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Cleft Palate > Cleft 7 > Flashcards

Cleft 7 Flashcards

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1
Q
  • Resonance disorders are common in individuals with a history of …
  • –Can be due to __ ___, or ___ in vocal tract
  • Velopharyngeal dysfunction can cause a __ __(hypernasality) and also __ __ of the air
  • –Significant nasal emission can cause other speech characteristics due to…

resonance:

A
  • 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
  • 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

resonance: natural frequency at which an object vibrates effectively

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2
Q

Normal resonance

  • Speech requires both…
  • Airflow is converted into…
  • Sound is modified by …
A
  • 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
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3
Q

Normal resonance

  • Resonance—tendency of a system to …
  • Resonance with speech—modification of ….
  • Resonance provides the …
A
  • 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.
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4
Q

normal resonance

  • Resonance is determined by …
  • Smaller cavities enhance ….
  • Larger cavities enhance…
A
  • 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.
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5
Q

normal resonance

  • Resonance is a component of all …
  • Vowels are actually ….
  • They are produced by changing the ….
  • Vowels affect the …, changing selective enhancement of ….
A
  • 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.
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6
Q

Normal resonance

  • High vowels have more….
  • High tongue position causes more …
A
  • 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.
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7
Q

resonance disorders

-Resonance disorder—…

-Types include the following:
1.
2.
3.
4.
A

-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:
    1. Hypernasality
    2. Hyponasality
    3. Cul-de-sac resonance - “potato in the mouth speech”
    4. Mixed resonance-challenging to Dx (combo of hyper and hypo)
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8
Q

hypernasality

  • Hypernasality—…
  • Due to __ ___ of the oral and nasal cavities during speech
  • Most perceptible on ___
A
  • 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

to assess, ask them to count from 60-69

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9
Q

hypernasality

When severe…

  • Voiced oral consonants become …
  • -___ production
  • Other consonants may be …
  • -____ production
A

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
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10
Q

Causes of Hypernasality

Causes include:

  • A …
  • A …
  • A very large…
  • …..
A

Causes include:

  • A velopharyngeal opening
  • A thin velum due to a submucous cleft
  • A very large oronasal fistula (in figures)
  • Nasal articulation on certain oral sounds (phoneme-specific) due to mislearning
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11
Q

Hyponasality and Denasality

  • Hyponasality—…
  • Denasality-…
  • In both cases, individual sounds __ __
A
  • 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”
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12
Q

Hyponasality and Denasality

  • Hyponasality and denasality particularly affect …
  • Nasal consonants sound similar to …
A
  • 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).
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13
Q

Hyponasality and Denasality

-Caused by blockage in nasopharynx or nasal cavity due to:
1.
2.
3.
4.
A
  • Caused by blockage in nasopharynx or nasal cavity due to:
    1. Allergic rhinitis
    2. Common cold
    3. Adenoid hypertrophy
    4. Hypertrophic tonsils that intrude into the pharynx
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14
Q

hyponasality and denasality

Causes with history of cleft lip/palate:
1.
2.
3.
4.
A

Causes with history of cleft lip/palate:

  1. Deviated septum
  2. Choanal stenosis or atresia
  3. Stenotic naris
  4. Maxillary retrusion which restricts pharyngeal and nasal cavity space
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15
Q

cul-de-sac resonance

  • Cul-de-sac resonance—…
  • Sound is …
  • Speech is perceived as …
A
  • 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.
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16
Q

cul-de-sac resonance

-Types of cul-de-sac resonance are defined by ….
-Types include:
1.
2.
3.

A
  • Types of cul-de-sac resonance are defined by blockage at the cavity’s exit point.
  • Types include:
    1. Oral cul-de-sac resonance
    2. Nasal cul-de-sac resonance
    3. Pharyngeal cul-de-sac resonance
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17
Q

Oral Cul-de-Sac Resonance

-Oral cul-de-sac resonance—…

  • Causes include:
    1. …
    2. ..
A

-Oral cul-de-sac resonance—sound is partially blocked from exiting the oral cavity during speech.

  • Causes include:
    1. Microstomia—a small mouth opening
    2. “Mumbling,” speaking without opening the mouth normally
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18
Q

nasal cul-de-sac resonance

  • Nasal cul-de-sac resonance—…
  • It is most noticeable with both…
  • Nasal cul-de-sac resonance is common with …
A
  • 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.
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19
Q

pharyngeal cul de sac resonance

-Pharyngeal cul-de-sac resonance—…

-Causes include:
1.
2.

A

-Pharyngeal cul-de-sac resonance—sound remains in the oropharynx during speech

  • Causes include:
    1. Large tonsils that block exit of the oropharynx and entrance to oral cavity
    2. Obstruction on the pharyngeal wall of the hypopharynx or oropharynx
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20
Q

mixed resonance

-Mixed resonance—…
-Although hypernasality and hyponasality cannot…
-Causes
1.
2.

A
  • 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
    1. VPI and obstruction
    2. Apraxia
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21
Q

effect of surgery on resonance

-Surgery can change the …

  • Adenoidectomy:
    1. …
    2. …
  • Tonsillectomy:
    1. …
A

-Surgery can change the anatomy of the resonating cavities and affect speech.

  • Adenoidectomy:
    1. Can improve hyponasality
    2. Can exacerbate or cause velopharyngeal insufficiency with hypernasality (and nasal air emission)
  • Tonsillectomy:
    1. Can eliminate pharyngeal cul-de-sac resonance
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22
Q

Treatment

1.
2.
3.

A
  1. Surgery
  2. Prosthetic device
  3. Speech therapy
    - -ONLY when abnormal resonance is phoneme-specific due to faulty articulation
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23
Q

Nasal Emission

-Nasal emission—..

-Four basic types of nasal emission:
1.
2.
3.
4.
A

-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:
    1. Inaudible nasal emission
    2. Audible nasal emission
    3. Nasal rustle (turbulence)
    4. Phoneme-specific nasal emission (PSNE)
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24
Q

Nasal Emission

  • Inaudible nasal emission—…
    1. There is very little …
    2. Hypernasality …
A
  • Inaudible nasal emission—occurs with a relatively large opening
    1. There is very little impedance to the flow and therefore, little friction or pressure.
    2. Hypernasality masks the sound of nasal emission.
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25
Nasal Emission -Inaudible nasal emission—... --Can cause secondary characteristics including: 1. 2. 3. 4. 5.
- Inaudible nasal emission—occurs with a relatively large opening - -Can cause secondary characteristics including: 1. Weak or omitted consonants 2. Short utterance length 3. A nasal grimace 4. Compensatory articulation productions 5. Dysphonia
26
Nasal Air Emission - Audible nasal emission—... 1. There is ... 2. There is less pronounced ... 3. There still may be some of the ...
- Audible nasal emission—occurs when there is a medium-sized velopharyngeal opening 1. There is greater resistance to the flow, making the nasal emission more audible. 2. There is less pronounced hypernasality to mask the nasal emission. 3. There still may be some of the other secondary characteristics due to a leak of airflow.
27
Nasal Air Emission - Nasal rustle (also called nasal turbulence)—... 1. There is __ __ to the flow, making the... 2. Air flow through a ... 3. Air is released into ... 4. Nasal rustle is usually ___, but increases with ...
- Nasal rustle (also called nasal turbulence)—occurs when there is a small velopharyngeal opening 1. There is great resistance to the flow, making the nasal emission more audible. 2. Air flow through a small opening results in higher air pressure than flow through a large opening. 3. Air is released into nasal cavity with pressure, causing very audible bubbling of nasal secretions. 4. Nasal rustle is usually inconsistent, but increases with increase in utterance length, speed, phonemic complexity, and even fatigue.
28
Obligatory Distortions and Compensatory Errors - Obligatory distortions—... - -Require__ ___ - Compensatory errors—... - -Require __ ___ and then __ ___
- 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
29
Obligatory Distortions ``` -Obligatory distortions due to a large velopharyngeal opening: 1. 2. 3. 4. ```
- Obligatory distortions due to a large velopharyngeal opening: 1. Weak or omitted consonants 2. Short utterance length 3. Nasalization of oral consonants 4. Nasal grimace
30
Weak or Omitted Consonants - Loss of air through the .... - The greater the nasal air emission, ...
- 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.
31
Short Utterance Length - Large opening causes ... - Utterance length becomes ...
- Large opening causes need to replenish lost airflow by taking more frequent breaths. - Utterance length becomes shortened and speech is choppy.
32
Nasalization of Oral Consonants -When voiced plosives are produced with large __ __ or __ __, these oral phonemes will sound more like their __ __(e.g., m/b, n/d, and g/ŋ).
-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).
33
Nasal Grimace - __ ___just above the __ __ and/or at the side of the __ - Overflow__ __in attempt to ...
- Muscle contractions just above the nasal bridge and/or at the side of the nares - Overflow muscle reaction in attempt to close velopharyngeal valve
34
Compensatory Articulation Productions -For an oronasal fistula: 1. 2. 3.
For an oronasal fistula: Palatal-dorsal production (also called middorsum palatal stop) Velar plosive Velar fricatives/affricates
35
Compensatory Articulation Productions - For an oronasal fistula: - -... - For an oronasal fistula: - -Velar fricative
- For an oronasal fistula: - -Palatal-dorsal production (also called middorsum palatal stop) - For an oronasal fistula: - -Velar fricative
36
Compensatory Articulation Productions ``` For VPI: - - - - - - - - - - ```
For VPI: - Pharyngeal plosive - Pharyngeal fricative/affricate - Velar fricatives/affricates - Posterior nasal fricative - - Nasal snort - Nasal sniff - Glottal stop - Glottal fricative - Breathiness Look at figures page to visuals*
37
Dysphonia definition?
Dysphonia—characterized by breathiness, hoarseness, low intensity, and/or glottal fry during phonation
38
Dysphonia -Children with clefts, craniofacial anomalies, or VPI have risk for dysphonia, due to the following: 1. 2. There may be... 3. 4.___ can be used as a compensatory strategy
- 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.
39
~Velopharyngeal Dysfunction (VPD) ``` Velopharyngeal dysfunction (VPD) --... ``` ``` Velopharyngeal insufficiency (VPI) --... ``` ``` Velopharyngeal incompetence (VPI) --... ``` Velopharyngeal mislearning --...
``` 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
40
Velopharyngeal Insufficiency
Velum moves normally, but is too short for closure due to abnormal structure
41
Velopharyngeal Insufficiency ``` Causes include: - - - - - - ```
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
42
History of Cleft Palate - ___-___% of patients with cleft palate will have VPI. - Velum may be... - Velum may have...
- 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.
43
Submucous Cleft ``` May Cause: - - - - ```
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
44
Deep Pharynx - Velum may be normal but ... - It can be seen in ...
- 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.
45
Adenoid Atrophy - Adenoid atrophy, particularly around ___, can increase the ... - Parents often report that their child has begun to ___. - The biggest concern is if there is __ __ due to cleft palate or __ __ __
- 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.
46
Irregular Adenoids - Normal VP closure requires a ... - Adenoid irregularity ... - Irregular adenoids can cause ...
- 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.
47
Hypertrophic Tonsils - Can extend into___ - May interfere with __ __ __ ___ - May intrude between the ....
- 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
48
Velopharyngeal Insufficiency (VPI) - Surgical or treatment procedures - - - - - - - -
- Surgical or treatment procedures - -Adenoidectomy - -Tonsillectomy- VERY, VERY rare - -Maxillary advancement - -Oral, nasal, and pharyngeal cavity tumors
49
Adenoidectomy - Adenoidectomy can cause ... - It is often ___ and resolves within __ __. - Permanent VPI is a __, especially with history of ... - VPI post adenoidectomy cannot be ...
- 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.
50
Tinsillectomy -VERY rarely has a ... -Only exceptions 1. 2.
-VERY rarely has a negative effect on resonance - Only exceptions 1. Significant scarring 2. Learned protective response to pain
51
Maxillary Advancement - Done ___ or through ___ to corrects ... - Often done for patients with... - Improves __ __ and aesthetics and eliminates __ __
- 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
52
Maxillary Advancement - Moving the maxillary forward also ... - Risk for VPI greatest with...
- Moving the maxillary forward also moves the velum forward | - Risk for VPI greatest with history of cleft
53
Oral, Nasal, and Pharyngeal Cavity Tumors -Treatment 1. 2. -Both increase __ ___, which can cause ____.
- Treatment 1. Resection (surgical removal) of tissue 2. Radiation therapy to shrink tissue -Both increase nasopharyngeal space, which can cause VPI.
54
Velopharyngeal incompetence What is it?
Velum has normal structure, but has inadequate movement for closure due to abnormal neurophysiology
55
Velopharyngeal incompetence Causes include: - - -
Causes include: - Neurological injury (e.g., traumatic brain injury, cerebral palsy, stroke) - Neuromuscular diseases (e.g., muscular dystrophy, myasthenia gravis, etc.) - Cranial nerve damage
56
Velopharyngeal incompetence Often associated with: - - -
Often associated with: - Velar and/or pharyngeal hypotonia - Dysarthria - Apraxia of speech
57
Hypotonia Definition: Can cause ...
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
58
``` Dysarthria Dysarthria—an __ ___ that affects all the subsystems of speech, including: 1. 2. 3. 4. ```
- Dysarthria—an oral-motor disorder that affects all the subsystems of speech, including: 1. Respiration 2. Phonation 3. Articulation 4. Velopharyngeal function
59
Dysarthria ``` .Characteristics of dysarthria related to VPI: 1. 2. 3. 4. ```
- Characteristics of dysarthria related to VPI: 1. Hypernasality 2. Weak or omitted consonants 3. Short utterance length 4. Decreased volume
60
Apraxia of Speech ``` Apraxia of speech—... Affects coordination of speech subsystems: 1. 2. 3. ```
- Apraxia of speech—a motor speech disorder that causes difficulty combining and sequencing motor movements - Affects coordination of speech subsystems: 1. Phonation 2. Articulation 3. Velopharyngeal function
61
Apraxia of Speech - Characteristics of apraxia related to VPI: - -- - Characteristics are due to: - -- - --
- 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
62
Velar Paralysis or Paresis -Brain stem or cranial nerve damage can cause specific ... - Often___ causing a __ ___ ___ - Common with __ __
- 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
63
Velar Fatigue and Stress Incompetence - __ __ and ___ sometimes occurs in musicians when playing wind instruments, even though ... - Velar fatigue may be ....
- 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.
64
Velopharyneal Mislearning - Velopharyngeal mislearning is an ... - --Velopharyneal mislearning results in an ... - --__ __, not surgery, is indicated for ... -Differential diagnosis between___ due to ___ alone versus those due to ___ is critically important.
- 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.
65
Velopharyngeal Mislearning Learned misarticulations can include: - __ ___learned due to __ or other structural ____ - Misarticulations in children without __ ___, causing __ __ __ ___ or phoneme-specific ____
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
66
Velopharyngeal Mislearning - Phoneme-specific nasal emission—occurs when the individual ... - Phoneme-specific hypernasality—occurs when the individual ...
- 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
67
Velopharyngeal Mislearning Hearing loss causes abnormal resonance. - VP function is learned through ... - Lack of ___ and ___ ____ affects ability to learn to use the VP valve for speech. - Individuals with severe __ ___ or ___ demonstrate abnormal resonance that can be a mixture of ___, ___, and even ____.
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.
68
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.
- 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.

Cleft Palate (8 decks)

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