Perceptual Evaluation of Speech and Velopharyngeal Function in Children With and Without Cleft Palate and the Relationship to Nasal Airflow Patterns

2002 ◽  
Vol 39 (4) ◽  
pp. 409-424 ◽  
Author(s):  
Hans Dotevall ◽  
Anette Lohmander-Agerskov ◽  
Hasse Ejnell ◽  
Björn Bake
Keyword(s):  
Cleft Palate ◽  
Nasal Airflow ◽  
Perceptual Evaluation ◽  
Velopharyngeal Function ◽  
The Relationship

Perceptual Evaluation of Speech and Velopharyngeal Function in Children with and without Cleft Palate and the Relationship to Nasal Airflow Patterns

2002 ◽  
Vol 39 (4) ◽  
pp. 409-424 ◽  
Author(s):  
Hans Dotevall ◽  
Anette Lohmander-Agerskov ◽  
Hasse Ejnell ◽  
Björn Bake
Keyword(s):  
Cleft Palate ◽  
Sensitivity And Specificity ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Strong Association ◽  
Airflow Rate ◽  
Nasal Airflow ◽  
Perceptual Evaluation ◽  
Velopharyngeal Function ◽  
The Relationship

Objectives The aim was to study the relationship between perceptual evaluation of speech variables related to velopharyngeal function and the pattern of nasal airflow during the velopharyngeal closing phase in speech in children with and without cleft palate. Participants Fourteen children with cleft lip and palate or cleft palate only and 15 controls aged 7 and 10 years. All were native Swedish speakers. Method Three experienced listeners performed a blinded perceptual speech evaluation. Nasal airflow was transduced with a pneumotachograph attached to a nasal mask. The duration from peak to 5% nasal airflow, maximum flow declination rate, and nasal airflow at selected points in time during the transition from nasal to stop consonants in bilabial and velar articulatory positions in sentences were estimated. The analysis was focused on the perceptual ratings of “velopharyngeal function” and “hypernasality.” Results A strong association was found between ratings of “velopharyngeal function” and “hypernasality” and the pattern of nasal airflow during the bilabial nasal-to-stop combination /mp/. Both the sensitivity and specificity were 1.00 for the bilabial temporal airflow measure in relation to ratings of “velopharyngeal function.” The nasal airflow rate during /p/ in /mp/ had a sensitivity of 1.00 and specificity of 0.92 to 0.96 in relation to ratings of “hypernasality.” Conclusion Assessment of the nasal airflow dynamics during the velopharyngeal closing phase in speech presents quantitative, objective data that appear to distinguish between perceptually normal and deviant velopharyngeal function with high sensitivity and specificity.

Instrumental Assessment in Cleft Palate Care

2013 ◽  
Vol 23 (2) ◽  
pp. 49-61 ◽  
Author(s):  
Jamie Perry ◽  
Graham Schenck
Keyword(s):  
Cleft Palate ◽  
New Developments ◽  
Perceptual Evaluation ◽  
Advantages And Disadvantages ◽  
Instrumental Assessment ◽  
Speech Language Pathologist ◽  
Hypernasal Speech ◽  
Perceptual Assessment ◽  
Velopharyngeal Function ◽  
And Function

Despite advances in surgical management, it is estimated that 20–30% of children with repaired cleft palate will continue to have hypernasal speech and require a second surgery to create normal velopharyngeal function (Bricknell, McFadden, & Curran, 2002; Härtel, Karsten, & Gundlach, 1994; McWilliams, 1990). A qualitative perceptual assessment by a speech-language pathologist is considered the most important step of the evaluation for children with resonance disorders (Peterson-Falzone, Hardin-Jones, & Karnell, 2010). Direct and indirect instrumental analyses should be used to confirm or validate the perceptual evaluation of an experienced speech-language pathologist (Paal, Reulbach, Strobel-Schwarthoff, Nkenke, & Schuster, 2005). The purpose of this article is to provide an overview of current instrumental assessment methods used in cleft palate care. Both direct and indirect instrumental procedures will be reviewed with descriptions of the advantages and disadvantages of each. Lastly, new developments for evaluating velopharyngeal structures and function will be provided.

The relationship between spectral properties and perceptual evaluation of hypernasality in children with cleft palate—vowel /i/

1998 ◽  
Vol 103 (5) ◽  
pp. 2891-2891
Author(s):  
Ryuta Kataoka ◽  
David Zajac ◽  
Robert Mayo ◽  
Donald Warren ◽  
Kaoru Okabe
Keyword(s):  
Cleft Palate ◽  
Spectral Properties ◽  
Perceptual Evaluation ◽  
The Relationship

Cephalometric Analysis in Submucous Cleft Palate: Comparison of Cephalometric Data Obtained from Submucous Cleft Palate Patients with Velopharyngeal Competence and Incompetence

2002 ◽  
Vol 39 (1) ◽  
pp. 105-109 ◽  
Author(s):  
Susam Park ◽  
Makoto Omori ◽  
Kogo Kato ◽  
Naotugu Nitta ◽  
Ichiko Kitano ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Orthodontic Treatment ◽  
Strong Relationship ◽  
Prognostic Indicator ◽  
Cephalometric Analysis ◽  
Submucous Cleft Palate ◽  
Velopharyngeal Function ◽  
The Relationship

Objective The purpose of this study was to investigate the relationship between craniofacial and nasopharyngeal morphology and velopharyngeal function in submucous cleft palate. Design and Patients Fifty-two lateral cephalometric radiographs of 46 sub-mucous cleft palate (SMCP) patients with velopharyngeal competence (24 patients) and incompetence (22 patients) at 4 and 7 years of age were studied. The patients had not received any surgical or orthodontic treatment prior to cephalography being performed. Results Significant differences were found between cephalometric variables (N-Ba, N-S-Ba angle) in children with velopharyngeal competence and incompetence. However, the results of our study showed that cephalometric data alone are not useful for predicting velopharyngeal function and can not serve as an absolute prognostic indicator. Conclusion There are many factors that can influence velopharyngeal function in SMCP patients. Cephalometric data did not demonstrate a strong relationship to velopharyngeal function.

Current Practice in Assessing and Reporting Speech Outcomes of Cleft Palate and Velopharyngeal Surgery: A Survey of Cleft Palate/Craniofacial Professionals

2012 ◽  
Vol 49 (2) ◽  
pp. 146-152 ◽  
Author(s):  
Ann W. Kummer ◽  
Stacey L. Clark ◽  
Erin E. Redle ◽  
Leisa L. Thomsen ◽  
David A. Billmire
Keyword(s):  
Cleft Palate ◽  
Rating Scales ◽  
Current Practice ◽  
Velopharyngeal Insufficiency ◽  
Surgical Success ◽  
Perceptual Evaluation ◽  
Speech Language Pathologist ◽  
Velopharyngeal Function ◽  
E Mail ◽  
Normal Speech

Objective To determine methods by which professionals serving cleft palate/craniofacial teams are evaluating velopharyngeal function and to ascertain what they consider as a successful speech outcome of surgery. Design A 12-question survey was developed for professionals involved in management of velopharyngeal dysfunction. Participants The survey was distributed through E-mail lists for the American Cleft Palate–Craniofacial Association and Division 5 of the American Speech-Language-Hearing Association. Only speech-language pathologists and surgeons were asked to complete the survey. A total of 126 questionnaires were completed online. Results Standard speech evaluations include perceptual evaluation (99.2%), intraoral examination (96.8%), nasopharyngoscopy (59.3%), nasometry (28.9%), videofluoroscopy (19.2%), and aerodynamic measures (4.3%). Significant variation existed in the types and levels of perceptual rating scales. Pharyngeal flap (52.9%) is the most commonly performed procedure for velopharyngeal insufficiency, followed by sphincter pharyngoplasty (27.5%). Criteria for surgical success included normal speech (50.8%), acceptable speech (27.9%), and “improved” speech (8%). However, most respondents felt that success should be defined as normal speech (71.2%). Most respondents believed that surgical success should be determined by the team speech-language pathologist (81.5%); although, some felt success should be determined by the patient/family (17.7%). Conclusion This survey shows considerable variability in the methods for evaluating and reporting speech outcomes following surgery. There is inconsistency in what is considered a successful surgical outcome, making comparison studies impossible. Most respondents thought that success should be defined as normal speech, but this is not happening in current practice.

Results of a Survey of Cleft Palate Teams concerning the Use of Nasendoscopy

1993 ◽  
Vol 30 (1) ◽  
pp. 35-39 ◽  
Author(s):  
Linda L. D'antonio ◽  
Bruce M. Achauer ◽  
Victoria M. Vander Kam
Keyword(s):  
Cleft Palate ◽  
National Survey ◽  
Standard Of Care ◽  
Research Tool ◽  
Clinical Tool ◽  
Perceptual Evaluation ◽  
Diagnostic Problems ◽  
Velopharyngeal Function ◽  
Endoscopic Assessment

A national survey was conducted concerning methods used for the evaluation of velopharyngeal function with emphasis on the role of nasendoscopy. Forty-five percent of questionnaires were returned. Ninety percent of the responding teams indicated that nasendoscopy was available. Sixty-one percent agreed that endoscopy was an important clinical tool and not solely a research tool. The majority (59%) considered 3 to 5 years of age to be the youngest, appropriate age for referral. Ninety percent agreed that nasendoscopy was indicated for difficult diagnostic problems and 41% reported endoscopic studies were appropriate for all patients for whom secondary palatal management is planned. The results of this survey suggest that endoscopic assessment of velopharyngeal function is used routinely as an adjunct to the perceptual evaluation of speech and has become the standard of care among cleft palate teams for difficult diagnostic cases. However, the data also indicate that increased availability does not necessarily assure optimal use.

A Respirometric Technique to Evaluate Velopharyngeal Function in Speakers with Cleft Palate, with and without Prostheses

1987 ◽  
Vol 30 (2) ◽  
pp. 268-275 ◽  
Author(s):  
Harvey R. Gilbert ◽  
Carole T. Ferrand
Keyword(s):  
Cleft Palate ◽  
Nasal Airflow ◽  
Perceptual Judgments ◽  
Sentence Repetition ◽  
Air Volume ◽  
Syllable Repetition ◽  
Two Measures ◽  
Reported Data ◽  
Velopharyngeal Function ◽  
Repetition Task

There is a paucity of respirometric quotient (RQ) data on individuals with velopharyngeal inadequacy. Paesani (1964) reported data using a technique that involved separate productions of the same task to obtain the RQ. The RQ values obtained were greater than unity, which is theoretically impossible. In the present study, respirometric quotients, the ratio of oral air volume expended to total volume expended, were obtained using separate but simultaneous productions of oral and nasal airflow. RQ values were calculated for 10 speakers with cleft palate, with and without their prosthetic appliances, and 10 normal speakers. As a group, those with cleft palate and without their appliances exhibited RQ values that were significantly lower than values obtained from the normal speakers and from speakers with the appliances in place. These findings indicated that there were no statistically significant differences in RQ values when comparing sentence repetition and counting tasks. These values were lower than those obtained for the nonnasal syllable repetition tasks, with the/m/ syllable repetition task generally being associated with the lowest RQ value of any of the speech tasks. The correlation between RQ values and perceptual judgments was -.60, indicating that there was modest agreement between the two measures. As RQ values decreased, perceptual judgments of nasality increased.

Perceptual Speech Outcomes After Early Primary Palatal Repair in Ugandan Patients With Cleft Palate

2020 ◽  
pp. 105566562098024
Author(s):  
Kim Bettens ◽  
Laura Bruneel ◽  
Cassandra Alighieri ◽  
Daniel Sseremba ◽  
Duncan Musasizib ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Cleft Lip ◽  
Speech Therapy ◽  
Cleft Lip And Palate ◽  
Control Group ◽  
English Speaking ◽  
And Gender ◽  
Early Primary ◽  
Velopharyngeal Function ◽  
Normal Speech

Objective: To provide speech outcomes of English-speaking Ugandan patients with a cleft palate with or without cleft lip (CP±L). Design: Prospective case–control study. Setting: Referral hospital for patients with cleft lip and palate in Uganda. Participants: Twenty-four English-speaking Ugandan children with a CP±L (15 boys, 9 girls, mean 8.4 years) who received palatal closure prior to 6 months of age and an age- and gender-matched control group of Ugandan children without cleft palate. Interventions: Comparison of speech outcomes of the patient and control group. Main Outcome Measures: Perceptual speech outcomes including articulation, resonance, speech understandability and acceptability, and velopharyngeal composite score (VPC-sum). Information regarding speech therapy, fistula rate, and secondary surgery. Results: Normal speech understandability was observed in 42% of the patients, and 38% were judged with normal speech acceptability. Only 16% showed compensatory articulation. Acceptable resonance was found in 71%, and 75% of the patients were judged perceptually to present with competent velopharyngeal function based on the VPC-sum. Additional speech intervention was recommended in 25% of the patients. Statistically significant differences for all these variables were still observed with the control children ( P < .05). Conclusions: Overall, acceptable speech outcomes were found after early primary palatal closure. Comparable or even better results were found in comparison with international benchmarks, especially regarding the presence of compensatory articulation. Whether this approach is transferable to Western countries is the subject for further research.

A Cadaveric and Magnetic Resonance Imaging Investigation of the Salpingopharyngeus

2021 ◽  
pp. 1-11
Author(s):  
Karen Perta ◽  
Eileen Kalmar ◽  
Youkyung Bae
Keyword(s):  
Magnetic Resonance Imaging ◽  
Body Weight ◽  
Magnetic Resonance ◽  
Three Dimensional ◽  
Hierarchical Regression ◽  
Resonance Imaging ◽  
Before And After ◽  
Velopharyngeal Function ◽  
The Relationship

Purpose The aim of the study was to update our information regarding the salpingopharyngeus (SP) muscle using cadaveric and in vivo magnetic resonance imaging (MRI) data. Primary objectives were to (a) observe the presence/absence of the muscle and (b) quantify and describe its dimensions and course. Method SP specimens from 19 cadavers (10 women, nine men) were analyzed. Following head bisection, measurements of SP, including width of the cartilaginous attachment (CW) and width of the superior muscle base (SMW), were taken before and after removal of the overlying mucosa. In addition, SP was analyzed in 15 healthy subjects (eight men, seven women) using high-resolution three-dimensional MRI data. CW and SMW measures were replicated in the paraxial MRI view. Results The presence of the salpingopharyngeal fold and muscle was confirmed bilaterally in all cadaveric and living subjects. Following mucosa removal, mean cadaveric CW and SMW measurements were 5.6 and 3.8 mm, respectively. Mean in vivo CW and SMW were 6.1 and 3.7 mm, respectively. Results from the hierarchical regression analyses revealed that, in both cadaveric and living groups, SMW is dependent on the relationship between age and body weight, after controlling for sex. Conclusions The salpingopharyngeal fold and SP muscle are always present bilaterally and can be quantified at the superior origin using both cadaveric and in vivo three-dimensional MRI data. Though both the superior origin and inferior course of SP are highly variable, the size of the SP muscle is dependent on characteristics known to affect muscle fibers, such as the relationship between age and body weight. Given the consistent and quantifiable presence of the SP muscle, its potential role in velopharyngeal function for speech and swallowing is reconsidered. Supplemental Material https://doi.org/10.23641/asha.14347859

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