Flashcards in COMPS: VPI/VPD Assess. & Management (O4) Deck (34):
What does "velopharyngeal inadequacy" mean? (AKA velopharyngeal dysfunction)
An 'umbrella term' that can mean "velopharyngeal insufficiency" or "velopharyngeal incompetency."
*VPI does not have to be caused by a cleft.
What is velopharyngeal insufficiency?
When the soft palate/velum isn't long enough to make contact with the posterior pharyngeal wall and close the gap. But the velum IS functioning correctly.
What is velopharyngeal incompetency?
When the muscles of the velum are not capable of lifting the velum to close the velopharyngeal port. The muscles may be long enough, but they don't work because they are weak.
*May be caused by neurogenic etiology such as stroke, a disease process, or some kind of apraxia.
What is velopharyngeal mislearning?
When a child is using the incorrect placement with the correct manner; the child has learned how to use the velum incorrectly. There is no insufficiency or inadequacy.
What is the difference between "hypernasality" and nasal air emission (NAE)?
Hypernasality occurs during vowel production; NAE occurs during consonant production.
What are some symptoms of VP Inadequacy/VPD? (4)
1. Hypernasality (vowels)
2. NAE (consonants)
*Note: Liquids and nasals will not help you in determining if a child has NAE since they naturally have air coming through the nose.
3. Ch uses compensatory articulation errors (a deliberate attempt to produce the distinctive features correctly- manner and voice correct, placement not.)
4. Ch has obligatory errors--> can't help errors, can't close VP port.
Name the assessment techniques for VPI/VPD. (inadequacy-umbrella term)
2. X-ray (radiographic study)
3. Nasoendoscopy/Endoscopic Visual Evaluation (???)
***Cannot access VP port through mouth. Must access through nose to be able to tell if velum is moving and to look at pharyngeal wall movement.
What might you find when assessing a client for velopharyngeal function (five different scenarios for the type of patency)?
TYPE OF PATENCY:
1. Normal speech and resonance w/normal VP function.
2. Consistent velopharyngeal dysfunction/inadequacy
3. Task-specific VPD (closes for some sounds but not for others; may be a timing issue)
4. Irregular VPD (no pattern as to when closure will and will not happen)
5. Abnormal resonance without VPD (often seen in spastic dysarthria after stroke)
What three things do you look at during an endoscopic eval for VPD?
1. Closure pattern (which structure is moving)
2. Type of patency (normal, consistent dysfunction, task-specific, etc...)
3. Degree/size of patency
4. Location of patency (left, right, front, center)
What does "patency" mean?
What are the patterns of closure? (list them)
1. Coronal pattern: most common; velum moves up to contact post. pharyngeal wall (90% population)
2. Saggital pattern: pharyngeal walls move vertically (5% population)
3. Circular: velum and pharygneal walls move to bring everything together (3% population)
4. Cicrular w/Passavant's Ridge (1-2% population)
0-5% patent is considered to be _________. (normal/small/medium/large)
6-15% patient is considered to be ________.(normal/small/medium/large)
16-40% patent is considered to be _______.(normal/small/medium/large)
41-100% patent is considered to be ______.(normal/small/medium/large)
During an endoscopy, if you see PINK tissue, this means the velopharyngeal port is ______ (open/closed)
...closed. you're seeing pink tissue.
During an endoscopy, if you see BLACK tissue, this means the velopharyngeal port is ______ (open/closed)
...open. you're seeing a black hole.
What are the three options for management of VPD/VPI?
1. Pharyngoplasty (surgery of the velopharynx in which a piece of tissue is cut off the posterior pharyngeal wall)
2. Speech appliance (retainers, obturators, lifts)
3. Behavioral management (speech therapy)
What are the two types of pharyngeal flaps (pharyngoplasty)?
1. the inferior flap (no longer performed because it was not as effective)
2. the superior flap
What is a BIG problem with pharyngeal flaps?
they can cause sleep apnea (and there is a possible link between sleep apnea and ADHD)
what vowel is best to use during a speech eval for vp closure?
/i/, since it is considered to be a sensitive vowel.
T/F: there is no need to complete a physical evaluation if the client shows task-specific VPD.
True. In this case, there is nothing physically wrong with the structure.
Discuss the Hynes/Orticochea/Lateral Pharyngoplasty.
The srgeon feathers the muscles out of the palatal pharyngeus muscle in the faucial pillars to create a Passavant's Ridge circular closure pattern.
T/F: pharyngoplasty will complicate a Class II malocclusion (maxilla too far in front of mandible) , and may worsen it.
FALSE: it will complicate a class III malocclusion (maxilla too far behind mandible) and may worsen it.
How old will a child typically be when he/she receives pharyngoplasty surgery? What impact does this have on articulation?
7-9 years old; by this time, compensatory articulation errors have been ingrained in the child's speech.
What are some surgical complications associated with pharyngoscopy?
[from a study on superior flaps done with 219 children at the Toronto Hospital for Sick Ch (1994)]
airway obstruction (9.1%- 20 children)
bleeding (8.2% - 18 children)
sleep apnea (4.1 - 9 children)
mortality (0.5% - 1 child)
OTHER STUDY (St. Louis Children's Hospital:
obstructive sleep apnea, hyponasality, mouth breathing, & nasal secretions.
What are some advantages to speech appliances?
-Earlier management is possible (3, 4, 5 years old)
-Revisions can be done as necessary
-May stimulate growth
-Allows for facial growth (obturator)
-Better for an unknown etiology (use obturator until figure out what's going on)
-Better if there is severe paralysis
-Better for severe artic disorders
-Better if there is a mild resonance imbalance.
List the types of appliances to aid velopharyngeal closure?
1. Palate obturator
2. Palatal lift
3. Obturator with speech bulb
What is a palatal lift?
A type of speech appliance used to manage VP port dysfunction by closing the port during speech. A palatal lift goes over the entire velum.
Used for a velum that is long enough but isn't strong enough. Adds length so the velum doesn't have to move very much to achieve closure.
PRO: no scarring.
What is a retainer used for?
To cover a fistula.
What are the 3 functions of the Eustachian tube?
1. Ventilation for equalization of air pressure.
2. Protection from nasal mucous running into ears (e.g., when blowing nose)
3. Clearance- drains fluid out of middle ear cavity.
T/F: There is a high incidence of otitis media with effusion (OME) in children with cleft lip/palate.
T/F: Conductive hearing loss is common in CLP children.
T/F: Conductive hearing loss in CLP children does not tend to improve with age.
FALSE- it does improve with age.