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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

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an overview nature of the velopharyngeal vp mechanism delivery of service
An Overview:Nature of the Velopharyngeal (VP) MechanismDelivery of Service

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

normal speech
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
Hard Palate(inferior view)

Premaxilla

Incisive foramen

Palatine process of maxillary bone

Posterior nasal spine

http://www.yorku.ca

nature of vp mechanism 3 components
Nature of VP Mechanism:3 components
  • Velum
  • Posterior pharyngeal wall (ppw)
  • Lateral pharyngeal wall (lpw)
velopharyngeal closure
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
Velopharyngeal Mechanism =

Velum + PPW + LPW

PPW

LPW

+

Velum

LPW

function of soft palate
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
Velopharyngeal Port

at rest (open) during speech

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

vpi vpd a definition
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
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
Velopharyngeal Inadequacy (VPI)

Adenoid pad

VP gap

velum

effect of vpi on speech and the terminology to describe it
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

delivery of care
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
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
Team Composition
  • Audiology
  • Dentistry
  • Genetics
  • Oral maxillofacial surgery
  • Plastic surgery
  • Psychology
  • Speech-language pathology
  • Patient and caregivers
team responsibilities
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
slide20

Birth of the CLP Team

Lancaster Cleft Palate Clinic - 1938

Photo: Courtesy of Dr. Ross Long, Jr.

referring to a team
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
Where do you find a team?
  • www.acpa-cpf.org
  • www.cleftline.org
  • http://www.cleftline.org/team_listings/state_dfg
summary
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
acknowledgements
Acknowledgements
  • 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
references nature of vp function
ReferencesNature 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 care resources
Delivery of CareResources
  • http://www.acpa-cpf.org/teamcare/Parameters07rev.pdf
  • Contact ACPA, Cleft Palate Foundation, or your local team