Cleft Palate - Praxis Review, Cleft Palate Praxis Practice Questions, Cleft palate

During a comprehensive speech evaluation, a speech-language pathologist asks the child being evaluated to prolong the vowel /i/. The SLP asks the child to repeat the same vowel, but will 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?

Hypernasality.
Hyponasality.
Cul de sack resonance.
Mixed resonance.

Hypernasality.

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?

Nasopharyngoscopy.
Aerodynamic instrumentation.
Videofluoroscopy.
Nasometry.

Nasometry.

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

Articulation placement procedures.
Velopharyngeal exercises.
Blowing exercises.
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?

Pierre Robin sequence.
Velocardiofacial syndrome.
Down syndrome.
Pfeiffer syndrome.

Pierre Robin sequence.

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

Lip.
Hard palate.
Alveolar Ridge.
Nasal sill.

Hard palate.

A speech-language pathologist in an outpatient clinic had a child referred to them by an otolaryngologist. In the client's notes, the physician states that the client demonstrates problems that are not able to be corrected medically or surgically and that speech therapy is indicated for this child. Given this information, which deficit is this child MOST LIKELY demonstrating?

Cul de sac resonance.
Nasal emission.
Pharyngeal fricative.
Hypernasality.

Pharyngeal fricative.

Although nasal emission is most commonly caused by VPI or by compensatory productions secondary to VPI, nasal emission can also occur due to velopharyngeal mislearning in the absence of VPI. Although the cause is unclear, some children learn to produce a pharyngeal sound (ie, pharyngeal fricative or posterior nasal fricative) for an oral sound. This substitution causes PSNE because the airflow necessarily is released through the VP port and then nasal cavity.

Because the nasal emission after correction occurs only on the misarticulated sounds, these compensatory productions would cause phoneme-specific nasal emission (PSNE)

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

Glottal stop.
Compensatory production.
Phoneme specific nasality.
Obligatory distortion.

Obligatory distortion.

A speech language pathologist in a 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?

Treacher Collins syndrome.
Beckwith-Wiedemann syndrome.
Van der Woude syndrome.
Opitz G syndrome.

Treacher Collins syndrome.

A child is referred to an otolaryngology and speech language pathology clinic at an acute care hospital after experiencing multiple episodes of nasal regurgitation and 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, the child is MOST LIKELY experiencing deficits in which of the following muscles?

Tensor veli palatini.
Musculus uvulae.
Palatoglossus.
Levator veli palatini.

Levator veli palatini.

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

Fusion disorder.
Submucous or occult cleft palate.
Class III palatal cleft.
Occult palate class I.

Submucous or occult cleft palate.

You have been asked to give and 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. You can accurately tell them that in utero, the hard palate fuses between the developmental ages of:

1-2 weeks.
4-6 weeks.
8-10 weeks.
12-16 weeks.

8-10 weeks.

An SLP evaluates the speech of a child with suspected velopharyngeal dysfunction. Loading sentences with which of the following types of stimuli would be most helpful to include in the speech evaluation?

A. Nasal phonemes
B. High-pressure oral stops and fricatives
C. Sustained /α/
D. Liquids and glides

B. High-pressure oral stops and fricatives

High-pressure consonants are most sensitive to the effects of velopharyngeal dysfunction, which involves a potential for weak pressure and nasal emission, both being obligatory features of velopharyngeal dysfunction. In addition, sentence-level stimuli are needed to include a variety of vowels that allow the listener the opportunity to perceive hypernasal resonance, which is also associated with velopharyngeal dysfunction.

An SLP will be working with a new mother to evaluate a term infant's feeding and swallowing skills to determine the infant's readiness for oral feeding. The infant has been diagnosed with a unilateral, complete cleft lip without cleft palate. The mother asks the SLP about what caused the infant's cleft lip. The SLP explains that while we know that both genetic and environmental factors are likely involved with this congenital birth abnormality, there is no consensus in research about a single cause of cleft lip.

The SLP completes a comprehensive oral sensorimotor and behavioral observation examination prior to initiating an oral-feeding trial. The following is documented in the SLP's assessment notes:

Right-sided complete cleft lip; otherwise unremarkable oral peripheral mechanism examination; medical chart notes no associated neurological difficulties or diagnosed syndromes; primitive reflexes present (e.g. for example, rooting); normal observation of posture, positioning, tone, and motor activity; infant presents awake, alert, and calm; baseline vital signs at rest are normal and no changes in respiratory rate, heart rate, or oxygen saturation noted with nonnutritive sucking; no respiratory stridor noted; mild external support needed to increase lip closure at introduction of pacifier nipple, and mother with strong desire to breastfeed. The mother expressed some anxiety and concern surrounding feeding an infant with a cleft lip.

During which of the following weeks of pregnancy did the infant's craniofacial structures not develop completely?

A. 4-7
B. 8-11
C. 12-15
D. 16-19

A. 4-7

An SLP will be working with a new mother to evaluate a term infant's feeding and swallowing skills to determine the infant's readiness for oral feeding. The infant has been diagnosed with a unilateral, complete cleft lip without cleft palate. The mother asks the SLP about what caused the infant's cleft lip. The SLP explains that while we know that both genetic and environmental factors are likely involved with this congenital birth abnormality, there is no consensus in research about a single cause of cleft lip.

The SLP completes a comprehensive oral sensorimotor and behavioral observation examination prior to initiating an oral-feeding trial. The following is documented in the SLP's assessment notes:

Right-sided complete cleft lip; otherwise unremarkable oral peripheral mechanism examination; medical chart notes no associated neurological difficulties or diagnosed syndromes; primitive reflexes present (e.g. for example, rooting); normal observation of posture, positioning, tone, and motor activity; infant presents awake, alert, and calm; baseline vital signs at rest are normal and no changes in respiratory rate, heart rate, or oxygen saturation noted with nonnutritive sucking; no respiratory stridor noted; mild external support needed to increase lip closure at introduction of pacifier nipple, and mother with strong desire to breastfeed. The mother expressed some anxiety and concern surrounding feeding an infant with a cleft lip.

Based on information from the oral sensorimotor and behavioral observation assessments, which of the following plans for continuing with an oral-feeding trial is most appropriate with the infant?

A. An oral-feeding trial should not be attempted until the infant's cleft lip is repaired.
B. An oral-feeding trial should not be attempted until a VFSS or FEES instrumental examination is completed.
C. An oral-feeding trial should be postponed until the infant's airway is examined by a physician.
D. An oral-feeding trial by the SLP can proceed during this initial feeding and swallowing assessment

D. An oral-feeding trial by the SLP can proceed during this initial feeding and swallowing assessment.

An SLP will be working with a new mother to evaluate a term infant's feeding and swallowing skills to determine the infant's readiness for oral feeding. The infant has been diagnosed with a unilateral, complete cleft lip without cleft palate. The mother asks the SLP about what caused the infant's cleft lip. The SLP explains that while we know that both genetic and environmental factors are likely involved with this congenital birth abnormality, there is no consensus in research about a single cause of cleft lip.

The SLP completes a comprehensive oral sensorimotor and behavioral observation examination prior to initiating an oral-feeding trial. The following is documented in the SLP's assessment notes:

Right-sided complete cleft lip; otherwise unremarkable oral peripheral mechanism examination; medical chart notes no associated neurological difficulties or diagnosed syndromes; primitive reflexes present (e.g. for example, rooting); normal observation of posture, positioning, tone, and motor activity; infant presents awake, alert, and calm; baseline vital signs at rest are normal and no changes in respiratory rate, heart rate, or oxygen saturation noted with nonnutritive sucking; no respiratory stridor noted; mild external support needed to increase lip closure at introduction of pacifier nipple, and mother with strong desire to breastfeed. The mother expressed some anxiety and concern surrounding feeding an infant with a cleft lip.

Which THREE of the following treatment strategies is most appropriate for the patient if the SLP finds the infant is safe for continued oral breastfeeding and follows up with the infant and mother with therapy and education prior to discharge home from the hospital?

A. Introducing external pacing with the infant's intake rate to support airway protection
B. Providing the mother with contact information for the local cleft lip and palate team for ongoing care and support
C. Incorporating adaptive seating for the infant during oral feedings
D. Positioning the infant in the optimal feeding position at the mother's breast
E. Completing education with the infant's mother about feeding interactions, strategies, and oral care

B. Providing the mother with contact information for the local cleft lip and palate team for ongoing care and support
D. Positioning the infant in the optimal feeding position at the mother's breast
E. Completing education with the infant's mother about feeding interactions, strategies, and oral care

Options (B), (D), and (E) are correct. Providing the mother with contact information for the local cleft lip and palate team for ongoing care and support would be an appropriate strategy. Positioning an infant with either the cleft lip at the top of the mother's breast or with the cleft lip against the mother's breast can aid in achieving lip closure around the nipple and/or help prevent leakage of milk from the infant's oral cavity. Completing education with this new mother will be very important, especially considering that this mother expressed concern and anxiety surrounding feeding her infant with a cleft lip.

Kelli is a 10-year-old patient with velopharyngeal dysfunction. She presents with hypernasality, audible nasal emission, and weak pressure for oral consonants. She also displays glottal stops and pharyngeal fricatives. She is in speech therapy, and her parents would like to know what to expect after she has pharyngeal flap surgery next week. Which of the following outcomes is most appropriate for the SLP to counsel Kelli's parents to expect?

A. Surgery should eliminate the glottal stops but not the pharyngeal factors.
B. Surgery should decrease the hypernasality and audible nasal emission.
C. Surgery should eliminate the need for ongoing speech therapy.
D. Surgery should decrease hypernasality and nasal emission and eliminate articulation errors.

B. Surgery should decrease the hypernasality and audible nasal emission.

Only speech therapy would correct the articulation errors, and only surgery would improve resonance and audible nasal emission.

Which of the following recommendations to a parent of an infant with cleft lip and palate should an SLP make to best optimize feeding for adequate nutrition and appropriate growth?
A. Providing a bottle rather than breast-feeding the infant
B. Positioning the infant in a supine position during feeding times
C. Allowing the infant to take as much time as needed to feed
D. Using a bottle with a modified nipple during feedings

D. Using a bottle with a modified nipple during feedings

A bottle with a modified nipple allows for greater control over the quantity of liquid expressed and the pacing of feeding.

Which of the following strategies to treat compensatory articulation errors is most appropriate for a child with hypernasality and glottal stop substitutions following surgery for velopharyngeal insufficiency?

A. Using oral motor exercises
B. Using a straw to elicit /s/forward slash s forward slash
C. Using tactile cues to elicit phonemes
D. Using negative practice

C. Using tactile cues to elicit phonemes

Tactile cues are used to elicit correct articulation placement.

Which of the following speech-sampling contexts best assesses hyponasality?

A. Producing sentences with oral sonorants
B. Counting in numerical order from 60 to 70
C. Saying single words with nasal consonants
D. Repeating words with oral-pressure consonants

C. Saying single words with nasal consonants

Hyponasality (too little nasal resonance) is most easily detected during the production of nasal consonants.

Infants with cleft lip and palate are susceptible to middle ear disease because which of the following muscles is commonly impaired?

A. The superior constrictor muscle
B. The levator veli palatini muscle
C. The palatopharyngeus muscle
D. The tensor veli palatini muscle

D. The tensor veli palatini muscle

The tensor veli palatini muscle when contracted opens the auditory tube, equalizing middle ear pressure. When the tensor is not functioning properly, the auditory tube is not opened, pressure is not equalized, and fluid may accumulate in the middle ear. The tensor veli palatini travels around the hamulus of the sphenoid bone, where it has a fanlike appearance, and becomes the palatine aponeurosis, extending from the hard palate to the free border of the soft palate.

Two months after undergoing surgery to improve velopharyngeal function, a client continues to exhibit nasal airflow only on the production of /s/ and /sh/, and also exhibits glottal stops for several pressure consonants. The most appropriate next action for the SLP to take is to

A. request consideration of prosthetic management
B. request a nasoendoscopic study
C. inform the surgeon that the client is not making satisfactory progress
D. provide speech treatment to correct compensatory articulation errors

D. provide speech treatment to correct compensatory articulation errors

It would be appropriate to provide speech-language services with the objective of reducing and eliminating the speech-production errors evidenced by the patient.

Which of the following strategies is most appropriate for an SLP to try in an effort to minimize the perception of mild nasal emission in a patient?

A. Increasing fundamental frequency
B. Using light articulatory contacts
C. Reducing mouth opening
D. Increasing rate of speech

B. Using light articulatory contacts

Using light articulatory contacts can help decrease perception of nasal emissions.

Which of the following conditions is primarily characterized by premature closure of the sutures of the skull?

A. Craniosynostosis
B. Craniopharyngioma
C. Deformational plagiocephaly
D. Positional plagiocephaly

A. Craniosynostosis

Craniosynostosis is a premature closure of one or more of the cranial sutures of the skull and can be associated with a cleft palate.

Which of the following instrumental assessment tools provides the most direct dynamic view of velopharyngeal movement during speech?

A. Nasopharyngoscopy
B. Lateral-view x-ray
C. Nasometry measurements
D. Aerodynamics

A. Nasopharyngoscopy

Nasopharyngoscopy is an example of a direct instrumental assessment tool that provides a dynamic (moving) view of the velopharyngeal movements.

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

hypernasality

Rationale: Hypernasality would occur if excessive amounts of acoustic energy were released into the nasal cavities during speech. By occluding the nares, any energy in the nasal cavity would be forced into the oral cavity and there would be no perception of hypernasality during these speech tasks. This type of evaluation would not reveal hyponasality, as this is a problem with normal nasal resonance. Additionally, cul de sac resonance would not be revealed, as this is a problem with sound already being obstructed in the pharyngel or nasal cavities. Further obstruction would not make a change in perception.

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

Nasal emissions occur when there is air lost through the nasal cavity during speech production. As this air is required to maintain speech, the quicker loss of air that accompanies nasal emissions would cause short utterance length. Additionally, because this air is being released, there will be a lack of pressure buildup in the oral cavity, leading to weak consonants, which in turn would lead to compensatory productions. Nasal emissions on their own would not cause a change in a client's resonatory capabilities, therefore the client would not be perceived as hypernasal.

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

articulation therapy

Rationale: When working with individuals who have VPI, speech therapy may be appropriate to address the client's compensatory articulation errors. For this reason, articulation therapy is the most appropriate selection for use with this child. Blowing exercises, oral motor exercises, and increasing oral activity are not effective at ameliorating any of the speech deficits present in individuals with VPI and are not indicated for those with this population.

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.

Rationale: The fact that this pediatric client is experiencing improvements in speech clarity with occlusion of the nose is an indicator that further assessment is warranted. Further assessment would allow the SLP working with this client to determine the extent of weakness that this patient is experiencing and allow the SLP to determine what changes can be made in order to aid in reduction of nasal emission and hypernasality.

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

Stickler syndrome includes cleft palate, specific craniofacial features (i.e. Pierre Robin sequence, midface hypoplasia, epicanthic folds, etc.) and a function concern for sensorineural hearing loss. Fetal alcohol syndrome, trisomy 13, and orofaciodigital syndrome type 1 include specific craniofacial features, but do not include sensorineural hearing loss as a functional concern. Sensorineural hearing loss is a functional concern in individuals with Sticker syndrome, so when this type of hearing loss is present, it is highly indicative of 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

Rationale: Nasometry utilizes a nanometer to give acoustic data regarding the presence of nasality in speech production (i.e. nasalance). As this researcher is interested in gathering acoustic data for this population, nasometry would be the most appropriate choice. On the other hand, aerodynamic instrumentation measures air pressure and airflow during speech production, videofluoroscopy provides a radiographic view of the velopharyngeal valve and nasopharyngoscopy allows the examiner to view the velopharyngeal port during speech. As such, these instruments do not provide acoustic data and are not appropriate selections.

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.

Rationale: The coronal pattern of velopharyngeal closure is the most common pattern in normal speakers and involves posterior movement of the soft palate against the posterior pharyngeal wall. If the SLP from this scenario noted "the most common closure pattern," this would be the most appropriate choice. Circular and sagittal closure patterns are the second most and third most common velopharyngeal closure pattern, respectively. For this reason, these answers would not be the most appropriate selection for the client from this scenario.

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

Rationale: Secondary palate structures include the hard palate, velum, and uvula. If this child was experiencing a complete cleft of the secondary palate, there would be a full cleft extending from the uvula to the incisive foramen. As such, the alveolar ridge would remain intact with this type of cleft.

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 hypernaslity.

Rationale: The child in this scenario had a change in speech quality following a surgery. While there has been some noted improvement, the child continues to present with significant hypernasality, possibly due to a lack of awareness. By bringing the deficit to the level of awareness, the child will be able to participate more fully in treatment efforts to reduce the perception of hypernasality. Following this step in treatment, other treatment options and speech therapy techniques may be utilized with this child.