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Flashcards in 3.5 Evaluation Protocol Deck (89)
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What is the clinical paradigm?


1. Listener judgement/perceptual analysis (client talks, we listen)
2. Perceptual assessment leads to assumptions about anatomy and physiology
3. Instrumental analysis should confirm perceptual judgement


Do we always use the clinical paradigm?


- No, sometimes perceptual measures and instrumental measures are divergent

- Need to use good clinical decision making skills and solid knowledge of anatomy and physiology


What is the evaluation protocol overview?


- Perceptual
- Oral examination
- Objective computer instruments
- Imaging
- Diagnostic therapy


In regards to the evaluation protocol, what components make up the perceptual part?


- Rating scales
- Clinical setting of VP closure


In regards to the evaluation protocol, what makes up the objective computer instruments?


- Nasometry
- Pressure flow


In regards to the evaluation protocol, what components make up the imaging part?


- Cephalometric radiographs
- Multiview Videofluoroscopy
- Fiberoptic Nasendoscopy
- Magnetic Resonance Imaging


In regards to the perceptual evaluation, the _______ and the ability to process and interpret what is heard becomes the most important assessment instrument.



In regards to the perceptual evaluation, auditory perceptual judgments are typically the _______ ________ in clinical decision-making and often __________ ______ ___________ against which instruments (objective) measures are evaluated?

- Final arbiter
- Provide the standards


What are the methods for the perceptual assessment?


- Phonetic transcriptions
- Rating scales to quantify speech features (such as hypernasality, audible nasal air emission and/or nasal turbulence, and intelligibility)
- Qualitative descriptions


In regards to the perceptual evaluation, how do you evaluation resonance?


- Connected speech (spontaneous or reading)
- Use prolonged vowels
- Listen for nasal emission, weak consonants, compensatory errors


In regards to the perceptual evaluation, what do you need to determine when evaluating resonance?


- type of resonance (normal oral resonance, hypernasality, hyponasality, cul-de-sac resonance or mixed resonance)
- Severity (mild, moderate or severe)


In regards to the perceptual evaluation, what speech samples can be used?


- Articulation test or screening of consonants
- Repetition of pressure-sensitive phonemes (pa, pa, pa, etc.)
- Repetition of sentences that are loaded with pressure-sensitive phonemes
- Counting from 60-70 (hypernasality)
- Counting from 90-100 (hyponasality)


In regards to the perceptual evaluation, what do you need to determine when getting a speech sample?


- Presence and type of nasal emission (unobstructed or obstructed)
- Consistency of nasal emission and whether it is phoneme-specific
- Effect on pressure consonants and utterance length


In regards to the orafacial examination, what are the two parts?


- Cranial nerves and assessment of facial structures
- Oral exam


What tools are used during the orafacial exam?


gloves, flashlight, mirror, and tongue blade


What facial parts do you examine during the exam?


- Lips
- Movement sufficient for speech production (i-oo)

- Eyes
- Hypo/hypertelorism
- Epicanthal folds

- Ears: Microtia, anotia, atresia

- Nose/airway
- look at patency of each nostril

- Maxilla
- micro/macrognathia, micro/macrostomia

- Dentition

- Tongue
- Ankyloglossia (tongue tie)


What oral parts do you examine during the exam?


- Hard palate
- vault: low or high
- Fistula
- Any devices (could impact speech)

- Velum/uvula
- Bifid uvula, zona pellucida
- Length of velum
- Mobility of velum ("ahh": ah...ah...ah)

- Pharynx
- Movement of lateral and posterior pharyngeal walls
- Passavant's ridge

- Tonsils
- Enlarged?


Can you asses velopharyngeal function by only looking at the oral surface?



What should you have the patient say instead of /ahhhhhhhh/?

/aaaaaaaaaah/ and have the patient stick the tongue out and down as far as possible


How should you evaluate oral motor function?

sequence speech with diadochokinetic (DDK) exercises (puh, tuh, kuh)


What judgments can be made during an oral exam?


- Symmetry of palate elevation
- Placement of velar dimple


What judgments cannot be made during an oral exam?


- Velopharyngeal closure
- Depth of Nasopharynx
- Pattern of closure


What do you look for during an oral exam?


- Presence of an oronasal fistula (if there is a history of cleft palate)
- Stigmata of a submucous cleft (if there is no history of cleft palate)
- Velar length and mobility during phonation
- Position of uvula during phonation (skewed indicates either enlarged tonsil or unilateral paralysis /paresis)
- Enlarged tonsils
- Dental or occlusal abnormalities
- Sign of oral-motor dysfunction (particularly if patient is syndromic)


What do we need to know about the see-scape?


- Excellent to evaluate presence of nasal air escape
- Especially inaudible nasal air escape
- Note if it is consistent of inconsistent
- Nasal mirror


What are positive findings of a perceptual eval?


- Age-appropriate place of articulation
- Any oral pressure sounds
- Oral pressure with nasal occlusion


What are negative findings of a perceptual eval?


- Compensatory articulation
- No improvement in oral pressure with nasal occlusion


What are considerations for nasal congestion that can mask VPI?


- Test both nostrils for patency
- Decongest nostrils and reassess if necessary


What can hoarseness mask?



What might behavioral hypernasality be present?

"whinning" or child's age


What are indirect instrumental assessments?


- Nasometry