An Overview: Nature of the Velopharyngeal VP Mechanism Delivery of Service

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An OverviewNature of the Velopharyngeal (VP)
MechanismDelivery of Service

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

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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

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Hard Palate(inferior view)
Incisive foramen
Premaxilla
Palatine process of maxillary bone
Posterior nasal spine
http//www.yorku.ca
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Nature of VP Mechanism3 components

• Velum
• Posterior pharyngeal wall (ppw)
• Lateral pharyngeal wall (lpw)

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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.

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Velopharyngeal Mechanism

• Velum PPW LPW

PPW
LPW

Velum
LPW
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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)
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Velopharyngeal Port

• at rest (open)
  during speech

Source www.choa.org/default.aspx?id762
(choaChildrens Healthcare of Atlanta)
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Velopharyngeal Inadequacy (VPI)(dysfunction -
VPD)
??? VPI
??? VPI
VP??
??? VPI
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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

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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

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Velopharyngeal Inadequacy (VPI)
Adenoid pad
VP gap
velum
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What happens to speech??????
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Effect of VPI on Speech(andthe terminology to
describe it)

• Hypernasality
• Nasal air emission
• Weak or omitted consonant sounds
• Articulation errors (compensatory)
• Facial grimace
• Phonatory disorders
• not hypernasality

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What Next??????
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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)

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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

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Team Composition

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

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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

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Birth of the CLP Team Lancaster Cleft Palate
Clinic - 1938
Photo Courtesy of Dr. Ross Long, Jr.
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Referring to a Team

• When a child has a cleft or craniofacial disorder
  
• When a resonance disorder or VPI is suspected

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Where do you find a team?

• www.acpa-cpf.org
• www.cleftline.org
• http//www.cleftline.org/team_listings/state_dfg
   

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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

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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

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Thank you very much.
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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.

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Delivery of CareResources

• http//www.acpa-cpf.org/teamcare/Parameters07rev.p
  df
• Contact ACPA, Cleft Palate Foundation, or your
  local team