Speech Production Basics: from normal to disorders

Question 1

Motor neurons innervating speech are part of the ___ system.

Answer 1

physiology

Question 2

What is the speech chain?

Answer 2

linguistic level → physiological level → acoustic level → physiological level → linguistic level

Question 3

T/F. The Lower vocal tract is responsible for resonating and modifying sound.

Answer 3

False, the UPPER vocal tract is responsible for resonating and modifying sound.

Question 4

Which system is the power source, performs inhalation vs exhalation, speech vs quiet breathing and is egressive?

Answer 4

respiratory system

Question 5

Vocal folds vibrations are best explained by ___ ___ theory. What does it state?

Answer 5

Myoelastic Aerodynamic theory

the rate of vocal fold vibration (in cps or Hz) is perceived as pitch.

f=ακ / m
males (120Hz), females (200Hz), children (over 300Hz)

Question 6

T/F. Pitch is controlled by folds stretching.

Answer 6

True.

Question 7

The ___-___ system is responsible for articulation and resonance consisting of various structures within the nasal oral and pharyngeal cavities, collectively called the ___ ___.

Answer 7

Supra-Laryngeal; vocal tract

Question 8

How are consonants produced?

Answer 8

manner of articulation “how”
place of articulation “where”
voicing

teeth (need upper incisors)

Question 9

Define the velopharynx.

Answer 9

soft palate and lateral and posterior pharyngeal walls

Question 10

The ___ is physiologically responsible for determining coupling/decoupling between oral and nasal cavities and modulating sound and air flow along the upper respiratory tract.

Answer 10

velopharynx

Question 11

What are cleft palate babies lacking?

Answer 11

no soft palate means that the levator veli palatini muscle sling is missing its attachment on hard palate

Question 12

How is cleft palate repaired? What type of problems are commonly reported?

Answer 12

levator veli palatini reconstruction and repositioning normally within 6-12 months

residual resonance problems - improperly positioned/structured palatal muscles, insuficient volume, contractile properties, fiber type compositions

Question 13

The Cleft-Palate-Craniofacial Team must have, as a minimum core, what professional?

Answer 13

1. speech-language pathology
2. surgery
3. orthodontics

Question 14

T/F. Feeding is an issue with cleft lip.

Answer 14

False, it is not an issue

Question 15

Which comes first, lip or palate repair, if both are present?

Answer 15

lip repair is followed by palate repair.

The patient needs to be 101lbs and at least 10 wks old

Question 16

The ___ velopharyngeal closure pattern is the most common pattern mainly achieved by the posterior/superior movement of the ___ (plus anterior movement of the ___ ___ wall).

Answer 16

coronal; velum; posterior palatal wall

Question 17

With circular velopharyngeal closure pattern, what is involved to make the sphincter?

Answer 17

soft palate, lateral and posterior palatal walls all contribute

Question 18

Describe the least common pathway for velopharyngeal closure patterns.

Answer 18

sagittal- achieved by the medial movement of the lateral palatal wall

Question 19

The primary palate includes the ___ and ___ ___. It can be complete or incomplete or unilateral or bilateral.

Answer 19

lip; alveolar process

Question 20

The secondary palate includes the ___ and ___ ___ (area ___ to incisive foramen). It can be complete or incomplete or unilateral or bilateral.

Answer 20

hard; soft; posterior

Question 21

What is seen with a submucous cleft?

Answer 21

intact mucous membrane

see: bifid uvula, zona pellucida (bluish tint along palate), furrow along midline, bony notch along the hard palate

Question 22

T/F. About 7,000 babies are born with cleft lip/palate every year in the US.

Answer 22

True.
cleft types: 
25% = lip only
25% = palate only
50% = lip and palate

Question 23

T/F. There is a high incidence in Native Americans and African Americans.

Answer 23

False, Native Americans and Asian Americans

Question 24

What is the incidence among gender?

Answer 24

males > females with combination clefts
males > females with severe forms
females > males with palatal clefts only

Question 25

What is the etiology?

Answer 25

multifactorial inheritance: predisposition is exasperated by environmental factors
-genetic and environmental (teratogens, drugs, smoking, insufficient folic acid)

Question 26

Formation of the structures of the primary and secondary palates occurs from roughly the end of the ___ week to the end of the ___ week.

Answer 26

5th; 12th

week 7 = wk for max / week 9 = palatal growth

Question 27

When can ultrasonographs detect a cleft?

Answer 27

as early as 13 weeks

Question 28

T/F. If the cleft is on the primary palate there are more dental issues compared to having a cleft on the secondary palate.

Answer 28

True.

Question 29

List the different types of velopharyngeal dysfunction.

Answer 29

velopharyngeal insufficiency (anatomical/structural defect)
velopharyngeal incompetence (neuromotor/physiological disorder)
velopharyngeal mislearning (faulty development of articulation patterns

Question 30

What is the gold standard for clinical assessment?

Answer 30

listener judgement (perceptual analysis)

Question 31

What areas are evaluated to assess velopharyngeal dysfunction?

Answer 31

1. resonance
2. nasal air emission (airflow deviation)
3. articulation (compensatory mis-articulation)
4. voice

Question 32

List some resonance disorders.

Answer 32

1. hypernasality
2. hyponasalitiy (denasality)
3. cul de sac (mumbled sound)
4. mixed (hyper- and hypo-)

Question 33

Airflow deviation errors depend on the ___ of the velopharyngeal gap, occurs with high pressure ___ and frequency is accompanied by facial ___.

Answer 33

size; consonants; grimace

Question 34

List some compensatory misarticulations.

Answer 34

1. glottal stops
2. pharyngeal stops/fricatives/affricates
3. mid-dorsal palatal stops
4. posterior nasal fricative

Question 35

What is overdriven in the absence of velopharyngeal valving?

Answer 35

laryngeal valving

Question 36

What instruments measure indirectly? Directly?

Answer 36

indirect - nasometer

direct - videofluoroscopy, flexible nasendoscopy (nasopharyngoscopy)

Question 37

What are VPD treatment options?

Answer 37

1. re-do palatoplasty
2. pharyngeal wall augmentation
3. pharyngoplasty (pharyngeal flap and sphincter pharyngoplasty)