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
