Ratings of Velopharyngeal Closure During Blowing and Speech

Abstract

The relationship between velopharyngeal behavior during blowing and during speech has remained unclear although there has been a tendency to assume that the two activities, both presumably requiring integrity of the valving mechanism, are in some way similar. Kantner (6) suggested that the aim of blowing was " to exercise the muscles of the soft palate and adjacent structures having to do with clo— sure of the opening into the nasopharynx. " His three major underlying assumptions for the use of blowing were: a) Blowing exercises would enable the patient to learn better voluntary control of muscle function. b) Blowing would lead to actual strengthening of the muscles. 0) Blowing would teach the patient to direct the air stream through the mouth. He doubted, however, that the skill developed through blowing exercises could be expected to carry over into equivalent skill in speech and questioned the use of such exercises in cases of gross palatal inadequacy. In a later discussion (5), he reiterated his contention that adequacy of structures for one activity should not be accepted as proof of adequacy for another. Morley (10) also emphasized blowing exercises in the speech training of children with clefts as did Moser (12) and Gaines and Wepman (4). Implicit in the use of these procedures was the assumption that purposeful blowing would help the patient direct the expired air stream through the mouth rather than through the nose. In the most recent edition of her book, Morley (11) places somewhat less stress upon blowing but continues to recommend it as a means of directing the breath stream and of developing full use of muscles responsible for velopharyngeal closure. Van Riper (14), like Morley, currently appears to de—emphasize blowing exercises. However, he recognizes that such procedures have probably been used more frequently than any other single device for strengthening the palate and he contends that they have a place in therapy if properly understood. He suggests that an " increasingly greater ratio of mouth air