Perceptual Assessment Flashcards
Abnormal Resonance
Inappropriate transmission of acoustic energy in the vocal tract.
Hypernasality
- Occurs when sound enters the nasal cavity inappropriately during speech
- Often called ‘nasal’
- Hypernasality is perceived on vowels not consonants
Hyponasality
Occurs when there is a reduction in the nasal resonance during speech due to blockage in the nasopharynx or entrence in the nasal cavity
Affects /m,n, and ng/ sounds
Cul-de-sac
- Abnormal resonance during speech which occurs when the transmission of acoustic energy is trapped in a blind pouch in the vocal tract with only one outlet. Speech is perceived as muffled due to the fact that the sound is contained in a cavity with no direct means of escape.
- A turbinate can swell up, or patient can have large tonsils and cause blockage
- Investigatetofindtheblockage
Examination includes
- Oral exam
- Language screening/evaluation
- Diagnostic Interview
- Measurements to evaluate velopharyngeal function
- Articulation Testing
Examination Goals
• Determine if abnormality exists and if it does, determine severity of the disorder
• Determine if instrumentation id necessary • And then if surgery and/or speech therapy
is necessary
• Determine appropriate treatment plan
Diagnostic Interview
• Carried out before perceptual evaluation
• Pre-evaluation questionnaire
– Speech history
– Medical history (including ear tubing, adenoid, and tongue placement)
– Development history – Feeding (mostly w/
submucous and CP) – Treatment history
• Interview the child and his/her parents
• Why parents?
– They can be good observers of child’s behavior
– Determine parent/child perception of problem
Listener Judgement
One measure to eval velopharyngeal function
– is considered the most important tool
– May be only measurement you see in your first evaluation
– Sometimes it’s the only tool you have
Methods of Rating Resonance
• Different rating methods are available
• Depends on SLP and the setting
– Simple scale for rating nasality
– Four-point, equal-appearing interval scale for rating hypernasality
– Seven-point, equal-appearing interval scale for rating hypernasality
– Eight-point scale for rating nasal resonance – Simple scale for rating hyponasality
Simple Scale For Rating Nasality
- Resonance: ___ normal ___ abnormal
* If abnormal: ___ hypernasal ___ hyponasal ___ mixed
Four-Point, Equal-Appearing Interval Scale For Rating Hypernasality
Hypernasality 1 Normal 2 Mild 3 Moderate 4 Severe
- Then more levels on the scale, the less reliable the scale will be.
- We use the 7 point scale at Carle an describe the scale in the report.
Some general info about nasality
– Hypernasaliy and hyponasality are considered resonance and heard during production of
vowels
– Nasal emission is the air coming out of the nose and noted during high pressure consonant production
A patient can have hypernasality and not nasal emission
Hypernasality can be heard when a patient has nasal emission of air
High Pressure Consonants-can have Nasal Emission (NE)
- Stops: p,b,t,d,k,g
* Fricatives: s,z,f,v,sh,th, • Affricates: ch,j
Nares Pinching Test -nasality
• Have the patient prolong a vowel sound ( /i/ is often used)
• The same speech sample is then repeated with the nostrils occluded by pinching the nares with the fingers. (some children do not like this)
• Change in sound indicates hypernasal
• If there is a quality change during nostril pinching, then this suggests that the resonance is hypernasal
• If there is no change then it could mean normal resonance, cul-de-sac resonance or hyponasality
– Another idea: Have the patient produce /mamama/-sound like /bababa/-suggest hyponasality
Nares Pinching Test –nasal emission
- Have the patient prolong a strident sound /s/ is often used –change nasal emission
- Use to detect hyponasality, have patient produce /ma,ma,ma/-only no change means hyponasality
Other methods
- Straw
- Stethoscope
- Listening Tube
Evaluate Nasal Emissions phrases/sentences
See -Scape
Mirror
Visual Detection – See ScapeTM
- Aplasticdevicethatcan detect the presence of nasal air emission
- Anasaloliveisplacedin the nostril and have the child produce oral sounds
- Thestyrofoamstopper’s movement indicates nasal air emission
Visual Detection – Dental Mirror
- Hold the mirror under the nares
* Look for fog built up during production of oral sounds
Rules for Speech samples:
– For hyponasality: should contain many nasal phonemes
– For hypernasality: should contain many oral sounds, vowels
– For nasal air emission: should contain many pressure-sensitive consonants
Sample Sentences Used for Hyponasality Evaluation
- My mama made lemonade for me.
- My name is Amy Minor.
- My mama takes money to the market. • Many men are at the mine.
Sample Low-Pressure Sentences- hypernasality
- How are you?
- Who are you?
- Where are you?
- Why are you here?
Speech samples for nasal emission
Counting and rote speech
Spontaneous connected speech
Counting and rote speech
count from 1 to 20
say the alphabets
count from 60 to 70 (contain many sibilants, velar plosives, alveolar plosives)
repeat 60, 60, 60, 60.. (high intraoral pressure)
count from 70 to 79: contain many nasal phonemes
Spontaneous connected speech
– The demand on VP mechanism is higher
– May probe by using a question: What do you like more? Basketball? Or soccer?
Sample High-Pressure Sentences for identifying nasal emission
- Paul likes apple pie.
- Put the baby in the buggy.
- Cookies are good to eat.
- Fred has five fish.
- John told a joke to Jim.
Younger child
What do you like best?
– Puppy dogs or kitty cats? – Baby dolls or teddy bears? – Cup cakes or cookies?
– Baseball or basketball?
– Dancing or singing?
Rote Speech
- ABC’s
* Nursery rhymes (i.e.patty cake) • Songs (i.e.Happy Birthday)
Nasometer
• Can be compared to objective norms for interpretation
• Use information for pre/post treatment comparison
If patient has nasal emission ( hypernasality) then may have:
VELOPHARYNGEAL INSUFFICIENCY VPI
Differential Diagnosis
- Nasality and nasal air emission problems are not always due to VPI
- Knowledge of the cause of problem is important for effective treatment
What is causing the VPI?
•Oronasal fistula – then maybe not VPI •Structure/movement of VP mechanism •Mislearning
Oronasal fistula
- Size: if diameter is larger than 5 mm, should have nasal air emission
- Also need to determine if it is connected to nasal cavity
Position of fistula can determine effects on speech
•If at incisive foramen (more common), may yield nasal air emission for lingual-alveolar sounds (as tongue is forcing air into nasal cavity)
•Fistula – the hole at incisive foramen; reopened after surgery
•Dehisce – larger reopening
A mid palatal fistula can result in the use of palatal-dorsal placement for many sounds as a compensatory strategy
A posterior fistula may be less common
Techniques to determine if fistula is symptomatic
- Mirror fogging test-have patient repeat /papapa/ then repeat /kakaka/
- If nasal emission noted more on /papapa/ than /kakaka/ then fistula is communicating
- Close fistula with chewing gum or dental wax
Mislearning vs. VPI
- Nasal emission is noted only on certain sounds
- There is good oral pressure snd no nasal emission on other pressure sensitive phonemes
- Nasal emission is eliminated by change in articulation placement
- Phoneme specific nasality
- Considered an articulation problem not resonance/VPI
- Called phoneme specific nasality
- Speech therapy, not surgery, is recommended
Direct Measurements
- Videofluoroscopy
- Nasoendoscopy
- Cephlometric xrays • MRI
Articulation Testing
Distinguish between: • Compensatory errors • Placement errors – phono vs. artic • Developmental errors • Should contain appropriate sounds, reasonable length, and appropriate syntax for child’s developmental level • Formal articulation tests – Goldman-Fristoe Test of Articulation
Compensatory Articulation Errors
Place Errors:
• Glottal Stop(most common)
• Pharyngeal Stop
• Mid-dorsal palatal stop
• Pharyngeal fricative (most common) • Velar fricative
• Posterior nasal fricative/nasal snorting/rustle at port
