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and word final stops. Sporadic, infrequent nasal
fricatives occurred in the speech sample but the
overriding error place and type was pharyngeal
fricative. His mild (and intermient) hypernasality,
the absence of audible nasal air emission, and ability
to produce all of the stop consonants and
(nonsibilant) fricatives with normal placement and
perceptibly good oral pressure suggest adequate VP
closure. EC was not cooperative for
videonasendoscopy assessment.
Speech therapy is recommended with the initial goal
of teaching and stabilizing a normal /s/ articulation
and eliminating his pharyngeal fricative substitution.
In addition, the finding that he inconsistently
replaces any of the oral stops with gloal stops but
also uses the stops correctly suggests the need for a
combined articulation/phonetic and phonological
therapy approach. EC was not stimulable for any of
the fricatives and affricates missing from his speech
sound inventory but he was stimulable for “long /t/”
so this would be a good starting point for teaching
/s/. It is anticipated that as oral productions replace
his pharyngeal and gloal placements, more
consistent velopharyngeal closure will be facilitated
and resonance will be normalized.
• Option #2: Summarize using a more objective form
such as the Reporting Form for Cleft Palate Speech
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Assessment presented in Appendix 8G (see
Appendix 8G for EC in Downloadable Forms).
Downloadable Forms for EC's speech assessment (see the Evolve
website).
• Conversational Speech: Partial transcripts of
compensatory articulations and other errors in EC's
conversational speech (two video excerpts, not the
whole sample): EC's Conv Speech Transcript VIDEO
1 and EC's Conv Speech Transcript VIDEO 2—2
pages.
— Included to provide a representative sampling.
— Also provides additional practice in listening for
pharyngeal fricatives and gloal stops .
• P-M-V Matrix for EC, based on EC's whole speech
sample—1 page.
• AESS Transcription and Score for EC—1 page.
— For sentence #9, the correct score for initial /t/ is
based on EC's first production before things got silly.
— For sentence #14, pharyngeal fricative replacement
for /ʃ/ is hard to hear and difficult to judge; it almost
sounds /s/ - like, but given that every other /ʃ/
produced by EC in the entire sample is replaced by
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pharyngeal fricative, it is unlikely that this one
production was an /s/.
• GFTA–2 Summary of results for EC.
• Appendix 8G Reporting Form for EC—4 pages.
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Baylis A, Chapman K, Cordero K, et al. Americleft Speech Outcomes
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interdisciplinary issues and treatment, for clinicians by clinicians.
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Instrumental Evaluation of
Velopharyngeal Function
Every speech disorder causes a range of disability. Velopharyngeal
inadequacy (VPI) is no exception. Speech-language pathologists (SLPs)
use terms such as “marginal,” “mild,” “mild-moderate,” “borderline,”
or “severe” to describe the shades of disordered speech resulting from
VPI (Morris, 1984; Van Demark and Morris, 1983).
Instrumentation is frequently used to supplement clinicians'
perceptions of speech quality in an effort to describe more accurately
those patients who may have some degree of difficulty with
velopharyngeal (VP) valving. In this chapter, we examine the role of
instrumentation in the clinical process of assessment of individuals who
may have VPI.
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What Instrumentation Can Do
For many years, the trained clinician's ear was viewed as the only tool
needed to assess the speech of a child with VPI. A strong case can be
made for this position today. VPI maers only if it results in speech
quality that negatively affects understandability or calls negative
aention to itself. No instrument can make such a determination beer
than the human ear aached to a discerning, well-educated human
brain. Judgments about the accuracy of results from most instrumental
approaches are validated by comparing them with perceptual
judgments (Dalston et al., 1993; Nellis et al., 1992; Waerson, 1998).
Instrumental assessment results are considered questionable or even
meaningless if they indicate complete VP closure for speech when at the
same time speech is perceived to be hypernasal or otherwise
perceptually indicative of incomplete VP closure.
Clinicians who infrequently work with individuals who have VPI are
often uncomfortable with their own subjective, perceptual assessments.
Some clinicians prefer “objective” backup for their perceptual
judgments. Instrumentation helps them beer appreciate the
physiology, aerodynamics, and acoustics underlying the percept.
Instrumental assessment is used to confirm and help explain the bases
for perceived VPI and to influence decisions about speech therapy and
physical management.
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What Instrumentation Cannot Do
SLPs often refer patients for “objective” assessment of what the VP
system can and cannot do without realizing that a complicating factor
exists. That factor is behavioral. In other words, the individual may
have a potentially functional VP system that he or she is simply (and
unknowingly) bypassing. For example, as discussed in Chapter 5, if the
speaker is habitually using gloal stops for all or nearly all pressure
consonants, the VP system will not even try to close. For
instrumentation to tell the clinician what is possible, the speaker must
first be trying to produce a sound that requires VP closure, oral
placement, and orally directed airflow. Speech production probes may
help inform the clinician about what is possible for the child with VPI.
Some children may find that whispered speech helps them bypass the
behavioral barrier to orally directed airflow during obstruent
productions. Other children may achieve a similar result by producing
“raspberries” or by using the manual nasal occlusion technique. The
boom line is that instrumentation cannot tell the clinician much if the
speaker is bypassing the system.
Another way to think of this is to recognize that VPI may involve
problems with either the instrument (the physical mechanism) or the
musician (the individual learning to use the physical mechanism).
Children born with cleft palate start off with an imperfect mechanism.
Appropriate surgery resolves that problem in most cases, but some
children continue to exhibit VPI. Speakers with less than optimal
surgical outcomes generally fall into two categories: those for whom the
surgery was simply inadequate and those who have trouble learning to
use the new mechanism (see Chapter 5). Learning to use a newly
adequate VP mechanism may take some time.
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