Special Populations Flashcards
3 causes of hypernasality
- velopharyngeal insufficiency (anatomic; deficit of structures; i.e. cleft lip-palate)
- velopharyngeal incompetence (physiological; motor deficit; i.e. CP, TBI)
- velopharyngeal mislearning (no anatomical or functional deficit, but error in learning)
which of hyponasality and hypernasality is SLP more involved in? which is more common?
- hypernasality more common.
- little role for SLP in hyponasality (others do interventions to remove the obstruction)
4 types of clefts
- labial (unilateral (L or R) or bilateral; complete or incomplete)
- palatal (complete of incomplete)
- labiopalatal
- occult submucous
3 clinical signs of submucous cleft palate
- bifid uvula
- zona pellucida (blue transparent zone)
- palpable V
3 important structures and role in velopharyngeal closure
velum
- moves towards posterior pharyngeal wall
lateral pharyngeal walls
- move towards midline
posterior phayngeal wall
- anterior movement toward velum
role of velopharyngeal mecanism is speech sound production
- nasality
(open for nasal vowels/consonants) - oral pressure
(close to allow adequate oral pressure buildup for consonants and vowels)
distinction between pneumatic and non-pneumatic closure of velopharyngeal mecanism
pneumatic is for speech
- smaller closure to allow rapid movements; increased demands on system
non-pneumatic closure is for swallowing, vomiting, nausea reflex
- for some clefts, no difficulties in non-pneumatic closure but difficulties with pneumatic
effects of clefts on suction
typically, tongue pressing on nipple against alveolar ridge/hard palate generates positive pressure in nipple that causes liquid to come out
- palatal cleft renders pressure for suction difficult or impossible to generate
+
nasal regurgitation
(cleft lip, especially unilateral, has little effect)
4 types of articulatory errors with clefts
- developmental errors
(part of typical development) - phonological errors
(same as SSD errors) - obligatory errors
(consequence of anatomical or physiological deficit; cannot be corrected with therapy) - compensatory errors
4 types of obligatory errors with clefts
- nasal emissions
- nasal turbulence
- weak oral consonants
- distortions caused by fistula or malocclusion
5 types of compensatory errors (that should be addressed in therapy) with clefts
glottal stop (VPI) - substituting plosive
nasal air emission (“snort”) (VPI)
- co-occurs with pressure sensitive sounds*?
pharyngeal fricative (VPI + fistula)
- approximation of tongue back and pharynx
- substituting fricative
pharyngeal plosive (VPI + fistula)
- contact of tongue back and pharynx
- substituting plosive (often velars)
platal mid-dorsal plosive (fistula)
- contact of tongue back with palate behind fistula
assessments tasks particular to clefts
3
“cul-de-sac” test
- for hypernasality, production of /a/ or phrase with no nasal phonemes with and without pinching nostrils
- for hyponasality, production of syllables with nasal phonemes with and without pinching nostrils
mirror test
- check for nasal emissions with mirror condensation
nasometer
with cleft, hypernasality should be consistent across oral sounds. why might nasal emission not be consistent?
(3)
variations of velopharyngeal closure related to certain sounds
- indicates not velopharyngeal dysfunction, but “phoneme specific nasal emissions”.
variations of velopharyngeal closure related to timing of closure
- i.e. motor dysfunction; like apraxia/CAS
variations of velopharyngeal closure related to strength of articulatory contacts
- touch closure in isolated sounds w/ effort; but difficulties in spontaneous context and at end of sentences
when is a fistula more symptomatic on resonance?
- smaller fistula = less symptomatic
- more posterior fistula = less symptomatic
(most symptomatic fistulas are in alveolar region)
cerebral palsy definition and criteria
non-progressive disorder of movement/posture related to neurological condition caused by lesion to motor systems during prenatal, perinatal or before 2-3-5 years of age, can be congenital or acquired.
- differing profiles (cognition, language, sensory, motor) according to extent and location of lesions
