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Spring '14-127 (Exam 1) > 2/10/14 VPI/VPD: Hypernasality, Hearing Physical Assessment and Management > Flashcards

2/10/14 VPI/VPD: Hypernasality, Hearing Physical Assessment and Management Flashcards

1
Q

What does VPI mean?

A

Velopharyngeal Inadequacy

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2
Q

Essentially, how does VPI show in our clients?

A

With hypernasal speech

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3
Q

The “I” in VPI stands for Inadequacy, what does that mean?

A

Two things…

  1. Velopharyngeal Insufficiency
  2. Velopharyngeal incompetency
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4
Q

What does Velopharyngeal Insufficiency mean?

A

Where the soft palate isn’t long enough to contact the posterior pharyngeal wall

This is → structural etiology

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5
Q

What does Velopharyngeal incompetency mean?

A

The muscles of the velum aren’t capable of lifting the velum in closing that VP port

This is → neurogenic etiology

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6
Q

What could be some causes of a Velopharyngeal incompetency?

A
  1. Stroke
  2. Disease process
  3. Apraxia
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7
Q

What is Velopharyngeal Mislearning?

A
  • The velum is perfectly capable of VP closure
  • The child has learned to make the phoneme wrong
  • They make the phoneme through the nose, just as fast as they would through the mouth
  • Place is wrong; manner is correct
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8
Q

If a child cannot do this within the oral cavity they will make these deliberate errors, what is it?

A

Impound oral pressure;

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9
Q

T/F: Hypernasality is only on consonants?

A

FALSE!!

Hypernasality is ONLY on VOWELS!!

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10
Q

What is Anatomical Mismatch?

A
  • Arrangement of the skull and facial bones has the face anterior enough, that the hard/soft palate following that means the velum can’t make contact
  • spine is far back; face is far forward & structurally the velum can’t cross the difference
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11
Q

What is Platybasis?

A
  • The space within the anatomical mismatch

- The triangle that can be drawn between the radiographic points

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12
Q

What are the points of the triangle?

She told Sarah and I on 2/17 that this will not be asked on the exam.

A
  1. Posterior NS
  2. Basilar portion of the Occipital bone that makes the joint with the sphenoid
  3. Ethmoid channel of the back of the nose
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13
Q

What is VPD?

A

Velopharyngeal Dysfunction

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14
Q

What are characteristics of hypernasality?

A
  • Descriptor of a vowel quality
  • Present as a voice perception
  • Only describe voice quality on VOWELS!
  • Quality of the voice on VOWELS
  • Perception on vowel quality
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15
Q

What does NAE stand for?

A

Nasal Air Emission

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16
Q

What is NAE?

A
  • Air coming through the nose when there shouldn’t be

- Liquids ( /l/ /r/ /w/ ) and nasals ( /m/ /n/ /-ng/ ) aren’t going to help determine whether a child has NAE

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17
Q

If you are testing for NAE what consonants will your be testing?

A

Pressure consonants

Testing words with /p/ /b/ /t/ /d/ /k/ /g/ /s/ /z/ & the affricates “sh” “ch” “j”

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18
Q

What is compensatory errors?

A
  • deliberate/cognitive attempt to produce the distinctive features correctly.
  • children can make air come out of their nose on purpose
  • Will get manner and voice, but not place
19
Q

What is obligatory errors?

A
  • hypernasality or NAE if child can’t close the VP port
  • cognitive choice → child makes the sound a different way in order to get the distinctive features s/he couldn’t produce
  • child can’t help it – They can’t close the VP port therefore there is NAE
20
Q

When we are trying to assess the cause, and we look in the child’s mouth and can’t see a visible cleft… what could it be?

A

submucous cleft

21
Q

What are some ways to assess VPI/VPD?

A
  • X-Rays
  • Videoflouroscopy

*** MRI and CT’s aren’t useful at this time

22
Q

What is an issue with using the videoflouroscopy?

A
  • Biggest problem you paint the service with barium → it burns
  • Have to snort it to look at the VP port; then children cry washing all the barium away
  • Have to highlight the surface with a contrast substance
23
Q

What is an issue of doing x-rays?

A

Cleft palate child will be receiving a high number of x-rays throughout their lives → a lot of exposure to radiation

24
Q

Why is an MRI & CT not useful?

A

Aren’t fast enough to get a clear image when the velum is moving

25
Q

Which velopharyngeal valving pattern is the most common?

A

Coronal

Velum is moving up to contact the VP wall

26
Q

Which velopharyngeal valving pattern is the second most common?

A

Sagittal

The movement is in the vertical plane

Pharynx closes to the velum

Roughly 5% of pop. has this closure

27
Q

What is the velopharyngeal valving pattern where the velum moves, the pharyngeal wall contracts, and everything comes together?

A

Circular

3% of population has a velum that closes like this;

28
Q

What is closure where you can see the ridge of muscles coming out of the posterior pharyngeal wall; it looks like a shelf?

A

Circular with Passavant’s Ridge

Rare: 1-3% of population has this

29
Q

T/F: Endoscopic visual exam of VP mechanism for speech can be performed by an SLP?

A

True

30
Q

What are the advantages of an SLP being able to perform an endoscopic visual exam of VP mechanism?

A
  • Performed repeatedly
  • Performed at a speech clinic
  • Less expensive
31
Q

When a client has normal speech and resonance with normal VP function why can’t we do therapy?

A

It is a surgical fix, therapy won’t word

32
Q

What is task-specific VPD also known as?

A

Inconsistent VPD

33
Q

What is task-specific VPD (Inconsistent VPD)?

A
  • Closes for some sounds, not others
  • Timing issue; VP port opens early & closes late
  • Therapy is more likely to work → velum is capable of closure, it just doesn’t always get there
  • Use endoscopic evaluation to look at the contact
34
Q

What is irregular VPD?

A

Where there is no consistent pattern

35
Q

During an endoscopic exam, what are we looking for?

A
  • Pattern of closure

- Degree of closure aka “Type of patency”

36
Q

What is pattern of closure?

A
  • Can’t see VP closure through the mouth
  • You can tell if the velum is moving or if there is pharyngeal wall movement
  • Patterns of closure are on a continuum
37
Q

What is Type of patency?

A
  • Can be in every direction (posterior/anterior, front/center, left/right?)
  • Describe relative to breathing ***
  • Look at VP Port when patient is breathing through their nose = 100% patency (the VP port if completely open)
38
Q

What type of closure is the coronal pattern?

A

Medium closure; 30-40%

39
Q

What type of closure is circular pattern?

A

Small/medium; 10-20%

40
Q

What type of closure is Circular with passavant’s ridge pattern?

A

Small closure; 10-15%

41
Q

What type of closure is the sagittal pattern?

A

Medium closure; 20-30%

42
Q

What is the most important tool we have?

A

Our ears

43
Q

When evaluated this type of case; what are our course of actions during the eval. process?

A
  • First thing you will do is listen & do a speech evaluation
  • Listen to errors; are they consistent?
  • Are they task-specific?

Spring '14-127 (Exam 1) (5 decks)

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