An Overview:

Nature of the Velopharyngeal (VP)

Mechanism

Delivery of Service

Linda D. Vallino-Napoli, PhD, MS, CCC-SLP/A

Normal Speech

Ability to coupling* and decoupling* the nasal cavity from the oral cavity (velopharyngeal valving)

–Normal resonance–Normal articulation–Normal phonation

*oral-nasal coupling – nasal sounds*oral-nasal decoupling – oral sounds

Hard Palate(inferior view)

http://www.yorku.ca

Posterior nasal spine

Incisive foramen

Palatine process of maxillary bone

Premaxilla

Nature of VP Mechanism:3 components

Velum Posterior pharyngeal wall

(ppw) Lateral pharyngeal wall (lpw)

Velopharyngeal Closure

In a nutshell…

During normal speech production, the velum moves upward and backward to contact the posterior pharyngeal wall. Simultaneously, the lateral pharyngeal walls move medially to abut against the edges of the velum.* These movements (vp closure)separate the oral and nasal cavities for oral consonants.

*The contribution of these components vary among individuals.

Velopharyngeal Mechanism =

Velum + PPW + LPW

+Velum

PPW LP

WLPW

Function of Soft Palate

Tensor Palati (#1)

Levator Palati (#2) (pulls palate

upward and backward) Palatoglossus (#3)

Palatopharyngeus (#4)

Superior Constrictor (#5) (medial movement of lpw)

 

Fritzell (1969)

Velopharyngeal Port

at rest (open) during speech

Source: www.choa.org/default.aspx?id=762 (choa=Children’s Healthcare of Atlanta)

Velopharyngeal Inadequacy (VPI)

(“dysfunction” - VPD)

??? VPI

??? VPI??? VPI VP??

VPI (VPD):A definition

Faulty velopharyngeal closure or…

The inability for the velum and related musculature to separate the oral and nasal cavities on oral consonants

Causes of VPI

Cleft VPI– Opening in the palate (cleft palate, large fistula)

Velopharyngeal insufficiency– Short palate– Post adenoidectomy– Post maxillary advancement

Velopharyngeal incompetency– Poor muscle function

Velopharyngeal mislearning– Phonemic-specific nasal emission

Velopharyngeal Inadequacy (VPI)

velumVP gap

Adenoid pad

What happens to speech??????

Effect of VPI on Speech(and…the terminology to describe it)

Hypernasality Nasal air emission* Weak or omitted consonant sounds Articulation errors (compensatory) Facial grimace Phonatory disorders

*not = hypernasality

What Next??????

Delivery of Care

“…children with special health care needs (Koop, 1987)…require comprehensive, coordinated care provided by health care systems that are readily accessible and responsive to the individual needs of the parents and their families.”

(ACPA, Parameters of Care, 2007)

ACPA, Parameters of Care(1993, 2000, 2007)

Optimal care of children with clefts and craniofacial conditions:

Best provided by an interdisciplinary team of specialists

From neonatal period through adulthood - until all management needs are met

Team Composition

Audiology Dentistry Genetics Oral maxillofacial surgery Plastic surgery Psychology Speech-language pathology Patient and caregivers

Team Responsibilities

Recognize the needs of each patient and assist in providing all services needed to complete care

Evaluate patients at regular intervals Hold regularly scheduled meetings to discuss

findings Develop treatment plan based on patient needs Maintain comprehensive records for each

discipline Communicate findings & recommendations Collaborate with providers in the community

Birth of the CLP TeamLancaster Cleft Palate Clinic - 1938

Photo: Courtesy of Dr. Ross Long, Jr.

Referring to a Team

When a child has a cleft or craniofacial disorder

When a resonance disorder or VPI is suspected

Where do you find a team?

www.acpa-cpf.org

www.cleftline.org

http://www.cleftline.org/team_listings/state_dfg  

Summary

Cleft and other conditions affecting VP function can present complex problems

Careful evaluations are essential to making an appropriate diagnosis and planning effective treatment

Interdisciplinary team management is the standard of care for these patients

AcknowledgementsAcknowledgements

Ross Long Jr, DMD, PhD (Lancaster Cleft Palate Program) for the photos of the Lancaster Cleft Palate Team.

ASHA and ACPA for sponsoring this symposium

Thank you very much.

ReferencesReferencesNature of VP FunctionNature of VP Function

Peterson-Falzone SJ, Hardin-Jones, MA, Karnell MP. Cleft Palate Speech. 3rd ed. St. Louis (MO): Mosby, Inc. 2001.

Zemlin WR. Speech and hearing science: anatomy and physiology. 4th ed. Englewood Cliffs (NJ): Prentice-Hall, 1997.

Delivery of CareDelivery of CareResourcesResources

http://www.acpa-cpf.org/teamcare/Parameters07rev.pdf

Contact ACPA, Cleft Palate Foundation, or your local team