Low-Tech Assessment

Background Information

20-30% of children with repaired palate will still present some degree of velopharyngeal dysfunction (VPD) and it is also seen in individuals without history cleft palate. Therefore, a comprehensive evaluation is needed. This includes low-tech and “no-tech” procedures.

A perceptual speech evaluation is the first step to checking for velopharyngeal insufficiency (VPI). An SLP should check articulation because VPI affects phoneme production. An SLP should be on the lookout for compensatory articulations (CA) and nasal air emission. Also, it is important to check the resonance and voice in a client for possible dysphonia.

Source: Kummer, A. (2011). Perceptual Assessment of Resonance and Velopharyngeal Function. Seminars in Speech and Language, 32(2):159-167.

Intra-Oral Examinations

Have client say “aaah”
Evaluate oral structures and oral function
Can detect signs of a submucous cleft (appears to be intact but there are abnormalities under the skin’s surface)
Note size of tonsils and adenoids
Signs of dysfunction

Source: Kummer, A. (n.d.). Resonance Disorders and Velopharyngeal Dysfunction: Evaluation and Treatment. [PDF Document]. Retrieved from Cincinatti Children's Hopsital http://www.cincinnatichildrens.org/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=118455&libID=118150.

Perceptual Assessment

Syllable Repetition: helps check for phoneme specific nasal air emission for sibilants and high vowels
- Have the client produce consonants in repetitive manner /pi,pi, pi, pi,pi/; /ti,ti,ti,ti,ti/
- Pay attention to pressure-sensitive phonemes (plosives, fricatives, and affricates)
- Check for nasal emission
- Check for compensatory articulation
- Test with low and high vowels, as high vowels are more prone to hypernasality

Sentence Repetition/Counting: Want to check for phoneme specific nasal emission because this is due to faulty learning not VPI. An SLP needs to check for this because it makes the difference between speech therapy and surgery.
- Similar to syllable repetition
- Choose sentences containing words with same phonemes (e.g., Katie likes chocolate chip cookies)
- Have client count from 60-70 to check for nasal emission, since these numbers contain a lot of /s/’s and High vowels /i/
Counting 90-99 helps when checking nasal production of /n/

Source: Kummer, A. (2011). Perceptual Assessment of Resonance and Velopharyngeal Function. Seminars in Speech and Language. 32(2): 159-167.

Resonance -Tactile Assessment

Resonance Tactile Tests: hypernasality can sometimes cause vibrations that can be felt on the nose (see image below).
- Check for this by placing index fingers lightly on cartilage area
- Use both nasal and non-nasal sentences
- Usually have a subjective scoring for the amount of vibrations felt during specific phoneme productions

Source: Kummer, A. (2011). Perceptual Assessment of Resonance and Velopharyngeal Function. Seminars in Speech and Language. 32(2), 159-167.

Image Printed with Permission

Cul de Sac Testing

Checking for hypernasality:
- Have the child produce sentences/phonemes without pinching
- Have the child produce the same sentences/phonemes while pinching nose shut
- If you hear a difference with nose closed, this suggest hypernasality or nasal emission, suggests velopharyngeal port is open, which is abnormal
- If no difference, test is inconclusive

Checking for hyponasality:
- Have client produce sentences/phonemes with nasal consonants
- Pinch the nostrils
- You should perceive a difference (e.g., “mom”--> “bob”)
- No change means inadequate nasal resonance for nasals
- Could be due to blockage, large adenoids, etc.

Sources: Westby, C. (2012). Assessing Velopharyngeal Incompetence. Word of Mouth, 23(3), 14-15.; Kuehn, D., & Henne, L. (2003). Speech Evaluation and Treatment for Patients With Cleft Palate. American Journal of Speech-Language Pathology, 12, 103-109.

Nasal Mirror Test

A mirror test allows the clinician a visual assessment of nasal air emission during speech (see image below).

Checking for hypernasality:
- Hold mirror under nares and evaluate nasal air emission based on condensation left on mirror during sentence production
- If you see lots of condensation on pressure-sensitive sounds, then you know it’s nasal air emission
- Need to place after person starts talking, and moved before person stop talking. This helps prevent getting fogging due to normal nasal breathing
- Use words without nasals to see ability to close the velopharyngeal port
- If you see mirror fogging in consonants like /p, t, k, b, d, g, s, z/ this means the port is not closing properly

Checking for hyponasality:
- Use sentences containing nasal sounds
- Should see fogging on the mirror
- Lack of fogging means inadequate nasal flow
- Have client close lips and breathe through nose. Watch for mirror fogging, which is normal.
- If client has a difficult time breathing this way, it is abnormal and means there is a blockage in the nasal passage

Checking for fistulas: A fistula is an opening to nasal passage through hard or soft palate.
- We can use a mirror test to check and see if nasal emission is due to faulty learning or fistula
- If mirror fogs during /p/ but not /k/, this suggests that the fistula is cause of leakage
- If a fistula is suspected, have the child produce words with /p/ and then /k/
- If mirror fogging is on /p/ leakage might be via the fistula or through the velopharynx, because the lip closure phoneme is located anterior to the fistula
- However, /k/ causes the tongue to contact the hard palate

Sources: Kummer, A. (2011). Perceptual Assessment of Resonance and Velopharyngeal Function. Seminars in Speech and Language. 32(2), 159-167.; Kuehn, D., & Henne, L. (2003). Speech Evaluation and Treatment for Patients With Cleft Palate. American Journal of Speech-Language Pathology, 12, 103-109.