Noninstrumental Assessment of Velopharyngeal Adequacy in Children

Abstract

212 Evaluation of communication skills in speakers with cleft palate, as with other speech disordered individuals, includes assessing the content, form, and use of language, the efficiency of the auditory processing system, the structural and functional integrity of the oral peripheral mechanism for speaking tasks, and the effectiveness of the speech product to carry the message to the listener. Procedures for evaluating children with cleft palate are similar to those used in a clinic setting for all clients. The basic difference is the emphasis given to the judgment of velopharyngeal adequacy. The primary task in a communication evaluation of a person with a cleft is to make a preliminary judgment regarding the ability of the velopharyngeal area to function for speech purposes. This judgment may be based on perceptual evidence from the results of articulation testing together with a clinical diagnosis of perceived aberrant voice quality, usually hypernasality. The term "velopharyngeal insufficiency" (VPI) is used to describe dysfunction of the palatopharyngeal port. Riski and Millard (1979) described two different subcategories of VPI—inadequacy and incompetency. Velopharyngeal inadequacy referred to an organic deficiency or shortness of tissue in the nasopharyngeal region. Velopharyngeal incompetency was used to describe poor function in the presence of adequate tissue. The goals of the diagnostic session are: (1) to describe the child's present velopharyngeal adequacy for speech; (2) to differentiate speech problems due to velopharyngeal function from problems due to immature phonological development, hearing problems, depressed cognitive functioning, and/or additional occlusal, dental, or orofacial structural abnormalities; (3) to predict the effects on speech of further surgical or prosthodontic intervention; (4) to develop recommendations for further referrals and remediation. With the tools available to the speech pathologist, one is able to make strong inferences regarding the adequacy of the velopharyngeal mechanism. However, these tools should be used for a tentative diagnosis only. The diagnosis should then be verified through instrumental assessment techniques, such as air flow studies, cephalometrics, radiology, or endoscopy, before further rehabilitative measures are undertaken. Two recent surveys have been reported (Middleton et al., 1981; Schneider and Shprintzen, 1980) on current clinical practices in the assessment of velopharyngeal adequacy. Schneider and