2/10/14 VPI/VPD: Hypernasality, Hearing Physical Assessment and Management Flashcards
What does VPI mean?
Velopharyngeal Inadequacy
Essentially, how does VPI show in our clients?
With hypernasal speech
The “I” in VPI stands for Inadequacy, what does that mean?
Two things…
- Velopharyngeal Insufficiency
- Velopharyngeal incompetency
What does Velopharyngeal Insufficiency mean?
Where the soft palate isn’t long enough to contact the posterior pharyngeal wall
This is → structural etiology
What does Velopharyngeal incompetency mean?
The muscles of the velum aren’t capable of lifting the velum in closing that VP port
This is → neurogenic etiology
What could be some causes of a Velopharyngeal incompetency?
- Stroke
- Disease process
- Apraxia
What is Velopharyngeal Mislearning?
- 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
If a child cannot do this within the oral cavity they will make these deliberate errors, what is it?
Impound oral pressure;
T/F: Hypernasality is only on consonants?
FALSE!!
Hypernasality is ONLY on VOWELS!!
What is Anatomical Mismatch?
- 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
What is Platybasis?
- The space within the anatomical mismatch
- The triangle that can be drawn between the radiographic points
What are the points of the triangle?
She told Sarah and I on 2/17 that this will not be asked on the exam.
- Posterior NS
- Basilar portion of the Occipital bone that makes the joint with the sphenoid
- Ethmoid channel of the back of the nose
What is VPD?
Velopharyngeal Dysfunction
What are characteristics of hypernasality?
- 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
What does NAE stand for?
Nasal Air Emission
What is NAE?
- 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
If you are testing for NAE what consonants will your be testing?
Pressure consonants
Testing words with /p/ /b/ /t/ /d/ /k/ /g/ /s/ /z/ & the affricates “sh” “ch” “j”
What is compensatory errors?
- 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
What is obligatory errors?
- 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
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?
submucous cleft
What are some ways to assess VPI/VPD?
- X-Rays
- Videoflouroscopy
*** MRI and CT’s aren’t useful at this time
What is an issue with using the videoflouroscopy?
- 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
What is an issue of doing x-rays?
Cleft palate child will be receiving a high number of x-rays throughout their lives → a lot of exposure to radiation
Why is an MRI & CT not useful?
Aren’t fast enough to get a clear image when the velum is moving
