COMPS: VPI/VPD Assess. & Management (O4)

Question 1

What does “velopharyngeal inadequacy” mean? (AKA velopharyngeal dysfunction)

Answer 1

An ‘umbrella term’ that can mean “velopharyngeal insufficiency” or “velopharyngeal incompetency.”

*VPI does not have to be caused by a cleft.

Question 2

What is velopharyngeal insufficiency?

Answer 2

When the soft palate/velum isn’t long enough to make contact with the posterior pharyngeal wall and close the gap. But the velum IS functioning correctly.

Question 3

What is velopharyngeal incompetency?

Answer 3

When the muscles of the velum are not capable of lifting the velum to close the velopharyngeal port. The muscles may be long enough, but they don’t work because they are weak.

*May be caused by neurogenic etiology such as stroke, a disease process, or some kind of apraxia.

Question 4

What is velopharyngeal mislearning?

Answer 4

When a child is using the incorrect placement with the correct manner; the child has learned how to use the velum incorrectly. There is no insufficiency or inadequacy.

Question 5

What is the difference between “hypernasality” and nasal air emission (NAE)?

Answer 5

Hypernasality occurs during vowel production; NAE occurs during consonant production.

Question 6

What are some symptoms of VP Inadequacy/VPD? (4)

Answer 6

1. Hypernasality (vowels)
2. NAE (consonants)
   * Note: Liquids and nasals will not help you in determining if a child has NAE since they naturally have air coming through the nose.
3. Ch uses compensatory articulation errors (a deliberate attempt to produce the distinctive features correctly- manner and voice correct, placement not.)
4. Ch has obligatory errors–> can’t help errors, can’t close VP port.

Question 7

Name the assessment techniques for VPI/VPD. (inadequacy-umbrella term)

Answer 7

1. Videofluroscopy
2. X-ray (radiographic study)
3. Nasoendoscopy/Endoscopic Visual Evaluation (???)

***Cannot access VP port through mouth. Must access through nose to be able to tell if velum is moving and to look at pharyngeal wall movement.

Question 8

What might you find when assessing a client for velopharyngeal function (five different scenarios for the type of patency)?

Answer 8

TYPE OF PATENCY:
1. Normal speech and resonance w/normal VP function.

2. Consistent velopharyngeal dysfunction/inadequacy
3. Task-specific VPD (closes for some sounds but not for others; may be a timing issue)
4. Irregular VPD (no pattern as to when closure will and will not happen)
5. Abnormal resonance without VPD (often seen in spastic dysarthria after stroke)

Question 9

What three things do you look at during an endoscopic eval for VPD?

Answer 9

1. Closure pattern (which structure is moving)
2. Type of patency (normal, consistent dysfunction, task-specific, etc…)
3. Degree/size of patency
4. Location of patency (left, right, front, center)

Question 10

What does “patency” mean?

Answer 10

“opening”

Question 11

What are the patterns of closure? (list them)

Answer 11

1. Coronal pattern: most common; velum moves up to contact post. pharyngeal wall (90% population)
2. Saggital pattern: pharyngeal walls move vertically (5% population)
3. Circular: velum and pharygneal walls move to bring everything together (3% population)
4. Cicrular w/Passavant’s Ridge (1-2% population)

Question 12

0-5% patent is considered to be _________. (normal/small/medium/large)

Answer 12

normal

Question 13

6-15% patient is considered to be ________.(normal/small/medium/large)

Answer 13

small

Question 14

16-40% patent is considered to be _______.(normal/small/medium/large)

Answer 14

medium

Question 15

41-100% patent is considered to be ______.(normal/small/medium/large)

Answer 15

large

Question 16

During an endoscopy, if you see PINK tissue, this means the velopharyngeal port is ______ (open/closed)

Answer 16

…closed. you’re seeing pink tissue.

Question 17

During an endoscopy, if you see BLACK tissue, this means the velopharyngeal port is ______ (open/closed)

Answer 17

…open. you’re seeing a black hole.

Question 18

What are the three options for management of VPD/VPI?

Answer 18

1. Pharyngoplasty (surgery of the velopharynx in which a piece of tissue is cut off the posterior pharyngeal wall)
2. Speech appliance (retainers, obturators, lifts)
3. Behavioral management (speech therapy)

Question 19

What are the two types of pharyngeal flaps (pharyngoplasty)?

Answer 19

1. the inferior flap (no longer performed because it was not as effective)
2. the superior flap

Question 20

What is a BIG problem with pharyngeal flaps?

Answer 20

they can cause sleep apnea (and there is a possible link between sleep apnea and ADHD)

Question 21

what vowel is best to use during a speech eval for vp closure?

Answer 21

/i/, since it is considered to be a sensitive vowel.

Question 22

T/F: there is no need to complete a physical evaluation if the client shows task-specific VPD.

Answer 22

True. In this case, there is nothing physically wrong with the structure.

Question 23

Discuss the Hynes/Orticochea/Lateral Pharyngoplasty.

Answer 23

The srgeon feathers the muscles out of the palatal pharyngeus muscle in the faucial pillars to create a Passavant’s Ridge circular closure pattern.

Question 24

T/F: pharyngoplasty will complicate a Class II malocclusion (maxilla too far in front of mandible) , and may worsen it.

Answer 24

FALSE: it will complicate a class III malocclusion (maxilla too far behind mandible) and may worsen it.

Question 25

How old will a child typically be when he/she receives pharyngoplasty surgery? What impact does this have on articulation?

Answer 25

7-9 years old; by this time, compensatory articulation errors have been ingrained in the child’s speech.

Question 26

What are some surgical complications associated with pharyngoscopy?

[from a study on superior flaps done with 219 children at the Toronto Hospital for Sick Ch (1994)]

Answer 26

airway obstruction (9.1%- 20 children)
bleeding (8.2% - 18 children)
sleep apnea (4.1 - 9 children)
mortality (0.5% - 1 child)

OTHER STUDY (St. Louis Children's Hospital:
obstructive sleep apnea, hyponasality, mouth breathing, & nasal secretions.

Question 27

What are some advantages to speech appliances?

Answer 27

• No risk
• Earlier management is possible (3, 4, 5 years old)
• Revisions can be done as necessary
• May stimulate growth
• Allows for facial growth (obturator)
• Better for an unknown etiology (use obturator until figure out what’s going on)
• Better if there is severe paralysis
• Better for severe artic disorders
• Better if there is a mild resonance imbalance.

Question 28

List the types of appliances to aid velopharyngeal closure?

Answer 28

1. Palate obturator
2. Palatal lift
3. Obturator with speech bulb

Question 29

What is a palatal lift?

Answer 29

A type of speech appliance used to manage VP port dysfunction by closing the port during speech. A palatal lift goes over the entire velum.

Used for a velum that is long enough but isn’t strong enough. Adds length so the velum doesn’t have to move very much to achieve closure.

PRO: no scarring.

Question 30

What is a retainer used for?

Answer 30

To cover a fistula.

Question 31

What are the 3 functions of the Eustachian tube?

Answer 31

1. Ventilation for equalization of air pressure.
2. Protection from nasal mucous running into ears (e.g., when blowing nose)
3. Clearance- drains fluid out of middle ear cavity.

Question 32

T/F: There is a high incidence of otitis media with effusion (OME) in children with cleft lip/palate.

T/F: Conductive hearing loss is common in CLP children.

Answer 32

TRUE

TRUE

Question 33

T/F: Conductive hearing loss in CLP children does not tend to improve with age.

Answer 33

FALSE- it does improve with age.

Question 34

T/F: There is no relationship between hearing loss and the type of palatal cleft, type of velopharyngeal management, type of surgery, or age at time of surgery..

Answer 34

TRUE