Resonance Disorders

The velopharyngeal port is open for

nasals

A client presenting with resonance disturbance secondary to a spastic dysarthria would present with a velopharyngeal

incompetence and dysfunction

The word “man” produced by a child with hyponasality might sound more like

bad

Hypernasality would most easily be detected using

the phrase “the berry is over there”

If a “snap” is heard at the releasing of the nares during production of a sustained /s/,

the VP port is open

Many younger children with VP problems exhibit sound

all of the above

Nasoendoscopy

is an instrumental assessment of the velopharyngeal mechanism

The classic signs of a submucous cleft are

all the above

These provide the source of vibration that gives rise to complex sound waves

vocal folds

Listening carefully to an individual’s voice during conversation

can provide a gross indication of what the prominent symptoms are

Individuals with hypernasality

are at increased risk for hoarseness associated with vocal hyperfunction

The clinician can make a gross observation of the relationship of the velum to the pharynx

through direct visualization of oral structures

A noninvasive computer system that measures the relative amount of oral-to-nasal acoustic energy in an individual’s speech

Nasometer

Nasoendoscopy involves

direct visualization of the velopharynx by endoscope

Cleft lip/palate is most likely to occur embryonically during the last trimester of pregnancy.

False

Nasal air emission and hypernasality produce identical effects on speech sound production.

False

Velopharyngeal insufficiency results from inappropriate articulation patterns.

False

Hyponasality refers to too much airflow through the nasal cavity when speaking.

False

25% of children with a repaired cleft palate will have residual velopharyngeal insufficiency.

True

Impaired motion of the VP mechanism due to tissue deficiency is referred to as which of the following?

VP Insufficiency

Which of the following sentences would be most helpful in making a judgment of hyponasality?

Mary made lemon jam.

Which of the following best represents a low-tech way for detecting nasal air emission?

See-Scape

For individuals with VPD, nasal emission of air is a common articulation error on which of the following types of phonemes?

All of the above

Therapy aimed at correct place of articulation is usually inappropriate for children with cleft palate because nasal emission and compensatory errors often resolve following successful surgical intervention.

False

The Nasometer collects oral and nasal sound intensity simultaneously using a single microphone located near the upper lip.

False

Radiation is still a concern that must be considered when employing videofluoroscopy to look at the movement of the VP mechanism.

True

If you suspect velopharyngeal insufficiency upon examination, what action should you take?

Refer to a specialist who can conduct imaging and provide physical/surgical management if needed

A dysarthric client with an immobile velum may benefit from a palatal lift.

True

Clients with nasal voices who produce high nasal airflow rates are perceived as having a cold or stuffed-up nose.

False

A pharyngeal flap is constructed from the pharyngeal mucosal tissue and attached to the tissue of the soft palate, such that a 'bridge' of tissue spans the excessive VP opening.

True

During resting breathing, the velum is 

Lowered and near or touching the base of the tongue

The velum is elevated and touching the lateral and posterior pharyngeal walls during

all of the above

Match the cause of velopharyngeal dysfunction to the best description: submucous cleft palate

Velopharyngeal Insufficiency

Match the cause of velopharyngeal dysfunction to the best description: deafness/hearing impairment

Velopharyngeal mislearning

Match the cause of velopharyngeal dysfunction to the best description: cerebral palsy

Velopharyngeal Incompetence

Match the cause of velopharyngeal dysfunction to the best description: TBI

Velopharyngeal Incompetence

Match the cause of velopharyngeal dysfunction to the best description: Deep Nasopharynx

Velopharyngeal Insufficiency

Match the cause of velopharyngeal dysfunction to the best description: persisting post-operative nasal emission (with adequate VP ability)

Velopharyngeal Mislearning

Hypernasality is most apparent on

Vowels

Hypernasality and nasal air emission mean the same thing. 

False

If you pinch your nostrils and make an /m/ sound, it will be exactly like you would produce /b/. 

True

A muffled quality resulting from blockage anterior to the VP mechanism is called 

cul-de-sac resonance

Match the oral and nasal resonance disorders: Thin voice

Oral Resonance Disorder

Match the oral and nasal resonance disorders: Laryngeal Focus Voice

Oral Resonance disorder

Match the oral and nasal resonance disorders: Denasality

Nasal Resonance Disorder

Match the oral and nasal resonance disorders: Hypernasality

Nasal Resonance Disorder

Match the oral and nasal resonance disorders: vocal tract focus that doesn't match gender expression

Oral Resonance Disorder

Match the oral and nasal resonance disorders: cul-de-sac resonance

Nasal Resonance Disorder

Which of the following is not a category of causes of resonance disorders? 

Traumatic

Woodwind players can injure their VP muscles from high intensity performance with high intra-oral pressure. This is called 

Stress VPD

Match the lip anatomy to the description: Frenulum

thin band of tissue connecting the upper lip to the gum

Match the lip anatomy to the description: Columella

vertical grooves on either side of the philtrum

Match the lip anatomy to the description: Philtrum

vertical groove below the nose

Which of these terms are synonyms? 

soft palate and velum

Ankyloglossia signs and symptoms may include [mark all that apply]

All of the above

The Eustachian tube connects the nasopharynx to the 

middle ear

The primary muscle in the velum (40% of mass and main elevating muscle) is the 

Levator Veli Palatini

Adenoidectomy and tonsillectomy have been implicated in VPI. Match the statement about adenoids and tonsils that best represents their potential for causing VPI: aid in velopharyngeal closure in children and removal may cause VPI

Adenoids

Adenoidectomy and tonsillectomy have been implicated in VPI. Match the statement about adenoids and tonsils that best represents their potential for causing VPI: are in oral cavity and do not contribute to VP closure

Tonsils

Match the following surgical procedures for VPI to their description: Inject substance into posterior pharyngeal wall

Pharyngeal augmentation

Match the following surgical procedures for VPI to their description: Lengthen velum

Furlow Z-plasty

Match the following surgical procedures for VPI to their description: Suture flap from posterior pharyngeal wall to velum

Pharyngeal flap

Identify the categories of treatment of velopharyngeal dysfunction: Palatal lift, palatal obturation, speech bulb obturator

Prosthetic treatment

Identify the categories of treatment of velopharyngeal dysfunction: Pharyngeal augmentation, Furlow Z-plasty, pharyngeal flap

Surgical treatment

Identify the categories of treatment of velopharyngeal dysfunction: Maxillary expansion treatment, bone graft

Dental and orthodontic treatment

A 5-year-old boy enters school and is flagged at his first speech-language screening with the following notes: some articulation errors and hypernasal speech. Parents report that he does have a history of middle ear issues. Your oral mechanism evaluation reveals a dark area on the soft palate and a very small uvula. You refer to the ENT/cleft team in your area with a note. 

Evaluate for submucous cleft

Match the common sound errors associated with VPD with their descriptions: Stopped air flow between tongue and posterior pharyngeal wall

Pharyngeal plosive

Match the common sound errors associated with VPD with their descriptions: Turbulent air flow between tongue and posterior pharyngeal wall

Pharyngeal fricative

Match the common sound errors associated with VPD with their descriptions: Vocal folds adduct and open (like a grunt)

Glottal stop

Match the common sound errors associated with VPD with their descriptions: Turbulent air flow between tongue and velum

Posterior nasal fricative

Match the common sound errors associated with VPD with their descriptions: Place of articulation moves posteriorly

Generalized backing

Match the common sound errors associated with VPD with their descriptions: Audible air coming out of nose on voiceless consonants

Nasal air emission

Match the surgery to the typical timeline: Generally repaired at 3-6 months

Cleft lip surgery

Match the surgery to the typical timeline: Generally repaired at 9-12 months

Cleft palate surgery

Indicate whether the velum is open or closed during the following behaviors: nasal sound production

open

Indicate whether the velum is open or closed during the following behaviors: vomiting

open

Indicate whether the velum is open or closed during the following behaviors: breathing

open

Indicate whether the velum is open or closed during the following behaviors: gagging

closed

Indicate whether the velum is open or closed during the following behaviors: Wind Instrument playing

closed

Indicate whether the velum is open or closed during the following behaviors: Bearing down

closed

Indicate whether the velum is open or closed during the following behaviors: Swallowing

closed

Indicate whether the velum is open or closed during the following behaviors: Oral sound production

closed

The most common velopharyngeal closure pattern is

coronal

The atrophy of adenoids (starting at 5 years old and mostly gone by teens) generally has no negative effect on speech unless children have tenuous VP closure due to submucous cleft or history of CP. 

True

Removal of enlarged tonsils

all of the above

The tonsils can be viewed during the oral mechanism exam. 

False

The adenoids can be viewed during the oral mechanism exam

False

Cleft lips may be

All of the above

Select the structures typically involved in complete and incomplete cleft palate: Complete cleft palate

hard palate and soft palate

Select the structures typically involved in complete and incomplete cleft palate: Incomplete cleft palate

soft palate only

The free-floating premaxilla is associated with 

bilateral cleft lip and palate

Unilateral orofacial clefts are more common on the 

left

Cleft lip occurs more often in ___. Cleft palate occurs more often in ___. 

boys, girls

Cleft lip or palate is the most common birth defect in the United States. Clefts happen very early in pregnancy, and is considered a  ___ condition, meaning it is caused by a combination of genetic predisposition and environmental factors, rather than a single identifiable cause. 

multifactorial

Cleft lip and cleft palate can be associated with a large number of craniofacial and genetic sequences or syndromes, some of which are rare. Orofacial clefts are associated with

All of the above

Speech Disorders in children with orofacial clefts may include [mark all that apply]

Velopharyngeal Dysfunction, Dental/Occlusal Abnormalities, Palatal Fistula, Hearing Loss

An infant's Eustachian tube is in a more horizontal position than an adult's. 

True

Match the speech issues to the categories of communication disorders associated with VPD: Laryngeal hyperfunction

Abnormal phonation

Match the speech issues to the categories of communication disorders associated with VPD: Nasal grimace

Abnormal airflow

Match the speech issues to the categories of communication disorders associated with VPD: Obligatory distortion

Abnormal articulation