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Resonance Disorders > Treatment > Flashcards

Treatment Flashcards

1
Q

Behavioural treatment can be helpful in all stages of development for someone with a cleft. List 5 other situations where it would be beneficial.

A
  • While waiting for a prosthesis/surgery
  • If VPD is inconsistent or mild
  • As a trial before more aggressive management
  • After palatal surgery or prosthesis received
  • When surgery/prosthesis not an option
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2
Q

True or false: Compensatory articulation errors are generally not resolved after physical management of VPI, and should be remediated through behavioural treatment.

A

True

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3
Q

List the most common types of compensatory articulation errors in children with congenital VPI.

A

Backing
Omissions
Glottal or pharyngeal substitutions

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4
Q

People with acquired VPD are at risk for hypernasality and obligatory artic errors, but not _____.

A

Compensatory artic errors

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5
Q

Therapy for compensatory artic errors should target _____(voiced/voiceless) sounds before _____ (voiced/voiceless) sounds.

A

Voiceless before voiced

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6
Q

The evidence for using biofeedback to improve control/completeness of VP closure is _____ (strong/limited/weak).

A

Limited - studies show efficacy in some groups with mild or inconsistent VPD, but we don’t have evidence on the dosage required or type of feedback

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7
Q

____ ______ forms the basis of artic therapy for resonance disorders.

A

Auditory discrimination

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8
Q

Speech hygiene techniques may be effective for people with mild hypernasality. List 3 examples.

A

Wider mouth opening
Oral voice projection
Increase loudness
Precise articulatory contacts

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9
Q

Blowing exercises or VP muscle training is not recommended because gains do not generalize to speech. What is the one thing they might rarely be good for?

A

Teaching forward airflow

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10
Q

PSNAE stands for _________ and represents people who produce audible nasal airflow on (or substitute posterior nasal frication for) specific consonants in particular contexts. It occurs in the absence of _____.

A

Phoneme Specific Nasal Air Emission

VPI

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11
Q

PSNAE requires ______, not _______ or a palatal appliance.

A

Speech therapy

Surgery

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12
Q

Speech therapy for PSNAE must include _____ and ____. It also often includes ____.

A

1) Auditory discrimination training, sound shaping

2) Visual/auditory/other feedback

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13
Q

If a client with PSNAE doesn’t respond to speech therapy in short period of time, you should…

A

Re-examine the possibility that nasal air emissions are related to VPI, or some complex phonological disorder.

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14
Q

The first step in treatment of cul-de-sac resonance is to…

A

Practice anterior alveolar sounds and low, forward vowels. This will ‘flatten’ the tongue and bring it forward.

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15
Q

It can be helpful to have a child with cul-de-sac resonance co-articulate a ____ with speech because the tongue back goes down and the velum goes up.

A

Yawn

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16
Q

Hyponasality can be treated with speech therapy when…

A

There is no physical obstruction

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17
Q

For hyponasality, you may try shaping nasals by…

A

Having the patient hum, then add vowels.

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18
Q

List the goals of primary surgical treatment of VPI.

A

1) Structural continuity of palatal vault
2) Separation of oral and nasal cavities
3) Provision of bulk and length to the velum with functional musculature to achieve closure

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19
Q

Cheiloplasty is…

A

Surgical repair of a cleft lip to attain permanent continuity and normal appearance.

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20
Q

Secondary surgery is needed for approximately ___% of palatal clefts due to continued VPI too severe for only behavioural therapy.

A

25%

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21
Q

The ‘rule of tens’ can guide the decision to perform a cleft lip surgery on an infant. List the four parts of the rule of tens.

A 
The child weighs 10lbs+
Child is 10+ weeks old
Hemoglobin is at least 10g
White count no higher than 10,000
(Plus good general health)
22
Q

Bilateral cleft lips are more difficult to repair than unilateral because…

A

Columella may be absent
Maxillary arches may collapse
May need to re-align maxillary and pre-maxillary segments beforehand

23
Q

After primary cleft lip surgery, secondary surgery is usually required in order to _____, re-align lip and nose, and/or ______.

A

Diminish scar appearance

Elevate nostrils

24
Q

Palatoplasty is…

A

Primary cleft palate repair surgery

25
Q

Many children receive palatoplasty between ___ and ___ months of age, but sometimes it is done a couple of months earlier or later.

A

9 to 18

26
Q

In palatoplasty, an important driver of timing decisions is to optimize VP closure for speech development, without compromising ___________.

A

Maxillofacial growth relationships

27
Q

_______ is special connective tissue that covers all bones in the body and possesses the potential to form bones.

A

Mucoperiosteum

28
Q

List three approaches to single stage palatoplasty.

A

Wardill-Kilner repair (2+ flaps of mucoperiosteum, may have dysfunctional scar formation)
Von Langenbeck repair (2 double based flaps, high fistula rate)
Furlow’s Double Opposing Z-plasty (popular, but difficult, may cause cross-bite)

29
Q

A pharyngeal flap is a portion of the pharyngeal wall that is surgically __________.

A

attached to the soft palate

30
Q

Post-op nasopharyngeal airway obstruction after pharyngeal flap surgery generally resolves within _______.

A

3 months

31
Q

List some problems that can arise if a pharyngeal flap is too wide.

A 
Mouth breathing
Failure to thrive
Chronic fatigue
Inattention, irratibility
Snoring
Hyponasality
Sleep apnea
Poor oral hygiene
32
Q

A pharyngeal flap may be constructed in a person with a repaired palatal cleft as a secondary procedure, usually between ___ and ___ years of age.

A

4.5 and 12

33
Q

VPI may persist after pharyngeal flap surgery if the flap is too ___, too ___, or too ___.

A

narrow
high
low

34
Q

What is the orticochea technique?

A

A secondary palatopharyngoplasty that uses palatopharyngeus muscle to narrow the VP port laterally.

35
Q

An injection into the posterior pharyngeal wall is called ______ and can be effective in those whose VPI is mild (shows ‘light touch’ closure).

A

Posterior pharyngeal wall augmentation

36
Q

A fistula is…

A

an abnormal connection between two body parts, usually after surgery or injury.

37
Q

Alveolar bone grafting accomplishes the purpose of…

A

stabilizing a cleft alveolar ridge in a person between 6-8 years of age.

38
Q

Up to ___% of patients may develop an oronasal fistula post-palatal surgery. Signs and symptoms include:

A

15-20%

  • regurgitation into nose
  • halitosis
  • complaints
39
Q

List the 3 options for prosthetic devices for VPI.

A

Palatal lift appliance
Pharyngeal obturator/speech bulb appliance
Maxillary obturator

40
Q

A prosthetic appliance may be recommended for:

A
  • those for whom secondary surgery isn’t an option
  • submucous clefts
  • congenital palatal insufficiency (CPI)
  • VPI secondary to neurological diagnosis
  • VPI due to ablative surgery
  • VPI of unknown etiology
41
Q

This appliance requires natural teeth or well-fitted dentures, and is best suited to patients who have some lateral pharyngeal wall movement.

A

Palatal lift

42
Q

This appliance is used permanently for when the velum is short or the hypopharynx is deep. It is often used for patients who have had radiation therapy who are at risk of poor oral health, as it covers less of the palate.

A

Pharyngeal obturator

43
Q

These two appliances may be used together for more extensive surgical removal.

A

Maxillary obturator and pharyngeal obturator

44
Q

This appliance is also called a palatal obturator.

A

Maxillary obturator

45
Q

Potential problems or contraindications for appliances may be…

A
  • Severe dysarthria
  • Compromised airway
  • Limited manual dexterity
  • Poor dental hygiene
  • No teeth
  • Non-compliance, behaviour issues
  • Cognitive delay
  • Hyperactive gag
  • Great distance from tx centre
46
Q

Speech therapy concurrent with prosthetic management will include…

A

Articulation therapy
Auditory discrimination training
Discrimination training for oral vs. nasal airflow

47
Q

SPIR stands for…

A

Soft Palate Insufficiency Reconstruction

48
Q

The difference between Surgical Design Simulation (SDS) planned hard palate reconstruction and the standard reconstruction is ________.

A

There is no guesswork in the SDS reconstruction, and it has better speech intellgibility outcomes

49
Q

The adhesion method of soft palate reconstruction showed good outcomes at 1 month, but not 1 year post-op, whereas the _____ method had good outcomes at both.

A

SPIR

50
Q

Soft palate reconstruction is usually done to replace tissue removed in tx of _______.

A

Head and neck cancer

51
Q

Cancer due to HPV requires _____ (more/less) tissue removal and radiation than squamous cell carcinoma.

A

Less

Resonance Disorders (3 decks)

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