Expiratory Muscle Strength Training for Hypernasal Speech in Children

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Expiratory Muscle Strength Training

At visit 1, participants will be block randomized based on PWSS score (5-6 or 7+) to Expiratory Muscle Strength Training (EMST) for 6 to 8 weeks or no exercises. Participants in the EMST-150 group will perform 5 sets of 5 resistive expirations once a day with a 10-15 second rest between each repetition and a 1-2 minute rest between each set of 5 repetitions.

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Maintenance Training

At visit 2, participants with improved (decreased) CAPS-A hypernasality rating of 1 or more points, for whom the family and/or surgeon is not currently considering surgical intervention for VPI, will be further randomized to continue "maintenance" EMST exercises or no exercises for 6 months. Participants in the "maintenance" group will complete 3-5 sessions exercise sessions each week (rather than daily training), with 2 sets of 5 resistive expirations (rather than 5 sets)

Change in nasalance scores after 6-8 weeks of exercises compared with baseline

Time frame: Baseline and 6-8 weeks

Percent change in nasalance measured during nasometry

Change in perceptual speech symptoms of velopharyngeal dysfunction following 6-8 weeks of exercises compared with baseline

Time frame: Baseline and 6-8 weeks

Perceptual symptoms of velopharyngeal incompetence measured using the CAPS-A-AM hypernasality score, on a scale of 0-4. 0 indicates nasality that is normal for the region, 1 (borderline/minimal) suggests a minimal or inconsistent increase in nasal resonance, 2 (mild) implies hypernasality that is evident on vowels with a high tongue posture, 3 (moderate) indicates hypernasality that is perceived across all vowels, and 4 (severe) signifies that hypernasality is evident in voiced consonants and all vowels.

Change in oral pressure following 6-8 weeks of exercises compared with baseline

Time frame: Baseline and 6-8 weeks

Percent change in oral pressure achieved when blowing through the EMST-150

Change in velopharyngeal flutter following 6-8 weeks of exercises compared with baseline

Time frame: Baseline and 6-8 weeks

Change in percentage of participants with oscillating oral pressure when blowing through the EMST-150

Change in oral pressure decay following 6-8 weeks of exercises compared with baseline

Time frame: Baseline and 6-8 weeks

Ratio of the magnitude of oral pressure decay when blowing through the EMST-150

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