Assessment of Velopharyngeal Incompetence

1. Assessment of Velopharyngeal Incompetence Dr. Hassan S. Attai M.B.ch.B---F.I.C.M.S Al-Karkh G. Hospital

2. Definition • Normal velopharyngeal function occurs when the nasal cavity is successfully closed off from the oral cavity during speech. Such closure is necessary for production of oral pressure consonants and normal resonance. • Normal velopharyngeal closure is achieved through the action and coordination of musculature such as the velum, lateral pharyngeal walls, and posterior pharyngeal walls.

3. Etiology and pathology: • Velopharyngeal dysfunction is resulting primarily from anatomical or structural defects such as cleft palate, submucous cleft palate, and short velum. • Velopharyngeal dysfunction is resulting primarily from physiological or functional defects such as poor muscle function, paralysis, neuromuscular disorders. • Variety of other causes including learned behaviors, hearing loss, phoneme-specific nasal air emission.

4. Assessment of VPI: • A full speech-language evaluation is essential when evaluating someone when velopharyngeal dysfunction is suspected. • VPI is often the most noticeable issue. Perceptual Assessment: • Techniques for assessing velopharyngeal dysfunction include auditory detection (e.g. listening tube), tactile detection (e.g. feeling the nares for nasal turbulence), and visual detection (e.g. air visible on “mirror test”). • the speech-language pathologist must assess intelligibility, or how significantly errors of resonance, airflow, and/or articulation affect the child’s overall speech intelligibility.

5. The chart below illustrates the areas of assessment that need finite attention

6. Objective Assessment • Following a perceptual assessment, an objective assessment may then take place to further assess speech disorders associated with velopharyngeal dysfunction. One type of objective assessment is used to assess the function of the velopharyngeal mechanism. These objective assessments include: • Nasometry, in which acoustic energy from the nasal and oral cavities is analyzed. • Aerodynamic assessment, in which a pressure-flow technique is used to estimate velopharyngeal orifice size and to measure this orifice differential pressure • Another type of objective assessment is used to visualize the velopharyngeal mechanism and function:

7. Nasoendoscopy, in which a fiberoptic nasopharyngoscope is used to directly observe the velopharyngeal port during speech . • Videofluoroscopy in which radiographic procedures are used to directly observe the velopharyngeal sphincter during speech. • Factors that may interfere with a professional’s ability to successfully evaluate the functional potential of the velopharyngeal mechanism using objective measures are the child’s age or maturity level to comply with such procedures, the presence of a severe phonological delay, the presence of glottal and/or pharyngeal articulations, and the presence of a palatal fistula. • The Cleft Palate/Craniofacial Team then collectively evaluates results from the perceptual and objective assessments in order to determine the cause of the child’s velopharyngeal dysfunction and to detail how the cause of velopharyngeal dysfunction determines the necessary and appropriate treatment for that particular child.

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