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Generic term for faulty velopharyngeal closure?
VP Inadequacy (VPI/A)
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VPI/A includes?
- VP insufficiency
- VP incompetency
- VP mislearning
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Where closure inadequacy is due to deviant structure, not enough tissue or other structural basis for VP closure problem?
VP insufficiency
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Where the closure inadequacy is due to neuromotor pathology, there is a mobility problem despite of the structural integrity of the soft palate and pharyngeal walls?
VP incompetency
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Where closure inadequacy occurs despite adequarte structures and neuromotor supply?
VP mislearning
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VPI/A Cleft ?
VP insufficiency
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VPI/A cleft Unrepaired palatal clefts are?
- Overt
- Submucous
- Occult submucous
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VPI/A Cleft Post-surgical insufficiency? (4)
- Post-palatal closure
- post-adenoidectomy
- post-pharyngeal flap or sphincter pharyngeoplasty
- Complicated by fistula
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VPI/A non-cleft ?
- VP insufficiency (VPI/S)
- VP incompetency (VPI/C)
- VP mislearning
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VPI/A non-cleft VP insufficiency mechanical interference? (4)
- excessive Tonsils
- irregular adenoid contour
- posterior pillar web
- combination of these
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VPI/A non-cleft VP insufficiency palatopharyngeal disportion (increases the pharyngeal depth, A-P dimension? (2)
- cervical anomalies (add depth to the nasopharynx)
- flattened cranial base
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VPI/A non-cleft VP insufficiency ablative palatal lesions? (1) maxillectomies, partial or total, that creat unwanted coupling between nasal and oral cavities in much the same way as a cleft does?
(2) penetrating wounds to orofacial structures
- (1)secondary to Cancer
- (2)Secondary to Traumatic injury
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VPI/A non-cleft VP incompetency: Primary motor/neuromotor control DSYARTHRIA-
Congenital? (3)
- cerebral palsy
- myotonias
- dystrophies
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VPI/A non-cleft VP incompetency: Primary motor/neuromotor control DSYARTHRIA-
Acquired? (3)
- TBI -closed head inhury
- CVA/brainstem stroke
- Progressive disease (ALS, myasthenia gravis, etc)
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VPI/A non-cleft VP incompetency: Motor association/motor programming APRAXIA? (2)
- Speech (AOS-apraxia of speech)
- Oral non-speech
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VPI/A non-cleft VP mislearning? (4)
- Phoneme-specific nasal emission
- Persisting post-op nasal emission
- compensatory misarticulations
- deafness/hearing impairment
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VPI/A non-cleft VP mislearning:
selective nasal emission on one or some of the HPCs in the absence of any significant hypernasality, and where other HPCs are produced with adequate oral pressures and oral air flow?
PSNE-phoneme specific nasal emission
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VPI/A non-cleft VP mislearning?
persisting nasal emission in cleft palate youngsters who have their palates repaired and appear to have adequate VP closure capability but who continue to use old/early learned patterns of nasal air emission.
Not a speech problem and not a surgical problem?
with adequate closure ability
Persisting post-op nasal emission
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VPI/A non-cleft VP mislearning:
VPI caused by maladaptive gestures?
Compensatory misarticulations
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Post-surgical insufficiency:
Surgical closure of the cleft palate does not guarantee adequate function. 10-20% of children will require additional (secondary) surgery beyond the initial repair?
Post-palatal closure
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Post-surgical insufficiency:
too aggressive an adenoidectomy (introgenic basis) or adenoidectomy unmasks a pre-existing insufficiency such as SMCP or OSMCP?
Post-adenoidectomy
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Post-surgical insufficiency:
or other form of secondary surgery; like initial palatoplasties, secondary surgeries are not always successful?
post-pharyngeal flap, post sphincter pharyngoplasty
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Post-surgical insufficiency:
while fistulas are not sources of VP insufficiency they may contribute a (second) source of unwanted oronasal coupling, and therefore nasal air escape and hypernasal resonance?
complicated by palatal/alveolar fistula
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___ affecting VP function is the largest subgroup in this category?
Primary motor/neuromotor control problems
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In acquired cases VPI/C is most often seen as a part of ?
flaccid/lower motor neuron (LMN) dysarthria with mixed (LMN/UMN) aslo prevalent
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When there is a dysarthria affecting speech muscles, those same muscles are equally impaired for ?
Oral non-speech movements of feeding/swallowing and orofacial gestures.
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VPI/A non-cleft VP incompetency: Motor association/motor programming
Pt with apraxic-type problem with VP closure, especially in children?
AOS- apraxia of speech
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VPI/A non-cleft VP incompetency: Motor association/motor programming
Unstudied area: syndromic clefting with persisting VP closure prblems are high inconsistent and affect speech and swallowing, causing intermittent nasal reflux/regurgitation?
Oral (non-speech) apraxia
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VPI/A non-cleft VP mislearning: PSNE
sounds most likely to be affected are?
- sibilant fricatives /s/,/z/
- affricates "sh" plus or minus "ch" and "dge"
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Hearing impairment can alter?
speech resonance in the direction of hypernasality or hyponasality
(over closure and under closure of the VP port)
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Individuals who are oral deaf speakers can present with such speech not because of an innate problem with VP closure but rather?
from the impact of the hearing loss on speech motor control and sensory learning.
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deaf/hearing impairment:
A consequence is ?
the interference with adequate learning of fine motor control required for VP closure adjustments and even for lingual articulatory contact.
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