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Cleft Palate > Ch. 7 > Flashcards

Ch. 7 Flashcards

1
Q

Resonance disorders are common in individuals with a history of ____ ____ and _____ or other craniofacial anomalies.
Can be due to ______ _______, or obstruction in vocal tract

A

Resonance disorders are common in individuals with a history of cleft lip and palate or other craniofacial anomalies.
Can be due to velopharyngeal dysfunction, or obstruction in vocal tract

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2
Q

Velopharyngeal dysfunction can cause a ______ disorder (hypernasality) and also _____ _______ of the air
Significant nasal emission can cause other speech characteristics due to lack of _____ _____ ______ and air pressure

A

Velopharyngeal dysfunction can cause a resonance disorder (hypernasality) and also nasal emission of the air
Significant nasal emission can cause other speech characteristics due to lack of adequate oral airflow and air pressure

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3
Q

Normal Resonance:

  • Speech requires both ______ and ______
  • Airflow is converted into _____ ______ by articulators, which is needed for _____-_____ _______ (plosives, fricatives and affricates)
  • Sound is modified by _______, which is needed for _____ consonants and ______.
A

Speech requires both airflow and sound.
Airflow is converted into air pressure by articulators, which is needed for pressure-sensitive consonants (plosives, fricatives and affricates)
Sound is modified by resonance, which is needed for voiced consonants and vowels

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4
Q

Schema of Speech Production

A

see ch. 7 powerpoint

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5
Q
  • Resonance—tendency of a system to ______(oscillate) with a larger ______ at some frequencies than others due to the natural vibration of the system
  • Resonance with speech—modification of ______ ______ through selective ________ of certain frequencies
  • Resonance provides the _____ and ______ of the voice
A

Resonance—tendency of a system to vibrate (oscillate) with a larger amplitude at some frequencies than others due to the natural vibration of the system
Resonance with speech—modification of phonated sound through selective enhancement of certain frequencies
Resonance provides the quality and uniqueness of the voice.

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6
Q
  • Resonance is determined by ____ and _____ of cavities of the _____ ______ (pharyngeal, oral, and nasal cavities).
  • _______ cavities enhance ______ frequencies.
  • ______ cavities enhance _____ frequencies and result in a richer sound.
A

Resonance is determined by size and shape of cavities of the vocal tract (pharyngeal, oral, and nasal cavities).
Smaller cavities enhance higher frequencies.
Larger cavities enhance lower frequencies and result in a richer sound.

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7
Q
  • Resonance is a component of ___ ______ consonants and all ______.
  • Vowels are actually ______ sounds.
  • They are produced by changing the ____ and ____ of the oral cavity with tongue, mandible, and lips.
  • Vowels affect the size and shape of oral cavity, changing selective enhancement of _____ frequencies and _____ of the vowel.
A

Resonance is a component of all voiced consonants and all vowels.
Vowels are actually resonance sounds.
They are produced by changing the size and shape of the oral cavity with tongue, mandible, and lips.
Vowels affect the size and shape of oral cavity, changing selective enhancement of formant frequencies and perception of the vowel.

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8
Q

High vowels have more nasal resonance than low vowels.
High tongue position causes more oral impedance and more oral pressure, which increases transpalatal transmission of the sound.

A

High vowels have more nasal resonance than low vowels.
High tongue position causes more oral impedance and more oral pressure, which increases transpalatal transmission of the sound.

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9
Q

Resonance disorder—abnormal _______ of sound energy through the oral, nasal,and/or pharyngeal cavities of the vocal tract duringspeech production

Types include the following:
\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_ resonance
\_\_\_\_\_\_\_\_\_\_ resonance
A

Resonance disorder—abnormal transmission of sound energy through the oral, nasal,and/or pharyngeal cavities of the vocal tract duringspeech production

Types include the following:
Hypernasality
Hyponasality
Cul-de-sac resonance
Mixed resonance
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10
Q

Hypernasality—abnormal ____ _______ during the production of _____ sounds
Due to abnormal ______ (sharing of acoustic energy) of the oral and nasal cavities during speech
Most perceptible on ______

A

Hypernasality—abnormal nasal resonance during the production of oral sounds
Due to abnormal coupling (sharing of acoustic energy) of the oral and nasal cavities during speech
Most perceptible on vowels

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11
Q

When hyper nasality is severe…
_____ _______ consonants become nasalized (e.g., m/b, n/d).
-_______ production
Other consonants may be substituted by _______ (e.g., n/s).
-_________ production

A

When severe…
Voiced oral consonants become nasalized (e.g., m/b, n/d).
Obligatory production
Other consonants may be substituted by nasals (e.g., n/s).
Compensatory production

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12
Q 
Hypernasality Causes include:
A \_\_\_\_\_\_\_\_\_ opening 
A thin \_\_\_\_\_\_ due to a \_\_\_\_\_\_ \_\_\_\_\_\_\_\_
A very large \_\_\_\_\_\_\_ \_\_\_\_\_\_\_ 
\_\_\_\_\_\_ articulation on certain \_\_\_\_\_\_ sounds (phoneme-specific) due to \_\_\_\_\_\_\_\_
A 
Causes include:
A velopharyngeal opening 
A thin velum due to a submucous cleft
A very large oronasal fistula 
Nasal articulation on certain oral sounds (phoneme-specific) due to mislearning
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13
Q

Hyponasality—a reduction in ______ _______ _________ during speech, particularly with ________ sounds
Denasality—___ ______ ______ during speech, including with nasal sounds
In both cases, individual sounds “__________”

A

Hyponasality—a reduction in normal nasal resonance during speech, particularly with nasal sounds
Denasality—no nasal resonance during speech, including with nasal sounds
In both cases, individual sounds “stuffed up”

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14
Q

Hyponasality and denasality particularly affect _____ _______ but also affect _______ if severe.
Nasal consonants sound similar to their _____ ________ (e.g., b/m, d/n, g/ŋ).

A

Hyponasality and denasality particularly affect nasal sounds but also affect vowels if severe.
Nasal consonants sound similar to their oral cognates (e.g., b/m, d/n, g/ŋ).

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15
Q

Hyponasality and Denasality Caused by blockage in nasopharynx or nasal cavity due to:
_____ _________: swollen nose from allergies
Common _______
______ ____________
________ tonsils that intrude into the _______

A

Caused by blockage in nasopharynx or nasal cavity due to:
Allergic rhinitis: swollen nose from allergies
Common cold
Adenoid hypertrophy
Hypertrophic tonsils that intrude into the pharynx

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16
Q

Hyponasality and Denasality Causes with history of cleft lip/palate:
_____ _________
_______ stenosis or ______
Stenotic _________
__________ retrusion which restricts pharyngeal and nasal cavity space

A 
Causes with history of cleft lip/palate:
Deviated septum 
Choanal stenosis or atresia
Stenotic naris
Maxillary retrusion which restricts pharyngeal and nasal cavity space
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17
Q

Cul-de-sac resonance—acoustic energy is _______ from exiting at a cavity’s normal ________
Sound is absorbed by _____ _______
Speech is perceived as ______ and _____ in volume.

A

Cul-de-sac resonance—acoustic energy is blocked from exiting at a cavity’s normal outlet
Sound is absorbed by soft tissues.
Speech is perceived as muffled and low in volume.

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18
Q 
Types of cul-de-sac resonance are defined by blockage at the cavity’s \_\_\_\_\_ point.
Types include:
\_\_\_\_\_\_ cul-de-sac resonance
\_\_\_\_\_\_ cul-de-sac resonance
\_\_\_\_\_\_\_cul-de-sac resonance
A 
Types of cul-de-sac resonance are defined by blockage at the cavity’s exit point.
Types include:
Oral cul-de-sac resonance
Nasal cul-de-sac resonance
Pharyngeal cul-de-sac resonance
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19
Q

Oral cul-de-sac resonance—sound is partially blocked from exiting the ______ cavity during speech.
Causes include:
________—a small mouth opening
“Mumbling,” speaking without opening the mouth normally

A

Oral cul-de-sac resonance—sound is partially blocked from exiting the oral cavity during speech.
Causes include:
Microstomia—a small mouth opening
“Mumbling,” speaking without opening the mouth normally

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20
Q

Nasal cul-de-sac resonance—sound is partially blocked from exiting the _______ cavity during speech.
It is most noticeable with both ______ (which would otherwise cause hypernasality) and an _____ ______ blockage.
Nasal cul-de-sac resonance is common with _____ _____/_____ when there is both VPI and blockage due to _____ stenosis.

A

Nasal cul-de-sac resonance—sound is partially blocked from exiting the nasal cavity during speech.
It is most noticeable with both VPI (which would otherwise cause hypernasality) and an anterior nasal blockage.
Nasal cul-de-sac resonance is common with cleft lip/palate when there is both VPI and blockage due to nares stenosis.

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21
Q

Pharyngeal cul-de-sac resonance—sound remains in the _______ during speech
Causes include:
Large ______ that block exit of the oropharynx and entrance to oral cavity
Obstruction on the ______ wall of the hypopharynx or oropharynx

A

Pharyngeal cul-de-sac resonance—sound remains in the oropharynx during speech
Causes include:
Large tonsils that block exit of the oropharynx and entrance to oral cavity
Obstruction on the pharyngeal wall of the hypopharynx or oropharynx

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22
Q

Mixed resonance—any combination of _______ (with or without nasal emission), _______, and _______ resonance
Although hypernasality and hyponasality cannot occur simultaneously, they can both occur on different ______ in the same speaker.
Causes
______ and obstruction
_______: timing the VP closure

A

Mixed resonance—any combination of hypernasality (with or without nasal emission), hyponasality, and cul-de-sac resonance
Although hypernasality and hyponasality cannot occur simultaneously, they can both occur on different sound in the same speaker.
Causes
VPI and obstruction
Apraxia: timing the VP closure

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23
Q

Adenoidectomy:
Can improve ___________
Can exacerbate or cause _________ ________ with hypernasality (and nasal air emission)

A

Adenoidectomy:
Can improve hyponasality
Can exacerbate or cause velopharyngeal insufficiency with hypernasality (and nasal air emission)

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24
Q

Tonsillectomy:

Can eliminate _________ cul-de-sac resonance

A

Tonsillectomy:

Can eliminate pharyngeal cul-de-sac resonance

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25
Q 
Treatment
\_\_\_\_\_\_\_
\_\_\_\_\_\_ device 
\_\_\_\_\_\_\_ \_\_\_\_\_\_
-ONLY when abnormal resonance is \_\_\_\_\_ \_\_\_\_\_\_ due to faulty articulation
A

Surgery
Prosthetic device
Speech therapy
ONLY when abnormal resonance is phoneme-specific due to faulty articulation

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26
Q

Nasal Emission

\_\_\_\_\_ \_\_\_\_\_\_—when there is an attempt to build up \_\_\_\_\_ air pressure for consonants while there is a \_\_\_\_\_ in the system (\_\_\_\_\_ valve or \_\_\_\_\_ fistula) 
Four basic types of nasal emission:
\_\_\_\_\_ nasal emission
\_\_\_\_\_ nasal emission
\_\_\_\_\_ \_\_\_\_\_ (turbulence)
\_\_\_\_\_ -\_\_\_\_\_ \_\_\_\_\_ \_\_\_\_\_ (\_\_\_\_\_ )
A 
Nasal emission—when there is an attempt to build up intraoral air pressure for consonants while there is a leak in the system (velopharyngeal valve or oronasal fistula) 
Four basic types of nasal emission:
Inaudible nasal emission
Audible nasal emission
Nasal rustle (turbulence)
Phoneme-specific nasal emission (PSNE)
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27
Q

Nasal Emission CONT.

_____ _____ _____ —occurs with a relatively _____ opening
There is very little impedance to the flow and therefore, little _____ or _____ .
_____ masks the sound of nasal emission.

A

Inaudible nasal emission—occurs with a relatively large opening
There is very little impedance to the flow and therefore, little friction or pressure.
Hypernasality masks the sound of nasal emission.

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28
Q

Nasal Emission CONT.

_____ _____ _____ —occurs with a relatively large opening

Can cause _____ characteristics including:

  • _____ or _____ consonants
  • _____ _____ _____
  • A _____ _____
  • _____ _____ _____
  • _____
A

Inaudible nasal emission—occurs with a relatively large opening

Can cause secondary characteristics including:

  • Weak or omitted consonants
  • Short utterance length
  • A nasal grimace
  • Compensatory articulation productions
  • Dysphonia
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29
Q

Nasal Air Emission

_____ _____ _____ —occurs when there is a _____ -sized _____ opening

  • There is _____ resistance to the flow, making the nasal emission more _____ .
  • There is _____ pronounced _____ to mask the nasal emission.
  • There still may be some of the other secondary characteristics due to a leak of airflow.
A

Audible nasal emission—occurs when there is a medium-sized velopharyngeal opening

  • There is greater resistance to the flow, making the nasal emission more audible.
  • There is less pronounced hypernasality to mask the nasal emission.
  • There still may be some of the other secondary characteristics due to a leak of airflow.
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30
Q

Nasal Air Emission CONT.

_____ _____ (also called _____ _____ )—occurs when there is a _____ velopharyngeal opening

  • There is great _____ to the flow, making the nasal emission more _____ .
  • Air flow through a _____ opening results in _____ air pressure than flow through a _____ opening.
  • Air is released into nasal cavity with pressure, causing very audible _____ of nasal _____ .
  • Nasal rustle is usually _____ , but _____ with _____ in utterance _____ , _____ , _____ complexity, and even _____ .
A

Nasal rustle (also called nasal turbulence)—occurs when there is a small velopharyngeal opening

  • There is great resistance to the flow, making the nasal emission more audible.
  • Air flow through a small opening results in higher air pressure than flow through a large opening.
  • Air is released into nasal cavity with pressure, causing very audible bubbling of nasal secretions.
  • Nasal rustle is usually inconsistent, but increases with increase in utterance length, speed, phonemic complexity, and even fatigue.
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31
Q

Obligatory Distortions and Compensatory Errors

_____ _____ —occur when _____ _____ is _____ but an _____ of the _____ or _____ causes distortion of _____
Require physical correction

_____ _____ —_____ that occur in response to _____ structure (or abnormal speech _____ )
Require physical correction and then _____ therapy

A

Obligatory distortions—occur when articulation placement is normal but an abnormality of the structure or physiology causes distortion of speech
Require physical correction

Compensatory errors—misarticulations that occur in response to abnormal structure (or abnormal speech physiology)
Require physical correction and then speech therapy

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32
Q

Obligatory Distortions

Obligatory distortions due to a large velopharyngeal opening:

  • _____ or omitted _____
  • _____ _____ length
  • _____ of _____ _____
  • _____ _____
A

Obligatory distortions due to a large velopharyngeal opening:

  • Weak or omitted consonants
  • Short utterance length
  • Nasalization of oral consonants
  • Nasal grimace
33
Q

Weak or Omitted Consonants

_____ of _____ through the _____ valve _____ the amount of _____ in the _____ cavity.

The _____ the _____ air _____ , the _____ the _____ .

A

Loss of air through the velopharyngeal valve reduces the amount of airflow in the oral cavity.

The greater the nasal air emission, the weaker the consonants.

34
Q

Short Utterance Length

_____ opening causes need to replenish lost airflow by taking more _____ _____ .

Utterance length becomes _____ and _____ is _____ .

A

Large opening causes need to replenish lost airflow by taking more frequent breaths.

Utterance length becomes shortened and speech is choppy.

35
Q

Nasalization of Oral Consonants

When voiced _____ are produced with _____ velopharyngeal opening or large _____ , these oral _____ will sound more like their _____ _____ (e.g., m/b, n/d, and g/ŋ).

A

When voiced plosives are produced with large velopharyngeal opening or large fistula, these oral phonemes will sound more like their nasal cognates (e.g., m/b, n/d, and g/ŋ).

36
Q

Nasal Grimace

Muscle _____ just above the nasal _____ and/or at the _____ of the _____

_____ muscle reaction in attempt to _____ velopharyngeal valve

A

Muscle contractions just above the nasal bridge and/or at the side of the nares

Overflow muscle reaction in attempt to close velopharyngeal valve

37
Q

Compensatory Articulation Productions

For an oronasal fistula:

  • _____ -_____ production (also called _____ _____ _____ )
  • Velar _____
  • Velar _____ /_____
A

For an oronasal fistula:

  • Palatal-dorsal production (also called middorsum palatal stop)
  • Velar plosive
  • Velar fricatives/affricates
38
Q

Compensatory Articulation Productions

For an _____ fistula:
_____ -_____ _____ (also called _____ _____ _____ )

A

For an oronasal fistula:

Palatal-dorsal production (also called middorsum palatal stop)

39
Q

Compensatory Articulation Productions

For an _____ fistula:
_____ _____

A

For an oronasal fistula:

Velar fricative

40
Q

Compensatory Articulation Productions

For VPI:

  • Pharyngeal _____
  • Pharyngeal _____ /_____
  • Velar _____ /_____
  • _____ _____ _____
  • Nasal _____
  • Nasal _____
  • Glottal _____
  • Glottal _____
  • _____
A

For VPI:

  • Pharyngeal plosive
  • Pharyngeal fricative/affricate
  • Velar fricatives/affricates
  • Posterior nasal fricative
  • Nasal snort
  • Nasal sniff
  • Glottal stop
  • Glottal fricative
  • Breathiness
41
Q

Compensatory Articulation Productions

For VPI:
_____ _____

A

For VPI:

Pharyngeal plosive

42
Q

Compensatory Articulation Productions

For VPI:
Pharyngeal fricative

A

For VPI:

_____ _____

43
Q

Compensatory Articulation Productions

For VPI:
_____ _____ _____

A

For VPI:

Posterior nasal fricative

44
Q

Compensatory Articulation Productions

For VPI:
_____ _____

A

For VPI:

_____ _____

45
Q

Dysphonia

Dysphonia—characterized by _____, _____, __________, and/or _____ _____during phonation

A

Dysphonia—characterized by breathiness, hoarseness, low intensity, and/or glottal fry during phonation

46
Q

Dysphonia

Children with clefts, craniofacial anomalies, or VPI have risk for _____, due to the following:

  • _____to achieve VP valving can lead to vocal _____.
  • There may be _____ _____ _____.
  • Dysphonia can be due to _____complications from long-term _____.
  • _____can be used as a _____strategy.
A

Children with clefts, craniofacial anomalies, or VPI have risk for dysphonia, due to the following:

  • Hyperfunction to achieve VP valving can lead to vocal nodules.
  • There may be congenital laryngeal anomalies.
  • Dysphonia can be due to laryngeal complications from long-term tracheostomy.
  • Breathiness can be used as a compensatory strategy.
47
Q

Normal Velopharyngeal Function

A

See Chapter 7, Slide 46

48
Q

Velopharyngeal Dysfunction (VPD)

A

See Chapter 7, Slide 47

49
Q

Velopharyngeal Dysfunction (VPD)

- \_\_\_\_\_ \_\_\_\_\_(\_\_\_\_\_)
General term for \_\_\_\_\_VP \_\_\_\_\_
- \_\_\_\_\_ \_\_\_\_\_(\_\_\_\_\_)
\_\_\_\_\_(\_\_\_\_\_) defects
- \_\_\_\_\_ \_\_\_\_\_ (\_\_\_\_\_)
\_\_\_\_\_(\_\_\_\_\_) disorder
- \_\_\_\_\_ \_\_\_\_\_
\_\_\_\_\_(\_\_\_\_\_) disorder
A 
- Velopharyngeal dysfunction (VPD)
General term for abnormal VP function 
- Velopharyngeal insufficiency (VPI)
Anatomical (structural) defects
- Velopharyngeal incompetence (VPI)
Neurophysiological (movement) disorder
- Velopharyngeal mislearning
Articulation (learning) disorder
50
Q

Velopharyngeal Insufficiency (VPI)

Velum moves _____, but is too _____for _____due to abnormal _____

A

Velum moves normally, but is too short for closure due to abnormal structure

51
Q

Velopharyngeal Insufficiency (VPI)

Causes include:

  • History of _____
  • _____cleft palate (overt or occult)
  • Short _____or deep _____(cranial base anomalies)
  • _____ _____
  • _____ _____
  • _____(_____) _____
A

Causes include:

  • History of cleft
  • Submucous cleft palate (overt or occult)
  • Short velum or deep pharynx (cranial base anomalies)
  • Adenoid atrophy
  • Irregular adenoids
  • Hypertrophic (enlarged) tonsils
52
Q

History of Cleft Palate

_____% to _____% of patients with cleft palate will have _____.
Velum may be too _____following repair.
Velum may have a _____on _____nasal surface.

A

20% to 30 % of patients with cleft palate will have VPI.
Velum may be too short following repair.
Velum may have a notch on posterior nasal surface.

53
Q

Submucous Cleft

May cause:
Small _____in the _____border of the _____
_____of musculus _____muscles
_____orientation of the _____ _____ _____muscles
_____pellucida

A

May cause:
Small notch in the posterior border of the velum
Hypoplasticity of musculus uvulae muscles
Anterior orientation of the levator veli palatini muscles
Zona pellucida

54
Q

Deep Pharynx

_____may be normal but unable to reach the _____ _____wall due to an abnormally _____pharynx.
It can be seen in some _____syndromes.

A

Velum may be normal but unable to reach the posterior pharyngeal wall due to an abnormally deep pharynx.
It can be seen in some craniosynostosis syndromes.

55
Q

Adenoid Atrophy

Adenoid atrophy, particularly around _____, can increase the _____of the pharynx, causing gradual onset of _____.
Parents often report that their child has begun to “_____.”
The biggest concern is if there is tenuous _____due to _____palate or _____cleft palate.

A

Adenoid atrophy, particularly around puberty, can increase the depth of the pharynx, causing gradual onset of VPI.
Parents often report that their child has begun to “mumble.”
The biggest concern is if there is tenuous closure due to cleft palate or submucous cleft palate.

56
Q

Irregular Adenoids

_____VP closure requires a _____seal.
_____irregularity (marked indentation or protrusion) prevents a tight seal.
Irregular adenoids can cause small _____and _____ _____.

A

Normal VP closure requires a tight seal.
Adenoid irregularity (marked indentation or protrusion) prevents a tight seal.
Irregular adenoids can cause small gap and nasal emission.

57
Q

Hypertrophic Tonsils

Can extend into _____
May interfere with _____ pharyngeal wall movement
May intrude between the _____ and _____ pharyngeal wall, preventing a _____ VP seal

A

Can extend into pharynx
May interfere with lateral pharyngeal wall movement
May intrude between the velum and posterior pharyngeal wall, preventing a tight VP seal

58
Q

Velopharyngeal Insufficiency (VPI)

Surgical or treatment procedures
  \_\_\_\_\_ 
  \_\_\_\_\_ - VERY, VERY rare
  \_\_\_\_\_ advancement
  \_\_\_\_\_ , \_\_\_\_\_ , and \_\_\_\_\_ cavity tumors
A 
Surgical or treatment procedures
  Adenoidectomy
  Tonsillectomy- VERY, VERY rare
  Maxillary advancement
  Oral, nasal, and pharyngeal cavity tumors
59
Q

Adenoidectomy

Adenoidectomy can cause VPI due to sudden increase in the _____ dimension.
It is often temporary and resolves within _____ weeks.
_____ _____ is a risk, especially with history of cleft or submucous cleft.
VPI post adenoidectomy cannot be corrected with _____ therapy.

A

Adenoidectomy can cause VPI due to sudden increase in the nasopharyngeal dimension.
It is often temporary and resolves within 6 weeks.
Permanent VPI is a risk, especially with history of cleft or submucous cleft.
VPI post adenoidectomy cannot be corrected with speech therapy.

60
Q

Tonsillectomy

VERY rarely has a _____ effect on resonance
Only exceptions
Significant _____
Learned protective response to pain

A

VERY rarely has a negative effect on resonance
Only exceptions
Significant scarring
Learned protective response to pain

61
Q

Maxillary Advancement

Done _____ or through distraction to corrects mid-face retrusion and Class _____ malocclusion
Often done for patients with history of cleft
Improves _____ profile and _____ and eliminates obligatory _____

A

Done surgically or through distraction to corrects mid-face retrusion and Class III malocclusion
Often done for patients with history of cleft
Improves facial profile and aesthetics and eliminates obligatory distortions

62
Q

Maxillary Advancement CONT.

Moving the maxillary forward also moves the _____ forward
Risk for VPI _____ with history of cleft

A

Moving the maxillary forward also moves the velum forward

Risk for VPI greatest with history of cleft

63
Q

Oral, Nasal, and PharyngealCavity Tumors

Treatment
_____ (surgical removal) of _____
_____ therapy to _____ tissue
Both _____ nasopharyngeal space, which can cause VPI.

A

Treatment
Resection (surgical removal) of tissue
Radiation therapy to shrink tissue
Both increase nasopharyngeal space, which can cause VPI.

64
Q

Velopharyngeal Incompetence (VPI)

Velum has _____ structure, but has inadequate movement for closure due to abnormal _____

A

Velum has normal structure, but has inadequate movement for closure due to abnormal neurophysiology

65
Q

Velopharyngeal Incompetence (VPI) CONT.

Causes include:
_____ injury (e.g., traumatic brain injury, cerebral palsy, stroke)
_____ diseases (e.g., muscular dystrophy, myasthenia gravis, etc.)
_____ _____ damage

A

Causes include:
Neurological injury (e.g., traumatic brain injury, cerebral palsy, stroke)
Neuromuscular diseases (e.g., muscular dystrophy, myasthenia gravis, etc.)
Cranial nerve damage

66
Q

Velopharyngeal Incompetence (VPI) CONT.

Often associated with:
Velar and/or pharyngeal _____
_____
_____ of _____

A

Often associated with:
Velar and/or pharyngeal hypotonia
Dysarthria
Apraxia of speech

67
Q

Hypotonia

Hypotonia—a state of _____ _____ tonicity and sometimes, reduced muscle _____
Can cause poor _____ and _____ movement
Is common in patients with _____ syndrome

A

Hypotonia—a state of low muscle tonicity and sometimes, reduced muscle strength
Can cause poor velar and pharyngeal movement
Is common in patients with velocardiofacial syndrome

68
Q

Dysarthria

Dysarthria—an \_\_\_\_\_ -\_\_\_\_\_ disorder that affects all the \_\_\_\_\_ of speech, including:  
\_\_\_\_\_ 
\_\_\_\_\_ 
\_\_\_\_\_ 
\_\_\_\_\_ function
A 
Dysarthria—an oral-motor disorder that affects all the subsystems of speech, including:  
Respiration 
Phonation
Articulation
Velopharyngeal function
69
Q

Dysarthria CONT.

Characteristics of dysarthria related to VPI: 
\_\_\_\_\_ 
\_\_\_\_\_ or omitted \_\_\_\_\_ 
\_\_\_\_\_ utterance length
Decreased \_\_\_\_\_
A 
Characteristics of dysarthria related to VPI: 
Hypernasality
Weak or omitted consonants
Short utterance length
Decreased volume
70
Q

Apraxia of Speech

Apraxia of speech—_____ speech disorder that causes difficulty _____ and _____ motor _____
Affects coordination of speech subsystems:
_____
_____
_____ function

A

Apraxia of speech—amotor speech disorder that causes difficulty combining and sequencing motor movements
Affects coordination of speech subsystems:
Phonation
Articulation
Velopharyngeal function

71
Q

Apraxia of Speech CONT.

Characteristics of apraxia related to VPI:
Inconsistent _____ of oral _____ and inconsistent _____ of _____ consonants
Characteristics are due to:
Poor _____ , _____ , and _____ of VP closure
Velum _____ inappropriately for _____ sounds and _____ inappropriately for _____ sounds

A

Characteristics of apraxia related to VPI:
Inconsistent nasalization of oral consonants and inconsistent denasalization of nasal consonants
Characteristics are due to:
Poor coordination, timing, and duration of VP closure
Velum raises inappropriately for nasal sounds and lowers inappropriately for oral sounds

72
Q

Velar Paralysis or Paresis

_____ _____ or _____ _____ damage can cause specific velopharyngeal _____ or _____ (partial loss of movement or weakness)
Often unilateral causing a _____ VP opening
Common with _____ _____

A

Brain stem or cranial nerve damage can cause specific velopharyngeal paralysis or paresis (partial loss of movement or weakness)
Often unilateral causing a unilateral VP opening
Common with hemifacial microsomia

73
Q

Velar Fatigue and Stress Incompetence

Velar fatigue and stress sometimes occurs in _____ when playing wind instruments, even though _____ is unaffected.
_____ _____ may be first symptom of a _____ neurological disorder.

A

Velar fatigue and stress sometimes occurs in musicians when playing wind instruments, even though speech is unaffected.
Velar fatigue may be first symptom of a progressive neurological disorder.

74
Q

Velopharyneal Mislearning

Velopharyngeal mislearning is an _____ disorder that includes the substitution of _____ or _____ sounds for _____ sounds.
Velopharyneal mislearning esults in an _____ velopharyngeal valve, causing _____ _____ or _____ during the production of those speech sounds.
_____ _____ , not surgery, is indicated for velopharyngeal mislearning.
_____ diagnosis between _____ due to _____ alone versus those due to _____ is critically important.

A

Velopharyngeal mislearning is an articulation disorder that includes the substitution of nasal or pharyngeal sounds for oral sounds.
Velopharyneal mislearning esults in an open velopharyngeal valve, causing nasal emission or hypernasality during the production of those speech sounds.
Speech therapy, not surgery, is indicated for velopharyngeal mislearning.
Differential diagnosis between misarticulations due to mislearning alone versus those due to VPI is critically important.

75
Q

Velopharyngeal Mislearning CONT.

Learned misarticulations can include:
_____ productions learned due to VPI or other structural anomalies
Misarticulations in children without structural anomalies, causing phoneme-specific nasal emission or phoneme-specific hypernasality

A

Learned misarticulations can include:
Compensatory productions learned due to VPI or other structural anomalies
Misarticulations in children without structural anomalies, causing phoneme-specific nasal emission or phoneme-specific hypernasality

76
Q

Velopharyngeal Mislearning CONT.

_____ -_____ _____ _____ —occurs when the individual uses a _____ _____ or _____ _____ _____ as a substitution for oral _____
_____ -_____ _____ —occurs when the individual consistently _____ a _____ sound for an _____ sound (e.g., ŋ/l or ŋ/r) or uses a high _____ position on certain _____

A

Phoneme-specific nasal emission—occurs when the individual uses a pharyngeal fricative or posterior nasal fricative as a substitution for oral fricatives
Phoneme-specific hypernasality—occurs when the individual consistently substitutes a nasal sound for an oral sound (e.g., ŋ/l or ŋ/r) or uses a high tongue position on certain vowels

77
Q

Velopharyngeal Mislearning CONT.

_____ _____ causes abnormal resonance.
VP function is learned through _____ and _____ feedback.
Lack of hearing and auditory feedback affects ability to learn to use the VP valve for speech.
Individuals with severe hearing impairment or deafness demonstrate abnormal _____ that can be a mixture of _____ , _____ , and even _____ -_____ -_____ resonance.

A

Hearing loss causes abnormal resonance.
VP function is learned through imitation and auditory feedback.
Lack of hearing and auditory feedback affects ability to learn to use the VP valve for speech.
Individuals with severe hearing impairment or deafness demonstrate abnormal resonance that can be a mixture of hypernasality, hyponasality, and even cul-de-sac resonance.

78
Q

Summary

SLP is responsible for diagnosing probable cause of resonance disorders and VPD.
There is a need to determine abnormal structure versus abnormal function.
Differential diagnosis is important so patient will receive appropriate treatment.
Resonance disorders and VPI are not directly treated by SLPs.
Speech therapy is appropriate for compensatory errors due to VPI and placement errors that cause phoneme-specific nasal emission or hypernasality.

A

SLP is responsible for diagnosing probable cause of resonance disorders and VPD.
There is a need to determine abnormal structure versus abnormal function.
Differential diagnosis is important so patient will receive appropriate treatment.
Resonance disorders and VPI are not directly treated by SLPs.
Speech therapy is appropriate for compensatory errors due to VPI and placement errors that cause phoneme-specific nasal emission or hypernasality.

Cleft Palate (7 decks)

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