Video Game Rehabilitation of Velopharyngeal Dysfunction: A Case Series

Abstract

Purpose Video games provide a promising platform for rehabilitation of speech disorders. Although video games have been used to train speech perception in foreign language learners and have been proposed for aural rehabilitation, their use in speech therapy has been limited thus far. We present feasibility results from at-home use in a case series of children with velopharyngeal dysfunction (VPD) using an interactive video game that provided real-time biofeedback to facilitate appropriate nasalization. Method Five participants were recruited across a range of ages, VPD severities, and VPD etiologies. Participants completed multiple weeks of individual game play with a video game that provides feedback on nasalization measured via nasal accelerometry. Nasalization was assessed before and after training by using nasometry, aerodynamic measures, and expert perceptual judgments. Results Four participants used the game at home or school, with the remaining participant unwilling to have the nasal accelerometer secured to his nasal skin, perhaps due to his young age. The remaining participants showed a tendency toward decreased nasalization after training, particularly for the words explicitly trained in the video game. Conclusion Results suggest that video game–based systems may provide a useful rehabilitation platform for providing real-time feedback of speech nasalization in VPD. Supplemental Material https://doi.org/10.23641/asha.5116828

Measurement of Nasalance Scores Without Touching the Philtrum for Better Comfort During Speech Assessment and Therapy: A Preliminary Study

“…Velopharyngeal dysfunction (VPD) is a resonance disorder related to the disturbance of sound energy transmission in the oral and nasal cavities and the velopharyngeal port during speech production (Cler et al, 2017; Kummer, 2011). Velopharyngeal dysfunction can cause hypernasality and/or hyponasality, and nasal air emission (Cler et al, 2017).…”

“…Velopharyngeal dysfunction (VPD) is a resonance disorder related to the disturbance of sound energy transmission in the oral and nasal cavities and the velopharyngeal port during speech production (Cler et al, 2017; Kummer, 2011). Velopharyngeal dysfunction can cause hypernasality and/or hyponasality, and nasal air emission (Cler et al, 2017). Hypernasality refers to the abnormal increase of nasal resonance due to palatal cleft, oronasal fistula, or VPD (Estrem & Broen, 1989; Guneren & Uysal, 2004; Hosseinabad et al, 2015).…”

“…Hyponasality refers to the abnormal reduction of nasal resonance due to the obstruction of the nasal cavity or pharynx caused by a deviated septum, maxillary retrusion, adenoid hypertrophy, or choanal stenosis (Guyette et al, 2001; Åsten et al, 2014; Koo et al, 2016). Nasal air emission refers to air leakage from the oral cavity into the nasal cavity when the port should be tightly closed (Cler et al, 2017). For the treatment of hypernasality caused by structural or neurological problems, surgical interventions are commonly needed, including palatoplasty for repairing the cleft palate, oronasal fistula closure surgery, and surgeries for velopharyngeal insufficiency or incompetence (Furlow, 1986; Murison & Pigott, 1992; Orticochea, 1999; Bae et al, 2002; Deren et al, 2005; Penna et al, 2007; Kummer, 2014).…”

“…For hyponasality caused by apraxia of speech or hearing impairment, speech therapy is recommended (Kummer, 2014). Speech therapy for VPD relies on either enhanced auditory or visual feedback (Cler et al, 2017). Enhanced auditory feedback refers to cues from a clinician’s auditory perception and devices that magnify the auditory-perceptual cues of the speaker.…”

Measurement of nasalance scores without touching the philtrum for better comfort during speech assessment and therapy

“…For the treatment of hyponasality and hypernasality, surgical interventions such as palatoplasty, oronasal fistula closure surgery, and surgeries for velopharyngeal insufficiency or incompetence are commonly performed [7,[12][13][14][15][16][17][18][19][20]. After surgery, speech therapy using nasometry and video games is usually conducted for further improving a patient's velopharyngeal closure activity [15,21].…”