The Effects of Muscle Exercises on Velopharyngeal Gap and Nasality

Abstract

The cleft palate literature is replete with statements recommending the use of muscle exercises for improving velopharyngeal functioning and speech. Proponents of these techniques (2, .9, 12, 16, 17', 1.9, 24, 25) have suggested exercises directed toward achieving voluntary control of muscle function and/or increasing muscle strength, bulk, and flexibility. Their proposals appear to be based on the assumptions that (a) velopharyngeal mechanisms function similarly to other neuromuscular mechanisms which have been modified through physical therapy procedures, and (b) improved velopharyngeal functioning for nonspeech activities will carry over into speech activities. The validity of using muscle exercises to increase velopharyngeal movements has been questioned. Some investigators (1, 3, 5, 6, 14, 15, 23) have suggested that velopharyngeal function differs during speech, swallowing, gagging, blowing and sucking. Others (8, 18, 21, 22) have pointed out that neuromuscular processes responsible for speech may be dissimilar to other neuromuscular processes involving the same muscle groups. Recent literature provides some support for muscle exercises. Yules and Chase (26) have described a muscle training program for developing pha-ryngeal wall movement during speech. Their procedures consisted of training 30 patients to bring under voluntary control movements elicited by electrical stimulation. Later these movements were shaped into spontaneous speech using operant conditioning techniques. They reported that 90 per cent of their patients either eliminated or decreased nasality during the course of treatment. Lubit and Larsen (11) have described an appliance which was developed to exercise the soft palate. They presented a case study suggesting that use of the exerciser may lead to desired changes in palatal function and speech. Massengill et al. (13) observed the influence of blowing, sucking, and swallowing exercises on velopharyngeal closure during the production of /i/ and /u/. Subjects were divided into three