Exam 3 Flashcards
single words uses
high pressure consonants
What are adaptive misarticulations
- occur in response to oral structural deviations
- are obligatory
Potential Causes of mechanical obstruction
- excessively large palatine TONSILS
- structurally anomalous faucial pillars
NAE primarily affects
high pressure/obstruent consonants
compensatory misarticulations (CMAs) are predominantly take place where in the oral cavity?
- errors in place and tend to be backed
- below the defect causing VPI
PSNE is perceptually seen as
a nasal fricative
What is in overjet
- protrusive premaxilla with or without Angle Class II malocclusion
What is velopharyngeal insufficiency due to (5)
- unrepaired palatal clefts
- mechanical interference (tonsils, adenoid, posterior pillar webbing)
- post-surgical insufficiency
- palatopharyngeal disproportion
- ablative palatal lesions (cancer, TBI)
Given diagram be able to identify landmarks associated with hard and soft palate (Module 17, slide 6?)
- rugae
- palatine tonsils
- anterior and post faucial pillars
- uvula
- median raphe
- hard palate
What does it mean when errors are obligatory vs optional/learned
OBLIGATORY
- due to structural or neurogenic problems
- require physical management
OPTIONAL/LEARNED
- habituated errors that are the result of early mislearning
- exist despite adequate VP closure
- require speech remediation
What are the four types of speech deviations associated with cleft palate speech
- resonance (hypernasality)
- airflow (nasal air emission)
- air pressure (weak or absent oral pressures)
- articulation (maladaptive compensatory misarticulations)
An open bite can be anterior or
lateral
The size of the tongue can be assessed by
- its objective size
- in relationship to the size of the mandibular or maxillary arch
How do you know the NAE is caused by phoneme specific nasal emission (PSNE)
- the NAE affects only selected phonemes
Compensatory misarticulations can persist after a cleft is repaired and can be a source of
VPI
How do you know NAE is caused by VPI
NAE will be constant/pervasive
Function of Palatopharyngeus
pulls soft palate back and down
- narrowing of VP port
- medial movements of lateral pharyngeal walls (below level of palatal plane)
- velar lowering
What is an open bite
- both the upper and lower teeth are forced outwards to an extent that the teeth of the upper and the lower jaw do not touch each other, even when the mouth is closed.
Airflow in cleft palate speech leads to
nasal air emission
True or false:
Learned NAE can be realized in different forms:
- as a fricative substitution, with or without turbulence
- as NE that is co-produced with the target, with or without turbulence
- No - as a nasal fricative substitution, with or without turbulence
- True
PSNE occurs in what population
non-cleft
What is velopharyngeal incompetency (internet definition)
- when there is a problem in how the soft palate moves to make speech sounds
How are obligatory errors better treated
surgically or prosthetically
What is the function of the uvulus?
- gives bulk to soft palate, and helps move uvula forward
- bulges the middle third of the dorsal surface of the velum making a major contribution to levator (velar) eminence
Where do missing teeth tend to be
where the cleft is or was
Can adequate movement to achieve velopharyngeal closure be detected intra-orally
no but we can describe whether or not any movement was observed and whether or not movement was symmetrical
What is VP mislearning (internet)
the person has not learned how to use the VP mechanism properly
Microglossia/underdeveloped tongue can cause
bilateral collapse in mandibular arch
How can adequate movement to achieve VP closure be detected
an instrumental evaluation (nasendoscopy or videofloroscopy)
Persisting post-op NE is perceptually sees as
- co-produced NE
- a nasal fricative
Is the cause of VP incompetence structural, neurogenic or mislearning
neurogenic
Causes of ankyloglossia: frenum is
- too short
- attached too far anteriorly
- attached too broadly on inferior surface
- combinations of above
VP incompetence is seen in patients with?
dysarthria
What is hyponasality, and which sounds does it affect?
- too little nasal resonance
- cold-in-the-head sound
- affects vowels, sonorants and nasal consonants
What is the function of the levator veli palatini?
- Levator veli palatini elevates and retracts the velum
Therapy for kids after 3 years old involves traditional articulation techniques with an emphasis on
- teaching the identity, location, and actions of oral structures (mirror, pictures)
- teaching how sounds are made (using multiple modalities of learning or the difference between oral and nasal airflow)
- phonemic placement techniques
- sound contrasts
Ectopic teeth are the consequence of
an underdeveloped, crowded maxillary/mandibular arch
What are the sampling contexts for assessing cleft palate speech
- single words
- sentences
- zoo passage
What are the different forms of VP closure?
- coronal (velum with lateral pharyngeal walls)
- sagittal (lateral pharyngeal walls with some velum)
- Circular (lateral pharyngeal walls and velum are equal)
- circular with passavant’s ridge (lateral pharyngeal walls, velum and passavant’s ridge are equal)
Function of superior pharyngeal constrictor?
- medial movements of the lateral pharyngeal walls
- forward movement of the posterior pharyngeal wall
- at the level of the palatal plane (or below for swallowing)
What causes of VP incompetency
- Dysarthria (primary motor/neuromotor control)
What is velopharyngeal inadequacy
- umbrella term for different types of velopharyngeal dysfunction
What are the non-cleft causes of VPI (velopharyngeal inadequacy)
palatopharyngeal disproportion
- mechanical obstruction
- VP incompetency
- VP mislearning
Adaptive oral misarticulations include speech sound errors because of
- dental deviations
- occlusal deviations
- lip incompetence 2 malocclusion (surgery or both)
What is macroglossia
unusually large tongue
An early focus of intervention for prelinguistic kids is on
achieving any sounds that have airflow
You must distinguish between what potential sources of NAE
- VPI
- fistula
- phoneme specific nasal air emission (PSNE)
What is diastema
- space between teeth not due to missing dentition
- common in transitional dentition
Is the cause of VP insufficiency structural, neurogenic or mislearning
structural
Do enlarged palatine tonsils usually interfere with velopharyngeal closure
no, unless they expand superiorly into the VP port
Analysis of a speech sample involves making the following analyses:
- rate overall intelligibility
- document phonetic inventory (inventory size, comparison to developmental norms, and presence of compensatory maladaptive articulations)
- document resonance
- document nasal air emission
Is the adenoid pad visible intra-orally
no
NAE can be _ or _
- audible or inaudible
- obligatory or learned
What are the structural causes of early VP mislearning
- deficient velopharyngeal valve
- absent or structurally aberrant bony partition
- hearing loss 2o MEE (2nd to middle ear infection)
What is nasal air emission
- airflow deviation characterized by speech airflow and emission through the nose
- inappropriate/abnormal coupling or oral and nasal cavities
Are obligatory errors expected to respond to behavioral treatments
no, unless the problem is subtle/mild
What is velopharyngeal insufficiency (internet definition)
when there is not enough tissue in the palate or throat to let the palate contact the back of the throat during speech.
(structural/anatomic/mechanical)
- due to anatomic dysfunction
what is phoneme-specific nasal emission (PSNE)
- nasal emission that is selective (affects only certain pressure consonants)
What is an underbite
the projection of the lower teeth beyond the upper
What are the potential causes of hypernasality
- cleft palate: (either persisting VP insufficiency or oronasal fistula)
What are some causes of VP mislearning (4)
- phoneme-specific nasal emission
- persisting post-op nasal emission (with adequate closure ability)
- compensatory misarticulations
- deafness/hearing impairment
What are treatable errors
those that are learned and no longer obligatory (because the cleft is now repaired)
What are the main muscles of velopharyngeal closure?
- levator veli palatini
- unulus
- palatopharyngeous
- superior pharyngeal constrictor
Audible NAE can be
turbulent or non-turbulent
Adaptive oral misarticulations are observed more often in
CL +- CP
What is the impact of VPI on phonation
- voice problems in cleft palate
- hoarseness 2nd to vocal nodules
- soft voice syndrome
Hyponasality can perceptually mask
a VPI
Cleft palate speech includes deviations in the following areas:
- resonance
- airflow
- air pressure
- articulation
What are compensatory misarticulations (CMAs)
- learned articulatory deviations
- substitution errors in place of articulation
What is mixed nasality
- elements of both hypernasality and hyponasality
- there is increased nasal cavity resistance
What is a submucous cleft
Mucosal covering is intact, but there is some clefting in hard or soft palate
When should SLPs meet with the parents in order to educate
before the child is 3 months old
What is nasal turbulence
- more of a snorting sound
- has been referred to as: posterior nasal friction, nasal snort, nasal rustle
intervention for prelinguistic kids focuses on
training parents so they can encourage/reinforce correct behaviors
Inaudible NAE is not
perceptually disruptive to speech but can be a sign of VPI
Potential causes of NAE
- VPI (there will be coupling at VP port)
- fistula (there will be coupling via the oral cavity)
The function of levator veli palatini?
- elevates and retracts the velum
- may contribute to medial movements of lateral pharyngeal walls occurring above the level of the palatal plane
- contributes to the levator eminence
What is VP closure?
A sphincteric activity that takes place in the nasopharynx and involves movements of soft palate and pharyngeal walls
What are the causes of weak pressure consonants
- due to abnormal coupling of oral and nasal cavities
- usually organically based
What are the two error patterns of learned NE
- phoneme-specific nasal emission (PSNE)
- persisting post-op nasal emission
What are ectopic teeth
- when the tooth does not follow its usual course
What are the main muscles of velopharyngeal closure?
1) Levator veli palatini
2) Uvulus
3) Palatopharyngeous
4) Superior pharyngeal constrictor
Resonance in cleft palate speech leads to
hypernasality
Audible NAE tends to co-occur with
high pressure consonants
What is Cul-de-sac resonance
- sound is trapped by anterior nasal cavity constriction
- i.e. deviated septum
Pressure in cleft palate affects speech in what way?
- weak oral pressures/weak pressure consonants
How do you know the NAE is caused by a fistula
- depending on the place of production
- the place of production will be at or anterior to the fistula
What is ankyloglossia “tongue tie” (online definition)
a congenital oral anomaly that may decrease mobility of the tongue tip
Hypernasality: changes in resonance primarily affects which sound categories?
- vowels
- vocalic consonants (glides/liquids)
Sentences uses
- high pressure consonants (1 target/sentence)
- nasal consonants (loaded)
- low pressure consonants /r, l, j, w/
What are the potential causes of palatopharyngeal disproportion
Short hard palate [brings soft palate forward]
- Short soft palate
- Excessive pharyngeal depth [20 anomalies of cervical spine/vertebrae, flattened cranial base]
Name some maladaptive compensatory misatriculations
- glottal stop
- pharyngeal stop
- mid dorsum palatal stop
- pharyngeal fricative
- pharyngeal affricate
- posterior nasal fricative (turbulence)
- nasal fricative (no turbulence)
What innervates the soft palate
the pharyngeal branch of CN X
Is the cause of VP mislearning structural, neurogenic or mislearning
mislearning
What is hypernasality
resonance distortion that results from abnormal coupling of oral and nasal cavities
What is the function of the uvulus?
Uvulus bulges the middle third of the dorsal surface of the velum making a major contribution to “elevator”
Articulation in cleft palate speech leads to
maladaptive compensatory misarticulations
Where is the adenoid pad
- posterior to the nasal cavity
- in the roof of the nasopharynx
- where the nose blends into the throat
Stigmata for submucous cleft
- notch in the bony palate
- zona pellucida (midline lucency)
- bifid uvula
When examining the hard palate, were looking for
- abnormal height (high or low)
- submucous cleft palate
- fistulas
Fistulas can occur in the
hard and soft palate
Role of the adenoid pad in VP closure in adults vs children
- minimal adenoid in adult (velopharyngeal closure in adult)
- adenoid present in child (veloadenoidal closure in child)
- gives bulk to pharyngeal wall in children
The “zoo passage” uses
- no pressure consonants
- assesses for hypernasality
Velopharyngeal muscles: What is the function for each? -Levator veli palatini -Uvulus -Palatopharyngeal constrictor -Superior pharyngeal constrictor
- Levator veli palatini elevates and retracts the velum
- Uvulus bulges the middle third of the dorsal surface of the velum making a major contribution to “elevator”
- Palatopharyngeal constrictor may contribute to narrowing of the velopharyngeal port; probably responsible for medial movements of lateral pharyngeal walls which occur below level of the palatal plane
- Superior pharyngeal constrictor is responsible for medial movements of the lateral pharyngeal wall and forward movement of the posterior pharyngeal wall at or below palatal plane for swallowing
What is persisting post-op NE
- NE that persists in repaired CP speakers who have the physiologic ability to attain closure
- Speaker continues the old pattern of directing air into the nasal cavity
- Not restricted to any certain sounds, sound group
