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This one is about: Exercises for Palatal Stimulation

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1. Place your index finger behind teeth; move to the hard palate, then to the area between the hard and soft palates; continue to move onto the muscle of the soft palate, and elevate that muscle while pushing back (apply some pressure, but be gentle). Stimulate the soft palate to elevate with pressure on the right side and left sides separately, (usually twice on each side per session).

Take your time so the child can do this willingly, without gagging (this may take several weeks); i.e., do this little by little.

2. If the child vocalizes, have him/her say "ah" for a sustained period of time while you are stimulating the soft palate (i.e. you have elevated and pushed back the velum, and are holding it in place).

Administer the palatal stimulation 3 - 5 times a day. Note: Touching of, or pressure on, the palate should not be done too soon after surgery. Wait until your plastic surgeon clears this type of exercise.

3. Options: a) Use hard, but smooth, surfaces of objects, toys, toothbrushes, textures, etc.

4. Additional exercises (after the above stimulation) may include blowing activities, with lengthy sustained oral air flow (may need to have the nose closed manually or with a nose clip), with encouragement to blow easily, softly, and in lengthy blows (use tactile cuing); this will accustom the child to sustained airflow through the mouth, in place of inappropriate nasal airflow. Naturally, oral airflow will eventually need to be applied to speech through specific speech practice, as this activity itself is not felt to improve velopharyngeal closure.

5. Specific speech exercises after palatal stimulation may include:

a. Nares occlusion (nose closed by fingers or nose clip).
b. encouragement to produce sustained oral airflow during speech (may begin the repetitions of, e.g., "papapa" etc. on one breath, before practice in connected speech);
c. use maximum verbal, visual tactile and kinesthetic cuing for all airflow and placement activities.

Portions adapted from:  PRE-FEEDING SKILLS by S.E. Morris and M.D. Klein, 1987.

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