cleft exam 4

Question 1

VPI: anatomical defects

PLUG WIT

Answer 1

(1) Anterior palatal levator insertion
(2) Absence or weakness of uvular muscle
(3) Glossopalatine muscle problems
(4) Webbing of pharyngopalatine muscle
(5) Tongue impairments

Question 2

VPI: Palatopharyngeal disproportion ADATA

Answer 2

(1) Abnormal basocranial angle
(2) Large anterior-posterior dimensions of pharynx
(3) Reduced horizontal aspect of velum
(4) Tonsils and adenoids

Question 3

VPI: interference with motion AGMP

Answer 3

(1) Too anterior glossopalatine muscle insertion
(2) Abnormal pharyngopalatine muscle insertion
(3) Maxillary advancement surgery

Question 4

VPI: structural factors VLM ACB PNS RAP

Answer 4

vii) Velar length and mobility: 85% moving
ix) Angulation of cranial base- tilted inferiorly causes greater distance between velum and pharyngeal wall
x) Position of nasal spine -posterior part of posterior bone where velum attaches, can direct velum upward or downward
xi) Role of adenoid pad- Enlarged may impede closure

Question 5

Bankson and Byrne

Answer 5

(1) S/z
(2) Speech difficulty is not due to distorted or missing dentition
(3) Mixture of other problems
(a) Coordination of tongue
(b) Maxillary arch too narrow

Question 6

Starr SMArT move

Answer 6

(1) Significant malocclusions is the problem
(2) Can cause artic difficulty
(3) Difficult for tongue to move where it needs to

Question 7

Counihan

Answer 7

(1) Maxillary arch too narrow, short

(2) maxillary arch problems→ artic problems

Question 8

Powers

Answer 8

good artic can occur despite anomalies

Question 9

McCutcheon

Answer 9

even something as small as reduced ruggae produced errors

Question 10

neuromotor patterns

Answer 10

learned in first two years, very hard to correct negative compensatory behaviors once they are learned– INTERVENE EARLY

Question 11

compensatory speech/language

Answer 11

substitutions

i) Glottal stops and pharyngeal fricatives
iii) Voice disorders
(1) Hyponasality- pharyngeal flap, obturator bulb too big
(2) Harshness/ hoarseness/ vocal roughness
(3) Intensity
(4) Hyper-hypofunction cycle
(5) aspirate

Question 12

obligatory speech/language

Answer 12

triad: hypernasality, nasal emission, weak pressure consonants

Question 13

articulation etiologies LOAN

Answer 13

learning problems
occlusal (not dentition)
auditory ability
nasal emission

Question 14

pseduo/prognathis

Answer 14

pseudo- maxilla retruded

prognathis- mandible protruded

Question 15

craniofacial team

Answer 15

i. Pediatrician- crucial role- big picture, assesses and manages health aspects
ii. plastic/ recon surgeon- closes lip/palate, secondary procedures for VPI, soft tissue reconstructions of face
iii. oral max surgeon- maxilla mandible
iv. orthodontist- teeth, jaw
v. pediatric dentist- dental health of child, assists in recommendations, works with makers of obturators etc
vi. Otolaryngologist- expertise in ears- PE tubes
vii. geneticist- family history analysis, clefts, recurrence
viii. clinical psychologist- helps family cope with difficulty, counseling
ix. Social worker- counsels family and individuals, patient and family advocacy, investigates services available and obtains services
x. **Pediatric nurse practitioner- very important
xi. **nurse- very important, preps patient
xii. Audiologist- does hearing testing, impact of HL on development, speech
xiii. coordinator- often SLP

Question 16

resonance testing Ct TOM

Answer 16

oral manometer
tongue anchor
counting 60-70-90

Question 17

nasal emission SACS

Answer 17

grimace (ala pinching)
clouding- mirror
scape-scope
stethoscope/airplane headphones

Question 18

phonation

Answer 18

aspirate, hyper-hypofunction

Question 19

speech: functional factors BEFOR W

Answer 19

reward, bonding, feeding/ breathing, overprotection, wait until surgery, impact on childs ego

Question 20

wells: strengthen. CHYBESS

Answer 20

yawning, yawn-phonate, chewing, puffing, swallowing, blowing, sucking, ejecting

Question 21

wells: excursion SIBS

Answer 21

stimulate velum and pharyngeal wall, speech bulb, stop a sneeze, quick inhalation

Question 22

wells: airstream

Answer 22

spitball, blow pen

Question 23

shelton no:BARS

Answer 23

sensory/somasthetic feedback doesnt not improve VPC; process of using speech appliances and reduction is not helpful; biofeedback does not help generalization

Question 24

kuehn CPR MANE

Answer 24

CPAP provides resistance against velum to strengthen; motor activities may not be as effective bc there are fewer nerve endings as you go deeper into oral cavity- no motor memory

Question 25

first meeting MDQ

Answer 25

2-3 mos post surgery or after lip has healed, model attachment and vocal play, describe/compare palatal structures, describe surgeries, embryology (blame), field Qs about childs intelligence

Question 26

second meeting LLN

Answer 26

7-12 months old, demonstrate language stimulation (vocal play continues, pitch changes, varied parts of speech, early sounds etc REDUCE GESTURE), explain naturalistic learning, teach developmental norms

Question 27

third meeting

Answer 27

6-8 weeks after palatal surgery (by 20 mos old), add more sounds (k/g, plosives), relaxation to avoid grimacing/tension, simple sentences, teach developmental order of sounds

Question 28

language risk factors

Answer 28

external: negative or non-reactions of caregivers,
lack of adaptive interactions, pity anxiety
internal: hearing, neurological, cognitive

Question 29

newborn risks

Answer 29

mood set by CF team; lack of mutual comforting, bonding, communication; parents must work to counteract early exposure to pain

Question 30

infant/toddler risks

Answer 30

parents must be intimately involved, positive mood

Question 31

identification/intervention risks

Answer 31

early intervention a must! knowledgeable transdisciplinary team necessary

Question 32

language stimulation training

Answer 32

motivation of child (bonding, naturalistic teaching), ID/use positive compensatory behaviors (lower lingual placement), reduce parents stress by teaching about child’s language, involve parents, additional management (referrals: ET, neuro, devt, physical)

Question 33

informal-structured situations

Answer 33

1. Expansion of fragments
2. Repetition of correct production
3. Parallel talk

Question 34

reactions to child utterances

Answer 34

try to understand errors, reinforce correct productions, repeat incorrect productions correctly (model) but keep in mind the developmental progression, extinguish negative compensatory behaviors

Question 35

early parent training

Answer 35

nurse- feeding, hygienic technique
coach parents (acknowledging childs progress, strengths, weakness)

Question 36

palatal training: indirect

Answer 36

1. No touching structures
2. No ejecting blowing etc
3. Emphasis on artic: k, g, ng hoping will effect VP closure
4. Mixed results- improve artic, but no change in VP closure

Question 37

palatal training: direct

Answer 37

1. Manipulation- move velum
2. Stroking massaging velum and ph wall
3. Wells activities: Blow, swallow, ejecting
4. Speech appliances and reduction (25%)

Question 38

palatal lift

Answer 38

i. fits into hard palate vault
ii. may be connected to dentition,
iii. almost touches pharyngeal wall
iv. velum sits on posterior part of appliance (bulb)
v. require less movement for velum to touch ph wall
vi. reduction: if velum strengthens, you can shave off some bulb to see if velum can close

Question 39

palatal stimulating device

Answer 39

i. k g, non nasals, sibilants
ii. velum moves up against bulb
iii. isometric exercises to strengthen velum
iv. reduction- of bulb to see if velum can still be pressed against smaller bulb- strengthened

Question 40

palatal stimulating during non-speech acts

Answer 40

a. Blow suck move palate
b. Massengill: Swallowing best for VP closure
c. Peterson: Touch stroke seemed to improve VPC but no carryover

Question 41

biofeedback

Answer 41

a. Client observes movement of own velum with nasoendoscopy
b. Shelton: Does not carryover, become automatic
c. Shprintzen: DOES help with VP closure
PROMISING