Levator Veli Palatini Muscle Activity in Relation to Intraoral Air Pressure Variation in Cleft Palate Subjects

1995 ◽  
Vol 32 (5) ◽  
pp. 376-381 ◽  
Author(s):  
David P. Kuehn ◽  
Jerald B. Moon
Keyword(s):  
Cleft Palate ◽  
Air Pressure ◽  
Levator Muscle ◽  
Emg Activity ◽  
High Activation ◽  
Levator Veli Palatini ◽  
Activation Level ◽  
High Activation Level ◽  
Intraoral Air Pressure ◽  
Total Activation

A comparison of the ranges of levator veli palatini EMG activity for speech versus a nonspeech task for subjects with cleft palate was the focus of this study. EMG values are also compared with subjects without cleft palate obtained in a previous study. Hooked-wire electrodes were inserted into the levator muscle of five adult subjects with cleft palate exhibiting mild hypernasality. Intraoral air pressure was measured concurrently. A blowing task was used to determine the subject's operating range for the levator muscle. Both the nonspeech and speech tasks were designed to sample the widest possible ranges of levator EMG activity. It was found that the subjects with cleft palate used a relatively high activation level for the levator muscle during speech, in relation to their total activation range, compared with the subjects without cleft palate. Implications are discussed In relation to possible anatomic and physiologic differences for cleft palate subjects compared to normal.

Change in Levator Veli Palatini Muscle Activity for Patients with Cleft Palate in Association with Placement of a Speech-Aid Prosthesis

2002 ◽  
Vol 39 (5) ◽  
pp. 503-508 ◽  
Author(s):  
Takashi Tachimura ◽  
Kanji Nohara ◽  
Yoshinori Fujita ◽  
Takeshi Wada
Keyword(s):  
Cleft Palate ◽  
Pressure Change ◽  
Mean Value ◽  
Emg Activity ◽  
Reserve Capacity ◽  
Activity Levels ◽  
Levator Veli Palatini ◽  
Velopharyngeal Incompetence ◽  
Velopharyngeal Closure ◽  
The Mean

Objective: The purpose of this study was to examine whether a speech-aid prosthesis normalizes the activity of the levator veli palatini muscle for patients with cleft palate who exhibit velopharyngeal incompetence. Design: Each subject was instructed to produce repetitions of /mu/, /u/, /pu/, /su/, and /tsu/ and to blow with maximum possible effort. Electromyographic (EMG) activity of the levator veli palatini muscle was recorded with and without a hybrid speech-aid prosthesis in place. Participants: The participants were five patients with repaired cleft palate who were routinely wearing a hybrid speech-aid prosthesis. Results: With the prosthesis in place, the mean value of levator activity changed positively in relation to oral air-pressure change during blowing. Differences in levator activity in relation to speech samples were similar to those in normal speakers. With the prosthesis in place, levator activity for speech tasks was less than 50% of the maximum levator activity for all subjects. The findings were similar to those reported previously for normal speakers. Conclusion: Placement of the prosthesis changed EMG activity levels of the levator veli palatini muscle to levels that are similar to normal speakers. It is possible that, with the increase in the differential levator activity between speech and a maximum force task, the velopharyngeal mechanism has a greater reserve capacity to maintain velopharyngeal closure compared with the noprosthesis condition.

scholarly journals Asymmetry and Positioning of the Levator Veli Palatini Muscle in Children With Repaired Cleft Palate

2020 ◽  
Vol 63 (5) ◽  
pp. 1317-1325 ◽  
Author(s):  
Katelyn J. Kotlarek ◽  
Catherine M. Pelland ◽  
Silvia S. Blemker ◽  
Michael S. Jaskolka ◽  
Xiangming Fang ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Velopharyngeal Insufficiency ◽  
Levator Muscle ◽  
Future Research ◽  
Imaging Protocol ◽  
Levator Veli Palatini ◽  
Velopharyngeal Closure ◽  
History Of ◽  
Magnetic Resonance Imaging Protocol ◽  
The Impact

Purpose The purpose of this study is to examine the differences in velopharyngeal dimensions as well as levator veli palatini (levator) muscle morphology, positioning, and symmetry of children with repaired cleft palate with velopharyngeal insufficiency (VPI), children with repaired cleft palate with complete velopharyngeal closure, and children with noncleft anatomy. Method Fifteen children ranging in age from 4 to 8 years were recruited for this study. Ten of the participants had a history of repaired cleft palate, half with documented VPI and the other half with velopharyngeal closure. Five participants with noncleft anatomy were matched for age from a normative database. The magnetic resonance imaging protocol, processing methods, and analysis are consistent with that used in previous literature. Results Regarding velopharyngeal dimensions, median values were statistically significantly different between groups for sagittal angle ( p = .031) and effective velopharyngeal ratio ( p = .013). With respect to the levator muscle, median values were statistically significant for average extravelar length ( p = .018), thickness at midline ( p = .021), and thickness between the left and right muscle bundles at the point of insertion into the velum ( p = .037). Remaining measures were not statistically significant. Conclusions The levator muscle is significantly different among these three groups with respect to thickness at midline, extravelar length, and symmetry at the point of insertion into the velum. Sagittal angle and effective velopharyngeal ratio are also significantly different. Participants with repaired cleft palate and VPI displayed the greatest degree of asymmetry. Future research should control for surgical procedure type to determine the impact of surgery on the levator muscle and surrounding velopharyngeal anatomy.

Levator Veli Palatini Muscle Activity in Relation to Intranasal Air Pressure Variation

1993 ◽  
Vol 30 (4) ◽  
pp. 361-368 ◽  
Author(s):  
David P. Kuehn ◽  
Jerald B. Moon ◽  
John W. Folkins
Keyword(s):  
Cleft Palate ◽  
Atmospheric Pressure ◽  
Positive Airway Pressure ◽  
Air Pressure ◽  
Electromyographic Activity ◽  
Resistive Load ◽  
Cpap Therapy ◽  
Levator Veli Palatini ◽  
Nasal Cavities ◽  
Velopharyngeal Closure

Continuous positive airway pressure (CPAP) therapy can be used to reduce hypernasality by elevating the air pressure in the nasal cavities during speech. The purpose of this study was to determine whether increased intranasal air pressure loads the major muscle of velopharyngeal closure, the levator veli palatini. Nine subjects, four with cleft palate and five without cleft palate, were studied. Electromyographic activity was measured from the levator veli palatini muscle with several levels of air pressure delivered to the nasal cavities using a commercially available CPAP instrument. It was found that levator veli palatini activity was significantly greater for the positive air pressure conditions than for the atmospheric pressure conditions for both subject groups. This indicates that the levator veli palatini muscle acts against the resistive load produced by the increased intranasal air pressure. The results support the use of CPAP therapy as a method of resistance exercise for strengthening velopharyngeal closure muscles.

Velopharyngeal Muscle Morphology in Children With Unrepaired Submucous Cleft Palate: An Imaging Study

2020 ◽  
pp. 105566562095474 ◽  
Author(s):  
Graham C. Schenck ◽  
Jamie L. Perry ◽  
Mary M. O’Gara ◽  
Amy Morgan Linde ◽  
Mitchell F. Grasseschi ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Imaging Study ◽  
The Body ◽  
Analysis Of Covariance ◽  
Velopharyngeal Insufficiency ◽  
Levator Muscle ◽  
Levator Veli Palatini ◽  
Submucous Cleft Palate ◽  
Α Angle ◽  
Normal Speech

Objective: To identify quantitative and qualitative differences in the velopharyngeal musculature and surrounding structures between children with submucous cleft palate (SMCP) and velopharyngeal insufficiency (VPI) and noncleft controls with normal anatomy and normal speech. Methods: Magnetic resonance imaging was used to evaluate the velopharyngeal mechanism in 20 children between 4 and 9 years of age; 5 with unrepaired SMCP and VPI. Quantitative and qualitative measures of the velum and levator veli palatini in participants with symptomatic SMCP were compared to noncleft controls with normal velopharyngeal anatomy and normal speech. Results: Analysis of covariance revealed that children with symptomatic SMCP demonstrated increased velar genu angle (15.6°, P = .004), decreased α angle (13.2°, P = .37), and longer (5.1 mm, P = .32) and thinner (4 mm, P = .005) levator veli palatini muscles compared to noncleft controls. Qualitative comparisons revealed discontinuity of the levator muscle through the velar midline and absence of a musculus uvulae in children with symptomatic SMCP compared to noncleft controls. Conclusions: The levator veli palatini muscle is longer, thinner, and discontinuous through the velar midline, and the musculus uvulae is absent in children with SMCP and VPI compared to noncleft controls. The overall velar configuration in children with SMCP and VPI is disadvantageous for achieving adequate velopharyngeal closure necessary for nonnasal speech compared to noncleft controls. These findings add to the body of literature documenting levator muscle, musculus uvulae, and velar and craniometric parameters in children with SMCP.

Levator Veli Palatini Muscle Activity in Relation to Intraoral Air Pressure Variation

1994 ◽  
Vol 37 (6) ◽  
pp. 1260-1270 ◽  
Author(s):  
David P. Kuehn ◽  
Jerald B. Moon
Keyword(s):  
Muscle Activity ◽  
Pressure Variation ◽  
Emg Activity ◽  
Control Mechanisms ◽  
Main Experiment ◽  
Lower Region ◽  
Operating Range ◽  
Levator Veli Palatini ◽  
Velopharyngeal Closure ◽  
Intraoral Air Pressure

The purpose of this investigation was to study the operating range of the levator veli palatini muscle for a nonspeech task (blowing) and to determine where in that range levator activity for speech lies. Ten adult subjects without speech or velopharyngeal abnormalities participated. Levator EMG activity for speech occurred in the lower region of the total range for blowing. In two subsequent experiments involving a subset of 4 subjects, it was found that overall effort may have had a small effect on levator activity apart from its role in velopharyngeal closure for aerodynamic purposes. The results of the main experiment are discussed in relation to the concept of threshold of fatigue as it may influence velopharyngeal control mechanisms.

scholarly journals Factors Associated with High Patient Activation Level among Individuals with Metabolic Syndrome at a Primary Care Teaching Clinic

2020 ◽  
Vol 11 ◽  
pp. 215013272093130
Author(s):  
Nur Hidayah Bahrom ◽  
Anis Safura Ramli ◽  
Mohamad Rodi Isa ◽  
Hasidah Abdul-Hamid ◽  
Siti Fatimah Badlishah-Sham ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Status ◽  
Patient Activation ◽  
High Activation ◽  
Factors Associated ◽  
Activation Level ◽  
High Activation Level ◽  
Logistic Regressions ◽  
Reported Health ◽  
Self Reported Health Status

Background: High activation level has been associated with higher education background, better self-rated health status, and having adequate health literacy. However, there is a gap in the literature regarding the level of activation and the factors associated with it among patients with metabolic syndrome (MetS) in the Malaysian primary care setting. Objectives: This study aims to determine activation levels and the factors associated with high activation among individuals with MetS in primary care. Methods: A cross-sectional study was conducted at a university primary care clinic. Patient activation was measured using the Patient Activation Measure®–13 Malay version. Activation levels were dichotomized into “low activation” (levels 1 and 2) and “high activation” (levels 3 and 4). To determine the factors associated with high activation, simple logistic regressions (SLogR) followed by multiple logistic regressions (MLogR) were performed. Results: Of 333 participants, 280 (84.1%) were included in the final analysis. The mean activation score was 59.4 (SD ±10.20) and 61.8% had high activation level. Two variables were found to be significant on MLogR. Those who were employed have the odds of 3.135 (95% CI 1.442-6.816) of having high activation compared with those who were unemployed. Those with good self-reported health status have the odds of 6.482 (95% CI 1.243-33.792) of having high activation compared to those with poor self-reported health status. Conclusions: The majority of participants had high activation levels. Those who were employed and those who had good self-reported health status were more likely to have high activation levels. Findings of this study could be used to develop patient activation interventions to improve self-management skills among individuals with MetS in primary care. These may include problem solving support, individualized care plans, peer or family support, and skill building. Those in high activation group can be trained to become mentors to support their peers who have low activation level.

Three-Dimensional Computer Reconstruction of the Levator Veli Palatini Muscle in Situ Using Magnetic Resonance Imaging

2007 ◽  
Vol 44 (4) ◽  
pp. 421-423 ◽  
Author(s):  
Jamie L. Perry ◽  
David P. Kuehn
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Cleft Palate ◽  
Three Dimensional ◽  
Muscle Length ◽  
Levator Muscle ◽  
Resonance Imaging ◽  
Computer Reconstruction ◽  
Levator Veli Palatini

Objective: Most studies have used two-dimensional (2D) data to image and study the velopharyngeal mechanism, oversimplifying the complexity of the system. Three-dimensional (3D) computer modeling and animation offers the advantage of viewing in all coordinate planes and gives the researcher the ability to apply external forces and chart resultant movement patterns. The objective of this project was to create a 3D model of the velopharyngeal mechanism, with primary focus on the levator veli palatini muscle, based on magnetic resonance imaging (MRI) data to demonstrate the velum at rest and during elevation. Method: Quantitative data, based on MRI analyses and consisting of levator muscle length, width, and orientation were modeled using the Maya software system. Results: Using data derived from MRI analyses, an accurate and realistic computer reconstruction of the levator muscle in situ was possible. A video of the animation was created to demonstrate the anatomy from variable view points, layering of the velar muscles, and movement of the velopharyngeal mechanism during vowel production. Conclusion: Improvements in visualization of the levator veli palatini muscle through 3D computer graphics offer a promising future for the field of speech science in providing advancements in basic research. It will be valuable in applied research and clinical activities such as surgical management for individuals impacted by a cleft palate. It is a step forward in creating models of abnormal anatomy (i.e., cleft palate) and is a step closer to a virtual surgical planning tool.

Levator Veli Palatini Muscle Fatigue during Phonation in Speakers with Cleft Palate with Borderline Velopharyngeal Incompetence

2006 ◽  
Vol 43 (1) ◽  
pp. 103-107 ◽  
Author(s):  
Kanji Nohara ◽  
Takashi Tachimura ◽  
Takeshi Wada
Keyword(s):  
Cleft Palate ◽  
Regression Line ◽  
Power Spectral Analysis ◽  
Levator Muscle ◽  
Control Group ◽  
Mean Power ◽  
Mean Power Frequency ◽  
Levator Veli Palatini ◽  
Velopharyngeal Incompetence ◽  
Syllable Repetition

Objective This study examined whether the levator veli palatini muscle in speakers with borderline velopharyngeal incompetence (BVP) with surgically treated cleft palate might be more fatigable during speech than that in speakers without clefts. Design Each subject was asked to pronounce the syllable /pu/ more than 50 times at a rate of one time per second. Mean power frequency (MPF) of one syllable was obtained from electromyogram data of the levator muscle by power spectral analysis. Participants Five patients with postsurgical cleft palates, who were identified as having BVP by nasopharyngeal fiberscopy, served as subjects, and five participants without clefts served as the control group. Results In all participants without clefts, the slopes of the regression line relating MPF to the course of syllable repetition were negative but not significant. However, in all participants with BVP, the slopes of the regression line were significantly negative. Conclusions These findings demonstrated that the levator muscle of speakers with BVP was more fatigable than that of speakers without clefts during repetition of syllables. This study suggests that the fatigability of levator muscle contributed to mild hypernasality in patients with BVP.

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