Clinics in communication disorders最新文献

The concepts regarding velopharyngeal function, the production of disordered nasalization, and the management of velopharyngeal dysfunction can be summarized as follows: 1. Although the function of the velopharyngeal mechanism is critical to the control of oral-nasal balance, the configuration and function of the speech articulatory system as a whole will determine the degree of nasalized speech that is produced. 2. Velopharyngeal dysfunction can be related to one or a combination of structural and motor limitations within the velopharyngeal mechanism. 3. There are two perceptual manifestations of velopharyngeal dysfunction. One is acoustic (nasality); the other is aerodynamic (nasal emission). For any given speaker, it is possible to hear both, and it is possible to hear one and not the other. 4. Velopharyngeal dysfunction can be treated in a variety of ways. The method of treatment should be determined by the structural characteristics of the velopharyngeal mechanism and the speech-motor abilities of the patient.

We have presented a discussion of three important concepts regarding early phonological assessment. The first is that the child's language level must be considered in collecting and analyzing a sample and in interpreting the results. For a child with age-level language abilities, the sample should consist of both a single-word test and a running speech sample; both independent and relational analyses are appropriate. For a child with delayed expressive language and a small productive vocabulary, a sample comprised of spontaneous productions is more appropriate. In this case, the sample should be analyzed in terms of sound classes and syllable and word shapes that occur; a phonological process analysis is inappropriate. Lexical selection patterns should be noted. The results of the analyses should be interpreted in view of the expectations for the child's language level. A child with a normally developing language system is expected to have more advanced phonology than a child of the same age with delayed language. Thus, a child with a large vocabulary and word combinations is expected to have an expanding phonological system, with a full range of sound classes and syllable and word shapes. If a child is delayed in language and is still within the first 50-word stage, the expectation is that the phonological system will be more limited. Critical features for the phonology of early productive vocabulary have been identified. Lack of one or more of these features is indicative of atypical phonological development at any age and language level. The second concept is that the phonological system as a whole must be considered. In particular, the analyses and expectations should be based on the presence or absence of sound classes and syllable shapes rather than on sounds per se. Lack of an entire class or syllable structure would be cause for concern; lack of a particular sound, even though it has been shown to be acquired early, would not be. Thus, lack of the entire fricative class at 36 months would be of concern, whereas errors on /f/, which according to Prather et al., 1975, is mastered by this age, would not be. The third important concept emerges from the case studies; both studies demonstrate that longitudinal assessment is necessary to document changing profiles over the course of development. A child such as David, who has a normal-but-delayed profile in language and phonology at one age, may subsequently exhibit atypical patterns as phonology and language dissociate.(ABSTRACT TRUNCATED AT 400 WORDS)

These case studies provide small, selected samples of the results of assessments of articulation skills and their phonologic applications and give some information related to velopharyngeal function during speech. These illustrations were based chiefly on perceptual assessment of speech because this type of assessment is used routinely by SLPs, and does not require instrumentation. Indicators for referral and communication to a cleft palate team were derived from the perceptual evaluation. Other articles in this issue discuss procedures for evaluation in considerable detail. Early identification of possible velopharyngeal problems and early referral to a cleft palate team can help to resolve speech, language, and hearing disorders related to cleft palate and velopharyngeal dysfunction. People who comprise cleft palate and craniofacial teams are most likely to have the experience, and the special instrumentation necessary, to make a definitive diagnosis. The team's comprehensive multidisciplinary evaluation should lead to thorough consideration of the many factors that are important for treatment planning. The information and services provided by the team will assist the audiologist and SLP in the conduct of their services for these clients. In this way, the communication disorders specialist becomes an affiliate of the team. The affiliate not only acts as a referent, but also may provide the necessary longitudinal services. The best interests of the client are promoted by ongoing communication between the team and the affiliates of the team.

The diagnosis and evaluation of velopharyngeal concerns is complex. It involves a variety of assessment techniques--both indirect, such as speech, and direct, using instrumentation to delineate how the velopharyngeal structures function. However, the most important tools we have for making decisions regarding velopharyngeal function and need for management are the speech characteristics. From thorough analysis of speech, there is much that can be learned about the status of velopharyngeal function and potential for change. The ultimate question that the speech diagnostician must attempt to answer concerns adequacy of velopharyngeal structures and function for producing acceptable speech.