Praxis cleft palate

During a comprehensive speech evaluation, an SLP asks the child being evaluated to prolong the
vowel /i/. The SLP asks the child to repeat the same vowel, but while pinching his/her nose closed.
Upon completing this action, the SLP notices a change in the sound of the vowel. What type of
resonance does this child MOST LIKELY demonstrate?

a. hypernasality
b. hyponasality
c. cul de sac resonance
d. mixed resonance

a. hypernasality

A child is referred to an SLP by an otolaryngologist (ENT) with a presenting problem of "distorted
speech." Following a comprehensive evaluation, the SLP determines that the child is experiencing
significant nasal emission during speech. Based on this information, which of the following problems
would this child NOT be experiencing?

a. short utterance length
b. compensatory errors
c. hypernasality
d. weak consonants

hypernasality

An SLP has been assigned to provide therapy to a child with a documented history of velopharyngeal insufficiency (VPI). Which activity would be the most appropriate method of therapy for the SLP to
utilize with this particular client?

a. blowing exercises
b. oral-motor exercises
c. articulation therapy
d.increasing oral activity

articulaltion therapy

A young child with developmental dysarthria exhibits hypernasality and nasal emissions on pressure
consonants. Examination of the hard palate failed to note any structural deviations while range of
motion for elevation of the soft palate appeared limited. Occlusion of the nose via a nose clip
normalized breath group length and improved clarity of speech sound production. What step should the
SLP take next in order to proceed appropriately?
a. The speaker should be immediately fitted with a palatal lift.
b. Complete a thorough evaluation of the velopharyngeal system prior to initiating treatment.
c. Treatment should target the respiratory system in order to improve breath group length.
d.Refer the child for reconstruction of the velopharyngeal system

Complete a thorough evaluation of the velopharyngeal system prior to initiating treatment.

An SLP has been working with a patient to improve the hypernasality of their speech. The child has
been diagnosed with a cleft palate, but also demonstrates a Pierre Robin sequence, midface
hypoplasia, and a mild sensorineural hearing loss. Give these specific characteristics, this child MOST
LIKELY demonstrates which disorder?

a. fetal alcohol syndrome
b. Trisomy 13
c. Stickler syndrome
d. Orofaciodigital syndrome type 1

Stickler syndrome.

A speech and language researcher is interested in compiling a data bank regarding objective measures
of the acoustic characteristics of cleft palate speech. Which of the following instrumental procedures
would be most helpful to this researcher?

a. nasopharyngoscopy
b. aerodynamic instrumentation
c. videofluoroscopy
d. nasometry

Nasometry.

A client arrives at the speech-language pathology clinic at an acute care hospital with complaints of "a
change in voice." After comprehensive endoscopic evaluation, the SLP notes that the deficit is most
likely not one of resonance due to problems of velopharyngeal closure, as this client exhibits "the most
common pattern of velopharyngeal closure." Which of the following BEST describes this client's pattern
of closure?

a. Circular pattern with approximately equal activity of the velum, lateral pharyngeal walls, and
posterior pharyngeal wall.
b. Coronal pattern with the velum contacting the pharyngeal wall.
c. Sagittal pattern with medial lateral pharyngeal wall motion as the primary contributor to closure.
d. Circular pattern with a Passavant's ridge.

Coronal pattern with the velum contacting the pharyngeal wall.

A child has been recently born with a complete cleft of the secondary palate. Given this diagnosis,
which structure would most likely NOT be affected?

a. hard palate
b. velum
c. alveolar ridge
d. uvula

Alveolar ridge.

A 6-year-old child is referred to an SLP by an otolaryngologist (ENT) physician, in order to receive
speech therapy. According to the child's mother, the child had normal speech until 2 years ago, when
he underwent adenoidectomy. Following this surgery, the child demonstrated severe hypernasality
which has slightly improved over the past year. The SLP performs a full evaluation, which reveals
normal articulation and significant hypernasality. What is the FIRST treatment option that should be
instituted for this child?

a. Speech and voice therapy for better sound control and airflow.
b. Exercises to strengthen the velopharyngeal musculature.
c. Discuss the inappropriateness of speech therapy, at this time, for the child with the physician.
d.Auditory training to improve awareness of the hypernaslity.

Auditory training to improve awareness of the hypernasality.

. A speech-language pathologist (SLP) is scheduled to perform an evaluation on a child with a chief complaint of "nasality." After performing the evaluation, the SLP finds that the child demonstrates insufficient resonance on nasal consonants. What type of resonance does this child demonstrate?

a. Hypernasality.
b. Hyponasality.
c. Oral cul de sac resonance.
d.Nasal cul de sac resonance.

Hyponasality.

After receiving surgical correction of velopharyngeal insufficiency, a child is referred to a speech-language pathologist (SLP) to receive speech therapy. Which activity is appropriate for correction of compensatory errors following the child's surgical procedure?

a. Articulation placement procedures.
b. Velopharyngeal exercises.
c. Blowing exercises.
d. Further surgical management.

Articulation placement procedures.

A neonate was diagnosed with cleft palate, micrognathia and airway obstruction. Given these characteristics, which of the following disorders is this infant MOST LIKELY experiencing?

a. Pierre Robin sequence.
b. Velocardiofacial syndrome.
c. Down syndrome.
d. Pfeiffer syndrome.

Pierre Robin sequence.

A child is referred to a speech-language pathologist (SLP) in order to receive speech therapy for problems associated with velopharyngeal insufficiency (VPI). In the referral notes, the SLP notices that this child demonstrates several common speech characteristics associated with VPI. Which of this child's speech characteristics would be most responsive to speech therapy?

a. Hypernasality.
b. Compensatory productions.
c. Obligatory errors.
d. Nasal emission.

Compensatory productions.

Following a complete otolaryngology (ENT) and speech-language pathology (SLP) evaluation after complaints of hypernasal speech, a child is diagnoses with a complete cleft of the primary palate. Which of the following structures would most likely NOT be affected by this type of cleft?

a. Lip.
b. Hard palate.
c. Alveolar ridge.
d. Nasal sill.

Hard palate

A speech-language pathologist (SLP) in private practice has been working with a child for the past 6 months in order to correct the child's speech distortions. However, the child has made no progress over the course of treatment, and the SLP prepares a referral for otolaryngology (ENT) intervention. With which of the following distortions does this child MOST LIKELY present?

a. Glottal stop.
b. Compensatory production.
c. Phoneme-specific nasality.
d. Obligatory distortion.

Obligatory distortion.

A speech-language pathologist (SLP) in private practice is receiving a new client in the clinic for treatment of a speech sound disorder. Upon reading the child's intake forms, the SLP notes that the child has previously been diagnosed with pronounced micrognathia, glossoptosis and hearing loss. Given these specific characteristics, this child MOST LIKELY demonstrates which disorder?

a. Treacher Collins syndrome.
b. Beckwith-Wiedemann syndrome.
c. Van der Woude syndrome.
d. Opitz G syndrome.

Treacher Collins syndrome.

A child is referred to an otolaryngology (ENT) and speech-language pathology (SLP) clinic at an acute care hospital after experiencing multiple episodes of nasal regurgitation in addition to significantly hypernasal speech. Upon full evaluation, it is found that the child has difficulty with elevation and retraction of the velum. Given these problems. This child is MOST LIKELY experiencing deficits in which of the following muscles?

a. Tensor veli palatini.
b. Musculus uvulae.
c. Palatoglossus.
d. Levator veli palatini.

Levator veli palatini.

You have been asked to give an in-service to a group of students who wish to eventually specialize in service delivery to children with cleft palates and their families. The students want to know detailed information about in utero development of the hard and soft palate (among other things). You can accurately tell them that in utero, the hard palate fuses between the developmental ages of

a. 1 and 2 weeks.
b. 4 and 6 weeks.
c. 8 and 9 weeks.
d. 10 and 12 weeks.
e. 12 and 16 weeks.

8 and 9 weeks.

Questions 19-21 refer to the following scenario:
A clinician in a private practice is approached by the parents of Tommy D., a 5-year-old boy. The parents want to place Tommy in kindergarten in the fall but say, "We know there's something wrong with him - we're just not sure what." According to Tommy's parents, he is a "sweet, lovable boy who will go to anybody. He likes to sing a lot, too." Because the parents live in a rural area, health care access has been limited. After seeing Tommy for the first time, the clinician refers his parents to a neurologist because she suspects that Tommy has a syndrome. He is small for his age and has an elfin-like appearance characterized by a small chin, turned-up nose, puffiness around the eyes, a long upper lip, and a wide mouth. His teeth are small and widely spaced.

19. The clinician suspects that Tommy has

a. Williams syndrome.
b. Apert syndrome.
c. Moebius syndrome.
d. Turner syndrome.
e. Hurler syndrome.

Williams syndrome.

Questions 19-21 refer to the following scenario:
A clinician in a private practice is approached by the parents of Tommy D., a 5-year-old boy. The parents want to place Tommy in kindergarten in the fall but say, "We know there's something wrong with him - we're just not sure what." According to Tommy's parents, he is a "sweet, lovable boy who will go to anybody. He likes to sing a lot, too." Because the parents live in a rural area, health care access has been limited. After seeing Tommy for the first time, the clinician refers his parents to a neurologist because she suspects that Tommy has a syndrome. He is small for his age and has an elfin-like appearance characterized by a small chin, turned-up nose, puffiness around the eyes, a long upper lip, and a wide mouth. His teeth are small and widely spaced.
. This syndrome is caused by a rare genetic disorder that affects an estimated 1 out of every 20,000 babies. It is caused by

a. a missing part of chromosome 22, known as 22q11.
b. an expanded number of cytosine-guanine-guanine (CGG) nucleic acid repeats on a specific gene on one of the distal ends of the X chromosome.
c. a spontaneous autosomal dominant mutation, whose gene and locus is FGR2 at 10q25—26.
d. autosomal dominant inheritance and deletion in the region of the long arm of chromosome 15 (15q11—15q13).
e. the deletion of approximately 25 genes on one copy of chromosome 7q11.23

the deletion of approximately 25 genes on one copy of chromosome 7q11.23

. The clinician knows that she will probably end up seeing Tommy for intervention if his parents are able to bring him on a weekly basis. She will probably be working on which of the following goals?

a. Pragmatics, to increase Tommy's ability to interact with others.
b. Oral-motor coordination, because children with this syndrome usually have oral-motor coordination problems, which contribute to decreased intelligibility.
c. Overall expressive and receptive language, because children with this syndrome generally have IQs of 50-70 (although some have good language skills).
d. Morphological skills, because although children with this syndrome usually have above-average IQs, they frequently delete bound morphemes from the beginnings and ends of words.
e. Feeding, because children with this syndrome tend to have feeding problems.

Overall expressive and receptive language, because children with this syndrome generally have IQs of 50-70 (although some have good language skills).

A condition in which the surface tissues of the soft or hard palate fuse but the underlying muscle or bone tissues do not is called

a. fusion disorder.
b. submucous or occult cleft palate.
c. class III palatal cleft.
d. submucosal cleft class IV.
e. occult palate class I.

submucous or occult cleft palate.

The surgical method of cleft palate repair that involves raising two bipedicled flaps of mucoperiosteum, bringing them together, and attaching them to close the cleft is called the

a. von Langenbeck surgical method.
b. V-Y retroposition.
c. Veau-Wardill-Kilner method.
d. pharyngeal flap procedure.
e. pharyngoplasty.

von Langenbeck surgical method.

A child comes to a clinic with her mother for articulation therapy. The mother tells the clinician that her daughter has Hurler's syndrome. Hurler's syndrome is caused by


a. autosomal recessive deficiency of X-L iduronidase.
b. a spontaneous autosomal dominant mutation of FGR2 at 10q25-26.
c. autosomal dominant inheritance and deletion in the region of the long arm of chromosome 15 (15q11-15q13).
d. an expanded number of cytosine-guanine-guanine (CGG) nucleic acid repeats on a specific gene on one of the distal ends of the Y chromosome.
e. an extra whole number chromosome 21, resulting in 47, rather than the normal 46 chromosomes.

autosomal recessive deficiency of X-L iduronidase.

A school-based clinician is assessing the velopharyngeal adequacy of Janie K., a 17-year-old immigrant high school student from the Philippines. Janie was born with a cleft of the palate and lip; there was no repair until her family came to the United States when Janie was 16 years old. In the Philippines, Janie and her family lived on Tablas, a small and rural island, where surgery was unavailable. Though the repair surgery in the United States a year ago was successful and Janie now has a more aesthetically pleasing appearance and better speech, there is still audible nasal emission and hypernasality when she speaks. The clinician plans to refer her to a local craniofacial team, but he also wants to conduct as thorough an examination as he can despite the lack of instrumentation available at his school site. He does have access to an oral manometer. Her uses this to provide a beginning point from which to refer Janie to the craniofacial team. After obtaining a ratio by comparing pressures achieved in the nostrils-occluded and the nostrils-open conditions, the clinician concludes that Janie especially needs to be referred to the craniofacial team for possible further surgery or a pharyngeal flap. When he used oral manometry, the clinician probably found that Janie
a. had a ratio of 1.0.
b. had a ratio of 1.2.
c. had a ratio of .96.
d. had a ratio of .92.
e. had a ratio of .87.

had a ratio of .87.

In infants and children with cleft palates, eustachian tube dysfunction is probably mostly related to the lack of contraction of the
a. levator veli palatini muscle.
b. veli palatini muscle.
c. tensor veli palatini muscle.
d. palatopharyngeus muscle
e. superior constrictor.

tensor veli palatini muscle.

A clinician is a member of a cleft palate team that asks her to conduct an objective assessment of an 8-year-old child's velopharyngeal mechanism. The clinician decides to do nasopharyngoscopy, in which a nasopharyngoscope is passed through the middle meatus and back to the area of velopharyngeal closure. This will enable the clinician to observe the child's

a. adenoid pads and anterior pharyngeal walls as the child prolongs /s/.
b. posterior and lateral pharyngeal walls, as well as the adenoid pad, as the child sustains /ɑ/.
c. nasal aspect of the velum and the adenoid pad as the child produces CVC words.
d. posterior and lateral pharyngeal walls, as well as the nasal aspect of the velum and the adenoid pad, as the child produces sentences.
e. posterior and lateral pharyngeal walls as well as the nasal aspect of the velum and the adenoid pad, as the child produces nasals /n/ and /m/.

posterior and lateral pharyngeal walls, as well as the nasal aspect of the velum and the adenoid pad, as the child produces sentences.

You are on a cleft palate and craniofacial anomalies team that evaluates children with cleft palates. When a child has a resonance problem, the team decides whether the child will benefit from speech therapy alone or more intensive medical intervention (e.g., surgery) is needed. As part of the assessment process, cephalometric analysis is used. In cephalometric analysis, the Cephalometric Assessment of Velopharyngeal Structures computer program analyzes the ratio relationship between the length of the soft palate and the depth of the nasopharynx. Which one of the following statements best summarizes a key principle that guides treatment decisions?

a. A ratio of less than 60 is usually found when the soft palate is too short and the nasopharynx is too shallow.
b. A ratio of less than 60 is usually found when the nasopharynx is too deep or the soft palate is too long.
c. A ratio of 60-80 generally indicates adequate tissue for velopharyngeal closure for speech.
d. If a ratio is higher than 80, this means the nasopharynx is too shallow or the velum is too long.
e. If a ratio is higher than 80, this means that the velum is too short or the nasopharynx is too shallow.

A ratio of 60-80 generally indicates adequate tissue for velopharyngeal closure for speech.

You are providing support for a man with Marfan syndrome; he has difficulties with respiration, and you are working on breathing techniques. He shares with you that he and his wife want to have a child, and they are concerned about their child possibly having Marfan syndrome. You refer him to a genetic counselor, who will share with him that Marfan syndrome is

a. an autosomal, dominant inherited disorder caused by mutations in the FBN1 gene.
b. an autosomal recessive disorder caused by mutations in the FBN1 gene.
c. a partial deletion syndrome caused by mutations in the FBN2 gene.
d. not genetically transferred to offspring, so the parents do not need to be concerned.
e. a full deletion syndrome caused by mutations in the FBN1 gene.

a. an autosomal, dominant inherited disorder caused by mutations in the FBN1 gene.

In your private practice, a father brings his 5-year-old son, Jordan, to see you. The kindergarten teacher has noticed that Jordan "talks kind of funny," and sometimes other children make fun of him. Justin was born with a cleft palate and has had repair surgery, and he has a history of conductive hearing loss secondary to otitis media with effusion. During your evaluation of Jordan's speech, you note that he is especially having difficulty producing affricates, fricatives, and plosives. This is probably because he is having continued difficulty with

a. vocal nodules.
b. hypertrophied adenoids.
c. mandibular hypoplasia.
d. maxillary deficiency.
e. velopharyngeal closure.

velopharyngeal closure.