Cleft-Leaders Project Flashcards
When does the lip & alveolus begin to develop in utero?
6-7 weeks of gestation
Development starts at the _____ ______
incisive foramen
When does the hard palate develop?
Begins at 8-9 weeks of gestation
When is the velum & uvula formed?
12 weeks gestation
Which muscle opens & closes the Eustachian Tube?
Tensor Veli Palatini
Why do kids with Cleft Palate often have conductive hearing loss?
Because their Tensor Veli Palatini muscle is displaced.
Which is the primary muscle in soft palate closure?
The Levator Veli Palatini lifts up & back in the soft palate to close against the PPW (posterior pharyngeal wall)
The point in palate from which lips fuse and from which the palate fuses is called the _______ ________
Incisive Foramen
Palate closes from incisive foramen toward the ________
Palate closes from incisive foramen toward the back (toward PPW)
Alveolus/ lips close from the incisive foramen toward the _____
Front/ towards the lips
How does the velum move?
Up & Back against the PPW for closure.
How do the Lateral Pharyngeal walls move? Which muscle?
From the sides, inwards; Superior Pharyngeal Constrictor muscle
Which muscle pulls the velum down?
Glossopalatini or palatoglossus
Which muscle is important in swallowing and may/ may not have a role in VP closure?
Palatopharyngeus
________ is the cartilage between tip of nose and face
Columella
_____ is the depression between the 2 seams
Philtrum (“love charm”)
3 characteristics of submucous cleft?
- Bifid Uvula
- Zona pellucida (bluish area in middle of velum)
- Notch in posterior border of hard palate
Another type of hidden cleft is called…
occult cleft– But, the only way to see that is through a nasoendoscopy exam, where you put the camera on the tube with a light, up through the nose to see if there’s a clefting.
You look above to see if the clefting is in the nasal mucosa, through that way
Muscle responsible for the velum to move upward and back, so it moves like a sling: up and back.
Levator veli palatini—- With a child with a cleft palate, the sling didn’t fuse and so it’s open, and so the child’s not going to have that proper movement in order to achieve velopharyngeal closure
the muscles that are involved with the LPW- lateral pharyngeal walls, so that they can move inward
Superior pharyngeal constrictors.
Muscle which contracts during phonation and creates that bulge in the velum
Musculus uvulae
Muscle which depresses the velum.
Palatoglossus muscle
muscle is responsible for the opening and closing of the eustachian tubes for middle ear drainage.
Tensor veli palatini
Why children with clefts have hearing issues?
So, it’s an important muscle because a lot of children with cleft palate, their hearing may be affected because that muscle is not inserted in the right place.
____ closure is when the velum moves towards the PPW to close
Coronal
_____ closure, where there is more movement of the lateral pharyngeal walls and little movement of the soft palate, the velum, and the posterior pharyngeal wall.
Sagittal
_____ closure is where all the areas are involved in closure
Circular pattern closure
_________ ______ is this dynamic structure in the posterior pharyngeal wall PPW- that occurs when you phonate and you swallow, and so with this closure, it goes against the Passavant’s ridge
Passavant’s ridge is this dynamic structure in the posterior pharyngeal wall PPW- that occurs when you phonate and you swallow, and so with this closure, it goes against the Passavant’s ridge
______ _______ is when there are structural issues involved
Velopharyngeal Insufficiency (structural, anatomical deficit)
_________ ________ is when there is a functional issue
Velopharyngeal incompetency refers to the
Refers to functional part of it - the movement area.
So, there may be a neurological or physiological issue involved that does not allow for velopharyngeal closure, maybe the tissue doesn’t move enough
apraxia, so it does not coordinate at the right times.
It may be related to ALS, dysarthria, brainstem tumor, stroke or TBI.
_________ ___________ is when structure and function are normal, but they have errors
Velopharyngeal mislearning
results in an articulation disorder that seems like velopharyngeal dysfunction, but the structure is normal and the function is normal.
: “p”, “t”, “k”, “g”, “s”, “ch”, “sh”, “v”, “j”., “s”. are classified as ____ _______ sounds
High Pressure
“w”, “l”, “r”, and “y”. are classified as ____ ______ sounds
Low Pressure
In ______-nasality. The “m”s and “n”s, which are the nasal sounds, may become oral sounds, such as “by bobby bakes bilk.
Hypo-nasality
In _____-nasality, , “b”s become “m”s, “d”s become “n”s, and “g”s, such as “g,” become “ng,
Hyper-nasality
Hyponasality characteristics may be present in ____________________________ in that the velum does not lower fast enough for nasal phonemes once it has been raised for the oral sounds
Hyponasality characteristics may be present in apraxia of speech (CAS, AOS), in that the velum does not lower fast enough for nasal phonemes once it has been raised for the oral sounds
__________________ occurs when transmission of acoustical energy is trapped in a blind pouch with an entrance, but there’s no outlet
oral cul-de-sac resonance “potato in the mouth”
Mixed resonance is when…
Hyper and Hypo Nasality co-occur
During oral examination, look for ______
Fistulas, including alveolar fistulas (check under upper lip)
Oral Exam– Notice amount of space btwn the ______ and the _________ ____________ ____
Velum & PPW-posterior pharyngeal wall. If a lot of space, hard to achieve velopharyngeal closure
Difficulty coordinating movements could be a sign of what
Oral apraxia
What sentences are recommended for assessment
Americleft sentences
What kind of approach(es) is/are best for good articulation therapy?
Multi-sensory approach (auditory, tactile, & visual cues) traditional Van Riper– isolation, to syllables to words, etc.
Should you start with voiced or voiceless sounds?
Start with voiceless
_______________ errors/ misarticulations are caused because of structural or physiological reason
Obligatory
Obligatory errors ___ (are/are not) corrected through speech therapy
Obligatory errors are not corrected through speech therapy, only surgery
Glottal stops, pharyngeal fricatives, pharyngeal stops, mid-dorsum palatal stops, & nasal rustles are possible examples of _______ misarticulations
Compensatory misarticulations, which are learned from having a faulty mechanism & may persist after surgery
Nasal emissions are only due to mislearning (T/F)
False. Nasal emissions can be obligatory (due to a structural reason-e.g. fistula leading the air to the nasal cavity)OR due to mislearning
speech therapists who do not know about cleft palate speech hear a glottal stop as an _______of a sound.
omission
What sound can be used before the target sound to help eliminate glottal stops
/h/ in a continuous prlonged manner hhhhhhp using gentle production of the stop sound /p/
Should you plug the nose when trying to eliminate glottal stops?
No, becausee glottal stops are at the level of the glottis, so plugging nose makes no difference
__________ _________ are typically mislearning errors used to substitute for fricatives and sometimes affricates
Pharyngeal Fricatives
A _____________ _____ is used to substitute for /k, g/
pharyngeal stop
Nasal rustle can occur due to ________ ______ or ____________________
structural defect or misarticulation.
If due to structural defect, nasal rustle typically occurs ____________ (consistently/ inconsistently) on high pressure sounds (p, t, k) & often increases with utterance length and/or fatigue
Inconsistently
Nasal rustle due to misarticulation typically occurs _________ (Consistently/ inconsistently) on certain phonemes
Consistently. Ex: every time produces “s” you may hear it. Most commonly happens on sibilants
The first part of the speech hierarchy is _____
Discrimination
What method do they use for syllables?
Acevedo Spoke method
Why don’t oral motor exercises work?
These non-speech movements will not help with speech, because the parts of the brain that control movements for speech are different from the parts of the brain that control non-speech movements. It’s a brain thing.
Why is strengthening not needed for speech therapy?
Very little strength is needed to produce speech. Agility and coordination are needed, but little strength. Also, it is surprisingly difficult to accurately determine strength. Therefore, any statements about weakness are questionable.
