June 25 Slides Flashcards
Name an evaluation used for clinical diagnosis.
low-tech perceptual speech evaluation
What 2 questions you should ask yourself when administering a low tech perceptual speech evaluation?
What can be treated medically? What can be treated therapeutically?
What does the evaluate of perceptual characteristics of speech tell you about the evaluation?
informs you about every other aspect of the evaluation
Is it enough to notice hypernasality in a low tech perceptual speech evaluation?
NO
What are 2 reasons why it is it NOT enough to notice hypernasality in a low tech perceptual speech evaluation?
- There are some speech characteristics which can trick your ear into thinking a velopharyngeal problem is present, when in fact the velopharynx is normal.
- There are some speech characteristics which can make velopharyngeal function sound worse than it is.
When should you distinguish differences between a speech error made because of a velopharyngeal problem and a speech error made that is not related to a velopharyngeal problem?
During the perceptual speech exam
What can happen if you do not distinguish differences between a speech error made because of a velopharyngeal problem and a speech error made that is not related to a velopharyngeal problem?
inappropriate care
True or False: The velopharynx is an articulator.
TRUE
What CAN happen to the velopharynx when an articulation disorder is present.
the velopharynx CAN behave in a disordered way
What can disordered articulation involving the velpharynz sound like?
velopharyngeal dysfunction
It is important to rule out true velopharyngeal dysfunction from what?
an articulation disorder
What should a perceptual speech assessment always include?
careful assessment of articulation
What needs to be determined for further instrumental assessment if it is needed.
Readiness: child is as prepared as possible via therapy prior to imaging
Should you treat an articulation disorder with surgery.
NEVER!!!!!
Before low tech perceptual speech evaluation is given, what 2 subjects do we need to know about?
- nasal consonants
2. oral production
What do we need to know about nasal consonants prior to giving the low tech speech perception examination?
- [m,n,ŋ]
- The velopharyx is open
- These consonants are resonated in the nose
- Do not use these consonants to assess velopharyngeal closure!
- Use these to assess velopharyngeal opening
What do we need to know about oral productions prior to giving the low tech speech perception examination?
- All other consonants
- Vowels
- The velopharynx is closed
- Highest intraoral pressures: fricatives [s,z,ʃ,ʧ,ʤ ] and stops [p,b,t,d,k,g]
- Use these to evaluate velopharyngeal closure
List the 4 articulation error types.
- Developmental
- Adaptive
- Obligatory
- Compensatory/Maladaptive
Describe developmental error.
- May not necessarily be related to the cleft
* Will respond to the same treatment as non-cleft children on your caseload
Describe adaptive error.
- Difference in production caused by structural difference
- May be acoustically appropriate
- Examples: [p,b,m] with macroglossia – [f,v] with anterior crossbite
Describe an obligatory error.
- Distortion caused by a structural anomaly
- Will not respond to articulation therapy
- Examples: nasalization, weakened pressure consonants, accompanying nasal emission, turbulence, or grimacing, sibilant distortions
How can I tell if a distortion is obligatory, caused by dental malocclusion?
Diagnostic therapy
How can I tell if a distortion is obligatory, due to velopharyngeal dysfunction?
plug the nose
Describe compensatory/maladaptive (active) error.
- Comprehensively described by Trost in 1981
- Further delineated by Peterson-Falzone and others
- Believed to develop as a compensation for defect of mechanism, often before the palate is repaired.
Name 3 kinds of compensatory/maladaptive errors.
- glottal stop
- posterior nasal fricative
- pharyngeal stops and fricatives
Pharyngeal fricative
Producing a fricative sound in the throat with the roof of the tongue instead of in the mouth with the front of the tongue.
Pharyngeal stop
tongue moves posteriorly to meet the pharyngeal wall or the walls of the pharynx move inward to meet the tongue, air then moves through the limited airway to make the sound
glottal stop
when true and false vocal folds adduct as a substitute for blocking the airflow of the vocal tract
How can I tell if an error is compensatory (maladaptive, active?) because of the structures in a child with a cleft?
plug the nose
Why worry about glottal stop, pharyngeal stop, and pharyngeal fricative articulations?
these may cause the velopharynx to open inappropriately
Velopharyngeal closure was significantly reduces with what kind of articulation? And what was it compared to?
- glottal articulations
- appropriate articulations
Some patients can have velopharyngeal closure significantly reduced with what 2 kinds of articulations?
Does this mean that these patients can never have velopharngeal closure with appropriate articuations? Why?
- glottal articulations
- glottal co-articulations
- NO because these compensatory articulations will not teach us about velopharyngeal closure
