Cleft Palate Speech-Components and Assessment
Voice and Resonance Disorders-ASLS-563
Key Components of “Cleft Palate Speech”
Disorder
Hypernasality
Type of
Disorder/Dysfunction
Resonance Disorder
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Hyponasalsity
and Denasality
Resonance Disorder
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Causes
Velopharyngeal
insufficiency (VPI) or
velopharyngeal
incompetence
Most noted with larger
velopharyngeal openings
Fairly large orolnasal
fistula
An obstruction in the
nasopharynx or nasal
cavity including:
narrowing or reducing
the size of the
nasopharyngeal space
during surgical
procedure to correct VPI
or craniofacial
conditions
Can occur due to apraxia
of speech caused by
difficulty coordinating
velopharyngeal
Characteristics
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Abnormal coupling of oral and nasal cavities during
speech
 Speech sounds muffled or mumbled
 Associated with speech sounds that are phonated
 More perceptible in vowels (more noted on high
vowels than low vowels)
 In mild-to-moderate hypernasality, nasalization of
phonemes is common (predominate use of nasal
sounds)
 Hypernasality on vowels and nasalization on
phonemes increases in connected speech
Hyponasalsity-blockage in the nasopharynx or nasal
cavity causing a reduction in normal nasal resonance
during speech
Denasality-total nasal airway obstruction
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Speech sounds “stuffed up”
Affect production of nasal consonants (/m/, /n/, /ng/)
Nasal consonants sound similar to their oral
phoneme cognates (b/m, d/n, g/ng)
Cul de Sac
Resonance
Resonance Disorder
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Mixed Resonance
Resonance Disorder
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Nasal Air
Emission
Velopharyngeal
Dysfunction
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movements with anterior
articulation
Structural abnormality,
particularly a blockage
of one of the resonating
cavities
Very large tonsils
Scar or obstruction on
the pharyngeal wall in
the hypopharynx
Combination of VPI and
blockage of the nasal
cavity
Transmission of acoustic
energy is blocked
Sound is trapped in a
blind pouch with only
one entrance and no
other outlet
Velopharyngeal
insufficiency
Blockage of nasal cavity
Nasal air emission
Irregular adenoid tissue
The presence of a leak in
the velopharyngeal valve
or oronasal fistula during
an attempt to build up
intraoral air pressure for
the production of
consonants
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Speech is perceived as muffled
Sounds quality is low intensity
Has been described as “potato-in-the-mouth”
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A combination of any of the following:
hypernasality, hyponasality, denasality, and Cul de
Sac resonance
Common in individuals with apraxia
Different types of resonance do not occur
simultaneously, they occur at different times in
connected speech
Most noted on pressure-sensitive phonemes
(plosives, fricatives, and affricates)
o Does not occur in the production of vowels
or semivowels
Often occurs with hypernasality, but can also occur
with normal resonance
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Nasal Grimace
Weak or Omitted
Consonants
Short Utterance
Length
Altered Rate and
Speech Segment
Durations
Velopharyngeal
Dysfunction
Velopharyngeal
Dysfunction
Velopharyngeal
Dysfunction
Velopharyngeal
Dysfunction
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Airflow is released
through the nose causing
a disruption in the
aerodynamic process of
speech
An overflow of muscle
reaction that occurs with
extreme effort to achieve
velopharyngeal closure
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Can be loud (small velopharyngeal opening), soft
(fairly large opening) or inaudible
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Reduced amount of air
pressure in the oral
cavity when producing
consonants due to air
flowing through the
velopharyngeal valve or
an oronasal fistula
Reduction of oral air
pressure available for
connected speech due to
significant nasal air
emission from an
unobstructed opening
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Increased respiratory
effort and the need to
take more frequent
breaths to compensate
for rapid loss of air
pressure through the
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Often accompanies significant nasal emission
Seen as a muscle contraction just above the nasal
bridge or at the side of the nares
Usually disappears spontaneously once
velopharyngeal function is corrected
Consonants are weak in intensity and pressure
o The greater the nasal air emission, the
weaker the consonant
o Expected primarily with the unobstructed
form of nasal emission
May cause consonants to be omitted completely
Speech will sound muffled or indistinct
Utterance length is shortened and connected speech
is choppy
More frequent breaths are required for replacing air
pressure
Respiratory volumes may be twice that of normal
speakers due to the attempt to raise intraoral
pressure by increasing airflow rate during consonant
production
o Speech is physically difficult
o Individual becomes fatigued during speech
Speech segment durations are abnormal
Utterance productions are longer
Individuals with hypernasality have longer voice
onset times
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Compensatory
and Obligatory
Articulation
Productions
Velopharyngeal
Dysfunction
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Dysphonia
Velopharyngeal
Dysfunction
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nose
Velopharyngeal
Insufficiency
Hpernasality, nasal air
emission, weak
consonants, and short
utterance length that are
a direct result of a
velopharyngeal or palatal
opening
History of congenital
anomalies or VPI
Vocal nodules
Passive speech characteristics or obligatory errorsthe product of structural abnormality
 Require surgical or prosthetic intervention for
correction
Active speech characteristics or compensatory
errors-manner of production is maintained but place of
articulation is altered and moved posteriorly to the
pharynx or larynx
 Under the patients control and can be modified with
speech therapy
Types of obligatory and compensatory articulation
productions:
 Middorsum palatal stop (palatal-dorsal production)
 Generalized backing
 Velar fricative
 Nasalization of oral consonants
 Nasalization of vowels
 Nasal snort
 Nasal stiff
 Pharyngeal plosive
 Pharyngeal fricative
 Pharyngeal affricate
 Posterior nasal fricative
 Glottal stops
 Substitution of /h/ for voiceless plosives
 Breathiness
 Breathiness, hoarseness, low intensity, and/or glottal
fry during phonation
 Hyperfunctional voice disorder in individuals with
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Laryngeal anomalies
Congenital malformation
syndromes
mildly impaired velopharyngeal valving due to
increased respiratory and muscular effort in attempt
to close the velopharyngeal port which causes
thickening and edema of the vocal folds leading to
vocal nodules
Kummer, 2008
Essential Components of Assessment for “Cleft Palate Speech” - Formal and Informal
Assessment
Diagnostic Interview
Language Screening
Description/Purpose
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Obtain Background Information
Questions can include information about:
o Current concerns
o Articulation
o Resonance
o Language
o Medical History
o Developmental History
o Feeding and Oral-Motor Skills
o Airway
o Treatment History
Language screening can be done by using a parent questionnaire
Informal language screening can be done by:
o Observing play behavior, gestures, spontaneous vocalizations and utterances
o Asking the child to follow commands or point to objects
o Listening to spontaneous speech
o Asking questions or asking for explanations
o Having child repeat sentences
Formal language screening
o Birth to 3 years
 Receptive-Expressive Emergent Language Scale (REEL), Early Language
Milestones (ELM), Rossetti Infant Toddler Language Scale
Speech Samples
Perceptual Evaluation
Low-Tech and No-Tech Evaluation
Procedures
o 2 to 6 years
 The Fluharty Preschool Speech and Language Screening Test
 Formal articulation tests
o To determine the cause of the speech problem (structure versus function) and
provide data to develop appropriate treatment plan for therapy
 Syllable repetition
o To isolate effects of other sounds and to determine if there is phoneme-specific
nasal air emission
o Pressure sensitive phonemes are tested with both a low and high vowel to
determine if hypernasality occurs more on high vowels than low vowels , or is
vowel specific
 Sentence repetition
o Can easily test articulation, nasal air emission, and resonance in the connected
speech environment
 Counting and rote speech
o Have the child count or recite the alphabet
 Spontaneous connected speech
o To assess articulation and resonance in connected speech
o Connected speech increases the demands on the velopharyngeal valving system to
achieve and maintain closure
Make sure to evaluate:
 Articulation
 Stimulability
 Nasal Air Emission
 Weak Consonants
 Short Utterance Length
 Oral-Motor Dysfunction
 Resonance
 Phonation
 Visual Detection
o Mirror Test, Air Paddle, See Scape
 Tactile Detection
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Orofacial Examination
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Nasometry
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Aerodynamics
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Radiography/Imaging
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o Feeling the sides of the nose
Auditory Detection
o Nose Pinch (Cul de Sac) Test, Stethoscope, Straw, Listening Tube
Visual inspection of the oral cavity to evaluate the orpharynx, velar morphology and
mobility, and the tonsils (in some cases the epiglottis can be seen)
Observe the following:
o Spacing between the eyes
o Shape and location of the ears
o Nose and airway
o Facial bones and profile
o Lips (bilabial closure at rest and during speech)
o Hard palate-observe the mucosa, incisive papilla and rugae, position of alveolar
ridge, and palatal vault
o Velum and uvula to determine velar integrity and look for characteristics of a
submuccous cleft
o Epiglottis in young children
o Posterior and lateral pharyngeal walls
o Tonsils
o Dentation and occlusion
o Tongue (structure and function)
o Oro-motor function-tongue, lips, and sequence of motor movements for speech
Nasometer-measures the relative amount of nasal acoustic energy in an individual’s
speech
Used to evaluate resonance and velopharyngeal function
Should not be used as an independent diagnostic measure
Pressure-flow technique is used to gather information regarding velopharyngeal function
and respiratory parameters
Lateral Cephalometric X-ray
o Radiographic images of the midsagittal plane of the head
o Shows the hared palate, velum, an posterior pharyngeal wall
o No longer used for routine assessment of velopharyngeal function
Magnetic Resonance Imaging
o Effective method for seeing the anatomy of the levator veli palatini muscle and
related structures, diagnosing an occult submucous cleft palate, and has been
suggested for evaluating velopharyngeal function
Videofluoroscpy
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Displays structures and function of the velopharyngeal mechanism
In order to view all aspects of the velopharyngeal sphincter, many views must be obtained
including:
o Lateral view
o Frontal view
o Base view
o Towne’s view
o Oblique view
Nasophaygoscopy
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Used for evaluating velopharyngeal dysfunction
o Can identify the cause as well as the size and location of the opening
o Can detect the presence of an obstruction in the vocal tract
Provides a view during speech of the nasal surface of the velum and all of the structures of
the velopharyngeal valve
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Kummer, 2008
References
Kummer, A. W. (2008). Cleft palate and craniofacial anomalies: Effects on speech and resonance (2nd ed.). Clifton Park, NY: Delmar
Cengage Learning.