1. Generic term for faulty velopharyngeal closure?
    VP Inadequacy (VPI/A)
  2. VPI/A includes?
    • VP insufficiency
    • VP incompetency
    • VP mislearning
  3. Where closure inadequacy is due to deviant structure, not enough tissue or other structural basis for VP closure problem?
    VP insufficiency
  4. 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
  5. Where closure inadequacy occurs despite adequarte structures and neuromotor supply?
    VP mislearning
  6. VPI/A Cleft ?
    VP insufficiency
  7. VPI/A cleft Unrepaired palatal clefts are?
    • Overt
    • Submucous
    • Occult submucous
  8. VPI/A Cleft Post-surgical insufficiency? (4)
    • Post-palatal closure
    • post-adenoidectomy
    • post-pharyngeal flap or sphincter pharyngeoplasty
    • Complicated by fistula
  9. VPI/A non-cleft ?
    • VP insufficiency (VPI/S)
    • VP incompetency (VPI/C)
    • VP mislearning
  10. VPI/A non-cleft VP insufficiency mechanical interference? (4)
    • excessive Tonsils
    • irregular adenoid contour
    • posterior pillar web
    • combination of these
  11. 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
  12. 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
  13. VPI/A non-cleft VP incompetency: Primary motor/neuromotor control DSYARTHRIA-
    Congenital? (3)
    • cerebral palsy
    • myotonias
    • dystrophies
  14. 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)
  15. VPI/A non-cleft VP incompetency: Motor association/motor programming APRAXIA? (2)
    • Speech (AOS-apraxia of speech)
    • Oral non-speech
  16. VPI/A non-cleft VP mislearning? (4)
    • Phoneme-specific nasal emission
    • Persisting post-op nasal emission
    • compensatory misarticulations
    • deafness/hearing impairment
  17. 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
  18. 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
  19. VPI/A non-cleft VP mislearning:
    VPI caused by maladaptive gestures?
    Compensatory misarticulations
  20. 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
  21. Post-surgical insufficiency:
    too aggressive an adenoidectomy (introgenic basis) or adenoidectomy unmasks a pre-existing insufficiency such as SMCP or OSMCP?
  22. Post-surgical insufficiency:
    or other form of secondary surgery; like initial palatoplasties, secondary surgeries are not always successful?
    post-pharyngeal flap, post sphincter pharyngoplasty
  23. 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
  24. ___ affecting VP function is the largest subgroup in this category?
    Primary motor/neuromotor control problems
  25. 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
  26. 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.
  27. 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
  28. 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
  29. 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"
  30. Hearing impairment can alter?
    speech resonance in the direction of hypernasality or hyponasality

    (over closure and under closure of the VP port)
  31. 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.
  32. 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.
Card Set
Mod 14 VP Impairments