Transcript Document

An Overview:
Nature of the Velopharyngeal
(VP) Mechanism
Delivery of Service
Linda D. Vallino-Napoli, PhD, MS, CCC-SLP/A
Normal Speech
Ability to coupling* and decoupling* the nasal
cavity from the oral cavity (velopharyngeal
valving)
– Normal resonance
– Normal articulation
– Normal phonation
*oral-nasal coupling – nasal sounds
*oral-nasal decoupling – oral sounds
Hard Palate
(inferior view)
Premaxilla
Incisive
foramen
Palatine process
of maxillary bone
Posterior
nasal spine
http://www.yorku.ca
Nature of VP Mechanism:
3 components
 Velum
 Posterior pharyngeal wall (ppw)
 Lateral pharyngeal wall (lpw)
Velopharyngeal Closure
In a nutshell…
During normal speech production, the velum moves upward
and backward to contact the posterior pharyngeal wall.
Simultaneously, the lateral pharyngeal walls move medially
to abut against the edges of the velum.* These movements
(vp closure)separate the oral and nasal cavities for oral
consonants.
*The contribution of these components vary among individuals.
Velopharyngeal Mechanism =
Velum + PPW + LPW
PPW
Velum
+
LPW
LPW
Function of Soft Palate
Tensor Palati (#1)
Levator Palati (#2) (pulls palate
upward and backward)
Palatoglossus (#3)
Palatopharyngeus (#4)
Superior Constrictor (#5)
(medial movement of lpw)
Fritzell (1969)
Velopharyngeal Port
at rest (open)
during speech
Source: www.choa.org/default.aspx?id=762 (choa=Children’s Healthcare of Atlanta)
Velopharyngeal Inadequacy (VPI)
(“dysfunction” - VPD)
???
VPI
???
???
VPI
VPI
VP??
VPI (VPD):
A definition
Faulty velopharyngeal closure or…
The inability for the velum and
related musculature to separate the
oral and nasal cavities on oral
consonants
Causes of VPI
 Cleft VPI
– Opening in the palate (cleft palate, large fistula)
 Velopharyngeal insufficiency
– Short palate
– Post adenoidectomy
– Post maxillary advancement
 Velopharyngeal incompetency
– Poor muscle function
 Velopharyngeal mislearning
– Phonemic-specific nasal emission
Velopharyngeal Inadequacy
(VPI)
Adenoid
pad
VP gap
velum
What happens to
speech??????
Effect of VPI on Speech
(and…the terminology to describe it)
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Hypernasality
Nasal air emission*
Weak or omitted consonant sounds
Articulation errors (compensatory)
Facial grimace
Phonatory disorders
*not = hypernasality
What Next??????
Delivery of Care
“…children with special health care needs
(Koop, 1987)…require comprehensive,
coordinated care provided by health care
systems that are readily accessible and
responsive to the individual needs of the
parents and their families.”
(ACPA, Parameters of Care, 2007)
ACPA, Parameters of Care
(1993, 2000, 2007)
Optimal care of children with clefts and craniofacial
conditions:
Best provided by an interdisciplinary
team of specialists
From neonatal period through adulthood - until all
management needs are met
Team Composition
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Audiology
Dentistry
Genetics
Oral maxillofacial surgery
Plastic surgery
Psychology
Speech-language pathology
Patient and caregivers
Team Responsibilities
 Recognize the needs of each patient and assist in
providing all services needed to complete care
 Evaluate patients at regular intervals
 Hold regularly scheduled meetings to discuss findings
 Develop treatment plan based on patient needs
 Maintain comprehensive records for each discipline
 Communicate findings & recommendations
 Collaborate with providers in the community
Birth of
the CLP
Team
Lancaster
Cleft Palate
Clinic - 1938
Photo: Courtesy of Dr. Ross Long, Jr.
Referring to a Team
 When a child has a cleft or craniofacial
disorder
 When a resonance disorder or VPI is
suspected
Where do you find a team?
 www.acpa-cpf.org
 www.cleftline.org
 http://www.cleftline.org/team_listings/state_dfg
Summary
 Cleft and other conditions affecting VP
function can present complex problems
 Careful evaluations are essential to making an
appropriate diagnosis and planning effective
treatment
 Interdisciplinary team management is the
standard of care for these patients
Acknowledgements
 Ross Long Jr, DMD, PhD (Lancaster Cleft
Palate Program) for the photos of the
Lancaster Cleft Palate Team.
 ASHA and ACPA for sponsoring this
symposium
Thank you very
much.
References
Nature of VP Function
 Peterson-Falzone SJ, Hardin-Jones, MA,
Karnell MP. Cleft Palate Speech. 3rd ed.
St. Louis (MO): Mosby, Inc. 2001.
 Zemlin WR. Speech and hearing science:
anatomy and physiology. 4th ed. Englewood
Cliffs (NJ): Prentice-Hall, 1997.
Delivery of Care
Resources
 http://www.acpacpf.org/teamcare/Parameters07rev.pdf
 Contact ACPA, Cleft Palate Foundation, or your
local team