whoop whoop! You are making a difference even if it doesn't feel like it some days :)