Ch. 7

Question 1

Resonance disorders are common in individuals with a history of ____ ____ and _____ or other craniofacial anomalies.
Can be due to ______ _______, or obstruction in vocal tract

Answer 1

Resonance disorders are common in individuals with a history of cleft lip and palate or other craniofacial anomalies.
Can be due to velopharyngeal dysfunction, or obstruction in vocal tract

Question 2

Velopharyngeal dysfunction can cause a ______ disorder (hypernasality) and also _____ _______ of the air
Significant nasal emission can cause other speech characteristics due to lack of _____ _____ ______ and air pressure

Answer 2

Velopharyngeal dysfunction can cause a resonance disorder (hypernasality) and also nasal emission of the air
Significant nasal emission can cause other speech characteristics due to lack of adequate oral airflow and air pressure

Question 3

Normal Resonance:

• Speech requires both ______ and ______
• Airflow is converted into _____ ______ by articulators, which is needed for _____-_____ _______ (plosives, fricatives and affricates)
• Sound is modified by _______, which is needed for _____ consonants and ______.

Answer 3

Speech requires both airflow and sound.
Airflow is converted into air pressure by articulators, which is needed for pressure-sensitive consonants (plosives, fricatives and affricates)
Sound is modified by resonance, which is needed for voiced consonants and vowels

Question 4

Schema of Speech Production

Answer 4

see ch. 7 powerpoint

Question 5

• Resonance—tendency of a system to ______(oscillate) with a larger ______ at some frequencies than others due to the natural vibration of the system
• Resonance with speech—modification of ______ ______ through selective ________ of certain frequencies
• Resonance provides the _____ and ______ of the voice

Answer 5

Resonance—tendency of a system to vibrate (oscillate) with a larger amplitude at some frequencies than others due to the natural vibration of the system
Resonance with speech—modification of phonated sound through selective enhancement of certain frequencies
Resonance provides the quality and uniqueness of the voice.

Question 6

• Resonance is determined by ____ and _____ of cavities of the _____ ______ (pharyngeal, oral, and nasal cavities).
• _______ cavities enhance ______ frequencies.
• ______ cavities enhance _____ frequencies and result in a richer sound.

Answer 6

Resonance is determined by size and shape of cavities of the vocal tract (pharyngeal, oral, and nasal cavities).
Smaller cavities enhance higher frequencies.
Larger cavities enhance lower frequencies and result in a richer sound.

Question 7

• Resonance is a component of ___ ______ consonants and all ______.
• Vowels are actually ______ sounds.
• They are produced by changing the ____ and ____ of the oral cavity with tongue, mandible, and lips.
• Vowels affect the size and shape of oral cavity, changing selective enhancement of _____ frequencies and _____ of the vowel.

Answer 7

Resonance is a component of all voiced consonants and all vowels.
Vowels are actually resonance sounds.
They are produced by changing the size and shape of the oral cavity with tongue, mandible, and lips.
Vowels affect the size and shape of oral cavity, changing selective enhancement of formant frequencies and perception of the vowel.

Question 8

High vowels have more nasal resonance than low vowels.
High tongue position causes more oral impedance and more oral pressure, which increases transpalatal transmission of the sound.

Answer 8

High vowels have more nasal resonance than low vowels.
High tongue position causes more oral impedance and more oral pressure, which increases transpalatal transmission of the sound.

Question 9

Resonance disorder—abnormal _______ of sound energy through the oral, nasal,and/or pharyngeal cavities of the vocal tract duringspeech production

Types include the following:
\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_ resonance
\_\_\_\_\_\_\_\_\_\_ resonance

Answer 9

Resonance disorder—abnormal transmission of sound energy through the oral, nasal,and/or pharyngeal cavities of the vocal tract duringspeech production

Types include the following:
Hypernasality
Hyponasality
Cul-de-sac resonance
Mixed resonance

Question 10

Hypernasality—abnormal ____ _______ during the production of _____ sounds
Due to abnormal ______ (sharing of acoustic energy) of the oral and nasal cavities during speech
Most perceptible on ______

Answer 10

Hypernasality—abnormal nasal resonance during the production of oral sounds
Due to abnormal coupling (sharing of acoustic energy) of the oral and nasal cavities during speech
Most perceptible on vowels

Question 11

When hyper nasality is severe…
_____ _______ consonants become nasalized (e.g., m/b, n/d).
-_______ production
Other consonants may be substituted by _______ (e.g., n/s).
-_________ production

Answer 11

When severe…
Voiced oral consonants become nasalized (e.g., m/b, n/d).
Obligatory production
Other consonants may be substituted by nasals (e.g., n/s).
Compensatory production

Question 12

Hypernasality Causes include:
A \_\_\_\_\_\_\_\_\_ opening 
A thin \_\_\_\_\_\_ due to a \_\_\_\_\_\_ \_\_\_\_\_\_\_\_
A very large \_\_\_\_\_\_\_ \_\_\_\_\_\_\_ 
\_\_\_\_\_\_ articulation on certain \_\_\_\_\_\_ sounds (phoneme-specific) due to \_\_\_\_\_\_\_\_

Answer 12

Causes include:
A velopharyngeal opening 
A thin velum due to a submucous cleft
A very large oronasal fistula 
Nasal articulation on certain oral sounds (phoneme-specific) due to mislearning

Question 13

Hyponasality—a reduction in ______ _______ _________ during speech, particularly with ________ sounds
Denasality—___ ______ ______ during speech, including with nasal sounds
In both cases, individual sounds “__________”

Answer 13

Hyponasality—a reduction in normal nasal resonance during speech, particularly with nasal sounds
Denasality—no nasal resonance during speech, including with nasal sounds
In both cases, individual sounds “stuffed up”

Question 14

Hyponasality and denasality particularly affect _____ _______ but also affect _______ if severe.
Nasal consonants sound similar to their _____ ________ (e.g., b/m, d/n, g/ŋ).

Answer 14

Hyponasality and denasality particularly affect nasal sounds but also affect vowels if severe.
Nasal consonants sound similar to their oral cognates (e.g., b/m, d/n, g/ŋ).

Question 15

Hyponasality and Denasality Caused by blockage in nasopharynx or nasal cavity due to:
_____ _________: swollen nose from allergies
Common _______
______ ____________
________ tonsils that intrude into the _______

Answer 15

Caused by blockage in nasopharynx or nasal cavity due to:
Allergic rhinitis: swollen nose from allergies
Common cold
Adenoid hypertrophy
Hypertrophic tonsils that intrude into the pharynx

Question 16

Hyponasality and Denasality Causes with history of cleft lip/palate:
_____ _________
_______ stenosis or ______
Stenotic _________
__________ retrusion which restricts pharyngeal and nasal cavity space

Answer 16

Causes with history of cleft lip/palate:
Deviated septum 
Choanal stenosis or atresia
Stenotic naris
Maxillary retrusion which restricts pharyngeal and nasal cavity space

Question 17

Cul-de-sac resonance—acoustic energy is _______ from exiting at a cavity’s normal ________
Sound is absorbed by _____ _______
Speech is perceived as ______ and _____ in volume.

Answer 17

Cul-de-sac resonance—acoustic energy is blocked from exiting at a cavity’s normal outlet
Sound is absorbed by soft tissues.
Speech is perceived as muffled and low in volume.

Question 18

Types of cul-de-sac resonance are defined by blockage at the cavity’s \_\_\_\_\_ point.
Types include:
\_\_\_\_\_\_ cul-de-sac resonance
\_\_\_\_\_\_ cul-de-sac resonance
\_\_\_\_\_\_\_cul-de-sac resonance

Answer 18

Types of cul-de-sac resonance are defined by blockage at the cavity’s exit point.
Types include:
Oral cul-de-sac resonance
Nasal cul-de-sac resonance
Pharyngeal cul-de-sac resonance

Question 19

Oral cul-de-sac resonance—sound is partially blocked from exiting the ______ cavity during speech.
Causes include:
________—a small mouth opening
“Mumbling,” speaking without opening the mouth normally

Answer 19

Oral cul-de-sac resonance—sound is partially blocked from exiting the oral cavity during speech.
Causes include:
Microstomia—a small mouth opening
“Mumbling,” speaking without opening the mouth normally

Question 20

Nasal cul-de-sac resonance—sound is partially blocked from exiting the _______ cavity during speech.
It is most noticeable with both ______ (which would otherwise cause hypernasality) and an _____ ______ blockage.
Nasal cul-de-sac resonance is common with _____ _____/_____ when there is both VPI and blockage due to _____ stenosis.

Answer 20

Nasal cul-de-sac resonance—sound is partially blocked from exiting the nasal cavity during speech.
It is most noticeable with both VPI (which would otherwise cause hypernasality) and an anterior nasal blockage.
Nasal cul-de-sac resonance is common with cleft lip/palate when there is both VPI and blockage due to nares stenosis.

Question 21

Pharyngeal cul-de-sac resonance—sound remains in the _______ during speech
Causes include:
Large ______ that block exit of the oropharynx and entrance to oral cavity
Obstruction on the ______ wall of the hypopharynx or oropharynx

Answer 21

Pharyngeal cul-de-sac resonance—sound remains in the oropharynx during speech
Causes include:
Large tonsils that block exit of the oropharynx and entrance to oral cavity
Obstruction on the pharyngeal wall of the hypopharynx or oropharynx

Question 22

Mixed resonance—any combination of _______ (with or without nasal emission), _______, and _______ resonance
Although hypernasality and hyponasality cannot occur simultaneously, they can both occur on different ______ in the same speaker.
Causes
______ and obstruction
_______: timing the VP closure

Answer 22

Mixed resonance—any combination of hypernasality (with or without nasal emission), hyponasality, and cul-de-sac resonance
Although hypernasality and hyponasality cannot occur simultaneously, they can both occur on different sound in the same speaker.
Causes
VPI and obstruction
Apraxia: timing the VP closure

Question 23

Adenoidectomy:
Can improve ___________
Can exacerbate or cause _________ ________ with hypernasality (and nasal air emission)

Answer 23

Adenoidectomy:
Can improve hyponasality
Can exacerbate or cause velopharyngeal insufficiency with hypernasality (and nasal air emission)

Question 24

Tonsillectomy:

Can eliminate _________ cul-de-sac resonance

Answer 24

Tonsillectomy:

Can eliminate pharyngeal cul-de-sac resonance

Question 25

``` Treatment _______ ______ device _______ ______ -ONLY when abnormal resonance is _____ ______ due to faulty articulation ```

Answer 25

Surgery Prosthetic device Speech therapy ONLY when abnormal resonance is phoneme-specific due to faulty articulation

Question 26

Nasal Emission ``` _____ ______—when there is an attempt to build up _____ air pressure for consonants while there is a _____ in the system (_____ valve or _____ fistula) Four basic types of nasal emission: _____ nasal emission _____ nasal emission _____ _____ (turbulence) _____ -_____ _____ _____ (_____ ) ```

Answer 26

``` Nasal emission—when there is an attempt to build up intraoral air pressure for consonants while there is a leak in the system (velopharyngeal valve or oronasal fistula) Four basic types of nasal emission: Inaudible nasal emission Audible nasal emission Nasal rustle (turbulence) Phoneme-specific nasal emission (PSNE) ```

Question 27

Nasal Emission CONT. _____ _____ _____ —occurs with a relatively _____ opening There is very little impedance to the flow and therefore, little _____ or _____ . _____ masks the sound of nasal emission.

Answer 27

Inaudible nasal emission—occurs with a relatively large opening There is very little impedance to the flow and therefore, little friction or pressure. Hypernasality masks the sound of nasal emission.

Question 28

Nasal Emission CONT. _____ _____ _____ —occurs with a relatively large opening Can cause _____ characteristics including: - _____ or _____ consonants - _____ _____ _____ - A _____ _____ - _____ _____ _____ - _____

Answer 28

Inaudible nasal emission—occurs with a relatively large opening Can cause secondary characteristics including: - Weak or omitted consonants - Short utterance length - A nasal grimace - Compensatory articulation productions - Dysphonia

Question 29

Nasal Air Emission _____ _____ _____ —occurs when there is a _____ -sized _____ opening - There is _____ resistance to the flow, making the nasal emission more _____ . - There is _____ pronounced _____ to mask the nasal emission. - There still may be some of the other secondary characteristics due to a leak of airflow.

Answer 29

Audible nasal emission—occurs when there is a medium-sized velopharyngeal opening - There is greater resistance to the flow, making the nasal emission more audible. - There is less pronounced hypernasality to mask the nasal emission. - There still may be some of the other secondary characteristics due to a leak of airflow.

Question 30

Nasal Air Emission CONT. _____ _____ (also called _____ _____ )—occurs when there is a _____ velopharyngeal opening - There is great _____ to the flow, making the nasal emission more _____ . - Air flow through a _____ opening results in _____ air pressure than flow through a _____ opening. - Air is released into nasal cavity with pressure, causing very audible _____ of nasal _____ . - Nasal rustle is usually _____ , but _____ with _____ in utterance _____ , _____ , _____ complexity, and even _____ .

Answer 30

Nasal rustle (also called nasal turbulence)—occurs when there is a small velopharyngeal opening - There is great resistance to the flow, making the nasal emission more audible. - Air flow through a small opening results in higher air pressure than flow through a large opening. - Air is released into nasal cavity with pressure, causing very audible bubbling of nasal secretions. - Nasal rustle is usually inconsistent, but increases with increase in utterance length, speed, phonemic complexity, and even fatigue.

Question 31

Obligatory Distortions and Compensatory Errors _____ _____ —occur when _____ _____ is _____ but an _____ of the _____ or _____ causes distortion of _____ Require physical correction _____ _____ —_____ that occur in response to _____ structure (or abnormal speech _____ ) Require physical correction and then _____ therapy

Answer 31

Obligatory distortions—occur when articulation placement is normal but an abnormality of the structure or physiology causes distortion of speech Require physical correction Compensatory errors—misarticulations that occur in response to abnormal structure (or abnormal speech physiology) Require physical correction and then speech therapy

Question 32

Obligatory Distortions Obligatory distortions due to a large velopharyngeal opening: - _____ or omitted _____ - _____ _____ length - _____ of _____ _____ - _____ _____

Answer 32

Obligatory distortions due to a large velopharyngeal opening: - Weak or omitted consonants - Short utterance length - Nasalization of oral consonants - Nasal grimace

Question 33

Weak or Omitted Consonants _____ of _____ through the _____ valve _____ the amount of _____ in the _____ cavity. The _____ the _____ air _____ , the _____ the _____ .

Answer 33

Loss of air through the velopharyngeal valve reduces the amount of airflow in the oral cavity. The greater the nasal air emission, the weaker the consonants.

Question 34

Short Utterance Length _____ opening causes need to replenish lost airflow by taking more _____ _____ . Utterance length becomes _____ and _____ is _____ .

Answer 34

Large opening causes need to replenish lost airflow by taking more frequent breaths. Utterance length becomes shortened and speech is choppy.

Question 35

Nasalization of Oral Consonants When voiced _____ are produced with _____ velopharyngeal opening or large _____ , these oral _____ will sound more like their _____ _____ (e.g., m/b, n/d, and g/ŋ).

Answer 35

When voiced plosives are produced with large velopharyngeal opening or large fistula, these oral phonemes will sound more like their nasal cognates (e.g., m/b, n/d, and g/ŋ).

Question 36

Nasal Grimace Muscle _____ just above the nasal _____ and/or at the _____ of the _____ _____ muscle reaction in attempt to _____ velopharyngeal valve

Answer 36

Muscle contractions just above the nasal bridge and/or at the side of the nares Overflow muscle reaction in attempt to close velopharyngeal valve

Question 37

Compensatory Articulation Productions For an oronasal fistula: - _____ -_____ production (also called _____ _____ _____ ) - Velar _____ - Velar _____ /_____

Answer 37

For an oronasal fistula: - Palatal-dorsal production (also called middorsum palatal stop) - Velar plosive - Velar fricatives/affricates

Question 38

Compensatory Articulation Productions For an _____ fistula: _____ -_____ _____ (also called _____ _____ _____ )

Answer 38

For an oronasal fistula: | Palatal-dorsal production (also called middorsum palatal stop)

Question 39

Compensatory Articulation Productions For an _____ fistula: _____ _____

Answer 39

For an oronasal fistula: | Velar fricative

Question 40

Compensatory Articulation Productions For VPI: - Pharyngeal _____ - Pharyngeal _____ /_____ - Velar _____ /_____ - _____ _____ _____ - Nasal _____ - Nasal _____ - Glottal _____ - Glottal _____ - _____

Answer 40

For VPI: - Pharyngeal plosive - Pharyngeal fricative/affricate - Velar fricatives/affricates - Posterior nasal fricative - Nasal snort - Nasal sniff - Glottal stop - Glottal fricative - Breathiness

Question 41

Compensatory Articulation Productions For VPI: _____ _____

Answer 41

For VPI: | Pharyngeal plosive

Question 42

Compensatory Articulation Productions For VPI: Pharyngeal fricative

Answer 42

For VPI: | _____ _____

Question 43

Compensatory Articulation Productions For VPI: _____ _____ _____

Answer 43

For VPI: | Posterior nasal fricative

Question 44

Compensatory Articulation Productions For VPI: _____ _____

Answer 44

For VPI: | _____ _____

Question 45

Dysphonia Dysphonia—characterized by _____, _____, __________, and/or _____ _____during phonation

Answer 45

Dysphonia—characterized by breathiness, hoarseness, low intensity, and/or glottal fry during phonation

Question 46

Dysphonia Children with clefts, craniofacial anomalies, or VPI have risk for _____, due to the following: - _____to achieve VP valving can lead to vocal _____. - There may be _____ _____ _____. - Dysphonia can be due to _____complications from long-term _____. - _____can be used as a _____strategy.

Answer 46

Children with clefts, craniofacial anomalies, or VPI have risk for dysphonia, due to the following: - Hyperfunction to achieve VP valving can lead to vocal nodules. - There may be congenital laryngeal anomalies. - Dysphonia can be due to laryngeal complications from long-term tracheostomy. - Breathiness can be used as a compensatory strategy.

Question 47

Normal Velopharyngeal Function

Answer 47

See Chapter 7, Slide 46

Question 48

Velopharyngeal Dysfunction (VPD)

Answer 48

See Chapter 7, Slide 47

Question 49

Velopharyngeal Dysfunction (VPD) ``` - _____ _____(_____) General term for _____VP _____ - _____ _____(_____) _____(_____) defects - _____ _____ (_____) _____(_____) disorder - _____ _____ _____(_____) disorder ```

Answer 49

``` - Velopharyngeal dysfunction (VPD) General term for abnormal VP function - Velopharyngeal insufficiency (VPI) Anatomical (structural) defects - Velopharyngeal incompetence (VPI) Neurophysiological (movement) disorder - Velopharyngeal mislearning Articulation (learning) disorder ```

Question 50

Velopharyngeal Insufficiency (VPI) Velum moves _____, but is too _____for _____due to abnormal _____

Answer 50

Velum moves normally, but is too short for closure due to abnormal structure

Question 51

Velopharyngeal Insufficiency (VPI) Causes include: - History of _____ - _____cleft palate (overt or occult) - Short _____or deep _____(cranial base anomalies) - _____ _____ - _____ _____ - _____(_____) _____

Answer 51

Causes include: - History of cleft - Submucous cleft palate (overt or occult) - Short velum or deep pharynx (cranial base anomalies) - Adenoid atrophy - Irregular adenoids - Hypertrophic (enlarged) tonsils

Question 52

History of Cleft Palate _____% to _____% of patients with cleft palate will have _____. Velum may be too _____following repair. Velum may have a _____on _____nasal surface.

Answer 52

20% to 30 % of patients with cleft palate will have VPI. Velum may be too short following repair. Velum may have a notch on posterior nasal surface.

Question 53

Submucous Cleft May cause: Small _____in the _____border of the _____ _____of musculus _____muscles _____orientation of the _____ _____ _____muscles _____pellucida

Answer 53

May cause: Small notch in the posterior border of the velum Hypoplasticity of musculus uvulae muscles Anterior orientation of the levator veli palatini muscles Zona pellucida

Question 54

Deep Pharynx _____may be normal but unable to reach the _____ _____wall due to an abnormally _____pharynx. It can be seen in some _____syndromes.

Answer 54

Velum may be normal but unable to reach the posterior pharyngeal wall due to an abnormally deep pharynx. It can be seen in some craniosynostosis syndromes.

Question 55

Adenoid Atrophy Adenoid atrophy, particularly around _____, can increase the _____of the pharynx, causing gradual onset of _____. Parents often report that their child has begun to “_____.” The biggest concern is if there is tenuous _____due to _____palate or _____cleft palate.

Answer 55

Adenoid atrophy, particularly around puberty, can increase the depth of the pharynx, causing gradual onset of VPI. Parents often report that their child has begun to “mumble.” The biggest concern is if there is tenuous closure due to cleft palate or submucous cleft palate.

Question 56

Irregular Adenoids _____VP closure requires a _____seal. _____irregularity (marked indentation or protrusion) prevents a tight seal. Irregular adenoids can cause small _____and _____ _____.

Answer 56

Normal VP closure requires a tight seal. Adenoid irregularity (marked indentation or protrusion) prevents a tight seal. Irregular adenoids can cause small gap and nasal emission.

Question 57

Hypertrophic Tonsils Can extend into _____ May interfere with _____ pharyngeal wall movement May intrude between the _____ and _____ pharyngeal wall, preventing a _____ VP seal

Answer 57

Can extend into pharynx May interfere with lateral pharyngeal wall movement May intrude between the velum and posterior pharyngeal wall, preventing a tight VP seal

Question 58

Velopharyngeal Insufficiency (VPI) ``` Surgical or treatment procedures _____ _____ - VERY, VERY rare _____ advancement _____ , _____ , and _____ cavity tumors ```

Answer 58

``` Surgical or treatment procedures Adenoidectomy Tonsillectomy- VERY, VERY rare Maxillary advancement Oral, nasal, and pharyngeal cavity tumors ```

Question 59

Adenoidectomy Adenoidectomy can cause VPI due to sudden increase in the _____ dimension. It is often temporary and resolves within _____ weeks. _____ _____ is a risk, especially with history of cleft or submucous cleft. VPI post adenoidectomy cannot be corrected with _____ therapy.

Answer 59

Adenoidectomy can cause VPI due to sudden increase in the nasopharyngeal dimension. It is often temporary and resolves within 6 weeks. Permanent VPI is a risk, especially with history of cleft or submucous cleft. VPI post adenoidectomy cannot be corrected with speech therapy.

Question 60

Tonsillectomy VERY rarely has a _____ effect on resonance Only exceptions Significant _____ Learned protective response to pain

Answer 60

VERY rarely has a negative effect on resonance Only exceptions Significant scarring Learned protective response to pain

Question 61

Maxillary Advancement Done _____ or through distraction to corrects mid-face retrusion and Class _____ malocclusion Often done for patients with history of cleft Improves _____ profile and _____ and eliminates obligatory _____

Answer 61

Done surgically or through distraction to corrects mid-face retrusion and Class III malocclusion Often done for patients with history of cleft Improves facial profile and aesthetics and eliminates obligatory distortions

Question 62

Maxillary Advancement CONT. Moving the maxillary forward also moves the _____ forward Risk for VPI _____ with history of cleft

Answer 62

Moving the maxillary forward also moves the velum forward | Risk for VPI greatest with history of cleft

Question 63

Oral, Nasal, and PharyngealCavity Tumors Treatment _____ (surgical removal) of _____ _____ therapy to _____ tissue Both _____ nasopharyngeal space, which can cause VPI.

Answer 63

Treatment Resection (surgical removal) of tissue Radiation therapy to shrink tissue Both increase nasopharyngeal space, which can cause VPI.

Question 64

Velopharyngeal Incompetence (VPI) Velum has _____ structure, but has inadequate movement for closure due to abnormal _____

Answer 64

Velum has normal structure, but has inadequate movement for closure due to abnormal neurophysiology

Question 65

Velopharyngeal Incompetence (VPI) CONT. Causes include: _____ injury (e.g., traumatic brain injury, cerebral palsy, stroke) _____ diseases (e.g., muscular dystrophy, myasthenia gravis, etc.) _____ _____ damage

Answer 65

Causes include: Neurological injury (e.g., traumatic brain injury, cerebral palsy, stroke) Neuromuscular diseases (e.g., muscular dystrophy, myasthenia gravis, etc.) Cranial nerve damage

Question 66

Velopharyngeal Incompetence (VPI) CONT. Often associated with: Velar and/or pharyngeal _____ _____ _____ of _____

Answer 66

Often associated with: Velar and/or pharyngeal hypotonia Dysarthria Apraxia of speech

Question 67

Hypotonia Hypotonia—a state of _____ _____ tonicity and sometimes, reduced muscle _____ Can cause poor _____ and _____ movement Is common in patients with _____ syndrome

Answer 67

Hypotonia—a state of low muscle tonicity and sometimes, reduced muscle strength Can cause poor velar and pharyngeal movement Is common in patients with velocardiofacial syndrome

Question 68

Dysarthria ``` Dysarthria—an _____ -_____ disorder that affects all the _____ of speech, including: _____ _____ _____ _____ function ```

Answer 68

``` Dysarthria—an oral-motor disorder that affects all the subsystems of speech, including: Respiration Phonation Articulation Velopharyngeal function ```

Question 69

Dysarthria CONT. ``` Characteristics of dysarthria related to VPI: _____ _____ or omitted _____ _____ utterance length Decreased _____ ```

Answer 69

``` Characteristics of dysarthria related to VPI: Hypernasality Weak or omitted consonants Short utterance length Decreased volume ```

Question 70

Apraxia of Speech Apraxia of speech—_____ speech disorder that causes difficulty _____ and _____ motor _____ Affects coordination of speech subsystems: _____ _____ _____ function

Answer 70

Apraxia of speech—amotor speech disorder that causes difficulty combining and sequencing motor movements Affects coordination of speech subsystems: Phonation Articulation Velopharyngeal function

Question 71

Apraxia of Speech CONT. Characteristics of apraxia related to VPI: Inconsistent _____ of oral _____ and inconsistent _____ of _____ consonants Characteristics are due to: Poor _____ , _____ , and _____ of VP closure Velum _____ inappropriately for _____ sounds and _____ inappropriately for _____ sounds

Answer 71

Characteristics of apraxia related to VPI: Inconsistent nasalization of oral consonants and inconsistent denasalization of nasal consonants Characteristics are due to: Poor coordination, timing, and duration of VP closure Velum raises inappropriately for nasal sounds and lowers inappropriately for oral sounds

Question 72

Velar Paralysis or Paresis _____ _____ or _____ _____ damage can cause specific velopharyngeal _____ or _____ (partial loss of movement or weakness) Often unilateral causing a _____ VP opening Common with _____ _____

Answer 72

Brain stem or cranial nerve damage can cause specific velopharyngeal paralysis or paresis (partial loss of movement or weakness) Often unilateral causing a unilateral VP opening Common with hemifacial microsomia

Question 73

Velar Fatigue and Stress Incompetence Velar fatigue and stress sometimes occurs in _____ when playing wind instruments, even though _____ is unaffected. _____ _____ may be first symptom of a _____ neurological disorder.

Answer 73

Velar fatigue and stress sometimes occurs in musicians when playing wind instruments, even though speech is unaffected. Velar fatigue may be first symptom of a progressive neurological disorder.

Question 74

Velopharyneal Mislearning Velopharyngeal mislearning is an _____ disorder that includes the substitution of _____ or _____ sounds for _____ sounds. Velopharyneal mislearning esults in an _____ velopharyngeal valve, causing _____ _____ or _____ during the production of those speech sounds. _____ _____ , not surgery, is indicated for velopharyngeal mislearning. _____ diagnosis between _____ due to _____ alone versus those due to _____ is critically important.

Answer 74

Velopharyngeal mislearning is an articulation disorder that includes the substitution of nasal or pharyngeal sounds for oral sounds. Velopharyneal mislearning esults in an open velopharyngeal valve, causing nasal emission or hypernasality during the production of those speech sounds. Speech therapy, not surgery, is indicated for velopharyngeal mislearning. Differential diagnosis between misarticulations due to mislearning alone versus those due to VPI is critically important.

Question 75

Velopharyngeal Mislearning CONT. Learned misarticulations can include: _____ productions learned due to VPI or other structural anomalies Misarticulations in children without structural anomalies, causing phoneme-specific nasal emission or phoneme-specific hypernasality

Answer 75

Learned misarticulations can include: Compensatory productions learned due to VPI or other structural anomalies Misarticulations in children without structural anomalies, causing phoneme-specific nasal emission or phoneme-specific hypernasality

Question 76

Velopharyngeal Mislearning CONT. _____ -_____ _____ _____ —occurs when the individual uses a _____ _____ or _____ _____ _____ as a substitution for oral _____ _____ -_____ _____ —occurs when the individual consistently _____ a _____ sound for an _____ sound (e.g., ŋ/l or ŋ/r) or uses a high _____ position on certain _____

Answer 76

Phoneme-specific nasal emission—occurs when the individual uses a pharyngeal fricative or posterior nasal fricative as a substitution for oral fricatives Phoneme-specific hypernasality—occurs when the individual consistently substitutes a nasal sound for an oral sound (e.g., ŋ/l or ŋ/r) or uses a high tongue position on certain vowels

Question 77

Velopharyngeal Mislearning CONT. _____ _____ causes abnormal resonance. VP function is learned through _____ and _____ feedback. Lack of hearing and auditory feedback affects ability to learn to use the VP valve for speech. Individuals with severe hearing impairment or deafness demonstrate abnormal _____ that can be a mixture of _____ , _____ , and even _____ -_____ -_____ resonance.

Answer 77

Hearing loss causes abnormal resonance. VP function is learned through imitation and auditory feedback. Lack of hearing and auditory feedback affects ability to learn to use the VP valve for speech. Individuals with severe hearing impairment or deafness demonstrate abnormal resonance that can be a mixture of hypernasality, hyponasality, and even cul-de-sac resonance.

Question 78

Summary SLP is responsible for diagnosing probable cause of resonance disorders and VPD. There is a need to determine abnormal structure versus abnormal function. Differential diagnosis is important so patient will receive appropriate treatment. Resonance disorders and VPI are not directly treated by SLPs. Speech therapy is appropriate for compensatory errors due to VPI and placement errors that cause phoneme-specific nasal emission or hypernasality.

Answer 78

SLP is responsible for diagnosing probable cause of resonance disorders and VPD. There is a need to determine abnormal structure versus abnormal function. Differential diagnosis is important so patient will receive appropriate treatment. Resonance disorders and VPI are not directly treated by SLPs. Speech therapy is appropriate for compensatory errors due to VPI and placement errors that cause phoneme-specific nasal emission or hypernasality.